Nokea
The client ate 45 g of carbohydrate (carb) with the dinner meal. The client is to receive 2 units of aspart insulin subcutaneously for each carb choice (CHO) eaten (1 carb choice = 15 g). Which syringe shows the correct amount of insulin that the nurse should administer?
- A. Illustration 1: 16 units
- B. Illustration 2: 29 units
- C. Illustration 3: 1 unit
- D. Illustration 4: 6 units
Correct Answer: D
Rationale: The client should receive 6 units of insulin. Eating 45 g of carbohydrates equals 3 CHOs. If the client is to receive 2 units of insulin for each CHO, the total amount of aspart insulin is 3 CHO times 2 units per CHO = 6 units.
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The nurse is preparing to administer the following medications. Which medication should the nurse question administering?
- A. The thyroid hormone to the client who does not have a T3, T4 level.
- B. The regular insulin to the client with a blood glucose level of 210 mg/dL.
- C. The loop diuretic to the client with a potassium level of 3.3 mEq/L.
- D. The cardiac glycoside to the client who has a digoxin level of 1.4 mg/dL.
Correct Answer: A
Rationale: Administering thyroid hormone without T3/T4 levels risks overtreatment, as levels confirm hypothyroidism. Insulin, diuretics, and digoxin are appropriate based on data.
Which laboratory test is most important for the nurse to monitor to determine how effectively the client's diabetes is being managed?
- A. Fasting blood glucose
- B. Blood chemistry profile
- C. Complete blood count
- D. Glycosylated hemoglobin (HbA1c)
Correct Answer: D
Rationale: HbA1c reflects average blood glucose control over 2-3 months, indicating long-term diabetes management.
Which sign/symptom indicates to the nurse the client is experiencing hypoparathyroidism?
- A. A negative Trousseau's sign.
- B. A positive Chvostek's sign.
- C. Nocturnal muscle cramps.
- D. Tented skin turgor.
Correct Answer: B
Rationale: A positive Chvostek’s sign (facial twitching) indicates hypocalcemia from hypoparathyroidism. Negative Trousseau’s, cramps, and turgor are less specific.
The client diagnosed with type 1 diabetes mellitus received regular insulin two (2) hours ago. The client is complaining of being jittery and nervous. Which interventions should the nurse implement? List in order of priority.
- A. Call the laboratory to confirm blood glucose level.
- B. Administer a quick-acting carbohydrate.
- C. Have the client eat a bologna sandwich.
- D. Check the client’s blood glucose level at the bedside.
- E. Determine if the client has had anything to eat.
Correct Answer: D,B,E,C,A
Rationale: 1. Check blood glucose at bedside: Jitteriness and nervousness suggest hypoglycemia, common 2 hours post-regular insulin (peak effect). Bedside glucose testing confirms hypoglycemia quickly, guiding treatment. 2. Administer quick-acting carbohydrate: If glucose is low (<70 mg/dL), a quick-acting carbohydrate (e.g., juice) rapidly corrects hypoglycemia. 3. Determine if the client has had anything to eat: Assessing recent food intake identifies if inadequate nutrition contributed to hypoglycemia, informing prevention. 4. Have the client eat a bologna sandwich: After stabilizing glucose, a complex meal sustains normoglycemia, but it’s slower-acting. 5. Call the laboratory: Lab confirmation is unnecessary and delays treatment, as bedside glucometry is standard.
The client is diagnosed with cancer of the head of the pancreas. Which signs and symptoms should the nurse expect to assess?
- A. Clay-colored stools and dark urine.
- B. Night sweats and fever.
- C. Left lower abdominal cramps and tenesmus.
- D. Nausea and coffee-ground emesis.
Correct Answer: A
Rationale: Cancer in the head of the pancreas obstructs the bile duct, causing clay-colored stools and dark urine from jaundice. Night sweats, cramps, and coffee-ground emesis are less specific.