A client is brought to the ED in an unresponsive state, and a dX of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would IMMEDIATELY
... [Show More] prepare to initiate which anticipated health care provider's prescription?
a) endotracheal intubation
b) 100 units of NPH insulin
c) IV infusion of normal saline
d) IV infusion of sodium bicarbonate - correct answer C
An external insulin pump is prescribed for a client with DM and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump?
a) is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals
b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream
d) gives a small continuous dose of short-duration insulin subQ-- and the client can self-administer a bolus with an additional dose from the pump before each meal - correct answer D
A client with a diagnosis of DKA is being treated in the ED. Which findings would the nurse expect to note as confirming this diagnosis? SATA:
a) increase in pH
b) comatose state
c) deep, rapid breathing
d) decreased urine output
e) elevated blood glucose level
f) low plasma bicarbonate level - correct answer C, E, F
The nurse teaches a client with DM about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? SATA:
a) polyuria
b) shakiness
c) palpitations
d) blurred vision
e) lightheadedness
f) fruity breath odor - correct answer B, C, E
A client with DM demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the MOST APPROPRIATE intervention to decrease the client's anxiety?
a) administer a sedative
b) convey empathy, trust, and respect toward the client
c) ignore the signs and symptoms of anxiety so that they will soon disappear
d) make sure that the client knows all the correct medical terms to understand what is happening - correct answer B
The nurse provides instructions to a client newly dX with type I DM. The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement?
a) I will stop taking my insulin if I'm too sick to eat
b) i will decrease my insulin dose during times of illness
c) i will adjust my insulin dose according to the level of glucose in my urine
d) i will notify my HCP if my blood glucose level is higher than 250 mg/dL - correct answer D
A client is admitted to a hospital with a dX of DKA. The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item?
a) ampule of 50% dextrose
b) NPH insulin subcutaneously
c) IV fluids containing dextrose
d) Phenytoin (Dilantin) for the prevention of seizures - correct answer C
The nurse is monitoring a client newly dX with DM for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia?
a) polyuria
b) diaphoresis
c) hypertension
d) increased pulse rate - correct answer A
The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places highest priority on which client problem?
a) lack of knowledge
b) inadequate fluid volume
c) compromised family coping
d) inadequate consumption of nutrients - correct answer B
The home health nurse visits a client with a dX of type 1 DM. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a NEED FOR FURTHER TEACHING?
a) i need to stop my insulin
b) i need to increase my fluid intake
c) i need to monitor my blood glucose every 3 to 4 hours
d) i need to call the HCP because of these symptoms - correct answer A
The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action?
a) lower the head of the bed
b) test the drainage for glucose
c) obtain a culture of the drainage
d) continue to observe the drainage - correct answer B
After several diagnostic tests, a client is dX with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder?
a) fatigue
b) diarrhea
c) polydipsia
d) weight gain - correct answer C
A client is admitted to an ED and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially?
a) warm the client
b) maintain a patent airway
c) administer thyroid hormone
d) administer fluid replacement - correct answer B
The nurse is caring for a client admitted to the ED with DKA. In the acute phase, the nurse plans for which priority intervention?
a) correct the acidosis
b) admin 5% dextrose IV
c) apply a monitor for an EKG
d) administer short-duration insulin IV - correct answer D
A client with type 1 DM calls the nurse to report current episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?
a) the best time for me to exercise is after i eat
b) the best time for me to exercise is after breakfast
c) the beset time for me to exercise is mid to late afternoon
d) the best time for me to exercise is after my morning snack - correct answer C
The nurse is completing an assessment on a client who is being admitted for a dX workup for primary hyperparathyroidsim. which client complaint would be characteristic of this disorder?
a) diarrhea
b) polyuria
c) polyphagia
d) weight gain - correct answer B
The nurse is caring for a post-op parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the health care provider immediately?
a) laryngeal stridor
b) abdominal cramps
c) difficulty in voiding
d) mild to moderate incisional pain - correct answer A
A client is dX with pheochromocytoma. The nurse understands that this is a condition that has which characteristic?
