A client with type 2 diabetes mellitus arrives to the clinic reporting episodes of weakness and palpitations. Which finding should the nurse recognize as a possible complication?

Hyperactive bowel sounds.

Anxiety and sighing.

Dark yellow urine.

Myalgia in wrists and hands.

Answer and Explanation

The Correct Answer is C

A. Hyperactive bowel sounds.
Hyperactive bowel sounds are more suggestive of gastrointestinal issues, such as intestinal hypermotility or increased peristalsis. While diabetes can affect the gastrointestinal system, hyperactive bowel sounds are not a specific indicator of the symptoms described by the client.

B. Anxiety and sighing.
Anxiety and sighing are more indicative of emotional or psychological factors rather than dehydration. While stress can impact blood sugar levels in individuals with diabetes, anxiety and sighing are not direct signs of the dehydration that may be associated with the reported symptoms.

C. Dark yellow urine.
Dark yellow urine can be a sign of concentrated urine, suggesting dehydration. In diabetes, especially when blood sugar levels are elevated, increased urine production (polyuria) can lead to dehydration. Dark yellow urine may indicate that the urine is more concentrated due to a lack of fluid intake.

D. Myalgia in wrists and hands.
Myalgia in the wrists and hands is not a typical symptom of dehydration related to diabetes. It could be associated with various conditions, such as musculoskeletal issues or nerve-related problems. This symptom is less likely to be directly linked to the reported weakness and palpitations.

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Correct Answer is A

Explanation

A. Platelet count 40,000 x10/μL (40.000 x109/L):
This is the correct answer. A platelet count of 40,000 x10/μL is significantly below the normal range (usually around 150,000 to 450,000/μL). Low platelet count (thrombocytopenia) can increase the risk of bleeding during and after a surgical procedure. The healthcare provider should be alerted to assess the risk and determine the appropriate management.

B. White blood cells 9,000/μL (9x109/L):
The white blood cell count is within the normal range, and it is not a significant concern for a vertebroplasty procedure.

C. Hematocrit 38% (0.38):
The hematocrit level is within the normal range and is not a significant concern for a vertebroplasty procedure.

D. Hemoglobin 12 g/dL (120 g/L):
The hemoglobin level is within the normal range and is not a significant concern for a vertebroplasty procedure.

A. Begin continuous observation for transient episodes of neurologic dysfunction. B. Place an indwelling urinary catheter and measure strict intake and output. C. Notify the stroke team to assist with acute assessment and management D. Raise the head of the bed to 30 degrees keeping head and neck in neutral alignment.

Correct Answer is C

Explanation

A. Begin continuous observation for transient episodes of neurologic dysfunction:
While continuous observation is important, the priority is to notify the stroke team for immediate assessment and management.

B. Place an indwelling urinary catheter and measure strict intake and output:
Monitoring intake and output is an important aspect of nursing care, but it is not the immediate priority when the client is presenting with signs and symptoms suggestive of a stroke.

C. Notify the stroke team to assist with acute assessment and management.
The client's symptoms, including an uneven smile with facial droop to the right side, weaker hand grasp strength on the right, and sudden, severe headache, are indicative of potential stroke symptoms. Quick notification of the stroke team is crucial to facilitate a rapid and comprehensive assessment. Time is a critical factor in the management of stroke, and prompt intervention can improve outcomes.

D. Raise the head of the bed to 30 degrees keeping head and neck in neutral alignment:
While positioning is important for maintaining physiological stability, it is not the immediate priority in the context of a potential stroke. Notifying the stroke team for rapid assessment and intervention takes precedence.

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A client with type 2 diabetes mellitus arrives to the clinic reporting episodes of weakness and palpitations. Which finding should the nurse recognize as a possible complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing the preoperative assessment for a client scheduled for a vertebroplasty of the cervical spine. Which finding should the nurse alert the healthcare provider of prior to the procedure?

Correct Answer is A

Explanation

Correct Answer is C

Explanation

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