Which is the best goal when planning nursing care for an older client diagnosed with diabetes mellitus?
Set walking distance goals.
Stabilize the serum glucose.
Plan for consistent exercise.
Facilitate self-management.
None of the above.
The Correct Answer is D
Choice A reason: Set walking distance goals is not the best goal, as it is too specific and may not be appropriate for all older clients with diabetes. Walking distance may vary depending on the client's physical condition, comorbidities, and preferences.
Choice B reason: Stabilize the serum glucose is not the best goal, as it is too vague and does not reflect the client's involvement in their care. Serum glucose levels may fluctuate depending on various factors, such as diet, medication, stress, and infection.
Choice C reason: Plan for consistent exercise is not the best goal, as it is not comprehensive and does not address other aspects of diabetes management, such as nutrition, medication, and monitoring. Exercise is only one component of a holistic care plan for older clients with diabetes.
Choice D reason: Facilitate self-management is the best goal, as it encompasses all the elements of diabetes care and empowers the client to take charge of their health. Self-management involves educating the client about diabetes, providing support and resources, and encouraging adherence to the prescribed treatment regimen.
Choice E reason: None of the above is not the correct answer, as there is one choice that is the best goal for planning nursing care for an older client with diabetes mellitus.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Organize the reperfusion recombinant tissue plasminogen activator (tPA) infusion is not the appropriate step, as it is a treatment for acute ischemic stroke, which has not been confirmed in this client. tPA is a clot-busting drug that can restore blood flow to the brain, but it has strict criteria and time window for its use. The nurse should not assume that the client has a stroke without further assessment and diagnosis.
Choice B reason: Determine symptom onset or when the fall occurred is not the appropriate step, as it is not the priority for this client. The nurse should first assess the client's vital signs, neurologic status, and potential injuries from the fall. The symptom onset or fall time may be relevant for the diagnosis and treatment of the underlying cause, but it is not the most urgent information to obtain.
Choice C reason: Arrange for a transfer immediately to the radiology department is not the appropriate step, as it is not the most immediate intervention for this client. The nurse should first stabilize the client's condition, perform a thorough assessment, and obtain orders from the medical provider. The radiology department may be needed for diagnostic tests, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), but it is not the first destination for this client.
Choice D reason: Perform a comprehensive neurologic assessment is the appropriate step, as it can help identify the possible cause of the client's balance problem and rule out a stroke or other serious condition. A neurologic assessment includes checking the client's level of consciousness, orientation, speech, cranial nerve function, motor strength, sensory perception, coordination, and reflexes. The nurse should also monitor the client's vital signs, oxygen saturation, and blood glucose levels.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A reason: Heart failure can cause fluid retention, which can lead to dehydration if the fluid is not properly balanced.
Choice B reason: Functional impairments can limit the ability to drink or access fluids, which can increase the risk of dehydration.
Choice C reason: Longitudinal furrows on the tongue are a sign of dehydration, as the tongue loses moisture and becomes dry and cracked.
Choice D reason: Hypertension is not directly related to dehydration, although it can be affected by fluid intake and electrolyte balance.
Choice E reason: Diabetes can cause increased urination, which can lead to dehydration if the fluid loss is not replaced.
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