the nurse is caring for a client with dm who is taking insulin the client develops a fever and becomes confused which action should the nurse take fir
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Nursing Elites

HESI RN

Leadership HESI Quizlet

1. The client with DM who is taking insulin develops a fever and becomes confused. Which action should the nurse take first?

Correct answer: A

Rationale: In a client with diabetes mellitus (DM) taking insulin, the development of fever and confusion may indicate hyperglycemia or diabetic ketoacidosis. Checking the blood glucose level is the priority action in this situation. This will help determine if the symptoms are related to high blood sugar levels, guiding further interventions. Administering a fever-reducing medication (choice B) addresses only the symptom of fever and does not address the underlying cause. Providing fluids to drink (choice C) is important but should come after addressing the potential hyperglycemia or diabetic ketoacidosis. Notifying the health care provider (choice D) can be important, but immediate action to evaluate and manage the client's condition should precede contacting the provider.

2. A client with hyperparathyroidism is receiving dietary instructions. Which of the following foods should the client avoid?

Correct answer: A

Rationale: In hyperparathyroidism, there are already elevated calcium levels in the body. Therefore, clients should avoid high-calcium foods like milk to prevent further increase in calcium levels. Bananas, spinach, and processed meats do not have significant calcium content and do not need to be avoided specifically in hyperparathyroidism.

3. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Correct answer: A

Rationale: Diabetes insipidus is a condition characterized by a deficiency of antidiuretic hormone (ADH). ADH plays a crucial role in regulating water balance by controlling the amount of water reabsorbed by the kidneys. Options B, C, and D are incorrect as they are not associated with diabetes insipidus. TSH (thyroid-stimulating hormone) is responsible for regulating thyroid function, while FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are involved in reproductive functions.

4. How often should rotation sites for insulin injection be separated from one another?

Correct answer: C

Rationale: Insulin injection sites should be rotated every 2-3 weeks to prevent lipodystrophy and ensure proper insulin absorption. Option A ('Every third day') is too frequent and does not allow enough time for the previous site to heal properly. Option B ('Every week') might not provide adequate time for the tissue to recover. Option D ('Every 2-4 weeks') could potentially lead to overuse of a single injection site, increasing the risk of lipodystrophy and inconsistent insulin absorption. Therefore, the recommended interval of every 2-3 weeks is optimal for insulin injection site rotation.

5. A nurse manager conducts evaluations with each staff member and reviews the staffing needs for the upcoming year. Which of the following best describes the behavior this manager is engaging in?

Correct answer: B

Rationale: The correct answer is B: Decisional activities. A nurse manager conducting evaluations and reviewing staffing needs for the future involves making decisions related to resource allocation, planning, and problem-solving. These activities fall under the category of decisional activities in management. Choice A, Interpersonal activities, would involve activities like communicating, motivating, and leading staff. Choice C, Informational activities, would involve activities like gathering and disseminating information. Choice D, Transformational activities, would involve inspiring and motivating staff to achieve organizational goals through vision and change.

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