Adult Health Final PrepU (Chapters 51, 7)
Which instruction about insulin administration should a nurse give to a client? "Always follow the same order when drawing the different insulins into the syringe." "Discard the intermediate-acting insulin if it appears cloudy." "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Shake the vials before withdrawing the insulin."
"Always follow the same order when drawing the different insulins into the syringe." The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "It looks like you aren't following the ordered diabetic diet." "The test must be repeated following a 12-hour fast." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly."
"It tells us about your sugar control for the last 3 months." The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.
The nurse caring for a Hispanic client is performing a cultural assessment. Which of the following statements or questions avoids stereotyping? "How do you celebrate Thanksgiving?" "I will ask the dietician if any Hispanic items are on the menu today." "Tell me about your cultural preferences." "When did you arrive in this country?"
"Tell me about your cultural preferences." Explanation: By asking the client to give information about cultural preferences, the nurse avoids making any assumptions and understands the client as a person, not as simply a member of a group. The question about Thanksgiving assumes that the cliet celebrates Thanksgiving or celebrates it in a way different from most Americans. The question about preferred Hispanic foods assumes that the client likes these types of items. The question about arrival in the country assumes that the client only recently immigrated, but many Hispanic people have been here for many generations.
A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "I will refer you to a dietician who can help you with your weight." "Your body is using protein and fat for energy instead of glucose." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "You may be having undiagnosed infections, causing you to lose extra weight."
"Your body is using protein and fat for energy instead of glucose." Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours
10 to 15 minutes The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 8:30 AM. 12:30 PM. 2:30 PM. 10:30 AM.
8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.
When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? Accuracy of the dosage Technique for injecting Duration of the insulin Area for insulin injection
Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? White blood cells Albumin Bacteria Red blood cells
Albumin Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of microalbumin.
A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? cardiac disease CVA type 2 diabetes All options are correct.
All options are correct. The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.
The yin and yang theory of illness proposes that the seat of energy in the body is within a specific area. Which of the following is the correct area of the body? Autonomic nervous system Cardiac system Pulmonary system Reproductive system
Autonomic nervous system Explanation: The yin/yang theory proposes that all organisms and objects in the universe consist of yin and yang energy. The seat of the energy forces is within the autonomic nervous system, where balance between the opposing forces is maintained during health.
Insulin is secreted by which of the following types of cells? Basal cells Melanocytes Beta cells Neural cells
Beta cells Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.
Which of the following alternative therapies would include a strict low carbohydrate diet? Energy therapy Biologically based therapy Mind-body interventions Alternative medical systems
Biologically based therapy Explanation: Biologically-based therapies includes herbal therapies and special diet therapies. Therapeutic touch is a type of energy therapy. Alternative medical systems are a complete system of theory and practice that are different from conventional medicine. Alternative medical systems are a complete system of theory and practice that are different from conventional medicine.
Three major paradigms are used to explain the causes of disease and illness. Which three of the following are the paradigms? Choose all three. Biomedical or scientific view Naturalistic or holistic perspective Magico-religious view Geographic view Dynamic perspective
Biomedical or scientific view Naturalistic or holistic perspective Magico-religious view Explanation: Three major views, or paradigms, attempt to explain the causes of disease and illness: the biomedical or scientific view, the naturalistic or holistic view, and the magico-religious view. The geographic view and the dynamic perspective are not considered paradigms of causes of illness.
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? Blood glucose can be controlled through diet and exercise Client is usually thin at diagnosis Client is prone to ketosis Clients demonstrate islet cell antibodies
Blood glucose can be controlled through diet and exercise Explanation: Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Blood glucose level 1,100 mg/dl Arterial pH 7.25 Plasma bicarbonate 12 mEq/L Blood urea nitrogen (BUN) 15 mg/dl
Blood glucose level 1,100 mg/dl HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
The nurse is providing education to an English-speaking client who immigrated to the United States 2 years ago. The nurse determines that further education may be needed when the client does which action? Changes the subject Laughs appropriately Makes eye contact Asks several questions
Changes the subject Explanation: Changing the subject may be a sign that the listener does not understand what is being said. Laughing appropriately, making eye contact, and asking questions are not indications that the client is in need of further education.
The nurse listens to a client explain that she is receiving manipulations from a health care provider. The nurse documents in the client's chart that the client is using which therapy? Chiropractic Therapeutic touch Reiki Herbal
Chiropractic Explanation: Chiropractic therapy involves manipulation as an intervention on body movement. Both Reiki and therapeutic touch are forms of energy therapy whereby the practitioner focuses on the energy fields within or outside of the body. Herbal therapy involves using a plant or plant parts to act on the body.
A nurse is caring for a client who suffered a fall while on vacation. He is from another state and has no visitors except his spouse, who seems lonely without any friends or family nearby. The nurse invites the spouse to attend services with her at the nurse's church, which is a denomination different from the spouse's. This could be construed as which of the following? Cultural blindness Acculturation Cultural taboo Cultural imposition
Cultural imposition Explanation: A cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture.
