NURS 309 Quiz 10

In developing an individualized meal plan for a pt with diabetes, which goals will be focal points of the plan? (SATA) a. Maintaining blood glucose levels at or as close to the normal range as possible b. Pt food preferences c. Allowing pts to eat as much as they desire d. Pt cultural preferences e. Limiting food choices only when guided by scientific evidence

a, b, d, e

. A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What info should the nurse include in a response to this client's statement? a. Regulated food intake is basic to control adherence b. Salt and sugar restriction is the main concern c. Small, frequent meals are better for digestion d. Large meals can contribute to a weight problem

a

The plan of care for a diabetic pt includes all of these interventions. Which intervention should you delegate to a UAP? a. Checking to make sure that the pt's bath water is not too hot - this is classified under the Pt's ADLs, which are within the scope of the UAP b. Discussing community resources for diabetic outpatient care - this requires higher level education and should only be done by the nurse c. Teaching the pt to preform daily inspection - this requires higher level education and should only be done by the nurse d. Assessing the pt's technique for drawing insulin into a syringe

a

What do you anticipated the physician will order for initial fluid replacement? (SATA) a. 0.9% NS - is the first fluid used to correct dehydration in most adults with DKA b. 0.45% NS - can be used for children or adults at risk for fluid volume overload (not dehydration) c. D5% in water and half-strength saline - solutions with dextrose are added to the therapy once the blood glucose level reaches 250 mg/dL d. NS with KCl

a

You overheard one of the UAP's talking to someone on the phone. The UAP says, "Yes, Mr. D is doing much better than when he first got here. I will tell him that you called and I will give him your message." What will you do first? a. Ask the UAP about the phone conversation that you just overheard - situation should be assessed to see if a HIPAA violation occurred b. Remind the UAP that release of information is outside her scope of practice c. Report the UAP to the nurse manager for a HIPPA violation d. Give positive feedback for trying to help the client and the caller

a

Which tasks are appropriate to assign to an experienced UAP? (SATA) a. Measuring and reporting Mr. D's vital signs every 15 minutes - taking VS are within the scope of the UAP b. Checking and reporting Mr. D's blood glucose level - taking VS are within the scope of the UAP (especially a UAP in the ED, but varies between states) c. Bagging and labeling Mr. D's belongings - this is within the scope of the UAP d. Updating the roommate regarding Mr. D's status - updating family /friends is a HIPPA issue, and the RN should decide how this information can be conveyed e. Measuring and recording the volume of Mr. D's vomitus

a, b, c, e

To clarify pertinent data, what questions are appropriate to ask Mr. D? (SATA) a. "When did your symptoms start?" b. "How many times have you vomited?" c. "What was your last blood sugar reading?" d. "Why didn't you go to see your physician?" e. "Where does your abdomen hurt?" f. "Did you take any insulin today?" g. "Do you have any allergies?"

a, b, c, f, g

A 58 yo with type 2 diabetes was admitted to your unit with a diagnosis of COPD exacerbation. When you prepare a care plan for this pt, what would you be sure to include? (SATA) a. Fingerstick blood glucose checks before meals and at bedtime - when diabetics get ill, their BG , and the administration of insulin maybe needed b. Sliding-scale insulin dosing as ordered - when diabetics get ill, there BG , and the administration of insulin maybe needed c. Bed rest until the COPD exacerbation is resolved - not necessary, and glucose may be better controlled when the patient is more active d. Teaching about the Atkins diet for weight loss - Atkins recommends decreasing the consumption of carbohydrates and is not a good diet for diabetics who need a moderate, yet constant source of carbs e. Demonstration of the components of foot care - th

a, b, e

Which tasks can you delegate to an UAP to facilitate Mr. D's transfer to the ICP? (SATA) a. Giving Mr. D's roommate directions to the ICU waiting room - directing family/visitors to waiting rooms is within the scope of the UAP b. Independently transporting Mr. D to the ICU - this needs to be done by an RN or MD; UAP can help, but cannot independently transport Pts to the ICU c. Collecting and organizing the chart and laboratory reports - the unit secretary usually prepares the papers, but the RN ensures everything is in order d. Obtaining a portable oxygen tank and cardiac monitor -gathering equipment is within the scope of the UAP e. Connecting Mr. D's ECG leads to the portable cardiac monitor -this is within the scope of the UAP in the ED (they usually have special training for this) f. Obtaining the last set of vital sign values -

