Quiz 1 NU 225

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans for a diet that is less flexible when using the insulin pump.

a. The patient programs the pump for an insulin bolus after eating.

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is most important for the nurse to communicate to the health care provider? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes.

a. The patient uses oral contraceptives.

A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels.

parathyroid hormone Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.

a. Give the patient 4 to 6 oz more orange juice.

A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first? a. Infuse 1 liter of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.

a. Infuse 1 liter of normal saline per hour.

A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? a. Lispro (Humalog) b. Glargine (Lantus) c. Detemir (Levemir) d. NPH (Humulin N)

a. Lispro (Humalog)

Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.

a. Measure the ankle-brachial index.

A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Obtain urine glucose and ketone levels. d. Start an insulin infusion at 0.1 units/kg/hr.

a. Place the patient on a cardiac monitor.

Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder?

"Have you had a recent unplanned weight gain or loss?" Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?

"I feel a lump in my throat when I swallow" Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide?

"come to the laboratory to have the blood drawn early in the morning" Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)?

- "You will need to avoid smoking before the test." - "Several blood samples will be obtained during the testing." - "The test requires that you fast for at least 8 hours before testing." Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.

An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain

50% dextrose solution Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Rotate NPH vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial.

A D E B C Rotate NPH vial Inject 20 units of air into NPH vial. Inject 2 units of air into regular insulin vial. Withdraw regular insulin. Withdraw 20 units of NPH.

1. In the video, the examiner is Click here to view the video clip a. percussing for liver size. b. percussing for splenomegaly. c. palpating for abdominal distention. d. palpating for abdominal tenderness.

ANS: A The video demonstrates percussion of the right anterior chest and right abdomen to determine liver height. DIF: Cognitive Level: Understand (comprehension) REF: 843 TOP: Nursing Process: Assessment

The rise in the incidence of both overweight and obese children is directly related to the increase in the number of children diagnosed with _______________.

ANS: type 2 diabetes Type 2 diabetes is an emerging problem in the pediatric population. At the time of diagnoses, approximately 50% of the beta cells and the pancreas of type 2 diabetic children are still producing insulin. Education regarding healthy dietary choices and exercise are essential in managing these children.

7. To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patients back and presses upward and inward with the other hand below the patients right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patients lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.

ANS: A The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patients back slightly with the left hand. The other methods will not allow palpation of the liver. DIF: Cognitive Level: Apply (application) REF: 844 TOP: Nursing Process: Assessment

15. A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.

ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurses initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO. DIF: Cognitive Level: Apply (application) REF: 849 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

14. A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a drink of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patients mouth with cold water

ANS: A Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate. DIF: Cognitive Level: Apply (application) REF: 15 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

ANS: A Feedback A A goiter is an enlargement or hypertrophy of the thyroid gland. B Goiter is not associated with this secretory organ. C Goiter is not associated with this secretory organ. D Goiter is not associated with this secretory organ.

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? a. During the "honeymoon" phase b. During adolescence c. During growth spurts d. During minor illnesses

ANS: A Feedback A During the "honeymoon" phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. B During adolescence, physical growth and hormonal changes contribute to an increase in insulin requirements. C Insulin requirements are typically increased during growth spurts. D Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor illness.

A child with GH deficiency is receiving GH therapy. What is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morning

ANS: A Feedback A Injections are best given at bedtime to more closely approximate the physiologic release of GH. B This time does not mimic the physiologic release of the hormone. C This time does not mimic the physiologic release of the hormone. D This time does not mimic the physiologic release of the hormone.

What information provided by the nurse would be helpful to a 15-year-old adolescent taking methimazole three times a day? a. Pill dispensers and alarms on her watch can remind her to take the medication as ordered. b. She can take the medication when she is nervous and feels she needs it. c. She can take two pills before school and one pill at dinner, which will be easier for her to remember. d. Her mother can be responsible for reminding her when it is time to take her medication.

ANS: A Feedback A Methimazole is an antithyroid medication that should be taken three times a day. Reminders will facilitate taking medication as ordered. B This medication needs to be taken regularly, not on an as-needed basis. C The dosage cannot be combined to reduce the frequency of administration. D Because of the adolescent's school schedule and activities, she, rather than her mother, needs to be responsible for her medication.

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? a. The child's safety b. The privacy of the child c. Development of a sense of industry d. Peer group acceptance

ANS: A Feedback A Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. B Privacy is not a life-threatening concern. C The treatment of type 1 diabetes should not interfere with the school-age child's development of a sense of industry. D Peer group acceptance, along with body image, are issues for the early adolescent with type 1 diabetes. This is not of greater priority than the child's safety.

