Med Surg II Test 3

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?

Fruity breath pg. 919

Normal serum sodium

135-145 mEq/L

Which type of insulin acts most quickly?

Lispro pg. 905

Hypernatremia

>145 mEq/L

Which of the following is an age-related change that may affect diabetes? Select all that apply.

-Decreased renal function -Taste changes -Decreased vision

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?

Albumin pg. 926

A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient?

Are you feeling any tingling in your hands or around your mouth? pg. 77

Which electrolyte is a major anion in body fluid?

Chloride pg. 55

A patient presents to the clinic complaining of symptoms that suggest diabetes mellitus. What criteria would support a diagnosis of diabetes mellitus?

Fasting plasma glucose ≥126 mg/dL pg. 898

When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance?

Hypermagnesemia (may result in coma, apnea, and cardiac arrest) pg. 82

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia pg. 920-921

A nurse is reviewing self-administration of insulin using a pre-filled pen with a client who started using the pen the previous week. The client asks what can be done to help reduce injection pain. Which of the following instructions should the nurse give the client?

Keep the pen at room temperature for a few minutes

A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure?

Maintenance of healthy blood pressure and prompt treatment of hypertension pg. 926

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur?

Metabolic alkalosis pg. 68

Which is a characteristic of type 2 diabetes?

insulin resistance pg. 894

Lispro (Humalog) is an example of which type of insulin?

Rapid-acting pg. 904

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?

"I will take this medication in the morning, with my first bite of breakfast." pg. 915

A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is:

"I'm going to give your son some insulin. Then I'll be happy to talk with you."

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

15 g of carbohydrates pg. 901

The nurse notes that a patient's urine osmolality is 980 mOsm/kg. What should the nurse assess as a possible cause of this finding?

Acidosis (normal osmolality 200-800)

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?

Alcoholism pg. 81

Which instruction about insulin administration should a nurse give to a client?

Always follow the same order when drawing the different insulins into the syringe pg. 907-908

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?

Dietitian pg. 899-900

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?

Extreme anxiety pg. 90

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?

Do not mix with other insulins pg. 905

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?

Elevated hematocrit level pg. 65

A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance?

glycosylated hemoglobin pg. 896

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the

malignancy is causing the electrolyte imbalance pg. 78

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply.

-Distended neck veins -Crackles in the lung fields -Shortness of breath pg. 65

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.

-Elevated blood urea nitrogen (BUN) and creatinine -Rapid onset -More common in type 1 diabetes pg. 922

A nurse is caring for a client who has type 1 diabetes mellitus and reports felling anxious and having palpitations. The glucometer reads 50 mg/dL. Which of the following actions should the nurse take?

Give the client 4 oz of apple juice

Which condition leads to chronic respiratory acidosis in older adults?

Thoracic skeletal change pg. 84

Which of the following is a factor affecting an increase in urine osmolality?

Syndrome of inappropriate antidiuretic hormone release (SIADH) pg. 58

A client with emphysema is at a greater risk for developing which acid-base imbalance?

chronic respiratory acidosis pg. 89

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of:

hypoglycemia pg. 898

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply.

-Client has not consumed food and continues to take insulin or oral antidiabetic medications. -Client has not consumed sufficient calories. -Client has been exercising more than usual. pg. 901

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining?

1 L pg. 64

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

10 to 15 g of a simple carbohydrate

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:

at least three times per week pg. 902-903

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

confusion and seizures pg. 68

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?

electrocardiogram (ECG) results pg. 82

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance?

hypokalemia pg. 85

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status?

weight pg. 65

A nurse is caring for a client who has type 1 diabetes mellitus and is in need of a long-acting insulin preparation. The nurse anticipates receiving a prescription for which of the following insulins?

Insulin glargine (provides basal glucose control, once daily at the same time each day)

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant?

Provide oral care every 2-3 hours pg. 70-71

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?

This insulin has no peak action and does not cause a hypoglycemic reaction pg. 905

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?

"Rotate injection sites within the same anatomic region, not among different regions." pg. 908

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents?

"Your child will need less blood work as his glucose levels stabilize."

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis.

-Blurred or deteriorating vision -Fatigue and irritability -Polyuria and polydipsia -Wounds that heal slowly or respond poorly to treatment

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.

-Ketosis-prone -Little or no endogenous insulin -Younger than 30 years of age pg. 894

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply.

-Leakage of fluid or serum (exudates) -Microaneurysms -Focal capillary single closure

A nurse is reviewing the results of routine laboratory tests performed as part of a client's annual physical examination. Which of the following values indicates a fasting blood glucose measurement that is outside of the expected reference range?

118 mg/dL

A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss?

