Med-Surg Nursing III Theory Questions & Answers

Med-Surg Nursing III Theory Questions & Answers The nurse is caring for a client admitted with type 2 diabetes who asks the nurse what "type 2" means. Which of the following statements is the best response by the nurse? a. "With type 2 diabetes, the body of the pancreas becomes inflamed." b. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." c. "With type 2 diabetes, the client is totally dependent on an outside source of insulin." d. "With type 2 diabetes, the body produces autoantibodies that destroy B-cells in the pancreas." b. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and the cells of the body become resistant to insulin or both. The nurse is caring for a 54-year-old client who is hospitalized with diabetes mellitus. Which of the following laboratory test results would provide information related to the client's past glucose control? a. Prealbumin level b. Urine ketone level Incorrect c. Fasting glucose level d. Glycosylated hemoglobin level d. Glycosylated hemoglobin level A glycosylated hemoglobin level (or hemoglobin A1C [A1C] test) detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2-3 months. The nurse is teaching a client with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). Which of the following actions by the client should alert the nurse that additional teaching is required? a. Chooses a puncture site in the centre of the finger pad The client should select a site on the sides of the fingertips, not on the centre of the finger pad. This area contains many nerve endings and would be unnecessarily painful. b. Washes hands with soap and water to cleanse the site to be used c. Warms the finger before puncturing the finger to obtain a drop of blood d. Tells the nurse that the result of 6.66 mmol/L indicates good control of diabetes a. Chooses a puncture site in the centre of the finger pad The client should select a site on the sides of the fingertips, not on the centre of the finger pad. This area contains many nerve endings and would be unnecessarily painful. The nurse is teaching a client with diabetes about proper composition of the daily diet. Which of the following percentages should the nurse explain is the guideline for daily carbohydrate intake? a. 80% b. 30% c. 45% d. 25% c. 45% The recommendation for carbohydrate intake is 45% to 60% of daily energy. Low-carbohydrate diets are not recommended for diabetes management. The nurse is caring for a client diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the client to actively participate in management of the diabetes, which of the following actions should the nurse do first? a. Assess client's perception of what it means to have diabetes. b. Ask the client to write down current knowledge about diabetes. Incorrect c. Set goals for the client to actively participate in managing his diabetes. d. Assume responsibility for all of the client's care to decrease stress level. a. Assess client's perception of what it means to have diabetes. In order for teaching to be effective, the first step is to assess the client. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the client. The nurse is beginning to teach a diabetic client about vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include in the teaching plan? a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, nerves, and skin. c. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. d. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of clients with diabetes. b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, nerves, and skin. Microangiopathy occurs in diabetes mellitus. The areas of the body most noticeably affected are the eyes (retinopathy), the kidneys (nephropathy), the nerves (neuropathy), and the skin (dermopathy). Sexual impotency and slowed gastric emptying result from microangiopathy. Macroangiopathy can occur in either type 1 or type 2 diabetes. The nurse is evaluating a client diagnosed with type 1 diabetes mellitus. Which of the following symptoms reported by the client is considered one of the classic clinical manifestations of diabetes? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision a. Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). The nurse is caring for a client with diabetes mellitus who is scheduled for a fasting blood glucose level at 0800 hours the next day. The nurse instructs the client to only drink water after which of the following times? a. 1800 hours b. 0400 hours c. midnight d. 0700 hours c. Midnight Typically, a client is ordered to be NPO for eight hours before a fasting blood glucose level. For this reason, the client who has a laboratory draw at 0800 hours should not have any food or beverages containing any calories after midnight. The nurse is caring for a client with diabetes mellitus who has a glucose level of 21.1 mmol/L and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? a. Central apnea b. Hypoventilation c. Kussmaul's respirations d. Cheyne-Stokes respirations c. Kussmaul's respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul's respirations, which are deep and nonlaboured. The nurse is assisting a diabetic client to learn dietary planning as part of initial management of diabetes. The nurse would encourage the client to limit intake of which of the following foods to help reduce the percent of fat in the diet? a. cheese b. broccoli c. chicken d. oranges a. cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. The nurse is reviewing laboratory results for a client with a 15-year history of diabetes. Which of the following laboratory results follows the expected pattern accompanying macrovascular disease as a complication of diabetes? a. Increased triglyceride levels b. Decreased low-density lipoproteins c. Increased high-density lipoproteins d. Decreased very-low-density lipoproteins a. Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebro-vascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. For this reason, the client should limit the amount of fat in the diet. The nurse has taught a client admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the client understands the principles of foot care if the client makes which of the following statements? a. "I should walk barefoot only in nice dry weather." b. "I should look at the condition of my feet every day." c. "I am lucky my shoes fit so nice and tight because they give me firm support." d. "When I am allowed up out of bed, I should check the shower water with my toes." b. "I should look at the condition of my feet every day." Clients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for delayed wound healing. Water temperature should be tested with the hands first. Properly fitted (not tight) shoes should be worn at all times. The nurse is caring for a client who received regular insulin 10 units subcutaneously at 2030 hours for a blood glucose level of 14.0 mmol/L. The nurse plans to monitor this client for signs of hypoglycemia at which of the following peak action times? a. hours b. hours c. hours Incorrect d. hours b. hours Regular insulin exerts peak action in two to three hours, making the client most at risk for hypoglycemia between 2230 and 2330 hours. The nurse is admitting a client with diabetes mellitus, malnutrition, and cellulitis. The client's potassium level is 5.6 mmol/L. The nurse considers that which of the following could be a contributing factor for this laboratory result? a. The level is consistent with renal insufficiency that can develop with renal nephropathy. b. The client may be excreting extra sodium and retaining potassium because of malnutrition c. There is a resulting decrease in serum glucose levels. d. Metabolic alkalosis as the pH will rebound. a. The level is consistent with renal insufficiency that can develop with renal nephropathy. Malnutrition does not cause sodium excretion accompanied by potassium retention; thus it is not a contributing factor to this client's potassium level. The additional stress of cellulitis may lead to an increase in the client's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters, in an attempt to compensate for a low pH. The nurse is caring for a client who has been receiving scheduled doses of phenytoin and begins to experience diplopia. Which of the following assessments should the nurse complete immediately? a. An aura b. Nystagmus or confusion c. Abdominal pain or cramping d. Irregular pulse or palpitations b. Nystagmus or confusion Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurological changes such as nystagmus, ataxia, confusion, dizziness, or slurred speech. The client has a prescription for phenytoin 100 mg q8hr IV. Available is a phenytoin injection containing 50 mg/mL. How many millilitres of solution should the nurse draw up for the dose? a. 0.5 b. 2 c. 5 d. 20 b. 2 100 mg / 50mg/mL = 2 Which of the following characteristics of a client's recent seizure is congruent with a complex partial seizure? a. The client lost consciousness during the seizure. b. The seizure involved lip-smacking and repetitive movements. c. The client fell to the ground and became stiff for 20 seconds. d. The etiology of the seizure involved both sides of the client's brain. b. The seizure involved lip smacking and repetitive movements. The most common complex partial seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity. Which of the following measures should the nurse prioritize when providing care for a client with a diagnosis of multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic vital signs and frequent reorientation Incorrect c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension a. Vigilant infection control and adherence to standard precautions Infection control is a priority in the care of clients with multiple sclerosis (MS), since infection is the most common precipitator of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in hypotension or fluid volume excess or deficit. The nurse recently admitted a client with a diagnosis of Parkinson's disease (PD) to a long-term care facility. Which of the following actions should the health care team take in order to promote adequate nutrition for this client? a. Provide multivitamins with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. d. Provide the client with a minced or puréed diet that is high in potassium and low in sodium. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. Nutritional support is a priority in the care of individuals with Parkinson's disease (PD). Such clients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or puréed diet, and a low carbohydrate diet is not indicated. Which of the following nursing diagnoses is likely to be a priority in the care of a client with myasthenia gravis (MG)? a. Acute confusion b. Bowel incontinence c. Activity intolerance d. Disturbed sleep pattern c. Activity intolerance The primary feature of myasthenia gravis (MG) is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern. The nurse is teaching a client with hypertension that uncontrolled hypertension may damage organs in the body. Which of the following mechanisms is the primary reason? a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. b. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d. Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions. a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. The nurse is teaching a client about dietary management of stage 1 hypertension. Which of the following instructions is best to include in the teaching plan? a. Restrict all caffeine. b. Restrict sodium intake. c. Increase protein intake. d. Use calcium supplements. b. Restrict sodium intake. The client should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. The nurse is caring for a client admitted with poorly controlled hypertension. Which of the following laboratory test results would indicate the presence of target organ damage secondary to the primary diagnosis? a. Blood urea nitrogen (BUN) of 5.36 mmol/L b. Serum uric acid of 0.20 mmol/L c. Serum creatinine of 145 mcmol/L d. Serum potassium of 3.5 mmol/L c. Serum creatinine of 145 mcmol/L The normal serum creatinine level is 15.3-76.3 mcmol/L. This elevated level indicates target organ damage to the kidneys.