exam 4 b
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? Washes hands with soap and water to cleanse the site to be used. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes. Warms the finger before puncturing the finger to obtain a drop of blood. Chooses a puncture site in the center of the finger pad.
Chooses a puncture site in the center of the finger pad.
Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? Increased high-density lipoproteins (HDL) Increased triglyceride levels Decreased low-density lipoproteins (LDL) Decreased very-low-density lipoproteins (VLDL)
Increased triglyceride levels
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? Intravenous administration of regular insulin Administer insulin glargine subcutaneously at hour of sleep Maintain nothing prescribed orally (NPO) status Intravenous administration of 10% dextrose
Intravenous administration of regular insulin
After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone? Polyuria and increased specific gravity of urine Hyperkalemia and poor skin turgor Increased blood urea nitrogen (BUN) and hypotension Hyponatremia and decreased urine output
Hyponatremia and decreased urine output
What interventions should the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. What interventions should the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. Instituting fall risk precautions Placing the client in high-Fowler position Providing frequent oral care Restricting fluids to 2 L per day Monitoring for and reporting neurologic changes
Instituting fall risk precautions Providing frequent oral care Monitoring for and reporting neurologic changes
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? Administer insulin glargine subcutaneously at hour of sleep Intravenous administration of 10% dextrose Intravenous administration of regular insulin Maintain nothing prescribed orally (NPO) status
Intravenous administration of regular insulin
A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? Cortical hormones stimulate rapid weight loss. Tissue catabolism results in a negative nitrogen balance. Glucocorticoids accelerate the process of gluconeogenesis. Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue.
Glucocorticoids accelerate the process of gluconeogenesis.
The nurse reviews the diagnostic reports of a client and discovers that the client has an injury to cranial nerve VII. What will the nurse observe upon assessment? Impairment of pupil constriction Impairment of eye movement Inhibition of peripheral vision Inhibition of tear production
Inhibition of tear production
The nurse is teaching a client about safe insulin administration. Which statement made by the client indicates the need for further education? "I should administer insulin only if there are any symptoms." "I should keep a daily logbook of times of insulin injection." "I should keep my medication in its original labeled container." "I should see whether the insulin is expired."
"I should administer insulin only if there are any symptoms."
Your patient's blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time? 1145 1230 1430 1630
1230
"A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: 2-4 HRS after administration 4-12 HRS after administration 16-18 HRS after administration 18-24 HRS after administration
4-12 HRS after administration
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? BP 126/80 A1C 9% FBG 130 mg/dL LDL cholesterol 100 mg/dL
A1C 9%
While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? Having diabetes insipidus Eating low-cholesterol foods Being 20 pounds (9 kilograms) overweight Drinking a daily alcoholic beverage
Being 20 pounds (9 kilograms) overweight
A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiologic changes associated with a long history of diabetes? Blurry, spotty, or hazy vision Arthritic changes in the hands Hyperactive knee and ankle jerk reflexes Dependent pallor of the feet and lower legs
Blurry, spotty, or hazy vision
A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? Routine insulin therapy and exercise Administer a different antibiotic for the UTI. Cardiac monitoring to detect potassium changes Administer IV fluids rapidly to correct dehydration
Cardiac monitoring to detect potassium changes
A client with type 2 diabetes travels frequently and asks how to plan meals during trips. What is the nurse's best response? "You can order diabetic foods on most airlines and in restaurants." Plan your food ahead and carry it with you from home." Monitor your blood glucose level frequently and eat accordingly." Choose the foods you normally do and follow your food plan wherever you are.
Choose the foods you normally do and follow your food plan wherever you are.
A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes, and the other client has type 2 diabetes. When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1? Onset of the disease is slow. Excessive weight is a contributing factor. Complications are not present at the time of diagnosis. Treatment involves diet, exercise, and oral medications.
