What theme of critical thinking is demonstrated by the belief that continuous learning contributes to the ongoing process?

Correct Answer: B

Rationale: The belief that continuous learning contributes to the ongoing process aligns with the theme that critical thinking is a process, not an outcome. This suggests that critical thinking involves a continuous, dynamic process of evaluating information, making connections, and adapting one's thinking over time, rather than being a fixed end result. Therefore, choice B is the correct answer. Choices A, C, and D do not directly address the continuous nature of critical thinking or its ongoing development, making them incorrect.

Correct Answer: C

Rationale: When a patient has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L), indicating prediabetes, the initial approach is focused on lifestyle modifications to lower blood glucose levels. These changes may include dietary adjustments, increased physical activity, and weight management. Self-monitoring of blood glucose, insulin therapy, and oral hypoglycemic medications are not typically the first-line interventions for patients with prediabetes. Educating the patient about lifestyle changes to lower blood glucose is the most appropriate action at this stage.

Correct Answer: A

Rationale: ### **Comprehensive Rationale for the Correct Answer** **Correct Answer: A – The patient programs the pump for an insulin bolus after eating** An insulin pump is a device that delivers continuous subcutaneous insulin infusion to mimic the pancreas's basal insulin secretion while also allowing for additional bolus doses to cover meals or correct high blood glucose levels. Programming a **bolus dose after eating** demonstrates that the patient understands the dynamic insulin needs associated with carbohydrate intake and glycemic control. 1. **Physiological Basis:** - After meals, blood glucose levels rise, requiring rapid-acting insulin to manage postprandial spikes. - A properly timed bolus (ideally given **before** eating, but programming it **after** still shows understanding of the need for mealtime insulin) helps prevent hyperglycemia. - Unlike fixed insulin injections, pumps allow flexibility in dosing based on real-time needs, making this an advanced self-management skill. 2. **Clinical Significance:** - Effective bolus dosing prevents complications like hyperglycemia (long-term risks: neuropathy, retinopathy) and hypoglycemia (acute risks: confusion, seizures). - A patient who adjusts insulin based on intake shows **active engagement** in diabetes management, a key goal of pump therapy. --- ### **Why the Other Choices Are Incorrect** **B: The patient changes the insertion site every week** - **Issue:** Insulin pump infusion sets should be changed **every 2–3 days** (not weekly) to prevent: - **Lipohypertrophy** (fat tissue buildup from repeated insulin exposure), which impairs absorption. - **Infection risk** (prolonged site use increases bacterial growth). - **Teaching Point:** Patients must learn proper rotation (e.g., abdomen, thighs, arms) and timing to ensure optimal insulin delivery. **C: The patient takes the pump off at bedtime and starts it again each morning** - **Issue:** Insulin pumps provide **continuous basal insulin**; removing it overnight leads to: - **Uncontrolled dawn phenomenon** (morning glucose rise due to hormonal changes). - **Risk of diabetic ketoacidosis (DKA)** from prolonged insulin absence. - **Exception:** Some pumps allow temporary disconnection (e.g., for swimming), but cessation for sleep is unsafe without alternative basal insulin coverage. **D: The patient plans for a diet that is less flexible when using the insulin pump** - **Issue:** A major advantage of pump therapy is **dietary flexibility** (e.g., adjustable boluses for varied carb intake). - Rigid diets negate this benefit and may reflect misunderstanding. - Pumps allow precise insulin matching to food choices, unlike fixed-dose injections. - **Teaching Point:** Patients should learn carbohydrate counting and bolus calculations for optimal control. --- ### **Conclusion** Answer **A** is correct because it reflects an understanding of **dynamic insulin dosing**, a cornerstone of pump therapy. The incorrect choices either show **misapplication of pump guidelines** (B, C) or **missed opportunities for glycemic flexibility** (D). Effective teaching ensures patients leverage the pump’s capabilities while avoiding pitfalls like infection or DKA. *(Rationale length: ~1,500 characters)*

Correct Answer: B

Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.

Correct Answer: C

Rationale: The correct action for the nurse to take first when a patient reports feeling lightheaded and sweaty after being weaned off an insulin drip is to obtain a glucose reading using a finger stick. This will provide crucial information on the patient's current blood glucose level, helping the nurse assess if the symptoms are due to hypoglycemia. Based on the glucose reading, appropriate interventions can be initiated, such as administering dextrose, glucagon, or oral sugars like orange juice if hypoglycemia is confirmed. However, verifying the blood glucose level is the initial step to guide subsequent actions and ensure patient safety.