A client with type 2 diabetes mellitus (DM) who normally takes an oral antidiabetic agent asks the nurse why insulin is necessary during this hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation and pneumonia. Review of the medication record indicates the client is taking methylprednisolone, clindamycin, and pioglitazone. How should the nurse respond?

"Antibiotics cause significant fluctuations in blood glucose, which are controlled with insulin."

"The infection and the steroid medications you are taking can increase your blood sugar."

"You may need to take insulin when you go home since your oral agent is no longer sufficient."

"The use of insulin is easier to control your blood sugars while you are hospitalized."

Answer and Explanation

The Correct Answer is B

A. While antibiotics can influence blood glucose, the primary reason for insulin in this context is the effect of steroids and infection on blood glucose levels.
B. Methylprednisolone, a steroid, can increase blood glucose levels, necessitating the use of insulin to manage elevated glucose levels during illness.
C. The need for insulin is related to the current hospitalization and medication effects, not necessarily a long-term change in diabetes management.
D. The ease of control is less relevant compared to the fact that steroids and infection can significantly impact blood glucose levels, necessitating insulin during hospitalization.

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Correct Answer is C

Explanation

A. The combination of glucose and insulin is used to shift potassium into cells, which would lower serum potassium levels further; this is not appropriate for treating hypokalemia.
B. Increasing dietary intake of potassium is important but not sufficient to correct a serum potassium level as low as 2.5 mEq/L, which requires more immediate intervention.
C. A potassium level of 2.5 mEq/L is critically low and can lead to life-threatening cardiac arrhythmias. The healthcare provider should be informed immediately to initiate potassium replacement therapy, likely via intravenous infusion.
D. Hourly urinary output measurements may be useful but are not the immediate priority in treating severe hypokalemia.

A. Avoid prolonged exposure to direct sunlight. B. Take the medications at least 12 hours apart. C. Use an additional form of contraception. D. Stop the oral contraceptive Immediately.

Correct Answer is C

Explanation

A. Erythromycin does not require the client to avoid sunlight, unlike some other antibiotics.
B. The timing of medication intake does not affect the interaction between erythromycin and oral contraceptives.
C. Erythromycin can reduce the effectiveness of oral contraceptives. It is essential to use an additional contraceptive method to prevent unintended pregnancy.
D. Stopping the oral contraceptive is not necessary but using an additional form of contraception is important.

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Naxlex Comprehensive Predictor Exams

The client's laboratory results indicate that the serum potassium level is 2.5 mEq/L (2.5 mmol/L). Which action should the nurse take? Reference Range: Potassium (K+) [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]

Correct Answer is C

Explanation

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Correct Answer is C

Explanation

While assessing a client who takes acetaminophen for chronic pain, the nurse observes that the client's skin looks yellow in color. Which action should the nurse take in response to this finding?

To detect common untoward effects of phenytoin, the nurse should assess a client with a seizure disorder for which sign or symptom?

The home care nurse has identified the nursing problem, "risk for hopelessness" for a client who is terminally ill with a life expectancy of several days. Which instruction should the nurse provide to the client's spouse?

A client is being evaluated for environmental allergies. While examining the client's nasal passage, which finding suggests to the nurse that the client is experiencing allergic rhinitis?

A parent brings a preteen daughter to the clinic for her first female examination. During the health assessment, the nurse should implement which technique to determine if the client has reached the age of menarche?