Lifespan summer midterm

Which statement correctly identifies a difference between duodenal and gastric ulcers?

Duodenal ulcer pain is aggravated by fasting

Which finding indicates that the airway is patent after suctioning the tracheostomy tube?

Effective breathing at a rate of 16 breaths/minute through the established airway

A nurse reviews the health history of a patient with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding?

Hypertension

A client scheduled for surgery has arranged for an autologous transfusion. What type of blood transfusion is this?

The client donates his or her own blood.

Which of the following is not a primary symptom of COPD?

Weight gain

After surgery, a client is on IV therapy for the next 4 days. How often should the nurse change the IV tubing for this client?

every 72 hours

A female patient has been diagnosed with "metabolic syndrome" or "insulin resistance." What findings support this diagnosis? Select all that apply.

↓ HDL of 30 mg/dL BMI of 30 kg/m2 Blood pressure of 145/90 ↑Triglycerides greater than 150 mg/dL

Ordered: amoxicillin clavulanate potassium oral suspension 0.6 g every 12 hr for a patient with a sinus infection. How many mL will you give for each dose? ______mL (250mg/5ml)

12ml

Because insulin normally decreases with exercise; patients on exogenous (injected) insulin, should eat a _______________ carbohydrate snack before moderate exercise to prevent hypoglycemia.

15g

The nurses recognizes that the older adult patient may have a reduced ability to concentrate urine, which is attributed to which of the following?

A decrease in the number of functioning nephrons

A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

Agitation

You are a nurse caring for a client who has just had a tracheostomy. What should you monitor frequently?

Airway patency

A nurse is assessing a client who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?

Assess for a patent airway.

A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?

Cheyne-Stokes respirations

The following data relate to an older client who is 2 hours postoperative after an esophagogastrostomy: : Physical Assessment Skin dry Urine output 20 mL/hr NG tube patent with 100 mL brown drainage/hr Restless Vital Signs Pulse: 128 beats/min Blood pressure: 88/50 mm Hg Respiratory rate: 20 on ventilator Cardiac output: 2.1 L/min Oxygen saturation: 99% Physician Orders Normal saline at 75 mL/hr Morphine sulfate 2 mg IV push every 1 hr PRN pain Intake and output every hour Vital signs every hour Vancomycin (Vancocin) 1 g IV every 8 hr What action by the nurse is best?

Consult the surgeon regarding need for increased IV fluids.

A diabetic client has come to see their provider for their annual physical. When the nurse returns to the room after the hospital gown has been put on, the client climbs up onto the exam table. It is noticed that there is a wound on the bottom of the foot. The client is unaware that it was present. The nurse knows that Diabetic foot ulcers are:

Due to impaired ability of the leukocytes to destroy bacteria resulting in infections. Due to poor sirculation in the lower extremeties contributing to poor healing. Due to the changes in the nerves resulting in the loss in sensation.

A nurse is caring for a client who has a peripheral line to the left arm. Assessment findings include: redness, heat, and warmth to the IV site, temperature 100.4, and the infusion has slowed. Based on the information above what actions should the nurse take? Select all that apply.

Elevate the extremity Discontinue the IV site Stop infusion

The nurse recognizes that which factors may have contributed to Skyler Hansen's low blood glucose in this case? (Select all that apply.)

Excessive physical activity Too little food Too much insulin

A patient is having testing to diagnose type 1 diabetes mellitus. Which diagnostic tests might be prescribed for this patient? Select all that apply.

Fasting blood glucose Hemoglobin A1c 2-hour postprandial Random blood glucose

A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.

Hemorrhage Atelectasis

In providing care to the patient who may have polycystic kidney disease, the nurse recognizes which finding as the first clinical manifestation of this disease process?

Hypertension

A nurse cares for a patient with a urine specific gravity of 1.040. What action should the nurse take?

Increase the patient's fluid intake.

The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what action?

Increased fluid intake to produce a full bladder

The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate?

Increased urine specific gravity

A client has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the client's discharge education accordingly. What preventive measure should the nurse encourage the client to adopt?

Increasing fluid intake

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of:

Infection

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

A nurse is working with an client who has been newly diagnosed with Type 1 Diabetes., and knows that finger tips can get tender quickly when learning to perform self monitoring blood glucose (SMBG). The nurse shares other sites that are commonly used:

Palm forearm thumb thigh upper arm calf

A client postoperatively reports to the nurse the need to urinate, but is unable to void. What should the nurse expect the healthcare provider to order? Select all that apply.