The two underlying goals of transcultural nursing are to provide which of the following? Choose the two that apply. Culture-ethnic care Culture-specific care Culture-universal care Culture-diverse care
Culture-specific care Culture-universal care The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care that promotes the well-being or health of individuals, families, groups, communities, and institutions.
Native Americans who are wearing their tribal dress are demonstrating their native dance to a community group. This is an example of which of the following? Acculturation Ethnic expression Race Ethnocentrism
Ethnic expression Explanation: Ethnicity is the bond or kinship people feel with their country of birth or place of ancestral origin. Race refers to biologic differences in physical features, such as skin color and eye shape. Ethnocentrism is the belief that one's ethnic heritage is the "correct" one and superior to others. Acculturation involves the process of adapting to or taking on the behaviors of another group.
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? Glucose via a urine dipstick test Glucose via an oral glucose tolerance test Glycosylated hemoglobin level Fasting blood glucose level
Glycosylated hemoglobin level Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.
The yin/yang theory of harmony and illness is rooted in which paradigm of health and illness? Biomedical Holistic Religious Scientific
Holistic Explanation: One example of a naturalistic or holistic belief, held by many Asian groups, is the yin/yang theory, in which health is believed to exist when all aspects of a person are in perfect balance or harmony.
The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? It carries glucose into body cells. It decreases the intestinal absorption of glucose. It stimulates the pancreatic beta cells. It aids in the process of gluconeogenesis.
It carries glucose into body cells. Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.
The nurse is conducting a community education class on cultural diversity. The nurse explains that cultural sensitivity includes which of the following? Knowledge of cultural preferences Individualized care for patients Evaluating cultural knowledge deficits Detecting cultural competence barriers
Knowledge of cultural preferences Explanation: Cultural sensitivity is being alert to and having knowledge of cultural preferences. Evaluation of cultural knowledge deficits and the detection of cultural competence barriers are components of cultural humility. Provision of individualized care for clients is a part of culturally competent nursing care.
The nursing instructor discussed the theory of energy forces existing between organisms and objects in the universe and called this yin-yang. Yin-yang is an example of which societal view of illness? Biomedical perspective Magico-religious perspective Naturalistic perspective Scientific perspective
Naturalistic perspective Explanation: The naturalistic view espouses that human beings are only one part of nature. The yin-yang theory promotes the idea that energy forces exist between organisms and objects in the universe. The balance between these forces is health. The biomedical or scientific view embraces a cause-and-effect philosophy of human body functions. The magico-religious view believes that supernatural forces dominate.
While providing personal care for a client, the nurse observes that the client is not comfortable with the close physical proximity. How will the nurse alleviate the discomfort of the client during personal care? Speak words or phrases in the client's language. Maintain sufficient distance. Ensure that the client's family member is present. Provide simple explanations of the need for physical proximity.
Provide simple explanations of the need for physical proximity. Explanation: Simple explanations of the need for physical proximity during clinical procedures and personal care alleviate the discomfort that the client may experience. Maintaining sufficient distance and ensuring that the client's family member is present may not help alleviate the discomfort some clients may experience. Speaking words or phrases in the client's language will help in communicating with clients who do not speak English.
The nurse is completing a cultural heritage assessment. Which items will be included in this portion of the health assessment? Select all that apply. Religion Participation in religious traditions Health history Celebration of holidays Use of tobacco Use of alternative therapies
Religion Participation in religious traditions Celebration of holidays Use of alternative therapies Explanation: Health-related beliefs and practices (such as religious traditions and celebration of holidays, and use of alternative health practices) can reflect the cultural heritage of the client. Asking questions can assist in determining cultural heritage. Religion, tobacco use, and/or health history assists in the health history but does not reflect upon heritage or culture.
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? Determining whether the patient is on insulin or taking oral antidiabetic medication Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found Making sure that the patient is aware that quantity of foods will be limited
Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? Autonomic neuropathy Nephropathy Retinopathy Sensory neuropathy
Sensory neuropathy Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.
The nurse remembers learning that three elements are frequently used to identify diversity. Choose the three from the following list. Skin color Religion Geographic area Age Income
Skin color Religion Geographic area Explanation: Cultural diversity has been identified in a number of ways including differences in skin color, religion, and geographic area.
Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: Transport of potassium. Storage of glucose as glycogen in the liver. Release of glucose. Synthesis of glucose from noncarbohydrate sources.
Synthesis of glucose from noncarbohydrate sources. Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? They cause wide fluctuations in the need for insulin. They decrease the need for insulin. They increase the need for insulin. They have no effect.
