Unit 2 - Worksheet

Match the following with the correct answers. A) Amputation rates among ... are 3 to 4 times higher than in other popluations with diabetes B) Type 2 diabetes tends to affect a younger population in C) The highest incidence of diabetes is among D) Complications of diabetes are more common in 1) Native Americans 2) nonwhites than in whites 3) Native Americans and African Americans 4) Native Americans and Alaska Natives

A) Amputation rates among ... are 3 to 4 times higher than in other popluations with diabetes - 1) Native Americans B) Type 2 diabetes tends to affect a younger population in - 2) nonwhites than in whites C) The highest incidence of diabetes is among - 4) Native Americans and Alaska Natives D) Complications of diabetes are more common in - 3) Native Americans and African Americans Cultural - Book page 1235

Match the following with its correct answer. A) Hyperthyroidism and hypothyroidism occur more commonly in B) Graves disease affects four to eight times as many C) Ectopic ACTH production is more common in 1) Women 2) Men 3) Women

A) Hyperthyroidism and hypothyroidism occur more commonly in - 1) Women B) Graves disease affects four to eight times as many - 3) Women C) Ectopic ACTH production is more common in - 2) Men Cultural - Book page 1256

Match the following with the appropriate answer. A) has a higher prevalence in African American men than white men B) Jewish men have a high incidence of C) are more common among whites than African Americans. D) has a higher incidence among white men the african American men 1) Uric acid stones 2) Urinary tract calculli 3) Bladder cancer 4) Prostate cancer

A) has a higher prevalence in African American men than white men - 4) Prostate cancer B) Jewish men have a high incidence of - 1) Uric acid stones C) are more common among whites than African Americans. - 2) Urinary tract calculli D) has a higher incidence among white men the african American men - 3) Bladder cancer Cultural - Book page 1122

A patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? Application of ostomy appliances Catheterization technique and schedule Analgesic use before emptying the pouch Use of barrier products for skin protection

Catheterization technique and schedule The Indiana pouch enables the patient to self-catheterize every 4 to 6 hours. There is no need for an ostomy device or barrier products. Catheterization of the pouch is not painful.

After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? The patient administers the glargine 30 to 45 minutes before eating each meal. The patient's family fills the syringes weekly and stores them in the refrigerator. The patient draws up the regular insulin and then the glargine in the same syringe. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.

The patient disposes of the open vials of glargine and regular insulin after 4 weeks. Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.

A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about premedicating to prevent nausea. where to obtain wigs and scarves. the importance of oral care during treatment. the need to empty the bladder before treatment.

the need to empty the bladder before treatment. The patient will be asked to empty the bladder before instillation of the chemotherapy. Systemic side effects are not experienced with intravesical chemotherapy.

A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? "Have you had a recent head injury?" "Do you have to wear larger shoes now?" "Are you experiencing tremors or anxiety?" "Is there any family history of acromegaly?"

"Do you have to wear larger shoes now?" Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

Which question by the nurse will help identify autonomic neuropathy in a diabetic patient? "Have you observed any recent skin changes?" "Do you notice any bloating feeling after eating?" "Do you need to increase your insulin dosage when you are stressed?" "Have you noticed any painful new ulcerations or sores on your feet?"

"Do you notice any bloating feeling after eating?" Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions also are appropriate to ask, but would not help in identifying autonomic neuropathy.

Which patient statement after the nurse has completed teaching a patient with type 2 diabetes about taking glipizide (Glucotrol) indicates a need for additional teaching? "Other medications besides the Glucotrol may affect my blood sugar." "If I overeat at a meal, I will still take just the usual dose of medication." "When I become ill, I may have to take insulin to control my blood sugar." "My diabetes is not as likely to cause complications as if I needed to take insulin."

"My diabetes is not as likely to cause complications as if I needed to take insulin." The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? 9:00 AM 11:30 AM 4:00 PM 8:00 PM

9:00 AM The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.

Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? Foul-smelling urine Complaint of flank pain Blood pressure 88/45 mm Hg Temperature 100.1° F (57.8° C)

Blood pressure 88/45 mm Hg The low blood pressure indicates that urosepsis and septic shock may be occurring and should be immediately reported. The other findings are typical of pyelonephritis.