Complications are not present at the time of diagnosis.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply. Confusion Excessive thirst Fruity-scented breath Decreased urinary output Hyperactivity
Confusion Excessive thirst Fruity-scented breath
While assessing a client recovering from a head injury, the nurse notices a loss of movement in the client's tongue while attempting to talk. Which could be the possible reason for the client's condition? Damage to the glossopharyngeal nerve Damage to the hypoglossal nerve Damage to the facial nerve Damage to the trigeminal nerve
Damage to the hypoglossal nerve
A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? Select all that apply. Hyperthermia Decreased level of consciousness Bradycardia Increased weight Nausea and vomiting Decreased serum sodium
Decreased level of consciousness Increased weight Nausea and vomiting Decreased serum sodium
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement? Ensure the client eats the bedtime snack Determine how much food the client ate at lunch Perform a glucometer reading at 0700 Offer the client protein after administering insulin
Ensure the client eats the bedtime snack
After treatment with propylthiouracil for hyperthyroidism, a client has the thyroid ablated with 131I. On a visit to the endocrine clinic, the client exhibits signs and symptoms of thyrotoxic crisis (thyroid storm). What does the nurse identify as the likely cause of thyrotoxic crisis? Deficiency of iodine Decreased serum calcium Increased sodium retention Excessive hormone replacement
Excessive hormone replacement
The registered nurse is caring for a client in the emergency department. Which conditions of the client made the nurse stabilize the cervical spine as the primary nursing intervention? Select all that apply. Blunt abdominal pain Facial chemical burns Flail chest Head injuries Renal colic pain
Facial chemical burns Flail chest Head injuries
An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: Gives small continuous dose of regular insulin subcutaneously and the client can self-administer a bolus with an additional dosage from the pump before each meal Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
Gives small continuous dose of regular insulin subcutaneously and the client can self-administer a bolus with an additional dosage from the pump before each meal
What is the action of the vasopressin hormone released from the client's posterior pituitary? Helps produce concentrated urine Enhances sodium reabsorption in the distal convoluted tubule Causes tubular secretion of sodium Promotes potassium secretion in the collecting duct
Helps produce concentrated urine
A client is admitted with a head injury. The nurse identifies that the client's urinary catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause? Increased serum glucose Deficient renal perfusion Inadequate antidiuretic hormone (ADH) secretion Excess amounts of intravenous (IV) fluid
Inadequate antidiuretic hormone (ADH) secretion
The primary health care provider prescribed tolvaptan to a client whose laboratory reports reveal low plasma osmolarity and continued secretion of vasopressin from syndrome of inappropriate antidiuretic hormone. During follow-up care, which finding in the client indicates a side effect of medication? Increased urine osmolarity Increased demyelination of brain neurons Decreased hyponatremia Decreased deep tendon reflexes
Increased demyelination of brain neurons
A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client? Select all that apply. Leg ulcers Loss of visual acuity Thick, yellow toenails Increased growth of body hair Decreased sensation in the feet
Leg ulcers Loss of visual acuity Thick, yellow toenails Decreased sensation in the fee
A client with diabetes mellitus has a blood glucose of 644 mg/dl. The nurse interprets that this client is most at risk of developing which type of acid base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Metabolic acidosis
A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? Obtain comprehensive dental care. Maintain hemoglobin A1c below 7%. Avoid sick people and wash hands. Coughing and deep breathing with splinting
Obtain comprehensive dental care.
