NiHi Exam 4 PRACTICE

39. The nurse explains that a pneumatic retinopexy is a repair of a retinal detachment using a bubble of to put pressure on the damaged retina.

ANS: gas A pneumatic retinopexy uses a bubble of gas to put pressure on the damaged retina. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1866 OBJ: 11 TOP: Pneumatic retinopexy KEY: Nursing Process Step: Implementation

43. Arrange the parts of the eye from the exterior to the most interior. (Separate letters by a comma and space as follows: A, B, C, D) a. Choroid b. Cornea c. Aqueous humor d. Retina e. Lens f. Iris

ANS: B, C, F, E, D, A The cornea is the outermost, followed by the aqueous humor, iris, lens, retina, and the choroid. PTS: 1 DIF: Cognitive Level: Application REF: Page 1840, Figure 52-1 OBJ: 2 TOP: Eye structure KEY: Nursing Process Step: Assessment

44. Place the nursing intervention in appropriate order for the immediate care of a patient with a penetrating wound of the eye. (Separate letters by a comma and space as follows: A, B, C, D) a. Assess eye, do not remove object b. Cover both eyes with an eye shield or cup c. Lay the patient down flat d. Check for the irregularity of the pupil e. Obtain medical attention immediately

ANS: C, A, D, B, E The patient should be placed on his back to prevent loss of the aqueous humor, assessment of the eye for the location of the object and whether the pupil is regular, cover the eye to prevent movement, and obtain medical attention immediately. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1870, Safety Alert OBJ: 10 TOP: Penetrating wound of the eye KEY: Nursing Process Step: Implementation

38. The home health patient complains of tearing and a feeling of dryness in the right eye. The nurse assesses that the eyelid is turned inward and the sclera is red. The nurse documents the presence of a(n) .

ANS: entropion An entropion is the abnormal turning in of the eyelid, causing irritation and tearing of the eye. PTS: 1 DIF: Cognitive Level: Application REF: Page 1859 OBJ: 8 TOP: Entropion KEY: Nursing Process Step: Assessment

40. The total removal of an eye is a(n) .

ANS: enucleation The surgical removal of the eyeball is an enucleation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1869 OBJ: 9 TOP: Enucleation KEY: Nursing Process Step: Assessment

41. The surgical incision into the eardrum with either a knife or a heated wire loop to relieve pressure in the middle ear is a(n) .

ANS: myringotomy The opening of the eardrum with a specialized knife or a heated wire loop to relieve pressure in the middle ear is a myringotomy. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1883 OBJ: 17 TOP: Myringotomy KEY: Nursing Process Step: Assessment

42. Progressive deafness caused by the ankylosis of the stapes is the condition of .

ANS: otosclerosis Progressive deafness related to the ankylosis of the stapes is diagnosed as otosclerosis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1885 OBJ: 16 TOP: Otosclerosis KEY: Nursing Process Step: Assessment

30. A nurse instructs a patient about how insulin affects blood glucose. (Arrange the events in sequence. Separate letters by a comma and space as follows: A, B, C, D.) A. Beta cells are stimulated to release insulin. B. Glucose enters the bloodstream. C. Glycogen is converted to glucose by alpha cells (glycogenesis). D. Glycogen is stored in the liver. E. Insulin transports glucose to muscle cells.

ANS: B, A, E, D, C Insulin transports the glucose to muscle cells or converts it to glycogen, which is stored in the liver to be accessed when hypoglycemia occurs. DIF: Cognitive Level: Analysis REF: p. 1059 OBJ: 3 TOP: Insulin's Effect on Glucose KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. A nurse reminds a patient with type I diabetes to rotate the insulin injection sites to prevent _____.

ANS: lipohypertrophy Using the same area for insulin injections causes swollen lumpy areas that interfere with the ab-sorption of insulin. DIF: Cognitive Level: Comprehension REF: p. 1071 OBJ: 5 TOP: Lipohypertrophy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. What does diabetes retinopathy result from? a. Capillaries in retina hemorrhage b. Long-term overdosing of insulin c. Retinal detachment d. Aging

ANS: A Retinopathy is caused when the capillaries in the retina have aneurysms or hemorrhage. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1861 OBJ: 9 TOP: Glaucoma KEY: Nursing Process Step: Assessment

16. A nurse is formulating a teaching plan for a 22-year-old woman taking rosiglitazone (Avandia). What should the nurse include information about in this plan to caution this patient? a. Decreased effectiveness of her birth control pills b. Excessive exposure to the sun c. Sudden drop in blood pressure with dizzi-ness d. Possible severe diarrhea

ANS: A Avandia causes some birth control pills to be less effective. DIF: Cognitive Level: Application REF: p. 1073 OBJ: 10 TOP: Side Effects of Avandia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

29. Why is otitis media found more frequently in children 6 to 36 months? a. Eustachian tubes in children are shorter and straighter. b. Infection descends via the eustachian tube to the throat. c. Children's eustachian tubes are more vertical and longer. d. Otitis media is seen equally in both children and adults.

ANS: A Children's shorter and straighter eustachian tubes provide easier access of the organisms from the nasopharynx to travel to the middle ear. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1881 OBJ: 16 TOP: Otitis media KEY: Nursing Process Step: Evaluation

9. A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition. What will DKA result in? a. Disorder of carbohydrates, fats, and pro-teins metabolism b. Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream c. Dangerously elevated pH and bicarbonate levels in the blood d. Severe hypoglycemia, which can result in coma and convulsions

ANS: A DKA is mainly related to the use of fat as an energy source because of an inability of the body to use glucose. The metabolism of fat produces ketones. DIF: Cognitive Level: Knowledge REF: p. 1064 OBJ: 6 TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. A client tells the nurse about experiencing symptoms of a hypoglycemic insulin reaction. Which action should the nurse take FIRST? a. Assess the blood glucose level, and administer glucose in the most appropriate form. b. Call the health care provider. c. Give the client juice or hard candy immediately. d. Have the client lie down and see if symptoms subside.

ANS: A Nursing care of clients who have hypoglycemia focuses on assessing symptoms, checking blood glucose level, and administering glucose in the most appropriate form. Teaching clients and their families how to prevent hypoglycemic reactions is also important, and clients should be encouraged to wear medical identification bracelets or tags that state they have type 1 diabetes.

