Nokea
The nurse is caring for a client with a prescribed subcutaneous (SQ) regular insulin sliding scale. The client's current blood glucose level is 360 mg/dL (19.98 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]. Which of the following actions should the nurse take? See the exhibit.
- A. Notify the primary health care provider (PHCP).
- B. Administer 8 units of regular insulin.
- C. Administer 10 units of regular insulin.
- D. Recheck the client's blood glucose in one hour.
- E. Administer the insulin intravenous (IV) push.
Correct Answer: A,B
Rationale: A blood glucose of 360 mg/dL is significantly elevated, requiring insulin per the sliding scale (e.g., 8 units for 351–400 mg/dL, depending on the exhibit) and PHCP notification for further management. IV push is inappropriate for SQ scales, and rechecking in one hour follows administration.
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The nurse is performing a physical assessment on a client with Cushing's disease. Which assessment findings should the nurse expect?
- A. Hypotension
- B. Acne
- C. Hirsutism
- D. Buffalo hump
- E. Truncal obesity
Correct Answer: B, C, D, E
Rationale: Cushing's disease from excess cortisol causes acne, hirsutism (excess hair), buffalo hump, and truncal obesity due to fat redistribution. Hypertension, not hypotension, is typical.
The nurse is teaching a client about storing their prescribed insulin. Which statement, if made by the client, would indicate a correct understanding of the teaching?
- A. Opened vials of insulin may be kept in the freezer.
- B. My opened vial of insulin is good for 45 days.
- C. If I travel, I can keep a vial of insulin in my car.
- D. Unopened vials of insulin should be stored in the refrigerator.
Correct Answer: D
Rationale: Unopened insulin vials should be refrigerated to maintain stability. Opened vials are good for about 28–30 days at room temperature, not 45 days. Freezing or storing in a car can degrade insulin.
The nurse is teaching a new group of nurses about insulin administration for a client with type I diabetes mellitus. Which of the following points should be included?
- A. Administer insulin subcutaneously, not intramuscularly.
- B. Regular insulin can be administered intravenously in emergency situations.
- C. Rotate injection sites to prevent lipohypertrophy.
- D. Long-acting insulin should not be mixed in the same syringe with other types of insulin
- E. It's safe to administer cold insulin directly from the refrigerator.
Correct Answer: A, B, C, D
Rationale: Subcutaneous administration is standard, IV regular insulin is for emergencies, rotation prevents tissue damage, and long-acting insulin shouldn't be mixed. Cold insulin can be irritating and should be warmed to room temperature.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 2 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
The nurse recognizes which of the following conditions may cause a client to manifest hyperglycemia?
- A. diabetes insipidus
- B. adrenal insufficiency
- C. pheochromocytoma
- D. hyperpituitarism
- E. pancreatitis
Correct Answer: C, D, E
Rationale: Pheochromocytoma releases catecholamines, raising glucose. Hyperpituitarism increases growth hormone, impairing glucose metabolism. Pancreatitis damages insulin-producing cells, causing hyperglycemia. Diabetes insipidus and adrenal insufficiency do not typically elevate glucose.
The nurse is reviewing data for a client who is establishing primary care. Select the findings from the history and physical that are risk factors for diabetes mellitus (type two).
- A. The client has a medical history of testicular cancer that was treated when he was 24.
- B. He also was told he had high blood pressure and high cholesterol.
- C. two years ago but never followed up with treatment.
- D. He has a body mass index of 28.
- E. He drinks one glass of red wine three times a week and stopped smoking cigarettes one year ago.
Correct Answer: B, D
Rationale: Hypertension, high cholesterol, and a BMI of 28 (overweight) increase type 2 diabetes risk via insulin resistance. Cancer history, wine, and smoking cessation are less directly related.