Exam 1 Study Questions

The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? 1 "I should drink a glass of water." 2 "I should eat three graham crackers." 3 "I should give myself 1 mg of glucagon." 4 "I should sit down and rest."

"I should eat three graham crackers."

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? 1. "The best time for me to exercise is every afternoon." 2. "The best time for me to exercise is right after I eat." 3. "The best time for me to exercise is after breakfast." 4. "The best time for me to exercise is after my morning snack."

1. "The best time for me to exercise is every afternoon." A hypoglycemic reaction may occur in the response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

Glucose is an important molecule in a cell because this molecule is primarily used for: 1. Extraction of energy 2. Synthesis of protein 3. Building of genetic material 4. Formation of cell membranes.

1. Extraction of energy Glucose catabolism is the main pathway for cellular energy production.

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except: 1. Hypoglycemia 2. Hyponatremia 3. Ketonuria 4. Polyphagia

1. Hypoglycemia

Albert refuses his bedtime snack. This should alert the nurse to assess for: 1. Elevated serum bicarbonate and a decreased blood pH. 2. Signs of hypoglycemia earlier than expected. 3. Symptoms of hyperglycemia during the peak time of NPH insulin. 4. Sugar in the urine

2. Signs of hypoglycemia earlier than expected.

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: 1. 6-8 hours 2. 10-14 hours 3. 16-20 hours 4. 24-28 hours

3. 16-20 hours

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: 1. Inhibits gluconeogenesis 2. Stimulates the release of insulin 3. Increases blood glucose levels 4. Provides more storage of glucose.

3. Increases blood glucose levels Glucagon, an insulin antagonist produced by the alpha cells in the islets of langerhans, leads to the conversion of glycogen to glucose in the liver.

The nurse is instructing a client who has been newly diagnosed with diabetes mellitus. Which intervention does the nurse teach the client that will help prevent microvascular complications of diabetes? 1 "Do not walk without shoes." 2 "Avoid urinating frequently." 3 "Have your eyes checked annually." 4 "Keep your blood sugar in good control."

4 "Keep your blood sugar in good control."

Which statement about prediabetes is correct? 1 It is a form of type 1 diabetes that tends to occur in people over age 50 years who are slender. 2 It describes an overweight person with insulin-dependent diabetes. 3 It involves an inability to respond to insulin or make sufficient insulin in the pancreas. 4 It describes people at risk for type 2 diabetes who have a fasting glucose level of 100-125 mg/dL.

4. It describes people at risk for type 2 diabetes who have a fasting glucose level of 100-125 mg/dL.

The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires IMMEDIATE intervention by the nurse? A. Client behavior that changes from anxious and restless to lethargic and confused B. Deep furrows on the surface of the tongue C. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched D. Urine output of 950 mL for the past 24 hours

A

A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an education plan, the nurse's first action should be to a. assess the patient's perception of what it means to have type 2 diabetes. b. demonstrate how to check glucose using capillary blood glucose monitoring. c. ask the patient's family to participate in the diabetes education program. d. discuss the need for the patient to actively participate in diabetes management.

A Rationale: Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone.

A Rationale: Glucose levels increase when patients are taking CORTICOsteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a complication of RA exacerbation or prednisone use. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient is likely to have an increased appetite when taking prednisone, but it will be important to avoid weight gain for the patient with RA.

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a. Give the patient a snack of cheese and crackers. b. Have the patient drink a glass of orange juice or nonfat milk. c. Administer a continuous infusion of 5% dextrose for 24 hours. d. Assess the patient for symptoms of hyperglycemia.

A Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's report, the nurse should a. obtain a glucose reading using a finger stick. b. administer 1 mg glucagon subcutaneously. c. have the patient eat a candy bar. d. have the patient drink 4 ounces of orange juice.

A Rationale: The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Candy bars contain fat, which would slow down the absorption of sugar and delay the response to treatment.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." b. "Restrict your fluid intake to no more than 2 liters a day." c. "Prevent hypoglycemia by eating a bedtime snack." d. "Limit your intake of protein to prevent ketoacidosis."

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control.

