Points Awarded Points Missed Percentage

20 0 100%

1. Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? A. B. C. D. Debriding the wound three times per day Using sterile technique during the dressing change Applying a heating pad Cleaning the wound with a povidone-iodine solution

Correct. CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Basic care and comfort COGNITIVE LEVEL: Analysis

Points Earned: 1/1 Your Response: B 2. The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100 subcutaneously daily for a patient with diabetes mellitus. A mid-afternoon snack of milk and crackers is given to A. B. C. D. prevent an insulin reaction. improve carbohydrate metabolism. improve nutrition. prevent diabetic coma.

Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by administration of too much insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is taking.

Points Earned: 1/1 Your Response: A 3. A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternatetreatment on hand? A. Glucagon B. Hydrocortisone

CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies COGNITIVE LEVEL: Application REFERENCE: Smeltzer. When the skin is affected. C. B. about angiopathy as a complication of diabetes. . it can lead to diabetic foot ulcers. Points Earned: 1/1 Your Response: A 4. D. et al. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of clients with diabetes. the client reports that he's impotent and says he's concerned about the effect on his marriage. it is called diabetic retinopathy. When it affects the eyes. S. and skin. Epinephrine Correct. B. In planning this client's care. A nurse is assigned to care for a postoperative client with diabetes mellitus. provide time for privacy. encourage the client to ask questions about personal sexuality. 2008.. Brunner and Suddarth's Textbook of Medical SurgicalNursing. the most appropriate intervention would be to: A. Microangiopathy occurs in diabetes mellitus. When the kidneys are affected. the client has nephropathy. D. Philadelphia: Lippincott Williams & Wilkins. a diabetic client. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes. 1411. 11th ed. During the assessment interview. kidneys. The nurse is beginning to teach Harry George. Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. provide support for the spouse or significant other. Which of the following information would be appropriate for the nurse to include? A.C. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. 50% dextrose D. suggest referral to a sex counselor or other appropriate professional. C. p.C. Points Earned: 1/1 Your Response: B 5.

C. 2008. Correct. p. CLIENT NEEDS CATEGORY: Safe. Points Earned: 1/1 Your Response: C 7. 1383. et al. the nurse should check: A. S. Cheyne-Stokes respirations Hypoventilation Kussmaul respirations Central apnea .C.Correct. D. p. glycosylated hemoglobin level.. B. has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. S. Philadelphia: Lippincott Williams & Wilkins. CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Comprehension REFERENCE: Smeltzer. C. To determine the effectiveness of the client's efforts. Brunner and Suddarth's Textbook of Medical SurgicalNursing. fasting blood glucose level. urine glucose level.C. a 54-year-old client admitted with diabetes mellitus. Harry George. D. Philadelphia: Lippincott Williams & Wilkins. If the nurse assesses further for signs of ketoacidosis. A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. B. <i>Brunner and Suddarth's Textbook of Medical Surgical-Nursing. what type of respiratory pattern would the nurse look for? A. Points Earned: 1/1 Your Response: D 6. 11th ed.. serum fructosamine level. 2008. 1419. et al. 11th ed. effective care environment CLIENT NEEDS SUBCATEGORY: Management of care COGNITIVE LEVEL: Application REFERENCE: Smeltzer.

and ketones are present in the blood and urine. The patient with diabetes should exercise regularly. D. This leads to a pattern of Kussmaul respirations. High serum glucose level and an increase in pH Low serum potassium and high serum bicarbonate level Decreased urine output and Kussmaul’s respirations High serum glucose level and low serum bicarbonate level Compromised skin integrity makes a diabetic more susceptible to infection.In diabetic ketoacidosis. the nurse should use aseptic techniques to A.35. B. B. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours as well as reducing blood pressure and lipid levels. including hypoglycemia. Which of the following findings would the nurse note as being consistent with this diagnosis? A. inhibit the growth of pathogens. C. The nurse tells her that if the diabetic patient exercises. The arterial pH is low. D. Points Earned: 1/1 Your Response: A 10. less than 7. the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. C. then the insulin requirement A. Points Earned: 1/1 Your Response: C 8. destroy bacteria on the skin. increases. is changed to regular insulin. minimize the risk of spreading infection to others. exercise can carry some risks for patients with diabetes. remains unchanged. B. In applying moist packs to his ulcerated foot. The plasma . A 69-year-old patient with diabetes mellitus is admitted with cellulitis of the right foot. A patient has asked why she needs to exercise. Points Earned: 1/1 Your Response: B 9. D. Rationale: In DKA the blood glucose level is higher than 250 mg/dL. A client is brought to the emergency department with suspected diabetic ketoacidosis (DKA). C. However. prevent the introduction of additional microorganisms. decreases. which are deep and nonlabored.

Points Earned: 1/1 Your Response: D Diabetic ketoacidosis symptoms include dry mucous membranes and drowsiness leading to coma. is pregnant and has type 2 diabetes. cold. A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. B. thirst and drowsiness. Correct. Review the findings in DKA if you had difficulty with this question.bicarbonate is also low. D. D. has had pancreatic cancer in the past has type 2 diabetes. Common early signs and symptoms of diabetic ketoacidosis include A. recalling that metabolic acidosis is associated with a low pH will direct you to option 3. slow pulse and increased blood pressure. C. prefers to take insulin orally. clammy skin and anxiety. The potassium level is usually elevated as a result of dehydration. 12. E. For the remaining options. The client would exhibit polyuria and Kussmaul’s respirations. The nurse explains that these medications are effective only if the client: A. bulging of the eyeballs and carpopedal spasms. Recalling that DKA is a complication of diabetes mellitus will assist in eliminating options 2 and 4. Test-Taking Strategy: Focus on the subject. CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies has type 1 diabetes. . DIF: Level of Cognitive Ability: Analysis OBJ: Client Needs: Physiological Integrity TOP: Content Area: Adult Health/Endocrine MSC: Integrated Process: Nursing Process/Data Collection Points Earned: 1/1 Your Response: D 11. B. C. the findings associated with DKA.

