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A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take?
- A. Document the finding in the client's chart.
- B. Administer a bolus of regular insulin IV.
- C. Call the surgeon to cancel the procedure.
- D. Draw blood gases to assess the metabolic state.
Correct Answer: A
Rationale: A blood glucose of 160 mg/dL is within the acceptable range (140"?180 mg/dL) for perioperative management in type 1 diabetes, supporting better outcomes. The nurse should document the finding and proceed. Insulin, cancellation, or blood gases are not indicated.
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A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take?
- A. Assess for pain or burning with urination.
- B. Review the client's liver function study results.
- C. Instruct the client to increase water intake.
- D. Test a sample of urine for occult blood.
Correct Answer: B
Rationale: Thiazolidinediones like pioglitazone can affect liver function. Dark urine may indicate liver impairment due to increased bilirubin. Reviewing liver function studies is the priority. Assessing for urinary symptoms, increasing water intake, or testing for occult blood are not directly related to this issue.
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury?
- A. Examine your feet using a mirror every day.
- B. Rotate your insulin injection sites every week.
- C. Check your blood glucose level before each meal.
- D. Use a bath thermometer to test the water temperature.
Correct Answer: D
Rationale: Clients with reduced sensation are at risk for burns from hot bathwater. Using a thermometer to check water temperature prevents injury. Daily foot checks, site rotation, and glucose monitoring are important but do not directly prevent burns.
A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: Insulin glargine: 12 units daily at 1800, Regular insulin: 6 units QID at 0600, 1200, 1800, 2400. Based on the client's medication administration record, which action should the nurse take?
- A. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
- B. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin.
- C. Draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together.
- D. Inject first the glargine and then the regular insulin right afterward.
Correct Answer: A
Rationale: Insulin glargine cannot be mixed with other insulins. Administering glargine first, followed by regular insulin as separate injections, is correct to avoid mixing and ensure proper action.
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.
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.