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The client diagnosed with type 1 diabetes is receiving Humalog, a rapid-acting insulin, by sliding scale. The order reads blood glucose level: <150, zero (0) units; 151 to 200, three (3) units; 201 to 250, six (6) units; >251, contact health-care provider. The unlicensed assistive personnel (UAP) reports to the nurse the client's glucometer reading is 189. How much insulin should the nurse administer to the client?
Correct Answer: 3 units
Rationale: Per the sliding scale, a glucose of 189 (151–200 range) requires 3 units of Humalog.
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The clinic nurse is evaluating the client with type 1 DM who intends to enroll in a tennis class. Which statement made by the client indicates that the client understands the effects of exercise on insulin demand?
- A. I will carry a high-fat, high-calorie food, such as a cookie.'
- B. I will administer 1 unit of lispro insulin prior to playing tennis.'
- C. I will eat a 15-gram carbohydrate snack before playing tennis.'
- D. I will need to rest for a while during tennis if I feel sweaty or shaky.'
Correct Answer: C
Rationale: Excessive exercise without sufficient carbohydrates can result in unexpected hypoglycemia.
The client diagnosed with acute pancreatitis has a ruptured pseudocyst. Which procedure should the nurse anticipate the HCP prescribing?
- A. Paracentesis.
- B. Chest tube insertion.
- C. Lumbar puncture.
- D. Biopsy of the pancreas.
Correct Answer: A
Rationale: A ruptured pancreatic pseudocyst can cause peritoneal irritation or fluid accumulation, potentially requiring drainage. Paracentesis removes abdominal fluid, which may be performed in severe cases, though surgical drainage or endoscopic intervention is more specific. Chest tube insertion is for pleural issues, lumbar puncture is for cerebrospinal fluid, and pancreatic biopsy is diagnostic, not therapeutic for a ruptured pseudocyst.
Which laboratory data make the nurse suspect the client with primary hyperparathyroidism is experiencing a complication?
- A. A serum creatinine level of 2.8 mg/dL.
- B. A calcium level of 9.2 mg/dL.
- C. A serum triglyceride level of 130 mg/dL.
- D. A sodium level of 135 mEq/L.
Correct Answer: A
Rationale: Elevated creatinine (2.8 mg/dL) suggests kidney damage, a complication of hyperparathyroidism’s hypercalcemia. Normal calcium, triglycerides, and sodium are unremarkable.
An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor's office one week later. Which statement that the client makes is most indicative of an adverse reaction to the medication?
- A. My chest hurt when I was sweeping the floor this morning.'
- B. I had severe cramps last night.'
- C. I am losing weight.'
- D. My pulse rate has been more rapid lately.'
Correct Answer: A
Rationale: Chest pain during activity suggests angina, a potential adverse effect of thyroid replacement therapy due to increased metabolic demand.
When directing the nursing assistant to weigh the client, which instruction is most important for obtaining accurate data?
- A. Have the client stand on a bedside scale.
- B. Weigh the client at the same time each day.
- C. Ask that slippers be removed when being weighed.
- D. Ask about the client's pre-disease weight.
Correct Answer: B
Rationale: Weighing the client at the same time each day ensures consistency and accounts for daily fluctuations in weight due to meals, hydration, or other factors.