A nurse in an emergency department is caring for an older adult client who has diabetes mellitus and is in a hyperglycemic-hyperosmolar state. Which of the following actions should the nurse take first?

Evaluate the client's understanding of diabetes management.

Administer potassium supplements.

Initiate a continuous infusion of 0.9% sodium chloride.

Chek for improvements in the client's level of consciousness.

Answer and Explanation

The Correct Answer is C

A) Evaluate the client's understanding of diabetes management: While it is important to assess the client’s understanding of diabetes management to prevent future hyperglycemic episodes, this is not the immediate priority. The client's current hyperglycemic-hyperosmolar state needs urgent intervention to stabilize their condition before educational measures can be effective.

B) Administer potassium supplements: Potassium supplementation may be necessary, especially if the client is hypokalemic, but it is not the first action. Electrolyte levels should be monitored and corrected as part of the treatment, but the initial priority is to address the severe dehydration and hyperglycemia.

C) Initiate a continuous infusion of 0.9% sodium chloride: This is the most critical first step. Clients in a hyperglycemic-hyperosmolar state are typically severely dehydrated due to osmotic diuresis. Initiating a continuous infusion of isotonic saline helps to restore intravascular volume, improve perfusion, and stabilize hemodynamics, which is essential before addressing other issues.

D) Check for improvements in the client's level of consciousness: Monitoring the client's level of consciousness is important as it provides information about their neurological status and response to treatment. However, this is a subsequent action after initiating fluid resuscitation, which directly addresses the immediate life-threatening aspects of the hyperglycemic-hyperosmolar state.

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Correct Answer is D

Explanation

A) Expect optimum visual acuity to return in 4 to 6 weeks: While some improvement in vision can be noted soon after cataract surgery, optimal visual acuity typically returns within 1 to 2 months. It's important to set realistic expectations for recovery. Telling the patient to expect optimum visual acuity to return in 4 to 6 weeks provides a more accurate timeframe for complete visual recovery.

B) Notify the provider if new floaters persist for more than 3 days: The presence of new floaters can be a sign of complications such as retinal detachment or vitreous hemorrhage. However, patients are generally advised to notify their provider immediately if they notice any new floaters, flashes of light, or a sudden decrease in vision, rather than waiting for three days. Immediate notification can lead to prompt evaluation and treatment if necessary.

C) Take aspirin every 4 to 6 hr for mild discomfort: Aspirin is generally avoided postoperatively due to its blood-thinning properties, which can increase the risk of bleeding. Instead, non-aspirin pain relievers like acetaminophen are usually recommended to manage mild discomfort after cataract surgery, as they do not carry the same risk of bleeding complications.

D) Avoid lifting objects that weigh 9.07 kg (20 lb) or more: Patients are advised to avoid lifting heavy objects and engaging in strenuous activities after cataract surgery to prevent increased intraocular pressure, which can interfere with healing and potentially cause complications such as bleeding or dislocation of the intraocular lens. This instruction helps ensure the safety and proper healing of the surgical site.

A. "I'll use pursed-lip breathing when I feel short of breath." B. "I'll skip my exercises for the week if I feel short of breath." C. "I will use my inhaler 30 minutes after each meal." D. "I will limit myself to drinking only 1 quart of water each day."

Correct Answer is A

Explanation

A) "I'll use pursed-lip breathing when I feel short of breath.": Pursed-lip breathing is a beneficial technique for clients with COPD as it helps keep the airways open longer, reduces the work of breathing, and improves ventilation. This statement indicates the client understands a key management strategy for COPD.

B) "I'll skip my exercises for the week if I feel short of breath.": Regular exercise is important for managing COPD, and while adjustments may be necessary when symptoms are severe, completely skipping exercise can lead to deconditioning and worsening of symptoms. This statement does not reflect appropriate management of COPD.

C) "I will use my inhaler 30 minutes after each meal.": Inhalers should be used as prescribed, usually before activities that might trigger symptoms, such as eating, rather than on a fixed schedule unrelated to symptoms or physician's guidance. This statement indicates a misunderstanding of inhaler use.

D) "I will limit myself to drinking only 1 quart of water each day.": Staying hydrated is important for thinning mucus in COPD. Unless there are specific medical reasons to restrict fluids, such as heart failure, limiting water intake could lead to dehydration and thickened mucus, making breathing more difficult. This statement is not appropriate for managing COPD.

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