health challenges glucose chapter questions

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? a. "I will go running when my blood sugar is too high to lower it." b. "I will go fishing frequently and pack a healthy lunch with plenty of water." c. "I do not need to increase my exercise routine since I am on my feet all day at work." d. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

"I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? a. "I will discard any insulin bottle that is cloudy in appearance." b. "The best injection site for insulin administration is in my abdomen." c. "I can wash the site with soap and water before insulin administration." d. "I may keep my insulin at room temperature (75° F) for up to 1 month."

a. "I will discard any insulin bottle that is cloudy in appearance." Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to 1 drink each day." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucoselowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

a. "I will limit my alcohol intake to 1 drink each day." The guideline for alcohol consumption in men with diabetes is 0-2 drinks per day. For women with diabetes it is 0-1 drink per day.

The percentage of daily calories for a healthy person consists of a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.

a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. The Dietary Guidelines for Americans recommend that 45% to 65% of total calories should come from carbohydrates. Ideally, 10% to 35% of daily caloric needs should come from protein. Persons should limit their fat intake to 20% to 35% of total calories. Fats can be divided into (1) potentially harmful (saturated fat and trans fat) and (2) healthier dietary fat (monounsaturated and polyunsaturated fat). To reduce the risk of obesity, we should consume less than 10% of calories from saturated fatty acids (about 20 g of saturated fat per day in a 2000-calorie diet) and choose foods with no trans-fatty acids.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? a. A 48-yr-old woman with a hemoglobin A1C of 8.4% b. A 58-yr-old man with a fasting blood glucose of 111 mg/dL c. A 68-yr-old woman with a random plasma glucose of 190 mg/dL d. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

a. A 48-yr-old woman with a hemoglobin A1C of 8.4% Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment a. A1C 9% b. BP 126/80 mmHg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

a. A1C 9% Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Keeping blood glucose levels in a tighter range (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk

The stable patient has a gastrostomy tube for enteral nutrition. Which care could the RN delegate to the LPN/VN? (Select all that apply.) a. Administer bolus or continuous feedings. b. Evaluate the nutritional status of the patient. c. Administer medications through the gastrostomy tube. d. Monitor for complications related to receiving enteral nutrition. e. Teach the caregiver about feeding via the gastrostomy tube at home.

a. Administer bolus or continuous feedings. c. Administer medications through the gastrostomy tube. For the stable patient, the LPN can administer bolus or continuous feedings and administer medications through the gastrostomy. The RN must evaluate the nutritional status of the patient, monitor for complications related to enteral nutrition, and teach the caregiver about feeding via the gastrostomy tube at home.

The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention? a. Assess patient's perception of what it means to have diabetes. b. Ask the patient to write down current knowledge about diabetes. c. Set goals for the patient to actively participate in managing his diabetes. d. Assume responsibility for all of the patient's care to decrease stress level.

a. Assess patient's perception of what it means to have diabetes. For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? a. Cheese b. Broccoli c. Chicken d. Oranges

a. Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? a. Chooses a puncture site in the center of the finger pad. b. Washes hands with soap and water to cleanse the site to be used. c. Warms the finger before puncturing the finger to obtain a drop of blood. d. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

a. Chooses a puncture site in the center of the finger pad. The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

A patient is admitted with anorexia nervosa and a serum potassium level of 2.4 mEq/L. What complication is most important for the nurse to observe for in this patient? a. Dysrhythmias b. Muscle weakness c. Increased urine output d. Anemia and leukopenia

a. Dysrhythmias A serum potassium level less than 2.5 mEq/L indicates severe hypokalemia, which can lead to life-threatening dysrhythmias (e.g., bradycardia, tachycardia, ventricular dysrhythmias). Other manifestations of potassium deficiency include muscle weakness and renal failure. Patients with anorexia nervosa often have iron-deficiency anemia and an elevated blood urea nitrogen level related to intravascular volume depletion and abnormal renal function.

A patient is being admitted with anorexia nervosa. Which clinical manifestations should the nurse anticipate? a. Sensitivity to heat, fatigue, and polycythemia b. Hair loss; dry, yellowish skin; and constipation c. Tented skin turgor, hyperactive reflexes, and diarrhea d. Dysmenorrhea, hypoactive bowel sounds, and hunger

b. Hair loss; dry, yellowish skin; and constipation The patient with anorexia nervosa, along with abnormal weight loss, is likely to have hair loss; dry, yellow skin; constipation; sensitivity to cold, and absent or irregular menstruation. Other signs of malnutrition may also be noted during physical examination.

