1 :

The client is a 26-year-old female with acute appendicitis. She has a 12-year history of type 1 diabetes and no other significant medical history. The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.

0730

Admitted the client. She is awake and alert. She rates her pain 2/10. Her pulses are equal bilaterally. Heart rate is 76 beats per minute, normal sinus rhythm. Her oxygen saturation is 100% on room air. She has a gauze dressing over her surgical site, which is clean and dry. Her temperature is 98.5° F (37° C). She urinated 50 ml upon arrival in the unit and is stating she is very thirsty. The patient states her last insulin glargine dose was this morning before surgery.

0745

  1. 2 units insulin lispro given 1800
  2. 12 units insulin glargine given
  3. The client ate 45 carbohydrates from her dinner tray. 3 units of insulin lispro given.

 

  1. Admit to the surgical floor
  2. Dextrose 5% and 0.9% sodium chloride to infuse at 125 mL/hr
  3. Advance diet as tolerated
  4. Insulin glargine 12 units subcutaneous every 12 hours
  5. Ceftriaxone 2 g IV every 24 hours for 3 days, first dose given in surgery
  6. Insulin lispro 1 unit subcutaneously per 15 carbohydrates

The nurse is preparing the client for discharge and discussing home medications. What home medications may affect the amount of insulin needed by the client? Select all that apply.


Answer Options

Hint : Some drugs raise blood sugar or lower insulin sensitivity.

Correct Answers:

  • Corticosteroids
  • Oral contraceptives
  • Epinephrine


Rationale :

B. Corticosteroids

🟣 Corticosteroids (e.g., prednisone) increase hepatic gluconeogenesis and decrease insulin sensitivity in peripheral tissues, leading to hyperglycemia.

🟣 These medications raise blood glucose levels, often necessitating an increase in basal and prandial insulin doses.

🟣 This effect is especially significant in clients with type 1 diabetes, where exogenous insulin is required to prevent ketoacidosis.

🟣 Close monitoring of glucose levels is essential when a client is placed on corticosteroids, even temporarily.

D. Oral contraceptives

🟡 Oral contraceptives contain estrogen and/or progesterone, which can cause insulin resistance over time.

🟡 These hormones affect glucose metabolism by increasing circulating glucose and potentially impairing glucose tolerance.

🟡 Women with diabetes taking oral contraceptives may require adjustments to insulin regimens, especially if glycemic control worsens.

🟡 Monitoring hemoglobin A1c and fasting glucose can help guide any required changes in insulin dosing.

E. Epinephrine

🔵 Epinephrine, a stress hormone, promotes glycogenolysis and gluconeogenesis, both of which raise blood sugar levels rapidly.

🔵 It also inhibits insulin secretion and increases insulin resistance, requiring additional insulin to maintain euglycemia.

🔵 In emergency settings or for chronic use (e.g., asthma inhalers), this effect is significant for type 1 diabetic clients.

🔵 Blood glucose should be closely monitored if epinephrine is used, especially during periods of physical or emotional stress.


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2 :

Hint : Fiber prevents straining.

Correct Answers:

  • Explain the benefits of a high fiber diet.


Rationale :

✅ High-fiber diets soften stool and reduce straining, which helps prevent irritation and worsening of hemorrhoids.

✅ Nuts and seeds are actually rich in fiber, so eliminating them may reduce overall fiber intake unless replaced appropriately.

✅ The nurse should clarify any misconceptions and educate that dietary fiber is essential in preventing constipation, a major contributor to hemorrhoids.

✅ Encouraging whole grains, fruits, vegetables, and adequate fluids is critical in long-term hemorrhoid management.


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3 :

Hint : Listeria risk = deli meats.

Correct Answers:

  • Opened package of deli sliced meats.


Rationale :

🥪 Deli meats, once opened, are highly prone to bacterial contamination, particularly Listeria monocytogenes, even when refrigerated at 40°F (4.4°C).

🥪 Listeria thrives in cold environments, making deli meats unsafe after 2+ days, especially for pregnant, elderly, or immunocompromised clients.

