A client with Type 2 diabetes is brought into the emergency room in an unresponsive state. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNK) is made. The nurse prepares for the administration of which initial therapy?

Administration of glucagon

Large amounts of IV saline solution

Long-acting IV insulin

Oxygen by nasal cannula

Answer and Explanation

The Correct Answer is B

B. Large amounts of IV saline solution: This is the correct initial therapy. HHNK is characterized by severe dehydration due to osmotic diuresis resulting from hyperglycemia. Therefore, the administration of large amounts of IV saline solution is essential to correct dehydration, restore intravascular volume, and improve tissue perfusion.
A. Glucagon is typically administered to treat severe hypoglycemia, not hyperglycemia.
C. Short-acting or regular insulin is administered initially to lower blood glucose levels rapidly. Long-acting insulin formulations may be used later to maintain glycemic control once the acute phase is managed.
D. Oxygen therapy may be indicated if the client is hypoxic, but it is not the initial therapy for HHNK. The priority in HHNK is to correct dehydration and hyperglycemia through fluid resuscitation and insulin therapy, respectively.

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Correct Answer is D

Explanation

D. This candidate has obesity-related comorbidities such as hypertension and gallstones, which may indicate a higher risk of complications from obesity. With a BMI of 42, this individual meets the criteria for bariatric surgery. Additionally, being older than 18 years old and having obesity-related comorbidities make this candidate a potentially suitable candidate for bariatric surgery.
A. Bariatric surgery may not be appropriate for individuals with severe alcohol addiction or unstable cardiovascular conditions like congestive heart failure. Additionally, with a BMI of 30, this candidate is considered overweight but may not meet the criteria for bariatric surgery.
B. Bariatric surgery is not typically recommended for adolescents with a BMI in the normal weight range (18.5 to 24.9), such as this candidate. Furthermore, severe acne alone would not be a sufficient indication for bariatric surgery.
C. Bariatric surgery candidates should be mentally stable and capable of understanding and adhering to the necessary pre- and postoperative guidelines.

A. eat small frequent meals during the day. B. enroll in smoking cessation classes as needed. C. take omeprazole 30 minutes after meals when acid levels are highest. D. elevate the head of the bed at night. E. eat your largest meal at bedtime.

Correct Answer is ["A","B","D"]

Explanation

A. Eating smaller, more frequent meals can help reduce the likelihood of gastric distention and decrease the pressure on the lower esophageal sphincter (LES), which can help reduce reflux symptoms.
B. Smoking is a risk factor for GERD as it can weaken the LES and increase acid reflux. Therefore, quitting smoking can help alleviate symptoms and improve overall health.
D. Elevating the head of the bed by 6 to 8 inches can help reduce nighttime reflux symptoms by using gravity to prevent stomach acid from flowing back into the esophagus.
C. Proton pump inhibitors (PPIs) like omeprazole are typically taken before meals to inhibit acid production and prevent reflux symptoms. Taking omeprazole after meals may not provide optimal acid suppression when it is most needed.
E. Eating a large meal right before bedtime can increase the likelihood of reflux symptoms as lying down after eating can worsen reflux. It is recommended to avoid large meals, particularly before bedtime, to minimize GERD symptoms.

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A client with Type 2 diabetes is brought into the emergency room in an unresponsive state. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNK) is made. The nurse prepares for the administration of which initial therapy?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is evaluating the histories of several candidates for bariatric surgery. Who is the best candidate for the surgery?

Correct Answer is D

Explanation

The nurse is providing discharge teaching for the client newly diagnosed with GERD. The teaching should Include Instructions to: (SELECT ALL THAT APPLY)

Correct Answer is ["A","B","D"]

Explanation

What symptoms would indicate to the nurse that the client receiving TPN is experiencing hyperglycemia?

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