MED SURGE w/L exam 3 study questions
What should a client with hypoglycemia ingest?
10 to 15 g of a simple carbohydrate.
A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action?
Contact the health care provider
What process should the nurse describe as the etiology of type 1 diabetes?
Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.
Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?
Do not mix with other insulins
The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition?
ERCP
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor?
Elevated alpha-fetoprotein
The leading cause of death after liver transplantation is what?
Infection
The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonia and to act as an osmotic agent?
Lactulose
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis?
Withholding all oral intake, as ordered, to decrease pancreatic secretions
A client is diagnosed with a disorder that affects pancreatic digestive enzymes, and their typsin levels are elevated. The client has jaundice and verbalizes severe abdominal pain. The nurse most likely anticipates which condition?
acute pancreatitis
A client recovering from a laparoscopic cholecystectomy reports severe right shoulder pain 24 hours after the procedure. Which education will the nurse provide to the client?
applying heating pad for 15 to 20 min
Which is a characteristic of type 2 diabetes?
insulin resistance
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis?
pancreatic necrosis
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about the management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?
" Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?
"I might need insulin later on, but probably not as much or as often."
The nurse is educating a patient being treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. Which statement made by the patient indicates that the patient understands the education?
"I need to decrease the amount of protein in my diet."
A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?
"I'm thirsty all the time. I just can't get enough to drink."
A patient must begin receiving the hepatitis B series of injections. The patient asks when the next two injections should be administered. Which is the best response by the nurse?
"You must have the second one in 1 month and the third in 6 months."
A student accepted into a nursing program must begin receiving the hep B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?
"You must have the second one in 1 month and the third in 6 months."
What statement best describes a client with severe or extreme obesity?
A BMI >40 kg/m2
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?
Abdominal paracentesis
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?
Albumin
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?
Ammonia
Name 3 signs of advanced liver disease?
Ascites, jaundice, and portal hypertension
Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy?
Assessing the color of the sclera every shift
Which of the following would the nurse expect to assess in a conscious client with hepatic encephalopathy?
Asterixis
What is asterixis?
Asterixis is a flapping tremor and is a sign of hepatic encephalopathy
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory findings should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?
Change in the client's handwriting and/or cognitive performance.
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?
Coma, anxiety, confusion, headache, and cool, moist skin
What step should be taken into consideration prior to making a meal plan for a patient with type 2 diabetes?
Determining whether the patient is on insulin or taking oral antidiabetic medication
What is extreme obesity?
Extreme or severe obesity is best defined as a BMI >40kg/m2. Waist-to-hip ratios are measured to determine severity of obesity; however, waist-to-hip ratios of >35 inches in women or >40 inches in men are associated with greater risk from obesity.
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he ahs noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client' s clinical manifestations?
Hepatic encephalopathy
The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?
Increase frequency of glucose self-monitoring.
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?
Increases ability for glucose to get into the cell and lowers blood sugar
A previously health adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what?
Liver transplantation
A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority?
Maintaining normal respiratory function
The nurse is caring for a patient with ascites as a result of hepatic dysfunction. Which intervention will the nurse provide to determine if the ascites is increasing? (select all that apply)
Measure abdominal girth daily. Monitor number of bowel movements per day
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?
Nervousness, diaphoresis, and confusion
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when the client will be able to resume normal activities. What information should the nurse provide?
Normal activities may be resumed in 1 week.
The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms?
Place the client in semi-Fowler's position.
When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
Positioning the client on the side with the knees flexed
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?
Presence of islet cell antibodies
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?
Radioisotope liver scan
A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis?
Self-digestion of the pancreas by its own proteolytic enzymes
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms are associated with hypoglycemia?
Sweating, tremors, and tachycardia
What instruction should a nurse give to a client with diabetes mellitus when teaching about 'sick day rules'?
Test your blood glucose every 4 hours.
What happens when hepatic encephalopathy gets worse?
The client lapses into frank coma and may have seizures. Simple tasks such as handwriting become difficult.
A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?
control blood glucose
A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
glycosylated hemoglobin level. HgA1C
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?
increased urine output
The nurse is caring for a patient with ascites. Which intervention will the nurse perform to correct the decrease in effective arterial blood volume that will lead to sodium retention?
infuse albumin
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odor breath. What could be the cause of the client's current serious condition?
ketoacidosis
What are the earliest sx of hepatic encephalopathy?
minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alteration in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses client may become difficult to awaken and completely disoriented w/ respect to time and place.
A client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding is the explanation for the inspection of feet?
sensory neuropathy
A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?
stage 2
The nurse is caring for a patient with ascites due to cirrhosis of the liver. Which position does the nurse determine will activate the renin-angiotensin-aldosterone and sympathetic nervous systema and decrease responsiveness to diuretic therapy?
upright
The nurse is administering lactulose to decrease the ammonia level in a patient who has hepatic encephalopathy. Which will the nurse carefully monitor for that may indicate a medication overdose?
watery diarrhea
