A&C Exam 2 Resp/Immune/Diabetes

The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? - "Smokeless tobacco products decrease the risk of kidney damage." - "I can help control my blood pressure by avoiding foods high in salt." - "I should have yearly dilated eye examinations by an ophthalmologist." - "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

"I can help control my blood pressure by avoiding foods high in salt."

The nurse instructs a patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? - "I plan to lose 25 lb this year by following a high-protein diet." - "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." - "I should include more fiber in my diet than a person who does not have diabetes." - "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

"I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? - "I should only walk barefoot in nice dry weather." - "I should look at the condition of my feet every day." - "I am lucky my shoes fit so nice and tight because they give me firm support." - "When I am allowed up out of bed, I should check the shower water with my toes."

"I should look at the condition of my feet every day."

The nurse teaches a patient recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? - "I will discard any insulin bottle that is cloudy in appearance." - "The best injection site for insulin administration is in my abdomen." - "I can wash the site with soap and water before insulin administration." - "I may keep my insulin at room temperature (75oF) for up to 1 month."

"I will discard any insulin bottle that is cloudy in appearance."

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? - "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." - "I will go running each day when my blood sugar is too high to bring it back to normal." - "I will plan to keep my job as a teacher because I get a lot of exercise every school day." - "I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week."

"I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week."

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? - A 58-yr-old patient with diabetic retinopathy - A 73-yr-old patient who takes propranolol (Inderal) - A 19-yr-old patient who is on the school track team - A 24-yr-old patient with a hemoglobin A1C of 8.9%

- A 73-yr-old patient who takes propranolol (Inderal)

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? - Routine insulin therapy and exercise - Administer a different antibiotic for the UTI. - Cardiac monitoring to detect potassium changes - Administer IV fluids rapidly to correct dehydration.

- Cardiac monitoring to detect potassium changes

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? - Cheese - Broccoli - Chicken - Oranges

- Cheese

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to best explain how this medication works? - Increases insulin production from the pancreas - Slows the absorption of carbohydrate in the small intestine - Reduces glucose production by the liver and enhances insulin sensitivity - Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

- Reduces glucose production by the liver and enhances insulin sensitivity

A patient is admitted with diabetes mellitus, malnutrition cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply.)? - The level may be increased as a result of dehydration that accompanies hyperglycemia. - The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. - The level is consistent with renal insufficiency that can develop with renal nephropathy. - The patient may be excreting extra sodium and retaining potassium because of malnutrition. - This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

- The level may be increased as a result of dehydration that accompanies hyperglycemia. - The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. - The level is consistent with renal insufficiency that can develop with renal nephropathy.

The nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply. 1.Cough 2.Dyspnea 3.Weight gain 4.High-grade fever 5.Chills and night sweats

1, 2, 5

The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client that which positions alleviate dyspnea? Select all that apply. 1.Sitting up and leaning on a table 2.Standing and leaning against a wall 3.Lying supine with the feet elevated 4.Sitting up with the elbows resting on knees 5.Lying on the back in a low Fowler's position

1,2,4

The nurse is doing volunteer work in a homeless shelter. The nurse should monitor the individuals for which initial signs and symptoms of tuberculosis? Select all that apply. 1.Fatigue 2.Lethargy 3.Chest pain 4.Morning cough 5.Low-grade fever 6.Labored breathing

1,2,4,5

The nurse is providing education to a group of adolescents diagnosed with asthma. The nurse informs the group that which can be triggers for an asthma attack? Select all that apply. 1.Dry air 2.Clean air 3.Exercise 4.Rest and sleep 5.An upper respiratory infection (URI) 6.Nonsteroidal antiinflammatory drugs (NSAIDs)

1,3,5,6

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually. 2. Avoid contact with other individuals, except family members, for at least 6 months. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 6. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.

1. Activities should be resumed gradually. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.

The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? 1."I should take hot baths because they are relaxing." 2."I should sit whenever possible to conserve my energy." 3."I should avoid long periods of rest because it causes joint stiffness." 4."I should do some exercises, such as walking, when I am not fatigued."

1."I should take hot baths because they are relaxing."

