ARCHER - PRACTICE QUESTIONS #3

The nurse is caring for a client who was prescribed prednisone. The nurse should instruct the client to take this medication at what time? A. In the morning B. Around noon C. Before bed D. Anytime, but at the same time every day

Choice A is correct. Corticosteroids should be taken in the morning, preferably before 9 AM. This mimics the natural release of glucocorticoids from the adrenal glands in the morning. Further, corticosteroids have an activating effect that, if taken late afternoon or at night, would cause insomnia. Choices B, C, and D are incorrect. Prednisone is a corticosteroid and has an activating effect. The client should take this medication at the same time every day, preferably in the morning, to avoid a disturbed sleep pattern.

The nurse is caring for a child diagnosed with a coarctation of the aorta who is scheduled for a surgical repair tomorrow morning. When the nurse auscultates the child's lung sounds, the nurse notes diffuse crackles and rales throughout the lung fields. The nurse interprets this assessment as which of the following? A. Pulmonary congestion B. Foreign body aspiration C. Pneumonia D. Systemic congestion

Choice A is correct. Crackles and rales are indicative of pulmonary congestion. Because this child has coarctation of the aorta, there is too much blood backing up in the lungs. It is impossible for the left side of the heart to move sufficient blood forward working against the coarctation. This causes the back up of blood in the lungs, and therefore the crackles and rales are indicative of pulmonary congestion. Choice B is incorrect. Crackles and rales are not indicative of foreign body aspiration. The child presenting with a foreign body aspiration would be coughing, choking, have difficulty breathing and speaking, and might start to turn cyanotic. When the nurse auscultates that patient's lungs, she would hear wheezing and stridor instead of crackles and rales. Choice C is incorrect. While rales can sometimes be auscultated in pneumonia, crackles are not usually present. Instead the nurse would auscultate rhonchi. Additionally, because of the congenital heart defect coarctation of the aorta, the nurse knows that blood will be backing up in the lungs leading to pulmonary congestion. She does not suspect pneumonia in this patient. Choice D is incorrect. Crackles and rales are not indicative of systemic congestion, rather they are a sign of pulmonary congestion. Signs of systemic congestion would include splenomegaly, JVD, weight gain, edema, and ascites.

The nurse is preparing to assess a child with cystic fibrosis at the outpatient clinic. The nurse anticipates that the primary healthcare provider (PHCP) will order which routine laboratory test? A. Blood glucose B. Total cholesterol C. 24-hour urine D. Blood cultures

Choice A is correct. Diabetes mellitus is a common co-morbidity associated with cystic fibrosis (CF). The damage that CF may cause to the pancreas may induce diabetes. Thus, random blood glucose levels and quarterly hemoglobin A1C levels are commonly ordered throughout the course of the illness. A random blood glucose level greater than 200 mg/dL (11.1 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]may suggest the presence of diabetes. Choice B is incorrect. Total cholesterol levels are important for monitoring nutritional status in CF clients but are not typically a routine test ordered specifically for cystic fibrosis. Choice C is incorrect. 24-hour urine tests are used for various purposes, such as assessing kidney function, and are not specific routine assessments for CF. Monitoring kidney function may be important in CF clients, but it is not typically done through 24-hour urine tests as part of routine assessments for CF. Choice D is incorrect. Blood cultures are not part of routine assessments for cystic fibrosis clients. They are ordered if bacteremia is suspected and are not part of routine monitoring for CF-related conditions.

The emergency department (ED) nurse is caring for a client who has overdosed on lorazepam. The nurse anticipates the primary healthcare provider (PHCP) will prescribe which medication? A. Flumazenil B. Phenylephrine C. Epinephrine D. Naloxone

Choice A is correct. Flumazenil is the antidote for benzodiazepine (BZD) overdose. Lorazepam is a benzodiazepine, so the nurse expects to administer Flumazenil to this client with BZD overdose. Choice B is incorrect. Phenylephrine is a decongestant used to treat stuffy nose and sinus congestion caused by the common cold, hay fever, or other allergies. There is no indication to give this medication in the case of a benzodiazepine overdose. Choice C is incorrect. Epinephrine is a catecholamine that increases the heart rate and blood pressure. This medication is commonly given intramuscular (IM) for anaphylaxis. Choice D is incorrect. Naloxone is the antidote for opioid overdose. Lorazepam is a benzodiazepine, not an opioid. Naloxone would reverse an overdose caused by morphine, fentanyl, oxycodone, or other opioid medications.

