An adult female client with type 1 diabetes mellitus is receiving NPH insulin 35 units each morning. Which finding should the practical nurse (PN) document as evidence that the amount of insulin is inadequate?

Choice A rationale:

Beginning continuous observation for transient episodes of neurologic dysfunction is important in the assessment and monitoring of the client's condition. However, in this scenario, the client is presenting with symptoms suggestive of a possible stroke or cerebrovascular event, and time is crucial. The nurse should prioritize actions that can lead to prompt diagnosis and treatment.

Choice B rationale:

Starting two large bore intravenous (IV) catheters and reviewing inclusion criteria for IV fibrinolytic therapy is the most urgent action. The client's symptoms, including sudden right-sided numbness, weakness, and facial droop, are indicative of a possible ischemic stroke. IV fibrinolytic therapy is time-sensitive and has a limited window of effectiveness. Establishing IV access and determining eligibility for this therapy should be the nurse's top priority to potentially improve the client's outcome.

Choice C rationale:

Administering aspirin to prevent further clot formation and platelet clumping is an important intervention in the treatment of ischemic stroke. However, it should not be the first action in this scenario. The priority is to assess for eligibility for IV fibrinolytic therapy, as this intervention has a more immediate impact on reversing the stroke's effects.

Choice D rationale:

Raising the head of the bed to 30 degrees and keeping the head and neck in neutral alignment is a reasonable nursing intervention to prevent complications such as aspiration and promote optimal cerebral blood flow. However, it is not the most urgent action in this case. The priority should be on assessing and potentially treating the stroke with IV fibrinolytic therapy.

Choice A rationale:

A bedside commode is positioned near the bed. Positioning a bedside commode near the bed is appropriate for a client with heart failure and COPD who may have mobility issues or difficulty walking to the bathroom. It promotes safety and convenience for the client.

Choice B rationale:

A full pitcher of water is on the bedside table. While it's essential to keep clients with heart failure adequately hydrated, having a full pitcher of water within easy reach might encourage excessive fluid intake, which can exacerbate heart failure symptoms. However, this choice is not an immediate risk requiring intervention.

Choice C rationale:

The client is lying in a supine position in bed. A client with heart failure and COPD should not be lying in a supine position because it can exacerbate respiratory distress and increase the workload of the heart. This is an observation that requires immediate intervention, such as repositioning the client to an upright or semi-fowler's position.

Choice D rationale:

A saline lock is present in the right forearm. The presence of a saline lock is a standard precaution in a hospitalized client and does not require immediate intervention unless there are specific issues with it, such as signs of infection or dislodgement. It does not pose an immediate harm to the client.

Choice E rationale:

A low sodium diet tray was brought to the room. A low sodium diet is crucial for managing heart failure because excessive sodium intake can lead to fluid retention and exacerbate symptoms. Ensuring that the client follows the prescribed diet is essential for their well-being, and any deviations may require immediate intervention.