a) causes profound hypotension
b) is manifested by severe hypoglycemia
c) is not curable and is treated symptomatically
d) causes the release of excessive amounts of catecholamines - correct answer D
The nurse is monitoring a client who was dX with type 1 DM and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? SATA:
a) tremors
b) anorexia
c) irritability
d) nervousness
e) hot, dry skin
f) muscle cramps - correct answer A, C, D
The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder?
a) a coagulation time of 5 mins
b) a urinary output of 50 mL/hour
c) a blood urea nitrogen level of 20 mg/dL
d) a heart rate that is 90 beats per minute and irregular - correct answer D
The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder?
a) it results from an oversecretion of insulin
b) it results from an undersecretion of corticotropic hormones
c) it results from an undersecretion of mineralocorticoid hormones
d) it results from an increased pituitary secretion of adrenocorticotropic hormone - correct answer D
The nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101 F, pulse of 88 bpm, respirations of 22 breaths/min, and BP of 100/72. Which finding would be of MOST concern for the nurse?
a) pulse
b) respiration
c) temperature
d) BP - correct answer C
The nurse is interviewing a client with type 2 DM. Which statement by the client indicates an understanding of the treatment for this disorder?
a) i take oral insulin instead of shots
b) by taking these meds, i am able to eat more
c) when i become ill, i need to increase the number of pills i take
d) the meds im taking help release the insulin i already make - correct answer D
The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?
a) i will need to limit the amount of protein in my diet
b) i should eat foods that have a lot of potassium in them
c) i am fortunate that i can eat all the salty foods i enjoy
d) i am fortunate that i donot need to follow any special diet - correct answer B
The nurse is caring for a client who is 2 days post-op following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carb-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is most appropriate at this time?
a) call a code to obtain needed assistance immediately
b) obtain a capillary blood glucose level and perform a focused assessment
c) ask the unlicensed assistive personnel (UAP) to stay with the client while obtaining 15 to 30 g of carbohydrate snack for the client to eat
d) stay with the client and ask the UAP to call the HCP for a prescription for IV 50% dextrose - correct answer B
The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority?
a) vital signs
b) intake and output
c) blood urea nitrogen results
d) urine for glucose and ketones - correct answer A
The nurse is preparing a client with a new dX of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this dX? SATA:
a) tremors
b) weight loss
c) feeling cold
d) loss of body hair
e) persistent lethargy
f) puffiness of the face - correct answer C, D, E, F
A client has just been admitted to the nursing unit following throidectomy. Which assessment is the priority for this client?
a) hypoglycemia
b) level of hoarseness
c) respiratory distress
d) edema at the surgical site - correct answer C
A client has been dX with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? SATA:
a) fever
b) nausea
c) lethargy
d) tremors
e) confusion
f) bradycardia - correct answer A, B, D, E
The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?
a) withdraws the NPH insulin first
b) withdraws the regular insulin first
c) injects air into NPH insulin vial first
d) injects an amount of air equal to the desired dose of insulin into each vial - correct answer A
The home care nurse visits a client recently dX with diabetes mellitus who is taking humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action?
a) freeze the insulin
b) refrigerate the insulin
c) store the insulin in a dark, dry place
d) keep the insulin at room temperature - correct answer B
Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication?
a) alcohol
b) organ meats
c) whole-grain cereals
d) carbonated beverages - correct answer A
Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. The nurse reviews the client's medical record and should question the prescription if which data is noted in the client's history?
a) insomnia
b) neuralgia
c) use of nitroglycerin
d) use of multivitamins - correct answer C
The health care provider prescribes exenatide (Byetta) for a client with type 1 DM who takes insulin. The nurse should plan to take which most appropriate intervention?
