Med Surg exam** condenced

1. A client with type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A. The client should withhold the next scheduled dose of insulin. B. The client should promptly eat some protein and carbohydrates. C. The client's insulin levels are inadequate. D. The client would benefit from a dose of metformin.

ANS: C Rationale: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

2. A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A. Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) B. Random plasma glucose greater than 150 mg/dL (8.3 mmol/L) C. Fasting plasma glucose greater than 116 mg/dL (6.4 mmol/L) on two separate occasions D. Random plasma glucose greater than 126 mg/dL (7.0 mmol/L)

ANS: A Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L), or a fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L).

3. A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class? A. Low fat generally indicates low sugar. B. Protein should constitute 30% to 40% of caloric intake. C. Most calories should be derived from carbohydrates. D. Animal fats should be eliminated from the diet.

ANS: C Rationale: For all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

4. A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client's family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the greatest impact on glucose reduction? A. Adequate sleep B. Low stimulation C. Exercise D. Low-fat diet

ANS: C Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low-fat intake and low levels of stimulation do not reduce a client's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is as pronounced as that of exercise.

5. A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of regular insulin three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's insulin? A. 10:45 AM B. 11:30 AM C. 11:45 AM D. 11:50 AM

ANS: B Rationale: Short-acting insulin is called regular insulin. It is in a clear solution and is usually given 15 minutes before a meal or in combination with a longer-acting insulin. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

6. A client has just been diagnosed with type 2 diabetes. The health care provider 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 health care provider prescribe for this client? A. A sulfonylurea B. A biguanide C. A thiazolidinedione D. An alpha-glucosidase inhibitor

ANS: B Rationale: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin, and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

7. A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? A. Do not eliminate insulin when nauseated and vomiting. B. Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). C. Eat three substantial meals a day, if possible. D. Reduce food intake and insulin doses in times of illness.

ANS: A Rationale: The most important issue to teach clients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL (16.6 mmol/L).

8. The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? A. The need for frequent eye examinations for clients with diabetes B. The fact that clients with diabetes have an elevated risk of myocardial infarction C. The relationship between kidney function and blood glucose levels D. The need to monitor urine for the presence of albumin

ANS: B Rationale: Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and kidney function are considered to be microvascular.

9. A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? A. Have blood glucose levels checked annually. B. Stop using tobacco in any form. C. Undergo eye examinations regularly. D. Lose weight, if obese.

ANS: D Rationale: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent diabetes.

10. A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? A. Type 1 diabetes B. Type 2 diabetes C. Non-insulin-dependent diabetes D. Prediabetes

ANS: A Rationale: Beta cell destruction is the hallmark of type 1 diabetes. Non- insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy

11. A client newly diagnosed with type 2 diabetes has been told by their family that they can no longer consume alcohol. The client asks the nurse if abstaining from all alcohol is necessary. What is the nurse's best response? A. "You should stop all alcohol intake. Alcohol is absorbed by your body before other important nutrients and may lead to very high blood glucose levels." B. "You do not need to give up alcohol entirely but there are potential side effects specific to clients with diabetes that you should consider." C. "You should no longer consume alcohol since it causes immediate low blood glucose levels in diabetic clients." D. "You can still consume alcohol, but limit your consumption to no more than 3 glasses of wine or beer daily because of the high sugar content of alcohol."

ANS: B Rationale: Clients with diabetes do not need to give up alcoholic beverages entirely. Moderation is the key. Moderate intake is no more than 1 alcoholic beverage (light beer, wine) for women and 2 drinks for men daily. Recommendations include avoiding mixed drinks and liqueurs because of the possibility of excessive weight gain, elevated glucose levels, and hyperlipidemia. Clients should be aware of potential side effects of alcohol consumption. These include diabetic ketoacidosis and hypoglycemia To combat possible hypoglycemia, clients with diabetes should not consume alcohol on an empty stomach.

