Theory Exam three

A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times?​ A. 0720​ B. 0730​ C. 0745​ D. 0815​

C. 0745​ Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following recommendations should the nurse make to the client for a sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar

C. Nonnutritive sugar substitute Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Ranitidine B. Guaifenesin C. Prednisone D. atorvastatin

C. Prednisone Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? A. 14 units B. 28 units C. 32 units D. 42 units

D. 42 units Each order of for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.

The diabetic educator is teaching a newly diagnosed client about monitoring blood glucose at home. Which of the following would the diabetic educator teach the patient to do at home? A. HgA1c B. SMBG C. Dipstick to check for ketones D. Glucose Tolerance Test

B. SMBG

A nurse is reviewing the medical record of a 19-year-old female client who has a urinary tract infection (UTI) and her labs indicate that she has elevated serum potassium. Her medical history includes Asthma, frequent sexual activity, and has Anemia. Which of the following does the nurse recognize as a risk factor? A. Asthma B. Sexually Active C. Anemia D. Elevated Serum Potassium

B. Sexually Active Sexually active females have a higher risk for urinary tract infections. Intercourse promotes "milking" bacteria from the vagina and perineum and may cause minor urethral trauma that predisposes women to UTIs.

A nurse is caring for a client who is 1 day postoperative following a transurethral resection of the prostate (TURP) and has a continuous bladder irrigation in place. What actions should the nurse take? (SATA) A Add the amount of bladder irrigation to the total output. B. Use sterile technique when preparing the irrigation solution. C. Ensure the drainage tubing is patent and without obstruction. D Contact the surgeon if the client reports a continual need to void. E. Notify the surgeon if the urine is bright red in appearance or has large clots.

B. Use sterile technique when preparing the irrigation solution. C. Ensure the drainage tubing is patent and without obstruction. E. Notify the surgeon if the urine is bright red in appearance or has large clots.

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? A. "Test your blood glucose levels every 8 hours." B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." C. "Withhold your usual daily dose of insulin." D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours."

B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." The client should check his urine for ketones when blood glucose levels are greater than 240 mg/dL in order to detect DKA. The client should contact the provider if he has moderate or large amounts of ketones in his urine.

A nurse is teaching a client who has diabetes about which dietary source should provide the greatest percentage of calories. Which of the following statements indicates the client understands the teaching? A. "Most of my calories each day should be from fats." B. "I should eat more calories from complex carbohydrates than anything else." C. "Simple sugars are needed more than other calorie sources." D. "Protein should be my main source of calories."

B. "I should eat more calories from complex carbohydrates than anything else." The client who has diabetes should consume the majority of calories from complex carbohydrates, such as whole grains, fruits, and vegetables.

A nurse is teaching a client who has diabetes mellitus and a new prescription for prednisone for a rash. Which of the following statements by the client indicates the need for further teaching? A. "I might need to decrease my regular insulin during this time." B. "I will gradually stop the prednisone when my rash goes away." C. "I might feel a little emotional when I am on this medicine." D. "I might have a hard time falling asleep while taking prednisone."

B. "I will gradually stop the prednisone when my rash goes away." The client should discontinue glucocorticoids gradually to reduce the risk for adrenal insufficiency. Manifestations of adrenal insufficiency include nausea, vomiting, confusion, and hypotension.

The time is 0710 and the nurse is caring for a type 1 diabetic that has glargine (Lantus) and lispro (Humalog) ordered to be given at 0700. The client's blood glucose is 134 mg/dL. Which of the following is correct? A. Administer both insulins in the same syringe. B. Administer glargine (Lantus) now and lispro (Humalog) once the breakfast arrives. C. Call the physician and question why the type I diabetic client needs two insulins. D. Administer both insulins now.

B. Administer glargine (Lantus) now and lispro (Humalog) once the breakfast arrives. Glargine (Lantus) is a long acting insulin and should never be given in the same syringe as any other medication. Lispro (Humalog) is a rapid acting insulin and should only be given right before meals.

A nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. What action should the nurse take first? A. Notify the provider. B. Check the tubing for kinks. C. Adjust the rate of the bladder irrigant. D. Irrigate the catheter.