The nurse preceptor is orienting a newly hired nurse caring for a client with advanced polycystic kidney disease (PKD). Which of the following actions by the newly hired nurse would require follow-up by the nurse preceptor? A. Requesting a prescription for ketorolac to help relieve the client's pain. B. Instructing the client on how to use guided imagery as a comfort strategy. C. Applying dry heat to the client's abdomen or flank for pain relief. D. Provides the client with foods high in fiber and low in salt.

Choice A is correct. For a client with advanced PKD, NSAIDs should be avoided. NSAIDs cause decreased renal blood flow and would be unhelpful (if not detrimental) in PKD management. If the newly hired nurse requests a prescription of ketorolac, an NSAID, this would require follow-up because it would be inappropriate. Choices B, C, and D are incorrect. These actions are appropriate and do not require follow-up. Pain control can be achieved for a client with PKD by applying dry heat to the abdomen or flank. Guided imagery is also a complimentary therapy that may be utilized. Constipation and pain are a concern with PKD, and the nurse providing food high in fiber would help mitigate constipation. In advanced PKD, the client should maintain a low sodium diet (2 grams/day). This contrasts with early in the disease process when the client loses sodium. However, the item states that this client has advanced PKD.

The nurse is assessing a client with hyperparathyroidism. Which of the following findings would support a diagnosis of hyperparathyroidism? A. nephrolithiasis B. hyperphosphatemia C. diarrhea D. halitosis

Choice A is correct. Hyperparathyroidism causes a client to develop hypercalcemia. While most clients are asymptomatic, clients may go on to develop manifestations such as nephrolithiasis, polyuria, confusion, constipation, and shortened QT interval. The client with hyperparathyroidism would cause the client to develop hypercalcemia, which increases the client's proclivity to develop nephrolithiasis. The reason for nephrolithiasis is that the urinary calcium levels are high, which makes conditions favorable for stone formation. Choice B is incorrect. Calcium and phosphorus have an inverse relationship. So, the phosphorus level will be low when the client's calcium level is high. The calcium is increased when a client has hyperparathyroidism. Choice C is incorrect. Hyperparathyroidism causes a client to have hypercalcemia. Hypercalcemia decreases bowel motility, leading to constipation, not diarrhea. Choice D is incorrect. Halitosis is when a client has foul-smelling breath. This is not a feature relevant to abnormalities of the parathyroid. Halitosis is a classic manifestation of Helicobacter pylori (H. pylori) infection.

The emergency department nurse is caring for a client exposed to inhalation anthrax. It would be essential for the nurse to take which action? A. Initiate continuous pulse oximetry B. Obtain a prescription for a chest radiograph C. Notify the public health department D. Prepare the client for a lumbar puncture

Choice A is correct. Inhalation anthrax poses a serious threat because the progression of symptoms may be rapid and become life-threatening. Anthrax may cause hypoxia, and continuous pulse oximetry monitoring is essential. This would enable the nurse to determine if the client's condition is deteriorating and may allow the nurse to immediately apply supplemental oxygen. Choices B, C, and D are incorrect. These actions apply to caring for a client with inhalation anthrax, but they do not prioritize monitoring the client's oxygenation status, which may rapidly deteriorate. A chest x-ray will be obtained to determine any abnormalities in the lung, and a lumbar puncture will be performed to evaluate for meningitis. Anthrax is a bioterrorism agent, and the public health department must be notified promptly, but it does not prioritize over direct client care. Additional Info Anthrax is a bioterrorism agent and must be taken seriously because it has a high mortality rate. Anthrax may be cutaneous or inhaled and is caused by exposure to the gram-positive bacterium. Nursing care is aimed at stabilizing the client's breathing and promptly initiating treatment, which is antibiotics (levofloxacin) and/or antitoxins such as raxibacumab.

The nurse is caring for a client suspected of having an endocrine disorder. Based on the client's laboratory data, the client is at the highest risk for which condition? See the exhibit. A. syndrome of inappropriate antidiuretic hormone (SIADH) B. diabetes insipidus (DI) C. cushing's syndrome/disease D. adrenal insufficiency

Choice A is correct. SIADH is highly likely based on the client's laboratory data showing hyponatremia, hemodilution, and increased urine specific gravity (concentration). SIADH causes increased water retention, thus leading to hemodilution and dilutional hyponatremia. The low urine output is also a feature (oliguria), and if urine is produced, it has a high specific gravity. Choice B is incorrect. Diabetes insipidus causes polyuria with a low specific gravity because the urine is mostly water. DI also features high sodium and hematocrit because all the water is excreted in the urine. Choice C is incorrect. Cushing's disease/syndrome causes hypernatremia because of the effect of aldosterone. This could lead to fluid retention, thereby decreasing the hematocrit. Choice D is incorrect. Adrenal insufficiency may cause hyponatremia, but it would not cause a decrease in hematocrit because the client is so dehydrated that hemoconcentration would occur.

