Exam 1

A client receiving chemotherapy is nauseated and has lost 15 pounds (6.8 kg) in one month. Which nutritional instruction would the nurse include in the plan of care? - Increase fluids with meals and snacks. - Eat frequent but small meals. - Eat two high-protein meals per day. - Eat either hot or cold foods at meal times.

Eat frequent but small meals.

The nurse is preparing to initiate an enteral feeding through a percutaneous endoscopic gastrostomy (PEG) tube. What intervention will the nurse include in the client's plan of care? - Ensure patency of the tube. - Check residual immediately after each enteral feeding. - Use an intravenous pump for administration of feeding formula. - Lay the client in prone position.

Ensure patency of the tube.

Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. What should the nurse do next? - Administer the next dose of insulin. - Have the client drink a glass of milk or orange juice. - Contact the client's health care provider (HCP) to decrease the insulin dose. - Tell the client to lie down for 30 minutes.

Have the client drink a glass of milk or orange juice.

A nurse hears a staff member giving incorrect information to the family of a client newly diagnosed with diabetes mellitus who is being discharged to home. The nurse wants to make sure the family has the proper information before the client is discharged. What should the nurse do? - Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity. - Go into the room, introduce yourself to the family, and complete the discharge teaching. - Have the nurse step outside of the room and tell the nurse that they are giving wrong information to the family. - Go into the room and correct the nurse so the family will be safe in providing home care.

Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity.

A client with diabetes is found unconscious after the morning dose of insulin. What would be a priority nursing intervention at this time? - Give fruit juice or milk as soon as the client is able to take fluids orally. - Contact the healthcare provider to report the client's status. - Withhold glucose in any form until the ketoacidosis is corrected. - Initiate treatment for hypoglycemia as a result of insulin.

Initiate treatment for hypoglycemia as a result of insulin.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? - infusing I.V. fluids rapidly as ordered - administering glucose-containing I.V. fluids as ordered - encouraging increased oral intake - restricting fluids

restricting fluids

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? - administering vasopressin as ordered - restricting sodium intake to 1 gm/day - elevating the head of the client's bed to 90 degrees - restricting fluids to 800 ml/day

restricting fluids to 800 ml/day

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? - to maintain cholesterol levels to prevent the long-term complications of vascular disease - to maintain blood glucose levels close to the normal range to reduce risk for long-term complications - to increase exercise and monitor weight to stay within a recommended healthy weight range - to meet energy needs by eating only foods that keep blood glucose within a relatively normal range

to maintain blood glucose levels close to the normal range to reduce risk for long-term complications

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? cleaning the wound with a povidone-iodine solution applying a heating pad using sterile technique during the dressing change debriding the wound three times per day

using sterile technique during the dressing change

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? - exophthalmos, diarrhea, and cold intolerance - diaphoresis, fever, and decreased sweating - weight gain, constipation, and lethargy - weight loss, nervousness, and tachycardia

weight loss, nervousness, and tachycardia

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms? - coma, anxiety, confusion, headache, and cool, moist skin - polyuria, polydipsia, polyphagia, and weight loss - polyuria, polydipsia, hypotension, and hypernatremia - Kussmaul respirations, dry skin, hypotension, and bradycardia

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

What indicator is best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement?

daily weight

What goal would be a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza?

obtaining adequate food intake

A nurse is teaching a client about how to recognize when treatment for hypothyroidism is effective. Which statement from the client would indicate that the nurse's teaching has been effective? - "I won't feel hot and sweaty anymore." - "Hopefully I won't lose any more weight." - "It will be a relief to be able to sleep more hours." - "I will start feeling more energetic."

"I will start feeling more energetic."

A client with cancer-related pain has been prescribed a narcotic analgesic to be given around the clock. The client is competent and has been actively involved in decisions regarding care. What should the nurse do if the client refuses the next dose of analgesia? - Document the client's choice and re-assess pain in 1 hour. - Try to persuade the client to take the medication as ordered by the doctor. - Emphasize the rationale for taking the medication now as ordered. - Ask the client's spouse to hold the client's hands while the nurse puts the pill under the tongue.

