Medical Surgical Exam 4 (NSG 123)

The correct answer is A: take child outside into the more humid night air for 15 min

Explanation for the correct answer:

A barky cough that worsens at night is a common sign of croup, a viral infection that causes inflammation and swelling of the larynx and trachea. One of the most effective home interventions for managing croup is to take the child outside into cool, humid air. This helps to reduce airway swelling, as the cool air can constrict the blood vessels, easing the inflammation. If it's not cold outside, parents can also run a hot shower and have the child breathe in the steam, which mimics the benefits of humid air.

Why the other options are wrong:

B. Take the child to the ED immediately

While it's important to seek medical care if the child is experiencing severe respiratory distress or difficulty breathing, the barky cough itself does not require an immediate emergency room visit. The cool, humid air is often effective in treating mild cases of croup, so an ED visit is not necessary unless the child is showing signs of severe respiratory distress, such as stridor at rest, difficulty swallowing, or cyanosis.

C. Give OTC cough suppressant

Cough suppressants are not recommended for children with croup. These medications can suppress the cough reflex, which is important for clearing the airway. Additionally, cough suppressants may cause side effects like sedation, which could make it harder to monitor the child's condition. It’s better to use non-medication interventions like humid air or cool mist to manage the cough.

D. Give child warm liquids to soothe the throat

While warm liquids may provide comfort for a sore throat, they are not effective in reducing the inflammation and swelling caused by croup. The cool, humid air is a more specific and effective intervention for managing croup symptoms and reducing airway swelling.

Summary:

For a child with a barky cough that worsens at night, the best advice is to take the child outside into cool, humid air for 15 minutes (A). This intervention can help reduce airway swelling and improve symptoms of croup. Going to the ED (B) is not necessary unless the child shows signs of severe distress, and cough suppressants (C) and warm liquids (D) do not address the underlying inflammation in the airway caused by croup.

The correct answer is C: glucagon (Glucagen)

Explanation for the correct answer:

C. glucagon (Glucagen)

Glucagon is the appropriate drug for treating severe hypoglycemia (low blood sugar) when a patient is unable to take oral glucose (e.g., unconscious or unresponsive). It works by stimulating the liver to release glucose into the bloodstream, which raises the blood sugar levels quickly. Glucagon is commonly administered subcutaneously or intramuscularly in emergency situations, typically by a caregiver or healthcare provider.

Why the other options are incorrect:

A. acarbose (Precose)

Acarbose is an alpha-glucosidase inhibitor used in the treatment of type 2 diabetes to delay the absorption of carbohydrates in the intestines, thus preventing postprandial blood sugar spikes. It does not treat hypoglycemia. In fact, acarbose can sometimes cause delayed hypoglycemia if combined with insulin or sulfonylureas, but it is not used to treat it.

B. propranolol (Inderal)

Propranolol is a beta-blocker used to treat conditions like hypertension, angina, and arrhythmias. It is not used to treat hypoglycemia and could mask symptoms of hypoglycemia, such as tremors, tachycardia, and anxiety, making it even harder for patients to recognize the low blood sugar early.

D. bumetanide (Bumex)

Bumetanide is a loop diuretic used to treat conditions like edema and hypertension. It is not related to treating hypoglycemia and is not used in the management of low blood sugar.

Summary:

Glucagon (Glucagen) is the correct treatment for severe hypoglycemia. It works by stimulating the release of glucose from the liver, rapidly raising blood sugar levels in an emergency. The other options listed do not address hypoglycemia and are used for different medical conditions.

The correct answer is D: encourage bananas, applesauce, and cracker

Explanation for the correct answer:

When a toddler has experienced dehydration due to diarrhea, reintroducing food gradually is important to prevent further gastrointestinal distress. The BRAT diet (bananas, rice, applesauce, and toast) is commonly recommended for children recovering from diarrhea because these foods are bland, low-fiber, and easy on the digestive system. They help firm up stools and provide essential nutrients without irritating the stomach. This is the most appropriate recommendation for a child recovering from dehydration and diarrhea.