12. An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? A. "I've always been a fan of sweet foods, but lately I'm turned off by them." B. "Lately, I drink and drink and can't seem to quench my thirst." C. "No matter how much sleep I get, it seems to take me hours to wake up." D. "When I went to the washroom the last few days, my urine smelled odd."

ANS: B Rationale: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

13. A diabetes educator is teaching a client about type 2 diabetes. The educator recognizes that the client understands the primary treatment for type 2 diabetes when the client states: A. "I read that a pancreas transplant will provide a cure for my diabetes." B. "I will take my oral antidiabetic agents when my morning blood sugar is high." C. "I will make sure to follow the weight loss plan designed by the dietitian." D. "I will make sure I call the diabetes educator when I have questions about my insulin."

ANS: C Rationale: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some clients may require insulin on an ongoing basis, or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

14. A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What are the current recommendations that the nurse would describe? A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

ANS: D Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

15. An older adult client with type 2 diabetes is brought to the emergency department by the client's daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A. Administration of antihypertensive medications B. Administering sodium bicarbonate intravenously C. Reversing acidosis by administering insulin D. Fluid and electrolyte replacement

ANS: D Rationale: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not given to clients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

16. A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? A. Ask the client to describe the process in detail. B. Observe the client drawing up and administering the insulin. C. Provide a health education session reviewing the main points of insulin delivery. D. Review the client's first hemoglobin A1C result after discharge.

ANS: B Rationale: Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

17. The nurse reviews foot care with an older adult client. Why would the nurse feel that foot care is so important to this client? A. An older adult client with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

ANS: B Rationale: The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the older adult with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs given for diabetes.

18. A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D. "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine."

ANS: A Rationale: The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test the blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the health care provider. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

19. Which of the following clients with type 1 diabetes is most likely to experience adequate glucose control? A. A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) B. A client who never deviates from the prescribed dose of insulin C. A client who adheres closely to a meal plan and meal schedule D. A client who eliminates carbohydrates from the daily intake

ANS: C Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by clients. For clients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, helps maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.

20. A pregnant client has been diagnosed with gestational diabetes. The client is shocked by the diagnosis, stating that they are conscientious about their health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A. Increased caloric intake during the first trimester B. Changes in osmolality and fluid balance C. The effects of hormonal changes during pregnancy D. Overconsumption of carbohydrates during the first two trimesters

ANS: C Rationale: Hyperglycemia and eventual gestational diabetes develop during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.

21. A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does this syndrome most often occur? A. Clients who are obese and who have no known history of diabetes B. Clients with type 1 diabetes and poor dietary control C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes

ANS: D Rationale: HHS occurs most often in older clients (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. HHS is a serious metabolic disorder resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. Obesity does play a role in HHS but clients usually have a history of type 2 diabetes. Clients with type 1 diabetes usually present with DKA (diabetic ketoacidosis). Adolescents with type 2 have a low incidence of this condition.

22. A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action? A. Avoid using the same injection site more than once in 2 to 3 weeks. B. Avoid mixing more than one type of insulin in a syringe. C. Cleanse the injection site thoroughly with alcohol prior to injecting. D. Inject at a 45-degree angle.

ANS: A Rationale: To prevent lipodystrophy, the client should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90-degree angle. Cleansing the injection site with alcohol is optional.

23. A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused this short-term change in treatment? A. Alterations in bile metabolism and release have likely caused hyperglycemia. B. Stress has likely caused an increase in the client's blood sugar levels. C. The client's efforts did not control the diabetes using nonpharmacologic measures. D. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

ANS: B Rationale: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The client's need for insulin is unrelated to the action of bile. The client's normal routine of nonpharmacological strategies of diet and exercise have been changed due to the client's admission to the hospital. Therefore, the client cannot overestimate what they cannot control. Electrolyte/ fluid balances may have some bearing on glucose levels, but stress is the most impactful cause of the change happening to this client.

24. The health care provider has explained to a client that the client has developed diabetic neuropathy in the right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A. "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B. "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C. "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D. "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose and ketone levels."

ANS: C Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugar (rather than fluctuations or variations in blood sugars) is thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.

