Passpoint Metabolism MS ML6

The nurse is caring for a neonate at 38 weeks' gestation when the nurse observes marked peristaltic waves on the neonate's abdomen. After this observation, the neonate exhibits projectile vomiting. The nurse notifies the health care provider (HCP) because these signs are indicative of which problem? A. diaphragmatic hernia B. esophageal atresia C. hiatal hernia D. pyloric stenosis

D Marked visible peristaltic waves in the abdomen and projectile vomiting are signs of pyloric stenosis. If the condition progresses without surgical intervention, the neonate will become dehydrated and develop metabolic alkalosis. Signs of esophageal atresia include coughing and regurgitation with feedings. Diaphragmatic hernia, a life-threatening event in which the abdominal contents herniate into the thoracic cavity, may be evidenced by breath sounds being heard over the abdomen and significant respiratory distress with cyanosis. Signs of hiatal hernia include vomiting, failure to thrive, and short periods of apnea.

A client is 12 hours post abdominal inguinal hernia repair done under general anesthesia. The practitioner orders to progress diet as tolerated. Which tray should the nurse choose for this client? A. bananas, rice, applesauce, and toast B. a bland diet tray C. milk, custard, and vanilla ice cream D. broth, gelatin cubes, and tea

D To begin the patient's transition to eating a regular diet, the nurse will first choose a clear-liquid diet. This includes transparent liquids, such as apple juice, ginger ale, and chicken broth. When clear liquids are tolerated, the client can then transition to a full-liquid diet consisting of fluids and foods that are liquid at room temperature. Some examples are milk, custard, ice cream, puddings, vegetable and fruit juices, refined or strained cereals, and egg substitutes. Although milk, custard, and vanilla ice cream may be included in a bland diet, it may also include semi-solid and solid foods that are not spicy. The BRAT diet is commonly used to combat diarrhea and limits intake to bananas, rice, applesauce, and toast.

A client comes to the office for a routine prenatal visit at 26 weeks gestation. The urine dipstick is negative for protein but 2+ for glucose. The nurse would teach the client about what testing that needs to be performed? A. 3-hour glucose tolerance test B. 24-hour urine collection C. 1-hour glucose tolerance test D. glycated hemoglobin level

C The recommendations for screening a pregnant woman for diabetes include drawing blood for glucose and HbA1C at the first prenatal visit. Gestational diabetes is determined around the 24th-28th week of gestation. Testing at this time would be a 1-hour oral glucose tolerance test. The mother is administered 75g of glucose, and blood is drawn 1 hour later. If the results are above 140 mg/dL (7.8 mmol/L), the test is abnormal, and a 3-hour oral glucose tolerance test would be performed. If the 3-hour test is positive, a diagnosis of gestational diabetes would be made. If protein had been present, a 24-hour urine collection for protein and creatinine clearance may be ordered, but the healthcare provider would more likely request spot urine protein-to-creatinine ratio.

An adolescent client is admitted for treatment of anorexia nervosa with a body mass index (BMI) of 13. What is the nurse's priority in planning the care? A. Encourage the client to perform muscle-building exercises. B. Meet daily with the client to discuss manipulation and countertransference. C. Keep the client on bed rest until the goal weight is achieved. D. Monitor the client's urine output and vital signs.

D A BMI of 13 is severely underweight and poses a risk to the client's physical health, including potential cardiac dysrhythmia, hypotension, or kidney failure. Although clients with eating disorders commonly use manipulative ploys and countertransference to resist weight gain, the priority at this stage of treatment is ensuring there are no life-threatening complications. Muscle building is not appropriate when the client is this underweight, but it can be added once weight gain is acceptable. Keeping the client on bed rest until a specified weight is attained is not recommended, because this can lead to complications related to immobility.

A nurse performs a fingerstick glucose-monitoring test for a client. The results are 49 mg/dL (2.7 mmol/L). Which clinical manifestations does the nurse assess for? A. polyphagia and flushed, dry skin B. polyuria, headache, and fatigue C. nervousness, diaphoresis, and confusion D. polydipsia, pallor, and irritability

C

The nurse is teaching a client who had a gastrectomy how to reduce the risk for dumping syndrome. What should the nurse teach the client to do? A. Avoid milk and other dairy products. B. Drink liquids with meals, avoiding caffeine. C. Decrease the carbohydrate content of meals. D. Sit upright for 30 minutes after meals.

