Med Surg- Exam 2
Labs for DKA?
-***Blood glucose: greater than 300 mg/dL (up to 800 mg/dL is typical) -Na: below, within, or above expected reference range -K: within or above the expected reference range -BUN greater than 30 mg/dL (increased secondary to dehydration) -Creatinine greater than 1.5 mg/dL (increased secondary to dehydration) -***Ketones present in blood and urine Blood osmolarity is high -***Metabolic acidosis with respiratory compensation (kussmaul respirations) -***pH less than 7.35 -Sodium bicarbonate 0-15 mEq/L -***Bicarbonate 1-15 mEq/L
Major S/S Diabetic Ketoacidosis:
-Increase glucose in blood -Ketones in blood and urine -PH <7.35, HCO@ <15 -Kussmaul breathing -Acetone breath -Polyuria -Polydipsia: -Polyphagia: -Weight loss -Blurred vision -Weakness -Orthostatic hypotension -Dehydration -Mental Status Changes -Nausea, Vomiting, abdominal pain
Terms for Diabetic Ketoacidosis:
-Metabolic acidosis: Breakdown of stored glucose, protein, and fat to produce ketone bodies -Acetone breath: bc of breakdown of ketones -Kussmal Respirations: body will compensate by blowing out acid and therefore the pt does kussmaul breathing -Polyuria: osmotic diuresis resulting in excess urine production -Polydipsia: osmotic diuresis causing excess loss of fluids resulting in dehydration and increased thirst -Polyphagia: cell starvation due to inability to receive glucose resulting in increased appetite -Orthostatic Hypotension: fluid volume depletion caused by osmotic diuresis resulting in dehydration
Nursing care of a diabetic pt on NPO, clear liquids, enteral, or parenteral:
-Pts with DM 1 need continued insulin administration while NPO to prevent DKA. -Monitor blood glucose consistently -Short acting insulin is often given at the time of clear liquid meals or enteral feedings to prevent hyperglycemia -Clients receiving continuous feeding (enteral or parenteral) require blood glucose monitoring and possible insulin injections at evenly spaced times (every 6 hr)
. A 52-year-old man has a triceps skinfold thickness of 18 mm, and his weight exceeds the ideal body weight for his height by 23%. Which nursing diagnosis should the nurse identify for this patient? a. Imbalanced Nutrition: More Than Body Requirements b. Risk for Imbalanced Nutrition: More Than Body Requirements c. Imbalanced Nutrition: Less Than Body Requirements d. Readiness for Enhanced Nutrition
A
A mother brings her 4-month-old infant for a well-baby checkup. The mother tells the nurse that she would like to start bottle feeding her baby because she cannot keep up with the demands of breastfeeding since returning to work. Which response by the nurse is appropriate? a. "Make sure you give your baby an iron-fortified formula to supplement any stored breast milk you have." b. "You really need to continue breastfeeding your baby." c. "Give your baby formula until he is 6 months old; then you can introduce whole milk." d. "Your baby weighs 14 pounds, so he will require about 36 ounces of formula a day."
A
A mother of a school-age child seeks healthcare because her child has had diarrhea after being ill with a viral infection. The patient states that after vomiting for 24 hours, his appetite has returned. Which recommendation should the nurse make to this mother? a. Consume a diet consisting of bananas, white rice, applesauce, and toast. b. Drink large quantities of water regularly to prevent dehydration. c. Take loperamide (an antidiarrheal) as needed to control diarrhea. d. Increase the consumption of raw fruits and vegetables.
A
A patient is brought to the emergency department experiencing leg cramps. He is irritable, his temperature is elevated, and his mucous membranes are dry. Based on these findings, the patient most likely has excess levels of which mineral? a. Sodium b. Potassium c. Phosphorus d. Magnesium
A
A patient is diagnosed with an intestinal infection after traveling abroad. The nurse should encourage the intake of which food to promote healing? a. Yogurt b. Pasta c. Oatmeal d. Broccoli
A
A patient who was prescribed furosemide (Lasix) is deficient in potassium. Which of the following is an appropriate goal for this patient? The patient will increase his consumption of: a. Bananas, peaches, molasses, and potatoes. b. Eggs, baking soda, and baking powder. c. Wheat bran, chocolate, eggs, and sardines. d. Egg yolks, nuts, and sardines.