What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? Closely monitoring the patient's intake and output Patient teaching related to levothyroxine (Synthroid) Providing a dark, low-stimulation environment Patient teaching related to radioactive iodine therapy
Patient teaching related to levothyroxine (Synthroid)
Upon assessing a female client, the nurse discovers an abnormal endocrine finding. Which finding in the client supports the nurse's conclusion? Facial hair Protruding eyes Pulse of 90 beats/min Blood pressure of 120/80 mmHg
Protruding eyes
What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury? Select all that apply. Providing adequate fluids within easy reach Reporting an increasing urine specific gravity Administering prescribed erythromycin Assessing for and reporting changeAssessing for and reporting changes in neurological statuss in neurological status Monitoring for constipation, weight loss, hypotension, and tachycardia
Providing adequate fluids within easy reach Monitoring for constipation, weight loss, hypotension, and tachycardia
"A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of Polyuria Severe dehydration Rapid, deep respirations Decreased serum potassium
Rapid, deep respirations
RAPID-ACTING: onset 15mins, peak 1 hour, duration 3 hours SHORT-ACTING: onset 30mins, peak 2 hours, duration 4 hours INTERMEDIATE-ACTING: onset 2 hours, peak 4 hours, duration 16 hours LONG-ACTING: onset 1 hour, no peak, duration 24 hours
Regular ®:short-acting Humalog :rapid-acting Novalog: rapid-acting NPH (N): Intermediate Lantus: long-acting
One of the benefits of glargine (Lantus) insulin is its ability to: Release insulin during the day to help control the basal glucose Release insulin evenly throughout the day to control basal glucose levels Simplify the dosing and better control blood glucose levels during the day Cause hypoglycemia with other manifestation of other adverse reactions
Release insulin evenly throughout the day to control basal glucose levels
The nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which finding in the client is consistent with the diagnosis? Presence of pedal edema Preservation of salt Decrease of vasopressin Retention of water
Retention of water
The primary healthcare provider prescribed a diagnostic study with contrast medium for an older adult who has an endocrine disorder. Which assessment result should the nurse check before the study? Urinary pH Serum creatinine Urinary creatinine Creatinine clearanc
Serum creatinine
The nurse assesses for damage to the glossopharyngeal (ninth cranial) and vagus (tenth cranial) nerves. Which action will the nurse ask the client to perform? Shrug Smell Smile Swallow
Swallow
The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan? Select all that apply. The client should obtain a finger stick blood glucose reading before each meal. The client does not need to follow a specific diet until insulin is required. The teaching plan should include signs and symptoms of hypoglycemia. The teaching plan does not need to include signs and symptoms of hypoglycemia, as the client is not on insulin The teaching plan should include sick day rules.
The client should obtain a finger stick blood glucose reading before each meal. The teaching plan should include signs and symptoms of hypoglycemia. The teaching plan should include sick day rules
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate (DDAVP) would be most appropriate? The patient should report any decrease in urinary elimination to the health care provider. The patient can expect to experience weight loss resulting from increased diuresis The patient should alternate nostrils during administration to prevent nasal irritation. The patient should monitor for symptoms of hypernatremia as a side effect of this drug.
The patient should alternate nostrils during administration to prevent nasal irritation.
An 18-year-old female client, 5'4'' tall, weighing 113 kg, comes to the clinic for a non-healing wound on her lower leg, which she has had for two weeks. Which disease process should the nurse suspect the client is developing? Type 1 diabetes Type 2 diabetes Gestational diabetes Acanthosis nigricans
Type 2 diabetes
A client with diabetes has been self-administering insulin twice a day. This morning the wife found her husband lethargic and confused. After the clent's admission to the emergency department, laboratory testing reveals a hemoglobin A1c level of 10% and a blood glucose level of 200 mg/dL (11.1 mmol/L). What does the nurse suspect as the most likely cause of this client's condition? Hypoglycemia Somogyi effect Uncontrolled blood glucose level Noncompliance with the prescribed insulin regimen
Uncontrolled blood glucose level
Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? Urine output Specific gravity Urine osmolarity Serum osmolarity
Urine osmolarity
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? fruity odor to the breath Deep respirations Erythema toxicum rash and pruritus Diaphoresis and altered mental state Nervousness and tachycardia
fruity odor to the breath Deep respirations
A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? Correct! Somogyi effect Dawn phenomenon Diabetic ketoacidosis Hyperosmolar nonketotic syndrome
Somogyi effect
The nurse should monitor for increases in which laboratory value for the patient as a result of being treated with dexamethasone (Decadron)? potassium Sodium Calcium Blood glucose
Blood glucose
A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? Checking the client's serum glucose level Assisting the client out of bed into a chair Placing the client in the high-Fowler position Ensuring the client's residual limb is elevated
Checking the client's serum glucose level
The nurse is assisting the primary healthcare provider, who is examining the client's skull radiograph. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is suspected. Which hormone release is mostprobably affected? Glucagon Cortisol Aldosterone Corticotropin
Corticotropin
A client with type I diabetes is placed on an insulin pump. The most appropriate short-term goal when teaching this client to control the diabetes is: Adhere to the medical regimen Remain normoglycemic for 3 weeks Demonstrate the correct use of the administration equipment List 3 self-care activities that are necessary to control the diabetes
Demonstrate the correct use of the administration equipment
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? Eat a piece of pizza. Eat 15 g of simple carbohydrates Take an extra dose of rapid-acting insulin. Drink some diet pop.