The nurse is providing immediate postprocedure care to a client who had a thoracentesis to relieve a tension pneumothorax that resulted from rib fractures. The goal is that the client will exhibit normal respiratory functioning, and the nurse provides instructions to assist the client with this goal. Which client statement indicates that further instruction is needed? 1."I will lie on the affected side for an hour." 2."I can expect a chest x-ray exam to be done shortly." 3."I will let you know at once if I have trouble breathing." 4."I will notify you if I feel a crackling sensation in my chest."

1."I will lie on the affected side for an hour."

A client with a history of recent upper respiratory infection comes to the urgent care center complaining of chest pain. The nurse determines that the pain is most likely of a respiratory origin if the client makes which statement about the pain? 1."It hurts more when I breathe in." 2."I have never had this pain before." 3."It hurts on the left side of my chest." 4."The pain is about a 6 on a scale of 1 to 10."

1."It hurts more when I breathe in."

The nurse is caring for a client who had tuberculin skin testing 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority? 1.Contact the health care provider (HCP). 2.Document the finding in the client's record. 3.Call the employee health service department. 4.Call the radiology department for a chest radiographic study to be done.

1.Contact the health care provider (HCP).

The nurse is caring for the client who is suspected of having lung cancer. The nurse should assess the client for which most frequent early symptom of lung cancer? 1.Cough 2.Hoarseness 3.Hemoptysis 4.Pleuritic pain

1.Cough

A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. The nurse should assess the client for which expected finding? 1.Dyspnea 2.Headache .Weight gain 4.Hypothermia

1.Dyspnea

The community health nurse is conducting an educational session with community members regarding the signs and symptoms associated with tuberculosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? Select all that apply. 1.Dyspnea 2.Headache 3.Night sweats 4.A bloody, productive cough 5.A cough with the expectoration of mucoid sputum

1.Dyspnea 3.Night sweats 4.A bloody, productive cough 5.A cough with the expectoration of mucoid sputum

The nurse is preparing to perform suctioning for a client with a tracheostomy tube and gathers the supplies needed for the procedure. What is the initial nursing action? 1.Hyperoxygenate the client. 2.Set the suction pressure range at 150 mm Hg. 3.Place the catheter into the tracheostomy tube. 4.Apply suction on the catheter, and insert it into the tracheostomy tube.

1.Hyperoxygenate the client.

A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 1.Positive 2.Negative 3.Inconclusive 4.Need for repeat testing

1.Positive With HIV-positive results on tuberculin skin testing with an area of induration larger than 5 mm

The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? 1.Protecting the client from infection 2.Providing emotional support to decrease fear 3.Encouraging discussion about lifestyle changes 4.Identifying factors that decreased the immune function

1.Protecting the client from infection

The nursing instructor is observing a nursing student suctioning a client through a tracheostomy tube. Which observation by the nursing instructor indicates an action by the student requiring the need for further instruction? 1.Suctioning the client every hour 2.Applying suction only during withdrawal of the catheter 3.Hyperventilating the client with 100% oxygen before suctioning 4.Applying suction intermittently during withdrawal of the catheter

1.Suctioning the client every hour

The nurse is monitoring the function of a client's chest tube that is attached to a drainage system. The nurse notes that the fluid in the water seal chamber rises with inspiration and falls with expiration. The nurse determines that which is occurring? 1.Tidaling is present. 2.There is a leak in the system. 3.The client has residual pneumothorax. 4.Suction should be added to the system.

1.Tidaling is present.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? - 8:40 PM to 9:00 PM - 9:00 PM to 11:30 PM - 10:30 PM to 1:30 AM - 12:30 AM to 8:30 AM

10:30 PM to 1:30 AM

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply. 1.Reduce fluid intake to less than 1500 mL/day. 2.Teach diaphragmatic and pursed-lip breathing. 3.Encourage alternating activity with rest periods. 4.Teach the client techniques of chest physiotherapy. 5.Keep the client in a supine position as much as possible.