C Carbohydrates are restricted, but protein, including meat and dairy products, is recommended because it is digested more slowly. Lying down for 30 minutes after a meal is encouraged to slow the movement of the food bolus. Fluids are restricted to reduce the bulk of food. There is no need to avoid caffeine.

A client is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment? A. weight gain B. nausea C. diarrhea D. tachycardia

A

The nurse should instruct a client with heart disease to avoid which foods that contribute to increases in serum cholesterol? A. polyunsaturated fat B. saturated fat C. phospholipids D. monounsaturated fat

B Saturated fats raise blood cholesterol.Polyunsaturated fats maintain blood cholesterol.Monounsaturated fats may help to maintain or lower blood cholesterol.Phospholipids do not have an effect on cholesterol but act as emulsifiers, keeping fats dispersed in water.

The nurse develops a teaching plan for the parent of an infant about introducing solid foods into the diet. The nurse should expect to include which measure in the plan to help prevent obesity? A. introducing the infant to the taste of vegetables by mixing them with formula or breast milk B. thin cereal with juice during the first several months C. mixing cereal and fruit in a bottle when offering solid food for the first few times D. decreasing the amount of formula or breast milk intake as solid food intake increases

D

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the health care provider will order diuretic therapy, restrict fluid intake, and provide sodium replacement to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise? A. tetany B. hypovolemic shock C. severe hyperkalemia D. cerebral edema

D Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema. Hypovolemic shock results from severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH.

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? A. Addison's disease B. hypoparathyroidism C. hyperthyroidism D. Cushing's syndrome

A

Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will: A. maintain normal fluid and electrolyte balance. B. select a diabetic diet correctly. C. state dietary restrictions. D. exhibit serum glucose level within normal range.

A Because diabetes insipidus involves the excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in the treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.

A client is interested in making dietary changes to reduce the risk for colon cancer. What dietary selections should the nurse suggest? A. bran muffin, skim milk, and stir-fried broccoli B. oatmeal raisin cookies, baked potato with sour cream, and a turkey sandwich C. croissant, granola and peanut butter squares, and whole milk D. granola, bagel with cream cheese, and cauliflower salad

A High-fiber, low-fat diets are recommended to reduce the risk for colon cancer. Stir-frying, poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of refined flour. They are also high in fat, as are peanut butter squares and whole milk, granola, cream cheese, and sour cream.

The nurse teaches a parent about caring for a 12-month-old child newly diagnosed with celiac disease. Which food would be most appropriate to include in the child's diet? A. rice cereal B. oatmeal C. pancakes D. waffles

A The child with celiac disease should not eat foods containing wheat, oats, rye, or barley. Pancakes and waffles are made from flour that typically is derived from wheat and therefore should be avoided. Foods containing rice, such as rice cereal, or corn are appropriate. Pancakes and waffles are made from flour that typically is derived from wheat and therefore should be avoided.

A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? A. beta-adrenergic blockers B. monoamine oxidase (MAO) inhibitors C. antineoplastic drugs D. antiparkinsonian drugs

B Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites? A. Insulin is absorbed unpredictably at all injection sites. B. Insulin is absorbed more slowly at abdominal injection sites than at other sites. C. Insulin is absorbed rapidly regardless of the injection site. D. Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

B Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

A client newly diagnosed with diabetes mellitus asks why they need ketone testing when the disease affects their blood glucose levels. How should the nurse respond? A. "Ketones can damage your kidneys and eyes." B. "Ketones will tell us if your body is using other tissues for energy." C. "The spleen releases ketones when your body can't use glucose." D. "Ketones help the physician determine how serious your diabetes is."

