Mary has been a diabetic for 10 years and is normally well controlled on 20 U of NPH insulin a day. She reports that she has a fever and is nauseated; her last three urine specimens had over 2% sugar and tested positive for acetone. Your evaluation of this situation is that

Correct Answer: C

Rationale: In this scenario, the correct answer is C) she has an infection that is increasing her insulin needs. When a person with diabetes like Mary experiences an infection, such as a fever, the body's stress response releases stress hormones like cortisol and adrenaline, which can counteract the effects of insulin. This leads to an increase in blood sugar levels and subsequently an increased need for insulin to maintain control. Option A) she has not been taking her insulin is incorrect because the symptoms described are more indicative of increased insulin requirements due to an infection rather than non-compliance. Option B) her urine-testing supplies are outdated is incorrect as the symptoms described are not related to faulty testing supplies but rather reflect physiological changes in response to an infection. Option D) she is resistant to insulin is incorrect because the symptoms described are more consistent with increased insulin requirements due to the stress response to an infection rather than insulin resistance. Educationally, understanding how infections can impact blood sugar levels in individuals with diabetes is crucial for healthcare providers to effectively manage their patients' conditions. It highlights the importance of monitoring blood sugar levels closely during times of illness and adjusting insulin doses accordingly to prevent complications. This case also emphasizes the need for patients with diabetes to be vigilant in managing their condition during times of illness.

Correct Answer: D

Rationale: The correct answer is D) Assess the surgical site for signs of bleeding or hematoma formation. Rationale: After a thyroidectomy, sore throat and difficulty swallowing can indicate potential complications such as bleeding or hematoma formation, which can compromise the patient's airway and require immediate intervention. Assessing the surgical site is crucial to identify any signs of bleeding or hematoma early on. This action is essential for the nurse to ensure prompt detection and management of any postoperative complications, preventing further harm to the patient. Why the others are wrong: A) Administering analgesics and reassuring the patient may provide temporary relief but does not address the underlying issue of potential bleeding or hematoma. B) Calling the surgeon immediately is important in some situations, but the nurse should first assess the patient's condition to provide accurate information to the surgeon. C) Deep breathing and coughing exercises are not appropriate in this scenario as they do not address the specific concerns related to sore throat and difficulty swallowing post-thyroidectomy. Educational context: This question highlights the importance of postoperative assessment and early recognition of complications following a thyroidectomy. Nurses need to be vigilant in monitoring patients for signs of bleeding or hematoma formation, as prompt intervention can be life-saving. Understanding the potential complications of thyroidectomy and knowing how to respond appropriately are critical skills for nurses caring for patients undergoing this procedure.

Correct Answer: A

Rationale: In this question, the correct answer is A) Fatigue and cold intolerance. This is because hypothyroidism is characterized by an underactive thyroid gland, leading to a decrease in metabolism. Fatigue is a common symptom due to the decreased energy production at the cellular level, and cold intolerance can occur as metabolism plays a role in regulating body temperature. Option B) Weight loss and hyperglycemia is incorrect because hypothyroidism typically leads to weight gain rather than weight loss, and hyperglycemia is more commonly associated with conditions like diabetes. Option C) Polydipsia and polyphagia are symptoms of diabetes, not hypothyroidism. Polydipsia refers to excessive thirst, and polyphagia refers to excessive hunger, both of which are related to the effects of high blood sugar levels in diabetes. Option D) Tachycardia and diarrhea are more indicative of hyperthyroidism, where the thyroid gland is overactive, leading to symptoms such as rapid heartbeat and increased bowel movements. Educationally, understanding the signs and symptoms of hypothyroidism is crucial for healthcare providers to accurately diagnose and treat patients. By knowing the characteristic features of this condition, appropriate interventions can be implemented to improve patient outcomes. This knowledge also helps in differentiating hypothyroidism from other endocrine disorders with overlapping symptoms, leading to more targeted and effective treatment approaches.

Correct Answer: C

Rationale: The correct answer is C) Pulmonary congestion. Explanation: Fluid overload is a condition characterized by an excess of fluid in the body, often due to issues with the heart, kidneys, or liver. Pulmonary congestion is a common sign of fluid overload, where fluid accumulates in the lungs leading to symptoms like shortness of breath, coughing, and crackles heard on auscultation. This occurs because the excess fluid leaks into the lungs from the congested blood vessels. Weakness (Option A) and headache (Option B) are not typical signs of fluid overload. Weakness may result from various causes such as electrolyte imbalances or anemia, while headaches can be due to migraines, tension, or other causes unrelated to fluid overload. Weight gain without edema (Option D) is a tricky distractor as it may seem related to fluid overload. However, in fluid overload, weight gain is usually accompanied by edema (swelling) due to the accumulation of fluid in the interstitial spaces. Weight gain without edema may point towards other reasons like increased calorie intake or decreased physical activity. Educational Context: Understanding the signs of fluid overload is crucial in healthcare, especially for nurses, physicians, and other healthcare providers. Recognizing these signs promptly can help in early intervention and appropriate management of patients with fluid overload, preventing complications such as pulmonary edema and heart failure exacerbation. This knowledge is essential in various clinical settings, including hospitals, clinics, and long-term care facilities.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D - "Monitor lying and standing blood pressure every 4 hours with cuff placed on the same arm." This task can be appropriately delegated to a nursing assistant because it involves routine monitoring that does not require specialized nursing judgment. Monitoring blood pressure in different positions is crucial in assessing for orthostatic hypotension, a common complication post-adrenalectomy in patients with pheochromocytoma. Option A is incorrect because adding strategies to provide a calm and restful environment post-operatively requires nursing knowledge and critical thinking to individualize care based on the patient's condition and needs. Option B is incorrect as warning the patient to avoid smoking and caffeinated beverages involves patient education and counseling, which should be done by a licensed healthcare provider. Option C is also incorrect as monitoring the patient's skin and mucous membranes for signs of hydration requires assessment skills to interpret the findings correctly. Educationally, it is important to understand the principles of delegation in nursing practice. Delegating tasks appropriately ensures efficient patient care while promoting the professional growth and development of all team members. Understanding which tasks can be delegated to nursing assistants versus those that require a higher level of expertise is essential for providing safe and effective care to patients.