test 1 med surge
c
12. A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin, and lisinopril (Prinivil). To prevent the risk of digitalis toxicity with these drugs, it is most important that the nurse monitor the patient's a. HR. b. BR c. potassium levels. d. gastrointestinal function.
a ( Because of clinical manifestations of long-term complications of diabetes take 10 to 20 years to develop, and because tight glucose control in the older patients is associated with an increased frequency of hypoglycemia, the goals for glycemia control are not as rigid as in the younger population. Treatment is indicated, and insulin may be used if the patient does not respond to oral agents. The patient's needs, rather than age, determine the respnsibility of others in care.)
A 72yr woman is diagnosed with diabetes. The nurse recognized that management of diabetes in the older adult: A. does not require as tight glucose as in younger diabetics B. is usually not treated unless the patient becomes severely hyperglycemia C. does not include treatment with insulin because of limited dexterity and vision D. usually requires that a younger family member be responsible for care of the patient
c
A client diagnosed with type 2 diabetes is admitted to the hospital with blood glucose of 560 mg/dL without urine ketones. This patient is demonstrating symptoms of: A. DKA B. Acute renal failure C. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) D. Hypoglycemia
a (these foods are high in sodium)
A client is admitted to the visiting nurse service for assessment and follow up after being discharge from the hospital with the new onset congestive heart failure (CHF). The nurse teaches the client about the dietary restrictions required with CHF. Which statement by the client indicates that further teaching is needed? A. I'm going to have a ham and cheese sandwich and potato chips for lunch B. I'm going to weight myself daily to be sure I don't gain too much fluid C. I can have most fresh fruits and fresh vegetables D. I am not supposed to eat cold cuts
c
A client recovering from pulmonary edema is preparing for discharge. The nurse plans to teach the client to do which of the following to manage or prevent recurrent symptoms after discharge? A. Take a double dose of the diuretic if peripheral edema is noted B. withhold prescribe digoxin (Lanoxin) if slight respiratory distress occurs C. Weigh himself or herself on a daily basis D. Sleep with the head of bed flat
hypoglycemia unawareness
A client who is unable to detect his or her own low blood sugar might be experiencing __________ __________
a (Because the client has diabetes, it is essential that the blood glucose level be determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.)
A client with diabetes mellitus has above-the-knee amputation because of severe peripheral vascular disease. Which is the nurse's primary responsibility 2 days following surgery when preparing the client for dinner? A. Checking the client's serum glucose level B. Assisting the client out of bed into a chair C. Placing the client in the high-Fowler's position D. Ensuring that the client's residual limb is elevated
a (Captopril is an antihypertensive med, ACE. An increase of water could actually aggravate the hypertension)
A clinic nurse is providing instructions to a client with hypertension who will be taking Captopril(capoten). Which statement by the client indicates a need for further instruction? A. I need to drink increased amounts of water B. I need to change positions slowly C. I need avoid taking hot baths and showers D. I need to sit down and rest if dizziness or lightheadedness occurs
true
A common cause of diastolic failure is left ventricular hypertrophy. (true/false)
a, b, d, e (Morphine sulfate reduces anxiety and may assist in reducing dyspnea. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety. The patient should be positioned in semi-Fowlers position to improve ventilation.)
A patient admitted with HF appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this patients anxiety (select all that apply)? A. Position patient in a semi-Fowlers position. B. Administrate ordered morphine sulfate. C. Position patient on left side with head of bed flat. D. Instruct patient on the use of relaxation techniques. E. Use a calm, reassuring approach while talking to patient.
a ((Ate 4 bananas, K+ found in bananas, with 5 glasses of milk, ca+ found in milk, read 2 magazines, magnesium, about 2 fossils, phosphorus, Spent $140 on Napkins, Na+, and a $100 on Clear heals,Cl, Did 15 BUN exercises and drank 1 Creatine shake, Creatinine, Met 3 Idiots, I for INR, 11 Pets, P is for PT, and 65 Hunks,H is for heparina PTT)
Ate 4 bananas with 5 glasses of milk, read 2 magazines about 2 fossils. Spent $140 on Napkins and a $100 on Clear heals. Did 15 BUN exercises and drank 1 Creatine shake . Met, 3 Idiots , 11 Pets and 65 Hunks. a
e
Dilates arterial and venous blood vessels in addition to relieving anxiety A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
b
Directly blocks sympathetic nervous system's negative effects on the failing heart: A. Valsartan B. Carvedilol C. Milrinone D. Isosorbide nitrate and hydralazine E. Furosemide
d
Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient says, A. "I should wash my feet daily with soap and warm water." B. "I should always wear shoes to protect my feet from injury." C. "If my feet are cold, I should wear socks instead of using a heating pad." D. "I'll know if I have sores or lesions on my feet because they will be painful."
