Final Unit 4
When assessing a client with Graves' disease, which clinical data would the nurse expect to find in the client's history? A. Diaphoresis B. Menorrhagia C. Dry, brittle hair D. Sensitivity to cold
A
Which explanation would the nurse provide when administering TPN to a client who asks why the solution is yellow? A. The vitamin B complex makes it yellow B. Preservatives in the solution make it yellow C. I will have the pharmacist come speak to you D. All TPNs are yellow
A
Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching is needed? A. I can eat as much dietetic fruit as I want B. I can can have a lettuce salad whenever I want C. I know that half of my diet should be carbs D. I need to reduce the amount of saturated fats in my diet
A *Dietetic fruit is NOT sugar free
What 2 other conditions can hypoglycemia look like?
A stroke or being drunk
How long do you have to scrub the hub for?
15 seconds
An increase in which blood component is responsible for the acidosis related to untreated DM? A. Ketones B. Glucose C. Lactic acid D. Glutamic acid
A
An obese client with type 2 diabetes asks about the intake of alcohol or special dietetic food in the diet. Which instruction would be included in the teaching plan? A. Alcohol can be consumed with its calories counted in the diet B. Unlimited amounts of sugar substitutes can be used C. Alcohol should not be used in cooking because it adds too many calories D. Special foods are needed because many regular foods cannot be used
A
Which information would the nurse include in the teaching plan of an adolescent who is found to have type 2 diabetes? SATA A. Insulin therapy B. Prophylactic antibiotics C. Blood glucose monitoring D. Oral hypoglycemic agents E. Adherence to treatment regimen
A, C, E *B is wrong because antibiotics are not necessarily needed to prevent infection. D is wrong because oral agents are used for TYPE 2
The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medication. Which medication would the nurse include in the teaching plan? SATA A. The client should obtain a finger-stick blood glucose reading before each meal B. The client does not need to follow a dietary plan C. The teaching plan should include signs and symptoms of hypoglycemia D. The teaching plan should include how to administer regular insulin E. The teaching plan should include sick day rules
A, C, E *D is not correct because the patient is taking oral drugs
Excessive levels of ketones can cause which of the following symptoms? SATA A. Too much acid in the blood B. Too much potassium in the blood C. Deep, rapid respirations over 30 D. Acetone breath (juicy fruit gum)
All
Which foods are high in K+? SATA A. Oranges and bananas B. Potatoes and tomatoes C. Spinach D. Beans E. Fish
All
Which finding in a client with Graves' disease would suggest an exacerbation of the disorder? SATA A. A 10-pound weight loss B. Very fast paced talking C. Hyperactive bowel sounds D. Heart rate 120 bpm E. BP 170/86
All the above *All symptoms of Graves'
Which info would the nurse include in the teaching plan for a client who will receive TPN at home? A. Showing how to mix the nutritional solutions B. Demonstrating how to test capillary glucose levels C. Identifying the types of infusion pumps that can be used D. Checking for Cather placement by palpating the insertion site
B *Blood glucose must be monitored because TPN can cause hyperglycemia
When a client's TPN bag is empty, which action is appropriate for the nurse to take? A. Perform a finger stick glucose test and call the PCP with the results B. Hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next bag C. Discontinue the infusion and flush the line with normal saline
B *Do not want to suddenly stop nutrition replacement; hanging a dextrose bag maintains therapy while waiting for new TPN bag
A client is suspected of having hypercorticolism. Which questions would the nurse include when performing the history-taking part of the admission assessment? A. Did you lose any weight unintentionally? B. Did you notice your extremities to be thin? C. Did you notice any roughness of your skin? D. Did you notice any skin darkening recently? E. Did the hair on your body get thicker recently?
