The nurse should observe the patient for symptoms of ketoacidosis when

Correct Answer: C

Rationale: The correct answer is C) an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. This is because in the absence of sufficient insulin, the body is unable to utilize glucose for energy and instead turns to breaking down fats, leading to ketone production and subsequent ketoacidosis. Option A is incorrect because bicarbonate loss due to illnesses causing nausea and vomiting does not directly lead to ketoacidosis. Option B is incorrect because although high glucose levels can lead to osmotic diuresis, it does not directly cause ketoacidosis. Option D is incorrect because skipping meals after taking insulin can lead to hypoglycemia, not ketoacidosis. In an educational context, understanding the pathophysiology of ketoacidosis is crucial for nurses caring for patients with diabetes. Recognizing the signs and symptoms that can lead to ketoacidosis allows for timely intervention and prevention of this serious complication. By grasping the underlying mechanisms, nurses can provide optimal care and education to prevent ketoacidosis in patients with diabetes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Monitor for vital signs and cardiac rhythm response to activity. The nurse should monitor vital signs and cardiac rhythm in a patient with hypothyroidism experiencing fatigue because hypothyroidism can lead to a decrease in metabolic rate, cardiovascular function, and overall energy levels. Monitoring these parameters can help in assessing the patient's response to activity and detecting any potential complications such as bradycardia or cardiovascular strain. Option A) Monitor for changes in orientation, cognition, and behavior, though important in assessing neurological status, is not the priority in this case as the primary concern is addressing the physiological effects of hypothyroidism on the cardiovascular system. Option C) Monitoring bowel movements is more related to gastrointestinal function and may not directly address the fatigue associated with hypothyroidism. Option D) While assisting in developing well-balanced meal plans is important for overall health, it is not the immediate priority for managing fatigue in a hypothyroid patient. Educationally, this question highlights the importance of prioritizing nursing interventions based on the patient's condition and the expected physiological effects. It emphasizes the need for nurses to understand the specific manifestations of hypothyroidism and how they impact patient care.

Correct Answer: B

Rationale: The correct answer is B) Administering β-adrenergic blockers. In the management of a patient with pheochromocytoma, the priority nursing intervention is to administer β-adrenergic blockers. Pheochromocytoma is a rare tumor of the adrenal gland that can cause excessive release of catecholamines, leading to severe hypertension and other cardiovascular complications. β-adrenergic blockers help counteract the effects of excess catecholamines, such as high blood pressure and tachycardia, which are common in patients with pheochromocytoma. Option A) Administering IV fluids is not the priority intervention in this case because fluid administration may exacerbate hypertension in patients with pheochromocytoma due to the excess catecholamine release. Option C) Monitoring blood pressure is important but not the priority over administering β-adrenergic blockers to address the underlying cause of hypertension. Option D) Monitoring intake and output and daily weights is a routine nursing intervention but does not address the immediate need to control the cardiovascular effects of excess catecholamines in pheochromocytoma. Educational Context: Understanding the pathophysiology of pheochromocytoma and the role of β-adrenergic blockers in managing its cardiovascular manifestations is crucial for nursing practice. Prioritizing interventions based on the acute needs of the patient can prevent complications and optimize outcomes in such critical situations.

Correct Answer: B

Rationale: Rationale: The correct answer is B) 4-6 P.M. because Lente insulin typically peaks around 4-12 hours after administration. Since Mr. Johnson received his dose at 7:30 A.M., the time frame of 4-6 P.M. aligns with when he is most likely to experience hypoglycemia due to the peak action of the insulin. Monitoring during this window allows for timely intervention if his blood sugar drops too low. Option A) 10-11 A.M. is too soon after the dose for hypoglycemia to typically occur as Lente insulin does not peak this early. Option C) between 2 A.M. and breakfast is incorrect as it does not coincide with the expected peak action time of Lente insulin. Option D) immediately after the injection is also incorrect as hypoglycemia is not an immediate risk with Lente insulin but rather occurs later due to its slower onset and longer duration of action. Educationally, understanding the timing of insulin action is crucial for healthcare providers to ensure patient safety and effective management of diabetes. By knowing when to expect peak effects and potential side effects like hypoglycemia, healthcare professionals can provide appropriate care and support to patients like Mr. Johnson.

Correct Answer: B

Rationale: The correct answer is B) Having greatly reduced symptoms on maintenance cortisone. Rationale: After a unilateral adrenalectomy, the patient will experience a decrease in cortisol production from the affected adrenal gland. As a result, the patient may require maintenance cortisone to replace the lost cortisol and manage symptoms effectively. This option reflects a realistic goal for Mrs. A. as it acknowledges the need for ongoing medical management post-surgery to control symptoms and ensure optimal health. Option A) Being free of symptoms without medication is incorrect because after adrenalectomy, the patient may still require cortisone replacement therapy to manage symptoms effectively. Option C) Being free of symptoms on daily ACTH injections is incorrect as ACTH is not typically used for symptom management post-adrenalectomy. Option D) Having activity restricted for life is incorrect as with proper medical management, patients can resume normal activities post-surgery. Educational Context: Understanding the postoperative care and management of patients undergoing adrenalectomy is crucial for healthcare providers. It is essential to recognize the need for cortisone replacement therapy and ongoing symptom management to ensure the patient's well-being and quality of life. By selecting the most appropriate discharge goal for Mrs. A., healthcare providers can support her recovery and long-term health outcomes effectively.