Document the client's choice and re-assess pain in 1 hour.

A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test?

It determines the average blood glucose level in the previous 2-3 months

The nurse is caring for a client with diabetes insipidus (DI). What is the nurse's priority intervention? - Monitoring urine for specific gravity >1.030 - Maintaining adequate hydration - Checking weight every three days - Watching for signs and symptoms of septic shock

Maintaining adequate hydration

A client is admitted with advanced hepatic failure, including symptoms of fatigue and confusion. These symptoms are likely due to which cause? - Hepatorenal syndrome is now presenting, which results in metabolic alkalosis. - The liver is not breaking down the ammonia, and it acts as a neurotoxin on the brain. - Portal hypertension is impairing the blood flow to the brain. - The medications usually used to treat liver failure often cause confusion.

The liver is not breaking down the ammonia, and it acts as a neurotoxin on the brain. explanation: "The increase in toxins because the liver has lost its capacity to detoxify will result in increased blood levels. The liver is responsible for breaking down ammonia and converting it to urea, so it can be excreted by the kidneys. High ammonia levels affect all the cells of the body, but are particularly toxic to the brain. Hepatorenal syndrome will result in metabolic acidosis--both the liver and kidneys are malfunctioning. Portal hypertension causes increased back-up pressure in the digestive organs, rather than in the brain. Medications are judiciously given in hepatic failure because the liver cannot detoxify the medications."

A client with a progressively enlarging neck comes into the clinic. The client mentions that they have been in a foreign country for the previous 3 months and that they didn't eat much while there because they didn't like the food. The client also mentions that they become dizzy when lifting their arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? - diabetes insipidus - goiter - Cushing's syndrome - diabetes mellitus

goiter

A white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for stroke? - being white - having bronchial asthma - being obese - being female

being obese

A nurse is assessing a client with hyperparathyroidism. Which finding should the nurse report immediately to the physician? urinary output of 30 mL/hour loss of appetite blood pressure of 118/79 mm Hg flank pain

flank pain

Which intervention is the most critical for a client with myxedema coma? - warming the client with a warming blanket - maintaining a patent airway - administering an oral dose of levothyroxine - measuring and recording accurate intake and output

maintaining a patent airway

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? - hypoglycemia - thyroid crisis - tetany - diabetic ketoacidosis

thyroid crisis

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? - "Administer insulin into sites above muscles that you plan to exercise heavily later that day." - "Administer insulin into areas of scar tissue or hypertrophy whenever possible." - "Inject insulin into healthy tissue with large blood vessels and nerves." - "Rotate injection sites within the same anatomic region, not among different regions."

"Rotate injection sites within the same anatomic region, not among different regions." Explanation: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level.

The laboratory comes to draw an Hgb A1c. The client asks the nurse what this test represents. Which statement would be correct? - "This test reflects the average blood glucose over a period of approximately 2-3 months." - "This test is needed to determine which insulin will be needed to prevent another diabetic ketoacidosis (DKA) episode." - "This blood test is done to measure hyperglycemia in your system for 3 to 4 days after you were diagnosed with diabetic ketoacidosis (DKA)." - "This test is done to determine length of time that will be needed to correct the diabetic ketoacidosis (DKA) state."

"This test reflects the average blood glucose over a period of approximately 2-3 months."

A nurse completes preoperative teaching for a client scheduled for a cholecystectomy. The client states, "If I lie still and avoid turning, I will avoid pain. Do you think this is a good idea?" What is the nurse's best response? - "Turn from side to side every 2 hours, and the nurse will administer pain medication to assist in movement." - "It is always a good idea to rest quietly after surgery, which will help minimize further pain." - "The physician will probably order you to lie flat for 24 hours." - "Why don't you decide about activity after you return from recovery?"

