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77 Cards in this Set

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The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks several blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what instruction about long-term care to the client?

Be sure to practice meticulous foot care

The nurse is planning the care of a patient who has type 1 diabetes and who will be undergoing knee replacement surgery. This patient's care plan should reflect an increased risk of what postsurgical complications? Select all that apply.

• Acidosis


• Hypoglycemia


• Glucosuria

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?

A biguanide

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation?

Ask the physician to delay the discharge because the client requires further teaching.

A patient with type 1 diabetes complains about waking up in the middle of the night nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood sugar readings have been 110 to 140 mg/dL; the patient admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse will plan to instruct the patient to do which of the following?

Check blood glucose at 3:00 am

Which statement best indicates that a client understands how to administer his own insulin injections?

I wrote down the steps in case I forget what to do

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:

Rapid acting insulin only

Mr. Thomas has come to the clinic complaining about having to get up frequently to void in the night, or nocturia. The physician is planning to order some tests to determine the cause of the problem. Of the following, which is not a probable cause of his problem?

Neurogenic bladder

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide?

Practice meticulous foot care

A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

Administer half of the client's typical morning insulin dose as ordered.

A patient with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestations associated with this classic symptom?

Muscle wasting and tissue lossCorrect

A patient is admitted with diabetic ketoacidosis (DKA). The physician writes all of the following orders. Which order should the nurse implement first?

Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

Which factor presents the most likely cause for weight gain in a diabetic client who is controlled with insulin?

Insulin is an anabolic hormone

A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause?

Macular degeneration

The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?

Clients have chronic renal failure

A program of weight loss and exercise is recommended for a client with type 2 diabetes. When teaching the client about lifestyle changes, what type of assessment would the nurse prioritize?

Individual cultural assessment

A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop?

Furuncle

A 1,200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The nurse is teaching the patient about meal planning using exchange lists. The teaching is determined to be effective based on which of the following statements?

For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion, a green salad with 1 teaspoon Italian dressing, 1 cup of watermelon, and a diet soda

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

Switch the client to a different oral antidiabetic agent

Once digested, what percentage of carbohydrates is converted to glucose?

100

The nurse is working with a coalition that is creating a global strategy to prevent and control diabetes. The nurse suggests which of the following strategies? Select all that apply.

• Policy creation for diabetes prevention


• Partnering with American Diabetes Association


• Focusing on healthy lifestyle programming


• Monitoring incidence and prevalence rates

A patient with type 2 diabetes has recently been placed on acarbose (Precose); the nurse is explaining how to take this medication. The teaching is determined to be effective based on which of the following statements?

“I will take this medication in the morning, with my first bite of breakfast.”

A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client'sblood glucose level. Which medication is the client most likely taking?

Carvedilol (Coreg)

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?

Initiate fluid replacement therapy.

A patient with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which of the following factors should the nurse monitor when caring for the patient?

Low blood glucose levels

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?

Hypotension

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.

• Hypertension• Age greater of 45 years or older


• Family history


• History of gestational diabetes


• Obesity

As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms, and consequences. One of the women in your lecture group asks if you know the death rate from diabetes mellitus. What is your response?

Seventh cause of death in the United States

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurse's priority action?

Assess the patient's readiness to learn.

A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient?

This is significant for poor neurologic outcomes.

Which of the following would be considered a “free” item from the exchange list?

diet soda

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?

High blood sugar decreases blood circulation to nerves.

You are the nurse caring for a patient who is Native American who arrives at the clinic for treatment related to type 2 diabetes. Which question would best provide you with information about the role of food in the patient's cultural practices and identify how the patient's food preferences could be related to his problem?

“Tell me about foods that are important in your culture and how you feel they influence your diabetes.”

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment?

Maintaining and monitoring the patient's fluid balance

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?

The nurse is assigned to a group of clients and will be providing education to all of them. The client most in need of teaching is the client who

is to perform daily foot checks as a result of diabetes

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

IV administration of 50% dextrose in water

A diabetes nurse is assessing a patient's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patient's knowledge of nutritional therapy in diabetes?

