nur 236 chapter 37 and 40
How long after exposure does the incubation period for gonorrhea last?
2 to 6 days The incubation period is 2 to 6 days before symptoms may appear.
Occurs during pregnancy
Gestational diabetes
A patient was recently diagnosed with latent autoimmune diabetes of adults (LADA). According to evidence based management, which medication is the health care provider mostly likely to prescribe in the early phase?
Metformin ( Glucophage)
What is an important safety intervention for type 1 diabetes patients?
Monitor intake and output carefully
During an assessment of an older adult patient, the nurse observes a red rash on the palms of the hands and the soles of the feet. What should the nurse do next?
Notify the charge nurse. A red rash on the palms of the hands and the soles of the feet is consistent with the secondary phase of syphilis. The nurse should notify the charge nurse and health care provider to allow for further workup and treatment as indicated. Floating the patient's heels or repositioning addresses prevention of skin breakdown, and emollients help decrease dry skin.
After being stained with crystal violet, how will a gram-positive gonococcus react?
Retain the original stain after the counterstain is applied. Staining procedures differentiate organisms by using dyes that have been found to stain some bacteria in specific ways. An example of this would be a Gram stain, in which bacteria are first stained with crystal violet, then treated with a strong iodine solution, decolorized with ethanol or ethanol acetone, and then counterstained with contrasting dye. Those retaining the initial stain are considered gram positive; those losing the stain but accepting the counterstain are considered gram negative.
postprandial
after a meal
The female patient should be advised not to --------------- before a vaginal examination.
douche
People with poor control over their diabetes are prone to infection because of decreased function of ............. and abnormal phagocyte function.
leukocytes
Chlamydia is tested for in the female by:
low vaginal swab for culture and identification
Recommended for all patients with type 1 or type 2 diabetes is ............ , a personalized diet plan.
medical nutrition therapy
Symptoms of PID include :
pain fever purulent vaginal discharge
A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make?
Periods of stress cause increases in glycogen production by the adrenal cortex." Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.
What are two problems concerning exercise for older diabetic patients?
Physical limitations may make it difficult for the elderly diabetic patient to exercise. If exercise is too strenuous, the elderly may experience hypoglycemia up to 24 hours after exercising.
The patient is reluctant to talk about his sexual history. Which statement by the nurse would be the most appropriate to complete the task of obtaining a sexual history, while considering the psychological comfort of the patient?
"lets start with your kidneys. Are you having trouble with urination?"
Which of the following signs and symptoms would you expect to find in the documentation of a patient with acute PID?
-Severe abdominal and pelvic pain and fever
What are two possible causes of PID?
-Sexually transmitted organisms, Chlamydia trachomatis or Neisseria gonorrhea. -Result of an infection following pelvic surgery or childbirth
Which nursing responsibilities are related to collecting specimens for diagnosis of STIs?
-if antimicrobials have been started, note this on the lab slip. -Provide appropriate draping and privacy -Document medication history -Label specimens and deliver to the lab with the corresponding lab slips.
The nurse is caring for a patient with syphilis. Which manifestation indicates that the syphilis has progressed to the secondary stage?
Positive serology A positive serology will appear in the secondary stage of syphilis. Penile discharge is not associated with the secondary stage of syphilis. A generalized skin rash, not purulent, may be seen in the secondary stage of syphilis. Scrotal swelling is not associated with syphilis.
The centers for disease control (CDC) Advisory Committee on immunization practices has recommended routine human papillomavirus (HPV) vaccination for all -------------- year old females.
11- 26
The nurse is educating a pregnant patient who is human immunodeficiency virus (HIV) positive. Which information is most important for the nurse to include in the teaching plan?
Remain on the medication protocol. Remaining on medication is essential. Certain prescribed drug combinations may significantly reduce the transmission to the fetus. Patients with HIV should avoid breast-feeding and cesarean birth. HIV can be spread by oral sex.
The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate?
Rotating injection sites helps enhance insulin absorption." Insulin injections are rotated within one body area to enhance absorption. Patients are given charts showing the places on the arms, legs, buttocks, and abdomen where insulin can be injected. Patients should be encouraged to keep a daily record of injection sites to help remember which sites have been used and to avoid the problem of altered or erratic absorption, which is a complication associated with overuse of a single site. The most important way to reduce the incidence of infection is to wash the hands before insulin administration and to avoid reusing syringes. Fatty tumors are not complications of overuse of a single injection site. The term insulin reaction refers to hypoglycemia, and hypoglycemia is not directly associated with the failure to rotate injection sites.
