test 3 nursing questions

A client with type 1 diabetes mellitus is admitted to the emergency department. Which of the following respiratory patterns requires immediate action? 1. Deep, rapid respirations with long expirations. 2. Shallow respirations alternating with long expirations. 3. Regular depth of respirations with frequent pauses. 4. Short expirations and inspirations.

1 rationale: Deep, rapid respirations with long expirations are indicative of Kussmaul's respirations, which occur in metabolic acidosis. The respirations increase in rate and depth, and the breath has a "fruity" or acetone-like odor. This breathing pattern is the body's attempt to blow off carbon dioxide and acetone, thus compensating for the acidosis. The other breathing patterns listed are not related to ketoacidosis and would not compensate for the acidosis.

A client with diabetes is taking insulin lispro (Humalog) injections. The nurse should advise the client to eat: 1. Within 10 to 15 minutes after the injection. 2. 1 hour after the injection. 3. At any time, because timing of meals with lispro injections is unnecessary. 4. 2 hours before the injection.

1 rationale: Insulin lispro (Humalog) begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of Humalog is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.

The nurse is instructing a client with PUD about the diet that should be followed during the acute phase. Which type of diet would the nurse stress? 1:bland foods 2: regular diet 3:gluten free foods 4:low carb foods

1 rationale: a bland, nonirritating diet is recommended during the acute symptomatic phase. During the acute phase, a regular diet can cause discomfort. Clients should avoid coffee, tea, cola, and other substances that increase gastric acid secretions.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8°F (38.8°C). What should the nurse do in response to these reported assessment data? 1. Promptly assess the client for potential perforation. 2. Tell the assistant to change the thermometers and retake the temperature. 3. Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4. Ask the UAP to bathe the client with tepid water.

1 rationale: a sudden spike in temp following an endoscopic procedure may indicate perforation of the Gi tract. the nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock.

A client with GERD is being treated with dietary management. The client states, "I like to have a glass of juice every day." which juice will the nurse recommend? 1:apple 2:orange 3:tomato 4:grapefruit

1 rationale: apple juice is nonirritating to the stomach and intestine. The other options are acidic and can decrease the pH of the stomach and irritate the GI mucosa

The RN develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease. Which measures would the nurse include to increase arterial blood flow to the extremities? 1:exercises that promote muscular activity 2:meticulous care for minor skin breakdown 3:elevation of the legs above the level of the heart 4:soaking the feet in hot water each day

1 rationale: arterial blood flow is improved with exercise by fostering the development of collateral circulation. -Meticulous care of minor skin breakdown is important for a person with diabetes but it does not improve arterial blood flow -elevating the legs above the heart reduces arterial blood flow; the legs should be kept dependent to facilitate tissue perfusion

A client with type 1 diabetes has an above the knee amputation because of severe lower extremity arterial disease. Two days after surgery, which intervention is appropriate when preparing the client to eat dinner? 1:checking the clients serum glucose level 2:assisting the client out of bed into a chair 3:placing the client in the high fowler position 4:ensuring the clients residual limb is elevated

1 rationale: because the client has type 1 diabetes, it is essential that the BG level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. -the rest flex the hips which should be avoided

Which physiological changes would the nurse expect to find in a client with a 20 year history of type 2 diabetes? 1:blurry, spotty, or hazy vision 2:arthritic changes in the hands 3:hyperactive knee and ankle jerk reflexes 4:dependent pallor of the feet and lower legs

1 rationale: blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur with diabetes. Diabetic retinopathy is an abnormal growth of new blood vessels in the retina. -clients who are diabetic have peripheral neuropathy which is HYPOactive not hyperactive reflexes

The nurse provided education to a pt with PUD regarding foods and substances to avoid that would increase the secretion of gastric acid. Which food choice for breakfast selection made by the client indicates a need for further teaching? 1:coffee and toast 2:grapes and cheese 3:apple juice and pancakes 4:cheese and crackers

1 rationale: caffeine-containing drinks such as coffee, tea, and soda can increase the production of gastric acid

Which rationale explains why the nurse also monitors a client with a history of GERD for clinical manifestations of heart disease? 1:esophegeal pain may imitate the symptoms of a heart attack 2:GERD may predispose the client to the development of heart disease 3:strenuous exercise may exacerbate reflux problems 4:similar lab study changes may occur in both problems

1 rationale: clients may interpret symptoms associated with myocardial infarction as esophageal reflux and ignore them.

Which type of pain would the nurse expect a client with a duodenal ulcer to report? 1:pain that is relieved with eating 2:pain that is worse with antacids 3:pain that is relieved with sleep 4:pain that is worse 1 hour after eating

1 rationale: duodenal ulcer pain is relieved with food and antacids and often awakens the client at night when sleeping. -gastric ulcer pain is worse with eating or 1 hour after eating

Which mechanism of action explains how glyburide decreases serum glucose levels? 1:stimulates the pancreas to produce insulin 2:accelerates the liver release of stored glycogen 3:increases glucose transport across the cell membrane 4:decreases absorption of glucose from the GI system

1 rationale: glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium

Which instruction from the primary health care provider would the nurse anticipate reinforcing with a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye? 1:discontinue metformin 1 day before the procedure 2:discontinue metformin 1 week before the procedure 3:discontinue metformin 3 days after the procedure 4:discontinue metformin 7 days after the procedure

1 rationale: metformin can react with the iodinated contrast dye that is given for a renal CT and cause lactic acidosis.

