Mastery level 8- passpoint

A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, the physician connects a 10-ml syringe to the catheter and withdraws a sample of blood. The physician then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. The nurse should

turn the client on the left side and place the bed in Trendelenburg's position.

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation?

having wisdom teeth extracted

The health care provider has prescribed salicylates for an older adult client with osteoarthritis to relieve pain. The nurse knows to assess the client for what potential adverse reaction?

hearing loss

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

restricting fluids to 800 ml/day

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in

serum glucose level.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

serum glycosylated hemoglobin (Hb A1c)

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of

sodium and potassium abnormalities.

A client has had a radical neck dissection for laryngeal cancer. Which action is the priority for nursing care immediately following this surgery?

suctioning the laryngectomy tube as often as needed

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to

suggest referral to a sex counselor or other appropriate professional.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. When conducting a focused assessment, what should the nurse should assess the client for?

tachycardia

A primigravid client at 30 weeks' gestation has been admitted to the hospital with premature rupture of the membranes without contractions. Her cervix is 2 cm dilated and 50% effaced. Which factor is most important for the nurse to assess next?

temperature

When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary?

waits 30 minutes to eat breakfast after injecting rapid-acting insulin

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?

weight gain, decreased appetite, and constipation

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication?

with meals or with an antacid

A nurse has just received report on four clients. Which client should the nurse see first?

A client who underwent a thyroidectomy and has new onset hoarseness.

The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100 mg intravenously at a rate of 10 mL/hour for a client in acute adrenal crisis. The nurse understands that this treatment is common in clients with which disease process?

Addison's disease

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which action should the nurse take?

Administer a saline bolus as needed.

A client presents with acute onset chest pain rated as 7/10 radiating to left arm and mid-scapular region, blood pressure of 155/95 mm Hg, heart rate of 98 beats/min, respiratory rate of 22 breaths/min, and an oxygen saturation of 94%. What is the nurse's priority intervention?

Administer sublingual nitroglycerin.

A client in the intensive care unit has a critically low potassium level of 1.9 mEq/l (mmol/l). What would be the best way to replace this client's potassium?

Administer two potassium chloride 10 mEq (10 mmol) in 100 ml 0.9% sodium chloride IVPB, over 1 hour each

The nurse caring for a client with an arteriovenous (AV) fistula notes that the fingers distal to the fistula are cold to the touch and the capillary refill time is greater than 3 seconds. What is the priority action by the nurse?

Contact the healthcare provider.

After knee arthroplasty, the client has a sequential compression device (SCD). What should the nurse do?

Discontinue the SCD when the client is ambulatory.

A nurse is monitoring a client on the telemetry unit. The electrocardiogram tracing shows a PR interval of 0.22 seconds. What is the appropriate action of the nurse?

Document the findings and continue to monitor the client.

A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first?

Elevate the head of the bed 30 to 45 degrees.

A child with hemophilia is brought to the clinic with spontaneous soft tissue bleeding of the right knee. Immediately on the child's arrival, what should the nurse do?

Elevate the right knee.

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

Have regular follow-up care.

The nurse is administering a tuberculin skin test. Place the steps for administering the tuberculin skin test in the correct order. All options must be used.

-Obtain a tuberculin syringe, a half-inch, 26-gauge needle, and purified protein derivative. -Draw up intermediate-strength purified protein derivative. -Clean forearm area with alcohol. -Inject 0.1 ml of the purified protein derivative. -Create a wheal that is 6 to 10 mm in diameter. -Remove the tuberculin syringe and dispose of the tuberculin syringe.

When educating the client with type 1 diabetes, the nurse knows that more education is needed when the client says:

"I will be able to switch to insulin pills when my sugar is under control."

The nurse is teaching a client about levothyroxine. Which instruction should a nurse offer the client?

"Take the drug on an empty stomach."

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. What should the nurse tell the client?

"Taking ginseng will increase the risk of hypoglycemia."

The nurse teaches a client with type 2 diabetes mellitus about diabetic retinopathy. Which statement if made by the client would indicate to the nurse that teaching was effective?

"Tight control of blood sugar and blood pressure can prevent damage to my eye."

A nurse is caring for a client with poorly managed diabetes mellitus who has a serious foot ulcer. When the nurse informs the client that the physician has ordered a wound care nurse to examine the wound, the client asks why should anyone other than the staff nurse care for the wound. The client states, "It's no big deal. I'll keep it covered and put antibiotic ointment on it." Which responses made by the nurse would be appropriate? Select all that apply.

-"We're very concerned about your foot and we want to provide the best possible care for you." -"You could possibly lose your foot without proper care." -"The wound nurse is specially trained to care for diabetic wounds."