Which routes are ways in which sexually transmitted infections (STIs) are transmitted? (select all that apply.)
Sexual intercourse Oral-genital route Contact with infected blood Placenta to infant Contact with infected body fluids
What is the treatment for syphilis?
Single dose benzathine penicillin G, or adequate blood levels of penicillin given over an 8 to 14 day period or ceftriaxone 1g IM for 14 days.
The nurse is educating a sexually active female patient about infection prevention. Which change during the premenstrual period increases the patient's risk of infection?
The cervical mucous plug becomes more permeable. The mucous plug in the cervix of women provides protection to the upper genital tract. The hormonal changes make it become more permeable around the menstrual period. This change can result in an increased risk for infections in the upper genital tract, such as pelvic inflammatory disease (PID). Oral contraceptives alter cervical secretions and result in a more alkaline environment. Vaginal lubrication does not increase risk of infection, and antibody levels do not lower during the premenstrual period.
The nurse is caring for a patient with ketosis. Which statement indicates that the patient correctly understands the phenomenon?
The condition resulted when my body tried to break down and use my stores of fats." People with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high, the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.
Once a diagnosis of syphilis is confirmed, the nurse understands that she must report the illness to which entity?
The local public health agency STIs are reported to the local public health agency for accumulation by the CDC. The local public health agency will get in touch with the sexual contacts of the patient and attempt to initiate treatment.
Which laboratory values are consistent with a patient in ketoacidosis?
Blood urea nitrogen (BUN) of 35 mg/dL Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmaul respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.
Why is tight control not advised for elderly type 2 diabetic patients?
Elderly patients develop hypoglycemia more quickly than younger people, and hypoglycemia may precipitate myocardial infarction, angina, stroke, or seizures.
Why are women at a greater risk for contracting sexually transmitted infections (STIs) than men?
Male secretions are in contact with female mucous membranes for longer periods of time. Male secretions are in contact with female mucous membranes longer than female secretions are in contact with the penis. Estrogen provides for vaginal lubrication and therefore reduces friction and tissue tearing.
For type 1 diabetes, which statement is true?
Must receive exogenous insulin
Which statement made by a patient indicates an understanding of the information and teaching about genital herpes?
Numbness and tingling may occur 24 hours before lesions appear
weight loss and exercise can delay onset of diabetes
Prediabetes
The nurse is teaching the patient how to manage his diabetes during times of minor illness, as such as during mild gastrointestinal upset. What is appropriate information to tell the patient?
Take at least 1 cup of water or calorie free, caffeine free liquid each hour
Little or no endogenous insulin
Type 1
The patient is receiving rapid acting insulin before meals. What action by the nurse is correct?
Wait until the food tray is delivered to the patient before giving the insulin dose.
When the nurse teaches about safer sex practices it should be stated that proper use of condoms includes using:
a spermicide containing nonoxynol-9
Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes?
d. 95% ANS: D Type 2 diabetics comprise 90% to 95% of all known cases.
Chlamydia is a danger to women because it can cause --------
infertility
Which statement by a patient's family member indicates an understanding of the signs and symptoms of hypoglycemia?
"He could be irritable because his sugar is low."
The nurse is providing information to a patient who has recently been diagnosed with genital herpes. Which statements indicate the need for further instruction? (select all that apply.)
"I am only contagious when I have open sores." "The infection is limited to only my genital region." "I will need to contact my physician for antibiotic cream for the open lesions whenever I have an outbreak The disease may be spread during outbreaks. It is possible to spread the infection with viral shedding between outbreaks. Herpes is a lifelong condition. There is no cure. The condition's treatment can include the administration of antiviral medication. Antibiotics are not typically indicated unless a secondary bacterial infection develops. Proper hand hygiene is important to prevent both further spreading of the virus and introduction of bacteria to the affected area.
Which statement indicates that a patient needs additional education about the vaccine for human papillomavirus (HPV)?
"I am relieved that the vaccine protects me from all HPV infections." The vaccine protects against the most prevalent infections, genital warts and precancerous cervical lesions, but not against all HPV infections. The remaining statements are correct.
Which statement by a patient most strongly indicates a need for further assessment and possible diagnostic testing to screen for diabetes?