The nurse is caring for a client experiencing an adrenal crisis (Addisonian crisis). The nurse should be prepared to administer which intravenous fluid? A. Lactated Ringers (LR) B. 0.9% saline C. Dextrose 5% in water (D5W) D. Dextrose 5% in water and Lactated Ringers (D5LR)

Choice B is correct. A client experiencing an adrenal crisis (Addisonian crisis) tends to have significant hypovolemia and hyponatremia. Because of the deficiency of steroid hormones, distributive shock may follow. Restoring the circulatory volume is essential in the management of this crisis. Isotonic solutions such as 0.9% saline or D5NS ( dextrose 5% in water combined with 0.9% saline) must be used. Isotonic saline can address both hypovolemia and hyponatremia in the adrenal crisis. If there is concomitant hypoglycemia, the D5NS solution is preferred to increase the glucose, sodium, and circulatory volume. Choices A, C, and D are incorrect. Although lactated ringers (LR) is an isotonic solution, it is inappropriate for managing an adrenal crisis because the client is experiencing concomitant hyponatremia. LR will not correct the hyponatremia (choice A). D5W is hypotonic and would be detrimental if given by itself because it would increase the free water and lower the sodium further by dilution (choice C). D5LR has a limited benefit in an adrenal crisis because of its inability to raise sodium levels (choice D).

The nurse manager regularly performs chart audits and room inspections in the unit. She tells the staff to address the unit's deficiencies during a meeting. Which concept of management is the nurse manager displaying? A. Benchmarking B. Continuous Quality Improvement C. Performance Improvement D. Quality Management

Choice B is correct. Continuous quality improvement continually assesses and evaluates the effectiveness of client care. Choice A is incorrect. In Benchmarking, the nurse manager compares best practices from top hospitals to her unit and adapts the best unit's methods to improve unit performance. Choice C is incorrect. This establishes a system of formal evaluation for job performance and recommends ways to improve performance as well as promote professional growth. Choice D is incorrect. Quality management is the act of overseeing all activities and tasks needed to maintain a desired level of excellence. This includes the determination of a quality policy, creating and implementing quality planning and assurance, as well as quality control/improvement.

The nurse is assessing clients for the risk of developing Cushing's syndrome. The nurse should identify which client is at greatest risk for this syndrome? A client A. recently diagnosed with hyperpituitarism and high blood pressure. B. who has been taking prednisone for 2 years to treat rheumatoid arthritis (RA). C. who has a goiter, and is receiving propranolol and propylthiouracil (PTU). D. experiencing eczema and is prescribed a seven-day course of topical hydrocortisone.

Choice B is correct. Cushing's syndrome is characterized by chronic exposure to a glucocorticoid. This is oftentimes referred to as secondary Cushing's syndrome. This client has been on a steroid for two years, and considering the long duration, this client is at the highest risk of developing this syndrome. Choices A, C, and D are incorrect. A client diagnosed with hyperpituitarism may risk Cushing's disease because of the increase in circulating cortisol and aldosterone. However, this client does not have the greatest risk because this client was recently diagnosed compared to the client with RA, and has been exposed to prednisone for two years. A goiter is a manifestation associated with hyperthyroidism and treating hyperthyroidism with propranolol and PTU would be appropriate. This would not have a relationship to increasing the risk for Cushing's syndrome. Topical steroids do not pose a significant risk for Cushing's syndrome, especially if they are used in short bursts.

