Test Two

The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that the teaching has been effective?

I will clean the catheter carefully before and after each catheterization

Which statement by a 22 year old female patient with cystitis indicates to the nurse that instruction regarding prevention of future urinary tract infections has been effective?

I will empty my bladder every 3 to 4 hours during the day.

Which statement by a patient with interstitial cystitis indicates to the nurse that further instruction is needed?

I will start taking high potency multiple vitamins every morning

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine?

Increased thyroxine level

A 28 year old male patient has just been diagnosed with polycystic kidney disease. Which information should the nurse include in the teaching during the first teaching session?

Options to consider for genetic counseling

What topic should the nurse teach a patient who had a pituitary adenoma after the hypophysectomy?

Oral corticosteroids to replace endogenous cortisol

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking Prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

Patient stopped taking the medication 2 days ago.

After change-of-shift report, which patient should the nurse assess first?

Patient with a urethral stricture who has not voided for 12 hours

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?

Patient with tetany who has a new order for IV calcium chloride

A patient admitted to the hospital with pneumonia has a history of functional urinary incontinence. Which nursing action will be included in the plan of care?

Place a bedside commode close to the patient's bed

A 27 year old patient admitted with diabetic ketoacidosis has a serum glucose level of 732 and serum potassium level of 3.1. Which action prescribed by the health care provider should the nurse take first?

Place the patient on a cardiac monitor

A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse include in the plan of care?

Teach the patient about the use of antifungal medications.

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

The patient took the prescribed metformin today.

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test?

The patient uses oral contraceptives

A 55 year old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing and coughing causes leakage of urine. Which intervention is appropriate to include in the care plan?

Teach the patient how to perform kegel exercises

Which assessment finding for an adult admitted with Graves' disease requires the most rapid intervention by the nurse?

Temperature 103.8

Which assessment finding in a patient who had a bilateral adrenalectomy requires the most rapid action by the nurse?

The BP is 88/50

The nurse is interviewing a new patient with diabetes who takes Avandia. Which information would the nurse anticipate resulting in the health care provider discontinuing the medication?

The patient has chest pressure when walking

Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider?

The patient has seen clots in the urine .

A 28 year old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?

The patient increases daily exercise when ketones are present in the urine.

The nurse is caring for a patient admitted with diabetes insipidus. Which information is most important to report to the health care provider?

The patient is confused and lethargic

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may

The patient may require administration of insulin while taking prednisone

Which patient action indicates an accurate understanding of the nurse's teaching about the use of an insulin pump?

The patient programs the pump for an insulin bolus after eating

The nurse is assessing a 55 year old female patient with type 2 diabetes who has a body mass index of 31. Which goal in the plan of care is most important for this patient?

The patient will reach a A1C of less than 7%

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide?

Glyburide stimulates insulin production and release from the pancreas

Which patient statement indicates that the nurse's teaching about Byetta has been effective?

I should take my daily asa at least an hour before the Byetta

Which nursing action is of the highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

Administer prescribed analgesics

A patient is admitted with diabetes insipidus. Which action will be appropriate for the RN to delegate to an experienced LPN?

Administer prescribed subcutaneous DDAVP

Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone?

Offer the patient hard candies to suck on.

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline?

Amitriptyline helps prevent transmission of pain impulses to the brain

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. What should the nurse include in preoperative teaching?

Avoid brushing teeth for at least 10 days after the surgery

Nursing staff on a hospital unit are reviewing rate of health care associated infections of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital?

Avoiding unnecessary urinary catheterization

An 82 year old patient in a long term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed

Diazepam

A patient receives aspart insulin at 8 am. At which time would the nurse anticipate the highest risk for hypoglycemia?

10 am

The nurse observed UAP taking the following actions when caring for a female patient with a urethral catheter. Which action requires that the nurse intervene?

Disconnecting the catheter from the drainage tube to obtain a specimen

Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?

Disturbed sleep pattern

After change of shift report which patient should the nurse assess first?

A 23 year old patient with type 1 diabetes who has a blood glucose of 40 mg/dL

After change of shift report which patient will the nurse assess first?

A 60 year old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa.

After receiving change of shift report about the following four patients, which patient should the nurse assess first?

A 70 year old female patient taking levothyroxine who has an irregular pulse of 134.

A patient with type 2 diabetes is schedule for a follow up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

A1C

When a patient with type 2 diabetes is admitted for a cholecystectomy which nursing action can the nurse delegate to a LPN?