Following an open loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented first? Insert a straight catheter and drain the bladder. Assist the patient to take a 15-minute sitz bath. Encourage the patient to drink several glasses of water. Teach the patient how to do isometric perineal exercises.

Assist the patient to take a 15-minute sitz bath. Sitz baths will relax the perineal muscles and promote voiding. Although the patient should be encouraged to drink fluids and Kegel exercises are helpful in the prevention of incontinence, these activities would not be helpful for a patient experiencing retention. Catheter insertion increases the risk for urinary tract infection (UTI) and should be avoided when possible

Which nursing action will be most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital? Avoid unnecessary catheterizations. Encourage adequate oral fluid intake. Test urine with a dipstick daily for nitrites. Provide thorough perineal hygiene to patients.

Avoid unnecessary catheterizations. Since catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other actions will also be helpful, but are not as useful as decreasing urinary catheter use.

Which action will the nurse include in the plan of care for a patient who has had a ureterolithotomy and has a left ureteral catheter and a urethral catheter in place? Provide education about home care for both catheters. Apply continuous steady tension to the ureteral catheter. Clamp the ureteral catheter unless output from the urethral catheter stops. Call the health care provider if the ureteral catheter output drops suddenly.

Call the health care provider if the ureteral catheter output drops suddenly. The health care provider should be notified if the ureteral catheter output decreases since obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Since the patient is not usually discharged with a ureteral catheter in place, patient teaching about both catheters is not needed.

Which nursing action should the nurse who is caring for a patient who has had an ileal conduit for several years delegate to nursing assistive personnel (NAP)? Assess for symptoms of urinary tract infection (UTI). Change the ostomy appliance. Choose the appropriate ostomy bag. Monitor the appearance of the stoma.

Change the ostomy appliance. Changing the ostomy appliance for a stable patient could be done by NAP. Assessments of the site, choosing the appropriate ostomy bag, and assessing for (UTI) symptoms require more education and scope of practice and should be done by the RN.

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral arterial disease. Which information will the nurse include in patient teaching? Choose flat-soled leather shoes. Set heating pads on a low temperature. Buy callus remover for corns or calluses. Soak the feet in warm water for an hour every day.

Choose flat-soled leather shoes. The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

A pregnant patient who has no personal history of diabetes, but does have a parent who is diabetic is scheduled for the first prenatal visit. Which action will the nurse plan to take on this initial visit? Teach about appropriate use of regular insulin. Discuss the need for a fasting blood glucose level. Schedule an oral glucose tolerance test for the twenty fourth week of pregnancy. Provide education about increased risk for fetal problems with gestational diabetes.

Discuss the need for a fasting blood glucose level. Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test also may be used to check for diabetes, but it would be done before the twenty fourth week. The other actions also may be needed (depending on whether the patient develops gestational diabetes), but they are not the first actions that the nurse should take.

A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider? Infuse 5% dextrose in normal saline at 75 mL/hr. Order regular diet after patient is awake and alert. Give ketorolac (Toradol) 10 mg PO PRN for pain. Obtain blood urea nitrogen (BUN), creatinine, and electrolytes in 2 hours.

Give ketorolac (Toradol) 10 mg PO PRN for pain. The NSAIDs should be avoided in patients with decreased renal function because nephrotoxicity is a potential adverse effect. The other orders do not need any clarification or change.

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? Glyburide decreases glucagon secretion from the pancreas. Glyburide stimulates insulin production and release from the pancreas. Glyburide should be taken even if the morning blood glucose level is low. Glyburide should not be used for 48 hours after receiving IV contrast media.

Glyburide stimulates insulin production and release from the pancreas. The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this category of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.

To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which test will the nurse plan to schedule for the patient? Urine dipstick for glucose Oral glucose tolerance test Fasting blood glucose level Glycosylated hemoglobin level

Glycosylated hemoglobin level The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

Which assessment finding for a patient who has had a cystectomy with an ileal conduit the previous day is most important for the nurse to communicate to the physician? Cloudy appearing urine Hypotonic bowel sounds Heart rate 102 beats/minute Continuous drainage from stoma

Heart rate 102 beats/minute Tachycardia may indicate infection, hemorrhage, or hypovolemia, which are all serious complications of this surgery. The urine from an ileal conduit normally contains mucus and is cloudy. Hypotonic bowel sounds are expected after bowel surgery. Continuous drainage of urine from the stoma is normal.