B. Check the tubing for kinks. When providing client care, the nurse should first use the least restrictive intervention; therefore, the nurse should check the catheter tubing for kinks. The nurse must ensure constant flow of the bladder irrigant into the catheter and outward drainage from the catheter to prevent clotting, which could occlude the catheter lumen.

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia? A.Bradycardia B.Cool, clammy skin C. Vomiting D.Fruity odor on the client's breath

B. Cool, clammy skin

A nurse is caring for a client who has type 1 diabetes mellitus and is not following the guidelines for therapy. Which of the following should the nurse consider as contributing factors to the client's nonadherence? (select all that apply) A. Gender B. Culture C. Literacy D. Dexterity E. Motivation

B. Culture C. Literacy D. Dexterity E. Motivation

A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk of renal calculi? A. Protein in the urine B. Dehydration C. Iron deficiency D. Obesity

B. Dehydration Dehydration can cause hypercalcemia which increases the risk for renal stone formation. Inadequate fluid intake can result in urinary stasis and promote the formation of calculi.

A nurse is reviewing the medical record of a client who has a urinary tract infection. Which of the following should the nurse recognize as a risk factor? A. COPD B. DIabetes melluitus C. Anemia D. Osteoporosis

B. Diabetes Mellitus Diabetes mellitus is a risk for factor for a UTI due to the increased amount of glucose present in the urine.

A nurse is caring for a client who has benign prostatic hyperplasia (BPH). What medications should the nurse plan to administer? A. Danazol B. Finasteride C. Fluoxymesterone D. Methyltestosterone

B. Finasteride Finasteride, a 5-alpha-reductase inhibitor, is used in the treatment of BPH to prevent the conversion of testosterone and to decrease prostate size.

A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take? A. Encourage intake of at least 3 L of fluids per day. B. Apply cold compress to the client's flank area. C. Restrict protein intake to 2 servings per day. D. Discourage ambulation.

A. Encourage intake of at least 3 L of fluids per day.

A nurse is caring for a client who is 2 hr postoperative following a transurethral resection of the prostate (TURP) gland. Which of the following assessments should the nurse view to be an indication of a postoperative complication? A. Urine output of 15ml/ Hr B. Pulse rate of 88/min C. Oral temperature of 37.4 degrees celsius ( 99 degrees F. ) D. An urge to void despite having an indwelling urinary catheter

A. Urine output of 15ml/ Hr

A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect? A. Hypoglycemia B. Nephropathy C. Hyperglycemia D. Ketoacidosis

A. Hypoglycemia Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety.

First drug generally prescribed in type 2 diabetes. A. Glucosamine B. Diet pills for weight loss C. Glucophage D. Insulin

C. Glucophage

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? A. Grapefruit juice B. Milk C. Alcohol D. Coffee

C. Alcohol The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia.

A nurse is developing a teaching a plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Establish short-term, realistic goals for the client. B. Give the client access to a video about diabetes. C. Determine what the client who knows about managing diabetes. D. Evaluate the effectiveness of the client's admission teaching plan.

C. Determine what the client who knows about managing diabetes. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should find out what the client knows before proceeding with the plan.

A nurse is caring for a client who has benign prostatic hyperplasia (BPH). The nurse should expect what assessment finding? A. Urge incontinence B. Critically elevated prostate-specific antigen (PSA) level C. Difficulty starting the flow of urine D. Painful urination

C. Difficulty starting the flow of urine Hesitancy or difficulty starting the flow of urine is an expected finding of BPH.

A nurse is planning care for a female client who has a T4 spinal cord injury and is at risk for acquiring urinary tract infections. Which of the following actions should the nurse include in the client's plan of care? A. Cleanse the perineum from back to front. B. Obtain a prescription for an indwelling urinary catheter. C. Encourage fluid intake at and between meals. D. Offer the client the bedpan every 2 hr.

C. Encourage fluid intake at and between meals. Increased fluid intake dilutes the urine, reduces stasis, and greatly reduces the urinary bacterial count. Consequently, the risk of nosocomial (hospital-acquired) UTI is reduced, even for a client who has a spinal cord injury.

