MED SURG 170 Exam 3 Evolve NCLEX Review – Galen College of Nursing.

MED SURG 170 Exam 3 Evolve NCLEX Review – Galen College of Nursing. CHAPTER 64 1. Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? A. Most clients with type 1 diabetes are born with it. B. People with type 1 diabetes are often obese. C. Those with type 2 diabetes make insulin, but in inadequate amounts. Correct D. People with type 2 diabetes do not develop typical diabetic complications. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications. 2. 2.ID: 8 The nurse receives report on a 52-year-old client with type 2 diabetes: Physical Assessment Diagnostic Findings Provider Prescriptions Lungs clear Glucose 179 mg/dL Regular insulin 8 units if blood glucose 250 to 275 mg/dL and cold to touch Right great toe mottled Hemoglobin A1c 6.9% Regular insulin 10 units if glucose 275 to 300 mg/dL Client states wears eyeglasses to read Which complication of diabetes does the nurse report to the provider? A. Poor glucose control B. Visual changes C. Respiratory distress D. Decreased peripheral perfusion Correct A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted. 3. 3.ID: 6 A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? A. 7:30 a.m. B. 11:00 a.m. Correct C. 2:00 p.m. D. 7:30 p.m. Onset of regular insulin is ½ to 1 hour; peak is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. For regular insulin received at 7:00 a.m., 7:30 a.m., 2:00 p.m., and 7:30 p.m. are not the anticipated peak times. 4. 4.ID: 0 A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client’s family? A. Causes and treatment of hyperglycemia B. Causes and treatment of hypoglycemia Correct C. Dietary control D. Insulin administration The causes and treatment of hypoglycemia must be understood by the client and family to manage the client’s diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the client with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation. 5. 5.ID: 2 The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? A. “I can break in my shoes by wearing them all day.” Correct B. “I need to monitor my feet daily for blisters or skin breaks.” C. “I should never go barefoot.” D. “I should quit smoking.” Shoes should be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering. People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated. Tobacco use further decreases peripheral circulation in a client with diabetes. 6. 6.ID: 4 The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? A. “I should begin exercising for at least an hour a day.” Correct B. “I should monitor my diet.” C. “If I lose weight, I may not need to use the insulin anymore.” D. “Weight loss can be a sign of diabetic ketoacidosis.” For long-term maintenance of major weight loss, large amounts of exercise (7 hr/wk) or moderate or vigorous aerobic physical activity may be helpful, but the client must start slowly. Monitoring the diet is key to type 2 diabetes management. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis. 7. 7.ID: 0 The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? A. “If I become hyperglycemic, it is a medical emergency.” B. “If I become hypoglycemic, I could become unconscious.” Correct C. “Medical personnel may need confirmation of my insurance.” D. “I may need to be admitted to the hospital suddenly.” Hypoglycemia is the most common cause of medical emergency in clients with diabetes. A MedicAlert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care. Hyperglycemia is not a medical emergency unless it is acidosis; people with diabetes tolerate mild hyperglycemia routinely. Insurance information and information needed for hospital admission do not appear on a MedicAlert bracelet. 8. 8.ID: 0 The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client’s knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? A. “I should drink a glass of water.” B. “I should eat three graham crackers.” Correct C. “I should give myself 1 mg of glucagon.” D. “I should sit down and rest.” Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia. 9. 9.ID: 4 A client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the client before providing instruction about the disease and its management? A. Current lifestyle B. Educational and literacy level Correct C. Sexual orientation D. Current energy level A large amount of information must be synthesized; typically written instructions are given. The client’s educational and literacy level is essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide selfcare. Although energy level will influence the ability to exercise, it is not essential. 10. 10.ID: 6 A client expresses fear and anxiety over the life changes associated with diabetes, stating, “I am scared I can’t do it all and I will get sick and be a burden on my family.” What is the nurse’s best response? A. “It is overwhelming, isn’t it?” B. “Let’s see how much you can learn today, so you are less nervous.” C. “Let’s tackle it piece by piece. What is most scary to you?” Correct D. “Other people do it just fine.” Suggesting the client tackle it piece by piece and asking what is most scary to him or her is the best response; this approach will allow the client to have a sense of mastery with acceptance. Referring to the illness as overwhelming is supportive, but is not therapeutic or helpful to the client. Trying to see how much the client can learn in one day may actually cause the client to become more nervous; an overload of information is overwhelming. Suggesting that other people handle the illness just fine is belittling and dismisses the client’s concerns. 11. 11.ID: 2 A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? A. Day of discharge B. On admission C. When the client states readiness D. While performing the test in the hospital Correct Teaching the client about the operation of the machine while performing the test in the hospital is the best way for the client to learn. The teaching can be reinforced before discharge. Instructing the client on the day of admission or the day of discharge would be overwhelming to the client because of all of the other activities taking place on those days. The client may never feel ready to learn this daunting task; the nurse must be more proactive. 12. 12.ID: 0 Which is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? A. American Diabetes Association Correct B. Centers for Disease Control and Prevention C. Health care provider office D. Pharmaceutical representative The American Diabetes Association can provide national and regional support and resources to clients with diabetes and their families. The Centers for Disease Control and Prevention does not focus on diabetes. The client’s health care provider’s office is not the best resource for diabetes information and support. A pharmaceutical representative is not an appropriate resource for diabetes information and support. 13. 13.ID: 4 A diabetic client has a glycosylated hemoglobin (HbA1C) level of 9.4%. What does the nurse say to the client regarding this finding? A. “Keep up the good work.” B. “This is not good at all.” C. “What are you doing differently?” Correct D. “You need more insulin.” Assessing the client’s regimen or changes he or she may have made is the basis for formulating interventions to gain control of blood glucose. HbA1C levels for diabetic clients should be less than 7%; a value of 9.4% shows poor control over the past 3 months. Telling the client this is not good, although true, does not take into account problems that the client may be having with the regimen and sounds like scolding. Although it may be true that the client needs more insulin, an assessment of the client’s regimen is needed before decisions are made about medications. 14. 14.ID: 0 The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? A. “I should go barefoot in my house so that my feet are exposed to air.” B. “I must inspect my shoes for foreign objects before putting them on.” Correct C. “I will soak my feet in warm water to soften calluses before trying to remove them.” D. “I must wear canvas shoes as much as possible to decrease pressure on my feet.” To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic clients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the client. The diabetic client must wear firm support shoes to prevent injury.