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1200.  73-year-old client with a history of diabetes type II brought to the emergency department by spouse for changes in mental status from their baseline. The client’s spouse reports that the client woke at 0600 to complete their morning routine. At approximately 1100 the client became unaware of their surroundings and began sweating profusely and slurring their words. Breath sounds are clear but noted with a fruity citrus odor and deep rapid respirations. Sinus tachycardia per cardiac monitor. The client is awake and alert, pupils equal and reactive to light. 205lbs (93kg). 1215. Voided 30mL dark amber urine sent for urinalysis. Comprehensive metabolic panel, CBC, and ABG. IV of normal saline started. Capillary glucose is 440. 1230 Transferred to ICU. IV fluids bolus given. 1300: Started on maintenance IV fluids and insulin drip. 1330: Capillary glucose 435. Awake, alert, oriented to person and place, talking in full complete sentences. Denies pain. Breath sounds are clear. Voided 300mL clear color urine.   Vital Signs   Time 1200 1215 1330 1330 Temp 99.5° F (37.5 °C) 99.5° F (37.5 °C) 98.9°F (37.1 °C) 98.9°F (37.1 °C) P 118 115 105 100 RR 32 30 30 24 B/P 97/66 98/70 100/70 109/70 Pulse oximeter 89% on RA 92% on 2L NC 94% on 2L NC 95% on 2L NC Medications   Empagliflozin 10 mg PO daily   Sitagliptin / metformin 50-1000 mg PO daily   Valsartan 160 mg PO daily   Laboratory Report   Lab Results Reference range   ABG pH 7.20 7.35-7.45   ABG PC02 45 35-45 mmHg   ABG HC03 32 22-26 mEq/L   Creatine (Serum) 1.9 0.9 to 1.4 mg/dL   Glucose random 435  70- 140 mg/dL   Other (urine) Positive ketones negative   Potassium(serum) 2.4 3.5 to 5.5 mEq/L   Orders   Admit to ICU with diagnosis of Ketoacidosis Give 1000ml IV 0.9 NS fluid bolus over 30 minutes The start .9NS with 20mEQ KCL/100 mL at 125mL/hr. Start regular insulin infusion at 0.1 Units/kg/h after fluid bolus Finger stick blood glucose hourly and titrate insulin infusion-based on ICU protocol Obtain electrolytes every 2 hours Continuous cardiac monitoring   Which findings indicate the treatment plan has been effective? SELECT ALL THAT APPLY.

1200. 73-year-old client with a history of diabetes type II brought to the emergency department by spouse for changes in mental status from their baseline. The client’s spouse reports that the client woke at 0600 to complete their morning routine. At approximately 1100 the client became unaware of their surroundings and began sweating profusely and slurring their words. Breath sounds are clear but noted with a fruity citrus odor and deep rapid respirations. Sinus tachycardia per cardiac monitor. The client is awake and alert, pupils equal and reactive to light. 205lbs (93kg). 1215. Voided 30mL dark amber urine sent for urinalysis. Comprehensive metabolic panel, CBC, and ABG. IV of normal saline started. Capillary glucose is 440.   Vital Signs   Time 1200 1215   Temp 99.5° F (37.5 °C) 99.5° F (37.5 °C)   P 118 115   RR 32 30   B/P 97/66 98/70   Pulse oximeter 89% on RA 92% on 2L NC   Medications   Empagliflozin 10 mg PO daily   Sitagliptin / metformin 50-1000 mg PO daily   Valsartan 160 mg PO daily   Laboratory Report   Lab Results Reference range ABG pH 7.20 7.35-7.45 ABG PC02 45 35-45 mmHg ABG HC03 32 22-26 mEq/L Creatine (Serum) 1.9 0.9 to 1.4 mg/dL Glucose random 435  70- 140 mg/dL Other (urine) Positive ketones negative Potassium(serum) 2.4 3.5 to 5.5 mEq/L What orders would the nurse anticipate for this patient? SELECT ALL THAT APPLY.  

The nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been adequate? Select all that apply.

What assessment indicates that teaching about hypoparathyroidism with dietary and medication interventions for treatment has been effective?

Which route of administration is most appropriate for a client with ketoacidosis who is receiving insulin to correct hyperglycemia?

In the care of a client with Type 2 diabetes, which actions will the nurse delegate to an unlicensed assistive personnel (UAP)? Select all that apply.

A nurse is performing an admission assessment on a client who has been diagnosed with diabetes insipidus. Which findings does the nurse anticipate during the assessment? Select all that apply.

Hyperparathyroidism can result in which of the following?

When caring for a client with a fracture of the ulna and radius, what assessment finding will the nurse report immediately to the health care provider?

Case Study Question 6 The nurse is caring for a 23-year-old client admitted to the medical-surgical unit following surgery for a compound fracture of the right tibia and fibula. Nurses’ Notes   0830: Admitted from Post Anesthesia Care Unit following surgery to repair an open fracture with internal fixation with application of a fiberglass cast. R lower extremity elevated. IV infusing as ordered. Client medicated for pain prior to transport. Vital Signs BP 110/72, HR 90, RR 29, Temp 99F (37.2C). Unable to assess pedal pulse on R lower extremity due to cast. Motion of toes limited by pain and cast. Will monitor for signs of acute complications. 0930: Client resting at this time. Will continue to monitor. 1100: Client reporting pain 10/10 in R lower extremity. Updated neurovascular checks. 1115: Vital Signs BP 82/44, HR 112, RR 22, Temp 99F (37.2C). Provider notified of client changes 1145: Cast removed at bedside, see updated flow sheet. 1245: Vital Signs BP 116/70, HR 88, RR 16, Temp 98.8 F(37.1C), pain 3/10.   Neurovascular Flowsheet   Right Lower Extremity Pain Score  0-10/10 Motion F = full L = limited N = none Sensation F = full P = partial N = none Capillary Refill B = brisk < 3 seconds S = sluggish > 3 seconds Color N = normal P = pale D = dusky C = cyanotic Warmth H = hot W = warm T = tepid C = cold   Pulse 4+ bounding 3+ increased 2+ normal 1+ weak 0 absent UTA unable to assess     Time:  0830 3/10 L F B N W UTA 0930 3/10 L F B N W UTA 1030 4/10 L F B N W UTA 1100 10/10 N N S P T UTA 1115 10/10 N N S P T UTA 1130 10/10 N N S D T UTA 1145 10/10 L N S P T 1+ 1245 3/10 L N S N C 0 Orders   0830: Admission Orders: Bedrest with right leg elevated on 2 pillows May use bedside commode with assistance, no weight bearing to R lower extremity Advance to Regular diet as tolerated VS and neurovascular checks every hour for 4 hours then every 4 hours. 1130: STAT Orders: Strict bedrest, maintain R leg at level of the heart Assist client to use bedpan; Monitor intake and output Keep client nothing by mouth until cleared Document height and weight Order cast cutting tray and compartment pressure measuring device to bedside Check Neurovascular status and vital signs every 15 minutes for 2 hours  IV fluid bolus of 500 mL of normal saline over 30 minutes for blood pressure