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The Client with Pancreatitis15. A client has an amylase level of 450 units/Land lipase level of 659 units/L. The client hasmid-epigastric pain with nausea. What assessmenthelps the nurse to determine severity of the client’scondition?■ 1. Ranson’s criteria.■ 2. Vital signs.■ 3. Urine output.■ 4. Glasgow Coma Scale.16. The client who has been hospitalized withpancreatitis does not drink alcohol because of herreligious convictions. She becomes upset whenthe physician persists in asking her about alcoholintake. The nurse should explain that the reason forthese questions is that:■ 1. There is a strong link between alcohol useand acute pancreatitis.■ 2. Alcohol intake can interfere with the testsused to diagnose pancreatitis.■ 3. Alcoholism is a major health problem, and allclients are questioned about alcohol intake.■ 4. The physician must obtain the pertinent facts,regardless of religious beliefs.17. The nurse monitors the client with pancreatitisfor early signs of shock. Which of the followingconditions is primarily responsible for making itdiffi cult to manage shock in pancreatitis?■ 1. Severity of intestinal hemorrhage.■ 2. Vasodilating effects of kinin peptides.■ 3. Tendency toward heart failure.■ 4. Frequent incidence of acute tubular necrosis.18. A client with acute pancreatitis has a bloodpressure of 88/40, heart rate of 128 beats per minute,respirations of 28 per minute, and Grey Turner’ssign. What action should the nurse perform fi rst?■ 1. Assess the urine output.■ 2. Place an intravenous line.■ 3. Position on the left side.■ 4. Insert a nasogastric tube.19. A client is admitted with acute necrotizingpancreatitis. Lab results have been obtained and aperipheral I.V. has been inserted. Which of the followingorders from a health care provider shouldthe nurse question?■ 1. Infuse a 500 mL normal saline bolus.■ 2. Calcium gluconate 90 mg in 100 mL NS.■ 3. Total parenteral nutrition (TPN) at 72 mL/hour.■ 4. Placement of a Foley catheter.20. Which of the following medications wouldthe nurse question for a client with acute pancreatitis?■ 1. Furosemide (Lasix) 20 mg I.V. push.■ 2. Imipenem (Primaxin) 500 mg I.V.■ 3. Morphine Sulfate 2 mg I.V. push.■ 4. Famotidine (Pepcid) 20 mg I.V. push.21. The nurse should monitor the client withacute pancreatitis for which of the following complications?■ 1. Heart failure.■ 2. Duodenal ulcer.■ 3. Cirrhosis.■ 4. Pneumonia.22. When providing care for a client hospitalizedwith acute pancreatitis who has acute abdominalpain, which of the following nursing interventionswould be most appropriate for this client? Select allthat apply.■ 1. Placing the client in a side-lying position.■ 2. Administering morphine sulfate for pain asneeded.■ 3. Maintaining the client on a high-calorie, highproteindiet.■ 4. Monitoring the client’s respiratory status.■ 5. Obtaining daily weights.23. The nurse notes that a client with acute pancreatitisoccasionally experiences muscle twitchingand jerking. How should the nurse interpret thesignifi cance of these symptoms?■ 1. The client may be developing hypocalcemia.■ 2. The client is experiencing a reaction to meperidine(Demerol).■ 3. The client has a nutritional imbalance.■ 4. The client needs a muscle relaxant to helphim rest.24. A client is receiving Propantheline bromide(Pro-Banthine) in the management of acute pancreatitis.Which of the following would indicate that thenurse should withhold the medication?■ 1. Absent bowel sounds.■ 2. Increased urine output.■ 3. Diarrhea.■ 4. Decreased heart rate.25. Which of the following dietary instructionswould be appropriate for the nurse to give a clientwho is recovering from acute pancreatitis?■ 1. Avoid crash dieting.■ 2. Restrict carbohydrate intake.■ 3. Eat six small meals a day.■ 4. Decrease sodium in the diet.26. Pancreatic enzyme replacements are orderedfor the client with chronic pancreatitis. Whenshould the nurse instruct the client to take them toobtain the most therapeutic effect?■ 1. Three times daily between meals.■ 2. With each meal and snack.■ 3. In the morning and at bedtime.