b
In diabetes, atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems A. can be prevented by tight glucose control B. occurs with a higher frequency and earlier onset than in the nondiabetic population C. is caused by the hyperinsulinemia related to insulin resistance common in type 3 diabetes D. cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake
c
In diabetic ketoacidosis (DKA), the production of ketones, can cause the client to develop: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
b
In diabetics _____ would >126 A. A1C (glycosylated hemoglobin) B. Fasting Plasma glucose (FPG) C. 2hr plasma glucose level D. glucose levels
a
In diabetics _____ would be >6.5 A. A1C (glycosylated hemoglobin) B. Fasting Plasma glucose (FPG) C. 2hr plasma glucose level D. glucose levels
c
In diabetics ______ would be >200 A. A1C (glycosylated hemoglobin) B. Fasting Plasma glucose (FPG) C. 2hr plasma glucose level D. glucose levels
a (the body requires food at regularly spaced intervals throughout the day, and omission or delay of meals can result in hypoglycemia, especially for the patient taking insulin or oral hypoglycemic agents)
In nutritional management of all types of diabetes, it is important for the patient to: A. eat regular meals at regular times B. restrict calories to promote moderate weight loss C. eliminate sucrose and other simple sugars from the diet D. limit saturated fat intake to 30% of dietary calorie intake
a, d, e
In which of the following microvascular complications of diabetes be manifested (select all that apply) A. Eyes B. Blood vessels C. Heart D. Skin E. Kidneys
c
Increases cardiac contractility and output and slows heart . A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
g
Increases cardiac contractility but may increase ventricular irritability A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: A. Insulin Resistance
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: B. B-cell secretory exhaustion
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: C. Inherited defect in insulin receptors
type 1
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: D. Immune mediated
type 1
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: E. Genetic predisposition
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: F. Inappropritate glucose production by the liver
type 1
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: G. B-cell destruction
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: H. Altered production of adipokines
type 2
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: I. Compensatory increased insulin production
type 1
Indicate whether the following mechanisms of diabetes mellitus are characteristic of the pathophysiology of type 1 or type 2 diabetes: J. Exposure to a virus
f
Blocks action of aldosterone, decreasing intravascular volume by sodium excretion, but retains potassium A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
d
Combination antihypertensive and antianginal agent; used only with African Americans: A. Valsartan B. Carvedilol C. Milrinone D. Isosorbide dinitrate and hydralazine E. Furosemide
skeletal muscle, adipose
Complete the following statements: A. Tissues that require insulin for glucose transport are __________ and ___________ tissues.
pancreatic beta
Complete the following statements: B. In type 1 diabetes, the body's own ____________ cells are attacked and destroyed
cortisol, epinephrine, glucagon, growth hormone
Complete the following statements: C. Four hormones released that are counter-regulatory to insulin are _____________ ____________ __________ and _____________ ___________
type 1
Complete the following statements: D. The type of diabetes that is strongly related to human leukocyte antigen (HLA) types is ________.
c
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
d (lispro is a rapid-acting insulin that has an onset of action of 5-15 minutes and should be injected at the time of the meal to within 15 minutes of eating)
Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnose type 1 diabetes. The nurse knows that when lispro insulin is used, it should be administered: A. only once day B. 1 hr before meals C. 30-45min before meals D. at mealtimes or within 15min of meals
dka, Kussmaul, keonuria, fruity odor, decreased pH, ketonemia
List 5 signs and symptoms that are present in DKA that are not seen in hyperglycemic hyperosmolar syndrome: 1. Kussmaul's respirations 2. keonuria 3. sweet fruity odor to breath 4. decreased arterial pH (Acidosis) 5. ketonemia (dka, Kussmaul, keonuria, fruity odor, decreased pH, ketonemia)
autonomic, sensorimotor
List the 2 most common types of diabetic neuropathies: 1. ___________ 2.___________
penrose, davol, jackson pratt
List the 3 types of drains placed into a surgical wound 1. ___________ 2. ___________ 3.______________
a,d, e
Manifestations of Metabolic Syndrome include (select all that apply) A. Elevated triglycerides B. Weight loss C. Muscle wasting D. Elevated low-density lipopretins E. Low high-density lipoproteins
3
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) A. male impotence 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
1
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) B. Damage to small vessels that supply the renal glomeruli 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
2
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) C. Related to altered lipid metabolism of diabetes 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
1
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) D. Microaneurysms and destruction of retinal capillaries 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
4
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) E. Atrophy of small muscles of the hands and feet 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
1
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) F. Capillary and arteriole membrane thickening specific to diabetes 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
4
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) G. Pain and paresthesia of the legs 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
2
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) H. Ulceration and amputation of the lower extremities 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
4
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) I. Foot ulcers without patient feeling pain 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
3
