RQ 10
3. The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin therapy. Which statements indicate the client needs more teaching concerning insulin therapy? Select all that apply.
1. "Because I am taking my insulin daily, I do not have to adhere to a diabetic diet."
3. An older patient with type 2 diabetes has cardiovascular autonomic neuropathy (CAN). Which instruction would the nurse provide for the assistive personnel (AP) assisting the patient with morning care?
2. Sit the patient up slowly on the side of the bed before standing. CAN affects sympathetic and parasympathetic nerves of the heart and blood vessels. It may lead to orthostatic (postural) hypotension and syncope
6. A patient with newly diagnosed diabetes has peripheral neuropathy. Which key points should the nurse include in the teaching plan for this patient? Select all that apply.
1. "Clean and inspect your feet every day." 2. "Be sure that your shoes fit properly." 5. "Report any nonhealing skin breaks to your health care provider (HCP)." 6. "Use a thermometer to check the temperature of water before taking a bath."
8. The client is diagnosed with hypothyroidism and is taking levothyroxine. Which data indicates the medication is effective?
1. The client's apical pulse is 84 bpm, and the blood pressure is 134/78. Levothyroxine (Synthroid) is a thyroid hormone. If the thyroid medication is effective, the client's metabolism should be within normal limits, and this pulse and blood pressure support this.
31. The nurse is preparing a teaching plan for a patient with type 2 diabetes who has been prescribed albiglutide. Which key points would the nurse include? Select all that apply.
1. The drug works in the intestine in response to food intake and acts with insulin for glucose regulation. 3. This drug is used with diet and exercise to improve glycemic control in adults with type 2 diabetes. 5. Albiglutide is administered by the subcutaneous route once a week.
5. A patient has newly diagnosed type 2 diabetes. Which task should the RN delegate to an experienced assistive personnel (AP)?
4. Checking the patient's glucose level before each meal The experienced AP would have been taught to perform tasks such as checking pulse oximetry and glucose checks, and these actions would be part of his or her scope of practice.
5. A 32-year-old client is in the neurologic unit after sustaining a head injury after falling from a ladder while working in the garage. The client is unable to eat or drink because of unconsciousness. The intensivist prescribes central line insertion and total parenteral nutrition (TPN) to be administered for nutritional support. Place an X to indicate whether each potential intervention listed below is either Anticipated (appropriate or necessary) or Contraindicated (is unnecessary or is harmful) for the client's plan of care at this time.
Administer insulin. ANTICIPATED Assess for diaphoresis. ANTICIPATED Monitor IV site. ANTICIPATED Follow Droplet Precautions. CONTRAINDICATED Monitor blood glucose level every 6 hours. ANTICIPATED Shut infusion off if bag is empty while waiting for next TPN bag to become available CONTRAINDICATED
51. Which complication should the nurse assess for in the elderly client newly diagnosed with hypothyroidism and prescribed levothyroxine?
1. Cardiac dysrhythmias Levothyroxine (Synthroid) is a thyroid hormone replacement. Synthroid increases basal metabolic rate, which can precipitate cardiac dysrhythmias
15. The client diagnosed with type 2 diabetes is admitted into the medical department with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, "I don't want to have to take shots. I take pills at home." Which statement is the nurse's best response?
1. "During illness, you may need to take insulin to keep your blood glucose level down." Blood glucose levels elevate during times of stress, surgery, or serious infection. The client diagnosed with type 2 diabetes may need to be given insulin temporarily to help keep the blood glucose level within normal limits.
10. Which statement best describes the pharmacodynamics of insulin?
1. Insulin lowers blood glucose by promoting use of glucose in the body cells. This statement explains pharmacodynamics, which is the drug's mechanism of action or how the body uses insulin.
42. The client diagnosed with a pituitary tumor has enlarged viscera and bone deformities. Which medication should the nurse administer?
1. Octreotide Octreotide (Sandostatin), a hormone, suppresses the pituitary gland's secretion of human growth hormone
12. In the care of a patient with type 2 diabetes, which actions should the nurse delegate to an assistive personnel (AP)? Select all that apply.
1. Providing the patient with extra packets of artificial sweetener for coffee 3. Recording the liquid intake from the patient's breakfast tray 5. Checking and recording the patient's blood pressure 6. Assisting the patient to ambulate to the bathroom
54. The nurse is preparing to administer liothyronine to a client diagnosed with hypothyroidism. Which data should cause the nurse to question administering the medication?
1. The client reports being nervous. Nervousness, jitteriness, and irritability are clinical manifestations of hyperthyroidism; therefore, the nurse should question administering thyroid hormone.
Thyroid Disorders 50. The client diagnosed with hypothyroidism is prescribed levothyroxine. Which assessment data supports the client's need to take more medication? Select all that apply.
1. The client reports being too cold. 2. The client reports being constipated.
29. The client diagnosed with pancreatitis is prescribed octreotide. Which data indicates the medication has been effective?
1. The client reports that diarrhea has subsided. To prevent withdrawal after weeks of administration of hydromorphone (Dilaudid), a narcotic opioid, the client should be tapered off the medication over several days.
12. Which statement best describes the scientific rationale for prescribing metformin?
1. This medication will decrease the hepatic production of glucose from stored glycogen. Metformin (Glucophage) is a biguanide that works to prevent gluconeogenesis in the liver.
28. The patient with type 2 diabetes has a health care provider prescription of NPO status for a cardiac catheterization. An LPN/LVN who is assigned to administer medications to this patient asks the supervising RN whether the patient should receive his prescribed repaglinide. What is the RN's best response?