■ 4. Every 4 hours, at specifi ed times.27. The nurse should teach the client withchronic pancreatitis to monitor the effectiveness ofpancreatic enzyme replacement therapy by doingwhich of the following?■ 1. Monitoring fl uid intake.■ 2. Performing regular glucose fi ngerstick tests.■ 3. Observing stools for steatorrhea.■ 4. Testing urine for ketones.28. The client with chronic pancreatitis shouldbe monitored closely for the development of whichof the following disorders?■ 1. Cholelithiasis.■ 2. Hepatitis.■ 3. Irritable bowel syndrome.■ 4. Diabetes mellitus.**************************************************************************** Nursing Care of Clients with PancreaticEndocrine DisordersA 23-year-old client manifests symptoms of hyperinsulinism.56. In response to a question about timing of symptomsduring the nursing history, when is the client most likely todescribe that symptoms typically occur?[ ] 1. After fasting more than 6 hours[ ] 2. About 2 hours after eating a meal[ ] 3. Late in the evening, before bedtime[ ] 4. Early in the morning, before breakfastA glucose tolerance test is ordered to determine if theclient has functional hypoglycemia.57. Which instruction by the nurse concerning the testprocedure is most accurate?[ ] 1. “You need to eat a large meal just before the test.”[ ] 2. “Bring a voided urine specimen to the laboratory.”[ ] 3. “You can drink coffee or tea in the morning beforethe test.”[ ] 4. “You will be given a sweetened drink before thetest.”58. To reduce or eliminate the symptoms that a clientwith functional hypoglycemia experiences, it is best for thenurse to recommend eating fi ve or six small meals containingwhich nutrient?[ ] 1. Simple sugars[ ] 2. Complete proteins[ ] 3. Complex carbohydrates[ ] 4. Unsaturated fats59. Which of the following provides the best evidencethat the dietary measures to control functional hypoglycemiaare therapeutic?[ ] 1. The client experiences fewer incidences of weaknessand tremors.[ ] 2. The client experiences fewer incidences of thirstand dry mouth.[ ] 3. The client experiences fewer incidences of musclespasms and fatigue.[ ] 4. The client experiences fewer incidences of hungerand abdominal cramps.A nurse participates in a community-wide screeningto identify adults who may have undiagnosed diabetesmellitus.60. If the screening includes a measurement of postprandialblood glucose, the nurse is correct in explaining thatblood will be drawn at which time?[ ] 1. Approximately 2 hours before breakfast[ ] 2. Approximately 2 hours after a meal[ ] 3. Approximately 2 hours before bedtime[ ] 4. Approximately 2 hours after fasting61. Which statement indicates that a client with anelevated 2-hour postprandial blood glucose level understandsthe signifi cance of the screening test?[ ] 1. “I need to eat less frequently.”[ ] 2. “I need to stop eating candy.”[ ] 3. “I need to consult my physician.”[ ] 4. “I need to begin taking insulin.”62. Which signs and symptoms are most appropriate forthe nurse to investigate when screening adults who havecome to have their blood glucose tested?[ ] 1. Diarrhea, anorexia, and weight gain[ ] 2. Constipation, weight loss, and thirst[ ] 3. Polycholia, polyemia, and polyplegia[ ] 4. Polyuria, polydipsia, and polyphagiaAfter the screening test, one client is referred to a physicianfor additional follow-up. Further diagnostic testsconfi rm that the client has type 2 diabetes mellitus.63. When given the news, the client denies the diagnosisand becomes angry, stating there has been a mistake in thetests. Which nursing action is most appropriate at this time?[ ] 1. Emphasizing the importance of treatment[ ] 2. Reassuring the client that the disease is easilymanaged[ ] 3. Explaining that many people live with diabetes[ ] 4. Listening as the client expresses current feelingsThe client with newly diagnosed type 2 diabetes mellitus isreferred to the diabetes clinic for teaching.64. When the client asks the nurse why regular exerciseis recommended for diabetic clients, the best answer is thatexercise tends to facilitate which positive outcome?[ ] 1. Regular exercise helps to control weight.