Liver Flashcards
The nurse should explain to a client that glipizide (Glucotrol) is effective for diabetics who
1. can no longer produce any insulin. 2. produce minimal amounts of insulin. 3. are unable to administer their injections. 4. have a sustained decreased blood glucose
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Strategy: Think about each answer choice.
(1) type 1 insulin-dependent diabetic is unable to produce insulin
(2) correct—oral hypoglycemic agents are administered to type 2 (non-insulin-dependent) clients who are able to produce minimal amounts of insulin
(3) type 1 diabetics who cannot administer their injections need alternate plans to be made for them to receive the injection from a family member
(4) Glucotrol is administered for an increase in blood glucose
The nurse supervises the staff providing care for an 18-month-old hospitalized with hepatitis A. The nurse determines that the staff’s care is appropriate if which of the following is observed?
1. The child is placed in a private room. 2. The staff removes a toy from the child's bed and takes it to the nurse's station. 3. The staff offers the child french fries and a vanilla milkshake for a midafternoon snack. 4. The staff uses standard precautions.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) correct—contact precautions required for diapered or incontinent clients
(2) do not remove toys from room, possibly contaminated
(3) diet should be high in carbohydrates and protein and low in fat
(4) contact precautions required in addition to standard precautions
The home care nurse visits a client with newly diagnosed type 1 diabetes. The physician orders include 1,200-calorie ADA diet, 15 units of NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the client at 5 PM, the nurse observes the client perform a blood sugar analysis. The result is 50 mg/dL. The nurse should observe for which of the following?
1. Confusion; cold, clammy skin; and an elevated pulse. 2. Lethargy; hot, dry skin; rapid deep respirations. 3. Alert and cooperative, blood pressure and pulse within normal limits. 4. Shortness of breath, distended neck veins, and a bounding pulse of 96.
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Strategy: Determine the cause of each answer choice.
(1) correct—symptoms of hypoglycemia, normal blood sugar 70–110 mg/dL
(2) symptoms of hyperglycemia, blood sugar above 110 mg/dL
(3) normal appearance and vital signs
(4) symptoms of fluid overload caused by heart failure, rapid infusion of IV fluids
A client takes gemfibrozil (Lopid) 600 mg PO bid. It is MOST important for the nurse to monitor which of the following?
1. Serum creatine. 2. Erythrocyte sedimentation rate (ESR). 3. Aspartate aminotransferase (AST) (or formerly SGOT). 4. Arterial blood gases (ABG).
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Strategy: Recall what each lab function is measuring and determine how it relates to gemfibrozil (Lopid).
(1) indicates renal function, normal 0.6 to 1.2 mg/dL
(2) indicates inflammation, normal 0 to 20 mm/h
(3) correct—indicates liver function, normal 8–20 units/L; lipid-lowering agent used with patients with high serum triglyceride levels, side effects include abdominal pain, cholelithiasis; take 30 minutes before breakfast and supper
(4) indicates acid/base balance
An older client undergoes the second exchange of intermittent peritoneal dialysis (IPD). Which of the following requires an intervention by the nurse?
1. The client complains of pain during the inflow of the dialysate. 2. The client complains of constipation. 3. The dialysate outflow is cloudy. 4. There is blood-tinged fluid around the intra-abdominal catheter.
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Strategy: “Requires an intervention” indicates you are looking for a complication.
(1) common complaint, moderate pain is frequently experienced as fluid is instilled during first few exchanges
(2) common complaint due to inactivity, decreased nutrition, use of medications; high-fiber diet and stool softeners help prevent
(3) correct—indicates peritonitis, also will see nausea and vomiting, anorexia, abdominal pain, tenderness, rigidity
(4) caused by subcutaneous bleeding, common during first few exchanges
Which of the following statements should the nurse make to a client who is going to self-administer continuous ambulatory peritoneal dialysis (CAPD) at home?
1. "Check your weight daily." 2. "Maintain clean technique at all times during the procedure." 3. "Milk the catheter to encourage extra fluid to be removed from the abdomen." 4. "Eat a well-balanced, low-protein diet."
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Strategy: Answers are a mix of assessments and implementations. Is assessment required? Yes. Is the assessment appropriate? Yes.
