A nurse is discussing the care of a client who has type 1 diabetes mellitus with an assistive personnel (AP). Which of the following situations should the nurse instruct the AP to report immediately?

The client refuses breakfast and requests to sleep.

The client asks the AP to trim his broken toenail.

The client reports urine that is dark yellow in color.

The client reports dizziness when standing.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin. Insulin is a hormone that helps the body to use glucose for energy. Glucose is a sugar that comes, in large part, from foods we eat. Insulin allows glucose to enter cells in the body. Therefore, if a client with type 1 diabetes refuses breakfast and requests to sleep, it could lead to hypoglycemia, a condition characterized by abnormally low blood glucose levels. Hypoglycemia can cause symptoms such as weakness, sweating, confusion, and in severe cases, unconsciousness or seizures. It is a medical emergency and should be reported immediately.

Choice B rationale:

Trimming a toenail may seem like a simple task, but for a person with diabetes, it can lead to serious complications. Diabetes can cause nerve damage that leads to numbness in the feet, making it difficult for a person to feel a cut, blister, or sore. These injuries can become infected and lead to serious complications, such as the need for amputation. However, this situation is not as immediately life-threatening as hypoglycemia and does not need to be reported immediately.

Choice C rationale:

Dark yellow urine can be a sign of dehydration, which can be a concern for individuals with diabetes. However, it can also be a result of less serious causes such as certain medications, foods, or simply not drinking enough fluids. While it’s important for the AP to encourage the client to drink more fluids, this situation is not as immediately life-threatening as hypoglycemia.

Choice D rationale:

Dizziness when standing, also known as orthostatic hypotension, can be a side effect of some medications used to treat diabetes. It can also be a symptom of dehydration or other conditions. While it’s important for the AP to monitor the client’s symptoms and report any changes, this situation is not as immediately life-threatening as hypoglycemia

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Correct Answer is C

Explanation

Choice A rationale:

Fluconazole Fluconazole is an antifungal medication used to treat and prevent fungal infections. It works by stopping the growth of certain types of fungus. However, it is not effective against bacterial infections such as anthrax.

Choice B rationale:

Tobramycin Tobramycin is an aminoglycoside antibiotic used to treat various types of bacterial infections, particularly Gramnegative infections. It works by stopping the growth of bacteria. However, it is not typically used to treat anthrax.

Choice C rationale:

Ciprofloxacin Ciprofloxacin is a fluoroquinolone antibiotic used for the treatment of a number of bacterial infections. This includes bone and joint infections, intra-abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For the treatment of anthrax, ciprofloxacin is one of the antibiotics that could be used. It works by killing the anthrax or by stopping the anthrax from growing. When the anthrax can’t grow anymore, it dies.

Choice D rationale:

Vancomycin Vancomycin is an antibiotic used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. However, it is not typically used to treat anthrax.

A. Proton pump inhibitors B. Calcium channel blockers C. Loop diuretics D. Phenytoin

Correct Answer is C

Explanation

Choice A rationale:

Proton pump inhibitors (PPIs) are used extensively for the treatment of gastric acid-related disorders, often over the long term, which raises the potential for clinically significant drug interactions in patients receiving concomitant medications.

However, there is no specific mention of a significant interaction between PPIs and aminoglycosides.

Choice B rationale:

Aminoglycoside antibiotics and calcium channel blockers can interact at the neuromuscular junctions. This interaction is of clinical significance because when these agents are given concurrently during the perioperative period they may lead to respiratory depression or prolonged apnea. However, this is not directly related to the therapeutic effect of aminoglycosides, but rather a side effect of their combined use.

Choice C rationale:

The loop-diuretics (ethacrynic acid, furosemide, bumetamide) and aminoglycoside antibiotics (kanamycin, gentamicin, tobramycin, amikacin, etc.) are important drugs frequently used to treat seriously ill patients. Not uncommonly both types of drugs are given to the same patient exposing that patient to the risk of a hearing loss (ototoxicity)5. In addition, the risk of ototoxicity could be enhanced by the concomitant use of loop diuretics and aminoglycoside antibiotics.

Choice D rationale:

Phenytoin is a medication used to treat seizures. It has a complex pharmacokinetic profile and can interact with many other drugs. However, there is no specific mention of a significant interaction between phenytoin and aminoglycosides.

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A nurse is discussing the care of a client who has type 1 diabetes mellitus with an assistive personnel (AP). Which of the following situations should the nurse instruct the AP to report immediately?

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Correct Answer is C

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Correct Answer is C

Explanation

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