GERO Test 2 Evolve Questions

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? A. Ketoacidosis B. Somogyi phenomenon C. Hypoglycemic reaction D. Hyperosmolar nonketotic coma

A Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

The nurse is caring for an older client admitted to the hospital with type 2 diabetes. What is important for the nurse to remember about older adults and type 2 diabetes? A. Older adults seldom develop ketoacidosis. B. Older adults secrete no endogenous insulin. C. Older adults have a lower risk of complications. D. Older adults develop a sudden onset of symptoms.

A Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes; therefore, ketones are not present in large enough amounts to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts. The incidence of chronic complications depends on the level of glucose control, not developmental level. The onset of type 2 diabetes is usually gradual, whereas in type 1 diabetes, it is sudden and dramatic.

An older adult with a history of diabetes reports giddiness, excessive thirst, and nausea. During an assessment, the nurse notices the client's body temperature as 105° F. Which condition does the nurse suspect in the client? A. Heat stroke B. Heat exhaustion C. Accidental hypothermia D. Malignant hyperthermia

A Older adults are more at a risk of heat stroke. Symptoms of heat stroke include giddiness, excessive thirst, nausea, and increased body temperature. Heat exhaustion is indicated by a fluid volume deficient. Heat exhaustion occurs when profuse diaphoresis results in excess water and electrolyte loss. Accidental hypothermia usually develops gradually and goes unnoticed for several hours. When the skin temperature drops below 95° F, the client suffers from uncontrolled shivering, memory loss, depression, and poor judgment. Malignant hyperthermia is an adverse effect of inhalational anesthesia that is indicated by a sudden rise in body temperature in intraoperative or postoperative clients.

What should the nurse monitor for when caring for a postoperative client who presents with 180 mL of urine in the urinary drainage bag from the past 8 hours? A. Renal failure B. Liver cirrhosis C. Diabetes mellitus D. Rheumatoid arthritis

A Postsurgical urine output should not be less than 30 mL per hour; urine output of less than that per hour indicates hypovolemia or renal failure. The client has urinated only 180 mL in the past 8 hours, which is less than 30 mL/hour. This indicates that the client may have renal failure. Liver cirrhosis causes scarring of the liver tissue, which may cause variceal bleeding and hepatic encephalopathy, but it is not associated with decreased urine output. Uncontrolled diabetes mellitus is manifested by frequent and excessive urination. Rheumatoid arthritis does not cause renal complications such as decreased urine output.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? A. Increased serum lipids B. Decreased hematocrit level C. Increased serum calcium levels D. Decreased blood urea nitrogen level

A With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.

A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Select all that apply. A. Anemia B. Dyspnea C. Jaundice D. Hyperexcitability E. Hypophosphatemia

A, B Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Lethargy occurs as a result of general depression of the central nervous system. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia.

A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client? Select all that apply. A. Leg ulcers B. Loss of visual acuity C. Thick, yellow toenails D. Increased growth of body hair E. Decreased sensation in the feet

A, B, C, E Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. Thick, yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish, which can result in gangrene, necessitating amputation. Diabetic neuropathies affect 60% to 70% of people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that results in impairment via an unknown process. Inadequate arterial circulation to hair follicles results in a lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing it to leg ulcers and infection.

A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion? Select all that apply. A. Headache B. Confusion C. Extreme thirst D. Profuse sweating E. Increased urination

A, B, D Neurologic responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. Thirst (polydipsia) is a classic symptom of hyperglycemia. Increased urination (polyuria) is a classic sign of hyperglycemia.

A nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin-dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply. A. Leg ulcers B. Loss of visual acuity C. Increased creatinine clearance D. Prolonged capillary refill in the toes E. Decreased sensation in the lower extremities

A, B, D, E Ulcers of the legs are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of occlusion of the small vessels, causing microaneurysms in the capillary walls. Macrovascular changes in the distal capillary beds interfere with blood flow to the distal extremities. Decreased sensation in the lower extremities is a complication of diabetes. Consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that causes impairment via an unknown process. Creatinine clearance decreases, not increases, as renal function deteriorates in response to microvascular damage to the small blood vessels that supply the glomeruli.

The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply. A. Confusion B. Hyperactivity C. Excessive thirst D. Fruity-scented breath E. Decreased urinary output

A, C, D Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased urination, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.

A nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation

B, C, D Palpitations, an adrenergic symptom, occur as the glucose level decreases; the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the central nervous system (CNS) becomes depressed. Thirst occurs with hyperglycemia in response to dehydration associated with osmotic diuresis. Hyperventilation occurs with diabetic ketoacidosis; Kussmaul respirations are an effort to counteract the effects of a buildup of ketones as the body seeks acid-base balance.