[ ] 2. Regular exercise helps to decrease appetite.[ ] 3. Regular exercise helps to reduce blood glucose levels.[ ] 4. Regular exercise helps to improve circulation tothe feet.A dietitian explains how to use the American DiabetesAssociation exchange list.65. Which statement by the client provides the bestevidence that the client understands the principle of anexchange list for meal planning?[ ] 1. “I can eat one serving from each category on theexchange list per day.”[ ] 2. “Measured amounts of food in each category areequal to one another.”[ ] 3. “The number of servings from the exchange list isunlimited.”[ ] 4. “I need to use the exchange list to determine thenutrition in food.”66. The nurse knows the diabetic client understandswhat “free” foods on the exchange list means if the clientexcludes which one of the following from a meal plan?[ ] 1. Iced tea[ ] 2. Flavored water[ ] 3. Light beer[ ] 4. Club soda67. Using the Dietary Exchange Plan for a 1,500 caloriediet in the chart below, which item is appropriate for thediabetic client to have in the midafternoon?Starch/bread Meat Vegetable Fruit Milk FatBreakfast 2 1 1 1Lunch 2 1 1 1 1Snack 1Dinner 2 2 1 1 2Bedtime 1 1 1[ ] 1. An 8-oz carton of milk[ ] 2. Two graham crackers[ ] 3. A medium apple[ ] 4. A 2-oz slice of turkeyThe physician prescribes glyburide (DiaBeta) orally forthe client to treat diabetes.68. When the client asks why a diabetic relative cannottake insulin orally, what is the best answer?[ ] 1. Insulin is inactivated by digestive enzymes.[ ] 2. Insulin is absorbed too quickly in the stomach.[ ] 3. Insulin is irritating to the gastric mucosa.[ ] 4. Insulin is incompatible with many foods.69. The diabetic client tells the nurse that breakfast isalways skipped. Which response by the nurse is mostappropriate?[ ] 1. “If you drink a glass of milk and eat a breakfastbar, that will be suffi cient for breakfast.”[ ] 2. “You should eat each meal and snack at the sametime each day.”[ ] 3. “If you skip breakfast, eat a high-calorie snack atmidmorning.”[ ] 4. “Wait to take your medication until you eat yourfi rst meal of the day.”After the client is discharged from the hospital, thephysician wants the client to continue to self-monitor theresponse to the diet and medication management.70. Which monitoring approach is best for the nurse torecommend?[ ] 1. Testing the urine with a chemical reagent strip[ ] 2. Using a glucometer to check capillary bloodglucose levels[ ] 3. Having laboratory personnel draw venous bloodsamples[ ] 4. Arranging for testing by a home health agencyNurseEmergency medical personnel bring a client who is lethargicand confused to the emergency department. A tentativediagnosis of type 1 diabetes mellitus and diabetic ketoacidosis(DKA) is made.71. Which assessment fi ndings would the nurse expect todocument if the client has DKA? Select all that apply.[ ] 1. The client is hypertensive and tachycardic.[ ] 2. The client is dyspneic and hypotensive.[ ] 3. The client breathes noisily and smells of acetone.[ ] 4. The client stares blankly and smells of alcohol.[ ] 5. The client has warm, fl ushed skin and has vomited.[ ] 6. The client complains of abdominal pain and isthirsty.The nurse documents that Kussmaul’s respirations weredetected during the initial assessment.72. Which respiratory pattern is the best description ofthe client’s breathing?[ ] 1. Fast, deep, labored respirations[ ] 2. Shallow respirations, alternating with apnea[ ] 3. Slow inhalation and exhalation through pursed lips[ ] 4. Shortness of breath with pausesThe nurse plans to monitor the client’s response to insulintherapy closely with an electronic glucometer and instructsthe emergency department technician to take periodiccapillary blood glucose measurements.73. Which techniques are correct when using an electronicglucometer to monitor the client’s capillary bloodglucose level? Select all that apply.[ ] 1. Clean the client’s fi nger with povidone-iodine(Betadine).[ ] 2. Take a set of vital signs before the test.[ ] 3. Pierce the central pad of the client’s fi nger.[ ] 4. Apply a large drop of blood to a test strip or area.