Which info would the nurse base a response on to a parent who asks for guidance regarding who to tell of the diagnosis of diabetes of their child who plays on the soccer team? 1:children with diabetes who participate in active sports can have episodes of hypoglycemia 2:children may have to leave athletic teams if school authorities learn that they have diabetes 3:the school nurse will treat the child if clinical findings of hypoglycemia are recognized early 4:the coach might violate confidentiality by discussing the childs condition with other faculty members

1 rationale: people associated with the school who are interacting with the child should be told about the childs condition. Knowledgeable people can be alert for early signs of hypoglycemia and have snacks available for the child to prevent an episode

Which med may contribute to the development of a peptic ulcer in a client receiving immunosuppressive therapy? 1:prednisone 2:azathioprine 3:cyclosporine 4:cyclophosphamide

1 rationale: prednisone is a corticosteroid that suppresses inflammatory responses. A side effect of prednisone is peptic ulcers.

Which rationale would the RN expect for a mother being reluctant to feed her 6-week-old infant who recently had surgery for hypertrophic pyloric stenosis? 1:afraid that her babys vomiting will resume 2:unaware that she is allowed to feed her baby 3:not sure how to feed her baby with a special nipple 4:uncertain whether her baby will tolerate the thickened formula

1 rationale: previous experiences with projectile vomiting are frightening

Which management strategy is the TX of choice for hypertrophic pyloric stenosis? 1:surgery 2:daily meds during infancy 3:slow feeding for several months 4:dietary restrictions throughout childhood

1 rationale: surgery only can correct this

Which info would the Rn include in the clients meds teaching on the admin of aspirin 650 mg every 6 hours as needed for arthritic pain? (select all) 1:report persistent abd pain 2:do not chew enteric coated tabs 3:take the aspirin with meals or a snack 4:see a dentist if bleeding gums develop 5:switch to acetaminophen if tinnitus occurs

1,2,3 rationale: -aspirin therapy may lead to GI bleeding, which may be manifested by abd pain, which needs to be reported -taking aspirin with food decreases ulceration -bleeding gums should be reported to HCP not dentist

Which medication is classified as an H2 receptor antagonist? (select all that apply) 1:nizatidine 2:ranitidine 3:famotidine 4:lansoprazole 5:metoclopramide

1,2,3 rationale: These medications are H2 receptor antagonists that reduces gastric acid secretion and provide symptomatic improvement in GERD

The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications? (select all that apply) 1:examine the feet daily 2:wear well fitting shoes 3:perform regular exercise 4:powder the feet after showering 5:visit the HCP weekly 6:test bathwater with toes before bathing

1,2,3 rationale: pts with diabetes have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma -well fitted shoes prevent pressure and rubbing that can cause tissue damage and ulcers -daily exercise increases the uptake of glucose by the muscles and improves insulin use

A client with type 1 diabetes for 25 years states, "I have been really bad for the past 15 years. I have not paid attention to my diet and have done little to control my diabetes". Which common complications of diabetes might the nurse expect to identify when assessing this client? (select all that apply) 1:leg ulcers 2:loss of visual acuity 3:thick, yellow toenails 4:increased growth of body hair 5:decreased sensation in the feet

1,2,3,5 rationale: -leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. -retinopathy, damage to the microvascular system of the retina (edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. -thick, yellow toenails result from prolonged inadequate arterial circulation to the feet -pedal pulses diminish, which can result in gangrene, necessitating amputation

Which insulin can be administered IV? (select all) 1:lispro 2:aspart 3:regular 4:glargine 5:glulisine

1,2,3,5 rationale: glargine is long acting insulin that is NOT approved for IV use

A nurse is participating in a diabetes screening program. Who of the following is (are) at risk for developing type 2 diabetes? Select all that apply. 1. A 32-year-old female who delivered a 91⁄2-lb (4,309-g) infant. 2. A 44-year-old Native American (First Nations) who has a body mass index (BMI) of 32. 3. An 18-year-old immigrant from Mexico who jogs four times a week. 4. A 55-year-old Asian who has hypertension and two siblings with type 2 diabetes. 5. A 12-year-old who is overweight.

1,2,4,5 rationale: The risk factors for developing type 2 diabetes include giving birth to an infant weighing more than 9 lb (4,082 g); obesity (BMI over 30); ethnicity of Asian, African, Native American, or First Nations; age greater than 45 years; hypertension; and family history in parents or siblings. Childhood obesity is also a risk factor for type 2 diabetes. Maintaining an ideal weight, eating a low-fat diet, and exercising regularly decrease the risk of type 2 diabetes.

The nurse is providing discharge instructions for a client with a diagnosis of GERD. Which recommendations would the RN give to the pt to limit symptoms of GERD? (select all) 1:avoid heavy lifting 2:lie down after eating 3:avoid drinking alcohol 4:eat small, frequent meals 5:increase fluid intake with meals 6:wear an abdominal binder or girdle

1,3,4 rationale: -heavy lifting increases intra-abdominal pressure allowing gastric contents to move up through the LES (regurgitation) causing heartburn (pyrosis) -alcohol, peppermints, caffeine, and chocolate decrease LES pressure which permits gastric contents to move from the stomach into the esophagus -increasing fluids with meals increase the gastric volume causing distention and reflux

