A nurse is assisting with the care of a client in the clinic.
Complete the following sentence by using the lists of options.
The client is at greatest risk for developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}
The client reports dizziness, lightheadedness, and problems when skipping meals, which suggests concern for blood glucose instability and cardiovascular effects of prescribed medications. Beta-blockers such as metoprolol can mask the adrenergic warning signs of hypoglycemia, making low blood sugar more dangerous for diabetic clients. Recognizing medication interactions and adverse effects is essential for preventing complications and promoting safe chronic disease management.
Rationale for correct choices:
• Hypoglycemia: Clients with diabetes are at risk for hypoglycemia, especially when meals are skipped or appetite is poor. Even though metformin itself rarely causes hypoglycemia, missed meals combined with glucose-lowering therapy can increase risk. In addition, beta-blockers can prevent recognition of early warning signs such as tachycardia and tremors. This makes hypoglycemia the most significant potential complication requiring attention.
• Metoprolol: Metoprolol is a beta-blocker that can mask common adrenergic symptoms of hypoglycemia such as palpitations, tremors, and tachycardia. As a result, the client may not recognize blood glucose drops until symptoms become severe, such as confusion or syncope. Since this client already reports skipping meals, the risk becomes more significant.
Rationale for incorrect choices:
• Bradycardia: Although metoprolol can cause bradycardia, the client’s current heart rate is 62/min, which is within normal range and not immediately concerning. The greater risk is unrecognized hypoglycemia because the client reports skipped meals and dizziness. Bradycardia is possible, but it is less urgent and less supported by the findings than hypoglycemia.
• Paresthesia: Paresthesia is more commonly associated with diabetic neuropathy or significant electrolyte disturbances rather than the medications listed here. The potassium level is normal at 3.5 mEq/L, and potassium chloride is being given to maintain balance, not causing neurologic symptoms. Metformin may contribute to vitamin B12 deficiency over long-term use, but that is not the primary risk highlighted in this scenario.
• Metformin: Metformin primarily lowers hepatic glucose production and generally does not cause hypoglycemia when used alone. It is safer in this regard compared to insulin or sulfonylureas. Skipped meals may still contribute to low glucose symptoms, but metformin itself is not the major cause of masked or severe hypoglycemia.
• Potassium: Potassium chloride is prescribed to prevent or correct hypokalemia and does not directly cause hypoglycemia. The client’s potassium level is at the lower end of normal, making supplementation appropriate. Abnormal potassium levels can affect cardiac conduction and muscle function, they do not explain the client’s concern about skipped meals and blood sugar changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus due to decreased lower esophageal sphincter tone or delayed gastric emptying. This causes symptoms such as heartburn, regurgitation, and chest discomfort, especially after meals or when lying down. Lifestyle modifications are a major part of management and help reduce reflux episodes and esophageal irritation. Teaching focuses on avoiding triggers and promoting behaviors that decrease gastric reflux.
Rationale:
A. Avoiding eating snacks at bedtime is correct because lying down soon after eating increases the likelihood of gastric contents refluxing into the esophagus. Late-night meals and bedtime snacks delay gastric emptying and worsen nighttime symptoms. Clients are usually advised to avoid eating for at least 2 to 3 hours before sleep to reduce reflux episodes.
B. Using peppermint extract for an upset stomach is incorrect because peppermint can relax the lower esophageal sphincter, which worsens reflux. Although peppermint may relieve some gastrointestinal discomfort, it increases the likelihood of acid moving upward into the esophagus. Clients with GERD should avoid peppermint-containing products.
C. Limiting foods that contain sodium is not a primary teaching point for GERD management. Sodium restriction may be important in conditions such as hypertension or heart failure, but it does not directly reduce reflux symptoms. GERD teaching focuses more on avoiding fatty foods, caffeine, chocolate, alcohol, and acidic foods.
D. Sleeping in a prone position is incorrect because lying flat or prone can worsen reflux by allowing stomach acid to move more easily into the esophagus. Clients are encouraged to elevate the head of the bed and preferably sleep with the upper body elevated. This positioning uses gravity to reduce nighttime reflux symptoms.
Correct Answer is B
Explanation
Therapeutic communication in psychiatric nursing focuses on promoting understanding, encouraging expression of feelings, and assessing the family’s knowledge and perceptions. When a family member asks about prognosis in depression, the nurse should avoid giving false reassurance or vague answers. Instead, the nurse should use open-ended questions to assess understanding and provide individualized education. This approach supports patient-centered care and strengthens therapeutic relationships.
Rationale:
A. “The important thing is that he gets better, not how long it takes.” This is a non-therapeutic response because it dismisses the partner’s concern about prognosis. It may come across as minimizing their anxiety and does not provide useful information. Effective communication should acknowledge concerns rather than redirecting or shutting them down.
B. “Tell me what you know about depression.” This is an appropriate therapeutic response because it uses an open-ended question to assess the partner’s understanding. This allows the nurse to identify knowledge gaps, misconceptions, and emotional concerns. It also creates an opportunity to provide accurate education tailored to the family’s needs.
C. “We’ve seen steady improvement in other clients who are depressed.” This is inappropriate because it provides generalized reassurance that may not apply to this specific client. Depression outcomes vary widely depending on severity, treatment adherence, and individual factors. This statement may give unrealistic expectations and is not individualized to the patient’s condition.
D. “No one really knows the answer to that question.” This is a blunt and non-therapeutic response that may increase anxiety and hopelessness. Although depression outcomes can be variable, the nurse should avoid dismissive or discouraging statements. Instead, communication should remain supportive while guiding the family toward understanding the treatment process and expected variability in recovery.
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