Which information will the nurse include when teaching a patient about use of somatropin (Genotropin)? The medication will improve vaginal dryness. Inject the medication subcutaneously every day. Blood glucose levels will decrease when taking the medication. Stop taking the medication if swelling of the hands or feet occurs.

Inject the medication subcutaneously every day. Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.

An 88-year-old with benign prostatic hyperplasia (BPH) has a markedly distended bladder and is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first? Insert a urinary retention catheter. Schedule an intravenous pyelogram. Administer lorazepam (Ativan) 0.5 mg PO. Draw blood for blood urea nitrogen (BUN) and creatinine testing.

Insert a urinary retention catheter. The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently.

Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider? Dysuria Hematuria Left-sided flank pain Temperature 100.1° F

Left-sided flank pain Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI).

Which nursing action will be included in the postoperative plan of care for a patient who has had a transsphenoidal resection of a pituitary tumor? Monitor urine output every hour. Palpate extremities for dependent edema. Check hematocrit hourly for first 12 hours. Obtain continuous pulse oximetry for 24 hours.

Monitor urine output every hour. After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action should the nurse take first? Administer 1 mg glucagon subcutaneously. Obtain a glucose reading using a finger stick. Have the patient drink 4 ounces of orange juice. Give the scheduled dose of lispro (Humalog) insulin.

Obtain a glucose reading using a finger stick. The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Administration of lispro would drop the patient's glucose further.

A patient in the hospital has a history of functional urinary incontinence. Which nursing action will be included in the plan of care? Place a bedside commode near the patient's bed. Demonstrate the use of the Credé maneuver to the patient. Use an ultrasound scanner to check postvoiding residuals. Teach the use of Kegel exercises to strengthen the pelvic floor.

Place a bedside commode near the patient's bed. Modifications in the environment make it easier to avoid functional incontinence. Checking for residual urine and performing the Credé maneuver are interventions for overflow incontinence. Kegel exercises are useful for stress incontinence.

When planning teaching for a patient who was admitted with myxedema coma and diagnosed with hypothyroidism, which strategy will be best for the nurse to use? Delay teaching until patient discharge. Ensure privacy by asking visitors to leave. Provide written handouts of all information. Offer multiple options for management of therapies.

Provide written handouts of all information. Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Since the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.

A patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect to find related to this illness? Poor skin turgor High urine ketones Recent weight gain Low blood pressure

Recent weight gain The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high.

Which information about a patient who receives rosiglitazone (Avandia) is most important for the nurse to report immediately to the health care provider? The patient's blood pressure is 154/92. The patient has a history of emphysema. The patient's noon blood glucose is 86 mg/dL. The patient has chest pressure when ambulating.

The patient has chest pressure when ambulating. Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data with the health care provider.

A patient who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which information given by the patient is most important to report to the health care provider? The patient is using opioids for pain. The patient has noticed clots in the urine. The patient is very anxious about the cancer. The patient is voiding every 4 hours at night.

The patient has noticed clots in the urine. Clots in the urine are not expected and require further follow-up. Voiding every 4 hours, use of opioids for pain, and anxiety are typical after this procedure.

Which action by a type 1 diabetic patient indicates that the nurse should implement teaching about exercise and glucose control? The patient always carries hard candies when engaging in exercise. The patient goes for a vigorous walk when the glucose is 200 mg/dL. The patient has a peanut butter sandwich before going for a bicycle ride. The patient increases daily exercise when ketones are present in the urine.

The patient increases daily exercise when ketones are present in the urine. When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? The patient changes the site for the insertion site every week. The patient programs the pump to deliver an insulin bolus after eating. The patient takes the pump off at bedtime and starts it again each morning. The patient states that diet will be less flexible when using the insulin pump.

The patient programs the pump to deliver an insulin bolus after eating. In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24 hours a day.

Which information from the patient's health history is most important for the nurse to communicate to the health care provider when a patient has an order for an oral glucose tolerance test? The patient uses oral contraceptives. The patient runs several days a week. The patient has a family history of diabetes. The patient had a viral illness 2 months ago.

The patient uses oral contraceptives. Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. A viral illness 2 months previously may be associated with the onset of type 1 diabetes but will not falsely affect the OGTT. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT.

