Nokea
The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
- A. 11 AM, shortly before lunch.
- B. 1 PM, shortly after lunch.
- C. 6 PM, shortly after dinner.
- D. 1 AM, while sleeping.
Correct Answer: D
Rationale: The correct answer is D, 1 AM, while sleeping. Isophane insulin suspension NPH (Humulin N) peaks around 6-8 hours after administration, which increases the risk of hypoglycemia during the night. Choice A, 11 AM, shortly before lunch, is incorrect because the peak effect of NPH insulin occurs much later. Choice B, 1 PM, shortly after lunch, is incorrect as it is too early for the peak effect of NPH insulin. Choice C, 6 PM, shortly after dinner, is also incorrect because the peak risk of hypoglycemia with NPH insulin occurs later in the night.
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A client with a history of peptic ulcer disease (PUD) is admitted after vomiting bright red blood several times over the course of 2 hours. In reviewing the laboratory results, the nurse finds the client's hemoglobin is 12 g/dL (120g/L) and the hematocrit is 35% (0.35). Which action should the nurse prepare to take?
- A. Continue monitoring for blood loss
- B. Administer 1,000 mL (1L) of normal saline
- C. Transfuse 2 units of platelets
- D. Prepare the client for emergency surgery
Correct Answer: D
Rationale: The correct answer is to prepare the client for emergency surgery. The client's presentation with bright red blood in vomitus suggests active bleeding, which is a medical emergency. With a hemoglobin of 12 g/dL and a hematocrit of 35%, the client is likely experiencing significant blood loss that may require surgical intervention to address the source of bleeding. Continuing to monitor for blood loss (Choice A) is not appropriate in this acute situation where immediate action is necessary. Administering normal saline (Choice B) may help with fluid resuscitation but does not address the underlying cause of bleeding. Transfusing platelets (Choice C) is not indicated in this scenario as platelets are involved in clot formation and are not the primary treatment for active bleeding in this context.
In a patient with chronic kidney disease, which of the following lab values would be expected?
- A. Elevated creatinine levels.
- B. Low hemoglobin levels.
- C. Elevated potassium levels.
- D. Low sodium levels.
Correct Answer: A
Rationale: In chronic kidney disease, elevated creatinine levels are expected due to impaired kidney function. Creatinine is a waste product that is typically filtered out by the kidneys. With kidney disease, the clearance of creatinine is reduced, leading to its accumulation in the blood. Low hemoglobin levels (choice B) may be seen in chronic kidney disease due to decreased production of erythropoietin. However, elevated potassium levels (choice C) and low sodium levels (choice D) are more commonly associated with kidney dysfunction but are not as specific indicators of chronic kidney disease as elevated creatinine levels.
The healthcare provider assesses a client with cirrhosis and finds 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema and ascites in clients with cirrhosis?
- A. Hyperaldosteronism causing increased sodium transport ion in renal tubules
- B. Decreased portacaval pressure with greater collateral circulation
- C. Decreased renin-angiotensin response related to increased renal blood flow
- D. Hypoalbuminemia that results in decreased colloidal oncotic pressure
Correct Answer: D
Rationale: In clients with cirrhosis, hypoalbuminemia leads to decreased colloidal oncotic pressure. This reduction in oncotic pressure contributes to the development of edema in the feet and legs (pitting edema) and ascites in the abdomen. Hyperaldosteronism (choice A) would lead to sodium retention but is not the primary mechanism behind edema and ascites in cirrhosis. Decreased portacaval pressure with greater collateral circulation (choice B) is not directly related to the pathophysiology of edema and ascites in cirrhosis. Decreased renin-angiotensin response related to increased renal blood flow (choice C) does not play a significant role in the development of edema and ascites in cirrhosis compared to the impact of hypoalbuminemia on colloidal oncotic pressure.
In a patient with chronic kidney disease, which of the following is a common complication?
- A. Hyperkalemia.
- B. Hypernatremia.
- C. Hypocalcemia.
- D. Hyperphosphatemia.
Correct Answer: A
Rationale: Hyperkalemia is a common complication in chronic kidney disease due to the kidneys' reduced ability to excrete potassium. As kidney function declines, potassium levels may increase, leading to hyperkalemia. Hypernatremia (increased sodium levels), hypocalcemia (low calcium levels), and hyperphosphatemia (elevated phosphate levels) are not typically associated with chronic kidney disease. Therefore, the correct answer is hyperkalemia.
The nurse is caring for a client who is postoperative for a femoral head fracture repair. Which intervention(s) should the nurse plan to administer for deep vein thrombosis prophylaxis?
- A. Pneumatic compression devices
- B. Incentive spirometry
- C. Assisted ambulation
- D. Calf-pump exercises
Correct Answer: A
Rationale: The correct intervention for deep vein thrombosis prophylaxis in a postoperative client with a femoral head fracture repair is the use of pneumatic compression devices. These devices help prevent stasis in the lower extremities by promoting venous return through intermittent compression. Incentive spirometry is used to prevent respiratory complications by promoting lung expansion and clearing secretions, not for DVT prophylaxis. Assisted ambulation and calf-pump exercises are beneficial for promoting circulation and preventing DVT, but pneumatic compression devices are more effective in this specific postoperative scenario.