22. What should the nurse include in the plan of care following a tympanoplasty? a. Elevating head of bed with operative side facing upward b. Enforcing bed rest for 72 hours c. Frequent turning, coughing, and deep breathing d. Continuous irrigation of the ear canal with antibiotic solutions

ANS: A Postoperative management for patients who have had a tympanoplasty consists of bed rest until the next morning. The head of the bed is elevated 40 degrees, and the operative side faces upward. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1889 OBJ: 17 TOP: Otitis media KEY: Nursing Process Step: Implementation

28. Which is a sign of acute angle closure glaucoma (AACG)? a. Large fixed pupil b. Nystagmus c. Bluish color in sclera d. Drooping eyelid

ANS: A Signs of AACG would be eye pain, large fixed pupil with reddened sclera, decreased vision, nausea, and vomiting. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1867 OBJ: 9 TOP: Glaucoma KEY: Nursing Process Step: Assessment

5. The 62-year-old home health patient who is recovering from eye surgery complains of a feeling of "grittiness" in the eye and is having blurred vision. The eyes are reddened and have stringy mucus. What do these complaints indicate? a. Sjögren syndrome b. Early cataracts c. Macular degeneration d. Retinal detachment

ANS: A The Sjögren syndrome of "dry eye" frequently appears after eye surgery. There is insufficient production of tears. Excessive use of antihistamines, antidepressants, and decongestants may cause this syndrome to appear. PTS: 1 DIF: Cognitive Level: Application REF: Page 1858 OBJ: 8 TOP: Sjögren syndrome KEY: Nursing Process Step: Assessment

8. What is the process when the lens of the eye changes its curvature to focus on the retina? a. Accommodation b. Constriction c. Convergence d. Refraction

ANS: A The ability of the lens to alter its curvature as it focuses on the retina is accommodation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1849 OBJ: 16 TOP: Accommodation KEY: Nursing Process Step: Implementation

15. When the patient in the emergency room complains of seeing flashing lights and a curtain down over his right eye, the nurse recognizes this as a symptom of which condition? a. Detached retina b. Macular degeneration c. Early sign of cataract d. Diabetic retinopathy

ANS: A The standard complaint of a detached retina is the report of seeing flashing lights and having a curtain being drawn over the eyes. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1865 OBJ: 9 TOP: Detached retina KEY: Nursing Process Step: Assessment

18. What should the nurse remind the hearing aid wearer to do when the nurse hears a whistling hearing aid? a. Reinsert the ear mold b. Change the battery c. Recharge the hearing aid d. Wash the ear mold with warm water

ANS: A The whistling hearing aid is usually caused by a poor fit of the ear mold. Reinsertion of the ear mold usually stops the whistling. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1880, Box 52-3 OBJ: 13 TOP: Hearing aid KEY: Nursing Process Step: Implementation

4. What does a tympanoplasty correct? a. Conductive hearing loss b. Sensorineural hearing loss c. Congenital hearing loss d. Functional hearing loss

ANS: A Tympanoplasty can correct a conductive hearing loss. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1889 OBJ: 17 TOP: Tympanoplasty KEY: Nursing Process Step: Implementation

27. A teaching plan for a patient with diabetes is focused on smoking cessation and the control of hypertension for the avoidance of microvascular complications. What are examples of microvascu-lar complications? (Select all that apply.) a. Macular degeneration b. End-stage renal disease (ESRD) c. Coronary artery disease (CAD) d. Peripheral vascular disease (PVD) e. Cerebrovascular accident (CVA)

ANS: A, B Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular complications. DIF: Cognitive Level: Comprehension REF: p. 1061 OBJ: 5 TOP: Microvascular Complications KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

33. Which may contribute to otitis media? (Select all that apply.) a. Exposure to cigarette smoke b. Allergies c. Upper respiratory infections d. Swimming e. Trauma f. Prolonged exposure to loud noise

ANS: A, B, C Otitis media is usually caused by an upper respiratory infection with gram-negative bacteria, such as Proteus, Klebsiella, and Pseudomonas. In addition, allergy, exposure to cigarette smoke, mycoplasma, and several viruses may be factors. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1881 OBJ: 16 TOP: Otitis media KEY: Nursing Process Step: Assessment

34. What factors must the nurse consider when assessing readiness to learn when teaching health promotion practices for the visually and hearing impaired? (Select all that apply.) a. Cultural beliefs b. Values c. Habits d. Income e. Occupation

ANS: A, B, C The nurse must consider the patient's culture, beliefs, values, and habits, as well as the special needs of the older adult. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1891 OBJ: N/A TOP: Health promotion KEY: Nursing Process Step: Assessment

32. Select all the conditions that may cause conductive hearing loss. (Select all that apply.) a. Buildup of cerumen b. Foreign bodies c. Otosclerosis of external auditory canal d. Trauma e. Exposure to ototoxic drugs f. Otitis media with effusion

ANS: A, B, C, F Common causes of conductive hearing loss are buildup of cerumen and otitis media with effusion (escape of effusion). Other conditions that may result in conductive hearing loss are foreign bodies, otosclerosis, and stenosis of the external auditory canal. Sensorineural hearing loss is usually due to trauma, infectious processes, or exposure to ototoxic drugs. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1878 OBJ: 12 TOP: Hearing loss KEY: Nursing Process Step: Assessment

28. How is the Whipple triad described? (Select all that apply.) a. Symptoms of hypoglycemia are present. b. Low blood glucose levels are documented when symptoms are present. c. Symptoms can be reproduced with an in-jection of regular insulin, 10 units. d. Muscular activity does not have any effect on blood glucose. e. Symptoms improved when the blood glu-cose level rises.