A
A patient with severe hemorrhoids is incontinent of liquid stool. Which of the following interventions is contraindicated? a. Apply an indwelling fecal drainage device. b. Apply an external fecal collection device. c. Place an incontinence garment on the patient. d. Place a waterproof pad under the patient's buttocks.
A
The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse can conclude that learning occurs if the patient says, "For 3 days prior to testing, I should avoid eating: a. Beef." b. Milk." c. Eggs." d. Oatmeal."
A
The nurse is listening for bowel sounds in a postoperative patient. The bowel sounds are slow, as they are heard only every 3 to 4 minutes. The patient asks the nurse why this is happening. What is the nurse's best response? a. "Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel." b. "Some people have a slower bowel than others, and this is nothing to be concerned about." c. "The foods you eat contribute to peristalsis, so you should eat more fiber in your diet." d. "Bowel peristalsis is slow because you are not walking. Get more exercise during the day."
A
The nurse is providing nutrition counseling for a patient planning pregnancy. The nurse should emphasize the importance of consuming which nutrient to prevent neural tube defects? a. Folic acid b. Calcium c. Protein d. Vitamin D
A
The nurse notices that a patient has spoon-shaped, brittle nails. This suggests that the patient is experiencing Imbalanced Nutrition: Less Than Body Requirements related to deficiency of which ofthe following nutrients? a. Iron b. Vitamin A c. Protein d. Vitamin C
A
What is the nurse's best response about developing diabetes to the patient whose father has type 1 diabetes mellitus? a. "You have a greater susceptibility for development of the disease because of your family history." b. "Your risk is the same as the general population, because there is no genetic risk for development of type 1 diabetes." c. "Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for becoming diabetic is 50%." d. "Because you are a woman and your father is the parent with diabetes, your risk is not increased for eventual development of the disease. However, your brothers will become diabetic."
A
Which action should the nurse take to assess a 2-year-old child for pinworms? a. Press clear cellophane tape against the anal opening at night to obtain a specimen. b. Collect a freshly passed stool from a diaper using a wooden specimen blade. c. Place a smear of stool on a slide and add two drops of reagent. d. Prepare the patient for a flat plate (x-ray) of the abdomen
A
Which food provides the body with no usable glucose? a. Wheat germ b. Apple c. White bread d. White rice
A
Which portion of a nutritional assessment must the registered nurse complete? a. Analyzing the data b. Obtaining intake and output c. Weighing the patient d. Obtaining the history
A
During an assessment, the patient states that his bowel movements cause discomfort because the stool is hard and difficult to pass. As the nurse, you make which of the following suggestions to assist the patient with improving the quality of his bowel movement? (Select all that apply.) a. Increase fiber intake. b. Increase water consumption. c. Decrease physical exercise. d. Refrain from alcohol. e. Refrain from smoking
A, B
The nurse is teaching a patient about the importance of reducing saturated fats in his diet. The nurse will recognize that learning has occurred if, upon questioning, the patient replies that he should read product labels to eliminate the intake of which saturated fat(s)? Choose all that apply. a. Palm oil b. Coconut oil c. Canola oil d. Peanut oil
A, B
To promote wound healing, the nurse is teaching a patient about choosing foods containing protein. The nurse will evaluate that learning has occurred if the patient recognizes which food(s) as an incomplete protein that should be consumed with a complementary protein? Choose all that apply. a. Whole grain bread b. Peanut butter c. Chicken d. Eggs
A, B
Which factor(s) place(s) the patient at risk for constipation? Choose all that apply. a. Sedentary lifestyle b. High-dose calcium therapy c. Lactose intolerance d. Consuming spicy foods
A, B
Which nutritional goal is appropriate for a patient newly diagnosed with hypertension? The patient will: a. Limit his intake of protein. b. Avoid foods containing gluten. c. Restrict his use of sodium. d. Limit his intake of potassium-rich foods.
