A patient's status post hypophysectomy had drainage on the mustache dressing. Which complication is this patient at risk for if the glucose level of the drainage is 50 mg/dL?
Visual deterioration
Diabetes
Meningitis
Hypoglycemia
The Correct Answer is C
A. Visual deterioration is not typically associated with nasal drainage following a hypophysectomy unless the optic nerves or structures are affected during surgery.
B. Diabetes is not related to the glucose content in the nasal drainage; it's unrelated to this situation.
C. The presence of glucose in the drainage indicates a possible cerebrospinal fluid (CSF) leak, as CSF contains glucose. A CSF leak increases the risk of meningitis due to the direct connection to the central nervous system.
D. Hypoglycemia is not associated with the glucose content of drainage fluid. This is more relevant to blood glucose levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Using a lift sheet is helpful for preventing injury and ensuring safe handling of the patient, but it is not the most critical safety measure for a patient with Cushing’s syndrome.
B. Assisting the patient to change positions slowly is the most important safety measure for a patient with Cushing’s syndrome. Patients with Cushing’s syndrome often have osteoporosis and a risk of fractures due to prolonged exposure to high cortisol levels, which can lead to weakened bones. Orthostatic hypotension may also occur, so changing positions slowly can prevent falls.
C. Padding the siderails of the bed is typically done for patients at risk of seizures or those with neurological issues, not as a primary concern for patients with Cushing’s syndrome.
D. While keeping suction equipment at the bedside is important for patients at risk of aspiration or respiratory issues, it is not the most critical measure for a patient with Cushing’s syndrome. The most significant concern is the risk of falls and fractures due to bone weakening and potential hypotension.
Correct Answer is A
Explanation
A. Obtain a prescription for supplemental oxygen: This is the correct answer. The patient is experiencing hypoxia, and ensuring adequate oxygenation is the priority. Oxygen supplementation is essential to correct the hypoxia, which can exacerbate metabolic disturbances like diabetic ketoacidosis (DKA). Improving oxygenation will also support other treatments, such as insulin administration, by improving tissue perfusion.
B. Obtain a prescription to administer insulin: While insulin is a key treatment for DKA, addressing hypoxia first is more urgent. Hypoxia can impair the effectiveness of insulin and other therapies, so stabilizing the patient’s oxygen levels should be prioritized before insulin administration.
C. Obtain a prescription to administer intravenous fluids: Administering fluids is important in DKA management, especially for rehydration and correcting electrolyte imbalances. However, addressing hypoxia first is the priority to stabilize the patient and ensure optimal perfusion for further interventions like fluid resuscitation.
D. Obtain a prescription to check the client's glucose level: This is not necessary, as the glucose level is likely already elevated, which is characteristic of DKA. The focus should be on stabilizing the patient's airway and oxygenation before monitoring glucose levels or starting insulin.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
