ATI Med-Surg

A nurse is providing instruction to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following statements by the client indicates an understanding of the teaching? "I will monitor my blood sugar carefully because the medication increases the secretion of insulin." "I should take this medication with a meal." "I can expect to gain weight while taking this medication." "While taking this medication, I will experience flushing of my skin."

"I should take this medication with a meal." The client should take metformin with or immediately following meals to improve absorption and to minimize gastrointestinal distress. Metformin decreases the amount of glucose produced in the liver and increases tissue sensitivity to insulin. Typically, clients lose weight when beginning to take metformin due to nausea and vomiting. Flushing of the skin is not an adverse effect of metformin.

A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? Negative urine ketones BUN 32 mg/dL pH 7.43 HCO3- 23 mEq/L

BUN 32 mg/dL DKA results in osmotic diuresis and subsequent dehydration. The nurse should expect a client who has DKA to have elevated BUN, creatinine, and specific gravity levels resulting from the excess glucose present in the urine. A client who has DKA experiences ketosis, which results in ketones in the urine and blood. The nurse should expect a client who has DKA to have a pH level less than 7.35 due to the increased production of ketones, which results in metabolic acidosis. The client might exhibit Kussmaul respirations, which are deep and rapid respirations that compensate for the decreased pH. Sodium bicarbonate is administered for severe acidosis when the client's pH level is less than 7. The nurse should expect a client who has DKA to have an HCO3- less than 15 mEq/L. This decreased value is due to an increased production of ketones, resulting in metabolic acidosis.

A nurse in emergency Department is caring for a client who is experiencing a thyroid storm. Which of the following manifestations should the nurse expect? (Select all that apply.) Fever Non-pitting edema Hypertension Tachycardia Hypoglycemia

Fever is correct. The nurse should expect the client to have a fever because of the excessive thyroid hormone release.Non-pitting edema is incorrect. Nonpitting edema is a manifestation of myxedema coma, a complication of hypothyroidism. Hypertension is correct. The nurse should expect one of the early manifestations of thyroid storm to include systolic hypertension because of the excessive thyroid hormone release. Tachycardia is correct. The nurse should expect the client to have tachycardia because of the excessive thyroid hormone release. Hypoglycemia is incorrect. Hypoglycemia is a manifestation of myxedema coma, a complication of hypothyroidism.

A nurse is caring for a client who has anorexia, low grade fever, night sweats, and a productive cough. Which of the following action should the nurse take first? Obtain a sputum sample Administer antipyretics. Provide hand hygiene education. Initiate airborne precautions.

Initiate airborne precautions. This client is exhibiting manifestations of tuberculosis. The greatest risk in this client situation is for other people in the facility to acquire an airborne disease from this client. Therefore, the first action the nurse should take is to initiate airborne precautions. The nurse should obtain a sputum sample to identify the micro-organisms that are causing the client's illness. However, there is another action that the nurse should take first. The nurse should administer antipyretics to treat the client's fever. However, there is another action that the nurse should take first. The nurse should provide hand hygiene education. However, there is another action that the nurse should take first.

A nurse is caring for a client who has a leg cast and his returning demonstration on the proper use of crotches while climbing stairs. Identify the sequence the client should follow when demonstrating crutch use.

The client should first place their body weight on the crutches. Next, they should advance the unaffected leg onto the stair. Third, they should shift their weight from the crutches to the unaffected leg. Last, they should bring the crutches and the affected leg up to the stair.

A nurse in a provider's office is assessing a client who has hypertension and takes propranolol. Which of the following findings should indicate to the nurse that the client is experiencing an adverse reaction to this medication? Report of a night cough Report of tinnitus Report of excessive tearing Report of increased salivation

Report of a night cough The nurse should recognize that a night cough is an early indication of heart failure and report this adverse reaction to the provider. Propranolol is a nonselective beta-adrenergic antagonist that has sensory effects, including dry eyes and vision changes. However, tinnitus is not an adverse effect of propranolol. Propranolol is a nonselective beta-adrenergic antagonist that can affect the heart, the lungs, and the eyes. Ophthalmic adverse effects include blurred vision and dry eyes. Propranolol is a nonselective beta-adrenergic antagonist that has several gastrointestinal effects, such as dry mouth, abdominal cramping, constipation, and diarrhea.

A nurse and an assistive personnel (AP) are caring for a client who has bacterial meningitis. The nurse should give the AP which of the following instructions? Wear a Mask. Droplet Precautions Wear a gown. Keep the client's room well-lit. Maintain the head of the bed at a 45° elevation.

Wear a Mask. Droplet Precautions A gown is necessary when caring for clients who require contact precautions. Bacterial meningitis does not spread via direct contact. Staff caring for this client should keep the illumination in the room dim and avoid bright light from windows to promote comfort and rest and avoid photophobia. Staff caring for this client should keep the head of the bed at a 30° elevation.