The nurse is caring for a client newly diagnosed with diabetic nephropathy. The nurse anticipates a prescription for which medication? A. Ciprofloxacin B. Enalapril C. Sevelamer D. Epoetin alfa

Choice B is correct. Diabetic nephropathy is marked by the client having proteinuria (> 300 mg in a 24-hour urine collection). This is evidence that the client's diabetes is progressing and causing vascular damage. Treatment is aimed at reinforcing good glycemic control by advising the client to manage their diet by controlling their intake of carbohydrates. Prescriptive therapies include ACE inhibitors such as enalapril because of their ability to cause increased blood flow to the kidneys. ACE-I's may be nephrotoxic, but they provide a benefit, and treatment is guided based on the client's eGFR and creatinine. Choices A, C, and D are incorrect. Ciprofloxacin is a fluoroquinolone antibiotic used in treating urinary infections. Sevelamer is a phosphate binder used in clients with renal disease. Epoetin alfa is colony stimulating agent used in anemia secondary to chemotherapy or end-stage renal disease. Additional Info ✓ Diabetic nephropathy is a vascular complication associated with diabetes mellitus ✓ The development of this complication may indicate that the diabetes mellitus is uncontrolled ✓ A key indicator of this condition is proteinuria (> 300 mg) in a 24-hour urine specimen ✓ Treatment is aimed at both blood pressure and glycemic control ✓ If diabetic nephropathy is diagnosed, exposure to nephrotoxic medications (NSAIDs, IV contrast dye) should be very limited ✓ While ACE-I's may be nephrotoxic, they do provide a benefit for diabetic nephropathy ✓ The physician will determine if an ACE-I may be used in this situation based on the client's eGFR and creatinine

The nurse is caring for a client who has nephrogenic diabetes insipidus. Which of the following medications should the nurse expect to be prescribed for the client? A. Prednisone B. Hydrochlorothiazide C. Verapamil D. Lithium

Choice B is correct. Hydrochlorothiazide is a thiazide diuretic and has a paradoxical effect when prescribed for individuals with diabetes insipidus. While commonly HCTZ causes a diuretic effect, when used for nephrogenic DI, it can increase the proximal sodium and water reabsorption, thereby reducing the urine output. Choice A is incorrect. Prednisone is indicated in the management of adrenal insufficiency. Choice C is incorrect. Verapamil is a calcium channel blocker and is efficacious for migraine headache prophylaxis and hypertension management. Choice D is incorrect. Lithium would be contraindicated as lithium may cause nephrogenic diabetes insipidus. Additional Info ✓ DI is a condition that may be central or nephrogenic ✓ The client is at risk for fluid volume deficit because the client may experience polyuria ✓ This may manifest as tachycardia, hypotension, and a thread pulse ✓ Common laboratory findings for an individual with DI include hypernatremia, decreased urine specific gravity (it is dilute), and increased hematocrit (hemoconcentration) ✓ Treatment for central diabetes insipidus is by administering desmopressin (intranasal or tablet) ✓ Nephrogenic diabetes insipidus is treated by withdrawing the offending agent (such as lithium) and the administration of thiazide diuretics or NSAIDs

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Levothyroxine for a client with a myxedema coma B. Hydrochlorothiazide for a client with hyperparathyroidism C. Hydrocortisone for a client with adrenal insufficiency D. Regular insulin for a client with diabetic ketoacidosis

Choice B is correct. Hyperparathyroidism causes hypercalcemia, and the treatment for hyperparathyroidism is a combination of 0.9% saline infusion followed by furosemide. Hydrochlorothiazide is a thiazide diuretic and causes the retention of calcium. This would be detrimental for a client experiencing hypercalcemia. This prescribed medication requires follow-up with the prescriber. Choices A, C, and D are incorrect. Levothyroxine is the essential treatment for myxedema, a severe form of hypothyroidism. Hydrocortisone is a priority treatment for adrenal insufficiency as the hallmark of this disease is an insufficient amount of mineralocorticoids and glucocorticoids. DKA is an endocrine emergency and requires aggressive fluid resuscitation and intravenous regular insulin.

The nurse is assessing a client with adrenal crisis. Which of the following findings would be consistent with a diagnosis of adrenal crisis? A. bradycardia B. hyponatremia C. hypertension D. pulse deficit

Choice B is correct. Hyponatremia is an expected finding associated with an adrenal crisis. The client with this crisis often has severe fluid volume deficit, which may easily turn into hypovolemic shock. The hyponatremia is from the client not having enough aldosterone, which causes sodium retention and potassium elimination. Choice A is incorrect. Bradycardia is not a consistent finding with an adrenal crisis. The client may have tachycardia if the crisis is severe enough because of the hypovolemia. Choice C is incorrect. Hypertension is not an expected finding with an adrenal crisis because of the fluid volume deficit. Low blood pressure progressing to hypotension is expected. This low blood pressure puts the client at risk for orthostatic hypotension. Treatment for an adrenal crisis is intravenous hydrocortisone coupled with intravenous fluids, either 0.9% sodium chloride (normal saline) or 5% Dextrose and 0.9% sodium chloride (normal saline). Choice D is incorrect. Pulse deficit suggests an arrhythmia. A pulse deficit is when the radial pulse rate is lower than the apical. This is not consistent with an adrenal crisis.

