Health Concepts Exam 2
How long does a hypomania episode last for? A. 2-5 days B. 4 days-1week C. 2 weeks D. 28-35 days
B
How long does a manic episode last for? A. 1 day B. 1 week C. 1 month D. 2 weeks
B
Use of splitting is most associated with which personality disorder? A.Antisocial B.Borderline C.Dependent D.Schizotypal
B
What is cyclothymic disorder? A. patient has tremors B. patient has borderline bipolar disorder C. patient has antisocial personality disorder D. Patient has an impaired circadian rhythm
B
2. Which mood disorder is characterized by the patient feeling depressed most of the day for a 2-year period? a). Dysthymia b). Cyclothymia c). Melancholic disorder d). Seasonal affective disorder
A
A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? A. Diet and exercise regime B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough
A
A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them? A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.
A
Bipolar 1 disorder has what episodes and how many of them? A. multiple manic episodes and at least 1 depressive episode B. multiple manic episodes and at least 2 depressive episodes C. 1 manic episode and multiple depressive episode D. multiple depressive episodes and at least one hypomanic episode
A
How long does a Mixed episode last for? A. 1 week B. 2 weeks C. 5 days D. 3 weeks
A
Perfectionism is a trait likely to be evident in a person with which personality disorder? A.Obsessive-compulsive B.Narcissistic C.Antisocial D.Avoidant
A
Type 1 diabetics typically have the following clinical characteristics: A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine
A
What is the definition of Dependence in the context of addiction? A. develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. When the drug is withdrawn, several physiologic reactions occur in the thalamus and brain stem. B. occurs when the person no longer responds to the drug in the way that person initially responded. Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially. C. Physiological and psychological signs and symptoms associated with stopping or reducing use of substances. D. Behaviors that prevent an individual from taking care of his or her own needs because of preoccupation with another who has an addiction.
A
What is the difference between Major depressive disorder and dysthymic disorder? A. same symptoms but less intense for a longer period of time B. same symptoms but more intense and less time C. same symptoms but less intense and less time D. It occurs seasonally
A
You are going over insulin administration education with a patient's mother. Which statement by her raises concern? ´A. "When she is sick I will hold her insulin." ´B. "I will bring her in every 3 months for a glycosylate hemoglobin blood drawn." ´C. "I ordered her a Medic-Alert bracelet yesterday." ´D. "I always carry sugary items in case she has a hypoglycemic attack."
A When a diabetic is sick, they should never hold their insulin. This is because when the body is stressed or has an infection they are at a very high risk for hyperglycemia so it is essential they monitor their blood glucose closely and administered insulin as needed. All the other options are correct
´During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? ´A. Increased food intake ´B. Decreased food intake ´C. Increased risk of hyperglycemia ´D. Decreased risk of insulin shock
A ´Food intake should be increased in the summer when the child is more active. During races and other competitions, more food may be required than at other practice times to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid administering too much insulin during a time of reduced need.
´A 15 year old, who is type 1 diabetic, reports that she almost "passes out" during gym class. What information would you assess from the teenager? ´A. Her eating habits prior to gym class ´B. How she takes her blood glucose after exercise. ´C. What type of form she needs to have filled out so she can be excused from gym class. ´D. None of the options are correct.
A ´It is very important to ask the teen when and what she eats before gym. Type 1 diabetics are encouraged to eat before physical activity to decrease the chances of hypoglycemia (which is what this teen is experiencing). She should take her blood glucose BEFORE exercise not AFTER. There is no need for her to be excused from gym class because exercise is essential for diabetics.
´The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: ´A. Hypoglycemia ´B. Frequent bruising ´C. Ketonuria D. Dry mouth
A ´Option A: Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. ´Option B: Type 2 diabetes can affect blood circulation which makes it easier for the skin to bruise. ´Option C: The presence of ketones in the urine happens due to a lack of available insulin. ´Option D: Losing a lot of fluids caused by frequent urination can lead to dehydration hence patients can develop dry mouth.
A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: ´A. High risk for deficient fluid volume ´B. Deficient knowledge: disease process and treatment ´C. Imbalanced nutrition: less than body requirements ´D. Disabled family coping: compromised
A ´Option A: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. ´Options B, C, and D are not related specifically to the issue of the question.
A mother brings her child in the office for a follow-up appointment and voices concern that her child has started urinating more than normal and is constantly thirsty & hungry. As the RN, you suspect? ´A. Diabetes Mellitus ´B. Phenylkentonuria ´C. Hypoglyemia ´D. Tret's syndrome
A ´The symptoms the mother is reports are the classic 3 P's of diabetes: polyuria, polydipsia, polyphagia.
