A client is ordered to receive insulin lispro (Humalog) at mealtimes. When should the nurse instruct the client to administer the medication?

Choice A rationale:

Uncontrolled diabetes mellitus: Corticosteroids can have a hyperglycemic effect, meaning they can raise blood sugar levels. This makes them generally unsuitable for use in patients with uncontrolled diabetes mellitus. In fact, corticosteroids might even worsen glycemic control in these patients. While corticosteroids might be used in some cases of diabetes mellitus, such as to treat diabetic retinopathy or nephropathy, they would be used cautiously and with close monitoring of blood sugar levels.

Choice B rationale:

A recent diagnosis of lung cancer: Corticosteroids are not a primary treatment for lung cancer. They might be used in some cases to help manage symptoms or side effects of other treatments, such as chemotherapy or radiation therapy. However, they would not typically be used as a first-line treatment for lung cancer itself.

Choice C rationale:

Acute exacerbation of COPD: Corticosteroids are a mainstay of treatment for acute exacerbations of COPD. They work by reducing inflammation in the airways, which helps to improve airflow and relieve symptoms such as wheezing, shortness of breath, and chest tightness. Corticosteroids can be given orally, intravenously, or by inhalation. The dose and duration of treatment will depend on the severity of the exacerbation.

Choice D rationale:

Chronic asthma: Corticosteroids are often used as a long-term control medication for chronic asthma. However, they are typically used at lower doses than those used for acute exacerbations of COPD. Inhaled corticosteroids are the preferred form of treatment for chronic asthma, as they deliver the medication directly to the airways and have fewer systemic side effects.

Choice A rationale:

Norepinephrine is a potent vasoconstrictor, meaning it narrows blood vessels. It primarily acts on arteries, but it can also constrict veins to a lesser extent.

Its primary actions are to increase systemic vascular resistance and blood pressure.

It is often used in conditions such as shock to raise blood pressure and improve perfusion to vital organs.

It is not a vasodilator and would not be appropriate for a patient requiring dilation of both arteries and veins.

Choice B rationale:

Nitroglycerin is a vasodilator that primarily acts on veins. It relaxes the smooth muscle in the walls of veins, which allows them to dilate and hold more blood.

This reduces the amount of blood returning to the heart, which in turn lowers preload and reduces cardiac workload.

Nitroglycerin is often used to treat angina pectoris, a condition characterized by chest pain due to insufficient blood flow to the heart.

While it can also have some vasodilatory effects on arteries, its primary action is on veins.

Choice C rationale:

Nitroprusside sodium (Nitropress) is a potent vasodilator that acts on both arteries and veins. It directly relaxes smooth muscle in the blood vessel walls, leading to dilation.

It is a very powerful vasodilator and can rapidly lower blood pressure.

It is often used in hypertensive emergencies to quickly reduce blood pressure and improve cardiac function.

It is also used in conditions such as congestive heart failure and acute aortic dissection to reduce afterload and improve cardiac output.

Choice D rationale:

Lidocaine is a local anesthetic agent that is primarily used to block nerve conduction. It does not have any direct vasodilatory effects.

It is sometimes used in the treatment of cardiac arrhythmias, but its mechanism of action in this setting is not related to vasodilation.