2, 3, 4

The nurse is preparing to suction a client via a tracheostomy tube. The nurse should plan to limit the suctioning time to a maximum of which time period? 1. 5 seconds 2. 10 seconds 3. 30 seconds 4. 60 seconds

2. 10 seconds

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. 1. A low arterial pco2 level 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise 4. A widened diaphragm noted on the chest x-ray 5. Pulmonary function tests that demonstrate increased vital capacity

2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise

The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the water seal chamber. What action is most appropriate? 1. Do nothing, because this is an expected finding. 2. Check for an air leak, because the bubbling should be intermittent. 3. Increase the suction pressure so that the bubbling becomes vigorous. 4. Clamp the chest tube and notify the health care provider immediately.

2. Check for an air leak, because the bubbling should be intermittent.

The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client? 1. A low respiratory rate 2. Diminished breath sounds 3. The presence of a barrel chest 4. A sucking sound at the site of injury

2. Diminished breath sounds

The nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly? 1.The client breathes in through the mouth. 2.The client breathes out slowly through the mouth. 3.The client avoids using the abdominal muscles to breathe out. 4.The client puffs out the cheeks when breathing out through the mouth.

2.The client breathes out slowly through the mouth.

A client who experiences frequent upper respiratory infections (URIs) asks the nurse why food does not seem to have any taste during illness. Which response by the nurse is most appropriate? 1."You lack the energy to cook wholesome meals." 2."Blocked nasal passages impair the sense of smell." 3."Loss of appetite is triggered by the infectious organism." 4."Infection blocks sensation in the taste buds of the tongue."

2."Blocked nasal passages impair the sense of smell."

The nurse has provided discharge instructions to the client who has had a pneumonectomy. Which statement, if made by the client, indicates an understanding of appropriate home care measures? 1."I should restrict my fluid intake for 2 weeks." 2."I should perform arm exercises 2 or 3 times a day." 3."If I experience any soreness in my chest or shoulder, I should notify the health care provider." 4."If I experience any numbness or altered sensation around the incision, I should contact the health care provider."

2."I should perform arm exercises 2 or 3 times a day."

The nurse is providing instructions to a client being discharged from the hospital following removal of a chest tube that was inserted after thoracic surgery. Which statement made by the client indicates a need for further teaching? 1."I should avoid heavy lifting for at least 4 to 6 weeks." 2."I should remove the chest tube site dressing as soon as I get home." 3."If I have any difficulty breathing, I should call the health care provider." 4."If I note any signs of infection, I should contact the health care provider."

2."I should remove the chest tube site dressing as soon as I get home."

A client is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours postoperatively, what type of drainage should the nurse expect? 1.Serous 2.Bloody 3.Serosanguineous 4.Bloody, with frequent small clots

2.Bloody

The nurse has assisted a health care provider (HCP) with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment finding, which action is most appropriate? 1.Inform the HCP. 2.Continue to monitor the client. 3.Reinforce the occlusive dressing. 4.Encourage the client to deep breathe.

2.Continue to monitor the client.

The nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal chamber. Which is the most appropriate nursing action? 1.Check for an air leak. 2.Document the findings. 3.Notify the health care provider. 4.Change the chest tube drainage system.

2.Document the findings.

The nurse is developing a plan of care for a client at risk for acute respiratory distress syndrome (ARDS). As part of the plan, the nurse will assess for which sign or symptom for early detection of this disorder? 1.Edema 2.Dyspnea 3.Frothy sputum 4.Diminished breath sounds

2.Dyspnea

The nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate and notes that the client is receiving 2 L/min. The client's SpO2 level is 86%. Based on this assessment, which action is appropriate? 1.Increase to 3 L/min and titrate until the SpO2 is 95%. 2.Increase to 3 L/min and titrate until the SpO2 is 88%. 3.Place the client on a nonrebreather mask on 100% FiO2. 4.Maintain at 2 L/min and call respiratory therapy for a breathing treatment.

2.Increase to 3 L/min and titrate until the SpO2 is 88%.

A client with a tracheostomy tube who is on a ventilator is at risk for impaired gas exchange. The nurse should assess for which finding as the best indicator of adequate ongoing respiratory status? 1.Oxygen saturation of 89% 2.Respiratory rate of 16 breaths/minute 3.Moderate amounts of tracheobronchial secretions 4.Small to moderate amounts of frank blood suctioned from the tube

2.Respiratory rate of 16 breaths/minute

A client who is experiencing respiratory difficulty asks the nurse, "Why it is so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses? 1.Air flows by gravity. 2.The respiratory muscles relax. 3.The respiratory muscles contract. 4.Air is flowing against a pressure gradient.

