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NUR2571 Exam 3 Study Guide Professional Nursing II PN 2 1 NUR2571 Exam 3 Study Guide : Professional Nursing II / PN 2 PN2 Exam 3 Neuro - S/s, causes of autonomic dysreflexia o s/s: hypertensive crisis , bradycardia, severe headache, stroke or seizure activity o Cause: noxious stimuli such as a full bladder, fecal impaction, wrinkle in clothing, menstrual cramps, erection, ingrown toenail, bladder infection, sitting on catheter tubing o High blood pressure and spinal cord injury- check their bladder o Hypertensive crisis (elevated systolic pressures of 260 to 300) - Gillian Barre, s/s, complications o s/s: starts in the legs and works its way up, motor weakness, areflexia (absence of reflexes), respiratory failure, face muscle deficit ▪ causes paresthesia and pain in hands and feet – this is reversible o Complications: respiratory distress - Multiple Sclerosis – s/s, what to avoid o s/s: NYSTAGMUS fatigue in lower extremities, pain or paresthesia, diplopia (changes in peripheral vision), tinnitus, vertigo, dysphagia, o avoid: avoid extreme temperatures, stress, smoking - Parkinson’s – What tx and meds are supposed to help o Levodopa/Carbidopa (Sinemet)- provides dopamine replacement to treat motor symptoms o Watch their swallowing- speech therapist o Provide finger foods o Encourage activity - Myasthenia Gravis – Testing for o Tensilon Test: baseline measurement of the cranial muscle strength 1 4 blurred vision, diplopia (double vision), glare and light sensitivity, halo around lights, absent red reflex, visible opacity, progressive and painless loss of vision o Treatment: surgical removal of the lens 4 53 - What is macular degeneration o The gradual central loss of vision that affects the macula of the eye o Often called age-related macular degeneration - Glaucoma, cause and tx o Leading cause of blindness o Cause: decreased fluid drainage or increased fluid secretion increases intraocular pressure and causes atrophic changes of the optic nerve and visual defects. o Treatment: ▪ prescribed eye medication (Pilocarpine, timolol, beta blockers ▪ check pulse and blood pressure before taking timolol Ears - What ototoxicity causes o Sensorineural hearing loss - Causes of sensorineural and conductive hearing loss o Conductive (something is physically stopping the sound): otosclerosis, ear wax, infection o Sensorineural: ototoxicity (mycin, flagel, NSAIDS, aspirin overdose) - Treatment and patient teaching for acute otitis media o At risk for loss of balance o Bacterial: treated with antibiotics o (SATA) Teaching: finish all antibiotics, take analgesics, apply a warm cloth, if pain gets uncontrollable then seek help Diabetes/Thyroid - Graves – pt. teaching, diet o Patient must discontinue any iodine containing medication 1 week prior to a thyroid scan o Radioactive Iodine teaching: not if pregnant, don’t kiss anyone or have sex for 5 days, don’t sit next to someone in a car for more than an hour, stay away from babies for 24 hours o Teaching: Monitor pulse, eat meals frequently o Diet: higher calories 5 6 - Type 1 – Cause o Auto-immune response or idiopathic o Diagnosed in childhood, little or no insulin, first sign is DKA 6 95 o Polyuria, polydipsia, polyphagia, Kussmauls respirations, fruity breath - Reducing diabetes vascular complications (SATA): o Check blood sugar, low carb low sugar low fat diet, exercise, stop smoking, watch BP A 24-year-old woman who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the pt that the best way to reduce the risk of HIV infection from drug use it to Participate in a needle-exchange program An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the nurse to give? Yes, you will learn what foods are allowed so you can eat with your friends An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor’s office one week later. Which statement that the client makes is the most indicative of an adverse reaction to the medication? My chest hurts when I was sweeping the floor this morning After teaching the wife of a client who has Parkinson disease, then nurse assess the wife’s understanding. Which statement by the client indicates that she correctly understands changes associated with this disease? He may have trouble chewing, so I will off bite- sized portions Which treatment is used to manage hyperthyroidism? Select all that apply. Irradiation of the thyroid and Thyroidectomy 9 10 Which problem is most likely to develop if hyperthyroidism remains untreated? Heart failure A client who has just had a thyroidectomy returns to the unit in stable condition. What equipment is it essential for the nurse to 10 161 have readily available? Tracheostomy set Which finding would be the greatest cause for concern to the nurse during the early postoperative period following a thyroidectomy? Carpal spasm when the blood pressure is taken An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor's office one week later. which statement that the client makes is most indicative of an adverse reaction to the medication? "My chest hurt when I was sweeping the floor this morning." Which diet does the nurse expect will be ordered for the client with hypothyroidism? High roughage, low calorie A client develops hypoparathyroidism after a total thyroidectomy. What treatment should the nurse anticipate? Administration of calcium A nurse is caring for an older adult client who has diabetes mellitus. The client reports loss of peripheral vision. For which of the following is the client at risk? Open-angle glaucoma A nurse is reinforcing selfcare instructions with a client following a trabeculectomy. Which of the following statements should the nurse include? "You need to limit your housekeeping activities." A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? (Select all that apply.) Genetic predisposition, Hypertension, and Age 11 14 Color and temperature of skin An elderly woman has been recently diagnosed as having Type 2 diabetes. Which of the following complaints that she has is most likely to be related to the diagnosis of diabetes mellitus? 