Nokea
Which of the following indicates a potential complication of diabetes mellitus?
- A. Inflamed and painful joints.
- B. Blood pressure of 160/100 mm Hg.
- C. Stooped posture.
- D. Hemoglobin of 9 g/dL (90 g/L).
Correct Answer: B
Rationale: A blood pressure of 160/100 mm Hg indicates hypertension, which is a common complication of diabetes mellitus due to atherosclerotic changes. Hypertension is a significant risk factor for cardiovascular diseases, which are prevalent in individuals with diabetes. Inflamed and painful joints (Choice A) are not directly related to diabetes complications but may be seen in conditions like arthritis. Stooped posture (Choice C) is more indicative of musculoskeletal issues like osteoporosis, not necessarily a typical complication of diabetes. Hemoglobin level of 9 g/dL (90 g/L) (Choice D) could signify anemia, which can occur in diabetes but is not a primary complication often associated with the disease.
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What is the most common symptom of hypoglycemia that the nurse should teach the diabetic client to recognize?
- A. Nervousness
- B. Anorexia
- C. Kussmaul's respirations
- D. Bradycardia
Correct Answer: A
Rationale: Nervousness is the most common symptom of hypoglycemia. It is often accompanied by other signs such as weakness, perspiration, confusion, and palpitations. Anorexia (lack of appetite) is not a typical symptom of hypoglycemia; it is more commonly associated with hyperglycemia. Kussmaul's respirations are a deep and labored breathing pattern seen in diabetic ketoacidosis, not hypoglycemia. Bradycardia (slow heart rate) is not a typical symptom of hypoglycemia; tachycardia (fast heart rate) is more commonly associated with hypoglycemia due to the release of catecholamines in response to low blood sugar.
Which lab result would be most indicative of renal failure?
- A. Elevated creatinine levels.
- B. Low potassium levels.
- C. Low calcium levels.
- D. High sodium levels.
Correct Answer: A
Rationale: The correct answer is A: Elevated creatinine levels. Creatinine is a waste product that is normally filtered by the kidneys. Elevated creatinine levels indicate impaired kidney function, which is commonly seen in renal failure.
Choice B, low potassium levels, is not typically associated with renal failure. In fact, renal failure is more likely to cause high potassium levels due to the kidneys' inability to excrete potassium effectively.
Choice C, low calcium levels, are not directly indicative of renal failure. Renal failure can lead to disturbances in calcium levels, but low calcium levels alone are not a specific marker for renal failure.
Choice D, high sodium levels, are also not typically associated with renal failure. In renal failure, there may be disturbances in sodium levels, but high sodium levels alone are not a direct indicator of renal failure.
The nurse is caring for a client who is receiving an IV infusion of normal saline and notices that the infusion is not flowing. The insertion site is not inflamed or swollen. What should the nurse do first?
- A. Check the tubing for kinks or obstructions.
- B. Increase the flow rate to improve the infusion.
- C. Reinsert the IV catheter in another vein.
- D. Call the physician for further instructions.
Correct Answer: A
Rationale: The correct first action for the nurse to take when an IV infusion is not flowing despite a normal insertion site is to check the tubing for kinks or obstructions. This step is crucial to ensure that there are no preventable issues impeding the flow of the IV solution. Increasing the flow rate without addressing potential obstructions could lead to complications such as infiltration. Reinserting the IV catheter in another vein should only be considered after ruling out tubing issues. Calling the physician for further instructions is not necessary at this stage as troubleshooting the tubing should be the initial intervention.
A client with chronic renal failure is on a low-protein diet. Which of the following is the best response by the nurse when the client asks why this diet is necessary?
- A. It reduces the workload on your kidneys.
- B. It helps prevent the buildup of waste products.
- C. It helps maintain electrolyte balance in your body.
- D. It helps prevent dehydration.
Correct Answer: B
Rationale: A low-protein diet is necessary for clients with chronic renal failure because it helps prevent the buildup of waste products, such as urea, in the body. Excess protein can lead to the accumulation of waste products that the compromised kidneys may not effectively filter out, further burdening the already impaired renal function. Choices A, C, and D are incorrect because the primary reason for a low-protein diet in chronic renal failure is to reduce the workload on the kidneys by minimizing the production of waste products that can exacerbate the condition, not specifically to reduce kidney workload, maintain electrolyte balance, or prevent dehydration.
A client's laboratory findings indicate elevations in thyroxine and triiodothyronine hormones. The nurse suspects that the client may have hyperthyroidism. Which assessment finding is most often associated with hyperthyroidism?
- A. Periorbital edema.
- B. Atrophied thyroid gland.
- C. Increased pulse rate.
- D. Diarrhea stools.
Correct Answer: C
Rationale: Increased pulse rate is commonly associated with hyperthyroidism due to the increased metabolic rate. Periorbital edema (Choice A) is more commonly associated with conditions like nephrotic syndrome or heart failure, not hyperthyroidism. Atrophied thyroid gland (Choice B) is not typically an assessment finding for hyperthyroidism as the gland is usually enlarged in this condition. Diarrhea stools (Choice D) can occur in hyperthyroidism, but it is not the most common assessment finding associated with the condition.