A client has been hospitalized for multiple sclerosis exacerbation and is being given high dose IV glucocorticoid steroid medications. The prescriber places new orders for weight based sliding scale insulin. The patient asks why they need insulin. Are they now diabetic? What is the nurse's best response?

Insulin is commonly given to all hospitalized clients.

You likely developed diabetes prior to hospitalization, but are just now being diagnosed.

You have developed type 1 diabetes and will need insulin for the rest of your life.

Glucocorticoid steroid medications can cause temporary hyperglycemia.

Answer and Explanation

The Correct Answer is D

Choice A reason: This choice is incorrect because insulin is not commonly given to all hospitalized clients. Insulin is a hormone that lowers blood sugar levels in the body. It is only given to clients who have diabetes or other conditions that cause high blood sugar, such as pancreatitis, sepsis, or steroid therapy. The nurse should explain the indication and purpose of insulin to the client and not make false or misleading statements.

Choice B reason: This choice is incorrect because the client did not likely develop diabetes prior to hospitalization, but are just now being diagnosed. Diabetes is a chronic condition where the body either does not produce enough insulin or does not use it properly, resulting in high blood sugar levels. Diabetes can be diagnosed by measuring the blood sugar levels, the hemoglobin A1c levels, or the oral glucose tolerance test. The nurse should not assume or imply that the client has diabetes without proper testing and confirmation.

Choice C reason: This choice is incorrect because the client did not develop type 1 diabetes and will not need insulin for the rest of their life. Type 1 diabetes is an autoimmune condition where the body destroys the insulin-producing cells in the pancreas, leading to a complete lack of insulin. Type 1 diabetes usually develops in childhood or adolescence, and requires lifelong insulin therapy. The nurse should not diagnose or predict the client's condition without evidence or authority.

Choice D reason: This choice is correct because glucocorticoid steroid medications can cause temporary hyperglycemia. Glucocorticoids are anti-inflammatory drugs that suppress the immune system and reduce inflammation. They are used to treat conditions such as multiple sclerosis, asthma, rheumatoid arthritis, and allergic reactions. However, they can also increase the blood sugar levels by stimulating the liver to produce more glucose and reducing the sensitivity of the cells to insulin. The nurse should inform the client that the insulin is needed to control the blood sugar levels while they are on steroid therapy, and that the insulin dose may be adjusted or discontinued when the steroids are tapered or stopped.

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Correct Answer is D

Explanation

Choice A reason: This choice is incorrect because fluids should not be limited to 1000 mL daily for a client taking hydrochlorothiazide. Hydrochlorothiazide is a diuretic that causes the body to lose water and salt through urine. Limiting fluids can lead to dehydration, electrolyte imbalance, and kidney damage. The client should drink enough fluids to prevent thirst and dry mouth, and follow the doctor's advice on fluid intake.

Choice B reason: This choice is incorrect because this medication is not best taken at night for a client taking hydrochlorothiazide. Hydrochlorothiazide can cause frequent urination, which can disrupt the sleep cycle and cause fatigue. The client should take this medication in the morning or at least 4 hours before bedtime to avoid nocturia (nighttime urination).

Choice C reason: This choice is incorrect because dairy products should not be avoided while on this medication for a client taking hydrochlorothiazide. Hydrochlorothiazide can lower the level of calcium in the blood, which can cause muscle weakness, cramps, and osteoporosis. Dairy products are a good source of calcium and can help prevent calcium deficiency. The client should consume adequate amounts of calcium and vitamin D, and have their blood calcium level checked regularly.

Choice D reason: This choice is correct because the client should consume high potassium foods such as bananas and oranges while on this medication. Hydrochlorothiazide can lower the level of potassium in the blood, which can cause irregular heartbeat, muscle weakness, and numbness. Potassium-rich foods can help prevent potassium deficiency and maintain normal heart and muscle function. The client should also have their blood potassium level checked regularly and avoid salt substitutes that contain potassium.

A. No answer is provided B. 1 C. No answer is too low D. No answer is too high E. No answer is too high

Correct Answer is B

Explanation

This choice is correct because it is the result of dividing the ordered dose (0.25 mg) by the strength of the tablet (250 mcg or 0.25 mg). The formula for calculating the number of tablets to be given is:

Tablets = Dose/ Strength

Therefore, the number of tablets to be given is:

Tablets = 0.25 mg/250 mcg = 0.25 mg/0.25 mg = 1

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