Test Bank For Medical Surgical Nursing, clinical Reasoning 6TH Edition LeMone / Burke/ Bauldoff / Gubrud Complete All Chapters

Test Bank For Medical Surgical Nursing, clinical Reasoning 6TH Edition LeMone / Burke/ Bauldoff / Gubrud Complete All Chapters LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank Question 1 Type: MCSA A patient with diabetes mellitus and poor circulation has thick and ingrown toenails. What should the nurse instruct the patient to do? 1. Soak feet in Epsom salts daily. 2. Use a clean sharp razor blade to trim nails. 3. Make an appointment with a podiatrist. 4. Cut toenails immediately prior to bathing. Correct Answer: 3 Rationale 1: There is no indication for this patient to soak feet daily in Epsom salts. Rationale 2: The use of a clean sharp razor could cause an injury. Rationale 3: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Rationale 4: Cutting the nails before a bath would be difficult because the nails are thick and ingrown. Global Rationale: The toenails of the patient with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails before a bath would be difficult because the nails are thick and ingrown. There is no indication of a need for soaking feet daily in Epsom salts. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank Copyright 2015 by Pearson Education, Inc. Learning Outcome: 5. Discuss best practices of self-care management of DM related to diet planning, sick day management, and exercise. MNL Learning Outcome: 10.5.4. Utilize the nursing process in care of client. Page Number: 530 Question 2 Type: MCSA A patient with diabetes asks what can be done to prevent the development of corns on the feet. How should the nurse respond to this patient? 1. “Make sure that you select shoes that are appropriately fitted.” 2. “Use corn pads to gradually remove the growths.” 3. “Corns are best treated by shaving them off.” 4. “A mild abrasive soap can be used to scrub the area to remove them.” Correct Answer: 1 Rationale 1: Corns can be prevented by wearing correctly fitting shoes. Rationale 2: Corn pads are not an option for the diabetic patient. Rationale 3: Shaving treatments to remove the corns and are not an option for the diabetic patient. Rationale 4: Scrubs to remove the corns are not option for the diabetic patient. Global Rationale: Corns can be prevented by wearing correctly fitting shoes. Corn pads, scrubs, and shaving treatments to remove the corns and are not options for the diabetic patient. Cognitive Level: Applying Client Need: Safe and Effective Care Environment Client Need Sub: Safety and Infection Control QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Discuss best practices of self-care management of DM related to diet planning, sick day management, and exercise. MNL Learning Outcome: 10.5.4. Utilize the nursing process in care of client. LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank Copyright 2015 by Pearson Education, Inc. Page Number: 530 Question 3 Type: MCSA A patient at risk for the development of type 2 diabetes mellitus asks why weight loss will reduce risk of the condition. Which response by the nurse is most accurate? 1. “The amount of foods taken in require more insulin to adequately metabolize them, resulting in diabetes.” 2. “Excess body weight impairs the body’s release of insulin.” 3. “Thin people are less likely to become diabetic.” 4. “The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin.” Correct Answer: 2 Rationale 1: This is not a true statement. Rationale 2: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. Rationale 3: While obesity is a risk factor for the development of diabetes, this does not answer the patient’s question. Rationale 4: Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin. Global Rationale: Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food ingested does not mean that diabetes will develop because more insulin is needed to process the food eaten. While obesity is a risk factor for the development of diabetes, this does not answer the patient’s question. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test Bank Copyright 2015 by Pearson Education, Inc. Learning Outcome: 2. Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM. MNL Learning Outcome: 10.5.2. Differentiate the risk factors and manifestations for diabetes. Page Number: 503 Question 4 Type: MCSA A patient recently diagnosed with type 1 diabetes mellitus does not understand why the disease developed because the patient is thin and eats all of the time. What is the most appropriate response by the nurse? 1. “Thin people can be diabetic, too.” 2. “Your condition makes it impossible for you to gain weight.” 3. “Diabetes makes it difficult for your body to obtain energy from the foods you eat.” 4. “Your lab tests indicate the presence of diabetes.” Correct Answer: 3 Rationale 1: While the statement about diabetics being thin is correct, it does not answer the patient’s question. Rationale 2: It is not impossible for diabetics to gain weight. Rationale 3: The diabetic patient is unable to obtain the needed glucose for the body’s cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. Rationale 4: Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient’s needs for teaching. Global Rationale: The diabetic patient is unable to obtain the needed glucose for the body’s cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. While the statement about diabetics being thin is correct, it does not answer the patient. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, it does not meet the patient’s needs for teaching. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2. Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM. MNL Learning Outcome: 10.5.2. Differentiate the risk factors and manifestations for diabetes. Page Number: 505 Question 5 Type: MCSA A 78-year-old patient without polyuria, polydipsia, or polyphagia has a serum glucose level of 130 mg/dL. What should the nurse conclude about this patient? 1. The patient might have eaten a meal with high sugar content prior to the testing. 2. The laboratory results might be erroneous. 3. The patient has type 1 diabetes mellitus. 