A malnourished patient has been diagnosed with protein deficiency. Which complications should the nurse anticipate? (Select all that apply.) a. Edema b. Asthma c. Anemia d. Malabsorption syndrome e. Impaired wound healing f. Gastrointestinal bleeding

a. Edema c. Anemia e. Impaired wound healing Protein deficiency can cause complications such as edema, anemia, and impaired wound healing. Decreased albumin in the vascular space allows fluids to leak into the interstitial spaces causing edema. Without adequate protein, blood formation is impaired. Adequate protein is required for wound healing. Asthma does not develop due to protein deficiency. A malabsorption syndrome may affect the amount of nutrients that are absorbed causing protein deficiency. Gastrointestinal bleeding is not a complication of protein deficiency.

The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision

a. Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

The patient has parenteral nutrition (PN) infusing with amino acids and dextrose. During shift change, the nurse reports the tubing, bag, and dressing were changed 20 hours ago. What care should the incoming nurse plan to deliver? (Select all that apply.) a. Giving the patient insulin if needed b. Ensuring that the next bag has been ordered c. Checking amount of solution left in the bag d. Assessing the insertion site and change the tubing e. Verifying the accuracy of the new solution and ingredients

a. Giving the patient insulin if needed b. Ensuring that the next bag has been ordered c. Checking amount of solution left in the bag d. Assessing the insertion site and change the tubing e. Verifying the accuracy of the new solution and ingredients The nurse should identify the amount of PN left in the bag when initiating care and request more if needed. Abrupt withdrawal of PN can cause hypoglycemia. The nurse should anticipate pharmacy preparation of a new bag may take significant time especially if additives are ordered. PN solutions are changed every 24 hours. The label on the bag should be verified with the order to ensure accuracy. The patient would receive insulin if hyperglycemic related to dextrose content parenteral nutrition or underlying diabetes mellitus. Sliding-scale coverage or addition of regular insulin to the parenteral nutrition would be provided if ordered. The insertion site should be monitored, and the tubing changed every 24 hours.

Which criteria must be met for a diagnosis of metabolic syndrome? (select all that apply) a. Hypertension b. High triglycerides c. Elevated plasma glucose d. Increased waist circumference e. Decreased low-density lipoproteins

a. Hypertension b. High triglycerides c. Elevated plasma glucose d. Increased waist circumference Three of the following 5 criteria must be met for a diagnosis of metabolic syndrome: Waist circumference of 40 inches or more in men and 35 inches or more in women Triglyceride levels higher than 150 mg/dL or need for drug treatment for high triglyceride levels High-density lipoprotein (HDL) cholesterol levels lower than 40 mg/dL in men and lower than 50 mg/dL in women or need for drug treatment for reduced HDL cholesterol levels Blood pressure: 130 mm Hg or higher systolic or 85 mm Hg or higher diastolic, or need for drug treatment for hypertension Fasting blood glucose level of 100 mg/dL or higher, or need for drug treatment for elevated glucose levels

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? a. Increased triglyceride levels b. Increased high-density lipoproteins (HDL) c. Decreased low-density lipoproteins (LDL) d. Decreased very-low-density lipoproteins (VLDL)

a. Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

a. Insulin administration d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment The nurse ensures that the patient understands the proper use of insulin. The nurse teaches the patient how to use the portable blood glucose monitor and how to recognize and treat signs and symptoms of hypoglycemia and hyperglycemia. These are referred to as "survival skills.

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) a. The level is consistent with renal insufficiency from renal nephropathy. b. The level may be high because of dehydration that accompanies hyperglycemia. c. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. d. The patient may be excreting sodium and retaining potassium from malnutrition. e. This level shows adequate treatment of the cellulitis and acceptable glucose control.

a. The level is consistent with renal insufficiency from renal nephropathy. b. The level may be high because of dehydration that accompanies hyperglycemia. c. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The increased potassium level does not show adequate treatment of cellulitis or acceptable glucose control.

Which are appropriate therapies for patients with diabetes? (select all that apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

a. Use of statins to reduce CVD risk c. Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy In patients with diabetes who have albuminuria, angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) are used. Both classes of drugs are used to treat hypertension and delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely 3 used lipid-lowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, in those with macular edema, and in some cases of Nonproliferative retinopathy.

Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate

a. X-ray The nurse should obtain x-ray confirmation to determine whether a blindly placed nasogastric or orogastric tube (small bore or large bore) is properly positioned in the gastrointestinal tract before giving feedings or medications. Air insertion, observing a patient for coughing, and measuring the pH of gastric aspirate are not appropriate ways to confirm whether a blindly placed nasogastric or orogastric tube is properly positioned in the gastrointestinal tract before use.

Health risks associated with obesity include (select all that apply) a. colorectal cancer. b. rheumatoid arthritis. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. e. systemic lupus erythematosus.

a. colorectal cancer. c. polycystic ovary syndrome. d. nonalcoholic steatohepatitis. Health risks associated with obesity include cardiovascular disease, hypertension, sleep apnea, type 2 diabetes, osteoarthritis, gout, gastroesophageal reflux disease, gallstones, nonalcoholic steatohepatitis, fatty liver and cirrhosis, and breast, endometrial, kidney, colorectal, pancreas, esophagus, and gallbladder cancers.

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.

a. hypokalemia. d. hypomagnesemia. e. hypophosphatemia. Refeeding syndrome is characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia). Hypophosphatemia is the hallmark of refeeding syndrome. It is associated with serious outcomes, including dysrhythmias, respiratory arrest, and neurologic problems (e.g., paresthesias). Refeeding syndrome can occur any time a malnourished patient starts aggressive nutritional support.

The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? a. "Smokeless tobacco products decrease the risk of kidney damage." b. "I can help control my blood pressure by avoiding foods high in salt." c. "I should have yearly dilated eye examinations by an ophthalmologist." d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

b. "I can help control my blood pressure by avoiding foods high in salt." Patients with type 2 diabetes to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment of retinopathy.

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? a. "I plan to lose 25 pounds this year by following a high-protein diet." b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." c. "I should include more fiber in my diet than a person who does not have diabetes." d. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."

b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes. High-protein diets are not recommended for weight loss.

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? a. "I should only walk barefoot in nice dry weather." b. "I should look at the condition of my feet every day." c. "I will need to cut back the number of times I shower per week." d. "My shoes should fit nice and tight because they will give me firm support."

b. "I should look at the condition of my feet every day." Patients with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.

A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

b. 5% dextrose solution. If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) should be given to prevent hypoglycemia.

Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? a. A 58-yr-old patient with diabetic retinopathy b. A 73-yr-old patient who takes propranolol (Inderal) c. A 19-yr-old patient who is on the school track team d. A 24-yr-old patient with a hemoglobin A1C of 8.9%

b. A 73-yr-old patient who takes propranolol (Inderal) Hypoglycemic unawareness is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

A patient who has sustained severe burns in a motor vehicle accident is starting parenteral nutrition (PN). Which principle should guide the nurse's administration of PN? a. Administration of PN requires clean technique. b. Central PN requires rapid dilution in a large volume of blood. c. Peripheral PN delivery is preferred over the use of a central line. d. Only water-soluble medications may be added to the PN by the nurse.

b. Central PN requires rapid dilution in a large volume of blood. Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is an excellent medium for microbial growth, aseptic technique is necessary during administration. Administration through a central line is preferred over the use of peripheral PN, and the nurse may not add any medications to PN.

The nurse is teaching a patient with type 1 diabetes who had surgery to revise a lower leg stump with a skin graft about nutrition. What food should the nurse teach the patient to eat to best facilitate healing? a. Nonfat milk b. Chicken breast c. Fortified oatmeal d. Olive oil and nuts

b. Chicken breast High-quality protein such as chicken breast is important for tissue repair. Nonfat milk, nuts, and fortified oatmeal have some protein but not as much as chicken breast.

