Nursing Elites

1. 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.

2. Which of the following symptoms would be most concerning in a client with diabetes insipidus?

• A. Polydipsia
• B. Polyuria
• C. Nocturia
• D. Hypertension

Correct answer: D

Rationale: In a client with diabetes insipidus, excessive thirst (polydipsia) and excessive urination (polyuria) are expected symptoms due to the inability to concentrate urine, leading to dilute urine production. Nocturia, waking up at night to urinate, is also common. However, hypertension is not a typical symptom of diabetes insipidus. The correct answer is D because hypertension may indicate a complication such as dehydration or electrolyte imbalances, which would require further assessment in a client with diabetes insipidus.

3. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:

• A. Elevated serum bicarbonate and decreased blood pH.
• B. Signs of hypoglycemia earlier than expected.
• C. Symptoms of hyperglycemia due to NPH insulin peak time.
• D. Presence of sugar in the urine.

Correct answer: B

Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.

4. A client with hyperparathyroidism is being assessed. Which of the following symptoms is the nurse likely to find?

• A. Tetany
• B. Hypocalcemia
• C. Bone pain
• D. Hypotension

Correct answer: C

Rationale: In hyperparathyroidism, there is excessive production of parathyroid hormone, leading to increased calcium resorption from the bones. This process causes bone pain, making choice C the correct answer. Tetany (choice A) is associated with hypocalcemia, not hyperparathyroidism. Hypocalcemia (choice B) is the opposite condition of hyperparathyroidism, where blood calcium levels are elevated. Hypotension (choice D) is not a typical symptom of hyperparathyroidism.

5. The client with type 1 DM asks why it is necessary to rotate injection sites when managing insulin therapy. The nurse's best response is:

• A. It helps prevent skin irritation.
• B. It helps prevent scar tissue buildup.
• C. It ensures more consistent insulin absorption.
• D. It makes the injections less painful.

Correct answer: C

Rationale: Rotating injection sites is necessary to ensure more consistent insulin absorption. This practice helps maintain stable blood glucose levels by preventing the formation of lipohypertrophy (fatty lumps under the skin) at injection sites. Choices A and B are incorrect as the primary purpose of rotating injection sites is not focused on preventing skin irritation or scar tissue buildup. While rotating injection sites may contribute to reducing pain over time, the primary benefit is the consistency in insulin absorption to support glycemic control, making choice D less relevant.

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