What clinical manifestation should the nurse assess for in a patient with uncontrolled diabetes mellitus and ketoacidosis?
Febrile and shallow respirations
Increased rate and depth of respiration
Weakness and weight gain
Extremity tremors followed by seizure activity
The Correct Answer is B
Choice A rationale
Febrile and shallow respirations are not typically associated with uncontrolled diabetes mellitus and ketoacidosis. These symptoms could be indicative of a different medical condition.
Choice B rationale
An increased rate and depth of respiration, also known as Kussmaul breathing, is a common clinical manifestation in patients with uncontrolled diabetes mellitus and ketoacidosis.
Choice C rationale
Weakness and weight gain are not typically associated with uncontrolled diabetes mellitus and ketoacidosis. These symptoms could be indicative of a different medical condition.
Choice D rationale
Extremity tremors followed by seizure activity are not typically associated with uncontrolled diabetes mellitus and ketoacidosis. These symptoms could be indicative of a different medical condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Administering the prescribed antibiotic early might not be the most immediate action. While antibiotics can help treat an infection, it’s crucial to first confirm the presence of an infection before starting antibiotic therapy.
Choice B rationale
Applying a sterile dressing to the area is important, but it’s not the priority nursing action. Dressings help protect the wound from further contamination, but they do not address the underlying issue of a potential infection.
Choice C rationale
Reporting the finding to the care provider is the priority nursing action. The symptoms described - a new foul odor coming from the incision, which is erythematous, tender, and warm to the touch - suggest a possible infection. Immediate reporting allows for prompt evaluation and treatment, which is crucial in preventing further complications.
Choice D rationale
Obtaining a culture of the incision might be necessary to identify the specific causative agent of the infection, but it’s not the priority action. It’s more important to first report the findings to the care provider.
Correct Answer is A
Explanation
Choice A rationale
Trimethoprim-sulfamethoxazole is an antibiotic used to treat or prevent bacterial infections. One of the key instructions for patients taking this medication is to increase fluid intake to 3 to
4 liters per 24 hours. This is because the medication can crystallize in the urine, which can lead to kidney stones or damage if the patient is not adequately hydrated.
Choice B rationale
Spending time in the sun does not improve the metabolism of trimethoprim-sulfamethoxazole. In fact, the medication can make the skin more sensitive to the sun, increasing the risk of sunburn.
Choice C rationale
Taking Kaopectate daily to prevent diarrhea is not a standard instruction for patients taking trimethoprim-sulfamethoxazole. Diarrhea can be a side effect of the medication, but it should be managed under the guidance of a healthcare provider.
Choice D rationale
There is no specific instruction to take trimethoprim-sulfamethoxazole every morning at the same time as hydrochlorothiazide. The timing of medication administration should be determined by the healthcare provider based on the patient’s overall treatment plan.
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