Which clinical manifestation would the nurse expect to assess in an infant diagnosed with hypertrophic pyloric stenosis (HPS)? (select all) 1:white vomitus 2:abdominal pain 3:peristaltic waves 4:insatiable hunger 5:abdominal distention

1,3,4 rationale: -the vomitus is white (color of milk) because the obstruction is above the ampulla of Vater, and the feedings are expelled before digestion and absorption take place. -Vomiting usually occurs shortly after a feeding. Visible peristaltic waves are typical of infants with HPS bc of gastric hypermotility. -Hunger is evidenced by crying and vigorous suckling that is not diminished after a feeding. The infant will accept a second feeding after a vomiting episode. The crying is caused by hunger not pain

Which manifestation would the RN include when teaching a client about ketoacidosis? (select all that apply) 1:confusion 2:hyperactivity 3:excessive thirst 4:fruity scented breath 5:decreased urinary output

1,3,4 rationale: DKA signs and symptoms often develop quickly, sometimes within 24 hours. DKA is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). DKA develops when the body is unable to produce enough insulin; without enough insulin, the body begins to break down fast as an alternative fuel. This process produces the buildup of ketones (toxic acids) in the bloodstream -common symptoms: confusion, thirsty, fruity smell, weakness and fatigue, frequent urination, nausea, vomit ,abdominal pain, SOB

The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medication. Which instruction would the nurse include in the teaching plan? (select all) 1:the client should obtain a finger stick blood glucose reading before each meal 2:the client does not need to follow a specific diet until insulin is required 3:the teaching plan should include signs and symptoms of hypoglycemia 4:the teaching plan should include how to administer regular insulin 5:the teaching plan should include sick day rules

1,3,5

Which factors contribute to a clients slow rate of healing? (select all) 1:diabetes 2:cataract 3:smoking 4:dermatitis 5:alcohol abuse

1,3,5 rationale: -diabetes causes narrowing of blood vessels, thereby causing diminished blood supply to the affected organ or tissue; clients with diabetes have a slow healing rate

Which info would the RN include in the teaching plan of an adolescent who is found to have type 1 diabetes? (select all) 1:insulin therapy 2:prophylactic antibiotics 3:blood glucose monitoring 4:oral hypoglycemic agents 5:adherence to the treatment regimen

1,3,5 rationale: because clients with type 1 have little or no endogenous insulin, they must take insulin.

Which clinical finding would the nurse expect when assessing an infant with a tentative diagnosis of hypertrophic pyloric stenosis? 1:visible peristaltic waves across the lower abd 2:palpable mass in the epigastric area to the right of the umbilicus 3:tenderness over the epigastric region not relieved by heat application 4:lower abd distention with vomiting of bile-stained gastric contents

2 rationale: a typical sign of hypertrophic pyloric stenosis is a mass caused by hypertrophy of the circular muscle of the pylorus. -the visible peristaltic waves move from left to right, not the lower abd -abd distention is not present in HPS; little food reaches the intestines bc of gastric obstruction

A 9 year old child with type 1 diabetes is prone to having hypoglycemic episodes in the morning. Which intervention would be included in the school nurse's plan of care for this child? 1:limiting fluid intake during school hours 2:asking the child each day what was eaten for breakfast 3:considering the presence of diabetes but treating the child the same as other children 4:checking several times a day for injuries because of participation in the physical education program

2 rationale: asking a child what was eaten for breakfast each day is necessary if the child experiences episodes of hypoglycemia

The RN is caring for an infant who is to undergo surgery for hypertrophic pyloric stenosis. Which clinical scenario would the nurse recognize as important for surgical success? 1:vomiting is not yet severe and projectile 2:fluid and electrolyte imbalances are corrected 3:small feedings of the thickened formula are tolerated 4:amount of drainage from gastric decompression is sufficient

2 rationale: dehydration and metabolic alkalosis must be corrected before the infant can undergo the stress of anesthesia and surgery successfully.

Which parent teaching would the nurse provide to prevent vomiting in an infant who had corrective surgery for hypertrophic pyloric stenosis? 1:rock the infant 2:keep the infant's head elevated 3:place the infant flat on the right side 4:keep the infant awake with sensory stimulation

2 rationale: elevating the infants head helps prevent vomiting through the use of gravity. -Movement increase the chance of vomiting. -Placing the infant on the side will not prevent vomiting and may result in aspiration.

Which client would the nurse suspect as having peptic ulcer disease after reviewing the morning lab reports? 1:haemophilus influenza 2:helicobacter pylori 3:pseduomonas aeruginosa 4:staphylococcus aureus

2 rationale: helicobacter pylori is a bacterium infecting the GI tract and causes peptic ulcers and gastritis.

A client is admitted to the hospital with a diagnosis of peptic ulcer. Which common complication would the RN assess for in this client? 1:perforation 2:hemorrhage 3:pyloric obstruction 4:esophageal varices

2 rationale: hemorrhage because of erosion of blood vessel walls is the most common complication of PUD.

Which assessment would the nurse perform while caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis? 1:quality of the cry 2:signs of dehydration 3:coughing up feedings 4:characteristics of the stool

2 rationale: hypertrophic pyloric stenosis causes partial and then complete obstruction. -nonprojectile vomiting progresses to projectile vomiting, which rapidly cause dehydration

Which parent teaching would the RN provide the parents of an infant being discharged after surgery for pyloric stenosis? 1:offer the baby creamy cereal at each feeding and follow it with a regular formula 2:hold the baby while continuing to feed a regular formula slowly and burp frequently 3:allow the baby to drink about 1oz of a regular formula per hour for a week, and progress slowly to larger amounts 4:place the baby on the right side in the crib during feedings with regular formula and minimize handling for 2 hours after feedings

2 rationale: if there are no complications, the infant resumes regular feedings soon after surgery.

