Diabetes/renal Failure Quiz

Front 1

The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks several blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what instruction about long-term care to the client?

Back 1

Be sure to practice meticulous foot care

Front 2

The nurse is planning the care of a patient who has type 1 diabetes and who will be undergoing knee replacement surgery. This patient's care plan should reflect an increased risk of what postsurgical complications? Select all that apply.

Back 2

• Acidosis

• Hypoglycemia

• Glucosuria

Front 3

A patient has just been diagnosed with type 2 diabetes. The physician 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 physician prescribe for this patient?

Back 3

A biguanide

Front 4

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation?

Back 4

Ask the physician to delay the discharge because the client requires further teaching.

Front 5

A patient with type 1 diabetes complains about waking up in the middle of the night nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood sugar readings have been 110 to 140 mg/dL; the patient admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse will plan to instruct the patient to do which of the following?

Back 5

Check blood glucose at 3:00 am

Front 6

Which statement best indicates that a client understands how to administer his own insulin injections?

Back 6

I wrote down the steps in case I forget what to do

Front 7

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:

Back 7

Rapid acting insulin only

Front 8

Mr. Thomas has come to the clinic complaining about having to get up frequently to void in the night, or nocturia. The physician is planning to order some tests to determine the cause of the problem. Of the following, which is not a probable cause of his problem?

Back 8

Neurogenic bladder

Front 9

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide?

Back 9

Practice meticulous foot care

Front 10

A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

Back 10

Administer half of the client's typical morning insulin dose as ordered.

Front 11

A patient with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestations associated with this classic symptom?

Back 11

Muscle wasting and tissue lossCorrect

Front 12

A patient is admitted with diabetic ketoacidosis (DKA). The physician writes all of the following orders. Which order should the nurse implement first?

Back 12

Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

Front 13

Which factor presents the most likely cause for weight gain in a diabetic client who is controlled with insulin?

Back 13

Insulin is an anabolic hormone

Front 14

A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause?

Back 14

Macular degeneration

Front 15

The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?

Back 15

Clients have chronic renal failure

Front 16

A program of weight loss and exercise is recommended for a client with type 2 diabetes. When teaching the client about lifestyle changes, what type of assessment would the nurse prioritize?

Back 16

Individual cultural assessment

Front 17

A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop?

Back 17

Furuncle

Front 18

A 1,200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The nurse is teaching the patient about meal planning using exchange lists. The teaching is determined to be effective based on which of the following statements?

Back 18

For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion, a green salad with 1 teaspoon Italian dressing, 1 cup of watermelon, and a diet soda

Front 19

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

Back 19

Switch the client to a different oral antidiabetic agent

Front 20

Once digested, what percentage of carbohydrates is converted to glucose?

Back 20

100

Front 21

The nurse is working with a coalition that is creating a global strategy to prevent and control diabetes. The nurse suggests which of the following strategies? Select all that apply.

Back 21

• Policy creation for diabetes prevention

• Partnering with American Diabetes Association

• Focusing on healthy lifestyle programming

• Monitoring incidence and prevalence rates

Front 22

A patient with type 2 diabetes has recently been placed on acarbose (Precose); the nurse is explaining how to take this medication. The teaching is determined to be effective based on which of the following statements?

Back 22

“I will take this medication in the morning, with my first bite of breakfast.”

Front 23

A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client'sblood glucose level. Which medication is the client most likely taking?

Back 23

Carvedilol (Coreg)

Front 24

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?

Back 24

Initiate fluid replacement therapy.

Front 25

A patient with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which of the following factors should the nurse monitor when caring for the patient?

Back 25

Low blood glucose levels

Front 26

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?

Back 26

Hypotension

Front 27

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.

Back 27

• Hypertension• Age greater of 45 years or older

• Family history

• History of gestational diabetes

• Obesity

Front 28

As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms, and consequences. One of the women in your lecture group asks if you know the death rate from diabetes mellitus. What is your response?

Back 28

Seventh cause of death in the United States

Front 29

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurse's priority action?

Back 29

Assess the patient's readiness to learn.

Front 30

A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient?

Back 30

This is significant for poor neurologic outcomes.

Front 31

Which of the following would be considered a “free” item from the exchange list?

Back 31

diet soda

Front 32

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?

Back 32

High blood sugar decreases blood circulation to nerves.

Front 33

You are the nurse caring for a patient who is Native American who arrives at the clinic for treatment related to type 2 diabetes. Which question would best provide you with information about the role of food in the patient's cultural practices and identify how the patient's food preferences could be related to his problem?

Back 33

“Tell me about foods that are important in your culture and how you feel they influence your diabetes.”

Front 34

A patient 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 patient's initial phase of treatment?

Back 34

Maintaining and monitoring the patient's fluid balance

Front 35

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?

Back 35

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action?

Front 36

The nurse is assigned to a group of clients and will be providing education to all of them. The client most in need of teaching is the client who

Back 36

is to perform daily foot checks as a result of diabetes

Front 37

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

Back 37

IV administration of 50% dextrose in water

Front 38

A diabetes nurse is assessing a patient's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patient's knowledge of nutritional therapy in diabetes?