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? a. Two hours after administration b. Four hours after administration c. Immediately after administration d. Thirty minutes after administration

ANS: A Feedback A The peak action for Regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. B The duration of Regular (short-acting) insulin is only 3 to 6 hours. Peak action occurs 2 to 3 hours after the insulin is administered. C Subcutaneously administered Regular (short-acting) insulin has an onset of action of 30 to 60 minutes after injection. The effectiveness of subcutaneously administered, short-acting insulin cannot be assessed immediately after administration. D Thirty minutes corresponds to the onset of action for Regular (short-acting) insulin.

Which nursing intervention is appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? Select all that apply. a. Initiate IV access. b. Begin IV fluid replacement with normal saline. c. Begin IV fluid replacement with D5 1/2NS. d. Weigh on arrival to the unit and then every other day. e. Maintain strict intake and output monitoring.

ANS: A, B, E Feedback Correct IV access should always be obtained on a hospitalized child with dehydration and a history of type 1 diabetes. Maintaining circulation is a priority nursing intervention. If the child is vomiting and unable to maintain adequate hydration, fluid volume replacement/rehydration is needed. Normal saline is the initial IV rehydration fluid, followed by half-normal saline. Maintaining strict intake and output is essential in calculating rehydration status. Incorrect D5 1/2NS is not the recommended fluid for rehydration of this patient. Weighing the patient on arrival is important, but following the initial weight, the child needs to be weighed more frequently than every other day. Comparison of admission weight and a weight every 8 hours provides an indication of hydration status.

4. The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.

ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction. DIF: Cognitive Level: Apply (application) REF: 846 TOP: Nursing Process: Planning

2. A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.

ANS: B The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes. DIF: Cognitive Level: Apply (application) REF: 837 TOP: Nursing Process: Implementation

17. Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly? a. 1 b. 2 c. 3 d. 4

ANS: B The spleen is usually not palpable, but when palpated, it is located in left upper quadrant of abdomen. DIF: Cognitive Level: Understand (comprehension) REF: 843 TOP: Nursing Process: Assessment

11. The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following? a. How do you get to the store to buy your food? b. Can you tell me the food that you ate yesterday? c. Do you have any difficulty in preparing or eating food? d. Are you taking any medications that alter your taste for food?

ANS: B This question is the most open-ended, and will provide the best overall information about the patients daily intake and risk for poor nutrition. The other questions may be asked, depending on the patients response to the first question. DIF: Cognitive Level: Apply (application) REF: 841 TOP: Nursing Process: Assessment

13. A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area

ANS: B Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment. DIF: Cognitive Level: Apply (application) REF: 846 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

1. Which information about an 80-year-old man at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion

ANS: B Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss. DIF: Cognitive Level: Apply (application) REF: 839 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

ANS: B Feedback A Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. B Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. C Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. D Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

Exophthalmos (protruding eyeballs) may occur in children with which condition? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

ANS: B Feedback A Hypothyroidism is not associated with exophthalmos. B Exophthalmos is a clinical manifestation of hyperthyroidism. C Hypoparathyroidism is not associated with exophthalmos. D Hyperparathyroidism is not associated with exophthalmos.

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent? a. Hypocalcemia b. Hypoglycemia c. Diabetes insipidus. d. Hyperglycemia

ANS: B Feedback A Symptoms of hypocalcemia are associated with hypoparathyroidism. B Growth hormone helps maintain blood sugar at normal levels. C Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is produced by the anterior pituitary. D Hyperglycemia results from an insufficiency of insulin, which is produced by the beta cells in the islets of Langerhans in the pancreas.

Diabetes insipidus is a disorder of the a. Anterior pituitary b. Posterior pituitary c. Adrenal cortex d. Adrenal medulla

ANS: B Feedback A The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. C The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. D The adrenal medulla produces catecholamines.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B Feedback A The child should receive his regular dose of insulin even if he does not have an appetite. B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. C If the child is not eating as usual, he needs calories to prevent hypoglycemia. D During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

ANS: B Feedback A Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. C Serum carbon dioxide is decreased in diabetic ketoacidosis. D Serum phosphorus is decreased in diabetic ketoacidosis.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of a. Vitamin D b. Cortisone c. Stool softeners d. Calcium carbonate

ANS: B Feedback A Vitamin D has no role in the therapy of adrenogenital hyperplasia. B The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced so that circulatory collapse occurs without immediate replacement. C Stool softeners have no role in the therapy of adrenogenital hyperplasia. D Calcium carbonate has no role in the therapy of adrenogenital hyperplasia