14 185 Pruritus vulvae A client is admitted to the hospital with recently diagnosed Type I diabetes mellitus and is to have fasting blood work drawn this morning. At 7:00 A.M., the lab has not arrived to draw the blood. The client's dose of regular insulin is scheduled for 7:30 A.M. What is the best action for the nurse to take? Withhold the insulin until the lab comes and the client will be eating within 15 to 30 minutes An elderly client with Type 2 diabetes mellitus develops an ingrown toenail. What is the best action for the nurse to take? Notify the physician Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective? C-reactive protein level Which information will the nurse include when teaching range of motion exercises to a patient with an exacerbation of rheumatoid arthritis Application of cold packs before exercise may decrease joint pain Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? Noon blood glucose of 52 mg/dL A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? Place the patient on a cardiac monitor The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which 15 16 finding indicates a need to contact the health care provider before giving the metformin? The patient's blood urea nitrogen (BUN) level is 60 mg/dL Which nursing action will the nurse include in the plan of care 16 10 Prinzmetal's angina After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates that she correctly understands changes associated with this disease? "He may have trouble chewing, so I will offer bite-sized portions." A nurse plans care for a client with Parkinson disease. Which intervention would the nurse include in this client's plan of care? Keep the head of the bed at 30 degrees or greater A nurse is teaching the daughter of a client who has Alzheimer's disease. The daughter asks, "Will the medication my mother is taking improve her dementia?" How would the nurse respond? "It will not improve her dementia but can help control emotional responses." A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital. Which psychosocial assessment would the nurse complete? Evaluate the client's reaction to a change of environment A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." How would the nurse respond? "I see you are still hungry. I will get you some toast." A nurse cares for a client with advanced Alzheimer's disease. The client's caregiver states, "She is always wandering off. What can I do to manage this restless behavior?" How would the nurse respond? "Engage the client in scheduled activities throughout the day." A nurse prepares to discharge a client with Alzheimer's disease. 19 20 Which statement would the nurse include in the discharge teaching for this client's caregiver? "Install deadbolt locks on all outside doors." A nurse is teaching a client with chronic migraine headaches. 20 211 Which statement related to complementary therapy would the nurse include in this client's teaching? "Lie down in a darkened room when you experience a headache." A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client's care? "Allow the client to be as independent as possible with activities." A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client's care? "Reorient the client to the day, time, and environment with each contact." A nurse assesses a patient with a spinal cord injury at level T5. The patient's blood pressure is 184/95 mm Hg, and the patient presents with a flushed face and blurred vision. What action would the nurse take first? Palpate the bladder for distention An emergency room nurse initiates care for a patient with a cervical spinal cord injury who arrives via emergency medical services. What action would the nurse take first? Evaluate respiratory status A patient is admitted with Guillain-Barré syndrome (GBS). What assessment takes priority? Respiratory system A patient with Guillain-Barré syndrome is admitted to the hospital. The nurse plans caregiving priority to interventions that address which priority patient problem? Inadequate airway 21 24 The patient's chart indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause? "Have you been exposed to loud noises?" 24 2153 The nurse works with patients who have hearing problems. Which action by a patient best indicates that goals for an important diagnosis have been met? Being active in community events and volunteer work A patient has external otitis. On what comfort measure does the nurse instruct the patient? Use of a heating pad to the ear An older adult in the family practice clinic reports a decrease in hearing over a week. What action by the nurse is most appropriate? Assess for cerumen buildup 1. Intervention for a Parkinson’s patient a. Head of bed at least 30 degrees 2. Which psycho-social assessment would the nurse compete for a newly admitted Alzheimer’s patient? a. Evaluate the client’s reaction to a change of environment 3. Pt. with T5 injury has blood pressure 200/140, flushed face, what do you do? a. Palpate the bladder for distention 4. Early onset s/s of MS a. Nystagmus 5. Med for acute exacerbation of MS a. Methylprednisolone (Medrol) 6. Which assessment finding would the nurse identify as a late manifestation of ALS? a. Impairment of respiratory muscles 7. A patient is admitted with Guillain-Barre syndrome (GBS). What assessment takes priority? a. Respiratory system 8. Most important when