C
The nurse is collecting a stool specimen. Arrange the following steps in the order in which the nurse should perform them. Label the steps from A to D, with A being the first step to perform. A. Have the patient defecate into a special container placed under the toilet seat. B. Put on gloves and place the specimen in a specimen container. C. Ask the patient to void to empty the bladder. D. Place a label on the specimen container.
C, A, B, D
The nurse recognizes which patient as having the greatest risk for undiagnosed diabetes mellitus? a. Young white man b. Middle-aged African-American man c. Young African-American woman d. Middle-aged Native American woman
D
What is a primary prevention tool used for colon cancer screening? a. Abdominal x-rays b. Blood, urea, and nitrogen (BUN) testing c. Serum electrolytes d. Occult blood testing
D
Which collaborative interventions will help prevent paralytic ileus in a patient who underwent right hemicolectomy for colon cancer? a. Administer morphine 4 mg IV every 2 hours for pain. b. Administer IV fluids at 125 mL/hr. c. Insert an indwelling urinary catheter to monitor I&O. d. Keep the patient NPO until bowel sounds return.
D
Which of the following interventions would help to prevent or relieve persistent nausea? a. Assess for signs of dehydration. b. Provide dietary supplements. c. Have the patient sit in an upright position for 30 minutes after eating. d. Immediately remove any food that the patient cannot eat
D
Which organ relies almost exclusively on glucose for energy? a. Liver b. Heart c. Pancreas d. Brain
D
When performing an abdominal assessment, what sequence of assessment techniques should the nurse use? Label the steps from A to D, with A being the first step to perform. A. Auscultation B. Palpation C. Percussion D. Inspection
D, A, C, B
Week 2 (Terminology)
Enteral: relating to the intestines Ascites: condition in which fluid collects in spaces within your abdomen. Melena: passage of black, tarry stools. Usually occurs as result of upper GI bleed by peptic ulcer disease, liver disease, and gastric cancer Eructation: burping or belching; release of gas from the stomach or esophagus Dyspepsia: upper abdominal discomfort, often chronic or persistent (indigestion). May be because of side effect of medications Occult: disease or process that is not accompanied by readily discernible s/s (ex. Fecal occult blood in feces that is not visible) Esophagogastroduodenoscopy: procedure that examines esophagus, stomach, and first portion of duodenum (small intestine) using long flexible tube with camera at the end. Scope inserted in mouth, and advanced to small intestine
Which of the following goals is appropriate for a patient with a nursing diagnosis of Constipation? The patient increases the intake of: a. Milk and cheese. b. Bread and pasta. c. Fruits and vegetables. d. Lean meats.
C
Which polysaccharide is stored in the liver? a. Insulin b. Ketones c. Glycogen d. Glucose
C
While addressing a community group, the nurse explains the importance of replacing saturated fats in the diet with mono- and polyunsaturated fats. She emphasizes that doing so greatly reduces the risk of which complication? a. Kidney failure b. Liver failure c. Stroke d. Lung cancer
C
MAIN COMPLICATIONS
-Diabetic retinopathy (impaired vision and blindness) -Diabetic neuropathy (caused from damage to sensory nerve fibers resulting in numbness and pain) -Diabetic nephropathy (damage to the kidneys from prolonged elevated blood glucose levels and dehydration) *OTHER: -Cardiovascular and cerebrovascular disease (HTN, MI, stroke) -Sexual dysfunction -DKA
WHAT ARE RISK FACTORS OF DIABETES MELLITUS?
-BMI OVER 25 -Metabolic syndrome -Pancreatitis and cushing's syndrome -First degree relative who has DM -Age 45 or older (DM 2), age 20-40 (DM1) -Report of sedentary lifestyle -History of vascular disease, polycystic ovary syndrome, gestational diabetes, or giving birth to an infant weighing more than 9 lb -Reports african, hispanic, asian, american indian, or pacific islander heritage -Has a blood pressure consistently greater than 140/90 mmHg -HgA1C greater than 5.7% impaired fasting glucose, or impaired glucose tolerance -HDL level less than 35 mg/dL or triglyceride level greater than 250 mg/dL
Labs for someone with HHS?
