Diabetes mellitus, Renal and Urinary Conditions HESI Practice

Which instruction should the nurse provide when teaching a patient how to exercise the pelvic floor?

contract muscles around the rectum

The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has

impaired glucose tolerance

Which test is required for a diagnosis of pyelonephritis?

urine for culture and sensitivity

Which tissues require insulin to enable movement of glucose into the tissue cells? (Select all that apply) - Liver - Brain - Adipose - Blood cells - Skeletal muscles

- liver - adipose tissue - skeletal muscle

A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?

Kussmaul respirations

Which type of patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? a. A 58-year-old patient with diabetic retinopathy b. a 73-year-old patient who takes propranolol (Inderal) c. A 19-year-old patient who is on the track team d. a 24-year-old patient with a hemoglobin A1C of 8.9%

a 73-year-old patient who takes propranolol (Inderal)

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

a. Insulin administration d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of

rapid, deep respirations.

The Nurse teachers the female patient who has frequent UTIs that she should: a. take tub baths with bubble baths b. void before and after sexual intercourse c. take prophylactic sulfonamides for the rest of her life d. restrict fluid intake to prevent the need for frequent voiding

void before and after sexual intercourse

The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? "Smokeless tobacco products decrease the risk of kidney damage." "I can help control my blood pressure by avoiding foods high in salt." "I should have yearly dilated eye examinations by an ophthalmologist." "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

"I can help control my blood pressure by avoiding foods high in salt."

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful?

"I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement?

"I should look at the condition of my feet every day."

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? "I will discard any insulin bottle that is cloudy in appearance." "The best injection site for insulin administration is in my abdomen." "I can wash the site with soap and water before insulin administration." "I may keep my insulin at room temperature (75° F) for up to 1 month."

"I will discard any insulin bottle that is cloudy in appearance."

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to 1 drink each day." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

"I will limit my alcohol intake to 1 drink each day."

A 21-yr-old female patient received instructions on how tp prevent recurrence of urinary tract infections. Which statement indicates that the teaching was effective.

"I will urinate before and after having intercourse."

In type 1 diabetes, glucose has an osmotic effect when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose?

- Polydipsia

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) - The level is consistent with renal insufficiency from renal nephropathy. - The level may be high because of dehydration that accompanies hyperglycemia. - The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. - The patient may be excreting sodium and retaining potassium from malnutrition. - This level shows adequate treatment of the cellulitis and acceptable glucose control.

- The level is consistent with renal insufficiency from renal nephropathy. - The level may be high because of dehydration that accompanies hyperglycemia. - The level may be raised due to metabolic ketoacidosis caused by hyperglycemia.

The nurse counsels a patient on dietary restrictions to prevent recurrent uric acid calculi. Which foods should the patient avoid?

- Venison, crab, and liver

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? 8:40 PM to 9:00 PM 9:00 PM to 11:30 PM 10:30 PM to 1:30 AM 12:30 AM to 8:30 AM

10:30 PM to 1:30 AM

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A 48-yr-old woman with a hemoglobin A1C of 8.4% A 58-yr-old man with a fasting blood glucose of 111 mg/dL A 68-yr-old woman with a random plasma glucose of 190 mg/dL A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

A 48-yr-old woman with a hemoglobin A1C of 8.4%

A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/Regular) in the morning and at 6:00 PM. when teaching the patient about this regimen, what should the nurse emphasize?

A set meal pattern with bedtime snack is necessary to prevent hypoglycemia

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mmHg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

A1C 9%

When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? - Achieving a normal weight - performing daily aerobic exercise - Eliminating red meat from the diet - Monitoring the blood glucose periodically

Achieving a normal weight

In teaching a patient with pyelonephritis about the disorder, the nurse tells the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through:

An ascending infection

An older male patient visits his primary care provider because of burning with urination and foul-smelling urine. What contributing factor should the provider consider?

Bening prostatic hyperplasia (BPH)

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time?