The client is totally dependent on an outside source of insulin. There is decreased risk of infection when feet are soaked in hot water. Points Earned: 1/1 Your Response: C 15. The body produces autoantibodies that destroy beta cells in the pancreas.. a 54-year-old client with diabetes mellitus. Points Earned: 1/1 Your Response: D 13. Strong soap should be used to decrease skin bacteria. . 1398.C. 6 pm on the evening before the test 4 am on the day of the test Midnight before the test 7 am on the day of the test Typically a client is ordered to be NPO for 8 hours before determination of the fasting blood glucose level. Brunner and Suddarth's Textbook of Medical SurgicalNursing. 2008. C. or both.COGNITIVE LEVEL: Application REFERENCE: Smeltzer. Harry George. Points Earned: 1/1 Your Response: D 14. The toenails should be cut straight across. The nurse explains that in type 2 diabetes: A. D. Philadelphia: Lippincott Williams & Wilkins. The nurse includes which of the following during this informational session? A. B. B. For this reason. asks the nurse what "type 2" means. is scheduled for a fasting blood glucose level at 8 am. In type 2 diabetes mellitus. The nurse instructs the client to only drink water after what time? A. et al. or both. C. A nurse is discussing foot care with a diabetic client and spouse. D. the client who has a lab draw at 8 am should not have any food or beverages containing any calories after midnight. the secretion of insulin by the pancreas is reduced. cellular resistance to insulin that is produced. Harry George. a 54-year-old client admitted with type 2 diabetes. 11th ed. B. The body of the pancreas becomes inflamed. p. the cells of the body become resistant to insulin. C. S. There is decreased insulin secretion.

Rationale: The client should be instructed to cut the toenails straight across. C.D. C. B. The breakfast trays arrive on the nursing unit at approximately 08:30. The client should be instructed to wash the feet daily using a mild soap. especially the heels and between the toes. D. Notify the physician. Give the client 4 oz of milk and a graham cracker with peanut butter. Lanolin should be applied to dry feet. Moisturizing lotion can be applied to the feet but should not be placed between the toes. Obtain a repeat fingerstick glucose level. The client is alert and oriented. If the meal trays are served at approximately 08:30. How should the nurse intervene? A. B. to prevent burns. foot care with the diabetic client. 09:00 07:00 07:30 08:00 Points Earned: 1/1 Your Response: D 17. D. and the client's skin is warm and dry. Test-Taking Strategy: Focus on the subject. A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client has an order for glyburide (DiaBeta) this morning. Eliminate option 1 because of the word “hot” and option 4 because of the word “strong. The client should not soak the feet in hot water. Correct. Review diabetic foot care instructions if you had difficulty with this question. Glyburide is an oral antidiabetic agent that should be given 30 minutes before meals. Obtain a serum glucose level.” From the remaining options. The nurse administers this medication at the correct time by giving it to the client at which of the following times? A. remember that lanolin should not be applied between the toes. DIF: Level of Cognitive Ability: Application OBJ: Client Needs: Physiological Integrity TOP: Content Area: Adult Health/Endocrine MSC: Integrated Process: Teaching and Learning Points Earned: 1/1 Your Response: C 16. the client should receive the dose at 08:00. .

Brunner and Suddarth's Textbook of Medical SurgicalNursing. Impaired adjustment. D. Consequently.C. Health-seeking behaviors (diabetes control). et al. about proper composition of the daily diet. A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris.CLIENT NEEDS CATEGORY: Safe. C. B. D. less than 30% of calories should derive from fat. 1390. and measures blood glucose before breakfast and at bedtime. 25% 75% 10% 60% The percent of dietary calories that should be eaten as carbohydrates is 55% to 60%. The nurse is teaching Harry George.. Points Earned: 1/1 Your Response: D 19. S. Deficient knowledge (treatment regimen). Points Earned: 1/1 . injects insulin afterbreakfast and dinner. The nurse explains to Harry George that the percentage of calories that should be derived from carbohydrates is: A. Defensive coping. B. a 54-year-old client with diabetes. the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks. 11th ed. Protein calories make up 12% to 20% of calories. Correct. C. CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application REFERENCE: Smeltzer. effective care environment CLIENT NEEDS SUBCATEGORY: Safety and infection control COGNITIVE LEVEL: Analysis Points Earned: 1/1 Your Response: A 18. Philadelphia: Lippincott Williams & Wilkins. 2008. the nurse should formulate a nursing diagnosis of: A. p. After the client's condition stabilizes.

However. The patient is a 20-year-old college student who has type I diabetes and normally walks each evening as part of her exercise regimen. Add 10 units of Regular insulin to her usual morning dose on the days she plans to swim. Delay the meal before the swimming class until the session is over. during. exercise can carry some risks for patients with diabetes including hypoglycemia. Time her morning insulin injection so that the peak action will occur during her swimming class. Points Earned: 1/1 Your Response: D .Your Response: A 20. Which adjustment in her treatment plan will the nurse help this patient make? A. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours as well as reducing blood pressure and lipid levels. and after swimming to determine the need for alterations in food or insulin. D. She now plans to enroll in a swimming class to meet her physical education requirement. B. C. Monitor her glucose level before.

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