Holistic exam 2-2-2022
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?
Weight reduction through diet and exercise
A client has been recently diagnosed with type 1 diabetes mellitus. He is seen in the emergency room every day with high blood sugar. The client apologizes to the nurse for bothering them every day, but he cannot give himself insulin injections. What should the nurse's response be?
"Has someone taught you how to take them?"
normal potassium levels
3.5-5.0 mEq/L
A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease?
"I skip lunch when I don't feel hungry."
A nurse is caring for a client who is scheduled to have a below the knee amputation. The client is visibly upset and angry and shouts at the nurse. Which of the following responses would be most appropriate?
"It's okay to be angry and upset. Is there anything I can do to help?"
A couple who are in their early 80s have provided constant care for their 44-year-old child who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have concerns around what question?
"Who will care for our child once we're unable?"
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5
normal lithium range?
0.6-1.2
normal BUN levels
10-20 mg/dL
The American diabetic association recommends that for all levels of caloric intake, the percentage of calories from carbs should not exceed ___________%
60
Normal calcium levels
8.6-10.2 mg/dL
normal chloride levels
97-107 mEq/L
A diabetic patient is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient A: withdraws the NPH dose into the syringe first B: Injects air equal to the NPH dose into the NPH vial first C: removes any air bubbles after withdrawing the first insulin D: Adds air equal the insulin dose into the regular insulin vial and withdraws the dose
A
A nurse finds a client crying after she was told hemodialysis is needed due to the development of renal failure. Which intervention is best? A: sit quietly with the client B: Refer the client to the hemodialysis team C: remind the client this is a temporary situation D: discuss with the client the other abilities she has
A
A patient with diabetes calls the clinic because she is experiencing nausea and flu like symptoms. The nurse advises the patient to A: Admin the usual insulin dosage B: Hold fluid intake until the nausea subsides C: come to the clinic immediately for evaluation and treatment D: monitor blood glucose every 1-2 hours and call if the glucose level is greater than 150 mg/dl
A
When caring for a patient with metabolic syndrome, the nurse gives the highest priority to teaching the patient about A: maintaining normal weight B: performing daily aerobic exercise C: eliminating red meat from the diet D: monitoring the blood glucose periodically
A
Which nursing intervention is appropriate for an adult client with chronic kidney disease? A: weigh the client daily before breakfast B: offer foods high in calcium and phosphorus C: serve the client large meals and a bedtime snack D: encourage the client to drink large amounts of fluids
A
Which of the following actions is most appropriate when caring for a client with a nursing diagnosis of "excess fluid volume" A: teach the client about sodium content of foods B: administration of vitamin D supplement C: assessing and documenting client's energy level D: Observing for signs of hypocalcemia
A
Which of the following actions should the nurse implement following a client's hemodialysis treatment? (Check all that apply) A: Check BUN and serum creatinine B: assess for headache and/or confusion C: obtain weight D: admin IV antibiotics E: obtain serum electrolytes F: assess access site for signs of bleeding
A,B,C,E,F
Which of the following are signs of fluid volume excess? (select all) A: dyspnea B: edema C: Bradycardia D: hypertension E: concentrated urine
A,B,D
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?
Administering 1 ampule of 50% dextrose solution, per physician's order
Which would be included in the teaching plan for a client diagnosed with diabetes mellitus?
An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.
The nurse is teaching the patient to perform peritoneal dialysis. The nurse reviews which of the following essential actions that will help prevent the major complication of peritoneal dialysis? A: monitor patient's daily weight B: Maintain strict aseptic techniques during connection and disconnection C: add heparin to the dialysate at least once per day D: change the catheter site dressing twice a day
B
A patient has lost most of her vision as a result of macular degeneration. When attempting to meet this patient's psychosocial needs, what nursing action is most appropriate?
Assess and promote the patient's coping skills during interactions with the patient.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?
Assess how the client would like to communicate
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill.
When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents?
Assist the child and the parents to develop coping mechanisms.
A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following?
Avoid using the same injection site more than once in 2 to 3 weeks.
