Nokea
The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
- A. I will make sure I eat breakfast within 2 hours of taking my insulin.
- B. I will need to carry candy or some form of sugar with me all the time.
- C. I will eat a snack around three o'clock each afternoon.
- D. I can save my dessert from supper for a bedtime snack.
Correct Answer: C
Rationale: NPH insulin peaks 4-12 hours after administration, so a snack around 3 PM helps prevent hypoglycemia during peak action.
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A burn client is in the acute phase of burn care. The nurse assesses jugular vein distention, edema, urine output of 20 cc in 2 hours, and crackles on auscultation. Which order would the nurse anticipate from the physician?
- A. Furosemide (Lasix) IV push
- B. Irrigate the Foley catheter
- C. Increase the IV fluids to 200 mL/hr
- D. Place the client in Trendelenburg position
Correct Answer: A
Rationale: Signs of fluid overload (JVD, edema, low urine output, crackles) suggest the need for furosemide (Lasix) to reduce excess fluid and prevent pulmonary edema.
The nurse is obtaining a history on a 74-year-old client. Which statement made by the client would alert the nurse to a possible fluid and electrolyte imbalance?
- A. My skin is always so dry.'
- B. I often use a laxative for constipation.'
- C. I have always liked to drink a lot of water.'
- D. I sometimes have a problem with dribbling urine.'
Correct Answer: B
Rationale: Frequent laxative use can cause fluid and electrolyte losses (e.g., potassium, sodium), leading to imbalances, unlike the other statements.
A client is being treated for irritable bowel syndrome (IBS). The nurse knows that the involvement of nursing, pharmacy, gastroenterology, and nutritional services is an example of which of the following approaches?
- A. continuity of care
- B. multidisciplinary
- C. managed care
- D. case management
Correct Answer: B
Rationale: A multidisciplinary approach involves multiple specialties (nursing, pharmacy, gastroenterology, nutrition) collaborating to manage IBS.
The nurse is monitoring the progress of a client in labor. Which finding should be reported to the physician immediately?
- A. The presence of scant bloody discharge
- B. Frequent urination
- C. The presence of green-tinged amniotic fluid
- D. Moderate uterine contractions
Correct Answer: C
Rationale: Green-tinged amniotic fluid indicates meconium, a sign of fetal distress requiring immediate reporting.
The nurse is assessing the laboratory results of a client scheduled to receive phenytoin (Dilantin). The Dilantin level, drawn 2 hours ago, is 30 mcg/mL. What is the appropriate nursing action?
- A. Administer the Dilantin as scheduled
- B. Hold the scheduled dose and notify the physician
- C. Decrease the dosage from 100 mg to 50 mg
- D. Increase the dosage to 200 mg from 100 mg
Correct Answer: B
Rationale: A Dilantin level of 30 mcg/mL is above the therapeutic range (10-20 mcg/mL), indicating toxicity risk. The nurse should hold the dose and notify the physician for further orders.