A newly diagnosed diabetic client is 24 hours post-op following abdominal surgery.
The 0700 blood glucose level is 200 mg/dl and the nurse administers 4 units of insulin aspart subcutaneously per the prescribed sliding scale.

When should the nurse first assess the client for signs and symptoms of hypoglycemia?

0800

0730

1130

1000

Answer and Explanation

The Correct Answer is B

Choice A rationale

Hypoglycemia, or low blood sugar, can occur after insulin administration. However, the onset of hypoglycemia is not immediate. Insulin aspart, a rapid-acting insulin, has a peak action time of approximately 1-3 hours after administration. Therefore, assessing the patient for signs and symptoms of hypoglycemia at 0800, one hour after administration, may be too early.

Choice B rationale

Assessing the patient for signs and symptoms of hypoglycemia at 0730, 30 minutes after insulin administration, is too early. The peak action time of insulin aspart is approximately 1-3 hours after administration. Therefore, the nurse should start assessing the patient for signs and symptoms of hypoglycemia closer to the time of peak action.

Choice C rationale

Assessing the patient for signs and symptoms of hypoglycemia at 1130, four and a half hours after insulin administration, may be too late. The peak action time of insulin aspart is approximately 1-3 hours after administration. Therefore, the nurse should start assessing the patient for signs and symptoms of hypoglycemia closer to the time of peak action.

Choice D rationale

Assessing the patient for signs and symptoms of hypoglycemia at 1000, three hours after insulin administration, is within the peak action time of insulin aspart. Therefore, this is the most appropriate time to start assessing the patient for signs and symptoms of hypoglycemia.

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Correct Answer is C

Explanation

Choice A rationale

Placing the patient back on the heparin infusion and redrawing laboratory values would not be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, the warfarin therapy is not yet fully effective, and there is no need to revert to heparin.

Choice B rationale

Asking the healthcare provider if the patient’s medication can be changed to rivaroxaban would not be the appropriate next step. Rivaroxaban is a different type of anticoagulant and would not necessarily be more effective in this situation.

Choice C rationale

Notifying the healthcare provider and asking if the dose of warfarin can be increased would be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, an increase in the warfarin dose may be necessary to achieve therapeutic anticoagulation.

Choice D rationale

Preparing to administer a dose of Vitamin K subcutaneously would not be the appropriate next step. Vitamin K is used to reverse the effects of warfarin and would be counterproductive in this situation.

A. NSAID such as ibuprofen. B. Antipyretic such as acetaminophen. C. Narcotic analgesic such as codeine. D. Anticonvulsant such as gabapentin.

Correct Answer is D

Explanation

Choice A rationale

NSAIDs such as ibuprofen are commonly used to manage pain and inflammation. However, they are not typically the first choice for treating phantom limb pain. Phantom limb pain is a complex condition that is thought to involve both peripheral and central mechanisms.

Choice B rationale

Antipyretics such as acetaminophen are used to reduce fever and relieve mild to moderate pain. However, they are not typically used as the primary treatment for phantom limb pain. This type of pain is often resistant to common analgesics, including acetaminophen.

Choice C rationale

Narcotic analgesics such as codeine can be used to manage severe pain. However, they are not typically the first choice for treating phantom limb pain due to the risk of dependency and the fact that this type of pain often does not respond well to opioids.

Choice D rationale

Anticonvulsants such as gabapentin are often used to manage neuropathic pain, including phantom limb pain. Gabapentin works by stabilizing electrical activity in the nervous system and altering the way the nerves send messages to the brain.

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Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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Naxlex Comprehensive Predictor Exams

A patient has been receiving warfarin sodium 2.5 mg PO daily for four days and the International Normalized Ratio (INR) is 1.9. What should be the nurse’s next step?

Correct Answer is C

Explanation

Choice B rationale

Choice C rationale

Choice D rationale

Which prescribed medication for the client recovering from a traumatic amputation does the nurse correlate to the treatment of phantom limb pain?

Correct Answer is D

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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