Back 38

Ask the patient to keep a food diary and review it with the nurse.

Front 39

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?

Back 39

Promote absorption.

Front 40

A patient who has developed kidney failure is discussing options with the physician for treatment. What does the nurse understand that kidney failure is associated with?

Back 40

A deficiency in circulating lymphocytes

Front 41

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

Back 41

Hydrating with saline intravenously before the test

Front 42

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient’s glomerular filtration rate (GFR) to be?

Back 42

A GFR of 30–59 mL/min/1.73 m2

Front 43

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?

Back 43

When the urine output is less than 30 mL/h

Front 44

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

Back 44

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

Front 45

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient?

Back 45

Anemia

Front 46

A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patient's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.

Back 46

• The cuffs are made of Dacron polyester.

• The cuffs stabilize the catheter.

• The cuffs prevent the dialysate from leaking.

• The cuffs provide a barrier against microorganisms.

Front 47

The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

Back 47

• Assess for the presence of peripheral edema.

• Assess the patient's BP.

Front 48

The nurse is instructing a senior high health class on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.

Back 48

• Regulates red blood cell production

• Regulate calcium and the synthesis of vitamin D

• Activates growth hormone

• Controls blood pressure• Excretes waste products

Front 49

The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply.

Back 49

• Transient ischemic attacks

• Retinal hemorrhage

• Cerebrovascular accident

Front 50

A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following?

Back 50

Place emergency medical equipment in the procedure room.

Front 51

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply.

Back 51

• Visible characteristics of the output

• Color of the output

• Quantity of output

Front 52

Which condition may contribute to hyperparathyroidism?

Back 52

Chronic renal failure

Front 53

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

Back 53

1 minute

Front 54

Which of the following electrolyte imbalances occur with adrenal insufficiency?

Back 54

Hyperkalemia

Front 55

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.

Back 55

• Potassium 6.4 mEq/L; dysrhythmias and abdominal distention

• Calcium 7.5 mg/dL; hypotension and irritability

• Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

Front 56

The nurse is reviewing the client’s lab results. Which lab result requires follow up by the nurse? Select all that apply.

Back 56

• Urine: RBC 20

• BUN 28 mg/dL

Front 57

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?

Back 57

Hydronephrosis

Front 58

Treatment of metabolic acidosis in chronic renal failure includes:

Back 58

no treatment

Front 59

A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response?

Back 59

Recognize this as an expected finding.

Front 60

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.

Back 60

• Specific gravity of the patient's urine

• Testing for the presence of glucose in the patient's urine

• Microscopic examination of urine sediment for RBCs

• Microscopic examination of urine sediment for casts

Front 61

Which statement by the client preparing for a voiding cystourethrography indicates further teaching by the nurse is needed?

Back 61

“The dye is injected through an IV.”

Front 62

A male client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, he frequently suffers from breathing difficulty. Which of the following measures should the nurse include in the care plan to relieve him of the distress? Choose all correct options.

Back 62

• Provide firm support for the incision when he coughs.

• Auscultate lung sounds once per shift.

• Help him to breathe deeply and cough every 2 hours.

Front 63

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Back 63

Hypertension

Front 64

A patient with ESKD is scheduled to have an arteriovenous fistula created. The nurse explains that the patient will have a temporary dialysis catheter because the fistula has to “mature.” The nurse will explain that the patient will have to wait how long before using the fistula?

Back 64

2 to 3 months

Front 65

A client with adrenal insufficiency is brought into the ED where you practice nursing. The client is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client’s family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include which of the following?

Back 65

Observe for signs of hyponatremia and hyperkalemia.

Front 66

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?

Back 66

Anemia

Front 67

A patient has experienced excessive losses of bicarbonate and has subsequently developed an acid–base imbalance. How will this lost bicarbonate be replaced?

Back 67

Renal tubular cells will generate new bicarbonate.

Front 68

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply.

Back 68

• Decreased protein intake

• Fluid restriction

• Decreased sodium intake

Front 69

Common tests of renal function include which of the following? Select all that apply.

Back 69

• Blood urea nitrogen (BUN)

• Renal concentration test

• Creatinine clearance

• Serum creatinine

Front 70

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?

Back 70

Albumin infusion

Front 71

The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase?

Back 71

It is accompanied by reduced blood flow to the nephrons.

Front 72

A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans?

Back 72

High-protein diet

Front 73

A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote?

Back 73

Close monitoring of urine output and kidney function

Front 74

Which of the following is an inappropriate nursing diagnosis for the client following a voiding cystourethrography?

Back 74

Deficient knowledge: procedure

Front 75

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms?

Back 75

No symptoms

Front 76

The nurse understands acute dialysis is indicated in which of the following situations?

Back 76

Impending pulmonary edema

Front 77

Following are complications the nurse should monitor for during dialysis except for which of the following?

Back 77

Hypertension