545.

A client is brought to the emergency department

in an unresponsive state, and a diagnosis of hyperosmolar
hyperglycemic syndrome is made. The
nursewould immediately prepare to initiate which
anticipated health care provider’s prescription?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate
546. An external insulin pump is prescribed for a client
with diabetes mellitus. When the client asks the
nurse about the functioning of the pump, the nurse
bases the response on which information about
the pump?
1. It is timed to release programmed doses of either
short-duration or NPH insulin into the bloodstream
at specific intervals.
2. It continuously infuses small amounts of NPH
insulin into the bloodstream while regularly
monitoring blood glucose levels.
3. It is surgically attached to the pancreas and
infuses regular insulin into the pancreas. This
releases insulin into the bloodstream.
4. It administers a small continuous dose of shortduration
insulin subcutaneously. The client can
self-administer an additional bolus dose from
the pump before each meal.
oot Care Instructions
Provide meticulous skin care and proper foot care.
Inspect feet daily and monitor feet for redness, swelling, or
break in skin integrity.
Notify the health care provider if redness or a break in the skin
occurs.
Avoid thermal injuries from hot water, heating pads, and
baths.
Wash feet with warm (not hot) water and dry thoroughly
(avoid foot soaks).
Avoid treating corns, blisters, or ingrown toenails.
Do not cross legs or wear tight garments that may constrict
blood flow.
Apply moisturizing lotion to the feet but not between the toes.
Prevent moisture from accumulating between the toes.
Wear loose socks and well-fitting (not tight) shoes; do not go
barefoot.
Wear clean cotton socks to keep the feet warm and change the
socks daily.
Avoid wearing the same pair of shoes 2 days in a row.
Avoid wearing open-toed shoes or shoes with a strap that goes
between the toes.
Check shoes for cracks or tears in the lining and for foreign
objects before putting them on.
Break in new shoes gradually.
Cut toenails straight across and smooth nails with an emery
board.
Avoid smoking.
547. A client with a diagnosis of diabetic ketoacidosis
(DKA) is being treated in the emergency department.
Which findings support this diagnosis?
Select all that apply.
1. Increase in pH
2. Comatose state
3. Deep, rapid breathing
4. Decreased urine output
5. Elevated blood glucose level
548. The nurse teaches a client with diabetes mellitus
about differentiating between hypoglycemia and
ketoacidosis. The client demonstrates an understanding
of the teaching by stating that a form of
glucose should be taken if which symptom or
symptoms develop? Select all that apply.
1. Polyuria
2. Shakiness
3. Palpitations
4. Blurred vision
5. Lightheadedness
6. Fruity breath odor
549. A client with diabetes mellitus demonstrates
acute anxiety when admitted to the hospital for
the treatment of hyperglycemia. What is the
appropriate intervention to decrease the client’s
anxiety?
1. Administer a sedative.
2. Convey empathy, trust, and respect toward the
client.
3. Ignore the signs and symptoms of anxiety, anticipating
that they will soon disappear.
4. Make sure that the client is familiar with the correct
medical terms to promote understanding of
what is happening.
550. The nurse provides instructions to a client newly
diagnosed with type 1 diabetes mellitus. The nurse
recognizes accurate understanding of measures to
prevent diabetic ketoacidosis when the client
makes which statement?
1. “I will stop taking my insulin if I’m too sick
to eat.”
2. “I will decrease my insulin dose during times of
illness.”
3. “I will adjust my insulin dose according to the
level of glucose in my urine.”
4. “I will notify my health care provider (HCP)
if my blood glucose level is higher than
250 mg/dL (14.2 mmol/L).”
551. A client is admitted to a hospital with a diagnosis of
diabetic ketoacidosis (DKA). The initial blood glucose
level is 950 mg/dL (54.2 mmol/L). A continuous
intravenous (IV) infusion of short-acting
insulin is initiated, along with IV rehydration with
normal saline. The serum glucose level is now decreased
to 240 mg/dL (13.7 mmol/L). The nurse
would next prepare to administerwhich medication?
1. An ampule of 50% dextrose
2. NPH insulin subcutaneously
3. IV fluids containing dextrose
4. Phenytoin for the prevention of seizures
552. The nurse is monitoring a client newly diagnosed
with diabetes mellitus for signs of complications.
Which sign or symptom, if exhibited in the client,
indicates that the client is at risk for chronic
complications
of diabetes if the blood glucose is not
adequately managed?
1. Polyuria
2. Diaphoresis
3. Pedal edema
4. Decreased respiratory rate
553. The nurse is preparing a plan of care for a client
with diabetes mellitus who has hyperglycemia.
The nurse places priority on which client problem?
1. Lack of knowledge
2. Inadequate fluid volume
3. Compromised family coping
4. Inadequate consumption of nutrients
554. The home health nurse visits a client with a
diagnosis
of type 1 diabetes mellitus. The client relates a
history of vomiting and diarrhea and tells the nurse
that no food has been consumed for the last
24 hours.Which additional statement by the client
indicates a n eed for further teaching?
1. “I need to stop my insulin.”
2. “I need to increase my fluid intake.”
3. “I need to monitor my blood glucose every 3 to
4 hours.”
4. “I need to call the health care provider (HCP)
because of these symptoms.”
