Diabetes Exam Practice Questions (Ch. 64) #2

The nurse is preparing to transfer Mr. D to the ICU and notices the cardiac monitor display. Which ECG pattern is cause for greatest concern? 1. Normal sinus rhythm 2. Ventricular tachycardia 3. Atrial fibrillation 4. Artifact (loose leads or patient movement)

2. The ECG pattern that shows ventricular tachycardia

The arterial blood gas results for Mr. D are: pH: 7.25, PaO2: 97 mm Hg, PaCO2: 25 mm Hg, Bicarbonate: 19 mEq/L. What physical assessment finding is most likely to accompany these laboratory results? A. Kussmaul respirations B. Dilated pupils C. Increase urination D. Elevated blood pressure

A. Kussmaul respirations

To clarify pertinent data, which questions are appropriate to ask Mr. D? SATA A. "When did your symptoms start?" B. "How many times have you vomited?" C. "When were you diagnosed with diabetes?" D. "Where does your abdomen hurt?" E. "Did you take any insulin today?" F. "Do you have any allergies?"

A. "When did your symptoms start?" B. "How many times have you vomited?" D. "Where does your abdomen hurt?" E. "Did you take any insulin today?" F. "Do you have any allergies?"

The nurse overhears the UAP talking to someone on the phone. The UAP says, "Yes, Mr. D is doing much better than when he first got here. I will tell him that you called, and I will give him your message." What will the nurse do first? A. Ask the UAP about the phone conversation that was just overheard B. Remind the UAP that release of information is outside her scope of practice C. Report the UAP to the nurse manager for client privacy violation D. Give positive feedback for trying to help the client and the caller

A. Ask the UAP about the phone conversation that was just overheard

Which person(s) should be allowed to have access to Mr. D's medical records? SATA A. ED provider who is managing Mr. D in the ED B. ED nurse who is caring for Mr. D in the ED C. ICU who will receive Mr. D upon transfer to the ICU D. Nursing students who wants to write a paper about diabetic ketoacidosis E. Roommate of Mr. D who is a medical student and a family friend F. Discharge nurse who will provide instructions and referrals at discharge

A. ED provider who is managing Mr. D in the ED B. ED nurse who is caring for Mr. D in the ED C. ICU who will receive Mr. D upon transfer to the ICU F. Discharge nurse who will provide instructions and referrals at discharge

In developing an individualized meal plan for a patient with diabetes, which goals will be focal points of the plan? SATA A. Maintain blood glucose levels at or as close to the normal range as possible B. Allow patient food preferences C. Permit patients to eat as much as they desire D. Honor patient cultural preferences E. Limit food choice only when guided by scientific evidence F. Include the family member who buys groceries and prepares meals in the teaching

A. Maintain blood glucose levels at or as close to the normal range as possible B. Allow patient food preferences D. Honor patient cultural preferences E. Limit food choice only when guided by scientific evidence F. Include the family member who buys groceries and prepares meals in the teaching

Which tasks are appropriate to delegate to an experienced unlicensed assistive personnel (UAP)? SATA A. Measuring and reporting Mr. D's vital signs every 15 minutes B. Checking and reporting Mr. D's blood glucose level C. Bagging and labeling Mr. D's belongings D. Updating the roommate regarding Mr. D's status E. Measuring emesis and cleaning the basin as needed F. Obtaining an infusion pump from the supply room

A. Measuring and reporting Mr. D's vital signs every 15 minutes B. Checking and reporting Mr. D's blood glucose level C. Bagging and labeling Mr. D's belongings E. Measuring emesis and cleaning the basin as needed F. Obtaining an infusion pump from the supply room

What does the nurse anticipate the HCP will order for initial fluid replacement? A. Normal saline (0.9% sodium chloride) B. Half-strength saline (0.45% sodium chloride) C. 5% dextrose in water and half-strength saline D. Normal saline with potassium chloride

A. Normal saline (0.9% sodium chloride)

A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement? A. Regulated food intake is basic to control B. Salt and sugar restriction is the main concern C. Small, frequent meals are better for digestion D. Large meals can contribute to a weight problem

A. Regulated food intake is basic to control

The nurse is reviewing the potassium values that were obtained when Mr. D first arrived to the ED. Which serum potassium level is most concerning? A. 3.5 mEq/L B. 2 mEq/L C. 5.8 mEq/L D. 6 mEq/L

B. 2 mEq/L

Along with exercise, what is the recommended calorie reduction for a patient with diabetes who needs to lose weight? A. 100-200 calories/day B. 250-500 calories/day C. 501-600 calories/day D. 601-750 calories/day