Cardiac monitoring to detect potassium changes

A patient admitted to the emergency department after a motor vehicle accident. Which urinalysis findings would the nurse expect if kidney trauma occurred? (Select all that apply.) Casts Glucose Bilirubin Myoglobinuria Red blood cells White blood cells

Casts Myoglobinuria Red blood cells

The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to UAP? - Discuss complications of diabetes - Check that the bathwater is not too hot - Check the patient's technique for drawing up insulin - Teach the patient to use a meter for self-monitoring of blood glucose

Check that the bathwater is not too hot

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction?

Consistently use the same size of insulin syringe to avoid dosing errors

What should the nurse include in the teaching plan for a female patient with a UTI?

Drink at least 2 quarts of water every day

What can patients at risk for kidney stones do to prevent them in many cases?

Drink enough fluids to produce dilute urine

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? - Eat a piece of pizza. - Drink some diet pop. - Eat 15 g of simple carbohydrates. - Take an extra dose of rapid-acting insulin.

Eat 15 g of simple carbohydrates.

A woman with no history of UTI who has urgency, frequency, and dysuria comes tot he clinic. A dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient?

Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days

Following electrohydraulic lithotripsy for treatment of kidney stones, the patient has a nursing diagnosis of risk for infection. What is the most appropriate nursing intervention for this patient?

Encourage fluid intake to 3L/day

The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? Excessive thirst Gradual weight gain Overwhelming fatigue Recurrent blurred vision

Excessive thirst

Which characteristic is more likely with acute pyelonephritis than with a lower UTI?

Fever

Polydipsia and polyuria related to diabetes are primarily due to

Fluid shifts resulting from the osmotic effect of hyperglycemia

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? a. Increased triglyceride levels b. Increased high-density lipoproteins (HDL) c. Decreased low-density lipoproteins (LDL) d. Decreased very-low-density lipoproteins (VLDL)

Increased triglyceride levels

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?

Increases amino acid transport into cells and protein synthesis

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence?

Kegel exercises

A patient has a right urethral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient immediately after the procedure, what is the most appropriate nursing action?

Measure urethral urinary drainage every 1 to 2 hours

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include?

Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin.

A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? 6:00 PM on the evening before the test Midnight before the test 4:00 AM on the day of the test 7:00 AM on the day of the test

Midnight before the test

The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia who has symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis?

Nitrites and leukocyte esterase are present in the urine.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively?

Obtain comprehensive dental care.

The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected? (Select all that apply.) Pain location Fever and chills Mental confusion Urinary hesitancy Urethral discharge Postvoid dribbling

Pain location Urinary hesitancy Urethral discharge

A patient with suprapubic pain and symptoms of urinary frequency and urgency has a 2 negative urine cultures. What is 1 assessment finding that would indicate interstitial cystitis (IC)?

Pain with bladder filling that is transiently relieved by urination

On assessment of the patient with a kidney stone passing down the ureter, what should the nurse expect the patient to report?

Severe, colicky back pain radiating to the groin

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks?

Spinach, cabbage, and tomatoes

Cortisol, glucagon, epinephrine, and growth hormone are referred to as counterregulatory hormones because they

Stimulate glucose output by the liver

A female patient has a UTI and kidney stones. The nurse knows that these are most likely which type of stone?

Sturvite

What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract?

There is a preexisting abnormality of the urinary tract

Which classification of urinary tract infection (UTI)is described as infection of the renal parenchyma, renal pelvis, and ureters?

Upper UTI

When caring for a patient with IC, what can the nurse teach the patient to do?

Use calcium glycerophosphate (prelief)

What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients?

Using strict sterile technique during irrigation and obtaining culture specimens

While caring for a 77-year old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient likely to experience?

Vague abdominal discomfort and disorientation

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?

