Diabetes evolve questions
The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? "Should we filter air circulation?" "Can we use less radiographic contrast dye?" "Should we add low-dose dobutamine?" "Should we decrease IV rates?"
"Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.
The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? "I can break in my shoes by wearing them all day." "I need to monitor my feet daily for blisters or skin breaks." "I should never go barefoot." "I should quit smoking."
"I can break in my shoes by wearing them all day." Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering. People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated. Tobacco use further decreases peripheral circulation in a client with diabetes.
The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? "I should go barefoot in my house so that my feet are exposed to air." "I must inspect my shoes for foreign objects before putting them on." "I will soak my feet in warm water to soften calluses before trying to remove them." "I must wear canvas shoes as much as possible to decrease pressure on my feet."
"I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic clients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the client. The diabetic client must wear firm support shoes to prevent injury.
The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? "I should begin exercising for at least an hour a day." "I should monitor my diet." "If I lose weight, I may not need to use the insulin anymore." "Weight loss can be a sign of diabetic ketoacidosis."
"I should begin exercising for at least an hour a day." For long-term maintenance of major weight loss, large amounts of exercise (7 hr/wk) or moderate or vigorous aerobic physical activity may be helpful, but the client must start slowly. Monitoring the diet is key to type 2 diabetes management. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis.
The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? "I should drink a glass of water." "I should eat three graham crackers." "I should give myself 1 mg of glucagon." "I should sit down and rest."
"I should eat three graham crackers." Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia.
The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? "If I become hyperglycemic, it is a medical emergency." "If I become hypoglycemic, I could become unconscious." "Medical personnel may need confirmation of my insurance." "I may need to be admitted to the hospital suddenly."
"If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency in clients with diabetes. A MedicAlert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care. Hyperglycemia is not a medical emergency unless it is acidosis; people with diabetes tolerate mild hyperglycemia routinely. Insurance information and information needed for hospital admission do not appear on a MedicAlert bracelet.
A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill." "You will receive dialysis the day before surgery and for about a week after."
"It is essential for you to wash your hands and avoid people who are ill." Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.
A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? "It is overwhelming, isn't it?" "Let's see how much you can learn today, so you are less nervous." "Let's tackle it piece by piece. What is most scary to you?" "Other people do it just fine."
"Let's tackle it piece by piece. What is most scary to you?" Suggesting the client tackle it piece by piece and asking what is most scary to him or her is the best response; this approach will allow the client to have a sense of mastery with acceptance. Referring to the illness as overwhelming is supportive, but is not therapeutic or helpful to the client. Trying to see how much the client can learn in one day may actually cause the client to become more nervous; an overload of information is overwhelming. Suggesting that other people handle the illness just fine is belittling and dismisses the client's concerns.
Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The anti-rejection medications will be taken for life." "I will drink 8 ounces of water with my medications."
"The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.
A diabetic client has a glycosylated hemoglobin (HbA1C) level of 9.4%. What does the nurse say to the client regarding this finding? "Keep up the good work." "This is not good at all." "What are you doing differently?" "You need more insulin."
"What are you doing differently?" Assessing the client's regimen or changes he or she may have made is the basis for formulating interventions to gain control of blood glucose. HbA1C levels for diabetic clients should be less than 7%; a value of 9.4% shows poor control over the past 3 months. Telling the client this is not good, although true, does not take into account problems that the client may be having with the regimen and sounds like scolding. Although it may be true that the client needs more insulin, an assessment of the client's regimen is needed before decisions are made about medications.
A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? "All of this is new. What can't you do?" "Are you afraid of dying?" "How are you doing this morning?" "What concerns do you have about your kidney disease?"
"What concerns do you have about your kidney disease?" Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.
A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."
"You sound frustrated with the situation." Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.
A client with type 2 diabetes has been admitted for surgery, and the health care provider has placed the client on insulin in addition to the current dose of metformin (Glucophage). The client wants to know the purpose of taking the insulin. What is the nurse's best response? "Your diabetes is worse, so you will need to take insulin." "You can't take your metformin while in the hospital." "Your body is under more stress, so you'll need insulin to support your medication." "You must take insulin from now on because the surgery will affect your diabetes."