B The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

The nurse completes an assessment of an infant at the well-child clinic. Which clinical manifestation(s) would lead the nurse to suspect that an infant has hypothyroidism? Select all that apply. A. tachycardia B. muscle weakness C. bulging eyes D. lethargy E. increased appetite F. cool extremities

B, D, E, F Hypothyroidism is a disorder in which the levels of active thyroid hormone are decreased. Clinical manifestations include cool extremities, mottling, lethargy, constipation, muscle weakness, and a hoarse cry. Hyperthyroidism occurs when thyroid hormone levels are increased. Clinical manifestations include increased appetite, goiter, irritability, prominent eyes, and tachycardia.

The mother of a toddler diagnosed with iron deficiency anemia asks what foods she should give her child. The nurse should evaluate the teaching as successful when the mother later reports that she feeds the toddler which foods? A. beef, lettuce, and juice B. eggs, cheese, and milk C. raisins, chicken, and spinach D. milk, carrots, and beef

C Good sources of dietary iron include red meats, poultry, green leafy vegetables, and dried fruits such as raisins. Milk products are poor sources of iron. Carrots are high in vitamin A.

A client in cardiac rehabilitation would like to eat the right foods to ensure adequate endurance on the treadmill. Which nutrient is most helpful for promoting endurance during sustained activity? A. fat B. water C. carbohydrate D. protein

C The stored glucose of muscle glycogen is the major fuel during sustained activity. Glucose production slows as the body begins to depend on fat stores for glucose and fatty acids. Protein is not the body's preferred energy source. Fat is a secondary source of energy. Water is not an energy source, although sufficient water is required to engage in aerobic activity without causing dehydration.

The nurse is teaching a new parent about the feeding patterns of a newborn infant. Which of the following statements by the parent would the nurse recognize as the correct description of a feeding pattern for a formula-fed infant? A. "Formula-fed infants experience shorter periods between feedings." B. "Formula-fed infants demand to feed every 1.5 to 3 hours." C. "Formula-fed infants digest their milk more rapidly." D. "Formula-fed infants usually feed every 3 to 4 hours."

D Formula is harder to digest than breast milk and therefore, babies typically feed less frequently than breastfed babies. Formula-fed infants should demand feedings every 3 to 4 hours compared to every 2 to 3 hours for breastfed babies.

A nurse is caring for a client with hypothyroidism. The client is extremely upset about altered physical appearance. The client doesn't want to take the medication because "it isn't doing any good." What should the nurse do? A. Tell the client to ask the health care provider if the medication dosage is correct. B. Tell the client that the client's appearance is fine and offer to help improve it. C. Tell the client to practice self-acceptance and be compliant with the treatment. D. Tell the client that as the medication corrects the hormone deficiency, improvement in appearance can be expected soon.

D Stating that the client will soon experience improvement is supportive and encouraging, and the response addresses the client's concern while motivating continued medication compliance. Stating that the client should ask the health care provider about the medication dosage might influence the client to alter the dosage; it also avoids addressing the client's concern. Stating that the client looks fine discounts the client's feelings. Advising the client to practice self-acceptance and be compliant is directive at a time when the client needs support and understanding.

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? A. adrenal cortex B. adrenal medulla C. parathyroid D. pancreas

A Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

While caring for a client and their 1-day-old neonate born vaginally at 30 weeks' gestation, the nurse explains the neonate's need for gavage feeding at this time instead of the client's plan for bottle-feeding. What should the nurse include as the rationale for this feeding plan? A. The neonate has difficulty coordinating sucking, swallowing, and breathing. B. Gavage feedings can minimize the neonate's increased risk for developing hypoglycemia. C. A high-calorie formula, presently needed at this time, is more easily delivered via gavage. D. This type of feeding, easily given in the isolette, decreases the neonate's risk for cold stress.

A Before 32 weeks' gestation, most neonates have difficulty coordinating sucking and swallowing reflexes along with breathing. Increased respiratory distress may occur with bottle-feeding. Bottle-feedings can be given after the neonate shows sucking and swallowing behaviors. High-calorie formulas can be given by bottle or by gavage feeding. Although frequent feeding prevents hypoglycemia, the feeding does not have to be given via a gavage tube. Although these neonates can be stressed by cold, they can be kept warm with blankets while being bottle-fed or fed while in the warm isolette environment.