When providing postoperative care for a patient who had a bilateral adrenalectomy, which assessment information requires the most rapid action by the nurse? The blood glucose is 176 mg/dL. The lungs have bibasilar crackles. The patient's BP is 88/50 mm Hg. The patient has 5/10 incisional pain.

The patient's BP is 88/50 mm Hg. The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.

The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which finding indicates a need to contact the health care provider before giving the metformin? The patient's blood glucose level is 166 mg/dL. The patient's blood urea nitrogen (BUN) level is 60 mg/dL. The patient is scheduled for a chest x-ray in an hour. The patient has gained 2 lb (0.9 kg) since yesterday.

The patient's blood urea nitrogen (BUN) level is 60 mg/dL. The BUN indicates impending renal failure and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin.

A patient undergoes a nephrectomy after having massive trauma to the kidney. Which assessment finding obtained postoperatively is most important to communicate to the surgeon? Blood pressure is 102/58. Incisional pain level is 8/10. Urine output is 20 mL/hr for 2 hours. Crackles are heard at both lung bases.

Urine output is 20 mL/hr for 2 hours. Because the urine output should be at least 0.5 mL/kg/hr, a 40 mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain.

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to cough and deep breathe every 2 hours postoperatively. remain on bed rest for the first 48 hours after the surgery. be positioned flat with sandbags at the head postoperatively. avoid brushing the teeth for at least 10 days after the surgery.

avoid brushing the teeth for at least 10 days after the surgery.

A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the patient, the nurse would expect to find high blood pressure. elevated blood glucose. tachycardia and cardiac palpitations. changes in secondary sex characteristics.

changes in secondary sex characteristics. Changes in secondary sex characteristics are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.

A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 PM. The clinic nurse will plan to teach the patient to check glucose level before, during, and after swimming. delay eating the noon meal until after the swimming class. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. time the morning insulin injection so that the peak occurs while swimming.

check glucose level before, during, and after swimming. The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the patient's technique of SMBG, the nurse identifies a need for additional teaching when the patient washes the puncture site using soap and warm water. chooses a puncture site in the center of the finger pad. hangs the arm down for a minute before puncturing the site. says the result of 130 mg indicates good blood sugar control.

chooses a puncture site in the center of the finger pad. The patient is taught to choose a puncture site at the side of the finger pad. The other patient actions indicate that teaching has been effective.

Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of anxiety related to effects of procedure on lifestyle. disturbed body image related to change in body function. The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient. The patient does not appear to be ready for enhanced coping. The patient's insistence that only the ostomy nurse care for the stoma indicates that denial is not present. readiness for enhanced coping related to need for information. self-care deficit, toileting, related to denial of altered body function.

disturbed body image related to change in body function. The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient. The patient does not appear to be ready for enhanced coping. The patient's insistence that only the ostomy nurse care for the stoma indicates that denial is not present.

When assessing a 30-year-old man who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of bladder infection. recent kidney trauma. gonococcal urethritis. benign prostatic hyperplasia.

gonococcal urethritis. The patient's clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. These symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection.

A patient admitted to the hospital with hypertension is diagnosed with a pheochromocytoma. The nurse will plan to monitor the patient for flushing. headache. bradycardia. hypoglycemia.

headache. The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose also may occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to give 50% dextrose as a bolus. insert a large-bore IV catheter. initiate oxygen by nasal cannula. administer glargine (Lantus) insulin.

insert a large-bore IV catheter. HHNC is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about self-monitoring of blood glucose. use of low doses of regular insulin. lifestyle changes to lower blood glucose. effects of oral hypoglycemic medications.

lifestyle changes to lower blood glucose. The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

When planning teaching for a patient with benign nephrosclerosis the nurse should include instructions regarding monitoring and recording blood pressure. obtaining and documenting daily weights. measuring daily intake and output amounts. preventing bleeding caused by anticoagulants.

monitoring and recording blood pressure. Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency. Anticoagulants are not used to treat nephrosclerosis.

After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for oral corticosteroids to replace endogenous cortisol. chemotherapy to prevent reoccurrence of the tumor. insulin use to maintain blood glucose at normal levels. sodium restriction to prevent fluid retention and hypertension.

oral corticosteroids to replace endogenous cortisol. Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.

A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the peripheral edema is decreased. patient's weight has increased. urine specific gravity is increased. patient's urinary output is increased.

patient's urinary output is increased. Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.