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? a. "If I develop an infection, I should stop taking my corticosteroid." b. "If I have pain over the transplant site, I will call the surgeon immediately." c. "I should avoid people who are ill or who have an infection." d. "I should take my cyclosporine exactly the way I was taught."

ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of anti-rejection medications may cause them to not work optimally.

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.

ANS: A The client's blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client's blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client's blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.

A nurse is assessing clients on a medical-surgical unit. Which client is at risk for hypokalemia? a. Client with pancreatitis who has continuous nasogastric suctioning b. Client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor c. Client in a motor vehicle crash who is receiving 6 units of packed red blood cells d. Client with uncontrolled diabetes and a serum pH level of 7.33

ANS: A A client with continuous nasogastric suctioning would be at risk for actual potassium loss leading to hypokalemia. The other clients are at risk for potassium excess or hyperkalemia.

A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? a.Insulin glargine b.Lente insulin c, Lispro insulin d. Regular insulin

ANS: A Insulin glargine (Lantus) is long-acting insulin with an onset of 1 hour. It is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. Intermediate-acting insulins include neutral-protamine-Hagedorn (NPH), Lente, and Humulin N. Rapid-acting insulins include insulin lispro. Regular insulin is short acting.

Which statement by a patient taking glipizide indicates that more teaching is indicated? a. "I will use a new needle every time I take the medication." b. "I will take the medication once a day in the morning." c. "I will eat my breakfast very soon after taking my Glucotrol." d. "This medication stimulates my pancreatic cells to make insulin."

ANS: A Glipizide (Glucotrol) is an oral antidiabetic agent. It is well absorbed from the GI tract and is highly protein-bound. Parenteral administration of this medication is not indicated. All other options are correct.

A patient received regular insulin at 7:30 am. At 9:30 am the patient feels slightly hungry and has a dull headache. The nurse should a. test the patient's blood glucose level. b. ensure that the patient has a meal. c. provide the patient with 4 ounces of orange juice. d. administer the next dose of insulin.

ANS: A The peak time for regular insulin is 2 to 4 hours. It is most important for the nurse to check the patient's blood glucose level to prevent a possible hypoglycemic reaction (insulin shock).

1. A nurse assesses a client who is admitted for treatment of fluid overload. Which manifestations should the nurse expect to find? (Select all that apply.) a. Increased pulse rate b. Distended neck veins c. Decreased blood pressure d. Warm and pink skin e. Skeletal muscle weakness

ANS: A, B, E Manifestations of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, and skeletal muscle weakness.

5. A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance? (Select all that apply.) a. Hypokalemia - Flaccid paralysis with respiratory depression b. Hyperphosphatemia - Paresthesia with sensations of tingling and numbness c. Hyponatremia - Decreased level of consciousness d. Hypercalcemia - Positive Trousseau's and Chvostek's signs e. Hypomagnesemia - Bradycardia, peripheral vasodilation, and hypotension

ANS: A, C Flaccid paralysis with respiratory depression is associated with hypokalemia. Decreased level of consciousness is associated with hyponatremia. Paresthesia with sensations of tingling and numbness is associated with hypophosphatemia or hypercalcemia. Positive Trousseau's and Chvostek's signs are associated with hypocalcemia or hyperphosphatemia. Bradycardia, peripheral vasodilation, and hypotension are associated with hypermagnesemia.

After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I need to have an annual appointment even if my glucose levels are in good control." b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." c. "I can still develop complications even though I do not have to take insulin at this time." d. "If I have surgery or get very ill, I may have to receive insulin injections for a short time."

ANS: B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future.

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? a. 75-year-old client whose blood glucose levels show little variation b. 55-year-old client who has hypoglycemic unawareness c. 80-year-old client with type 2 diabetes mellitus d. 45-year-old client with type 1 diabetes mellitus

ANS: B Comparison studies have shown wide variation between fingertip and alternate sites, and variation is most evident during times when blood glucose levels are rapidly changing. Teach patients that there is a lag time for blood glucose levels between the fingertip and other sites when blood glucose levels are changing rapidly and that the fingertip reading is the only safe choice at those times. Because of this lag time, clients who have hypoglycemic unawareness should never use alternate sites for SMBG. Cognitive Level: Applying or Higher Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Implementation

2. A nurse is caring for a client who exhibits dehydration-induced confusion. Which intervention should the nurse implement first? a. Measure intake and output every 4 hours. b. Apply oxygen by mask or nasal cannula. c. Increase the IV flow rate to 250 mL/hr. d. Place the client in a high-Fowler's position.

