Unit 4 Book Questions

A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (DiaBeta), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels? A. It is a temporary condition related to the stress response with increased glucose release. B. He is converting to a type 1 diabetic. C. The oral antidiabetic drug is no longer working for him. D. Patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.

A. It is a temporary condition related to the stress response with increased glucose release. The release of glucose may be in response to a stressful situation, such as hospitalization and infection. Blood glucose levels will continue to be monitored, and control may improve as the infection clears and the patient is discharged.

The patient is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient? A. Make sure the patient's breakfast is available to eat before administering this insulin. B. Offer the patient a high-carbohydrate snack in 6 hours. C, Hold the insulin if the blood glucose level is greater than 100 mg/dL. D. Administer the medications in two separate syringes.

A. Make sure the patient's breakfast is available to eat. Hum along is a rapid acting insulin that is administered for elevated glucose levels. It should be given within 15 minutes before meals. Hypoglycemia reactions may occur rapidly if Humalog insulin is not supported by sufficient food intake.

What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? (Select all that apply.) A. Monitor blood glucose levels before and after exercise. B. Eat a complex carbohydrate prior to strenuous exercise. C. Exercise may increase insulin needs. D. Withhold insulin prior to engaging in strenuous exercise. E. Take extra insulin prior to exercise

A. Monitor blood glucose levels before and after exercise. B. Eat a complex carbohydrate prior to strenuous exercise. Options 3, 4, and 5 are incorrect. Regular exercise may assist the body to use glucose more effectively, and insulin needs may decrease. Insulin dose should not be withheld or increased prior to exercise. If symptoms suggest that hypo- or hyperglycemia are occurring during exercise, the patient should consult the healthcare provider about changing the insulin regimen.

The nurse is talking with the parents of a child who will receive somatropin (Nutropin) about the drug therapy. Which important detail will the nurse include in the teaching for these parents? A. The drug must be given by injection. B. The drug must be given regularly throughout adolescence and young adulthood to achieve desired effects. C. If the drug therapy is given throughout adolescence, it could add 6 (15 cm) to 8 inches (20 cm) to the child's height. D. Daily laboratory monitoring will be required during the first weeks of therapy

A. The drug must be given by injection

A nurse is preparing the teaching plan for a patient who will be discharged on methylprednisolone (Medrol Dosepak) after a significant response to poison ivy. The nurse will include instruction on reporting which adverse effects to the healthcare provider? (Select all that apply.) A. Tinnitus B. Edema C. Eye pain or visual changes D. Abdominal pain E. Dizziness upon standing

B. Edema C. Eye pain or visual changes D. Abdominal pain The above are possible side effects from methylprednisone. Options 1 and 5 are incorrect.

The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which statement indicates that the patient needs additional teaching? A. "If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice." B. "My insulin needs may increase when I have an infection." C. "I must draw the NPH insulin first if I am mixing it with regular insulin." D. "If my blood glucose levels are less than 60 mg/dL, I should notify my healthcare provider.

C. "I must draw the NPH insulin first if I am mixing it with regular insulin." Additional teaching is needed to ensure that the patient is mixing insulin correctly in the same syringe. The short acting solution (regular insulin) should be drawn into the syringe first, followed by the longer acting (intermediate) solution (NPH).

Which assessment findings would cause the nurse to withhold the patient's regularly scheduled dose of levothyroxine (Synthroid)? A. A 1-kg (2-lb) weight gain B. A blood pressure reading of 90/62 mmHg C. A heart rate of 110 beats/minute D. A temperature of 37.9°C (100.2°F)

C. A heart rate of 110 beats/minute A heart rate of 110 may indicate that the dosage is too high. The nurse should withhold the medication and contact the provider.

A patient is being treated with methimazole (Tapazole) for hyperthyroidism, pending thyroidectomy. While the patient is taking this drug, what symptoms will the nurse teach the patient to report to the healthcare provider? A. Tinnitus, altered taste, thickened saliva B. Insomnia, nightmares, night sweats C. General weakness, muscle cramps, and dry skin D. Dry eyes, decreased blinking, reddened conjunctiva

C. General weakness, muscle cramps, and dry skin The above are early signs of hypothyroidism and may indicate over treatment.

A patient will be started on desmopressin (DDAVP) for treatment of diabetes insipidus. Which instruction should the nurse include in the teaching plan? A. Drink plenty of fluids, especially those high in calcium. B. Avoid close contact with children or pregnant women for 1 week after administration of the drug. C. Obtain and record your weight daily. D. Wear a mask if around children and pregnant women.

C. Obtain and record your weight daily. Obtain and record weight daily to monitor for the presence of peripheral edema

The nurse is assisting a patient with chronic adrenal insufficiency to plan for medication consistency while on a family vacation trip. He is taking hydrocortisone (Cortef) and fludrocortisones (Florinef) as replacement therapy. What essential detail does this patient need to remember to do? A. Take his blood pressure once or twice daily. B. Avoid crowded indoor areas to avoid infections. C. Have his vision checked before he leaves. D. Carry an oral and injectable form of both drugs with him on his trip.

D. Carry an oral and injectable form of both drugs with him on his trip

A patient with type 2 diabetes has been nothing by mouth (NPO) since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications? A. Hold all medications as per the NPO order. B. Give him the medications with a sip of water. C. Give him half the original dose. D. Contact the healthcare provider for further orders.

D. Contact the healthcare provider for further orders. The need for oral hypoglycemic medication may have been overlooked. Contacting the healthcare provider ensures that the provider is aware that the patient has diabetes and that no medication for diabetes were ordered.

A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are 2 different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress? A. The patient needs to plan the next insulin injection around the peak times. B. Additional insulin may be needed at peak times to avoid hyperglycemia. C. It is best to plan exercise or other activities around peak insulin activity. D. The risk for hypoglycemia is greatest around the peak of insulin activity.

D. The risk for hypoglycemia is greatest around the peak of insulin activity. Insulin peak times are the periods of maximum insulin utilization with the greatest risk of hypoglycemia.