B and E *These are signs of Cushing syndrome
A client is diagnosed with Cushing syndrome. The nurses would monitor the client for which cardiovascular complication? A. Chest pain B. Tachycardia C. Hypertension D. A-fib
C
What would you do if the external length of the catheter was 4 cm yesterday and 7 cm today? A. Remove the dressing, then slowly advance catheter back to where it was yesterday B. Immediately remove catheter and dressing C. Stop using catheter and contact the provider
C
Which purpose would KCl added to the IV solution of a client with DKA serve? A. Treats hyperpnea B. Prevents flaccid paralysis C. Prevents hypokalemia D. Treats cardiac dysrhythmias
C
When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1? A. Onset of the disease is slow B. Excessive weight is a contributing factor C. Complications are not present at the time of diagnosis D. Treatment involves diet, exercise, and oral medications
C *Complications arise typically from long-term, untreated type 1 diabetes
How does gluconeogenesis raise serum glucose? A. Suppress insulin production by pancreas B. Stimulates liver to produce glucose (from glycogen) C. Sensitive insulin receptors in fat and skeletal muscle D. Breaks down non-carbs into glucose
D
Which statement explains why TPN is infused through a central line rather than a peripheral line? A. It prevents the development of infection B. There is less chance of this infusion infiltrating C. It is more convenient, so clients can use their hands D. The large amount of blood helps dilute the concentrated solution
D
The nurse notes that a patient gained 2 lbs in 24 hours. This is equivalent to a fluid gain of approximately A. 250 mL B. 500 mL C. 750 mL D. 1000 mL
D *2.2 lbs = 1 kg = 1000 mL
When a norepinephrine IV infusion is prescribed for a client in septic shock, which IV line would the nurse choose for the infusion? A. Implanted port B. Midline catheter C. 18-gauge peripheral venous catheter D. PICC line
D *Norepinephrine is a VESICANT, which means it can cause serious tissue damage if it enters wrong layer of skin. Best infused with a PICC line to avoid potential tissue necrosis complication
A client is admitted to the hospital with a diagnosis of acute pancreatitis. The HCP prescription includes NPO and TPN. The nurse explains that the TPN therapy provides which benefits? A. Is the easiest method for administering needed nutrition B. Is the safest method for meeting the client's nutrition needs C. Will satisfy the client's hunger without the discomfort associated with eating D. Will meet the client's nutritional needs without causing discomfort precipitated by eating
D *TPN nutrition avoids stimulating the pancreas while eating otherwise by mouth
A patient is prescribed insulin glargine (Lantus). Which statement should the nurse include in the discharge instructions? A. The insulin will have a cloudy appearance in the vial B. The insulin should be injected twice daily C. The patient should mix Lantus with the intermediate acting insulin D. The patient will have less risk of hypoglycemia reactions with this insulin
D - remember it has no peak!
Clear insulin solutions are always short-acting. T or F?
F - insulin glargine is clear
Treatment can be monitored by blood or urine. T or F?
F - only blood (hemoglobin A1C)
Blood sugar control will best be achieved if the patient follows a plan created by the HCP. T or F?
F - patient should be the source of control with their care plan
What are 6 significant adverse effects that may be experienced while on prednisone therapy?
Increased BP, weight gain, insomnia, mood changes, increased serum glucose, bone thinning
Why is blood sugar not immediately checked before administering every dose of metformin?
It does not stimulate release of insulin
What waste product does gluconeogenesis create?
Ketones
For each condition, what kind of glucocorticoid therapy may be prescribed? Use HIGH, LOW, or NONE RA Lupus Cushing syndrome Addison disease Preventing asthma exacerbation
RA: HIGH Lupus: HIGH Cushing syndrome: NONE Addison disease: LOW Preventing asthma exacerbation: LOW
How do glucocorticoids raise serum glucose?
Stimulate liver to produce glucose (from glycogen)
Addison disease and adrenal crisis can cause hyperkalemia and hyponatremia. T or F?
T
After the insertion of a PICC line, an X-ray is required before first use to confirm placement. T or F?
T
Exercise improves cellular response to insulin. T or F?
T
Metabolic syndrome often precedes type 1 diabetes. T or F?
T
Most long-term complications of diabetes occur secondary to disruption of blood flow. T or F?
T
The primary goal of treating diabetes is to prevent long-term complications and manage symptoms of hyperglycemia. T or F?
T
DKA occurs in which type of diabetes?