Which education would the nurse provide the parent of an infant with pyloric stenosis? 1:it is unlikely that surgery will be necessary 2:This is a condition with an excellent prognosis 3:This condition results form an error of metabolism 4:special feedings will be needed for a few weeks after surgery

2 rationale: in the absence of severe dehydration and malnutrition, the mortality rate is very low; immediate fluid and electrolyte replacement followed by surgery usually results in full recovery -surgery is necessary and the success rate is high and has rapid recovery -pyloric stenosis is a structural defect; hypertrophy of the circular muscle of the pylorus causes obstruction at the pyloric sphincter; this is not caused by an inborn error of metabolism

Which response would a nurse give to a client who asks "why cant I take the insulin in pills instead of taking shorts?", during a teaching session about insulin injections? 1:insulin cannot be manufactured in pill form 2:insulin is destroyed by gastric juices, rendering it ineffective 3:your HCP decides the route of admin 4:your HCP will prescribe pills when you are ready

2 rationale: insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. -insulin is not given orally at this time bc it is inactivated by digestive enzymes.

Which complication associated with type 1 diabetes should the nurse include in the teaching plan for the parent of a newly diagnosed child? 1:obesity 2:ketoacidosis 3:resistance to treatment 4:hypersensitivity to other medications

2 rationale: ketoacidosis is a complication of type 1 diabetes; children require close blood glucose monitoring because of the demands of growth and their erratic diets.

Which information would the nurse provide to a client with type 1 diabetes who requests information about the differences between penlike insulin delivery devices and syringes? 1:the penlike devices have a shorter injection time 2:penlike devices provide a more accurate dose delivery 3:the penlike delivery system uses a smaller gauge needle 4:penlike devices cost less by having reusable insulin cartridges

2 rationale: penlike insulin delivery devices are more accurate because they are easy to use; also, they promote adherence to insulin regimens because the medication can be administered discreetly.

When will the nurse monitor for a potential hypoglycemic reaction after administering daily regular insulin to a client with type 1 diabetes at 8 am? 1:at breakfast 2:before lunch 3:before dinner 4:in the early afternoon

2 rationale: regular insulin is short acting and peaks in 2-4 hours, which in this case will be at or before lunch. Breakfast is too soon; regular insulin peaks in 2-4 hours.

The RN is obtaining a health history from a client with a diagnosis of peptic ulcer disease. The nurse identifies a possible contributory risk factors when the client makes which statement? 1:my blood type is A positive 2:I smoke one pack of cigs a day 3:I have been overweight most of my life 4:my BP has been high lately

2 rationale: smoking cigs increases the acidity of gastrointestinal secretions, which damages the mucosal lining.

Which manifestation of hypertrophic pyloric stenosis in an infant would the nurse expect when palpating the abdomen? 1:a distended colon 2:marked tenderness around the umbilicus 3:an olive-sized mass in the right upper quadrant 4:rhythmic peristaltic waves in the lower abdomen

3 rationale: The olive like mass is caused by the thickened muscle (hypertrophy) of the pyloric sphincter.

a pt evaluated at a clinic, and the HCP suspects that the pt has anemia and a peptic ulcer. To determine if the client has a peptic ulcer, the RN expects that which diagnostic test will be performed. 1:barium enema 2:gastric biopsy 3:gastric culture 4:stool exam

3 rationale: a gastric culture enables the HCP to identify the presence of H pylori. 2-3rds of individuals with gastric or duodenal ulcers are infected with this organism.

Which is the priority short term goal when teaching a pt with type 1 diabetes who is placed on an insulin pump to control the diabetes? 1:the client will adhere to the medical regimen 2:the client will remain normoglycemic for 3 weeks 3:the client will demonstrate the correct use of the insulin pump 4:the client will list three self care activities that are necessary to control the diabetes

3 rationale: demonstrating the correct use of the admin equipment is a short term, client orient goal that is necessary for the pt to control the diabetes and is measurable when the pt performs a return demo for the nurse

Which clinical finding would the nurse expect when assessing a 3-week-old infant with hypertrophic pyloric stenosis who is severely dehydrated? 1:weight loss of 5% 2:severe allergic reaction 3:depressed anterior fontanel 4:urine specific gravity of 1.014

3 rationale: depressed fontanels related to decreased cerebral spinal fluid are a classic sign of FVD in infants. -5% is a mild dehydration, infants with severe will have 15% weight loss

While hospitalized, a client with diabetes is observed picking at calluses on the feet. Which intervention would the nurse implement immediately? 1:warn the client of the danger of infection 2:suggest that the client wear white cotton socks 3:teach the client the importance of effective foot care 4:check the clients shoes for their fit in the area of the calluses

3 rationale: inadequate foot care can lead to skin breakdown, poor healing, and subsequent infection, so the nurse should teach the client the importance of effective food care.

Which explanation would the Rn provide to a client with gastric ulcer disease who asks the nurse why the HCP has prescribed metronidazole? 1:to augment the immune response 2:to potentiate the effect of antacids 3:to treat helicobacter pylori infection 4:to reduce hydrochloric acid secretion

3 rationale: two thirds of clients with peptic ulcer disease are found to have h pylori infecting the mucosa and interfering with its protective function.

