Health and Illness Test 2 (Prep U)

Glargine (Lantus).

An example of a long-acting insulin is

35-40 kg/m2

Class II obesity is a BMI

Rapid-acting

Lispro (Humalog) is an example of which type of insulin?

Increased adipose tissue Impairment of peripheral blood flow Blood stasis Formation of a thrombus

Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population.

Increases ability for glucose to get into the cell and lowers blood sugar

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

Glargine, NPH, and Lente

insulin that is only administered subcutaneously.

NPH

intermediate-acting insulin

3 to 5 hours

the duration for rapid-acting insulin such as Novolog is

Metabolic acidosis

what would be diagnosed based on the findings related to a low pH level (<7.3) and a low bicarbonate level.

Fluid replacement with an intravenous solution containing electrolytes as prescribed

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

activation of the renin-angiotensin-aldosterone system (RAAS). The RAAS will retain water via aldosterone and ADH synthesis. Na+ will draw more H2O into the interstitial spaces. A decrease in ADH would result in excess water loss. Hepatic protein synthesis would not affect short-term water balance. Blood cannot be diverted away from the glomeruli.

A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

glycosylated hemoglobin level. Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:

Metabolic alkalosis

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

32.7 Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.

A client weighs 215 lbs and is 5' 8" tall. The nurse calculate this client's body mass index (BMI) as what?

"Choose a cereal with less than 2 grams of fiber per serving."

A client who is post op from bariatric surgery tells the nurse, "I love cereal for breakfast. Do you have recommendations for which kind I should eat?" How should the nurse respond?

-Usually occurs after disruption of the pylorus. -Symptoms are usually relieved after pharmacological treatment.

A client who is postoperative from bariatric surgery is diagnosed with bile reflux after reports of severe epigastric pain and vomiting of bilious material. What statements are true regarding this condition? Select all that apply.

Rapid gastric dumping Rapid gastric dumping may lead to steatorrhea, excessive fat in the feces. The primary cause of this finding is rapid gastric dumping. Excessive fat intake can make the problem worse; however, this is not the primary cause of the symptoms.

A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding?

Metformin Metformin (Glucophage) is a diabetes medication that also promotes weight loss. The other medications are diabetes medications; however, these promote weight gain, not weight loss.

A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering?

"The fat is passed in your stools."

A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?

Osteoarthritis

A client with obesity reports pain in the joints. Which musculoskeletal condition related to obesity does the nurse suspect the client has?

Underlying problem of insulin resistance

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?

Administering an antiemetic to treat the client's frequent vomiting Vomiting results in the loss of hydrogen ions, potentially resulting in metabolic alkalosis.

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Intermittent muscle spasms and reports of numbness around her mouth

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment, the nurse should focus on which clinical manifestation associated with this calcium level?

8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by:

"It binds with enzymes to help prevent digestion of fat." Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?

Low Fowler's In addition to decreasing incisional pain, this position also promotes gastric emptying.

A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort?

Protein metabolism Metabolism of proteins produces amino acids and liberates sulphur and other compounds that will form nonvolatile acids. Nucleic acid metabolism is insignificant, as is the TCA regarding H+ production. The incomplete metabolism of fat will generate acids, but the complete metabolism will not.

A nurse educator is explaining the production of acids and bases. Which phenomenon should he cite as the most significant example of metabolic acid production?

There is a 6-20 year decrease in overall life expectancy for those with obesity.

A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true?

Nervousness, diaphoresis, and confusion

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

100 units of regular insulin in normal saline solution Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?

Intravenous administration of a KCl solution KCl administration facilitates the renal retention of hydrogen ions, resulting in lowering of pH.

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give?

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?

15 g of carbohydrates.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

"Older adults have a slightly higher prevalence of obesity in comparison to the general population."

A nurse prepares community teaching on healthy lifestyle modifications to a group of older adults. When discussing obesity rates of older adults in comparison with the rest of the population, what will the nurse include?

Both undernutrition and obesity The WHO mentions that many developing nations now face a double-burden of both undernutrition and obesity. Both of these issues occur simultaneously and create a public health burden to developing nations.

A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face?

Hypertension Coronary artery disease Heart failure Myocardial infarction

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply.

ketosis-prone Little or no endogenous insulin Younger than 30 years of age

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.

138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of:

Humulin-R

A short-acting insulin is

Switch the client to a different oral antidiabetic agent. The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent.

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

bicarbonate/carbonic acid regulation.

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:

Days The renal mechanisms for regulating acid-base balance cannot adjust the pH within minutes, as respiratory mechanisms can, but they continue to function for days, until the pH has returned to normal or near-normal range. It is the respiratory system that responds within minutes to return the body's pH near to its normal limits.

