Concepts 1: Test 3 NCLEX Q's

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? "Are you rotating the injection site?" "Are you aspirating before you inject the insulin?" "Are you using a 1-inch needle to give the injection?" "Are you placing an air bubble in the syringe before injection?"

"Are you rotating the injection site?"

The nurse is assessing a client who has small groups of vesicles over his chest and upper abdominal area. They are located only on the right side of his body. The client states his pain level is 8/10, and describes the pain as burning in nature. Which question is most appropriate to include in the data collection? 1. "Did you have chicken pox as a child?" 2. "How many sexual partners have you had?" 3. "Did you use an electric blanket on your side?" 4. "Why don't you try docosanol cream (Abreva) on your lesions?"

1 The client has the symptoms of herpes zoster, or shingles, which is caused by the same organism as chicken pox. Asking about sexual partners is inappropriate for this disorder. An electric blanket use does not cause this type of lesions. Abreva is used on herpes simplex I (cold sores).

A client with diabetes mellitus who refuses to take insulin as prescribed exhibits markedly increased blood glucose levels after a meal. The nurse caring for the client anticipates that which initial body response to elevated glucose levels will worsen the situation for the client? 1.Glycogenolysis 2.Gluconeogenesis 3.Binding of glucose onto cell membranes 4.Transport of glucose across cell membranes

1. glycogenesis As blood glucose levels rise when glucose is not being carried into the cells, the body interprets this to mean that more glucose is needed. The initial response by the body is to use up the stores of glycogen in the liver. The conversion of glycogen to glucose for use by the body is called glycogenolysis. If this mechanism fails, the body breaks down fats and proteins and converts them into glucose; this process is called gluconeogenesis. Glucose binds onto cell membranes and is transported across them into the cells when there is sufficient circulating insulin. gnatavicius, Workman (2013), pp. 1411-1412

The nurse is caring for a patient with Parkinson's disease. What adjustments should the nurse make in the dietary habits of the patient to prevent malnutrition and constipation? Select all that apply.

1.Include whole grains and fruits in the diet. 2.Cut food into bite-size pieces. 3.Serve hot foods on a warmed plate. Patients with Parkinson's disease are predisposed to malnutrition and constipation, owing to inadequate food intake caused by difficulty in chewing and swallowing. To promote adequate nutrition, the nurse should include whole grains and fruits in the diet, which prevent constipation. The food should be cut bite size.

A client with acquired immunodeficiency syndrome (AIDS) reports nausea, vomiting, and abdominal pain after beginning didanosine (Videx) therapy. The clinic nurse emphasizes what instruction to this client? 1. Take crackers and milk with each dose of the medication. 2. Come to the health care clinic to be seen by the health care provider. 3. Decrease the dose of the medication until the next clinic visit. 4. This is an uncomfortable but expected side effect of the medication.

2 Pancreatitis, which can be fatal, is the major dose-limiting toxicity associated with the administration of didanosine (Videx). The client should be seen by the health care provider and be monitored for indications of developing pancreatitis. The reported symptoms are not the primary subject, and so the options directed toward explaining or managing them are not correct. The nurse should not encourage the client to alter the medication dose without first notifying the health care provider.

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 1.Urine is negative for ketones. 2.Serum potassium is 6.8 mEq/L. 3.Serum osmolality is 260 mOsm/L. 4.Arterial blood gas values are: pH 7.52, Pco2 44 mm Hg, HCO3 30 mEq/L.

2 Movement of hydrogen ions from the extracellular to the intracellular fluid promotes the movement of potassium from intracellular to extracellular fluid. Thus the serum potassium level will rise. The value in option 2 is greater than the normal range of 3.5 to 5.0 mEq/L. Presence of ketones in urine would be expected, and the serum osmolality would be elevated to reflect dehydration (the serum osmolality in option 3 is decreased). The client with DKA experiences metabolic acidosis (not metabolic alkalosis as noted in option 4).

A client who is prescribed zidovudine (Retrovir) has been diagnosed with severe neutropenia. The nurse anticipates which intervention will be implemented? 1. The medication dose will be reduced. 2. The medication will be temporarily discontinued. 3. Prednisone will be added to the medication regimen. 4. Epoetin alfa (Epogen) will be added to the medication regimen.

2. Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or neutropenia develops, treatment should be interrupted until there is evidence of bone marrow recovery. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is given to clients experiencing anemia.

