550 Exam 1 EAQ Questions
The primary health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. Which is the goal of fasting glucose levels for a client with diabetes mellitus?
70 to 105 mg/dL of blood
Which data would the nurse use to determine a client's score on the Braden Scale to predict a client's risk for developing pressure injuries?
Anorexia Hemiplegia History of diabetes Urinary incontinence
A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate?
Asses the client's blood glucose level
Based on laboratory values, which client's needs would the nurse address first?
B
Which physiological changes would the nurse expect to find in a client with a 20-year history of type 2 diabetes?
Blurry, spotty or hazy vision
Which type of bacterial infection is seen in the figure?
Cellulitis
When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1?
Complications are not present at the times of diagnosis
Which short-term goal is the priority for a client with a new insulin pump who is receiving discharge instructions?
Demonstrate correct use of the insulin pump
Which action would the nurse take when a client with type 1 diabetes reports hunger, thirst, tiredness, and frequent urination?
Determine client's blood glucose level
Which factor in a client's health history increases the risk of hearing loss?
Diabetes Noisy environment Ear infections Loud Music
Which client condition is likely to improve significantly with the use of hearing aids
Diminished sensitivity of the cochlea
Which step should the nurse take to alert the risk management system after notifying the primary health care provider of a client's fall?
Document the incident in the occurrence report tool
Which intervention by the nurse would be beneficial to promote a healthy lifestyle in an older adult client who lives alone at home and refrains form physical activity for fear of falling when walking?
Encourage the client to wear nonskid shoes Suggest that the client use an assistive device Help the client rearrange furniture in the house
Which observation by the nurse indicates a client's decrease in hearing acuity?
Frequent use of words such as "what" Postural changes while listening to the speaker Bending toward the other person while talking Mismatch between the questions asked and the responses given
Which nursing intervention assists in decreasing the potential occurrence of pressure ulcers when providing care for a client with quadriplegia?
Frequently reposition the client on a scheduled basis
Which ocular symptom would the nurse expect a client with a diagnosis of dry age-related macular degeneration to report?
Loss of central vision
Which rationale would the nurse include in teaching a client with glaucoma about the need for treatment?
Lost vision cannot be restored
Which risk factors regarding fall prevention and safety for older adults would the nurse manager include in a presentation to a group of nurses?
Medications Visual changes Orthostatic hypotension
Which type of vision problem would the nurse document when a client describes being able to see near objects clearly, but objects in the distance are blurry?
Myopia
The nurse provides education about the signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms?
Nervous and weak
Which nurse's action is important for establishing good communication with the client who has impaired hearing?
Obtaining the client's attention before speaking
Which outcome is likely if the nurse palpates a client's joins during an acute episode of rheumatoid arthritis?
Pain
Which intervention is beneficial to an older adult in acute care who is at risk of skin breakdown?
Providing thorough skin care Reducing shear forces and friction Avoiding pressure with proper positioning
The nurse is educating a client about managing hypoglycemia unawareness. Which information would the nurse provide?
Refrain form alternative testing sites
Which client response is indicative of a hypoglycemic reaction?
Tremors Confusion Diaphoresis
Which result would the nurse expect to find when assessing the laboratory values of a client with type 2 diabetes?
Urine negative for ketones and positive glucose in the blood
When obtaining the history of a client recently diagnosed with type 1 diabetes, which symptom would the nurse expect to see?
Weight loss
Which statement about caring for a hearing aid indicates the need for further learning?
"I should always keep my hearing aid on" "I can use hair sprays and hair oil while wearing a hearing aid"
Which client statement indicates that the discharge teaching after a cataract extraction and an intraocular lens implant is effective?
"I should call the clinic if my eye begins to hurt."
Which statement made by the nurse indicates the need for further teaching when assessing clients with dark skin?
"I will use a fluorescent light source to assess the skin color"
A 9-year-old child who had cerebral palsy, scoliosis, contractures of elbows and wrists and is also incontinent. Which nursing action will best achieve the goal of skin integrity?
Changing disposable diapers every 2 to 3 hours
While assessing the skin of a light-skinned client, the nurse concludes that the client has ecchymosis. Which skin color variation would confirm this diagnosis?
Dark red color
Which physiological change occurs in older adults and warrants the nurse teaching the client about safety tips to prevent falls?
Decreased bone density
Which symptom would the nurse expect the client who has primary open-angle glaucoma to report?
Decreased peripheral vision
Which factors increase the risk for social isolation for an older adult?
Experiencing progressive macular degeneration Living alone since a spouse's death 3 years ago
Which information would the nurse include in a teaching plan when teaching a client with diabetes about the advantages of using an insulin pump?
It can improve A1c levels Clients may be able to exercise without eating more carbohydrates
Which clinical finding is commonly associated with hyperglycemia?
Polyuria Polydipsia Polyphagia
Which eye problem is the leading cause of blindness in clients with diabetes?
Retinopathy
Which point requires correction regarding wellness promotion in the older adult?
"Curing diseases or other illnesses completely is essential to promote wellness in the older adult" "It is necessary to prevent older adults from taking part in physical activities to keep them from sustaining injuries" "An older adult should live in social isolation to prevent stress"
Which statement shows ineffective learning after the nurse teaches self-management tips on the safety and quality care for skin cleaning to a client with a pressure ulcer?
"I will apply powders and talc on the perineum"
Sterile warm saline soaks three times a day are prescribed for a client with cellulitis from a puncture wound. The primary nurse places a clean basin, washcloth, and protective pad at the bedside in preparation for the soak but is unable to continue the procedure. Which step would the new nurse assigned to complete the soak do?
Collect new supplies before starting
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications?
Examine the feet daily Wear well-fitting shoes Perform regular exercise
Which nursing action is most appropriate to help reduce the likelihood of an older adult client falling during the night?
Instructing the client to call the nurse before going to the bathroom
Which information would the nurse include in the teaching plan of an adolescent who is found to have type 1 diabetes?
Insulin therapy Blood glucose monitoring Adherence to the treatment regimen
Which action by the client would the nurse expect is the reason for increased tissue necrosis with damaged capillary beds found during the follow-up visit of a client who received information about safety measures and precautions when taking care of a pressure ulcer?
Massaging the reddened skin areas Using donut-shaped pillows for pressure relief
The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements and daily vitamins. Which finding would indicate that the therapy is helping?
Mobility increases
Which goal is the nurse trying to achieve by reinforcing to the client that is important to seek treatment for primary open-angle glaucoma (POAG)?
Prevent blindness
Which finding in the client's history will alert the nurse to the most likely cause of the sensorineural hearing loss?
Prolonged exposure to noise
Which instructions to minimize the risk of falls in the home would the nurse provide that caregiver of an older client who requires the use of a walker with wheels?
Remove cords Use bright lighting Get rid of throw rugs
An emaciated older adult with dementia develops a large pressure ulcer after refusing to change position for extended periods of time. The family blames the nurses and threatens to sue. What is considered when determining the source of blame for the pressure injury?
The client should have been turned regularly