Exam 3

•To determine the presence of respiratory alkalosis in the laboring client, what should the nurse evaluate her for? a.A change in the respiratory rate b.A tingling sensation in the hands c.Periodic changes in the fetal heart rate d.A pulse oximetry reading of less than 98%

b.A tingling sensation in the hands

•An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen? a.Determine what the adolescent has been taught about diabetes. b.Encourage the adolescent to express feelings about having diabetes. c.Explain to the parents that it is their responsibility to demonstrate their acceptance. d.Provide the family with printed materials about the consequences of ineffectively controlled diabetes.

b.Encourage the adolescent to express feelings about having diabetes.

•An adolescent with type 1 diabetes is brought to the emergency department unconscious. The blood glucose level is found to be 742 mg/dL. What clinical manifestation does the nurse expect the adolescent to exhibit during the initial assessment? a.Pyrexia b.Hyperpnea c.Bradycardia d.Hypertension

b.Hyperpnea

•A woman who has gestational diabetes gives birth at term to a large-for-gestational age (LGA) infant weighing 9 lb 6 oz (4250 g). For what complication should the newborn be monitored? a.Anemia b.Hypoglycemia c.Increased calcium d.Meconium aspiration

b.Hypoglycemia

A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to a. Withhold the regular dose of insulin. b. Drink cool fluids with high glucose content. c. Check the blood glucose level every 2 to 4 hours. d. Use a less strenuous form of exercise than usual until the illness resolves.

c. Check the blood glucose level every 2 to 4 hours.

The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goals is most appropriate? a. Make all patients responsible for the management of their disease. b. Involve the family and significant others in the care of these patients. c. Enable the patients to become active participants in the management of their disease. d. Provide the patients with as much information as soon as possible to prevent complications.

c. Enable the patients to become active participants in the management of their disease.

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a.Potassium is returned to extracellular fluid when metabolic acidosis is corrected. b.Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells. c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells. d.In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.

c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells.

•Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? a.Providing oxygen b.Encouraging carbohydrates c.Administering fluid replacement d.Teaching facts about dietary principles

c.Administering fluid replacement

•A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis? a.An elevated pH, elevated PCO2 b.A decreased pH, elevated PCO2 c.An elevated pH, decreased PCO2 d.A decreased pH, decreased PCO2

c.An elevated pH, decreased PCO2

•A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis

c.Metabolic acidosis

•What is a nursing priority to prevent complications in clients with respiratory acidosis? a.Assessing the nail beds b.Listening to breath sounds c.Monitoring breathing status d.Checking muscle contractions

c.Monitoring breathing status

•A nurse is caring for an 11-year-old child with type 1 diabetes. Two hours after breakfast the child becomes pale, diaphoretic, and shaky. What action should the nurse take? a.Notifying the practitioner b.Administering supplemental insulin c.Obtaining a current blood glucose level d.Giving orange juice with a slice of bread

c.Obtaining a current blood glucose level

•A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? a.Skeletal and nervous b.Circulatory and urinary c.Respiratory and urinary d.Muscular and endocrine

c.Respiratory and urinary

•A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? a.pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg b.pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg d.pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg

c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg

striae

cushings

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "The laboratory test result is positive for type 2 diabetes." b. "You will develop type 2 diabetes within 5 years." c. "The test reis normal, and diabetes is not a problem." d. "You are at increased risk for developing diabetes."

d. "You are at increased risk for developing diabetes."

•A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? a.7.20 and 60 mg/dL b.7.50 and 60 mg/dL c.7.50 and 460 mg/dL d.7.20 and 460 mg/dL

d.7.20 and 460 mg/dL

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? a.A patient with a traumatic brain injury b.A patient with type 1 diabetes mellitus c.A patient with acute respiratory failure d.A patient with nasogastric tube suction

d.A patient with nasogastric tube suction

•A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? a.Fluid loss b.Glycosuria c.Increased blood glucose level d.Kussmaul respirations

d.Kussmaul respirations

goiter and ephtalmous

ephtalmous - graves and hyper goiter - hypo/hyper thyroid

myxedema

hypothyroidism levothyroxine

What is the Dawn Phenomenon?

in the earlier hours of the day there is a spike in blood sugar

The nurse is caring for a client who suddenly becomes lethargic and has an increase in the depth and rate of respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis

The client has severe metabolic alkalosis. Which intervention has the highest priority? A. Raise the side rails on the client's bed. B. Measure the urine output and skin turgor. C. Teach the family about metabolic alkalosis. D. Administer intravenous NaHCO3 as ordered.