The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? 1. Carbohydrates only. 2. Fats and carbohydrates only. 3. Protein and carbohydrates only. 4. Proteins, fats, and carbohydrates.

4 rationale: Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins.

A client is to receive glargine insulin in addition to a dose of aspart. When the nurse checks the blood glucose level at the bedside, it is greater than 200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins? 1. Put air into the glargine insulin vial, and then air into the aspart insulin vial, and draw up the correct dose of aspart insulin first. 2. Roll the glargine insulin vial, then roll the aspart insulin vial. Draw up the longer-acting glargine insulin first. 3. Shake both vials of insulin before drawing up each dose in separate insulin syringes. 4. Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then, with a different insulin syringe, put air into the aspart vial and draw up the correct dose.

4 rationale: Glargine is a long-acting recombinant human insulin analog. Glargine should not be mixed with any other insulin product. Insulins should not be shaken; instead, if the insulin is cloudy, roll the vial or insulin pen between the palms of the hands.

The nurse is administering the initial dose of a rapid-acting insulin to a client with type 1 diabetes. The nurse should assess the client for hypoglycemia within: 1. 0.5 hours. 2. 1 hour. 3. 2 hours. 4. 3 hours.

4 rationale: Rapid-acting insulin has an onset in 15 minutes, peaks at 1 hour, and lasts for 3 to 4 hours. Rapid-acting insulin is administered right before or right after a meal. The nurse should assess the client for hypoglycemia 1 hour following administration of the drug.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. The nurse should do which of the following first? 1. Administer pain medication as prescribed. 2. Raise the head of the bed. 3. Prepare to insert a nasogastric tube 4. Notify the physician.

4 rationale: The client is experiencing a perforation of the ulcer, and the nurse should notify the physician immediately. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation.

The nurse is teaching a client about safe insulin administration. Which statement made by the client indicates the need for further education? 1:I should see whether the insulin is expired 2:I should keep a daily logbook of times of insulin injection 3:I should keep my medication in its original labeled container 4: I should administer insulin only if there are any symptoms

4 rationale: The client should admin insulin regardless of symptoms and should maintain the dose and daily schedule as prescribed by the HCP

An adult with type 2 diabetes mellitus has been NPO since 10 PM in preparation for having a nephrectomy the next day. At 6 AM on the day of surgery, the nurse reviews the client's chart and laboratory results. Which finding should the nurse report to the physician? 1. Urine output of 350 mL in 8 hours. 2. Urine specific gravity of 1.015. 3. Potassium of 4.0 mEq (4 mmol/L). 4. Blood glucose of 140 mg/dL (7.8 mmol/L).

4 rationale: The client's blood glucose level is elevated, beyond levels accepted for fasting; normal blood glucose range is 70 to 120 mg/dL (3.9 to 6.7 mmol/L). The specific gravity is within normal range (1.001 to 1.030). Urine output should be 30 to 50 mL/h; thus, 350 mL is a normal urinary output over 8 hours. The potassium level is normal.

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. Which is the best response by the RN? 1:you can order diabetic foods on most airlines and in restaurants. 2:plan your food ahead and carry it with you from home 3:monitor your blood glucose level frequently and eat accordingly 4:choose the foods you normally do and follow your food plan wherever you are

4 rationale: according to an individual's needs, consistency and regularity in the food pan should be maintained; this is a basic principle of dietary management of diabetes. ordering diabetic foods is not necessary; the client can make selections from regular food choices.

An infant has had a pyloromyotomy performed after the diagnosis of hypertrophic pyloric stenosis. In which position would the nurse teach the parent to place the infant during and after feeding? 1:supine for feedings; held upright afterward to be burped 2:side lying for feedings; rocked afterward to reduce crying 3:at a 45 degree angle for feedings; prone with the upper body elevated afterward 4: right side lying at 90 degrees angle (semi fowler)

4 rationale: during and after feeding, the position that most favor gravity is used to promote the retention of fluid, prevent vomiting, and facilitate the flow of gastric contents through the pyloric sphincter; therefore the infant should be placed at a 90-degree angle on the right side with the upper body elevated

The nurse is teaching a client about GERD. Which statement made by the client indicates a correct understanding of GERD management? 1: three meals per day is the best regimen to avoid GERD symptoms 2:i can reduce my GERD symptoms through a high-carb, low fat diet 3:a snack at bedtime will help reduce the acidity of my stomach during the night 4: I will place a 6inch block under the head of my bed to help with digestion

4 rationale: elevation of the HOB can enhance esophageal emptying and reduce symptoms of GERD. A low fat diet, high protein diet is recommended. Eating should be avoided 3 hours before bedtime to reduce acid production, and the client should be instructed to consume small, frequent meals throughout the day to avoid gastric distention

Which is an appropriate teaching goal for a client who is newly diagnosed as having type 2 diabetes? 1:to perform foot care weekly 2:to administer insulin as prescribed 3:to test urine for both sugar and acetone 4:to identify symptoms of hypo/hyperglycemia

4 rationale: knowledge of this is critical to the client's health and well being and essential for survival -foot care should be done daily -type 2 needs oral hypoglycemic not insulin

Which statement by pt who has a gastric ulcer and asks what to do if epigastric pain occurs indicates that teaching was effective? 1:eliminating fluids with meals will prevent pain 2:i will increase my food intake to avoid an empty stomach 3:taking an aspirin with milk will relieve my pain and coat my ulcer 4:taking an antacid preparation will decrease pain due to gastric acid

4 rationale: over the counter antacid preparations neutralize gastric acid and relieve pain.