158.0 lbs pg. 64

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be?

275-300 mOsm/kg pg. 58

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?

3 months pg. 903

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?

6.5% pg. 898

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?

7:45 AM pg. 904-905

The nurse has cared for four patients with type 1 diabetes over the past few shifts. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of his or her type 1 diabetes?

A patient who adheres to a meal plan and meal schedule pg. 900

A volume-depleted patient would present with which of the following diagnostic lab results?

BUN-to-creatinine ratio of 24:1 pg. 63

A patient newly diagnosed with type 2 diabetes is attending a nutrition class specifically designed for type 2 diabetics. What general guideline would it be important to teach the patients at this class?

Calorie intake should support a reasonable body weight pg. 931

An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next?

Consider sodium restriction with discontinuation of salt tablets. pg. 86

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of:

Deficient knowledge (treatment regimen). pg. 931

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?

Elevated blood pressure pg. 65

The nurse is preparing to administer a patient's scheduled dose of Novolin 70/30. When administering this dose of insulin, the nurse should:

Ensure that the insulin is not given near a previous injection site pg. 908

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following?

Extracellular fluid volume deficit pg. 65

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure?

Glycosylated hemoglobin level pg. 903

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?

Increase frequency of glucose self-monitoring pg. 903

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger pg. 897

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

Increases ability for glucose to get into the cell and lowers blood sugar pg. 902

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first?

Infuse 0.9% normal saline solution 1 L/hr for 2 hours (dehydration, electrolyte loss, and acidosis should be corrected first) pg. 921

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?

Insulin production insufficient pg. 896-897

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

It enhances the transport of glucose across the cell membrane pg. 896

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?

Ketones will tell us if your body is using other tissues for energy pg. 904

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

Metformin (biguanide) pg. 912-913

A nurse is teaching a client who has type 1 diabetes mellitus about the peak time of neutral protamine Hagedorn (NPH) insulin. Which of the following statements by the client indicates an understanding of the teaching?

NPH insulin peaks in 6 to 14 hours (onset of 60-120 min, peak 6-14hr, and duration 16-24hr)

A patient who is diagnosed with type 1 diabetes would be expected to:

Need exogenous insulin pg. 904

A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patient's abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient?

Osmosis pg. 56

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?

Presence of Trousseau sign pg. 77

A nurse is teaching a client who has a new diagnosis of type 2 diabetes mellitus about metformin. The nurse should explain that this type of medication works by which of the following mechanisms?

Reducing hepatic glucose production

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?

Sensory neuropathy pg. 930

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

Serum glycosylated hemoglobin (Hb A1c) pg. 903-904

A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators?

Sodium level of 150 mEq/L pg. 70

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

Suggest referral to a sex counselor or other appropriate professional pg. 927

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the:

Synthesis of glucose from noncarbohydrate sources. pg. 895

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?

Test your blood glucose every 4 hours pg. 920

An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate:

The administration of hypotonic or isotonic IV solution pg. 64

A nurse is teaching a client who has type 1 diabetes mellitus about the use of an insulin pump. Which of the following information should the nurse include in the teaching?

The risk for developing DKA can be increased with the use of an insulin pump

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?

The short-acting insulin is withdrawn before the intermediate-acting insulin. pg. 905

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?

They increase the need for insulin pg. 900

A nurse is teaching a client who was recently diagnosed with type 1 diabetes mellitus how to check blood glucose levels. Which of the following instructions should the nurse include in the teaching?

To collect a sample for testing, hold the test strip next to the blood on the fingertip

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:

Trousseau's sign pg. 77

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?

Underlying problem of insulin resistance pg. 915

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition?

Your body is using protein and fat for energy instead of glucose pg. 894

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for:

hyponatremia pg. 58

Early signs of hypervolemia include

increased breathing effort and weight gain pg. 65

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?

hypoglycemia pg. 929

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?

jugular vein distention pg. 68

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

pulse pg. 72

A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patient's most recent blood work, the nurse should pay particular attention to the patient's levels of:

sodium pg. 68

Which factor is the focus of nutrition intervention for clients with type 2 diabetes?

weight loss pg. 898, 900

A hospital patient has been ordered a sliding scale of Humulin R for the duration of her admission. The patient's medication administration record specifies the first administration time of the day at 08:00 and the nurse knows that breakfast trays typically arrive on the unit between 07:45 and 07:50. When should the nurse administer the patient's insulin?

0730 pg. 905

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to:

Inhibit the production of glucose by the liver pg. 912

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

Coma, anxiety, confusion, headache, and cool, moist skin

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?

Regular pg. 905

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes?

Presence of autoantibodies against islet cells (autoimmune response) pg. 896

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?

Respiratory acidosis pg. 89