Final Practice #4 (Nurs327)
A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? a. "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." b. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates." c. "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." d. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar."
a
A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priorityaction? a. Assess the client's readiness to learn. b. Identify the client's body mass index. c. Ensure that the client understands the basic pathophysiology of diabetes. d. Teach the client "survival skills" for diabetes.
a
A client is being discharged after a liver transplant and the nurse is performing discharge education. When planning this client's continuing care, the nurse should prioritize what risk diagnosis? a. Risk for Infection Related to Immunosuppressant Use b. Risk for Injury Related to Decreased Hemostasis c. isk for Contamination Related to Accumulation of Ammonia d. Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
a
A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? a. "I'm thirsty all the time. I just can't get enough to drink." b. "I have a cough and cold that just won't go away." c. "It seems like I have no appetite. I have to make myself eat." d. "I notice pain when I urinate."
a
A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment? a. Maintaining and monitoring the client's fluid balance b. Assessing the client for signs and symptoms of venous thromboembolism c. Assessing the client's level of consciousness d. Monitoring the client for dysrhythmias
a
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? a. Administering 1 ampule of 50% dextrose solution, per physician's order b. Administering a 500-ml bolus of normal saline solution c. inserting a feeding tube and providing tube feedings d. Observing the client for 1 hour, then rechecking the fingerstick glucose level
a
A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? a. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." b. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." c. "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine." d. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day."
a
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a. "How did this happen? I've been faithful my entire marriage." b. I'll be very careful when preparing food for my family." c. I'll take all my medications as ordered." d. I'll wash my hands often."
a
The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? a. Severe abdominal pain b. Mental agitation c. Fever d. Jaundice
a
Which nursing assessment is most important in a client diagnosed with ascites? a. Daily measurement of weight and abdominal girth b. Palpation of abdomen for a fluid shift c. Assessment of the oral cavity for foul-smelling breath d. Auscultation of abdomen
a
The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply. a. May improve blood glucose levels b. Decrease the need for exogenous insulin c. Help reduce cholesterol levels d. Increase potassium levels e. May reduce postprandial glucose levels
a,b,c
A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. a. Ketoconazole b. Valproic acid c. Insulin d. Acetaminophen e. Diazepam
a,b,d
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. a. Ascites b. Enlarged liver size c. Accelerated behaviors and mental processes d. Excess storage of vitamin C e. Hemorrhoids
a,b,e
A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. a. Transmission of the virus is possible with oral-anal contact during sex. b. Typically there is a spontaneous recovery. c. The incubation period for this virus is up to 4 months. d. There is a 50% risk that cirrhosis will develop. e. There is a 70% chance that jaundice will occur.
a,b,e
The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply. a. Leakage of fluid or serum (exudates) b. Microaneurysms c. Blurred optic discs d. Detachment e. Focal capillary single closure
a,b,e
A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply. a. Applying interventions to reduce the client's temperature b. Administering insulin to reduce blood glucose levels c. Administering beta blockers to reduce heart rate d. Administering diuretics to prevent fluid overload e. Administering corticosteroids
a,c
A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. a. Increase in blood glucose from 3:00 AM until breakfast b. Elevated blood glucose at bedtime c. Normal bedtime blood glucose d. Rise in blood glucose about 3:00 AM e. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM
a,c,e
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to do what action? a. Gradually replace the prednisone with an over-the-counter (OTC) alternative. b. Slowly taper down the dose of prednisone, as prescribed. c. Take the drug concurrent with levothyroxine. d. Take each dose of prednisone with a dose of calcium chloride.
b
A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client's history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of: a. simple carbohydrates. b. sodium. c. calcium. d. potassium.