Eat 15 g of simple carbohydrates
The nurse is providing care for a client with small-cell carcinoma of the lung who develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply. Edema Polyuria Bradycardia Hypotension Hyponatremia
Edema Hyponatremia
A nurse is caring for a client with endocrine problems. Which lab finding will alert the nurse that aldosterone will be released? Hypokalemia Hypoglycemia Hyponatremia Hypochloremia
Hyponatremia
The nurse is assessing a client experiencing diabetic ketoacidosis (DKA). Which unique response associated with DKA that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? Fluid loss Glycosuria Kussmaul respirations Increased blood glucose level
Kussmaul respirations
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.
Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
The nurse is caring for a client immediately after a subtotal thyroidectomy. How will the nurse assess for unilateral injury of the laryngeal nerve? Checking the throat for edema Asking the client to say what the current time is Eliciting spasms of the facial muscles Palpating the neck for seepage of blood
Asking the client to say what the current time is
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? Endotracheal intubation 100 units of NPH insulin IV infusion of normal saline IV infusion of sodium bicarbonate
IV infusion of normal saline
The client is admitted to the hospital with a large goiter, and a thyroidectomy is performed. What should the nurse do during the first four hours after the surgery? Select all that apply. Ensure that the client lies flat Monitor vital signs every hour Monitor for stridor or dyspnea Monitor for the signs and symptoms of tetany Assess the sides and back of the client's neck for evidence of bleeding
Monitor for stridor or dyspnea Assess the sides and back of the client's neck for evidence of bleeding
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels Assessing the patient's white blood cell levels and assessing for infection Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia
While caring for a client who sustained a severe head injury in a motor vehicle accident, the nurse observes that the client is constantly passing urine and is dehydrated. What does the nurse suspect as the cause for the client's condition? Decreased secretion of aldosterone Decreased secretion of atrial natriuretic peptide Decreased secretion of antidiuretic hormone Decreased secretion of parathyroid hormone
Decreased secretion of antidiuretic hormone
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? Nervousness and tachycardia Erythema toxicum rash and pruritus Diaphoresis and altered mental state Deep respirations and fruity odor to the breath
Deep respirations and fruity odor to the breath
A registered nurse is providing information to a group of student nurses regarding the actions of parathyroid hormone (PTH). Which statement made by the student nurse indicates a need for further teaching? Select all that apply. It activates vitamin D in the kidneys." Its secretion increases serum calcium levels." It allows reabsorption of phosphorus in the kidney tubules." It decreases serum calcium levels by increasing bone resorption." It regulates calcium and phosphorous metabolism by acting on the gastrointestinal tract."
It allows reabsorption of phosphorus in the kidney tubules." It decreases serum calcium levels by increasing bone resorption."
What is the action of vasopressin? Stimulates bone marrow to make red blood cells Promotes sodium reabsorption Reabsorbs water into the capillaries Promotes tubular secretion of sodium
Reabsorbs water into the capillaries
A client with type 1 diabetes is placed on an insulin pump. What is the priority short-term goal when teaching this client to control the diabetes? The client will adhere to the medical regimen." The client will remain normoglycemic for 3 weeks." Correct! The client will demonstrate correct use of the insulin pump." The client will list three self-care activities that are necessary to control the diabetes."
The client will demonstrate correct use of the insulin pump.