"I seem to be really thirsty, but I guess it could be the heat."
Which statement by the patient indicates a need for additional teaching on diabetic foot care?
"I should soak my feet in hot water every day and use mild soap."
The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching?
"This problem goes away completely once I give birth." Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes. The patient correctly understands that gestational diabetes occurs because of hormonal changes in pregnancy, proper diet and regular exercise may help decrease the likelihood of developing type 2 diabetes, and the baby will require monitoring for hypoglycemia throughout the patient's pregnancy.
A new nursing assistant expresses fear in caring for patients with HIV/Aids. Later, the nurse observes this assistant helping a hepatitis B patient who is menstruating with toileting. She is not wearing gloves. Which statement s would help the nursing assistant to understand infection control precautions in caring for patients with STI?
"use standard precautions for all patients, especially when body fluids are involved."
Which requirement(s) is/are part of the criteria for "tight control" of hyperglycemia? (select all that apply.)
-Administer insulin injections three times a day based on glucometer reading -Maintain fasting glucose within normal limits. -Maintain normal weight for height and age -Maintain cholesterol within normal limits. Patients attempting tight control follow an intensive therapy plan of blood glucose testing and insulin injections, three or more times a day, or they use an insulin pump. Maintaining a normal fasting glucose, weight for height and age, and cholesterol helps establish "tight control" of hyperglycemia.
Which viral agent is thought to attack the beta cells of the pancreas causing an onset of insulin dependent diabetes mellitus (type 1)?
-Coxsackievirus
When discussing exercise programs with the diabetic, which instruction(s) is/are important for the nurse to include? (select all that apply.)
-Delay exercise until glucose controlled -Keep a quick source of glucose readily available while exercising -Begin slowly and build up to 30 to 45 minutes -Only use the abdominal injection site for insulin The patient should delay exercise until glucose is controlled, keep a quick source of glucose readily available, begin slowly and build, and use the abdominal injection site for insulin. The patient should check the glucose level before exercising.
The nurse is caring for a patient suspected of having ketoacidosis. Which manifestation(s) is/are characteristic with early ketoacidosis? (select all that apply.)
-Fruity breath -Polyuria -Thirst Ketoacidosis is a complication associated with type 1 diabetes. Some of the earliest symptoms may be polyuria, fatigue, anorexia, abdominal pain, and a fruity smell to the breath. Later signs and symptoms include sunken eyes as a result of excessive dehydration. Nausea is not associated with ketoacidosis.
Which factor(s) may cause diabetes mellitus (DM)? (select all that apply.)
-Genetic -Microbiologic -Metabolic -Immunologic Genetic, microbiologic, metabolic, and immunologic factors influence the development of diabetes mellitus. Allogenic refers to cells or tissues that are from different individuals in the same species.
The nurse is interviewing a patient to establish a database. The patient has reported being excessively thirsty, but has never been diagnosed with diabetes. Which questions would be appropriate to ask the patient during this initial interview?
-Have you had any recent weight loss? -Have you become increasingly hungry over the past few months? -Are you having any trouble sticking to your dietary plan? -Do you have to urinate (go to the toilet) more than you used to? -Have you noticed that you are more tired than you were 6 months ago? -Has anyone in your family ever been told he or she has diabetes.
Which genetic factor(s) increase(s) the risk of a person developing diabetes mellitus (DM)? (select all that apply.)
-Number of relatives with DM -Genetic closeness of relatives with DM -Race Genetic factors that increase the risk of developing diabetes include the number and genetic closeness of relatives with diabetes, as well as race. BMI and sedentary lifestyle are not genetic factors.
How can the use of oral contraceptives increase the risk of acquiring a sexually transmitted infection (STI)? (select all that apply.)
-Oral contraceptives cause an alkaline vaginal environment. -Oral contraceptives may reduce the perception of the need for condom use -Oral contraceptives must be taken regularly in order to be effective. The use of oral contraceptive pills causes the vaginal vault to become alkaline from cervical secretions, which makes for a conducive environment for STIs. Oral birth control pills make the need for a condom redundant as pregnancy will be averted by the medication. Oral contraceptives do not cause bone marrow suppression, and while birth control must be taken regularly in order to be effective, this contributes to the risk of pregnancy, not an STI.
----------------- and -------------- associated with STIs increases the risk of developing human immunodeficiency virus (HIV) infection that can result in AIDs.
-inflamed tissue -open lesions
Which statement(s) explain(s) a reason for weight loss in type 1 diabetics? (select all that apply.)
-loss of body fluid -Metabolization of body fats Weight loss in type 1 diabetics can be attributed to loss of body fluids and metabolization of fats. Insulin intolerance, stress of the disease, and altered diet are not reasons for weight loss in type 1 diabetes.
Doxycycline is prescribed for the patient with a chlamydial infection. The order would most likely say to administer the medication -------- for ------------ days.
-orally -7
Which factors make diabetics prone to infection?
-poor control of diabetes -Decreased blood supply to the tissues related to atherosclerosis of blood vessels -Chronic neurologic and vascular changes allow organisms to enter tissues
Four signs and symptoms of hypoglycemia include:
-tremulousness -hunger -headache -pallor -sweating -palpitations -blurred vision -weakness
When teaching about HPV vaccination (Gardasil/Cervarix), include which facts?
-two vaccines are effective in preventing genital warts -Three vaccines are available
The nurse is educating a young woman newly diagnosed with genital herpes. Which information is most important for the nurse to include in the teaching plain?
. Avoid all sexual contact until lesions completely resolve. To prevent spreading genital herpes, the patient should avoid sex until all the lesions are gone. Genital herpes is a viral condition and symptoms can be managed by antiviral medication. Increasing fluid intake will help to dilute urine and can manage pain, but is of lesser importance than preventing the spread of genital herpes. The patient should don gloves when applying topical ointment.
For older patients who are taking oral hypoglycemic agents, list two relevant facts related to aging.......
1. The older adult metabolizes and excretes drugs more slowly than the younger patient; drugs stay active in the body longer 2. Some first generation oral hypoglycemic agents (diabinese) have a long half life and remain active even longer in the older patient.
The patient takes his NovoLog 70/30 at 0700. When should the nurse suggest that the patient schedule exercise?
1300. Exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a rapid-acting insulin that peaks 1 to 3 hours after administration. Since the insulin is administered at 70/30, scheduling exercise for 1300 would mean that it occurs after the peak insulin action.
The ADA recommends screening all adults, especially if overweight, for type 2 diabetes starting at age:
45, to be repeated every 3 years
The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What can the nurse infer from these findings?
The patient's blood glucose control has improved over the last several months. HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively. A reduction in the value indicates improved glucose control by the patient. There is no evidence of insulin sensitivity. The need for insulin is not decreased in this patient.
The nurse explains that the three cardinal signs of type 1 diabetes mellitus (DM) are __________, __________, and __________.
The three Ps—polydipsia, polyphagia, and polyuria—are the cardinal signs of diabetes
Discharge from the skin lesions of a pateint with syphilis is contagious in the primary stage until ..........
They are healed.
Which patient is exhibiting manifestations consistent with the primary stage of syphilis?
A female patient with a painless nodule on her vagina Syphilis has three stages. The chancre, or painless, hard nodule, is visible in the primary stage of syphilis and disappears within a few weeks. The secondary stage occurs approximately 6 weeks later; symptoms may include a generalized skin rash. In tertiary syphilis, spirochetes access to all body tissues and a gumma (a soft encapsulated tumor) may appear on any organ.
The nurse is caring for a patient with genital herpes. Which manifestation alerts the nurse to a potential signal of an impending outbreak?
Tingling sensation in the vagina Many women with herpes can predict an outbreak because of tingling or burning in the vagina. Elevations in temperature, increased vaginal discharge, and headaches are not common precursors of a herpes outbreak.
Adult onset
Type 2
In men --------- associated with sexual activity my be the first sign of STI.
UTI
Which goal is the primary objective of a diabetic diet?
Adequate nutrition with weight control Currently, the diabetic diet is much less stringent than diets of years past. The primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control. The newer diets allow for some sweets and some fast foods. Fats are not adequate sources of energy. Fat intake should be limited to reduce complications related to weight gain and cardiovascular concerns.
To which factor(s) can the rise in the number of sexually transmitted infections (STIs) be attributed? (select all that apply.)
