Which of the following is FALSE regarding patient education for insulin therapy?
- A. It improves the patients experience and adherence to insulin therapy
- B. It requires time and preparation
- C. It can only be done by diabetes nurse educators
- D. Different topics and focus can be covered at different stages of insulin therapy
Correct Answer: C
Rationale: Insulin education boosts adherence and takes prep varied topics hit stages, and checking understanding's key. But pinning it to diabetes nurse educators alone flops; GPs, pharmacists, even peers can teach, widening reach. Team effort trumps solo specialty, ensuring chronic care's flexible, not bottlenecked, a practical truth in diabetes' long haul.
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A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?
- A. Are you getting adequate rest and sleep each day?
- B. It is normal to be fatigued even for years afterward.
- C. This is not normal and I'll let the provider know.
- D. Try adding more vitamins B and C to your diet.
Correct Answer: B
Rationale: Radiation therapy, commonly used for breast cancer, can cause persistent fatigue as a side effect due to cellular damage and the body's prolonged healing process. This fatigue can last for months or even years post-treatment, varying by individual factors like radiation dose and overall health. Telling the client it's normal validates her experience, reduces anxiety, and helps her family understand this as a common outcome rather than a personal failing. Asking about rest is useful but doesn't address the family's frustration or provide context. Declaring it abnormal and escalating to the provider is inaccurate unless other symptoms suggest a new issue, potentially causing unnecessary worry. Suggesting vitamins lacks evidence for resolving radiation-induced fatigue and shifts focus from education. The nurse's role here is to reassure and educate, making the normalization of long-term fatigue the most appropriate response, fostering coping and support within the family.
A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?
- A. I've had a backache for several days
- B. I feel nauseated and have no appetite
- C. I can walk a mile a day
- D. I am urinating more frequently
Correct Answer: B
Rationale: Digoxin's tightrope nausea and anorexia flag toxicity, a common adverse hit as levels climb, risking arrhythmias. Backache's vague, walking's a win, urination's unrelated. Nurses catch this, checking levels, a red light in this heart-boosting med's dance.
Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention?
- A. Platelet count
- B. Electrolytes
- C. Hemoglobin
- D. Hematocrit
Correct Answer: B
Rationale: Tumor lysis syndrome, a post-chemotherapy emergency, floods blood with cell breakdown products potassium, phosphate, uric acid disrupting electrolytes, risking renal failure or cardiac arrest. Monitoring electrolytes is critical to catch hyperkalemia or hyperphosphatemia, guiding urgent correction like dialysis. Platelets drop with chemotherapy but aren't TLS-specific. Hemoglobin and hematocrit track anemia, not lysis effects. Electrolytes' volatility in TLS demands focus abnormalities signal escalating danger, a nurse's lifeline to intervene, ensuring rapid response to this metabolic storm in cancer treatment's wake.
The nurse is working in the emergency department and has four clients arrive at the same time. Which client should the nurse see first?
- A. A client requesting antibiotics for a cough
- B. A client who has a facial fracture with severe facial and oral swelling
- C. A client who states she has not urinated in 8 hours
- D. A client with a history of chronic obstructive pulmonary disease reporting increased dyspnea
Correct Answer: B
Rationale: Facial fracture with severe swelling risks airway ABCs dictate first look, as edema could choke breathing fast. Cough's stable, anuria's concerning but not immediate, COPD dyspnea's chronic unless crashing. Nurses triage swelling, anticipating intubation, a split-second save in this ED rush.
Damage control resuscitation:
- A. Is not indicated unless it is clear the patient's physiology has been deranged by severe injury.
- B. Is not indicated unless the patient is in the hospital.
- C. Is likely to involve restriction of fluid administration in a hypotensive, bleeding patient.
- D. Is likely is be assessed for adequacy by palpation of the radial pulse in patients with a head injury.
Correct Answer: C
Rationale: Damage control resuscitation (DCR) mitigates trauma's lethal triad (hypothermia, acidosis, coagulopathy). It's indicated preemptively in severe bleeding, not just post-derangement, to prevent physiologic collapse. It begins pre-hospital (e.g., paramedics), not only in-hospital, using blood products early. Fluid restriction in hypotensive bleeding limits dilutional coagulopathy, favoring permissive hypotension until haemostasis crucial in uncontrolled haemorrhage. Radial pulse palpation gauges perfusion broadly, but head injury patients need cerebral perfusion pressure prioritization, not DCR adequacy. ABC remains foundational. Fluid restriction's role balancing shock correction with bleeding exacerbation defines DCR's shift from crystalloid overload, improving survival in exsanguinating trauma.