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch, the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate? 1: administer insulin to the client 2:give the client lunch immediately 3:encourage the client to drink fluids 4:assess the clients BG level

4 rationale: the client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within 4 hours or just before lunchtime

Which information would the nurse reinforce when teaching a client with gastroesophageal reflux disease (GERD) about antacid therapy? 1:Antacids should be taken 1 hour before meals 2:these should be scheduled at 4 hour intervals 3:antacid tablets are just as fast and effective as the liquid form 4:antacids commonly interfere with the absorption of other medications

4 rationale: they interfere with medications such as anticholinergics, barbiturates, tetracycline, and digoxin. -should be taken 1-2 hours after meals and at bedtime

Which lab test would the RN expect to be prescribed that will reveal the effectiveness of a diabetic regimen for a child with type 1 diabetes? 1: serum glucose 2:glucose tolerance 3:fasting blood sugar 4:glycosylated hemoglobin

4 rationale: this test provides an accurate long-term index of the average blood glucose level for the 100-120 days before the test; the test is not affected by short-term variations. A result of less than 8% for this child indicates that the diabetic regimen is effective

An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says: 1. "If I know I'll be having alcohol, I must not take metformin; I could develop lactic acidosis." 2. "If my physician approves, I may drink alcohol with my metformin." 3. "Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat." 4. "If I feel bloated, I should call my physician."

1 rationale: A rare but serious adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are fatal. Ideally, one should stop metformin for 2 days before and 2 days after drinking alcohol. Signs and symptoms of lactic acidosis are weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light-headedness, and bradycardia or cardiac arrhythmias. Bloating is not an adverse effect of metformin.

Which diet would the nurse anticipate for a 4 week old infant after surgical repair for hypertrophic pyloric stenosis? 1:electrolye solution 2:full strength formula 3:half strength formula 4:cereal thickened water

1 rationale: After surgery, initial feedings consist of an electrolyte solution such as Pedialyte until the infant's tolerance of progressive feedings is determined

Which family history would the nurse recognize as a risk factor for an infant developing hypertrophic pyloric stenosis (HPS)? 1:a first cousin underwent surgery for HPS 2:the birth was preterm, and the birth weight was 4lb 3:An older brother had idiopathic vomiting during infancy 4:The older sister experienced an intestinal obstruction during early infancy

1 rationale: The higher incidence of hypertrophic pyloric stenosis amount first degree relatives seems to indicate a hereditary cause

After an acute episode of upper GI bleeding, a client vomits undigested antacids and reports having severe epigastric pain. The RN assessment reveals an absence of bowel sounds, a pulse rate of 134, and shallow respirations of 32. In addition to calling the HCP, what action should the nurse take? 1:prepare the pt for surgery 2:request a chest x ray 3:place the pt in the supine position, with legs elevated 4:ask the pt if there have been any black stools

1 rationale: these symptoms are classic indicators of a perforated ulcer, for which immediate surgery is indicated; this should be anticipated.

Which parent education would the RN provide for an infant who is restarting bottle feedings after surgery for hypertrophic pyloric stenosis (HPS)? 1:start with small, frequent feedings 2:rock for 20 mins after feeding 3:keep the infant awake for 30 minutes after feeding 4:position the infant flat on the right side during feedings

1 rationale: this decreases the risk of vomiting

A pt diagnosed with a duodenal ulcer asks, what is likely to be prescribed next?" which is the nurse's best response? 1:medication. This provides healing for most peptic ulcers 2:management of pain while you are eating. This is when pain usually occurs 3: surgery. this is usually performed soon after the first attack 4:aggresive treatment. untreated ulcers can lead to cancer of the stomach

1 rationale: treatment with medications, rest, diet, and stress reduction relieves symptoms, heals the ulcer, and prevents complications and recurrence. -clients with duodenal ulcers have pain after eating and especially at night; GASTRIC ulcers cause pain during or close to eating -surgery may be done after multiple recurrences and for treating complications

Which intervention would the RN prioritize when planning a teaching program for a child who was recently diagnosed with Type 1 diabetes? 1:exploring the childs feelings about diabetes 2:explaining how to calculate carbohydrate intake 3:ensuring that the child learns to monitor blood glucose 4:helping the child practice administering insulin injection

1 rationale: understanding the childs feelings about diabetes is essential in helping guide positive self-concept and discussing how to still be a normal child.

Which interventions would the nurse include in the plan of care for a client with GERD? (select all) 1:encourage client to follow the prescribed treatment regimen 2:keep the HOB elevated to 30 degree 3:avoid placing the client in the supine position for 2-3 hours after a meal 4:instruct the client to eat 6 small meals a day with the last just before bedtime 5:instruct the client to take a proton pump inhibitor before the first meal of the day

1,2,3 rationale: -clients should avoid food and activities that cause reflux such as eating late at night -proton pump inhibitors should be taken before the first meal of the day and are more common in treating peptic ulcer disease

A client with GERD needs to make dietary and lifestyle changes. Which instructions would the nurse include in the client's discharge teaching? (select all that apply) 1:encourage the client to quit smoking 2:elevate the food of the bed 3:avoid milk and dairy products 4:eat three large, evenly spaced meals daily 5:avoid lying down for 2-3 hours after eating

1,5 rationale: -the head not foot of bed should be elevated to prevent nighttime reflux; at night, infrequent swallowing and a recumbent position can impair esophageal clearance.

