A nurse is assisting with the care of a client in the emergency department.

Exhibits

The nurse is reviewing the client’s health information. For each potential provider’s prescription, tick to specify if the assessment findings is consistent with myocardial infraction or gastroesophageal reflux disease (Gerd), each finding may support more than one disease process.

Choice A reason: Injecting insulin into a muscle that is going to be exercised can increase the absorption of insulin and lower the blood glucose level, leading to hypoglycemia. Therefore, it is advisable to avoid injecting insulin into the same body part that will be involved in the exercise.

Choice B reason: Carrying a complex carbohydrate snack with you when you exercise is not a good idea. Complex carbohydrates take longer to digest and raise the blood glucose level slowly. They are not suitable for treating or preventing hypoglycemia during or after exercise. A simple carbohydrate snack, such as glucose tablets, juice or candy, is more appropriate for this purpose.

Choice C reason: Exercising first thing in the morning before eating breakfast is not recommended for people with type 1 diabetes. This can cause a drop in blood glucose level and increase the risk of hypoglycemia. It is beter to have a balanced breakfast that includes some carbohydrates and adjust the insulin dose accordingly before exercising.

Choice D reason: Increasing the intensity of your exercise routine if your urine is positive for ketones is a dangerous practice. Ketones are produced when the body breaks down fat for energy due to lack of insulin or glucose. High levels of ketones can lead to diabetic ketoacidosis, a life-threatening condition that requires urgent medical atention. Intense exercise can raise the blood glucose level further and worsen the situation. If your urine is positive for ketones, you should avoid vigorous activity and check your blood glucose and ketone levels frequently.

Choice A: Weigh the client weekly. This is incorrect because the client receiving PN should be weighed daily, not weekly, to monitor fluid balance and nutritional status. The nurse should also measure the client’s intake and output, blood glucose, electrolytes, and other laboratory values daily.

Choice B: Reduce the rate of the solution gradually to discontinue. This is correct because the nurse should taper off the PN solution slowly to prevent rebound hypoglycemia, which can occur when the high concentration of glucose in the PN solution is abruptly stopped. The nurse should follow the provider’s orders or the facility’s protocol for reducing and discontinuing PN.

Choice C: Remove solution from refrigerator 2 hr before infusion. This is incorrect because the nurse should remove the PN solution from the refrigerator 30 to 60 minutes before infusion, not 2 hr, to allow it to reach room temperature. Infusing a cold solution can cause discomfort, vasoconstriction, and impaired absorption of nutrients.

Choice D: Shake the solution before hanging if there is a layer of fat present on the top. This is incorrect because the nurse should not shake the PN solution at all, as this can cause fat emulsion droplets to coalesce and form large particles that can clog the filter or cause embolism. The nurse should gently invert or roll the PN solution container to mix it if there is any separation of components.