They increase the need for insulin. Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
Which specialty in nursing involves providing nursing care in the context of the client's culture? Transcultural nursing Multicultural nursing Biocultural nursing Multilingual nursing
Transcultural nursing Explanation: Transcultural nursing, founded by Leininger (1977), is considered a specialty in nursing. It refers to nursing care that is provided within the context of another's culture. Multiculturalism is a philosophy that recognizes ethnic diversity within a society; it is not a nursing specialty. Biocultural refers to physical characteristics or behavior related to or resulting from a person's cultural background; it is not a nursing specialty. A nurse who is multilingual is fluent in more than one language
A new client is admitted to the unit, and the nurse's initial assessment will include a systematic appraisal of the client's cultural characteristics, health practices, and beliefs. What type of assessment will the nurse perform to gather this information? cultural biocultural multicultural procedural
cultural Explanation: A cultural nursing assessment is a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. The nurse should include cultural beliefs and health practices in any initial assessment. When assessing any client, the nurse must consider general appearance and obvious physical characteristics, components that make up biocultural assessment.
The inability of a person to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies is termed cultural imposition. cultural taboo. cultural blindness. acculturation.
cultural blindness
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: prefers to take insulin orally. has type 1 diabetes. is pregnant and has type 2 diabetes. has type 2 diabetes.
has type 2 diabetes Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: polyphagia. anorexia. polydipsia. polyuria.
polyphagia. While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.
A client has been on the unit for 3 weeks receiving treatment for bacterial meningitis. The client is being discharged, and the nurse is discussing the disease process and future prevention. As part of teaching, the nurse must: respect the client's beliefs about the cause of illness. try to change the client's beliefs about the cause of illness. give the client extensive scholarly reading material about the cause of illness. ask the client to adopt a more modern approach to his or her views on illness.
respect the client's beliefs about the cause of illness. Explanation: A person's beliefs about health and illness and how illness is treated are strongly influenced by culture. Nurses may disagree with a client's health or illness beliefs. However, they must appreciate these beliefs to assist the client in achieving health goals. Trying to change the client's beliefs is not an appropriate part of teaching. Although certain written information may be helpful, a large quantity of scholarly information is not appropriate.
The nurse remembers learning that three elements are frequently used to identify diversity. Choose the three from the following list. Geographic area Religion Age Income Skin color
skin color religion geographic area Cultural diversity has been identified in a number of ways including differences in skin color, religion, and geographic area.
NPH is an example of which type of insulin? Short-acting Rapid-acting Long-acting Intermediate-acting
Intermediate-acting NPH is an intermediate-acting insulin.
After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? "This transplant will provide me with a cure for my diabetes." "They'll need to create a connection from the pancreas to allow enzymes to drain." "I will receive a whole organ with extra cells to produce insulin." "I might need insulin later on but probably not as much or as often."
"I might need insulin later on but probably not as much or as often." Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.
The nurse is caring for a client scheduled for an emergency cardiac catheterization. The transport team arrives to take the client to the catheterization laboratory at the same time a group of men arrive to see the client. The client explains to the nurse that these men are the elders from church who have come to perform a "laying on of hands" to help the client have a cardiac catheterization safely. The best response by the nurse is which of the following? "This is an emergency procedure; we do not have time for this." "The transport team is here; we must not keep the staff in the cath lab waiting." "Please understand that we cannot take the time for this ritual." "I will wait outside of your room with the transport team; let us know when you are finished."
"I will wait outside of your room with the transport team; let us know when you are finished." Explanation: It is important to respect the client's wishes. This ritual may provide the peace of mind the client needs to mentally enter into this procedure.
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? "Ketones can damage your kidneys and eyes." "The spleen releases ketones when your body can't use glucose." "Ketones help the physician determine how serious your diabetes is." "Ketones will tell us if your body is using other tissues for energy."
"Ketones will tell us if your body is using other tissues for energy." The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Test your blood glucose every 4 hours." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Follow your regular meal plan, even if you're nauseous." "Don't take your insulin or oral antidiabetic agent if you don't eat."
"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
The nurse is caring for a client who is in contact isolation for an infection. The client informs the nurse that a shaman will be coming to visit and asks for privacy during that time. The most appropriate response from the nurse will be which of the following? "When the shaman arrives I will help him with the personal protective equipment he will need." "The shaman will have to talk with you from the doorway of your room." "I will arrange a small conference room in which the two of you can meet privately." "It would be better to postpone this meeting until you are out of isolation."
"When the shaman arrives I will help him with the personal protective equipment he will need." Explanation: Nurses should make an effort to accommodate the client's beliefs while also advocating for the treatment proposed by health science.
A patient tells the nurse that she will be researching an alternative method of treatment for her disease. What is the best response by the nurse? "You should comply with what the physician tells you is the best treatment." "Those types of treatments are not reliable and can be harmful to you." "If you use an alternative method of treatment, you cannot use traditional medicine as a treatment." "You are within your right to search for other methods of treatment. Just be sure to inform your physician what treatments you are using."
