Nursing Elites

1. A client with diabetes mellitus who is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. What intervention should the nurse recommend to help prevent hypoglycemia while the client is sleeping?

• A. Eat a bedtime snack.
• B. Avoid physical activity.
• C. Take half the usual dose of insulin.
• D. Discontinue insulin until the next meal.

Correct answer: A

Rationale: Eating a bedtime snack is the most appropriate intervention to prevent hypoglycemia during the night when NPH insulin peaks. This snack helps maintain blood glucose levels and counteracts the risk of hypoglycemia. Avoiding physical activity is not recommended as it can further lower blood sugar levels. Taking half the usual dose of insulin can lead to inadequate control of blood sugar levels. Discontinuing insulin until the next meal can result in uncontrolled hyperglycemia, especially during the peak action of NPH insulin.

2. A client with diabetes is taking insulin lispro (Humalog) injections. The nurse should advise the client to eat:

• A. Within 10 to 15 minutes after the injection.
• B. 1 hour after the injection.
• C. At any time, because timing of meals with lispro injections is unnecessary.
• D. 2 hours before the injection.

Correct answer: A

Rationale: The correct answer is to eat within 10 to 15 minutes after the injection. Insulin lispro, also known as Humalog, is a rapid-acting insulin that starts working very quickly. Eating shortly after the injection helps match the food intake with the insulin action, reducing the risk of hypoglycemia. Choice B is incorrect because waiting 1 hour after the injection may lead to a mismatch between insulin activity and food intake. Choice C is incorrect as timing meals with lispro injections is essential to optimize glycemic control. Choice D is incorrect as eating 2 hours before the injection is not in alignment with the rapid action of insulin lispro and may lead to fluctuations in blood sugar levels.

3. The home health nurse provides teaching about insulin self-injection to a client who was recently diagnosed with diabetes mellitus. When the client begins to perform a return demonstration of an insulin injection into the abdomen, which instruction should the nurse provide?

• A. Select a different injection site
• B. Continue with the insulin injection
• C. Keep the skin flat rather than bunched
• D. Lie down flat for better skin exposure

Correct answer: B

Rationale: Choosing to continue with the insulin injection is the correct instruction in this scenario because it allows the client to demonstrate proper technique and reinforces their learning. Selecting a different injection site (choice A) is not necessary if the client is injecting into the abdomen as it is a suitable site. Keeping the skin flat rather than bunched (choice C) is a good practice but is not the priority in this situation where the client is demonstrating the injection technique. Lying down flat for better skin exposure (choice D) is not required and may not be practical for the client during routine self-injections.

4. The healthcare provider is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the healthcare provider question for this patient?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Clindamycin (Cleocin)
• D. Tetracycline (Sumycin)

Correct answer: D

Rationale: The correct answer is D, Tetracycline (Sumycin). Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth. Azithromycin, Clarithromycin, and Clindamycin are antibiotics that are generally safe for use in children and do not have the same tooth discoloration side effect as Tetracycline. Therefore, these antibiotics would be more appropriate choices for a 7-year-old patient.

5. A pregnant client tells the nurse, “I am experiencing a burning pain when I urinate.” How should the nurse respond?

• A. This means labor will start soon. Prepare to go to the hospital.
• B. You probably have a urinary tract infection. Drink more cranberry juice.
• C. Make an appointment with your provider to have your infection treated.
• D. Your pelvic wall is weakening. Pelvic muscle exercises should help.

Correct answer: C

Rationale: Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. Choice A is incorrect because burning pain during urination does not signify the start of labor. Choice B is incorrect because while cranberry juice may help prevent urinary tract infections, it is not a treatment. Choice D is incorrect because burning pain when urinating is not indicative of weakening pelvic muscles.

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