A nurse is caring for a client who has a hyperkalemia and is receiving insulin therapy. Which of the following should the nurse recognize as an adverse outcome?

Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L)

Serum sodium 138 mEq/L (136 to 145 mEq/L)

Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL)

Serum glucose 58 mg/dL (74 to 106 mg/dL)

Answer and Explanation

The Correct Answer is D

A. Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L): A normal potassium level suggests effective treatment of hyperkalemia.

B. Serum sodium 138 mEq/L (136 to 145 mEq/L): This is within the normal sodium range and unrelated to the adverse effects of insulin therapy.

C. Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL): This is within the normal calcium range, unaffected by insulin therapy for hyperkalemia.

D. Serum glucose 58 mg/dL (74 to 106 mg/dL): Hypoglycemia is a potential adverse effect of insulin therapy because insulin drives glucose into cells, lowering blood sugar.

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Correct Answer is A

Explanation

A. Fasting blood glucose 155 mg/dL (70-105): A fasting blood glucose of 155 mg/dL exceeds the threshold for diabetes risk (≥126 mg/dL). This result strongly indicates impaired glucose regulation or diabetes mellitus.

B. Casual blood glucose 178 mg/dL (less than 200): Casual glucose <200 mg/dL does not meet the diagnostic criteria for diabetes or prediabetes, as casual glucose ≥200 mg/dL is diagnostic of diabetes in symptomatic individuals.

C. HbA1c 5.2% (49%-69%): HbA1c levels ≥5.7% indicate prediabetes, and ≥6.5% is diagnostic of diabetes. This value is within the normal range.

D. 2-hr blood glucose 132 mg/dL (less than 200): A 2-hour glucose level after an oral glucose tolerance test (OGTT) of 140-199 mg/dL indicates prediabetes, and ≥200 mg/dL confirms diabetes. This value does not indicate risk.

A. "I will use Lantus insulin immediately before each meal." B. "I should shake the bottle of insulin before withdrawing the medication." C. "Insulin injected into the thigh is the most rapidly absorbed." D. "Unopened vials of insulin should be kept in my refrigerator."

Correct Answer is D

Explanation

A. "I will use Lantus insulin immediately before each meal.": Lantus (insulin glargine) is a long-acting insulin designed to provide basal glucose control and should not be used before meals.

B. "I should shake the bottle of insulin before withdrawing the medication.": Insulin should be gently rolled, not shaken, to avoid air bubbles or degradation of the insulin.

C. "Insulin injected into the thigh is the most rapidly absorbed.": The abdomen has the fastest absorption rate for insulin injections, followed by the arm, thigh, and buttocks.

D. "Unopened vials of insulin should be kept in my refrigerator.": Insulin should be refrigerated until opened to maintain potency. Once opened, it can be kept at room temperature for up to 28 days.

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A nurse is caring for a client who has a hyperkalemia and is receiving insulin therapy. Which of the following should the nurse recognize as an adverse outcome?

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