Administer the prescribed lispro insuline before transporting the patient to surgery

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?

Do you feel bloated after eating?

A 40 year old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis which questions should the nurse ask?

Do you have to wear larger shoes now?

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin?

Abdomen

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?

Administer IV calcium gluconate

A 30 year old patient has a new diagnosis of type 2 diabetes. When should the nurse recommend the patient a dilated eye exam?

ASAP

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

Antithyroid medications may take several months for full effect

Which nursing assessment of a 70 year old patient is most important to make during initiation of thyroid replacement with levothyroxine?

Apical pulse rate

The nurse is preparing to teach a 43 year old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?

Assess the patient's perception of what it means to have diabetes

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?

Assess the patient's respiratory effort

A patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented?

Assist the patient to soak in a 15 minute sitz bath

A 68 year old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care?

Assist the patient to the bathroom every 2 hours during the day.

Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse?

Audible crackles bilaterally over the posterior chest to the midscapular level

The nurse is caring for a patient following an adrenalectomy. What is the highest priority in the immediate postoperative period?

Balancing fluids and electrolytes

Which finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?

Blood pressure 90/48 mmHg.

An active 32 year old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

Blood pressure of 140/88

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. What topic should the nurse plant to teach the patient?

Calcium supplements to normalize serum calcium levels

A 68 year old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?

Catheterization technique and schedule

The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to UAP?

Change the ostomy appliance

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?

Changes in diet and exercise may control blood glucose levels in type 2 diabetes

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1 pm. What advice should the clinic nurse plan to give the patient?

Check glucose level before, during and after swimming

The health care provider suspects the Somogyi effect in a 50 year old patient whose 6am blood glucose is 230. Which action will the nurse teach the patient to take?

Check the blood glucose during the night

A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first?

Check the blood pressure and heart rate.

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes and sensory neuropathy of the feet and legs?

Choose flat soled leather shoes

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching?

Chooses a puncture site in the center of the finger pad

Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise?

Determine what types of activities the patient enjoys

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism?

Decreased facial hair

Which assessment finding is most important to the health care provider regarding a patient who has had left sided extracorporeal shock wave lithotripsy?

Decreased urine output

Which nursing actions will be included in the plan of care for a patient with Graves' disease who has exophthalmos?

Elevate the head of the patient's bed to reduce periorbital fluid

What should the nurse will teach about when preparing a patient with bladder cancer for intravesical chemotherapy?

Emptying the bladder before the instillation

A patient with primary hyperparathyroidism has a serum phosphorous level of 1.7 and calcium of 14. Which nursing action should be included in the plan of care?

Encourage 4000 mL of fluids daily

A 58 year old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present based on these finding?

Excess fluid volume

A patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider?

Give ketorolac 10 mg PO PRN for pain

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?

Give the patient 4-6 oz more orange juice

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

Give the patient a snack of peanut butter and crackers

A few weeks after an 82 year old patient with a new diagnosis of type 2 diabetes has been placed on Metformin therapy, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?

Glomerular filtration rate is decreased

A young adult male patient seen at the primary care clinic reports feeling continued fullness after voiding and a split, spraying urine stream. What should the nurse ask about patient's history?

Gonococcal urethritis

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid temporary relief from the symptoms?

Have the patient rebreathe from a paper bag.

The nurse is assessing a 22 year old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response?

Have you lost weight lately?

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Humalog

Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse?

I can choose any foods as long as I use enough insulin to cover the calories.

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching?

I had the flu earlier this week, so I couldn't take the hydrocortisone

Which patient statement to the nurse indicates a need for additional instruction in administering insulin?

I need to rotate injection sites among my arms, legs and abdomen each day

Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone?

I need to shop for foods low in sodium and avoid adding salt to food.

A patient has just arrived in the PACU after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon?

Increasing neck swelling

A patient with DKA is brought to the emergency department. Which prescribed action should the nurse implement first?

Infuse 1 L of normal saline per hour

Which information will the nurse include when teaching a 50 year old male patient somatropin?

Inject the medication subcutaneously every day

A 76 year old with benign prostatic hyperplasia is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first?

Insert an indwelling urinary catheter

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome. What should the nurse anticipate doing?

Inserting an IV catheter

Which information will the nurse include when teaching the patient with urinary tract infection about the use of phenazopyridine?