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. 1. A major risk factor for complications is obesity and central abdominal obesity. 2. Supplemental insulin is mandatory for controlling the disease. 3. Exercise increases insulin resistance. 4. The primary nutritional source requiring monitoring in the diet is carbohydrates. 5. Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations.

1,5 rationale: Being overweight and having a large waist-hip ratio (central abdominal obesity) increase insulin resistance, making control of diabetes more difficult. The American and Canadian Diabetes Associations recommend a yearly referral to an ophthalmologist and podiatrist. Exercise and weight management decrease insulin resistance. Insulin is not always needed for type 2 diabetes; diet, exercise, and oral medications are the first-line treatment. The client must monitor all nutritional sources for a balanced diet—fats, carbohydrates, and protein.

Which explanation would the RN provide to a pt with burns and crushing injuries caused by an accident prescribed oral antacids and IV ranitidine who asks how these meds work? 1:these meds work together to decrease bowel irritability 2:they limit acidity in the GI tract 3:they are very effective in clients with multiple trauma 4:these meds decrease vomiting

2

Which assessment finding would the nurse report to the primary HCP because it likely indicates pyloric stenosis? 1:loud bowel sounds 2:sudden expulsion of diarrheal stool 3:peristaltic waves that traverse the epigastrium 4:regurgitation of a portion of the feeding when burped

3 rationale: left to right peristalsis is noted as the stomach tries to force the feeding into the duodenum.

Which info would be included in the teaching plan for the older adult with peptic ulcer disease who is taking an antacid and sucralfate? 1:antacids should be taken 30 mins before a meal 2:sucralfate should be taken on an empty stomach 1 hour before meals 3:sucralfate is prescribed for the long-term maintenance of peptic ulcer disease 4:sodium bicarbonate is an inexpensive over the counter antacid with few adverse effects

2 rationale: sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either 1-2 hours after meals. It should also be administered no sooner than 30 mins before or after an antacid -sucralfate is prescribed for the short term treatment for peptic ulcer

Why is the vomitus of an infant with pyloric stenosis white rather than bile-stained? 1: the pyloric sphincter obstructs the bile duct 2:there is an obstruction above the opening of the common bile duct 3:the bile duct sphincter is connected to the hypertrophied pyloric muscle 4:there is a constriction of the cardiac sphincter that obstructs the flow of bile

2 rationale: the common bile duct enters the duodenum. The pyloric sphincter is located between the end of the stomach and the beginning of the duodenum; therefore, when it is hypertrophied the tight sphincter prevents any mixing of vomited formula with bile

The nurse is caring for a client who has had a gastroscopy. Which of the following may indicate that the client is developing a complication related to the procedure? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100°F (37.8°C). 3. The client appears drowsy following the procedure. 4. The client has epigastric pain. 5. The client experiences hematemesis.

2,4,5 rationale: Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? 1:glargine 2:NPH insulin 3:insulin aspart 4:insulin detemir

3 rationale: insulin aspart is a rapid-acting insulin (within of 10-20 minutes) and is used to meet a client's immediate insulin needs. For DKA, you need a rapid acting insulin -glargine/detemir: long-acting, onset of 1.5 hours -NPH: intermediate-acting insulin, onset of 1-2 hours

Which eye problem is the leading cause of blindness in clients with diabetes? 1:cataracts 2:glaucoma 3:retinopathy 4:astigmatism

3

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which of the following findings has the greatest effect on fluid loss? 1. Hypotension. 2. Decreased serum potassium level. 3. Rapid, deep respirations. 4. Warm, dry skin.

3 rationale: Due to the rapid, deep respirations, the client is losing fluid from vaporization from the lungs and skin (insensible fluid loss). Normally, about 900 mL of fluid is lost per day through vaporization. Decreased serum potassium level has no effect on insensible fluid loss. Hypotension occurs due to polyuria and inadequate fluid intake. It may decrease the flow of blood to the skin, causing the skin to be warm and dry.

The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for many years. Currently the client reports having periods of hypoglycemia followed by periods of hyperglycemia. The nurse should specifically ask if the client is 1. Eating snacks between meals. 2. Initiating the use of the insulin pump. 3. Injecting insulin at a site of lipodystrophy. 4. Adjusting insulin according to blood glucose levels.

3 rationale: Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections, which can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been receiving insulin for many years, this is the most likely cause of poor control. Eating snacks between meals causes hyperglycemia. Adjusting insulin according to blood glucose levels would not cause hypoglycemia but normal levels. Initiating an insulin pump would not, of itself, cause the periods of hyperglycemia.

Which pain description would the nurse expect a client to report when describing pain associated with a suspected duodenal peptic ulcer? 1:an ache radiating to McBurney point 2:an intermittent, colicky right flank pain 3:a gnawing sensation in the epigastric area 4:a generalized abd pain intensified by movement

3 rationale: peptic ulcer pain is usually described as a gnawing sensation and is often caused by H pylori and NSAIDS.

Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)? 1:as needed 2:with meals 3:at bedtime 4:before meals

3 rationale: ranitidine is typically administered in a single dose at bedtime. This medication is used for 4-6 weeks in combination with other therapy.