The nurse is interviewing a client taking prescribed methimazole for hyperthyroidism. Which assessment finding requires notification to the physician? A. body mass index (BMI) 23 B. sore throat C. pulse (P) 84 D. skin rash

Choice B is correct. Methimazole may cause rare agranulocytosis. If a client endorses infectious symptoms such as a sore throat, the nurse will need to notify the physician because this may predispose the client to a life-threatening infection. Both PTU and methimazole may cause agranulocytosis. Choice A is incorrect. Hyperthyroidism causes weight loss, and the client having a normal BMI (18.5 to 24.9) is not a finding requiring follow-up by the physician. Choice C is incorrect. Hyperthyroidism may cause tachycardia. A pulse of 84 is normal and does not require follow-up. Choice D is incorrect. Skin rash is a benign effect associated with this medication. This finding does not need to be relayed to the physician.

The nurse is evaluating a client three days post-operative for signs and symptoms of infection. Which of the following is not a sign of infection from a surgical wound? A. Pus and clear drainage from the site B. Some redness along the edges of the site C. Increasing warmth from the wound D. Red streaks from the site

Choice B is correct. Some redness at the surgical site is a normal finding three days after surgery. Signs of infection include pus, excess wound drainage, increasing warmth from the wound, and red streaks from the site. Choice A is incorrect. While light, clear drainage is an expected finding three days post-operatively, pus drainage is not. Pus indicates a developing infection. Choice C is incorrect. While some heat is normal, an increase in temperature produced by the wound indicates infection at the site. Choice D is incorrect. Red streaks indicate a potentially dangerous infection at the wound and could mean the development of a disease and even sepsis.

The nurse is caring for an infant with the below tracing on the electrocardiogram (ECG). The nurse should plan to take which initial action? See the image below. A. Instruct the infant to beardown. B. Prepare a bag filled with ice and water. C. Assess the infant's axillary temperature. D. Obtain the infant's carotid pulse.

Choice B is correct. This tracing reflects supraventricular tachycardia (SVT), which is concerning because of the very high rate. The rate may be as high as 180 to 280 beats/min in infants. Characteristically, SVT does not have P-waves as they are buried in the T-waves. Preparing a bag filled with ice and water is essential because this may be applied to the face above the nose and mouth for 15 to 30 seconds. If that is ineffective, another vagal maneuver would be pressing the infant's knees to the chest for 15-30 seconds. Choices

The nurse is caring for a client scheduled for a thyroidectomy. The primary healthcare provider prescribes potassium iodide-iodine. The nurse understands that this medication is intended to A. decrease the risk of agranulocytosis postoperatively. B. prevent postoperative hypocalcemia. C. reduce the size and vascularity of the thyroid. D. decrease postoperative blood glucose levels.

Choice C is correct. For a client scheduled for thyroidectomy, potassium iodide-iodine (Lugol's solution) may be prescribed to decrease the risk of gland vascularity and surgical blood loss. A complication following thyroidectomy is significant blood loss, and having this medication taken 10 days before surgery will mitigate this risk. Choice A is incorrect. This medication does not decrease the risk of agranulocytosis. The antithyroid medications, especially methimazole, have the tendency to cause agranulocytosis, and the client's white blood cell count should be monitored during therapy. Choice B is incorrect. Lugol's solution does not act to prevent postoperative hypocalcemia. Postoperative hypocalcemia is a concern following this surgery (injury to the parathyroid), however, the treatment for this would be postoperative prescribed calcium carbonate. Choice D is incorrect. Lugol's solution does not have an influence on postoperative blood glucose levels.

The nurse has instructed a client with type 1 diabetes mellitus about proper exercise. Which of the following client statements indicates a correct understanding of the teaching? A. "I should carry a snack rich in protein just in case I feel shaky." B. "I will not take my prescribed daily glargine insulin if I plan on exercising." C. "I can initially expect my glucose level to rise with vigorous exercise." D. "I should start my exercise near the time that my insulin peaks."