(1) correct—assessment; daily weight necessary with peritoneum empty to assess fluid volume status, guidelines for weight gain/loss set by physician
(2) implementation; strict aseptic technique required to prevent contamination, sterile = aseptic, clean = antiseptic
(3) implementation; don’t milk catheter, drainage by gravity only
(4) implementation; encouraged to eat a high-protein diet because of protein loss with CAPD
An adult client has regular insulin ordered before breakfast. The nurse notes that the client’s blood glucose level is 68 mg/dL and the client is nauseated. Which of the following actions should the nurse take?
1. Immediately give the client orange juice to drink. 2. Administer the insulin on time. 3. Withhold the insulin, and notify the physician. 4. Return the breakfast tray to the kitchen.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) may cause vomiting
(2) correct—take insulin or oral agent as ordered, check blood glucose or urine ketones every 3 to 4 hours, sip 8 to 12 oz liquid per hour, substitute easily digested soft foods, liquids if solids not tolerated
(3) blood glucose increases during illness; even though client can’t eat, administer insulin
(4) does not address the client’s problem
The nurse prepares to perform peritoneal dialysis on an older patient. The patient states that he/she had pain the last time the procedure was done. It is MOST appropriate for the nurse to take which of the following actions?
1. Administer a warm drink to the patient. 2. Administer a warm bath to the patient. 3. Warm the bag of dialysate solution with a heating pad. 4. Warm the bag of dialysate solution in a microwave oven.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) does not affect pain with fluid infusion
(2) does not affect pain with fluid infusion
(3) correct—temperature can be regulated, warming reduces pain caused by cold solution
(4) contraindicated because of unpredictable warming patterns
The nurse cares for a 26-year-old woman immediately after delivery of 8-lb, 4-oz baby girl. The patient’s history indicates that she was diagnosed with type 1 diabetes at age 12. The nurse expects which of the following changes to occur in the patient?
1. The blood sugar will fall because of a sudden decrease in insulin requirements. 2. The blood sugar will rise because of a rapid decrease in circulating insulin. 3. The blood sugar will gradually rise because of a decreased level of metabolic stress. 4. The blood sugar will gradually fall because of a decrease in food intake.
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Strategy: Think about each answer choice.
(1) correct—hormonal interference in glucose metabolism during pregnancy causes insulin requirements to increase then decrease after delivery
(2) blood sugar will fall after delivery
(3) blood sugar level will fall after delivery
(4) fall in blood sugar not primarily caused by decrease in food intake
An adult client with newly diagnosed type 1 diabetes is being seen by the home health nurse. The physician has placed the client on an 1,800-calorie ADA diet, ordered the client to self-administer 15 units of NPH insulin each day before breakfast, and check his blood sugar qid. When the nurse visits the client at 5 PM, the nurse discovers that the client has not eaten since noon and has just returned from jogging. The client’s vital signs are: BP 110/80, pulse 120/min, respirations 18/min, and temperature 98.2°F (36.8°C). The nurse anticipates the client’s blood sugar to be which of the following?
1. 250 mg/dL. 2. 160 mg/dL. 3. 90 mg/dL. 4. 50 mg/dL.
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Strategy: Think about each answer choice.
(1) hyperglycemia symptoms are hot dry skin, rapid, deep respirations (Kussmaul), lethargic, polyuria, polydipsia, polyphagia, glycosuria, nausea, and vomiting
(2) NPH insulin is intermediate-acting, onset 3-4 hours, peak 8-16 hours, duration 18-26 hours
(3) normal blood sugar 70-110 mg/dL
(4) correct—hypoglycemia symptoms are cool, clammy skin, diaphoresis, nervousness, weakness, hunger, confusion, headache, slurred speech, coma
The nurse instructs a client with newly diagnosed type 1 diabetes how to treat hypoglycemia at home. The nurse should instruct the client to do which of the following actions if symptoms of hypoglycemia occur?
1. Eat a candy bar. 2. Drink 1/2 cup fruit juice followed by a protein snack. 3. Inject 10 units of Humulin R. 4. Inject glucagon.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) too concentrated a carbohydrate, will cause hyperglycemia
(2) correct—will correct hypoglycemia and stabilize blood sugar
(3) treatment for hyperglycemia
(4) used if person becomes unconscious