"You are within your right to search for other methods of treatment. Just be sure to inform your physician what treatments you are using." Explanation: Patients may choose to seek an alternative to conventional medical or surgical therapies. Out of respect for the way of life and beliefs of patients from different cultures, it is often necessary that healers and health care providers respect the strengths of each approach. Nurses must assess all patients for the use of complementary therapies, be alert to the danger of herb-drug interactions or conflicting treatments, and be prepared to provide information to patients about treatments that may be harmful.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of regular insulin in normal saline solution 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in dextrose 5% in water
100 units of regular insulin in normal saline solution
A female diabetic patient who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/week, approximately what should her daily caloric intake be? 1200 calories 1500 calories 1000 calories 1,800 calories
1000 calories Calorie-controlled diets are planned by first calculating a person's energy needs and caloric requirements based on age, gender, height, and weight. An activity element is then factored in to provide the actual number of calories required for weight maintenance. To promote a 1- to 2-pound weight loss per week, 500 to 1,000 calories are subtracted from the daily total.
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: 120 mg/dL, 1 hour postprandial. 80 mg/dL, 1 hour postprandial. 90 mg/dL before meals. 138 mg/dL, 2 hours postprandial.
138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: I.M. or subcutaneous glucagon. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 units of fast-acting insulin. I.V. bolus of dextrose 50%.
15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
What is the duration of regular insulin? 4 to 6 hours 3 to 5 hours 12 to 16 hours 24 hours
4-6hrs The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled? 8.0% 7.5 % 8.5% 6.5%
6.5% Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dL. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.
Which statement is true regarding gestational diabetes? It occurs in most pregnancies. Onset usually occurs in the first trimester. A glucose challenge test should be performed between 24 and 28 weeks. There is a low risk for perinatal complications.
A glucose challenge test should be performed between 24 and 28 weeks. Explanation: A glucose challenge test should be performed between 24 and 48 weeks in women at average risk. It occurs in 2% to 5% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.
Which is the best thing the nurse can do to provide culturally sensitive care? Become familiar with physical differences among ethnic groups. Provide the proper food for nourishment. Accept each client as a unique individual. Facilitate rituals that bring comfort to the client.
Accept each client as a unique individual. Explanation: Becoming familiar with physical differences, providing food that is customary to the culture, and facilitating rituals are all recommendations for enhancing sensitive cultural care, but according to Leininger, accepting each client as an individual is a characteristic that is found in the specialty of transcultural nursing.
The nurse is providing care to a client who implements some of the principles and practices of Complementary and Integrative Health. What should the nurse include when planning this client's care? Select all that apply. Accommodating special dietary considerations Facilitating visits to the facility by a shaman Scheduling times for the client to receive reflexology treatments Providing a safe and quiet place for performing yoga Teaching staff about the risks and benefits of acupuncture
Accommodating special dietary considerations Providing a safe and quiet place for performing yoga Explanation: The practitioner prescribes modalities such as yoga, herbal medicine, fasting and eating cleansing foods, meditation, and massage. Acupuncture and reflexology are treatment modalities that are not components of Complementary and Integrative Health. The shaman plays a central role in Native-American medicine.
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome? Administer IV fluid slowly to prevent circulatory overload and collapse. Administer 10 L of IV fluid over the first 24 hours. Administer 2 to 3 L of IV fluid rapidly. Administer a dextrose solution containing normal saline solution.
Administer 2 to 3 L of IV fluid rapidly. Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly ordered fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution.
How can a nurse improve his or her transcultural sensitivity and demonstrate culturally competent nursing care? All of the responses are correct. The nurse can learn to speak a second language. The nurse can become familiar with physical differences among ethnic groups. The nurse can perform a cultural and health beliefs assessment and plan care accordingly.
All of the responses are correct. Explanation: Culturally sensitive nursing care is evidenced by examining your personal beliefs, communication habits, and healthcare practices.
The nurse is completing discharge instructions for a client. The nurse can best evaluate the likeliness of the client to adhere to the instructions by use of which method? Ask the client if he or she agrees with the instructions that are outlined. Observe the client's face to see if he or she is smiling, which can be interpreted as compliance. Make the client promise to follow the instructions and be compliant with the plan. Ask the client if there is anything in the discharge plan that will interfere with compliance.
Ask the client if there is anything in the discharge plan that will interfere with compliance. Some individuals will not openly disagree with people in authority or who possess advanced education. Smiling is not necessarily proof of compliance. Agreeing with the plan of care is not the same as "doing" or complaining but finding out if there is anything in the plan of care that the client does not agree to adhere to is a step to establishing a plan of care that is client oriented.
When the nurse attempts to obtain vital signs, the client pulls away, gathers the bed covers to the chin, and speaks in a language unintelligible to the nurse. What is the best action for the nurse to take? Talk slowly and explain current actions. Use gesturing and pictures to explain current actions. Smile and take the vital signs anyway. Attempt to retrieve an interpreter.
