Nurs 327 exam 4

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it?

"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual."

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what?

"I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours."

Which statement indicates that a client with diabetes mellitus understands proper foot care?

"I'll wear cotton socks with well-fitting shoes."

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?

"I'm thirsty all the time. I just can't get enough to drink.

A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer?

"If you are going to use up the vial within 1 month it can be kept at room temperature."

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply.

"Internal secretion of hormones is the function of the endocrine pancreas." "The endocrine pancreas secretes hormones through a ductless gland." "The exocrine pancreas secretes hormones from excretory ducts." "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

postnecrotic cirrhosis

-broad bands of scar tissue -previous viral hepatitis/ typically follows viral hepatitis

rapid acting (novalog, humalog)

1-2H (onset 10-15min)

weight reduction of 2lbs per week what carbs should be intake per day?

1000 carbs

insulin secretion increases 3-5 minutes after a meal and returns to baseline, if ate at 7:30, when baseline?

10:30AM

Hepatitis A, what are correct about this disorder?

70% chance jaundice occurs transmission of virus possible with anal-oral contact typically there is spontaneous recovery

post pituitary

ADH, Oxycontin

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client?

Acetaminophen Ketoconazole Valproic acid

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?

Administering 1 ampule of 50% dextrose solution, per physician's order

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply.

Administration of calcitonin Intravenous isotonic saline solution in large quantities Monitoring the patient for fluid overload

A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response?

Adrenal medulla (secretes epinephrine and noroepinephrine so fight or flight)

Which type of cell secretes glucagon and promotes gluconeogenesis?

Alpha

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis?

Assess the client's breath odor

Hasimoto's Thyroiditis

Autoimmune attack on thyroid, leading to hypotyroidism

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question?

Change the second IV solution to dextrose 5% in water.

biliary cirrhosis

Cirrhosis develops from chronic biliary obstruction, bile stasis, and inflammation, resulting in severe obstructive jaundice.

The nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results?

Lower than 50 to 60 mg/dL (2.77 to 3.33 mmol/L)

anterior pituitary

GH, FSH, ACTH, LH, Prolactin

The patient has liver failure and you know she has an increased risk for bleeding because of the client's inability to synthesize prothrombin in the liver. What factor contributes to this loss of function?

Inability to use vitamin K

Portal Hypertension

Increased venous pressure in the portal circulation caused by cirrhosis or compression of the hepatic vascular system.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply.

Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes?

Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Sexual activity

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply.

Leakage of fluid or serum (exudates) Microaneurysms Focal capillary single closure

Glargine insulin (Lantus)

Long-acting insulin ☐ Administered once daily, anytime during the day but always at the same time each day. ☐ Glargine insulin forms microprecipitates that dissolves slowly over 24 hr and maintains a steady blood sugar level with no peaks or troughs. ☐ Administer glargine insulin subcutaneous only and never administer IV. NO PEAK

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply.

May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply.

Normal bedtime blood glucose Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM

A nurse educator is teaching a chapter on "The Function of the Endocrine System." Which hormone would not be included as one of the six hypothalamic hormones?

Prolactin

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?

Reflects the amount of glucose stored in hemoglobin over past several months.

You are discussing macrovascular complications of diabetes with the client. The nurse would address what topic during this dialogue?

The fact that there is an increased risk of myocardial infarction

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication?

Thyrotoxic crisis

Alcoholic cirrhosis

a disease involving scarring and deterioration of liver cells as a result of chronic alcohol abuse

acute pancreatitis

abdominal pain, back pain

Radioistope liver scan is performed when?

access liver size, blood flow, obstruction

hypoparathyroidism

hypocalcemia, tetany

The client has returned to the floor after a laparoscopic cholecystectomy. You should assess this patient for what serious potential complication of this surgery?

bile duct injury

nusring assessment MOST important with Ascites?

daily meaursement of abdominal girth

heaptic Cirrhosis, what findings lead to discovery?

enlarged iver, ascites, hemmorids

hyperparathyroidism

excessive production of parathormone from tumor, increased calicum concentration in the blood

Cushing syndrome symptoms

fatty hump between shoulders, a rounded face, and pink or purple stretch marks on skin, thinning fragile skin, slow healing of cuts, insect bites and infections, acne, decreased libido, decreased fertility, irregular or absent menstrual periods, fatigue, muscle weakness, cognitive difficulties, and headaches. hypokalemia, hyperglycemia, acne, BEARDS glaucoma

hep A

fecal-oral, s/s: flu like symptoms, jaundice, dark urine

ECRP

fibroscoptic endoscope that looks inside the biliary tree from the small intestine into the pancreas

adrenal cortex produces what?

glucocorticoids and mineralocorticoids

exocrine pancreas

hormones

Graves disease

hyperthyroidism

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone

increase serum calcium

hep C

increased risk of cancer

endocrine pancreas

insulin, glucagon, somatostion (creates hypoglycemic effect)

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.)

measure abdominal girth daily perform daily weights

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

Intermediate NPH

onset 1-3H, PEAK: 4-10H

Regular insulin (Humulin R, Novolin R)

short acting onset .5-1H PEAK: 2-4H

hyperthyroidism, nurse specify in clients meal plan

small frequnent meals high in protien and carbs

diarrhea, vommiting. client has hx of adrenal insufficency, what should client increase take up of?

sodium

hep B

without symptoms, rash