Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse?

Correct Answer: A

Rationale: The correct response is option A) "That is a good range for your glucose levels." This response is the best choice because a blood glucose level between 80-90 mg/dL is within the normal range and indicates good control of blood sugar following a hypoglycemic episode. It shows that the patient's glucose levels have stabilized and are not excessively low or high. Option B is incorrect because suggesting an increase in insulin without assessing the patient's current condition could lead to hypoglycemia. Option C is incorrect as advising the patient to increase food intake without proper assessment could potentially lead to hyperglycemia. Option D is incorrect as reducing insulin dosage without proper guidance from a healthcare provider can also lead to fluctuations in blood sugar levels. In an educational context, it's crucial for nurses to understand the management of blood glucose levels post-hypoglycemic episode and to support patients in maintaining stable levels within the target range. Providing accurate information and guidance empowers patients to manage their condition effectively and prevent complications related to blood sugar control.

Correct Answer: B

Rationale: In the context of hyperparathyroidism, the correct nursing intervention of increasing fluid intake to 3000 to 4000 mL daily is crucial for several reasons. Hyperparathyroidism leads to increased levels of parathyroid hormone, which can result in hypercalcemia. Increasing fluid intake helps to prevent kidney stone formation, a common complication of hypercalcemia, by promoting urinary calcium excretion. Option A, padding side rails as a seizure precaution, is unrelated to the management of hyperparathyroidism. Seizures are not a typical manifestation of this condition. Option C, maintaining bed rest to prevent pathologic fractures, is not the best intervention for hyperparathyroidism. While bone resorption can lead to weakened bones and an increased risk of fractures in this condition, promoting bed rest can lead to further bone loss. Option D, monitoring the patient for Trousseau's and Chvostek's signs, is more indicative of hypocalcemia, not hypercalcemia associated with hyperparathyroidism. These signs are related to low calcium levels, not high levels seen in hyperparathyroidism. In an educational context, understanding the rationale behind the correct intervention emphasizes the importance of managing fluid intake to prevent complications associated with hypercalcemia in patients with hyperparathyroidism. It also highlights the need for nurses to have a strong foundation in pathophysiology to provide effective and evidence-based care for patients with endocrine disorders.

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: C

Rationale: In the scenario of Mr. Conrad recovering from diabetic ketoacidosis (DKA), an expected outcome to evaluate the effectiveness of treatment is increasing responsiveness. This is because improving responsiveness indicates a positive response to treatment, with Mr. Conrad becoming more alert and responsive as his condition stabilizes. Option A, thirst, is not the expected outcome as excessive thirst is a common symptom of DKA due to dehydration and high blood sugar levels. Decreased urine output (Option B) is also not the expected outcome as increased urine output is a common symptom of DKA. An elevated hematocrit level (Option D) is not the expected outcome as DKA typically leads to hemoconcentration and elevated hematocrit due to dehydration. Educationally, understanding the expected outcomes of treating DKA is crucial for healthcare professionals to monitor and assess the effectiveness of interventions. Increasing responsiveness indicates neurological improvement and overall better physiological functioning, providing valuable insights into the patient's progress and response to treatment. This knowledge helps in optimizing patient care and making informed decisions in managing DKA and similar conditions.

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.