A nurse is collecting data from a client with diabetes mellitus who is confused, flushed, and has an acetone odor on breath. The nurse should anticipate a prescription for which insulin?
Glargine
Regular
NPH
Detemir
The Correct Answer is B
Choice A reason: Glargine is a long-acting insulin providing basal coverage, not suitable for acute diabetic ketoacidosis (DKA). DKA, indicated by confusion, flushing, and acetone breath, requires rapid correction of hyperglycemia and acidosis. Glargine’s slow onset cannot address acute metabolic decompensation effectively, making it inappropriate for this scenario.
Choice B reason: Regular insulin is short-acting, ideal for treating diabetic ketoacidosis, as indicated by confusion, flushing, and acetone breath. It rapidly lowers blood glucose and corrects acidosis by facilitating glucose uptake and inhibiting ketogenesis, addressing the acute metabolic crisis effectively through intravenous administration.
Choice C reason: NPH is an intermediate-acting insulin, unsuitable for acute DKA management. Its slower onset and prolonged action do not provide the rapid glucose and ketone correction needed in DKA, where confusion and acetone breath indicate severe metabolic acidosis requiring immediate intervention with short-acting insulin.
Choice D reason: Detemir, a long-acting insulin, is used for basal glucose control, not acute DKA. Its gradual onset does not address the urgent need to correct hyperglycemia and ketosis in a patient with confusion and acetone breath, which require rapid-acting insulin to stabilize metabolic derangements quickly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Gestational diabetes involves insulin resistance due to placental hormones, not primarily beta cell failure to respond to insulin. It occurs during pregnancy and usually resolves post-delivery, making it distinct from type 2 diabetes, where insulin resistance and beta cell dysfunction are chronic.
Choice B reason: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency, not beta cells failing to respond to insulin. The lack of insulin production distinguishes it from type 2, where insulin resistance is the primary issue.
Choice C reason: Type 2 diabetes is characterized by insulin resistance, where peripheral tissues and beta cells fail to respond effectively to insulin, combined with progressive beta cell dysfunction. This leads to relative insulin deficiency, making this the correct diagnosis for the described pathophysiology.
Choice D reason: Impaired glucose tolerance is a prediabetic state with elevated glucose levels but not yet meeting diabetes criteria. It involves mild insulin resistance but not significant beta cell failure to respond to insulin, distinguishing it from established type 2 diabetes with more pronounced dysfunction.
Correct Answer is C
Explanation
Choice A reason: Right shoulder pain post-laparoscopic cholecystectomy is not due to prolonged positioning. It results from carbon dioxide used to insufflate the abdomen, irritating the diaphragm and causing referred pain via the phrenic nerve, making this statement incorrect for explaining the pain’s origin.
Choice B reason: Nitrous dioxide is not used in laparoscopic cholecystectomy; carbon dioxide is the standard insufflation gas. This gas causes diaphragmatic irritation, leading to referred shoulder pain, not nitrous dioxide, making this statement factually incorrect regarding the cause of postoperative pain.
Choice C reason: Ambulation helps dissipate carbon dioxide gas trapped in the abdomen post-laparoscopic cholecystectomy, reducing diaphragmatic irritation and referred shoulder pain. Movement facilitates gas absorption and excretion via the lungs, alleviating discomfort, making this the correct nursing statement to relieve the patient’s pain.
Choice D reason: Residual pain from cholecystitis is unlikely post-cholecystectomy, as the gallbladder, the source of inflammation, is removed. Shoulder pain is due to surgical gas, not ongoing cholecystitis, making this statement incorrect for explaining the postoperative pain experienced by the client.
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