NUR2571 Exam 3 Study Guide Professional Nursing II PN 2.pdf NUR2571 Module 5 Quiz Professi, Exams of Nursing

Download NUR2571 Exam 3 Study Guide Professional Nursing II PN 2.pdf NUR2571 Module 5 Quiz Professi and more Exams Nursing in PDF only on Docsity! 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 ▪ Have atropine available (antidote) - ALS – patient and family teaching (SATA), late s/s o Teaching: emotional support, teaching about signs/prevent respiratory distress, speech therapy (how 2 to communicate), physical therapy, talk about choices for end of life care o Late s/s: respiratory distress - Alzheimer’s – pt. and family teaching, what meds are used for, safety measures o Safety measures: remove scatter rugs, lock doors/alarms, good lighting, install handrails, place mattress on the floor, remove clutter, secure electrical cords to baseboards, keep cleaning supplies locked, wear identification bracelet o Meds: doesn’t cure but helps with behavior/emotional problems o Teaching: encourage AD support groups, safe environment, keep on a sleeping schedule, provide verbal and nonverbal communication, offer snacks and finger food, be consistent and repetitive, give memory training o promote self-care for as long as possible - Migraines – what helps, patient teaching, s/s of common migraine (SATA) o s/s: photophobia, pulsating sensation (throb), pain that gets worse with activities o patient teaching/what helps: dark environment - SCI (Spinal Cord Injury) – what to assess first, pt. teaching for respiratory o If blood pressure is high assess bladder first o Use of incentive spirometer to prevent pneumonia or ARDS Eyes - What is Strabismus o Commonly known as cross eyed; a vision condition in which a person cant align both eyes simultaneously under normal conditions. One or both of the eyes may turn in, out, up, or down - S/s, tx of cataracts o s/s: decreased visual acuity (reduced night vision) 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 5 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 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 6 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 A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.) Blurred vision and White pupils 7 A nurse is collecting data from a client who has Parkinson's disease. Which of the following are expected findings? (Select all that apply.) Pill-rolling tremor of the fingers, Shuffling gait, and Lack of facial expressions A nurse is assisting with a plan of care for the nutritional needs of a client who has stage 4 Parkinson's disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) Record diet and fluid intake daily, Add thickener to liquids, and Offer nutritional supplements between meals. A nurse is caring for a client who is to start therapy with bromocriptine (Parlodel). For which of the following should the nurse monitor? (Select all that apply.) Dyskinesias, Orthostatic hypotension, and Constipation A nurse is caring for a client who has Parkinson's disease and displays manifestations of bradykinesia. Which of the following is an appropriate action by the nurse? Assist with hygiene as needed A client is diagnosed as having insulindependent diabetes mellitus (IDDM). She received regular insulin at 7:30 A.M. When is she most apt to develop a hypoglycemic reaction? Mid-morning 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." At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority? 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? 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. 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. 11 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 The nurse is preparing a patient for a Tensilon (edrophonium chloride) test. What action by the nurse is most important? Obtaining atropine sulfate A patient with myasthenia gravis has the priority patient 12 problem of inadequate nutrition. What assessment finding indicates that the priority goal for this patient problem has been met? Weight gain of 3 lbs (1.4 kg) in 1 month An older patient is hospitalized with Guillain-Barré syndrome. A family member tells the nurse that the patient is restless and seems confused. What action by the nurse is best? Assess the patient's oxygen saturation A patient is in the preoperative holding area waiting for cataract surgery. The patient says "Oh, yeah, I forgot to tell you that I take clopidogrel, or Plavix." What action by the nurse is most important? Notify the surgeon immediately A patient does not understand why vision loss due to glaucoma is irreversible. What explanation by the nurse is best? "Because eye pressure was too high, the tissue died." A patient is taking timolol (Timoptic) eyedrops. The nurse assesses the patient's pulse at 48 beats/min. What action by the nurse is the priority? Hold the eyedrops and notify the provider A nurse is seeing patients in the ophthalmology clinic. Which patient would the nurse see first? Patient who has had cataract surgery and has worsening vision A nurse is teaching a patient about ear hygiene and health. What patient statement indicates a need for further teaching? "A soft cotton swab is alright to clean my ears with." The student nurse is performing a Weber tuning fork test. What technique is most appropriate? Placing the vibrating fork in the middle of the patient's head 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?" 15 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 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 16 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 12. The nurse should teach the client to avoid which of the following drinks when taking Glimepiride? a. Alcohol 13. Which of the following instruction should the nurse provide regarding glargine insulin? a. Insulin glargine has a duration of 18 to 24 hours 17 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 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? 20 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. 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 21 that the nurse should intervene immediately? UAP turn on the patient's television. The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider? The patient has eye pain rated at a 5 (on a 0 to 10 scale). Which finding in an emergency department patient who reports being struck in the right eye with a fist is a priority for the nurse to communicate to the health care provider? The patient complains of "a curtain" over part of the visual field. The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? The nurse encourages the patient to cough. Which nursing activity is appropriate for the registered nurse (RN) working in the eye clinic to delegate to experienced unlicensed assistive personnel (UAP)? Application of a warm compress to a patient's hordeolum A patient with a head injury after a motorcycle crash arrives in the emergency department (ED) complaining of shortness of breath and severe eye pain. Which action will the nurse take first? Check the patient's oxygen saturation. Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? Mannitol (Osmitrol) 100 mg IV The priority nursing diagnosis for a patient experiencing an acute attack with Meniere's disease is risk for falls related to dizziness. Which information about a patient who had a stapedotomy yesterday is most important for the nurse to communicate to the health care provider? The patient's oral temperature is 100.8° F (38.1° C). A 75-year-old patient who lives alone at home tells the nurse, "I am afraid of losing my independence because my eyes don't work as well they used to." Which action should the nurse take first? Ask the patient more about what type of vision problems are being experienced. 22 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 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?" 25 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 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 26 department. Which prescribed action should the nurse implement first? Infuse 1 L of normal saline per hour. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? Obtain a glucose reading using a finger stick. A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? The patient uses oral contraceptives. Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse's assessment of the patient? Noon blood glucose of 52 mg/dL When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible Blood pressure of 140/88 mmHg A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination as soon as possible. After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? "I should take my daily aspirin at least an hour before the Byetta." A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? Glomerular filtration rate is decreased. The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take 27 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 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." 30 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 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 31 depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond? a. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" 30. A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Presence of protein in the urine 31. A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? a. Proteins 32. A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice 33. A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum potassium level of 2.5 mmol/L 34. A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? a. Monitor your BG levels at least every 4 hours while sick 35. A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Glasgow coma scale score is unchanged 36. A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 1600 37. After teaching a client 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. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick 38. When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to 32 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. 3. Wash your hands. 4. Inject air into the regular insulin.