[ ] 5. Don gloves before piercing the client’s fi nger.[ ] 6. Perform a quality control before the test.After using the glucometer, the emergency departmenttechnician reports to the nurse that the client’s capillaryblood glucose measures 498 mg/dL.74. Based on the client’s blood glucose measurement, thenurse immediately reevaluates the client. Which physicianorders should the nurse anticipate? Select all that apply.[ ] 1. STAT serum blood glucose[ ] 2. Intravenous regular insulin[ ] 3. Vital signs every 2 hours[ ] 4. A diet of six small, frequent meals[ ] 5. Electronic glucometer measurements before mealsand at bedtime[ ] 6. Continuous cardiac monitoringAfter stabilization in the emergency department, the clientwith diabetic ketoacidosis (DKA) is admitted to a stepdownunit for further observation and treatment. Afterseveral episodes of hyperglycemia, the physician orderssliding-scale regular insulin administered subcutaneouslyfor the client.75. How soon after administering the client’s dose ofregular insulin subcutaneously should the nurse assess forsigns of hypoglycemia?[ ] 1. 5 minutes later[ ] 2. 30 minutes later[ ] 3. 6 hours later[ ] 4. 10 hours later76. The nurse teaches the client with newly diagnoseddiabetes mellitus about the signs and symptoms of hypoglycemia.Which of the following should the nurse stressin teaching? Select all that apply.[ ] 1. Sleepiness[ ] 2. Shakiness[ ] 3. Thirst[ ] 4. Hunger[ ] 5. Diaphoresis[ ] 6. ConfusionDuring the midmorning after receiving insulin, the clientreports feeling weak, shaky, and dizzy. The nurse asks thenursing assistant to obtain a capillary blood glucose measurementwith a glucometer.77. The nursing assistant reports to the nurse that the client’sblood glucose reading is 58 mg/dL. What is the mostappropriate nursing action at this time?[ ] 1. Administer the next scheduled dose of insulin.[ ] 2. Give the client ? cup of sweet fruit juice.[ ] 3. Report the client’s symptoms to the physician.[ ] 4. Perform a complete head-to-toe assessment.The client with type 1 diabetes mellitus must learn to combinetwo insulins—regular and intermediate-acting—andself-administer the injection before being discharged.78. Which action is the best indication that the clientneeds more practice in combining two insulins in onesyringe?[ ] 1. The client rolls the vial of intermediate-actinginsulin to mix it with its additive.[ ] 2. The client instills air into both the fast-acting andintermediate-acting insulin vials.[ ] 3. The client instills the intermediate-acting insulininto the vial of rapid-acting insulin.[ ] 4. The client inverts each vial before withdrawing thespecifi ed amount of insulin.79. When the client practices self-administration of theinsulin, which action is correct?[ ] 1. Piercing the skin at a 30-degree angle[ ] 2. Using a syringe calibrated in minims[ ] 3. Using a 29-gauge needle on the syringe[ ] 4. Rotating abdominal sites for each injection80. The nurse receives an order to administer Novolin R10 units with Novolin N 20 units to be given subcutaneouslyat 0730 hours. Place the following actions in correctsequence to show how the nurse would mix the medications.Use all the options.1. Instill 20 units of air inthe vial of Novolin N.2. Instill 10 units of air inthe vial of Novolin R.3. Withdraw 20 units ofinsulin from the vial ofNovolin N.4. Withdraw 10 units ofinsulin from the vial ofNovolin R.The nurse implements a diabetes teaching plan in anticipationof the client’s discharge.81. Which statement indicates that the client has misunderstoodthe nurse’s teaching?[ ] 1. “I may need more insulin during times of stress.”[ ] 2. “I may need more food when exercising strenuously.”[ ] 3. “My insulin needs may change as I get older.”[ ] 4. “My dependence on insulin may stop eventually.”82. The nurse discusses the long-term effects of diabetesmellitus with the client and realizes that the client needsfurther teaching when the client identifi es which occurrenceas a complication of this disease?[ ] 1. Blindness[ ] 2. Stroke[ ] 3. Renal failure[ ] 4. Liver failure83. When the client asks how to store an opened vial ofinsulin, which answer by the nurse offers the most correctinstruction?