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) J. Delayed gastric emptying 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
2
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) K. Ischemic heart disease 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
3
Match the following characteristics as they relate to complications of diabetes (answers may be used more than once) L. Painless myocardial infarction 1. Microvascular 2. Macrovascular 3. Autonomic neuropathy 4. Sensory neuropathy
e
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 1. Decreases endogenous glucose production A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
d
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 10. Effectiveness measured by 2hr postprandial glucose A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
d
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 11. Taken with the first bite of each meal A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
e
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 12. Not used in patients with heart failure A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
b
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 2. Should be taken within 30 minutes of each meal A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
a
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 3. Decreases glycogenolysis A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
a
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 4. Enhance cell sensitivity to insulin A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
b
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 5. Rapid- and short-acting release of insulin from the pancreas A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
d
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 6. Delays glucose absorption from the GI tract A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
a
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 7. Stimulates production and release of insulin and enhances cellular sensitivity to insulin A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
c
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 8. Increases glucose uptake, especially in muscles A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
c
Match the following oral glucose-lowering agents with their descriptions (answers may be used more than once) 9. Primary effect is decreased glucose production by liver A. Sulfonylurea B. Meglitinide C. Biguanide D. Glucosidase-inhibitor E. Thiazolidinediones
h
Recombinant form of a netriuretic peptide that decreases preload and afterload A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
false (reduced)
Systolic HF results in a normal left ventricular ejection fraction. (true/false)
false (diastolic failure)
Systolic failure is characterized by abnormal resistance to ventricular filing. (true/false)
polydipsia, polyphagia, polyuria
The 3 P's of diabetes:
aldrete system
The __________ __________ is system that is used to assess a client's readiness to be discharged from the PACU
d
The evaluation team for cardiac transplantation determines that the patient who would most benefit from a new heart is: a. a 24 year old man with Down syndrome who has receive excellent care from parents in their 60s b. a 46 year old single woman with limited support system who has alcohol-induced cardiomyopathy c. a 60 year old man with inoperable artery disease who has not been compliant with lifestyle changes and rehabilitation programs d. a 52 year old women with end-stage coronary artery disease who has limited financial resources but is emotionally stable and has strong social support
b(checking temperature of the bath is part of assisting with activities of daily living, ADL, and within NAP scope of care)
The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to nursing assistive personnel (NAP) A. Discuss complications of diabetes B. Check that the bath water is not too hot C. Check the patient's technique for drawing insulin D. Teach the patient to use the glucometer for in-home glucose monitoring
a
The health care provider prescribes spironolactone (Aldactone) for the patient with chronic heart failure. Diet modifications related to the use of this drug that the nurse includes in patient teaching include a. decreasing both sodium and potassium intake. b. increasing calcium intake and decreasing sodium intake. c. decreasing sodium intake and increasing potassium intake. d. decreasing sodium intake and using salt substitutes for seasoning.
d (insulin glargine, lantus, a long-acting insulin that is continuously released with no peak of action, cannot be diluted or mixed with any other insulin or solution)
The home care nurse should intervene to correct a patient whose insulin administration includes: A. warming a prefilled refrigerated syringe in the hands before administration B. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator C. placing the insulin bottle currently in use in a small container on the bathroom counter-top D. mixing an evening dose of regular insulin glargine in one syringe for administration
c (impaired glucose tolerance exists when a 2hr plasma glucose level is higher than normal but lower than the level diagnostic for diabetes, 140-199. Impaired fasting glucose exists when fasting glucose levels are greater than the 126 mg/dL diagnostic if diabetes. Both conditions represent a condition known as prediabetes.)
The nurse determines that a patient with a 2hr OGTT of 152 mg/dL has: A. diabetes B. impaired fasting glucose C. impaired glucose tolerance D. elevated glycosylated hemoglobin (Hb)
c
The nurse determines that treatment of heart failure has been successful when the patient experiences a. weight loss and diuresis b. warm skin and less fatigue c. clear lung sounds and decrease heart rate (HR) d. absence of chest pain and improved level of consciousness (LOC)
d
The nurse determines the additional discharge teaching is needed when the patient with chronic heart failure syas a. "I will take my pulse every day and call the clinic if it is irregular or less than 50" b. "I should hold my digitalis and call the doctor if I experience nausea and vomiting" c. "I plan to organize my household tasks so I don't have to constantly go up and down the stairs" d. "I should weigh myself every morning and go on a diet if I gain more than 2 or 3 pounds in 2 days"
d (Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the prescriber if the patient exhibited any of these symptoms.)