25. A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments? A. Monitoring the client's neutrophil levels B. Assessing the client for signs of impaired liver function C. Monitoring the client's level of consciousness and behavior D. Reviewing the client's creatinine and BUN levels

ANS: D Rationale: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the client's kidney function. This drug does not typically affect clients' neutrophils, liver function, or cognition.

26. A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A. Infection B. Acute pain C. Acute confusion D. Impaired urinary elimination

ANS: A Rationale: Decreased sensations of pain and temperature place clients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.

27. A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A. IV administration of 50% dextrose in water B. Subcutaneous administration of 10 units of Humalog C. Subcutaneous administration of 12 to 15 units of regular insulin D. IV bolus of 5% dextrose in 0.45% NaCl

ANS: A Rationale: In hospitals and emergency departments, for clients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate, and insulin would exacerbate the client's condition.

28. A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A. Always carry a form of fast-acting sugar. B. Perform exercise prior to eating whenever possible. C. Eat a meal or snack every 8 hours. D. Check blood sugar at least every 24 hours.

ANS: A Rationale: The following teaching points should be included in information provided to the client on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

29. A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? A. Signs and symptoms of diabetic nephropathy B. Management of diabetic ketoacidosis C. Effects of surgery and pregnancy on blood sugar levels D. Recognition of hypoglycemia and hyperglycemia

ANS: D Rationale: It is imperative that newly diagnosed clients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the client's immediate "survival skills" following a new diagnosis.

30. A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A. "If you are going to use up the vial within 1 month, it can be kept at room temperature." B. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

ANS: A Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

31. A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action? A. Ensure that the client understands the basic pathophysiology of diabetes. B. Identify the client's body mass index. C. Teach the client "survival skills" for diabetes. D. Assess the client's readiness to learn.

ANS: D Rationale: Before initiating diabetes education, the nurse assesses the client's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.

32. A student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A. A combination of protein and carbohydrates, such as a small cup of yogurt B. Two teaspoons of sugar dissolved in a cup of apple juice C. Half of a cup of juice, followed by cheese and crackers D. Half a sandwich with a protein-based filling

ANS: C Rationale: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours.

33. A client 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 client's initial phase of treatment? A. Monitoring the client for dysrhythmias B. Maintaining and monitoring the client's fluid balance C. Assessing the client's level of consciousness D. Assessing the client for signs and symptoms of venous thromboembolism

ANS: B Rationale: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the client for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

34. A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend? A. Participation in a support group for persons with diabetes B. Regular consultation of websites that address diabetes management C. Weekly telephone "check-ins" with an endocrinologist D. Participation in clinical trials relating to antihyperglycemics

ANS: A Rationale: Participation in support groups is encouraged for clients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on clients' circumstances.

35. A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? A. Examine feet weekly for redness, blisters, and abrasions. B. Avoid the use of moisturizing lotions. C. Avoid hot-water bottles and heating pads. D. Dry feet vigorously after each bath.

ANS: C Rationale: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the client should gently, not vigorously, pat feet dry to avoid injury.

36. The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A. Teach the client about actions to slow the progression of nephropathy. B. Ensure that the client receives a comprehensive assessment of liver function. C. Determine whether the client has been using expired insulin. D. Administer a fluid challenge and have the test repeated.

ANS: A Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the client's liver function is not likely affected. There is no indication for the use of a fluid challenge.

37. A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? A. Persistently cold feet B. Pain that does not respond to analgesia C. Acute pain, unrelieved by rest D. The presence of a tingling sensation

ANS: D Rationale: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.

38. A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse? A. "DKA can be caused by taking too much insulin." B. "DKA can be caused by taking too little insulin." C. "DKA can happen without a cause." D. "DKA will not happen with type 1 diabetes."

ANS: B Rationale: Three main causes of DKA are decreased or missed dose of insulin, illness or infection, and undiagnosed and untreated diabetes. DKA may be the initial manifestation of type 1 diabetes. For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates. Drinking fluid every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours, and the client should take the usual dose of insulin.