2.The respiratory muscles relax.

A client diagnosed with tuberculosis (TB) is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? 1.This is expected and will last for at least 1 year. 2.This is expected, and the client should gradually increase activity as tolerated. 3.This is an unexpected finding with TB, but it should resolve within 1 month or so. 4.This is a short-lived problem that should be gone within 1 week after beginning medication therapy.

2.This is expected, and the client should gradually increase activity as tolerated.

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse prepare for the client? 1.Face tent 2.Venturi mask 3.Aerosol mask 4.Tracheostomy collar

2.Venturi mask

The nurse caring for a client with chronic obstructive pulmonary disease (COPD) anticipates which arterial blood gas (ABG) findings? 1.pH, 7.40; PaO2, 90 mm Hg; CO2, 39 mEq/L; HCO3, 23 mEq/L 2.pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L 3.pH, 7.47; PaO2, 82 mm Hg; CO2, 30 mEq/L; HCO3, 31 mEq/L 4. pH, 7.31; PaO2, 95 mm Hg; CO2, 22 mEq/L; HCO3, 19 mEq/L

2.pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L

The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding? 1. Slow, deep respirations 2.Rapid, deep respirations 3.Paradoxical respirations 4. Pain, especially with inspiration

4. Pain, especially with inspiration

The Nurse Is Assessing The Functioning Of A Chest Tube Drainage System In A Client Who Has Just Returned From The Recovery Room Following A Thoracotomy With Wedge Resection. Which Are The Expected Assessment Findings? Select All That Apply. 1. Excessive bubbling in the water seal chamber 2. Vigorous bubbling in the suction control chamber 3. Drainage system maintained below the client's chest 4. 50 ml of drainage in the drainage collection chamber 5. Occlusive dressing in place over the chest tube insertion site 6. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation

3. Drainage system maintained below the client's chest 4. 50 ml of drainage in the drainage collection chamber 5. Occlusive dressing in place over the chest tube insertion site 6. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation

The nurse is suctioning a client via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which nursing intervention is appropriate? 1. Continue to suction. 2. Notify the health care provider immediately. 3. Stop the procedure and reoxygenate the client. 4. Ensure that the suction is limited to 15 seconds.

3. Stop the procedure and reoxygenate the client.

The nurse provides instructions to a client after a total laryngectomy. Which statement by the client indicates a need for further instruction? 1."I need to protect the stoma from water." 2."Soaps should be avoided near the stoma." 3."I should use diluted alcohol on the stoma to clean it." 4."I should apply a non-oil-based ointment to the skin surrounding the stoma."

3."I should use diluted alcohol on the stoma to clean it."

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse how to manage the amount of oxygen given. How should the nurse instruct the client? 1.Do not exceed 1 L/min. 2.Do not exceed 2 L/min. 3.Adjust the oxygen depending on SpO2. 4.Adjust the oxygen depending on respiratory rate.

3.Adjust the oxygen depending on SpO2.

A client arrives in the hospital emergency department with a bloody nose. What is the initial nursing action? 1.Place the client in supine position. 2.Apply an ice collar around the client's neck. 3.Assist the client to a sitting position with the head tilted forward. 4.Instruct the client to swallow the blood until the bleeding can be controlled.

3.Assist the client to a sitting position with the head tilted forward.

