Exam 1 (COPING, METABOLISM, NUTRITION)

he nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? "Smokeless tobacco products decrease the risk of kidney damage." "I can help control my blood pressure by avoiding foods high in salt." "I should have yearly dilated eye examinations by an ophthalmologist." "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

"I can help control my blood pressure by avoiding foods high in salt." Patients with type 2 diabetes to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment of retinopathy.

Polydipsia and polyuria related to diabetes are primarily due to a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excess glucose to hemoglobin.

b. fluid shifts resulting from the osmotic effect of hyperglycemia.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability

A. Tachycardia High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

A 72-year-old client diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When the healthcare provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A. The client is at risk for falls. B. The client should be treated with cognitive therapies because of his advanced age. C. The client has a history of nonadherence with medications. D. The client may become addicted faster than younger clients.

A. The client is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a client who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly clients become addicted faster than younger clients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa? A. Chronic low self-esteem B. Ineffective coping: impulsive responses to problems C. Disturbed body image D. Risk for injury: electrolyte imbalance

D. Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. This electrolyte imbalance is potentially life threatening. While appropriate none of the other options are as likely to risk the client's life.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client at what level of anxiety? A. mild. B. panic. C. moderate. D. severe.

D. severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A. Social anxiety disorder B. Agoraphobia C. Panic disorder D.Adult separation anxiety disorder

D.Adult separation anxiety disorder

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? Eat a piece of pizza. Drink some diet pop. Eat 15 g of simple carbohydrates. Take an extra dose of rapid-acting insulin.

Eat 15 g of simple carbohydrates.

The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? Prealbumin level Urine ketone level Fasting glucose level Glycosylated hemoglobin level

Glycosylated hemoglobin level (this is Hbg A1c)

When a client is prescribed lorazepam 1 mg po four times a day (qid) for 1 week for generalized anxiety disorder, the nurse should which intervention as the priority? A. question the physician's order because the dose is excessive. B. explain the long-term nature of benzodiazepine therapy. C. teach the client to limit caffeine intake. D. tell the client to expect mild insomnia.

C. teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam.

Which statement is true of the eating disorder referred to as bulimia? A. Patients with bulimia severely restrict their food intake. B. One sign of bulimia is lanugo. C. Patients with bulimia binge eat but do not engage in compensatory measures. D. Patients with bulimia often appear at a normal weight.

D. Patients with bulimia often appear at a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

The treatment team meets to discuss a client's plan of care. Which of the following factors will be priorities when planning interventions? A. Availability of immediate family to come to meetings B. Financial ability C. Current college performance D. Readiness to change behaviors

D. Readiness to change behaviors The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A. Thyrotoxicosis B. Hypothyroidism C. Hyperthyroidism D. Graves' disease

B. Hypothyroidism

The nurse recognizes additional teaching is needed when the patient prescribed a low-sodium, low-fat cardiac diet selects which food? Baked flounder Angel food cake Canned chicken noodle soup Baked potato with margarine

Canned chicken noodle soup

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? 8:40 PM to 9:00 PM 9:00 PM to 11:30 PM 10:30 PM to 1:30 AM 12:30 AM to 8:30 AM

10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A 48-yr-old woman with a hemoglobin A1C of 8.4% A 58-yr-old man with a fasting blood glucose of 111 mg/dL A 68-yr-old woman with a random plasma glucose of 190 mg/dL A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

48-yr-old woman with a hemoglobin A1C of 8.4%

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. B. Glycemic control is adequate; no changes are needed. C. Hypoglycemia is a risk; teach the patient the symptoms. D. Instruct the patient to limit activity and weekly exercise.

A. Refer the patient to a diabetes educator because the result reflects poor glycemic control.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin."

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? A. "I can be successful if I do all the things required to learn the job." B. "I can never learn all there is to know for the job." C. "I do not have the ability to handle that job." D. "I may be fired from the job but eventually I will find something else to do with my life."

A. "I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75° F) for up to 1 month."

A. "I will discard any insulin bottle that is cloudy in appearance." Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

A. "I'll take this medication in the morning so as not to interfere with sleep." Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

A. "Inject this insulin with your first bite of food, because it is very fast acting."

Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." D. "Headache and dizziness may occur but not very frequently."