ANS: B Dehydration most frequently leads to poor cerebral perfusion and cerebral hypoxia, causing confusion. Applying oxygen can reduce confusion, even if perfusion is still less than optimal. Increasing the IV flow rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the client too rapidly with IV fluids can lead to cerebral edema. Measuring intake and output and placing the client in a high-Fowler's position will not address the client's problem.

5. A nurse is assessing clients on a medical-surgical unit. Which adult client should the nurse identify as being at greatest risk for insensible water loss? a. Client taking furosemide (Lasix) b. Anxious client who has tachypnea c. Client who is on fluid restrictions d. Client who is constipated with abdominal pain

ANS: B Insensible water loss is water loss through the skin, lungs, and stool. Clients at risk for insensible water loss include those being mechanically ventilated, those with rapid respirations, and those undergoing continuous GI suctioning. Clients who have thyroid crisis, trauma, burns, states of extreme stress, and fever are also at increased risk. The client taking furosemide will have increased fluid loss, but not insensible water loss. The other two clients on a fluid restriction and with constipation are not at risk for fluid loss.

Which time frame would be most appropriate for administering sliding-scale lispro insulin? a. Within 30 minutes of consuming breakfast b. When the breakfast tray is served and ready to eat c. Within 1 hour of obtaining blood glucose measurement d. Within 15 minutes of obtaining blood glucose measurement

ANS: B Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes.

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a. "Change positions slowly when you get out of bed." b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." c. "If you miss a dose of this drug, you can double the next dose." d. "Discontinue the medication if you develop a urinary infection."

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

For which clients is it most important for the nurse to check frequently for dehydration? (Select all that apply.) a. 24-year-old athlete who is NPO for 4 hours awaiting an appendectomy b. 42-year-old client who has diabetes insipidus c. 56-year-old client recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) d. 68-year-old client with poorly controlled type 2 diabetes mellitus e. 72-year-old client taking 80 mg of furosemide orally every day f. 74-year-old undergoing a bowel preparation with multiple enemas before colon surgery

ANS: B, D, E, F

1. Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes? a. "Avoid drinking ice-cold beverages." b. "Be sure to check your blood pressure twice daily." c. "Change positions slowly when moving from sitting to standing." d. "Check your hands and feet weekly for areas of numbness or sensation change."

ANS: C Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults. Although checking blood pressure twice daily is helpful, it does not prevent orthostatic hypotension, nor is there any guarantee that such hypotension will occur during blood pressure measurement. Sensation changes are associated with peripheral neuropathy, not cardiovascular autonomic neuropathy. Avoiding cold beverages is no longer a recommended action.

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the client's chart. b. Assess tactile sensation in the client's hands. c. Examine the client's feet for signs of injury. d. Notify the health care provider.

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen."

ANS: C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

9. A nurse teaches a client who is at risk for mild hypernatremia. Which statement should the nurse include in this client's teaching? a. "Weigh yourself every morning and every night." b. "Check your radial pulse twice a day." c. "Read food labels to determine sodium content." d. "Bake or grill the meat rather than frying it."

ANS: C Most prepackaged foods have a high sodium content. Teaching clients how to read labels and calculate the sodium content of food can help them adhere to prescribed sodium restrictions and can prevent hypernatremia. Daily self-weighing and pulse checking are methods of identifying manifestations of hypernatremia, but they do not prevent it. The addition of substances during cooking, not the method of cooking, increases the sodium content of a meal.

