Exam 3 (F/E, Acid- Base, Diabetes, COPD, Asthma, and Thyroid disorders)
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium level of 2.9 mEq/L. Which of the following statements made by the patient indicates the need for further teaching? a) "I can use laxatives and enemas but only once a week." b) "I will be sure to buy frozen vegetables when I grocery shop." c) "A good breakfast for me will include milk and a couple of bananas." d) "I will take a potassium supplement daily as prescribed."
A
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? a) pH 7.20, PaCO2 36, HCO3 14- b) pH 7.50, PaCO2 29, HCO3 22- c) pH 7.31, PaCO2 48, HCO3 24- d) pH 7.47, PaCO2 45, HCO3 33-
A
Which signs and symptoms would you likely see on a patient with hypokalemia? a. Heart arrhythmia b. Constipation c. Nausea d. Muscle weakness e. Bradycardia
A, B, D
The nurse is assessing a patient with COPD which diagnostic tests are appropriate? a. Chest X ray b. CBC c. liver enzyme test d. Capnogram e. ABG f. Pulse oximetry g. Breathing test
A, B, D, E, F
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. a) Alter smooth muscle tone b) Decrease alveolar ventilation c) Reduce airway obstruction d) Increase oxygen distribution
A, C, D
A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C.1100 D.1700
C
A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; PCO2 48 (6.4 kPa); PO2 58 (7.7 kPa); HCO3 26 (26 mmol/L). Which prescriptions should the nurse implement first? a) sputum culture b) albuterol nebulizer c) chest x-ray d) ipratropium inhaler
B
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? a) "Ketones can damage your kidneys and eyes." b) "Ketones will tell us if your body is using other tissues for energy." c) "The spleen releases ketones when your body can't use glucose." d) "Ketones help the physician determine how serious your diabetes is."
B
The nurse is caring for a geriatric client in the home setting. Due to geriatric changes decreasing thirst, the nurse is likely to see a decrease in which fluid location which contains the most body water? a) Interstitial fluid b) Intracellular fluid c) Intravascular fluid d) Extracellular fluid
B
The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following? a) Headache b) Confusion c) Hallucinations d) Nausea
B
Which of the following inhibits bone resorption and promotes bone formation? a) Corticosteroids b) Calcitonin c) Parathyroid hormone d) Estrogen
B
A patient presents to the Emergency Department experiencing a severe anxiety attack and is hyperventilating. The nurse would expect the patient's pH value to be which of the following? a) 7.35 b) 7.45 c) 7.50 d) 7.30
C
A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime
C
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis
C
Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels? A. calcium, sodium B. phosphate, calcium C. calcium, phosphate D. sodium, calcium
C
Patients diagnosed with hypervolemia should avoid sweet or dry food because a) it can lead to weight gain. b) it can cause dehydration. c) it increases the patient's desire to consume fluid. d) it obstructs water elimination.
C
The client has been prescribed lisinopril to treat hypertension. The nurse should assess the client for which electrolyte imbalance? a) hyponatremia b) hypermagnesemia c) hyperkalemia d) hypocalcemia
C
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client a) Records in a diary the number achieved after one breath b) Sits in a straight-back chair and leans forward c) Exhales hard and fast with a single blow d) Inhales deeply and holds the breath
C
Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N
C
13. A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in? A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's
D
A client has partial-thickness burns on both lower extremities and portions of the trunk. Which I.V. fluid does the nurse plan to administer first? a) Albumin b) Normal saline solution with 20 mEq of potassium per 1,000 ml c) Dextrose 5% in water (D5W) d) Lactated Ringer's solution
D
A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema? a) Air pollution b) Infectious agents c) Allergens d) Cigarette smoking
D
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? a) Intravenous methylprednisolone (Solu-Medrol) 120 mg b) Ipratropium bromide (Alupent) by metered-dose inhaler c) Vancomycin 1 gram intravenously over 1 hour d) Oxygen through nasal cannula at 2 L/minute
D
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? a) pH, 7.5; PaCO2 30 mm Hg b) pH, 7.35; PaCO2 70 mm Hg c) pH, 7.29; PaCO2 30 mm Hg d) pH, 7.25; PaCO2 50 mm Hg
D
A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? a) Dysuria b) Blurred vision c) Leg cramps d) Tachycardia
D
A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? a) Potassium b) Chloride c) Calcium d) Sodium
D
A neonate weighing 1,870 g with a respiratory rate of 46 breaths/minute, a pulse rate of 175 bpm, and a serum pH of 7.11 has received sodium bicarbonate intravenously. The drug has been effective if the neonate: a) develops respiratory alkalosis. b) does not become edematous. c) is not dehydrated. d) does not go into metabolic acidosis.