Which priority focused assessments would the nurse perform when caring for a patient recently started on parenteral nutrition (PN)? a. Skin integrity and skin turgor b. Electrolyte levels and daily weights c. Auscultation of lung and bowel sounds d. Peripheral edema and level of consciousness

b. Electrolyte levels and daily weights The use of PN necessitates frequent and thorough assessments. Key assessments include daily weights and close monitoring of electrolyte levels. Assessments of bowel sounds, integument, peripheral edema, level of consciousness, and lung sounds, may be variously performed, but close monitoring of fluid and electrolyte balance supersedes these in importance related to the PN.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? a. Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease. b. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. c. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes. d. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.

b. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Microangiopathy occurs in diabetes. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? a. 6:00 PM on the evening before the test b. Midnight before the test c. 4:00 AM on the day of the test d. 7:00 AM on the day of the test

b. Midnight before the test Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

A frail older adult with recent severe weight loss is taught to eat a high-protein, high-calorie diet at home. Which foods would the nurse suggest for breakfast? a. Orange juice and dry toast b. Oatmeal with butter and cream c. Banana and unsweetened yogurt d. Waffles with fresh strawberries

b. Oatmeal with butter and cream Oatmeal, butter, and cream are all examples of breakfast items that would be appropriate to include for a patient on a high-protein, high-calorie diet.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? a. Avoid sick people and wash hands. b. Obtain comprehensive dental care. c. Maintain hemoglobin A1C below 7%. d. Coughing and deep breathing with splinting

b. Obtain comprehensive dental care. A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

A patient was admitted with a fractured hip after being found on the floor of her home. She was extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding would be of most concern to the nurse? a. Blood glucose level of 145 mg/dL b. Serum phosphate level of 1.9 mg/dL c. White blood cell count of 10,000/µL d. Serum potassium level of 4.6 mEq/L

b. Serum phosphate level of 1.9 mg/dL Refeeding syndrome can occur if a malnourished patient is started on aggressive nutritional support. Hypophosphatemia (serum phosphate level <2.4 mg/dL) is the hallmark of refeeding syndrome and could result in dysrhythmias, respiratory arrest, and neurologic problems. An increase in the blood glucose level is expected during the first few days after PN is started. The goal is to maintain a glucose range of 110 to 150 mg/dL. An elevated white blood cell count (>11,000/µL) could indicate an infection. Normal serum potassium levels are between 3.5 and 5.0 mEq/L.

The nurse is evaluating the nutritional status of a patient undergoing radiation treatment for oropharyngeal cancer. Which laboratory test would best indicate the patient has protein-calorie malnutrition (PCM)? a. Serum transferrin b. Serum prealbumin c. C-reactive protein (CRP) d. Alanine transaminase (ALT)

b. Serum prealbumin In the absence of an inflammatory condition, the best indicator of PCM is prealbumin; prealbumin is a protein synthesized by the liver and indicates recent or current nutritional status. Decreased transferrin levels and elevated liver enzyme levels (ALT) are other indicators that protein is deficient. CRP is increased during inflammation and is used to determine if prealbumin, albumin, and transferrin are decreased related to protein deficiency or an inflammatory process.

A patient who cannot afford enough food for her family states she only eats after her children have eaten. At a clinic visit, she reports bleeding gums, loose teeth, and dry, itchy skin. Which vitamin deficiency would the nurse suspect? A. Folic acid B. Vitamin C C. Vitamin D D. Vitamin K

b. Vitamin C This patient is lacking vitamin C as evidenced by the bleeding gums, loose teeth, and dry, itchy skin. Manifestations of folic acid deficiency include megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, or forgetfulness. Manifestations of vitamin D deficiency include muscular weakness, excess sweating, diarrhea, bone pain, rickets, or osteomalacia. Manifestations of vitamin K deficiency include defective blood coagulation.

Polydipsia and polyuria related to diabetes are primarily due to a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excess glucose to hemoglobin.

b. fluid shifts resulting from the osmotic effect of hyperglycemia. The osmotic effect of glucose cause the manifestations of polydipsia and polyuria.

Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. skeletal protein. b. glycogen. c. visceral protein. d. fat stores.

b. glycogen. (1) a. skeletal protein. d. fat stores. c. visceral protein. (4) Initially, the body selectively uses carbohydrates (e.g., glycogen) rather than fat and protein to meet metabolic needs. These carbohydrate stores, found in the liver and muscles, are minimal and may be totally depleted within 18 hours. After carbohydrate stores are depleted, skeletal protein begins to be converted to glucose for energy. Within 5 to 9 days, body fat is being used to supply much of the needed energy. In prolonged starvation, up to 97% of calories are provided by fat, and protein is conserved. Depletion of fat stores depends on the amount available, but fat stores typically are used up in 4 to 6 weeks. After fat stores are used, body or

