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MED SURG 170 Exam 3 Evolve NCLEX Review- Galen College of Nursing
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MED SURG170 Exam 3
Evolve
NCLEX
Review-
Galen
College of
Nursing
, CHAPTER 64 B. 11:00 a.m. Correct
1. 1.ID: 4615471568 C. 2:00 p.m.
Which explanation best assists a client in differentiating type D. 7:30 p.m.
1 diabetes from type 2 diabetes? Onset of regular insulin is ½ to 1 hour; peak is 2 to 4 hours.
A. Most clients with type 1 diabetes are born Therefore, 11:00 a.m. is the anticipated peak time for regular
with it. insulin received at 7:00 a.m. For regular insulin received at
B. People with type 1 diabetes are often 7:00 a.m., 7:30 a.m., 2:00 p.m., and 7:30 p.m. are not the
obese. anticipated peak times.
C. Those with type 2 diabetes make insulin, 4. 4.ID: 4615471550
but in inadequate amounts. Correct A client newly diagnosed with diabetes is not ready or willing
D. People with type 2 diabetes do not develop to learn diabetes control during the hospital stay. Which
typical diabetic complications. information is the priority for the nurse to teach the client
People with type 2 diabetes make some insulin but in and the client’s family?
inadequate amounts, or they have resistance to existing A. Causes and treatment of hyperglycemia
insulin. Although type 1 diabetes may occur early in life, it
B. Causes and treatment of
may be caused by immune responses. Obesity is typically
hypoglycemia Correct
associated with type 2 diabetes. People with type 2 diabetes
C. Dietary control
are at risk for complications, especially cardiovascular
D. Insulin administration
complications.
The causes and treatment of hypoglycemia must be
2. 2.ID: 4615471528
understood by the client and family to manage the client’s
The nurse receives report on a 52-year-old client with type 2
diabetes effectively. The causes and treatment of
diabetes: hyperglycemia is a topic for secondary teaching and is not the
Physical Diagnostic
Assessment Findings Provider Prescriptions priority for the client with diabetes. Dietary control and
Regular insulin 8 units if
Glucose insulin administration are important, but are not the priority
blood
Lungs clear 179 mg/dL glucose 250 to 275 mg/dL in this situation.
and cold to touch
Right great toe Hemoglobin Regular insulin 10 units if 5. 5.ID: 4615471562
mottled A1c 6.9% glucose 275 to 300 mg/dL The nurse is providing discharge teaching to a client with
Client states
wears diabetes about injury prevention for peripheral neuropathy.
Which statement by the client indicates a need for further
Which complication of diabetes does the nurse report to the
teaching?
provider?
A. “I can break in my shoes by wearing them
A. Poor glucose control
all day.” Correct
B. Visual changes
B. “I need to monitor my feet daily for
C. Respiratory distress
blisters or skin breaks.”
D. Decreased peripheral perfusion Correct
C. “I should never go barefoot.”
A cold, mottled toe may indicate arterial occlusion secondary
D. “I should quit smoking.”
to arterial occlusive disease or embolization; this must be
Shoes should be properly fitted and worn for a few hours a
reported to avoid potential gangrene and amputation.
day to break them in, with frequent inspection for irritation
Although one glucose reading is elevated, the hemoglobin
or blistering. People with diabetes have decreased peripheral
A1c indicates successful glucose control over the past 3
circulation, so even small injuries to the feet must be
months. After the age of 40, reading glasses may be needed
managed early. Going barefoot is contraindicated. Tobacco
due to difficulty in accommodating to close objects. Lungs are
use further decreases peripheral circulation in a client with
clear and no evidence of distress is noted.
diabetes.
3. 3.ID: 4615471536
6. 6.ID: 4615471564
A client with type 1 diabetes mellitus received regular insulin
The nurse is teaching a client with type 2 diabetes about the
at 7:00 a.m. The client should be monitored for hypoglycemia
importance of weight control. Which comment by the client
at which time?
indicates a need for further teaching?
A. 7:30 a.m.
, A. “I should begin exercising for at least an remedy hypoglycemia. Glucagon should be administered only
hour a day.” Correct in cases of severe hypoglycemia.
B. “I should monitor my diet.”
C. “If I lose weight, I may not need to use the 9. 9.ID: 4615471544
insulin anymore.” A client has just been diagnosed with diabetes. Which factor
D. “Weight loss can be a sign of diabetic is most important for the nurse to assess in the client before
ketoacidosis.” providing instruction about the disease and its management?
For long-term maintenance of major weight loss, large A. Current lifestyle
amounts of exercise (7 hr/wk) or moderate or vigorous aerobic B. Educational and literacy level Correct
physical activity may be helpful, but the client must start
C. Sexual orientation
slowly. Monitoring the diet is key to type 2 diabetes
D. Current energy level
management. Weight loss can minimize the need for insulin
A large amount of information must be synthesized; typically
and can also be a sign of diabetic ketoacidosis.
written instructions are given. The client’s educational and
7. 7.ID: 4615471570
literacy level is essential information. Although lifestyle should
The nurse is providing discharge teaching to a client with be taken into account, it is not the priority. Sexual orientation
newly diagnosed diabetes. Which statement by the client will have no bearing on the ability of the client to provide self-
indicates a correct understanding about the need to wear a care. Although energy level will influence the ability to
MedicAlert bracelet? exercise, it is not essential.
A. “If I become hyperglycemic, it is a medical
emergency.”
10. 10.ID: 4615471526
B. “If I become hypoglycemic, I could become
A client expresses fear and anxiety over the life changes
unconscious.” Correct
associated with diabetes, stating, “I am scared I can’t do it all
C. “Medical personnel may need confirmation
and I will get sick and be a burden on my family.” What is the
of my insurance.”
nurse’s best response?