Choice C is correct. For the client with type 1 diabetes mellitus, glucose levels will initially rise with exercise. The epinephrine released from the adrenal gland will cause the liver to discharge more glucose into the body. Prolonged exercise is likely to cause hypoglycemia because of the uptake of glucose from the muscles. Choices A, B, and D are incorrect. The client should be instructed to carry a simple carbohydrate with them in the event they develop hypoglycemia. Protein would have limited effects on blood glucose. So while a snack is recommended, it should be carbohydrate rich - not protein. Glargine insulin should be taken because this insulin does not peak (long-acting insulin) and is necessary to provide appropriate basal glucose control. The client should notbe instructed to exercise when their insulin peaks as this may cause hypoglycemia.

The nurse is caring for a client who reports diarrhea, unintentional weight loss, and nervousness. The primary healthcare provider (PHCP) orders a thyroid panel, and the nurse understands the client is at the highest risk for A. Myxedema B. Bell's palsy C. Grave's disease D. Cushing syndrome

Choice C is correct. Grave's disease is the most common cause of hyperthyroidism. It is characterized by increased heart rate, excessive sweating, heat intolerance, exophthalmos (bulging eyeballs), fatigue, tachycardia, shortness of breath, fine muscle tremors, thin silky hair/skin, and infrequent blinking. Choices A, B, and D are incorrect. Myxedema, or hypothyroidism, is characterized by severe, non-pitting edema, puffy, edematous face and periorbital area, coarse facial features, dry skin, and dry, coarse hair. Bell's palsy is caused by a lower motor neuron lesion resulting in damage to cranial nerve VII and is characterized by unilateral paralysis of the face. Cushing syndrome is caused by excessive secretion of ACTH and chronic steroid use. Clinical features of Cushing's syndrome include weight gain, truncal obesity, increased blood glucose, and hirsutism.

The nurse is performing discharge teaching for a client prescribed propylthiouracil (PTU). Which client statement indicates effective understanding? A. "I should increase my intake of foods containing iodine." B. "This medication may cause my urine to have a reddish discoloration." C. "I will need to have my liver enzymes monitored while I take this medication." D. "If this medication starts to work, I should notice some weight loss."

Choice C is correct. PTU is an antithyroid medication commonly prescribed for hyperthyroidism. A concern is that this medication may cause serious hepatic injury. Baseline liver function tests should be obtained and monitored throughout the duration of a client taking PTU. Choice A is incorrect. Foods and supplements containing iodine increase thyroid hormone synthesis and should be avoided for an individual with hyperthyroidism. Choice B is incorrect. Urine discoloration is not associated with this medication. Reddish urine discoloration is typically associated with phenazopyridine. Choice D is incorrect. If the medication should work, the client should notice weight gain. Hyperthyroidism causes an increase in the metabolic rate and causes weight loss. As the medication reduces the circulating thyroid hormones, the client should start to gain weight and have it normalize.

While working in the emergency department, the nurse is taking care of a client who has overdosed on morphine. Which of the following medications does she expect the healthcare provider will order? A. Sodium bicarbonate B. Flumazenil C. Diphenhydramine D. Naloxone

Choice D is correct. Naloxone is the antidote for opioid overdose. Naloxone would be used in the overdose of morphine, fentanyl, oxycodone, or other opioid medications. Choice A is incorrect. Sodium bicarbonate is a base produced by the kidneys to buffer the pH of the blood. When the pH is acidic, sodium bicarbonate is produced to help bring the pH back to the appropriate range. This medication is administered when there is an acid-base imbalance in the body, specifically for an acidotic pH with a base deficit. It would not be indicated in the care of a morphine overdose. Choice B is incorrect. Flumazenil is the antidote for benzodiazepine overdose. Morphine is an opioid, not a benzodiazepine, so the nurse would not expect to administer flumazenil to this patient. Choice C is incorrect. Diphenhydramine is an antihistamine commonly prescribed for allergies. There would be no indication for diphenhydramine in a morphine overdose, so the nurse would not expect to administer this to the patient.

The nurse is caring for a client newly diagnosed with type I diabetes mellitus. It would be essential to educate the client to A. check their hemoglobin A1C level every three months. B. rotate injection sites for insulin administration. C. examine their feet with a mirror daily. D. recognize the symptoms of hypoglycemia.

