RNSG1533 Exam 3 Metabolism Elimination Acid Base
A nurse is providing preoperative teaching to a client who will undergo surgery to create a temporary colostomy. The client asks the nurse about the difference between colostomies and ileostomies. Which of the following responses should the nurse make? A. "A colostomy drains stool, and an ileostomy drains urine." B. "A colostomy is temporary, and an ileostomy is permanent." C. "A colostomy is from the large intestine, and an ileostomy is from the small intestine." D. "An ileostomy requires dietary restrictions, while a colostomy does not."
C. "A colostomy is from the large intestine, and an ileostomy is from the small intestine."
A nurse is providing teaching to a client who has a history of urinary tract infections (UTIs). Which of the following client statements indicates the need for additional teaching? A. "I will empty my bladder every 4 hours." B. "I will drink 2 L of fluids per day." C. "I will use a vaginal douche daily." D. "I will wear cotton underwear."
C. "I will use a vaginal douche daily."
A nurse is teaching a client who has type 2 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I will apply moisturizer between my toes." B. "I will soak my feet daily." C. "I'll be sure to wear cotton socks every day." D. "I'll use a heating pad to warm my feet."
C. "I'll be sure to wear cotton socks every day."
A nurse is providing teaching about nutrients to a client. Which of the following statements should the nurse include? A. "Carbohydrates transport nutrients throughout the body." B. "Fats prevent ketosis." C. "Protein builds and repairs body tissue." D. "Carbohydrates help regulate body temperature."
C. "Protein builds and repairs body tissue."
A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."
C. "You don't have to give up pasta; just adjust the amount you eat."
A nurse is caring for a client who is 2 days postoperative following gastric surgery and has an NG tube inserted. Which of the following findings should the nurse report to the provider? A. Dryness of the mucous membranes B. Hypoactive bowel sounds in all quadrants C. 200 mL of bright red drainage from the NG tube D. Suction set at continuous low suc
C. 200 mL of bright red drainage from the NG tube
A nurse is caring for a client who had a nephrostomy tube inserted 8 hours ago. Which of the following actions should the nurse include in the client's plan of care? A. Flush the nephrostomy tube every 4 hours with sterile water. B. Clamp the nephrostomy tube intermittently to establish continence. C. Check the skin at the nephrostomy site for irritation from urine leakage. D. Monitor for and report any blood-tinged drainage to the provider immediately
C. Check the skin at the nephrostomy site for irritation from urine leakage.
A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A. Foods high in vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories
C. Foods high in fiber
A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce total hours of sleep B. Keep the immediate environment warm C. Increase caloric intake with meals D. Gradually increase activity
C. Increase caloric intake with meals
A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure
C. Kussmaul respirations
A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? A. Proteinuria B. Oliguria C. Polyuria D. Glycosuria
C. Polyuria
A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? A. Elevated blood pressure B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food
C. Rigid abdomen
A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread."
D. "I should replace white bread with whole-grain bread."
A nurse is teaching a client who has a spinal cord injury to perform intermittent urinary self-catheterization at home after discharge. Which of the following statements indicates that the client understands the procedure? A. "I'll drink less water so I don't have to catheterize myself too often." B. "I must use sterile technique for each of the catheterizations." C. "I should stop the catheterization when I have removed 150 mL of urine." D. "I will perform intermittent self-catheterization every 2 to 3 hr."
D. "I will perform intermittent self-catheterization every 2 to 3 hr."
A nurse is providing teaching to a client who is scheduled for a sigmoid colon resection with colostomy. Which of the following statements by the client indicates a need for further teaching? A. "Because most of my colon is still intact and functioning, my stool will be formed." B. "My stoma will appear large at first, but it will shrink over the next several weeks." C. "My colostomy will begin to function in 2 to 6 days after surgery." D. "I'll have to consume a soft diet after surgery."