It may change your urine color.

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel who are working in the diabetic clinic?

Measure the ankle brachial index

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transphenoidal resection of a pituitary tumor. Which nursing action should be included?

Measure urine volume every hour

A 26 year old female who has type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a blood glucose level of 210 despite taking her usual glargine and lispro insulin. What should the nurse advise the patient to do?

Monitor blood glucose every 4 hours and contact the clinic if it rises.

What action should the nurse take when providing care for a patient who has an adrenortical adenoma causing hyperaldosteronism?

Monitor the blood pressure every 4 hours.

Which topic should the nurse include when planning a teaching session for a patient with benign nephrosclerosis?

Monitoring and recording blood pressure

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizde. Which patient indicates a need for additional teaching?

My diabetes won't cause complications because I don't need insulin

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?

Nausea and projectile vomiting

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action?

New onset changes in the patient's voice

Which laboratory value reported by the UAP indicates an urgent need for the nurse to assess the patient?

Noon blood glucose of 52

A patient who was admitted with DKA secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

Obtain a glucose reading using a finger stick

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm?

Propanolol

Which action will the nurse anticipate taking for an otherwise healthy 50 year old who has just been diagnosed with stage 1 renal cell carcinoma?

Provide preoperative teaching about nephrectomy

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self management at home?

Provide written reminders of information taught

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the nurse expect during the assessment?

Purplish streaks on the abdomen

A 44 year old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be helpful for the patient problem of disturbed body image related to changes in appearance?

Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

A hospitalized patient who is diabetic received 38 units of NPH insulin at 7 am and 1 pm. The patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest xray. What is the best action by the nurse to prevent hypoglycemia?

Request that if testing is further delayed the patient will eat lunch first

The nurse is taking a health history from a 29 year old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take?

Schedule the patient for a fasting blood glucose level

A patient who has hyperthyroidism is treated with radioactive iodine. Which information should the nurse include in discharge teaching?

Symptoms of hypothyroidism will occur as the RAI therapy takes effect

Which action indicates accurate understanding of the nurse's teaching about administration of aspart insulin?

The patient cleans the skin with soap and water before insulin administration

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful?

The patient discards the open vials of glargine and regular insulin after 4 weeks.

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible SIADH?

The patient has a serum sodium level of 118

Which finding indicates a need to contact the health care provider before the nurse administers Metformin?

The patient's estimated glomerular filtration rate is 42

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?

The periorbital and peripheral edema are resolved

A 29 year old woman with systemic lupus erythematosus has been prescribed 2 weeks of high dose prednisone therapy. Which information about the prednisone is most important for the nurse to include?

The prednisone dose should be decreased gradually

Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone?

Urinary output is increased

A 48 year old male patient who weights 242 lb undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon?

Urine output is 20 mL/hr for 2 hours

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is the priority?

Use an ultrasound scanner to check the postvoiding residual volume.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter?

What medications are you taking?

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about

lifestyle changes to lower blood glucose

The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain and treatment with

anticoagulants

What risks will the nurse plan to teach a 27 year old woman who smokes two packs of cigarettes daily?

bladder cancer

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually?

blood pressure, serum creatinine, urine for microalbuminuria, monofilament testing of the foot

Which assessment data reported by a patient is consistent with a lower urinary tract infection?

burning on urination

A patient seen in the clinic for bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider?

left sided flank pain

After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care?

call the health care provider if the ureteral catheter output drops suddenly

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?

costovertebral tenderness

A 56 year old patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone. Which initial laboratory result should the nurse expect?

decreased serum sodium

What should the nurse include when teaching an adult patient to prevent the recurrence of kidney stones ?

drinking 3000 mL of fluid each day

What finding should the nurse plan to assess for in a patient diagnosed with a pheochromocytoma?

headache

A patient had a cystectomy with an ileal conduit yesterday. Which new assessment data is most important for the nurse to communicate to the health care provider?

heart rate 102 bpm

Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency?

increasing serum sodium levels

A patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the patient to avoid?

liver, chicken

A 46 year old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take?

obtain a midstream urine specimen for culture and sensitivity testing

What should the nurse ask the patient about to determine possible causes of acute glomerulonephritis?

recent sore throat and fever

An adult patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect?

recent weight gain

To prevent recurrence of uric acid kidney stones, the nurse teaches the patient to avoid eating

sardines and liver