What are the warning signs of a suppressed immune response? Select all that apply. A. 4 or more ear infections B. 2 or more serious sinus infections C. 2 or more months taking antibiotics with minimal effect D. 2 or more pneumonias E. Failure of an infant to grow/thrive F. Seasonal allergies G. Recurrent deep skin or organ abscesses H. Sun burning easily I. Persistent thrush or fungal infections J. Tinnitus K. need for IV antibiotics L. Auditory hallucinations M. 2 or more deep seated infections including septicemia O. Family history of PI
A, B, C, D,E, G, I, K,M, O
Select all that apply. What are the symptoms for Major depressive episode? A. Sleep B. Interest C. Concentration D. Drowsiness E. Energy F. Appetite G. Psychomotor retardation H. Psychomotor agitation I. Suicide
A, B, C, E, F, G, I think Sig E Caps
What are clinical findings of a suppressed immune functioning? Select all that apply A. May appear poorly nourished or have wasting syndrome B. May have chronic wounds C. May have fast wound healing D. May have chronic wounds E. May have acute wounds F. May have enlarged lymph nodes G. Presence of opportunistic infection H. May have seasonal allergies
A, B, D, F, G
What are the symptoms of a manic episode? Select all that apply? A. Grandiosity B. Decreased need for sleep C. Increased need for sleep D. Pressured speech E. Relaxed speech F. Flight of ideas G. Concentration H. Distractibility I. Increased activity/agitation J. Risky activities K. Depression
A, B, D, F, H, I, J Just think massive mania
A nurse is teaching a group of patients about Metabolic syndrome. Which assessment features are associated with the syndrome? (Select all that apply.) A.Male waist circumference 44 inches B.Fasting blood glucose 66 mg/dL C.Triglyceride value of 162 mg/dL D.Blood pressure 135/85 E.Patient is taking blood pressure medication
A, C, D, E Rationale: Metabolic syndrome is the simultaneous presence of metabolic factors known to increase risk for developing type 2 DM and cardiovascular disease (Frazer, 2015). Features of the syndrome include Abdominal obesity: waist circumference of 40 inches (100 cm) or more for men and 35 inches (88 cm) or more for women Hyperglycemia: fasting blood glucose level of 100 mg/dL or more or on drug treatment for elevated blood glucose levels Hypertension: systolic BP of 130 mm Hg or more or diastolic BP of 85 mg Hg or more or on drug treatment for hypertension Hyperlipidemia: triglyceride level of 150 mg/dL or more or on drug treatment for elevated triglycerides; high-density lipoprotein (HDL) cholesterol less than 40 mg/dL for men or less than 50 mg/dL for women
How long does a major depressive episode last for ? A. 2 days B. 2 months C. 2 weeks D. 2 years
C
A Type 2 diabetic may have all the following signs or symptoms EXCEPT: A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing
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 the 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
What is the definition of tolerance? A. develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. When the drug is withdrawn, several physiologic reactions occur in the thalamus and brain stem. B. occurs when the person no longer responds to the drug in the way that person initially responded. Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially. C. Physiological and psychological signs and symptoms associated with stopping or reducing use of substances.
B
Which of the following statements are true regarding Type 2 diabetes treatment? A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.
B
When caring for a patient having a hypoglycemic episode, the nurse knows which symptom requires immediate intervention? A.Hunger B.Confusion C.Headache D.Tachycardia
B Glucose is necessary for brain function. Confusion is a marker of severe hypoglycemia requiring immediate intervention. Irritability/anxiety, hunger, tachycardia, headache, sweating, and seizures are additional signs of hypoglycemia
´Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? ´A. 6.5-7% ´B. 5.7-6.4% ´C. 5-5.6% D. >5.6%
B ´Option B: Glycosylated hemoglobin levels between 5.7%-6.4% is considered as pre-diabetes. ´Option A: Glycosylated hemoglobin levels over 6.5 % are considered diagnostic of diabetes. ´Options C and D: Glycosylated hemoglobin levels less than 5.6 % are normal.
´Which of the following chronic complications is associated with diabetes? ´A. Dizziness, dyspnea on exertion, and coronary artery disease ´B. Retinopathy, neuropathy, and coronary artery disease ´C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts ´D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias
B ´Option B: These are all chronic complications of diabetes. ´Option A: Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. ´Option C: Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia. ´Option D: Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism.
´Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: ´A. 1130 and 1330 ´B. 1330 and 1930 ´C. 1530 and 2130 D. 1730 and 2330
B ´The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
During a manic episode, a patient is observed acting hyperactive, restless, and disorganized. The patient goes to the dining room, and begins to throw food, and dishes around. Verbal intervention by the staff is ineffective. The staff then escorts the patient from the dining room to the patient's room to dine alone. What is the rationale for this intervention? a). Prevent other patients from observing the behavior. b). The patient's behavior poses a substantial risk of injury to others and self. c). Protect the patient's biological integrity until medication takes effect. d). Reinforce limit setting, making sure that the patient learns how to follow unit rule
B I assume
Which of the following patient statements about the diabetic diet regime is correct?* A. "I'll try to consume about 20% carbs and 40% fats on a daily basis." B. "Foods that are high in mono and poly fats are avocados, olives, and nuts." C. "Meats increase the glycemic index; therefore, I should only consume 5% of them on a daily basis." D. "I should completely avoid starchy vegetables like potatoes and corn."
B. "Foods that are high in mono and poly fats are avocados, olives, and nuts."
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. ´A. Thirst ´B. Palpitations ´C. Diaphoresis ´D. Slurred speech ´E. Hyperventilation
BCD ´Palpitations occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.
Which behavior indicates that a patient diagnosed with borderline personality disorder is improving? A.The patient cries when her roommate refuses to go to the dining room with her. B.The patient yells at the group facilitator when he points out that she is monopolizing the group. C.The patient informs a staff member that she is having thoughts of harming herself. D.The patient tells the evening staff that the day staff excused her from group to smoke when she got upset.
C
Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog
C
Which property is for the immunoglobulin IgG? A. Found in mucus, saliva, tears, and breast milk. Protects against pathogens B. May be attached to the surface of a B cell or secreted into the blood. Responsible for early stages of immunity C. Secreted by the plasma cells in the blood. Able to cross the placenta into the fetus D. Part of the B cell receptor. Activates basophils and mast cells E. Protects against parasites. Responsible for allergic reactions
C
The nurse is teaching a patient with type 1 diabetes about exercise. The nurse understands the patient should avoid exercise during what time? A.During colder months B.When serum glucose is less than 150 C.When ketones are present in the urine D.When emotional stressors are high for the patient
C Exercise should be avoided if ketones are present in the urine. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels.
´A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that: ´A. Exercise is contraindicated in the type 1 diabetic child ´B. Soccer and baseball are too strenuous, but swimming is acceptable. ´C. Exercise is not restricted unless indicated by other health conditions. D. The level of activity depends on the type of insulin required.
C ´Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.
What is Metabolic Syndrome? AKA Syndrome X
Classified as simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease
What are 2 serious consequences of a suppressed immune response ?
Cancer and infection
A male client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, nurse Perry should assess for which behavioral clues? A. A rigid posture, restlessness, and glaring B. Depression and physical withdrawal C. Silence and noncompliance D. Hypervigilance and talk of past violent acts
Correct Answer: A. A rigid posture, restlessness, and glaring Behavioral clues that suggest the potential for violence include a rigid posture, restlessness, glaring, a change in usual behavior, clenched hands, overtly aggressive actions, physical withdrawal, noncompliance, overreaction, hostile threats, recent alcohol ingestion or drug use, talk of past violent acts, inability to express feelings, repetitive demands and complaints, argumentativeness, profanity, disorientation, inability to focus attention, hallucinations or delusions, paranoid ideas or suspicions, and somatic complaints.
Kevin is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with: A. Antisocial personality disorder B. Borderline personality disorder C. Obsessive-compulsive personality disorder D. Narcissistic personality disorder
Correct Answer: A. Antisocial personality disorder The client's history of delinquency, running away from home, vandalism, and dropping out of school are characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others. Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and the violation of others' rights are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.
Mr. Garcia, an attorney who throws books and furniture around the office after losing a case, is referred to the psychiatric nurse in the law firm's employee assistance program. Nurse Beatriz knows that the client's behavior most likely represents the use of which defense mechanism? A. Regression B. Projection C. Reaction-formation D. Intellectualization
Correct Answer: A. Regression An adult who throws temper tantrums, such as this one, is displaying regressive behavior, or behavior that is appropriate at a younger age. Adapting one's behavior to earlier levels of psychosocial development. For example, a stressful event may cause an individual to regress to bed-wetting after they have already outgrown this behavior.