A clinic nurse periodically cares for a client diagnosed with acquired immunodeficiency syndrome. The nurse assesses for an early manifestation of Pneumocystis jiroveci infection by monitoring for which of the following at each client visit? 1. Fever 2. Cough 3. Dyspnea on exertion 4. Dyspnea at rest

2. The client with P. jiroveci infection usually has a cough as the first symptom, which begins as nonproductive and then progresses to productive. Later signs include fever, dyspnea on exertion, and finally dyspnea at rest.

A home health nurse is visiting a client with type 1 diabetes mellitus. The client tells the nurse that he is not feeling well and has had a "respiratory infection" for the past week, which seems to be getting worse. After interviewing the client, what should be the initial nursing action? 1.Notify the health care provider. 2.Document the assessment data. 3.Check the client's blood glucose. 4.Obtain the client's sputum for culture and sensitivity.

3

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1.Serum pH of 9.0 2.Absent ketones in the urine 3.Serum bicarbonate of 22 mEq/L 4.Blood glucose level of 500 mg/dL

4. In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL, ketonuria, serum pH less than 7.35, and serum bicarbonate less than 16 mEq/dL.

Which observation of the patient made by the nurse is most indicative of Parkinson's disease?

difficulty rising from a chair and beginning to walk The bradykinesia of PD prevents automatic movementsand activities such as beginning to walk, rising from achair, or even swallowing saliva cannot be executed unlessthey are consciously willed.

A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse plans care for the client, knowing that pathological fat metabolism is occurring if the client has elevated levels of which substance? glucose ketones glucagon lactate dehydrogenase

ketones Ketones are a by-product of fat metabolism. When this process occurs to an extreme, the resulting condition is called ketoacidosis.

The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse would incorporate which of the following as a priority in the plan of care?

prevent client from infection

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? "I need to stop my insulin." "I need to increase my fluid intake." "I need to monitor my blood glucose every 3 to 4 hours." "I need to call the health care provider (HCP) because of these symptoms."

"I need to stop my insulin."

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? "I will stop taking my insulin if I'm too sick to eat." "I will decrease my insulin dose during times of illness." "I will adjust my insulin dose according to the level of glucose in my urine." "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

"I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease?

.Lose balance and fall backward In a pull test, when the examiner stands behind the patient and gives a tug backward on the shoulder, the patient loses balance and falls backward. This reaction indicates postural instability, a common feature in PD.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply. 1.Polyuria 2.Polydipsia 3.Polyphagia 4.Dry mouth 5.Flushed, dry skin 6.Moist mucous membranes

1, 2, 3, 4, 5 Clinical manifestations of DKA include polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive hunger), dry mouth, and flushed dry skin. The client with DKA experiences dehydration. Therefore option 6 would not be noted.

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. viruses genetic factors autoimmune factors human leukocyte antigen (HLA) primary failure of glucagon secretion

1-4 (not glucagon) Viruses and autoimmune factors are thought to play a role in the development of type 1 diabetes mellitus. Other causes of type 1 diabetes mellitus include genetic factors, specifically the presence of the human leukocyte antigen (HLA). This factor is found in many clients with type 1 diabetes mellitus. The problem with type 1 diabetes mellitus is destruction of the beta cells. It is not caused by a primary failure of glucagon secretion. Ignatavicius,

Which of the following individuals is least likely at risk for the development of Kaposi's sarcoma?

1. A kidney transplant client 2. A male with a history of same-sex partners 3. A client receiving antineoplastic medications 4. An individual working in an environment where exposure to asbestos exists Answer: 4 Rationale: Kaposi's sarcoma is a vascular malignancy that presents as a skin disorder and is a common acquired immunodeficiency syndrome indicator. It is seen frequently in men with a history of same-sex partners. Although the cause of Kaposi's sarcoma is not known, it is considered to be the result of an alteration or failure in the immune system. The renal transplant client and the client receiving antineoplastic medications are at risk for immunosuppression. Exposure to asbestos is not related to the development of Kaposi's sarcoma.