A. Raise the side rails on the client's bed.

A patient with severe diarrhea is at risk for what acid-base imbalance? A.Acidosis B.Alkalosis C.Ketoacidosis D.None of the above

A.Acidosis

Which symptom requires immediate intervention during a hypoglycemic episode? A.Confusion B.Hunger C.Headache D.Tachycardia

A.Confusion

Which are clinical manifestations of Respiratory Alkalosis? SATA A.Deep rapid respirations B.Tachycardia C.Confusion D.Numbness & Tingling E.Hypertension

A.Deep rapid respirations B.Tachycardia C.Confusion D.Numbness & Tingling

Teaching a patient who is a diabetic would include? SATA A.Diet rich in fruits and vegi's B.Limit alcohol intake C.Monitor carb intake D.Check blood glucose levels regularly E.Carry sugar tablets at all times F.Exercise prior to bedtime G.Take insulin doses as scheduled

A.Diet rich in fruits and vegi's B.Limit alcohol intake C.Monitor carb intake D.Check blood glucose levels regularly E.Carry sugar tablets at all times

Signs of Addisonian Crisis are? SATA A.Low Na B.Elevated K C.Low BP D.Increase respirations

A.Low Na B.Elevated K C.Low BP treat: IV solucortef followed by IV fluids

Include the following when teaching a diabetic about foot care? SATA A.Use a bath thermometer to test water temps B.Never go barefoot C.Soak feet daily D.Examine feet at least once a week E.Wear clean soaks everyday F.Give insulin injections in toes

A.Use a bath thermometer to test water temps B.Never go barefoot E.Wear clean soaks everyday

The nurse should ask which of the following questions to detect the risk factors for metabolic acidosis? Select all that apply. A. Have you been vomiting today? B. When did your kidneys stop working? C. How long have you had diarrhea? D. Are you still feeling short of breath? E. What type of antacid did you take? F. Which weight loss diet are you using?

B. When did your kidneys stop working? C. How long have you had diarrhea? F. Which weight loss diet are you using?

Best way to monitor for fluid overload is what? A.Lab work for BUN/Create levels B.Auscultate lungs for crackles C.Monitor I/O's D.Monitor BP

B.Auscultate lungs for crackles

A diabetic patient has the following ABG's pH 7.26, PaO2 99, pCO2 27, HCO3 18. What is the possible cause? A.Severe vomiting B.DKA C.Hyperventilation D.Pneumonia

B.DKA

A pt. with an increased urine output of 3L with Diabetes Insipidus should be treated with which medication? A.Lasix B.Desmopressin C.Rapid acting insulin D.Levothyroxine

B.Desmopressin

Safety measures used for radioactive iodine? SATA A.Avoid pregnant women and children only following first dose B.Flush toilet multiple times C.Use separate bathroom D.Don't share items E.Wash clothes separately

B.Flush toilet multiple times C.Use separate bathroom D.Don't share items E.Wash clothes separately

Levothyroxine is used for the treatment of what? A.DM B.Hypothyroid C.Cushing's D.SIADH

B.Hypothyroid

What insulin is given with meals? A.NPH B.Lispro C.Metformin D.Glargine

B.Lispro

The nurse is assessing a client who has diabetic ketoacidosis. Her assessment reveals tachycardia, lethargy, and hyperventilation. Treatment for the ketoacidosis has been initiated. What should the nurse do about the hyperventilation? A.Request an order for pain medication and oxygen at 6 L/min. B.Lubricate the patient's lips and allow continued hyperventilation. C.Have the patient breathe into a paper bag to stop hyperventilating. D.Contact the physician immediately regarding this complication.

B.Lubricate the patient's lips and allow continued hyperventilation.

When would you give D50? A.Pt. is alert with a blood glucose level of 60 B.Pt is unconscious with a glucose level of 40 C.Pt. can not find their glucose tablets D.After you check glucose level with a lab draw

B.Pt is unconscious with a glucose level of 40

In gestational diabetes the hormones begin to change in what trimester that leads to insulin resistance? A.First trimester B.Second trimester C.Insulin resistance is not an issue during pregnancy D.You just have to deal with this issue throughout the entire pregnancy.

B.Second trimester

What is the Somogyi effect?

Blood sugar drops around 3 or 4 in the morning but in the earlier hours of the day there is a spike in blood sugar

•The client newly diagnosed with type 1 diabetes asks why insulin is given only by injection and not as an oral drug. What is the nurse's best response? •A. "Injected insulin works faster than oral drugs to lower blood glucose levels." •B. "Oral insulin is so weak that it would require very high dosages to be effective." •C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes." •D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes."

The client newly diagnosed with diabetes asks why he is always so thirsty. What is the nurse's best response? A. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." B. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." D. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost

C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

What is the nurse's priority for a patient with respiratory acidosis? A.Administer oxygen B.Assess vital signs C.Assess the airway D.Administer bronchodilators

C.Assess the airway

When should you administer insulin to a patient? A.After meals B.Only to type one diabetics C.Before meals and after blood glucose levels have been checked D.Only when symptomatic

C.Before meals and after blood glucose levels have been checked

What is the best test to determine if a patients DM is well controlled? A.Lab draw for blood glucose level B.Bedside finger stick C.Hemoglobin A1C D.Serum K level

C.Hemoglobin A1C

The following ABG's pH 7.38, PaO2 97, PaCO2 30, HCO3 20 indicate what issue? What compensatory mechanism would you expect? A.Polyuria B.Polydipsia C.Kussmaul Respirations D.Hypokalemia due to release of acids