-Blood glucose: greater than 600 mg/dL -Na: normal or low -K: normal to high as a result of dehydration; must monitor for decrease when treatment started -BUN greater than 30 mg/dL (increased secondary to dehydration) -Creatinine greater than 1.5 mg/dL (increased secondary to dehydration) -Blood osmolarity greater than 320 mOsm/L -Absent ketones in blood and urine -Absence of acidosis -pH greater than 7.4 -Bicarbonate greater than 20 mEq/L
Nursing Intervention
***Monitor blood glucose!!! (monitoring blood glucose and administering insulin are important priorities because this will cause resolution of this disease process) ***Check for ketones in the urine ***Monitor blood potassium levels. Potassium levels might initially be increased because potassium has been pulled out of the cells, but with insulin therapy potassium will shift into cells and clients will need to be monitored for hypokalemia. Monitor cardiac rhythm consistently. Monitor for weak pulse, shallow respirations, malaise, muscle weakness, confusion. Make sure urinary output is adequate before administering potassium. **Administer regular insulin 0.1-0.15 unit/kg as an IV bolus dose and then follow with continuous IV infusion of regular insulin at 0.1 unit/kg/hr
WHAT DO YOU TEACH CLIENT ABOUT DIABETES MELLITUS?
-Exercise and good nutrition (carbs: 45% of daily intake, protein 15-20% of daily intake depending on kidney function, unsaturated and polyunsaturated fats: 20-35% of total daily intake) -Low in saturated fats to decrease LDL, assist with weight loss for secondary prevention of diabetes, and reduce risk for heart disease. -Perform physical activity at least 3x/week (150 min/week) *Only exercise when glucose levels are between 80-250 mg/dL; *DO NOT exercise if ketones are present in urine *If more than 1 hr has passed since eating and high-intensity exercise is planned, consume a carb snack first
During a nutritional assessment, the nurse calculates that a female patient's BMI is 27. The nurse would advise the patient to follow which of these recommendations? a. This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight. b. This measurement indicates that the patient is underweight and will need to take measures to gain weight. c. This measurement indicates that the patient is morbidly obese and may be a candidate for bariatric surgery. d. This measurement indicates that the patient is of normal weight and should continue with current lifestyle.
A
During a physical examination, the nurse notes that the patient's skin is dry and flaking. What additional data would the nurse expect to find to confirm the suspicion of a nutritional deficiency? a. Hair loss and hair that is easily removed from the scalp b. Inflammation of the tongue and fissured tongue c. Inflammation of peripheral nerves and numbness and tingling in extremities d. Fissures and inflammation of the mouth
A
The nurse assesses a patient's abdomen 4 days after abdominal surgery and notes that bowel sounds are absent. This finding most likely suggests which postoperative complication? a. Paralytic ileus b. Small bowel obstruction c. Diarrhea d. Constipation
A
The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following drugs while taking insulin? a. Furosemide (Lasix) b. Dicumarol (Bishydroxycoumarin) c. Reserpine (Serpasil) d. Cimetidine (Tagamet)
A
When conducting a health history assessment, the nurse would want to know what most important information about the patient's elimination status? (Select all that apply.) a. Recent changes in elimination patterns b. Changes in color, consistency, or odor of stool or urine c. Time of day patient defecates d. Discomfort or pain with elimination e. List of medications taken by patient f. Patient's preferences for toileting
A, B, D, E
Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a hypoglycemic reaction? (Select all that apply.) a. Tremors b. Nervousness c. Extreme thirst d. Flushed skin e. Profuse perspiration f. Constricted pupils
A, B, E
Which instruction(s) should the nurse give to the patient complaining of constipation? Choose all that apply. a. Drink at least eight glasses of water or non-caffeinated fluid per day. b. Include a minimum of four servings of meat per day. c. Consume a high-fiber diet. d. Exercise as you feel necessary.
