The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction?

"I need to increase my intake of dietary items that are high in calcium."

"I need to eat foods high in potassium."

"I need to eat small, frequent meals and snacks if nauseated."

"I need to drink at least 2 to 3 L of fluid daily."

Answer and Explanation

The Correct Answer is A

A. "I need to increase my intake of dietary items that are high in calcium.": Hyper-parathyroidism leads to elevated calcium levels in the blood due to overproduction of parathyroid hormone (PTH). Increasing calcium intake would exacerbate the condition.

B. "I need to eat foods high in potassium.": Furosemide, a diuretic, can cause potassium loss through increased urination, so it is important to increase potassium intake. Foods like bananas, oranges, and potatoes are good sources of potassium.

C. "I need to eat small, frequent meals and snacks if nauseated.": Nausea is a common symptom in hyperparathyroidism, and small, frequent meals can help prevent nausea and improve overall comfort and nutritional intake.

D. "I need to drink at least 2 to 3 L of fluid daily.": Adequate hydration is important for kidney function and to help prevent kidney stones, which are a common complication in hyperparathyroidism due to high calcium levels.

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Correct Answer is ["B","C","D","E"]

Explanation

A. Push IV potassium: Potassium should be administered slowly and with caution, as administering potassium too rapidly can cause cardiac arrhythmias. Potassium should only be given according to specific protocols and after monitoring serum potassium levels.

B. Administer intravenous potassium: In diabetic ketoacidosis (DKA), potassium levels often decrease due to insulin therapy, which shifts potassium into cells. Intravenous potassium is often required to replace lost potassium and prevent dangerous complications.

C. Assess fluid volume status: In DKA, the client experiences significant fluid loss due to polyuria (frequent urination) and dehydration. It is important to closely monitor the client’s fluid volume status and correct it with intravenous fluids, typically normal saline.

D. Check for urinary ketones: Urinary ketones are a key marker in diagnosing DKA. The nurse should monitor for the presence of ketones in the urine as it helps assess the degree of ketosis and the effectiveness of treatment.

E. Maintain adequate ventilation: In DKA, respiratory compensation (such as Kussmaul breathing) is common as the body attempts to correct acidosis. Adequate ventilation should be ensured to support the respiratory system and correct the metabolic acidosis.

A. Wait until the client finishes half of the meal before giving the insulin B. Administer the insulin immediately before the client begins eating. C. Hold the insulin until the client's blood glucose is rechecked D. Administer the insulin 30 minutes after the client finishes eating.

Correct Answer is B

Explanation

A. Wait until the client finishes half of the meal before giving the insulin: Regular insulin has a quick onset and should be administered shortly before or at the beginning of a meal to prevent postprandial hyperglycemia.

B. Administer the insulin immediately before the client begins eating: Regular insulin should be administered before meals to ensure that it begins to work as the client eats, helping to control the rise in blood sugar that occurs after eating.

C. Hold the insulin until the client's blood glucose is rechecked: The current blood glucose level of 167 mg/dL is elevated but not dangerously high. Regular insulin should be administered at the start of the meal, and the blood glucose can be rechecked later if needed.

D. Administer the insulin 30 minutes after the client finishes eating: Regular insulin should be given before meals. Administering insulin after eating can lead to high blood sugar levels as the insulin won't be able to act promptly to manage the glucose rise from the meal.

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The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction?

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