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A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately?
- A. Serum chloride level of 98 mmol/L.
- B. Serum calcium level of 8.8 mg/dL.
- C. Serum sodium level of 132 mmol/L.
- D. Serum potassium level of 2.5 mmol/L.
Correct Answer: D
Rationale: Insulin promotes potassium movement into cells, risking hypokalemia (2.5 mmol/L is low). This requires immediate intervention to prevent complications like arrhythmias. The other values are near normal and not directly related to insulin therapy.
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A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, 'Can I ask my niece to prefill my syringes and then store them for later use when I need them?' How should the nurse respond?
- A. Yes, prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.
- B. Yes, syringes can be filled with insulin and stored for a month in a location that is protected from light.
- C. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes.
- D. No, insulin syringes cannot be prefilled and stored for any length of time outside of the container.
Correct Answer: A
Rationale: Insulin in prefilled plastic syringes is stable for up to 3 weeks when refrigerated, stored vertically with the needle up to prevent clogging. The other options are incorrect regarding storage duration, material, or stability.
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?
- A. Document the finding in the client's chart.
- B. Assess tactile sensation in the client's hands.
- C. Examine the client's feet for signs of injury.
- D. Notify the health care provider.
Correct Answer: C
Rationale: Diabetic neuropathy is common in long-standing diabetes, increasing the risk of injury in areas with decreased sensation, such as the feet. Examining the feet for signs of injury is the priority to prevent complications like infections or ulcers. Documentation, assessing hand sensation, and notifying the provider should follow after the initial assessment.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has a capillary blood glucose of 33 mg/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
- A. Administer 1 mg of intramuscular glucagon.
- B. Encourage the client to drink orange juice.
- C. Insert a new intravenous access line.
- D. Administer 25 mL dextrose 50% (D50) IV push.
Correct Answer: A
Rationale: The client's severe hypoglycemia (blood glucose 33 mg/dL) and unresponsiveness require immediate treatment. Intramuscular glucagon is the priority since the IV line is infiltrated, and oral intake is not feasible. Inserting a new IV or administering D50 IV can follow once access is restored.
A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next?
- A. Administer another half-cup of orange juice.
- B. Administer a half-ampule of dextrose 50%.
- C. Administer 10 units of regular insulin subcutaneously.
- D. Administer 1 mg of glucagon intramuscularly.
Correct Answer: A
Rationale: The client has mild hypoglycemia, and since the initial orange juice did not resolve symptoms, repeating the oral glucose treatment is appropriate. Intravenous dextrose, insulin, or glucagon are not indicated for mild, unresolved symptoms in an alert client.
After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
- A. I have so many complications, exercising is not recommended.
- B. I will exercise more frequently because I have so many complications.
- C. I used to run for exercise; I will start training for a marathon.
- D. I should look into swimming or water aerobics to get my exercise.
Correct Answer: D
Rationale: Swimming or water aerobics is a suitable exercise for clients with diabetic complications, as it minimizes foot injury risk. Vigorous exercise like marathon running or avoiding exercise altogether is not recommended.