A client has been prescribed insulin based on carbohydrate counting adjustments. The carbohydrate ratio is 1:10, the premeal target blood sugar is 110, and the high blood sugar correction factor is 50. The client’s premeal blood sugar was 225 and they consumed the following for dinner: 6 ounces baked chicken breast (0 g), 1 cup brown rice (45 g), 1 cup steamed broccoli (12 g), 2 TBS margarine (0 g). How many units of insulin will the nurse administer for the carbohydrates that were consumed?

4.5 units

5.7 units

6.2 units

7.1 units

Answer and Explanation

The Correct Answer is B

Choice A rationale
This choice suggests that the nurse would administer 4.5 units of insulin for the carbohydrates consumed. However, this is not accurate. The carbohydrate ratio is 1:10, meaning 1 unit of insulin is needed for every 10 grams of carbohydrates. The client consumed 57 grams of carbohydrates (45g from rice + 12g from broccoli). Therefore, the calculation would be 57g ÷ 10 = 5.7 units of insulin. This choice underestimates the amount of insulin needed, which could lead to hyperglycemia, or high blood sugar.
Choice B rationale
This choice is correct. The client’s carbohydrate ratio is 1:10, meaning 1 unit of insulin is needed for every 10 grams of carbohydrates. The client consumed 57 grams of carbohydrates (45g from rice + 12g from broccoli). Therefore, the calculation would be 57g ÷ 10 = 5.7 units of insulin. This amount of insulin would help to properly metabolize the carbohydrates consumed and maintain the client’s blood sugar within the target range.
Choice C rationale
This choice suggests that the nurse would administer 6.2 units of insulin for the carbohydrates consumed. However, this is not accurate. The carbohydrate ratio is 1:10, meaning 1 unit of insulin is needed for every 10 grams of carbohydrates. The client consumed 57 grams of carbohydrates (45g from rice + 12g from broccoli). Therefore, the calculation would be 57g ÷ 10 = 5.7 units of insulin. This choice overestimates the amount of insulin needed, which could lead to hypoglycemia, or low blood sugar.
Choice D rationale
This choice suggests that the nurse would administer 7.1 units of insulin for the carbohydrates consumed. However, this is not accurate. The carbohydrate ratio is 1:10, meaning 1 unit of insulin is needed for every 10 grams of carbohydrates. The client consumed 57 grams of carbohydrates (45g from rice + 12g from broccoli). Therefore, the calculation would be 57g ÷ 10 = 5.7 units of insulin. This choice significantly overestimates the amount of insulin needed, which could lead to hypoglycemia, or low blood sugar.

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Correct Answer is B

Explanation

Choice A rationale
Fluid retention is a common side effect of prednisone, but it is not directly associated with compression fractures of the vertebrae.
Choice B rationale
Long-term use of prednisone can lead to osteoporosis, a condition that weakens bones and makes them more likely to break. Osteoporosis can increase the risk of fractures, including compression fractures of the vertebrae. This is likely the adverse effect of prednisone that is most associated with the client’s findings.
Choice C rationale
Adrenal insufficiency is a potential side effect of long-term prednisone use. However, it is not directly linked to compression fractures of the vertebrae.
Choice D rationale
While gastrointestinal bleeding can occur with prednisone use, it is not directly related to compression fractures of the vertebrae.

A. A client with a hip fracture and is on bedrest for 4 weeks B. A client who has severe pain and is prescribed morphine C. A client who is post-operative and is on a clear liquid diet D. A client with recent a stroke and has difficulty swallowing

Correct Answer is D

Explanation

Choice A rationale
A client with a hip fracture and is on bedrest for 4 weeks may indeed experience constipation due to decreased physical activity. However, this situation would not necessarily require the nurse to question the order for psyllium. Psyllium is a bulk-forming laxative that can help relieve constipation by increasing stool bulk and improving bowel regularity.
Choice B rationale
Morphine is an opioid medication that can cause constipation as a side effect. Therefore, a client who is experiencing severe pain and is prescribed morphine may benefit from a laxative like psyllium to help manage opioid-induced constipation. This situation would not necessarily require the nurse to question the order for psyllium.
Choice C rationale
A client who is post-operative and is on a clear liquid diet may experience constipation due to the low fiber content of the diet. However, this situation would not necessarily require the nurse to question the order for psyllium. Once the client progresses to a regular diet, psyllium can help add bulk to the stool and promote regular bowel movements.
Choice D rationale
This choice is correct. A client with a recent stroke who has difficulty swallowing may be at risk for aspiration, or the inhalation of food or liquid into the lungs, when taking psyllium. Psyllium is a bulk-forming laxative that absorbs water in the intestines to form a softer, bulkier stool. If a client with swallowing difficulties were to aspirate the psyllium, it could potentially expand in the lungs when it comes into contact with moisture, leading to serious complications. Therefore, the nurse should question the order for psyllium in this situation.

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Naxlex Comprehensive Predictor Exams

A client with asthma has been taking prednisone daily for two years and is now in the emergency department complaining of back pain. An MRI of the spine shows a compression fracture of a vertebra. Which adverse effect of prednisone is most likely associated with these findings?

Correct Answer is B

Explanation

The physician orders psyllium for constipation. Which client situation would require the nurse to his order?

Correct Answer is D

Explanation

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