A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. To focus on effective learning with this client, which of the following interventions should the nurse use? A. Ask the client to perform a return demonstration of insulin injection. B. Review the action of insulin therapy. C. Explore the client's feelings about dietary modifications. D. Have the client practice blood-glucose monitoring using a glucometer.

C. Explore the client's feelings about dietary modifications. This teaching intervention allows the client to express his acceptance of this change and focuses on effective learning.

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? A. HbA1c 5.5% B. 2 hr blood glucose 170 mg/dL C. Fasting blood glucose 155 mg/dL D. Casual blood glucose 180 mg/dL

C. Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus.

A nurse is caring for a client who has benign prostatic hyperplasia (BPH). The nurse should expect all of the following findings except? A. Incontinence B. Nocturia C. Pain in the scrotum D. Dysuria

C. Pain in the scrotum

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider? A. "I drink at least 2 quarts of fluid every day." B. "The last time I voided it was painful and red-tinged." C. "My period ended 2 days ago." D. "I don't eat shellfish because it gives me hives."

D. "I don't eat shellfish because it gives me hives." The client says she experiences hives after eating shellfish, which indicates a sensitivity. The contrast dye typically used for an IVP is an iodine derivative, and the client with a shellfish sensitivity may have cross-sensitivity to iodine and a serious iodine allergy. This nurse should report these finding to the client's provider.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? A. "I am to take my blood sugar readings after meals." B. "Insulin allows me to eat ice cream at bedtime." C. "A weight reduction program will make me hypoglycemic." D. "I give the insulin injections in my abdominal area."

D. "I give the insulin injections in my abdominal area."

A nurse is providing dietary teaching to a client who has calcium oxalate kidney stones. Which of the following statements indicates an understanding of the teaching? A. "I can have almonds as a snack." B. "I can use soy milk with my cereal." C. "I may eat a sweet potato for dinner." D. "I may eat a banana with my breakfast."

D. "I may eat a banana with my breakfast." Excessive dietary intake of oxalate can increase the risk of calcium oxalate stone. Bananas are not high in oxalate. Therefore, this food choice indicates an understanding of teaching.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? A. "Have an eye examination once per year." B. "Examine your feet carefully every day." C. "Wear compression stockings daily." D. "Maintain stable blood glucose levels."

D. "Maintain stable blood glucose levels." Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? A. Only once a day. B. 1 hour before meals C. 30 to 45 minutes before meals. D. At mealtime or within 15 minutes of meals.

D. At mealtime or within 15 minutes of meals. Lispro is a rapid-acting insulin that has onset of action of approximately 15 minutes and should be injected at the time of the meal or within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals.

A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take? A. Apply cold compress to the client's flank area. B. Restrict protein intake to 2 servings per day. C. Discourage ambulation. D. Encourage intake of at least 3 L of fluids per day.

D. Encourage intake of at least 3 L of fluids per day. The nurse should encourage the client to consume at least 3,000 mL of fluids per day to dilute the urine, increase hydrostatic pressure behind the stone, and move the calculi down the urinary tract.

A nurse is evaluating client's laboratory results. The nurse should recognize that an increase in the client's prostate specific antigen (PSA) laboratory value is indicative of what diagnosis? A. Breast cancer B. Colon cancer C. Liver cancer D. Prostatic cancer

D. Prostatic cancer An increased PSA level is indicative of a prostate cancer diagnosis, as well as other prostate problems.

A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL? A. Administer 15 g of carbohydrates B. retest the blood glucose C. Administer 1 mg of glucagon D. Administer IV dextarose

A. Administer 15 g of carbohydrates The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.

A nurse is caring for a client who is 2 hr postoperative following a transurethral resection of the prostate (TURP) gland. What assessment should the nurse view to be an indication of a postoperative complication? A. Output of burgundy colored urine B. Pulse rate of 88/min C. Oral temperature of 38.2° C (100.76° F) D. An urge to void despite having an indwelling urinary catheter

A. Output of burgundy colored urine Output of burgundy colored urine may indicate venous bleeding, a potential complication following a TURP. Should this occur, the nurse should inform the provider and anticipate an order for increased CBI rate or manual irrigation of the catheter.