B. 250-500 calories/day

In the initial emergency care for Mr. D, which HCP prescriptions would the nurse question? SATA A. Start a peripheral IV line with a large bore catheter B. Obtain a urine specimen with a small-bore straight catheter C. Administer regular insulin subcutaneously D. Maintain the client in a semi-Fowler position E. Initiate continuous electrocardiographic (ECG) monitoring F. Encourage intake of oral fluids as tolerated

B. Obtain a urine specimen with a small-bore straight catheter C. Administer regular insulin subcutaneously F. Encourage intake of oral fluids as tolerated

The ED nurse is reviewing the intensive care unit (ICU) admission orders. There is a prescription for an IV potassium infusion. Related specifically to the potassium infusion, which information would the ICU nurse be most interested in knowing? A. Mental status and cognition have improved with therapy B. Urinary output is 60 mL/hr, and urine is a clear yellow color C. Admitting blood pressure was 100/60 mm Hg; last BP is 125/76 mm Hg D. There are two existing peripheral IV lines, and both flush easily

B. Urinary output is 60 mL/hr, and urine is a clear yellow color

Mr. D says to the nurse, "Please don't call my mother. If she knows I'm in the hospital, she'll make me quit school and move back home. I know I messed up, but I really don't want to move back in with my parents." What is the best therapeutic communication response? A. "None of the staff will say anything, but you should tell her yourself" B. "Your mom loves you, and she is just concerned about your well-being" C. "It sounds like you want to be independent and responsible for yourself" D. "You are an adult, and you have the right to make your own decisions"

C. "It sounds like you want to be independent and responsible for yourself"

The ED nurse is preparing the SBAR report before the ICU transfer. Which detail would be most appropriate to include as background to ensure that Mr. D's right to privacy is maintained? A. Client is a premed student who was studying for finals, and this interfered with his normal routine B. Roommate is a medical student and a family friend, and he brought Mr. D to the ED C. Client has not informed family that he is in the hospital, and he is reluctant to allow notification D. Client arrived, alert and conversant, but he initially had trouble focusing on questions

C. Client has not informed family that he is in the hospital, and he is reluctant to allow notification

For the initial emergency care of Mr. D, what is the priority collaborative treatment goal? A. Correction of hyperglycemia with IV insulin B. Correction of acid-base imbalance using IV bicarbonate C. Correction of fluid imbalance with IV fluids D. Correction of potassium imbalance with IV potassium

C. Correction of fluid imbalance with IV fluids

What is the priority nursing concept to consider in planning the initial emergency interventions for Mr. D? A. Gas exchange B. Acid-base imbalance C. Fluid and electrolyte imbalance D. Adherence

C. Fluid and electrolyte imbalance

What is the basic principle of meal planning for a patient with type 1 DM? A. Five small meals per day plus a bedtime snack B. Taking extra insulin when planning to eat sweet foods C. High-protein, low-carbohydrate, and low-fiber foods D. Considering the effects and peak action times of the patient's insulin

D. Considering the effects and peak action times of the patient's insulin

Which member of the health care team is demonstrating a behavior that is an example of a barrier to interprofessional collaboration? A. ICU nurse asks the ED nurse to hold the client for 30 minutes until shift change is over B. Admitting endocrinology specialist directs the ED nurse to change the rate of all IV fluids C. ED provider reviews the triage nurse's admission notes before completing the provider summary D. ED nurse tells the charge nurse that the UAP failed to record vital signs in a timely fashion

D. ED nurse tells the charge nurse that the UAP failed to record vital signs in a timely fashion

The HCP instructs the nurse to give 1 L of IV fluid over the next hour. The available IV pump delivers fluid in mL/hr and allows three digits for programming the flow rate. What should the nurse do first? A. Try to find a pump that will accurately deliver the fluid B. Program the IV pump for 1L/hr and start the infusion C. Ask the HCP to revise the rate to accommodate the available equipment D. Program the IV pump for 999 mL/hr and start the infusion

D. Program the IV pump for 999 mL/hr and start the infusion

The nurse has completed the triage assessment and history taking. Now what is the priority action? A. Page the ED health care provider to come to triage B. Call the client's parents for permission to treat C. Notify the client's primary health care provider D. Take the client immediately to the treatment room

D. Take the client immediately to the treatment room

In caring for Mr. D, the nurse is vigilant for signs and symptoms of hypokalemia. What signs and symptoms should the nurse watch for? SATA A. Fatigue B. Cold, clammy skin C. Muscle weakness D. Hypotension E. Weak pulse F. Shallow respiration