The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which of the following symptoms? a. Muscle aches b. Constipation c. Pounding headache d. anorexia and nausea
b, c, d
The nurse is admitting a client to the hospital with a diagnosis of hypoglycemia. Identify the clinical indicators that the nurse should expect. Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred Speech E. Hyperventilation
c (rapid deep respirations are symptoms of DKA. Stage 2 ulcers are bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate a need to teach the patient about site rotation)
The nurse is assessing a newly admitted diabetic patient. Which of these observations should be addressed as a priority by the nurse? A. Bilateral numbness of both hands B. Stage 2 pressure ulcer on the right heel C. Rapid respirations with deep inspiration D. Areas of lumps and dents on the abdomen
c (Further assessment needed)
The nurse is caring for a client who has been transferred to the surgical unit after a pelvic exenteration. During the post-op period the client complains of pain in the calf area. What actions should the nurse take? A. Ask the client walk and observe the gait B. Lightly massage the calf area to relieve the pain C. Check the calf area for temperature, color, and size D. Administer PRN morphine sulfate as prescribed for post-op pain 15.57
b (Infection increases the body's metabolic rate, and insulin is not available for increased demands)
The nurse is caring for a postoperative client who also has diabetes. When caring for this client, the nurse needs to understand that the most common cause of diabetic ketoacidosis is: A. Emotional stress B. Presence of infection C. Increased insulin dose D. Inadequate food intake
c (Kussmaul respirations occur in diabetic coma as the body attempts to correct a low pH causes by the accumulation of ketones, ketoacdiosis; HHNS affects type 2, the insulin prevents the breakdown of fats into ketones)
The nurse is caring for several clients who have diabetes. When assessing these clients, the nurse should understand that a difference between diabetic coma and hyperglycemia hyperosmolar nonketotic syndrome (HHNS) is that a response clients in diabetic coma experience is: A. Fluid loss B. Glycosuria C. Kussmaul respirations D. Increased blood glucose level
a (Liquids containing simple carbohydrates are most readily absorbed and thus increase blood glucose level quickly)
The nurse is monitoring a client's blood glucose level via a finger stick measurement. The Nurse identifies that the client is experiencing a hypoglycemia reaction. Which nursing intervention should be instituted immediately to relieve the symptoms associated with this reaction? A. Giving 4 oz of fruit juice B. Administering 5% dextrose solution IV C. Withholding a subsequent dose of insulin D. Providing a snack of cheese and dry crackers
b (The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hypokalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and rises to within normal range.)
The nurse is preparing to administer digoxin to a patient with HF. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dl. The nurse should do which of the following at this time? A. Withhold the daily dose until the following day. B. Withhold the dose and report the potassium level. C. Give the digoxin with a salty snack, such as crackers. D. Give the digoxin with extra fluids to dilute the sodium level.
b, d
The nurse is reviewing the medical record for data associated with a client's admission to the hospital for an episode of diabetic ketoacidosis. Which information related to this event should the nurse document on the client's medical record? Select all that apply. A. Sweating B. Low PCO2 C. Retinopathy D. Acetone breath E. Elevated serum bicarbonate level 31:04
c (Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.)
The priority nursing assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be A. Urine output. B. Lung sounds. C. Blood pressure. D. Respiratory rate.
c
The treatment for DKA and HHS differ primarily in that: A. DKA requires administration of bicarbonate to correct acidosis B. Potassium replacement is not necessary in management of HHS C. HHS requires greater fluid replacement to correct the dehydration D. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level
a
The treatment of choice for a client experiencing the Symogi effect is to: A. Reduce insulin dose B. Only use regular insulin C. Increase insulin D. Only use lispro
b (During exercise, a diabetic person needs both adequate glucose to prevent exercise-induced hypoglycemia and adequate insulin because counterregulatory hormones are produced during the stress of exercise and may cause hyperglycemia. Exercise after meals is best, but a 10-15g carb snack may be taken if exercise is performed before meals or is prolonged. Blood glucose levels should be monitored before, during, and after exercise to determine the effect of exercise on the lvels)
To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the patient using glucose-lowering agents that exercise should be undertaken: A. only after a 10-15 carb snack is eaten B. about 1hr after eating, when blood glucose levels are rising C. when glucose monitoring reveals that the blood glucose is in the normal range D. when blood glucose levels are high because exercise always has a hypoglycemia effect
a (metabolic syndrome is a cluster of abnormalities that include elevated insulin levels, elevated triglycerides, and low-density lipoproteins, LDL, and decreased high-density lipoproteins, HDL. These abnormalities greatly increase the risk for cardiovascular disease associated with diabetes that can be prevented or delayed with weight loss. Exercise is also important, but normal weight is most important)
When caring for a patient with metabolic syndrome, the nurse gives the highest priority to teaching the patient about: A. Maintaining a normal weight B. Performing daily aerobic exercise C. eliminating red meat from the diet D. monitoring the blood glucose periodically