A, C
For a patient with Risk for Imbalanced Nutrition: Less Than Body Requirements related to Impaired Swallowing, which nursing interventions are appropriate? Choose all that apply. a. Check inside the mouth for pocketing of food after eating. b. Provide a full liquid diet that is easy to swallow. c. Remind the patient to raise the chin slightly to prepare for swallowing. d. Keep the head of the bed elevated for 30 to 45 minutes after feeding.
A, D
An African American is at an increased risk for which of the following? (Select all that apply.) a. Vitamin D deficiency b. Type 1 diabetes c. Celiac disease d. Type 2 diabetes e. Hypertension f. Metabolic syndrome
A, D, E, F
What is diabetic ketoacidosis?
Acute, life-threatening condition characterized by uncontrollable hyperglycemia (>300 mg/dL), metabolic acidosis, and accumulation of ketones in blood and urine. Onset is rapid.
The nurse must irrigate the colostomy of a patient who is unable to move independently. How should the nurse position the patient for this procedure? a. Semi-Fowler's position b. Left side-lying position c. Supine with the head of the bed lowered flat d. Supine with the head of bed raised to 30 degrees
B
A patient who has been immobile since sustaining injuries in a motor vehicle accident complains of constipation. The nurse encourages him to consume eight to ten 8-ounce servings of fluid daily. Which fluid(s) should the patient avoid because of the diuretic effect? Choose all that apply. a. Cranberry juice b. Water c. Coffee d. Ginger ale e. Tea
C, E
A middle-aged patient with a history of alcohol abuse is admitted with acute pancreatitis. This patient will most likely be deficient in which nutrients? a. Iron b. B vitamins c. Calcium d. Phosphorus
B
A patient who was diagnosed with senile dementia has become incontinent of urine. The patient's daughter asks the nurse why this is happening. What is the nurse's best response? a. "The patient is angry about the dementia diagnosis." b. "The patient is losing sphincter control due to the dementia." c. "The patient forgets where the bathroom is located due to the dementia." d. "The patient wants to leave the hospital."
B
A patient with trigeminal neuralgia is prescribed a mechanical soft diet. This diet places the patient at risk for which complication? a. Dehydration b. Constipation c. Hyperglycemia d. Diarrhea
B
Considering normal developmental and physical maturation in children, for which age would a goal of "Achieves bowel control by the end of this month" be most realistic? a. 18 months b. 3 years c. 4 years d. 5 years
B
Patients may be deficient in which vitamin during the winter months? a. A b. D c. E d. K
B
The healthcare team suspects that a patient has an intestinal infection. Which action should the nurse take to help confirm the diagnosis? a. Prepare the patient for an abdominal flat plate. b. Collect a stool specimen that contains 20 to 30 mL of liquid stool. c. Administer a laxative to prepare the patient for a colonoscopy. d. Test the patient's stool using a fecal occult test.
B
The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern? a. The patient's son uses a marked pillbox to set up the patient's medications weekly. b. The patient has lost 10 pounds (4.5 kg) during the last month. c. The patient is cared for by a daughter during the day and stays with a son at night. d. The patient tells the nurse that a close friend recently died.
B
The nurse in a long-term care facility is teaching a group of residents about increasing dietary fiber. Which foods should she explain are high in fiber? a. White bread, pasta, and white rice b. Oranges, raisins, and strawberries c. Whole milk, eggs, and bacon d. Peaches, orange juice, and bananas
B
The nurse is caring for a patient who has suffered a spinal cord injury and is concerned about the patient's elimination status. What is the nurse's best action? a. Speak with the patient's family about food choices. b. Establish a bowel and bladder program for the patient. c. Speak with the patient about past elimination habits. d. Establish a bedtime ritual for the patient.
B
The nurse is completing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient? a. Regular diet b. Low sodium diet c. Pureed diet d. Low sugar diet
B
When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dL? a. "Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity." b. "The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel." c. "Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP." d. "The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis."
B
When changing a diaper, the nurse observes that a 2-day-old infant has passed a green-black, tarry stool. What should the nurse do? a. Notify the provider immediately. b. Do nothing; this is normal. c. Give the baby sterile water until the mother's milk comes in. d. Apply a skin barrier cream to the buttocks to prevent irritation.
