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How soon after administering the client's dose of regular insulin subcutaneously should the nurse assess for signs of hypoglycemia?
- A. 5 minutes later
- B. 30 minutes later
- C. 6 hours later
- D. 10 hours later
Correct Answer: B
Rationale: Regular insulin peaks around 2-4 hours, but early hypoglycemia can occur within 30 minutes, requiring assessment.
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The concepts of nutrition and metabolism have been identified for the client. Which referral should the nurse include in the plan of care?
- A. Physical therapy.
- B. Social work.
- C. Speech therapy.
- D. Dietary.
Correct Answer: D
Rationale: A dietary referral addresses nutrition and metabolism, optimizing dietary management for conditions like diabetes. Other referrals are unrelated.
The client is a 62-year-old woman who is 30 pounds overweight. She comes to the doctor's office complaining of headaches, frequent hunger, excessive thirst, and urination. The presenting complaints suggest that the nurse should assess for other signs of which condition?
- A. Hypothyroidism
- B. Acute pyelonephritis
- C. Addison's disease
- D. Diabetes mellitus
Correct Answer: D
Rationale: Headaches, polyphagia, polydipsia, and polyuria are classic symptoms of diabetes mellitus, especially in an overweight individual.
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement?
- A. Ensure the client eats the bedtime snack.
- B. Determine how much food the client ate at lunch.
- C. Perform a glucometer reading at 0700.
- D. Offer the client protein after administering insulin.
Correct Answer: A
Rationale: Humulin N peaks in 4–12 hours, risking nocturnal hypoglycemia. A bedtime snack prevents this. Lunch intake is irrelevant, morning glucose checks are too late, and protein alone is insufficient.
The client with type 1 DM is scheduled for major surgery in the morning. The nurse on the night shift observes that the client's daily insulin dose remains the same as previously given. Which nursing action is most appropriate?
- A. Notify the prescribing HCP about the client's surgery and ask about any insulin changes.
- B. Write an order to decrease the morning insulin dose by one-half of the prescribed dose.
- C. Do nothing; the HCP would want the client to receive the usual insulin dose prior to surgery.
- D. Have the day shift nurse check a morning glucose level and, if normal, hold the insulin dose.
Correct Answer: A
Rationale: Because the client will be NPO for surgery, the nurse should verify the insulin type and dose to be administered to prevent a hypoglycemic reaction.
Which diet does the nurse expect will be ordered for the client with hypothyroidism?
- A. High protein, high calorie
- B. Restricted fluids, low protein
- C. High roughage, low calorie
- D. High carbohydrate, low roughage
Correct Answer: C
Rationale: A high-roughage, low-calorie diet supports weight loss and relieves constipation in hypothyroidism.