The nurse assesses a child with suspected juvenile hypothyroidism. Which signs or symptoms should the nurse expect this child to manifest? A. dry skin and constipation B. short attention span and weight loss C. rapid pulse and heat intolerance D. weight loss and flushed skin

A Clinical manifestations of juvenile hypothyroidism include dry skin, constipation, sparse hair, and sleepiness. Short attention span, weight loss, moist flushed skin, rapid pulse, and heat intolerance suggest hyperthyroidism.

The nurse is completing a health assessment of a client with suspected Graves disease. When conducting a focused assessment, the nurse should assess the client for which finding? A. tachycardia B. cold skin C. weight gain D. anorexia

A Graves disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.

A client has been admitted to the hospital for treatment of kidney stones. The client asks the nurse where the Atkins diet items are on the menu. What is the nurse's understanding of the diagnosis and diet? A. A diet high in protein may strain the kidney function. B. A diet low in fruits promotes higher glycemic control. C. A diet low in fat reduces cholesterol. D. A diet high in carbohydrates may increase insulin production.

A High-protein, low-carbohydrate diets like the Atkins diet have been widely promoted as effective weight loss plans. The diet also allows for a high fat intake. The complications associated with this diet include high cholesterol, kidney problems, and osteoporosis.

WBC: 4000 K: 4.9 Na: 132 Albumin: 2.5 The nurse is reviewing a client's daily labs. Which lab report would concern the nurse related to the client's risk for skin breakdown? A. albumin B. potassium C. sodium D. WBC

A The laboratory tests are all within normal limits with the exception of the sodium and albumin level. While the sodium level is slightly low, the albumin level is significantly low with a normal level of 3.5-5.0 mg/dL. Additionally, albumin is a much more important indicator of the nutritional status and risk for skin breakdown than the remainder of the laboratory studies.

A multigravida client has given birth to a large-for-gestational-age infant with an Apgar score of 8 and 9. What is the priority nursing assessment for the infant? A. jaundice B. hypoglycemia C. passage of meconium D. failure to thrive

B A large-for-gestational-age infant is at risk for hypoglycemia due to the possibility of a birth parent having diabetes (may or may not be diagnosed or related to gestation). The fetus makes insulin in response to the blood glucose that crosses the placenta; after birth, the fetus continues to make insulin even though high maternal blood glucose is no longer present. The result is neonatal hypoglycemia.The nurse will continue to monitor for passage of meconium in the newborn, but it may take several hours and is not a priority at this time.While nurses assess amniotic fluid for meconium so they can suction the airway at birth and attempt to prevent meconium aspiration of the newborn, this infant is already at least 5 minutes of age and breathing (according to the Apgar scores). The infant may develop jaundice or failure to thrive, but there is no information to suggest these findings at this time.

A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications? A. regular insulin with breakfast; NPH after breakfast B. NPH 1 hour before and regular 0.5 hours before breakfast C. both insulins 0.5 hours before breakfast D. in two separate syringes with breakfast

C Regular and NPH insulins are scheduled together one-half hour before breakfast. They do not need to be given separately or in different syringes.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? A. hypocalcemia and hyperkalemia B. hypokalemia and hypoglycemia C. hyperkalemia and hyperglycemia D. hypernatremia and hypercalcemia

B Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.

A client diagnosed with hypothyroidism (myxedema) is receiving levothyroxine. Which assessment findings would require a nursing intervention? Select all that apply. A. adventitious breath sounds B. heart rate of 132 beats/min C. dysrhythmias D. dysuria E. mild chest pain

B, C, E Levothyroxine (thyroid hormone replacement medication) increases cardiac demand, which can cause increased heart rate, palpitations, and chest pain. These clients are at risk for a myocardial infarction. Adventitious breath sounds are abnormal, extra sounds, but are not related to receiving levothyroxine. Dysuria means painful urination and is not a side effect of levothyroxine.

