Nokea
The nurse is teaching a client with diabetes mellitus (type two) newly prescribed rapid-acting insulin. Which of the following information should the nurse include?
- A. Once you open your vial of insulin, discard it 25 days after opening it.
- B. Inject yourself with this insulin 20-30 minutes before meals.
- C. You can inject yourself with this insulin while you are actively eating.
- D. This insulin is administered right before you go to bed to minimize overnight blood sugar spikes.
Correct Answer: C
Rationale: Rapid-acting insulin, like lispro, can be injected just before or during meals to match carbohydrate intake. Vials are typically good for 28 days, not 25, and bedtime dosing is for long-acting insulin.
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The nurse is caring for a client with Graves' disease who has exophthalmos. The nurse should recommend that the client
- A. prevent eye dryness by applying artificial tears.
- B. use scanning techniques to move the head from side to side.
- C. take their thyroid hormone as prescribed.
- D. sleep flat on your back without any pillows.
Correct Answer: A
Rationale: Exophthalmos in Graves' disease causes protruding eyes, increasing the risk of dryness and irritation. Artificial tears help maintain moisture and protect the eyes. Sleeping flat may worsen eye protrusion, and thyroid hormone management is unrelated to exophthalmos directly.
The nurse is caring for a client with diabetic ketoacidosis (DKA) who is receiving an infusion of regular insulin. Which of the following clinical data should be reported to the primary healthcare provider (PHCP) immediately?
- A. Glucose 297 mg/dL, 16.52 mmol/L (70-110 mg/dL, 4.0-11.0 mmol/L)
- B. Potassium 3.2 mEq/L, 3.2 mmol/L (3.5-5 mEq/L, 3.5-5.1 mmol/L)
- C. BUN 24 mg/dL, 8.568 mmol/L (10-20 mg/dL, 2.5 to 6.4 mmol/L)
- D. Hemoglobin A1C 8.9% ( < 7%, 4.8%-6.0%)
Correct Answer: B
Rationale: In DKA, insulin shifts potassium into cells, risking hypokalemia. A level of 3.2 mEq/L is critical and needs immediate reporting to prevent arrhythmias. Glucose, BUN, and HbA1C are monitored but less urgent.
The nurse administers a combination of regular insulin and NPH insulin subcutaneously to a client at 0800. At which time should the nurse initially assess the client for hypoglycemia based on the peaks of the medications?
- A. 830
- B. 1000
- C. 1200
- D. 1400
Correct Answer: B
Rationale: Regular insulin peaks at 2-4 hours (1000-1200), and NPH peaks at 4-12 hours. Initial hypoglycemia risk is highest around 1000 due to regular insulin's peak effect.
The nurse is caring for a client with type 1 diabetes mellitus who develops hyperglycemia between 5:00 and 6:00 AM as a result of the nighttime release of growth hormone. The nurse should recognize that this condition is consistent with
- A. dawn phenomenon.
- B. Somogyi effect.
- C. hyperosmolar hyperglycemic syndrome (HHS).
- D. diabetic ketoacidosis (DKA).
Correct Answer: A
Rationale: Dawn phenomenon is early morning hyperglycemia from growth hormone and cortisol release, common in type 1 diabetes. Somogyi involves rebound from hypoglycemia, and HHS and DKA are acute complications.
The nurse is caring for a client with Addison's disease. Which statement, if made by the client, would require follow-up?
- A. I started using table salt instead of salt substitutes.
- B. I joined a gym to train for an upcoming marathon.
- C. I recently started wearing a MedicAlert bracelet.
- D. If I start to feel ill, I should call my doctor right away.
Correct Answer: B
Rationale: Addison's causes weakness and hypotension; marathon training is excessive and risky, requiring follow-up. Salt use, MedicAlert, and calling the doctor are appropriate.