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Which of these tests would the nurse expect to monitor for the evaluation of clients aged 18 and older with poor glycemic control?
- A. A glycosylated hemoglobin (A1c) should be performed during an initial assessment and during follow-up assessment, which should occur in longer than 3-month intervals
- B. A glycosylated hemoglobin is to be obtained at least two years
- C. A fasting glucose and a glycosylated hemoglobin is to be obtained at 3 months intervals after the initial assessment
- D. A glucose tolerance test, a fasting glucose and a glycosylated hemoglobin should be obtained at 6-month intervals after the initial assessment
Correct Answer: A
Rationale: The American Diabetes Association (ADA) recommends obtaining a glycosylated hemoglobin during an initial assessment and then routinely as part of continuing care for clients with poor glycemic control.
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When caring for a client with hypocalcaemia, the nurse should assess for:
- A. A decreased level of consciousness
- B. Tetany
- C. Bradycardia
- D. Respiratory depression
Correct Answer: B
Rationale: Hypocalcemia can cause tetany (muscle spasms or twitching) due to increased neuromuscular excitability.
A neonate born 12 hours ago to a methadone maintained woman is exhibiting a hyperactive MORO reflex and slight tremors. The newborn passed one loose, watery stool. Which of these is a nursing priority?
- A. Hold the infant at frequent intervals.
- B. Assess for neonatal withdrawal syndrome
- C. Offer fluids to prevent dehydration
- D. Administer paregoric to stop diarrhea
Correct Answer: B
Rationale: Assess for neonatal withdrawal syndrome. These symptoms indicate possible opioid withdrawal, requiring immediate assessment.
A client with acquired immunodeficiency syndrome has a T cell count of 180 . The medication frequently used for the client with T cell counts less than 200 is:
- A. Garamycin (gentamicin)
- B. Zovirax (acyclovir)
- C. Pentam (pentamidine)
- D. Immune globulin
Correct Answer: C
Rationale: Pentamidine is used for Pneumocystis prophylaxis in AIDS patients with T-cell counts <200. Gentamicin is an antibiotic, acyclovir treats herpes, and immune globulin is not specific.
A 9-year-old with type 1 diabetes takes insulin glargine and NPH regularly. While at school, the client becomes shaky, diaphoretic, and pale. What is the most appropriate action by the nurse?
- A. Administer scheduled dose of NPH insulin
- B. Give emergency glucagon IM injection
- C. Give peanut butter and crackers
- D. Provide 4 oz (120 mL) of a regular soft drink
Correct Answer: D
Rationale: Shakiness, diaphoresis, and pallor indicate hypoglycemia. Providing 15 grams of fast-acting carbohydrates, such as 4 oz of a regular soft drink, is the first-line treatment.
A student nurse is preparing to administer the hepatitis B vaccine to a newborn. Which statement by the student nurse requires the preceptor to provide further teaching?
- A. A 5/8-inch, 25-gauge needle is appropriate for intramuscular injection in newborns.
- B. I will clean the injection site with an antiseptic swab before administration.
- C. I will draw the medication into a 1-mL syringe.
- D. The medication should be administered into the deltoid muscle.
Correct Answer: D
Rationale: The deltoid muscle is not developed enough in newborns for intramuscular injections. The hepatitis B vaccine should be administered in the anterolateral thigh.