By reabsorbing HCO3- from the glomerular filtrate and excreting H+ from the fixed acids that result from lipid and protein metabolism, the kidneys work to return or maintain the pH of the blood to normal or near-normal values. How long can this mechanism function when there is a change in the pH of body fluids?

Glycosylated hemoglobin level

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure?

Osmoreceptors Sensory neurons, called osmoreceptors, which are located in or near the thirst center in the hypothalamus, respond to changes in the osmolality of extracellular fluid by swelling or shrinking.

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Synthesis of glucose from noncarbohydrate sources.

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the:

18.5-25 BMI

Normal weight BMI is

hypergylcemia

Polydipsia, polyuria, and polyphagia are symptoms associated with

Hyperventilation One of the most common causes of respiratory alkalosis is hyperventilation, which is characterized by episodes of overbreathing, often associated with anxiety.

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision.

Signs and symptoms associated with hypoglycemia include

24 hours.

The duration of Lantus insulin is

12 to 16 hours.

The duration of NPH insulin is The duration of NPH insulin is

Muscle weakness Muscle cramps, weakness, and fatigue reflect the effects of hyponatremia on skeletal muscle function and are often early signs of hyponatremia. Dry, sticky mucous membranes as well as tachycardia reflect hypernatremia.

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Metabolic acidosis

The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg (5.05 kPa) HCO3:18 mEq/L (18 mmol/L) The nurse would interpret this as:

CO2 Carbon dioxide (CO2) is regulated by the lungs. HCO3 and H+ are regulated by kidneys.

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?

"The medication should be taken at meal time to allow the binding of phosphate." Sevelamer HCl is given with meals to bind dietary phosphate.

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

30 mins to 1 hr

The onset of action of short-acting regular insulin is

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Respiratory control mechanisms of restoring acid-base balance are done via regulation of production of carbonic acid and stimulation of the chemoreceptors in the brain.

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Parathyroid hormone The small, but vital, amount of ECF calcium, phosphate, and magnesium is directly or indirectly regulated by vitamin D and parathyroid hormone.

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

4 to 6 hours

What is the duration of regular insulin?

Cardiac

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Sodium 158 mEq/L (158 mmol/L) and serum osmolality of 320 mOsm/kg (320 mmol/kg)

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

ketones

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?

orlistat phentermine lorcasein

medications for obesity

25-30

overweight BMI range

3 to 4 hrs

the onset of action of intermediate-acting NPH insulin is

Increased hunger

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

A reduction in cardiac contractility, causing cardiac dysrhythmias

A change in the pH of the body affects all organ systems. When the pH falls to less than 7.0, what can occur in the cardiovascular system? Select all that apply.

Desmopressin acetate Diabetes insipidus is caused by a deficiency of or a decreased response to ADH. The preferred drug for treating DI is desmopressin acetate.

A client arrives in the emergency department with hypovolemia related to excretion of "at least 3 gallon jugs of dilute, water-like urine in the past 24 hours." In collaboration with the physician, the nurse prepares to administer which medication?

Fluid volume excess

A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?

Seizures Diarrhea Blurred vision Elevated liver function tests Methanol, or wood alcohol, causes metabolic acidosis and severe optic nerve and central nervous system toxicity. Other effects include diarrhea, nausea/vomiting, liver failure (as exhibited by elevated liver function tests), seizures, pain, and difficulty breathing.

A client is brought to the emergency room after ingesting methanol. Which manifestations indicate possible complications? Select all that apply.

Initiating an insulin IV infusion along with fluid replacement

A client with a blood glucose reading of 673 mg/dL (37.4 mmol/L) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders?

Lethargy Confusion Seizures

A client with a history of heart and kidney failure is brought to the emergency department and is diagnosed with decompensated heart failure. Which assessment findings are associated with excess intracellular water related to plasma sodium level of 129 mEq/L (129 mmol/L)? Select all that apply.

administering intravenous sodium bicarbonate as prescribed. Sodium bicarbonate is among the more common treatments for the metabolic acidosis that results from high alcohol intake.

A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:

Serum osmolarity Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder?

Hypoglycemia

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?

has type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:

"It tells us about your sugar control for the last 3 months." the test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn.

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:

8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by:

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

Gabapentin Gabapentin (Neurontin) is an anticonvulsant medication which promotes weight gain.

A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity?

"Do not drink alcohol while taking this medication."

A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication?

Bicarbonate 19 mEq/L Potassium 3.3 mEq/L The nurse will monitor the client for hypokalemia and signs of metabolic acidosis. The bicarbonate level is low, indicating metabolic acidosis.

A nurse cares for an obese client taking phentermine/topiramate-ER. Which laboratory findings will the nurse recognize as most concerning and will report to the health care provider? Select all that apply.

