Nokea
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.
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The nurse in the clinic is caring for a 32-year-old female client.
Item 5 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]
Orders
1714:
Arrange for a follow-up appointment in 3 days
Lab orders: serum complete blood count, complete metabolic panel, hemoglobin A1C
24-hour urinary cortisol excretion
The nurse reviews the physician's orders. The nurse educates the client about the ordered 24-hour urinary cortisol excretion. Which of the following information should the nurse include?
- A. You will need to begin this test by discarding your first urine specimen.
- B. Note the time that you started the 24-hour urine collection.
- C. During the urine collection, only save specimens larger than 30 mL.
- D. Do not collect urine voided while having a bowel movement.
- E. The urine specimen should be kept on ice or refrigerated.
- F. You will need to increase your daily fluid intake to 3 liters during this test.
- G. Collect and retain all urinary specimens during the 24-hour period.
Correct Answer: A, B, D, E, G
Rationale: Discarding the first specimen, noting the start time, avoiding contamination from bowel movements, refrigerating samples, and collecting all urine ensure accurate 24-hour cortisol measurement. Volume thresholds and increased fluid intake are not standard requirements.
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question?
- A. Furosemide for a client with hyperparathyroidism
- B. Methimazole for a client with hyperthyroidism
- C. Hydrocortisone for a client with diabetes insipidus
- D. Prazosin for a client with pheochromocytoma
Correct Answer: C
Rationale: Hydrocortisone is inappropriate for diabetes insipidus, which requires desmopressin to manage water reabsorption. Furosemide may be used in hyperparathyroidism, methimazole treats hyperthyroidism, and prazosin manages hypertension in pheochromocytoma.
The nurse has instructed a client scheduled for an injection of dulaglutide for diabetes mellitus (type two). Which of the following statements by the client would require follow-up?
- A. I should tell my doctor if I experience abdominal pain and vomiting.
- B. I should take this medication within one hour of eating a meal.
- C. If this medication works, I should notice a reduction in my hemoglobin A1C (HbA1c).
- D. I will receive this medication once a week.
Correct Answer: B
Rationale: Dulaglutide, a GLP-1 agonist, is taken weekly regardless of meals, not within one hour of eating. Abdominal pain/vomiting should be reported, HbA1c reduction is expected, and weekly dosing is correct.
The nurse is reviewing endocrine disorders with a group of students. It would be correct for the nurse to identify which manifestation is associated with hyperthyroidism?
- A. Injected (red) conjunctiva
- B. Insomnia
- C. Increased systolic blood pressure
- D. Diaphoresis
- E. Confusion
Correct Answer: B, C, D
Rationale: Hyperthyroidism increases metabolism, causing insomnia, elevated systolic BP, and sweating (diaphoresis). Red conjunctiva and confusion are not typical features of this condition.
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.