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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. Clamp the catheter for 30 minutes prior to irrigating. B. Slowly irrigate catheter with saline using an infusion pump. C. Use a sterile syringe to irrigate with 20 mL normal saline. D. Power flush with 60 mL to remove mucous obstructions.

Correct Answer is C

Explanation

Rationale:

A. Clamping the catheter before irrigation is not recommended as it could cause urine retention and increase the risk of infection.

B. An infusion pump is not typically used for catheter irrigation as manual control is preferred for monitoring flow and pressure.

C. Using a sterile syringe to gently irrigate the catheter with 20 mL of normal saline is the correct approach. This method helps to clear fibrin clots and sediment without applying excessive pressure, which could damage the bladder or catheter.

D. Power flushing with 60 mL could apply excessive pressure, potentially causing trauma to the bladder or urethra.

A. Acetaminophen. B. Captopril. C. Omeprazole. D. Prednisone.

Correct Answer is A

Explanation

Rationale:

A. Acetaminophen, especially in high doses or with prolonged use, is known to cause hepatotoxicity, which can lead to jaundice. Notifying the healthcare provider is crucial to prevent further liver damage.

B. Captopril, an ACE inhibitor used for hypertension, is not commonly associated with jaundice or liver dysfunction.

C. Omeprazole, a proton pump inhibitor used for GERD, is less likely to cause liver damage compared to acetaminophen.

D. Prednisone, a corticosteroid, can have many side effects, but hepatotoxicity is not among the most common, making acetaminophen the most concerning drug in this context.

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Correct Answer is C

Explanation

Correct Answer is A

Explanation

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The nurse is preparing a bladder irrigation for an adult client who has a long-term indwelling urinary catheter. The urine is cloudy with fibrin clots and sediment. Which intervention should the nurse implement?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

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