Quiz #1

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

a. monitoring the blood glucose level closely.

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

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

The nurse is reviewing the chart of a client with type 2 diabetes prior to a scheduled appointment. The chart states:Progress notes10/15/160245Client states that he has not been following his prescribed diabetes management program for the past 2 to 3 months. Client is aware of his blood glucose monitoring regimen and diet but has difficulty integrating each into his routines. Client denies recent changes in urinary function, sensation or vision.How can the nurse best determine this client's glycemic control since the last assessment? a. Arrange assessment of the client's fasting glucose level. b. Review the results of the client's HbA1c. c. Ask the client to complete a 24-hour food recall. d. Ask the client to describe recommended diet and glucose monitoring routine.

b. Review the results of the client's HbA1c.

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

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

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

b. reminding the client to check the glucose level before each meal

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

c. "I will start feeling more energetic."

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

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

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

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

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

c. Eat frequent but small meals.

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

d. Addison's disease

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

240

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

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

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

a. Ensure patency of the tube.

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

a. Pain management

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

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

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

a. acetaminophen

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

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

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

c. Initiate treatment for hypoglycemia as a result of insulin.

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

c. Maintaining adequate hydration

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

c. thyroid crisis

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

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

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

a. T3, thyroxine (T4), and calcitonin.

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

a. The client will correctly demonstrate blood glucose testing prior to discharge.

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

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

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

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

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

b. restricting fluids to 800 ml/day

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

b. weight loss, nervousness, and tachycardia

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

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

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

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

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

a. being obese

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

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

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

a. decreased body temperature and cold intolerance.

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

b. maintaining a patent airway

The nurse is to administer insulin to a client with diabetes mellitus. Which illustration indicates the appropriate syringe to use? a. b. c. d.

c.

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

d. Monitor blood glucose closely, and assess for signs of hypoglycemia.

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

d. aspiration.

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

a. goiter

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

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

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

c. glucagon

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

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