B
Which laboratory test result most accurately reflects a patient's nutritional status? a. Albumin b. Prealbumin c. Transferrin d. Hemoglobin
B
Which nutrient deficiency increases the risk for pressure ulcers? a. Carbohydrate b. Protein c. Fat d. Vitamin K
B
Which patient is most likely experiencing positive nitrogen balance? A patient admitted: a. With third-degree burns of his legs. b. In the sixth month of a healthy pregnancy. c. From a nursing home who has been refusing to eat. d. With acute pancreatitis
B
Where in the body is glucose stored? Choose all that apply. a. Brain b. Liver c. Skeletal muscles d. Smooth muscles
B, C
The nurse must administer an enema to an adult patient with constipation. Which of the following would be a safe and effective distance for the nurse to insert the tubing into the patient's rectum? Choose all that apply. a. 2 in (5.1 cm) b. 3 in (7.6 cm) c. 4 in (10.2 cm) d. 5 in (12.7 cm)
B,C
The nurse associates which assessment finding in the diabetic patient with decreasing renal function? a. Ketone bodies in the urine during acidosis b. Glucose in the urine during hyperglycemia c. Protein in the urine during a random urinalysis d. White blood cells in the urine during a random urinalysis
C
The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse should explain that ingestion of which substance may cause a false-negative fecal occult blood test? a. Vitamin D b. Iron c. Vitamin C d. Thiamine
C
The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body? a. Large intestine b. Stomach c. Small intestine d. Pancreas
C
Which is a key treatment intervention for the patient admitted with diverticulitis? a. Antacid b. Antidiarrheal agent c. Antibiotic therapy d. NSAIDs
C
WHAT CAUSES DIABETES?
BLINDNESS END STAGE RENAL DISEASE NONTRAUMATIC LOWER LIMB AMPUTATIONS HEART DISEASE STROKE
A diabetic patient is brought into the emergency department unresponsive. The arterial pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis? a. Decreased hunger sensation b. Report of no urine output c. Increased respiratory rate d. Decreased thirst
C
A nurse is teaching wellness to a women's group. The nurse should explain the importance of consuming at least how much fluid to promote healthy bowel function (assume these are 8-ounce servings)? a. 3 to 4 servings a day b. 5 to 6 servings a day c. 7 to 8 servings a day d. 9 to 10 servings a day
C
A patient has a colostomy in the descending (sigmoid) colon and wants to control bowel evacuation and possibly stop wearing an ostomy pouch. To help achieve this goal, nurse should teach the patient to: a. Call the primary care provider if the stoma becomes pale, dusky, or black. b. Limit the intake of gas-forming foods such as cabbage, onions, and fish. c. Irrigate the stoma to produce a bowel movement on a schedule. d. Avoid returning to the use of an ostomy appliance if he becomes ill.
C
A patient who underwent surgery 24 hours ago is prescribed a clear liquid diet. The patient asks for something to drink. Which item may the nurse provide for the patient? a. Tea with cream b. Orange juice c. Gelatin d. Skim milk
C
A patient with a skin infection is prescribed cephalexin (an antibiotic) 500 mg orally q 12 hours. The patient complains that the last time he took this medication, he had frequent episodes of loose stools. Which recommendation should the nurse make to the patient? a. Stop taking the drug immediately if diarrhea develops. b. Take an antidiarrheal agent, such as diphenoxylate. c. Consume yogurt daily while taking the antibiotic. d. Increase your intake of fiber until the diarrhea stops.
C
A patient with type 1 diabetes mellitus is admitted with hyperglycemia and associated acidosis. The presence of which alternative fuel in the body is responsible for the acidosis? a. Glycogen b. Insulin c. Ketones d. Proteins
C
A patient's 2:1 parenteral nutrition container infuses before the pharmacy prepares the next container. This places the patient at risk for which complication? a. Sepsis b. Pneumothorax c. Hypoglycemia d. Thrombophlebitis
C
During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present? a. Vitamin C b. Vitamin B c. Essential fatty acid d. Protein
C
During the day shift, a patient's temperature measures 97°F (36.1°C) orally. At 2000, the patient's temperature measures 102°F (38.9°C). What effect does this rise in temperature have on the patient's basal metabolic rate? a. Increases the rate by 7% b. Decreases the rate by 14% c. Increases the rate by 35% d. Decreases the rate by 28%
C
What is diabetes?
