The nurse prepares to teach four clients about diabetes mellitus. Which client has the greatest need for instructions?

Reference Range:

Glycosylated hemoglobin A1C (HbA1C) [good glycemic control: less than 10%]

Random blood glucose [less than or equal to 200 mg/dL (less than 11.1 mmol/L]

Postprandial glucose (1-hour gestational diabetes) [less than 140 mg/dL (less than 7.8 mmol/L)]

Fasting blood glucose [70 to 110 mg/dL (less than 6.1 mmol/L)]

A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L).

An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L).

A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L).

An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%.

Answer and Explanation

The Correct Answer is A

A. A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L): This client’s fasting glucose is well above the normal range. Prednisone can increase blood glucose levels, placing the child at risk for hyperglycemia. This indicates a need for urgent education on blood glucose management while on steroids.

B. An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L): This blood glucose level is within normal limits for random testing. No immediate need for change in diabetic teaching is evident based on this value.

C. A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L): Her result meets the upper limit range for gestational diabetes. While she requires ongoing monitoring, her values do not indicate a need for urgent intervention.

D. An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%: Although this indicates poor long-term control, it reflects a chronic issue. The child with an acutely elevated fasting glucose and corticosteroid use is at greater immediate risk and thus has higher priority for education.

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Free Nursing Study Resources

Correct Answer is ["B","C","E"]

Explanation

A. Explain expected side effects of postoperative chemotherapy: Chemotherapy and its side effects are typically discussed after surgery when the treatment plan is clearer. The focus before surgery should be on preparing the child and family for the surgery itself.

B. Monitor blood pressure every 2 hours for hypertension: Wilm's tumor can be associated with hypertension due to renin production from the tumor, so monitoring the child's blood pressure closely is essential to detect any signs of hypertension early.

C. Provide parents with simple explanations and repeat often: Simplified, repeated explanations are key to helping parents understand the diagnosis and surgical procedure. This approach supports emotional comfort and ensures informed decision-making.

D. Attend all healthcare provider and parent conferences: While it is important to support the family, the nurse’s role in attending all healthcare provider and parent conferences is not mandatory unless specifically needed for continuity of care.

E. Measure the child's abdominal girth: Measuring abdominal girth is essential preoperatively to monitor for any abdominal changes, such as swelling or distension, which could indicate tumor growth or other complications related to the Wilm's tumor.

A. Review the need for the UAP to wear a face mask while in close contact with the client. B. Remind the UAP to apply a fitted respirator mask before entering the client's room. C. Assign the UAP to provide care for another client and assume full care of the client. D. Instruct the UAP to notify the nurse of any changes in the client's respiratory status.

Correct Answer is A

Explanation

A. Review the need for the UAP to wear a face mask while in close contact with the client: Influenza is transmitted through respiratory droplets, so the UAP should wear a mask in addition to gown and gloves when assisting the client.

B. Remind the UAP to apply a fitted respirator mask before entering the client's room:
A fitted respirator mask (e.g., N95) is generally used for airborne precautions such as tuberculosis which requires droplet precautions. A face mask is sufficient in this case.

C. Assign the UAP to provide care for another client and assume full care of the client:
While it may be necessary to adjust staffing, this is an extreme response. The UAP can continue caring for the client with proper precautions.

D. Instruct the UAP to notify the nurse of any changes in the client's respiratory status:
While it is always important for the UAP to report changes in the client’s condition, this action does not address the immediate concern about PPE use.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 3-year-old child is admitted with a Stage II Wilm's tumor. Which preoperative intervention(s) should the nurse implement? Choose all that apply.

Correct Answer is ["B","C","E"]

Explanation

An older adult client with a history of heart failure is admitted with influenza and requests assistance to sit up in bed to eat lunch. The nurse observes the unlicensed assistive personnel (UAP) wearing a gown and gloves to assist the client. Which action should the nurse take?

Correct Answer is A

Explanation

Exhibits Chart data is reviewed. Drag from Word Choices to complete the sentence. Client symptoms are indicators of dropdown.

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