When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? A. The injury isn't consistent with the history or the child's age. B. The mother and father tell different stories regarding what happened. C. The family is poor. D. The parents are argumentative and demanding with emergency department personnel.
Correct Answer: A. The injury isn't consistent with the history or the child's age. When the child's injuries are inconsistent with the history given or impossible because of the child's age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. Physical indicators may include injuries to a child that are severe, occur in a pattern or occur frequently. These injuries range from bruises to broken bones to burns or unusual lacerations. The child may present for care unrelated to the abuse, and the abuse may be found incidentally.
Edward, a 66-year-old client with slight memory impairment and poor concentration, is diagnosed with primary degenerative dementia of the Alzheimer's type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To assess for progression to the middle stage of Alzheimer's disease, the nurse should observe the client for: A. Occasional irritable outbursts. B. Impaired communication. C. Lack of spontaneity. D. Inability to perform self-care activities.
Correct Answer: B. Impaired communication. Signs of advancement to the middle stage of Alzheimer's disease include exacerbated cognitive impairment with obvious personality changes and impaired communication, such as inappropriate conversation, actions, and responses. Symptoms of Alzheimer's disease depend on the stage of the disease. Alzheimer's disease is classified into preclinical or presymptomatic, mild, and dementia-stage depending on the degree of cognitive impairment. These stages are different from the DSM-5 classification of Alzheimer's disease.
Cely with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? A. Calcium B. Sodium C. Chloride D. Potassium
Correct Answer: B. Sodium Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. It is also important to monitor patients for dehydration and lower the dose when there are signs of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than 2 mEq/L
Nurse Pauline is aware that Dementia unlike delirium is characterized by: A. Slurred speech B. Insidious onset C. Clouding of consciousness D. Sensory perceptual change
Correct Answer: B. insidious onset Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. The pathophysiology of dementia is not understood completely. Most types of dementia, except vascular dementia, are caused by the accumulation of native proteins in the brain. History must be obtained from the patient and their family members. Patients may present with symptoms of change in behavior, getting lost in familiar neighborhoods, memory loss, mood changes, aggression, social withdrawal, self-neglect, cognitive difficulty, personality changes, difficulty performing tasks, forgetfulness, difficulty in communication, vulnerability to infections, loss of independence, etc., A detailed history should include past medical, family, drug, and alcohol history.
A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone
D
Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A. Avoid shopping for large amounts of food. B. Control eating impulses. C. Identify anxiety-causing situations. D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Bulimia nervosa is a condition that occurs most commonly in adolescent females, characterized by indulgence in binge-eating, and inappropriate compensatory behaviors to prevent weight gain.
A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse Lenny should formulate a nursing diagnosis of: A. Ineffective individual coping related to feelings of guilt. B. Situational low self-esteem related to feelings of loss of control. C. Risk for violence: Self-directed related to impulsive mutilating acts. D. Risk for violence: Directed toward others related to verbal threats.
Correct Answer: C. Risk for violence: Self-directed related to impulsive mutilating acts. The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn't substantiate the other options. Borderline personality disorder (BPD) is 1 of 4 Cluster-B disorders that include borderline, antisocial, narcissistic, and histrionic. Borderline personality disorder (BPD) is characterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior
A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he drinks one (1) qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? A. Vomiting, diarrhea, and bradycardia B. Dehydration, temperature above 101° F (38.3° C), and pruritus C. Hypertension, diaphoresis, and seizures D. Diaphoresis, tremors, and nervousness
Correct Answer: D. Diaphoresis, tremors, and nervousness Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability.
Mr. Cruz visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects: A. Cyclothymic disorder. B. Atypical affective disorder. C. Major depression. D. Dysthymic disorder.
Correct Answer: D. Dysthymic disorder. Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks.
Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse in-charge do first: A. Recognize this as a drug interaction. B. Give the client Cogentin. C. Reassure the client that these are common side effects of lithium therapy. D. Hold the next dose and obtain an order for a stat serum lithium level.
Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithium level Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and a test is done to validate the observation. Monitoring of therapeutic levels includes trough plasma levels drawn 8 to 12 hours after the last dose. The therapeutic range is 1.0 to 1.5 mEq/L for acute treatment and 0.6 to 1.2 mEq/L for chronic therapy. Monitoring should be done every 1 to 2 weeks until reaching the desired therapeutic levels. Then, check lithium levels every 2 to 3 months for six months. It is also important to monitor patients for dehydration and lower the dose when there are signs of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than 2 mEq/L.
Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true? A. It's characterized by an acute onset and lasts about 1 month. B. It's characterized by a slowly evolving onset and lasts about 1 week. C. It's characterized by a slowly evolving onset and lasts about 1 month. D. It's characterized by an acute onset and lasts hours to a number of days.
Correct Answer: D. It's characterized by an acute onset and lasts hours to a number of days Delirium has an acute onset and typically can last from several hours to several days. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention.
Bipolar 2 disorder has what episodes and how many of them? A. multiple manic episodes and at least 1 depressive episode B. multiple manic episodes and at least 2 depressive episodes C. 1 manic episode and multiple depressive episode D. multiple depressive episodes and at least one hypomanic episode
D
The _____ ______ secrete insulin which are located in the _______. A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas
D
What is the definition of the term flashback? A. develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. When the drug is withdrawn, several physiologic reactions occur in the thalamus and brain stem. B. occurs when the person no longer responds to the drug in the way that person initially responded. Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially. C. Physiological and psychological signs and symptoms associated with stopping or reducing use of substances. D. transitory reoccurrences of perceptual disturbances reminiscent of disturbances experienced in earlier hallucinogenic intoxication
D
A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? ´A. Pulse ´B. Blood pressure ´C. Respiration D. Temperature
D ´An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.
When do most patients tend to develop gestational diabetes during pregnancy? A. Usually during the 1-3 month of pregnancy B. Usually during the 2-3 month of pregnancy C. Usually during the 1-2 trimester of pregnancy D. Usually during the 2-3 trimester of pregnancy
D. usually during the 2-3 trimester of pregnancy The answer is D. Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester.
What statement or statements are INCORRECT regarding Diabetic Ketoacidosis? A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing will always present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D
E
Mood vs Affect what is the difference?
Mood is the emotional state that a patient experiences with a sustained attitude. We also learn it from the patient's self report Affect is the way the patient conveys their emotional state. Relates more to others perception of the patient's emotional state and responsiveness. So think of Big mood and cause and AFFECT for behavior for it.
A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician's order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician? A. "It burns when I urinate." B. "My back is hurting." C. "I feel tired." D. "I feel the baby kick about 10 times an hour."
The answer is A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.
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
The answer is A. Humalog is a rapid-acting insulin. It has an onset: 15 minutes and duration: 3 hours Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.
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
The answer is A. Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours. Watch the YouTube video to learn the mnemonics on how to remember these times...very helpful.
A patient completes a one hour glucose tolerance test. The patient's result is 190 mg/dL. As the nurse you know that the next step in the patient's care is to? A. Continue monitoring pregnancy, the test is normal B. Reassess blood glucose in 2 weeks C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test D. Provide education to the patient about how to manage gestational diabetes during pregnancy
The answer is C. A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.
A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to: A. Administer Dextrose 50% IV per protocol B. Continue to monitor the glucose C. Give the patient 4 oz of fruit juice D. None, this is a normal blood glucose reading
The answer is A. This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.
Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic? A. Blood glucose 55 mg/dL B. Blood glucose 82 mg/dL C. Blood glucose 148 mg/dL D. Blood glucose 325 mg/dL
The answer is B. Euglycemic means "normal" blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL...Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic
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."
The answer is B. Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.
A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication
The answer is B. Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.
You're discharging a patient who just gave birth to a baby at 39 weeks gestation. The patient had gestational diabetes throughout her pregnancy. Her blood glucose levels have now returned to normal. When should the patient first follow-up with her physician for blood glucose testing? A. 1-3 years B. 6-12 weeks postpartum C. 1 year postpartum D. Not applicable since this condition has resolved and only occurs during pregnancy
The answer is B. Patients who've had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.
Which of the following patients is at most risk for Type 2 diabetes? A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided.
The answer is B. Remember Type 2 diabetes risk factors are related to lifestyle....being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.
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.
The answer is B. Remember when drawing up regular and intermediate insulins...you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.
A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A. None, this is a normal blood glucose reading. B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C. A bedtime snack may prevent this phenomenon. D. This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.
The answer is B. This is known as the DAWN PHENOMENON and is best treated with a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.
A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You're educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes? A. "Once I deliver the baby, it will go away, and I will not need any further testing." B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." C. "There are no risks or complications related to gestational diabetes other than hyperglycemia." D. "I'm at risk for delivering a baby that is too small for its gestational age due to this condition."
The answer is B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.
1. Which of the following symptoms do NOT present in hyperglycemia? A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria
The answer is C.
A patient with diabetes asks you about what type of exercise they should perform throughout the week. The best response is: A. Lifting weights B. Sprinting C. Swimming D. Jumping
The answer is C. Aerobic exercise is the best and swimming is the only option that is an aerobic exercise.
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
The answer is C. Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900...it would peak at 1100.
Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N
The answer is C. Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.
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
The answer is C. Precose is an alpha-glucoside inhibitor that works by lowering the blood sugar by slowly breaking down starchy foods in the GI system which helps slowly rise the blood sugar. Therefore, it should be taken with the first bite of food.
When are most pregnant patients tested for gestational diabetes? A. 6-12 weeks gestation B. 12-20 weeks gestation C. 24-28 weeks gestation D. 34-36 week gestation
The answer is C: 24-28 weeks gestation
A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition? A. 1 hour glucose tolerance test B. 24 hour urine collection C. Hemoglobin A1C D. 3 hour glucose tolerance test
The answer is D. If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.
A patient has a blood glucose of 58 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. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.
The answer is D. Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.
Which of the following statements are INCORRECT about exercise management for the diabetic patient? A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B. "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C. "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D. All of the options are correct statements.
The answer is D. Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.
Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________. A. high; prolactin and human chorionic gonadotropin (hCG) B. low; estriol and human placental lactogen (hPL) C. high; human chorionic gonadotropin (hCG) and cortisol D. low; human placental lactogen (hPL) and cortisol
The answer is D. The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.
You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal. A. <70 mg/dL B. <250 mg/dL C. >160 mg/dL D. <140 mg/dL
The answer is D: <140 mg/dL
A 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetes
The answers are A, C, D, and G. Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word "MOMMA". Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).
A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply: A. Fasting result B. 1 hour result C. 2 hour result D. 3 hour result
The answers are B and C. Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL
You're providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin: A. "Insulin is a type of cell that provides glucose to the body from the blood." B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood." D. "Insulin is a protein that helps carry glucose into the cell for energy."
The answers are B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.
A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply: A. Blood glucose 110 mg/dL B. Blood pressure 190/102 C. Proteinuria D. Linea nigra E. Negative glycosuria
The answers are B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria...meaning there is glucose leaking in the urine).
A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply: A. Hyperglycemia B. Hypoglycemia C. Respiratory distress D. Jaundice E. Hyperthermia
The answers are B and C. The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn's risk of respiratory distress at birth.
You're teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply: A. Sweating B. Confusion C. Frequent hunger D. Polydipsia E. Anxiety F. Frequent urination
The answers are C, D, and F. Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose).
What are some treatments/therapies for Major depressive disorder?
cognitive behavioral therapy psychodynamic therapy (talk) Electroconvulsive therapy (ECT) Light therapy (good for seasonal depression)
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
he answer is C. Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900...it would peak at 1100.
Nurse Amy is aware that the client is at highest risk for suicide? A. One who appears depressed frequently thinks of dying and gives away all personal possessions. B. One who plans a violent death and has the means readily available. C. One who tells others that he or she might do something if life doesn't get better soon. D. One who talks about wanting to die.
orrect Answer: B. One who plans a violent death and has the means readily available. The client at highest risk for suicide is one who plans a violent death (for example, by gunshot, jumping off a bridge, or hanging), has a specific plan (for example, after the spouse leaves for work), and has the means readily available (for example, a rifle hidden in the garage). Several suicide-related demographic factors often occur in the same person. For example, if a male police officer with major depression and a significant problem with alcohol commits suicide using his service revolver (which, unfortunately, happens not infrequently), 5 risk factors are involved: sex, occupation, depression, alcohol, and gun availability.
What powerful tool will increase self-efficacy and control for a person who is stressed? 1.Self-perception 2.Denial 3.Education 4.Maladaptive coping
•Answer 3 •Education regarding the situation and alternative coping measures is a powerful tool to increase self-efficacy and control.
What is the key element associated with an examination of coping? 1.Observation of behavior 2.Psychological testing 3.Physical examination 4.Assessment of vital signs
•Answer: 1 •Observation of behavior is the key element associated with an examination of coping. This includes how the individual functions in the presence of the stressor and how the individual reacts when speaking of the stressor.
Anger, anxiousness, sadness, and hopelessness are evidence of which coping type? 1.Primary 2.Positive 3.Adequate 4.Poor
•Answer: 4 •Evidence of poor coping behaviors includes anger, anxiousness, sadness, or hopelessness.