The nurse is caring for a client who has a finger stick blood glucose level of 130 mg/dL (7.21 mmol/L). Prior to administering the scheduled dose of acarbose, the nurse is informed that morning meal trays will be 30 minutes late. Which action should the nurse take?Reference Range:
Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]
Notify the healthcare provider.
Administer the medication.
Hold the medication until the meal trays arrive.
Obtain another finger stick blood glucose level.
The Correct Answer is C
A. Notify the healthcare provider: Notification of the healthcare provider is not immediately necessary just because of a meal delay. The nurse can manage the situation appropriately by adjusting the medication timing to ensure patient safety without requiring immediate provider involvement.
B. Administer the medication: Acarbose should be taken with the first bite of food to effectively delay carbohydrate absorption. Administering it without food available increases the risk of hypoglycemia, especially since the glucose level is already slightly elevated but within a manageable range.
C. Hold the medication until the meal trays arrive: Acarbose must be taken with the first mouthful of food to match the timing of glucose absorption. Holding the medication until the meal arrives ensures optimal therapeutic effect and prevents unnecessary hypoglycemia.
D. Obtain another finger stick blood glucose level: Rechecking the blood glucose is unnecessary at this time. The primary concern is coordinating the medication with food intake, not monitoring glucose trends over a short 30-minute delay.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A","dropdown-group-3":"D"}
Explanation
0845: The peak action of insulin lispro occurs about 1 to 2 hours after injection. Since it was administered at 0745, the nurse should expect a peak effect beginning around 0845, when the insulin will have its strongest blood glucose-lowering action.
0745: 0745 is the time when the insulin lispro was administered, not when it starts working. Since lispro usually takes about 15 to 30 minutes to begin acting, 0745 is too early to expect therapeutic action.
0815: Lispro insulin begins to work approximately 15 to 30 minutes after subcutaneous administration. Since it was given at 0745, the nurse should expect it to start lowering blood glucose around 0815, consistent with its pharmacologic profile.
0915: Given that insulin lispro peaks 1 to 2 hours after administration, the later part of the peak window would occur around 0915. This timing ensures the nurse monitors for potential hypoglycemia at the height of insulin activity.
Correct Answer is A
Explanation
A. Caution when changing from a sitting to a standing position: Carbidopa-levodopa can cause orthostatic hypotension, leading to dizziness and falls. Teaching the client to rise slowly and carefully helps prevent sudden drops in blood pressure and significantly reduces the risk of injury.
B. Ambulate using a four point cane or a walker with wheels: Assistive devices can help with mobility in Parkinson’s disease, but their use should be based on a physical therapist’s evaluation. Not every client will immediately require a walker or cane upon starting treatment.
C. Place small rugs on smooth surfaces such as tile or wood floors: Small rugs actually increase the risk of tripping and falling, especially for clients with Parkinson’s disease, who already have gait instability. It is safer to remove rugs rather than add them.
D. Obtain a hospital bed with side rails and an over bed trapeze: A hospital bed with side rails and an overbed trapeze might be necessary for clients with advanced Parkinson's disease who have significant mobility limitations or require assistance with repositioning in bed. However, for a newly diagnosed client, this level of equipment is likely unnecessary and could foster dependence.
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