Nokea
Medication administration record
Allergies: No known allergies
Sliding-Scale Serum Glucose Level Regular Insulin Dose
<150 mg/dL (<8.3 mmol/L) 0 units
150-199 mg/dL (8.3-11 mmol/L) 3 units
200-249 mg/dL (11.1-13.8 mmol/L) 5 units
250-299 mg/dL (13.9-16.6 mmol/L) 7 units
≥300 mg/dL (≥16.7 mmol/L) 9 units and notify the health care provider
The nurse is caring for a client who has a prescription for 25 units of NPH insulin and sliding-scale regular insulin. The client's serum glucose level is 237 mg/dL (13.2 mmol/L). How many total units of insulin should the nurse administer to the client? Record your answer using a whole number.
Correct Answer: 29
Rationale: Assuming a sliding-scale protocol (e.g., 4 units for 201-250 mg/dL), 25 units NPH + 4 units regular = 29 units total.
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What information would be most important for the nurse to obtain from a client with suspected bladder cancer who reports blood in the urine but no associated pain?
- A. Family history
- B. Industrial chemical exposure
- C. Tobacco use
- D. Usual diet
Correct Answer: C
Rationale: Tobacco use is the strongest risk factor for bladder cancer, strongly linked to painless hematuria. Chemical exposure is relevant but less common, family history is weak, and diet is not a primary factor.
The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the client’s caregiver?
- A. Administer the medication around the clock even if the client denies having pain
- B. Avoid administering with immediate-release opioids to prevent respiratory depression
- C. Change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs
- D. Request a tapered dose from the health care provider if pain decreases to prevent tolerance
Correct Answer: A
Rationale: Around-the-clock dosing maintains pain control in cancer, preventing peaks and troughs. Combining with immediate-release opioids is common, dosage changes require provider orders, and tapering is less critical in terminal care.
An adult woman who broke her right ankle is seen in the physician's office one week after the cast was applied. Which observation indicates to the office nurse that the client is using crutches correctly?
- A. The client moves the left crutch forward, then the right foot, then the right crutch, and finally the left foot.
- B. The client moves the left crutch and the right foot together, and then moves the right crutch and the left foot together.
- C. The client moves the left foot and the crutches forward while bearing weight on the right foot.
- D. The client bears weight on the left foot, and then moves the right foot and the crutches forward.
Correct Answer: A
Rationale: The four-point crutch gait (left crutch, right foot, right crutch, left foot) is stable and correct for a non-weight-bearing right ankle, ensuring balance and safety.
Which type of accidental poisoning would the nurse expect to occur in children under age 6?
- A. Oral ingestion
- B. Topical contact
- C. Inhalation
- D. Eye splashes
Correct Answer: A
Rationale: Oral ingestion. Young children are most likely to ingest toxic substances due to their exploratory behavior.
An elderly war veteran with prostate cancer and coronary artery disease is hospitalized for urosepsis. The client becomes angry with one of the unlicensed assistive personnel (UAP) who is trying to help the client bathe. Later, the UAP expresses frustration with the client to the nurse. Which statement would be the most appropriate response?
- A. I’ll talk with the client to see why the client is angry
- B. It sounds like you shouldn’t work with this client, so I will reassign you
- C. Let’s go together to ask about the client’s concerns
- D. Why don’t you go talk with the client about why the client is angry?
Correct Answer: C
Rationale: Going together to address concerns promotes teamwork, de-escalates conflict, and ensures the client’s needs are met. Individual talks risk miscommunication, and reassignment avoids resolution.