1. A nurse teaches clients at a community center about risks for dehydration. Which client is at greatest risk for dehydration? a. A 36-year-old who is prescribed long-term steroid therapy b. A 55-year-old receiving hypertonic intravenous fluids c. A 76-year-old who is cognitively impaired d. An 83-year-old with congestive heart failure

ANS: C Older adults, because they have less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids independently or cannot make his or her need for fluids known is at high risk for dehydration

The patient experiences the Somogyi effect. Which statement regarding the Somogyi effect does the nurse identify as being true? a. This is a hyperglycemic condition. b. The condition usually occurs immediately after dinner. c. It is a response to excessive insulin. d. Management usually requires increase of the bedtime insulin dose.

ANS: C The Somogyi effect is a response to excessive insulin resulting in a hypoglycemic condition usually occurring in the predawn hours of 2:00 to 4:00 am. A rapid decrease in blood glucose during the nighttime hours stimulates a release of hormones (e.g., cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, and glycogenolysis, thus creating the Somogyi effect. Management of the Somogyi effect involves monitoring blood glucose between 2:00 am and 4:00 am and reducing the bedtime insulin dosage.

A patient is prescribed metformin. Which is a side effect/adverse effect common to metformin? a. Seizures b. Constipation c. Bitter or metallic taste d. Polyuria and polydipsia

ANS: C Metformin has a bitter or metallic taste. Seizures, constipation, polyuria, and polydipsia are not side effects/adverse effects of metformin.

A nurse gives a patient NPH insulin at 8:00 am. At 2:00 pm the nurse finds the patient extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The nurse should a. call the health care provider. b. ensure that the patient has a meal. c. provide the patient with 4 ounces of orange juice. d. administer the next dose of insulin.

ANS: C NPH is an intermediate-acting insulin that peaks in 6 to 12 hours. Because the patient is conscious, it is most important for the nurse to provide the orange juice to prevent a possible hypoglycemic reaction (insulin shock).

When teaching the patient about the storage of insulin, which statement will the nurse include? a. Keep the insulin in the freezer. b. Warm the insulin in the microwave before administration. c. Do not place insulin in sunlight or a warm environment. d. Open insulin vials lose their strength after one year.

ANS: C Unopened insulin vials are refrigerated until needed. Once an insulin vial has been opened, it may be kept (1) at room temperature for 1 month or (2) in the refrigerator for 3 months. Insulin is less irritating to the tissues when injected at room temperature. Insulin vials should not be put in the freezer. In addition, insulin vials should not be placed in direct sunlight or in a high-temperature area. Prefilled syringes should be stored in the refrigerator and should be used within 1 to 2 weeks. Opened insulin vials lose their strength after approximately 3 months.

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise."

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)

ANS: D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.

17. A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital? a. Ask family members to speak quietly to keep the client calm. b. Assess urine color, amount, and specific gravity each day. c. Encourage the client to drink at least 1 liter of fluids each shift. d. Dangle the client on the bedside before ambulating.

ANS: D An older adult with moderate dehydration may experience orthostatic hypotension. The client should dangle on the bedside before ambulating. Although dehydration in an older adult may cause confusion, speaking quietly will not help the client remain calm or decrease confusion. Assessing the client's urine may assist with the diagnosis of dehydration but would not prevent injury. Clients are encouraged to drink fluids, but 1 liter of fluid each shift for an older adult may cause respiratory distress and symptoms of fluid overload, especially if the client has heart failure or renal insufficiency.

7. After teaching a client who is prescribed a restricted sodium diet, a nurse assesses the client's understanding. Which food choice for lunch indicates the client correctly understood the teaching? a. Slices of smoked ham with potato salad b. Bowl of tomato soup with a grilled cheese sandwich c. Salami and cheese on whole wheat crackers d. Grilled chicken breast with glazed carrots

ANS: D Clients on restricted sodium diets generally should avoid processed, smoked, and pickled foods and those with sauces and other condiments. Foods lowest in sodium include fish, poultry, and fresh produce. The ham, tomato soup, salami, and crackers are often high in sodium.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "I will see the eye doctor when I have a vision problem and yearly after age 40." c. "My vision will change quickly. I should see the ophthalmologist twice a year." d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