555. The nurse is caring for a client after
hypophysectomy
and notes clear nasal drainage from the client’s
nostril. The nurse should take which initial
action?
1. Lower the head of the bed.
2. Test the drainage for glucose.
3. Obtain a culture of the drainage.
4. Continue to observe the drainage.
556. The nurse is admitting a client who is diagnosed
with syndrome of inappropriate antidiuretic hormone
secretion (SIADH) and has serum sodium
of 118 mEq/L (118 mmol/L). Which health care
provider prescriptions should the nurse anticipate
receiving? Select all that apply.
1. Initiate an infusion of 3% NaCl.
2. Administer intravenous furosemide.
3. Restrict fluids to 800 mL over 24 hours.
4. Elevate the head of the bed to high Fowler’s.
5. Administer a vasopressin antagonist as
prescribed.
557. A client is admitted to an emergency department,
and a diagnosis of myxedema coma is made.
Which action should the nurse prepare to carry
out initially?
1. Warm the client.
2. Maintain a patent airway.
3. Administer thyroid hormone.
4. Administer fluid replacement.
558. The nurse is caring for a client admitted to the
emergency department with diabetic ketoacidosis
(DKA). In the acute phase, the nurse plans for
which priority intervention?
1. Correct the acidosis.
2. Administer 5% dextrose intravenously.
3. Apply a monitor for an electrocardiogram.
4. Administer short-duration insulin intravenously.
559. Aclient with type 1 diabetesmellitus calls the nurse
to report recurrent episodes of hypoglycemia with
exercising. Which statement by the client indicates
an adequate understanding of the peak action of
NPH insulin and exercise?
1. “I should not exercise since I am taking insulin.”
2. “The best time forme to exercise is after breakfast.”
3. “The best time for me to exercise is mid- to late
afternoon.”
4. “NPH is a basal insulin, so I should exercise in
the evening.”
560. The nurse is completing an assessment on a client
who is being admitted for a diagnostic workup for
primary hyperparathyroidism. Which client complaint
would be characteristic of this disorder?
Select all that apply.
1. Polyuria
2. Headache
3. Bone pain
4. Nervousness
5. Weight gain
561. The nurse is teaching a client with
hyperparathyroidism
how to manage the condition at home.
Which response by the client indicates the need
for additional teaching?
1. “I should limit my fluids to 1 liter per day.”
2. “I should use my treadmill or go for
walks daily.”
3. “I should follow a moderate-calcium, highfiber
diet.”
4. “My alendronate helps to keep calcium from
coming out of my bones.”
562. A client with a diagnosis of addisonian crisis is
being admitted to the intensive care unit. Which
findings will the interprofessional health care team
focus on? Select all that apply.
1. Hypotension
2. Leukocytosis
3. Hyperkalemia
4. Hypercalcemia
5. Hypernatremia
563. The nurse is monitoring a client who was diagnosed
with type 1 diabetes mellitus and is being
treated with NPH and regular insulin. Which
manifestations would alert the nurse to the presence
of a possible hypoglycemic reaction? Select
all th at apply.
1. Tremors
2. Anorexia
3. Irritability
4. Nervousness
5. Hot, dry skin
6. Muscle cramps
564. The nurse is performing an assessment on a client
with pheochromocytoma. Which assessment data
would indicate a potential complication associated
with this disorder?
1. A urinary output of 50 mL/hour
2. A coagulation time of 5 minutes
3. Aheart rate that is 90 beats/minute and irregular
4. A blood urea nitrogen level of 20 mg/dL
(7.1 mmol/L)
565. The nurse is monitoring a client diagnosed with
acromegaly who was treated with transsphenoidal
hypophysectomy and is recovering in the intensive
care unit. Which findings should alert the nurse to
the presence of a possible postoperative complication?
Select all that apply.
1. Anxiety
2. Leukocytosis
3. Chvostek’s sign
4. Urinary output of 800 mL/hour
5. Clear drainage on nasal dripper pad
566. The nurse performs a physical assessment on a client
with type 2 diabetes mellitus. Findings include
a fasting blood glucose level of 120 mg/dL
(6.8 mmol/L), temperature of 101 °F (38.3 °C),
pulse of 102 beats/minute, respirations of 22
breaths/minute, and blood pressure of 142/72
mm Hg. Which finding would be the priority concern
to the nurse?
1. Pulse
2. Respiration
3. Temperature
4. Blood pressure
567. The nurse is preparing a client with a new diagnosis
of hypothyroidism for discharge. The nurse determines
that the client understands discharge
instructions if the client states that which signs
and symptoms are associated with this diagnosis?
Select all that apply.
1. Tremors
2. Weight loss
3. Feeling cold
4. Loss of body hair
5. Persistent lethargy
6. Puffiness of the face
568. A client has just been admitted to the nursing unit
following thyroidectomy. Which assessment is the
priority for this client?
1. Hypoglycemia
2. Level of hoarseness
3. Respiratory distress
4. Edema at the surgical site
569. Aclient has been diagnosed with hyperthyroidism.
The nurse monitors for which signs and symptoms
indicating a complication of this disorder? Select
all that apply.
1. Fever
2. Nausea
3. Lethargy
4. Tremors
5. Confusion
6. Bradycardia