An older client with hypertension is admitted to the hospital. Which data from the client's history and diagnostic workup represent risk factors for hypertension? Select all that apply. A. Taking an aspirin a day B. Occasional cocaine use C. Reduced hemoglobin level D. African-American heritage E. Increased high-density lipoprotein (HDL)

B, D Cocaine is a stimulant that causes tachycardia and hypertension. Hypertension is more prevalent in African-Americans in the United States. Aspirin decreases platelet aggregation, thus reducing the risk for cardiovascular disease. Lowered hemoglobin may increase the heart rate, not the blood pressure. Increased HDL reduces the risk for cardiovascular disease because it helps to remove excess cholesterol from the blood, thereby preventing atheromas.

The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply. A. "They play a role in erythropoiesis." B. "They play a role in acid-base balance." C. "They play a role in vitamin D activation." D. "They play a role in blood pressure regulation." E. "They play a role in fluid and electrolyte balance."

B, E Maintaining the acid-base balance of the body by selectively reabsorbing and secreting certain substances from the blood is a regulatory function of the kidneys. The kidneys also perform the regulatory function of electrolyte balance by regulating the reabsorption of certain electrolytes while eliminating others depending on their levels in the serum. The kidneys perform hormonal function by secreting a hormone called erythropoietin that aids in synthesis of red blood cells (erythropoiesis). Activation of vitamin D is a hormonal function of the kidneys. The kidneys perform hormonal function by secreting the hormone renin that assists in blood pressure control.

A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. Which test result should the nurse anticipate? A. Arterial pH of 7.5 B. Hematocrit of 54% C. Potassium of 6.3 mEq/L (6.3 mmol/L) D. Creatinine of 1.2 mg/dL (106 mcmol/L)

C Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62 to 124 mcmol/L) and therefore is not anticipated.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes, and the other client has type 2 diabetes. When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1? A. Onset of the disease is slow. B. Excessive weight is a contributing factor. C. Complications are not present at the time of diagnosis. D. Treatment involves diet, exercise, and oral medications.

C Clinical presentation of type 1 diabetes is characterized by acute onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, as pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and therefore the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.

While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? A. Having diabetes insipidus B. Eating low-cholesterol foods C. Being 20 pounds (9 kilograms) overweight D. Drinking a daily alcoholic beverage

C Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown. Diabetes insipidus is caused by too little antidiuretic hormone (ADH) and has no relationship to type 2 diabetes. High-cholesterol diets and atherosclerotic heart disease are associated with type 2 diabetes. Alcohol intake is not known to predispose a person to type 2 diabetes

The nurse is assessing a client who reports frequent urination. Which inquiry made by the nurse will help determine diabetes insipidus? A. "Do you have history of cancer?" B. "Are you on fluoroquinolone therapy?" C. "Are you on lithium carbonate therapy?" D. "Do you have a history of lymphoma?"

C Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Therefore enquiring about lithium carbonate therapy can help assess for diabetes insipidus, which has a clinical manifestation of frequent urination. Inquiry about history of cancer helps in assessing syndrome of inappropriate antidiuretic hormone (SIADH) because some cancer therapy drugs result in SIADH. Treatment with fluoroquinolone antibiotics also can result in SIADH. Hodgkin's and Non-Hodgkin's lymphoma are causes of SIADH.

A client is admitted to the hospital with a long history of hypertension. The nurse should assess the client for which complication? A. Cataracts B. Esophagitis C. Kidney failure D. Diabetes mellitus

C Some renal impairment usually is present even with mild hypertension and is attributed to the ischemia resulting from narrowed renal blood vessels and increased intravascular pressure; decreased blood flow causes atrophy of renal structures, such as tubules, glomeruli, and nephrons, leading to kidney failure. Retinopathy, resulting in blurred vision, retinal hemorrhage, and blindness, occurs with a long history of hypertension because of increased intravascular pressure, not cataracts. Esophagitis is caused by esophageal reflux disease, not a long history of hypertension. Hypertension does not cause diabetes mellitus; however, chronic elevations of serum glucose accelerate atherosclerosis, resulting in the development of hypertension.