b ( the 36yr has a BMI of 38, obese, with a waist-to-hip ratio of 1.1 with central obesity and is more at risk than the others. The 30yr has the least risk with BMI of 27.3, overweight, and a gynoid shape; the 42yr has a BMI of 24.2, normal weight, with 1 risk factor in the waist-hip-ratio of 1.0, and the 68yr has BMI of 27.9, overweight, with waist-hip-ratio of 0.9, but risk is not as great as the 56yr one)
Which of the following patients is most as risk for complications of obesity: A. 30yr woman who is 5ft weighs 140lb, and carries weight in her thighs B. 36yr woman with a BMI of 38, a waist measurement of 38in and a hip measurement of 36in C. A 42yr man with a waist measurement of 36in and a hip measurement of 42 in who is 5ft 11 in D. A 68yr man with a waist measurement of 38 in and a hip measurement of 42 in who is 5ft 11in and weighs 200lb
d (type 2 has a strong genetic influence, and offspring of parents who both have type 2 have an increased chance of developing it)
Which of the following patients would a nurse plan to teach how to prevent or delay the development of diabetes: A. A 62yr obese white man B. An obese 50yr Hispanic woman C. A child whose father has type 1 diabetes D. A 34yr woman whose parents both have type 2
c
Which of the following should a client do postoperatively to prevent atelectasis? A. Log roll B. Recite name and date C. Use incentive spirometer D. Leg exercises
a
Which of the following should the nurse instruct a client diagnosed with type 2 diabetes mellitus regarding medication therapy? A. The medication is in addition to diet and exercise B. The medication will cure the diabetes C. Insulin is not needed to treat type 2 diabetes mellitus D. Limit excess activity and increase rest throughout the day
ace, end, -pril, side effect, cough
ace, end, -pril, side effect, cough
beta, blockers, end, lol
beta, blockers, end, lol
calcium channel, end -pine
calcium channel, end -pine
diuretic, end -ide
diuretic, end -ide
dka, onset slow 4-10hrs, lack insulin, gi upset, acetone breath, thirsty, tachycardia, hypotension, high blood sugar
dka, onset slow 4-10hrs, lack insulin, gi upset, acetone breath, thirsty, tachycardia, hypotension, high blood sugar
left hf, nocturnal, dyspnea, confusion, restlessness, orthopnea, tachycardia, fatigue, cyanosis, blood sputum, tachypnea
left hf, nocturnal, dyspnea, confusion, restlessness, orthopnea, tachycardia, fatigue, cyanosis, blood sputum, tachypnea
potassium sparing, spironolactone
potassium sparing, spironolactone
hypoglycemia
Hypoglycemia, hyperglycemia or both - too much exercise without food
a
2 days following a self-managed hypoglycemic episode at home, the pt tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dl. The best response by the nurse is A. "that is a good range for your glucose levels" B. "You should call your health care provider because you need to have your insulin increased" C. "That level is too low in view of your recent hypoglycemia, and you should increase your food intake" D. "You should only take half your insulin dosage for the next few days to get your glucose level back to normal"
d ( If a diabetic patient is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or subcut administration of 1mg of glucagon should be done. If the unconsciousness has another cause such as ketosis, the rise in glucose caused by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Insulin is contraindicated without knowledge of the patient's glucose level, and oral carbohydrate cannot be given when patients are unconscious)
29. A diabetic patient is found unconscious at home, and a family member calls the clinic. After determining that no gluco meter is available, the nurse advises the family member to: A. try to arouse the patient to drink some orange juice B. administer 10U of regular insulin subcutaneously C. call for an ambulance to transport the patient to a medical facility D. administer glucagon 1mg IM or subcut
b
5. The pathophysiologic mechanism that results in the pulmonary edema of left-sided heart failure is a. increased right ventricular preload. b. increased pulmonary hydrostatic pressure. c. impaired alveolar oxygen and carbon dioxide exchange. d. increased lymphatic flow of pulmonary extravascular fluid.
b, c ( The patient has one prior test result that meets criteria for a diagnosis of diabetes, but on a subsequent day must again have results from one of the 3 tests that meet the criteria for diabetes diagnosis)
7. During routine health screening, a patient is found to have a fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At the follow-up visit, a diagnosis of diabetes would be made based on (select all that apply) A. glucosuria of 3+ B. an A1C of 7.5% C. a FPG of >126 mg/dL (7.0 mmol/L) D. random blood glucose of 126 mg/dL (7.0 mmol/L) E. a 2hr oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)
b( Thrombus formation occurs in the heart when the chambers do not contract normally and empty completely. Both a-fib and very low left ventricular output, LV ejection fraction <20%, lead to thrombus formation, which is treated with anticoagulants to prevent the release of emboli into the circulation)
9. A patient with chronic HF has a-fib and an LV ejection fraction (LVEF) of 18%. To decrease the risk of complications from these conditions, the nurse anticipates the administration of : A. diuretics B. anticoagulants C. B-adrenergic blockers D. potassium supplements
c
A 2400-mg sodium diet is prescribed for a patient with chronic heart failure. The nurse recognizes that additional teaching is necessary when the patient states, a. "I should limit my milk intake to 2 cups a day." b. "I can eat fresh fruits and vegetables without worrying about sodium content:' c. "I can eat most foods as long as I do not add salt when cooking or at the table." d. "I need to read the labels on prepared foods and medicines for their sodium content."