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider? 1.Dry cough 2.Hematuria 3.Bronchospasm 4.Blood-streaked sputum

3.Bronchospasm

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? 1.Hot, flushed feeling 2.Sudden chills and fever 3.Chest pain that occurs suddenly 4.Dyspnea when deep breaths are taken

3.Chest pain that occurs suddenly

The nurse reads that a client's tuberculin skin test is positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation? 1.Systemic tuberculosis 2.Pulmonary tuberculosis 3.Exposure to tuberculosis 4.No evidence of tuberculosis

3.Exposure to tuberculosis

The nurse is performing an assessment on a female client who complains of fatigue, weakness, muscle and joint pain, anorexia, and photosensitivity. Systemic lupus erythematosus (SLE) is suspected. What should the nurse further assess for that also is indicative of SLE? 1.Ascites 2.Emboli 3.Facial rash 4.Two hemoglobin S genes

3.Facial rash

A client is diagnosed with Goodpasture's syndrome. The nurse determines that this client's renal disease is caused by a type II hypersensitivity response. Which laboratory results would be most important for the nurse to evaluate? 1.Urinalysis 2.Electrolytes 3.Glomerular filtration rate (GFR) 4.Partial thromboplastin time (PTT)

3.Glomerular filtration rate (GFR)

A nursing student is developing a plan of care for a client with a chest tube that is attached to a chest drainage system. Which intervention in the care plan indicates the need for further teaching for the student? 1.Position the client in semi Fowler's position. 2.Add water to the suction chamber as it evaporates. 3.Instruct the client to avoid coughing and deep breathing. 4.Tape the connection sites between the chest tube and the drainage system.

3.Instruct the client to avoid coughing and deep breathing.

The nurse is providing an educational session to community members regarding histoplasmosis. The nurse should provide which information about this disease? 1.It is caused by a tick bite. 2.It is caused by contamination from cat feces. 3.It can be caused by the inhalation of spores from bird droppings. 4.It can be contagious by respiratory contact with an infected person.

3.It can be caused by the inhalation of spores from bird droppings. (AKA mycelia)

The nurse is caring for a postoperative pneumonectomy client. Which finding on assessment of the client is an adverse sign or symptom indicating pulmonary edema? 1.Pain with deep breathing 2..Increased chest tube drainage 3.Lung crackles in the remaining lung 4.Respiratory rate of 20 breaths/minute

3.Lung crackles in the remaining lung

The nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit? 1.Dilate the major bronchi. 2.Increase surfactant production. 3.Maintain inflation of the alveoli. 4.Enhance ciliary action in the tracheobronchial tree.

3.Maintain inflation of the alveoli.

The nurse is providing instructions to a client about diaphragmatic breathing. The nurse tells the client that this technique is helpful because in normal respiration, as the diaphragm contracts, it takes which action? 1.Aids in exhalation 2.Moves up and inward 3.Moves downward and out 4.Makes the thoracic cage smaller

3.Moves downward and out

The nurse is assisting a radiologist to facilitate a thoracentesis. The nurse assists the client to a position that widens the spaces between the ribs to help drain which area? 1.Alveoli 2.Trachea 3.Pleural space 4.Main bronchi

3.Pleural space

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? 1.Chest x-ray 2.Bronchoscopy 3.Sputum culture 4.Tuberculin skin test

3.Sputum culture

The nurse has assisted the health care provider and the anesthesiologist with placement of an endotracheal (ET) tube for a client in respiratory distress. What is the initial nursing action to evaluate proper ET tube placement? 1.Tape the ET tube in place, and note the centimeter marking at the lip line. 2.Ask the radiology department to obtain a stat portable radiograph at the client's bedside. 3.Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds. 4.Attach the ET tube to the ventilator and determine whether the client is able to tolerate the tidal volume prescribed.

3.Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds.

The clinic nurse administers a tuberculin skin test to a client. The nurse tells the client to return to the clinic for the results in how long? 1. 6 to 12 hours 2. 12 to 24 hours 3. 24 to 28 hours 4. 48 to 72 hours

4. 48 to 72 hours

The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? 1. Stay very still. 2. Exhale very quickly. 3. Inhale and exhale quickly. 4. Perform the Valsalva maneuver.

4. Perform the Valsalva maneuver.

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? 1. Sitting up in bed 2. Side-lying in bed 3. Sitting in a recliner chair 4. Sitting up and leaning on an overbed table

4. Sitting up and leaning on an overbed table ***AVOID low fowler's***

The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? 1."I need to continue medication therapy for 1 month." 2."I can't shop at the mall for the next 6 months." 3."I can return to work if a sputum culture comes back negative." 4."I should not be contagious after 2 to 3 weeks of medication therapy."

