At 8 a.m. the nurse is reviewing patient assignments and notes one of the patients has a current blood glucose of 264. Breakfast is routinely served at 8:30. The following orders are noted in the chart. What action should the nurse take? Accucheck before meals and at bedtime with sliding scale insulin aspart SQ: Glucose 0-150 Administer 0 units; 151-200 Administer 2 units; 201-250 Administer 4 units: 251-300 Administer 6 units: 301-350 Administer 8 units; 351- 400 Administer 10 units; >400 Notify physician.

Provide 2 units insulin aspart 50

Provide 6 units insulin aspart 50

Provide 10 units insin apart SQ

Provide 4 units insulin aspart 50

Answer and Explanation

The Correct Answer is B

A. This option corresponds to the blood glucose range of 151-200. However, the patient's current blood glucose level is 264, which falls into the range of 251-300. Therefore, administering 2 units would not be appropriate in this case.

B. The patient's current blood glucose level is 264, which falls into the range of 251-300. According to the sliding scale insulin aspart orders, for this range, 6 units should be administered. This option aligns with the patient's blood glucose level and the prescribed protocol.

C. This option corresponds to the blood glucose range of 351-400. The patient's blood glucose level of 264 does not fall into this range, so administering 10 units would be excessive and potentially lead to hypoglycemia.

D. This option corresponds to the blood glucose range of 201-250. The patient's current blood glucose level is 264, which falls into the range of 251-300. Therefore, administering 4 units would not be sufficient to address the elevated blood glucose level.

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Correct Answer is A

Explanation

1 AM while sleeping: NPH insulin, like Humulin N, typically reaches its peak effectiveness about 4-12 hours after administration. Since the client takes it at 5 PM, the time of greatest risk for hypoglycemia is around 1 AM when the insulin's effects are at their peak. This is a critical period for monitoring blood glucose levels.

B. 8 PM shortly after dinner: By 8 PM, the NPH insulin's effectiveness is not at its peak. It's been about 3 hours since administration, and the insulin is still working to lower blood glucose levels. This time frame is not associated with the highest risk of hypoglycemia.

C. 6 PM shortly after dinner: At 6 PM, it's been only about an hour since the client took the NPH insulin. The insulin is just beginning to take effect, and the risk of hypoglycemia is not as high as it would be later in the night.

D. 11:00 AM, shortly before lunch: By 11:00 AM, the effects of the NPH insulin from the previous evening have largely worn off. This time frame is not associated with a high risk of hypoglycemia related to the evening dose of NPH insulin.

A. Drowsiness B. Dry skin C. Bradycardia D. Heat intolerance

Correct Answer is D

Explanation

A. Drowsiness is not a typical manifestation of thyrotoxicosis. Instead, individuals with thyrotoxicosis often experience restlessness and anxiety due to excessive thyroid hormone levels.

B. Dry skin is more commonly associated with hypothyroidism (insufficient thyroid hormone levels), rather than thyrotoxicosis (excessive thyroid hormone levels).

C. Bradycardia (slower than normal heart rate) is a symptom of hypothyroidism, not thyrotoxicosis. In thyrotoxicosis, tachycardia (an abnormally rapid heart rate) is a common finding.

D. Correct. Heat intolerance is a classic symptom of thyrotoxicosis. Excessive thyroid hormone levels can lead to an increased metabolic rate, making individuals more sensitive to heat.

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Naxlex Comprehensive Predictor Exams

The client with type 1 diabetes mellitus is prescribed to take NPH (Humulin N) insulin at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur about what time?

Correct Answer is A

Explanation

A nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect?

Correct Answer is D

Explanation

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include?

Synthroid 0.3 mg p.o. daily is ordered. You have Synthroid in 150 mcg tablets. Give tablets.

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching?

The nurse is assessing an older patient with type 2 diabetes mellitus. What age-related endocrine change should the nurse expect in this patient?

A nurse is caring for a client who is 8 hr postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client?

A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?

When preparing to provide morning medications, the nurse would give levothyroxine (Synthroid) ordered daily in which of the following ways?