a) withhold the medication and call the HCP, questioning the prescription for the client
b) administer the medication within 60 mins b4 the morning and evening meal
c) monitor the client for the GI side effects after administering the med
d) withdraw the insulin from the prefilled pen into an insulin syringe to prep for administration - correct answer A
A client taking Humulin NPH insulin and rugular insulin every morning. The nurse should provide which instructions to the client? SATA:
a) hypoglycemia may be experienced before dinnertime
b) the insulin dose should be decreased if illness occurs
c) the insulin should be administered at room temp
d) the insulin vial needs to be shaken vigorously to break up the precipitates
e) the NPH insulin should be drawn into the syringe first, then the regular insulin - correct answer A, C
The home health care nurse is visiting a client who was recently dX with type 2 DM. the client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these meds. The nurse should provide which instructions to the client? SATA:
a) diarrhea may occur secondary to the metformin
b) the repaglinide is not taken if a meal is skipped
c) the repaglinide is taken 30 mins before eating
d) a simple sugar food item is carried and used to treat mild hypoglycemia episodes
e)metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.
f) muscle pain is an expected effect of metformin and may be treated with acetaminophen (tylenol) - correct answer A, B, C, D
The community health nurse visits a client at home. Prednisone, 10 mg orally daily, has been prescribed for the client and the nurse teaches the client about the med. Which statement, if made by the client, indicates that further teaching is necessary?
a) i can take aspirin or my antihistamine if i need it
b) i need to take the med every day at the same time
c) i need to avoid coffee, tea, cola, and cock in my diet
d) if i gain more than 5 lbs in a week, i will call my HCP - correct answer A
A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this med? SATA:
a) administer methimazole with food
b) place the client on a low-cal, low-protein diet
c) assess the client for unexplained bruising or bleeding
d) instruct the client to report side/adverse effects such as sore throat, fever, or headaches
e) use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration - correct answer A, C, D
The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this med? SATA:
a) insomnia
b) weight loss
c) bradycardia
d) constipation
e) mild heat intolerance - correct answer A, B, E
The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the med at which time?
a) with food
b) at lunchtime
c) on an empty stomach
d) at bedtime with a snack - correct answer C
The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the HCP if which problem occurs?
a) Fatigue
b) Tremors
c) Cold intolerance
d) Excessively dry skin - correct answer B
The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition?
a) myxedema
b) graves disease
c) addison's disease
d) cushing's syndrome - correct answer B
The nurse is instructing a client regarding intradermal desmopressin (DDAVP). The nurse should tell the client that which occurence is a side effect of the medication?
a) headache
b) vulval pain
c) runny nose
d) flushed skin - correct answer C
A daily dose of Prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the med and should instruct the client that which time is BEST to take this med?
a) at noon
b) at bedtime
c) early morning
d) any time, at the same time, each day - correct answer C
Prednisone is prescribed for a client with DM who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone?
a) an additional dose of prednisone daily
b) a decreased amount of humulin NPH insulin daily
c) an increased amount of daily Humulin NPH insulin
d) the addition of an oral hypoglycemic medication daily - correct answer C
A client with DM visits a health care clinic. The client's DM previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
a) prednisone
b) phenelzine (Nardil)
c) Atenolol (Tenormin)
d) Allopurinol (Zyloprim) - correct answer A
On the day of discharge, the client newly dX with type 1 diabetes says to the nurse, "tell me again, what should I do if I develop a fever?" Which response is best?
a) increase your caloric intake and decrease your insulin dosage.
b) discontinue taking insulin until after your febrile state has passed
c) continue taking insulin as prescribed
d) contact your physician to have the insulin dose adjusted - correct answer C
Need for insulin is increased with any concurrent illness, especially an infection; presence of a (fever?!), inability to ingest food, nausea, vomiting, diarrhea, and erratic blood glucose levels are all reasons for an immediate call to the physician (should they occur when the patient continues taking their insulin as prescribed)
The nurse understands that which type of insulin has the longest duration of action?
a) Regular
b) Glargine
c) NPH
d) Humulin R - correct answer B
onset of Glargine insulin: 3 to 4 hours
Small amount has NO peak;
duration = 24 hours
*NPH also has a duration of 24 hours but unlike Glargine, it DOES have a peak (4-12 hours)
the nurse in the outpatient clinic cares for a client with the diagnosis of Cushing's disease. The nurse should expect to observe which symptom?
a) weight loss
b) thin legs and arms
c) hypoglycemia
d) hypotension - correct answer B
even though there is truncal obesity, clients will have thin arms and legs due to MUSCLE WASTING
Patients will also have edema, purple striations, and a decreased resistance to infection [Show Less]