A patient with type I diabetes mellitus is scheduled for a total hip replacement and will be NPO after midnight.
The nurse noticed that the provider did not write an order to adjust the client’s daily insulin dose, which includes NPH and regular insulin.
What is the best action for the nurse to take?

Contact the provider for an order to decrease the morning insulin dose by half of the prescribed morning dose

Do nothing because the provider would want the client to receive the usual insulin dose prior to surgery

Notify the care provider who wrote the insulin order in the client’s medical record

Hold the morning dose of NPH and regular insulin until after a fasting glucose is done

Answer and Explanation

The Correct Answer is C

Rationale for Choice A:

Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.

It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.

Rationale for Choice B:

It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.

Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.

It is important to adjust insulin doses to prevent hypoglycemia in these patients.

Rationale for Choice D:

Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.

It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.

Rationale for Choice C:

This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.

The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.

It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.

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Correct Answer is A

Explanation

Choice A rationale:

Oxytocin is a hormone that stimulates uterine contractions. It is not a tocolytic, which is a medication that inhibits uterine contractions. In fact, oxytocin is often used to induce labor or to augment labor that is progressing slowly.

It acts on the myofibrils in the uterine muscle, causing them to contract more forcefully and frequently. This leads to cervical dilation and effacement, and ultimately to the birth of the baby.

Oxytocin is typically administered as an intravenous (IV) infusion. The dosage is carefully titrated to achieve the desired effect on the uterus.

It is important to note that oxytocin can have serious side effects, including uterine hyperstimulation, fetal distress, and postpartum hemorrhage. Therefore, it should only be used under the close supervision of a healthcare provider.

Choice B rationale:

Magnesium sulfate is a tocolytic that is often used to prevent preterm labor. It works by relaxing the smooth muscle of the uterus.

It is typically administered as an IV infusion. The dosage is carefully monitored to ensure that the magnesium level in the blood does not become too high.

Side effects of magnesium sulfate can include flushing, nausea, vomiting, and headache. In rare cases, it can also cause serious complications such as respiratory depression and cardiac arrest.

Choice C rationale:

Nifedipine is a calcium channel blocker that is sometimes used as a tocolytic. It works by relaxing the smooth muscle of the uterus and blood vessels.

It is typically administered as an oral tablet. Side effects of nifedipine can include headache, dizziness, flushing, and low blood pressure.

Choice D rationale:

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used as a tocolytic. It works by inhibiting the production of prostaglandins, which are substances that promote uterine contractions.

It is typically administered as an oral tablet or suppository. Side effects of indomethacin can include nausea, vomiting, heartburn, and diarrhea.

A. Albuterol (Proventil) B. Oxygen C. Nitroglycerin D. Aspirin

Correct Answer is B

Explanation

Choice A rationale:

Albuterol (Proventil) is a bronchodilator that is used to treat acute asthma attacks and chronic obstructive pulmonary disease (COPD). It works by relaxing the smooth muscles in the airways, which allows more air to flow into the lungs. While albuterol can be helpful in relieving shortness of breath, it is not the first-line treatment for a patient with chest pain and low oxygen saturation. This is because albuterol does not address the underlying cause of the chest pain, which is likely a lack of oxygen to the heart muscle.

Choice C rationale:

Nitroglycerin is a vasodilator that is used to treat angina (chest pain) and heart failure. It works by relaxing the blood vessels, which allows more blood to flow to the heart. Nitroglycerin can be helpful in relieving chest pain, but it is not the first-line treatment for a patient with low oxygen saturation. This is because nitroglycerin can actually worsen hypoxemia (low oxygen levels in the blood) by dilating blood vessels in the lungs.

Choice D rationale:

Aspirin is a blood thinner that is used to prevent and treat blood clots. It is often given to patients with chest pain who are suspected of having a heart attack. However, aspirin is not the first-line treatment for a patient with low oxygen saturation. This is because aspirin does not address the underlying cause of the low oxygen saturation, which is likely a problem with the lungs or heart.

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Naxlex Comprehensive Predictor Exams

Which of the following medications is not categorized as a tocolytic?

Correct Answer is A

Explanation

A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

Correct Answer is B

Explanation

The nurse is applying erythromycin ointment to the lower lid of the newborn’s eyes. What is the purpose of this medication for the newborn?

Which client statement demonstrates understanding of the nurse’s teaching for levothyroxine (Synthroid)?

The client asks the nurse about storing insulin. Which response by the nurse is correct?

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?

Which of the following medications does the nurse identify as a calcium channel blocker used to treat tachycardia and manage heart rate?

What specific administration techniques should the nurse employ when administering NPH insulin?

A patient diagnosed with hyperthyroidism is about to start antithyroid medication therapy. Which food should the patient avoid as advised by the nurse?