"Turn from side to side every 2 hours, and the nurse will administer pain medication to assist in movement."

A coworker asks another nurse if a client received their pathology report. The coworker is not directly involved in the care of the client. How should the nurse respond? Select all that apply: "You need to review the hospital policy related to client privacy." "The report came back, and the pathology was benign." "I'm sorry, but I'm not at liberty to give you that information." "Information can only be shared if you're involved in the client's care." "If you log into the client's chart, you will be able to read the information."

"You need to review the hospital policy related to client privacy." "I'm sorry, but I'm not at liberty to give you that information." "Information can only be shared if you're involved in the client's care."

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour?

5

A nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent - diarrhea. - aspiration. - gastric ulcers. - abdominal distention.

aspiration

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? - related to bone demineralization resulting in pathologic fractures - related to edema and dry skin secondary to fluid infiltration into the interstitial spaces - related to tetany secondary to a decreased serum calcium level - related to exhaustion secondary to an accelerated metabolic rate

related to bone demineralization resulting in pathologic fractures

The nurse is assigned a client newly diagnosed with type 2 diabetes. Which tasks should the nurse delegate to a unlicensed assistive personnel (UAP)? - teaching the client how to use a glucometer - reminding the client to check the glucose level before each meal - making an appointment with the dietitian - assessing the client's technique when injecting insulin

reminding the client to check the glucose level before each meal

A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply: - hyperkalemia - skeletal muscle weakness - mood changes - hypocalcemia - increased susceptibility to infection - hypotension

skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection

Which medication can the nurse administer through a nasogastric (NG) tube? - regular insulin - enteric-coated aspirin - sublingual nitroglycerin - acetaminophen

acetaminophen

A client with hypothyroidism is afraid of needles and doesn't want to have their blood drawn. What should the nurse say to help alleviate the client's concerns? - "When your thyroid levels are stable, we won't have to draw your blood as often." - "I'll stay here with you while the technician draws your blood." - "It's only a little stick. It'll be over before you know it." - "The physician has ordered this test so you can get better sooner."

"I'll stay here with you while the technician draws your blood."

A client newly diagnosed with hypothyroidism asks the nurse how long it will be necessary to take the prescribed levothyroxine. What should the nurse tell the client? - "Since the medication is expensive, the health care provider will check your progress and the dose may be able to be reduced in a few months." - "It will be necessary to take the medication for the rest of your life." - "If your thyroid responds to the medication, the medication can be gradually withdrawn in 1 to 2 years." - "The medication can be discontinued when your thyroid-stimulating hormone (TSH) level is normal."

"It will be necessary to take the medication for the rest of your life."

A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? - "Prevent developing hypertension by reducing stress and limiting salt intake." - "You should stop cigarette smoking." - "Follow a high-protein diet including meat, dairy, and eggs." - "Maintain weight within normal limits for your body size and muscle mass."

"Maintain weight within normal limits for your body size and muscle mass."

A school nurse is assessing an obese 10-year-old child who wants to lose weight. What question will be most important for the nurse to ask to develop a realistic plan of care? - "What kinds of foods do your parents serve at meal times and for snacks?" - "How long have you been worried about your weight?" - "Do your parents have any medical conditions?" - "Do you have friends who can support you while you try to lose weight?"

"What kinds of foods do your parents serve at meal times and for snacks?"

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? - "You must lie flat for 24 hours after surgery." - "You must restrict your fluid intake." - "You must avoid coughing, sneezing, and blowing your nose." - "You must report ringing in your ears immediately."

"You must avoid coughing, sneezing, and blowing your nose."

The child's provider orders 720 ml of total parenteral nutrition (TPN) to be infused over the next 24 hours. The nurse will record TPN intake of how many milliliters at the end of the eight hour shift?