Phentermine Sympathomimetic amines, such as phentermine, are contraindicated in clients with glaucoma. The other answer choices represent obesity medications; however, these are not contraindicated in clients with glaucoma.

A nurse cares for an older adult client with obesity who also has glaucoma. Which obesity medication is contraindicated in this client?

Endoscopy

A nurse caring for a client who is post op bariatric surgery notes that the client has no bowel sounds and suspects the client may have a bowel obstruction. What treatment or therapy does the nurse expect the client will require?

Control blood glucose levels. Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy.

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?

It has over 100 times more genes than the human genome.

A nurse geneticist is researching the gut microbiome and its relationship to disease. What is true regarding the microbiome?

Increased urine output Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

Albumin Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of microalbumin.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?

"Avoid taking non-steroidal anti-inflammatory drugs."

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers?

Restricts the client's ability to eat. Bariatric surgical procedures work by restricting a patient's ability to eat (restrictive procedure), interfering with ingested nutrient absorption (malabsorptive procedures), or both

A nurse works in a bariatric clinic and cares for client with obesity who will or have undergone bariatric surgery. What is the nurse's understanding of how the procedure works?

"You should take your insulin after you eat breakfast and dinner." NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice?

Chemical buffer systems of the body fluids The kidneys The lungs

The body regulates the pH of its fluids by what mechanism? Select all that apply.

Body weight change Daily weights are a reliable index of water volume gain (1 L of water weighs 2.2 pounds). Daily weight measurements taken at the same time each day with the same amount of clothing provide a useful index of water gain due to edema. When an unbalanced distribution of body water exists in the tissues and organs, assessment of surface skin tissue turgor will be inaccurate. Measurement of renal output is unreliable because fluid retention may be a compensatory response, or the renal system may be dysfunctional. Serum sodium levels are affected by multiple variables other than body water volume.

The most reliable method for measuring body water or fluid volume increase is by assessing:

50% to 60% One half to two thirds of the patient's usual morning dose of insulin (either intermediate-acting insulin alone or both short- and intermediate-acting insulins) is administered subcutaneously in the morning before surgery. The remainder is then administered after surgery.

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?

10 to 15 mins

The onset of action of rapid-acting lispro is within

The client will compensate with the respiratory system. The one thing that a nurse can expect is that a client with a metabolic disorder will compensate with the respiratory system.

What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?

A BMI >40 kg/m2

What statement best describes a client with severe or extreme obesity?

Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind?

500-1,000 calories

When discussing lifestyle modifications with a client who has obesity, what caloric deficit should the nurse recommend in order for the client to safely lose weight?

Carbonic anhydrase Although CO2 is a gas and not an acid, a small percentage of the gas combines with water to form H2CO3. The reaction that generates H2CO3 from CO2 and water is catalyzed by an enzyme called carbonic anhydrase.

When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction?

3 am During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day?

Respiratory acidosis

a decreased pH and an increased PCO2 represents

dawn phenomenon

abnormal early-morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes.

Impaired alveolar ventilation

The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common?

A pH moves toward the normal range. The client who is compensating for an acid-base imbalance will have a pH that has moved back into the normal range.

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

It carries glucose into body cells.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

The client has eaten and has not taken or received insulin. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?

respiratory alkalosis

an increased pH and a decreased PCO2 represents

Report of decreased urine output, no edema noted in ankles, increasing headache SIADH manifests as a dilutional hyponatremia. Decrease urine output, absence of edema, and headaches are signs of this.

A client has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the client for syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment would alert the clinic nurse that the client may be developing this complication?

Renal insufficiency Clients with a history of renal sufficiency or liver disease should use caution while taking this medication as it has been linked to increase rates of cholelithiasis and liver failure

A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication?

The client has abnormalities in his buffer system.

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status?

Increased pH value

The nurse is caring for a client who has consistently been vomiting throughout several days. What will the nurse expect to find when evaluating the client's blood gas values?

Hypokalemia and hypoglycemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Promote absorption.

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?

metabolic alkalosis

an increased pH and a increased HCO3 represents

Regular

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?

Metabolic acidosis

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate uncovering during evaluation of the arterial blood gas?

Fluid accumulating in the interstitial spaces distal to the tumor The normally small amount of fluid remaining in the interstitium is removed by the lymphatic system and returned to the systemic circulation. Any excess fluids and osmotically active plasma proteins that may have leaked into the interstitium are picked up by vessels of the lymphatic system and returned to circulation.

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Osmosis Osmosis is the force that moves water from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water. Active transport is the movement of ions against an electrical or chemical gradient. Diffusion is the process by which particles in solution move from an area of higher concentration to lower, resulting in equal distribution. Filtration is the process of passing a liquid through a filter that is accomplished by gravity, vacuum, or pressure.