doing a Tensilon test a. Having atropine 25 26 9. A patient is taking long-term corticosteroids for myasthenia gravis. What teaching is most important? a. Avoid large crowds and people who are ill 10. A client’s chart indicates anisocoria. For what would the 26 2195 a. Ice packs 2. Which practice is most effective to lower risk of infection in HIV patient? a. Standard precautions 3. What can cause an increase in viral load? a. Not adhering to medication regimen 4. Goal for a patient with wasting syndrome a. Has a weight gain of 2lbs in a month 5. Riskiest for catching HIV a. Anal intercourse 6. Elisa test is negative. What should the nurse do next? a. Assess sexual patterns and activity 7. AIDS pt. has weeping sores. What is important about dressing changes? a. Disposing soiled dressings properly 8. Pt. upset about finding out they have HIV< what should nurse do? a. Assess support system 9. Most common infection that occurs in clients with AIDS a. Pneumocystis carinii pneumonia 10. Test for the presence of HIV antibodies in a client? a. ELISA 11. Discharge instructions to a client diagnoses with systemic lupus erythematosus (SLE) a. Body temperature should be monitored 12. Pt. with rheumatoid arthritis complains of morning stiffness. The instructions should include a. Take a warm shower first thing 13. Signs of lupus a. Butterfly shaped rash on face 14. Lab looked at for RA a. ESR 15. Which lab to worry about when pt. has lupus a. Large amounts of protein in the urine 16. Which RA patient would the nurse see first? a. Patient with a red, hot, swollen right wrist 17. What to teach patient with Lupus a. Notify your provider at once if you have a fever 29 30 18. With immunocompromised patients, what components of cell-mediated immunity is the problem? a. Suppressor T cells 19. Pt. with AIDS has TB, what should you do first? a. Place the patient under airborne precautions 30 3116 20. Which of these can exacerbate Lupus? a. Pregnancy 1. A client who has a long history of DM and is being admitted to the ER for DKA. Which insulin will you give? a. Regular 2. What is true about Glipizide a. Glipizide stimulates your pancreas to release insulin 3. Manifestation of hypoglycemia? a. Blurred vision 4. A nurse is caring for a client who gets regular insulin via a sliding scale. After giving at 0715, when should the pt. eat? a. 0745 5. When the nurse finds the client’s blood glucose to be 48 mg/dL on the glucometer, he should give the client which one? a. Graham crackers 6. A nurse is planning a community diabetes management program. Which long-term foal should the nurse include? a. Clients will have a decreased incidence of foot amputations 7. To focus on effective earning with this a type 1 diabetic, which of the following interventions should the nurse use? a. Ask the client to perform a return demonstration of insulin injection 8. A nurse is caring for a client who has type 1 diabetes. Which should the nurse recommend for a sweetener? a. Nonnutritive sugar substitute 9. Which dietary source should provide the greatest percentage of calories for diabetes? a. I should eat more calories from complex carbohydrates than anything else 10. Teaching for NPH insulin a. Expect the NPH insulin to peak in 6 to 14 hours. 11. Which of the following medications can cause glucose intolerance? a. Prednisone 3137 14. A nurse plans to administer his regular insulin sq before he eats at 0800. After glucose check, what is next? a. Give the insulin at 0730 15. Goal for preventing the long-term complications of retinopathy and nephropathy a. Maintain stable blood glucose levels 16. Which statements made by the type 1 client indicates an understanding of the teaching? a. I give the insulin injections in my abdominal area 17. A nurse is providing teaching to an adolescent who has T1D. which should the nurse include in the teaching? a. Obtain an influenza vaccine annually 18. Which of the following statements indicates an understanding of the teaching about diabetic foot care? a. Ill check my feet every day for sores and bruises 19. Type 1 client lying in bed, sweating and reporting feeling anxious. Which of the following should the nurse suspect? a. Hypoglycemia 20. Nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect? a. Acetone odor to breath 21. DKA, blood glucose of 925, what do you do first? a. 0.9% sodium chloride IV bolus 22. NPH insulin instructions a. Eat a snack 8 hours after giving The nurse evaluates that wearing bifocals improved the patient's myopia and presbyopia by assessing for both near and distant vision. A nurse should instruct a patient with recurrent staphylococcal and seborrheic blepharitis to use a gentle baby shampoo to clean the lids as needed. When assisting a blind patient in ambulating to the bathroom, the nurse should 33 34 walk slightly ahead of the patient and allow the patient to hold the nurse's elbow. A nurse should include which instructions when teaching a patient with repeated hordeolum how to prevent further infection? 