Attempt to retrieve an interpreter. Explanation: Ideally, obtaining an interpreter will increase the communication between client and nurse. Talking slower or gesturing may not provide a clear understanding for client or nurse. Proceeding without the approval of client could violate the client's cultural beliefs.
The nurse is caring for a client who expresses the belief that her illness (cellulitis) is a result of bacteria that has caused an infection. To which of the following views of disease/illness does this client allude? Naturalistic and/or holistic Magico-religious Biomedical and/or scientific Modernistic and/or physician oriented
Biomedical and/or scientific Explanation: The three major views that attempt to explain the cause of disease/illness are biomedical or scientific (cause and effect), naturalistic or holistic (forces of nature), and magico-religious (supernatural forces). The idea of bacteria causing an infection relates to the scientific or cause-and-effect theory.
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? Polyuria, polydipsia, polyphagia, and weight loss Kussmaul's respirations, dry skin, hypotension, and bradycardia Coma, anxiety, confusion, headache, and cool, moist skin Polyuria, polydipsia, hypotension, and hypernatremia
Coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mf/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul's respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.
It is important for the nurse to acknowledge cultural differences that may influence the delivery of health care. In order to do this, the nurse must do which of the following? Be clear with the client about the nurse's own cultural perspective. Confront the nurse's own bias and influence of his or her culture. Talk to the client about the nurse's own cultural heritage. Be aware that ethnic culture does not change.
Confront the nurse's own bias and influence of his or her culture. Explanation: To truly acknowledge the cultural differences that may influence health care delivery, the nurse must confront bias and recognize the influence of his or her own culture and cultural heritage.
While taking a nursing history, the nurse is made to feel uncomfortable when a client positions himself very close to the nurse. The nurse should do which of the following? Calmly ask the client to move back to a distance that is more comfortable for the nurse. Consider that the client's cultural preferences for space and distance may be a reason for this behavior. Report the inappropriate behavior to the nurse's supervisor. Ask a colleague to complete the health history.
Consider that the client's cultural preferences for space and distance may be a reason for this behavior. If the client appears to position himself/herself too close or too far away, the nurse should consider cultural perferences for space and distance. Ideally, the client should be permitted to assume a position that is comfortable to him or her in terms of distance.
The nursing assistant was reluctant to allow the Muslim patient room for a prayer rug in her room. The inability to recognize the values, beliefs, and practices of others because of strong ethnocentric preferences is which of the following? Acculturation Cultural imposition Cultural blindness Cultural taboos
Cultural blindness Explanation: Cultural blindness is an inability to recognize the values, beliefs, and practices of others because of strong ethnocentric preferences. Cultural taboos are activities governed by rules of behavior that a particular cultural group avoids, forbids, or prohibits. Acculturation involves adapting to or taking on the behaviors of another group. Cultural imposition is an inclination to impose one's cultural beliefs, values, and patterns of behavior on people from a different culture.
The nurse observes that a coworker is unable to understand that an intelligent person would engage the services of a medicine man. The nurse's coworker has strong ethnocentric tendencies and an inability to recognize others' values, beliefs, and practices. The nurse understands that the coworker's behavior is an example of which attitude? Cultural blindness Cultural taboo Cultural imposition Acculturation
Cultural blindness Explanation: Cultural blindness results in bias and stereotyping. Cultural taboos are those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a culture adapt or learn how to take on the behaviors of another group.
Which of the following terms refers to Leininger's description of the person's inability to recognize his or her own values, beliefs, and practices and those of others? Culture Minority Cultural blindness Subculture
Cultural blindness Explanation: Leininger's description of cultural blindness is the person's inability to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Leininger was the founder of the specialty called transcultural nursing and advocated culturally competent nursing care. Minority refers to a group of people whose physical or cultural characteristics differ from the majority of people in a society. Subculture refers to a group that functions within a culture.``
The inability to recognize the values, beliefs, and practices of others because of strong ethnocentric preferences is which of the following? Cultural blindness Cultural imposition Acculturation Cultural taboos
Cultural blindness Cultural blindness is an inability to recognize the values, beliefs, and practices of others because of strong ethnocentric preferences. Cultural taboos are activities governed by rules of behavior that a particular cultural group avoids, forbids, or prohibits. Acculturation involves adapting to or taking on the behaviors of another group. Cultural imposition is an inclination to impose one's cultural beliefs, values, and patterns of behavior on people from a different culture.
Which of the following is a process by which the nurse consistently works in the cultural context of the client, family, and community? Stereotyping Ethnicity Cultural competence Subculture
Cultural competence Explanation: Providing culturally competent care is a process by which the nurse consistently endeavors to work in the cultural context of the client and his or her family and community. Stereotyping means assuming that all people in a particular cultural, racial, or ethnic group share the same values and beliefs, behave similarly, and are basically alike. Ethnicity is the bond or kinship that people feel with their country of birth or place of ancestral origin. Subculture refers to a particular group that shares characteristics identifying the group as a distinct entity.