a, d, e, f

In caring for Mr. D, you are vigilant for signs and symptoms of hypokalemia. What are you watching for? (SATA) a. Fatigue - other symptoms of hypokalemia include: paralytic ileus, N & V, abdominal distension, confusion, and irritability b. Seizure activity - this is more associated with hypoglycemia c. Hallucinations - this is more associated with hypoglycemia d. Muscle weakness e. Hypotension f. Weak pulse g. Shallow respirations h. Cold, clammy skin -

a, d, e, f, g

An insulin infusion is ordered for Mr. D to begin at 0.1 units/kg/hr. Mr. D weights 155#. The pharmacy delivers a premixed bag of 100 units of regular insulin in 100 mL of normal saline. Another nurse has calculated the infusion pump setting as 10 mL/hr. What will you do next? a. Tell the nurse to obtain a pump and start the infusion as calculated - insulin a high alter drug & calculations should always be doubled checked by 2 RN's b. Advise the nurse to recalculate the infusion rate - the flow rate is incorrect, the pump should be programmed to 7mL; insulin a high alter drug and calculations should always be doubled checked c. Call the physician and ask for the exact pump setting to be clarified - this is inappropriate since the nurse is in charge of pump calculations d. Allow the nurse to independently administer the infusion using her own best judgment

b

In the emergency department during initial assessment of a newly0admitted pt with diabetes, the nurse discovers all of these findings. Which finding should be reported to the health care provider immediately? a. Hammer toe of the left second metatarsophalangeal joint - this is related to chronic diabetes and is not an urgent problem b. Rapid respiratory rate with deep inspirations - Kussmaul Respirations are symptoms of DKA; which requires immediate attention c. Numbness and tingling bilaterally in the feet and hands - this is related to chronic diabetes and is not an urgent problem d. Decreased sensitivity and swelling of the abdomen

b

The nurse identifies that the dietary teaching provided for a client with diabetes is understood when the client states, My diet: a. Should be rigidly controlled to avoid emergencies b. Can be planned around a wide variety of commonly used foods c. Is based on nutritional requirements that are the same for all people d. Must not include eating any combination dishes and processed foods-

b

Which statement about dietary concepts for a pt with diabetes is true? a. Alcoholic beverage consumption is unrestricted b. Carbohydrate counting is emphasized when adjusting dietary intake of nutrients c. Sweeteners should be avoided because of the side effects d. Both soluble and insoluble fiber foods should be limited

b

You are preparing to transfer Mr. D to the ICU, and you observe the cardiac monitor pattern. Which finding is of greatest concern? a. P wave precedes every QRS complex - this is normal b. Ventricular dysrhythmias are occurring - this is suggestive of hypokalemia, which is a significant cause of death in people with DKA c. QRS complexes are occurring more frequently - this is present in tachycardia d. The isoelectric line shows an artifact -

b

You are receiving the intensive care unit (ICU) admission orders. There is an order for an IV potassium infusion. Related specifically to the order for potassium, which information would the ICU nurse be most interested in knowing? a. Mental status has improved with therapy b. Urinary output is 60 mL/hr and urine is a clear yellow color - before K+ is administered, it is important to know that the kidneys are functioning c. Blood pressure was 100/60 mm Hg on admission and is now 125/76 mm Hg d. One IV site showed infiltration, but the current IV line flushes easily

b

You are reviewing the potassium values that were obtained when Mr. D first arrived in the ED. Which serum potassium level would concern you the most? a. 3.5 mEq/L b. 2.0 mEq/L - after insulin, hypokalemia is expected as the K+ shifts back into the cells; therefore, if K+ is initially low, it will be even lower after therapy c. 5.8 mEq/L d. 6.0 mEq/L