4."I should not be contagious after 2 to 3 weeks of medication therapy."

A young adult client has never had a chest x-ray before and expresses to the nurse a fear of experiencing some form of harm from the test. Which statement by the nurse provides valid reassurance to the client? 1."You'll wear a lead shield to partially protect your organs from harm." 2."The amount of x-ray exposure is not sufficient to cause DNA damage." 3."The test isn't harmful at all. The most frustrating part is the long wait in radiology." 4."The x-ray exam itself is painless, and a lead shield protects you from the minimal radiation."

4."The x-ray exam itself is painless, and a lead shield protects you from the minimal radiation."

The nurse determines that the client with a chest tube to a closed drainage system is experiencing an air leak. Which finding is indicative of this? 1.Tidaling is absent. 2.Gentle bubbling is observed in the suction control chamber. 3.Vacillation of water in the water seal chamber occurs during respiration. 4.Continuous bubbling is observed in the water seal chamber during inspiration and expiration.

4.Continuous bubbling is observed in the water seal chamber during inspiration and expiration.

A complete blood cell (CBC) count is performed in a client with systemic lupus erythematosus (SLE). The nurse would suspect that which finding will be noted in the client with SLE? 1.Decreased platelets only 2.Increased red blood cell count 3.Increased white blood cell count 4.Decreased number of all cell types

4.Decreased number of all cell types

The clinic nurse is providing instructions to a client with a diagnosis of pharyngitis. The nurse provides which instruction to the client? 1.Drink hot tea throughout the day. 2.Drink hot cocoa instead of coffee. 3.Restrict fluid intake to 1000 mL daily. 4.Eat foods that are highly seasoned in moderation.

4.Eat foods that are highly seasoned in moderation.

A client with chronic obstructive pulmonary disease (COPD) has a respiratory rate of 24 breaths per minute, bilateral crackles, and cyanosis and is coughing but unable to expectorate sputum. Which problem is the priority? 1.Low cardiac output secondary to cor pulmonale 2.Gas exchange alteration related to ventilation-perfusion mismatch 3.Altered breathing pattern secondary to increased work of breathing 4.Inability to clear the airway related to inability to expectorate sputum

4.Inability to clear the airway related to inability to expectorate sputum

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? 1.Bilateral wheezing 2.Inspiratory crackles 3.Intercostal retractions 4.Increased respiratory rate

4.Increased respiratory rate

The nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes constant bubbling in the water seal chamber. Which is the most appropriate initial nursing action? 1.Continue to monitor. 2.Document the findings. 3.Change the chest tube drainage system. 4.Perform a focused respiratory assessment.

4.Perform a focused respiratory assessment.

The nurse instructs a client to use the pursed-lip method of breathing and evaluates the teaching by asking the client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote which outcome? 1.Promote oxygen intake. 2.Strengthen the diaphragm. 3.Strengthen the intercostal muscles. 4.Promote carbon dioxide elimination.

4.Promote carbon dioxide elimination.

The nurse is caring for a client with tuberculosis (TB) who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness? 1.Allow the client to deal with the disease in an individual fashion. 2.Ask family members whether they wish a psychiatric consultation. 3.Encourage the client to visit with the pastoral care department's chaplain. 4.Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

4.Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

The nurse is assessing a client with the typical clinical manifestations of tuberculosis (TB). During history-taking the nurse anticipates that the client will report presence of cough and fatigue for what period of time? 1.1 or 2 days 2.1 to 2 weeks 3.Almost 1 week 4.Several weeks to months

4.Several weeks to months

A client seen in an ambulatory clinic has a facial rash that is present on both cheeks and across the bridge of the nose. The nurse interprets that this finding is consistent with manifestations of which disorder? 1.Hyperthyroidism 2.Pernicious anemia 3.Cardiopulmonary disorders 4.Systemic lupus erythematosus (SLE)

4.Systemic lupus erythematosus (SLE)

The nurse caring for a client with a closed chest drainage system notes that the fluctuation (tidaling) in the water seal chamber has stopped. On the basis of this assessment finding, the nurse would suspect which occurrence? 1.The system needs changing. 2.Suction needs to be increased. 3.Suction needs to be decreased. 4.The chest tube may be obstructed.

