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Which of the following statements by the client's parent indicates a correct understanding of the teaching about management for type 1 diabetes mellitus? Select all that apply
- A. I may need to administer insulin more frequently when my child is ill
- B. Insulin requirements will change as my child grows
- C. Insulin should be injected deeply enough to reach the muscle
- D. Overnight social events should be avoided to prevent changes in my child's routine
- E. Proper diet and exercise can eliminate the need for insulin during adulthood.
Correct Answer: A,B
Rationale: Clients with type 1 diabetes mellitus (DM) have impaired insulin production due to autoimmune destruction of pancreatic beta
cells. Because clients with type 1 DM do not produce insulin, lifelong insulin replacement is required. Insulin requirements
will change with growth and development
Insulin requirements may increase because stressful events (eg, illness) cause blood glucose levels to rise. When the
client is ill, the parent should be instructed to notify the health care provider, monitor blood glucose levels closely, test the urine
for ketones, increase insulin administration per sliding scale, and monitor for signs of dehydration
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The nurse reinforces teaching about managing diabetes mellitus during an acute illness. For each of the statements made by the client,click to specify whether the statement indicates correct understanding or incorrect understanding
- A. I should not take insulin if I cannot eat due to nausea.
- B. I should drink extra fluids to stay hydrated when I am experiencing an illness.
- C. I will check my blood glucose levels more frequently if I am experiencing an illness
- D. I need to check my urine for ketones if my blood glucose levels are persistently elevated
- E. I will reduce my carbohydrate intake if I experience high blood glucose levels during an
illness.
Correct Answer:
Rationale: When a client with diabetes mellitus experiences an infection or another illness, the release of stress hormones can cause increased insulin
resistance, which increases the blood glucose level and leads the body to break down fats for energy (ketosis). This can precipitate diabeti
ketoacidosis (DKA) as break down of fatty acids produces ketones. Interventions for managing diabetes mellitus and preventing DKA durin
an illness include:
• Increasing fluid intake to help clear ketones from the system and prevent dehydration during illness
• Checking blood glucose levels more frequently (eg, every 4 hr) to monitor for hyperglycemia
• Monitoring the urine for ketones if blood glucose levels are persistently elevated (>240 mg/dL [13.3 mmol/L]) for early detection of
impending DKA
• Consuming beverages that contain glucose and replacing electrolytes if nausea and vomiting are present
• Notifying the health care provider of persistently elevated blood glucose levels, ketones in the urine, high fever, nausea, vomiting, or
diarrhea
For each potential intervention, click to specify if the intervention is expected or not expected for the care of the client.
- A. Daily weights
- B. IV furosemide
- C. Fluid restriction
- D. Supplemental oxygen
- E. Antihypertensive medications
- F. Nebulized albuterol breathing treatments
Correct Answer:
Rationale: Expected interventions for acute decompensated heart failure (HF) focus on reducing cardiac workload and improving
oxygenation. These include:
• Daily weights should be performed to monitor fluid volume status and guide treatment. Ideally, daily weights should be
performed at the same time of day, on the same scale, and with the client wearing the same amount of clothing.
• Diuretics (eg, furosemide) prevent reabsorption of sodium and chloride in the kidneys, which increases fluid excretion in
urine and decreases preload. Diuretics provide symptomatic relief by reducing pulmonary congestion and peripheral
edema. These are the cornerstone of therapy and often a priority after oxygen therapy.
• Fluid restriction is indicated to decrease circulating fluid volume and prevent excess strain on the heart.
• Supplemental oxygen should be administered to improve oxygen delivery in clients with HF due to impaired gas
exchange from pulmonary edema.
• Antihypertensive medications reduce cardiac workload and improve contractility by lowering blood pressure (ie,
afterload).
Nebulized albuterol is a bronchodilator administered to improve oxygenation in clients with reactive airway disease (eg.
asthma, chronic obstructive pulmonary disease). Bronchodilators will not improve oxygenation in clients with pulmonary
edema and are not expected for treatment of HF.