A nurse is providing general information to a group of high school students about preventing human immunodeficiency virus (HIV) transmission. The nurse would inform the students that which of the following is an unsafe behavior? 1. Abstinence 2. Mutual monogamy 3. Use of latex condoms 4. Use of natural skin condoms

4. The use of natural skin condoms is not considered safe because the pores in the condom are large enough for the virus to pass through. Abstinence is the safest way to avoid HIV infection. The next most reliable method is participation in a mutually monogamous relationship. The use of latex condoms is considered safe because the latex prevents the transmission of the HIV virus as long as the condom is used properly and remains in place and intact.

A client with human immunodeficiency virus (HIV) who has contracted tuberculosis (TB) asks the nurse how long the medication therapy lasts. The nurse responds that the duration of therapy would likely be for at least

9 total months and at least 6 months after cultures convert to negative The client with tuberculosis who is coinfected with HIV requires that antitubercular therapy last longer than usual. The prescription is usually for a total of 9 months and at least 6 months after sputum cultures convert to negative.

A client reports to the health care clinic to obtain testing regarding human immunodeficiency virus (HIV) status after being exposed to an individual who is HIV positive. The test results are reported as negative, and the client tells the nurse that he feels so much better knowing that he had not contracted HIV. The nurse explains the test results to the client, telling the client that: 1. There is no further need for testing. 2. A negative HIV test is considered accurate. 3. A negative HIV test is not considered accurate during the first 6 months after exposure. 4. The test should be repeated in 1 week.

A test done for HIV should be repeated. There might be a lag period after the infection occurs and before antibodies appear in the blood. Therefore a negative HIV test is not considered accurate during the first 6 months after exposure.

The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that immunization provides which of the following?

Acquired immunity from disease

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? Correct the acidosis. Administer 5% dextrose intravenously. Apply a monitor for an electrocardiogram. Administer short-duration insulin intravenously.

Administer short-duration insulin intravenously.

A patient with Parkinson disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition?

Allowing adequate time for the patient to eat will limit frustration and improve overall intake.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. Increase in pH Comatose state Deep, rapid breathing Decreased urine output Elevated blood glucose level

Comatose state Deep, rapid breathing Elevated blood glucose level

To reduce the risk for falls in the patient with Parkinson's disease, what should the nurse teach the patient to do?

Consciously lift the toes when walking

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? Administer a sedative. Convey empathy, trust, and respect toward the client .Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

Convey empathy, trust, and respect toward the client.

A nurse is assisting in developing a plan of care for a pregnant client with acquired immunodeficiency syndrome (AIDS). The nurse determines that which of the following is the priority concern for this client?

Development of an infection Acquired immunodeficiency syndrome decreases the body's immune response, making the infected person susceptible to infections. AIDS affects helper T lymphocytes, which are vital to the body's defense system. Opportunistic infections are a primary cause of death in people affected with AIDS. Therefore preventing infection is a priority of nursing care. Although the concerns in options 1, 3, and 4 may need to be addressed at some point in the care of the client, these are not the priority.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? Polyuria Diaphoresis Pedal edema Decreased respiratory rate

Polyuria

A client with acquired immunodeficiency syndrome (AIDS) has difficulty swallowing. The nurse has given the client suggestions to minimize the problem. The nurse determines that the client has understood the instructions if the client verbalized to increase intake of foods such as: 1. Raw fruits and vegetables 2. Hot soup 3. Peanut butter 4. Puddings

The client is instructed to avoid spicy, sticky, or excessively hot or cold foods. The client also is instructed to avoid foods that are rough, such as uncooked fruits or vegetables. The client is encouraged to take in foods that are mild, nonabrasive, and easy to swallow. Examples of these include baked fish, noodle dishes, well-cooked eggs, and desserts such as ice cream or pudding. Dry grain foods such as crackers, bread, or cookies may be softened in milk or another beverage before eating.

A nurse is assisting in developing a plan of care for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing intervention should the nurse suggest including in the plan of care to manage this symptom?

Administer an antipyretic at bedtime. For clients with AIDS who experience night fever and night sweats, it is useful to offer an antipyretic at bedtime. It is also helpful to keep a change of bed linens and night clothes nearby for use. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if there is profuse diaphoresis. The client should have liquids at the bedside to drink. Options 1, 2, and 4 are important interventions but they are unrelated to the subject of fever and night sweats.

A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse should assess the client for a hypoglycemic reaction at which times? Between 1:00 and 3:00 p.m. 10 minutes after administration Between 4:00 p.m. and 12:00 a.m. Between 8:00 and 10:00 p.m.

