Nokea
The nurse reviews laboratory data for a client with suspected diabetes mellitus (DM). Which action should the nurse take based on the client's hemoglobin A1C? See Exhibit.
- A. assess the client for an infection
- B. instruct the client that the results are within normal limits
- C. assess the client's urine for glycosuria
- D. educate the client on a diet with low-glycemic foods
Correct Answer: D
Rationale: Without specific HbA1C values, a suspected DM diagnosis warrants dietary education on low-glycemic foods to manage blood sugar. Infection or glycosuria assessment depends on results, and normal limits are unlikely if DM is suspected.
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The nurse has instructed a client with diabetes mellitus (type 1) about proper exercise. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I should carry a snack rich in protein just in case I feel shaky.
- B. I will not take my prescribed daily glargine insulin if I plan on exercising.
- C. I can initially expect my glucose level to rise with vigorous exercise, but if I continue exercising, my levels may eventually decrease.
- D. I should start my exercise near the time that my insulin peaks.
Correct Answer: C
Rationale: Vigorous exercise can initially raise blood glucose due to stress hormones, but prolonged activity increases glucose uptake by muscles, lowering levels. Carrying a carbohydrate-rich snack, not protein, is best for hypoglycemia. Insulin should never be skipped, and exercising at peak insulin time risks hypoglycemia.
The following scenario applies to the next 1 items
The emergency department (ED) nurse cares for a 49-year-old male
Item 1 of 1
Nurses' Notes
0914 - Client presents to the ED with his wife reporting headaches, palpitations, sweating, and an occasional tremor in his upper extremities. The client states that these are 'episodes' and usually occur after the client engages in strenuous activity or is under stress. The onset of these symptoms was months ago, and the client could not identify a concrete time frame. The client says he has increased his alcohol consumption from two standard glasses of wine daily to three because of the 'stress at work.' He often wakes up with an occasional headache. He says that the episodes have been occurring more often and that the headaches are frustrating because they do not abate with over-the-counter medications such as acetaminophen. He states that he doesn't have any other symptoms, except he has been drinking more water lately, but attributes that to his work outside setting up a garden. He reports a weight loss of 2 kilograms (4.4 pounds) over the past month. His current body mass index is 23. His medical history includes iron deficiency anemia, herpes simplex virus, and irritable bowel syndrome. His medications include docusate, valacyclovir, and iron sucrose. He reports that his mother and father had a stroke because of high blood pressure, which makes him quite concerned. On assessment, the client is alert and fully oriented. Affect is cooperative. The peripheral pulses are +2. Lung sounds are diminished bilaterally. Bowel sounds were present in all four quadrants. He says he has a headache but cannot provide a numerical rating score stating 'it just hurts.' Vital signs: T 97.5° F (36.4° C), P 110, RR 18, BP 161/80, pulse oximetry reading 96% 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 an order for a hemoglobin A1C, Obtain an order for a 24-hour urine collection, Request a prescription for a benzodiazepine, Request a prescription of an antihypertensive.
- B. peripheral pulses, mental status, capillary blood, glucose blood pressure.
- C. alcohol withdrawal syndrome, essential hypertension, pheochromocytoma, diabetes mellitus, type II
Correct Answer: C, A, D, B
Rationale: Pheochromocytoma causes headaches, palpitations, and hypertension from catecholamine excess. Order a 24-hour urine collection for catecholamines, request antihypertensives, and monitor BP and mental status for progress.
The nurse is planning care for a client following bilateral adrenalectomy. The nurse should anticipate a prescription for which postoperative medication?
- A. Pantoprazole
- B. Propylthiouracil (PTU)
- C. Propranolol
- D. Hydrocortisone
Correct Answer: D
Rationale: Bilateral adrenalectomy removes adrenal glands, necessitating lifelong hydrocortisone replacement to provide glucocorticoids and prevent adrenal insufficiency. Pantoprazole, PTU, and propranolol are not indicated for this purpose.
The nurse is assessing a client with adrenal crisis. Which of the following findings would be consistent with a diagnosis of adrenal crisis?
- A. bradycardia
- B. hyponatremia
- C. hypertension
- D. pulse deficit
Correct Answer: B
Rationale: Adrenal crisis causes cortisol and aldosterone deficiency, leading to hyponatremia from sodium loss. Bradycardia, hypertension, and pulse deficit are not typical; tachycardia and hypotension are more common.
The nurse is performing an assessment on a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment findings would support the diagnosis of SIADH?
- A. Peripheral edema
- B. Excessive urine production
- C. Normal or slightly increased blood pressure
- D. Low urine specific gravity
Correct Answer: A, C
Rationale: SIADH causes water retention, leading to edema and normal or slightly elevated BP from fluid overload. Urine is concentrated (high specific gravity), not low, and output is reduced, not excessive.