A. "You need to notify your doctor if you have a sore throat and fever." Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? (Select all that apply.) A. An eating disorder B. A history of sexual abuse C. A previous suicide attempt D. A history of childhood trauma E. A sibling with the disorder

A. An eating disorder B. A history of sexual abuse D. A history of childhood trauma E. A sibling with the disorder Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

A. Blood glucose control for 24 hours Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for this client's treatment plan while in the hospital? A. Client will be medically stabilized while in the hospital. B. Client will take a leave of absence from college to alleviate stress. C. Client will return to a pre-drug level of functioning within 1 week. D. Client will state within 3 days that they will totally abstain from drugs and alcohol.

A. Client will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. What information should the nurse provide the client regarding this practice? A. Explain the high possibility of an adverse reaction. B. Agreeing that this will help the client to remember the medications. C. Caution the client to drink several glasses of water daily. D. Suggest that the client also use a sun lamp daily.

A. Explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

Which approach to reducing client stress is most effective for children experiencing postoperative pain? A. Guided Imagery B. Meditation C. Breathing exercises D. Journal keeping

A. Guided Imagery With guided imagery people are taught to focus on pleasant images to replace negative or stressful feelings. This focus diverts a person from less positive thoughts or obsessions, resulting in a refreshed outlook. It is especially useful for children experiencing pain and anxiety. The other options may be too complicated for a child to master effectively.

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A. Increased triglyceride levels

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? A. It will be prescribed at a higher than typical dose. B. Long-term management of symptoms is best achieved with tricyclic antidepressants. C. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. D. It will reduce the need for cognitive therapy.

A. It will be prescribed at a higher than typical dose. Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this disorder, tricyclic antidepressants helped reduce binge eating and vomiting over short terms.

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. D. The patient may be excreting sodium and retaining potassium from malnutrition. E. This level shows adequate treatment of the cellulitis and acceptable glucose control.

A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The increased potassium level does not show adequate treatment of cellulitis or acceptable glucose control.

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? A. Thyroid stimulating hormone (TSH) B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level

A. Thyroid stimulating hormone (TSH) If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks, and adjust the levothyroxine dosage as indicated.

Nursing assessment of an alcohol-dependent client 6 to 8 hours after the last drink would most likely reveal the presence of which early sign of alcohol withdrawal? A. Tremors B. Seizures C. Hallucinations D. Blackouts

A. Tremors Tremors are an early sign of alcohol withdrawal. The remaining options are not events considered early signs of alcohol withdrawal.

What stress-reduction technique should a nurse teach an individual experiencing severe performance anxiety? A. deep breathing. B. journal keeping. C. restructuring and setting priorities. D. assertiveness.

A. deep breathing. Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. None of the other options are typically associated with anxiety management.

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."

B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes. High-protein diets are not recommended for weight loss

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I will need to cut back the number of times I shower per week." D. "My shoes should fit nice and tight because they will give me firm support."

B. "I should look at the condition of my feet every day."

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? A. "I will not take any over-the-counter medication while on the fluoxetine." B. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." C. "I will report increased thirst and urination to my provider." D. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction."

B. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

Which statement would best show acceptance of a depressed, mute client? A. "It is important for you to share your thoughts with someone who can help you evaluate your thinking." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "I will be spending time with you each day to try to improve your mood."

B. "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? A. "Is this part of the reason you think no one likes you?" B. "Let's look at what you just said that you can 'never do anything right.'" C. "Tell me what things you think you are not able to do correctly." D. "That is the most unrealistic thing I have ever heard."

B. "Let's look at what you just said that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? A. "Instead of focusing on what stressors are, let's explore your coping skills." B. "Stressors are events that happen that threaten your current functioning and require you to adapt." C. "Stressors are complicated neuro stimuli that cause mental illness." D. "It's best if you ask questions like that of your provider for a complete answer."

B. "Stressors are events that happen that threaten your current functioning and require you to adapt." Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation.

Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the school track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9%

B. A 73-yr-old patient who takes propranolol (Inderal) Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

Which client behavior illustrates eustress? A. A man is laid off from his job. B. A bride is planning for her wedding. C. An adolescent gets into a fight at school. D. A college student fails an exam.

