The nurse is performing discharge planning for a client newly diagnosed with type 1 diabetes mellitus. It would be most important for the plan to include:
using a 23 gauge 1/2 inch needle for subcutaneous insulin.
monitoring the skin for dryness at injection site.
reporting multiple consecutive blood glucose levels over 200 mg/dL.
emphasizing the need to get eyes checked every 3 months.
The Correct Answer is C
A. While using the correct needle size is important for insulin administration, it is not the most critical aspect of discharge planning. The focus should be on managing blood glucose levels and recognizing when medical intervention is needed.
B. Monitoring the skin for dryness at the injection site is a good practice, but it is not the most urgent issue to address in discharge planning for a newly diagnosed diabetic client.
C. Consistently elevated blood glucose levels above 200 mg/dL may indicate poor control of diabetes and require prompt adjustments in treatment. Teaching the client to recognize and report hyperglycemia is essential to prevent complications such as diabetic ketoacidosis (DKA).
D. Eye exams are important for long-term diabetes management to monitor for diabetic retinopathy, but every 3 months is excessive. Annual eye exams are typically sufficient unless otherwise indicated by the healthcare provider.
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View Related questions
Correct Answer is A
Explanation
A. Requesting a prescription to culture the wound is the priority action because the presence of redness, warmth, and serosanguinous drainage could indicate an infection that needs to be confirmed and treated appropriately.
B. While antibiotics may be necessary if an infection is confirmed, it is crucial to first determine the presence of infection through culturing the wound.
C. Assuring the client that these findings are normal may delay necessary intervention if an infection is present, which could worsen the client's condition.
D. Cleaning the wound with sterile normal saline may be appropriate as part of wound care, but it does not address the underlying concern of possible infection and would not be prioritized over obtaining a culture.
Correct Answer is B
Explanation
A. 1500: This is incorrect
B. The calculation is as follows:
Remaining fluid: 600 mL
IV rate: 100 mL/hour
Time to empty the bag: 600 mL ÷ 100 mL/hour = 6 hours
Adding 6 hours to the report time:
0700 + 0600 = 1300
The correct answer is 1300.
C. 1400: This is incorrect
D. 1500: This is incorrect