A nurse is caring for a client who suffered a fall while on vacation. He is from another state and has no visitors except his spouse, who seems lonely without any friends or family nearby. The nurse invites the spouse to attend services with her at the nurse's church, which is a denomination different from the spouse's. This could be construed as which of the following? Cultural blindness Acculturation Cultural taboo Cultural imposition
Cultural imposition A cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture.
Which term refers to the tendency to force one's cultural beliefs, values, and patterns of behavior on a person or people from a different culture? Acculturation Cultural blindness Cultural imposition Cultural taboos
Cultural imposition Cultural imposition is the tendency to force one's cultural beliefs, values, and patterns of behavior on a person or people from a different culture. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Acculturation is the process by which members of cultural group adapt to or learn how to take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.
Ethnocentrism is closely related to which of the following? Cultural competence Cultural imposition Ethnicity Subculture
Cultural imposition Explanation: Ethnocentrism is closely related to cultural imposition. Providing culturally competent care is a process by which the nurse consistently endeavors to work in the cultural context of the client and his or her family and community. Subculture refers to a particular group that shares characteristics identifying the group as a distinct entity.
Effective, individualized care that shows respect for the dignity, personal rights, preferences, beliefs, and practices of people receiving care while acknowledging the bias of the caregiver and preventing that bias from interfering with care. This is a definition of? Culturally competent nursing care The Patient's Bill of Rights A nursing pledge written by Florence Nightingale The School of Nursing's mission statement
Culturally competent nursing care Explanation: Culturally competent nursing care is defined as effective, individualized care that shows respect for the dignity, personal rights, preferences, beliefs, and practices of people receiving care while acknowledging the bias of the caregiver and preventing that bias from interfering with care.
The nurse working in a predominantly Amish community realizes that one reason the Amish do not obtain mammograms is because of transportation issues. The nurse obtains a grant to fund a dedicated van to provide transportation for members of the community to obtain mammograms. According to Leininger, this nurse is providing culturally congruent nursing care through which of the following? Culture care accommodation Culture care restructuring Cultural imposition Cultural blindness
Culture care accommodation Explanation: The nurse is using culture care accommodation by overcoming the transportation issues to help the clients achieve a beneficial health outcome. Culture care restructuring refers to actions that help clients change their lifestyle toward more beneficial patterns. Cultural imposition is the imposition of one's culture on a person from a different culture. Cultural blindness is the inability of people to recognize their own values and beliefs and/or those of others.
A patient who is diagnosed with type 1 diabetes would be expected to: Need exogenous insulin. Receive daily doses of a hypoglycemic agent. Be restricted to an American Diabetic Association diet. Have no damage to the islet cells of the pancreas.
Need exogenous insulin Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Defensive coping. Health-seeking behaviors (diabetes control). Deficient knowledge (treatment regimen). Impaired adjustment.
Deficient knowledge (treatment regimen). The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.
A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? Social worker Home health nurse Psychiatrist Dietitian
Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? Blurred vision Polyuria Polydipsia Hypoglycemia
Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.
Which of the following is the belief that one's values and beliefs are superior to others? Acculturation Ethnocentrism Cultural imposition Cultural taboo
Ethnocentrism Explanation: Ethnocentrism is the belief that one's ethnic heritage is the "correct" one and superior to others. Acculturation involves the process of adapting to or taking on the behaviors of another group. Cultural imposition is the inclination to impose one's cultural beliefs, values, and patterns of behavior on people of a different culture. Cultural taboos are activities governed by rules of behavior that a particular cultural group avoids, forbids, or prohibits.
What cultural group does the nurse understand may be late for a scheduled appointment at the clinic because of a wide frame of reference? Hispanic Arabian Native American Asian`
Hispanic Explanation: However, for patients from some cultures, time is a relative phenomenon, with little attention paid to the exact hour or minute. For example, some Hispanic people consider time in a wider frame of reference and make the primary distinction between day and night.
A patient who is Asian practices the yin/yang theory of harmony and illness. What paradigm of health and illness is this practice rooted in? Biomedical Holistic Religious Scientific
Holistic Explanation: The naturalistic or holistic perspective is another viewpoint that explains the cause of illness and is commonly embraced by many Native Americans, Asians, and others. According to this view, the forces of nature must be kept in natural balance or harmony. One example of a naturalistic belief, held by many Asian groups, is the yin/yang theory, in which health is believed to exist when all aspects of a person are in perfect balance or harmony. Rooted in the ancient Chinese philosophy of Taoism (which translates as "The Way"), the yin/yang theory proposes that all organisms and objects in the universe consist of yin and yang energy.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? Systemic inflammatory response syndrome Diabetic ketoacidosis Hyperglycemic hyperosmolar syndrome Multiple-organ dysfunction syndrome
Hyperglycemic hyperosmolar syndrome Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes (Reynolds, 2012). The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis).