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? a. "With type 2 diabetes, the body of the pancreas becomes inflamed." b. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." c. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

c. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." In type 2 diabetes, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? a. 8:40 PM to 9:00 PM b. 9:00 PM to 11:30 PM c. 10:30 PM to 1:30 AM d. 12:30 AM to 8:30 AM

c. 10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? a. Routine insulin therapy and exercise b. Administer a different antibiotic for the UTI c. Cardiac monitoring to detect potassium changes d. Administer IV fluids rapidly to correct dehydration

c. Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? a. Eat a piece of pizza. b. Drink some diet pop. c. Eat 15 g of simple carbohydrates. d. Take an extra dose of rapid-acting insulin.

c. Eat 15 g of simple carbohydrates. When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

A patient who has dysphagia after a stroke is receiving enteral nutrition through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into the plan of care? a. Use 30 mL of normal saline to flush the tube every 4 hours. b. Avoid flushing the tube any time the patient is receiving continuous feedings. c. Flush the tube before and after feedings if the patient's feedings are intermittent. d. Flush the PEG with 100 mL of sterile water before and after medication administration.

c. Flush the tube before and after feedings if the patient's feedings are intermittent. The nurse should flush feeding tubes with 30 mL of water, not normal saline, every 4 hours and before and after medication administration during continuous feeding or before and after intermittent feeding. Flushes of 100 mL are excessive and may cause fluid overload in the patient.

A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? a. Central apnea b. Hypoventilation c. Kussmaul respirations d. Cheyne-Stokes respirations

c. Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

Which statement best describes the etiology of obesity? a. Obesity primarily results from a genetic predisposition. b. Psychosocial factors can override the effects of genetics in causing obesity. c. Obesity is the result of complex interactions between genetic and environmental factors. d. Genetic factors are more important than environmental factors in the etiology of obesity.

c. Obesity is the result of complex interactions between genetic and environmental factors. The cause of obesity involves significant genetic and biologic susceptibility factors that are highly influenced by environmental and psychosocial factors.

The nurse recognizes that most of a patient's caloric needs should come from which source? a. Fats b. Proteins c. Polysaccharides d. Monosaccharides

c. Polysaccharides Carbohydrates should constitute between 45% and 65% of caloric needs compared with 20% to 35% from fats and 10% to 35% from proteins. Polysaccharides are the complex carbohydrates that are contained in breads and grains. Monosaccharides are simple sugars.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works? a. Increases insulin production from the pancreas. b. Slows the absorption of carbohydrate in the small intestine. c. Reduces glucose production by the liver and enhances insulin sensitivity. d. Increases insulin release from the pancreas and inhibits glucagon secretion.

c. Reduces glucose production by the liver and enhances insulin sensitivity. Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

The nurse is providing care for a patient who is a strict vegetarian. Which would be the best dietary choices the nurse recommends to prevent iron deficiency? a. Brown rice and kidney beans b. Cauliflower and egg substitutes c. Soybeans and hot breakfast cereal d. Whole-grain bread and citrus fruits

c. Soybeans and hot breakfast cereal Vegetarians are at a particular risk for iron deficiency, a problem that can be prevented by regularly consuming high-iron foods such as hot cereals and soybeans. The other foods listed are not classified as high sources of iron.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

c. rapid, deep respirations. Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.

This bariatric surgical procedure involves creating a gastric pouch that is reversible, and no malabsorption occurs. Which surgical procedure is this? a. Vertical gastric banding b. Biliopancreatic diversion c. Roux-en-Y gastric bypass d. Adjustable gastric banding

d. Adjustable gastric banding With adjustable gastric banding (AGB), the stomach size is limited by an inflatable band placed around the fundus of the stomach. The band is connected to a subcutaneous port and can be inflated or deflated to change the stoma size to meet the patient's needs as weight is lost. The procedure is done laparoscopically and, if needed, can be modified or reversed after the first procedure.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? a. Call the provider. b. Give insulin as ordered. c. Assess for other neurologic symptoms. d. Check the patient's blood glucose level.

d. Check the patient's blood glucose level. Check blood glucose whenever hypoglycemia is suspected so that immediate action can be taken if necessary.