6. A nurse is evaluating a client who is being treated for dehydration. Which assessment result should the nurse correlate with a therapeutic response to the treatment plan? a. Increased respiratory rate from 12 breaths/min to 22 breaths/min b. Decreased skin turgor on the client's posterior hand and forehead c. Increased urine specific gravity from 1.012 to 1.030 g/mL d. Decreased orthostatic light-headedness and dizziness

ANS: D The focus of management for clients with dehydration is to increase fluid volumes to normal. When fluid volumes return to normal, clients should perfuse the brain more effectively, therefore improving confusion and decreasing orthostatic light-headedness or dizziness. Increased respiratory rate, decreased skin turgor, and increased specific gravity are all manifestations of dehydration.

Which is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? 1 American Diabetes Association 2 Centers for Disease Control and Prevention 3 Health care provider office 4 Pharmaceutical representative

American Diabetes Association

Glucagon injection give IM

Amp D50 IV

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure. Laboratory results include a potassium level of 7.0 mEq/L. Which medication does the nurse anticipate administering? A. Insulin (regular insulin) and dextrose (D20W) B. Loperamide (Imodium) C. Sodium polystyrene sulfonate (Kayexalate) D. Supplemental potassium

Answer: A Rationale: If potassium levels are high, a combination of 20 units of regular insulin in 100 mL of 20% dextrose in water may be prescribed to promote movement of potassium from the blood into the intracellular fluid. Imodium is used in the treatment of diarrhea. Kayexalate is used for hyperkalemia, but not when the potassium level is this high (7.0). Additional potassium would make the client's condition more critical.

The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires IMMEDIATE intervention by the nurse? A. Client behavior that changes from anxious and restless to lethargic and confused B. Deep furrows on the surface of the tongue C. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched D. Urine output of 950 mL for the past 24 hours

Answer: A Rationale: The client's change in level of consciousness from anxious and restless to lethargic and confused suggests poor cerebral blood flow, or shrinkage or swelling of brain cells caused by fluid shifts within the brain cells. These changes indicate a need for immediate intervention to prevent further damage to cerebral function. Deep furrows on the surface of the tongue, poor skin turgor, and low urine output are all caused by the fluid volume deficit, but do not indicate complications of dehydration that are immediately life-threatening.

Which question is most important for the nurse to ask the client who has a serum potassium level of 2.9 mEq/L? A. "Do you use sugar substitutes?" B. "Do you use diuretics or laxatives?" C. "Have you had any muscle twitches or cramps, especially at night? D. "Have you or any member of your family ever been diagnosed with lung disease?"

Answer: B Rationale: The serum potassium level is low, and the client has hypokalemia. Misuse or overuse of diuretics, especially high -ceiling (loop) and thiazide diuretics, and laxatives are common causes of hypokalemia among older adults and clients with eating disorders. Sugar substitutes do not change serum potassium levels. Muscle cramps and twitching may occur with hyperkalemia and hypocalcemia but not with hypokalemia. Lung disease is not associated with hypokalemia. (Pg. 165 - NCLEX challenge box)

A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His current medications are digoxin (Lanoxin), chlorothiazide (Diuril), and oral potassium supplements. He tells the nurse that he has had flulike symptoms for the past week and has been unable to drink for the past 48 hours. The health care provider requests laboratory specimens to be drawn and an isotonic IV to be started. Which IV fluid does the nurse administer? A. 0.45% saline B. 5% dextrose in 0.45% saline C. 5% dextrose in Ringer's lactate D. 5% dextrose in water (D5W)

Answer: D Rationale: 5% dextrose in water (D5W) is an isotonic solution. 0.45% saline is a hypotonic solution, while 5% dextrose in 0.45% saline and 5% dextrose in Ringer's lactate are hypertonic solutions.