A client with diabetes experiences tremors, pallor, and diaphoresis. What should the nurse consider is a possible cause of these clinical manifestations? A. Overeating B. Intestinal virus C. Aerobic exercise D. Missed insulin dose

C These responses are indicative of hypoglycemia, which can be caused by increased activity; activity decreases insulin resistance and increases glucose metabolism. Overeating causes hyperglycemia. Infections cause hyperglycemia because of the release of stress-related hormones. Missing an insulin dose causes hyperglycemia.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? A. Decreased serum glucose levels B. Decreased serum calcium levels C. Increased blood urea nitrogen levels D. Increased serum bicarbonate levels

C With diabetic ketoacidosis blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally above 300 mg/dL (16.7 mmol/L). The calcium level is unrelated to diabetic ketoacidosis. Serum bicarbonate levels are below 15 mEq/L (15 mmol/L).

The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes? A. Cataracts B. Glaucoma C. Retinopathy D. Astigmatism

C Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.

A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply. A. Polyuria B. Jaundice C. Azotemia D. Hypertension E. Polycythemia

C, D Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.

Which instructions will be most beneficial for a diabetic client with renal disease? Select all that apply. Select all that apply A. Recommend the client drink boiled water B. Suggest the client to go for a morning walk C. Instruct the client to check blood pressure regularly D. Contact the primary healthcare provider before taking ibuprofen E. Encourage the client to undergo a microalbuminuria test yearly

C, D, E High blood pressure affects normal kidney function. Clients with renal disease must monitor blood pressure, because increased blood pressure can damage the vessel walls of the kidneys, thereby causing kidney damage, leading to kidney failure. Thus clients with renal disease should be encouraged to check their blood pressure regularly. Drugs such as ibuprofen are potent nephrotoxic agents; therefore, the client must be advised to contact the primary healthcare provider before ingestion to avoid further complications. Diabetic clients should undertake a microalbuminuria test yearly to determine the risk of developing end-stage kidney disease. Drinking boiled water may reduce the risk of infections; however, this instruction is less beneficial when compared to the other interventions. Going for a walk will improve the overall health of the client, but it is not a specific intervention that improves kidney function.

The nurse recalls that which diseases in elderly clients include the prolonged dwindling disease trajectory? Select all that apply. Select all that apply A. Lung cancer B. Heart failure C. Frailty disease D. Disabling stroke E. Alzheimer disease

C, D, E The prolonged dwindling disease trajectory is generally seen in clients with frailty disease, disabling stroke, and Alzheimer disease. Clients with lung cancer do not follow this disease trajectory; instead, these clients experience the short period of evident decline disease trajectory. Clients with organ failure do not follow the prolonged dwindling disease trajectory; instead, these clients follow the trajectory of long-term limitations with intermittent serious episodes.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations? A. Irritability, polydipsia, and polyuria B. Polyuria, polydipsia, and polyphagia C. Nocturia, weight loss, and polydipsia D. Polyphagia, polyuria, and diaphoresis

B Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately. Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy. Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it. Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia.

A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? A. Prevention of uremic frost B. Prevention of chronic fatigue C. Prevention of tubular necrosis D. Prevention of dependent edema

B Kidney failure[1][2] results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathologic condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.

An older adult client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation should alert the nurse to the fact that the client may be developing a life-threatening response to the drug? A. Difficulty breathing B. Increased pulse rate C. Orthostatic hypotension D. Increased blood glucose

A Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol. A decreased, not increased, pulse rate is associated with atenolol. It does not usually affect beta 2 (vascular) receptor sites, which will cause an increase in pulse rate. Orthostatic hypotension may be experienced; however, it can be minimized by teaching the client to move from lying to sitting and from sitting to standing positions slowly to allow the body time for the blood pressure to adjust to the change in position. Atenolol will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the drug may mask the clinical manifestations of hypoglycemia.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? Select all that apply. Select all that apply A. Thirst B. Headache C. Nervousness D. Fruity breath odor E. Excessive urination

Thirst, Fruity breath Odor and Excessive Urination Thirst (polydipsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a by-product of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia because of central nervous system irritation

What principle of teaching specific to an older adult should the nurse consider when providing instruction to such a client recently diagnosed with diabetes mellitus? A. Knowledge reduces general anxiety. B. Capacity to learn decreases with age. C. Continued reinforcement is advantageous. D. Readiness of the learner precedes instruction.

C Neurologic aging causes forgetfulness and a slower response time; repetition increases learning. Continued reinforcement is an example of repetition. The facts that knowledge reduces general anxiety and that the readiness of the learner precedes instruction reflect principles that are applicable to learning regardless of the client's age. Capacity to learn decreases with age.

A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiologic changes associated with a long history of diabetes? A. Blurry, spotty, or hazy vision B. Arthritic changes in the hands C. Hyperactive knee and ankle jerk reflexes D. Dependent pallor of the feet and lower legs

A Blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.