240

The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100 mg intravenously at a rate of 10 mL/hour for a client in acute adrenal crisis. The nurse understands that this treatment is common in clients with which disease process? - hypoparathyroidism - Addison's disease - Cushing's syndrome - hyperthyroidism

Addison's disease

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? - Inserting a feeding tube and providing tube feedings - Administering 1 ampule of 50% dextrose solution, per physician's order - Observing the client for 1 hour, then rechecking the fingerstick glucose level - Administering a 500-ml bolus of normal saline solution

Administering 1 ampule of 50% dextrose solution, per physician's order

The nurse has prepared hydromorphone 1 mg I.V. for a client reporting pain 7/10. Just prior to administration, the client requests an oral pain medication instead. What is the priority action by the nurse? - Ask another nurse to witness the waste of the prepared medication into the sink. - Return the prepared medication to the client's medication drawer and obtain an oral medication as requested. - Dispose of the prepared medication in the sharps container and obtain an oral medication. - Explain to the client that once a medication is prepared, it should be administered and that an oral medication can be given at the next dose.

Ask another nurse to witness the waste of the prepared medication into the sink.

The nurse reviewed laboratory values for a client with type 1 diabetes mellitus. The client's hemoglobin A1c (HbA1c) is 9 percent. What is the priority action for the nurse? Obtain a fasting serum glucose level Tell the client the test result shows that the client's blood sugars are not under control Assess the client's baseline knowledge about their treatment regimen Assess the home log of blood glucose levels

Assess the client's baseline knowledge about their treatment regimen

A client with type 2 diabetes has just started to take dulaglutide. The client reports having severe nausea. What should the nurse instruct the client to do to manage the nausea? Select all that apply: - Increase the fat content in the diet - Drink ginger tea - Stop using the drug - Avoid fried foods - Eat small meals more frequently

Drink ginger tea Avoid fried foods Eat small meals more frequently

The nurse is caring for a client with type 2 diabetes mellitus. One hour after taking an oral diabetic medication, the client becomes nauseated and vomits. What is the initial action of the nurse? - Monitor blood glucose closely, and assess for signs of hypoglycemia. - Notify the healthcare provider for a prescription for glucose tablets. - Administer another dose of the drug. - Administer subcutaneous insulin.

Monitor blood glucose closely, and assess for signs of hypoglycemia. Explanation: When a client who has taken an oral antidiabetic agent vomits, the nurse should monitor blood glucose and frequently assess for signs of hypoglycemia. After one hour, most of the medication would have been absorbed. Any food ingested may be lost, and repeating the dose would further lower glucose levels

A client with a subdural hematoma needs a feeding tube inserted due to inadequate swallowing ability. How would the nurse best explain this to the family? - Demonstrate to the family that pureed foods or liquids result in coughing. This signifies the importance of the need for a feeding tube. - Because of limited mobility, the client is susceptible to developing pneumonia. Extra nutrients are necessary to strengthen the immune system and promote recovery. - Tube feedings are less invasive than total parenteral nutrition; either one can meet hydration and nutritional needs. - Nutrients are needed; however, eating and drinking without control of the swallowing reflex can result in aspirational pneumonia.

Nutrients are needed; however, eating and drinking without control of the swallowing reflex can result in aspirational pneumonia.

A client with type I diabetes mellitus is scheduled to have surgery. The client has been nothing-by-mouth (NPO) since midnight. In the morning, the nurse notices the client's daily insulin has not been prescribed. What should the nurse do first?

Obtain the client's blood glucose at the bedside

A 79-year-old client has been admitted to the unit. The client is diagnosed with a left hip fracture secondary to a fall, and is scheduled for a left total hip replacement (LTHR). The client's comorbidities are hypertension and diabetes. The client is a full code with no known allergies (NKA). What is the nurse's priority action for this client? - Promote sleep and rest - Encourage therapeutic communications - Maintain standard precautions - Pain management

Pain management

A nurse is preparing a client with type 1 diabetes for discharge. The client can perform self-care; however, the client has had a problem with unstable blood glucose levels in the past. Which intervention should the nurse include for this client's safe discharge? Select all that apply: - Consult with home health nurse. - Refer the client to a dietitian. - Review proper insulin administration. - Give the client sample meal plans. - Refer the client to a social worker.