B. A bride is planning for her wedding. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A. Type 2 diabetes B. Altered fat metabolism leading to ketones C. Arterial blood pH of 7.35 to 7.45 D. Sudden onset, triggered by acute illness E. Plasma osmolality of 300 to 320 mOsm/L

B. Altered fat metabolism leading to ketones D. Sudden onset, triggered by acute illness E. Plasma osmolality of 300 to 320 mOsm/L Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? A. Mood stabilizers B. Antidepressants C. Atypical antipsychotics D. Anxiolytics

B. Antidepressants The antidepressant fluoxetine has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.

Which statement is true regarding substance addiction and medical comorbidity? A. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier. B. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. C. Most substance abusers do not have medical comorbidities. D. There has been little research done regarding substance addiction disorders and medical comorbidity.

B. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.

The nurse is providing teaching to a preoperative client just before surgery. The client is becoming more and more anxious and begins to report dizziness and heart pounding. The client also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? A. To reinforce the preoperative teaching by restating it slowly. B. Do not attempt any further teaching at this time. C.Have a family member read the preoperative materials to the client. D.Have the client read the teaching materials instead of providing verbal instruction.

B. Do not attempt any further teaching at this time. Clients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

According to current theory, which statement regarding eating disorders is accurate? A. Eating disorders are rarely comorbid with other mental health disorders. B. Eating disorders are possibly influenced by sociocultural factors. C. Eating disorders are frequently misdiagnosed. D. Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder.

B. Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? A. Asking the client what he means when he says, "I am dying." B. Encouraging the client to take slow, deep breaths C. Offering an explanation about why the symptoms are occurring D. Verbalizing mild disapproval of the anxious behavior

B. Encouraging the client to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when which assessment data is observed? A. Has serum potassium level of 3 mEq/L or greater. B. Has systolic blood pressure less than 90 mm Hg. C. Weighs 10% below ideal body weight. D. Has a heart rate less than 60 beats/min.

B. Has systolic blood pressure less than 90 mm Hg. Systolic blood pressure of less than 90 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise. None of the remaining options represent data aligned with the criteria for hospitalization.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease. B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. C. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes. D. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.

B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin.

A client has a 4-year history of using cocaine intranasally. When brought to the hospital in an unconscious state, what nursing measure should be included in the client's plan of care? A. Induction of vomiting B. Observation for tachycardia and seizures C. Monitoring of opiate withdrawal symptoms D. Administration of ammonium chloride

B. Observation for tachycardia and seizures Tachycardia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. None of the other options are associated with the nursing care required of cocaine stimulation.

What is the major reason for the hospitalization of a depressed client? A. Inability to go to work B. Suicidal ideation C. Psychomotor agitation D. Loss of appetite

B. Suicidal ideation

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? A. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over B. Talking with friends and attending a loss support group C. Starting a hobby to keep her mind off the troubling event D. Antianxiety medication to help her relax

B. Talking with friends and attending a loss support group Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem.

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? A. Improving interpersonal skills B. Weight restoration C. Learning effective coping methods D. Changing family interaction patterns

B. Weight restoration Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status. The other options are addressed are secondary to the physiological goal of weight restoration.

In helping a child to adapt to a hospitalization experience, the best approach would be to A. let the parents bring in food from home that the child is used to eating for all meals. B. establish a daily routine and schedule with the child and parent to help maintain consistency. C. allow the child to select his room on the unit. D. allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment.

B. establish a daily routine and schedule with the child and parent to help maintain consistency. By providing a daily routine and schedule, the nurse helps to support consistency. It is not realistic for the child to bring in all of his favorite toys or allow the child to make a room selection on the unit. Bringing food in from home for all meals is not realistic and may not be advised based on therapeutic treatment.

A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression? A. "I still pray and read my Bible every day." B. "I've heard others say that depression is a sign of weakness." C. "I still feel bad about my sister dying of cancer. I should have done more for her!" D. "My mother wants to move in with me, but I want to independent."

C. "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? A. Anticholinergic medication. B. Standard antipsychotic medication. C. A short-acting benzodiazepine medication. D. Tricyclic antidepressant medication.

C. A short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? A. Amitriptyline is very expensive, so the client may have to buy fewer at a time. B. The health care provider wants to see whether any side effects occur within the first week of administration. C. Amitriptyline is lethal in overdose. D. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness.

C. Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the client had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the client would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? A. Symptoms started right after being robbed at gunpoint. B. Eating in public makes the client extremely uncomfortable. C. Being unable to work for the last 12 months. D. Repeated verbalizing prayers results in a relaxed feeling.

C. Being unable to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? A. White blood cell (WBC) count B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level

C. Beta human chorionic gonadotropin (hCG) test Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 (131I) can be administered. 131I is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC count, ECG, and creatinine level are not indicated before treatment with iodine-131.

