A 46-year-old woman who was diagnosed with an upper respiratory infection yesterday and prescribed an antibiotic presents to the ED reporting. "l just don't feel right." The client has a history of diabetes mellitus type 2, hypertension, peripheral neuropathy, vascular disease, and retinopathy. On admission to a medical-surgical unit, the nurse implements a plan of care to prevent complications and maintain client safety while in the hospital.
Indicate which nursing action is appropriate to prevent complications of diabetes mellitus and maintain client safety while in the hospital.
Administer angiotensin-converting enzyme (ACE) inhibitor as prescribed.
Administer intravenous 5%D/NS at 200 mL/hr.
Administer I mg glucagon 1M PRN for blood glucose 70-90 mg/dL (3.9-5.0 mmol/L).
Ensure the path to the bathroom is well-lit.
Teach the client to rise slowly from the bed.
Coordinate meal-time insulin with food delivery and consumption.
Correct Answer : D,F,G
Option A is incorrect because administering an ACE inhibitor may be a part of the patient's regular medication regimen, but it is not specific to preventing complications of diabetes mellitus while in the hospital.
Option b is incorrect because administering intravenous fluids at a high rate may result in fluid overload, electrolyte imbalances, and other complications, which may not be appropriate for this patient.
Option c is incorrect because administering glucagon is not a preventative measure, but rather an intervention for treating hypoglycemia.
Option d is correct because ensuring a well-lit path to the bathroom is important for fall prevention, but it does not directly address the prevention of complications of diabetes mellitus.
Option e is incorrect because encouraging the client to drink sugar-free liquids is a general recommendation for maintaining hydration and may not be specific to preventing complications of diabetes mellitus.
Option f is correct because teaching the client to rise slowly from the bed is important for preventing orthostatic hypotension, but it does not directly address the prevention of complications of diabetes mellitus.
Option g is correct because Patients with diabetes mellitus are at risk for hypoglycemia when taking insulin or oral hypoglycemic agents. Proper coordination of meal-time insulin with food delivery and consumption can help prevent hypoglycemia or hyperglycemia. This includes ensuring that the patient receives insulin at the appropriate time in relation to meals and monitoring blood glucose levels regularly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Cushing syndrome is caused by excessive cortisol production by the adrenal glands, which can result in weight gain and redistribution of fat to the abdomen, giving it a characteristic rounded appearance.
The other options mentioned in the question are not typically associated with Cushing syndrome. Chronically low blood pressure is not typically seen in Cushing syndrome, as cortisol is a hormone that can raise blood pressure. A bronzed appearance of the skin is more commonly seen in conditions like Addison's disease, where there is a deficiency of cortisol. Decreased axillary and pubic hair is not a common finding in Cushing syndrome, although excessive hair growth (hirsutism) may occur due to the excess of androgens produced by the adrenal glands.
Correct Answer is B
Explanation
IV fluids are not typically used as a treatment for UTIs (urinary tract infections) as they do not directly address the infection itself. The main reason for administering IV fluids to a patient with a UTI would be to ensure adequate hydration, especially if the patient is experiencing fever or other symptoms of dehydration. Adequate hydration can also help improve the efficacy of antibiotics in treating the infection by ensuring that the urinary system is properly functioning and able to flush out bacteria.
Therefore, option b would be the closest answer as IV fluids may be given to facilitate the administration of IV antibiotics. However, it is important to note that antibiotics are the primary treatment for UTIs, and IV fluids are usually given as a supportive measure to ensure the patient's overall well-being. Flushing bacteria from the urinary tract or diluting bacteria are not considered primary rationales for administering IV fluids in a patient with a UTI. Relief of pain and discomfort may be managed with pain medication, but this is not the primary reason for IV fluid administration.
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