Exam 2 NCLEX Questions

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120 mg/dl, temperature of 101, pulse of 88, respirations of 22, and a BP of 104/84. Which finding would be of most concern of the nurse?

temperature

"Which instruction about insulin administration should the nurse give to a client?

"Always follow the same order when drawing the different insulins into the syringe"

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

6-14 hours after administration

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Increases blood glucose levels

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

Do all of the above

The nurse expects that a types 1 diabetic may receive ----- of his or her morning dose of insulin preoperatively :

50-60%

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:

Vasopressin (Pitressin Synthetic)

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

126 mg/dl

Nurse Wayne is aware that a positive Chvostek's sign indicate?

Hypocalcemia

The insulin that has the most rapid onset of action would be:

Lispro

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:

Trousseau's sign

Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

"Be sure to take glipizide 30 minutes before meals."

Acarbose (Precose), an alpha glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauline would be aware of the client's need for additional teaching when the client states:

"If I have hypoglycemia, I should eat some sugar, not dextrose."

Tom is ready to be discharged from the med-surg unit after 5 days of hospitalization. Which client statement indicates to the nurse that Tom understands the discharge teaching about cellular injury?

"If I have redness, drainage, or fever, I should call my healthcare provider" Redness, drainage, or fever are signs of infection associated with cellular injury.

A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

"It tells us about your sugar control for the last 3 months"

A female client whose physical findings suggest hyper pituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob evils preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

"You must avoid coughing, sneezing, and blowing your nose"

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDVAP). Which instruction should nurse Lina provide?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage.

A male client has just been diagnosed with types 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

"You'll need less insulin when you exercise or reduce you food intake"

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia which exercise. Which statement by the client indicated an inadequate understanding of the peak action go NPH insulin and exercise?

"the best time for me to exercise is every afternoon"

Nurse Katee is caring for Adam, a 22 year old client in a long term facility. Which nursing intervention would be appropriate when identifying nursing interventions aimed at promoting & preventing contractures?

- Maintaining correct body alignment at all times. - Using a footboard or pillows to keep feet in correct position. - Performing active & passive range of motion exercises

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.

1. inject air equal to NPH dose into NPH vile 2. Inject air equal to regular dose into regular dose vile 3. Invert regular insulin bottle and withdraw regular insulin dose 4. Invert NPH vile and withdraw NPH dose

An agitated, confused female client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Associated recommends ingesting 10 to 15 g of simple carbohydrates, such ss three to five pieces of hard candy, two to three packs of sugar or 4 oz of fruit juice

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1330 and 1930

Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

15 to 20 g of a fast-acting carbohydrate such as orange juice

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insults are effective for an approximate duration of:

16-20 hours

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 in) and should be used only once every:

2-3 weeks

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect:

A blood pressure of 176/88 mm Hg

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

Administer regular insulin IV

A client with type 1 DM has a finger-stick glucose level of 258 mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

Administered the insulin as ordered

A 22-year-old lady is displaying facial grimaces during her treatment in the hospital due to burn trauma. Which nursing intervention should be included for reducing pain due to cellular injury?

Administering anti-inflammatory agents as prescribed

A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicated that the client's hypertension is caused by excessive hormone secretion from which of the following glands?

Adrenal cortex

The nurse is aware that the following is the most common cause of hyperaldosteronism?

An Adrenal adenoma

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Antidiuretic hormone (ADH).

The patient X is diagnosed with constipation. As a knowledgeable nurse which nursing intervention is appropriate for maintaining normal bowel movement?

Assessing dietary intake

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?

At least three times a week.

A client with DM has an above the knee amputation because of severe peripheral vascular disease. Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to:

Check the client's serum glucose level

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

Diaphoresis

Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

Consuming a low-carbohydrate, high protein diet and avoiding fasting

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to:

Convey empathy, trust, and respect toward the client.

A client's blood gas reflect diabetic acidosis. The nurse should expect:

Decreased HCO3

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

Deposits of adipose tissue in the trunk and dorsocervical area

A female client with Cushing's Syndrome is admitted to the medical surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

Depression

A client with a diagnosis of DKA is being treated in the ER. Which finding would nurse expect to note as confirming this diagnosis?

Elevated blood glucose level and low plasma bicarbonate

Glucose is an important molecule in a cell because the molecule is primarily used for:

Extraction of energy

"Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

Fluid intake less than 2,500 ml/day.

When a client is first admitted with hyperglycemic hyperosmolar nonletotic syndrome (HHNS), the nurse's priority is to provide:

Fluid replacement

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following?

