Nokea
The nurse is reviewing data for a client who is establishing primary care. Select the findings from the history and physical that are risk factors for diabetes mellitus (type two).
- A. The client has a medical history of testicular cancer that was treated when he was 24.
- B. He also was told he had high blood pressure and high cholesterol.
- C. two years ago but never followed up with treatment.
- D. He has a body mass index of 28.
- E. He drinks one glass of red wine three times a week and stopped smoking cigarettes one year ago.
Correct Answer: B, D
Rationale: Hypertension, high cholesterol, and a BMI of 28 (overweight) increase type 2 diabetes risk via insulin resistance. Cancer history, wine, and smoking cessation are less directly related.
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The nurse has instructed a client scheduled for an injection of dulaglutide for diabetes mellitus (type two). Which of the following statements by the client would require follow-up?
- A. I should tell my doctor if I experience abdominal pain and vomiting.
- B. I should take this medication within one hour of eating a meal.
- C. If this medication works, I should notice a reduction in my hemoglobin A1C (HbA1c).
- D. I will receive this medication once a week.
Correct Answer: B
Rationale: Dulaglutide, a GLP-1 agonist, is taken weekly regardless of meals, not within one hour of eating. Abdominal pain/vomiting should be reported, HbA1c reduction is expected, and weekly dosing is correct.
The nurse is caring for a client with diabetic ketoacidosis (DKA) who is receiving an infusion of regular insulin. Which of the following clinical data should be reported to the primary healthcare provider (PHCP) immediately?
- A. Glucose 297 mg/dL, 16.52 mmol/L (70-110 mg/dL, 4.0-11.0 mmol/L)
- B. Potassium 3.2 mEq/L, 3.2 mmol/L (3.5-5 mEq/L, 3.5-5.1 mmol/L)
- C. BUN 24 mg/dL, 8.568 mmol/L (10-20 mg/dL, 2.5 to 6.4 mmol/L)
- D. Hemoglobin A1C 8.9% ( < 7%, 4.8%-6.0%)
Correct Answer: B
Rationale: In DKA, insulin shifts potassium into cells, risking hypokalemia. A level of 3.2 mEq/L is critical and needs immediate reporting to prevent arrhythmias. Glucose, BUN, and HbA1C are monitored but less urgent.
The nurse administers a combination of regular insulin and NPH insulin subcutaneously to a client at 0800. At which time should the nurse initially assess the client for hypoglycemia based on the peaks of the medications?
- A. 830
- B. 1000
- C. 1200
- D. 1400
Correct Answer: B
Rationale: Regular insulin peaks at 2-4 hours (1000-1200), and NPH peaks at 4-12 hours. Initial hypoglycemia risk is highest around 1000 due to regular insulin's peak effect.
The nurse is educating a diabetic client regarding foot care. Which of the following statements by the client indicates a correct understanding of the nurse's instructions?
- A. I need to check my feet daily for sores, blisters, dry skin, and cuts.
- B. I need to wash my feet daily and keep them dry.
- C. If I get sores or blisters on my feet, I should not pop them.
- D. I need to apply cream to my heels and between my toes daily.
- E. I should wear tight compression socks on both feet.
Correct Answer: A, B, C
Rationale: Daily checks, washing, and keeping feet dry prevent complications. Not popping sores avoids infection. Cream between toes risks fungal growth, and tight socks impair circulation.
The following scenario applies to the next 1 items
The nurse in the emergency department cares for a 45-year-old female
Nurses’ Note
The client reports significant fatigue that has worsened over the past eight weeks. Additionally, the client reports constipation, hair loss, and a 3-kilogram (6.6 pounds) weight gain. She reports missing work because of difficulty concentrating and persistent fatigue.
The client is alert and fully oriented. She appears fatigued and reports dizziness when she moves quickly. Periorbital edema, various bruises, and facial swelling were noted on assessment. Peripheral pulses were intact and weak. The client denies any pain.
Vital Signs
Oral temperature 97 F (36.1o C); Pulse 51/minute; Respirations 15/minute.
BP 93/61 mm Hg; Oxygen saturation 95% on room air.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. Obtain a prescription for levothyroxine, Obtain a prescription for methimazole, Have the client complete a blood transfusion consent, Obtain an order for a urine cortisol level, Initiate fall precautions.
- B. Vital Signs, Serum TSH/T3/T4 levels, Intake and Output, Cortisol Level, BUN and Creatinine.
- C. Graves' disease, Cushing's syndrome, Hypothyroidism, Systemic Lupus Erythematosus, Adrenal Insufficiency.
Correct Answer: C, A, E, B
Rationale: Fatigue, weight gain, and bradycardia suggest hypothyroidism. Levothyroxine treats it, fall precautions address dizziness, and TSH/T3/T4 and vital signs monitor progress.