A nurse is collecting data from a client who has diabetes mellitus.
Which of the following findings indicates that the client is experiencing DKA?

Confusion

Polydipsia

Rapid pulse

Clammy skin

Answer and Explanation

Correct Answer : A,B,C

Choice A rationale:

Confusion can be a symptom of Diabetic Ketoacidosis (DKA). DKA is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can’t produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

Choice B rationale:

Polydipsia, or excessive thirst, is another common symptom of DKA. High blood sugar levels can cause increased urination, leading to dehydration and an increased feeling of thirst.

Choice C rationale:

A rapid pulse is also a symptom of DKA. This is because the body is trying to compensate for the low amount of fluid in your blood vessels due to dehydration.

Choice D rationale:

Clammy skin is not typically a symptom of DKA. It’s more commonly associated with hypoglycemia (low blood sugar), not hyperglycemia (high blood sugar) which is what occurs in DKA1.

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Correct Answer is C

Explanation

The correct answer is Choice C.

Let’s go through the calculation step by step:

Step 1: Identify the order and the available medication. The order is for dexamethasone (Decadron) 6mg IM. The available stock is dexamethasone 4mg/1ml in a 5ml multidose vial.

Step 2: Determine the amount of medication needed to fulfill the order. This is done by dividing the ordered amount by the concentration of the available medication.

So, we have:

Step 2 Calculation=Concentration of Available MedicationOrdered Amount Substituting the given values: Step 2 Calculation=4 mg/mL6 mg Step 3: Perform the calculation.

Step 3 Calculation=1.5 mL

So, the nurse will prepare 1.5 mL of this medication.

Now, let’s discuss the rationales for each choice:

Choice A rationale:

75 mLs is not the correct amount. This would be a significantly larger dose than ordered, which could lead to an overdose.

Choice B rationale:

5 mLs is not the correct amount. This would also be a larger dose than ordered, which could lead to an overdose.

Choice C rationale:

1.5 mLs is the correct amount. This is calculated by dividing the ordered dose (6 mg) by the concentration of the available medication (4 mg/mL).

Choice D rationale:

15 mLs is not the correct amount. This would be a significantly larger dose than ordered, which could lead to an overdose.

A. “The treatment with this medication will last for one month.” B. “It is best to take the medication with meals.” C. “This medication can cause insomnia.” D. “Urine and other secretions might turn orange.”

Correct Answer is D

Explanation

Choice A rationale:

Rifampin is an antibiotic used to treat or prevent tuberculosis (TB). However, the treatment with this medication typically lasts longer than one month. In fact, TB treatment usually involves taking several drugs for a long time.

Choice B rationale:

While it’s important to take some medications with meals to increase absorption or decrease stomach upset, rifampin should be taken at least 1 hour before or 2 hours after a meal. This helps to ensure optimal absorption of the medication.

Choice C rationale:

Insomnia is not typically listed as a common side effect of rifampin. The medication can cause a number of side effects, but these more commonly include things like upset stomach, loss of appetite, nausea, vomiting, diarrhea, and changes in behavior.

Choice D rationale:

One of the known side effects of rifampin is that it can cause a red-orange discoloration of body fluids, including urine, sweat, saliva, and tears. This can be alarming to patients if they are not forewarned, so it’s important for the nurse to provide this information during discharge instructions.

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A nurse is collecting data from a client who has diabetes mellitus. Which of the following findings indicates that the client is experiencing DKA?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The physician orders an injection of dexamethasone (Decadron) 6mg IM for a patient. The available stock is dexamethasone 4mg/1ml in a 5ml multidose vial. How many mLs of this medication will the nurse prepare?

Correct Answer is C

Explanation

A nurse is providing discharge instructions to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide?

Correct Answer is D

Explanation

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A nurse is collecting data from a client who has diabetes mellitus.
Which of the following findings indicates that the client is experiencing DKA?