An elderly client with diabetes comes to the clinic with her daughter. The nurse reviews foot care with the client and her daughter. Why would the nurse feel that foot care is so important to this client?
Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
A client is diagnosed with chronic renal failure and told he must start hemodialysis. Client teaching interventions should include which interventions? A: Follow a high potassium diet B: strictly follow the hemodialysis schedule C:There will be few changes in your lifestyle D: use alcohol on the skin to clean it because of integumentary changes
B
A nurse is caring for a patient who has just had a renal biopsy. Which of the following complications is the most immediate risk to the patient? A: Infection B: Bleeding C: Hematuria D: Renal failure
B
A nurse working in an outpatient clinic plans a screening program for diabetes. Recommendations for screening would include A: oral glucose tolerance tests for all minority populations every year B: fasting plasma glucose for all individuals at age 45 and then every three years C: testing all people before the age of 21 for islet cell antibodies D: Testing for type 2 diabetes only in overweight or obese individuals
B
During a routine health screening, a patient is found to have a fasting plasma glucose of 142 mg/dl. At a follow up visit, a diagnosis of diabetes can be made based on A: Glucosuria of 3+ B: a fasting plasma glucose level of 210 mg/dl C: a random plasma glucose of 155 mg/dl D: a 2 hour oral glucose tolerance test of 180 mg/dl
B
Goals of nutritional therapy for a pt with type 2 diabetes include maintenance of A: ideal body weight B: normal serum glucose and lipid levels C: a special diabetic diet using dietetic foods D: Five small meals per day with a bedtime snack
B
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention? A: Contravening B: Improving C: Restoring D: Deteriorating
B
Ketoacidosis occurs as a complication of diabetes when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. the glucose level becomes so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.
C
Lispro insulin (Humalog) is ordered for a pt with newly diagnosed diabetes mellitus. The nurse knows that when Lispro insulin is used, it should be administered A: only once a day B: one hour before meals C: at mealtime of within 15 minutes of meals D: thirty to 45 minutes before meals
C
The nurse is caring for a pt with chronic kidney disease. Lab results reveal a potassium level of 6.2 mEq/L. The nurse should assess the pt for? A: Constipation B: polyuria C: ECG changes D: Hypotension
C
When teaching the patient with diabetes mellitus about insulin demonstration, the nurse instructs the pt to A: Pull back on the plunger after inserting the needle to check for blood B: clean the skin at the injection site with an alcohol swab before each injection C: consistently use the same size of the appropriate strength insulin to avoid dosing errors D: rotate injection sites from arms to thighs to abdomen with each injection to prevent lypodystrophies
C
The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to:
Conduction disorder
In addition to promoting the transport of glucose from the blood into the cell, insulin also A: Enhances the breakdown of adipose tissue for energy B: Stimulates hepatic glycogenolysis and gluconeogensis C: prevents the transport of triglycerides into adipose tissue D: accelerates the transport of amino acids into cells and their synthesis into protein
D
One goal of renal dialysis for a client who has chronic renal failure is to: A: restore kidney function B: replace hormonal function to the kidneys C: Allow the client to have a diet without any restrictions D: balance serum electrolytes
D
Which of the following characteristics are NOT associated with a chronic illness?
Illness will subside and be cured with effective treatment and/or therapy
A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?
Excess Fluid Volume
True or false? In chronic glomerulonephritis, the kidneys are reduced to as little as 50% of their normal size
False
True or false? Regular insulin is a rapidly acting insulin that has a duration of 4-6 hours
False
True or false? Type 1 diabetes, which affects approximately 95% of people with the disease, is characterized by insulin resistance and impaired insulin secretion
False
_______________ is used when a patient is acutely ill until kidneys resume function and for long-term replacement therapy for chronic kidney disease and end stage kidney disease
Hemodialysis
____________________ is the most immediate life threatening of the fluid and electrolyte imbalances that occur in patients with kidney disorders.
Hyperkalemia
A home health nurse is conducting a home visit to a patient who receives wound care twice weekly for a diabetic foot ulcer. While performing the dressing change, the nurse realizes that she forgot to bring the adhesive gauze specified in the wound care regimen. What is the nurse's best action?
