A client admitted to the emergency department with deep rapid respirations, fruity breath odor, and blood glucose of 520 mg/dL. Which insulin administration method is most appropriate?

Subcutaneous glargine

Intramuscular lispro

Subcutaneous NPH

Intravenous regular insulin

Answer and Explanation

The Correct Answer is D

Rationale:

A. Glargine is a long-acting, basal insulin with a peakless effect. It is not suitable for acute hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), because it does not act quickly enough to reduce dangerously high blood glucose levels.

B. Lispro is a rapid-acting insulin, but intramuscular injection is not standard; it is administered subcutaneously. IM absorption can be unpredictable and may not provide reliable glucose lowering in emergencies.

C. NPH is an intermediate-acting insulin with delayed onset (1–2 hours) and a peak at 4–12 hours. It cannot rapidly lower blood glucose in an acute hyperglycemic crisis, making it inappropriate for emergency management.

D. Regular insulin given IV acts immediately and can be titrated continuously to rapidly reduce blood glucose in emergencies like DKA. IV administration allows close monitoring of glucose and potassium levels and is considered the standard of care for acute hyperglycemic crises in hospitalized patients.

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Correct Answer is A

Explanation

Rationale:

A. HbA1C reflects average blood glucose over approximately 2–3 months by measuring the percentage of hemoglobin molecules that are glycated. This provides a long-term view of glucose control, helping guide therapy adjustments and predict risk for complications such as retinopathy, nephropathy, and neuropathy.

B. HbA1C does not measure ketones. Ketone testing is performed via urine dipstick or blood beta-hydroxybutyrate, which is used to detect ketoacidosis, not long-term glucose control.

C. Fasting blood glucose or point-of-care glucose testing reflects current blood sugar, not long-term control. HbA1C provides a historical average, rather than a single snapshot.

D. HbA1C does not measure pancreatic function or insulin production. Tests such as C-peptide or insulin levels are used to assess endogenous insulin production.

A. Increase fluid intake B. Use stool softeners or bulk-forming agents C. Limit physical activity D. Encourage high-fiber foods E. Schedule regular bowel times

Correct Answer is ["A","B","D","E"]

Explanation

Rationale:

A. Adequate hydration is crucial for softening stool and promoting bowel motility, especially in MS patients who may have neurogenic bowel or decreased mobility. Insufficient fluid intake can lead to hard, dry stools, worsening constipation and increasing the risk of complications like hemorrhoids or fecal impaction.

B. Medications such as docusate (stool softener) or psyllium (bulk-forming fiber) can help prevent straining and make bowel movements easier. In MS, nerve damage may reduce peristalsis and bowel coordination, so these agents support regularity and prevent complications associated with chronic constipation.

C. Physical activity stimulates the gastrointestinal tract and bowel motility. In MS patients, immobility already contributes to constipation due to slower colonic transit. Limiting activity would aggravate constipation. Gentle exercise, such as walking or stretching, should be encouraged to improve bowel function.

D. Fiber increases stool bulk and water retention, which helps stimulate peristalsis and improve regularity. Foods like whole grains, fruits, and vegetables are recommended. Low-fiber diets, common in some MS patients due to chewing/swallowing difficulties or diet restrictions, can worsen constipation.

E. Establishing a consistent routine, often after meals to take advantage of the gastrocolic reflex, encourages predictable bowel movements. This is especially important in MS clients with neurogenic bowel, who may have decreased sensory awareness of the need to defecate. Ignoring this can lead to infrequent, difficult, or incomplete bowel movements.

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A client admitted to the emergency department with deep rapid respirations, fruity breath odor, and blood glucose of 520 mg/dL. Which insulin administration method is most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient asks why the doctor ordered an HbA1C test instead of just checking fasting blood sugar. The nurse's best response is:

Correct Answer is A

Explanation

The nurse is developing a plan of care for an MS client with constipation. Which interventions are appropriate? SELECT ALL THAT APPLY

Correct Answer is ["A","B","D","E"]

Explanation

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