a (when mixing regular with a longer-acting insulin, regular insulin should always be drawn into the syringe first to prevent contamination of the regular insulin vial with longer-acting insulin additives)
A diabetic patient is learning to mix regular insulin and NPH inulin 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 to the insulin dose into the regular vial withdraws the dose
a (lung sounds constitute indicator of left sided heart function)
A nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? A. listening to lung sounds B. assessing for peripheral and sacral edema C. assessing for jugular vein distention D. monitoring for organomegaly
c (OTC meds such as analgesics, antacids, laxatives, sedatives, toothpaste, mouthwash can increase sodium)
A nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming: A. Cantaloupe B. Broccoli C. Antacids D. bananas
b ( The ADA recommends that testing for type 2 diabetes with FPG should be considered for all individuals at the age of 45 and above and if normal repeated every 3 years. Testing for immune markers of type 1 diabetes is not recommended. Testing at a younger age or more frequently should be done for members of a high-risk ethnic population, including African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders)
A nurse working in an outpatient clinic plans a screening program for diabetes. Recommendations for screening would include: A. oral glucose tolerance testing (OGTT) for all minority populations every year B. FBG for all individuals at age 45 and then every 3 years C. testing for all people before the age of 21 for islet cell antibodies D. testing for type 2 diabetes only in overweight or obese individuals
c(Patient's elevated glucose on arising may be the result of either dawn phenomenon or Somogyi effect, and the best way to determine whether needs more or less insulin is by monitoring the glucose at bedtime, between 2:00 and 4:00 am and on arising. If predawn levels are below 60 mg/dL, the insulin dose should be reduced, but if the 2-4 am blood glucose is high, the insulin should be increased)
A patient taking insulin has recorded fasting glucose levels above 200 mg/dl (11.1 mmol/L) on awakening for the last five mornings. The nurse advises the patient to: A. increase the evening glucose production B. use a single-dose insulin regimen with an intermediate-acting insulin C. monitor the glucose level at bedtime between 2:00 and 4:00 am and on arising D. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect
a (PAWP of 25 means the PA systolic pressure is much higher. Patient is likely to have diastolic heart failure from pulmonary hypertension because left ventricular filling pressures are high but ejection fraction is normal.)
A patient with HF has an ejection fraction of 60% and a pulmonary artery wedge pressure (PAWP) of 25 mm Hg. Which disorder most likely is the cause of the HF? A. Pulmonary hypertension B. Acute Pulmonary edema C. Stenosis of the aortic valve D. Left ventricular hypertrophy
b(The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension. NSAIDs, H2-receptor blockers, and high-potassium foods do not pose a risk in combination with nitrates.)
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid A. High-potassium foods. B. Drugs to treat erectile dysfunction. C. Over-the-counter H2-receptor blockers. D. Nonsteroidal antiinflammatory drugs
a (Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence contractility, afterload, or vessel tone.)
A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation.
a
A patient with diabetes calls the clinic because she is experiencing nausea and flulike symptoms. The nurse advises the patient to: A. administer the usual insulin dosage B. hold fluid intake until the nausea subsides C. come to the clinic immediately for evaluation and treatment D. monitor the blood glucose every 1-2hr and call if the glucose rises over 150 mg/dL
d (A high Fowler's position increases the thoracic capacity, improving ventilation; sitting with the legs dependent helps pool blood in the extremities and decrease venous return, or preload. Coughing and deep breathing will not clear the lungs of pulmonary edema. Intake and output and daily weights should be done to monitor the effects of treatment but do not directly address impaired gas exchange. During periods of acute dyspnea, rest is necessary to decrease oxygen demand)
A patient with heart failure has tachypnea, severe dyspnea, and a SpO2 of 84%. The nurse identifies a nursing diagnosis of impaired gas exchange related to increased preload and mechanical failure. An appropriate nursing intervention for this diagnosis is to a. assist the patient to cough and deep breathe q2hr b. assess intake and output q8hr and weigh the patient daily C. encourage alternate rest and acitivty perioids to reduce cardiac workload d. place the patient in high fowler's position with the feet dangling over the bedside
b (A split-mixed dose of insulin requires that the patient adhere to a set meal pattern to provide glucose for action of the insulins, and a bedime snack is usually required when patients take a long-acting insulin late in the day to prevent nocturnal hypoglycemia)
A patient with type 1 uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 PM. When teaching the patient about his regimen, the nurses stresses that: A. Hypoglycemia is most likely to occur before the noon meal B. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia C. Flexibility in food intake is possible because insulin is available 24hr/day D. Pre-meal glucose checks are required to determine needed changes daily dosing
a
A physical assessment finding that the nurse would expect to be present in the patient with acute left-sided heart failure is: A. bubbling crackles and tachycardia. B. hepatosplenomegaly and tachypnea. C. peripheral edema and cool, diaphoretic skin. D. frothy blood-tinged sputum and distended jugular veins.