D
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. Which of the following demonstrates that the nurse understands the correct procedure for preparing this medication? a) Different types of insulin are not to be mixed in the same syringe. b) If administered immediately, there is no requirement for withdrawing one type of insulin before another. c) The intermediate-acting insulin is withdrawn before the short-acting insulin. d) The short-acting insulin is withdrawn before the intermediate-acting insulin.
D
A patient has a phosphate level of 5.6. The doctor orders the patient to take Phoslo. What education will you provide to this patient regarding this medication? A. levels are the highest B. Take the medication with 8 oz of water C. Take the medication on an empty stomach D. Take the medication with a meal or right after E. Take the medication before bedtime when phosphate
D
Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system? a) Duodenum b) Ileum c) Cecum d) Jejunum
D
The nurse is caring for a client with a metabolic acidosis (pH 7.25). Which of the following values is most useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? a) PaCO2 b) Serum sodium level c) PaO2 d) Anion gap
D
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? a) Crackles in the lung fields b) Cool and pale skin c) Distended jugular veins d) Dark, concentrated urine
D
5. You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."
A
A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to a) Exhale slowly b) Increase the flow of oxygen c) Take deep breaths d) Perform upper chest breaths
A
A client has just been diagnosed as being in status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: a) respiratory alkalosis b) metabolic acidosis c) metabolic alkalosis d) respiratory acidosis
A
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? a) Hypokalemia b) Hypernatremia c) Hypophosphatemia d) Hyperchloremia
A
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: a) hyperkalemia. b) hypernatremia. c) hypercalcemia. d) hypokalemia.
A
A patient has a calcium level of 12.5. Which medication will most likely be ordered for this patient? A. Calcitonin B. 10% Calcium Gluconate C. Calcium Chloride D. Hydrochlorothiazide
A
A patient has a sodium level of 119. Which of the following is not a cause of this finding? A. Impaired thirst B. Low salt diet C. Over secretion of ADH (antidiuretic hormone) D. Hypotonic fluid infusion (overload)
A
A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance? A. Potassium level of 6.0 B. Potassium level of 2.5 C. Potassium level of 5.0 D. Potassium level of 3.5
A
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition? A. Bradypnea B. Tachypnea C. Bradycardia D. None of the options are correct
A
A patient is ordered to receive hypotonic IV solution to provide free water replacement. Which of the following solutions will the nurse anticipate administering? a) 0.45% NaCl b) 0.9% NaCl c) Lactated Ringer's solution d) 5% NaCl
A
A patient is post-opt from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for? a. Respiratory acidosis b. Respiratory alkalosis c. Hypokalemia d. Metabolic acidosis
A
A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A. 1900 B. 1300 C. 1130 D. 1500
A
A patient states they have been vomiting for the last 4 days. The patient is irritable, weak, and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which of the following conditions are presenting? A. Metabolic alkalosis partially compensated B. Metabolic alkalosis fully compensated C. Metabolic acidosis partially compensated D. Metabolic acidosis not compensated
A
A patient undergoing treatment for Rhabdomyolysis with a phosphate level of 6.0 is about to eat their dinner. What food from their food tray would you remove due to it high contents of phosphate? A. Breaded chicken and French fries B. Rice and broccoli C. Macaroni and 2 oz of canned tuna D. Baby carrots and peas
A
A patient's lab work shows that they have a high parathyroid hormone level. Which of the following conditions is the patient at risk for? A. Hypercalcemia B. Hypocalcemia C. Hypokalemia D. Hyperkalemia
A
Diabetic ketoacidosis, aspirin toxicity, and renal failure are examples of the causes of ___________________. A. High anion gap metabolic acidosis B. Normal anion gap metabolic acidosis C. Low anion gap metabolic acidosis D. Normal anion gap respiratory acidosis