An increase in the number of sexually active teenagers An increase in the opportunity to have multiple partners A knowledge deficit about signs and symptoms of STIs Teenagers being reluctant to report diseases Rising numbers of STIs may be attributed to an increase in the number of sexually active teenagers, an increase in the opportunity to have multiple partners, a knowledge deficit about signs and symptoms of STIs, and teenagers being reluctant to report diseases. Young people are often unable to acquire confidential health care.
Which reason best explains why diabetics are prone to infection?
Atherosclerotic vascular changes decrease blood supply to tissues. The primary reason for increased risk of infection in diabetic patients is the hyperglycemic environment. Lesser risk factors include atherosclerotic vascular changes, abnormal phagocyte function, and decreased leukocyte function.
A patient has been diagnosed with chlamydia for the second time in a 5-month period. Data collection reveals that the patient was not compliant with the plan of treatment with the last infection. Which medication does the nurse anticipate that the provider will prescribe?
Azithromycin Chlamydia is best treated with a single dose of azithromycin for patients having a compliance problem. Doxycycline requires a 7-day course of therapy and may not be best given this patient's history. Erythromycin is indicated to manage the disease in pregnant women. Diflucan is an antifungal medication used in the management of candidiasis.
The nurse instructs a sexually active teenager that frequent douching can cause which infection?
Bacterial vaginosis Bacterial vaginosis is caused when frequent douching changes the pH of the vaginal vault and creates an environment conducive to bacterial invasion. Sexually transmitted infections (STIs) like syphilis are not transferred by douching. PID is a condition that most often results from an untreated infection. Vaginitis is an inflammatory condition that does not result from douching.
Which statement is true about STIs?
Barrier protection should be used during intercourse with new partners, even if the woman is on the pill.
The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest?
Begin an exercise program and lose weight. All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes. Annual eye examinations are important to detect onset of diabetic retinopathy. A food diary can help the patient to visualize food intake that may be subconscious otherwise. Diabetics are prone to foot problems and wounds and should inspect their feet daily.
A patient who has been diagnosed with chlamydia is started on a protocol of doxycycline. Which information is important for the nurse to include in the teaching? (select all that apply.)
Use a condom to protect partners from disease. Chlamydia can develop into pelvic inflammatory disease (PID). Take the entire prescription of antibiotics. Chlamydia can result in an ectopic pregnancy. The patient should understand the importance of using condoms to protect her partner and taking the entire course of antibiotics to prevent resistance or relapse. The patient should also understand that chlamydia increases the risk of developing PID or an ectopic pregnancy. The patient's partner should receive treatment as well
When caring for a male patient with a suspected gonorrheal infection, which action is most important for the nurse to take?
Wait 1 hour after the patient voids to collect a urethral swab. Since the urine will have flushed out the organisms, the nurse should wait at least 1 hour post void before collecting the specimen. The infection has not been confirmed, so no report should be made at this time. The patient's temperature should be obtained each shift. Administering antibiotics before cultures are drawn may cause cultures to be negative even though the drug or the dose may not be sufficient to cure the infection. If possible, obtain cultures prior to administering antibiotics
Which exercise activities are considered the safest for older diabetic patients?
Walking, swimming, and riding a stationary exercise bicycle
The nurse is collecting information from a patient during her annual pelvic examination. The patient reports that she has noted a strong vaginal odor after intercourse. Which condition may be present?
Chlamydia Chlamydia may cause a strong vaginal odor noted after sexual intercourse. Gonorrhea causes vaginal discharge and a difficulty voiding. Bacterial vaginosis is associated with a fishy vaginal odor and discharge. Syphilis causes a chancre sore.
The nurse is aware that men with gonorrhea are more likely to seek medical attention because their symptoms are more visible than those of women. Which clinical manifestation is most consistent with symptoms of gonorrhea in men?
Copious, purulent penile discharge Signs and symptoms of gonorrhea in men include purulent penal discharge and scrotal pain. Gonorrhea should not cause hematuria when urinating, penile ulcers with a foul odor, or scaly scrotal lesions.
The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours. Which statement correctly explains the reason for this problem?
Counterregulatory hormones produce hyperglycemia. Dawn phenomenon is produced in the morning by the circadian release of growth hormones, epinephrine, and glucagon during the night. Rebound hyperglycemia, also known as the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem. The dawn phenomenon is characterized by elevated blood glucose in the morning and is caused by release of growth hormone, glucagon, and epinephrine during the night, as part of the body's natural circadian rhythm. These hormones act to raise the body's blood sugar. The dawn phenomenon is the reason why most people with diabetes do not tolerate carbohydrates well in the morning. The treatment is an intermediate-acting insulin at night.