"Your body is under more stress, so you'll need insulin to support your medication." Because of the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for the client who uses oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides. No evidence suggests that the client's diabetes has worsened; however, surgery is stressful and may increase insulin requirements. Metformin may be taken in the hospital; however, not on days when the client is NPO for surgery. When the client returns to his or her previous health state, oral agents will be resumed.
In reviewing the health care provider admission requests for a client admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? 20 mEq KCl for each liter of IV fluid IV regular insulin at 2 units/hr IV normal saline at 100 mL/hr 1 ampule NaHCO3 IV now
1 ampule NaHCO3 IV now NaHCO3 is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state, which presents with hyperglycemia and absence of ketosis/acidosis. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from diuresis. IV regular insulin at 2 units/hr will correct hyperglycemia. IV normal saline at 100 mL/hr will correct dehydration.
A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? 7:30 a.m. 11:00 a.m. 2:00 p.m. 7:30 p.m.
11:00 a.m. Onset of regular insulin is ½ to 1 hour; peak is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. For regular insulin received at 7:00 a.m., 7:30 a.m., 2:00 p.m., and 7:30 p.m. are not the anticipated peak times.
A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse?
167 drops/min
Which of these clients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? A 58-year-old with sensory neuropathy who needs teaching about foot care A 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr A 70-year-old who needs blood glucose monitoring and insulin before each meal A 76-year-old who was admitted with fatigue and shortness of breath
A 70-year-old who needs blood glucose monitoring and insulin before each meal A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because clients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit. The 58-year-old with sensory neuropathy, the 68-year-old with diabetic ketoacidosis, and the 76-year-old with fatigue and shortness of breath all have specific teaching or assessment needs that are better handled by nurses more familiar with caring for older adults with diabetes.
Which is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? American Diabetes Association Centers for Disease Control and Prevention Health care provider office Pharmaceutical representative
American Diabetes Association The American Diabetes Association can provide national and regional support and resources to clients with diabetes and their families. The Centers for Disease Control and Prevention does not focus on diabetes. The client's health care provider's office is not the best resource for diabetes information and support. A pharmaceutical representative is not an appropriate resource for diabetes information and support.
Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output
Abrupt decrease in urine output An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation.
A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action does the nurse plan to take next? Instruct the client to continue with the current diet and metformin use. Discuss the need to check blood glucose several times every day. Talk about the possibility of adding rapid-acting insulin to the regimen. Ask the client about current dietary intake and medication use.
Ask the client about current dietary intake and medication use. The nurse's first action should be to assess whether the client is adherent to the currently prescribed diet and medications. The client's current diet and medication use have not been successful in keeping glucose in the desired range. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The HbA1C indicates that the client's average glucose level is not in the desired range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse should not assume that adding insulin, which must be prescribed by the provider, is the answer without assessing the underlying reason for the treatment failure.
Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? Assist the client's spouse in choosing appropriate dietary items. Evaluate the client's use of a home blood glucose monitor. Inspect the extremities for evidence of poor circulation. Assist the client with washing the feet and applying moisturizing lotion.
Assist the client with washing the feet and applying moisturizing lotion. Assisting with personal hygiene is included in the role of home health aides. Assisting with dietary choices, evaluating the effectiveness of teaching, and performing assessments are complex actions that should be implemented by licensed nurses.
When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? Select all that apply. Check brachial pulses daily. Auscultate for a bruit every 8 hours. Teach the client to palpate for a thrill over the site. Elevate the arm above heart level. Ensure that no blood pressures are taken in that arm.
Auscultate for a bruit every 8 hours. Teach the client to palpate for a thrill over the site. Ensure that no blood pressures are taken in that arm. A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.
A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Auscultate for pericardial friction rub. Assess for crackles. Monitor for decreased peripheral pulses. Determine if the client is able to ambulate.
Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.
Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Consuming a low-calcium diet Avoiding peas, nuts, and legumes Drinking cola beverages only once daily Increasing dairy products enriched with vitamin D
Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.
A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? Avoiding venipuncture and blood pressure measurements in the affected arm Modifications to allow for complete rest of the affected arm How to assess for a bruit in the affected arm How to practice proper nutrition
Avoiding venipuncture and blood pressure measurements in the affected arm Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.