a
A post-operative client with a leg cast is at risk for developing which of the following complications? A. Compartment syndrome B. Atelectasis C. Pneumonia D. Respiratory acidosis
true
A primary risk factor for HF is coronary artery disease. (true/false)
e
Primary effect is to decrease intravascular fluid volume, thus decreasing preload and improving left ventricular function: A. Valsartan B. Carvedilol C. Milrinone D. Isosorbide nitrate and hydralazine E. Furosemide
a, b, c, d, e
Priority for preventing HF: A. Diabetes mellitus B. High Blood Pressure C. Age 65 and older D. CAD E. Cholesterol over 200mg
a
Africans and Hispanics susceptible to HTN a
hypoglycemia
Alcohol intake can lead to ____________, so the client should eat while drinking.
a
Prevents vasocontriction and blocks aldosterone; used for patient that cannot tolerate angiotensin-converting enzyme inhibitors: (side effects: hyperkalemia, decreased renal function) (end in -tan) A. Valsartan B. Carvedilol C. Milrinone D. Isosorbide nitrate and hydralazine E. Furosemide
95, 105
Chloride:_____-_______
both
Hypoglycemia, hyperglycemia or both - change in vision
hypoglycemia
Hypoglycemia, hyperglycemia or both - cold, clammy skin
both
Hypoglycemia, hyperglycemia or both - headache
a
Decreases afterload by reducing levels of angiotensin 2 and aldosterone: A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
a
Describe the process that occurs to cause the following classic diabetes symptoms A. polyuria (high glucose levels cause loss of glucose in urine with osmotic diuresis) B. Polydipsia (thirst caused by fluid loss of polyuria) C. Polyphagia (cellular starvation from lack glucose and use of fat and protein for energy) a
hyperglycemia
Hypoglycemia, hyperglycemia or both - increased dietary intake
hyperglycemia
Hypoglycemia, hyperglycemia or both - nausea and vomiting
hyperglycemia
Hypoglycemia, hyperglycemia or both - precipitated by stress
b (maintenance of as near-normal blood glucose levels as possible and achievement of optimal serum lipid levels with dietary modification are believed to be the most important factors in preventing both short and long term complications of diabetes.)
Goals of nutritional therapy for the patient 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. 5 small meals per day with a bedtime snack
hypoglycemia
Hypoglycemia, hyperglycemia or both - slurred speech and iritability
a
Identifying 4 risk factors for primary hypertension that are not related to lifestyle behaviors Age—hypertension progresses with increasing age. Gender—hypertension is more prevalent in men up to age 55 and then, above that age, more in women. Ethnicity—African Americans have twice the incidence of hypertension than do white Americans. Family history—hypertension is strongly familial. A
c
If a client has a random plasma glucose level greater than 200 mg/dL what should be done? A. Nothing B. Begin treatment for diabetes C. Draw a blood sample for a hemoglobin A1C level D. Assess for use of an insulin pump
d
If a client receives a dose of lispro insulin, what must be done next? A. Exercise B. Eat within one hour C. Continue normal activities of daily living D. Eat within 15 minutes
c
Improves cardiac contraction, decreases afterload, and increases CO A. Valsartan B. Carvedilol C. Milrinone D. Isosorbide nitrate and hydralazine E. Furosemide
fruity
In DKA, the client will exhibit an acetone, or _______ breath odor
d (Insulin is an anabolic hormone, responsible for growth, repair, and storage, and it facilitates movement of amino acids into cells, synthesis of protein, storage of glucose as glycogen, and deposition of triglycerides and lipids as fat into adipose tissue)
In addition to promoting the transport of glucose from the blood into the cell, insulin also: A. Enhances the breakdown of adipose tissue and energy B. Stimulates hepatic glycogenolysis and gluconeogenesis C. Prevents the transport of triglycerides into adipose tissue D. Accelerates the transport of amino acids into cells and their synthesis into protein
b
Primarily reduces preload and increases myocardial oxygen supply A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
right hf
Murmurs, jugular venous distention, edema, weight gain, ascites, hepatomegaly are all associated with (right hf, left hf)
B, d, a, c
Place the following anatomical sites in order of the speed of absorption of insulin: A. Thighs B. Abdomen C. Buttocks D. Arms
left hf
Pleural effusion, crackles, low PaO2 slight increase PaCO2, PMI displaced interiorly and posteriorly (LV hypertrophy), frothy pink-tinged sputum, nocturia, dry hacking cough, orthopnea, paroxysmal nocturnal dyspnea are all associated with (right hf, left hf)
d
Potent vasodilator that decreases both preupload and afterload, increasing cardiac contractility and output A. enalapril B. IV nitroglycerin C. digoxin D. IV nitroprusside E. IV morphine F. spironolactone G. dopamine H. nesiritide
135, 145
Sodium: _____-______
b (potassium sparing, side effect hyperkalemia, dehydration, hyponatremia, and lethargy)
The clinic nurse is reviewing the assessment findings for a client who has been taking Spironolactone (Aldactone) for treatment of HTN. Which of the following, if noted in the client's record, would indicate that the client is experiencing a side effect related to the medication? A. Potassium level of 3.2 meq/L B. A potassium level of 5.8 meq/L C. Client complain of constipation D. client complaint of dry skin
c (BNP is relased from the ventricles in response to ventricular stretch and is a good marker for heart failure. If elevated, shortness of breath is due to heart failure; if normal, it is due to pulmonary disease. BNP opposes the actions of the rennin-angiotensin-aldosterone system resulting in vasodilation and reduction in blood volume. Exercise stress testing and cardiac catheterization are more important to diagnose CAD and although BUN may be elevated in heart failure, it is a reflection of renal perfusion.)