A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.) A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. D. Sustain hyperglycemia to reduce deterioration of nerve cells. E. Maintain optimal blood pressure to prevent kidney damage.

A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. E. Maintain optimal blood pressure to prevent kidney damage.

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? A. " I will feel shaky." B. "I will be more thirsty than usual." C. "My skin will be warm and moist." D. "My appetite will be decreased."

A. " I will feel shaky." Manifestations of hypoglycemia include feeling shaky and nervous.

A nurse is providing teaching to a client about measures to prevent urinary tract infections (UTIs). Which of the following client statements indicates a need for more teaching? A. "I will need to wipe my perineal area from back to front after urination." B. "I will need to empty my bladder regularly and completely." C. "I will need to drink apple cider vinegar each day." D. "I need to drink 8 cups of liquid each day."

A. "I will need to wipe my perineal area from back to front after urination." Wiping the perineal area from back to front increases the risk for urethral contamination and a resulting UTI.

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? A. Graham crackers B. 1 tsp sugar C. 4 oz diet soda D. 4 oz skim milk

A. Graham crackers After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

A client who has type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? A. "Your body is destroying the cells that secrete insulin." B. "Your body has insulin resistance and decreased insulin secretion." C. "An infection in your pancreas destroyed the cells that make insulin." D. "Your kidneys are not able to reabsorb water which leads to Type 2 diabetes mellitus."

B. "Your body has insulin resistance and decreased insulin secretion." A client genetically susceptible can develop Type 2 diabetes mellitus when obesity and physical inactivity lead to insulin resistance at cells as well as decreased secretion of insulin by pancreatic beta-cells.

A nurse is assessing a client who has diabetes mellitus and reports foot pain. The nurse should evaluate the client for which of the following alterations as indications that the client has an infection? A. Bradycardia B. An increase in neutrophils C. An increase in RBCs D. An increase in platelets E. Localized edema

B. An increase in neutrophils E. Localized edema

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Assess for hypoglycemia 4 hr after the insulin injection. B. Inject the insulin 15 min before a meal. C. Monitor for polyuria. D. Administer with short-acting insulin.

B. Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

A nurse is performing a monofilament sensory assessment of a client who has diabetes mellitus. When performing this assessment, for which of the following complications is the nurse monitoring? A. Nephropathy B. Neuropathy C. Radiculopathy D. Retinopathy

B. Neuropathy Neuropathy is a loss of sensation in the feet, which is a complication that occurs as a result of long term hyperglycemia which affects the microvasculature and causes demyelination of the nerves. Peripheral neuropathy is assessed by lightly touching a monofilament to different areas of the client's feet to assess the client's ability to feel light touching. An inability to feel light touching is indicative of peripheral neuropathy, which places the client at risk for injury and infection.

A nurse is planning care for a client who is 2 hr postoperative following a transurethral resection of the prostate. The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include? A. Restrict the client's oral fluid intake. B. Remind the client he might feel a constant urge to void. C. Monitor the client's urine output every 6 hr. D. Weigh the client every evening.

B. Remind the client he might feel a constant urge to void. The client who is receiving continuous bladder irrigation will experience a continuous urge to void because of pressure on the internal sphincter from the catheter balloon.

A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll wear sandals in warm weather." B. "I'll put lotion between my toes after drying my feet." C. "I'll check my feet every day for sores and bruises." D. "I'll soak my feet in cool water every night before I go to bed."

C. "I'll check my feet every day for sores and bruises." The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see.

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? A. Hypertension B. Hematuria C. Weight loss D. Bradycardia

C. Weight loss Weight loss is an expected finding for a client who has uncontrolled diabetes.

A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client? A. "If the medicine causes an upset stomach, take an antacid at the same time." B. "Limit your daily fluid intake while taking this medication." C. "This medication can cause photophobia, so be sure to wear sunglasses outdoors." D. "You should report any tendon discomfort you experience while taking this medication."

D. "You should report any tendon discomfort you experience while taking this medication." The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture.