The client’s blood glucose level is 220 mg/dL. The client is about to eat breakfast. The prescribed sliding scale indicates that 4 units of insulin lispro (Humalog) be given subcutaneously at 7:30 am. At what time is the client most at risk for hypoglycemia?

Choice A reason: Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.

Choice B reason: Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.

Choice C reason: Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.

Choice D reason: Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.

Choice A reason: Lithium toxicity is a concern but not inevitable. It occurs with levels above 1.5 mEq/L, often due to dehydration or drug interactions, common in trauma settings. However, routine monitoring of levels is a more immediate nursing priority than assuming toxicity, as early detection prevents severe outcomes like seizures or renal damage.

Choice B reason: Lithium is primarily excreted by the kidneys, not metabolized by the liver. Liver function tests are not indicated for lithium monitoring, as it does not undergo hepatic metabolism. This statement is inaccurate, as renal function tests are critical to assess lithium clearance and prevent toxicity in trauma patients.

Choice C reason: Stress does not directly increase lithium requirements. Trauma-related dehydration or renal impairment can elevate lithium levels, risking toxicity, but this is due to reduced clearance, not increased need. This statement is inaccurate, as dosing adjustments should be based on serum levels, not stress alone.

Choice D reason: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and trauma-related factors like dehydration or medications can alter levels, risking toxicity or subtherapeutic effects. Regular serum level monitoring is critical, especially in acute settings, to ensure safety and efficacy, making this statement accurate and a priority nursing concern.