39. A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. A. Leukocytosis B. Glycosuria C. Dehydration D. Hypernatremia E. Hyperglycemia

ANS: B, C, E Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hyponatremia and increased osmolarity occur. Leukocytosis does not take place.

1. A nurse touches a patients hand to indicate caring and support. What channel of communication is the nurse using?

A) auditory

B) visual

C) olfactory

D) kinesthetic

D

2. A nurse is teaching a home care patient how to administer a topical medication. The patient is watching television while the nurse is talking. What might be the result of this interaction?

A) The message will likely be misunderstood.

B) The stimulus for communication is unclear.

C) The receiver will accurately interpret the message.

D) The communication will be reciprocal.

A

3. A nurse gives a speech on nutrition to a group of pregnant women. What is the speech itself known as?

A) stimulus

B) source

C) message

D) channel

C

4. The family of a patient in a burn unit asks the nurse for information. The nurse sits with the family and discusses their concerns. What type of communication is this?

A) intrapersonal

B) interpersonal

C) organizational

D) focused

B

5. Which of the following is an example of nonverbal communication?

A) A nurse says, I am going to help you walk now.

B) A nurse presents information to a group of patients.

C) A patients face is contorted with pain.

D) A patient asks the nurse for a pain shot.

C

6. A student caring for an unconscious patient knows that communication is important even if the patient does not respond. Which nonverbal action by the student would communicate caring?

A) making constant eye contact with the patient

B) waving to the patient when entering the room

C) sighing frequently while providing care

D) holding the patients hand while talking

D

7. Which of the following statements is true of factors that influence communication?

A) Nurses provide the same information to all patients, regardless of age.

B) Men and women have similar communication styles.

C) Culture and lifestyle influence the communication process.

D) Distance from a patient has little effect on a nurses message.

C

8. A nurse is sitting near a patient while conducting a health history. The patient keeps edging away from the nurse. What might this mean in terms of personal space?

A) The nurse is too far away from the patient.

B) The nurse is in the patients personal space.

C) The patient does not like the nurse.

D) The patient has concerns about the questions.

B

9. Why is communication important to the assessing step of the nursing process?

A) The major focus of assessing is to gather information.

B) Assessing is primarily focused on physical findings.

C) Assessing involves only nonverbal cues.

D) Written information is rarely used in assessment.

A

10. Which of the following statements accurately describe the relationship between therapeutic communication and the nursing process?

Select all that apply.

A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step.

B) Only the written word in the form of a medical record is used during the diagnosing step of the nursing process.

C) The implementing step requires communication among the patient, nurse, and other team members to develop interventions and outcomes.

D) Verbal and nonverbal communication are used to teach, counsel, and support patients and their families during the implementation phase.

E) Nurses rely on the verbal and nonverbal cues they receive from their patients to evaluate whether patient objectives or goals have been achieved.

F) Because one nurse cannot provide 24-hour coverage for patients, significant information must be passed on to

A,D,E

A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step.

D) Verbal and nonverbal communication are used to teach, counsel, and support patients and their families during the implementation phase.

E) Nurses rely on the verbal and nonverbal cues they receive from their patients to evaluate whether patient objectives or goals have been achieved.

11. A nurse uses the SBAR method to hand off the communication to the healthcare team. Which of the following might be listed under the B of the acronym?

A) vital signs

B) mental status

C) patient problem

D) further testing

B

12. What is the goal of the nurse in a helping relationship with a patient?

A) to provide hands-on physical care

B) to ensure safety while caring for the patient

C) to assist the patient to identify and achieve goals

D) to facilitate the patients interactions with others

C

13. Which of the following is a characteristic of the helping relationship?

A) it occurs spontaneously

B) it is similar to a social relationship

C) it is an unequal sharing of communication

D) it is based on the needs of the nurse

C

14. What action by the nurse will facilitate the helping relationship during the orientation phase?

A) providing assistance to meet activities of daily living

B) introducing himself or herself to the patient by name

C) designing a specific teaching plan of care

D) preparing for termination of the relationship

B

15. Which of the nursing roles is primarily performed during the working phase of the helping relationship?

A) teacher and counselor

B) provider of care

C) leader and manager

D) researcher

A

16. A nurse who is discharging a patient is terminating the helping relationship. Which of the following actions might the nurse perform in this phase? Select all that apply.

