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The nurse is planning to address diabetic meal planning with the client recently diagnosed with type 1 DM. Which action should the nurse take first?
- A. Encourage use of non-nutritive sweeteners that contain no calories.
- B. Emphasize the importance of keeping regular mealtimes every day.
- C. Teach the client how to count the carbohydrates in meals and snacks.
- D. Ask the client to identify favorite foods and the client's usual mealtimes.
Correct Answer: D
Rationale: Asking about favorite foods and usual mealtimes is an assessment question used in obtaining a thorough diet history; the nurse should take this action first prior to beginning teaching.
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The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client?
- A. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed.
- B. Teach the client regarding sexual functioning and androgen replacement therapy.
- C. Explain the signs and symptoms of infection and when to call the health-care provider.
- D. Demonstrate turn, cough, and deep-breathing exercises the client should perform every two (2) hours.
Correct Answer: C
Rationale: Infection signs are critical post-adrenalectomy due to immunosuppression risks. Steroid replacement is for bilateral procedures, androgen therapy is rare, and breathing exercises are inpatient-focused.
The nurse is caring for multiple clients with DM. It is most important for the nurse to initiate a referral to a diabetes educator for which client?
- A. The client who states diabetes is well controlled with diet and exercise; Hgb A1c is 11%.
- B. The client requesting diabetes information; fingerstick glucose is 132 mg/dL, Hgb A1c is 5.6%.
- C. The client who states perfect compliance with diet, exercise, and meds; Hgb A1c is 7%.
- D. The client with short-term memory loss; fingerstick glucose is 110 mg/dL, Hgb A1c is 4.5%.
Correct Answer: A
Rationale: It is most important for the nurse to initiate a referral for clients who falsely think their diabetes is well controlled. The client's Hgb A1c, which measures average blood glucose over the previous 3 months, is 11%, indicating that the diabetes is not well controlled.
What is the best way to assess for hemorrhage in a client who has had a thyroidectomy?
- A. Check the pulse and blood pressure hourly.
- B. Roll the client to the side and check for evidence of bleeding.
- C. Ask the client if he/she feels blood trickling down the back of the throat.
- D. Place a hand under the client's neck and shoulders to feel bed linens.
Correct Answer: D
Rationale: Placing a hand under the neck and shoulders detects blood pooling under the incision, a common site for post-thyroidectomy hemorrhage.
Which signs/symptoms should the nurse expect to assess in the client diagnosed with an insulinoma?
- A. Nervousness, jitteriness, and diaphoresis.
- B. Flushed skin, dry mouth, and tented skin turgor.
- C. Polyuria, polydipsia, and polyphagia.
- D. Hypertension, tachycardia, and feeling hot.
Correct Answer: A
Rationale: An insulinoma is a pancreatic tumor causing excessive insulin secretion, leading to hypoglycemia. Symptoms include nervousness, jitteriness, and diaphoresis (Whipple’s triad). Flushed skin and dehydration suggest hyperglycemia, polyuria/polydipsia/polyphagia are diabetes symptoms, and hypertension/tachycardia are more typical of pheochromocytoma.
Because the client is receiving levothyroxine (Synthroid) for the first time, the nurse recognizes the need to cheese the client to assess the effect of the effect of replacement therapy. For which signs and symptoms should the nurse assess? Select all that apply.
- A. Dyspnea
- B. Palpitations
- C. Excessive bruising
- D. Raised, red rash
- E. Hyperactivity
- F. Insomnia
Correct Answer: B,E,F
Rationale: Levothyroxine can cause signs of hyperthyroidism if overdosed, including palpitations, hyperactivity, and insomnia.