The diagnostic test that is most useful in differentiating dyspnea related to pulmonary effects of heart failure from dyspnea related to pulmonary disease is: A. exercise stress testing B. cardiac catheterization C. b-type natriuretic peptide (BNP) levels D. determination of blood urea nitrogen (BUN)
a (Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion. Errors in insulin dosing and complications of insulin therapy are still potential risks with insulin pumps)
The major advantage of using an insulin pump is that: A. tight glycemic control can be maintained B. errors in insulin dosing are less likely to occur C. complications of insulin therapy are prevented D. frequent blood glucose monitoring is unnecessary
false (dysrhythmia)
The mechanisms by which hypervolemia acts as a precipitating cause of HF include decreasing CO and increasing the workload and oxygen requirements of the myocardium (true/false)
c
The most common cause of hospitalization for the client diagnosed with diabetes is: A. Heart attack B. Pneumonia C. Wounds on the feet D. Urinary tract infection
d(PND is awakening from sleep with a feeling of suffocation and a need to sit up to be able to breath, and patients learn that sleeping with the upper body elevated on several pillows helps prevent PND. Orthopnea is an inability to breathe effectively when lying down, and nocturia occurs with heart failure as fluid moves back into the vascular system during recumbency, increasing renal blood flow.)
The nurse assess the patient with chronic biventricular heart failure for paroxysmal nocturnal dyspnea by questioning the patient regarding: A. the presence of difficulty breathing at night B. frequent awakening to void during the night C. the present of a dry,hacing cough when resting D. the use of two or more pillows to help breathing during sleep
c
The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose 3 months after initial instruction. An error in the performance of SMBG noted by the nurse that requires intervention is: C. cleaning the puncture site with alcohol before the puncture
d (Although all these drugs may cause hypotension, nitroprusside is a potent dilator of both arteries and veins and may cause such marked hypotension that dobutamine may be needed; Milrinone has a positive inotropic effect and nitroglycerin primarily dilates veins; furosemide may cause hypotension due to diuretic effect depletion of intravascular fluid volume)
The nurse monitors the patient receiving treatment for acute decompensated heart failure with the knowledge that marked hypotension is most likely to occur with the IV administration of a. furosemide (Lasix). b. milrinone (Primacor). c. nitroglycerin (Tridil). d. nitroprusside (Nipride).
c (The protein in milk and cheese may be slowly converted to glucose, gluconeogenesis, providing the body with some glucose during sleep while the Humulin N insulin is still acting)
The nurse plans an evening snack of milk, crackers, and cheese for an average-sized client who is receiving Humulin N insulin. This snack provides: A. Encouragement to stay on the diet B. Added calories to promote weight gain C. Nourishment to counteract late insulin activity D. High-carbohydrate nourishment for immediate use
a
The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that a common cause of death in heart transplant patients during the first year is a. infection b. heart failure c. embolization d. malignant conditions
b (Dopamine is a β-adrenergic agonist whose inotropic action is reserved for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not warrant the use of dopamine.)
The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include A. Acute anxiety. B. Hypotension and tachycardia. C. Peripheral edema and weight gain. D. Paroxysmal nocturnal dyspnea (PND)
c (U100 insulin must be used with a U100 syringe, but for those using lose doses of insulin, syringes are available that have increments of 1 unit instead of 2 units. Errors can be made in dosing if patients switch back and forth between different sizes of syringes. Aspiration before injection of the insulin is not recommended, nor is the use of alcohol to clean the skin. Because the rate of peak serum concentration varies with the site selected for injection, injections should be rotated within a particular area, such as the abdomen)
When teaching the patient with diabetes about insulin administration, the nurse instructs the patient to: A. pull back 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 syringe to avoid dosing errors D. rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies
a
Which cells of the pancreas produce glucagon? A. Alpha B. Beta C. Delta D. F
d
Which of the following can the nurse do when planning care for an elderly client recovering from surgery? A. Encourage the completion of care activities in a set amount of time B. Refer to the client by his or her first name C. Turn on the overhead lights when entering the room D. Permit the client time to respond to questions because of a hearing deficit
b
Which of the following is a reason NPH insulin may appear cloudy. A. It has crossed the expiry date B. it has additives C. It has been contaminated by regular insulin D. It has been refrigerated
extremity warmth, color, pulses, capillary refill
While assessing a post-operative client, the nurse checks peripheral circulation. List the steps that the nurse undertakes to do this. 1. ____________ 2. ____________ 3. ________________ 4._______________
a
You don't know if you have htn A