Why the other options are wrong:

A. offer her flavored gelatin if she is hungry

While gelatin may provide some hydration, it is not an ideal choice for a toddler recovering from dehydration due to diarrhea. Flavored gelatin is high in sugar and lacks the necessary nutrients that a child needs to recover properly, especially following diarrhea.

B. make sure she gets lots of clear liquids

Clear liquids (such as water or broth) can help with hydration in the initial stages of diarrhea, but after dehydration has been treated, the focus should shift toward providing easily digestible foods that help restore electrolyte balance and nutrients. Relying solely on clear liquids is not enough for recovery in the long term.

C. give her plenty of fruit juice or soda

Fruit juice and soda can actually worsen diarrhea due to their high sugar content, which can irritate the digestive system and lead to further dehydration. These beverages are not recommended for toddlers with diarrhea, especially after dehydration has been treated.

Summary:

The best approach for a toddler recovering from dehydration due to diarrhea is to introduce bland, easy-to-digest foods, such as bananas, applesauce, and crackers (D), which can help restore nutrient balance without further upsetting the digestive system. The other options (A, B, C) are not appropriate because they either lack essential nutrients or can exacerbate gastrointestinal symptoms.

The correct answer is A: Maintain good oral hygiene.

Explanation for the correct answer:

A. Maintain good oral hygiene

Phenytoin (Dilantin) is known to cause gingival hyperplasia (enlargement of the gums), especially with long-term use. It is important for the client to maintain good oral hygiene, including regular brushing, flossing, and dental check-ups, to minimize the risk of gum overgrowth.

Why the other options are incorrect:

B. You can switch between brand name or generic for medications.

Switching between brand name and generic versions of phenytoin can cause fluctuations in blood levels. Phenytoin has a narrow therapeutic index, meaning that even small changes in blood levels can affect its effectiveness or increase the risk of side effects. It is important for the client to stick to either the brand name or generic version, as recommended by their healthcare provider.

C. This medication is safe to take during pregnancy.

Phenytoin is not considered safe during pregnancy. It is a teratogen and can cause harm to the developing fetus, such as fetal hydantoin syndrome. If the client is pregnant or planning to become pregnant, they should discuss alternative treatments with their healthcare provider.

D. Take this medication on an empty stomach.

Phenytoin can be taken with or without food. However, it is often recommended to take it with food to reduce the risk of gastrointestinal side effects such as nausea. The nurse should clarify with the client that they do not need to take it on an empty stomach unless instructed otherwise by their healthcare provider.

Summary:

For a client taking phenytoin (Dilantin), maintaining good oral hygiene is important to prevent gum enlargement (gingival hyperplasia). The nurse should also advise the client about the importance of consistency in the brand and generic forms, the risks during pregnancy, and the flexibility of taking the medication with or without food.

The correct answer is A: Serum potassium.

Explanation for the correct answer:

A. Serum potassium:

In clients with diabetes mellitus, particularly those experiencing polyuria, the body excretes more fluid, which leads to dehydration and the loss of electrolytes. Polyuria, a common symptom of uncontrolled diabetes, can cause the kidneys to excrete more potassium, leading to hypokalemia (low serum potassium). Therefore, it is crucial to monitor the serum potassium levels in clients with diabetes, especially when they have polyuria, to prevent complications such as arrhythmias or muscle weakness.

Why the other options are incorrect:

B. Serum magnesium:

While magnesium levels can be altered in diabetes, they are not as directly related to polyuria as potassium. Magnesium imbalances in diabetes are more often associated with chronic complications, but monitoring potassium is more urgent in the context of polyuria.

C. Serum calcium:

Calcium levels are not typically the most urgent concern in diabetes with polyuria. Hypercalcemia or hypocalcemia could occur with other conditions, but they are not directly linked to the polyuria seen in diabetes.

