Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered?

Correct Answer: D

Rationale: In managing diabetes, the timing of insulin administration is crucial to achieve optimal blood glucose control. The correct answer, option D - "At mealtime or within 15 minutes of meals," is the most appropriate timing for administering lispro insulin. Lispro insulin is a rapid-acting insulin that is designed to mimic the body's natural insulin response to meals. By administering lispro insulin at mealtime or shortly thereafter, it helps to cover the rise in blood sugar that occurs after eating, thus preventing postprandial hyperglycemia. Option A, "Only once a day," is incorrect because lispro insulin is a rapid-acting insulin that needs to be administered multiple times a day to match the body's natural insulin production and control blood sugar levels effectively throughout the day. Option B, "1 hour before meals," is incorrect because lispro insulin is a rapid-acting insulin that is designed to act quickly after administration. Administering it 1 hour before meals may lead to mismatched insulin action and mealtime glucose levels. Option C, "30 to 45 minutes before meals," is also incorrect because although it is closer to the correct timing, the peak action of lispro insulin is around 30 minutes after administration. Administering it too early before meals may lead to hypoglycemia before the meal is consumed. In an educational context, understanding the timing of insulin administration is fundamental for healthcare professionals caring for patients with diabetes. Proper insulin timing can help prevent complications such as hyperglycemia or hypoglycemia, leading to better management of the disease and improved patient outcomes. It is essential to educate both patients and healthcare providers on the appropriate timing of insulin administration to ensure safe and effective diabetes management.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer: Increased urine output, increased serum sodium, and decreased urine specific gravity. When a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is treated with water restriction, the goal is to correct the excess water retention and dilutional hyponatremia caused by the excessive release of antidiuretic hormone. The correct answer reflects the expected outcomes of effective treatment. With water restriction, the patient will excrete more water through increased urine output, leading to a reduction in total body water. As a result, the serum sodium concentration will increase back to normal levels, addressing the initial hyponatremia. The decrease in urine specific gravity indicates that the urine is becoming less concentrated as the body eliminates excess water. Now, let's analyze the other options: - Option A: This is incorrect as it suggests decreased serum sodium, which is the opposite of the expected outcome of treatment for SIADH. - Option C: This is incorrect as it suggests decreased urine output, which would not be expected with effective treatment for SIADH. - Option D: This is incorrect as it suggests decreased serum sodium, which is not the expected result of treatment for SIADH. Educationally, understanding the treatment and expected outcomes of SIADH is crucial for nurses and healthcare professionals to provide effective care to patients with this condition. Recognizing the signs of effective treatment, such as the changes in urine output, serum sodium levels, and urine specific gravity, is essential for monitoring the patient's response to therapy and ensuring positive outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Monitor for vital signs and cardiac rhythm response to activity. The nurse should monitor vital signs and cardiac rhythm in a patient with hypothyroidism experiencing fatigue because hypothyroidism can lead to a decrease in metabolic rate, cardiovascular function, and overall energy levels. Monitoring these parameters can help in assessing the patient's response to activity and detecting any potential complications such as bradycardia or cardiovascular strain. Option A) Monitor for changes in orientation, cognition, and behavior, though important in assessing neurological status, is not the priority in this case as the primary concern is addressing the physiological effects of hypothyroidism on the cardiovascular system. Option C) Monitoring bowel movements is more related to gastrointestinal function and may not directly address the fatigue associated with hypothyroidism. Option D) While assisting in developing well-balanced meal plans is important for overall health, it is not the immediate priority for managing fatigue in a hypothyroid patient. Educationally, this question highlights the importance of prioritizing nursing interventions based on the patient's condition and the expected physiological effects. It emphasizes the need for nurses to understand the specific manifestations of hypothyroidism and how they impact patient care.

Correct Answer: B

Rationale: The correct answer is B) Administering β-adrenergic blockers. In the management of a patient with pheochromocytoma, the priority nursing intervention is to administer β-adrenergic blockers. Pheochromocytoma is a rare tumor of the adrenal gland that can cause excessive release of catecholamines, leading to severe hypertension and other cardiovascular complications. β-adrenergic blockers help counteract the effects of excess catecholamines, such as high blood pressure and tachycardia, which are common in patients with pheochromocytoma. Option A) Administering IV fluids is not the priority intervention in this case because fluid administration may exacerbate hypertension in patients with pheochromocytoma due to the excess catecholamine release. Option C) Monitoring blood pressure is important but not the priority over administering β-adrenergic blockers to address the underlying cause of hypertension. Option D) Monitoring intake and output and daily weights is a routine nursing intervention but does not address the immediate need to control the cardiovascular effects of excess catecholamines in pheochromocytoma. Educational Context: Understanding the pathophysiology of pheochromocytoma and the role of β-adrenergic blockers in managing its cardiovascular manifestations is crucial for nursing practice. Prioritizing interventions based on the acute needs of the patient can prevent complications and optimize outcomes in such critical situations.

Correct Answer: B

Rationale: Rationale: The correct answer is B) 4-6 P.M. because Lente insulin typically peaks around 4-12 hours after administration. Since Mr. Johnson received his dose at 7:30 A.M., the time frame of 4-6 P.M. aligns with when he is most likely to experience hypoglycemia due to the peak action of the insulin. Monitoring during this window allows for timely intervention if his blood sugar drops too low. Option A) 10-11 A.M. is too soon after the dose for hypoglycemia to typically occur as Lente insulin does not peak this early. Option C) between 2 A.M. and breakfast is incorrect as it does not coincide with the expected peak action time of Lente insulin. Option D) immediately after the injection is also incorrect as hypoglycemia is not an immediate risk with Lente insulin but rather occurs later due to its slower onset and longer duration of action. Educationally, understanding the timing of insulin action is crucial for healthcare providers to ensure patient safety and effective management of diabetes. By knowing when to expect peak effects and potential side effects like hypoglycemia, healthcare professionals can provide appropriate care and support to patients like Mr. Johnson.