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ATI Concept Level Exam 2
Total Questions : 60
Showing 10 questions, Sign in for moreThe client was received in the emergency department from home via private vehicle. The client reports experiencing fatigue, blurred vision, dizziness, and headache for the past 2 days. The client also reports running out of blood glucose strips and Humulin regular insulin due to lack of financial means. The client lives alone at home and expresses fear of possible falls due to fatigue and dizziness. Orders have been received to increase Glargine from 20 units to 25 units at bedtime. Other medications taken at home remain the same at this time.
The client’s medication administration includes Aldactone 50 mg PO twice daily, Digoxin 0.25 mg PO every morning, and Carvedilol 25 mg PO twice daily. The client’s diagnostic results show a blood glucose level of less than 160 mg/dL with no coverage, and 160 to 220 mg/dL with 2 units of Glargine U 100 25 units subcutaneous at bedtime. The client’s fingerstick/random blood glucose is checked before breakfast & bedtime with regular insulin subcutaneous sliding scale coverage: 221 to 280 mg/dL with 3 units, 281 to 340 mg/dL with 6 units, 341 to 400 mg/dL with 8 units, and greater than 400 with a call to the physician.
BP 120/2 mm Hg, Pulse rate 88/min, Temperature 36.8° C (98.2° F), Respirations 20/min.
HbA1C 8.4% (less than 7% for diabetics), Blood glucose 235 mg/dL (74 to 106 mg/dL), Hemoglobin 14.2 g/dL (12 to 18 g/dL), Hematocrit 42.69% (37 to 52%), Total WBC count 6000/mm³ (5000 to 10,000/mm³), HDL 75 mg/dL (greater than 55 mg/dL), LDL 124 mg/dL (less than 130 mg/dL), BNP 52 pg/mL (less than 100 pg/mL), Chest x-ray: Clear. No evidence of infiltrates.
Appearance: Clear, Color: Amber, pH: 5.8, Specific gravity: 1.012, Leucocyte esterase: Negative, Nitrates: None, Crystals: None.
A nurse is caring for a client who is being admitted to the medical-surgical unit from the emergency department. The nurse is reviewing the client’s medical records.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Explanation
Potential Condition:
- B. Type 1 diabetes mellitus
The client’s symptoms of fatigue, blurred vision, dizziness, and headache, along with a high blood glucose level and HbA1C, suggest that they are experiencing hyperglycemia, a condition common in individuals with Type 1 diabetes mellitus.
Actions to Take:
- B. Teach the client about the signs of hyperglycemia.
- D. Assess the client’s feet for sensation.
Teaching the client about the signs of hyperglycemia will help them recognize when their blood sugar is high and take appropriate action. Assessing the client’s feet for sensation is also important as diabetes can lead to peripheral neuropathy, which can result in a loss of sensation in the feet.
Parameters to Monitor:
- B. Blood pressure
- D. Fingerstick blood glucose
Monitoring the client’s blood pressure is important as hypertension can be a complication of diabetes. Regularly checking the client’s fingerstick blood glucose levels will help ensure that their diabetes is being effectively managed.
Which piece of information should the nurse include in the teaching?
Where should the nurse expect to find the uterine fundus when palpating the patient’s abdomen?
After checking the patient’s morning glucose level, what action should the nurse take?
Which of the following conditions should the nurse mention as an example of a neural tube defect?
The patient asks the nurse what will be evaluated during this test.
Which of the following should the nurse include? (Select all that apply.)
After inserting a nasogastric (NG) tube into the patient, what findings should the nurse anticipate?
Which of the following statements should the nurse include in the teaching?
Which of the following statements is a therapeutic response by the nurse?
Which diagnostic test should the nurse anticipate the healthcare provider will order?
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