Perform a Bladder Scan Complete a straight catheterization

A female client is undergoing a bladder training program as a treatment for urinary incontinence. Which technique would be the most appropriate for the nurse to suggest?

Performing Kegel exercises

A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training?

Place client on a timed voiding schedule.

The nurse monitors for which clinical manifestations in the patient diagnosed with acute glomerulonephritis? Select all that apply.

Proteinuria Serum creatinine 2.4 mg/dL Hematuria

Once the Type 1 diabetic from the simulation lab regained consciousness after receiving 50% Dextrose in water to treat his hypoglycemia which of the following interventions by the nurse would be appropriate to prevent another decrease in blood glucose?

Provide a snack of cheese and crackers

While in the hospital, Skyler Hansen receives short-acting and intermediate-acting insulin. The nurse knows that when preparing the two insulins, which insulin should be drawn into the syringe first?

Short-acting

The charge nurse is reviewing IV therapy orders. What information must be included in each order? Select all that apply.

Specific drug dose to be added to the solution Specific type of solution Rate of administration Frequency of drug administration

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and a productive cough

The nurse is attempting to insert a peripheral IV when the patient reports tingling and a feeling of "pins and needles". What does the nurse do next?

Stop immediately, remove the catheter, and choose a new site

A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?

Streptococcal infection

A patient is taking insulin and has a fasting blood glucose of 85 mg/dL, a postprandial blood glucose level of 160mg/dL, and a hemoglobin A1c level of 5.5%. What is the nurse's interpretation of these findings?

The client is demonstrating good control of blood glucose.

The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to

The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to

A nurse working in an endoscopy clinic is screening patients for the risk of developing Barrett's esophagus. The nurse should consider which patient at greatest risk?

The patient who has had untreated GERD for 30 years

The nurse is supervising a student who is preparing an IV bag with IV administration tubing. For which action by the student nurse must the nurse intervene?

The student touches the tubing spike

Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis?

Undigested food blocking the diverticulum, predisposing the area to bacterial invasion

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information?

Void immediately after sexual intercourse.

Type 1 diabetes the insulin-producing beta cells in the pancreas are destroyed by a combination of the following factors? Select all that apply.

environmental genetic immulogic

A client is receiving a blood transfusion and the nurse notes hives and itching to the clients arms and chest. What type of reaction is the client experiencing?

hemolytic transfusion reaction

A client has symptoms suggestive of peritonitis. Nursing management would not include

limiting analgesics to avoid the formation of paralytic ileus.

Chronic glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:

no symptoms.

When interpreting the results of a Mantoux test, the nurse explains to the client that a reaction occurs when the intradermal injection site shows:

redness, roundness, and elevation (enduration)

The nurse has completed an assessment of the renal and urinary system, indicate which assessment finding indicates a need for additional follow up. (Select all that apply)

tenderness with kidney palpation acute confusion flank bruising

Clients with ___________risk factors are at higher risk of developing renal cell carcinoma that can easily metastasize to _________.

tobacco use and HTN lungs and liver

A client presents to the emergency room after a vehicle accident. The client is actively bleeding and the physician orders packed red blood cells stat. With the administration of blood the nurse should verify client and component information with another RN and Stay with the client for the 1st 15-30 minutes of infusion .

verify client and component information with another RN Stay with the client for the 1st 15-30 minutes of infusion

A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response?

"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

The nurse is teaching a diabetes support group about the importance of self glucose monitoring. The nurse knows that more instruction is required when one of the clients state:

"As long as I keep my fasting blood sugar under 150, I should be able to prevent long-term complications."."

A client who has occasional gastric symptoms is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching?

"Eliminating bothersome foods will help."

A nurse assesses a patient with renal insufficiency and a low red blood cell count. The patient asks, "Is my anemia related to the renal insufficiency?" How should the nurse respond?

"Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow."

A patient with a history of hypertension is diagnosed with chronic kidney disease. When the patient asks the nurse how this occurred, which response by the nurse is the best?

"High blood pressure reduces renal blood flow and harms the kidney tissue, causing this diagnosis."

Which patient statement indicates effective teaching related to acute gastritis?

"I need to avoid using aspirin or nonsteroidal medications for routine pain relief."

Which statement by the patient being discharged after treatment for acute glomerulonephritis indicates the need for further teaching?

"I will increase the protein in my diet to help me heal."

When providing patient education for Skyler Hansen, it is important for the nurse to emphasize the peak effect times for insulin. The expected peak for regular insulin is which of the following

"I will make sure to eat one snack per day"

A nurse is teaching a client who has chronic obstructive pulmonary disease about ways to facilitate eating. Which of the following statements indicates a need for further teaching?

"I will take my bronchodilators after meals."

A nursing instructor is explaining the difference between infiltration and phlebitis to a student. Which statement is most appropriate?

"Infiltration occurs when IV fluid escapes into the tissue, while phlebitis is inflammation of the vein."

A nurse teaches a patient with diabetes mellitus about sick-day management. Which statement would the nurse include in this patient's teaching?

"Monitor your blood glucose levels at least every 4 hours while sick."

A client is schedule to have surgery and asks if their spouse can donate blood to be used during surgery. The client's blood type is O+ and the spouse's blood type is A+. How should the nurse respond.

"Unfortunately your blood types are not compatible. You spouse can still donate blood for use by other clients."

Another medication that may have been given in this case would have been glucagon. What does the nurse understand would be the correct dosage for this medication?

1 mg IV, IM, or subcutaneous

A client was diagnosed with chronic kidney disease. For each potential providers prescription, indicate if the potential prescription is anticipated or contraindicated for the client. 1. Treat hypertension with metoprolol 25mg daily_____ 2. Treat fluid retention with lasix 20mg daily______ 3. Increase dietary sodium intake____ 4. Educate on exercise and weight loss _____

1. Anticipated 2. Anticipated 3. Contraindicated 4. Contraindicated

Match the following definitions. 1. Urine output less than 0.5ml/kg/hr_____ 2. red blood cells in the urine_____ 3. painful or difficult urination_____ 4. decreased urine output of less than 50ml in 24 hours______ 5. awakening at night to urinate

1. oliguria 2. hematuria 3. dysuira 4. anuria 5. nocturia

A provider orders methylprednisolone (Solu-Medrol) 0.05mg/kg/min for a patient that weighs 147 lbs. The infusion contains 200 mg methylprednisolone (Solu-Medrol) in 100 mL D5W. Calculate the infusion rate in mL/hr. Round to the nearest tenths place. Record only a number.

100.3ml/hr

Give Aminophylline 25 mg/hr. Aminophylline is available as 1 Gram/500ml of fluid. At what rate should the infusion run per hour? ____ ml/hr (Round to the tenths place)

12.5

Give Aminophylline 25 mg/hr. Aminophylline is available as 1 Gram/500ml of fluid. At what rate should the infusion run per hour? ______ ml/hr (Round to the tenths place)

12.5

72 kg = ______lbs *Round to the tenths place

158.4

The prescription is for cimetadine (Tagamet) 300 mg IV piggyback (IVPB). The IV drug book instructs you to mix 300 mg in 100 mL of D5W and to infuse it in 1 hour. The drop factor is 15 gtt/ml. How many drops per minute should the IVPB infuse? _______ gtts/min. (Round to the nearest drop)

25

Order: Deltasone 7.5 mgAvailable: Deltasone 2.5 mg/tablet

3 tablets

Ordered: furosemide 38 mg IV, a diuretic, for a patient with edema. How many mL will you give? _______ (40mg/4ml)

3.6ml

A patient is receiving 1 Gm of Cefoxitin in 100 mL of fluid at 40 gtts/min. The drop factor on the tubing is 12 gtt/mL. How long will it take ( in minutes) for the fluid to infuse? Answer with the number value only.

30

A patient is receiving 1 Gm of Cefoxitin in 100 mL of fluid at 30 gtts/min. The drop factor on the tubing is 12 gtt/mL. How long will it take ( in minutes) for the fluid to infuse? Answer with the number value only.

40

The nurse should intervene immediately if a patient has which blood glucose level?

40 mg/dL

A provider orders disopyramide (Norpace) to be infused at a rate of 0.4mg/min. The pharmacy supplies the medication in an IV bag containing 250mg in 500 mL of D5W. Calculate the infusion rate in mL/hr. Round to the nearest tenths place. Record only a number

48ml

An emergency department nurse cares for a patient who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate (mL/hr) would the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.) __________ mL/hr

500

You are providing nutrition education to a patient that has been just diagnosed with type 1 diabetes mellitus and specifically discussing the exchange system. The following is an example of a meal the patient ate at supper last night. What are the total number of carbohydrate exchanges for this meal? Round to the nearest whole number. Lean 3 oz. chicken breast = 0 g carbs 1 cup of cooked white rice = 45 g carbs 1 cup of sweet corn = 29 g carbs 1 cup of 2% milk - 12 g carbs

6 exchanges

The nurse is caring for a patient with dementia in the long-term care facility when the patient has a change in cognitive function. What should the nurse suspect this patient may be experiencing?

A UTI

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line with 0.45% normal saline that is infiltrated Which action should the nurse take first?

Administer 1 mg of intramuscular or subcutaneous glucagon.

Which assessment finding would be most consistent with advanced emphysema?

Barrel-shaped chest

Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)?

Cigarette smoking

Which of the following risk factors has been associated with renal cancer?

Cigarette smoking

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?

Cloudy urine

Which condition is often misdiagnosed in the older adult patient with acute glomerulonephritis?

Congestive heart failure

Which is a late sign of hypoxia?

Cyanosis

You are caring for a client with COPD. Select the 4 findings that require follow-up.

Disorientation Yellow sputum Ankle edema

Which instruction does the nurse give the CNA who has been delegated to check blood pressure on 6 patients being infused with peripheral IV fluids?

Do the blood pressure checks on the opposite arm of the IV infusion

A sputum study has been ordered for a client who has developed coarse chest crackles and a fever. At what time should the nurse best collect the sample?

First thing in the morning

The nurse correlates which clinical manifestation with the pathophysiology of acute pyelonephritis? (Select all that apply.)

Flank pain Fever Nausea and vomiting

The nurse would expect that a patient experiencing moderate hypoglycemia would exhibit which of the following sets of signs and symptoms?

Headache, light headedness, slurred speech

A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply.

Hypertension Polyuria Abdominal pain

The nurse identifies which nursing diagnosis as the highest priority for the patient admitted with peptic ulcer disease (PUD) and possible perforation?

Impaired GI tissue integrity

The nurse assesses the IV site prior to administering 50 mL of dextrose 50% in water (D50W) intravenously to a patient with hypoglycemia per protocol. The nurse identifies redness and swelling at the IV site. Which action should the nurse take?

Insert another IV to administer the D50W

A 35-year-old male client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary provider, what intervention should the nurse prioritize?

Insertion of a nasogastric tube

Macrovascular complications seen in diabetes consist of changes in the medium and large blood vessels. this results in the following disorders , except

MI/myocardial infarction

A client undergoes surgery to remove a malignant tumor followed by a urinary diversion procedure. Which postoperative procedure is the most important for the nurse to perform?

Maintain skin and stomal integrity.

A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function?

Monitor the client's intake and output.

Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following?

Osteoporosis

Which nursing diagnosis is appropriate for a client with renal calculi?

Risk for infection

The nurse correlates which laboratory result as the most reliable indicator of impaired renal function?

Serum creatinine 2.4 mg/dL

A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?

Stage 3

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply.

Suprapubic pain Difficulty starting a urine stream Hematuria Elevated temperature

The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding?

The client's bladder is not completely empty.

A client's neck dissection surgery resulted in damage to the client's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize?

The client's swallowing ability

An adult client has tested positive for tuberculosis (TB). While providing client teaching, what information should the nurse prioritize?

The importance of adhering closely to the prescribed medication regimen

The nurse has been caring for a client who has been prescribed an antibiotic for pharyngitis and has been instructed to take the antibiotic for 10 days. One day 4, the client is feeling better and plans to stop taking the medication. What information should the nurse provide to this client?

The importance of finishing all antibiotics as prescribed.

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply.

abdominal distention sudden, sustained abdominal pain

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions?

"I should avoid orange juice and eating tomatoes until my esophagus heals."

A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following statements should the nurse include?

"Take a deep breath in through your nose."

The order is for Kefzol 500 mg. The label says Kefzol 1 Gram/ 3mL. How many mL of the medication will the nurse give? ________mL

1.5ml

During a teaching session, a parent asks the nurse which inhaler to use for quick relief if the child has an asthma attack. What teaching should the nurse review with the parent?

Albuterol is a short-acting inhalant and will relax muscles quickly.

A nurse is caring for a diabetic client in a long-term care facility where they are receiving rehabilitation services. It is noted that blood glucose readings are consistently higher than expected on the carbohydrate restricted diet that is provided. When the nurse sees the client eating candy, the client is confronted. The reply is "oh, these? They are sugar-free." When the label is read, it states "sugar-free", but when the nutrition label is read , the nurse shows the client that the sorbitol (sugar alcohol) has the same number of calories that the same candy that is NOT sugar free has. This is a case of:

An education opportunity Misleading labels

A community health nurse serves a diverse population. What individual would likely face the highest risk for parotitis?

An older adult whose medication regimen includes an anticholinergic

A patient has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful?

Arrange a dietary consult

The nurse is caring for a client who has returned to the unit following a bronchoscopy. The client is asking for something to drink. Which criterion will determine when the nurse should allow the client to drink fluids?

Presence of a cough and gag reflex

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education?

Encourage the patient to take approximately 10 breaths per hour, while awake.

A nurse is caring for a type 2 diabetic that is having surgery for a total knee replacement. The nurse reads that the client is on both an oral antidiabetic agent and insulin at home. It is well understood that stress hormone causes :

Hyperglycemia

Your patient in the ED presents with a distended rigid and board-like abdomen, severe abdominal pain, an oral temperature of 102o F, the inability to pass gas, and nausea and vomiting. Upon obtaining a history you learn he had a colon resection a week ago for a bowel obstruction. What are the priority medical interventions for this patient ? (select all that apply)

IV Antibiotic therapy. Decrease abdominal distention by decompression with NG tube.

Microvascular complications of diabetes effect the small to medium blood vessels resulting the following, : Select all that apply

Nephropathy Retinopathy Sexual dysfunction

A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.

Rovsing's sign; acute appendicitis

A nursing instructor is discussing Diabetic Ketoacidosis with her students. They learn that the the following factors could lead to the development of this dangerous illness: Select all that apply.

intentional skipping of insulin doses Error in drawing up insulin New diagnosis of Type 1 Diabetes illness and infections

A provider orders normal saline IV 120ml/hr to a client that was admitted for pneumonia. The nurse knows this type of IV fluid is

isotonic

A client presents to the ER after a car accident and has had trauma resulting in blood loss. What fluid does the nurse expect the provider to order?

1/2 normal saline

Orders are for 500 mL D5W to infuse at 40 mL/hr. The drop factor is 15 gtts/mL. Calculate the gtt/min. flow rate. ________ gtts/min. Round to the nearest drop.

10

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent?

90%

The nurse is assessing a client whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this client?

A barrel chest

Review the assessment findings and indicate if the findings need immediate follow-up by the nurse or other medical professionals.

A client is receiving a blood transfusion and has developed a temperature of 100.6 degrees Fahrenheit. A client has an IV in the left hand with pain, swelling, and redness.

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make for the client?

A room with air exhaust directly to the outdoor environment [negative pressure]

The nurse is assessing a patient's IV insertion site. What must the nurse look for during the assessment? Select all that apply.

Asses the site for redness and swelling Check for patency and blood return Ensure that the dressing is clean, dry, and intact Observe for hardness or drainage

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote?

Always carry a form of fast-acting sugar.

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema:

An abnormal distention of the air spaces with destruction of the alveolar walls

A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms?

An absence of blood in stool

A nurse provides care for a client receiving oxygen from a nonrebreather mask. Which nursing intervention has the highest priority?

Assessing the client's respiratory status, orientation, and skin color

A patient is receiving IV therapy via an infusion pump. What is the priority nursing responsibility related to the equipment?

Ensure the IV pump is programmed correctly

A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client's care, which of the following nursing diagnoses should the nurse prioritize?

Ineffective Tissue Perfusion Related to Bowel Ischemia

A nurse assesses a patient with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, welling area at the site the patient uses most frequently for insulin injection. What action would the nurse take?

Instruct the patient to rotate sites for insulin injection.

The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?

Iodine allergy

The nurse is preparing to give a patient IV drug therapy. What information should the nurse know before administering the drug? Select all that apply.

Parameters to monitor related to immediate drug effects Indications, contraindications, and precautions for IV therapy Compatibility with other IV medications Rate of infusion and dosage of drugs Appropriate dilution, pH, and osmolarity of solution

Tube feedings are advised for a client who is recovering from oral surgery. The nurse manages the tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to reduce the risk of aspiration? Select all that apply.

Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. Check tube placement and gastric residual prior to feedings.

A common clinical manifestation of the four different forms of diabetes are the Three P's, aka: Select all that apply

Polyuria Polydypsia Polyphagia

A student nurse is providing care to an older patient with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene?

Preparing to administer a viscous lidocaine gargle.

A patient with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The patient's blood pressure when lying down is 122/80 mm Hg and when standing was 98/52 mm Hg. What priority action by the nurse is most appropriate?

Start a large-bore IV with normal saline (NS)

The nurse caring for a client receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the client is having difficulty breathing and complains of severe chest tightness. What is the most appropriate initial action for the nurse to take?

Stop the transfusion immediately.

Complete the following sentence by choosing from the list of options. The client receiving IV fluids is at highest risk for developing________ as evidence by the clients_______.

hemolytic transfusion reaction bounding pulse and dyspnea

A nurse is preparing to administer intravenous fluids, including accessing a vein. What is the most potentially harmful risk posed for the client when accessing the vein?

infection