A. Fatigue C. Muscle weakness D. Hypotension E. Weak pulse F. Shallow respiration

Which tasks can the nurse direct an experienced UAP to performed to facilitate Mr. D's transfer to the ICU? SATA A. Giving Mr. D's roommate directions to the ICU waiting room B. Independently transporting Mr. D to the ICU C. Collecting and organizing the chart and laboratory reports D. Obtaining a portable oxygen tank and cardiac monitor E. Connecting Mr. D's ECG leads to the portable cardiac monitor F. Obtaining the last set of vital sign values

A. Giving Mr. D's roommate directions to the ICU waiting room D. Obtaining a portable oxygen tank and cardiac monitor E. Connecting Mr. D's ECG leads to the portable cardiac monitor F. Obtaining the last set of vital sign values

The ED nurse is trying to call report to the ICU, but is told, "We are were not notified about the admission." What should the nurse do first? A. Call the admissions office supervisor to resolve the delay B. Ask the unit secretary to call the admissions office now C. Write an incident report; a delay violates Joint Commission guidelines D. Ask the ICU nurse to take the report regardless of the clerical omission

B. Ask the unit secretary to call the admissions office now

Which statement about dietary concepts for patients with diabetes is true? A. Alcoholic beverage consumption is unrestricted B. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients C. Sweeteners should be avoided because of the side effects D. Both soluble and insoluble fiber foods should be limited

B. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients

Mr. D, a 19-year-old pre-med student, has been brought to the ED by his roommate, who is a medical student and family friend. Mr. D reports abdominal pain, polyuria, vomiting, and thirst. He appears flushed, and his lips and mucous membranes are dry and cracked. His skin turgor is poor. He has deep, rapid respirations, and there is a fruity odor to his breath. He has type 1 diabetes and "may have skipped a few doses of insulin because of cramming for finals." He is alert and conversant but is having trouble focusing on the nurse's questions. VS: Blood glucose: 685 mg/dL, BP: 100/60 mm Hg, HR: 120 beats/min, RR: 33 breaths/min, Temp: 100.8

Answer the following questions below

An insulin infusion is ordered for Mr. D to begin at 0.1 units/kg/hr. Mr. D weighs 155 lb. The pharmacy delivers a premixed bag of 100 units of regular insulin in 100 mL of normal saline. Nurse A has calculated the infusion pump setting as 10 mL/hr. What will the charge nurse do next? A. Tell nurse A to obtain a pump and start the infusion as calculated B. Advise nurse A to recalculate the infusion rate C. Call the HCP and ask for the exact pump setting to be clarified D. Allow nurse A to administer the infusion using her own judgement

B. Advise nurse A to recalculate the infusion rate

The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does the nurse include? SATA A. Only perform SMBG before breakfast B. Wash hands before using the meter C. Do a retest if the results seem unusual D. It is okay to reuse lancets in the home setting E. Do not share the meter F. How to calibrate the machine

B. Wash hands before using the meter C. Do a retest if the results seem unusual E. Do not share the meter F. How to calibrate the machine

The nurse identifies that the dietary teaching provided for a client with diabetes is understood when the client states, "My diet: A. should be rigidly controlled to avoid emergencies" B. can be planned around a wide variety of commonly used foods" C. is based on nutritional requirements that are the same for all people" D. must not include eating any combination dishes and processed foods"

B. can be planned around a wide variety of commonly used foods"

As the nurse is getting ready to transfer Mr. D to the ICU, the unit secretary hands the nurse the last blood glucose result, which is 150 mg/dL. What should the nurse do first? A. Proceed with the transfer because the blood glucose is trending toward the normal value B. Stop the insulin infusion, proceed with the transfer, and inform the ICU nurse on arrival C. Immediately notify the HCP and anticipate an order for IV fluid of 10% glucose D. Slow the insulin infusion and obtain an order to have the blood glucose redrawn

C. Immediately notify the HCP and anticipate an order for IV fluid of 10% glucose

A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin (Novolin N). What does this snack provide? A. Encouragement to stay on the diet B. Added calories to promote weight gain C. Nourishment to counteract late insulin activity D. High-carbohydrate nourishment for immediate use

C. Nourishment to counteract late insulin activity

What is the recommended protocol for patients with type 2 DM who must lose weight? A. Participate in an aerobic program twice a week for 20 minutes each session B. Slowly increase insulin dosage until mild hypoglycemia occurs C. Reduce calorie intake moderately and increase exercise D. Reduce daily calorie intake to 1000 calories and monitor urine for ketones

C. Reduce calorie intake moderately and increase exercise