Correct Answer: A,B,D

Rationale: Keeping the patient NPO minimizes gastrointestinal motility and prevents further accumulation of intestinal contents, reducing the risk of perforation and worsening obstruction. Bowel rest is crucial in promoting resolution. Nasogastric tube placement alleviates distention by decompressing the stomach and removing gastric contents, reducing vomiting and the risk of aspiration while improving patient comfort. Rectal tubes are not effective in decompressing small bowel obstructions since the obstruction prevents material from reaching the rectum. Frequent oral care prevents mucosal dryness and infection risk in patients who are NPO and receiving suction therapy, promoting overall oral hygiene.

Correct Answer: A

Rationale: Lispro (Humalog) is a rapid-acting insulin analog designed for mealtime glucose control. It begins action within 15 minutes, peaks in 1 hour, and lasts 2 to 4 hours. Its quick onset matches postprandial glucose spikes, enhancing glycemic control during meals and preventing hyperglycemia from carbohydrate intake. Glargine (Lantus) is a long-acting basal insulin with no peak and prolonged action. It does not target mealtime spikes but provides steady glucose control over 24 hours. Its slow onset and constant release profile are unsuitable for immediate postprandial glucose management. Detemir (Levemir) is a long-acting basal insulin, similar to glargine, with extended action for baseline glucose control. It lacks the rapid onset needed for mealtime management, making it inappropriate for postprandial hyperglycemia control, as observed in Lispro efficacy. NPH (Humulin N) is an intermediate-acting insulin with delayed onset and peak activity. It supports baseline glucose regulation but fails to address mealtime glucose control promptly. Its time profile does not align with the immediate needs of postprandial hyperglycemia management.

Correct Answer: A

Rationale: Assisting the patient to the bathroom is within the scope of practice for a Nursing Aide (N
A) and does not require advanced training, making it an appropriate task to delegate while ensuring patient needs are met. Teaching weight-bearing precautions involves patient education, which is the responsibility of the Registered Nurse (RN) due to the need for professional judgment and instruction clarity. Pain level assessment requires critical thinking and professional judgment, which are within the RN's scope of practice. This cannot be delegated to an NA. Instruction on incentive spirometer use requires understanding of therapeutic goals, patient capability, and respiratory assessment, tasks specific to the RN and beyond the scope of an NA.

Correct Answer: F

Rationale: Dextrose IVP is unnecessary with hyperglycemia. It increases the glucose level further, risking complications like hyperosmolar hyperglycemic state. This treatment is reserved for severe hypoglycemia. Glucagon raises blood glucose and is contraindicated for hyperglycemia. It is used to treat hypoglycemia, not elevated glucose levels seen here. Holding insulin neglects hyperglycemia management, allowing complications like ketoacidosis or delayed glucose control. Insulin is necessary to address elevated blood sugar. Calling the MD delays hyperglycemia treatment unnecessarily, as nurses can administer insulin per protocols in cases like this. Administering 15 units of Humalog risks inducing hypoglycemia. It is an excessive dose given the glucose level of 243 mg/dL. Administering 4 units of Humalog is an appropriate corrective dose for a pre-meal glucose of 243 mg/dL. Rapid-acting insulin efficiently reduces glucose to safer levels, aligning with treatment protocols. Administering 9 units of Humalog risks overcorrecting hyperglycemia, potentially causing hypoglycemia, as it exceeds typical sliding scale guidelines for this glucose level. Administering 5 units of Humalog could be reasonable for slight hyperglycemia, but it is not specifically aligned with the sliding scale dose appropriate for 243 mg/dL.

Correct Answer: B

Rationale: Estimating carbohydrate content rather than measuring can lead to inaccuracies in blood sugar control for diabetic patients. Precise carbohydrate counting is essential for maintaining glycemic control and preventing hyperglycemia or hypoglycemia, making this approach unsuitable in diabetes education. Balancing carbohydrate intake with insulin or medication is a critical aspect of diabetes management. This ensures stable blood glucose levels as insulin dosage or medication is adjusted according to the patient's carbohydrate consumption, providing personalized glycemic control effectively. Avoiding all carbohydrates is not a realistic or scientifically sound recommendation, as carbohydrates are essential for energy production. Teaching portion control and healthy carbohydrate choices is more effective for diabetic management than complete avoidance. Counting carbohydrates from sugary foods alone ignores the contribution of complex carbohydrates to blood glucose levels. A comprehensive approach that considers all sources of carbohydrates ensures accurate diabetes education and better long-term blood sugar control.