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."
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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Correct Answer is B
Explanation
Rationale:
A. Rubber-soled slippers do not provide adequate support or stability for a client with weakness.
B. Tennis shoes with velcro offer good support, stability, and ease of use, which is important for clients with weakness or impaired mobility.
C. Leather-soled loafers may be slippery and do not provide as much support or stability.
D. Slip-on rubber shower shoes lack adequate support and can be unsafe for ambulation.
Correct Answer is C
Explanation
Rationale:
A. While additional sleep may be helpful, it does not address the root cause of the hangover effect from temazepam.
B. A benzodiazepine antagonist is typically used in cases of overdose, not for managing next-day drowsiness.
C. Temazepam is a benzodiazepine, and sudden discontinuation can lead to withdrawal symptoms. The nurse should advise the client to taper off the medication gradually under medical supervision to prevent withdrawal symptoms and minimize the "hangover" effect.
D. Stopping the medication abruptly can lead to withdrawal symptoms and is not recommended.