ANS: A, B, E Whipple triad is the presence of the symptoms of hypoglycemia (e.g., diaphoresis, pallor, tachycar-dia), the documentation of low blood glucose levels when symptoms are present, and the im-provement of symptoms as the blood glucose level rises. DIF: Cognitive Level: Comprehension REF: p. 1084 OBJ: 9 TOP: Whipple Triad KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

25. What are functional causes of hypoglycemia? (Select all that apply.) a. Dumping syndrome b. Overdose of insulin c. Addison disease d. Prolonged muscular exercise e. Chronic alcoholism

ANS: A, C, D Dumping syndrome, Addison disease, and prolonged exercise are functional causes of hypogly-cemia. Overdose of insulin and chronic alcoholism are exogenous causes. DIF: Cognitive Level: Knowledge REF: p. 1084 OBJ: 1 TOP: Functional Causes of Hypoglycemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

35. Which of the following are causes of cataracts? (Select all that apply.) a. Long-term use of corticosteroids b. Hypotension c. Congenital from exposure to maternal rubella d. Diabetes mellitus e. Exposure to sand and dust f. Smoking

ANS: A, C, D, F Among the many causes of cataracts are long-term corticosteroid use, maternal rubella, diabetes mellitus, and smoking. PTS: 1 DIF: Cognitive Level: Application REF: Page 1859 OBJ: 9 TOP: Cataracts KEY: Nursing Process Step: Assessment

24. A patient who had an enucleation of the right eye has been admitted PACU. What should the nurse include in the plan of care? a. Turn, cough, and deep breathe every 3 hours b. Apply a pressure dressing over the right eye socket c. Document dressing assessment every 2 hours d. Turn on the affected side

ANS: B A pressure dressing will be applied to the right eye socket and the dressing should be checked every hour for the first 24 hours. PTS: 1 DIF: Cognitive Level: Application REF: Page 1872 OBJ: 11 TOP: Infections/inflammatory disorders KEY: Nursing Process Step: Assessment

12. Which complaint made by a 64-year-old patient during a health interview would alert the nurse to the possibility of cataracts? a. Pain in the eyes b. Difficulty driving at night c. Loss of peripheral vision d. Dry eyes

ANS: B Blurring of vision and difficulty driving at night is often the first subjective symptom reported by a patient who has cataracts. PTS: 1 DIF: Cognitive Level: Application REF: Page 1860 OBJ: 9 TOP: Cataracts KEY: Nursing Process Step: Assessment

7. When a patient with type 2 diabetes says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." What should the nurse explain about the level of hemoglobin A1c? a. Shows how a high level of glucose can cause a significant drop in the hemoglobin level b. Shows what the glucose level has done during the past 3 months c. Indicates a true picture of the patient's nu-tritional state d. Reflects the effect of a high level of glu-cose on the ability to produce red blood cells (RBCs)

ANS: B By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the past 3 months because the glucose stays bound to the hemoglobin for the life of the RBC. DIF: Cognitive Level: Comprehension REF: p. 1075 OBJ: 9 TOP: Hemoglobin A1c: Glycosylated Hemoglobin Level KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. A client who has diabetes begins to experience nausea, vomiting, weakness, fatigue, and blurred vision. The nurse observes the client's skin is warm and flushed and notes a fruity odor to the client's breath. The nurse should anticipate the client will be treated for: a. hypoglycemia b. diabetic ketoacidosis c. hyperosmolar hyperglycemic nonketotic syndrome d. insulin resistance

ANS: B Diabetic ketoacidosis (DKA) occurs predominantly in clients who have type 1 diabetes and can be precipitated by factors such as stress, illness, or surgery. DKA may occur gradually or suddenly, and manifestations are similar to those of hyperglycemia (polyuria, polyphagia, and polydipsia); other symptoms may include nausea and vomiting, abdominal pain, headache, weakness, fatigue, blurred vision, skin that is hot and of poor turgor, Kussmaul's respirations, and fruity breath odor.

10. In which situation would a client possibly require glucose management by sliding scale insulin? a. clients with type 1 diabetes mellitus experiencing illness, stress, or surgery b. clients with type 1 or type 2 diabetes mellitus experiencing illness, stress, or surgery c. clients newly diagnosed with type 2 diabetes mellitus d. clients participating in a rigorous sport or activity

ANS: B During times of surgery, illness, or stress, clients may have their glucose levels maintained with an insulin sliding scale in lieu of their regular treatment.

1. The nurse is aware that the patient has 20/40 vision. This means that the patient can see at 20 feet what the normal eye can see at feet. a. 100 b. 200 c. 300 d. 400

ANS: B The Snellen Eye Chart tests visual acuity. A vision evaluation of 20/40 means that the patient can see at 20 feet what the person with normal vision can see at 200 feet. PTS: 1 DIF: Cognitive Level: Application REF: Page 1850 OBJ: 7 TOP: Snellen evaluation KEY: Nursing Process Step: Assessment

15. A patient has come to the physician's office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her physician. She asks the nurse if she has diabetes. What is the most accurate nursing response? a. "Having a fasting serum glucose that high certainly indicates diabetes." b. "That test indicates that we need to perform more tests that are specific for diabetes." c. "How do you feel? Do you have any other signs of diabetes?" d. "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."

ANS: B The nurse needs to answer the patient's question in a way that gives information and is not mis-leading. Although 135 mg/dL is high, a nonpathologic explanation may be found. More tests should be performed to evaluate the patient. DIF: Cognitive Level: Comprehension REF: p. 1066 OBJ: 9 TOP: Laboratory Tests for Diabetes KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. The nurse will assess for when the older adult home health patient complains that the entire right side of his head hurts and he cannot chew without pain. a. mumps b. external otitis c. otitis media d. labyrinthitis

ANS: B The symptoms of painful head, painful chewing, and pain when the auricle is moved all indicate external otitis, frequently caused by compacted cerumen. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1880 OBJ: 16 TOP: External otitis KEY: Nursing Process Step: Assessment

14. A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very strangely and seems confused. The friend states that the patient has diabetes and takes insulin. Which signs of hypoglycemia might the nurse assess? a. Slow pulse rate and low blood pressure b. Irritability, anxiety, confusion, and dizzi-ness c. Flushing, anger, and forgetfulness d. Sleepiness, edema, and sluggishness

ANS: B When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hor-mones is epinephrine, which causes these symptoms. DIF: Cognitive Level: Comprehension REF: p. 1084 OBJ: 1 TOP: Hypoglycemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. A patient with type 1 diabetes asks why his 0700 insulin has been changed from NPH insulin to 70/30 premixed insulin. What is the best explanation by the nurse that explains about 70/30 insulin mixture? a. It is absorbed more rapidly into the blood-stream. b. It has no peak action time and lasts all day. c. It makes insulin administration easier and safer. d. It provides a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

ANS: C 70/30 insulin is 30% rapid-acting insulin and 70% intermediate-acting insulin. The rapid action of the 0700 premixed insulin prevents hyperglycemia after the morning meal and the mixed drug re-duces the risk of error in drawing up two insulins. DIF: Cognitive Level: Comprehension REF: p. 1070 OBJ: 8 TOP: Use of 70/30 Insulin KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

17. The nurse takes into consideration that the Weber test indicated a conductive hearing loss in a patient because the patient reported hearing the tone: a. equally in both ears. b. as a shrill noise. c. louder in his affected ear. d. very faintly.