34 3158 Discard all open or used cosmetics applied near the eyes. The nurse developing a teaching plan for a patient with herpes simplex keratitis should include which instruction? Wash hands frequently and avoid touching the eyes. Which teaching point should the nurse plan to include when caring for a patient whose vision is corrected to 20/200? Where to obtain specialized magnifiers. The nurse is developing a plan of care for an adult patient diagnosed with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which action should be included in the plan of care? Discussing the need for sexually transmitted infection testing Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? Administration of corticosteroid eye drops In reviewing a 55-year-old patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess peripheral vision. A patient with a right retinal detachment had a pneumatic retinopexy procedure. Which information will be included in the discharge teaching plan? The purpose of maintaining the head in a prescribed position A 72-year-old patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? "I will cover up with long-sleeved shirts and pants for the next 5 days." To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by noting any changes in the patient's visual field. A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after 35 38 Which action should the nurse take? Speak normally but more slowly. A 75-year-old patient with presbycusis is fitted with binaural hearing aids. Which information will the nurse include when teaching the patient how to use the hearing aids? 38 3290 Experiment with volume and hearing ability in a quiet environment initially. Which information will the nurse include for a patient contemplating a cochlear implant? Cochlear implants require training in order to receive the full benefit. Which statement by a patient with bacterial conjunctivitis indicates a need for further teaching? "I will remove my contact lenses at bedtime." Which information will the nurse include when teaching a patient with keratitis caused by herpes simplex type 1? Importance of taking all of the ordered oral acyclovir (Zovirax) The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? The patient takes 2 antihypertensive medications. During the preoperative assessment of the patient scheduled for a right cataract extraction and intraocular lens implantation, it is most important for the nurse to assess the visual acuity of the patient's left eye. The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to make eye contact with the patient and ask about any need for assistance. Which action could the registered nurse (RN) who is working in the eye and ear clinic delegate to a licensed practical/vocational nurse (LPN/LVN)? Use a Snellen chart to check a patient's visual acuity. The occupational health nurse is caring for an employee who is complaining of bilateral eye pain after a cleaning solution splashed into the employee's eyes. Which action will the nurse take first? Flush the eyes with sterile saline. 39 40 Unlicensed assistive personnel (UAP) perform all the following actions when caring for a patient with Ménière's disease who is experiencing an acute attack. Which action by UAP indicates 40 4232 A patient who received a corneal transplant 2 weeks ago calls the ophthalmology clinic to report that his vision has not improved with the transplant. Which action should the nurse take? Remind the patient it may take months to restore vision after transplant. Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction? Fill the irrigation syringe with body-temperature solution. Which action will the nurse include in the plan of care for a patient with benign paroxysmal positional vertigo (BPPV)? Teach the patient that canalith repositioning may be used to reduce dizziness. When teaching a patient about the treatment of acoustic neuroma, the nurse will include information about ways to avoid falls. Which patient arriving at the urgent care center will the nurse assess first? Patient with acute right eye pain that occurred while using home power tools The nurse is working in an urgent care clinic that has standardized treatment protocols for implementation by nursing staff. After reviewing the history, physical assessment, and vital signs for a 60- year-old patient as shown in the accompanying figure, which action should the nurse take first? Report the vision change to the health care provider Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? Changes in diet and exercise may control blood glucose levels in type 2 diabetes. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about lifestyle changes to lower blood glucose. A 28-yr-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? The patient increases daily exercise when ketones are present 43 44 in the urine. The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? "Have you lost weight lately?" 44 4253 A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? Glycosylated hemoglobin The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? The patient will reach a glycosylated hemoglobin level of less than 7%. A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to check glucose level before, during, and after swimming. The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? "I can choose any foods, as long as I use enough insulin to cover the calories." To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take? Determine what types of activities the patient enjoys. Which statement by the patient indicates a need for additional instruction in administering insulin? "I need to rotate injection sites among my arms, legs, and abdomen each day." Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? The patient cleans the skin with soap and water before insulin administration. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? 10:00 AM c. 2:00 PM Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? The patient programs the pump for an insulin bolus after eating. A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? 45 48 will the nurse teach the patient to take? Check the blood glucose during the night Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? Give the patient a snack of peanut butter and crackers. 48 4295 Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? "Do you feel bloated after eating?" Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? Choose flat-soled leather shoes. Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? The patient's blood urea nitrogen (BUN) level is 52 mg/dL. A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline? Amitriptyline helps prevent transmission of pain impulses to the brain. A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? The patient took the prescribed metformin today. Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? The patient discards the open vials of glargine and regular insulin after 4 weeks. A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin? abdomen. The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? The patient has chest pressure when walking The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? Schedule the patient for a fasting blood glucose level. A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has 49 50 a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? Place the patient on a cardiac monitor. A patient with diabetic ketoacidosis is brought to the emergency 50 5237 next? Give the patient 4 to 6 oz more orange juice. Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? Measure the ankle-brachial index. After change-of-shift report, which patient will the nurse assess first? A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa After change-of-shift report, which patient should the nurse assess first? A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? Blood pressure Serum creatinine Urine for microalbuminuria Monofilament testing of the foot In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? Rotate NPH vial. Inject 20 units of air into NPH vial. Inject 2 units of air into regular insulin vial. Withdraw regular insulin. Withdraw 20 units of NPH. 1. A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? a. "Your brain needs a constant supply of glucose because it cannot store it." 2. A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum osmolarity: 375 mOsm/kg 3. After teaching a young adult client who is newly diagnosed 53 54 with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "Diabetes can cause blindness, so I should see the ophthalmologist yearly." 54 5258 4. A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Examine the client's feet for signs of injury. 5. A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." 6. A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." 7. A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 48-year old American Indian 8. A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? a. "Do not share your monitoring equipment." 9. A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." 10. After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. I will take this medicine immediately before I eat 11. A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Review the client's liver function study results. 55 58 mm Hg 20. A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of IV insulin 58 5390 21. A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond? a. One glass of wine is okay with a meal and is counted as two fat exchanges 22. A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? a. "Walk at a moderate pace for 1 mile daily." 23. A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas- kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? a. One acute rejection episode does not mean that you will lose the new organs. 24. After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? a. "If I develop an infection, I should stop taking my corticosteroid." 25. The nurse correlates which laboratory value with inadequate functioning of a transplanted pancreas? a. 50% decrease in urine amylase level 26. A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? a. Consult the provider to test for ketoacidosis 27. A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the client’s chart 28. A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to 59 60 prevent injury? a. Use a bath thermometer to test the water temperature 29. A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has 60 6332 stick myself with a needle." How should the nurse respond? a. Tell me what it is about the injections that are concerning you 39. A nurse assesses a client with diabetes mellitus who self- administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Instruct the client to rotate sites for insulin injection 40. A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Metformin (Glucophage) 41. After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. I should decrease my intake of protein and eliminate carbs from my diet 42. A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL • Postprandial blood glucose: 200 mg/dL • Hemoglobin A1c level: 5.5% a. Good control of blood glucose 43. A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: a. Draw up and inject the insulin glargine first, then draw up and inject the regular insulin 44. A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications. 1. Inspect bottles for expiration dates. 2. Gently roll the bottle of NPH between the hands. 63 3. Wash your hands. 64 4. Inject air into the regular insulin. 64 6353 5. Withdraw the NPH insulin. 6. Withdraw the regular insulin. 7. Inject air into the NPH bottle. 8. Clean rubber stoppers with an alcohol swab. a. ANS: 3, 1, 2, 8, 7, 4, 6, 5 45. A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds 46. A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations c. Tachycardia e. Orthostatic hypotension 47. A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." c. "Trim toenails straight across with a nail clipper." 48. A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a.Stroke b. Kidney failure c. Blindness 48. A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that 65