C.Kussmaul Respirations

What is the first thing you should do for a pt. admitted with myxedema coma? A.Administer STH B.Give IVF C.Maintain an airway D.Give insulin dose

C.Maintain an airway

What medication must be held prior to a CT scan with contrast? A.Glipizide B.Acetaminophen C.Metformin D.MSO4

C.Metformin

Your patients ABG's are pH 7.15, PaO2 58, PaCO2 65, HCO3 23. What is the cause for this? A.Hyperventilation with anxiety B.Diarrhea for 12 hours C.Obstruction related to aspiration of food D.Renal failure

C.Obstruction related to aspiration of food

When should a patient with type 1 diabetes avoid exercise? A.When serum glucose is less than 150 B.During colder months C.When ketones are present in the urine D.When emotional stressors are high for the patient

C.When ketones are present in the urine

The client newly diagnosed with type 2 diabetes asks how diabetes type 1 and diabetes type 2 are different. What is the nurse's best response? •A. "Diabetes type 1 develops in people younger than 40 years and diabetes type 2 develops only in older people." •B. "Diabetes type 2 develops in people younger than 40 years and diabetes type 1 develops only in older people." •C. "Patients with type 1 diabetes are at higher risk for obesity and heart disease, whereas patients with type 2 diabetes are at higher risk for strokes." •D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

The nurse in the emergency department is caring for a client who is on a ventilator. The patient's blood gases report reveals a pH 7.48, PaO2 85 mm Hg, a PaCO2 32 mm Hg, and a HCO3 25 mEq/L. What is the nurse's interpretation of these results? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D. Respiratory alkalosis

A client is having their first severe, acute asthma episode. It began 2 hours ago. What blood gas values should the nurse expect to see? A. pH high, PaCO2 high, HCO3- high B. pH low, PaCO2 low, HCO3- low C. pH low, PaCO2 high, HCO3- high D. pH low, PaCO2 high, HCO3- normal

D. pH low, PaCO2 high, HCO3- normal

Fasting is a great way to control acid-base balance? •True •False

False

•What are the S/S of DKA?

Fruity breath, high and dry, ketones in urine

What are the symptoms of a Thyroid Strom?

High fever, high bp, tachycardia, irritability, distended neck veins, (no vitamins or minerals w/ Synthroid)

•What do you do in order to treat DKA?

Hydration - 1 liter of fluid pushed in over and hour

Why is it important for DM patients to follow up with their PCP when they are sick?

Illness causes blood glucose to increase

What is the priority for a patient with a Na level of 120?

Seizure precautions then fall precautions

How should a patient stop steroids?

Taper gradually

Why should a pt. with Cushing's avoid crowds?

To prevent risk of infection

When mixing insulin always draw up the lispro before NPH? True False

True

What is the difference between Type 1 and Type 2 diabetes?

Type 1 - insulin dependent diabetes mellitus Type 2 - insulin resistance, manage with diet and exercise, may take insulin when stressed or sick

The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? a. Hypokalemia b. Fluid overload c. Hypoglycemia d. Hyperphosphatemia

a. Hypokalemia

•A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? a.7.20 b.7.35 c.7.45 7.48

a.7.20

•The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a.Acid-base balance b.Fluid balance c.Oxygen depletion d.Metabolic acidosis

a.Acid-base balance

•The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? a.Insulin needs will increase during the second trimester. b.Insulin needs will decrease during the second trimester. c.Insulin needs will not change during the second trimester. d.Insulin will be switched to an oral antidiabetic medication during the second trimester.

a.Insulin needs will increase during the second trimester.

•A nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply. a.Leg ulcers b.Loss of visual acuity c.Increased creatinine clearance d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

a.Leg ulcers b.Loss of visual acuity d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis

a.Metabolic acidosis

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have. a.Muscle cramping b.Warm, flushed skin c.Respiratory rate of 36 d.Blood pressure of 94/52

a.Muscle cramping

Why is controlling blood glucose levels important? •A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure. •B. High blood glucose levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures. •C. Low blood glucose levels increase the risk for peripheral neuropathy, Alzheimer's disease, and premature aging. •D. Low blood glucose levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.

•A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure.

•Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? •A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." •B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." •C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." •D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

•B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level."

•A client with type 2 diabetes who also has heart failure is prescribed metformin extended-release (Glucophage XR) once daily. On assessment, the nurse finds that the client now has muscle aches, drowsiness, low blood pressure, and a slow, irregular heartbeat. What is the nurse's best action? •A. Assess the client's blood glucose level and prepare to administer IV glucose. •B. Reassure the client that these symptoms are normal effects of this drug. •C. Hold the dose and notify the prescriber immediately. •D. Administer the drug at bedtime to prevent falls.

•C. Hold the dose and notify the prescriber immediately.

•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. •Increased pH •Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions

•Hyperventilation - 1 •Increased CO2 elimination - 2 •Decreased blood H+ ions - 3 •Increased pH - 4