MedSurg Quiz 10

In caring for Mr. D, the nurse is digital for signs and symptoms of hypokalemia. What signs and symptoms should the nurse watch for? Select all that apply.

-Fatigue -Muscle weakness -Hypotension -Weak pulse -Shallow respirations

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 theraputic communication response?

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

To clarify pertinent data, what questionnaire appropriate to ask Mr. D? Select all that apply.

-"When did your symptoms start?" -"How many times have you vomited?" -"Where does your abdomen hurt?" -"Did you take any insulin today?" -"Do you have any allergies?"

Which person(s) should be allowed to have access to Mr. D's medical records? Select all that apply.

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

Which tasks can the nurse direct an experienced UAP to perform to facilitate Mr. D's transfer to the ICU?

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

In developing an individualized meal plan for a patient with diabetes, which goals will be focal points of the plan?

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

Which tasks are appropriate to deliver to an experienced unlicensed assistive personnel (UAP)? Select all that apply.

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

In the initial emergency care for Mr. D, which HCP prescriptions would the nurse question? Select all that apply.

-Obtain a urine specimens with a small bore straight catheter -Administer regular insulin subcutaneously -Encourage intake of oral fluids as tolerated

The nurse is providing discharge teaching to a patient about self monitoring of blood glucose (SMBG). What information does the nurse include? Select all that apply.

-Wash hands before using the meter -Do a retest if the results seem unusual -Do not share the meter -How to calibrate the machine

The nurse is preparing to transfer Mr. D to the ICY and notices the cardiac monitor display. Which ECG pattern is cause for greatest concern?

2 (v tach)

The nurse is reviewing the potassium values that were obtained when Mr. D first arrived in the ED. Which serum potassium level is most concerning?

2 mEq/L (2mmol/L)

Along with exercise, what is the recommended calorie reduction for a patient with diabetes who must lose weight?

250-500 calories/day

An insulin infusion is ordered for Mr.D to begin at 0.1 units/kg/hr. Mr. D weights 155lbs. 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?

Advise nurse A to recalculate the infusion rate

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 hime your message." What will the nurse do first?

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

The ED nurse is trying to call a report to the ICU but is told, "We were not notified about the admission." What should the nurse do first?

Ask the unit secretary to call the admissions office now

Which statement about dietary concepts for a patient with diabetes is true?

Carbohydrate counting is emphasized when adjusting dietary intake of nutrients

The ED nurse is preparing the SBAR report before the ICU transfer. Which detain would be most important to include as background to ensure that Mr. D's right to privacy is maintained?

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

What is the basic principle of meal planning for a patient with type 1 DM?

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

For the initial emergency care of Mr. D, what is the prior collaborate treatment goal?

Correction of fluid imbalance with IV fluids

Which member of the health care team is demonstrating a behavior that is an example of a barrier to interprofessional collaboration?

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

What is the priority nursing concept to consider in planning the initial emergency interventions for Mr. D?

Fluid and electrolyte imbalance

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?

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

What physical assessment finding is most likely to accompany these laboratory results?

Kussmaul respirations

What does the nurse anticipate the HCP will order for the initial fluid replacement?

Normal saline (0.9% sodium chloride)

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?

Nourishment to counteract late insulin activity

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?

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

What is the recommended protocol for patients with type 2 DM who must lost weight?

Reduce calorie intake moderately and increase exercise

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?

Regulated food intake is basic to control

The nurse has completed the triage assessment and history taking. Now what is the priority action?

Take the client immediately to a treatment room.

The ED nurse is reviewing the intensive care unit (ICU) admission orders. There is a prescription of an IV potassium infusion. Related specifically to the potassium infusion, which information would the ICU nurse be most interested in knowing?

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

The nurse identifies that the dietary teaching provided for a client with diabetes in understood when the client states, "My diet:

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