Chronic disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both
When administering an enema, list the following steps in the order in which they should be performed. Label the steps from A to F, with A being the first step to perform. A. Document the results of the procedure. B. Assess the patient for cramping. C. Insert the tubing about 3 to 4 inches into the rectum. D. Lubricate the tip of the enema tubing generously. E. Raise the container to the correct height and instill the solution at a slow rate. F. Encourage the patient to hold the solution for 3 to 15 minutes, depending on the type of enema.
D, C, E, B, F, A
2. After instructing a mother about nutrition for a preschool-age child, which statement by the mother would indicate correct understanding of the topic? a. "I usually use dessert only as a reward for eating other foods." b. "I will hide vegetables in casseroles and stews to get my child to eat them." c. "I do not give my child snacks; they simply spoil his appetite for meals." d. "I know that lifelong food habits are developed during this stage of life."
D
A patient has anemia. An appropriate goal for that the patient would be for him to increase his intake of which nutrient? a. Calcium b. Magnesium c. Potassium d. Iron
D
A patient with a colostomy complains to the nurse, "I am noticing really bad odors coming from my pouch." To help control odor, which foods should the nurse advise him to consume? a. White rice and toast b. Tomatoes and dried fruit c. Asparagus and melons d. Yogurt and parsley
D
During an interview, the nurse is discussing dietary habits with a patient. Which tool would be the best choice to use as a quick screening tool to assess dietary intake? a. Food diary b. Calorie count c. Comprehensive diet history d. 24-hour recall
D
The nurse educates a patient about the primary risk factors for irritable bowel syndrome. Which behavior by the patient would be evidence of learning? The patient: a. Reduces her intake of gluten-containing products. b. Does not consume foods that contain lactose. c. Consumes only two servings of caffeinated beverages per day. d. Takes measures to reduce her stress level
D
The nurse is assessing a patient who underwent bowel resection 2 days ago. As she auscultates the patient's abdomen, she notes low-pitched, infrequent bowel sounds. How should she document this finding? a. Hyperactive bowel sounds b. Abdominal bruit sounds c. Normal bowel sounds d. Hypoactive bowel sounds
D
The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient? a. "Your weight is within normal limits. Continue maintaining with current lifestyle choices." b. "You are a little overweight. Cut down on calories and increase your activity, and you should be fine." c. "You are morbidly obese, and we would like to schedule you an appointment to speak with a bariatric specialist about surgery." d. "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight."
D
What is the goal for nursing interventions for DKA?
Hydrate the pt, decrease blood glucose, monitor K+ level, correct acid-base imbalance
Hyperglycemic Hyperosmolar State (HHS)
Hyperglycemia (greater than 600 mg/dL) that leads to dehydration, and an absence of ketosis.
What are the risk factors for HHS?
Infection, stress, medical conditions (MI, cerebral vascular injury, sepsis), meds (glucocorticoids, thiazide diuretics, phenytoin, beta blockers, calcium channel blockers)
What does diabetic ketoacidosis mainly occur in?
Mainly occurs in T1 diabetics but can happen in T2 patients if they have severe illness
What are the signs/symptoms of HHS?
Polyuria (urination), polydipsia(thirst), polyphagia(hunger), weight loss, blurred vision, headache, weakness, orthostatic hypotension, mental status changes, seizures, myoclonic jerking, reversible paralysis
What are th causes of diabteic ketoacidosis?
Undetected diabetes, body does not have enough insulin to handle stress and illness, pt is not eating enough, pt is not taking insulin as scheduled
How if HHS caused by?
Undiagnosed/poorly managed DM, or inadequate fluid intake or poor kidney function.
What is the pathophysiology of diabetic ketoacidosis?
When supply of insulin is insufficient, glucose cannot be properly used for energy. So, the body compensates by breaking down fat stores as a secondary source of fuel