The healthcare provider orders a new medication for a 5-year-old client. The nurse educator asks the student, "What is a medication dose affected by?" What is the best response by the student? Select all that apply.

-"disease state" -"weight"

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris and a hemoglobin A1C of 10%. Which actions should the nurse take? Select all that apply.

-Prepare to schedule a trans-esophageal echo (TEE). -Evaluate the client's diabetic management regimen. -Obtain a blood sample for a troponin level.

Which information should the nurse include about hypoglycemia when teaching a client newly diagnosed with type 2 diabetes mellitus? Select all that apply.

-Regular meals and a bedtime snack will decrease the incidence of hypoglycemia. -Symptoms of hypoglycemia can include irritability, hunger, shaking, and sweating. -A carbohydrate food source should be available during strenuous exercise. -Alcohol consumption can increase the incidence of hypoglycemia.

A client in the emergency department has symptoms of anxiety, a "racing heart," and dyspnea. The cardiac monitor shows sinus tachycardia with a heart rate of 122. What is the appropriate action of the nurse?

Assess the client's vital signs and oxygen saturation.

A nurse is teaching a client with diabetes mellitus about self-management. Which statement would be correct about the administration of lispro insulin?

Take the insulin at around the same time each day at a meal.

A child is admitted to the hospital with a febrile seizure. What action should the nurse take?

Keep the room temperature low and bedclothes to a minimum.

The nurse is caring for a client following a motor vehicle incident with head trauma. Diabetes insipidus is suspected. Which nursing intervention is appropriate?

Measure and record urinary output.

The nurse is caring for a client in active labor and notes minimal variability on the external fetal monitor tracing. What are the nurse's priority interventions?

Position to left lateral, O2 per nonrebreather mask at 10 L.

A 22-year-old client with quadriplegia in supine position is apprehensive and flushed, with a blood pressure of 210/100 mmHg and heart rate of 50 bpm. Which nursing intervention should be done first?

Raise the head of the bed immediately to 90 degrees

A client has just returned from having a central venous catheter placed and is prescribed I.V. solution to run at 100 ml/hr. What is the appropriate action by the nurse?

Review the x-ray results to ensure correct catheter placement.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes?

The body and mood will gradually return to normal.

A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observing the client for:

Vertigo.

A client with diabetic ketoacidosis (DKA) has asked the unlicensed nursing assistant for another pitcher of water. It is the third such request over the past 4 hours. The nurse would recognize this request as which manifestation?

an occurrence of the excess loss of fluid associated with osmotic diuresis

After receiving an I.M. injection, a client complains of burning pain at the injection site. Which nursing action would be most appropriate at this time?

applying a warm compress to dilate the blood vessels

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?

assess vital signs.

Which condition may contribute to hyperparathyroidism?

chronic renal failure

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's spouse reports that the client acted confused and was extremely weak upon waking that morning. The client's blood pressure is 90/58 mm Hg, pulse is 116 beats/minute, and temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion?

hydrocortisone

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

hypercalcemia

What important considerations would the nurse make when teaching and caring for a client newly diagnosed with diabetes mellitus?

involving the client in the development of the teaching plan and encouraging questions and active participation

The nurse should teach the diabetic client that which is most indicative of hypoglycemia?

nervousness

A client is prescribed exenatide. What should the nurse instruct the client to do? Select all that apply.

-Review the one-time set-up for each new pen. -Inject in the thigh, abdomen, or upper arm. -Administer the drug within 60 minutes before morning and evening meals.

An obese client, age 65, is diagnosed with type 2 diabetes. When educating this client about the diagnosis, the nurse knows that more education is needed when the client says which statement? Select all that apply.

If I follow my diet and exercise, I won't have diabetes any more." "I can never eat a hot fudge sundae again." "I guess I will need to stop meeting my friends at the coffee shop."

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

The isophane (NPH) insulin is peaking.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse administer hydromorphone in small doses?

as potent as morphine in larger doses.

When obtaining the nursing history of a client who has type 1 diabetes mellitus, the nurse should assess the client for which early symptom of diabetic nephropathy?

microalbuminuria

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? Select all that apply.

-excessive thirst -excessive hunger -frequent, high-volume urination

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client?

nitroprusside

A client who has had AIDS for years is being treated for a serious episode of pneumonia. A psychiatric nurse consult was arranged after the client stated, "I'm tired of being in and out of the hospital. I'm not coming in here anymore. I have other options." The nurse would evaluate the psychiatric nurse consult as helpful if the client makes which statements?

"I realize that I really do have more time to enjoy my friends and family."

A client is going to receive an insulin pump prior to discharge and the nurse has done extensive teaching. Which statement indicates that the client has a good understanding about the pump?

"I will need to monitor blood glucose levels multiple times a day while on the insulin pump."