ANS: C A conductive hearing loss can be diagnosed by the Weber test. A person with a conductive loss will hear the noise louder in his affected ear. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1885 OBJ: 16 TOP: Weber test KEY: Nursing Process Step: Assessment

23. When the patient stares at the black dot on an Amsler grid, what should the nurse ask him to report? a. Any color visible on the grid b. Fading of the edges of the grid c. Any distortion of the grid d. Movement of the black dot

ANS: C Amsler grid, a diagnostic tool for retinal disorders, requires that the patient look at the dot on the grid and report any distortion in the grid lines. PTS: 1 DIF: Cognitive Level: Application REF: Page 1850, Figure 52-3 OBJ: 9 TOP: Aging KEY: Nursing Process Step: Assessment

19. What should the nurse advise the 20-year-old to do who has been put on cefaclor (Ceclor) for a resistant otitis media? a. Store suspension at room temperature b. Discontinue drug when symptoms abate c. Avoid alcoholic beverages d. Take with meals only

ANS: C Drinking alcohol is discouraged while on Ceclor. The drug should be taken in its entirety and stored in the refrigerator. The drug can be taken with or without meals. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1880, Table 52-5 OBJ: 16 TOP: Ceclor KEY: Nursing Process Step: Implementation

12. As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs guidelines for exercise. Which guideline should be included? a. Plan exercise so that it coincides with the peak action of insulin. b. Insulin should be injected into the lower extremity before exercise because that site provides the greatest absorption. c. Exercise should be performed daily at the same time of day and at the same intensity. d. Keep exercise at a minimum to conserve your energy.

ANS: C If the body is using more glucose than available, the body will draw on fatty acids, which will give off ketones. DIF: Cognitive Level: Application REF: p. 1068 OBJ: 10 TOP: Exercise KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. Which forms of type 1 diabetes are characterized by an absolute insulin deficiency requiring management with insulin injections? a. gestational diabetes mellitus b. impaired glucose tolerance c. immune-mediated or idiopathic diabetes mellitus d. chemical-induced diabetes mellitus

ANS: C Immune-mediated or idiopathic diabetes mellitus are two forms of diabetes resulting from pancreatic beta-cell destruction or primary defect in beta-cell function. They are characterized by an absolute insulin deficiency requiring management with insulin injections.

16. The major goal of medical nutrition therapy for clients with diabetes mellitus is to: a. reduce serum lipid levels b. improve health through optimal nutrition c. maintain as near-normal a blood glucose level as possible d. wean insulin-dependent clients with diabetes from insulin through diet control

ANS: C The goals of nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, prevent complications of diabetes, and improve overall health.

5. The self-care goal of a patient with diabetes is to keep the blood sugar within normal limits. What causes hyperglycemia to occur? a. Blood glucose levels rise, stimulating the production of insulin. b. Insulin conversion of glycogen to glucose is inhibited. c. The body responds to glucose-starved tis-sues by changing stored glycogen into glucose. d. Glycogen is unable to be stored in the liver and muscles.

ANS: C The hypothalamus is receiving a message that the cells need glucose, so it responds by adding more glucose to the already overburdened blood. DIF: Cognitive Level: Comprehension REF: p. 1059 OBJ: 3 TOP: Hyperglycemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The patient tells the nurse that he is legally blind. How would this information impact the nurse's plan of care for this patient? a. The patient would be considered totally blind. b. This patient probably has some light perception, but no usable vision. c. This patient has some usable vision, which enables function at an acceptable level. d. The nurse would need to determine how this patient's visual impairment affects normal functioning.

ANS: D "Legal blindness" refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced by 20 degrees. Categories have been established to help determine the exact extent of the vision loss and what assistive measures are appropriate for the individual. The nurse will need more information as to the exact extent of the vision loss for this patient. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1851 OBJ: N/A TOP: Legal blindness KEY: Nursing Process Step: Planning

3. One of the housekeepers splashes a chemical in the eyes. What should be the first priority? a. Transport to a physician immediately b. Cover the eyes with a sterile gauze c. Irrigate with H2O for 5 minutes d. Irrigate with normal saline solution for 20 minutes

ANS: D Burns are medically treated with a prolonged, 15- to 20-minute or longer normal saline flush immediately after burn exposure. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1871 OBJ: 11 TOP: Chemical burn of eye KEY: Nursing Process Step: Implementation

10. A patient has been admitted to the hospital with the diagnosis of DKA. What vital signs should a nurse anticipate that the patient will exhibit? a. Temperature, 99° F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow b. Temperature, 98.6° F; pulse, 76 beats/min; respirations, 16 breaths/min and deep c. Temperature, 98° F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow d. Temperature, 97.4° F; pulse, 110 beats/min; respirations, 26 breaths/min and deep

ANS: D DKA is caused by the attempt of the body to metabolize fat for energy, which results in an acidotic state. The classic signs of DKA are hypothermia, tachycardia, and Kussmaul respirations (rapid and deep) to blow off the acid ions via respirations. The respirations will have a fruity odor. DIF: Cognitive Level: Analysis REF: p. 1065 OBJ: 7 TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. How would the nurse explain the purpose of photocoagulation to a diabetic patient with diabetic retinopathy? a. The procedure will destroy the retina, which is not getting enough blood supply. b. The procedure will reduce edema in the macula of the eye. c. The procedure will vaporize fatty deposits that appear in the retina. d. The procedure will destroy new blood vessels, seal leaking vessels, and help prevent retinal edema.