D. "I'll have to consume a soft diet after surgery."
A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis? A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7.38 D. Bicarbonate level 12 mEq/L
D. Bicarbonate level 12 mEq/L
A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw
D. Coleslaw
A nurse is caring for a client who has gastrointestinal bleeding. The provider suspects a bleeding lesion in the colon. The initial approach to treatment likely will involve which of the following procedures? A. Exploratory laparotomy B. Double-contrast barium enema C. Magnetic resonance imaging D. Colonoscopy
D. Colonoscopy
A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL
D. Fasting blood glucose 95 mg/dL
A nurse is assessing a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? A. Absence of bowel sounds in all 4 abdominal quadrants B. Passage of blood-tinged liquid stool C. Presence of flatus D. Hyperactive bowel sounds above the obstruction
D. Hyperactive bowel sounds above the obstruction
A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? A. Constipation B. Headache C. Bradycardia D. Hypertension
D. Hypertension
A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the evening intermediate-acting insulin dose to 90 min before dinner B. Increase the client's morning caloric intake C. Omit the client's evening snack D. Monitor the client's nighttime blood glucose levels
D. Monitor the client's nighttime blood glucose levels
A nurse is accepting a transfer from the postanesthesia care unit (PACU) of a client who has had a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the bedside for this client? A. Cardiac monitor B. Defibrillator C. Thoracotomy tray D. Tracheostomy tray
D. Tracheostomy tray
Which condition would most likely cause a pregnant woman with type 1 diabetes the greatest difficulty during her pregnancy? Placenta previa Hyperemesis gravidarum Placental abruption Rh incompatibility
Hyperemesis gravidarum
pH: 7.26 (7.35 - 7.45) CO2: 39 (35 - 45) HCO3: 19 (22 - 26)
Metabolic Acidosis
pH: 7.81 (7.35 - 7.45) CO2: 44 (35 - 45) HCO3: 34 (22 - 26)
Metabolic Alkalosis
pH 7.31 (7.35 - 7.45) PaCO₂ 30 (35-45) HCO₃ 24 (22 -26)
Metabolic acidosis
pH 7.54 (7.35 - 7.45) PaCO₂ 30 (35 - 45) HCO₃ 24 (22 - 26)
Respiratory Alkalosis
pH: 7.78 (7.35 - 7.45) CO2: 29 (35 - 45) HCO3: 22 (22 - 26)
Respiratory Alkalosis
pH 7.31 (7.35 - 7.45) PaCO₂ 50 (35 - 45) HCO₃ 29 (22 - 26)
Respiratory acidosis
Which information would the nurse include when teaching a pregnant woman about the pathophysiologic mechanisms associated with gestational diabetes? Pregnancy fosters the development of carbohydrate cravings. There is progressive resistance to the effects of insulin. Hypoinsulinemia develops early in the first trimester. Glucose levels decrease to accommodate fetal growth.
There is progressive resistance to the effects of insulin.
A patient receives insulin aspart at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a. 10:00 AM b. 12:00 AM c. 2:00 PM d. 4:00 PM
a. 10:00 AM
In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what type of activities the patient enjoys. b. Remind the patient that exercise will improve self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.
a. Determine what type of activities the patient enjoys.
Which statement by the patient indicates a need for additional instruction in administering insulin? a. I need to rotate injection sites among my arms, legs, and abdomen each day. b. I can buy the 0.5 mL syringes because the line markings will be easier to see. c. I should draw up the regular insulin first after injecting air into the NPH bottle. d. I do not need to aspirate the plunger to check for blood before injecting insulin.
a. I need to rotate injection sites among my arms, legs, and abdomen each day.
A patient is recently diagnosed with diabetes. In reviewing their past history, which would be early indicators of the problem? (select all that apply) a. Lethargy b. Fruity-smelling breath c. Boundless energy d. Weight loss e. Increased sweating f. Getting up often at night to go to the bathroom
a. Lethargy b. Fruity-smelling breath c. Boundless energy e. Increased sweating f. Getting up often at night to go to the bathroom
Treatment of diabetes may include which of the following? (select all that apply) a. Replacement therapy with insulin b. Control of glucose absorption through the GI tract c. Drugs that stimulate insulin release or increase sensitivity of insulin receptor sites d. Surgical clearing of the capillary basement membranes e. Slowing of gastric emptying f. Diet and exercise programs
a. Replacement therapy with insulin f. Diet and exercise programs
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet.
