Nokea
The nurse is educating a client about newly prescribed lispro insulin. The nurse should instruct the client to self-administer this insulin
- A. 30-45 minutes before a meal.
- B. one hour after a meal.
- C. 20-30 minutes before a meal.
- D. 5-15 minutes before a meal.
Correct Answer: D
Rationale: Lispro, a rapid-acting insulin, should be administered 5–15 minutes before meals to match carbohydrate intake and prevent postprandial hyperglycemia. Other timings are incorrect for its rapid onset.
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The nurse is performing discharge teaching for a client prescribed propylthiouracil (PTU). Which client statement indicates effective understanding?
- A. I should increase my intake of foods containing iodine.
- B. This medication may cause my urine to have a reddish discoloration.
- C. I will need to have my liver enzymes monitored while I take this medication.
- D. If this medication starts to work, I should notice some weight loss.
Correct Answer: C
Rationale: PTU can cause hepatotoxicity, requiring liver enzyme monitoring. Iodine intake should be moderated, PTU does not cause reddish urine, and effective treatment may cause weight gain, not loss.
The nurse is conducting health screenings for hypothyroidism at the community health fair. Which client is at the highest risk for this condition? A client who is
- A. underweight, anxious, has a rapid pulse, and reports persistent diarrhea.
- B. overweight, reports perspiration while playing sports, and reports feeling cold all the time.
- C. obese, has high blood pressure, and has frequent reports of thirst.
- D. obese, has periorbital edema, and reports a decrease in motivation.
Correct Answer: D
Rationale: Hypothyroidism causes weight gain, edema, and fatigue or decreased motivation. Underweight, rapid pulse, and diarrhea suggest hyperthyroidism; thirst and hypertension are less specific.
The nurse is caring for assigned clients. The nurse should recognize which client is at risk of developing hypoglycemia? A client
- A. with diabetic ketoacidosis receiving continuous regular insulin intravenously.
- B. receiving methylprednisolone for an exacerbation of asthma.
- C. with pancreatitis and is receiving total parenteral nutrition (TPN).
- D. who is nothing by mouth (NPO) status following a coronary artery bypass graft (CABG).
- E. who received six units of lispro insulin one hour ago and has not eaten.
Correct Answer: A, E
Rationale: Continuous insulin in DKA and lispro without food increase hypoglycemia risk due to excess insulin action. Steroids raise glucose, and TPN and NPO status are less directly related.
The nurse plans care for a client experiencing a hyperglycemic-hyperosmolar state (HHS). The nurse should anticipate which prescriptions from the primary healthcare provider (PHCP)?
- A. 0.9% saline infusion
- B. Glargine insulin
- C. Sodium polystyrene
- D. Sodium bicarbonate
Correct Answer: A
Rationale: HHS involves severe hyperglycemia and dehydration. 0.9% saline corrects fluid loss. Glargine is long-acting and not ideal for acute HHS, sodium polystyrene treats hyperkalemia, and bicarbonate is rarely used unless pH is critically low.
The nurse observes the newly hired registered nurse prepare to administer neutral protamine hagedorn (NPH) insulin to a client. Which action by the newly hired nurse requires follow-up?
- A. asks the client which site the insulin was last injected.
- B. checks the client's blood glucose levels prior to administering the insulin injection.
- C. shakes the insulin vial before withdrawing insulin.
- D. reminds the client to report symptoms of clammy skin and disorientation.
Correct Answer: C
Rationale: NPH insulin should be gently rolled, not shaken, to mix the suspension without creating bubbles, which can affect dosing accuracy. Asking about injection sites, checking glucose, and reminding about hypoglycemia symptoms are correct actions.