A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? Causes and treatment of hyperglycemia Causes and treatment of hypoglycemia Dietary control Insulin administration
Causes and treatment of hypoglycemia The causes and treatment of hypoglycemia must be understood by the client and family to manage the client's diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the client with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation.
A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action does the nurse take first? Check the blood glucose. Administer oxygen. Offer reassurance. Attach a cardiac monitor.
Check the blood glucose. The client's clinical presentation is consistent with diabetic ketoacidosis, so the nurse should initially check the client's glucose level. Based on the oxygen saturation, oxygen administration is not necessary. The nurse provides support, but it is early in the course of assessment and intervention to offer reassurance without more information. Cardiac monitoring may be implemented, but the first action should be to obtain the glucose level.
The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first? Client taking repaglinide (Prandin) who has nausea and back pain Client taking glyburide (Diabeta) who is dizzy and sweaty Client taking metformin (Glucophage) who has abdominal cramps Client taking pioglitazone (Actos) who has bilateral ankle swelling
Client taking glyburide (Diabeta) who is dizzy and sweaty The client taking glyburide (Diabeta) who is dizzy and sweaty has symptoms consistent with hypoglycemia and should be assessed first because this client displays the most serious adverse effect of antidiabetic medications. Although the client taking repaglinide who has nausea and back pain requires assessment, the client taking glyburide takes priority. Metformin may cause abdominal cramping and diarrhea, but the client taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.
The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? Client with chronic kidney failure who was just admitted with shortness of breath Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted Client with azotemia whose blood urea nitrogen and creatinine are increasing Client receiving peritoneal dialysis who needs help changing the dialysate bag
Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.
The nurse has just received change-of-shift report on the endocrine unit. Which client does the nurse see first? Client with type 1 diabetes whose insulin pump is beeping "occlusion" Newly diagnosed client with type 1 diabetes who is reporting thirst Client with type 2 diabetes who has a blood glucose of 150 mg/dL Client with type 2 diabetes with a blood pressure of 150/90 mm Hg
Client with type 1 diabetes whose insulin pump is beeping "occlusion" Because glucose levels will increase quickly in clients who use continuous insulin pumps, the nurse should assess this client and the insulin pump first to avoid diabetic ketoacidosis. Thirst is a symptom of hyperglycemia and, although important, is not a priority; the nurse could delegate a fingerstick blood glucose to unlicensed assistive personnel while assessing the client whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL is mildly elevated, this is not an emergency. Mild hypertension is also not an emergency.
To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Office secretary Schoolteacher Taxicab driver
Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.
Which signs and symptoms indicate rejection of a transplanted kidney? Select all that apply. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities
Crackles in the lung fields Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.
The nurse receives report on a 52-year-old client with type 2 diabetes:Physical AssessmentDiagnostic FindingsProvider PrescriptionsLungs clearGlucose 179 mg/dLRegular insulin 8 units if blood glucose 250 to 275 mg/dL and cold to touchRight great toe mottledHemoglobin A1c 6.9%Regular insulin 10 units if glucose 275 to 300 mg/dLClient states wears eyeglasses to readWhich complication of diabetes does the nurse report to the provider? Poor glucose control Visual changes Respiratory Distress Decreased peripheral perfusion
Decreased peripheral perfusion A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted.
A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? Blood pressure of 118/78 mm Hg Weight loss of 3 pounds during hospitalization Dyspnea and anxiety at rest Central venous pressure (CVP) of 6 mm Hg
Dyspnea and anxiety at rest Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.
A client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the client before providing instruction about the disease and its management? Current lifestyle Educational and literacy level Sexual orientation Current energy level
Educational and literacy level A large amount of information must be synthesized; typically written instructions are given. The client's educational and literacy level is essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.
When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Ham Eggplant Macaroni
Eggs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.
Which clients are at risk for acute kidney injury (AKI)? Select all that apply. Football player in preseason practice Client who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Accountant with diabetes Client in the intensive care unit on high doses of antibiotics Client recovering from gastrointestinal influenza
Football player in preseason practice Client who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Client in the intensive care unit on high doses of antibiotics Client recovering from gastrointestinal influenza To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.
A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique
Handwashing The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.
Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? Increased blood urea nitrogen (BUN) Increased creatinine level Pale-colored urine Decreased sodium level
Increased blood urea nitrogen (BUN) An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.
Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue
Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.
Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? Diltiazem (Cardizem) Lisinopril (Zestril) Clonidine (Catapres) Doxazosin (Cardura)
Lisinopril (Zestril) Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.
The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitors Opiates Calcium channel blockers
Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.
While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? Select all that apply. Obtain the client's pre-hemodialysis weight. Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.
Obtain the client's pre-hemodialysis weight. Document the amount the client drinks throughout the shift. Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.
The nurse caring for four diabetic clients has all of these activities to perform. Which is appropriate to delegate to unlicensed assistive personnel (UAP)? Perform hourly bedside blood glucose checks for a client with hyperglycemia. Verify the infusion rate on a continuous infusion insulin pump. Monitor a client with blood glucose of 68 mg/dL for tremors and irritability. Check on a client who is reporting palpitations and anxiety.
Perform hourly bedside blood glucose checks for a client with hyperglycemia. Performing bedside glucose monitoring is an activity that may be delegated because it does not require extensive clinical judgment to perform; the nurse will follow up with the results. Intravenous therapy and medication administration are not within the scope of practice for UAP. The client with blood glucose of 68 mg/dL will need further monitoring, assessment, and intervention not within the scope of practice for UAP. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention; this client must be assessed by licensed nursing staff.
An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? Urine output 12-lead electrocardiogram (ECG) Potassium level Rate of IV fluids
Potassium level With insulin therapy, serum potassium levels fall rapidly as potassium shifts into the cells. Detecting and treating the underlying cause is essential. Insulin treats symptoms of diabetes by putting glucose into the cell as well as potassium; ectopy, indicative of cardiac irritability, is not associated with changes in urine output. A 12-lead ECG can verify the ectopy, but the priority is to detect and fix the underlying cause. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the cause.
Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? History of hiatal hernia Presence of diabetes and glycosylated hemoglobin of 6.8% History of basal cell carcinoma on the nose 5 years ago Presence of tuberculosis
Presence of tuberculosis Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.
Which action is correct when drawing up a single dose of insulin? Wash hands thoroughly and don sterile gloves. Shake the bottle of insulin vigorously to mix the insulin. Pull back plunger to draw air into the syringe equal to the insulin dose. Recap the needle and save the syringe for the next dose of insulin.
Pull back plunger to draw air into the syringe equal to the insulin dose. The plunger is pulled back to draw an amount of air into the syringe that is equal to the insulin dose. The air is then injected into the insulin bottle before withdrawing the insulin dose. Although handwashing is important before any medication administration, sterile gloves are not required. The bottle of insulin should be rolled gently in the palms of the hands to mix the insulin, not shaken. Insulin syringes are never recapped or reused; the syringe and needle should be disposed of (without recapping) in a puncture-proof container.
A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? RN who has floated from pediatrics for this shift LPN/LVN with experience working on the medical unit RN who usually works on the general surgical unit New graduate RN who just finished a 6-week orientation
RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.
The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? Select all that apply. Restricted protein Liberal sodium Restricted fluids Low potassium Low fat
Restricted protein Restricted fluids Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.
When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? Mild discomfort at the insertion site Temperature 100.8° F 1+ ankle edema Anorexia
Temperature 100.8° F Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.
When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? Pulse oximetry reading of 95% Sinus bradycardia, rate of 58 beats/min Blood pressure of 148/90 mm Hg Temperature of 101.2° F (38.4° C)
Temperature of 101.2° F (38.4° C) Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.
Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? Most clients with type 1 diabetes are born with it. People with type 1 diabetes are often obese. Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes do not develop typical diabetic complications.
Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications.
While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? Instruct the client to deep-breathe and cough. Document the effluent as output. Turn the client to the opposite side. Re-position the catheter.
Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.
Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Serum potassium of 5.0 mEq/L
Visual changes Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.
A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? Day of discharge On admission When the client states readiness While performing the test in the hospital
While performing the test in the hospital Teaching the client about the operation of the machine while performing the test in the hospital is the best way for the client to learn. The teaching can be reinforced before discharge. Instructing the client on the day of admission or the day of discharge would be overwhelming to the client because of all of the other activities taking place on those days. The client may never feel ready to learn this daunting task; the nurse must be more proactive.