A) making formal introductions

B) making a contract regarding the relationship

C) providing assistance to achieve goals

D) helping patient perform activities of daily living

E) examining goals of relationship for achievement

F) helping patient establish helping relationship with another nurse

E,F

17. What term describes a nurse who is sensitive to the patients feelings but remains objective enough to help the patient achieve positive outcomes?

A) competent

B) caring

C) honest

D) empathic

D

18. What is the primary focus of communication during the nursepatient relationship?

A) time available to the nurse

B) nursing activity to be performed

C) patient and patient needs

D) environment of the patient

C

19. Which of the following is an example of a closed-ended question or statement?

A) How did that make you feel?

B) Did you take those drugs?

C) What medications do you take at home?

D) Describe the type of pain you have.

B

20. A patient tells the nurse that he is very worried about his surgery. Which of the following responses by the nurse is a clich?

A) Tell me what you are worried about.

B) What is it that you are worried about?

C) Do you want to cancel your surgery?

D) Dont worry, everything will be fine.

D

21. A nurse tells a patient, Why wont you get out of bed? Are you always this lazy? This is an example of which of the following barriers to communication?

A) using comments that give advice

B) using judgmental language

C) using leading questions

D) using probing questions

B

22. A nurse is caring for a patient who is visually impaired. Which of the following is a recommended guideline for communication with this patient?

A) Ease into the room without acknowledging presence until the patient can be touched.

B) Speak in a louder tone of voice to make up for lack of visual cues.

C) Explain reason for touching patient before doing so.

D) Keep communication simple and concrete.

C

What is the nurses best defense if a patient alleges nursing negligence?

A) testimony of other nurses

B) testimony of expert witnesses

C) patients record

D) patients family

C

A nurse is documenting the intensity of a patients pain. What would be the most accurate entry?

A) Patient complaining of severe pain.

B) Patient appears to be in a lot of pain and is crying.

C) Patient states has pain; walking in hall with ease.

D) Patient states pain is a 9 on a scale of 1 to 10.

D

Which of the following data entries follows the recommended guidelines for documenting data?

A) Patient is overwhelmed by the diagnosis of pancreatic cancer.

B) Patient kidneys are producing sufficient amount of measured urine.

C) Following oxygen administration, vital signs returned to baseline.

D) Patient complained about the quality of the nursing care provided on previous shift.

C

Alice Jones, a registered nurse, is documenting assessments at the beginning of her shift. How should she sign the entry?

A) Alice J, RN

B) A. Jones, RN

C) Alice Jones

D) AJRN

B

In which of the following cases should a progress note be written? Select all that apply.

A) for any nursepatient interaction

B) when admitting a patient

C) when receiving a patient postoperatively

D) when assisting a patient with ADLs

E) when a procedure is performed

F) when a patient sends back an untouched dinner tray

B,C,E

A student has reviewed a patients chart before beginning assigned care. Which of the following actions violates patient confidentiality?

A) writing the patients name on the student care plan

B) providing the instructor with plans for care

C) discussing the medications with a unit nurse

D) providing information to the physician about laboratory data

A

Which of the following are examples of breaches of patient confidentiality? Select all that apply.

A) A nurse discusses a patient with a coworker in the elevator.

B) A nurse shares her computer password with a relative of a patient.

C) A nurse checks the medical record of a patient to see who should be called in an emergency.

D) A nurse updates the employer of a patient regarding the patients return to work.

E) A nurse uses a computer to document a patients response to pain medication.

F) A head nurse accesses the medical records of a nurse on her shift to check her condition.

A,B,D,F

Which of the following are examples of incidental disclosures of patient health information that are permitted? Select all that apply.