The nurse instructs an older adult client to increase intake of dietary potassium when the client is prescribed which classification of drugs? A. Alpha antagonists B. Beta blockers C. Corticosteroids D. High-ceiling (loop) diuretics

Answer: D Rationale: High-ceiling (loop) diuretics are potassium-depleting drugs. The client should increase intake of dietary potassium to compensate for this depletion. Alpha antagonists, beta blockers, and corticosteroids are not potassium-depleting drugs. Loop diuretics blocks reabsorption of K+, Na+, H2O, and Cl-

Which assessment finding indicates to the nurse that fluid resuscitation therapy for the client with isotonic dehydration is effective? A. Respiratory rate has changed from 16 to 18 breaths/min. B. Urine specific gravity has increased from 1.040 to 1.050. C. Neck veins are flat when the client moves to a sitting position. D. Pulse pressure has changed from 22 mm Hg to 32 mm Hg.

Answer: D Rationale: Isotonic dehydration manifests as hypovolemia and shock. The increasing pulse pressure (difference between the diastolic and systolic blood pressures) is an indication that the fluid volume deficit is being corrected. All other options do not show improvement in dehydration. The normal urine specific gravity is 1.00-1.03, and incr levels indicate dehydration (Pg. 158 - NCLEX challenge box)

Rotating injection sites when administering insulin prevents which of the following complications? 1. Insulin edema 2. Insulin lipodystrophy 3. Insulin resistance 4. Systemic allergic reactions

B. Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.

Which of the following chronic complications is associated with diabetes? 1. Dizziness, dyspnea on exertion, and coronary artery disease. 2. Retinopathy, neuropathy, and coronary artery disease 3. Leg ulcers, cerebral ischemic events, and pulmonary infarcts 4. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia's

B. These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.

The nurse determines there is no need for further instruction related to a low-sodium diet when the patient says: a. "I can have all the dried fruits I want." b. "I'm looking forward to a tall glass of tomato juice." c. "I'm going to eat my favorite avocado and orange salad." d. "I'm going to eat a cheeseburger with extra catsup."

C - "I'm going to eat my avocado and orange salad."

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? 1. Give glyburide again 2. Give subcutaneous insulin and monitor blood glucose 3. Monitor blood glucose closely, and look for signs of hypoglycemia. 4. Monitor blood glucose, and assess for signs of hyperglycemia.

C. When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemia. The client wouldn't have hyperglycemia if the glyburide was absorbed.

A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy

C: Autonomic neuropathy

An older adult is admitted to the medical surgical unit with dehydration. The nurse performs which of these assessments to determine whether the client is safe for independent ambulation? Assesses for dry oral mucous membranes Checks for orthostatic blood pressure changes Notes pulse rate is 72 beats/min and bounding Evaluates that the serum potassium level is 4.0 mEq/L (4.0 mmol/L)

Checks for orthostatic blood pressure changes

The nurse uses a diagram to demonstrate how in dehydration the water is drawn into the plasma from the cells by the process of: A. distillation B. diffusion C. filtration D. osmosis

D. osmosis

A client is admitted to the hospital with dehydration secondary to influenza and vomiting. The provider orders an intravenous (IV) potassium replacement for potassium level of 2.7 mEq/L (2.7 mmol/L). Which of these best practice techniques does the nurse include when administering this medication? a. Ensuring that the concentration is no greater than 1?9?mEq/10?9?mL of solution b, Use a vein in the hand for better flow c, Use an IV pump to deliver the medication d. Check IV access for blood return after the infusion e. Push the medication over 5 minutes

Ensuring that the concentration is no greater than 1?9?mEq/10? 9 mL of solution Use an IV pump to deliver the medication

A client is receiving 250 mL of a 3% sodium chloride solution intravenously for severe hyponatremia. Which signs and symptoms indicate to the nurse that this therapy is effective? a. The client reports hand swelling. b. Bowel sounds are present in all four abdominal quadrants. c. Serum potassium level has decreased from 4.4 mEq/L (mmol/L) to 4.2 mEq/L (mmol/L). d. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg.