After identifying that a patient has possible nutritional deficits, which action will the nurse perform next? a. Provide supplements between meals. b. Encourage eating meals with others. c. Have family bring in food from home. d. Complete a full nutritional assessment.

d. Complete a full nutritional assessment. A full nutritional assessment includes history and physical examination and laboratory data. The nutritional assessment will need to be done to provide the basis for nutrition intervention. The interventions may include supplements if ordered, family bringing food from home, and socializing with meals.

The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? a. Prealbumin level b. Urine ketone level c. Fasting glucose level d. Glycosylated hemoglobin level

d. Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

A patient who is unable to swallow because of progressive amyotrophic lateral sclerosis is prescribed enteral nutrition through a newly placed gastrostomy tube. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Irrigate the tube between feedings. b. Provide wound care at the gastrostomy site. c. Give prescribed liquid medications through the tube. d. Position the patient with a 45-degree head of bed elevation.

d. Position the patient with a 45-degree head of bed elevation. UAP may position the patient receiving enteral feedings with the head of bed elevated. The LPN/VN or an RN could perform the other activities.

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome. Hyperosmolar hyperglycemia syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to make enough insulin to prevent diabetes related ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

The nurse is reviewing the laboratory test results for a patient with metastatic lung cancer who was admitted with a diagnosis of malnutrition. The serum albumin level is 4.0 g/dL, and prealbumin is 10 mg/dL. How will the nurse interpret these results? a. The albumin level is normal, so the patient does not have protein malnutrition. b. The albumin level is increased, which is common in patients with cancer who have malnutrition. c. Both the serum albumin and prealbumin levels are reduced, consistent with the diagnosis of malnutrition. d. The serum albumin level is normal, but the low prealbumin level accurately reflects the patient's nutritional status.

d. The serum albumin level is normal, but the low prealbumin level accurately reflects the patient's nutritional status. Prealbumin has a half-life of 2 days and is a better indicator of recent or current nutritional status. Serum albumin has a half-life of about 20 to 22 days. The serum level may lag behind actual protein changes by more than 2 weeks and is therefore not the best indicator of acute changes in nutritional status.

A patient received a small-bore nasogastric (NG) tube after a laryngectomy. Which action has the highest priority before initiating enteral feedings? a. Testing aspirated fluid pH b. Auscultating while instilling air c. Elevating head of bed to 40 degrees d. Verifying NG tube placement with x-ray

d. Verifying NG tube placement with x-ray It is imperative to ensure that an NG tube is in the gastrointestinal tract rather than the patient's lungs. When an NG tube has been recently inserted, it is important to confirm this placement with an x-ray that will identify the tube's radiopaque tip. Aspiration and air auscultation may not distinguish between gastric and respiratory placement of the tube. Although elevating the head of bed at least 30 degrees is necessary to prevent aspiration, placement must first be confirmed before starting feedings.

The obesity classification that is most often associated with cardiovascular health problems is a. primary obesity. b. secondary obesity. c. gynoid fat distribution. d. android fat distribution.

d. android fat distribution. A person with fat primarily in the abdominal area (i.e., whose body is apple shaped) is at greater risk for obesity-related complications (e.g., heart disease) than is a person whose fat is primarily in the upper legs (i.e., whose body is pear shaped). Those whose fat is distributed over the abdomen and upper body (i.e., neck, arms, and shoulders) are classified as having android obesity

The best nutritional therapy plan for a person who is obese a. is high in animal protein. b. is fat-free and low in carbohydrates. c. restricts intake to under 800 calories per day. d. lowers calories with foods from all the basic groups.

d. lowers calories with foods from all the basic groups. Lower caloric intake is a cornerstone for any weight loss or maintenance program. A good weight loss plan should include foods from the 4 basic food groups and be nutritionally sound.

A patient with extreme obesity has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient a. may have severe diarrhea early in the postoperative period. b. will not be allowed to ambulate for 1 to 2 days postoperatively. c. will require nasogastric suction until the drainage is pale yellow. d. may have limited amounts of oral liquids during the early postoperative period.

d. may have limited amounts of oral liquids during the early postoperative period. During the immediate postoperative period, room temperature water and low calorie clear liquids are given. Begin with 15 mL increments every 10 to 15 minutes. Gradually increase intake to a goal of 90 mLs every 30 minutes by postoperative day one.

A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2 . b. reports episodes of nightly nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

d. reports an unintentional weight loss of 10 lb in 2 months. A loss of more than 5% of usual body weight over 6 months, whether intentional or unintentional, is a critical indicator for further assessment.