A
During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a) Glycosylated hemoglobin level b) Fasting blood glucose level c) Urine dipstick for glucose d) Oral glucose tolerance test
A
The home health nurse visits a client with a diagnosis of type 1 diabetes. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? a. I need to stop my insulin b. I need to increase my fluid intake c. I need to monitor my blood glucose every 3 to 4 hours d. I need to call the HCP because of these symptoms
A
The nurse is analyzing the arterial blood gas (AGB) results of a client diagnosed with severe pneumonia. What ABG results are most consistent with this diagnosis? a) pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L b) pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L c) pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L d) pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L
A
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? a) 3 AM b) 5 AM c) 9 AM d) 7 AM
A
Which condition would most likely contribute to hyponatremia? a. Diabetes b. Burns c. Nausea d. Ascites
A
Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? a) Patient's eating and sleeping habits b) Patient's ability to self-administer insulin c) Cognitive problems d) Patient's history
A
Which of the following is accurate regarding status asthmaticus? a) A severe asthma episode that is refractory to initial therapy b) Patients have a productive cough. c) Usually occurs with warning d) Usually does not progress to severe obstruction
A
Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? a) Alcoholism b) Loss of gastric acid c) Inflammatory bowel disease d) Intestinal resection
A
You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours
A
The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a) 3 hours b) 10 to 15 minutes c) 1 to 2 hours d) 30 to 40 minutes
B
The nurse is providing care for a patient with hyponatremia. Serum sodium is at 115 mEq/L. Which of the following interventions would you provide for this patient? a. Provide ambulatory exercises b. Maintain a quiet environment c. Engage patient in conversation d. Provide snacks after meals
B
A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. a) Crackles b) Cough c) Dyspnea d) Wheezing
B, C, D
A client with a history of respiratory problems tells the nurse that he would like to explore strategies to reduce his risks. He also mentions being currently unemployed and not wanting to pursue costly strategies. What would the nurse emphasize as the single most cost-effective intervention to reduce the risk of developing COPD or slow its progression? a) Herbal therapies b) Cessation of smoking c) Reduction of smoking d) Weight loss
B
A client with emphysema is at a greater risk for developing what acid-base imbalance? a) Metabolic alkalosis b) Chronic respiratory acidosis c) Respiratory alkalosis d) Chronic metabolic acidosis
B
A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism? A. Hyperventilation (tachypnea) B. Hypoventilation (bradypnea) C. Increased potassium level (hyperkalemia) D. Constipation
B
A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH 7.23. Which of the following conditions are presenting? A. Metabolic alkalosis partially compensated B. Metabolic acidosis partially compensated C. Respiratory alkalosis not compensated D. Metabolic acidosis fully compensated
B
A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition? A. Anxiety attack B. Chronic obstructive pulmonary disease (COPD) C. Fever D. Aspirin toxicity
B
A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin.
B
A patient newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the patient is experiencing insulin waning. Based on this diagnosis, the nurse will expect which of the following changes to the patient's medication regimen? a) Increasing morning dose of long-acting insulin b) Administering a dose of intermediate-acting insulin before the evening meal c) Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack d) Changing the time of injection of evening intermediate-acting insulin from dinnertime to bedtime
B
A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern? A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."