D. “I may need to be admitted to the hospital
A. “It is overwhelming, isn’t it?”
suddenly.”
B. “Let’s see how much you can learn today, so you
Hypoglycemia is the most common cause of medical
are less nervous.”
emergency in clients with diabetes. A MedicAlert bracelet is
C. “Let’s tackle it piece by piece. What is most scary
helpful if the client becomes hypoglycemic and is unable to
to you?” Correct
provide self-care. Hyperglycemia is not a medical emergency
D. “Other people do it just fine.”
unless it is acidosis; people with diabetes tolerate mild
Suggesting the client tackle it piece by piece and asking what
hyperglycemia routinely. Insurance information and
is most scary to him or her is the best response; this approach
information needed for hospital admission do not appear on a
will allow the client to have a sense of mastery with
MedicAlert bracelet.
acceptance. Referring to the illness as overwhelming is
8. 8.ID: 4615471530
supportive, but is not therapeutic or helpful to the client.
The nurse is teaching a client about the manifestations and
Trying to see how much the client can learn in one day may
emergency treatment of hypoglycemia. In assessing the
actually cause the client to become more nervous; an
client’s knowledge, the nurse asks the client what he or she
overload of information is overwhelming. Suggesting that
should do if feeling hungry and shaky. Which response by the
other people handle the illness just fine is belittling and
client indicates a correct understanding of hypoglycemia
dismisses the client’s concerns.
management?
A. “I should drink a glass of water.”
11. 11.ID: 4615471532
B. “I should eat three graham
A client recently admitted with new-onset type 2 diabetes
crackers.” Correct
will be discharged with a self-monitoring blood glucose
C. “I should give myself 1 mg of glucagon.”
machine. When is the best time for the nurse to explain to
D. “I should sit down and rest.”
the client the proper use of the machine?
Eating three graham crackers is a correct management
A. Day of discharge
strategy for mild hypoglycemia. Water or resting does not
B. On admission
, C. When the client states readiness The nurse is teaching a client with diabetes about proper foot
D. While performing the test in the care. Which statement by the client indicates that teaching
hospital Correct was effective?
Teaching the client about the operation of the machine while A. “I should go barefoot in my house so that
performing the test in the hospital is the best way for the my feet are exposed to air.”
client to learn. The teaching can be reinforced before B. “I must inspect my shoes for foreign objects
discharge. Instructing the client on the day of admission or before putting them on.” Correct
the day of discharge would be overwhelming to the client C. “I will soak my feet in warm water to
because of all of the other activities taking place on those soften calluses before trying to remove them.”
days. The client may never feel ready to learn this daunting D. “I must wear canvas shoes as much
task; the nurse must be more proactive. as possible to decrease pressure on my
feet.”
12. 12.ID: 4615471560 To avoid injury or trauma to the feet, shoes should be
Which is the best referral that the nurse can suggest to a inspected for foreign objects before they are put on. Diabetic
client who has been newly diagnosed with diabetes? clients should not go barefoot because foot injuries can occur.
A. American Diabetes Association Correct To avoid injury or trauma, a callus should be removed by a
B. Centers for Disease Control and Prevention podiatrist, not by the client. The diabetic client must wear
C. Health care provider office firm support shoes to prevent injury.
D. Pharmaceutical representative
The American Diabetes Association can provide national and 15. 15.ID: 4615471548
regional support and resources to clients with diabetes and An intensive care client with diabetic ketoacidosis (DKA) is
their families. The Centers for Disease Control and Prevention receiving an insulin infusion. The cardiac monitor shows
does not focus on diabetes. The client’s health care provider’s ventricular ectopy. Which assessment does the nurse make?
office is not the best resource for diabetes information and A. Urine output
support. A pharmaceutical representative is not an B. 12-lead electrocardiogram (ECG)
appropriate resource for diabetes information and support. C. Potassium level Correct
D. Rate of IV fluids
13. 13.ID: 4615471524 With insulin therapy, serum potassium levels fall rapidly as
A diabetic client has a glycosylated hemoglobin (HbA 1C) level potassium shifts into the cells. Detecting and treating the
of 9.4%. What does the nurse say to the client regarding underlying cause is essential. Insulin treats symptoms of
this finding? diabetes by putting glucose into the cell as well as potassium;
A. “Keep up the good work.” ectopy, indicative of cardiac irritability, is not associated with
B. “This is not good at all.” changes in urine output. A 12-lead ECG can verify the ectopy,
C. “What are you doing differently?” Correct but the priority is to detect and fix the underlying cause.
D. “You need more insulin.” Increased fluids treat the symptoms of dehydration secondary
Assessing the client’s regimen or changes he or she may have to DKA, but do not treat the cause.
made is the basis for formulating interventions to gain control
of blood glucose. HbA1C levels for diabetic clients should be 16. 16.ID: 4615471546
less than 7%; a value of 9.4% shows poor control over the In reviewing the health care provider admission requests for a
past 3 months. Telling the client this is not good, although client admitted in a hyperglycemic-hyperosmolar state, which
true, does not take into account problems that the client may request is inconsistent with this diagnosis?
be having with the regimen and sounds like scolding. A. 20 mEq KCl for each liter of IV fluid
Although it may be true that the client needs more insulin, an B. IV regular insulin at 2 units/hr
assessment of the client’s regimen is needed before decisions C. IV normal saline at 100 mL/hr
are made about medications. D. 1 ampule NaHCO3 IV now Correct
NaHCO3 is given for the acid-base imbalance of diabetic
14. 14.ID: 4615471540 ketoacidosis, not the hyperglycemic-hyperosmolar state,
which presents with hyperglycemia and absence of
ketosis/acidosis. KCl 20 mEq for each liter of IV fluid will
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