A) A nurse working in a physicians office puts out a sign-in sheet for incoming patients.

B) Two nurses are overheard talking about a patient through the door of an empty patient room.

C) A nurse places a patient chart in a holder on the examining room door with the name facing out.

D) A nurse leaves an x-ray on a light board in the hallway that leads to the examining rooms.

E) A nurse calls out the name of a patient who is seated in the waiting room.

F) A nurse leaves a reminder for an appointment on a patients answering machine along with the results of lab work.

A,B,E

A patient asks to see his medical record (chart). How would the nurse respond?

A) I cant let you do that without a doctors order.

B) Our hospital policy is that you cant do that.

C) I will get your chart and provide you with privacy to read it.

D) Why would you want to do that? It will only make you worry.

C

A physicians order reads up ad lib. What does this mean in terms of patient activity?

A) may walk twice a day

B) may be up as desired

C) may only go to the bathroom

D) must remain on bed rest

B

Which of the following abbreviations are on the list of the Joint Commission do not use abbreviations? Select all that apply.

A) U (unit)

B) QD (daily)

C) NPO (nothing per os)

D) mL (milliliters)

E) > (greater than)

F) mcg (micrograms)

A,B,E

What is the primary purpose of the patient record?

A) communication

B) advocacy

C) research

D) education

A

In what type of documentation method would a nurse document narrative notes in a nursing section?

A) problem-oriented medical record

B) source-oriented record

C) PIE charting system

D) focus charting

B

Which one of the following methods of documentation is organized around patient diagnoses rather than around patient information?

A) problem-oriented medical record (POMR)

B) source-oriented record

C) PIE charting system

D) focus charting

A

What is the primary purpose of focus charting?

A) nursing diagnoses

B) medical problems

C) patient concerns

D) expected outcomes

C

A nurse organizes patient data using the SOAP format. Which of the following would be recorded under S of this acronym?

A) patient complaints of pain

B) patient symptoms

C) patients chief complaint

D) patient interventions

A

Which of the following methods of documenting patient data is least likely to hold up in court if a case of negligence is brought against a nurse?

A) problem-oriented medical record

B) charting by exception

C) PIE charting system

D) focus charting

B

Which of the following information would a nurse include as part of a minimum data set when using electronic medical records? Select all that apply.

A) patient sex

B) patient admission date

C) patient physical assessment

D) patient insurance

E) patient history

F) patient ethnicity

A,B,D,F

A nurse has access to computerized standardized plans of care. After printing one for a patient, what must be done next?

A) Date it and put it in the patients record.

B) Sign it and put it in the Kardex.

C) Individualize it to the specific patient.

D) Use it as printed, based on common needs.

C

What part of the patients record is commonly used to document specific patient variables, such as vital signs?

A) progress notes

B) nursing notes

C) critical paths

D) graphic record

D

A nurse is documenting information about a patient in a long-term care facility. What is used in a Medicare-certified facility as a comprehensive assessment and as the foundation for the Resident Assessment Instrument (RAI)?

A) PIE system

B) minimum data set

C) OASIS

D) charting by exception

B

What is the primary purpose of an incident report?

A) means of identifying risks

B) basis for staff evaluation

C) basis for disciplinary action

D) format for audiotaped report

A

A group of nurses visits selected patients individually at the beginning of each shift. What are these procedures called?

A) nursing care conferences

B) staff visits

C) interdisciplinary referrals

D) nursing care rounds

D

A nurse uses informatics to plan nursing care for a patient. Which three terms best describes this science as it is applied to nursing?

A) data, information, knowledge

B) process, documentation, analysis

C) research, controls, variables

D) hypothesis, nursing, practice

A

What generalization can be made about safety in patient care?

A) Healthcare providers exclude safety as a patient need.

B) Although safety is a basic human need, it is provided by self-care.

C) Safety is an important need, but not as important as self-actualization.

D) Safety is a paramount concern underlying all nursing care.

D) Safety is a paramount concern underlying all nursing care.