Refer the client to a dietitian. Give the client sample meal plans. Review proper insulin administration.

The nurse is reviewing the chart of a client with type 2 diabetes prior to a scheduled appointment. The chart states: Progress notes: Client states that he has not been following his prescribed diabetes management program for the past 2 to 3 months. Client is aware of his blood glucose monitoring regimen and diet but has difficulty integrating each into his routines. Client denies recent changes in urinary function, sensation or vision. How can the nurse best determine this client's glycemic control since the last assessment? - Ask the client to complete a 24-hour food recall. - Ask the client to describe recommended diet and glucose monitoring routine. - Review the results of the client's HbA1c. - Arrange assessment of the client's fasting glucose level.

Review the results of the client's HbA1c.

A client has been admitted with type 2 diabetes mellitus and asks to have the local medicine man come and help decide what traditional aboriginal medicines could help. What are the appropriate nursing interventions based on this client's request? - Suggest that the client inform and discuss with the interprofessional team how traditional therapies could be integrated into the plan of care. - Tell the client that traditional healing methods are not likely to work for control of diabetes. - Let the client know there is a choice and a decision needs to be made as to whether traditional or medical means will be used to control the diabetes. - Recommend that the client wait until the diabetes is under control and the client is discharged home before using traditional medicines.

Suggest that the client inform and discuss with the interprofessional team how traditional therapies could be integrated into the plan of care.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces... - thyrotropin-releasing hormone (TRH) and TSH. - T3, thyroxine (T4), and calcitonin. - TSH, triiodothyronine (T3), and calcitonin. - iodine and thyroid-stimulating hormone (TSH).

T3, thyroxine (T4), and calcitonin.

A nurse is planning care for a client newly diagnosed with diabetes mellitus type 1. Which statement illustrates an appropriate outcome criterion? - The client will correctly demonstrate blood glucose testing prior to discharge. - The client will take medication as scheduled. - The client will not experience any complications. - The client will follow verbal instructions.

The client will correctly demonstrate blood glucose testing prior to discharge

The nurse is assigned to care for the following clients. Which client should the nurse see first? - a client diagnosed with type 2 diabetes and a glucose level of 137 mg/dL - a client diagnosed with Graves disease and a heart rate of 94 beats per minute - a client diagnosed with Cushing disease and 1+ edema - a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute

a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? - plasma bicarbonate 12 mEq/L (12 mmol/L) - arterial pH 7.25 - blood glucose level 1,100 mg/dl (61.05 mmol/L) - blood urea nitrogen (BUN) 15 mg/dl (0.82 mmol/L)

blood glucose level 1,100 mg/dl (61.05 mmol/L)

A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate? water and eggnog chicken broth and juice milk and diet soda coffee and milkshakes

chicken broth and juice

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for - decreased body temperature and cold intolerance. - systolic murmur at the left sternal border. - flushed, warm, moist skin. - exophthalmos and conjunctival redness.

decreased body temperature and cold intolerance.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? - 50% dextrose - hydrocortisone - epinephrine - glucagon

glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate.

What important considerations would the nurse make when teaching and caring for a client newly diagnosed with diabetes mellitus? - having the client work closely with a peer who has diabetes to learn about the condition and control - involving the client in the development of the teaching plan and encouraging questions and active participation - informing the client about complications that could occur if the client is noncompliant - allowing the client to develop the teaching plan and assess readiness to learn about different aspects of the disease

involving the client in the development of the teaching plan and encouraging questions and active participation

A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is: - providing a daily bath. - monitoring the blood glucose level closely. - elevating the head of the bed 60 degrees. - assessing vital signs every 30 minutes.

monitoring the blood glucose level closely