b

You are trying to call a report to the ICU but are told, "We were not notified about the admission." You call the admitting clerk, but she says, "I was never notified." You ask the unit secretary and he tells you, "I forgot to do it." What should you do first? a. Report the unit secretary to the manager - client care is too important, in this situation, than filling a complaint b. Ask the secretary to call the admissions office now - in order to correct the omission, have the admission's office called right away c. Take the secretary aside and allow him to explain his actions - client care is more important, than determining why the secretary made the omission d. Ask the ICU to take the report regardless of the clerical omission

b

The nurse is providing discharge teaching to a pt about self-monitoring of blood glucose (SMBG). What info does the nurse include? (SATA) a. Only perform SMBG before breakfast b. Wash hands before using the meter c. Do a retest if the results seem unusual d. It is okay to reuse lancets in the home setting e. Do not share the meter

b, c, e

A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin (Novolin N). What does this snack provide? a. Encouragement to stay on the diet b. Added calories to promote weight gain c. Nourishment to counteract late insulin activity d. High-carbohydrate nourishment for immediate use

c

An LPN/LVN's assessment of two diabetic pts reveals all of these findings. Which would you instruct the LPN/LVN to report immediately? a. Fingerstick glucose reading of 185 mg/dL b. Numbness and tingling in both feet c. Profuse perspiration d. Bunion on the left great toe

c

Mr. D says to you, "Please don't call my mother. If she knows I'm in the hospital, she'll make me quit school and move back home. I know I messed up, but I really don't want to move back in with my parents." What is the best therapeutic communication response? a. "None of the staff will say anything, but you should tell her yourself." - this is inappropriate since the nurse is giving unsolicited advice b. "Your mom loves you, and she is just concerned about your well-being." - this is platitude that is not supported by firsthand knowledge of this family c. "It sounds like you want to be independent and responsible for yourself." - acknowledging and reflecting underlying feelings is therapeutic d. "You are an adult and you have a right to make your own decisions."

c

The pt with DM had a pancreas transplant and take daily doses of cyclosporine (Neoral). For which key lab assessment does the nurse monitor? a. Serum electrolytes b. CBC with differential count c. Serum creatinine d. Clotting studies

c

What is the priority nursing diagnosis for Mr. D? a. Ineffective Breathing Pattern related to acidosis - although he is Kussmaul breathing, this is his's body's way of compensating for the acidosis b. Anxiety related to the uncertainty of the outcome - relevant, but should not be formally addressed until he become physically stable (think Maslow's) c. Deficient Fluid Volume related to hyperglycemia - Mr. D is severely dehydrated and is at risk for hypovolemic shock and electrolyte imbalance d. Noncompliance related to medications and treatment plan -r

c

In the initial emergency care for Mr. D, which orders would you question? (SATA) a. Start a peripheral IV line with a large-bore catheter b. Insert a Foley catheter with a urinometer c. Administer regular insulin subcutaneously - SQ insulin is not absorbed quickly; & is inappropriate in an emergency situation (IV insulin should be given) d. Maintain the client in a semi-Fowler position e. Initiate continuous electrocardiographic (ECG) monitoring f. Encourage intake of oral fluids as tolerated

c, f

The male diabetic pt asks the nurse for advice about alcohol consumption. What is the nurse's best response? a. It is best to have alcohol near bedtime b. As long as your diabetes is under control you can drink as much as you like c. You should drink only one alcoholic beverage with each meal d. Avoid more than two drinks a day and have them with or shortly after meals

d

What is the basic principle of meal planning for apt with type 1 DM? a. Five small meals per day plus a bedtime snack b. Taking extra insulin when panning to eat sweet foods c. High protein, low-carb, and low-fiber foods d. Considering the effects and peak action times of the pt's insulin

d

You have completed to triage assessment and history taking. Now, what is your priority action? a. Page the ED physician to come immediately to triage - patient is not unresponsive b. Call the client's parents for permission to treat - patient is old enough to give consent c. Notify the client's primary care physician - this is usually done by the ED physician after the preliminary workup; but varies with each institution d. Take the client immediately to a treatment room

d