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? Blurred vision Polydipsia Hypoglycemia Polyuria
Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Numbness Fatigue Increased hunger Dizziness
Increased hunger The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? Creates an overall feeling of well-being and lowers risk of depression Decreases need for pancreas to produce more cells Decreases risk of developing insulin resistance and hyperglycemia Increases ability for glucose to get into the cell and lowers blood sugar
Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? Creates an overall feeling of well-being and lowers risk of depression Increases ability for glucose to get into the cell and lowers blood sugar Decreases risk of developing insulin resistance and hyperglycemia Decreases need for pancreas to produce more cells
Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? Onset most common during adolescence Insufficient insulin production Less common than type 1 diabetes Little relation to prediabetes
Insufficient insulin production Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence; although, it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Prediabetes can lead to type 2 diabetes.
Of the following nurse theorists, which one is considered the founder of transcultural nursing? Dorthea Orem Madeline Leininger Jean Watson Patricia Benner
Madeline Leininger Explanation: Madeleine Leininger is the founder of the speciality called transcultural nursing. Jean Watson founded the caring theory, Orem the self-care theory, and Benner the novice to expert model.
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? Lispro (Humalog) Glargine (Lantus) NPH Iletin II
NPH Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.
Yin yang is an example which societal view of illness? Biomedical perspective Magico-religious perspective Naturalistic perspective Scientific perspective
Naturalistic perspective Explanation: The naturalistic view espouses that human beings are only one part of nature. The biomedical or scientific view embraces a cause-and-effect philosophy of human body functions. The magico-religious view believes that supernatural forces dominate.
A patient who is diagnosed with type 1 diabetes would be expected to: Receive daily doses of a hypoglycemic agent. Be restricted to an American Diabetic Association diet. Need exogenous insulin. Have no damage to the islet cells of the pancreas.
Need exogenous insulin. Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? Polyphagia and flushed, dry skin Polydipsia, pallor, and irritability Nervousness, diaphoresis, and confusion Polyuria, headache, and fatigue
Nervousness, diaphoresis, and confusion Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.
A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Increase in blood glucose from 3:00 AM until breakfast Rise in blood glucose about 3:00 AM Elevated blood glucose at bedtime Normal bedtime blood glucose
Normal bedtime blood glucose Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.
A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? Obesity Presence of autoantibodies against islet cells Rare ketosis Altered glucose metabolism
Presence of autoantibodies against islet cells There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? Requirement for oral hypoglycemic agents Presence of islet cell antibodies Rare ketosis Obesity
Presence of islet cell antibodies Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? Glargine Lente NPH Regular
Regular Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.
Which of the following is the consequence of a nurse equating the client's skin color and other physical features with culture? Developing cultural competence Stereotyping Developing transcultural sensitivity Generalizing
Stereotyping Explanation: Although ethnic and racial groups overlap, nurses must not equate skin color and other physical features with culture. Doing so may lead to erroneous assumptions that all people with certain physical attributes share the same culture and ethnicity. Such an attitude leads to stereotyping. Generalizing acknowledges common trends in a group and recognizes that more information is needed. Equating clients' skin color and other physical features with culture does not help develop cultural competence and transcultural sensitivity.
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Bradycardia, thirst, and anxiety Dry skin, bradycardia, and somnolence Polyuria, polydipsia, and polyphagia Sweating, tremors, and tachycardia
Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? The client continues medication therapy despite adequate food intake. The client has been exercising more than usual. The client has eaten and has not taken or received insulin. The client has not consumed sufficient calories.
The client has eaten and has not taken or received insulin. If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.
A client of Japanese descent describes a family trait of having less relief from analgesics than friends of White/Caucasian descent. The nurse recognizes that, because of this trait, which statement applies? The client may need higher doses of this drug. The client may need lower doses of this drug. This medication should not be prescribed to this client. Biocultural ecology is the study of biologic cultural differences.
The client may need higher doses of this drug. Explanation: Even though bicultural ecology is the study of biologic cultural differences, it does not answer the question. According to biocultural assessment, people of Japanese descent metabolize certain drugs more quickly, which predisposes them to subtherapeutic drug concentration, requiring higher drug doses.
A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? The client's mental and emotional status The client's consumption of carbohydrates The client's exercise routine History of radiographic contrast studies that used iodine
The client's consumption of carbohydrates While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not as important to information related to the client's to be noted in a client with high blood sugar.
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? To restore liver glycogen and prevent secondary hypoglycemia To decrease the possibility of nausea and vomiting To stimulate her appetite To decrease the amount of glycogen in her system
To restore liver glycogen and prevent secondary hypoglycemia A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system.
Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? Using sterile technique during the dressing change Debriding the wound three times per day Cleaning the wound with a povidone-iodine solution Applying a heating pad
Using sterile technique during the dressing change The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.
Which factor is the focus of nutrition intervention for clients with type 2 diabetes? Weight loss Protein metabolism Blood glucose level Carbohydrate intake
Weight loss Explanation: Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.
During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: at least once per week. at least three times per week. at least five times per week. every day.
at least three times per week Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.
Food choices and how frequently a person eats are often determined by: cultural and/or religious beliefs and practices. perception of one's class in society. level of education completed. status within the cultural or familial hierarchy.
cultural and/or religious beliefs and practices. Explanation: Culture often dictates the types of food and how frequently a person eats, the types of utensils he or she uses, and the status assigned to particular individuals (e.g., who eats first, who gets the most to eat). Religious practices also impose certain rules and restrictions, such as fasting, eliminating certain foods, or following a vegetarian diet.
The inability of a person to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies is termed cultural blindness. cultural taboo. cultural imposition. acculturation.
cultural blindness. Explanation: Cultural blindness results in bias and stereotyping. Acculturation is the process by which members of a culture adapt to or learn how to take on the behaviors of another group. Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural taboos are those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group.
A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions which contribute to developing metabolic syndrome? Select all that apply. low LDL elevated blood glucose levels abdominal obesity All options are correct.
elevated blood glucose levels abdominal obesity Metabolic syndrome includes obesity, especially in the abdominal area; high blood pressure (BP); elevated triglyceride, low-density lipoprotein (LDL), and blood glucose levels; and a low high-density lipoprotein (HDL) level.
Native Americans who are wearing their tribal dress are demonstrating their native dance to a community group. This is an example of which of the following? Race Ethnic expression Acculturation Ethnocentrism
ethnic expression Ethnicity is the bond or kinship people feel with their country of birth or place of ancestral origin. Race refers to biologic differences in physical features, such as skin color and eye shape. Ethnocentrism is the belief that one's ethnic heritage is the "correct" one and superior to others. Acculturation involves the process of adapting to or taking on the behaviors of another group.
A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: urine glucose level. serum fructosamine level. glycosylated hemoglobin level. fasting blood glucose level. glycosylated hemoglobin level.
glycosylated hemoglobin level. Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? ketoacidosis hyperosmolar hyperglycemic nonketotic syndrome hepatic disorder All options are correct.
ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.
A nurse has engaged a translator to help in communicating with a client. When asking questions of the client and obtaining answers, the nurse should: look at the client while asking questions and carefully listen to the client's response. record each session to avoid any later confusion or disputes over what was said. take careful notes as the translator speaks. make sure that a family member is present at all times.
look at the client while asking questions and carefully listen to the client's response. Explanation: When using a translator with clients who speak little or no English, the nurse must look at the client, not the translator, when asking questions and listening to the client's response. There is no need to record the communication. Notes may be taken, but this is not the approach for asking questions and obtaining answers. Although family may be present, it is not mandatory for communication using a translator and, in some cases, may actually hinder the communication.
Which culturally related perspective on illness/disease involves a belief in supernatural forces or a higher power? magico-religious biomedical or scientific naturalistic or holistic homeopathic
magico-religious Explanation: According to the magico-religious perspective, supernatural forces dominate. Examples include faith healing in some Christian faiths and voodoo or witchcraft in some Caribbean cultures. Health beliefs are a person's ideas about what causes illness, the role of the sick person, how to restore health, and how one stays healthy. The biomedical or scientific view is generally shared by Western healthcare personnel. An example is the belief that bacterial or viral organisms cause meningitis. The natural/holistic view espouses that human beings are only one part of nature. Natural balance or harmony is essential for health. Homeopathy is an alternative treatment modality. It is not a cultural view of illness/disease.
The belief that clients with the same skin color belong to a similar social group is an example of which of the following? Subculture Race Stereotyping Ethnicity
stereotyping Stereotyping means assuming that all people in a particular cultural, racial, or ethnic group share the same values and beliefs, behave similarly, and are basically alike. Ethnicity is the bond or kinship that people feel with their country of birth or place of ancestral origin. Race refers to biologic differences in physical features, such as skin color and eye shape. Subculture refers to a particular group that shares characteristics identifying the group as a distinct entity.
Which specialty in nursing involves providing nursing care in the context of the client's culture? Transcultural nursing Multicultural nursing Biocultural nursing Multilingual nursing
transcultural nursing Transcultural nursing, founded by Leininger (1977), is considered a specialty in nursing. It refers to nursing care that is provided within the context of another's culture. Multiculturalism is a philosophy that recognizes ethnic diversity within a society; it is not a nursing specialty. Biocultural refers to physical characteristics or behavior related to or resulting from a person's cultural background; it is not a nursing specialty. A nurse who is multilingual is fluent in more than one language.