4. The patient will need to be assessed for other manifestations of diabetes. Correct Answer: 4 Rationale 1: A slight elevation in serum glucose level warrants further investigation. Rationale 2: There is no reason to question the laboratory results at this time. Rationale 3: There is inadequate information to make a diagnosis of type 1 diabetes mellitus. Rationale 4: Older adults with diabetes might not present with the classic symptoms of polyuria, polyphagia, or polydipsia. Symptoms of diabetes in older patients can include hypotension, periodontal disease, infections, and strokes. A slight elevation in serum glucose level warrants further investigation. Global Rationale: Older adults with diabetes might not present with the classic symptoms of polyuria, polyphagia, or polydipsia. Symptoms of diabetes in older patients can include hypotension, periodontal disease, infections, and strokes. A slight elevation in serum glucose level warrants further investigation. In an adequately functioning endocrine system, dietary intake is managed by the needed amounts of insulin produced by the pancreas. There is no reason to question the laboratory results at this time. There is inadequate information to make a diagnosis of type 1 diabetes mellitus. Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2. Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM. MNL Learning Outcome: 10.5.2. Differentiate the risk factors and manifestations for diabetes. Page Number: 506, 508 Question 6 Type: MCSA The nurse notes that a 41-year-old patient’s fasting blood glucose level is 125 mg/dL. What should the nurse suspect is occurring with the patient? 1. severe hyperglycemia 2. consistent with diabetes 3. normal results 4. consistent with prediabetes Correct Answer: 4 Rationale 1: This is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. Rationale 2: Diabetes is fasting blood glucose level of 126 mg/dL or greater. Rationale 3: A normal fasting blood glucose level is less than or equal to 100 mg/dL. Rationale 4: Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL. Global Rationale: Fasting blood glucose of 125 mg/dL is not severe hyperglycemia. If it were, the nurse would immediately notify the health care provider. This is not an indication of diabetes. A normal fasting blood glucose level is less than or equal to 100 mg/dL. Prediabetes is a fasting blood glucose level greater than 100 mg/dL and under 126 mg/dL. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 2. Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM. MNL Learning Outcome: 10.5.3. Examine the diagnosis, monitoring, treatment options, and complications for diabetes. Page Number: 505 Question 7 Type: MCSA A patient recently diagnosed with diabetes wants to check the urine for glucose instead of using capillary blood because of the cost. Which response should the nurse make to the patient? 1. “Urine testing is best when combined with serum testing.” 2. “Urine testing is as reliable as finger stick testing.” 3. “Yes, urine testing is cheaper than glucose test strips.” 4. “Would you like to switch to this method of monitoring?” Correct Answer: 1 Rationale 1: Urine glucose testing is no longer recommended for the patient with diabetes who is self-managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Rationale 2: Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Rationale 3: Telling the patient he is correct does not provide adequate information. Rationale 4: It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized by the patient. Global Rationale: Urine glucose testing is no longer recommended for the patient with diabetes who is self- managing the condition. The blood glucose level is likely to be drastically different than a urine level because urine may sit in the bladder for several hours. If the result is negative, the blood glucose could be normal, hyperglycemic (up to 180 mg/dL), or hypoglycemic (less than 70 mg/dL). Advising the patient the method of testing is not reliable is not entirely correct and does not provide needed information to the patient. Telling the patient he is correct does not provide adequate information. It is inappropriate for the nurse to make such a suggestion about the method of testing to be utilized to the patient. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Discuss best practices of self-care management of DM related to diet planning, sick day management, and exercise. MNL Learning Outcome: 10.5.3. Examine the diagnosis, monitoring, treatment options, and complications for diabetes. Page Number: 509 Question 8 Type: MCSA A patient with type 1 diabetes mellitus who had one episode of vomiting in the past 2 hours asks if the routine insulin injection should be taken. What action by the nurse is best at this time? 1. Contact the physician. 2. Explain the need to take the insulin. 3. Document the refusal and continue on with the planned care. 4. Check the patient’s fasting serum glucose level. Correct Answer: 2 Rationale 1: Contacting the physician at this time is premature. Rationale 2: Taking the insulin is the best course of action. The usual dose of insulin should be taken even if ill. Rationale 3: Documentation of the patient’s refusal is premature, as efforts have not been made to discuss the need for the medication. Rationale 4: Checking the morning fasting serum glucose will not reflect the patient’s current glucose level. Global Rationale: Taking the insulin is the best course of action. The usual dose of insulin should be taken even if ill. Contacting the physician at this time is premature. Documentation of the patient’s refusal is premature, as efforts have not been made to discuss the need for the medication. Checking the morning fasting serum glucose will not reflect the patient’s current glucose level. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Discuss best practices of self-care management of DM related to diet planning, sick day management, and exercise. MNL Learning Outcome: 10.5.3. Examine the diagnosis, monitoring, treatment options, and complications for diabetes. Page Number: 519 Question 9 Type: MCSA A patient beginning insulin for type 2 diabetes is experiencing blurred vision and is concerned about becoming blind. What response by the nurse is most appropriate? 1. “I will make an appointment for you to see an ophthalmologist.” 2. “I will call the physician to report your symptoms.” 3. “Blurry vision is very common. Do not worry.” 4. “This is a normal response when insulin therapy is initiated.” Correct Answer: 4 Rationale 1: It is beyond the scope of practice for the nurse to make a referral to another physician. Rationale 2: Contacting the physician is premature. Rationale 3: Telling the patient it is “nothing” minimizes the concerns voiced, and does not provide adequate information to the patient. Rationale 4: Vision changes are normal during the first weeks of insulin therapy. They will gradually resolve.