[ ] 1. The best place for storing insulin is in the bathroom,close to the shower.[ ] 2. The best place to store insulin is in the refrigerator.[ ] 3. The best way to store insulin is at room temperature.[ ] 4. The best place for storing insulin is in a warmlocation but out of sunlight.The nurse includes foot care as a component of diabetesteaching.84. Which statement by the client about foot care indicatesa need for further teaching?[ ] 1. “I need to inspect my feet daily.”[ ] 2. “I should soak my feet each day.”[ ] 3. “I need to wear shoes whenever I’m not sleeping.”[ ] 4. “I need to schedule regular appointments with thepodiatrist.”After 3 months, the client returns for a follow-up appointmentwith the physician to evaluate the progress ofs elf-care.85. Which information is most important for the nurseto elicit from the client to effectively evaluate compliancewith the prescribed therapy?[ ] 1. The dosage and frequency of insulinadministration[ ] 2. The client’s glucose monitoring records for thepast week[ ] 3. The client’s weight and vital signs before the offi ceinterview[ ] 4. The symptoms experienced in the past month86. Which laboratory test is most important for the nurseto monitor to determine how effectively the client’s diabetesis being managed?[ ] 1. Fasting blood glucose[ ] 2. Blood chemistry profi le[ ] 3. Complete blood count[ ] 4. Glycosylated hemoglobin (HbA1c)During the physician’s visit, the client reports researchingthe use of insulin pumps on the Internet and wants to knowthe possibility of being a candidate. After evaluating theclient and discussing the request, the physician asks thenurse to provide instructions about management of the client’sdiabetes using a continuous insulin infusion pump.87. The nurse teaches the client how the infusion pumpoperates and correctly points out that the infusion is typicallyadministered in which location?[ ] 1. In a vein within the nondominant hand[ ] 2. In the muscular tissue of the thigh[ ] 3. In the subcutaneous tissue of the abdomen belowthe belt line[ ] 4. In an implanted I.V. catheter threaded into the neckThe nurse cares for an older client who is insulin dependentand lives in a long-term care facility.88. When developing the client’s care plan, which interventionis most appropriate to add?[ ] 1. Encourage the client to use an electric razor.[ ] 2. Tell the client to fi le rather than cut toenails.[ ] 3. Make sure that the client receives mouth care twiceper day.[ ] 4. Advise the client to use deodorant soap when bathing.89. The nurse has prepared 24 units of Humulin N insulinfor subcutaneous administration. Identify with an X thepreferred location for insulin administration to facilitaterapid absorption.90. Which sign is most suggestive that a client with type2 diabetes is developing hyperosmolar hyperglycemicnonketotic syndrome (HHNS)?[ ] 1. The client’s serum glucose level is 650 mg/dL.[ ] 2. The client’s urinary output is 3,000 mL/24 hours.[ ] 3. The client’s skin is cool and moist.[ ] 4. The client’s urine contains acetone.A client with type 1 diabetes mellitus comes to the cliniccomplaining of persistent bouts of nausea, vomiting,and diarrhea for the past 4 days. The client has skippedinsulin injections because of not being able to eat or keepanything down.91. Which instruction should the nurse give the clientabout insulin administration during periods of illness?[ ] 1. Monitor blood glucose levels every 2 to 4 hours.[ ] 2. Eat candy or sugar frequently.[ ] 3. Attempt to drink a high-calorie beverage everyhour.[ ] 4. Test urine daily for protein.92. During change of shifts, a nurse discovers that ahospitalized client with diabetes received two doses ofinsulin. After notifying the physician, which nursingaction is most appropriate?[ ] 1. Completing an incident report[ ] 2. Calling the intensive care unit (ICU)[ ] 3. Performing frequent neurologic checks[ ] 4. Monitoring the client’s blood glucose level******************************** **************************** ********************* ................
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