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A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take?
- A. Apply ice to the site to reduce inflammation.
- B. Consult the provider for a new administration route.
- C. Assess the client for other signs of cellulitis.
- D. Instruct the client to rotate sites for insulin injection.
Correct Answer: D
Rationale: The spongy, swollen area suggests lipohypertrophy from repeated injections at the same site. Rotating injection sites prevents this complication. Ice, a new route, or assessing for cellulitis are not appropriate for lipohypertrophy.
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A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education?
- A. Test your urine daily for ketones.
- B. Use only buffered insulin in your pump.
- C. Store the insulin in the freezer until you need it.
- D. Change the needle every 3 days.
Correct Answer: D
Rationale: Changing the needle every 3 days reduces infection risk with insulin pumps. Testing urine for ketones, using buffered insulin, or freezing insulin are not recommended practices.
A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?
- A. Serum potassium level has increased.
- B. Blood osmolarity has decreased.
- C. Glasgow Coma Scale score is unchanged.
- D. Urine remains negative for ketone bodies.
Correct Answer: C
Rationale: An unchanged Glasgow Coma Scale score indicates no improvement in consciousness, suggesting inadequate fluid replacement in HHS. Increased potassium, decreased osmolarity, and negative ketones are expected or not indicative of treatment failure.
A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching?
- A. When ill, avoid eating or drinking to reduce vomiting and diarrhea.
- B. Monitor your blood glucose levels at least every 4 hours while sick.
- C. If vomiting, do not use insulin or take your oral antidiabetic agent.
- D. Continue your prescribed exercise regimen even if you are sick.
Correct Answer: B
Rationale: Monitoring blood glucose every 4 hours during illness helps manage fluctuations. Continuing medications, eating as tolerated, and avoiding exercise during illness are also recommended, making the other options incorrect.
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, 'I will never be able to stick myself with a needle.' How should the nurse respond?
- A. I can give your injections to you while you are here in the hospital.
- B. Everyone gets used to giving themselves injections. It really does not hurt.
- C. Your disease will not be managed properly if you refuse to administer the shots.
- D. Tell me what it is about the injections that are concerning you.
Correct Answer: D
Rationale: Exploring the client's concerns about injections promotes understanding and tailored education, supporting self-care. Offering to give injections, minimizing concerns, or warning about poor management are less effective.
A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, 'I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing.' How should the nurse respond?
- A. Following-Drug regimen more closely would have prevented this.
- B. One acute rejection episode does not mean that you will lose the new organs.
- C. Dialysis is a viable treatment option for you and may save your life.
- D. Since you are on the national registry, you can receive a second transplantation.
Correct Answer: B
Rationale: An acute rejection episode does not necessarily lead to organ loss, as immunosuppressive therapy can often manage it. Blaming the client, emphasizing dialysis, or discussing retransplantation is not supportive or accurate in this context.