The nurse is caring for a client on day 1 post-surgical procedure. The client becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the client's actions? A.Reassure the client that what they are feeling is normal anxiety and do deep breathing exercises with her. B. Reassure the client that you will stay until the anxiety subsides. C. Call for staff help and assess the client's vital signs. D. Use the call light to inquire whether the client has been prescribed prn anxiety medication.

C. Call for staff help and assess the client's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration

C. Cardiac monitoring to detect potassium changes

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A. Take the patient's blood pressure. B. Give the patient's PRN dose of insulin. C. Check the patient's capillary blood sugar. D. Advise the patient to lie down with the legs elevated.

C. Check the patient's capillary blood sugar.

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? A. Behaves in ways that are the opposite of his or her feelings. B. Misses appointments. C. Justifies illogical ideas and feelings. D. Makes jokes to relieve tension.

C. Justifies illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? A. Discounting positive attributes B. Catatonia C. Learned helplessness D. Self-blame

C. Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings.

A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive. What nursing intervention should be implemented to best assure the safety of the client and the milieu? (Select all that apply.) A. Assigning a psychiatric technician to "talk him down" B. Administering naltrexone as needed per hospital protocol C. Obtaining an order for seclusion and close observation D. Obtaining a prescription for a benzodiazepine E. Taking him to the gym on the psychiatric unit

C. Obtaining an order for seclusion and close observation D. Obtaining a prescription for a benzodiazepine Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off as well as the calming effect of a benzodiazepine. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist.

Jacob, a college student whose friend recently committed suicide, rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? A. Projection B. Denial C. Perception D. Repression

C. Perception Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress.

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? A. Cognitive reframing B. Cultural support C. Social support D. Life satisfaction

C. Social support Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. None of the other options are expected to be provided by the self-help group format.

Cocaine exerts which of the following effects on a client? A. Immediate imbalance of emotions B. Paranoia C. Stimulation and euphoria D. Stimulation after 15 to 20 minutes

C. Stimulation and euphoria Cocaine exerts two main effects on the body, both anesthetic and stimulant. None of the other options are associated with the effects of cocaine.

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by implementing which intervention? A. Stressing the need to suppress overt conflict within the family B. Encouraging the family to use their usual social behaviors at meals C. Teaching the family about the disorder and the client's behaviors D. Urging the family to demonstrate greater caring for the client

C. Teaching the family about the disorder and the client's behaviors Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member. While the other options may be appropriate for specific client families, they are not as fundamental as the correct option.

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? A. The effect of the individual's health-sustaining behaviors B. The individual's degree of spirituality C. The individual's perception of the event D. The amount of social support available to the individual

C. The individual's perception of the event Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. While the other options may be factors none contribute to the degree of stress than one's perception of the stressor.

A client diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes this technique? A. guided imagery. B. therapeutic touch. C. biofeedback. D. assertiveness training.

C. biofeedback. Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this.

Effective care of a client suspected of experiencing bulimia nervosa calls for the nurse to perform which assessment? A. body fat analysis. B. a range of motion assessment. C. inspection of the oral cavity. D. inspection of body cavities.

C. inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries. None of the other options represent frequently engaged dysfunctional behaviors.

Ali is a 17-year-old patient diagnosed with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? A. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." B. "I always purge when I'm alone so that I'm not a bad role model for my younger sister." C. "I purge only once a day now instead of twice." D. "I am a hard worker and I am very compassionate toward others."

D. "I am a hard worker and I am very compassionate toward others." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I will go running when my blood sugar is too high to lower it." B. "I will go fishing frequently and pack a healthy lunch with plenty of water." C. "I do not need to increase my exercise routine since I am on my feet all day at work." D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

A client being prepared for discharge tells the nurse, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? A. "It helps your mood so that you don't feel the need to do drugs." B. "It is a sedative that will help you sleep at night, so you are more alert and able to make good decisions." C. "It will keep you from experiencing flashbacks." D. "It helps prevent relapse by reducing drug cravings."

D. "It helps prevent relapse by reducing drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. None of the other options do not accurately describe the action of naltrexone.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. They tend to be more effective for men. B. They often cause the client to have diurnal variation. C. Recent memory impairment is commonly observed. D. Onset of action is from 1 to 3 weeks or longer.