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to: a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming
a. check glucose level before, during, and after swimming
Insulin is available in several forms or suspensions which differ in several ways. However, they do NOT differ in their a. effect on the pancreas. b. onset and duration of action. c. means of administration. d. tendency to cause adverse effects.
a. effect on the pancreas.
The long-term alterations in nutrient metabolism associated with diabetes mellitus result in a. obesity. b. vascular changes that can increase risk of heart attack and/or stroke. c. chronic obstructive pulmonary disease. d. lactose intolerance.
b. vascular changes that can increase risk of heart attack and/or stroke.
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask? a. Are you anorexic? b. Is your urine dark colored? c. Have you lost weight lately? d. Do you crave sugary drinks?
c. Have you lost weight lately?
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1diabetes says which of the following? a. I can have an occasional alcoholic drink if I include it in my meal plan. b. I will need a bedtime snack because I take an evening dose of NPH insulin. c. I can choose any foods, as long as I use enough insulin to cover the calories. d. I will eat something at meal times to prevent hypoglycemia, even if I am not hungry
c. I can choose any foods, as long as I use enough insulin to cover the calories.
Miglitol differs from the sulfonylureas in that it a. greatly stimulates pancreatic insulin release. b. greatly increases the sensitivity of insulin receptor sites. c. delays the absorption of glucose, leading to lower glucose levels. d. cannot be used in combination with other antidiabetic agents.
c. delays the absorption of glucose, leading to lower glucose levels.
The medical management of diabetes mellitus is aimed at a. controlling caloric intake. b. increasing exercise levels. c. regulating blood glucose levels. d. decreasing fluid loss.
c. regulating blood glucose levels.
Which would be the first choice for a newly diagnosed patient with diabetes mellitus type II who does not have any other health problems? a. Canagliflozin b. Liraglutide c. Pioglitazone d. Metformin
d. Metformin
A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.
d. The patient increases daily exercise when ketones are present in the urine.
pH 7.28 (7.35 - 7.45) PaCO₂ 30 (35 - 45) HCO₃ 10 (22 - 26)
metabolic acidosis
pH: 7.25 (7.35 - 7.45) PaCO₂: 40 (35 - 45) HCO₃: 18 (22 - 26)
metabolic acidosis
A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia
C. Difficulty sleeping
Teaching subjects for the patient with diabetes should include a. diet and exercise changes that are needed. b. the importance of avoiding exercise and eating one meal a day. c. protection from exposure to any infection and avoiding tiring activities. d. avoiding pregnancy and taking hygiene measures.
a. diet and exercise changes that are needed.
Which of the following is a cause of metabolic acidosis? A Diarrhea B Low platelet count C UTI D Pre-eclampsia
A diarrhea
A nurse is performing discharge teaching about ostomy care while at home for a client who has a newly placed ileostomy. Which of the following instructions should the nurse include in the teaching? A. "Empty your ostomy pouch when it becomes half full." B. "Place an aspirin in the ostomy pouch to eliminate odor." C. "Change the ostomy appliance every week." D. "Cleanse the site around the stoma with hydrogen peroxide and water."
A. "Empty your ostomy pouch when it becomes half full."
A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My cells are resistant to the effects of insulin." B. "My body breaks down sugars too efficiently." C. "My pancreas does not produce insulin." D. "My body produces antibodies against pancreatic beta cells."
A. "My cells are resistant to the effects of insulin."
A nurse in the emergency department is caring for a client who has a fruity breath odor, a dry mouth, and extreme thirst. Which of the following assessments should the nurse make? A. Blood glucose level B. Pupillary reaction to light C. Deep tendon reflexes D. Liver function tests
A. Blood glucose level
A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis
A. Bradycardia
A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? A. Calcium B. Sodium C. Potassium D. Phosphorous
A. Calcium
A nurse is teaching a client who has a colostomy about ways to reduce flatus and odor. Which of the following strategies should the nurse include? A. Eat crackers and yogurt regularly B. Chew minty gum throughout the day C. Drink orange juice every day D. Put an aspirin in the pouch
A. Eat crackers and yogurt regularly
A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? A. Encourage the client to control weight B. Inspect the client's feet once each week C. Restrict the client's activity D. Apply moisturizer between the client's toes
A. Encourage the client to control weight
A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose
A. Glycosylated hemoglobin levels
nurse is planning care for a client who had a stroke. The client has hemiplegia and occasional urinary incontinence. Which of the following actions should the nurse include in the client's plan of care? A. Offer the client a bedpan every 2 hr B. Limit the client's daily fluid intake until he is no longer incontinent C. Request a prescription for an indwelling urinary catheter from the client's provider D. Ambulate the client to the bathroom every 30 min
A. Offer the client a bedpan every 2 hr
A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Shakiness B. Urinary frequency C. Dry mucous membranes D. Excess thirst
A. Shakiness
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign
A. Tachycardia and hypertension D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign
A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and fresh pears
A. White bread and plain yogurt
Which of the following would result in respiratory acidosis? A Hyperventilation B Hypoventilation C Hypoxia D Hypocapnia
B Hypoventilation
Which of the following is a cause of metabolic alkalosis? A Diarrhoea B Vomiting C Cyanide toxicity D Addison's disease
B Vomiting
A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? A. "You should exercise during a peak insulin time." B. "Wear a medical alert identification tag when you exercise." C. "Exercise can decrease the effects of insulin and cause your blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."
B. "Wear a medical alert identification tag when you exercise."
A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan
B. Ask the client to identify the types of foods she prefers
A nurse is teaching a client about urinary tract infections (UTIs). Which of the following manifestations should the nurse include? A. Weight gain B. Back pain C. Vaginal discharge D. Muscle cramps
B. Back pain
A nurse is obtaining a guaiac test from a client. This test is performed to detect which of the following? A. Fecal material in vomit B. Blood in stool C. Infestation of parasites D. Microorganisms in urine
B. Blood in stool
A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? A. Cucumbers and tomatoes B. Cabbage and peaches C. Strawberries and corn D. Figs and nuts
B. Cabbage and peaches
A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria
B. Diaphoresis
A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to perform? (Select all that apply.) A. Use antimicrobial ointment on the peristomal skin B. Empty the bag when it is one-third to one-half full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water E. Apply the skin barrier while the skin is slightly moist
B. Empty the bag when it is one-third to one-half full C. Cut the skin barrier opening a little larger than the ostomy D. Wash the peristomal skin with mild soap and water
A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take? A. Place the drainage bag on the client's abdomen when transferring from a bed to cart B. Empty the drainage bag when half-full of urine C. Rest the drainage bag on the floor when closing the drainage spigot during emptying D. Disconnect the drainage bag when obtaining a urine specimen
B. Empty the drainage bag when half-full of urine
A nurse is assessing a client who was brought to the emergency department following a motor-vehicle crash. Which of the following findings is a manifestation of bladder trauma? A. Stress incontinence B. Hematuria C. Pyuria D. Fever
B. Hematuria
A nurse is conducting a home visit for an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? A. Dementia B. Hypoglycemia C. Infection D. Transient ischemic attack
B. Hypoglycemia
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors
B. Increased urination
A nurse is monitoring a client following a thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? A. Elevated blood pressure B. Involuntary muscle spasms C. Cold intolerance D. Weight loss
B. Involuntary muscle spasms
A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening? A. Men who smoke B. Men and women who are obese C. Women who have hepatitis D. Men and women who consume high-protein and low-carbohydrate foods
B. Men and women who are obese
A nurse is assessing a client who is recovering from a thyroidectomy and has a harsh, high-pitched respiratory sound. Which of the following actions should the nurse take? A. Hyperextend the client's neck B. Prepare for a tracheostomy C. Lower the head of the bed D. Administer morphine
B. Prepare for a tracheostomy
