an external insulin pump is prescribed for a client with dm the client asks the nurse about the functioning of the pump the nurse bases the response o

HESI RN

HESI Leadership and Management

1. An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

A. Gives small continuous doses of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.
B. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.
C. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.
D. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Correct answer: A

Rationale: The correct answer is A. An external insulin pump delivers small continuous doses of regular insulin subcutaneously throughout the day to meet the basal insulin needs. The client can also self-administer a bolus dose with an additional dosage from the pump before each meal to cover the mealtime insulin needs. Option B is incorrect as insulin pumps do not typically release programmed doses of insulin into the bloodstream at specific intervals; instead, they infuse insulin subcutaneously. Option C is incorrect as insulin pumps are not surgically attached to the pancreas; they are worn externally. Option D is incorrect as NPH insulin is not commonly used in insulin pumps, and the pumps do not continuously infuse insulin directly into the bloodstream but rather subcutaneously.

2. A female client with physical findings suggestive of a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, necessitating a transsphenoidal hypophysectomy. The evening before the surgery, Nurse Jacob reviews preoperative and postoperative instructions provided to the client earlier. Which postoperative instruction should the nurse emphasize?

A. You must lie flat for 24 hours after surgery.
B. You must avoid coughing, sneezing, and blowing your nose.
C. You must restrict your fluid intake.
D. You must report ringing in your ears immediately.

Correct answer: B

Rationale: Following a transsphenoidal hypophysectomy, it is crucial to avoid activities such as coughing, sneezing, and blowing the nose to prevent an increase in intracranial pressure or the risk of cerebrospinal fluid leakage. Coughing, sneezing, or nose blowing can strain the surgical site, potentially leading to complications. Lying flat for 24 hours is not typically required after this surgery. Fluid intake should be encouraged to prevent dehydration. Ringing in the ears is not a common complication associated with this type of surgery.

3. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?

A. The best time for me to exercise is every afternoon.
B. The best time for me to exercise is right after I eat.
C. The best time for me to exercise is after breakfast.
D. The best time for me to exercise is after my morning snack.

Correct answer: A

Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.

4. Which advice is most beneficial for a new nurse manager?

A. Strive to embody the manager your staff desires while also aligning with your administration's expectations.
B. Keep in mind that it may take 6 months to feel at ease in a new role.
C. Begin by mentoring other novice nurse managers.
D. Participate in substantial personal growth endeavors.

Correct answer: B

Rationale: The most helpful advice for a new nurse manager is to understand that it can take up to 6 months to feel comfortable in a new position. This allows the individual to manage their expectations and give themselves time to adapt to their new role. Choice A may be overwhelming and could cause conflicting priorities for the new nurse manager. Choice C, while valuable, might not be the immediate focus for someone new to the role. Choice D, although important, may not be as time-sensitive as the adjustment period in the new position.

5. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

Correct answer: C

Rationale: In Cushing's syndrome, the characteristic features include central obesity with deposits of adipose tissue in the trunk and dorsocervical area, often referred to as a 'buffalo hump.' Hypotension (Choice A) is not typically associated with Cushing's syndrome; instead, hypertension is more common. Thick, coarse skin (Choice B) is seen in conditions like hypothyroidism, not specifically in Cushing's syndrome. Weight gain in the arms and legs (Choice D) is not a typical finding in Cushing's syndrome; rather, weight gain is more prominent in the central areas of the body.