D. Serum chloride:

Chloride levels, like calcium and magnesium, can be affected by various factors, but serum potassium is much more critical to monitor in the context of polyuria in diabetes, as excessive loss of potassium can lead to significant complications.

Summary:

In a client with diabetes mellitus, type 2, and polyuria, serum potassium is the most important laboratory result to monitor due to the risk of hypokalemia from increased fluid loss. While other electrolytes like magnesium, calcium, and chloride can be monitored as needed, potassium is the primary concern because of its direct link to dehydration and polyuria in this context.

The correct answer is B: apply moisturizing lotion to dry feet but not between the toes.

Explanation for the correct answer:

B. apply moisturizing lotion to dry feet but not between the toes

People with diabetes mellitus (DM) are at increased risk for diabetic neuropathy and poor circulation, which can lead to dry skin and foot problems. Applying a moisturizing lotion to the feet (but not between the toes) is an important part of foot care because it prevents dryness and cracking of the skin, which can increase the risk of infection. However, it is essential to avoid applying lotion between the toes to prevent moisture accumulation, which can promote the growth of fungal infections (such as athlete's foot).

Why the other options are incorrect:

A. soak feet in hot water

Soaking feet, especially in hot water, is not recommended for individuals with diabetes. The loss of sensation from neuropathy means the person might not feel the temperature, risking burns or further skin damage. Additionally, prolonged soaking can lead to skin breakdown and increase the risk of infection.

C. always have podiatrist cut your toenails, never cut yourself

While it's important for individuals with diabetes to have their toenails cared for properly, the statement "always have a podiatrist cut your toenails" is not an absolute necessity. If a person with diabetes can properly cut their toenails, it can be done carefully at home using proper techniques. However, if they have difficulty due to poor vision or neuropathy, it is wise to have a podiatrist or healthcare professional trim the nails. The key is to avoid cutting toenails too short or at an angle, which could cause ingrown nails.

D. avoid using mild soap on the feet

This statement is incorrect. Mild soap is recommended for foot care because it helps cleanse the feet without causing irritation or drying out the skin. Harsh soaps can strip the skin of essential oils, increasing the risk of dryness and cracks.

Summary:

The best foot care instruction for a client with diabetes is to apply moisturizing lotion to dry feet, avoiding the area between the toes. This helps prevent skin damage while avoiding moisture buildup between the toes, which can lead to fungal infections.

The correct answer is D: The older a woman gets, the greater chance of developing breast cancer.

Explanation for the correct answer:

D. The older a woman gets, the greater chance of developing breast cancer.

As women age, the risk of developing breast cancer increases, especially after the age of 50. This is due to factors such as longer exposure to estrogen and the accumulation of genetic mutations over time. Age is one of the most significant risk factors for breast cancer, with most cases being diagnosed in women aged 50 and older. This makes it a key focus when educating senior women on the importance of breast health and regular screenings.

Why the other options are wrong:

A. Clients should find out about their family history of breast cancer.

While family history is an important risk factor, this is more relevant for younger women or those with a strong family history of breast cancer. However, even without a family history, the risk of breast cancer increases with age, so while this is useful information, age-related risk is the most important factor to emphasize to senior women.

B. Men at this age can get breast cancer also and should be screened.

While breast cancer in men is possible, it is rare. The risk of breast cancer in men is much lower than in women, and this is not the most important concern for a class of senior women. The focus should be on the risks specific to women, especially those related to age.

C. Monthly breast self-exams is the key to early detection.

Breast self-exams (BSE) have been de-emphasized in recent years, as research has shown they do not significantly reduce mortality from breast cancer. Regular mammograms and clinical breast exams are more effective for early detection. Emphasizing self-exams over other methods could be misleading.

Summary:

The most important risk factor for breast cancer in older women is age. As women age, especially after 50, the risk of developing breast cancer increases. While other factors, such as family history and self-exams, are important, age-related risk should be the primary focus in education for senior women. Regular screenings, such as mammograms, are essential for early detection and improved outcomes.