With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines additional teaching is needed when the patient does that? - Withdraws the NPH dose into the syringe first - Injects air equal to the NPH dose into the NPH vial first - Removed any air bubbles after withdrawing the first insulin - Adds air equal to the insulin dose into the regular vial and withdraws the dose

Withdraws the NPH dose into the syringe first

During a routine health screening, a patient is found to have a fasting plasma glucose of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results? (Select all that apply) - A1C of 7.5% - Glycosuria of 3+ - FBG > 127 mg/dL (7.0 mmol/L) - Random blood glucose of 126 mg.dL (7.0 mmol/L) - a 2 hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)

- A1C of 7.5% - FBG > 127 mg/dL (7.0 mmol/L)

Which problem is priority when caring for a patient with renal stones?

Acute Pain

A patient with a history of gout has been diagnosed with renal calculi. Which treatment will be used with this patient. (select all that apply) Reduce dietary oxalate Administer allopurinol Administer a-penicillamine Reduce animal protein intake Reduce intake of milk product

Administer allopurinol Reduce intake of milk product

A patient is admitted to the hospital with severe renal colic The nurse's first priority in management of the patient is to

Administer opioids as prescribed

The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention?

Assess patient's perception of what it means to have diabetes.

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi?

Associated with alkaline urine

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. When should the nurse administer lispro insulin?

At mealtime or within 15 mins of meal

Which type of urinary tract stones are the most common and often obstruct ureters?

Calcium oxalate

A nurse caring for a patient hospitalized with diabetes would look for which laboratory test to obtain information on the patient's past glucose control?

Glycosylated hemoglobin level

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works?

Reduces glucose production by the liver and enhances insulin sensitivity

What characterizes type 2 diabetes?

beta-cell exhaustion; insulin resistance; genetic predisposition; altered production of adipokines; inherited defect in insulin receptors; inappropriate glucose production by the liver

When working with patients with urologic problems, which nursing interventions could be delegated to the UAP? (select all that apply) - Assess the need for catheterization - Use bladder scanner to estimate residual urine - Teach patient pelvic floor muscle (kegel) exercises - Insert indwelling catheter for incomplicated patient - Assist incontinent patient to commode at regular intervals - Provide perineal care with soap and water around a urinary catheter

- Assist incontinent patient to commode at regular intervals - Provide perineal care with soap and water around a urinary catheter

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included? (select all that apply) - Exercise regularly - Maintain a healthy weight - Have BP checked regularly - Assess for visual changes on a monthly basis - Monitor for polyuria, polyphagia, and polydipsia

- Exercise regularly - Maintain a healthy weight - Monitor for polyuria, polyphagia, and polydipsia

Which laboratory results indicate the patient has prediabates? - Glucose tolerance result of 132 mg/dL (7.3 mmol/L) - Glucose tolerance result of 240 mg/dL (13.3 mmol/L) - Fasting blood glucose result of 80 mg/dL (4.4 mmol/L) - Fasting blood glucose result of 120 mg/dL (6.7 mmol/L)

- Fasting blood glucose result of 120 mg/dL (6.7 mmol/L)

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? - An obese 40-year-old Hispanic woman - A 20-year-old man whose father has type 1 diabetes - A 34-year-old woman whose parents both have type 2 diabetes - A 12-year old bot whose father has maturity-onset diabetes of the young (MODY)

A 34-year-old woman whose parents both have type 2 diabetes

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability?

Check the patient's blood glucose level

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? Cheese Broccoli Chicken Oranges

Cheese

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? a. Chooses a puncture site in the center of the finger pad. b. Washes hands with soap and water to cleanse the site to be used. c. Warms the finger before puncturing the finger to obtain a drop of blood. d. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

Chooses a puncture site in the center of the finger pad.

A patient with type 2 diabetes is reporting a second urinary tract infection (UTI) within the past month. Which medication should the nurse expect to be ordered for the recurrent infection?

Ciprofloxacin

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? "I will go running when my blood sugar is too high to lower it." "I will go fishing frequently and pack a healthy lunch with plenty of water." "I do not need to increase my exercise routine since I am on my feet all day at work." "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week.

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

Which are appropriate therapies for patients with diabetes? (select all that apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

a. Use of statins to reduce CVD risk c. Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy