310 U World

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every

15 g of carbohydrates The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

Which of the following instructions should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?

Be sure to get regular follow-up care Regular follow-up care for the client with Graves' disease is critical because most cases eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. While exercise to improve cardiovascular fitness is important, for this client the importance of regular follow-up is most critical.

The nurse understands that which of these body substances are modes of transmission for hepatitis B?

Blood Semen Vaginal secretions

The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison's disease). The nurse recognizes which finding associated with the disease?

Bronze pigmentation of skin

Which signs and symptoms should the nurse report to the healthcare provider for the client recovering from an open cholecystectomy?

Clay-colored stools Yellow-tinted sclera Abdominal pain

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?

Hematemesis Signs and symptoms of hemorrhage includes hypotension, tachycardia, black tarry stool, and hematemesis (vomiting of blood). These are signs and symptoms of possible hemorrhage a nurse should be looking for in a patient with an ulcer.

A nurse is caring for a client who has Cushing syndrome due to an adrenal tumor. Which assessment finding(s) should the nurse anticipate in this client?

Hirsutism Serum sodium is 154 mEq/L Truncal Obesity

The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective?

I may experience some discomfort when I eat a high-fat meal."

A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?

IV administration of octreotide (Sandostatin)

Based on the clinical manifestations of Cushing syndrome, which nursing intervention would be appropriate for a client who is newly diagnosed with Cushing syndrome?

Increase intake of fluids high in potassium.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

Increased urine output : Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer

Omeprazole (Prilosec)

A nurse is caring for a client with hyperaldosteronism (Conn's Syndrome). Which assessment(s) should the nurse anticipate in this client?

Polyuria Hypertension Hypokalemia

A client with peptic ulcer disease wants to know non-pharmacologic ways that he can prevent recurrence. Which of the following measures would the nurse recommend?

Smoking cessation Following a regular schedule for rest, relaxation, and meals Avoidance of alcohol

The nurse cares for a client diagnosed with type I diabetes mellitus who came to the emergency department with the acute complication of diabetic ketoacidosis (DKA). After checking the blood glucose, which prescription should the nurse implement first?

Start an IV line and infuse normal saline as prescribed NS would be the first implementation because DKA is marked by severe dehydration r/t hyperglycemia and electrolyte imbalances. It would be logical to start fluids before you leave the room to draw up insulin to lower serum glucose. The other answers are not correct.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?

They increase the need for insulin Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

. A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

Two to 3 soft bowel movements daily Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the patient's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.]

A client with hyperthyroidism is about to receive radioactive iodine as an outpatient. What safety measures should the nurse teach the client to protect his family while he undergoes treatment?

Use of disposable eating utensils The client with hyperthyroidism can receive radioactive iodine as an outpatient with some precautions, such as using disposable eating utensils, and avoiding kissing, sexual intercourse, and holding babies. Good hand washing is always necessary to prevent the spread of infection; however, it provides no protection against radioactive iodine therapy. Isolation isn't necessary, but radiation precautions are.

The nurse writes a problem of "altered body image" for a 34-year-old client with Cushing's disease. Which intervention should be implemented?

Use therapeutic communication to allow the client to discuss feelings.

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?

below-normal serum potassium level a client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?

promote absorption Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site, but not the primary reason for rotation of sites. Insulin is not injected into the muscle.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

rapid, thready pulse This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with tingling around the mouth and muscle twitching in the right arm. Which action is most important for the nurse to implement first?

Obtain a serum calcium level serum calcium is 8.6-10.2 mg /dL (2.15-2.55 mmol/L). Hypocalcemia (serum calcium <8.6 mg/dL [2.15 mmol/L]) is a potential complication of thyroidectomy because the parathyroids that regulate calcium levels in the blood are accidentally removed during this surgical procedure. The nurse should monitor the client closely for signs of hypocalcemia, which include tetany (overactive neurological responses such as tingling in the hands, feet, and around the mouth; spasms or cramps that can occur even in the larynx; positive Trousseau or Chvostek sign). A serum calcium level should be drawn, and the nurse should ensure that calcium gluconate is readily available in case this complication occurs.

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective?

"I should control my blood glucose with diet, exercise, and medication" Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacteria. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories

The nurse is caring for a client with cirrhosis of the liver. Which blood test values would the nurse typically anticipate to be elevated when reviewing the clients morning laboratory values?

Ammonia Bilirubin Prothrombin time

A nurse is teaching a patient who just underwent a gastric bypass, due to peptic ulcers, how to prevent dumping syndrome. What are ways the patient can prevent dumping syndrome?

Avoid gassy foods, such as beans, broccoli, corn etc. Eat slowly, small bites, chew well Avoid carbonated drinks

Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?

Episodes of high psychosocial stress

The nurse in an outpatient clinic receives a blood test report of moderately elevated thyroid-stimulating hormone (TSH) and markedly decreased T3 and T4 levels. Which signs and/or symptoms should be expected in the client's evaluation?

Cold intolerance Constipation Forgetfulness Hair loss Hypothyroidism is a thyroid disorder characterized by thyroid hormone deficit (low T3 and T4). TSH is elevated due to compensatory increase from pituitary. Hypothyroidism affects almost every body system and is predominately associated with a slow metabolic rate. Some common manifestations include the following: Decreased gut motility leading to constipation Cool and pale skin due to decreased blood flow; hyperkeratosis results in dry and rough skin Brittle nails and hair; hair loss due to poor blood supply Bradycardia from low metabolic state Joint pains and muscle aches are common Clients can develop dementia and depression due to mental slowing Cold intolerance characteristic Modest weight gain

Which of the following would be the most important nursing assessment in a patient diagnosed with ascites?

Daily weight and measurement of abdominal girth

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?

Dyspnea and hypertension Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.

A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease?

Esophageal pain may imitate the symptoms of a heart attack. Symptoms associated with myocardial infarction may be interpreted by a client as esophageal reflux and therefore ignored. GERD does not predispose to heart disease. Exercise does not seem to exacerbate esophageal reflux problems unless the stomach is full when exercising. Exercising to maintain a healthy weight helps reduce esophageal reflux. Laboratory workups help differentiate these two diagnoses. Tests, such as cardiac enzymes, can help to reveal a myocardial infarction, thereby facilitating differentiation between these problems.

A male client with a history of cirrhosis is admitted to the Intensive Care Unit (ICU) with esophageal varices. Which signs and symptoms alert the nurse to suspect rupturing of the esophageal varices?

Hemoglobin of 9.1 g/dL and Hematocrit of 32% Heart Rate of 124 beats per minute Cool, clammy skin Signs and symptoms of bleeding esophageal varices are those of acute blood loss and shock. Hemoglobin and hematocrit values will be lowered as a result of blood loss, tachycardia will occur in attempt to compensate for this blood loss, and the skin will be cool and clammy due to decreased blood volume. Calcium levels and calf pain are not specifically related to rupture of esophageal varices.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

I will have to take vitamin B12 shots up to 1 year after surgery. Intrinsic factor is lost with removal of the stomach, and vitamin B12 is needed to maintain the hemoglobin level and prevent pernicious anemia. If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. This deficiency in vitamin B12 metabolism can result in decreased production of red blood cells, or pernicious anemia.

The nurse practicing in an out-patient clinic cares for a client recently diagnosed with hyperthyroidism. Which diet-related teaching should the nurse add to the client's plan of care?

Include meals and snacks high in protein content Teach avoidance of caffeine-containing liquids Teach the client about consumption of a high-calorie diet of 4000-5000 calories/day Hyperthyroidism leads to a high metabolic rate. It is important for the nurse to teach the client nutritional measures, including consumption of a diet high in calories (high in protein, carbohydrates, vitamins, and minerals) to satisfy hunger and prevent weight loss and tissue wasting.