The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Hypoglycemia. Hypoglycemia occurs when blood glucose levels drop too low, leading to symptoms like shakiness, confusion, irritability, and slurred speech. This is a common complication in patients with diabetes, especially those on insulin or certain oral medications. Option A) DKA (Diabetic Ketoacidosis) is characterized by high blood glucose levels, ketones in the urine, and symptoms like fruity breath and abdominal pain. It is a serious condition that usually occurs in uncontrolled diabetes with very high blood sugar levels. Option C) HHS (Hyperosmolar Hyperglycemic State) is a condition of extremely high blood glucose levels leading to severe dehydration. This condition is more common in type 2 diabetes and typically presents with symptoms like extreme thirst and neurologic changes but usually not shakiness or confusion. Option D) Hyperglycemia refers to high blood glucose levels, but the symptoms described in the question (shakiness, confusion, irritability, slurred speech) are more indicative of low blood sugar levels (hypoglycemia). Educationally, understanding the differences between these conditions is crucial for nurses caring for patients with diabetes. Recognizing the signs and symptoms of hypo- and hyperglycemia is essential for prompt intervention to prevent complications. Nurses should be able to differentiate between these conditions based on clinical presentation to provide appropriate and timely care to their patients.

Correct Answer: B

Rationale: The correct answer is B: Provide written instruction for all information related to the drug therapy. Explanation: Providing written instructions is crucial when teaching a patient about levothyroxine therapy for hypothyroidism. Written materials offer a permanent reference that the patient can revisit as needed, ensuring comprehension and adherence to the treatment plan. Since managing hypothyroidism with levothyroxine involves a delicate balance of hormone levels, clear and comprehensive written instructions help the patient understand dosing, timing, potential side effects, and the importance of adherence to the prescribed regimen. Why the other options are incorrect: A) Explaining that alternate-day dosage may be used if side effects occur is not the most appropriate response in this scenario. Adjusting dosage should be done under the guidance of a healthcare provider, and patients should not self-adjust their medication regimen. C) Assuring the patient that a return to normal function will occur with replacement therapy oversimplifies the process. Achieving hormonal balance with levothyroxine therapy is a gradual process that requires monitoring and adjustments. D) Informing the patient that the drug must be taken until the hormone balance is reestablished is partially true but lacks the specificity and detail that providing written instructions would offer. Educational context: In healthcare, patient education is a vital component of promoting adherence to treatment plans and achieving positive outcomes. By providing patients with written instructions, healthcare providers can empower them to take an active role in their care, improve medication adherence, and enhance their overall health literacy. Teaching patients about their treatment options and medications in a clear and accessible manner fosters better understanding and collaboration between healthcare providers and patients.

Correct Answer: C

Rationale: The best breakfast option to suggest to Mrs. Klein, who has been diagnosed with diabetes and put on a 1200 calorie diabetic diet, is option C - a cheese omelet (4 oz cheddar, three eggs), one slice of toast, and one glass of milk. This option is the most suitable as it provides a balanced mix of carbohydrates, protein, and fat according to the prescribed diet plan. Option A is high in carbohydrates and lacks protein, which can lead to unstable blood sugar levels for a diabetic individual. Option B contains too many carbohydrates from corn flakes and orange juice, which can spike blood sugar levels. Option D is high in refined carbohydrates and lacks sufficient protein. Educationally, it is important to understand the impact of different nutrients on blood sugar levels in diabetic patients. Teaching patients like Mrs. Klein about making balanced meal choices that align with their dietary requirements is crucial in managing their condition effectively. Encouraging a diet rich in lean proteins, whole grains, and healthy fats can help stabilize blood sugar levels and improve overall health outcomes.

Correct Answer: C

Rationale: In the context of diabetes, Hyperglycemic hyperosmolar nonketotic coma (HHNK) is a serious complication characterized by extremely high blood sugar levels without the presence of ketones. Polyuria, which is excessive urination, is a hallmark symptom of HHNK. A) Hypertension is not a typical symptom of HHNK. While diabetes can lead to hypertension over time, it is not a direct symptom of HHNK. B) Bradycardia, or a slow heart rate, is also not a common symptom of HHNK. In fact, the body's response to the high blood sugar levels in HHNK often leads to dehydration and increased heart rate (tachycardia) rather than bradycardia. D) Kussmaul respirations are rapid, deep, and labored breathing patterns that are typically seen in diabetic ketoacidosis (DKA), not in HHNK. In HHNK, the body tries to compensate for the high blood sugar levels by increasing urine production, leading to dehydration and electrolyte imbalances. Understanding the specific symptoms associated with different diabetic complications is crucial for healthcare professionals to provide timely and appropriate interventions. Educating students on these distinctions can help them develop critical thinking skills in assessing and managing patients with diabetes-related complications.

Correct Answer: B

Rationale: In the scenario of a patient who has just undergone a subtotal thyroidectomy, monitoring for signs of hemorrhage and shock (Option B) during the first 12 hours postoperatively is crucial. This is because post-thyroidectomy hemorrhage is a significant complication that can lead to airway compromise, hypovolemic shock, and potential death. Monitoring for early signs such as neck swelling, difficulty breathing, tachycardia, and hypotension allows for prompt intervention and prevention of serious consequences. In contrast, the other options are not priorities during the immediate postoperative period after a thyroidectomy. Instructing the patient to avoid moving the head (Option A) is not as critical as monitoring for hemorrhage and shock. Administering medications to reduce thyroid hormone levels (Option C) and preparing the patient for thyroid replacement therapy (Option D) are important aspects of long-term care but are not immediate concerns in the first 12 hours postoperatively. Educationally, understanding the priorities in post-thyroidectomy care is essential for nurses to provide safe and effective care to these patients. By emphasizing the importance of vigilant monitoring for complications like hemorrhage and shock, nurses can ensure early detection and intervention, ultimately improving patient outcomes and safety.