MedSurg Exam 1(Pt. 1)

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 1. "Are you rotating the injection site?" 2. "Are you aspirating before you inject the insulin?" 3. "Are you using a 1-inch needle to give the injection?" 4. "Are you placing an air bubble in the syringe before injection?"

1. "Are you rotating the injection site?"

The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse should provide the client with which best instruction? 1. Eat meals at approximately the same time each day. 2. Adjust meal times depending on blood glucose levels. 3. Vary meal times if insulin is not administered at the same time every day. 4. Avoid being concerned about the time of meals so long as snacks are taken on time.

1. Eat meals at approximately the same time each day.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 1. Glycosylated hemoglobin of 6% 2. Presence of ketones in the urine 3. Presence of albumin in the urine 4. Fasting blood glucose level of 150 mg/dL

1. Glycosylated hemoglobin of 6%

A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

1. Polyuria

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

1. Polyuria

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply. 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Dry mouth 5. Flushed, dry skin 6. Moist mucous membranes

1. Polyuria 2. Polydipsia 3. Polyphagia 4. Dry mouth 5. Flushed, dry skin

A client's serum blood glucose level is 48 mg/dL. The nurse would expect to note which as an additional finding when assessing this client? 1. Slurred speech 2. Increased thirst 3. Increased appetite 4. Increased urination

1. Slurred speech

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. 1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA) 5. Primary failure of glucagon secretion

1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA)

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period? 1. Vital signs 2. Fluid balance 3. Anxiety level 4. Creatinine levels

1. Vital signs

The family of a bedridden client with type 2 diabetes mellitus and a chronic kidney disease calls a nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 1. "What is the client's urine output?" 2. "What is the client's capillary blood glucose level?" 3. "Has there been any change in the dietary intake?" 4. "Have you increased the amount of fluids provided?"

2. "What is the client's capillary blood glucose level?"

A client with diabetes mellitus has a blood glucose level of 50 mg/dL and reports feeling hungry and shaky. Which should the nurse provide the client? 1. 3 oz of 2% milk 2. 4 oz of apple juice 3. 2 oz of orange juice 4. A teaspoon of granulated sugar

2. 4 oz of apple juice

A client with diabetes mellitus demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the most appropriate intervention to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety so that they will soon disappear. 4. Make sure that the client knows all the correct medical terms to understand what is happening. 2. Convey empathy, trust, and respect toward the client.

2. Convey empathy, trust, and respect toward the client.

A client with diabetes mellitus experiences breakdown of fats for conversion to glucose. The nurse determines that this response is occurring if the client has elevated levels of which substance? 1. Glucose 2. Ketones 3. Glucagon 4. Lactic dehydrogenase 2. Ketones

2. Ketones

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 1. Urine is negative for ketones. 2. Serum potassium is 6.8 mEq/L. 3. Serum osmolality is 260 mOsm/L. 4. Arterial blood gas values are: pH 7.52, Pco2 44 mm Hg, HCO3 30 mEq/L..

2. Serum potassium is 6.8 mEq/L

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Lightheadedness

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would monitor for which problems associated with this disease? Select all that apply. 1. Obesity 2. Syncope 3. Hirsutism 4. Hypotension 5. Muscle weakness

2. Syncope 4. Hypotension 5. Muscle weakness

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2. Test the drainage for glucose.

A newly diagnosed client with diabetes mellitus is started on a two-dose insulin protocol combination of short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast and what portion before the evening meal? 1. Half before breakfast and half before the evening meal 2. Two thirds before breakfast and one third before the evening meal 3. One third before breakfast and two thirds before the evening meal 4. Three fourths before breakfast and one fourth before the evening meal

2. Two thirds before breakfast and one third before the evening meal

Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply. 1. Ketones are present in the urine. 2. Urine specific gravity is 1.001. 3. Jugular venous distention is observed. 4. Serum osmolality is 320 mOsm/kg of water. 5. Blood glucose levels are greater than 200 mg/dL. 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

2. Urine specific gravity is 1.001. 4. Serum osmolality is 320 mOsm/kg of water. 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The nurse plans care, understanding that, as part of this response, the endocrine system will increase production and secretion of which mineralocorticoid? 1. Cortisol 2. Glucagon 3. Aldosterone 4. Adrenocorticotropic hormone

3. Aldosterone

A home health nurse is visiting a client with type 1 diabetes mellitus. The client tells the nurse that he is not feeling well and has had a "respiratory infection" for the past week, which seems to be getting worse. After interviewing the client, what should be the initial nursing action? 1. Notify the health care provider. 2. Document the assessment data. 3. Check the client's blood glucose. 4. Obtain the client's sputum for culture and sensitivity.