Forcing Fluids

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

Gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

A male client with types 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse jack explains that these medication are only effective if the client:

Has type 2 diabetes

Lisa, a client with altered urinary function, is under the care of nurse Tine. Which intervention is appropriate to include when developing a plan for care for Lisa, who is experiencing urinary dribbling?

Having the client perform kegal exercises

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:

High risk for deficient fluid volume

Mang Rogelio, a 32 year old patient is about to be discharged from the acute care setting. Which nursing intervention is the most important to include in the plan of care?

Home environment evaulation

When a client is in diabetic ketoacidosis, the insulin that would be administered is:

Human regular insulin

A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would expect which of the following disorders?

Hyperparathyroidism

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

Hypocalcemia

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

Hypoglycemia

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

IV bolus, followed by continuous infusion

Which nursing diagnosis is of highest priority for a female client with hyperthyroidism?

Imbalanced nutrition: less than body requirements related to thyroid hormone excess.

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of deficient fluid volume?

Increased urine osmolarity

A 36 year old male client is about to be discharged from the hospital after 5 days due to surgery. Which intervention should be included in the home health care nurse's instructions about measures to prevent constipation.

Instructing the client to fill a 2-L bottle with water every night & drink it the next day. Adequate fluids & fiber in diet are key to preventing constipation.

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin lipodystrophy

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M q.i.d. as replacement therapy. What is the mechanism of action of corticotropin?

It interacts with plasma membrane receptors to promote enzymatic actions that affect protein, fat, and carbohydrate metabolism.

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

Kussmaul's respirations and a fruity odor on the breath

Which adaptions should the nurse caring for a client with diabetic ketoacidosis expect the client tot exhibit? Select all that apply.

Low PCO2 Retinopathy

Jeron is admitted in the hospital due to bacterial pneumonia. He is febrile, diaphoretic, & has shortness of breath & asthma. Which goal is the most important for this client?

Maintenance of adequate oxygen. For a client with asthma & infection, oxygenation is the priority

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Monitor blood glucose closely, and look for signs of hypoglycemia.

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

More insulin

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by:

Muscle Weakness

"An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

Myxedema coma

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

Neck vein distention

"Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:

Onset to be at 2:30 pm and its peak to be at 4 pm

Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

Oral anticoagulants

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

Palpation for increased pulse volume is the arteries of the lower extremities

"The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

Palpitations diaphoresis Slurred speech

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Potassium

A client with diabetes mellitus visits a health care clinic. the client's diabetes perviously had been controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

Prednisone (Deltasone)

Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent nd says he's concerned about its effects on his marriage. In planning this client's care, the most appropriate intervention would be:

Suggest referral to a sex counselor or other appropriate professional.

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mg PO daily. For which condition is levothyroxine is the preferred agent?

Primary hypothyroidism

Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

Puffiness of the face and hands

A client with DM states " I cannot eat big meals; I prefer to snack throughout the day". The nurse should carefully explain that the:

Regulated food intake is basic to control

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

Related to bone demineralization resulting in pathologic fractures Poorly controlled hyperparathyroidism may cause and elevated serum calcium level.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting Fluids

Which of the following chronic complications is associated with diabetes?

Retinopathy, neuropathy, and CAD

Nurse Troy is aware that the most appropriate for a client with Addison's disease?

Risk for infection

A 12 year old boy was admitted in the hospital two days ago due to hyperthermia. His attending nurse, Dennis, is quite unsure about his plan of care. Which of the following nursing interventions should be included in the car of plan for the client?

Room temperature For patients with hyperthermia, reducing the room temperature may help decrease the body temperature.

In a 29-year-old female client whois being successfully treated for Cushing's Syndrome, nurse Lynette would expect a decline in:

Serum glucose level

A male client with a tentative diagnosis of hyperosmolar hyperglycemia nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

Serum osmolarity

Albert refuses his bedtime snack. This should alert the nurse to assess for:

Signs of hypoglycemia earlier than expected.

When caring for a female client with a history go hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description:

Sulfisoxazole (Gastrisin)

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

Switch the client to a different oral anti-diabetic agent

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

Tachycardia

Nurse Ruth assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should expect which complication?

Tetany

Mr. McPartlin suffered abrasions & lacerations after a car accident. He was hospitalized & was treated for a couple of weeks. When planning care for a client with cellular injury, the nurse should consider which scientific rationale?

The presence of infection may slow down the healing process. Infection impairs would healing. Adequate blood supply is essential for healing.

For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

They debride the wound and promote healing by secondary intention.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Thyroid crisis

Which of the following causes of HHNS is most common?

Undiagnosed, untreated diabetes mellitus

"During preoperative teaching for a female client who will undergo a subtotal thyroidectomy, the nurse should include which statement?

You must avoid hyperextending your neck after surgery

A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

phentolamine (Regitine)