Which condition would the RN identify as the likely cause of profound weakness and nervousness in a client that became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin after a light breakfast with no additional intake in the 3 hours since that time? 1:hyperglycemia 2:hyperinsulinemia 3:hypoglycemia 4:hypoinsulinemia

3 rationale: severe hypoglycemia is a finding in diabetic clients who take insulin and miss a meal. Signs and symptoms of hypoglycemia are nervousness, weakness, confusion, and disorientation

A pt presents with gastric pain, vomit, dehydration, weakness, lethargy, and shallow respirations. Lab results indicate metabolic alkalosis. A diagnosis of gastric ulcer is made. Which is the primary nursing concern? 1:chronic pain 2:risk of injury 3:electrolyte imbalance 4:inadequate gas exchange

3 rationale: the stomach produces about 3 L of secretions per day. Fluid lost through vomit can produce inadequate fluid volume and electrolyte imbalance, which can lead to dysrhythmias and death.

Which time range would a nurse teach as the highest risk for hypoglycemia to a client with type 1 diabetes who self administers NPH insulin every morning at 8 am? 1:9 to 10 am 2:10 to 11 am 3:noon to 8 pm 4:8 to midnight

3 rationale: the time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate acting insulin peaks in 4-12 hours.

Which info would the nurse include when teaching a type 2 diabetic controlled with oral antidiabetic medications who is prescribed regular insulin when admitted for elective surgery? 1:you will need a higher serum glucose level while on bed rest 2:the stress of surgery may cause hypoglycemia 3:with insulin, dosage can be adjusted to your changing needs during recovery from surgery 4:the possibility of surgical complication is greater when a client takes oral hypoglycemics

3 rationale: there is better control of blood glucose levels with short acting insulin (regular). -The level of glucose must be maintained as close to normal as possible; elevated glucose levels are not desirable for clients on bed rest. -the stress of surgery will precipitate hyperglycemia (not hypo), which is best controlled with exogenous insulin -oral hypoglycemis do NOT increase surgical complications

Which factors can predispose a client with type 1 diabetes to a DKA coma? (select all that apply) 1:taking too much insulin 2:getting too much exercise 3:excessive emotional stress 4:running a fever with the flu 5:eating fewer calories than prescribed

3,4 rationale: emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level.

The Rn is caring for a pt with GERD. Which info would the Rn provide the client to prevent the worsening of the disorder? (select all) 1:eat a snack before bed 2:include vigorous exercise 3:wear loose fitting clothing 4:begin a weight loss program 5:sleep with the head of bed elevated

3,4,5

When obtaining a nursing history from a client with a suspected gastric ulcer, which signs and symptoms should the nurse assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weightloss. 5. Melena.

3,4,5 rationale: Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to have a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to have pain that occurs during the night and is frequently relieved by eating.

A RN is caring for a client with peptic ulcers and dysphagia. Which task would not be delegated to a UAP who is assisting in the care of a client with peptic ulcers and dysphagia? 1:assisting the pt with feeding 2:assisting the pt with bathing 3:assisting the client in oral hygiene 4:assisting the pt in administration of meds

4

Which explanation would the RN give to a 6 year old child about their type 1 diabetes? 1:diabetes is caused by not having any insulin in your body 2:youll learn how to give yourself insulin now that you have diabetes 3:diabetes will require you to take insulin shots for the rest of your life 4:taking insulin for your diabetes is like getting new batteries for your superhero toys

4

A client is diagnosed with a peptic ulcer. The nurse instructs the client to contact the HCP immediately if the clients stool has which appearance? 1:frothy 2:ribbon shaped 3:pale or clay-colored 4:dark brown or black

4 rationale: Dark black stools (melena) indicate GI bleeding and needs to be reported

Which condition is treated with a proton pump inhibitor (PPI)? 1:diarrhea 2:vomiting 3:cardiac dysrhythmias 4:GERD

4 rationale: PPIs are effective in decreasing the secretions of gastric acid, helping alleviate the symptoms of GERD

Which response will the RN provide to a client with type 2 diabetes taking one glyburide tablet daily who asks whether an extra tablet should be taken before exercise? 1:you will need to decrease how much you are exercising 2:an extra pill will help your body use glucose when exercising 3:the amount of medication you need to take is not related to exercising 4:do not take an extra pill because you may become hypoglycemic when exercising

4 rationale: exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism

Which mechanism of action is a characteristic of famotidine prescribed for a client with peptic ulcer disease? 1:increases gastric motility 2:neutralizes gastric acidity 3:facilitates histamine release 4:inhibits gastric acid secretion

4 rationale: famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increasing gastric motility, neutralizing gastric acidity, and facilitating histamine release are not actions of famotidine

The nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe? 1: insulin glargine 2: insulin detemir 3:insulin lispro mix 75/25 4:isophane insilin neutral protamine hagedorn (NPH)

4 rationale: isophane insulin NPH is safe to mix with regular human insulin. No other insulin type should be mixed with insulin glargine, insulin detemir, or insulin lispro mix 75/25

Which finding is an indication of ulcer perforation in a client with PUD? (select all that apply) 1:tachycardia 2: hypotension 3:rigid abdomen 4:nausea and vomiting 5:back and shoulder pain

All are correct rationale: perforation of an ulcer can cause tachycardia and hypotension (both caused by fluid volume shifts from the vascular compartment to the abdominal cavity). A client with a perforated ulcer would have a hard, rigid abdomen (caused by tensed muscles) and nausea and vomiting. Back and shoulder pain can occur as a result of irritation of the phrenic nerve