3. "No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO." Repaglinide is a meglitinide analog drug and should not be given. It is a short-acting agent used to prevent postmeal blood glucose elevation. It should be given within 1 to 30 minutes before meals and can cause hypoglycemia shortly after dosing if a meal is delayed or omitted.
33. The critical care nurse is to start an IV insulin drip on a patient with type 2 diabetes who was admitted with a diagnosis of hyperosmolar hyperglycemic state. The patient weighs 178 lbs. Serum glucose is 600 mg/dL (33.3 mmol/L). The concentration of the drip is 250 units regular insulin in 250 mL normal saline. The health care provider prescribes an initial IV bolus of 0.15 unit per Kg to be followed by a continuous IV drip of 0.1 unit per Kg per hour. How much insulin would the nurse give the patient for the bolus? At what rate in mL/hr would the nurse set the IV pump for the continuous drip?\
Bolus - 12.1 units Continuous IV - 8 mL/hr
3. A 44-year-old postoperative client returned to the nursing unit from the PACU following bilateral mastectomy. The client has four Jackson-Pratt drains from the incisional areas on the chest. The nurse assesses VS and performs the physical assessment. Enoxaparin 40 mg subcutaneously daily Apply sequential compression devices (SCDs) below the knee bilaterally for venous thrombosis prevention Based on the client findings, complete the following sentence by choosing from the lists of options provided. To ensure client safety, the nurse plans to first _______1 to address _______2
Options for 1 Administer enoxaparin Options for 2 Thrombus risk
7. The female client diagnosed with secondary adrenal insufficiency is prescribed ACTH. Which information should the nurse discuss with the client?
1. Instruct the client to limit dietary salt. This medication will cause sodium absorption and cause edema; therefore, the client should decrease salt intake.
9. The nurse is discussing insulin vial storage with the client. Which statement indicates the client understands the teaching concerning insulin storage?
1. "I will keep my unopened vials of insulin in the refrigerator." insulin in the refrigerator will maintain the insulin's strength and potency. Once the insulin vial is opened, it may be kept at room temperature for 1 month.
14. The client diagnosed with hyperthyroidism undergoes a bilateral thyroidectomy. Which statements indicate the client understands the discharge instructions? Select all that apply.
1. "I will take my thyroid hormone pill every day." 2. "I need to check my thyroid level frequently." 3. "If I have diarrhea, I should contact my doctor."
19. Which statement by the client diagnosed with type 1 diabetes indicates the client understands the medication teaching concerning insulin degludec?
1. "I will throw away my pen in 30 days, even if there is medicine in the pen." Any medication remaining after 30 days should be discarded to ensure it has the same potency as when it was first opened.
17. The nurse is administering medications to a client diagnosed with type 1 diabetes. The client's 1100 glucometer reading is 310. 301 to 350 8 units Which action should the nurse implement?
1. Administer eight units of regular insulin subcutaneously. The client's reading is 310; therefore, the nurse should administer eight units of regular insulin as per the HCP's order.
56. The client diagnosed with hyperthyroidism is administered radioactive iodine, I-131, and tells the nurse, "I don't think the medication is working. I don't feel any different." Which statement is the nurse's best response?
1. "It may take up to several months to get the full benefits of the treatment." The goal of radioactive therapy for hyperthyroidism is to destroy just enough of the thyroid gland so that thyroid function levels return to normal. Full benefits may take several months.
6. The client newly diagnosed with type 1 diabetes asks the nurse, "Why should I get an external portable insulin pump?" Which statement is the nurse's best response?
1. "It will cause you to have fewer hypoglycemic reactions, and it will control blood glucose levels better." . It delivers basal insulin infusion (continuous release of a small amount of insulin) and bolus doses with meals. This provides fewer hypoglycemic reactions and better blood glucose levels.
20. The client diagnosed with diabetes is prescribed insulin degludec and liraglutide 100/3.6 injection. Which statement indicates the client needs more medication teaching?
1. "Low blood glucose levels are no concern with this combination of medications." Administration of any insulin can cause hypoglycemia when combined with medications that act to decrease appetite.
4. The 2-year-old child is diagnosed with cystic fibrosis (CF). Which interventions should the nurse discuss with the child's parent? Select all that apply.
1. Administer OTC mucolytic agents. 2. Perform postural drainage and chest percussion. 3. Sprinkle pancreatic enzymes on the child's food.
Adrenal Disorders 31. The client diagnosed with Addison's disease is being discharged. Which statement indicates the client needs more discharge teaching?
1. "I will be sure to keep my dose of steroid constant and not vary." The corticosteroid dose may have to be increased during the stress of infection or surgery. replicate the body's responses to stress
5. The 36-year-old client is prescribed conjugated estrogen tablets after a total abdominal hysterectomy. The client calls the nurse in the health clinic and reports she is producing breast milk. Which intervention should the nurse discuss with the client?
1. Discontinue taking the estrogen until seen by the HCP. Conjugated estrogen tablets (Premarin) are an estrogen replacement hormone. The medication should be stopped until the HCP can be seen because this warrants a dosage adjustment or permanent discontinuation. The estrogen stimulates the hypothalamus to produce prolactin, which stimulates the production of breast milk.
10. The client diagnosed with type 1 diabetes is scheduled for a computed tomography (CT) abdominal scan with contrast. The client is taking metformin and 70/30 insulin 24 units at 0700 and 1600. Which instruction should the nurse discuss with the client?
