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The nurse administers a usual morning dose of 4 units of regular insulin and 8 units of NPH insulin at 7:30 am to the client with a blood glucose level of 110 mg/dL. Which statements regarding the client's insulin are correct?
- A. The onset of the regular insulin will be at 7:45 am and the peak at 1:00 pm.
- B. The onset of the regular insulin will be at 8:00 am and the peak at 10:00 am.
- C. The onset of the NPH insulin will be at 8:00 am and the peak at 10:00 am.
- D. The onset of the NPH insulin will be at 12:30 pm and the peak at 11:30 pm.
Correct Answer: B
Rationale: The onset of regular insulin (short acting) is one-half to 1 hour, and the peak is 2 to 3 hours. The onset of NPH insulin (intermediate acting) is 2 to 4 hours, and the peak is 4 to 12 hours.
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The nurse is reviewing information for the client with type 1 DM. The nurse concludes that the client may be experiencing the Somogyi phenomenon, as evidenced by which finding?
- A. 02:00 blood glucose between 80-110 mg/dL and morning levels between 80-100 mg/dL
- B. 02:00 blood glucose between 50-60 mg/dL and morning levels between 48-62 mg/dL
- C. 02:00 blood glucose between 130-140 mg/dL and morning levels between 180-200 mg/dL
- D. 02:00 blood glucose between 45-62 mg/dL and morning levels between 200-305 mg/dL
Correct Answer: D
Rationale: The nurse should conclude that the low blood glucose in the middle of the night (45-62 mg/dL) and a rebound morning hyperglycemia (200-305 mg/dL) are signs of Somogyi phenomenon, also known as Somogyi effect.
The nurse is reviewing the serum laboratory report for the hospitalized client who has adrenocortical insufficiency. The nurse should immediately notify the HCP about which value?
- A. WBC 11,000/mm3
- B. Glucose 138 mg/dL
- C. Sodium 148 mEq/L
- D. Potassium 6.2 mEq/L
Correct Answer: D
Rationale: The serum potassium of 6.2 mEq/L indicates hyperkalemia, which can cause dysrhythmias and requires immediate notification.
The nurse identifies the client problem 'risk for imbalanced body temperature' for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care?
- A. Discourage the use of an electric blanket.
- B. Assess the client's temperature every two (2) hours.
- C. Keep the room temperature cool.
- D. Space activities to promote rest.
Correct Answer: A
Rationale: Hypothyroidism causes cold intolerance; discouraging electric blankets prevents burns due to reduced sensation. Frequent temperature checks, cool rooms, and rest are less relevant.
The nurse manager of a medical-surgical unit is asked to determine if the unit should adopt a new care delivery system. Which behavior is an example of an autocratic style of leadership?
- A. Call a meeting and educate the staff on the new delivery system being used.
- B. Organize a committee to investigate the various types of delivery systems.
- C. Wait until another unit has implemented the new system and see if it works out.
- D. Discuss with the nursing staff if a new delivery system should be adopted.
Correct Answer: A
Rationale: An autocratic leader unilaterally decides and informs staff, as in educating them on a chosen system. Committees, waiting, and staff discussions are democratic or laissez-faire.
The nurse identified a concept of metabolism for a client diagnosed with diabetes. Which antecedent would be identified as placing the client at risk for diabetes?
- A. Nutrition.
- B. Sensory perception.
- C. pH regulation.
- D. Medication.
Correct Answer: A
Rationale: Poor nutrition (e.g., high sugar intake) is a key risk factor for diabetes, impacting metabolism. Sensory, pH, and medications are less directly causative.