The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention?

Correct Answer: C

Rationale: The correct answer is C) Cleaning the puncture site with alcohol before the puncture. This error requires intervention because using alcohol to clean the puncture site can falsely elevate the blood glucose reading, leading to inaccurate results and potentially incorrect insulin dosing. Option A is incorrect because checking blood glucose before and after exercising is a good practice to monitor the impact of physical activity on blood sugar levels. Option B is incorrect because puncturing the finger on the side of the finger pad is a correct technique to minimize pain and discomfort. Option D is incorrect because holding the hand down for a few minutes before the puncture can improve blood flow to the finger, making it easier to obtain an adequate blood sample. Educational Context: It's essential for diabetic patients to perform SMBG accurately to manage their condition effectively. Teaching correct techniques, such as proper hand hygiene instead of using alcohol wipes, ensures accurate results and appropriate treatment decisions. Providing ongoing education and reinforcement of correct practices is crucial for optimal diabetes management.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Tracheostomy tray. During a thyroidectomy surgery, there is a risk of damaging the recurrent laryngeal nerve, which can lead to vocal cord paralysis and airway compromise. In case of emergency situations like difficulty breathing due to vocal cord paralysis, having a tracheostomy tray readily available in the room is crucial. A tracheostomy tray contains the necessary equipment to perform an emergency tracheostomy, providing an alternative airway when upper airway obstruction occurs. Option B) IV calcium gluconate is used to manage hypocalcemia, a common complication after thyroidectomy due to inadvertent removal or damage to the parathyroid glands. While important for managing hypocalcemia, it is not directly related to managing an emergency airway situation caused by vocal cord paralysis. Option C) Oxygen equipment is important for respiratory support in various situations, but in the context of vocal cord paralysis leading to airway compromise, oxygen alone may not be sufficient to manage the emergency. A definitive airway intervention like a tracheostomy would be needed. Option D) Paper and pencil for communication may be useful for aiding communication with a patient who cannot speak but is not directly related to managing a compromised airway due to vocal cord paralysis. In an educational context, understanding the potential complications of thyroidectomy, such as damage to the recurrent laryngeal nerve and subsequent vocal cord paralysis, is crucial for nursing practice. Knowing the appropriate emergency equipment needed in such situations and being prepared to act swiftly can significantly impact patient outcomes and safety during and post-surgery. This question reinforces the importance of preparedness and quick decision-making in managing surgical complications.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Alendronate (Fosamax). The rationale behind this is that Alendronate is a bisphosphonate medication commonly used in patients on corticosteroid therapy to prevent corticosteroid-induced osteoporosis. Corticosteroids can lead to bone loss by interfering with calcium absorption and increasing bone resorption, making patients more prone to osteoporosis. Option A) Potassium is not used to prevent corticosteroid-induced osteoporosis. Potassium is an electrolyte that is important for nerve and muscle function, but it is not directly involved in preventing bone loss associated with corticosteroid use. Option C) Furosemide (Lasix) is a diuretic medication used to treat fluid retention and high blood pressure. It is not indicated for preventing corticosteroid-induced osteoporosis. Option D) Pantoprazole (Protonix) is a proton pump inhibitor commonly used to reduce stomach acid production and treat conditions like gastroesophageal reflux disease (GERD) and ulcers. It is not used specifically to prevent corticosteroid-induced osteoporosis. In an educational context, it is crucial for nursing students to understand the adverse effects of corticosteroid therapy, such as osteoporosis, and the importance of preventive measures like using bisphosphonates. This knowledge helps nurses provide comprehensive care to patients on corticosteroid therapy, ensuring their overall well-being and quality of life.

Correct Answer: C

Rationale: Rationale: The correct answer is C) Insulin reaction. When a patient like Jane Doe receives NPH insulin but delays eating for an extended period, they are at risk for an insulin reaction (hypoglycemia). NPH insulin has an onset of action around 1-2 hours after administration, so if a patient doesn't eat within a reasonable timeframe, their blood sugar levels can drop dangerously low, leading to symptoms like dizziness, confusion, sweating, and even loss of consciousness. Option A) Dehydration is incorrect because it is not directly related to the scenario described. Option B) Ketoacidotic coma is unlikely in this case because NPH insulin does not typically cause ketoacidosis, which is more common in type 1 diabetes or during periods of severe insulin deficiency. Option D) Hyperosmolar hyperglycemic coma is also less likely as NPH insulin is a shorter-acting insulin and typically does not lead to extreme hyperglycemia that would result in a hyperosmolar state. Educational Context: This question highlights the importance of timely administration of insulin in relation to meals to prevent hypoglycemia. It also underscores the need for healthcare providers to educate patients on the timing of insulin injections in coordination with meals to maintain optimal blood sugar levels and prevent complications. Understanding insulin action, patient education, and timely interventions are crucial aspects of nursing care in managing diabetes effectively.

Correct Answer: C

Rationale: In assessing a client suspected of having Cushing syndrome, it is crucial to include an evaluation of changes in body structure and weight. This is because Cushing syndrome is characterized by the excessive production of cortisol, leading to symptoms such as central obesity, muscle wasting, and thin skin. Changes in body structure and weight are key indicators of the metabolic disturbances associated with Cushing syndrome. Option A, increased pigmentation, is more commonly associated with Addison's disease, where there is an increase in melanocyte-stimulating hormone. Option B, decreased urinary output, is not a typical symptom of Cushing syndrome but may be seen in conditions like kidney failure. Option D, increased thickening and coarsening of skin, is more indicative of conditions like acromegaly, caused by excess growth hormone. Educationally, understanding the specific signs and symptoms of endocrine disorders like Cushing syndrome is essential for nurses to provide comprehensive care. By knowing the distinctive features of each condition, nurses can accurately assess, diagnose, and plan appropriate interventions for their patients. This knowledge enhances patient outcomes and improves the quality of care provided.