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. Aspirin Toxicity:
Effect on Blood Gases: Aspirin toxicity can cause respiratory alkalosis due to increased respiratory rate (hyperventilation), leading to a decreased PaCO2 and increased pH.
Relation to Given Blood Gases: It could potentially cause the observed blood gas values (low PaCO2 and high pH), making it a possible cause.

B. Fever:
Effect on Blood Gases: Fever might cause hyperventilation, resulting in respiratory alkalosis with decreased PaCO2 and increased pH.
Relation to Given Blood Gases: It could potentially cause the observed blood gas values.

C. Anxiety Attack:
Effect on Blood Gases: Anxiety attacks can lead to hyperventilation and subsequent respiratory alkalosis with low PaCO2 and high pH.
Relation to Given Blood Gases: It could potentially cause the observed blood gas values.

D. Chronic Obstructive Pulmonary Disease (COPD):
Effect on Blood Gases: COPD typically causes respiratory acidosis due to impaired gas exchange, resulting in elevated PaCO2 and decreased pH.
Relation to Given Blood Gases: COPD wouldn't typically cause the observed blood gas values of low PaCO2 and high pH.

A. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." B. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." C. "If you are going to use up the vial within 1 month, it can be kept at room temperature." D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

Correct Answer is A

Explanation

A. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature."
This statement suggests a duration of up to 21 days for room temperature storage after the vial is in use. However, most insulins can typically be stored at room temperature for up to 28 days after initial use. This recommendation might be more conservative than necessary for many types of insulin.

B. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature."
This choice suggests a timeframe of 14 days for room temperature storage after opening the vial. However, for many insulins, the recommended duration for room temperature storage after opening is up to 28 days.

C. "If you are going to use up the vial within 1 month, it can be kept at room temperature."
This option extends the timeframe to 1 month for room temperature storage after the vial is in use. However, the generally recommended duration for many insulins is up to 28 days after opening.

D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."
This choice suggests a very short duration of 7 days for room temperature storage after opening the vial. Most insulins can typically be stored at room temperature for a longer duration after initial use.

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Naxlex Comprehensive Predictor Exams

A patient has the following blood gases: PaCO2 33, pH 7.50, HCO3 23. Which of the following could NOT be the cause of this condition?

Correct Answer is D

Explanation

A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer?

Correct Answer is A

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)

A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.5°F and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?

A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. Which topic will the nurse address address?

A client comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

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)

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?

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education?