The nurse has reviewed the information from the Prescriptions. The nurse is reinforcing education on heart failure management. Which of the following client statements indicate a correct understanding of the teaching? Select all that apply.
- A. I am going to join a cardiac rehabilitation program
- B. I should take my furosemide at bedtime."
- C. I will check my blood pressure before each dose of carvedilol.
- D. I will notify my health care provider if I develop muscle cramps.
- E. I will weigh myself once a week.
Correct Answer: A,C,D
Rationale: Pharmacological management of heart failure (HF) focuses on reducing cardiac workload and improving cardiac output. Beta
blockers (eg, carvedilol) reduce cardiac workload by inhibiting the action of catecholamines (eg, epinephrine, norepinephrine)
on beta-adrenergic receptors in the heart. Beta blockers decrease myocardial oxygen demand by decreasing blood
pressure (BP) and heart rate (HR). Therefore, clients prescribed antihypertensive medications (eg, carvedilol) should be
instructed to check BP and HR before each dose to monitor for hypotension and bradycardia
Loop diuretics (eg, furosemide, bumetanide) are potassium-wasting, which increases the client's risk of hypokalemia
Angiotensin system inhibitors (eg, sacubitril-valsartan) and potassium supplements cause hyperkalemia. Clients should be
taught symptoms of hypo- or hyperkalemia (eg, muscle cramps) and instructed to notify the health care provider if they occur
(Option 4).
The nurse reinforces discharge teaching to the client after laser peripheral iridotomy. Which of the following client statements indicate an understanding of the teaching? Select all that apply.
- A. Gently pulling down my lower eyelid creates a pocket where I should administer the drops.
- B. I will apply pressure over the inner corner of my eye after administering each medication
- C. I will stop taking diphenhydramine because it can cause a glaucoma attack.
- D. I will wait 5 minutes between administering each eye drop medication.
- E. Touching my eye with the medication applicator may cause an infection.
Correct Answer: A,B,C,D,E
Rationale: Laser peripheral iridotomy is a surgical intervention for acute angle-closure glaucoma (ACG) that involves creating a small hole in the iris to
prevent the drainage pathway from closing and improve movement of aqueous humor into regular outflow channels. Ophthalmic alpha-
adrenergic agonists (eg, apraclonidine, brimonidine) are administered postoperatively to reduce aqueous humor production and prevent an
elevation in intraocular pressure.
Important considerations for the administration of ophthalmic drops include:
• Pulling the lower eyelid down by gently pressing on the lower orbital bone to expose the conjunctival sac (Option 1)
• Applying pressure over the inner corner of the eye (eg, lacrimal duct) after each medication to avoid systemic absorption (Option 2)
• Waiting at least 5 minutes before instilling a different medication into the same eye to allow absorption of the first medication and to
avoid overflow with multiple drops (Option 4)
• Holding the dropper ½*% in (1-2 cm) above the conjunctival sac to prevent contamination of the dropper and infection of the eye
(Option 5)
Clients should also be instructed to consult with their health care provider before taking over-the-counter medications (eg, decongestants,
anticholinergics, antihistamines) because a subsequent episode of acute ACG may be triggered by certain medications (Option 3).
The nurse is reinforcing home care teaching to the client. Which statement by the client requires the nurse to provide further instruction?
- A. I should ask family members to bring prepared meals to me." (13%)
- B. "I should eat small, frequent meals every 2-3 hours." (16%)
- C. I will avoid drinking fluids with my meals." (30%)
- D. I will eat hot soups to settle my stomach." (38%)
Correct Answer: D
Rationale: Self-management of hyperemesis gravidarum is an important component of discharge teaching. The goal of home care is to prevent nausea
and vomiting and promote appropriate nutritional intake and weight gain, which can support a healthy pregnancy.
Some triggers for nausea and vomiting include an empty or overly full stomach, strong food odors, and greasy or fatty foods. It is often
recommended that clients eat cold or bland foods due to the increased aromas associated with hot foods. Therefore, the nurse should
provide further teaching to this client who plans to eat hot soup because this may precipitate nausea (Option 4). The nurse can suggest
eating foods such as toast, crackers, nuts, or cold cereal.