4.The chest tube may be obstructed.

The nurse is caring for a hospitalized client who is retaining carbon dioxide (CO2) because of respiratory disease. The nurse anticipates which physical response will initially occur? 1.The client will lose consciousness. 2.The client's sodium and chloride levels will rise. 3.The client will complain of facial numbness and tingling. 4.The client's arterial blood gas results will reflect acidosis.

4.The client's arterial blood gas results will reflect acidosis.

A client has a chest tube attached to a water seal drainage system. As part of routine nursing care, the nurse should ensure that which intervention is implemented? 1.The water seal chamber has continuous bubbling, and assessment for crepitus is done once a shift. 2.The amount of drainage into the chest tube is noted and recorded every 24 hours in the client's record. 3.The suction control chamber has sterile water added every shift, and the system is kept below waist level. 4.The connection between the chest tube and the drainage system is taped, and an occlusive dressing is maintained at the insertion site.

4.The connection between the chest tube and the drainage system is taped, and an occlusive dressing is maintained at the insertion site.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? - A 48-yr-old woman with a hemoglobin A1C of 8.4% - A 58-yr-old man with a fasting blood glucose of 111 mg/dL - A 68-yr-old woman with a random plasma glucose of 190 mg/dL - A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

A 48-yr-old woman with a hemoglobin A1C of 8.4%

A patient with Type 2 DM is hospitalized for pneumonia and placed on prednisone and insulin on a sliding scale. She states "I've never taken insulin before!" What is the best response of the nurse? A. "Prednisone may increase your BG levels." B. "The doctor ordered it for you." C. "You now have Type 1 diabetes from stress." D. "You now must take insulin daily."

A. Infections such as pneumonia and hospitalization itself can both increase blood glucose as well.

Your patient is unresponsive and sweaty. His blood glucose is 40. Which nursing diagnosis has highest priority? A. Aspiration, risk for B. Falls, risk for C. Imbalanced nutrition, less than, risk for D. Imbalanced nutrition, more than, risk for

A. Aspiration, risk for

A patient who is newly diagnosed with Type 1 DM. What nursing diagnosis is least appropriate for this patient? A. Imbalanced nutrition: more than body requirements. B. Risk for injury: hypoglycemia. C. Risk for infection. D. Knowledge deficit.

A. Imbalanced nutrition: more than body requirements.

4.The nurse is assigned to the care of a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? - Assess patient's perception of what it means to have diabetes. Correct - Ask the patient to write down current knowledge about diabetes. - Set goals for the patient to actively participate in managing his diabetes. Incorrect - Assume responsibility for all of the patient's care to decrease stress level.

Assess patient's perception of what it means to have diabetes.

Which patient is of highest priority for the nurse? A. A patient with hyperglycemia. B. A patient with hypoglycemia.

B. A patient with hypoglycemia.

A patient who is newly diagnosed with Type 1 DM is learning about diabetic foot care. Which should the patient avoid? A. Antiperspirants. B. Foot soaks. C. Lotions. D. Nail files.

B. Foot soaks. they macerate the skin

What is the priority action for a patient with signs and symptoms of hypoglycemia? A. Call the MD for orders B. Check the blood glucose level C. Have the patient sit or lie down D. Start an IV and give D50

B: ***Check patient's blood glucose. Note this question does not ask you what you will do FIRST. You need to check the blood glucose to figure out what to do.

The patient received 5 units of regular and 30 units of NPH @ 0730. When is he at highest risk for a hypoglycemic reaction? Breakfast: 0800 Lunch: 1200 Supper: 1800 A. After breakfast (0930 - 1030) B. After lunch (1330 - 1530) C. After supper (1900 - 2100) D. Bedtime (2200 - 2400)

B: 1330 - 1530 (peak of NPH)

The patient received 5 units of regular and 30 units of NPH @ 0730. When will the insulin first begin to work? A. 15 minutes B. 30 minutes C. 2 hours D. 4 hours

B: 30 minutes (onset of regular)

A patient with Type 1 DM is NPO for surgery this AM. He takes 10 units NPH each morning and needs 4 units of regular insulin (BG = 244) this AM. Which is appropriate? A. Give 4 units regular insulin & 10 units NPH. B. Give 4 units regular insulin; hold the NPH. C. Give 10 units NPH; hold 4 units regular insulin. D. Hold both the NPH and regular insulin.

