A nurse is caring for a client who has Meniere's disease. Which of the following instructions should the nurse include?

Use large-print books.

Avoid standing on chairs or ladders.

Stay away from flickering lights.

Minimize unnecessary room changes.

Answer and Explanation

The Correct Answer is B

A. Use large-print books: Meniere’s disease primarily affects balance and hearing. Large-print books are not specifically necessary for managing Meniere’s disease, although they may benefit clients with vision impairment.

B. Avoid standing on chairs or ladders: Meniere's disease can cause vertigo, which increases the risk of falls. The nurse should advise the client to avoid activities that could lead to falls, such as standing on chairs or ladders, especially during episodes of vertigo.

C. Stay away from flickering lights: Flickering lights may trigger migraines or seizures in some individuals but are not specifically related to Meniere’s disease, avoiding flickering lights is not a primary focus for managing the disease.

D. Minimize unnecessary room changes: While minimizing sudden movements or changes in the environment can be helpful for maintaining balance, "minimizing unnecessary room changes" is not a key instruction for managing Meniere's disease.

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Correct Answer is C

Explanation

A. Excessive urinary output: In syndrome of inappropriate antidiuretic hormone (SIADH), there is decreased urinary output, not excessive output. The body retains water due to increased antidiuretic hormone (ADH), leading to fluid retention.

B. Elevated sodium level: Due to excessive water retention and dilution of electrolytes, clients with SIADH typically experience hyponatremia (decreased sodium level), not an elevated sodium level. The retained water dilutes the body's sodium concentration.

C. Bounding peripheral pulses: Bounding peripheral pulses are expected in SIADH due to fluid overload, as the body retains excessive water. This leads to increased blood volume and can cause the peripheral pulses to feel strong or "bounding."

D. Hyperactive deep tendon reflexes: Hyperactive deep tendon reflexes are typically associated with conditions such as hypercalcemia or hyperthyroidism, not SIADH. SIADH is more likely to cause muscle weakness and fatigue due to hyponatremia.

A. Apply dressing to the foot wound. B. Administer regular insulin 4 units subcutaneously x 1 dose. C. schedule an appointment with an ophthalmologist. D. Consult an outpatient wound care specialist.

Correct Answer is B

Explanation

Rationale for Correct Choice

Administer regular insulin 4 units subcutaneously x 1 dose: The client’s blood glucose is significantly elevated at 250 mg/dL and they are showing signs of hyperglycemia (polyuria, weight loss, nausea). Administering insulin addresses an immediate metabolic imbalance and helps prevent complications such as diabetic ketoacidosis.

Rationale for Incorrect Choices

Apply dressing to the foot wound: Although the wound requires care, it is not the most urgent issue. Delaying insulin administration in a hyperglycemic client with systemic symptoms could increase the risk of metabolic crisis. Wound care can follow stabilization.
Schedule an appointment with an ophthalmologist: While ophthalmologic evaluation is essential for clients with diabetes, this is a non-urgent referral and can be scheduled after acute needs like hyperglycemia and wound care are addressed.
Consult an outpatient wound care specialist: Coordinating specialized wound care is important for infection control and healing, but it is not time-sensitive. The priority is addressing the elevated blood glucose level first to stabilize the client's condition.

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A nurse is caring for a client who has Meniere's disease. Which of the following instructions should the nurse include?

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