A nurse making a home visit for a patient living in a high-crime area observes that the apartment building does not have outside lighting. Why is this an important assessment?

A) It will make the patient less able to go to social gatherings.

B) Assessment includes risk factors in the home.

C) Although important, this assessment is irrelevant to care.

D)Nurses in home healthcare are not concerned with safety.

B) Assessment includes risk factors in the home.

Which of the following are examples of developmental risk factors? Select all that apply.

A) A toddler is allowed to crawl in a house that has not been childproofed.

B) A machinist works in an environment that exposes him to loud noises.

C) A sales executive worries that he wont make his yearly sales quota.

D) An elderly woman in a long-term healthcare facility is at high risk for falls.

E) A 42-year-old woman is unable to move her left side following a stroke.

F) A teenager has difficulty ambulating following multiple fractures from a MVA.

A) A toddler is allowed to crawl in a house that has not been childproofed.

D) An elderly woman in a long-term healthcare facility is at high risk for falls.

A patient is very anxious and states, I am so stressed. Why do these factors affect the patients safety?

A) stress increases retention of information

B) stress affects interpersonal relationships

C) stress increases concern about hazards

D) stress tends to narrow the attention span

D) stress tends to narrow the attention span

A nurse is assessing a patient who recently had a stroke. What is one area of assessment necessary to promote safety?

A) skin integrity

B) neuromuscular status

C) hygiene

D) abdominal integrity

B) neuromuscular status

A patient with type 1 diabetes has impaired sensation in her lower extremities. What teaching would be necessary to reduce her risk of injury?

A) Always test the temperature of bath water before stepping in.

B) Take your insulin twice a day as we have discussed.

C)Remember to follow your diet so you lose weight this month.

D) Rub lotion on the skin of your legs and feet twice a day.

A) Always test the temperature of bath water before stepping in.

Which of the following people is at greater risk for accidental injury?

A)

an infant just learning to crawl

B)

an older adult who walks 2 miles a day

C)

an athlete who exercises on a regular basis

D)

a worker who operates industrial machines

What age group is most vulnerable to toxic fumes or asphyxiation?

A) young children

B) adolescents

C) young adults

D) middle adults

Which of the following nursing diagnoses would be appropriate for teaching interventions for a single mother who leaves her toddler unattended in the bathtub?

A) Noncompliance

B) Risk for Suffocation

C) Risk for Falls

D) Risk for Imbalanced Body Temperature

A confused elderly woman who keeps attempting to remove tubes from her surgical incision is placed in wrist restraints. Which of the following diagnoses would be appropriate for this patient?

A) Risk for Contamination

B) Risk for Trauma

C) Risk for Falls

D) Risk for Disuse Syndrome

Which set of terms best describes first-aid care?

A) long-term, chronic illness

B) professional, hospital

C) immediate, temporary

D) skilled, complex

A nurse is conducting a prenatal class for expectant parents. What is one topic that should be addressed to promote safety in the developing fetus?

A) alcohol consumption and smoking

B) infant hygiene and feeding

C) the stages of labor with possible complications

D) the role of the father in proper prenatal care

What safety device for children is mandated by law in all 50 states?

A) bumper pads in baby cribs

B) infant car seats and carriers

C) automatic hot water heater controls

D) parental controls for Internet access

An emergency room nurse is assessing a toddler with multiple bruises and burns. The nurse suspects the toddler has been abused. What is legally required of the nurse?

A) Nothing; the nurse has no control over the toddlers home.

B) Refer the caregivers of the toddler to a home health nurse.

C) Verbally confront the caregivers about the suspicions.

D) Report suspicions about the abuse to proper authorities.

A grade school nurse is addressing parents at a PTA meeting regarding car safety. Which of the following is a recommended safety guideline for this age group?

A) All school-aged children need to be secured in safety seats.

B) Booster seats should be used for children until they are 4-feet 9-inches tall or at least 8 years of age.

C) Children under 8 years old should ride in the back seat.

D) All school-aged children need to be secured in lap seat belts.