Basal insulins (typically given at bedtime) are typically given as usual the night before surgery. The conservative nurse will most likely notify the physician to make sure that this is correct if the preop orders do not specify this, however, this really depends on the policy of your institution. NPH is usually NOT given due to the longer duration of its action. Even though the patient is NPO, if the surgeon wants the blood sugar normalized, regular insulin may be given.

1. A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."

A patient on metformin is scheduled for an angiogram using contrast dye the day after tomorrow. Which is appropriate? A. Give the metformin tomorrow morning, give with a sip of water the day of the test, and continue the metformin the day after the procedure. B. Give the metformin tomorrow morning, hold the metformin the day of the test, then restart the metformin the day after the procedure. C. Hold the metformin tomorrow morning and the day of the test, then continue the metformin two days after the procedure.

C. Hold the metformin tomorrow morning and the day of the test, then continue the metformin two days after the procedure.

Your patient is unresponsive and sweaty. His blood glucose is 40. In which position should this patient be placed? A. Head of bed flat, feet elevated B. High Fowlers C. Side-lying D. Supine

C. Side-lying

3. The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? - Chooses a puncture site in the center of the finger pad - Washes hands with soap and water to cleanse the site to be used - Warms the finger before puncturing the finger to obtain a drop of blood - Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

Chooses a puncture site in the center of the finger pad

How many units of (a) regular insulin and (b) NPH insulin will you give? A. 7 units R, 0 units NPH B. 7 units R, 30 units NPH C. 5 units R, 0 units NPH D. 5 units R, 30 units NPH 30 units NPH insulin SC BID @ 0730 and 1630 Sliding Scale Regular insulin SC AC and HS

D: 5 units regular, 30 units NPH

The patient is on a corrective CHO count. How much regular insulin will he receive? A. 2 units before meal B. 2 units after meal C. 4 units before meal D. 4 units after meal Grilled chicken sandwich, 1/2 cup corn, 1/2 cup green beans, small apple, 1 diet coke. Ratio 15 Gm=1 unit - Bun = 30 grams - Chicken = 0 grams - ½ cup corn = 15 grams - ½ cup green beans = 0 grams - Small apple=15 grams - Diet coke = 0 grams

D: Ratio 15 Gm=1 unit - Bun = 30 grams - 1/2 cup corn = 15 grams - Small apple=15 grams - Total Grams=60 - Ratio: 60/15= 4 - 4 units regular insulin given after meal

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise her to take? - Eat a piece of pizza. - Drink some diet pop. - Eat 15 g of simple carbohydrates. - Take an extra dose of rapid-acting insulin.

Eat 15 g of simple carbohydrates.

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient correlates with the diagnosis? - Excessive thirst - Gradual weight gain - Overwhelming fatigue - Recurrent blurred vision

Excessive thirst

2. The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? -Prealbumin level -Urine ketone level -Fasting glucose level - Glycosylated hemoglobin level

Glycosylated hemoglobin level

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? - Increased triglyceride levels - Increased high-density lipoproteins (HDL) - Decreased low-density lipoproteins (LDL) - Decreased very-low-density lipoproteins (VLDL)

Increased triglyceride levels

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? - Central apnea - Hypoventilation - Kussmaul respirations - Cheyne-Stokes respirations

Kussmaul respirations

5. The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? - Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. - Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. - Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. - Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? - 6:00 PM on the evening before the test - Midnight before the test - 4:00 AM on the day of the test - 7:00 AM on the day of the test

Midnight before the test

A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? - Avoid sick people and wash hands. - Obtain comprehensive dental care. - Maintain hemoglobin A1C below 7%. - Coughing and deep breathing with splinting

Obtain comprehensive dental care.

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. Call the physician. b. Administer insulin as ordered. c. Check the patient's blood glucose level. d. Assess for other neurologic symptoms.

c. Check the patient's blood glucose level.