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Hypoglycemia

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?

Inflammatory edema When the capillary pores become enlarged or the integrity of the capillary wall is damaged, capillary permeability is increased. When this occurs, plasma proteins and other osmotically active particles leak into the interstitial spaces, increasing the tissue colloidal osmotic pressure, thereby contributing to the accumulation of interstitial fluid. Among the conditions that increase capillary permeability are burn injury, capillary congestion, inflammation, and immune responses.

Which fluid is most likely to contain edema fluid with high protein content?

-Hypertonic food bolus from the stomach to the small intestine -Release of metabolic peptides -Tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea -Rapid rise of glucose, release of insulin, reactive hypoglycemia It is thought that this rapid transit of the hypertonic food bolus from the stomach into the small intestines instead causes a rapid and exuberant release of metabolic peptides that are responsible for the symptoms of dumping syndrome, including: tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea. After defecation, the client then may experience a rapid rise of glucose, release of insulin, and resulting reactive hypoglycemia.

Place the pathophysiological steps in correct order for the development of dumping syndrome.

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?

RYGB Modified RYGB Gastric band

The nurse cares for a client who is post op bariatric surgery and reports dysphagia. Which procedures are most likely to cause these symptoms? Select all that apply.

Breast Colorectal Cervical Obesity increases the risk of developing certain cancers, including breast, cervical, colorectal, endometrial, esophageal, gallbladder, liver, ovarian, non-Hodgkin lymphoma, pancreatic, prostate, kidney, and thyroid.

The nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. Which cancers will the nurse include in the teaching? Select all that apply.

Neither shrink nor swell An example of an isotonic solution is 0.9% NaCl. Cells placed in an isotonic solution, which has the same effective osmolality of the intracellular fluid, neither shrink nor swell.

The nurse is administering a unit of packed red blood cells to a client and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

Isotonic fluid volume excess Isotonic fluid volume excess is manifested by an increase in interstitial and vascular fluids. It is characterized by weight gain over a short period of time. An increase in vascular volume may be evidenced by distended neck veins, slow-emptying peripheral veins, a full and bounding pulse, and an increase in central venous pressure. When excess fluid accumulates in the lungs, there are complaints of shortness of breath and difficult breathing, respiratory crackles, and a productive cough.

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

It enhances the transport of glucose across the cell membrane. Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

It cannot be mixed with any other type of insulin. Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation.

Which statement is correct regarding glargine insulin?

Interstitial

Which volume represents the greatest percentage of water in the extracellular compartment?

Cushing's disease Cushing's disease, results from excess cortisol in the blood.

A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity?

Class I obesity

A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI?

Stimulate GI peristalsis Early oral hydration stimulates GI peristalsis

A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose?

"Expect to lose 10-35% of total body weight 2 to 3 years postoperatively."

A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response?

Mechanical compression and prophylactic anticoagulation Both mechanical compression (intermittent pneumatic compression devices) and prophylactic anticoagulation with low molecular weight heparin agents are prescribed in the client who is postoperative bariatric surgery. Early ambulation is encouraged; however, it is not the only intervention.

A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?

Over time, we have become efficient in food storage and deposition of fat stores. According to the "thrifty gene" theory, hunting for scarce food sources during prehistoric times consumed a lot of energy, and food sources were not abundant. Storing fat to provide energy sources during times of food scarcity was a physiologic adaptive response to these environmental challenges and over time, we became more efficient in food storage and fat deposition.

A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity?

10 to 15 minutes The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?

Give him an electrolyte solution by mouth. Fluid volume deficit results in postural hypotension (dizziness while upright) due to decreased blood volume. Sunken eyes and elevated temperature also point to a fluid volume deficit. The most important action to take is to replace fluid; however, pure water without accompanying electrolytes, such as sodium, may cause hyponatremia (water retention and a decrease in serum osmolality). Thus, an oral electrolyte solution is recommended; in more severe cases an IV would be appropriate.

The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100°F (37.7°C), and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first?

Cardiac monitoring looking for prolonged PR interval and flattening of the T wave Hypokalemia produces a decrease in the resting membrane potential, causing prolongation of the PR interval. It also prolongs the rate of ventricular repolarization, causing depression of the ST segment, flattening of the T wave, and appearance of a prominent U wave.

Which assessment should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L (2.7 mmol/L)?

"Always follow the same order when drawing the different insulins into the syringe." The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

Which instruction about insulin administration should a nurse give to a client?

Lispro The onset of action of rapid-acting lispro is within 10 to 15 minutes.

Which type of insulin acts most quickly?

mEq/L The milliequivalent is used to express the charge equivalency for a given weight of an electrolyte and is expressed as milliequivalents per liter (mEq/L).

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?