Ask the patient to keep a food diary and review it with the nurse.

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?

Promote absorption.

A patient who has developed kidney failure is discussing options with the physician for treatment. What does the nurse understand that kidney failure is associated with?

A deficiency in circulating lymphocytes

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

Hydrating with saline intravenously before the test

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient’s glomerular filtration rate (GFR) to be?

A GFR of 30–59 mL/min/1.73 m2

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?

When the urine output is less than 30 mL/h

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient?

Anemia

A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patient's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.

• The cuffs are made of Dacron polyester.


• The cuffs stabilize the catheter.


• The cuffs prevent the dialysate from leaking.


• The cuffs provide a barrier against microorganisms.

The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

• Assess for the presence of peripheral edema.


• Assess the patient's BP.

The nurse is instructing a senior high health class on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.

• Regulates red blood cell production


• Regulate calcium and the synthesis of vitamin D


• Activates growth hormone


• Controls blood pressure• Excretes waste products

The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply.

• Transient ischemic attacks


• Retinal hemorrhage


• Cerebrovascular accident

A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following?

Place emergency medical equipment in the procedure room.

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply.

• Visible characteristics of the output


• Color of the output


• Quantity of output

Which condition may contribute to hyperparathyroidism?

Chronic renal failure

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

1 minute

Which of the following electrolyte imbalances occur with adrenal insufficiency?

Hyperkalemia

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.

• Potassium 6.4 mEq/L; dysrhythmias and abdominal distention


• Calcium 7.5 mg/dL; hypotension and irritability


• Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

The nurse is reviewing the client’s lab results. Which lab result requires follow up by the nurse? Select all that apply.

• Urine: RBC 20


• BUN 28 mg/dL

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?

Hydronephrosis

Treatment of metabolic acidosis in chronic renal failure includes:

no treatment

A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response?

Recognize this as an expected finding.

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.

• Specific gravity of the patient's urine


• Testing for the presence of glucose in the patient's urine


• Microscopic examination of urine sediment for RBCs


• Microscopic examination of urine sediment for casts

Which statement by the client preparing for a voiding cystourethrography indicates further teaching by the nurse is needed?

“The dye is injected through an IV.”

A male client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, he frequently suffers from breathing difficulty. Which of the following measures should the nurse include in the care plan to relieve him of the distress? Choose all correct options.

• Provide firm support for the incision when he coughs.


• Auscultate lung sounds once per shift.


• Help him to breathe deeply and cough every 2 hours.

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Hypertension

A patient with ESKD is scheduled to have an arteriovenous fistula created. The nurse explains that the patient will have a temporary dialysis catheter because the fistula has to “mature.” The nurse will explain that the patient will have to wait how long before using the fistula?

2 to 3 months

A client with adrenal insufficiency is brought into the ED where you practice nursing. The client is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client’s family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include which of the following?

Observe for signs of hyponatremia and hyperkalemia.

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?

Anemia

A patient has experienced excessive losses of bicarbonate and has subsequently developed an acid–base imbalance. How will this lost bicarbonate be replaced?

Renal tubular cells will generate new bicarbonate.

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply.

• Decreased protein intake


• Fluid restriction


• Decreased sodium intake

Common tests of renal function include which of the following? Select all that apply.

• Blood urea nitrogen (BUN)


• Renal concentration test


• Creatinine clearance


• Serum creatinine

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?

Albumin infusion

The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase?

It is accompanied by reduced blood flow to the nephrons.

A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans?

High-protein diet

A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote?

Close monitoring of urine output and kidney function

Which of the following is an inappropriate nursing diagnosis for the client following a voiding cystourethrography?

Deficient knowledge: procedure

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms?

No symptoms

The nurse understands acute dialysis is indicated in which of the following situations?

Impending pulmonary edema

Following are complications the nurse should monitor for during dialysis except for which of the following?

Hypertension