The nurse is reviewing the patient's record. Select to highlight the findings that demonstrate that the patient is improving.
1430: Nurses' Note: Urine output 50 mL/hr dark amber color. Continues to be lethargic.
1430: Vital Signs: Temp 100.4°F (37.8°C) HR 110 bpm: regular RR 24 breaths/min: rapid, deep SpO2 98% on room air BP 94/56 mm Hg
1430: Labs: Glucose 460 mg/dl
HR 110 bpm
regular RR 24 breaths/min
BP 94/56 mm Hg
Glucose 460 mg/dl
The Correct Answer is ["A","B","C","D"]
HR: 110 bpm; regular - The heart rate has decreased from 115 bpm and is now regular, suggesting improved cardiac rhythm stability.
RR: 24 breaths/min; rapid, deep - The respiratory rate has decreased from 26 breaths/min, indicating less rapid breathing.
BP: 94/56 mm Hg - While the blood pressure remains relatively low, there is a slight improvement compared to the previous reading.
Glucose 460 mg/dl - The glucose level has decreased from 525 mg/dL and 530 mg/dL in previous readings. While still elevated, this indicates some improvement in hyperglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Lean proteins like baked turkey breast are generally well-tolerated by individuals with GERD. Turkey is low in fat, which reduces the likelihood of triggering reflux symptoms.
B. Spaghetti with red sauce can be problematic for individuals with GERD due to the acidity of the tomato sauce, which can exacerbate reflux symptoms. Tomato-based foods are often best avoided or consumed in moderation by those with GERD.
C. Corned beef brisket is high in fat, which can increase the risk of reflux symptoms. Fatty foods, especially those high in saturated fat like corned beef, are known triggers for GERD.
D. Citrus flavors, including lemon, can trigger reflux symptoms in some individuals. However, if the dish is prepared with a small amount of lemon pepper seasoning and does not cause symptoms for the individual, it may be acceptable.
Correct Answer is D
Explanation
D. Obesity and weight loss are more directly linked to type 2 diabetes but they are not primary factors in the management of type 1 diabetes. Type 1 diabetes is characterized by the autoimmune destruction of beta cells, leading to an absolute deficiency of insulin. Weight loss can improve insulin sensitivity, which might be relevant for type 2 diabetes or insulin resistance, but type 1 diabetes patients will always require exogenous insulin regardless of weight changes.
A. Patients with type 1 diabetes are at risk for diabetic ketoacidosis (DKA), a serious condition caused by high blood glucose levels and ketone buildup due to insufficient insulin. Monitoring blood glucose levels is crucial in preventing DKA.
B. Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin- producing beta cells in the pancreas. A viral infection can sometimes trigger this autoimmune response in genetically susceptible individuals.
C. There is a genetic component to type 1 diabetes, and having a family history of the disease can increase the risk, although environmental factors also play a role.
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