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The following scenario applies to the next 1 items
The home health nurse visits a client with chronic diabetes insipidus
Item 1 of 1
Nurses’ Note
1415 – Home health visit completed because the client was admitted to the hospital twice in the past six weeks for treatment nonadherence related to diabetes insipidus. Extensive teaching provided and reviewed education on prescribed desmopressin intranasal, maintenance of fluids, daily weight, intake and output, and when to seek emergency care.
Which client statements would indicate a correct understanding of the teaching?
- A. I should limit the amount of fluids that I drink after 5:00 PM.
- B. I will need to weigh myself at the same time every day.
- C. I should put both doses of the desmopressin in one nostril.
- D. I need to keep a log of my fluid intake and urine output.
- E. I may need an additional dose if I keep urinating a lot.
- F. If I develop confusion with this medication, I should call 911.
Correct Answer: B, D, F
Rationale: Daily weighing and logging intake/output monitor diabetes insipidus. Confusion may signal hyponatremia, needing emergency care. Fluid limits are incorrect, desmopressin dosing is per nostril, and extra doses require a provider's order.
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The nurse is developing a plan of care for a client with hypothyroidism that is not controlled with medication. The nurse should recommend
- A. applying lotion after a warm bath.
- B. high-fiber snacks.
- C. caffeinated beverages to promote energy.
- D. physical activities with frequent rest breaks.
- E. adding fans to the room to keep it cool.
Correct Answer: A, B, D
Rationale: Hypothyroidism causes dry skin, constipation, and fatigue. Lotion hydrates skin, high-fiber snacks aid bowel movements, and rest breaks accommodate low energy. Caffeine may overstimulate, and fans are unhelpful as clients feel cold, not hot.
A nurse is caring for a client receiving metformin. Which of the following laboratory data should be reported to the provider?
- A. Decreased blood urea nitrogen (BUN) level
- B. Decreased glomerular filtration rate (GFR)
- C. Decreased fasting plasma glucose
- D. Decreased hemoglobin A1C
Correct Answer: B
Rationale: A decreased GFR indicates renal impairment, increasing the risk of metformin-associated lactic acidosis, requiring immediate reporting. Decreased BUN, glucose, and HbA1c are expected or less urgent.
The nurse is evaluating the treatment plan for a client with type II diabetes mellitus. Select the findings in the nurses' note that indicate that the client is not meeting the treatment goals
- A. The client presents for a routine follow-up after being diagnosed with diabetes mellitus type II.
- B. The most recent hemoglobin A1C was 7.6%.
- C. A weight gain of three kilograms was noted.
- D. The client reports a painless ulcer on the right anterior ankle.
- E. The client stated he stopped walking barefoot.
- F. The client requested a referral for a diabetic cooking class.
Correct Answer: B, C, D
Rationale: HbA1C of 7.6% exceeds the target (<7%), indicating poor control. Weight gain and a painless ulcer suggest complications like poor circulation or neuropathy. Stopping barefoot walking and requesting classes are positive steps.
The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for
- A. enalapril.
- B. calcium gluconate.
- C. levothyroxine.
- D. propranolol.
Correct Answer: D
Rationale: Thyroid storm is a life-threatening hyperthyroid state. Propranolol, a beta-blocker, reduces heart rate, blood pressure, and other hypermetabolic symptoms. Enalapril is for hypertension, calcium gluconate for hypocalcemia, and levothyroxine worsens hyperthyroidism.
The nurse is teaching a client who is receiving newly oral prednisone. Which of the following Information should the nurse include concerning the possible side effects of this medication?
- A. Increased susceptibility to infection
- B. Weight gain
- C. Insomnia
- D. Blood glucose elevation
- E. Increased urine output
Correct Answer: A,B,C,D
Rationale: Prednisone, a corticosteroid, suppresses immunity (increasing infection risk), causes weight gain, insomnia, and elevates blood glucose. Increased urine output is not a common side effect; it’s more associated with diuretics.