The correct answer is A: Your pancreas is not secreting enough insulin to help regulate your blood sugar level.

Explanation for the correct answer:

Diabetes mellitus, particularly type 1 diabetes or type 2 diabetes, is primarily characterized by problems with insulin production and/or utilization. In the case of type 1 diabetes, the pancreas does not produce enough insulin, which is a hormone that helps regulate blood sugar levels. In type 2 diabetes, the pancreas may produce insulin, but the body's cells do not respond effectively to it, leading to high blood sugar levels. This is why the correct response focuses on insulin secretion and its role in blood sugar regulation.

Why the other options are wrong:

B) Your pancreas is not breaking down glycogen that leads to increased blood sugar level.

This is incorrect because the pancreas does not break down glycogen. Glycogen is stored in the liver and muscles, and it is broken down into glucose when needed, mainly through the action of glucagon (produced by the pancreas). The issue in diabetes is more related to the pancreas' insulin production or the body's ability to respond to insulin, not its inability to break down glycogen.

C) Your liver is secreting too much glucagon and that leads to increased blood sugar level.

This is a partially correct statement, but it’s not the main issue in diabetes. The liver does indeed secrete glucagon, which triggers the release of glucose from glycogen stores, but the primary issue in diabetes is the insulin deficiency or insulin resistance, which prevents proper blood sugar regulation. While an imbalance in glucagon secretion can occur, it is not the primary cause of the high blood sugar seen in diabetes.

D) Your liver is absorbing too much insulin that is why it cannot be used by the blood.

This is incorrect because the liver does not absorb insulin. Insulin is a hormone that works throughout the body to allow glucose to enter cells, particularly muscle and fat cells, to be used for energy. In type 2 diabetes, there is often insulin resistance, where cells do not respond properly to insulin. The liver plays a role in glucose production, but the problem in diabetes is not related to the liver absorbing insulin.

Summary:

The most accurate explanation for why a person might have diabetes, despite not eating a lot of sugar, is that the pancreas is not secreting enough insulin or the body's cells are not using insulin properly. This results in high blood sugar levels because insulin is required to regulate glucose in the bloodstream

The correct answer is C: serum BG level is 118

Explanation for the correct answer:

The combination of glyburide and metformin is commonly used to manage type 2 diabetes. Glyburide is a sulfonylurea that increases insulin production, while metformin works by improving insulin sensitivity and decreasing hepatic glucose production. The goal of treatment is to maintain blood glucose levels within a normal range.

A serum blood glucose (BG) level of 118 mg/dL is within the normal fasting range, which is typically between 70-130 mg/dL for individuals with diabetes. Therefore, this suggests that the medications are effectively controlling the client's blood glucose level.

Why the other options are wrong:

A. Skin turgor is elastic

While good skin turgor is a sign of hydration, it does not specifically indicate the effectiveness of diabetes medications. Proper hydration is important, but this does not provide direct information about blood glucose control.

B. Urine ketones are negative

The absence of ketones in the urine is generally a positive sign, as the presence of ketones can indicate uncontrolled diabetes, especially in type 1 diabetes. However, in type 2 diabetes, this does not directly reflect the effectiveness of oral hypoglycemic therapy. The primary indicator of medication effectiveness is blood glucose control, not ketones.

D. Glucometer reads BG of 170

A blood glucose level of 170 mg/dL is higher than the recommended target range for most clients with diabetes. Generally, the target range for postprandial (after meals) blood glucose is less than 180 mg/dL. A level of 170 mg/dL suggests that the blood glucose is not well controlled, indicating that the combination medication may not be effective at this time.

Summary:

The serum BG level of 118 mg/dL (C) suggests that the glyburide/metformin combination is effectively managing the client's blood glucose levels. The other options either focus on hydration or higher glucose levels, which do not directly indicate medication effectiveness in controlling blood sugar.