A client with a long history of ulcerative colitis takes sulfasalazine to control the condition. The nurse should assess the client for which nutritional deficit that can occur as a result of taking this drug? A. niacin deficit B. iron deficit C. folic acid deficit D. cobalamin deficit

C Clients who take sulfasalazine are susceptible to developing impaired folic acid absorption. Common clinical manifestations of a folic acid deficiency are gastrointestinal disturbances, such as anorexia, nausea, vomiting, and a smooth, beefy red tongue. The client should be encouraged to eat food high in folic acid, such as green leafy vegetables, meat, fish, legumes, and whole grains. Cobalamin deficiency, niacin deficiency, and iron deficiency are not side effects of sulfasalazine.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse 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? A. hypoglycemia B. diabetic ketoacidosis C. thyroid crisis D. tetany

C Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

A school nurse is called to assess a 12-year-old child with type 1 diabetes mellitus who is experiencing lightheadedness, tachycardia, and pallor during physical education class. What is the priority action by the nurse? A. Give the child some fruit juice to drink. B. Provide a snack of cheese and crackers. C. Administer the insulin that is due at this time. D. Notify the parents about the child's lightheadedness.

A Increased exercise has likely caused a drop in serum glucose levels, producing symptoms of hypoglycemia. The first action is to give the child a source of fast-acting carbohydrate (approximately15 grams) such as juice or candy. Cheese and crackers can be given once the acute symptoms of hypoglycemia have resolved to provide a longer-lasting source of complex carbohydrate and protein. Ideally the nurse would use blood glucose monitoring to direct this treatment. The nurse should not give insulin even if it is due now, because of the child's symptoms. The parents need to be notified of the child's symptoms, but the priority action is to care for the client.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? A. serum sodium level of 134 mEq/L (134 mmol/L) B. serum potassium level of 5.8 mEq/L (5.8 mmol/L) C. blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L) D. blood glucose level of 90 mg/dl (4.9 mmol/L)

B Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

An unconscious client is to receive 200 mL of tube feeding every 4 hours. The nurse checks for the client's gastric residual before administering the next scheduled feeding and obtains 40 mL of gastric residual. What should the nurse do next? A. Delay feeding the client for 1 hour, and then recheck the residual. B. Readminister the residual to the client, and continue with the feeding. C. Dispose of the residual, and continue with the feeding. D. Withhold the tube feeding, and notify the health care provider (HCP).

B Gastric residuals are checked before administration of enteral feedings to determine whether gastric emptying is delayed. A residual of less than 50% of the previous feeding volume is usually considered acceptable. In this case, the amount is not excessive, and the nurse should reinstill the aspirate through the tube and then administer the feeding. If the amount of gastric residual is excessive, the nurse should notify the HCP and withhold the feeding. Disposing of the residual can cause electrolyte and fluid losses.

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? A. to meet energy needs by eating only foods that keep blood glucose within a relatively normal range B. to maintain blood glucose levels close to the normal range to reduce risk for long-term complications C. to increase exercise and monitor weight to stay within a recommended healthy weight range D. to maintain cholesterol levels to prevent the long-term complications of vascular disease

B Maintaining normal blood glucose is the most important factor in preventing long-term complications associated with diabetes. Therefore, the most important purpose of nutritional management is maintaining blood glucose as close to normal as possible to prevent long-term complications. Following nutritional recommendations will meet energy needs, may contribute to weight control, and keep cholesterol levels within acceptable ranges, but the most important reason for nutritional management is to maintain blood sugars in the normal range.

During a visit to the prenatal clinic, a pregnant client at 32 weeks' gestation has heartburn. The client needs further instruction when they say they must do what to manage heartburn? A. Eat small, frequent meals. B. Avoid lying down right after eating. C. Avoid highly seasoned foods. D. Consume liquids only between meals.

D Consuming most liquids between meals rather than at the same time as eating is an excellent strategy to deter nausea and vomiting in pregnancy but does not relieve heartburn. During the third trimester, progesterone causes relaxation of the sphincter and the pressure of the fetus against the stomach increases the potential for heartburn. Avoiding highly seasoned foods, remaining in an upright position after eating, and eating small, frequent meals are strategies to prevent heartburn.

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating A. "The test must be repeated following a 12-hour fast." B. "It tells us about your sugar control for the last 3 months." C. "It looks like you aren't following the ordered diabetic diet." D. "Your insulin regimen must be altered significantly."