A client presents with bilateral leg pain and cramping in the lower extremities. The client has a history of cardiovascular disease, diabetes, and varicose veins. To guide the assessment of the pain and cramping, the nurse should include which question when completing the initial assessment? A. "Does walking for long periods of time increase your pain?" B. "Does standing without moving decrease your pain?" C. "Have you had your potassium level checked recently?" D. "Have you had any broken bones in your lower extremities?"

A Clients with a medical history of heart disease, hypertension, phlebitis, diabetes, or varicose veins often develop vascular-related complications. The nurse should recognize that the relationship of symptoms to exercise will clarify whether the presenting problem is vascular or musculoskeletal. Pain caused by a vascular condition tends to increase with activity. Musculoskeletal pain is not usually relieved when exercise ends. Low potassium levels can cause cramping in the lower extremities; however, given the client's health history, vascular insufficiency should be suspected. Previously healed broken bones do not cause cramping and pain.

The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan? Select all that apply. A. The client should obtain a finger stick blood glucose reading before each meal. B. The client does not need to follow a specific diet until insulin is required. C. The teaching plan should include signs and symptoms of hypoglycemia. D. The teaching plan does not need to include signs and symptoms of hypoglycemia, as the client is not on insulin. E. The teaching plan should include sick day rules.

A, C, E All diabetic clients, regardless of type, should check finger stick blood sugars before each meal and snack. Antidiabetic medications can cause hypoglycemia; therefore, the client needs to be instructed on the symptoms of hypoglycemia. All diabetic clients need to be educated on sick day rules. All diabetic clients should follow the American Diabetes Association diet.

The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia? A. Crohn disease B. Cushing disease C. End-stage renal disease D. Gastroesophageal reflux disease

C One of the kidneys' functions is to eliminate potassium from the body; diseases of the kidneys often interfere with this function, and hyperkalemia may develop, necessitating dialysis. Clients with Crohn disease have diarrhea, resulting in potassium loss. Clients with Cushing disease will retain sodium and excrete potassium. Clients with gastroesophageal reflux disease are prone to vomiting that may lead to sodium and chloride loss with minimal loss of potassium.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? A. Facial flushing B. Edema and pruritus C. Dribbling after voiding and dysuria D. Diminished force and caliber of stream

B The accumulation of metabolic wastes in the blood ( uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon? A. Eat a snack before going to bed. B. Measure the blood glucose level between 2 AM and 4 AM. C. Identify whether morning symptoms are typical for hyperglycemia. D. Administer the prescribed bedtime insulin immediately before going to bed.

B During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counterregulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The client should check blood glucose between 2 AM and 4 AM and if the blood glucose is less than 70, the client is having a Somogyi effect. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. The manifestation (symptoms) of hyperglycemia has no role in differentiating the conditions.

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply. Select all that apply A. Polyuria B. Paresthesias C. Hypertension D. Metabolic alkalosis E. Widening pulse pressure

B, C Paresthesias[1][2] occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? A. Urine output B. Specific gravity C. Urine osmolarity D. Serum osmolarity

C Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus.

After reviewing the urine diagnostic reports of four clients, a nurse suspects a client is at risk to develop end-stage kidney disease. Which client's findings support the nurse's suspicion? A. 98 mg/24 hr B. 198 mg/24 hr C. 298 mg/24 hr D. 398 mg/24 hr

D Clients with urinary albumin levels greater than 300 mg/24 hr (200 mcg/min) are at risk of developing end-stage kidney disease. Client D has a serum albumin concentration of 398 mg/24 hr, which indicates that the client may develop end-stage kidney disease. Therefore the findings of client D support the nurse's suspicion. Serum albumin levels in the range of 30 to 299 mg/24 hr indicate persistent albuminuria, which is an early stage of nephropathy, especially in diabetic clients. Therefore serum albumin concentrations of clients A, B, and C, which are 98, 198, and 298 mg/24 hr, are indicative of microalbuminuria.

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor? A. Ketonuria B. Weight loss C. Ketoacidosis D. Low blood sugar

D Oral hypoglycemic agents decrease serum glucose levels that may precipitate hypoglycemia. Ketonuria occurs with insulin-dependent diabetes. Weight gain usually is noted in adult-onset diabetes. Ketoacidosis occurs with insulin-dependent diabetes.

A nurse is caring for a client with diabetes insipidus. Which clinical manifestation should a nurse expect the client to exhibit? A. Increased blood glucose B. Decreased serum sodium C. Increased specific gravity D. Decreased urine osmolarity

D Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity[1][2]. Diabetes insipidus does not affect glucose levels; diabetes mellitus affects glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine