A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?

Stress has likely caused an increase in the client's blood sugar levels.

The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures.

Alterations in bile metabolism and release have likely caused hyperglycemia.

Answer and Explanation

The Correct Answer is A

A. Stress has likely caused an increase in the client's blood sugar levels:
This statement is accurate. Stress, especially related to surgery, can lead to increased levels of stress hormones, such as cortisol and catecholamines, which can elevate blood sugar levels. Surgery is a physiological stressor that can impact glucose metabolism.

B. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars:
This is the most appropriate choice. Surgery, anesthesia, and changes in fluid balance can affect blood glucose levels. The stress response to surgery can lead to fluctuations in blood sugar, and patients may need insulin during this period.

C. The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures:
This statement is not accurate. Overstimulation is not a common cause of the need for insulin in the context of surgery. The stress and physiological changes associated with surgery are more likely contributors.

D. Alterations in bile metabolism and release have likely caused hyperglycemia:
While alterations in metabolism can impact glucose regulation, in the context of surgery, the primary factors are the stress response, changes in fluid balance, and potential alterations in the ability to eat or drink normally rather than specific effects on bile metabolism.

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Correct Answer is D

Explanation

A. Respiratory Acidosis:
Explanation: Respiratory acidosis occurs when there is inadequate elimination of carbon dioxide, leading to an increase in PaCO2 and a decrease in blood pH. This is typically associated with conditions that impair ventilation.

B. Metabolic Alkalosis:
Explanation: Metabolic alkalosis is characterized by an elevated blood pH and bicarbonate (HCO3-) concentration. It is not directly caused by hyperventilation but is often associated with conditions such as excessive vomiting or excessive bicarbonate intake.

C. Metabolic Acidosis:
Explanation: Metabolic acidosis is characterized by a decrease in blood pH and bicarbonate concentration. It is not directly caused by hyperventilation but may result from conditions such as diabetic ketoacidosis or lactic acidosis.

D. Respiratory Alkalosis:
Explanation: Hyperventilation is the most common cause of respiratory alkalosis. During hyperventilation, there is an excessive loss of carbon dioxide (CO2) through rapid breathing, leading to a decrease in the partial pressure of carbon dioxide (PaCO2) in the blood. This results in an increase in blood pH, causing an alkalotic state.

A. I will inject my insulin by pinching up a large area of skin, and then inserting the needle. B. I can mix my regular acting insulin and my Lantus in the same syringe. C. I can inject my insulin in the same location each time. D. I can use a needle/syringe more than once since I am the only one using it. E. I will discard my used syringes in a hard container, like an empty plastic milk jug.

Correct Answer is ["A","B"]

Explanation

A. I will inject my insulin by pinching up a large area of skin, and then inserting the needle.
The correct technique for subcutaneous insulin injection involves pinching a small area of skin (creating a skinfold) and inserting the needle at a 90-degree angle. Injecting into a large area might result in inadequate subcutaneous administration.

B. I can mix my regular acting insulin and my Lantus in the same syringe.
Lantus (insulin glargine) is a long-acting insulin that should not be mixed with other insulins. It should be administered separately to maintain its long-acting profile.

C. I can inject my insulin in the same location each time.
This statement is correct. Injecting insulin into the same general area consistently can help with consistent absorption.

D. I can use a needle/syringe more than once since I am the only one using it.
It is not safe to reuse needles or syringes. Single-use needles and syringes should be disposed of properly after each use to prevent infection and other complications.

E. I will discard my used syringes in a hard container, like an empty plastic milk jug.
This statement is correct. Used syringes should be discarded in a puncture-resistant container, and an empty plastic milk jug can serve as a suitable container for disposal.

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Naxlex Comprehensive Predictor Exams

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon an assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the MOST common cause of which acid-base imbalance?

Correct Answer is D

Explanation

The nurse instructs the client about the self-administration of insulin. Which statement or statements by the patient indicate a need for further teaching? (SELECT ALL THAT APPLY)

Correct Answer is ["A","B"]

Explanation

A client has been brought to the emergency department by paramedics after being found unconscious. The client's Medic Alert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

A client with Cushing's syndrome is receiving education about dietary changes from the nurse. Which statement by the patient demonstrates the need for further teaching?

The nurse is monitoring a client who was diagnosed with Type 1 Diabetes Mellitus and is being treated with NPH and regular insulin. Which manifestations alert the nurse to the presence of a possible hypoglycemic reaction? (SELECT ALL THAT APPLY)

The nurse is caring for a female client with type 2 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

A client diagnosed with type 1 diabetes states he is not comfortable with self-injections and asks the nurse if oral an anti- diabetic agent can be prescribed instead. Which of the following responses from the nurse is appropriate?

The nurse is caring for a patient diagnosed with hypothyroidism. When assessing this patient, what sign or symptom would the nurse expect?