ANS: D Photocoagulation is useful in diabetic retinopathy to cauterize hemorrhaging vessels and to destroy new vessels. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1863 OBJ: 9 TOP: Diabetic retinopathy KEY: Nursing Process Step: Implementation

17. A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700. The patient has also been instructed not to take anything by mouth (NPO) in preparation for laboratory work that will not be drawn until 1000. What action should the nurse implement? a. Give the insulin as ordered. b. Give the insulin with a small snack. c. Inform the charge nurse. d. Hold the insulin until after the blood draw.

ANS: D Holding the insulin to adhere to the NPO order is appropriate. The patient will not be getting food until after the laboratory work; consequently, the insulin will not be needed until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate. DIF: Cognitive Level: Application REF: p. 1071-1072 OBJ: 8 TOP: Insulin with NPO Order KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

22. How long does it take for Humulin R 20 units to peak? a. 15 minutes b. 30 minutes c. 1 hour d. 2 hours

ANS: D Humulin R has its onset in approximately 30 minutes, but its peak is in 2 hours. DIF: Cognitive Level: Knowledge REF: p. 1070 OBJ: 8 TOP: Humulin R Insulin Peak KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. When a client's glucose level drops below 70 mg/dL, often before meals or when insulin action is peaking, the client is experiencing: a. diabetic ketoacidosis b. diabetic neuropathy c. hyperosmolar hyperglycemic nonketotic syndrome d. hypoglycemia

ANS: D Hypoglycemia (insulin reaction) is a complication of type 1 diabetes that can be fatal unless it is recognized and treated promptly. While hypoglycemia can occur at any time of day, clients experience it most frequently before meals or when their prescribed insulin action peaks. Causes of hypoglycemia include skipping meals, eating late, engaging in unplanned exercise, and administering excess insulin.

11. Which complication of insulin therapy is characterized by a rapid decrease in serum glucose, usually at night, causing the release of glucose-elevating hormones and an elevated glucose level in the morning, which may be inadvertently treated with an increased insulin dose? a. dawn phenomenon b. insulin resistance c. lipodystrophy d. Somogyi phenomenon

ANS: D The Somogyi phenomenon occurs when a rapid decrease in serum glucose, usually at night, causes the release of glucose-elevating hormones and an elevated glucose level in the morning. Adjusting insulin dosing to avoid the peaking of insulin during the night will correct this effect.

7. What is a common mistake that hinders communication when communicating with the hearing impaired? a. Overaccentuating words b. Facing the patient when speaking c. Speaking in conversational tones d. Speaking into the ear with the hearing aid

ANS: A Do not overaccentuate words. Speak in a normal tone; do not shout or raise the pitch of voice. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1870, Health Promotion OBJ: 14 TOP: Communication KEY: Nursing Process Step: Implementation

36. What would a nurse do when the patient arrives in the PACU after a left stapedectomy? (Select all that apply.) a. Turn the patient to his right side b. Change dressing as it becomes soiled c. Turn patient every 2 hours d. Leave the bed flat e. Medicate immediately on the complaint of nausea

ANS: A, D, E The bed is left in the flat position and the patient is positioned with the operated side facing up, the patient is not turned, and the dressing is not changed by the nurse. The patient should be medicated immediately on complaint of nausea to prevent vomiting and possible disruption of graft. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1887 OBJ: 17 TOP: Stapedectomy KEY: Nursing Process Step: Implementation

20. What should a nurse include when drawing up a patient's diabetes teaching plan? a. Develop an exercise plan because regular exercise helps control blood glucose levels. b. Monitor blood sugar levels only if not feeling well to ensure that the fingertips are not pricked too much. c. If nervousness, palpitations, or hunger is experienced, take a small dose (1 to 2 U) of regular insulin and call the physician. d. Use over-the-counter measures for any foot blisters, calluses, or wounds before seeking medical help.

ANS: A Exercise is an integral part of the patient's ability to take charge of his or her diabetes and needs to be included in the teaching plan. DIF: Cognitive Level: Application REF: p. 1068 OBJ: 8 TOP: Diabetes Teaching Plan KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. Subcutaneous insulin absorption occurs MOST quickly when injected into which area? a. abdomen b. arms c. hips d. thighs

ANS: A Factors affecting absorption should be considered when selecting an injection site. Absorption occurs most quickly in the abdomen, followed by the arms, thighs, hips, and subscapular regions.

1. What is the primary function of insulin? a. to stimulate active transport of glucose into muscle and adipose tissue cells b. to convert glycogen to glucose c. to stimulate breakdown of adipose tissue d. to increase breakdown of protein into amino acids

ANS: A Insulin is a hormone produced and secreted by the pancreas. Insulin stimulates the active transport of glucose into muscle and adipose tissue cells, making it available for cell use.

23. A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenome-non. What symptom supports this suspicion? a. Headache on awakening and enuresis b. 6 AM blood sugar of 58 mg/dL and nausea c. Abdominal pain and elevated blood pres-sure d. Drowsiness and disorientation after eating

ANS: A The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of hypogly-cemia during the early morning. The patient wakes with a headache, enuresis, nausea and vomiting, nightmares, and a high level of blood sugar. DIF: Cognitive Level: Comprehension REF: p. 1077 OBJ: 8 TOP: Somogyi Phenomenon KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. Why would the nurse encourage a group of teenagers to protect their eyes with dark sunglasses while using a UV lamp? a. The lamp can cause cataracts. b. The lamp can cause presbycusis. c. The lamp can cause keratitis. d. The lamp can cause ectropion.

ANS: A The proteins in the lens of the eye are vulnerable to UV light and can develop cataracts. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1890 OBJ: 9 TOP: Health promotion KEY: Nursing Process Step: Implementation

13. Which nursing intervention would minimize a client's risk of developing lipodystrophies? a. administering insulin intramuscularly b. rotating sites of administration c. using human insulin d. using insulin at room temperature

ANS: B Failure to rotate injection sites may cause a complication known as lipodystrophy, a change in the subcutaneous fat that decreases the absorption of the insulin.