B
A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is MOST important? a. Recheck the glucose level b. Give the patient ½ cup (4 oz) of fruit juice c. Call the doctor d. Keep the patient nothing by mouth
B
A patient with hypovolemic hyponatremia is started on IV fluids. Which of the following fluids do you expect the patient to be started on? A. 0.33% Saline B. 3% Saline C. 0.45% Saline D. D5W
B
A patient's calcium level is 11.2. Which of the following conditions could be the cause? A. None, 11.2 is a normal calcium level B. Hydrochlorothiazide C. Cushing's Syndrome D. Hypoparathyroidism
B
An EKG shows a shortened QT interval. Which of the following lab values would be indicative of this change? A. Calcium level of 8.0 B. Calcium level of 12.0 C. Calcium level of 8.7 D Calcium level of 9.2
B
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? a) Metabolic alkalosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic acidosis
B
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to what acid-base imbalance? a) Metabolic acidosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic alkalosis
B
Which of the following is not a cause of hypocalcemia? A.Low parathyroid hormone B.Crohn's Disease C. Acute Pancreatitis D. Thiazide Diuretics
D
A client appears flushed and has shallow respirations. The arterial blood gas report shows the following: pH, 7.24; partial pressure of arterial carbon dioxide (PaCO2), 49 mm Hg (6.5 kPa); bicarbonate (HCO3-), 24 mEq/L (24 mmol/L). These findings are indicative of which acid-base imbalance? a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d) respiratory alkalosis
C
A client is admitted to a hospital with a diagnosis of DKA. The inital blood glucose was 950 mg/dL. A continuous IV infusion of short acting insulin is initiated, along with IV rehydration with NS. The serum glucose level is now 240 mg/dL. The nurse would NEXT prepare to administer which item? a. Ampule of 50% dextrose b. NPH insulin SQ c. IV fluids containing dextrose d. Phenytoin for the prevention of seizures
C
A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: a) act as a diuretic. b) help maintain urine acidity. c) prevent the development of ketosis. d) reduce demands on the liver.
C
A patient has a calcium level of 7.2. What sign below is indicative of this lab value? A. None this is a normal calcium level B. Prolonged QT interval on the EKG C. Hypoactive bowel sounds D. Shortened ST segment
C
The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the health care provider (HCP) of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? a) creatinine b) protein c) potassium d) aldosterone
C
The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? a) Cardiovascular compromise b) Lung function c) Insensible fluid loss d) Summer allergies
C
What of the following is NOT an expected treatment for a phosphate level of 2.2? A. Encouraging the patient to eat fish, beef, chicken, and organ meats B. Administering Vitamin-D supplements C. Administering Phoslo by mouth with meals D. Ensuring patient safety due to risk of bone fractures
C
Which of the following is NOT a cause of metabolic acidosis? A. Aspirin toxicity B. Ileostomy C. Hyperaldosteronism D. Carbonic anhydrase inhibitors
C
Which of the following is the most rapid acting insulin? a) Regular b) NPH c) Humalog d) Ultralente
C
Which of the following is the progressive increase in blood glucose from bedtime to morning? a) Dawn phenomenon b) Diabetic ketoacidosis (DKA) c) Insulin waning d) Somogyi effect
C
A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. a) Polyuria b) Polydipsia c) Muscle twitching and spasms d) Numbness e) Tingling f) Aphasia
C, D, E
A patient has a blood glucose of 45 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Call the doctor for further orders. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 3 graham crackers to eat.
D
When assessing a client with fluid volume deficit, the nurse would expect to find: a. Increased pulse rate and blood pressure. b. Dyspnea and respiratory crackles. c. Headache and muscle cramps. d. Orthostatic hypotension and flat neck veins.
D
Which indicates that the client with diabetes insipidus understands how to manage care? a) The client will select a diabetic diet correctly. b) The client will state dietary restrictions. c) The client will exhibit serum glucose level within normal range. d) The client will maintain normal fluid and electrolyte balance.
D
Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)? a) Passive smoking b) Occupational exposure c) Ambient air pollution d) Exposure to tobacco smoke
D