A client with a cervical spinal injury (C7) is experiencing autonomic dysreflexia. The nurse should first assess the client for which precipitating factor?

An acutely distended bladder.

Profuse forehead diaphoresis.

Skeletal traction misalignment.

A severe pounding headache.

Answer and Explanation

The Correct Answer is A

A.   One of the most common triggers is a distended bladder. When the bladder becomes full, it sends signals to the spinal cord, but due to the injury, these signals are unable to pass beyond the level of injury. This results in uncontrolled sympathetic activation, leading to symptoms such as hypertension, sweating, and headache.
B.   Forehead diaphoresis, or sweating, is a potential symptom of autonomic dysreflexia. However, it is more of a consequence rather than a precipitating factor. It occurs as a result of sympathetic nervous system activation in response to the triggering stimulus.
C.   Skeletal traction misalignment is not a common precipitating factor for autonomic dysreflexia. Autonomic dysreflexia is typically triggered by stimuli related to visceral or autonomic reflexes, such as bladder distention or bowel impaction, rather than mechanical issues like traction misalignment.
D.   A severe pounding headache can occur as a symptom of autonomic dysreflexia, but it is not the primary precipitating factor. The headache is a result of the sudden increase in blood pressure that occurs during autonomic dysreflexia.

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Correct Answer is C

Explanation

C. The client's symptoms of weakness and palpitations are suggestive of hypoglycemia, a common complication in individuals with diabetes, particularly those on glucose-lowering medications such as insulin or sulfonylureas. Excessive perspiration, also known as diaphoresis, is a classic symptom of hypoglycemia and indicates the body's response to low blood sugar levels.

A. Cold extremities can be a sign of poor peripheral circulation, which may occur in individuals with diabetes, particularly in advanced stages or in the presence of peripheral vascular disease. However, it is not as specific to the acute episode of hypoglycemia
B. Myalgia (muscle pain) in the wrists and hands is not a typical symptom of hypoglycemia.
D. Dark yellow urine may indicate dehydration, which can occur in individuals with poorly controlled diabetes or during episodes of hyperglycemia. While dehydration is a concern in diabetes management, it is not directly related to the acute episode of hypoglycemia.

A. "If my fasting blood sugar is less than 100 mg/dL (5.6 mmol/L) next time, I can go back to my usual eating habits." B. "I can never eat sugar again." C. "Making these changes will also help me avoid other chronic health conditions." D. "If I have symptoms like increased thirst and urination, I should come in and get my blood sugar checked." E. "If I make the changes we talked about, I will not get type 2 diabetes."

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

Understanding;

"Making these changes will also help me avoid other chronic health conditions."

"If I have symptoms like increased thirst and urination, I should come in and get my blood sugar checked."

No understanding;

"If my fasting blood sugar is less than 100 mg/dL (5.6 mmol/L) next time, I can go back to my usual eating habits."

"I can never eat sugar again."

"If I make the changes we talked about, I will not get type 2 diabetes."

Understanding

Adherence to the DASH diet reduces the risk of diabetes mellitus as well as other conditions such as myocardial infarction, hypertension and stoke

Overt diabetes mellitus presents with polyuria and polydipsia due to osmotic diuresis- the presence of increased glucose excreted in the urine exert an osmotic pressure, drawing water into the urine and increasing its volume.

No understanding

Having a normal fasting blood glucose is a good finding. However, resumption of poor eating habits increases the risk of diabetes mellitus moving forward. Also, there are other diagnostic criteria foe diabetes mellitus apart form fasting blood glucose such as OGTT, HbA1c

It is okay for the client to consume unrefined sugar without increased risk of diabetes mellitus. Refined sugars, however, are not recommended.

Adhering to dietary changes lowers the risk of diabetes but does not eliminate it. Other factors including genetics play a role in the development of diabetes mellitus.

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A client with a cervical spinal injury (C7) is experiencing autonomic dysreflexia. The nurse should first assess the client for which precipitating factor?

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Naxlex Comprehensive Predictor Exams

A client with type 2 diabetes mellitus arrives to the clinic reporting episodes of weakness and palpitations. Which finding is most important for the nurse to monitor?

Correct Answer is C

Explanation

Review H and P, nurse's note, and laboratory results. Click to mark whether the client statement indicates understanding or no understanding of the education given

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

Patient Data Exhibits Review H and P, nurse's note, and laboratory results. What other nutritional recommendation(s) would be helpful for this client in reducing risk for type 2 diabetes mellitus? Select all that apply.

Patient Data Exhibits Based on the laboratory data, the client has dropdown related to dropdown

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