A nurse is preparing to administer insulin to a client with diabetes. Before administering the insulin, the nurse should prioritize which action?

Assessing the client's blood pressure.

Monitoring the client's blood glucose levels.

Asking the client about any allergies.

Checking the client's oxygen saturation.

Answer and Explanation

The Correct Answer is B

Choice B rationale:

The nurse should prioritize monitoring the client's blood glucose levels before administering insulin. It is essential to know the client's current blood sugar level to determine the appropriate dose of insulin to administer safely. Giving insulin without knowing the current blood glucose level can lead to hypoglycemia or hyperglycemia, both of which can be dangerous for the client.

Choice A rationale:

Assessing the client's blood pressure is important but not the priority before administering insulin. High or low blood pressure can be a concern in clients with diabetes, but checking blood glucose levels takes precedence when preparing to administer insulin.

Choice C rationale:

Asking the client about any allergies is a good practice before administering any medication, but it is not the priority in this situation. The immediate concern is to address the hyperglycemia with insulin while ensuring the client's safety.

Choice D rationale:

Checking the client's oxygen saturation is not directly related to insulin administration for diabetes. It may be relevant in certain medical conditions or emergencies, but it is not a priority action before giving insulin.

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Correct Answer is A

Explanation

Choice A rationale:

The nurse should instruct the patient and their family to keep the drainage system below the chest level at all times. This positioning helps ensure proper drainage of fluid or air from the chest, preventing any backflow or obstruction in the system. Gravity assists in maintaining the drainage flow, promoting the effectiveness of the chest tube.

Choice B rationale:

Deep breathing and coughing exercises are essential while the chest tube is in place. These exercises help prevent complications such as atelectasis and pneumonia by promoting lung expansion and clearing secretions. The patient should be encouraged to perform these exercises as directed by the healthcare provider.

Choice C rationale:

The nurse should educate the patient and their family to notify the physician immediately if they observe any subcutaneous emphysema around the chest tube site. Subcutaneous emphysema is a potential complication of chest tube placement, indicating air leakage into the tissues. Prompt notification allows for timely intervention to prevent further complications.

Choice D rationale:

The nurse should inform the patient that the drainage color may change from serosanguineous (pale, pink, or slightly bloody) to bright red during the recovery process. Initially, the drainage may be bloody, but as healing progresses, it should become clearer. However, if the drainage suddenly becomes bright red, it could indicate active bleeding, and the healthcare provider should be notified immediately.

A. Increased insulin production. B. Decreased glucose production by the liver. C. Inadequate cellular uptake of glucose. D. Overproduction of glucagon by the pancreas.

Correct Answer is C

Explanation

Choice A rationale:

Increased insulin production is not the primary cause of elevated blood sugar levels and excessive thirst in a client with diabetes. In fact, in type 1 diabetes, there is a lack of insulin production, while in type 2 diabetes, there is insulin resistance, both leading to inadequate cellular uptake of glucose.

Choice B rationale:

Decreased glucose production by the liver is also not the primary cause of the symptoms. In diabetes, the liver can overproduce glucose, especially in the fasting state, contributing to hyperglycemia.

Choice C rationale:

Inadequate cellular uptake of glucose is the correct choice. In diabetes, the body's cells do not effectively utilize glucose due to either insufficient insulin or insulin resistance, leading to high blood sugar levels in the blood.

Choice D rationale:

Overproduction of glucagon by the pancreas is not the primary cause of elevated blood sugar levels and excessive thirst. Glucagon, a hormone produced by the pancreas, raises blood sugar levels when necessary, but it is not the main culprit in diabetes.

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A nurse is preparing to administer insulin to a client with diabetes. Before administering the insulin, the nurse should prioritize which action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is educating a patient and their family about chest tube care. What instructions should the nurse include?

Correct Answer is A

Explanation

A nurse is caring for a client with diabetes who presents with elevated blood sugar levels and excessive thirst. The nurse understands that these symptoms are primarily caused by:

Correct Answer is C

Explanation

A nurse is preparing a patient for chest tube insertion. Which of the following nursing actions should the nurse take during the preparation process?

A client with a chest tube reports severe dyspnea, absent breath sounds on the affected side, and jugular venous distension. The nurse assesses increased intrathoracic pressure. What is the appropriate nursing action?

A client with a chest tube shows signs of infection, such as fever, chills, increased white blood cell count, and purulent drainage. What intervention should the nurse prioritize?

A nurse is providing education to a client with diabetes on foot care. The nurse should include which statement to promote foot health?

A client with diabetes is experiencing frequent episodes of hypoglycemia. The nurse should recommend which of the following strategies to prevent hypoglycemic episodes?

A nurse is preparing to administer insulin to a client with diabetes. Before administering the insulin, the nurse should prioritize which action?

A nurse caring for a patient with a chest tube notices a sudden decrease in drainage with pink frothy sputum and crackles on auscultation. What condition should the nurse suspect, and what intervention is appropriate?

A nurse is caring for a patient with a chest tube and drainage system. The patient reports continuous bubbling in the water-seal chamber. Which of the following statements should the nurse make?