b
A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? a. Acute confusion b. Infection c. Impaired urinary elimination d. Acute pain
b
A nurse is aware that insulin secretion increases 3 to 5 minutes after a meal and then returns to baseline. If a patient ate breakfast at 7:30 AM, the nurse would expect a baseline level by: a. 2:30 PM b. 10:30 AM c. 12:30 PM d. 8:30 AM
b
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? a. Is less costly than performing daily blood sugar test b. Reflects the amount of glucose stored in hemoglobin over past several months. c. Best indicator for the nutritional state of the client d. Provides best information on the body's ability to maintain normal blood functioning
b
The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? a. A diet high in fiber and plant-sourced fat b. Small, frequent meals, high in protein and calories c. Three large, bland meals a day d. A reduced calorie diet, high in nutrients
b
Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes? a. Decreased urination and constipation b. Increased appetite and thirst c. Low blood pressure and pulse d. Vomiting and diarrhea
b
Which statement indicates that a client with diabetes mellitus understands proper foot care? a. "I'll schedule an appointment with my physician if my feet start to ache." b. "I'll wear cotton socks with well-fitting shoes." c. "I'll go barefoot around the house to avoid pressure areas on my feet." d. "I'll rotate insulin injection sites from my left foot to my right foot."
b
Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. a. Decreases the levels of high-density lipoproteins b. Decreases total cholesterol c. Increases glucose uptake by body muscles d. Increases resting metabolic rate as muscle size increases e. Increases lean muscle mass
b,c,d,e
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply. a. Administration of calcium carbonate b. Monitoring the patient for fluid overload c. Administration of calcitonin d. Administration of a bronchodilator e. Intravenous isotonic saline solution in large quantities
b,c,e
A nurse is caring for an older adult client who has type 2 diabetes mellitus. She suspects that the patient is exhibiting symptoms of diabetic ketoacidosis (DKA) instead of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which of the following are indicators of a diagnosis of DKA? Select all that apply. a. Serum osmolality of 380 mOsm/L b. Blood glucose level of 280 mg/dL c. Plasma bicarbonate level of 26 mmol/L d. Arterial pH of 7 e. Plasma bicarbonate level of 13 mEq/L
b,d,e
A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? a. Assess the client's ability to take a deep breath b. Assess for excessive sweating c. Assess the client's breath odor d. Assess the client's ability to move all extremities
c
A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? a. The client's diet should be low protein with ample fat. b. The client may experience short-term changes in cognition. c. The client is at an increased risk for developing infection. d. The client is at a decreased risk for development of thrombophlebitis and thromboembolism.
c
A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? a. Hold insulin infusion for 30 minutes. b. Infuse 500 ml of normal saline solution over 1 hour. c. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. c. Change the second IV solution to dextrose 5% in water.
c
A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments? a. Monitoring the client's level of consciousness and behavior b. Monitoring the client's neutrophil levels c. Reviewing the client's creatinine and BUN levels d. Assessing the client for signs of impaired liver function
c
A female diabetic patient who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/week, approximately what should her daily caloric intake be? a. 1500 calories b. 1,800 calories c. 1000 calories d. 1200 calories
c
A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? a. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature." b. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." c. "If you are going to use up the vial within 1 month it can be kept at room temperature." d. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature."
c
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a. Administering frequent oral feedings b. Encouraging frequent visits from family and friends c. Positioning the client on the side with the knees flexed d. Administering an analgesic once per shift, as ordered, to prevent drug addiction
c
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? a. Dry mouth, which makes the client thirsty b. Acetone in the urine c. Frequent vomiting, leading to loss of fluid volume d. High glucose concentration in the blood
c
A client was admitted for critical care due to esophageal varices and precarious physical condition. What could cause the client's varices to hemorrhage? a. little protective tissue to protect fragile veins b. rough food c. chemical irritation d. All options are correct.
d
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a. Inability for the liver to reabsorb serum glucose b. Ingestion of foods high in sugar c. Renal failure d. Dysfunction of the pancreatic islet cells
d
The nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a. 95 mg/dL (5.27 mmol/L) b. Between 60 and 75 mg/dL (3.33 to 4.16 mmol/L) c. Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) d. Lower than 50 to 60 mg/dL (2.77 to 3.33 mmol/L)
d