Between 1:00 and 3:00 p.m.

A client with acquired immunodeficiency syndrome (AIDS) is taking zidovudine (Retrovir) 200 mg orally three times daily. The client reports to the health care clinic for follow-up blood studies, and the results of the blood studies indicate severe neutropenia. Which of the following would the nurse anticipate to be prescribed for the client?

Discontinuation of the medication Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or severe neutropenia develops, treatment should be discontinued until there is evidence of bone marrow recovery. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is given to clients experiencing anemia.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? Glycosylated hemoglobin of <6% Presence of ketones in the urine Presence of albumin in the urine Fasting blood glucose level of 150 mg/dL (8.57 mmol/L)

Glycosylated hemoglobin of <6%

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? An ampule of 50% dextrose NPH insulin subcutaneously IV fluids containing dextrose Phenytoin for the prevention of seizures

IV fluids containing dextrose

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate , Cogentin) orally daily. The nurse provides information to the spouse regarding the side effects and should tell the spouse to report?

Inability to urinate Benztropine mesylate is an anticholinergic, which causes urinary retention. monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1.Lack of knowledge 2.Inadequate fluid volume 3.Compromised family coping 4.Inadequate consumption of nutrients

Inadequate fluid volume

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? Endotracheal intubation 100 units of NPH insulin Intravenous infusion of normal saline Intravenous infusion of sodium bicarbonate

Intravenous infusion of normal saline

A patient with Parkinson's disease is started on levodopa. What should the nurse explain about this drug?

It is a precursor of dopamine that is converted to dopamine in the brain. The bradykinesia of PD prevents automatic movementsand activities such as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words.

The classic triad of manifestations associated with Parkinson's disease is tremor, rigidity, and bradykinesia. What is aconsequence related to rigidity?

Muscle soreness and pain

A client who is human immunodeficiency virus (HIV) positive has had a Mantoux skin test. The results show a 7-mm area of induration. The nurse evaluates that this result is:

Positive The client with HIV is considered to have positive results on Mantoux skin testing with an area of 5 mm of induration or greater. The client without HIV is positive with induration greater than 10 or 15 mm if the client is at low risk. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is also possible for the client infected with HIV to have false negative readings because of the immunosuppression factor.

A client with acquired immunodeficiency syndrome (AIDS) is experiencing shortness of breath related to Pneumocystis jiroveci pneumonia. Which measure should the nurse suggest to assist the client in performing activities of daily living? 1. Provide supportive care with hygiene needs. 2. Provide meals and snacks with high protein, high calorie, and high nutritional value. 3. Provide small, frequent meals. 4. Offer low microbial food.

Providing supportive care with hygiene needs as needed reduces the client's physical and emotional energy demands and conserves energy resources for other functions such as breathing. Options 2, 3, and 4 are important interventions for the client with AIDS but do not address the subject of activities of daily living. Option 2 will assist the client in maintaining appropriate weight and proper nutrition. Option 3 will assist the client in tolerating meals better. Option 4 will decrease the client's risk of infection.

The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understands that this has been confirmed by which of the following?

Punch biopsy of the cutaneous lesions Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis through the upper body and then to the face and oral mucosa. They can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions.

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? Platelets Muscle tissue Adipose tissue Red blood cells (RBCs)

Red blood cells (RBCs)

The nurse has given instructions to a client with Parkinson's disease about maintaining mobility. Which action demonstrates that the client understands the directions?

Rocks back and forth to start movement with bradykinesia. The client with Parkinson's should exercise in the morning when energy levels are highest. The client should avoid sitting in soft deep chairs. they are difficult to get up from. The client can rock back and forth.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply Polyuria Shakiness Palpitations Blurred vision Lightheadedness Fruity breath odor

Shakiness Palpitations Lightheadedness

A client with Parkinson's disease is at risk for falls because of an abnormal gait. The nurse assesses the client, expecting to observe which type of gait?

Shuffling and propulsive The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping.

The client with acquired immunodeficiency syndrome has raised, dark purplish lesions on the trunk of the body. The nurse anticipates that which of the following procedures will be done to confirm whether these lesions are due to Kaposi's sarcoma?

Skin biopsy

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? Try to exercise before mealtimes. Administer insulin after exercising. Take a blood glucose test before exercising. Exercise is best performed during peak times of insulin.

Take a blood glucose test before exercising.