B The nurse is providing accurate information to the client when they state that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

The nurse is caring for a laboring client with pregestational diabetes mellitus who is in active labor. The client reports nausea and "feeling flushed." The nurse notes a fruity odor to the client's breath. What is the nurse's priority intervention? A. Administer insulin as prescribed. B. Administer an antiemetic IV push. C. Obtain the client's blood glucose level. D. Give the client oral glucose.

C Signs and symptoms of diabetic ketoacidosis include nausea and vomiting, a fruity or acetone breath odor, signs of dehydration (such as flushed, dry skin), hyperglycemia, ketonuria, hypotension, deep and rapid respirations, and a decreased level of consciousness. In contrast, hypoglycemia causes sweating, tremors, palpitations, and behavioral changes. To know what the client is experiencing, a blood glucose level must be obtained. An antiemetic will not treat diabetic ketoacidosis.

A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during the first 24 hours? A. Administer insulin subcutaneously. B. Administer a bolus of glucose I.V. C. Provide frequent early feedings with formula. D. Avoid oral feedings.

C The neonate of a mother with gestational diabetes may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia. Insulin shouldn't be administered because the neonate of a mother with gestational diabetes is at risk for hypoglycemia. A bolus of glucose given I.V. may cause rebound hypoglycemia. If glucose is given I.V., it should be administered as a continuous infusion. Oral feedings shouldn't be avoided because early, frequent feedings can help avoid hypoglycemia.

A nurse is reviewing home medications for a client recently admitted to a long-term psychiatric unit. The charge nurse asks why this client has frequent blood draws over the next few weeks. The nurse would be correct to state which home medication dosages vary according to the blood levels of the drug? A. clozapine B. alprazolam C. clonazepam D. lithium carbonate

D Dosages for lithium, an antimanic drug, are individualized to achieve a maintenance blood level of 0.8 to 1.2 mEq/L for acute mania and 0.8 to 1.0 mEq/L for long-term control of bipolar disorder. Although clozapine use requires monitoring of white blood cell counts and clonazepam use requires monitoring of complete blood count and liver function tests, these tests aren't used to individualize dosages of the drugs. Alprazolam dosages aren't based on blood levels of the drug.

A nurse is providing dietary instructions to a client with diabetes. What is most important for the nurse to include in teaching for prevention of hypoglycemia? A. Drink orange juice if lightheadedness occurs. B. Reduce carbohydrate intake when drinking alcohol. C. Increase protein intake in the morning. D. Avoid delaying or skipping meals.

D Hypoglycemia is an important complication in the treatment of diabetes. The risk of hypoglycemia increases as nutritional intake decreases, so it is most important to teach the client to avoid delaying or skipping meals. Carbohydrate intake has the greatest influence on blood glucose levels, so increasing protein in the morning will not prevent hypoglycemic episodes. Drinking alcohol inhibits the release of glucose from the liver; therefore it would be important to increase carbohydrate intake when drinking alcohol. Lightheadedness is a manifestation of hypoglycemia, and drinking orange juice would be the means to treat the hypoglycemia, not prevent it.

VS q15min for 4hr then qhr for 8 hr Oxygen 2L NC 1000mL Ns q8hr 10mg morphine IM q4hr PRN 10u of regular insulin stat The nurse is reviewing the postoperative prescriptions (see chart) just written by a health care provider (HCP) for a client with type 1 diabetes who has returned to the surgery floor from the recovery room following surgery for a left hip replacement. The client has a pain rating of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client'sclient's glucose level, the nurse should do what first? A. Administer oxygen per nasal cannula at 2 L per minute. B. Take the vital signs. C. Administer the morphine. D. Contact the health care provider (HCP) to rewrite the insulin prescription.

D Insulin is on the list of error-prone medications, and the nurse should ask the HCP to rewrite the prescription to spell out the word "units" and to indicate the route by which the drug is to be administered. The nurse should contact the HCP immediately as the nurse is to administer the insulin now. The nurse can then also report the most current glucose level. While waiting for the insulin prescription to be rewritten, the nurse can administer the pain medication if needed, start the oxygen, and check the client's vital signs.

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 A. cretinism. B. thyroid storm. C. Hashimoto's thyroiditis. D. myxedema coma.

D Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.