Choice D is correct. Recognizing the signs and symptoms of hypoglycemia is essential since hypoglycemia can be lethal. Signs and symptoms of hypoglycemia include palpitations, tachycardia, cool and clammy skin, lethargy, and coma. Choices A, B, and C are incorrect. Checking a hemoglobin A1C level every three months, rotating injection sites, and examining the feet in a mirror are key teaching points for a client newly diagnosed with diabetes. However, hypoglycemia may be lethal, and the client must recognize these symptoms.

The nurse plans care for a client experiencing a hyperglycemic-hyperosmolar state (HHS). The nurse should anticipate which prescriptions from the primary healthcare provider (PHCP)? A. 0.9% saline infusion B. Glargine insulin C. Sodium polystyrene D. Sodium bicarbonate

Explanation Choice A is correct. Hyperglycemic-hyperosmolar state (HHS) is likely to develop in individuals with type II diabetes mellitus. The patient secretes just enough insulin to prevent ketosis in HHS but not enough to prevent hyperglycemia. Severe hyperglycemia causes an individual to experience significant diuresis, causing severe dehydration. Correcting fluid and electrolyte imbalances is essential for an individual with HHS. The clinical guideline is to infuse one liter of saline in one hour and reassess the client's volume status thereafter. Choices B, C, and D are incorrect. Insulin may be utilized in HHS, but the priority treatment is correcting the severe dehydration. If insulin is utilized, regular insulin may be prescribed - not glargine, which is long-acting and has no peak. Sodium polystyrene is indicated for hyperkalemia. The client with HHS commonly has hypokalemia because of the alkalosis they experience. This medication would be contraindicated in HHS and indicated in DKA. Sodium bicarbonate is indicated to treat metabolic acidosis, the client with HHS is in an alkalotic state, so this treatment would be detrimental.

The nurse is taking a sample of the fluid pulled from a nasogastric tube to ensure proper placement. The nurse will confirm appropriate placement of the NG tube if the stomach contents have a pH of: A. 3.4 B. 7 C. 5.9 D. 8

Explanation Choice A is correct. The nurse would believe that the NG tube is correctly placed if the aspirate shows a pH below 5.5. Stomach contents should be acidic ( a pH less than 5.5). Before medication or food administration, it is crucial always to verify the correct placement of the nasogastric tube ( NGT). The gold standard to verify tube placement is visualization on an x-ray. However, given the risks of radiation exposure with X-rays and delayed feeding, alternative options are often used to verify the tube placement before feeding or giving medications to the client. The most commonly used first-line verification method is measuring the pH of the NG tube aspirate to make sure it falls in line with that of gastric contents. Most guidelines recommend that the pH of an NGT aspirate should be ≤5.5 (acidic) to confirm proper placement. Choices B, C, and D are incorrect. A pH of 7 or 8 is alkaline ( Choices B and D). An alkaline pH ( >7.0) often indicates a lung aspirate ( respiratory tract) rather than gastric. If the pH of the aspirate is greater than 5.5, a chest x-ray must subsequently be ordered to evaluate the NGT placement. Similarly, a pH of 5.9 ( Choice C) is not low enough to be considered a normal finding for gastric contents and hence, not adequate to ensure a proper NG tube placement. The subsequent step is to obtain a chest x-ray since this pH is greater than 5.5.

A nurse is preparing to administer prednisone 5 mg orally to a client with primary hyperparathyroidism. The nurse understands that prednisone is given to this client because: A. Prednisone increases the client's immune function B. Prednisone increases the client's vitamin D levels C. Prednisone decreases gastrointestinal absorption of calcium D. Prednisone decreases the release of calcium by the bones

hoice C is correct. Prednisone, like all glucosteroids, decreases gastrointestinal absorption of calcium, specifically in the intestines. Therefore, in a client with hyperparathyroidism, prednisone may be used to reduce the client's high serum calcium levels (hypercalcemia). Choice A is incorrect. Prednisone is an immunosuppressant, and it decreases the body's ability to fight infections. Choice B is incorrect. Glucocorticoids (including prednisone) antagonize vitamin D, resulting in a subsequent decrease in the client's vitamin D and calcium levels. Choice D is incorrect. Long-term administration of corticosteroids, including prednisone, causes osteoporosis. Steroids decrease bone formation and increase bone resorption by affecting calcium regulation (i.e., decreasing calcium absorption and increasing excretion) and inhibiting osteoblast function.