The nurse reviews insulin administration with a client. Which statement best indicates that the client will continue to perform the procedure correctly?

"I wrote down the steps in case I forget what to do."

A client recently diagnosed with hyperparathyroidism demands to see what the healthcare provider has written in the chart. What is the nurse's best response?

"I'll get the chart and set up a time for you to review it with your healthcare provider."

A physician has referred a client newly diagnosed with diabetes mellitus to the diabetes nurse-educator. When the nurse brings up the subject, the client states, "I'd rather work with you than with a stranger." What is the nurse's best response?

"I'll set up a meeting for today. Then you and I can meet to talk about how things went."

The nurse should review the glucose level of which clients who are going to surgery today? Select all that apply.

-a client with diabetes mellitus controlled by diet -a client with a high stress response to surgery -a client receiving corticosteroids for the past 3 months

A nurse obtains a fingerstick glucose level of 45 mg/dl (2.47 mmol/L) on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene?

obtain a repeat fingerstick glucose level.

A client who is 12 hours post total thyroidectomy reports tingling around the mouth. Which assessment is the priority?

calcium level

A nurse has received a change-of-shift report on four clients. Which client should the nurse assess first?

client experiencing tracheal deviation following a subclavian catheter insertion

The nurse is teaching the client to self-administer insulin. Which approach to establishing learning goals will likely be most effective? When the goals are established by the:

client, nurse, pharmacist, and health care provider, so the client can participate in planning care with the entire team.

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test?

cortisol levels before and after the system is challenged with a synthetic steroid

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?

fluid deprivation test

The adrenal cortex is responsible for producing which substances?

glucocorticoids and androgens

A nurse is caring for an older adult client who is admitted with an electrolyte imbalance. Which laboratory values should be a priority concern for the nurse? Select all that apply.

pH 7.32 potassium 5.8 mEq/L

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?

potassium chloride

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of

profound neuromuscular irritability.

A nurse should expect a client with hypothyroidism to report

puffiness of the face and hands.

` A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss?

rapid, deep respirations

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?

reserving an antecubital site for a peripherally inserted central catheter (PICC)

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?

tachycardia

The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel?

decreasing contact with blood and blood-contaminated fluids

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client?

delayed wound healing

The nurse teaches the client with type 1 diabetes mellitus about the importance of maintaining stable blood glucose levels. The nurse should suggest the client include which type of food to minimize the rise in blood glucose level after meals?

dietary fiber

The nurse in the emergency department is triaging victims of an airplane crash. Prioritize the clients in the order in which they should be treated from first to last. All options must be used.

-a 14-year-old with a 2-inch (5.1-cm) laceration to the chin, history of asthma, respirations 26 breaths/min, audible wheezing -a 22-year-old with a 2-inch (5.1-cm) laceration to the left temple, slightly confused -a 22-year-old female, 36 weeks pregnant with contractions every 10 to 15 minutes -a 75-year-old with a 2-inch (5.1-cm) laceration to the left forearm

A nurse is caring for a client who is being discharged after a thyroidectomy. Which discharge instructions would be appropriate for this client? Select all that apply.

-Take thyroid replacement medication as ordered. -Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician.

A client receives 12 units of intermediate- or long-acting insulin and 6 units of fast-acting insulin each morning. Place the following actions in chronological order of how the nurse would demonstrate how to mix insulins. Use all options.

-Wipe off the vials with an alcohol swab. -Inject 12 units of air into the intermediate- or long-acting insulin vial. -Inject 6 units of air into the fast-acting insulin vial. -Withdraw 6 units of fast-acting insulin. -Withdraw 12 units of intermediate- or long-acting insulin .

A client is diagnosed with diabetes mellitus. The physician orders 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes their hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?

Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH.

A client is ordered prednisone daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning?

Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern.

Immediately following a thyroidectomy, the nurse asks the client to say "hello." The client moves the lips, but is not able to speak the word. What should the nurse do next?

Notify the surgeon.

The client has chronic pancreatitis. What should the nurse teach the client to do to monitor the effectiveness of pancreatic enzyme replacement?

Observe stools for steatorrhea.

The nurse is assessing a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). What findings does the nurse attribute to complications of this condition?

jugular vein distention and confusion

The comatose victim of a car accident is to have a gastric lavage. Which position would be most appropriate for the client during this procedure?

lateral

A client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap?

metabolic acidosis

A client receiving thyroid replacement therapy develops influenza and forgets to take the prescribed thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing what life-threatening complication?

myxedema coma

A nurse is assessing a client who is postoperative and unable to verbally answer questions. Which non-verbal behavior(s) should the nurse interpret as the client having pain Select all that apply.

-clenching -restlessness -grimacing