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A client with diabetes has a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that should be prepared in the insulin syringe?
- A. 42 units
- B. 14 units
- C. 28 units
- D. 32 units
Correct Answer: A
Rationale: The correct answer is A: 42 units. To calculate the total number of units of insulin to be prepared in the syringe, you need to add the units of regular insulin (14 units) and NPH insulin (28 units). Therefore, 14 units + 28 units = 42 units. This is the total amount of insulin that should be drawn up and administered subcutaneously.
Summary of other choices:
B: 14 units - This is only the amount of regular insulin and doesn't include the NPH insulin.
C: 28 units - This is only the amount of NPH insulin and doesn't include the regular insulin.
D: 32 units - This is the sum of 14 units of regular insulin and 18 units of NPH insulin, which is incorrect as the NPH insulin prescribed is 28 units, not 18 units.
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A 45-year-old woman presents with fatigue, weight gain, and constipation. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: A
Rationale: The most likely diagnosis is A: Hypothyroidism. High TSH and low free T4 levels indicate primary hypothyroidism. Elevated TSH is a compensatory response by the pituitary gland to stimulate the thyroid to produce more thyroid hormones, but the thyroid gland is unable to do so effectively, resulting in low free T4 levels. Fatigue, weight gain, and constipation are classic symptoms of hypothyroidism.
- B: Hyperthyroidism is characterized by low TSH and high free T4 levels, opposite of the lab results presented.
- C: Thyroiditis may initially present with high or low thyroid hormone levels, but the combination of high TSH and low free T4 levels is more indicative of hypothyroidism.
- D: Thyroid cancer typically does not cause abnormal thyroid hormone levels; it is more commonly associated with thyroid nodules or masses.
A 28-year-old woman presents with abdominal pain, bloating, and diarrhea. She notes that her symptoms improve with fasting. She has a history of iron deficiency anemia. What is the most likely diagnosis?
- A. Irritable bowel syndrome
- B. Celiac disease
- C. Lactose intolerance
- D. Crohn's disease
Correct Answer: B
Rationale: The most likely diagnosis is Celiac disease (Choice B) due to the patient's symptoms of abdominal pain, bloating, diarrhea, and improvement with fasting, which are consistent with malabsorption seen in Celiac disease. The history of iron deficiency anemia also supports this, as it is a common complication of Celiac disease due to impaired absorption of nutrients. Irritable bowel syndrome (Choice A) typically does not improve with fasting, lactose intolerance (Choice C) does not usually cause iron deficiency anemia, and Crohn's disease (Choice D) typically presents with more severe symptoms and different patterns of improvement.
After a client's neck dissection surgery resulted in damage to the superior laryngeal nerve, what area of assessment should the nurse prioritize?
- A. The client's swallowing ability
- B. The client's ability to speak
- C. The client's management of secretions
- D. The client's airway patency
Correct Answer: A
Rationale: The correct answer is A: The client's swallowing ability. Damage to the superior laryngeal nerve can lead to swallowing difficulties, as it innervates the muscles involved in swallowing. Prioritizing assessment of swallowing ability is crucial to prevent aspiration and ensure adequate nutrition intake.
Incorrect choices:
B: The client's ability to speak - Damage to the superior laryngeal nerve mainly affects swallowing, not speech.
C: The client's management of secretions - While important, it is secondary to swallowing assessment in this context.
D: The client's airway patency - Although important, focusing on swallowing ability is more directly related to the nerve damage.
When planning care for a 16-year-old with appendicitis presenting with right lower quadrant pain, what should the nurse prioritize as a nursing diagnosis?
- A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
- B. Risk for infection related to possible rupture of the appendix
- C. Constipation related to decreased bowel motility and decreased fluid intake
- D. Chronic pain related to appendicitis
Correct Answer: B
Rationale: The correct answer is B: Risk for infection related to possible rupture of the appendix. This is the priority nursing diagnosis because appendicitis can lead to a life-threatening condition if the appendix ruptures. The nurse needs to monitor for signs of worsening infection such as fever and increased pain.
A: Imbalanced nutrition is not the priority as it is secondary to the risk of infection.
C: Constipation is not the priority as it is not directly related to the life-threatening complication of appendicitis.
D: Chronic pain is also not the priority as the risk of infection and potential rupture take precedence in the care of the patient.
A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?
- A. I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.
- B. It's hard to believe that there are actually medications that can treat obesity.
- C. I'm a bit nervous to start this medication because I know I'll need blood tests sometimes.
- D. I'm going to have to do some rearranging of my finances to make sure I can afford this medication.
Correct Answer: A
Rationale: The correct answer is A because the client's statement indicates a lack of understanding about the comprehensive approach needed to address obesity. Phentermine/topiramate-ER is not a standalone solution; it is most effective when used in conjunction with lifestyle changes like exercise and dietary modifications. By expressing a dislike for exercise and dietary changes, the client demonstrates a reliance solely on the medication, which is not conducive to long-term weight management. This suggests a need for further education on the importance of holistic lifestyle modifications in conjunction with medication therapy.
Choice B is incorrect because the client expressing disbelief at medications for obesity is not necessarily indicative of a need for further education; it may simply reflect surprise or lack of awareness. Choice C is incorrect as the client's nervousness about blood tests is a common concern and does not necessarily indicate a need for more education. Choice D is also incorrect as financial concerns are valid but do not directly relate to the need for additional health education.