🥪 These products should be used within 3–5 days of opening and ideally consumed earlier in high-risk populations.

🥪 Proper storage and timely consumption are crucial to prevent foodborne illness from Listeria.


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4 :

Hint : Soft protein helps heal.

Correct Answers:

  • High protein soft diet.


Rationale :

🍳 A high-protein soft diet supports tissue healing and immune function, both of which are critical in clients receiving chemotherapy.

🍳 Stomatitis causes oral pain and inflammation, making chewing and swallowing difficult—soft foods are more tolerable.

🍳 Adequate protein intake prevents further weight loss and muscle wasting, which are common with cancer treatment.

🍳 Foods like soft scrambled eggs, yogurt, and mashed beans fit well within this dietary recommendation.


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5 :

Hint : Vitamin C aids iron.

Correct Answers:

  • Orange juice.


Rationale :

🍊 Vitamin C in orange juice enhances non-heme iron absorption by converting it into a more bioavailable form.

🍊 Iron in oatmeal and other plant sources requires acidic assistance to be properly absorbed by the gut.

🍊 Beverages like coffee or tea inhibit iron absorption, making orange juice a superior pairing for iron-rich meals.

🍊 This is especially important for clients recovering from blood loss and anemia.


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6 :

Hint : I&O reflects fluid status.

Correct Answers:

  • Review the intake and output record.


Rationale :

🧠 Confusion in older adults may result from fluid and electrolyte imbalances, often reflected in intake and output trends.

🧠 Reviewing the I&O record helps identify dehydration or fluid overload, both of which can alter mental status.

🧠 Early detection through I&O tracking allows for prompt hydration or diuresis interventions, depending on the underlying issue.

🧠 Monitoring fluids is a key assessment step before assuming cognitive decline in elderly clients.


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7 :

Hint : Dysphagia + liquids = risk.

Correct Answers:

  • Client experiencing dysphagia who is prescribed a full liquid diet.


Rationale :

🥤 Dysphagia significantly increases the risk for aspiration, especially when consuming thin liquids like soups or milk.

🥤 A full liquid diet without thickened consistency modifications can lead to choking or aspiration pneumonia.

🥤 Clients with swallowing difficulties require careful assessment and possibly speech therapy recommendations for safer textures.

🥤 Preventing aspiration is essential to avoid respiratory complications and ensure safe nutritional intake.


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8 :

Hint : Replace electrolytes, not just fluid.

Correct Answers:

  • Consume a sports drink before and during training.


Rationale :

🏃 Sports drinks provide electrolytes such as sodium, potassium, and magnesium, which are lost through sweat.

🏃 These electrolytes help prevent muscle cramps that occur during prolonged physical exertion.

🏃 Water alone may not replenish electrolyte deficits, especially for long-distance runners or endurance athletes.

🏃 Consuming the drink before and during activity ensures better hydration and muscle function.


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9 :

Hint : Less sodium = less strain.

Correct Answers:

  • Restrict sodium rich foods and excessive oral fluids.


Rationale :

🧂 Clients with glomerulonephritis often have fluid retention and hypertension due to reduced kidney filtration.

🧂 Sodium promotes water retention, exacerbating edema and cardiovascular strain in these clients.

🧂 Limiting fluid intake helps prevent overload and allows the kidneys to manage excretion more effectively.

🧂 This restriction helps control symptoms and prevent progression of kidney damage.


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10 :

Hint : Vision improves with Vitamin A.

Correct Answers:

  • "I can see at night when I wake up now."


Rationale :

🌙 Vitamin A is vital for the formation of rhodopsin, a photopigment in the retina essential for night vision.

🌙 Night blindness is an early symptom of Vitamin A deficiency, particularly in malnourished children.

🌙 Improved night vision suggests the child’s vitamin A levels are being adequately restored through supplements.

🌙 This statement demonstrates a functional improvement, validating effective nutritional intervention.


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Total Questions: 10

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