NS: D Where sodium goes, water follows. Clients with severe hyponatremia are most often hypovolemic and hypotensive because fluid does not stay in the plasma volume when sodium levels are low. The plasma volume leaks into the interstitial space, which leads to edema formation. Having the blood pressure increase is the best nonlaboratory indicator that the treatment is effective. Cognitive Level: Applying or higher Client Needs Category: Safe and Effective Care Environment Nursing Process Step: Evaluation

A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time? A. Place the client on bed rest. B. Evaluate the electrolyte levels. C. Administer the ordered diuretic. assess for orthostatic hypotension. D. initiate cardiac monitoring

Place the client on bed rest. Evaluate the electrolyte levels. assess for orthostatic hypotension. initiate cardiac monitoring

The nurse is teaching a client with newly diagnosed type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? a. "I will begin exercising for at least an hour a day." b. "I will monitor my diet and avoid empty calories." c. "If I lose weight, I may not need to use the insulin anymore." d. "Weight loss can be a sign of diabetic ketoacidosis."

a. "I will begin exercising for at least an hour a day."

The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse? a. Client behavior that changes from anxious to lethargic b. Deep furrows on the surface of the tongue c. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched d. Urine output of 950 mL for the past 24 hours

a. Client behavior that changes from anxious to lethargic

The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral neuropathy. Which statement by the client indicates a need for further teaching about injury prevention? a. "I can break in my shoes by wearing them all day." b. "I need to monitor my feet daily for blisters or skin breaks." c. "I will never go barefoot." d. "I need to quit smoking."

a. I can break in my shoes by wearing them all day

A patient newly diagnosed with Type I DM is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be a. confused with cold, clammy skin an pulse of 110 b. lethargic with hot dry dkin and rapid deep respirations c. alert and cooperative with BP of 130/80 and respirations of 12 d. short of breath, with distended neck veins and bounding pulse of 96.

a. confused with cold, clammy skin an pulse of 110

1. The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and a hemoglobin A1c (A1C) of 5.9%. What is the nurse's interpretation of these findings? a. The client's glucose control for the past 24 hours has been good but the overall control is poor. b. The client's glucose control for the past 24 hours has been poor but the overall control is good. c. The values indicate that the client has poorly managed his or her disease. d. The values indicate that the client has managed his or her disease well.

ans: D

3. After teaching a client who is being treated for dehydration, a nurse assesses the client's understanding. Which statement indicates the client correctly understood the teaching? a. "I must drink a quart of water or other liquid each day." b. "I will weigh myself each morning before I eat or drink." c. "I will use a salt substitute when making and eating my meals." d. "I will not drink liquids after 6 PM so I won't have to get up at night."

b. "I will weigh myself each morning before I eat or drink.

A client develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform first? a. Draws blood for laboratory tests b. Elevates the head of the bed c. Places the extremities in a dependent position d. Puts the client in a side-lying position

b. Elevates the head of the bed

Because the 80-year-old patient is prone to dehydration related to the age-related change of decreased thirst and kidney function, the nurse monitors for the earliest sign of dehydration, which is: a. reduced skin turgor. b. constipation. c. increased temperature. d. thirst.

b. constipation.

The nurse is assessing a patient with renal failure and notes fatigue, muscle cramps, confusion, and headache. The nurse will monitor the patient's _____ level. a. potassium b. sodium c. calcium d. chloride

b. sodium

A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin? a. "Your diabetes is getting worse, so you will need to take insulin." b. "You can't take your metformin while in the hospital." c. Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily." d. "You must take insulin from now on because the surgery will affect your diabetes."

c. Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily."

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next? a. Instruct the client to continue with the current diet and metformin use. b. Discuss the need to check blood glucose several times every day. c. Talk about the possibility of adding rapid-acting insulin to the regimen. d. Ask the client about current dietary intake and medication use.

d. Ask the client about current dietary intake and medication use

The nurse is planning care for a 72-year-old resident of a long-term care facility who has a history of dehydration. Which action does the nurse delegate to unlicensed assistive personnel (UAP)? a. Assessing oral mucosa for dryness b. Choosing appropriate oral fluids c. Monitoring skin turgor for tenting d. Offering fluids to drink every hour

d. Offering fluids to drink every hour

What is the opposite of insulin - prevents hypoglycemia

glucagon

hunger, headache, tremors, sweating, confusion, temporary vision problems

hypoglycemia