pheochromocytoma

A hormone-secreting tumor that can occur in the adrenal glands. Pheochromocytomas usually develop in the small glands on top of the kidneys (adrenal glands). They most commonly affect people between the ages of 20 and 50, but can occur at any age. Because of hormones secreted, symptoms include high blood pressure, sweating, rapid heartbeat, and headache. Surgery to remove the tumor is usually required. RATIONALE: The client is experiencing pheochromocytoma, which causes the classic triad of symptoms (headache, hyperglycemia, hypertension). Other clinical features supporting the diagnosis include how the symptoms are induced during stressful periods (episodic), tremors, weight loss, and thirst, which is explained by elevated blood glucose and heat intolerance, seen in pheochromocytoma.

serum thyroxine

A lower than normal level of T4 may be due to: Hypothyroidism (including Hashimoto disease and other disorders involving an underactive thyroid) Severe acute illness. Malnutrition or fasting.

While preparing to discharge a 2-year-old newly diagnosed with hypothyroidism, you include which of the following educational points in your discharge teaching? Select all that apply. Take the thyroid medication at the same time each day. Take the thyroid medication 30 minutes after breakfast. Avoid taking the thyroid medication in the evening. No follow-up labs are necessary. Encourage increased fluids and fibrous foods

Additional Info ✓ Hypothyroidism labs show low T4 and elevated TSH ✓ Other education points may include signs and symptoms of hyperthyriodism, which can be caused by thyroid replacement therapy

The nurse is assessing a client with diabetic ketoacidosis (DKA). Which of the following would be an expected finding? Select all that apply. Thready pulse Jugular venous distention (JVD) Coarse tremors Tachycardia Orthostatic hypotension

Choices A, D, and E are correct. A client presenting with DKA will have signs and symptoms of dehydration that range from mild to severe. Tachycardia is a common finding in DKA because of the fluid volume deficit. This, in turn, causes a client to have a thready pulse. Orthostatic hypotension is also a common finding because of dehydration. Choices B and C are incorrect. JVD is a finding associated with fluid volume overload. A client with DKA will not have this sign because DKA is associated with dehydration. Coarse tremors would be a neurological finding that would be concerning for neurodegenerative diseases such as Parkinson's. Coarse tremors are not an expected finding with DKA.

Thiocyanate levels

The thiocyanate level in plasma is considered to be a good indicator of exposure to cyano-containing organic substances since thiocyanate levels are inexorably high when the plasma cyanide levels are high.

ecchymosis

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.

Hypoplastic left heart syndrome (HLHS)

characterized by a very small, underdeveloped left atrium, ventricle, and aorta. Essentially, the entire left side of the heart is not developed. This infant will appear cyanotic and quickly show signs of heart failure

The nurse is caring for a client who reports having a durable power of attorney. The nurse understands that this type of advance directive A. legally designates their spouse or significant other, allowing them to have a voice in health care treatment options as the client ages. B. designates an individual by the client to assist in medical decision-making who also becomes responsible for all of the client's medical bills. C. legally designates an individual to make medical decisions when the client can no longer do so. D. is a specific designation specifying who can receive and discuss the client's privileged healthcare information

hoice C is correct. A health care proxy is an individual named in a written legal document designated to make medical decisions for the client when the client is no longer able to make decisions for themself. Choice A is incorrect. Although a client may designate their spouse or significant other as their health care proxy, an official health care proxy requires the completion of legal paperwork and a copy of the documents to be provided to the hospital or healthcare provider. Without doing so, the significant other or spouse cannot be the legally designated health care proxy. Choice B is incorrect. Health care proxies make decisions about healthcare. In general, if the health care proxy follows the client's pre-discussed wishes, there are no financial implications for the health care proxy. Choice D is incorrect. A health care proxy designation and a designation to receive confidential information protected under HIPAA are two distinct designations.

ductus arteriosus

normal duct in fetal circulation that allows oxygenated blood to shunt from the pulmonary artery to the aorta and bypass pulmonary circulation. The ductus arteriosus should close shortly after birth, but if it does not, it is known as a patent ductus arteriosus (PDA). These infants present with a machine-like murmur

transposition of the great arteries (TGA)

the pulmonary artery and aorta are switched, creating two separate loops for blood circulation. The deoxygenated blood enters the right atrium from the body and is sent directly back to the body via the transposed aorta. Oxygenated blood enters the left atrium from the lungs and is sent back to the lungs via the transposed pulmonary artery. These two closed loops can only be connected via an opening in the septum, either an ASD, VSD, PDA, or PFO. The child will depend on one of these openings for systemic oxygenation. The infant may present with severe cyanosis at birth