ATI RN
NP125 Med Surg Exam Questions
Extract:
Question 1 of 5
The patient's meal has been delivered, and the nurse checks the patient's pre-meal blood sugar. The result is 50 mg/dL. The patient is clammy, diaphoresis, and non-arousable. The next step the nurse should take is:
Correct Answer: B
Rationale: Administering 1 mg of glucagon intramuscularly stimulates glycogenolysis in the liver, increasing blood glucose levels. However, it is slower in onset compared to IV dextrose, which is critical in a non-arousable patient with a dangerously low blood glucose level of 50 mg/dL. Time efficiency is vital in this emergency. Administering 25 g of dextrose IV pushes glucose directly into the bloodstream, providing an immediate increase in blood glucose. This is the most appropriate action for a non-arousable, hypoglycemic patient. Normal blood glucose ranges between 70-100 mg/dL fasting, making this an emergency requiring prompt correction. Encouraging the patient to eat may be effective in mild hypoglycemia, but not for a critically low level like 50 mg/dL in a non-arousable patient. This delay can result in prolonged neuroglycopenic effects, worsening the patient's condition. Administering 7 units of Humalog insulin would worsen the hypoglycemia by facilitating glucose uptake into cells, which is contraindicated in this situation. Instead, glucose administration is required to correct the hypoglycemia immediately.
Question 2 of 5
Which insulin is used for basal dosing for 24-hour coverage and has no peak?
Correct Answer: D
Rationale: Lispro (Humalog) is a rapid-acting insulin used for mealtime glucose control. It has an onset of 15 minutes and peaks within 30 minutes to 1 hour, making it unsuitable for basal dosing. Aspart (NovoLog), another rapid-acting insulin, is similar to lispro in its onset and peak times. It is also used for mealtime glucose control, not basal glucose regulation. Regular insulin (Humulin R) is a short-acting insulin with an onset of 30 minutes to 1 hour and a peak of 2 to 4 hours. It cannot provide the steady basal glucose control required for 24-hour coverage. Glargine (Lantus) is a long-acting insulin that provides consistent basal glucose control with no pronounced peak. It is designed for once-daily dosing to maintain stable glucose levels over 24 hours, meeting the requirements for basal dosing.
Question 3 of 5
Which of the following is an important consideration when teaching carbohydrate counting to a diabetic patient?
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.
Question 4 of 5
If both Insulin glargine (Lantus) and insulin lispro (Humalog) are due simultaneously, the nurse can mix the two insulins in the same syringe and administer them as one injection.
Correct Answer: B
Rationale: Mixing insulin glargine and lispro in the same syringe is contraindicated due to their incompatible chemical formulations. Glargine's acidic pH alters lispro's effectiveness when mixed, impairing glycemic control. Separate administration preserves their individual pharmacokinetics and therapeutic actions. Separate injections ensure each insulin maintains its unique action profile. Glargine provides basal control, while lispro manages rapid postprandial spikes. Their chemical incompatibility mandates separate administration, optimizing glycemic management and reducing potential adverse effects from mixed formulations.
Question 5 of 5
The patient's meal has been delivered, the nurse checks the patient's pre-meal blood sugar, and the result is 243 mg/dL. The patient is awake, alert, hungry, and able to swallow. The next step the nurse should take is:
Correct Answer: D
Rationale: Administering dextrose IVP is inappropriate for hyperglycemia. It elevates blood sugar further, risking complications like hyperosmolar hyperglycemic state. It is used to treat severe hypoglycemia instead. Glucagon stimulates glycogen breakdown into glucose, increasing blood sugar. It is contraindicated in hyperglycemia, as it would aggravate elevated glucose levels. It is a treatment for severe hypoglycemia. Holding insulin allows hyperglycemia to persist, increasing risks of complications like ketoacidosis. Insulin administration is essential to reduce the glucose level safely. Rapid-acting insulin like Humalog reduces hyperglycemia efficiently, bringing preprandial blood glucose closer to the target range of 70-130 mg/dL. Administering 4 units is a reasonable corrective dose based on the blood glucose of 243 mg/dL.