25. What must a patient do following a left vitrectomy? a. Remain flat in bed for 48 hours b. Position self in a face-down position for 4 to 5 days c. Assume a side-lying position with the left side down for 3 days d. Keep head upright and cushioned with pillows for 24 hours

ANS: B Following a vitrectomy, the patient must assume a face-down position or turn the face to the right side for 4 to 5 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1874 OBJ: 11 TOP: Vitrectomy KEY: Nursing Process Step: Planning

24. A patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The blood glucose level is very high (880 mg/dL) on admission. The physician believes that the condi-tion is the result of large amounts of glucose solutions administered intravenously (IV) during re-nal dialysis. What should the nurse anticipate that the patient would exhibit? a. Fruity breath and a high level of ketones in her urine b. Severe dehydration and hypernatremia caused by the hyperglycemia c. Exactly the same symptoms and signs as DKA d. Kussmaul respirations, nausea, and vomit-ing

ANS: B IV solutions containing glucose bypass the digestive system; consequently, the pancreas is not triggered to release insulin. However, just enough insulin is present to prevent the breakdown of fatty acids and the formation of ketones. DIF: Cognitive Level: Application REF: p. 1066 OBJ: 5 TOP: Hyperglycemic Hyperosmolar Nonketotic Syndrome KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. What is the first indication of macular degeneration? a. The loss of peripheral vision b. The loss of central vision c. The loss of color discrimination d. Eye fatigue

ANS: B Macular degeneration is characterized by the slow loss of central and near vision. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1864 OBJ: 9 TOP: Macular degeneration KEY: Nursing Process Step: Assessment

2. A teenaged client appears to have developed hybrid diabetes. The nurse is aware that this type of diabetes causes the client to have which of the following? (Select all that apply.) a. insulin resistance associated type 1 diabetes b. antibodies against pancreatic islet cells associated with autoimmunity c. antibodies against pancreatic islet cells associated with type 1 diabetes d. insulin resistance associated with obesity e. insulin resistance associated type 2 diabetes f. antibodies against pancreatic islet cells associated with type 2 diabetes

ANS: B, C, D, E Youth with hybrid or mixed diabetes typically have insulin resistance associated with obesity and type 2 diabetes and antibodies against pancreatic islet cells associated with autoimmunity and type 1 diabetes.

1. The nurse is reviewing a client's medical history. Which factors would indicate that client is at risk for the development of diabetes? (Select all that apply.) a. triglyceride level of 199 mg/dL b. first child weighed 9 lbs 3 oz c. body mass index of 32 d. blood pressure of 138/78 e. taking antihypertensive medications f. great uncle who was diabetic

ANS: B, C, E The criteria for those who should be screened for diabetes include triglyceride level of 250 mg/dL or greater, hypertension, gestational diabetes, having a child weighing over 9 lbs, immediate family history, at-risk ethnic group, high-density lipoprotein (HDL) of 35 mg/dL or less, and having one of the two precursors of diabetes.

21. What has most likely occurred in a patient who has been diagnosed with endogenous hypoglyce-mia? a. Taken an overdose of hypoglycemic drugs b. Been following a very restricted fasting diet or is malnourished c. Excessive secretion of insulin or an in-crease in glucose metabolism d. Exercised unwittingly without replenishing needed fluids and nutrients

ANS: C Endogenous refers to within; in this patient, it refers to internal factors, such as an increase of insu-lin or glucose metabolism. Both conditions would lead to hypoglycemia. DIF: Cognitive Level: Application REF: p. 1084 OBJ: 1 TOP: Hypoglycemia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. A home health care nurse is assessing a patient with type 1 diabetes who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52 mg/dL. What action by this patient most likely caused this episode of hypoglycemia? a. Taking a new form of birth control pill this morning b. Using large amounts of sugar substitute in her tea this morning c. A 2-hour long exercise class at the spa this morning d. Administering an insufficient dose of insu-lin this morning

ANS: C Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much insulin for the available glucose and has become hypoglycemic. DIF: Cognitive Level: Application REF: p. 1068 OBJ: 10 TOP: Diabetes: Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

37. What should the nurse do when assisting a blind person to walk in an unfamiliar hospital environment? (Select all that apply.) a. Discourage the use of the cane b. Advise the patient to walk quickly c. Describe the surroundings d. Encourage the patient to ask for verbal cues e. Place patient hand on nurse's shoulder or elbow

ANS: C, D, E The patient should be given verbal cues about the environment. Allow the patient to hold the nurse's shoulder or elbow while the nurse walks in front, and encourage the use of a cane to let the patient "examine" the boundaries and obstacles. PTS: 1 DIF: Cognitive Level: Application REF: Page 1851 OBJ: N/A TOP: Assisting blind to walk KEY: Nursing Process Step: Implementation

2. When the body produces an excess amount of insulin, the nurse should monitor for signs and symptoms of: a. diabetes insipidus b. diabetes mellitus c. hyperglycemia d. hypoglycemia

ANS: D Hypoglycemia, or low blood glucose, results when the body produces an excess amount of insulin.

6. A young patient complains that diabetes is causing her to "have no life at all. It's too hard." What is the most helpful response by the nurse? a. "Yes, you must make some sacrifices." b. "It's hard, but with significant alterations in your lifestyle, you can live a long life." c. "What's hard about exercise, diet, and medicine?" d. "Let's talk about what makes it so hard."

ANS: D Involving the patient in decisions about how she will cope with her diabetes will make the goals more realistic and personal, which will give her a greater chance of success in meeting them. DIF: Cognitive Level: Application REF: p. 1081 | p. 1083 OBJ: 8 TOP: Diabetes Lifestyle KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

20. How should the nurse advise a patient who has severe vertigo from labyrinthitis? a. Lean against a wall and not head forward until vertigo lessens. b. Bend at the waist and take several deep breaths. c. Drink an iced drink slowly. d. Lie immobile and hold the head in one position until the vertigo lessens.

ANS: D Lying immobile and holding the head in one position will lessen vertigo. PTS: 1 DIF: Cognitive Level: Application REF: Page 1880, Patient Teaching OBJ: 16 TOP: Vertigo KEY: Nursing Process Step: Implementation

21. What do miotic eyedrops do for a patient with glaucoma? a. Dilate the pupil and sharpen vision b. Lubricate and moisten the dry eye c. Irrigate the surface of the eye d. Constrict the pupil and open the canal of Schlemm

ANS: D Miotic eyedrops allow the pupil to constrict and open the canal of Schlemm to drain the excess fluid. PTS: 1 DIF: Cognitive Level: Application REF: Page 1868 OBJ: 4 TOP: Aging KEY: Nursing Process Step: Assessment

20. What is the MOST common chronic complication of diabetes mellitus? a. blindness b. renal failure c. morbid obesity d. neuropathy

ANS: D Neuropathies are the most common chronic complication of diabetes; they occur more frequently with age and duration of the disease. While all types of nerves can be affected, sensorimotor polyneuropathy (peripheral neuropathy), involving the lower extremities, and autonomic neuropathy, involving virtually any organ system, occur most frequently.