A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic, and is having difficulty feeding. The nurse recognizes that this is most suggestive of a. Hypocalcemia b. Hypothyroidism c. Hypoglycemia d. Phenylketonuria (PKU)

ANS: B Feedback A When hypocalcemia is present, neonates may display twitching, tremors, irritability, jitteriness, electrocardiographic changes, and, rarely, seizures. B An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, and coldness to touch. C Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy, seizures, respiratory alterations including apnea, hypotonia, high-pitched cry, bradycardia, cyanosis, and temperature instability. D Infants with PKU may initially have digestive problems with vomiting, and they may have a musty or mousy odor to the urine, infantile eczema, hypertonia, and hyperactive behavior.

Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? Select all who apply. a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B, C, E Feedback Correct Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Incorrect These conditions do not usually cause SIADH.

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

ANS: B, D, E Feedback Correct A child with hypothyroidism will display fatigue, dry, thick skin, and cold intolerance. Incorrect Weight loss and diarrhea are signs of hyperthyroidism.

12. A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.6 F. d. The apical pulse is 104 beats/minute.

ANS: C A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure. DIF: Cognitive Level: Apply (application) REF: 849 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

9. After assisting with a needle biopsy of the liver at a patients bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patients postbiopsy coagulation studies.

ANS: C After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site. DIF: Cognitive Level: Apply (application) REF: 850 TOP: Nursing Process: Implementation

16. While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patients knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors.

ANS: C Familial adenomatous polyposis is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP. DIF: Cognitive Level: Apply (application) REF: 840 TOP: Nursing Process: Planning

8. Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds

ANS: C Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally. DIF: Cognitive Level: Apply (application) REF: 843 TOP: Nursing Process: Assessment

6. Which statement to the nurse from a patient with jaundice indicates a need for teaching? a. I used cough syrup several times a day last week. b. I take a baby aspirin every day to prevent strokes. c. I use acetaminophen (Tylenol) every 4 hours for back pain. d. I need to take an antacid for indigestion several times a week

ANS: C Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patients jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education. DIF: Cognitive Level: Apply (application) REF: 840 TOP: Nursing Process: Assessment

What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

ANS: C Feedback A A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. B Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. D Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

ANS: C Feedback A Blood glucose monitoring is more expensive but provides improved management. B It is as accurate as equivalent testing done in laboratories. C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. D The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

A common clinical manifestation of juvenile hypothyroidism is a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

ANS: C Feedback A Children with hypothyroidism are usually sleepy. B Constipation is associated with hypothyroidism. C Thick, dry skin, mental decline, cold intolerance, and weight gain are associated with juvenile hypothyroidism. D Decelerated growth is common in juvenile hypothyroidism.

New parents ask the nurse, "Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is a. Appropriate community referral for affected infants b. Parental education about raising a special needs child c. Early identification of serious genetically transmitted metabolic diseases d. Early identification of electrolyte imbalances

ANS: C Feedback A Community referral is appropriate after a diagnosis is made. B With early identification and treatment, serious complications such as intellectual impairment are prevented. C Early identification of hypothyroidism is basic to the prevention of intellectual impairment in the child. D Although electrolyte imbalances could occur with some of the inborn errors of metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte imbalances.

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? a. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. b. Give DDAVP only if urine output decreases. c. The child should have free access to water and toilet facilities at school. d. Cleanse skin before administering the transdermal patch.

ANS: C Feedback A DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. B DDAVP needs to be given continuously as ordered by the physician. C The child's teachers should be aware of the diagnosis, and the child should have free access to water and toilet facilities at school. D DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

ANS: C Feedback A Rotating injection sites is appropriate because insulin absorption varies at different sites. B Keeping records of serum glucose and insulin sites and amounts is appropriate. C Children with type 1 diabetes will require life-long insulin therapy. D Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 60 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

ANS: C Feedback A Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. B Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. C Irritability and serum glucose less than 60 mg/dL are neuroglycopenic manifestations of hypoglycemia. D Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

ANS: C Feedback A The adolescent with Graves' disease is not constipated. B Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child's medical provider. C To adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. D The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9 1/2 years

ANS: C Feedback A These ages fall within the expected range of pubertal onset. B These ages fall within the expected range of pubertal onset. C Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated. D These ages fall within the expected range of pubertal onset.

Which sign, when exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus? a. Weight gain b. Increased urine specific gravity c. Increased urination d. Serum sodium level of 130 mEq/L

ANS: C Feedback A Weight gain results from retention of water when there is an excessive production of antidiuretic hormone; in diabetes insipidus there is a decreased production of antidiuretic hormone. B Concentrated urine is a sign of the syndrome of inappropriate antidiuretic hormone (SIADH), in which there is an excessive production of antidiuretic hormone. C The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine. D A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an increased serum sodium concentration (greater than 145 mEq/L).

10. A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.

ANS: D Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study. DIF: Cognitive Level: Apply (application) REF: 848 TOP: Nursing Process: Implementation

5. The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).

ANS: D If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patients anxiety about discomfort. DIF: Cognitive Level: Apply (application) REF: 849 TOP: Nursing Process: Assessment

3. When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency.

ANS: D The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation. DIF: Cognitive Level: Apply (application) REF: 835 TOP: Nursing Process: Assessment

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Blurred vision

ANS: D Feedback A Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. B Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. C Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus. D Fatigue and blurred vision are clinical manifestations of type 1 diabetes mellitus.

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

ANS: D Feedback A Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. B Participation in sports is not contraindicated for a child with type 1 diabetes. C The child with type 1 diabetes may participate in sports activities regardless of climate. D Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia.

Type 1 diabetes, the most common childhood endocrine disease, presents challenges to the nurse in the areas of teaching, management, and adherence. Due to recent changes in health care delivery systems, meeting the needs of a type 1 diabetic child has become even more complicated. Unless the newly diagnosed child is in diabetic ketoacidosis, the child may not be hospitalized. Is this statement true or false?

ANS: T This statement is correct. Therefore the nurse must develop a plan of care that involves child and family education and supports them in either an inpatient or in outpatient setting.

A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test?

Allergies to iodine and shellfish Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

B C D F b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria f. Monofilament testing of the foot

The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test?

History of renal insufficiency Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patient's diagnosis of a pituitary tumor.

A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show

Increased urinary cortisol Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give a bolus of 50% dextrose. b. insert a large-bore IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.

b. insert a large-bore IV catheter.

The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing

a 24-hour urine test for free cortisol Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

a. "Do you feel bloated after eating?"

Which statement by the patient indicates a need for additional instruction in administering insulin? a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I can buy the 0.5 mL syringes because the line markings will be easier to see." c. "I should draw up the regular insulin first after injecting air into the NPH bottle." d. "I do not need to aspirate the plunger to check for blood before injecting insulin."

a. "I need to rotate injection sites among my arms, legs, and abdomen each day."

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a. 10:00 AM b. 12:00 AM c. 2:00 PM d. 4:00 PM

a. 10:00 AM

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Use callus remover for corns or calluses. d. Soak feet in warm water for an hour each day.

a. Choose flat-soled leather shoes.

In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what type of activities the patient enjoys. b. Remind the patient that exercise will improve self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.

a. Determine what type of activities the patient enjoys.

The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask? a. "Are you anorexic?" b. "Is your urine dark colored?" c. "Have you lost weight lately?" d. "Do you crave sugary drinks?"

c. "Have you lost weight lately?"

A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet.

a. The patient will reach a glycosylated hemoglobin level of less than 7%.

A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.

a. check glucose level before, during, and after swimming.

A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?

antidiuretic hormone level Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient's hyponatremia.

After change-of-shift report, which patient should the nurse assess first? a. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12% b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL c. 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dL d. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL

A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)? a. Amitriptyline decreases the depression caused by your foot pain. b. Amitriptyline helps prevent transmission of pain impulses to the brain. c. Amitriptyline corrects some of the blood vessel changes that cause pain. d. Amitriptyline improves sleep and makes you less aware of nighttime pain.

b. Amitriptyline helps prevent transmission of pain impulses to the brain.

The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? a. Ask the patient's family to participate in the diabetes education program. b. Assess the patient's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management.

b. Assess the patient's perception of what it means to have diabetes mellitus.

An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy? a. Hemoglobin A1C level 6.2% b. Blood pressure 146/88 mmHg c. Heart rate at rest 58 beats/minute d. High density lipoprotein (HDL) level 65 mg/dL

b. Blood pressure 146/88 mmHg

Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.

b. Give the patient a snack of peanut butter and crackers.

Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? a. Glyburide decreases glucagon secretion from the pancreas. b. Glyburide stimulates insulin production and release from the pancreas. c. Glyburide should be taken even if the morning blood glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media.

b. Glyburide stimulates insulin production and release from the pancreas.

Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates the most urgent need for the nurse's assessment of the patient? a. Bedtime glucose of 140 mg/dL b. Noon blood glucose of 52 mg/dL c. Fasting blood glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL

b. Noon blood glucose of 52 mg/dL

The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first? a. Teach the patient about administering regular insulin. b. Schedule the patient for a fasting blood glucose level. c. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy. d. Provide teaching about an increased risk for fetal problems with gestational diabetes.

b. Schedule the patient for a fasting blood glucose level.

Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient stores the insulin in the freezer after administering the prescribed dose. d. The patient pushes the plunger down while removing the syringe from the injection site.

b. The patient cleans the skin with soap and water before insulin administration.

A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam a. every 2 years. b. as soon as possible. c. when the patient is 39 years old. d. within the first year after diagnosis.

b. as soon as possible.

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose a. washes the puncture site using warm water and soap. b. chooses a puncture site in the center of the finger pad. c. hangs the arm down for a minute before puncturing the site. d. says the result of 120 mg indicates good blood sugar control.

b. chooses a puncture site in the center of the finger pad.

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. "I can have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I can choose any foods, as long as I use enough insulin to cover the calories." d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

c. "I can choose any foods, as long as I use enough insulin to cover the calories."

After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? a. "I may feel hungrier than usual when I take this medicine." b. "I will not need to worry about hypoglycemia with the Byetta." c. "I should take my daily aspirin at least an hour before the Byetta." d. "I will take the pill at the same time I eat breakfast in the morning."

c. "I should take my daily aspirin at least an hour before the Byetta."

After change-of-shift report, which patient will the nurse assess first? a. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon b. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.

The health care provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take? a. Avoid snacking at bedtime. b. Increase the rapid-acting insulin dose. c. Check the blood glucose during the night d. Administer a larger dose of long-acting insulin.

c. Check the blood glucose during the night

A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye exam was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.

c. Glomerular filtration rate is decreased.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

c. Obtain a glucose reading using a finger stick.

Which information is most important for the nurse to report to the health care provider before a patient with type 2 diabetes is prepared for a coronary angiogram? a. The patient's most recent HbA1C was 6.5%. b. The patient's admission blood glucose is 128 mg/dL. c. The patient took the prescribed metformin (Glucophage) today. d. The patient took the prescribed captopril (Capoten) this morning.

c. The patient took the prescribed metformin (Glucophage) today.

A 26-year-old patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin? a. thigh. b. buttock. c. abdomen. d. upper arm.

c. abdomen.

A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.

c. lifestyle changes to lower blood glucose.

A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a. use only the lispro insulin until the symptoms are resolved. b. limit intake of calories until the glucose is less than 120 mg/dL. c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.

c. require administration of insulin while taking prednisone.

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. "If I overeat at a meal, I will still take the usual dose of medication." b. "Other medications besides the Glucotrol may affect my blood sugar." c. "When I am ill, I may have to take insulin to control my blood sugar." d. "My diabetes won't cause complications because I don't need insulin."

d. "My diabetes won't cause complications because I don't need insulin."

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level

d. Glycosylated hemoglobin level

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? a. The patient administers the glargine 30 minutes before each meal. b. The patient's family prefills the syringes with the mix of insulins weekly. c. The patient draws up the regular insulin and then the glargine in the same syringe. d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.

d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.

The nurse is interviewing a new patient with diabetes who receives rosiglitazone (Avandia) through a restricted access medication program. What is most important for the nurse to report immediately to the health care provider? a. The patient's blood pressure is 154/92. b. The patient has a history of emphysema. c. The patient's blood glucose is 86 mg/dL. d. The patient has chest pressure when walking.

d. The patient has chest pressure when walking.

A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

d. The patient increases daily exercise when ketones are present in the urine.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's blood glucose level is 174 mg/dL. b. The patient has gained 2 lb (0.9 kg) since yesterday. c. The patient is scheduled for a chest x-ray in an hour. d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.

d. request that if testing is further delayed, the patient be returned to the unit to eat.

During the physical examination of a 36-year-old female, the nurse finds that the patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to

document that the thyroid was nonpalpable The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for

elevated serum potassium Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

The nurse reviews a patient's glycosylated hemoglobin (Hb A1C) results to evaluate

glucose control over the past 90 days Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor?

ionized calcium Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to

keep the specimen refrigerated or on ice The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching?

the RN palpates the neck thoroughly to check thyroid size Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider?

the patient has a 5-lb (2.3 kg) weight loss A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

Which information about a 30-year-old patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?

the patient takes oral corticosteroids for rheumatoid arthritis Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level?

the serum albumin level is low Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

thyroid-stimulating hormone (TSH) level A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?

value system When dealing with a patient with a chronic condition such as diabetes, identification of the patient's values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.