Post-Conference Flashcard

Front

A young adult female client presents to the emergency department (ED) with onset of dizziness, nausea, and diaphoresis. The client is alert and engaged with a history of type 2 diabetes mellitus (DM). The client’s serum glucose is 184 mg/dL with a current blood pressure (BP) of 152/94 mm Hg. Based on this data, which hospital protocol workup should the nurse implement in the provision of client care?

Back

Acute Myocardial Infarction (MI) Protocol

Answer explanation

Blood sugar is higher, not low (takes out Hypoglycemia option) 2) BP is high, but not severe (takes out Hypertensive Emergency) 3) Symptoms are dizziness, nausea and diaphoresis - would we expect to see this with stroke? Myocardial infarction (MI) typically presents with severe, crushing substernal chest pain and radiation of pain down the left arm, neck, or jaw. Other symptoms include nausea, heartburn, abdominal discomfort, shortness of breath, diaphoresis, dizziness,and fatigue. The nurse should recognize these symptoms and take immediate action to ensure the client receives the appropriate medical care to decrease the likelihood of complications which could include death.

Front

Which client assessment finding is a priority for the nurse report to the healthcare provider (HCP)? A body mass index of 19.3 kg/m2, Fasting cholesterol of 187 mg/dL, Five round, brown-pink moles, measuring 2 mm, Hyperpigmented thickened plaques on the creases of the neck

Back

Hyperpigmented thickened plaques on the creases of the neck

Answer explanation

The nursing priority frameworks to go through your mind: ABC (nothing falls in here); Maslow's Hierarchy (no obv safety concerns), acute vs. chronic (the moles could be there long term, but are round)

What you will at some point know: underweight is BMI < 18; cholesterol should be < 200

Urgent vs. nonurgent: plaque in neck creases, not something you typically see. Hyperpigmented plaques on the neck indicate acanthosis nigricans, a manifestation indicative of insulin resistance and may be referred to as diabetic dermopathy. The nurse reports this finding to the HCP as further investigation is required because this client may have undiagnosed metabolic syndrome or diabetes mellitus.

Front

Which response by the nurse is accurate when the partner of a non-diabetic client, who is being treated for septic shock asks, “Why is my partner receiving insulin?”

Back

An increase in glucose is a normal response to stress and insulin is given to maintain your partner's blood sugar level.

Answer explanation

Gluconeogenesis, caused by the release of “fight or flight” hormones can be caused by any acute illness, infection, surgery, or trauma resulting in stress-induced hyperglycemia. The goal is to maintain normal levels of glucose in the body when this is experienced by a critically ill client.

Front

Which medication does the nurse expect the healthcare provider (HCP) to prescribe for a client who is diagnosed with heart failure and reports a dry, chronic cough and an incident of angioedema with the use of enalapril?

Back

Losartan 80 mg PO daily

Answer explanation

Angiotensin-converting enzyme (ACE) inhibitors (e.g., enalapril) are medications that promote relaxation of the veins and arteries to lower blood pressure (BP). While most commonly used in the treatment of hypertension, this medication can also be used to treat heart failure (HF).

Captopril is another angiotensin-converting enzyme (ACE) inhibitor so it will have the same side effects of nagging cough and angioedema.

When a client with heart failure needs to be switched to another medication due to a nagging cough and angioedema, angiotensin II receptor blockers (ARBs) such as losartan are considered.

Front

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? Options: Polyuria, Diaphoresis, Pedal edema, Decreased respiratory rate

Back

Polyuria

Answer explanation

Chronic hyperglycemia contributes to microvascular and macrovascular complications of DM. Classic symptoms of hyperglycemia include: polyuria, polydipsia and polyphagia. Diaphoresis may occur in hypoglycemia - hypoglycemia is not an acute complication of DM. Options 3 and 4 are not associated with DM.