A patient with type 1 diabetes uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this regimen, what should the nurse emphasize?

Correct Answer: C

Rationale: In this scenario, option C is the correct answer. When teaching a patient with type 1 diabetes about using a combination of NPH and regular insulin, emphasizing a set meal pattern with a bedtime snack is crucial to prevent hypoglycemia. This is because NPH insulin has a peak action around 4-12 hours after administration, making the risk of hypoglycemia higher during the night. A bedtime snack helps maintain blood sugar levels until morning. Option A is incorrect because hypoglycemia is more likely to occur during the night or early morning due to the peak action of NPH insulin. Option B is incorrect because while NPH insulin provides coverage for a longer duration, it still has a peak action that needs to be considered. Option D is incorrect because premeal glucose checks are typically more important for rapid-acting insulins, not NPH insulin. In an educational context, it is essential for nurses to teach patients with diabetes about the specific action profiles of different insulins and how to adjust their meal patterns and insulin doses accordingly to maintain optimal blood sugar control and prevent complications like hypoglycemia. This knowledge empowers patients to manage their condition effectively and improve their quality of life.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Monitor neurologic status at least every 2 hours. In Syndrome of Inappropriate Antidiuretic Hormone (SIADH), there is an excess of ADH leading to water retention and dilutional hyponatremia. Monitoring neurologic status is crucial as hyponatremia can lead to neurological complications such as confusion, seizures, and coma. Checking neurologic status every 2 hours allows for early detection of any neurological changes, ensuring prompt intervention. Option B) is incorrect because in SIADH, where there is water retention, restricting sodium intake can further worsen hyponatremia. Option C) is incorrect as keeping the head of the bed elevated does not prevent ADH release. Option D) is incorrect as notifying the healthcare provider about a decrease in blood pressure is not directly related to managing SIADH. Educationally, understanding the rationale behind monitoring neurologic status in SIADH reinforces the importance of frequent assessment to prevent serious complications associated with electrolyte imbalances. Nurses need to be vigilant in assessing and monitoring patients with endocrine disorders like SIADH to provide safe and effective care.

Correct Answer: D

Rationale: The correct answer is D) Autoimmune-induced atrophy of the thyroid gland. In primary hypothyroidism, the thyroid gland is unable to produce sufficient thyroid hormones due to damage or dysfunction. The most common cause of primary hypothyroidism in adults is autoimmune thyroiditis, also known as Hashimoto's disease. This condition involves the immune system mistakenly attacking the thyroid gland, leading to its inflammation and eventual atrophy, resulting in decreased hormone production. Option A) Malignant or benign thyroid nodules: While thyroid nodules can affect thyroid function, they are not a primary cause of hypothyroidism. Nodules can lead to hyperthyroidism or remain asymptomatic. Option B) Surgical removal or failure of the pituitary gland: This would result in secondary hypothyroidism, where the pituitary gland fails to produce enough thyroid-stimulating hormone (TSH) to stimulate the thyroid gland. Option C) Surgical removal or radiation of the thyroid gland: This would also lead to hypothyroidism, but it would be considered iatrogenic or secondary hypothyroidism, as it is a direct consequence of thyroid gland removal or damage, not autoimmune-induced atrophy. Educational context: Understanding the causes of primary hypothyroidism is crucial for healthcare professionals to accurately diagnose and treat patients with thyroid disorders. Knowing the role of autoimmune processes in thyroid dysfunction helps in providing appropriate interventions and management strategies for individuals with Hashimoto's disease. This knowledge is essential for healthcare providers in various fields, including endocrinology, primary care, and nursing, to ensure optimal patient care and outcomes.

Correct Answer: A

Rationale: In the case of a patient with primary hyperaldosteronism, the correct answer to question the healthcare provider's prescription would be A) Furosemide (Lasix). This is because primary hyperaldosteronism results in excessive aldosterone production, leading to sodium and water retention, potassium excretion, and hypertension. Furosemide, a loop diuretic, would exacerbate potassium loss, which is already a concern in these patients due to aldosterone's effects on potassium excretion. Option B) Spironolactone (Aldactone) is actually a preferred treatment for primary hyperaldosteronism as it is a potassium-sparing diuretic and an aldosterone receptor antagonist, helping to counteract the effects of excess aldosterone. Option C) Amiloride (Midamor) is another potassium-sparing diuretic and could also be considered appropriate in this scenario. Option D) Aminoglutethimide (Cytadren) is not typically used in the treatment of primary hyperaldosteronism. Aminoglutethimide is an adrenal steroid inhibitor primarily used in the management of Cushing's syndrome. In an educational context, understanding the rationale behind drug choices in specific endocrine disorders is crucial for nursing practice. This knowledge ensures safe and effective patient care by being able to identify appropriate medications and question prescriptions that may be contraindicated or potentially harmful in certain conditions like primary hyperaldosteronism.

Correct Answer: A

Rationale: In the case of an insulin-dependent diabetic like Mr. Weber experiencing occasional severe reactions leading to unconsciousness in the afternoon, the most appropriate nursing action is to place a tube of commercially prepared glucose paste at his bedside (Option A). This is because severe hypoglycemia can lead to unconsciousness, and administering glucose quickly is crucial to raise blood sugar levels rapidly and reverse the hypoglycemic state. Option B, administering regular insulin, is incorrect as it would further lower Mr. Weber's blood sugar levels, worsening his condition. Option C, checking his level of consciousness every hour, is not as effective as providing immediate intervention with glucose paste. Option D, keeping a supply of orange juice in the refrigerator, is less concentrated than glucose paste and may not act quickly enough to address severe hypoglycemia. Educationally, this question highlights the importance of rapid response in managing hypoglycemic emergencies in diabetic patients. It emphasizes the critical role of glucose administration in quickly reversing the effects of low blood sugar to prevent serious complications like unconsciousness. This scenario also underscores the significance of preparedness and having appropriate supplies readily available to address medical emergencies effectively.