26. What should a teaching plan about foot care include for a patient with diabetes? (Select all that apply.) a. Wash and carefully dry the feet every day. b. Apply lotion between the toes. c. Protect the feet from extreme temperatures. d. Walk barefoot only indoors. e. Buy shoes that are comfortable and sup-portive.

ANS: A, C, E Washing, inspecting, and drying the feet, especially between the toes, is essential. Protecting the feet from heat and cold and wearing supportive shoes is important to good foot health. Lotion can be applied to the soles and tops of the feet but not between the toes. Walking barefoot is contrain-dicated for a person with diabetes. DIF: Cognitive Level: Knowledge REF: p. 1063 OBJ: 5 TOP: Foot Care KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. The nurse should instruct clients with diabetes about "sick day management" of their disease by emphasizing which action? a. Report blood glucose lower than 100 mg/dL to the health care provider. b. Continue taking the scheduled insulin or oral hypoglycemic agent. c. Use sliding scale insulin to manage hypoglycemia. d. Increase intake of carbohydrates for the duration of the illness.

ANS: B It is important that persons with diabetes have a plan for maintaining their diabetes in the event of illness. It is important that they continue taking the scheduled insulin or oral hypoglycemic agent when they are experiencing illness, because illness and fever can increase blood glucose and the need for insulin.

3. Symptoms of glycosuria, polyuria, polydipsia, and ketoacidosis are indicative of which of these conditions? a. gestational diabetes mellitus b. idiopathic diabetes mellitus c. impaired glucose tolerance d. non-insulin-dependent diabetes mellitus

ANS: B Manifestations of type 1 diabetes typically include abrupt onset of glycosuria (glucose in the urine), polydipsia (excessive thirst), polyuria (increased urination), and polyphagia (increased hunger); ketonuria (ketones in the urine) may develop as fat stores are metabolized for energy.

9. When the newly blind male home health patient asks the nurse how he might get assistance, who might the nurse suggest he contact? a. American Red Cross b. American Foundation for the Blind for a list of agencies c. Local hospital social worker d. The public health department

ANS: B The American Foundation for the Blind has lists of agencies to assist and educate the visually impaired patient. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1852 OBJ: 15 TOP: Medications KEY: Nursing Process Step: Implementation

6. Four hours after a stapedectomy the patient complains that hearing has not improved at all. What knowledge would the nurse use to shape a response? a. A large percentage of stapedectomies are not successful b. It will take at least 10 days for the graft to heal c. Hearing will not return until edema subsides d. Hearing will improve after irrigation of the ear

ANS: C Hearing improvement will not be noted until edema subsides and the packing is removed. PTS: 1 DIF: Cognitive Level: Application REF: Page 1887 OBJ: 17 TOP: Stapedectomy KEY: Nursing Process Step: Implementation

31. The nurse counsels the 16-year-old boy that playing his music at high volume can result in impairment in hearing related to: a. damaged tympanic membrane. b. protective buildup of cerumen. c. damage of the fine hair cells in the organ of Corti. d. rupture of the oval window.

ANS: C Long-term exposure to loud noises can damage the fine hair cells in the organ of Corti, which causes a conductive hearing loss. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1890 OBJ: 12 TOP: Health promotion KEY: Nursing Process Step: Assessment

7. What is the cornerstone of treatment for the person who has type 2 diabetes? a. blood glucose monitoring b. medication with oral hypoglycemic agents c. nutritional therapy d. weight loss

ANS: C Medical management of type 2 diabetes focuses on dietary management, particularly for weight control, and exercise. If diet and exercise do not adequately control blood sugar levels, oral hypoglycemic medications or parenteral administration of insulin may be prescribed.

15. What is the advantage of giving metformin, a biguanide, to a client requiring oral hypoglycemic agents? a. It can be administered on a more flexible schedule. b. It does not have the major side effects of nausea, abdominal discomfort, and diarrhea. c. It does not increase insulin release or produce hypoglycemic episodes. d. It does not tend to react with other medications.

ANS: C Metformin (Glucophage), a biguanide, does not increase insulin but works by making existing insulin more effective at the cellular level.

14. In caring for a client who is taking oral hypoglycemic agents, the nurse recognizes these medications are used in the treatment of which type of diabetes? a. gestational, requiring therapy for a very short time b. type 1, not stable with insulin administration only c. type 2, not controlled with diet and exercise d. type 1 and type 2, not controlled by diet and exercise

ANS: C Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.

13. What should a patient who has had a cataract repair avoid? a. The use of eye patches b. The use of sunglasses c. The lifting of heavy objects d. Reading for long periods of time

ANS: C Postcataract patients should avoid any activity that increases the intraocular pressure, such as lifting heavy objects, stooping, and bending. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1860 OBJ: 11 TOP: Blindness KEY: Nursing Process Step: Planning

10. The nurse clarifies that the difference between a photorefractive keratectomy (PRK) and a laser in-situ keratomileusis (LASIK) is that a LASIK: a. reshapes the central cornea. b. makes partial-thickness radial incisions in the cornea. c. removes some internal layers of the cornea. d. implants intracorneal rings.

ANS: C The LASIK procedure removes some of the internal layers of the cornea affecting the central zone of vision. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1853 OBJ: 11 TOP: Visual acuity KEY: Nursing Process Step: Implementation

3. A patient tells a nurse that she eats "huge" amounts of food but stays hungry most of the time. What should the nurse explain as the cause of hunger experienced by persons with type 1 diabetes? a. Excess amount of glucose b. Need for additional calories to correct the increased metabolism c. Fact that the cells cannot use the blood glucose d. Need for exercise to stimulate insulin se-cretion

ANS: C The cells cannot use the glucose without insulin, so the patient with diabetes still feels hungry event though abundant glucose is circulating in the blood. DIF: Cognitive Level: Comprehension REF: p. 1059 OBJ: 3 TOP: Hunger in the Patient with Diabetes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse should teach the client to monitor for which complication of diabetic neuropathy? a. arthrosclerosis b. diabetic retinopathy c. injury and undetected foot injury d. kidney failure

ANS: C The incidence of neuropathy increases with age and duration of the disease. Decreased sensations in the lower extremities and decreased pain and temperature sensations coupled with decreased circulation places the client at risk for undetected foot injury.