1. Do not take metformin after the procedure until the HCP approves. Metformin (Glucophage), a biguanide, has a potential side effect of producing lactic acid. Lactic acidosis could result when metformin is administered simultaneously or within a close time span of the contrast dye used for the CT scan. It is recommended to hold the medication 48 hours before and after the CT scan with contrast.
T 11. The client diagnosed with chronic pancreatitis is prescribed pancrelipase. Which data indicates the dosage should be increased?
1. Fatty, frothy, foul-smelling stools . This would indicate the dosage is too small and needs to be increased
16. The client with type 1 diabetes is diagnosed with diabetic ketoacidosis (DKA). The HCP prescribes regular insulin IV by continuous infusion. Which intervention should the intensive care nurse implement when administering this medication?
1. Flush the tubing with 50 mL of the insulin drip before administering it to the client. Regular insulin adheres to the lining of the plastic IV tubing; therefore, the nurse should flush the tubing with at least 50 mL of the insulin solution so that insulin will not adhere. If this is not done, the client will not receive the correct insulin dose during the first few hours of administration.
12. The client diagnosed with Addison's disease is prescribed prednisone. Which laboratory data should the nurse expect this medication to alter?
1. Glucose Prednisone is a glucocorticoid medication that affects glucose metabolism; therefore, the nurse should expect the glucose level to be altered.
9. The nurse is administering the following medications. Which medication should the nurse question administering?
1. Glyburide to a client diagnosed with type 1 diabetes Glyburide (Micronase) is a sulfonylurea. The sulfonylureas stimulate beta-cell production of insulin. Clients diagnosed with type 1 diabetes have no functioning beta cells; therefore, they cannot be stimulated.
18. The client diagnosed with type 2 diabetes is prescribed sitagliptin. Which information should the nurse discuss with the client?
1. Instruct the client to report any blisters on the skin or pain on the left side. Side effects with sitagliptin are pancreatitis (pain on the left side) and Stevens-Johnson Syndrome (painful blisters and skin rashes).
6. The 10-year-old client is receiving somatropin. Which clinical manifestations warrant nurse intervention?
1. Polyuria, polydipsia, and polyphagia Growth hormone is diabetogenic; therefore, any clinical manifestations of diabetes mellitus, such as polyuria, polydipsia, and polyphagia, should be reported to the HCP immediately.
Pituitary Disorders 41. The client diagnosed with DI is prescribed desmopressin. Which comorbid condition warrants a change in medication?
1. Sinusitis DDAVP is an antidiuretic hormone. It is administered intranasally, and a sinus infection could interfere with medication absorption.
13. The client diagnosed with poison ivy is prescribed prednisone. Which information should the nurse discuss with the client? Select all that apply.
1. Take the medication with food. 2. The medication must be tapered.
3. The client diagnosed with DI is receiving desmopressin intranasally. Which assessment data warrants the client notifying the HCP? Select all that apply.
1. The client has gained 2 kg in the past 24 hours. 2. The client has to urinate 20 to 30 times daily.
16. A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. The charge nurse observes a newly graduated RN performing all of the following patient tasks. Which action requires that the charge nurse intervene immediately?
2. Encouraging the patient to drink orange juice The signs and symptoms the patient is exhibiting are consistent with hyperglycemia. The RN should not give the patient additional glucose
. 17. A patient has newly diagnosed type 2 diabetes. Which action should the RN assign to an LPN/LVN rather than an experienced assistive personnel (AP)?
3. Administering subcutaneous insulin on a sliding scale as needed The AP's scope of practice includes checking vital signs and assisting with morning care.
15. The unlicensed assistive personnel (UAP) notifies the registered nurse (RN) that the client reports being jittery and nervous and is diaphoretic. The client is diagnosed with type 2 diabetes. Which interventions should the RN implement? Rank in order of performance. 1. Have the UAP check the client's glucose level. 2. Tell the UAP to give the client orange juice. 3. Check the client's MAR. 4. Immediately go to the room and assess the client. 5. Assist the UAP in changing the client's bed linens.
41235
39. The client diagnosed with Addison's disease asks the nurse, "Why do I have to take fludrocortisone?" Which statement is the nurse's best response?
1. "Fludrocortisone helps the body retain sodium." Fludrocortisone (Florinef) is a mineral corticosteroid. Mineral corticosteroids help the body maintain the correct serum sodium levels.
49. The nurse is administering morning medications. Which medication should the nurse question?
1. Desmopressin to a client diagnosed with DI and angina Desmopressin (DDAVP), a pituitary hormone, causes vasoconstriction and is contraindicated for clients diagnosed with angina because of coronary vasoconstriction.
57. The client diagnosed with hyperthyroidism is prescribed propylthiouracil (PTU). Which statement by the client warrants immediate intervention by the nurse?
1. "I have a sore throat and have had a fever." PTU is a hyperthyroid treatment. The antithyroid medication may affect the body's ability to defend itself against bacteria and viruses; therefore, the nurse should intervene if the client has any sore throat, fever, chills, malaise, or weakness.
Type 2 Diabetes 11. The client diagnosed with type 2 diabetes is prescribed the medication glipizide. Which statement by the client warrants intervention by the nurse?
1. "I usually have one glass of wine with my evening meal." Glipizide (Glucotrol) stimulates the pancreas to secrete more insulin. may cause an Antabuse-like reaction when taken with alcohol, causing the client to become nauseated and vomit.
27. The RN is orienting a newly graduated nurse who is providing diabetes education for a patient about insulin injection. For which teaching statement by the new nurse must the RN intervene?
1. "To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs." Although it is important to rotate injection sites for insulin, it is preferred that the injection sites be rotated within one anatomic site (e.g., the abdomen) to prevent day-to-day changes in the absorption rate of the insulin.
5. The client diagnosed with type 1 diabetes is reporting a dry mouth, extreme thirst, and increased urination. For each intervention, specify if the intervention is indicated or not indicated for the client's care.
1. Administer one amp of IV 50% glucose. NOT INDICATED 2. Prepare to administer IV regular insulin. INDICATED 3. Inject insulin isophane subcutaneously in the abdomen. NOT INDICATED 4. Hang an IV infusion of D5W at a keep open rate. NOT INDICATED 5. Check the client's blood glucose level via a glucometer. INDICATED 6. Provide the client with orange juice to drink. NOT INDICATED
25. The client diagnosed with acute pancreatitis is reporting severe abdominal pain. For each intervention, specify if the intervention is indicated or not indicated for the client's care.
1. Ask the client to rate the pain on a 1 to 10 scale. INDICATED 2. Determine when the client received the last dose of medicine. INDICATED 3. Administer hydrocodone pain medicine. NOT INDICATED 4. Assist the client to a semi-Fowler's position. INDICATED 5. Apply oxygen at 4 L/min via nasal cannula. INDCIATED
14. The nurse is caring for a patient with diabetes who is developing diabetic ketoacidosis (DKA). Which task delegation or assignment is most appropriate?
1. Ask the unit clerk to page the health care provider (HCP) to come to the unit. The nurse should not leave the patient.
27. The nurse is administering pancreatic secretin to a client to rule out chronic pancreatitis. Which procedure should the nurse follow?
1. Aspirate gastric and duodenal contents before and after the medication. Gastric and duodenal contents are aspirated and sent to the laboratory for analysis before and after administration of pancreatic secretin, a pancreas secretory hormone that stimulates the pancreas to secrete enzymes.
2. The nurse is caring for an older patient with type 1 diabetes and diabetic retinopathy. What is the nurse's priority concern for assessing this patient?
1. Assess ability to measure and inject insulin and to monitor blood glucose levels. The older patient with diabetic retinopathy also has general age-related vision changes, and the ability to perform self-care may be seriously affected.
4. The nurse administered 12 units of regular insulin to the client diagnosed with type 1 diabetes at 0700. Which meal prevents the client from experiencing hypoglycemia?
1. Breakfast Regular insulin peaks in 2 to 4 hours; therefore, the breakfast meal would prevent the client from developing hypoglycemia.
16. The nurse is caring for the client diagnosed with type 2 diabetes. The client is reporting a headache, jitteriness, and nervousness. For each intervention, specify if the intervention is indicated or not indicated for the client's care.
1. Check the client's serum blood glucose level. INDICATED 2. Give the client a glass of orange juice. INDICATED 3. Determine when the last antidiabetic medication was given. INDICATED 4. Assess the client's blood pressure and apical pulse. INDICATED 5. Administer prescribed insulin via sliding scale. NOT INDICATED
24. The HCP prescribed chlordiazepoxide for a 55-year-old client diagnosed with chronic pancreatitis. Which statement is the scientific rationale for prescribing this medication?
1. Chlordiazepoxide limits complications related to alcohol withdrawal. The chlordiazepoxide (Librium), a sedative-hypnotic, is helpful in preventing delirium tremens for clients withdrawing from alcohol.
19. The school nurse is teaching a class about type 2 diabetes in children to elementary school teachers. Which information is most important for the nurse to discuss with the teachers?
1. Clinical manifestations of hypoglycemia and immediate treatment The most important information for teachers to know is how to treat potentially life-threatening complications secondary to the medications used to treat type 2 diabetes.
17. The overweight client diagnosed with type 2 diabetes reports to the clinic nurse a 35-pound weight loss in the past 4 months. Which intervention should the nurse implement first?
1. Determine if the client has had an increase in hypoglycemic reactions. Changes in weight will affect the amount of medication needed to control blood glucose. The nurse should determine if the client's medication dose is too high by determining if the client has increased hypoglycemic reactions.
18. The client diagnosed with type 2 diabetes tells the clinic nurse about taking ginseng to help improve memory. Which intervention should the clinic nurse implement?
1. Determine if the client is currently taking any type of antidiabetic medication. The nurse should determine if the client is taking any medication because many oral hypoglycemics interact with herbs. Ginseng and garlic may increase the hypoglycemic effects of oral hypoglycemics.
44. The client diagnosed with mild DI is prescribed chlorpropamide. Which discharge instruction should the nurse teach the client?
1. Discuss clinical manifestations of an insulin reaction. Chlorpropamide (Diabinese). A Sulfonylureas are mainly used to treat type 2 diabetes because they stimulate the pancreas to secrete insulin. The client should be aware that an insulin reaction (hypoglycemic reaction) can occur.
23. The client diagnosed with chronic pancreatitis has a nasogastric tube attached to suction. The charge nurse observes the primary nurse instill a liquid antacid down the tube and then clamp the tube. Which action should the charge nurse take?
1. Do nothing because this is the correct procedure. The tube should remain clamped for 1 hour before it is reconnected to suction to allow the medication to be absorbed.
55. The nurse is discussing levothyroxine with the client diagnosed with hypothyroidism. For each intervention, specify if the intervention is indicated or not indicated for the client's care.
1. Encourage the client to decrease the fiber in the diet. NOT INDICATED 2. Discuss the need to monitor the T3, T4 levels daily. NOT INDICATED 3. Tell the client to take the medication with food only. NOT INDICATED 4. Instruct the client to report any significant weight changes. INDICATED 5. Discuss the importance of not using iodized salt. NOT INDICATED 6. Explain the importance of not taking medication with grapefruit juice. NOT INDICATED 7. Instruct the client to take the medication in the morning. INDICATED 8. Teach the client to monitor daily glucose levels. NOT INDICATED
Pharm Ch 6 Type 1 Diabetes 1. The nurse administered 25 units of insulin isophane to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement?
1. Ensure the client eats the nighttime (HS) snack. The nurse needs to ensure the client eats the nighttime (HS) snack to help prevent nighttime hypoglycemia.
23. The assistive personnel reports to the RN that a patient with type 1 diabetes has a question about exercise. What important points would the RN be sure to teach this patient? Select all that apply.
1. Exercise guidelines are based on blood glucose and urine ketone levels. 3. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL (5.6 and 13.9 mmol/L). 5. A 5- to 10-minute warm-up and cool-down period should be included in your exercise. 6. For unplanned exercise, increased intake of carbohydrates is usually needed.
9. A 58-year-old patient with type 2 diabetes was admitted to the acute care unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When the RN prepares a care plan for this patient, what would he or she be sure to include? Select all that apply.
1. Fingerstick blood glucose checks before meals and at bedtime 2. Sliding-scale insulin dosing as prescribed 5. Demonstration of the components of foot care 6. Discussing the relationship between illness and glucose levels
34. The nurse is providing diabetic teaching for an 18-year-old patient with newly diagnosed type 1 diabetes. Which key information would the nurse be sure to include in the teaching plan for this patient?
1. Fingerstick glucose monitoring 2. Insulin injection 4. Signs of hypoglycemia and hyperglycemia 6. Need for daily foot care 7. Relationship of mealtime and action of insulin 8. Sick day procedures
11. An LPN/LVN is assigned to administer a rapid-acting insulin (lispro) to a patient with type 1 diabetes. What essential information would the RN be sure to tell the LPN/LVN?
1. Give this insulin when the food tray has been delivered and the patient is ready to eat. The onset of action for a rapid-acting insulin such as lispro is within minutes, so it should be given only when the patient has food and is ready to eat. Because of this, rapid-acting insulin is sometimes called "see food" insulin.
8. Which assessment data best indicates the client diagnosed with type 1 diabetes is adhering to the medical treatment regimen? The client's laboratory values are populated in the chart below. Glycosylated hemoglobin 5.8% Less than 5.7%
1. Glycosylated hemoglobin A glycosylated hemoglobin (A1c) gives a blood glucose level average over the past 3 months and indicates adherence to the medical treatment regimen. A glycosylated hemoglobin level of 5.8% is close to normal and indicates that the client is adhering to the treatment regimen.
26. The nurse is caring for an 81-year-old adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patient's risk for development of hyperglycemic-hyperosmolar syndrome (HHS)? Select all that apply.
1. Hydrochlorothiazide prescribed to control blood pressure 3. Avoids consuming liquids in the evening 6. Glucose greater than 600 mg/dL (33.3 mmol/L)
34. The emergency department nurse is caring for a client diagnosed with an Addisonian crisis. Which intervention should the nurse implement first?
1. Start an 18-gauge catheter with normal saline. The nurse must treat an Addisonian crisis like all other shock situations. An IV and fluid replacement are imperative to prevent or treat shock.
47. Which medication should the nurse administer to the client diagnosed with nephrogenic DI?
1. Ibuprofen NSAIDs inhibit prostaglandin production and are used to treat nephrogenic DI.
52. The client diagnosed with hyperthyroidism is administered radioactive iodine (I-131). Which intervention should the nurse implement?
1. Instruct the client to avoid close contact with children for 1 week. The client should not be in close contact with children or pregnant women for 1 week after medication administration because the client will be emitting small amounts of radiation.
38. The client diagnosed with iatrogenic Cushing's disease calls the clinic nurse and reports a temperature of 100.1°F (37.8°C). Which intervention should the nurse implement?
1. Instruct the client to come to the clinic for an antibiotic. Clients diagnosed with Cushing's disease are at risk for developing infections related to excess production of cortisol by the adrenal glands.
2. The nurse is teaching the client diagnosed with type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client?
1. Instruct the client to dial in the number of insulin units needed to inject. The insulin pen injector resembles a fountain pen. It contains a disposable needle and insulin-filled cartridge. When the client operates the insulin pen, the correct dose is obtained by dialing the number of insulin units needed.
13. The nurse is discussing oral glyburide with the client diagnosed with type 2 diabetes. Which information should the nurse discuss with the client?
1. Instruct the client to take the oral hypoglycemic medication with food. The oral hypoglycemic medication should be administered with food to decrease gastric upset.
37. The client is diagnosed with Cushing's syndrome due to ectopic production of adrenocorticotropic hormone (ACTH) by a bronchogenic tumor. Which medication should the nurse anticipate the HCP prescribing?
1. Ketoconazole Ketoconazole (Nizoral) is an antiinfective that also suppresses adrenal hormone production. This side effect makes it helpful in treating overproduction of adrenal hormones
20. The client newly diagnosed with type 2 diabetes and prescribed an oral hypoglycemic medication calls the clinic and tells the nurse that their sclera has a yellow color. Which intervention should the clinic nurse implement?
1. Make an appointment for the client to come to the HCP's office. Oral hypoglycemics are metabolized in the liver and may cause elevations in liver enzymes. The client should be instructed to report the first findings of yellow skin, sclera, pale stools, or dark urine to the HCP.
7. The nurse in the medical department is preparing to administer insulin lispro to a client diagnosed with type 1 diabetes. Which intervention should the nurse implement?
1. Make sure the client eats the food on the bedside meal tray. Insulin lispro (Humalog) peaks in 30 minutes to 1 hour; therefore, the client needs to eat when—or shortly after—the medication is administered to prevent hypoglycemia.
40. The client admitted with primary adrenal insufficiency provides the nurse with a list of home medications. The client's medications are populated in the chart below. Mitotane Before breakfast Which medication should the nurse question?
1. Mitotane Mitotane (Lysodren) is an antineoplastic agent that suppresses cortisone production. The nurse would question this medication for a client with adrenal insufficiency.
26. The client diagnosed with acute pancreatitis is placed on total parenteral nutrition (TPN). Which interventions should the nurse implement? Select all that apply.
1. Monitor blood glucose levels every 6 hours. 2. Check the TPN bag with the client's medication administration record (MAR). 3. Change the tubing with every new bag of TPN.
58. The client diagnosed with hyperthyroidism is prescribed an antithyroid medication. Which interventions should the nurse implement? Select all that apply.
1. Monitor the client's thyroid function tests. 2. Monitor the client's weight weekly. 3. Monitor the client for gastrointestinal distress. 4. Monitor the client's vital signs. 5. Monitor the client for activity intolerance.
Pancreatitis 21. The nurse is administering medications. Which medication should the nurse question administering?
1. Morphine sulfate to a client diagnosed with pancreatitis Morphine can cause spasms of the pancreatic ducts and the sphincter of Oddi; therefore, the nurse would question administering this medication.
22. The nurse has received the morning report. Which medication should be administered first?
1. Pancreatin to a client diagnosed with chronic pancreatitis Pancreatin (Donnazyme) is a pancreatic enzyme and is administered with every meal and snack. The nurse should administer this medication so the medication and breakfast foods simultaneously arrive in the small intestine.
35. The client diagnosed with Cushing's disease is prescribed pantoprazole. Which statement is the scientific rationale for prescribing this medication?
1. Pantoprazole decreases the excess amounts of gastric acid. Pantoprazole (Protonix), a PPI, decreases production of stomach acid by inhibiting the proton-pump step in gastric acid production.
2. The client is diagnosed with primary hyperaldosteronism and prescribed spironolactone. The client's laboratory values and vital signs are populated in the chart below. Potassium 4.2 mEq/L 3.5 to 5.3 mEq/L or mmol/L Which data supports that the medication is effective?
1. Potassium level Spironolactone, a potassium-sparing diuretic, normalizes potassium levels for clients diagnosed with hyperaldosteronism
Comprehensive 1. The client diagnosed with Addison's disease tells the clinic nurse about taking licorice every day to help the disease process. Which intervention should the nurse implement?
1. Praise the client because licorice increases aldosterone production. Licorice increases the aldosterone effect, which helps treat Addison's disease.
30. The client diagnosed with pancreatitis is reporting polydipsia and polyuria. Which medication should the nurse prepare to administer?
1. Regular insulin subcutaneously after assessing the blood glucose level Regular insulin (Humulin R) is administered by a sliding scale to decrease blood glucose levels. Clients diagnosed with pancreatitis should be monitored for development of diabetes mellitus. Polydipsia and polyuria are classic findings of diabetes mellitus.
8. The plan of care for a patient with diabetes includes all of these interventions. Which intervention should the nurse delegate to assistive personnel (AP)?
1. Reminding the patient to put on well-fitting shoes before ambulating Reminding the patient to put on well-fitting shoes (after the nurse has taught the patient about the importance of this action) is part of assisting with activities of daily living and is within the education and scope of practice of the AP.
45. The 30-year-old client is prescribed chorionic gonadotropin. Which intervention should the nurse implement?
1. Schedule regular pelvic sonograms. Chorionic gonadotropin (Chorigon) is a hormone substitute. This medication is given to cause ovarian follicle maturation and trigger ovulation. The client is monitored for overstimulation of the ovaries by pelvic sonograms.
29. The RN is caring for a patient with diabetes admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would the nurse include in a teaching plan for the patient and family before discharge? Select all that apply.
1. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL (3.3 mmol/L). 4. Repeat the carbohydrate treatment if the symptoms do not resolve. 5. Eat a small snack of carbohydrates and protein if the next meal is more than an hour away. 6. If the patient has severe hypoglycemia, does not respond to treatment, and is unconscious, transport to the emergency department (ED).
46. The HCP ordered furosemide for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum laboratory values are populated in the chart below. Laboratory Test Client Values Reference Values Sodium 135 mEq/L 135 to 145 mEq/L or mmol/L Which laboratory test would be monitored to determine the medication effectiveness?
1. Sodium levels Furosemide (Lasix) is a loop diuretic. In the syndrome of inappropriate antidiuretic hormone secretion (SIADH), the body retains too much water. Elevated fluid levels in the body result in dilutional hyponatremia. So a normal Na = effective due to fluid being excreted.
43. The client diagnosed with DI is admitted in acute distress. Which interventions should the nurse implement? Select all that apply.
1. Start an IV with lactated Ringer's solution. 2. Insert an indwelling catheter. 3. Monitor the urine-specific gravity.
32. The client diagnosed with Cushing's disease is prescribed alendronate to prevent osteoporosis. For each intervention, specify if the intervention is indicated or not indicated for the client's care.
1. Take the medication and sit upright for 30 minutes. INDICATED 2. Take the medication just before going to bed. NOT INDICATED 3. Take the medication with an antacid to alleviate gastric disturbances. NOT INDICATED 4. Take the medication at least 30 minutes before breakfast. INDICATED 5. Take the medication with a full glass of water. INDICATED 6. Take the medication with coffee or orange juice. NOT INDICATED
33. The client diagnosed with Cushing's disease is scheduled for a bilateral adrenalectomy. Which information regarding the prescribed prednisone should the nurse teach? Select all that apply.
1. Take the medication regularly; do not skip doses. 2. Notify the HCP if you start feeling thirsty all the time. 3. Wear a MedicAlert bracelet in case of an emergency.
28. Which intervention should be implemented when discharging a client diagnosed with chronic pancreatitis and receiving high doses of hydromorphone for the past 4 weeks?
1. Taper the medication slowly over several days before discharge. To prevent withdrawal after weeks of administration of hydromorphone (Dilaudid), a narcotic opioid, the client should be tapered off the medication over several days.
36. The client is diagnosed with Cushing's syndrome as a result of long-term steroid therapy. Which assessment findings support this condition?
1. The client has a round face and multiple ecchymotic areas on the arms. A round face (moon face) indicates a redistribution of fat from steroid therapy. Multiple ecchymotic areas on the arms indicate a redistribution of subcutaneous fats away from the arm (thin extremities).
14. The client diagnosed with type 2 diabetes is receiving the combination oral medication glyburide and metformin. Which data indicates the medication is effective?
1. The serum blood glucose level is 118 mg/dL (fasting). glucose level should be within normal limits, less than 100 mg/dL (fasting). A 118 mg/dL is close to normal; therefore, the medication can be considered effective.
48. The client diagnosed with Hodgkin's disease is prescribed vincristine. Since the last treatment, the client reports the inability to fit into their rings and most shoes because of weight gain. Which intervention should the nurse implement first?
1. Weigh the client and report the findings to the oncologist. The client's symptoms indicate SIADH. The nurse should assess weight gain, hold the medication, and notify the HCP.
53. The client diagnosed with hyperthyroidism is prescribed propylthiouracil (PTU). The client's laboratory values are populated in the chart below. White blood cell count (WBC) 4.5 x 103/microL 4.5 to 11.1 × 103/microL Which laboratory data should the nurse monitor?
1. White blood cell (WBC) count The client receiving PTU, a hyperthyroid treatment, is at risk for agranulocytosis; therefore, the client's WBC count should be checked periodically.
25. The RN is the preceptor for a senior nursing student who will teach a patient with diabetes about self-care during sick days. For which statement by the student must the RN intervene?
2. "Test your urine for ketones whenever your blood glucose level is less than 240 mg/dL (13.3 mmol/L)." Urine ketone testing should be done whenever a patient's blood glucose is greater than 240 mg/dL (13.3 mmol/L).
22. While the RN is performing an admission assessment on a patient with type 2 diabetes, the patient states that he routinely drinks three beers a day. What is the nurse's priority follow-up question at this time?
2. "When during the day do you drink your beers?" Alcohol has the potential for causing alcohol-induced hypoglycemia. It is important to know when the patient drinks alcohol and to teach the patient to ingest it shortly after meals to prevent this complication.
15. The RN is serving as preceptor to a newly graduated nurse who has recently passed the RN licensure (NCLEX®) examination. The new nurse has only been on the unit for 2 days. Which patient should be assigned to the newly graduated nurse?
2. A 58-year-old patient with diabetes who has cellulitis of the left ankle The new nurse is very early in orientation to the unit. Appropriate patient assignments at this time include patients whose conditions are stable and not complex.
21. Which actions can the school nurse delegate to an experienced assistive personnel (AP) who is working with a 7-year-old child with type 1 diabetes in an elementary school? Select all that apply.
2. Administering oral glucose tablets when the blood glucose level falls below 60 mg/dL (3.3 mmol/L) 4. Obtaining blood glucose readings using the child's blood glucose monitor 5. Reminding the child to have a snack after the physical education class
19. The nurse is responsible for the care of a patient with diabetes who is unable to swallow, is unconscious and seizing, and has a blood glucose level of less than 20 mg/dL (1.1 mmol/L). Which actions are the most appropriate responses for this patient at this time? Select all that apply.
2. Give glucagon 1 mg subcutaneously or intramuscularly (IM). 3. Repeat the dose of glucagon in 10 minutes if the patient remains unconscious. 4. Apply aspiration precautions because glucagon can cause vomiting. 6. Notify the health care provider (HCP) immediately.
24. The experienced assistive personnel (AP) has been delegated to take vital signs and check fingerstick glucose on a postoperative patient with diabetes. Which vital sign change would the RN instruct the AP to report immediately?
4. Glucose increase from 190 to 236 mg/dL (10.6 to 13.1 mmol/L) An unexpected rise in blood glucose is associated with increased mortality and morbidity after surgical procedures.
13. In the emergency department, during the initial assessment of a newly admitted patient with diabetes, the nurse discovers all of these findings. Which finding should be reported to the health care provider immediately?
2. Rapid respiratory rate with deep inspirations Rapid, deep respirations (Kussmaul respirations) are symptomatic of diabetic ketoacidosis.
Leadership Ch 13 1. A patient with type 1 diabetes asks the nurse if he will ever be able to stop taking insulin. What is the nurse's best response?
3. "No, your pancreas no longer makes insulin so you have to take insulin on a daily basis." The patient is a type 1 diabetic. These patients no longer make their own insulin and require an external injectable form of insulin.
32. The nurse is assessing a newly admitted older adult with diabetes. Assessment reveals an abnormal appearance of the feet (see the figure below). The nurse recognizes this as which deformity?
3. Charcot foot deformity Charcot foot is a diabetic foot deformity. The foot is warm, swollen, and painful. Walking collapses the arch, shortens the foot, and gives the sole of the foot a "rocker bottom" shape.
4. The nurse is preparing to review a teaching plan for a patient with type 2 diabetes mellitus. To determine the patient's level of compliance with his prescribed diabetic regimen, which value would the nurse be sure to review?
3. Glycosylated hemoglobin (HgbA1c) level The higher the blood glucose level is over time, the more glycosylated the hemoglobin becomes. The HgbA1c level is a good indicator of the average blood glucose level over the previous 120 days.
7. An LPN/LVN is assigned to perform assessments on two patients with diabetes. Assessments reveal all of these findings. Which finding would the RN instruct the LPN/LVN to report immediately?
3. Profuse perspiration Profuse perspiration is a symptom of hypoglycemia, a complication of diabetes that requires urgent treatment.
30. The nurse is evaluating a patient with diabetes for foot risk category. The patient lacks protective sensation and shows evidence of peripheral vascular disease. According to the American Diabetes Association (ADA), which foot risk category best fits this patient?
3. Risk category 2 category 2 (does not have protective sensation and has evidence of peripheral vascular disease)
10. An assistive personnel (AP) tells the nurse that while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she will always need to take insulin now. What is the RN's priority for teaching the patient?
4. Discuss the relationship between illness and increased glucose levels When a patient with diabetes is ill or has surgery, glucose levels become elevated and administration of insulin may be necessary.
20. While working in the diabetes clinic, the RN obtains the following information about an 8-year-old patient with type 1 diabetes. Which finding is most important to address when planning child and parent education?
4. Morning preprandial glucose range of 55 to 70 mg/dL (3.1 to 3.9 mmol/L) The low morning fasting blood glucose level indicates possible nocturnal hypoglycemia.
18. A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first?
4. Use a glucometer to check the patient's glucose level. Before orange juice or insulin is given, the patient's blood glucose level should be checked. Checking blood pressure is a good idea but is not the first action the nurse should take.
NGN Ch 6 1. A 58-year-old client is recovering from an L4-L5 spinal fusion completed 3 hours ago. The client is on the medical-surgical nursing unit, and is prescribed hydromorphone via PCA, 0.2 mg every 10 minutes, with a 4-mg lock-out dose in 4 hours. The nurse is preparing a plan of care for this client. For each body system below, click to specify the potential intervention that would be appropriate for the initial plan of care to monitor for or prevent adverse effects of hydromorphone. Each body system may support more than one potential nursing intervention.
Renal ☐ Assess renal function. ☐ Monitor I&O. Respiratory ☐ Assess RR frequently. ☐ Ensure naloxone is available. Cardiovascular ☐ Instruct the client to change positions slowly. ☐ Assess BP and HR frequently. Gastrointestinal ☐ Administer ondansetron as indicated. ☐ Ensure adequate intake of fluids and fiber. Urinary ☐ Assess the bladder frequently. ☐ Prompt the client to void every 4 hours.
6. A 46-year-old client was admitted to the hospital after reporting increased thirst, increased hunger, and increased urination for the last 7 days. On admission, the client's blood glucose level was significantly elevated, and the client was treated for DKA. After being stabilized, the client was discharged to home with a diagnosis of new-onset DM. The home care nurse is visiting the client and is providing teaching on self-management and measures to prevent hospitalization. The client tells the home care nurse about often feeling hungry, irritable, shaky, and weak and having a headache. Based on the client's reported symptoms, which five measures would the home care nurse plan to teach this client to implement when these symptoms occur?
□ Eat 6 saltine crackers. □ Eat 3 graham crackers. □ Drink 120 mL of fruit juice. □ Drink 240 mL of skim milk. □ Consume 6 to 10 hard candies.
2. A 72-year-old client with a history of peripheral vascular disease has an arterial leg ulcer that is open and draining copious amounts of drainage. The client is seen by the wound care team, and the physician prescribes negative-pressure wound therapy (NPWT). Which five interventions would the nurse include in the plan of care for the client to maintain and ensure a good seal during NPWT?
□ Identify air leaks using a stethoscope. □ Make sure the periwound skin surface area is dry. □ Avoid wrinkles when applying the transparent film. □ Fill uneven skin surfaces with a skin barrier product. □ Frame the periwound area with a hydrocolloid dressing.
4. A 22-year-old client presents to the outpatient clinic reporting feeling "down" and stating having difficulty maintaining responsibilities with school. Describes not being able to meet assignment deadlines and thinks about considering quitting school. The client is referred to the counseling and psychological center and is beginning group therapy. Based on this scenario, which of the following interventions would the psychiatric nurse plan for the client? Select all that apply.
□ Set realistic goals for behavior modification. □ Reward the client for practicing new behaviors. □ Encourage the client to practice behavior modifications. □ Help the client identify their own behaviors needing change. □ Reinforce self-worth with time and attention by giving one-to-one time.
