Nokea
The nurse has administered five units of regular insulin and ten units of NPH insulin. After administering both prescribed insulins, the nurse should assess the client for hypoglycemia
- A. thirty minutes after administration.
- B. two to four hours after administration.
- C. four to six hours after administration.
- D. ten to twelve hours after administration.
Correct Answer: B
Rationale: Regular insulin peaks in 2–4 hours, posing the highest hypoglycemia risk during this time. NPH insulin peaks later (4–12 hours). Assessing 2–4 hours after administration aligns with regular insulin’s peak effect.
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The following scenario applies to the next 1 items.
The nurse in the physician's office is caring for a 41-year-old female client.
Item 1 of 1
Progress Notes
1043
Subjective: Client presents for a follow-up appointment five weeks after she was prescribed sertraline for depressive symptoms. She reports no improvement and even reports worsening as she is having difficulty focusing at work. Specifically, she reports feeling like she is in a 'brain fog.' Two weeks ago, she started taking over-the-counter stool softeners because of constipation, which did not improve even after introducing more fiber in her diet. Finally, she reports that her shoes are no longer fitting because of edema in her ankles and feet.
Objective: Client is alert and oriented to person, place, and time. 2+ peripheral pulses. S1/S2 heart tones. Hypoactive bowel sounds in all quadrants. Clear lung sounds. Trace periorbital and 1+ pedal edema.
Assessment and plan: Will order laboratory testing as this client is showing strong clinical signs of primary hypothyroidism.
Vital Signs
T 97°F (36.1°C) P 58 RR 16 BP 107/65 Pulse oximetry reading 98% on room air
Orders
obtain thyroid panel
discontinue sertraline
The nurse reviews the physician's progress notes, orders, and the client's vital signs. Complete the sentence below with the appropriate answers. If the client has primary hypothyroidism, the client's thyroid panel will have a high...... and low......
- A. thyroid-stimulating hormone (TSH)
- B. free thyroxine (T4)
- C. serum triiodothyronine (T3)
- D. thyroid-stimulating hormone (TSH).
- E. free thyroxine (T4).
- F. thyrotropin receptor antibodies (TRAbs).
Correct Answer: A, B
Rationale: Primary hypothyroidism involves low thyroid hormone production, so TSH rises to stimulate the gland, and free T4 falls due to reduced output. T3 and TRAbs are less specific here.
The nurse is caring for a client scheduled for a computed tomography (CT) scan with contrast. The nurse recognizes which medication should be held after the procedure?
- A. labetalol
- B. metformin
- C. levodopa
- D. ondansetron
Correct Answer: B
Rationale: Metformin should be held after a CT scan with contrast due to the risk of lactic acidosis if contrast-induced nephropathy occurs. Labetalol, levodopa, and ondansetron are not affected by contrast.
The nurse is caring for a client with diabetes mellitus (type one) with diabetic ketoacidosis (DKA). Which laboratory result is critical for the nurse to monitor closely during the client's treatment?
- A. Blood urea nitrogen (BUN)
- B. Serum creatinine
- C. Serum potassium
- D. Serum magnesium
Correct Answer: C
Rationale: In DKA, insulin shifts potassium into cells, risking hypokalemia, which can cause arrhythmias. Close monitoring of serum potassium is critical during treatment.
This nurse is caring for a client who is receiving prescribed tolvaptan. Which of the following findings would indicate a therapeutic response?
- A. Fasting blood glucose 100 mg/dL (5.55 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- B. Urine specific gravity 1.010 [1.005-1.030]
- C. Total cholesterol 176 mg/dL (4.55 mmol/L) [-200 mg/dL, 3.5-5.2 mmol/L]
- D. Blood urea nitrogen (BUN) 5 mg/dL (1.785 mmol/L) [10-20 mg/dL, 2.1-8.0 mmol/L]
Correct Answer: B
Rationale: Tolvaptan treats SIADH by increasing free water excretion, lowering urine specific gravity (e.g., 1.010). Glucose, cholesterol, and BUN are not directly affected by tolvaptan.
The nurse has obtained a prescription for desmopressin to treat diabetes insipidus (DI). The nurse understands that it is essential to monitor the clients
- A. serum sodium level.
- B. serum glucose.
- C. serum magnesium level.
- D. serum calcium level.
Correct Answer: A
Rationale: Desmopressin treats diabetes insipidus by reducing water excretion, risking hyponatremia. Monitoring serum sodium is essential. Glucose, magnesium, and calcium are not primarily affected.