4. What does the lack of insulin in patients with type 1 diabetes cause that increases the risk for cardiovascular disorders? a. High glucose levels that irritate and shrink the vessels b. Inadequate metabolism of proteins, which causes ketosis c. Increased fatty acid levels d. Increased metabolism of ketones, which causes hypertension

ANS: C The increase in fatty acid levels causes an increase in the level of triglycerides and an attendant rise in low-density lipoprotein levels. DIF: Cognitive Level: Knowledge REF: p. 1059-1060 OBJ: 5 TOP: Diabetes: Complications KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. What action should the nurse implement based on the reading of 72 mg/dL? a. Notify the charge nurse of the reading. b. Give regular insulin per a sliding scale. c. Give him 8 oz of skim milk. d. Administer the oral glucose tablet.

ANS: C The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hypoglycemic agent will not work quickly enough. The charge nurse can be notified later. Giving insulin per a sliding scale would lower the blood sugar level. DIF: Cognitive Level: Application REF: p. 1064 OBJ: 10 | 11 TOP: Hypoglycemic Reaction KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. Which person would be MOST likely to develop type 2 diabetes? a. a 20-year-old white athlete with a family history of diabetes b. a 30-year-old black athlete with a family history of diabetes c. a 40-year-old black female who is 50 pounds overweight d. a 50-year-old white male who is 10 pounds overweight

ANS: C The primary risk factor for developing type 2 diabetes is obesity; other risk factors include age, insufficient exercise, hypertension, dyslipidemia, history of gestational diabetes mellitus, ethnic background, and family history of diabetes.

1. A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin. What is the reason that the blood glucose is elevated? a. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth hormone) levels b. Malfunction of the glycogen-storing capa-bilities of the liver c. Destruction of the beta cells in the pancreas d. Insulin resistance of the receptor cells in the muscle tissue

ANS: C Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate insulin be-cause of the destruction of beta cells. DIF: Cognitiv`e Level: Comprehension REF: p. 1059 OBJ: 2 TOP: Type 1 Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. When mixing two different types of insulin in the same syringe, which type is always drawn up first? a. lente, intermediate acting b. NPH, intermediate acting c. regular, short acting d. ultra lente, long acting

ANS: C When mixing insulins, remember the memory trick of "RNs do it correctly!" R--Draw up regular (short acting) into the syringe first. N--Draw up the NPH (intermediate acting) insulin into the same syringe second.

11. What does the cataract treatment of phacoemulsification involve? a. "Drying" the cataract with hypertonic saline b. Removing the lens through the anterior capsule c. The insertion of a new lens d. Breaking the cataract with ultrasound

ANS: D Phacoemulsification uses ultrasound to break up the cataract. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1860 OBJ: 11 TOP: Infectious/inflammatory disorders KEY: Nursing Process Step: Planning

22. A client newly diagnosed with type 2 diabetes mellitus has a nursing diagnosis of Knowledge deficit: diabetes, medical regimen, diet, exercise, and self-care management skills. Which nursing goal is appropriate for this client? a. to maintain current weight b. to maintain vital signs within normal limits c. to use the food pyramid for meal planning d. to relate the importance of an exercise program

ANS: D The goals of exercise and nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, to prevent complications of diabetes, and to improve overall health. Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.

18. A patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was given. What is the best response by the nurse? a. "The exchange program is a carefully de-veloped and very important program that allows you to take control of your disease." b. "A lot of people have trouble with that program. You aren't the first one to go off your diet." c. "We had better check your blood work to see what you've done to yourself." d. "Okay. Let's talk about what you do eat and drink and how you manage your dia-betes."

ANS: D To evaluate the effectiveness of treatment, the nurse must first find out how the patient perceives the importance of diet, drugs, and exercise. DIF: Cognitive Level: Application REF: p. 1067 OBJ: 8 TOP: Nutrition KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. The nurse is caring for a client who has a family history of diabetes, is obese, and is aging. Which type of diabetes would the nurse suspect this client has? a. gestational diabetes mellitus b. immune-mediated diabetes mellitus c. type 1 diabetes mellitus d. type 2 diabetes mellitus

ANS: D Type 2 diabetes mellitus initially begins with insulin resistance, where the cells are not able to use the insulin properly. As it progresses, the pancreas gradually loses the ability to produce adequate qualities of insulin. Risk factors include family history, age, obesity, ethnicity, and a history of gestational diabetes.

2. A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin. The nurse explains that in type 2 diabetes mellitus, the body still makes insulin. What other information is pertinent for the nurse to relay? a. Overweight and underactive people cannot simply use the insulin produced. b. Metabolism is slowed in some people, so they have to take a pill to speed up their metabolism. c. Sometimes the autoimmune system works against the action of the insulin. d. The cells become resistant to the action of insulin. Pills are given to increase the sen-sitivity.

ANS: D Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more sensitive. DIF: Cognitive Level: Comprehension REF: p. 1059 OBJ: 2 TOP: Type 2 Diabetes Mellitus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A nurse preparing to administer insulin to a patient who has type 1 diabetes. The physician has prescribed two types of insulin, 10 U of regular insulin and 35 U of neutral protamine Hagedorn (NPH) insulin. Which is the proper procedure for the nurse to follow when preparing these medi-cations? a. Draw up the insulins in two separate sy-ringes to avoid confusion. b. Draw up the regular insulin before drawing up the NPH insulin. c. Inject air into the NPH insulin, draw it up to 35 U, and then inject air into the clear regular insulin and withdraw to 45 U. d. Inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

ANS: D When drawing up two insulins, the vials are injected with air, and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insu-lins. DIF: Cognitive Level: Application REF: p. 1071 OBJ: 11 TOP: Insulin Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort