Test 4 Adult 2
Which specific action is a priority for the nurse to teach a client with diabetes who has peripheral neuropathy to prevent harm?
never go barefoot
A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session?
"It is essential for you to wash your hands and avoid people who are ill."
What is a normal urine specific gravity level?
1.005-1.030
When (at which time) will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes received regular insulin at 7:00 a.m.?
11:00 am
What is the normal phosphorus range?
2.8-4.5
What is the normal BUN range?
6-24
The nurse has just received report on a group of clients. Which client is the nurse's first priority?
A 26 yr old with type 1 diabetes whose insulin pump is beeping occlusion
The nurse has just received report on a group of clients. Which client is the nurse's first priority?
A 45 yr old taking metformin who has abdominal cramps
Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites?
A 55 yr old who as hypoglycemic unawareness
The RN has just received change-of-shift report. Which client will the nurse assess first?
A client with chronic kidney failure who was just admitted for shortness of breath
The nurse is caring for client who is receiving erythropoietin. Which assessment finding indicates a positive response to the medication?
A decrease in fatigue
A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 L of normal saline infused over 2 hours. Which staff member would be assigned to care for the client?
An RN who usually works on the general surgical unit
A client with a recently created vascular access for hemodialysis is being discharged. Which teaching will the nurse include in the discharge instructions?
Avoid venipuncture and blood pressure measurements in the affected arm
Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm?
Change positions slowly when moving from sitting to standing
When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends which food selection?
eggs
Which statement made by the client alerts the nurse to the possibility of hypothyroidism?
I am always tired, even when I 10-12 hours of sleep
Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed?
If I continue to lose weight, I may need to increase my dosage
Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)?
Insert an indwelling catheter and monitor urinary output
What is the nurse's best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug?
Insulin is a small protein that is destroyed in stomach acid and intestinal enzymes
A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared that I can't do it all and will get so sick that I will be a burden on my family." What is the nurse's best response?
Lets tackle it piece by piece. What part is most scary to you?
The nurse teaches a client who is recovering from acute kidney injury to avoid which type of medication?
NSAIDS
Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "dawn phenomenon" to achieve better control?
Take your evening insulin dose right before bed instead of at supper time
Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation?
The abdominal site is best because it is closest to the pancreas
Discharge teaching has been provided for a client recovering from kidney transplantation. Which client statement indicates understanding of the teaching?
The antirejection meds will need to be taken for life
What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty?
The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose
A client is being treated for kidney failure. Which nursing statement encourages the client to express his or her feelings?
What concerns do you have about your kidney disease?
How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible?
You can have a beer with your meal if you test yourself for hypoglycemia after
What is the nurse's best response to a client with type 2 diabetes controlled with metformin who asks why now that he is recovering from surgery, is he prescribed to receive insulin therapy for a few days?
You need insulin temporarily because the stress of the surgery causes increase blood glucose for a day or two
Which client will the nurse assess as at risk for acute kidney injury (AKI)? (Select all that apply.) CORRECT a. Client in the intensive care unit on high doses of antibiotics b. Football player in preseason practice c. Accident victim recovering from a severe hemorrhage d. Accountant with poorly controlled diabetes mellitus e. Client who underwent contrast dye radiology f. Client recovering from gastrointestinal influenza
a. Client in the intensive care unit on high doses of antibiotics b. Football player in preseason practice c. Accident victim recovering from a severe hemorrhage e. Client who underwent contrast dye radiology f. Client recovering from gastrointestinal influenza
When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which nursing actions are required? (Select all that apply.) CORRECT a. Ensure that no blood pressures are taken in that arm b. Teach the client to palpate for a thrill over the site. c. Elevate the arm above heart level d. Auscultate for a bruit every 8 hours. e. Check brachial pulses daily.
a. Ensure that no blood pressures are taken in that arm b. Teach the client to palpate for a thrill over the site. d. Auscultate for a bruit every 8 hours.
The nurse is caring for a client following a kidney transplant. Which assessment data indicate to the nurse possible rejection of the kidney? (Select all that apply.) CORRECT a. Crackles in the lung fields b. temperature of 98.8 c. Blood pressure of 164/98 mm Hg d. Blood urea nitrogen (BUN) 21 mg/dL (7.5 mmol/L), creatinine 0.9 mg/dL (80 mcmol/L) e. 3+ edema of the lower extremities
a. crackles in the lungs c. blood pressure of 164/98 e. 3+ edema of the lower extremities
For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) a. Decreased Urine Output b. hypotension c. weight gain of more than 2.2 lbs in 24 hrs d. persistent headache e. hyperglycemia f. acute confusion
a. decreased urine output c. weight gain of more than 2.2 lbs in 24 hrs d. persistent headache f. acute confusion
Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) a. elevated temp b. tachycardia c. somnolence d. elevated systolic B/P e. abdominal pain and nausea f. slow RR
a. elevated temp b. tachycardia d. elevated systolic B/P e. abdominal pain and nausea
Which new-onset symptoms will the nurse instruct a client with diabetes who is prescribed to take the sodium-glucose cotransport inhibitor, empagliflozin, to report to the diabetes health care provider to prevent harm? (Select all that apply.) a. muscle weakness and dizziness upon standing b. redness and tenderness at injection site c. rapid weight gain and shortness of breath d. redness and tenderness of the perineum e. sensation of hunger, tremors, sweating, and confusion f. pain and burning upon urination
a. muscle weakness and dizziness upon standing d. redness and tenderness of the perineum e. sensation of hunger, tremors, sweating, and confusion f. pain and burning upon urination
Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min?
applying oxygen by mask
Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air?
assessing blood glucose
A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted?
auscultate for pericardial friction rub
Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)?
avoid over the counter meds unless prescribed by you HCP
Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy?
avoid peas, nuts, and legumes
The nurse is teaching dietary modification to a client with acute kidney injury (AKI). What dietary teaching will the nurse include? (Select all that apply.) a. liberal sodium b. low fat c. restricted fluids d. restricted protein e. low potassium
c. restricted fluids d. restricted protein e. low potassium
While managing care for a client with chronic kidney disease, which action does the registered nurse (RN) plan to delegate to assistive personnel (AP)? (Select all that apply.) a. Explain the components of a low-sodium diet b. Document the amount the client drinks throughout the shift. c. Auscultate the client's lung sounds every 4 hours. d. Check the arteriovenous (AV) fistula for a thrill and bruit. e. Obtain the client's prehemodialysis weight.
b. document the amount the client drinks throughout the shift e. obtain the clients prehemodialysis weight
Which statements regarding hyperthyroidism are accurate? (Select all that apply.) a. has a sudden onset of symptoms b. is more common among women than men c. produces symptoms of a hypermetabolic state d. most common form is graves disease e. can be diagnoses by the presence of goiter f. often occurs weeks after exposure to ionizing radiation
b. is more common among women that men c. produces symptoms of a hypermetabolic state d. most common in graves disease
Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) a. goiter b. nonpitting edema in hands and feet c. warm, moist skin d. decreased deep tendon reflexes e. agitation and inability to sleep f. pulse below 60 bpm
b. nonpitting edema in hands and feet d. decreased deep tendon reflexes f. pulse below 60 bpm
A client newly diagnosed with type 1 diabetes says she is not ready to learn everything about diabetes control right now. Which information has the greatest priority for the nurse to teach this client and her family for now to prevent harm? (Select all that apply.) a. causes of type 1 diabetes b. what to do when ill c. symptoms and treatment of hypoglycemia d. insulin administration e. dietary control of blood glucose f. importance of regular exercise
b. what to do when ill c. symptoms and treatment of hypoglycemia d. insulin administration
What is the average A1C level?
below 5.7%
Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed?
bilateral muscle twitching
Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) a. hypertonic saline b. furosemide c. calcium gluconate d. oxygen e. suction f. emergency trach kit
c. calcium gluconate d. oxygen e. suction f. emergency tach kit
To prevent prerenal acute kidney injury, which person will the nurse encourage to increase fluid consumption?
construction worker
A client with end-stage kidney disease has been placed on fluid restrictions. Which assessment data indicates to the nurse that the fluid restriction has not been followed?
dyspnea and anxiety at rest
Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management?
education and literacy skills
What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet?
examining both feet for indications of injury
For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider?
hand tremors
A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is important for the nurse to implement?
handwashing
Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur?
i will eat 3 graham crackers
The nurse is caring for a client with kidney failure. Which assessment data indicates the need for increased fluids?
increased BUN
Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy?
intermittent constipation
What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot?
make an appointment with your podiatrist as soon as possible
What level of creatinine indicates kidney failure? (men and women ranges)
men: greater than 1.4 women: greater than 1.2
Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy?
monitor oxygen saturation
What is the nurse's best response when family members of a client with hyperthyroidism express concern about the client's frequent mood swings?
mood swings are common and should diminish with treatment
Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)?
no change in urine output with minimal fluid intake
Which action is appropriate for the nurse to delegate to the assistive personnel (AP) when caring for clients with diabetes?
performing blood glucose checks on a patient who requires insulin
Which assessment is a priority for the nurse to make when a client with diabetic ketoacidosis (DKA) who is being monitored while receiving an insulin infusion begins to show an irregular heart beat with inverted T-waves?
potassium level
Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys?
protein in the urine during a random urinalysis
Which changing trends in a client's serum laboratory values indicate to the nurse that thyroid hormone replacement therapy for hypothyroidism is effective?
rising thyroid hormones (TH) levels and decreasing thyroid-stimulating hormones (TSH) levels
Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider?
serum sodium increase from 122 to 140
The nurse is caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter. Which assessment finding requires nursing action?
temp of 100.8
When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider (HCP) immediately?
temp of 101.2
How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%?
the values indicate that the patient has managed his/her disease well
While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action will the nurse implement?
turn the patient to the opposite side
Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective?
urine output of 30-50 ml/hr