D. Onset of action is from 1 to 3 weeks or longer. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? A. "Try not to think about the feelings and sensations you're experiencing." B. "Let's try to focus on that adorable little granddaughter of yours." C. "Why don't you sit down over there and work on that jigsaw puzzle?" D. "What things have you done in the past that helped you feel more comfortable?"

D. "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

What is an appropriate long-term client-centered goal/outcome for a recovering substance abuser? A. Ability to discuss the addiction with significant others. B. Substitute a less addicting drug for the present drug. C. State an intention to stop using illegal substances. D. Abstain from the use of mood-altering substances.

D. Abstain from the use of mood-altering substances. Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. The remaining options would be considered short-term goals.

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? A. Child clings to parents for comfort. B. Child tells nurses and staff to "go away." C. Child is constantly crying and sobbing. D. Child no longer cries.

D. Child no longer cries. Demonstrating regressive behavior is a characteristic of the stage of despair. All of the other options indicate a stage of protest.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of greatest importance to this particular client? A. Find out if the client uses acting-out behavior. B. Establish whether the client has chronic hypertension related to high anxiety. C. Ascertain how long ago the trauma occurred. D. Determine the use of chemical substances for anxiety relief.

D. Determine the use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Forming superficial relationships B. Depression and sadness C. Inactivity D. Exhibit loud crying

D. Exhibit loud crying In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent. Inactivity is a sign of despair in a young child, not protest. A depressed, sad child indicates despair, not the protest phase. The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight? A. Verbalize awareness of the sensation of hunger. B. Develop a pattern of normal eating behavior. C. Discuss fears and feelings about gaining weight. D. Gain a maximum of 3 lb.

D. Gain a maximum of 3 lb. The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema. While all the remaining goals are appropriate, none have the physical focus that is the initial priority.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A. Telling the client that he or she must relax whenever tension mounts B. Not allowing the client to seek reassurance from staff C. Having the client repeatedly touch "dirty" objects D. Not allowing the client to wash hands after touching a "dirty" object

D. Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon? A. The client is probably experiencing transference. B. The client may be angry at someone else and projecting that anger to staff. C. The client is getting better and is able to be assertive. D. The client may be at high risk for self-harm.

D. The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the client may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

A 26-year-old patient who abuses heroin states, "I've been using more heroin lately because I've begun to need more to feel the effect I want." What effect does this statement describe? A. Intoxication B. Withdrawal C. Addiction D. Tolerance

D. Tolerance Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? A. Prompting the client if the reply is slow B. Reviewing the client's medical record to support the client's response C. Repeating the question if the client does not answer promptly D. Waiting quietly for the client to reply

D. Waiting quietly for the client to reply Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? A. Do not reweigh client when client requests. B. Weigh 2 times daily first week, then three times weekly. C. Permit no oral intake before weighing. D. Weigh fully clothed before breakfast.

D. Weigh fully clothed before breakfast. Clients should be weighed daily first week, then three times weekly wearing only bra and panties or underwear before ingesting any food or fluids in the morning. Reweighing is not a request that should be afforded to the client.

A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? Central apnea Hypoventilation Kussmaul respirations Cheyne-Stokes respirations

Kussmaul respirations

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to 1 drink each day." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose-lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

a. "I will limit my alcohol intake to 1 drink each day."

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mmHg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

a. A1C 9%

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

a. Insulin administration d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

Which are appropriate therapies for patients with diabetes? (select all that apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

a. Use of statins to reduce CVD risk c. Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about a. energy level. b. intake of vitamin C. c. employment history. d. frequency of sexual intercourse.

a. energy level.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? a. Avoid sick people and wash hands. b. Obtain comprehensive dental care. c. Maintain hemoglobin A1C below 7%. d. Coughing and deep breathing with splinting

b. Obtain comprehensive dental care. A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

An appropriate technique to use during physical assessment of the thyroid gland is a. asking the patient to hyperextend the neck during palpation. b. percussing the neck for dullness to define the size of the thyroid. c. having the patient swallow water during inspection and palpation of the gland. d. using deep palpation to determine the extent of a visibly enlarged thyroid gland.

c. having the patient swallow water during inspection and palpation of the gland.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

c. rapid, deep respirations.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? a. Call the provider. b. Give insulin as ordered. c. Assess for other neurologic symptoms. d. Check the patient's blood glucose level.

d. Check the patient's blood glucose level.