3. Check the client's blood glucose.

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible thyroid surgery complication? 1. Increased serum sodium level 2. Increased serum glucose level 3. Decreased serum calcium level 4. Decreased serum albumin level

3. Decreased serum calcium level

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level 6. Low plasma bicarbonate level

3. Deep, rapid breathing 5. Elevated blood glucose level 6. Low plasma bicarbonate level

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs should the nurse monitor for? Select all that apply. 1. Anorexia 2. Dizziness 3. Hypertension 4. Weight loss 5. Moon facies 6. Truncal obesity

3. Hypertension 5. Moon facies 6. Truncal obesity

A client's serum blood glucose level is 389 mg/dL. The nurse would expect to note which as an additional finding when assessing this client? 1. Unsteady gait 2. Slurred speech 3. Increased thirst 4. Cold, clammy skin

3. Increased thirst

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1. Ampule of 50% dextrose 2. NPH insulin subcutaneously 3. Intravenous fluids containing dextrose 4. Phenytoin (Dilantin) for the prevention of seizures

3. Intravenous fluids containing dextrose

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous infusion of normal saline

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous of sodium bicarbonate

3. Intravenous infusion of normal saline

A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 1. Diarrhea 2. Infection 3. Polydipsia 4. Weight gain

3. Polydipsia

A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL. The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 1. Hyponatremia 2. Rise in serum pH 3. Presence of ketone bodies 4. Elevated serum bicarbonate level

3. Presence of ketone bodies

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 pm." 2. "I will check my blood glucose level 1 hour after each meal." 3. "I will check my blood glucose level 2 hours after each meal." 4. "I will check my blood glucose level before each meal and at bedtime."

4. "I will check my blood glucose level before each meal and at bedtime."

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL.

4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."

A client is undergoing an oral glucose tolerance test. The nurse interprets that the client's results are compatible with diabetes mellitus if the glucose level is at which value after 120 minutes (2 hours)? 1. 80 mg/dL 2. 110 mg/dL 3. 130 mg/dL 4. 160 mg/dL

4. 160 mg/dL

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

4. Apply a moisturizing lotion to dry feet but not between the toes.

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 which information about the pump? 1. Is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals 2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream 4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the health care provider's documentation and should expect to note which diagnosis? 1. Hypoglycemia 2. Pheochromocytoma 3. Diabetic ketoacidosis (DKA) 4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

A client is experiencing an episode of hypoglycemia. The nurse understands that the physiological mechanism that should take place to combat this decrease in the blood glucose level is which mechanism? 1. Decreased cortisol release 2. Increased insulin secretion 3. Decreased epinephrine release 4. Increased glucagon secretion

4. Increased glucagon secretion

A client who has had intracranial surgery is experiencing diabetes insipidus. The nurse understands that the diabetes insipidus resulted from which problem? 1. Water intoxication 2. Excess production of dopamine 3. Excess production of angiotensin II 4. Insufficient production of antidiuretic hormone (ADH)

4. Insufficient production of antidiuretic hormone (ADH)

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 1. Platelets 2. Muscle tissue 3. Adipose tissue 4. Red blood cells

4. Red blood cells

A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis and a serum glucose level of 789 mg/dL. The health care provider (HCP) prescribes 10 units of regular insulin by intravenous (IV) bolus, followed by a continuous insulin infusion at a rate of 5 units/hr. The pharmacy sends 500 mL of normal saline solution containing 50 units of regular insulin. After administering the IV bolus of 10 units of regular insulin, the nurse sets the infusion pump flow rate of the normal saline solution containing 50 units of regular insulin to infuse at how many milliliters per hour to deliver 5 units/hr?

50 ml/ hr