One problem that occurs fair often in elderly type 2 diabetes patients is hyperglycemic hyperosmolar syndrome (HHS). It occurs most often after:
a febrile illness or gastrointestinal flu
The largest population groups affected by STIs are ---------- and ------------.
adolescents and young adults
Evaluation of correct balance of food, exercise, and insulin for a diabetic patient would be to:
assess trends of blood sugar levels
The long term consequences of diabetes mellitus are chiefly the result of damage to the large and small ...........
blood vessels
Weight loss in patients with type 1 diabetes occurs partly because of the loss of .............and partly because in the absence of sufficient ................, the body begins to metabolize its own proteins and stored fat.
body fluid insulin
STIs are primarily passed through intimate contact with ----------.
body fluids
Which factors indicate reasons why young patients are frequently reluctant to have their sexually transmitted infections (STIs) reported? (select all that apply.)
Fear of parental reaction Embarrassment about their condition Fear of reprisal from identified contacts Fear of information becoming public Fear of rejection by peers
The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next?
Give 6 ounces of orange juice. These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice. The nurse should withhold the patient's scheduled insulin at this time. The nurse should document the findings and then notify the charge nurse.
Which sexually transmitted infections (STIs) must be reported? (select all that apply.)
Gonorrhea Pelvic inflammatory disease. Chlamydia Lymphogranuloma All STIs listed are reportable in all states except for vaginitis. Syphilis is also a reportable STI. However, each state may add others to that list
The patient is a type 1 diabetic who has been admitted for ketoacidosis and influenza. Which assessment findings are most likely to be documented in this patient's record?
Headache, thirst, and anorexia
Which diagnostic test would be ordered to evaluate the response to therapy at a 6 month follow up appointment?
Hemoglobin A
A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate?
High glucose levels in the blood pull cellular water into circulating volume and increase thirst. Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.
A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease. How does diabetes predispose the patient to cardiovascular complications?
Hyperglycemic periods cause thickening of the basement membrane in vessels, which causes atherosclerosis. Periods of hyperglycemia cause thickening of the vessels, chiefly the basement membrane (thin layer of connective tissue under the epithelium). The vessels of the retina, renal glomeruli, peripheral nerves, muscles, and skin are affected. Larger vessels are also affected, predisposing the patient to atherosclerosis and vascular occlusion. Two out of three people with diabetes die prematurely from heart attack or stroke.
The nurse watches a patient perform an insulin injection. Which observation(s) indicate(s) that the patient needs additional instruction? (select all that apply.)
c. The patient rubs the injection site after administration of the insulin injection. d. The patient draws up the cloudy insulin and then the clear insulin. e. The patient shakes the insulin bottle before administration. The patient should not rub the injection site because it could alter absorption. When mixing two types of insulin, in order to prevent contamination of the second vial, the patient should withdraw clear insulin into the syringe first. Shaking the bottle can damage the solution; the patient should gently roll the bottle between the palms of the hands. Administering the injection at a 90-degree angle and cleaning the injection site prior to injection describe appropriate technique.
The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describes islet cell antibodies?
Islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus (DM). The antibodies cause beta cells to quit production of insulin.
The patient comes to the emergency room complaining of abdominal pain. The nurse assesses dry, hot skin, fruity breath, and deep respirations. To which problem should the nurse attribute these findings?
Ketoacidosis Abdominal pain with dry, hot skin, fruity breath, and deep respirations is characteristic of ketoacidosis. Manifestations of an insulin reaction, or hypoglycemia, include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Rebound hyperglycemia, or the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem.
Why is weight loss not a priority goal for an elderly diabetic patient?
Many elderly people have difficulty eating due to problems with teeth, finacial inability to afford the correct food, or the inability to obtain and prepare desirable foods due to arthritis or other disabilities. Weight loss is not recommended unless present weight is more than one and half times normal for height and age.
The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria?
NovoLog Lantus is a long-lasting insulin. It may be administered only one time per day. NovoLog and Humalog are both rapid-onset insulin preparations. Regular insulin is classified as a short-acting insulin.
The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation?
Obtain regularly scheduled fasting blood glucose levels. The ADA recommends screening with a fasting blood glucose. Adherence to a weight loss plan, regular exercise, and stress reduction techniques help control diabetes but do not monitor it.