Improvise, if possible, using sterile gauze and adhesive tape.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
Increased serum creatinine level
A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results?
Less than 70 mg/dL (3.7 mmol/L)
A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response?
Lessen workload on the kidneys
The nurse is working with a patient who is newly diagnosed with MS. What basic information should the nurse provide to the patient?
MS is a progressive demyelinating disease of the nervous system.
An older adult patient has noticed a significant amount of vision loss in the last few years. What does the nurse recognize as the most common cause of visual loss in older adults?
Macular degeneration
Normal creatinine levels
Male: 0.6-1.2 mg/dL Female: 0.5-1.1 mg/dL
A legally blind client is in pre-op area prior to an appendectomy. What steps does the nurse take to effectively communicate with this client ?
Notify the client prior to touching the client.
A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin?
Observe the client drawing up and administering the insulin.
A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status?
Observing the client's urinary output.
A client with diabetes is attending a class on the prevention of associated diseases. What action should the client perform to reduce the risk of osteomyelitis?
Perform meticulous foot care.
The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder?
The child constantly stares at a rotating wheel on the crib mobile.
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
True or false? Depression is most commonly associated with suicide
True
True or false? Diabetes is the primary cause of chronic kidney disease
True
True or false? Kidney transplantation has become the treatment of choice for most patients with end stage kidney disease
True
True or false? Latent autoimmune diabetes of adults is a subtype of diabetes in which progression of autoimmune beta cell destruction in the pancreas is slower than in type 1 and 2 diabetes
True
True or false? Peritonitis is the most common and most serious complication of peritoneal dialysis
True
True or false? The glomerular filtration rate and the creatine clearance decrease with end stage kidney disease
True
True or false? When mixing short acting and longer acting insulin, the ADA recommended procedure is that the regular insulin be drawn up first
True
True or false? Proliferative retinopathy, a diabetic microvascular disease, represents the greatest threat to vision; it is characterized by the proliferation of new blood vessels growing from the retina into the vitreous
True
A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site?
abdomen
The three main clinical features of diabetic ketoacidosis are hyperglycemia, dehydration with electrolyte loss, and _________________
acidosis
The nurse is teaching a group of adults about health promotion. What should the nurse recommend in order to minimize participants' risk of COPD?
avoid smoking
A widely accepted criterion for acute kidney injury is a 50% or greater increase in serum _______________ above baseline.
creatinine
The ______________ phenomenon is an example of morning hyperglycemia that is characterized by a relatively normal blood glucose level until approx 3:00AM when blood glucose levels begin to rise
dawn
What is a common side effect of a chronic illness and can affect up to one-third of those who suffer from chronic illnesses?
depression
Define azotemia
elevation of BUN and creatinine levels
True or false? Failure of the temporary dialysis access accounts for most hospital admissions of pt's undergoing chronic hemodialysis
false
A nurse is explaining ADHD to a community parents' group. What characteristics of this disorder are exhibited by an affected child?
inattention, impulsiveness, hyperactivity
define pyelonephritis
kidney infection that is a type of urinary tract infection that generally begins in the urethra or bladder to one or both kidneys
Which medications have been found to be effective as a treatment in ADHD?
methylphenidate
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply.
muscle cramps lethargy bleeding of the oral mucous membranes
Any condition that damages the glomerular membrane and results in increased permeability to plasma proteins is ________________ syndrome.
nephrotic
The main goal of diabetes treatment is to normalize insulin activity and blood glucose levels to reduce the development of vascular and ___________ complications
neuropathic
Classic clinical manifestations of diabetes include polyuria, polydipsia, and _____________
polyphagia
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
sodium polystyrene sulfonate (Kayexalate)
During an assessment of a client who is experiencing stress related physiologic symptoms, the nurse recognizes which symptoms the client is having are dermatologic?
sweating
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
wash and inspect the feet daily.
A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is:
weight
The most accurate indicator of fluid loss or gain in an acutely ill patient with a kidney disorder is _____________ which must be assessed daily.
weight
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:
who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.
