A client with Type 2 diabetes, controlled with diet and metformin, also has chronic obstructive pulmonary disease (COPD). During an exacerbation of COPD, the client is prescribed prednisone to control inflammation. For which side effect should the nurse monitor the client?

Increased blood glucose levels.

Increased potassium levels.

Increased white blood cell count.

Increased ketones in the urine.

Answer and Explanation

The Correct Answer is A

Choice A reason:
Prednisone is a corticosteroid that can cause hyperglycemia, especially in clients with diabetes. The nurse should monitor blood glucose levels because prednisone can increase insulin resistance and hepatic glucose production, leading to elevated blood glucose levels. Normal fasting blood glucose levels range from 70 to 99 mg/dL, and for individuals with diabetes, maintaining blood glucose levels within the target range set by their healthcare provider is crucial to prevent complications.

Choice B reason:
While corticosteroids can affect electrolyte balance, they typically cause a decrease in potassium levels, not an increase. Therefore, monitoring for hypokalemia, rather than hyperkalemia, would be more appropriate when a patient is on prednisone. The normal range for serum potassium is 3.5 to 5.0 mEq/L.

Choice C reason:
Corticosteroids like prednisone can cause leukocytosis, an increase in white blood cell count, as part of their immunosuppressive action. However, this is generally not a harmful side effect unless accompanied by infection or other complications. The normal range for white blood cell count is approximately 4,500 to 11,000 cells per microliter.

Choice D reason:
Increased ketones in the urine, or ketonuria, is not a typical side effect of prednisone. Ketonuria is more commonly associated with uncontrolled diabetes, particularly Type 1 diabetes, when there is an insulin deficiency and the body resorts to fat breakdown, leading to ketone production.

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Correct Answer is C

Explanation

Choice A Reason
Limit setting may be helpful for a client who displays hypervigilance and refuses to attend unit activities, as it can provide clear expectations and help reduce anxiety. However, this behavior does not pose an immediate risk to the safety of others, making limit setting less essential compared to behaviors that could lead to harm.

Choice B Reason
While being flirtatious toward staff members may be inappropriate and require intervention, it is typically addressed through professional boundaries rather than limit setting. Limit setting in this context would involve clarifying acceptable behaviors within the therapeutic relationship.

Choice C Reason
Urging another client to commit violence is a behavior that necessitates immediate limit setting. This behavior poses a direct threat to the safety of others and disrupts the therapeutic environment. Limit setting here would involve immediate intervention to prevent harm and to maintain a safe environment for all clients.

Choice D Reason
A client who clings to the nurse and seeks advice on inconsequential matters may benefit from limit setting to encourage independence and appropriate use of staff time. However, this behavior is not as disruptive or dangerous as inciting violence, making it a lower priority for limit setting.

A. Urine negative for ketones. B. Sodium 135 mg/dL and Potassium 3.5 mEq/L. C. BUN 34 mg/dL and Creatinine 4.2 mg/dL. D. White blood cell count 12,000/mm³.

Correct Answer is C

Explanation

Choice A Reason
Urine negative for ketones is a normal finding and does not typically indicate an acute problem. Ketones in the urine can be a sign of uncontrolled diabetes or starvation, but their absence is expected in a well-nourished individual who is not in a state of diabetic ketoacidosis.

Choice B Reason
Sodium at 135 mg/dL and Potassium at 3.5 mEq/L are within normal ranges. The normal range for serum sodium is approximately 135-145 mEq/L, and for serum potassium, it is around 3.5-5.0 mEq/L. These values do not indicate an immediate concern for the patient with urosepsis.

Choice C Reason
A BUN of 34 mg/dL and Creatinine of 4.2 mg/dL are concerning. The normal range for BUN is approximately 6-20 mg/dL, and for Creatinine, it is about 0.6-1.2 mg/dL for males and 0.5-1.1 mg/dL for females. Elevated levels of BUN and Creatinine indicate impaired kidney function, which can be a complication of urosepsis and the nephrotoxic effects of gentamicin and vancomycin.

Choice D Reason
A white blood cell count of 12,000/mm³ is slightly elevated, which may be expected in a patient with an infection such as urosepsis. The normal range is approximately 4,500-11,000 WBCs/mm³. While this should be monitored, it does not require immediate reporting unless there is a significant change or it is outside the patient's baseline.

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A client with Type 2 diabetes, controlled with diet and metformin, also has chronic obstructive pulmonary disease (COPD). During an exacerbation of COPD, the client is prescribed prednisone to control inflammation. For which side effect should the nurse monitor the client?

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Naxlex Comprehensive Predictor Exams

For which of the following behaviors would limit setting be most essential? The client:

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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