The nurse is caring for an older adult patient who is diabetic. The nurse cautions against the technique of "tight control" of hyperglycemia. Which statement explains why this management method is not recommended?
Older adults may experience cardiovascular problems from hypoglycemia. One complication of the "tight control" method includes hypoglycemia. Older adults experience hypoglycemia more quickly than do younger people, and older adults are more prone to hypoglycemic episodes. The older adult may progress to dangerously low levels of blood glucose before signs and symptoms are obvious. Severe hypoglycemia in the older adult can precipitate myocardial infarction, angina, stroke, or seizures. For this reason, "tight control" may not be the best thing for the older adult. Older adults can accurately test and administer insulin, possess a higher risk for hypoglycemia, and do not possess an unstable metabolic rate.
There is an increase in STIs among single women over 60. Often they mistakenly assume that because they do not need to use ----------- when having intercourse.
condoms
A female patient comes to the emergency department with severe abdominal pain, a temperature of 101° F, and a foul-smelling, purulent vaginal discharge. The nurse recognizes that these findings are consistent with which infection?
Pelvic inflammatory disease (PID) Fever, abdominal pain, and purulent discharge are cardinal indicators of PID. Gonorrhea most often presents in females with vaginal discharge and burning with urination. The initial state of syphilis presents with chancre (hard, painless sore) on the mucous membrane of the mouth or genitals. Vaginosis most often presents with symptoms including a grayish-white discharge that has a fishy odor.
The nurse urges a female patient with gonorrhea to seek medical care. Which complication(s) can occur if gonorrhea is left untreated? (select all that apply.)
Pelvic inflammatory disease (PID) Sterility Obstructed fallopian tubes Ectopic pregnancy Ophthalmia neonatorum in the newborn
The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin?
d. The body's immune system destroyed beta cells. ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.
A patient with type 1 diabetes mellitus (DM) is preparing for a moderate 30-minute exercise period. Which action best indicates that the patient understands condition management?
d. The patient consumes a simple carbohydrate snack after 30 minutes of activity. ANS: D During moderate exercise (such as brisk walking, bowling, or vacuuming), 5 g of simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute intervals during the continued activity. (A food example with 5 g of simple carbohydrate is 1 tsp honey.)
Whenever a type 1 diabetic patient knows that he is going to exercise heavily, he should:
eat an extra high protein snack to prevent hypoglycemia
The nurse recommends that the newly diagnosed patient with herpes get current information about her disease from the local _______________.
health department The health department has clinics and written information in several languages that would be helpful to the newly diagnosed person.
The ----------------- virus can cause -------------------- in the female.
human papilloma cervical cancer
An infection such as influenza can be a cause of diabetic ketoacidosis because:
infection causes an increased metabolic rate and release of extra glucose
The diabetic patient undergoing surgery experiences considerable stress, which alters his blood sugar levels. For this reason, he is usually given:
intravenous insulin during surgery
An abundance of the byproducts of fat metabolism results in potent organic acids called...............
ketones
Diabetic ............ occurs directly from changes in the renal blood circulation.
nephropathy
It is known that the risk of having some form of diabetes increases in proportion to the ............. of relatives who are affected, the ...................... of the relatives, and the severity of their disease.
number genetic closeness
The reason a patient with uncontrolled type 2 diabetes tends to gain weight is because:
of insulin resistance; the food he eats is not fully metabolized
When teaching a patient who is being treated for Chlamydia trachomatis, the nurse should stress that:
partners must be treated concurrently
A mother with hepatitis B (HBV) transmits the disease to her fetus via the blood traveling through the ..............
placenta
When insulin is not present in adequate amounts to meed metabolic needs, the body breaks down ...... and ..... for energy
proteins fats
STIs are to be reported to the .................
public health agency
The older diabetic is at risk of developing hypoglycemia even before ......... are obvious.
signs and symptoms
Threat of renal, retinal, and neurologic complications
type 1
Rarely develops ketosis
type 2
A patient has come to the clinic after having been notified of exposure to gonorrhea. He states that his exposure occurred 11 days ago. If he is infected, signs and symptoms that would be expected are:
urinary frequency and burning with purulent discharge from the urethra.
------------- have an increased risk of sexually transmitted infection (STI) spread by intimate physical contact.
women
