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A client with type 2 diabetes mellitus (DM) who normally takes an oral antidiabetic agent asks the nurse why insulin is necessary during this hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation and pneumonia. Review of the medication record indicates the client is taking methylprednisolone, clindamycin, and pioglitazone. How should the nurse respond?

"Antibiotics cause significant fluctuations in blood glucose, which are controlled with insulin."

"The infection and the steroid medications you are taking can increase your blood sugar."

"You may need to take insulin when you go home since your oral agent is no longer sufficient."

"The use of insulin is easier to control your blood sugars while you are hospitalized."

Answer and Explanation

The Correct Answer is B

Rationale:

A. While antibiotics can influence blood glucose, the primary reason for insulin in this context is the effect of steroids and infection on blood glucose levels.

B. Methylprednisolone, a steroid, can increase blood glucose levels, necessitating the use of insulin to manage elevated glucose levels during illness.

C. The need for insulin is related to the current hospitalization and medication effects, not necessarily a long-term change in diabetes management.

D. The ease of control is less relevant compared to the fact that steroids and infection can significantly impact blood glucose levels, necessitating insulin during hospitalization.

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A. Maintain a cheerful and calm appearance while spending time with the client. B. Listen for changes in what the client hopes for and try to help meet the goals. C. Avoid the client having to make any decisions to help save the client's energy. D. Offer meals prepared with the client's favorite foods at frequent, regular intervals.

Correct Answer is B

Explanation

Rationale:

A. A cheerful and calm appearance may not always align with the client's emotional needs and could feel insincere.

B. As the client nears the end of life, their hopes may shift, and it is crucial for the spouse to listen and help fulfill these evolving goals to provide comfort and maintain dignity.

C. Encouraging the client to make decisions as they are able can empower them, rather than avoiding decision-making.

D. Offering favorite foods is thoughtful but does not directly address the emotional and psychological aspects of hopelessness.

A. Demonstrate how to select dose based on before meal blood sugar readings. B. Teach the client self-injection skills for daily subcutaneous administration. C. Provide information on increasing medication dosage if ketoacidosis occurs. D. Explain to the family how to inject this medication for severe hypoglycemia.

Correct Answer is B

Explanation

Rationale:

A. Insulin glargine is a long-acting insulin, and its dose is not based on before-meal blood sugar readings.

B. The client needs to be taught how to self-administer insulin glargine, as it is given subcutaneously once daily, usually at the same time each day.

C. Increasing the dosage in response to ketoacidosis is inappropriate; emergency treatment is required for this condition.

D. Insulin glargine does not have a role in treating severe hypoglycemia; fast-acting glucose or glucagon is used for such situations.

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Correct Answer is B

Explanation

Correct Answer is B

Explanation

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The home care nurse has identified the nursing problem, "risk for hopelessness" for a client who is terminally ill with a life expectancy of several days. Which instruction should the nurse provide to the client's spouse?

Correct Answer is B

Explanation

The nurse is planning discharge teaching for a client with type 2 diabetes mellitus who has a new prescription for insulin glargine. Which action should the nurse plan to Include in the discharge teaching?

Correct Answer is B

Explanation

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