Type 1
The most accurate indicator of fluid gain or loss in an acutely ill patient is
Weight changes
Identify 5 characteristics of metabolic syndrome
Weight gain, increased BP, high HDL, low LDL, impaired fasting glucose
Which lab values supports the presence of DKA? A. Increased serum lipids B. Decreased hematocrit level C. Increased serum calcium levels D. Decreased blood urea nitrogen level
A *Increased breakdown of fat in DKA
A client begins to have difficult breathing 30 minutes after the insertion of a subclavian central line. Which would the nurse do first? A. Raise the head of the bed B. Apply oxygen C. Assess breath sounds D. Call the PCP to get a chest X-ray
A *Do the LEAST invasive thing first
Which action would the nurse take when a client report pain and burning at a IV site after the nurse flushed the saline lock with normal saline? A. Remove IV catheter and restart the saline lock in another site B. Document the finding per protocol and reassess the site in 8 hours C. Flush the IV catheter and saline lock again vigorously with normal saline D. Change the dressing and apply a new dressing, per protocol
A *Pain indicates the IV is not in correct placement
How does glucagon raise serum glucose? SATA A. Suppress insulin production by pancreas B. Stimulates liver to produce glucose (from glycogen) C. Sensitive insulin receptors in fat & skeletal muscle D. Break down non-carbs into glucose
A and B
Which clinical manifestations exhibited by a client taking Levothyroxine for hypothyroidism for 3 months would cause the nurse to suspect a decrease in dosage is needed? SATA A. Tremors B. Bradycardia C. Somnolence D. Heat intolerance E. Decreased BP
A and B *Symptoms of hyperthyroidism
Which manifestations of surgical induced hypothyroidism might the client exhibit after thyroid surgery? SATA A. Fatigue B. Dry skin C. Insomnia D. Excitability E. Weight loss F. Intolerance to heat
A and B *Symptoms of hypothyroidism
Vascular access devices are removed if there is A. An unresolved complication B. Discontinuing IV therapy C. No longer a need in the plan of care D. A max dwell time has been reached
A, B, C
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which intervention would the nurse include to decrease the risk of complications? SATA A. Examine the feet daily B. Wear well-fitting shoes C. Perform regular exercise D. Power the feet after showering E. Visiting the PCP weekly F. Test bath water with your toes
A, B, C *D is not correct because the powder can cause build up and potential infection between toes. F is not correct because diabetics can lose feeling in their toes so temp is not accurate
The nurse suspects that a client as DM. Which statements made by the client helped the nurse reach this conclusion? SATA A. I am 65 years old B. I quite often feel thirsty C. I eat every 2 hours D. I have excessive sweating E. I sometimes experience shortness of breath
A, B, C *These are signs of HIGH blood sugar, other symptoms are associated with thyroid disorder
The regulation of type 1 diabetes in an 8-year old child is best attained with the combination of therapeutic modalities in addition to the administration of insulin. Which modalities would the nurse include in he teaching plan? SATA A. Dietary control B. Regular exercise C. Urine testing for glucose D. Blood glucose monitoring E. Use of oral hypoglycemic agents
A, B, D *E is not correct because oral agents are used for TYPE 2
Which complication would the nurse assess for when caring for a client receiving TPN? SATA A. Infection B. Hyperglycemia C. ABO incompatibility D. Electrolyte imbalance E. Cardiac dysrhythmias
A, B, D *Sugar is excellent source for bacterial growth. C and E are incorrect because they are not associated with TPN
Which is the reason the nurse would monitor a client with a diagnosis of Cushing syndrome for symptoms of DM? A. Cortical hormones stimulate rapid weight loss B. Tissue catabolism results in a negative nitrogen balance C. Glucocorticoids accelerate the process of gluconeogenesis D. Excessive ACTH secretion damages pancreas
C *Excess glucocorticoids can cause hyperglycemia
Which insulin will he nurse prepare for the emergency treatment of DKA? A. Glargine B. NPH insulin C. Insulin aspart D. Insulin detemir
C *It is fast acting
Which lab value supports the presence of DKA in a client with type 1 diabetes? A. Decreased serum glucose levels B. Decreased serum calcium levels C. Increased blood urea nitrogen levels D. Increased serum bicarbonate levels
C *Usually a result of dehydration from DKA
Which reason would the nurse identify as the purpose for using a central venous access device to administer TPN to a client with cancer of the pancreas? A. Infection is uncommon B. It permits free use of the hands C. The chance of the infusion infiltrating is decreased D. The amount of blood in a major vein helps dilute the solution
D *An undiluted, highly concentrated solution can cause irritation or blockage
The nurse is assessing the skin of a client with cortisol deficiency and expects which finding? A. Dry skin B. Ulcerated skin C. Generalized edema D. Diminished axillary hair
D *Cortisol deficiencies lose hair
Adverse effects of prednisone therapy are the polar opposite of Cushing syndrome. T or F?
F - similar symptoms because both are the result of excess steroids
Weight loss is always needed to decrease the patients insulin requirements. T or F?
F - weight loss, diet, and exercise are all important
Identify 10 potential symptoms of hypoglycemia
Fatigue, blurry vision, sweating, dizzy, anxiety, shaky, hungry, tachycardia, headache, irritability
Which manifestations would the nurse include when teaching a patient about the signs of DKA? SATA A. Confusion B. Hyperactivity C. Excessive thirst D. Fruity-scented breath E. Decreased urinary output
A, C, D
Which factors contributes to a client's slow rate of healing? SATA A. Diabetes B. Cataract C. Smoking D. Dermatitis E. Alcohol abuse
A, C, E