Nokea
The client with type 1 diabetes mellitus is taught to take NPH insulin at 5 p.m. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
- A. 11 a.m., shortly before lunch.
- B. 1 p.m., shortly after lunch.
- C. 6 p.m., shortly after dinner.
- D. 1 a.m., while sleeping.
Correct Answer: D
Rationale: NPH insulin peaks 4–12 hours after administration (around 9 p.m. to 5 a.m.), with the greatest hypoglycemia risk overnight, such as at 1 a.m.
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Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
- A. Encourage the client to ambulate every 2 to 4 hours.
- B. Offer 3 to 4 oz of a carbonated beverage periodically.
- C. Encourage use of a stool softener.
- D. Continue I.V. fluid therapy.
Correct Answer: A
Rationale: Ambulation stimulates bowel motility, reducing the risk of paralytic ileus post-renal surgery by promoting gastrointestinal function.
A 56-year-old female who is receiving radiation therapy tells the nurse that she feels inadequate as a wife and mother because she can no longer carry out her usual duties with the same energy as before. What recommendations should the nurse make to help the client cope with this situation?
- A. Suggest that she reassign all household chores to other members of the family.
- B. Suggest that she prioritize her activities and ask for help from friends and family.
- C. Suggest that she ignore the household chores during the crisis period.
- D. Tell her not to worry so much because everyone gets a little tired at this phase of the therapy.
Correct Answer: B
Rationale: Prioritizing activities and seeking help from friends and family helps the client manage her energy and responsibilities, reducing feelings of inadequacy.
A client with a hemorrhagic stroke is slightly agitated, heart rate is 118, respirations are 22, bilateral rhonchi are auscultated, SpO2 is 94%, blood pressure is 144/88, and oral secretions are noted. What order of interventions should the nurse follow when suctioning the client to prevent increased intracranial pressure (ICP) and maintain adequate cerebral perfusion?
- A. Suction the airway.
- B. Hyperoxygenate.
- C. Suction the mouth.
- D. Provide sedation.
Correct Answer: B,D,A,C
Rationale: The correct order is: 1) Hyperoxygenate to prevent hypoxia (B); 2) Provide sedation to reduce agitation and ICP spikes (D); 3) Suction the airway to clear secretions (A); 4) Suction the mouth to remove residual secretions (C). This sequence minimizes ICP increases and ensures oxygenation.
The nurse should teach the client that signs of digoxin toxicity include which of the following?
- A. Rash over the chest and back.
- B. Increased appetite.
- C. Visual disturbances such as seeing yellow spots.
- D. Elevated blood pressure.
Correct Answer: C
Rationale: Visual disturbances, like seeing yellow spots (xanthopsia), are a hallmark of digoxin toxicity, requiring prompt reporting.
A client has mitral stenosis and is a prospective valve recipient. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which of the following regimens would pose the greatest health hazard to this client at this time?
- A. Medication therapy.
- B. Diet modification.
- C. Activity restrictions.
- D. Dental care.
Correct Answer: A
Rationale: Medication therapy (e.g., anticoagulants, diuretics) is critical to manage symptoms and prevent complications like thromboembolism in mitral stenosis.