N371 Exam 1 Content
Which instructions would the nurse include when educating a patient with diabetes about how to prevent fasting hyperglycemia known as "dawn phenomenon"? "Administer Humalog (insulin lispro) between 5 and 6 a.m." "Administer Humulin R (insulin [human recombinant]) between 5 and 6 a.m." "Administer Lantis (insulin glargine) at 10 p.m. instead of with the evening meal." "Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal."
"Administer Humulin 70/30 (insulin isophane and insulin regular) at 10 p.m. instead of with the evening meal." Rationale To prevent fasting hyperglycemia known as the "dawn phenomenon," the patient would be instructed to administer Humulin 70/30 at 10 p.m. instead of with the evening meal. Dawn phenomenon results from a nighttime release of adrenal hormones that cause blood glucose elevations in the early morning. It is managed by providing more insulin in the overnight period. Giving a dose of intermediate-acting insulin such as Humulin 70/30 at 10 p.m. instead of with an evening meal will provide more insulin for the overnight period, reducing the chance of dawn phenomenon. Humalog and Humulin R are, respectively, rapid- and short-acting insulins that are not appropriate for this purpose. Administering Lantis at 10 p.m. instead of with the evening meal will not help prevent dawn phenomenon, because insulin glargine is a 24-hour acting insulin.
A patient who has been on long-term corticosteroid treatment calls the health care provider's office to report fatigue, nausea, and salt cravings. What question by the nurse is priority? "Have you been using salt substitutes?" "Have you stopped taking your corticosteroid?" "Do you have any notable swelling in your abdomen?" "Do you have any abnormal swelling on your upper back and shoulders?"
"Have you stopped taking your corticosteroid?" Rationale Patients who are on long-term corticosteroid treatment should not abruptly stop taking their medication. They will have symptoms of Addison's disease; therefore, it is important to ask if the patient is taking it when the patient exhibits Addisonian symptoms. Salt substitutes would not cause these symptoms. The patient would not have swelling in the abdomen. Swelling in the back or shoulders is not a priority question.
A patient with a pulmonary embolism is being discharged home on warfarin. Which response suggests the patient requires additional teaching about warfarin therapy by the nurse prior to discharge? "I will have to buy myself an electric shaver." "I will call my provider before I go to the dentist." "I can use a rectal suppository if I become constipated." "I will not participate in my soccer club games until I'm off the warfarin."
"I can use a rectal suppository if I become constipated." Rationale Several safety precautions are important for the patient to understand about bleeding when being discharged on anticoagulant therapy such as warfarin. The patient should take stool softeners to prevent hard stools or straining but should not insert a rectal suppository (unless they are prescribed and well-lubricated) or enema because they can cause bleeding. Avoiding contact sports, contacting the provider before going to the dentist, and using an electric shaver demonstrate appropriate knowledge about warfarin safety upon discharge.
The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective? "I should go barefoot in my house so that my feet are exposed to air." "I must inspect my shoes for foreign objects before putting them on." "I will soak my feet in warm water to soften calluses before trying to remove them." "I must wear canvas shoes as much as possible to decrease pressure on my feet."
"I must inspect my shoes for foreign objects before putting them on." Rationale To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic patients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the patient. The diabetic patient must wear firm support shoes to prevent injury.
The nurse is teaching a patient about the manifestations and emergency treatment of hypoglycemia. In assessing the patient's knowledge, the nurse asks the patient what he or she should do if feeling hungry and shaky. Which response by the patient indicates a correct understanding of hypoglycemia management? "I should sit down and rest." "I should drink a glass of water." "I should eat three graham crackers." "I should give myself 1 mg of glucagon."
"I should eat three graham crackers." Rationale Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia.
The nurse is educating a patient who is taking an anticoagulant drug. Which patient statement indicates a need for further teaching? "I should use an electric shaver." "I should avoid participating in any contact sports." "I should take aspirin whenever I have severe pain." "I should apply ice to any sites that may bruise for at least one hour."
"I should take aspirin whenever I have severe pain." Rationale Aspirin is an anticoagulant and may increase this patient's risk for bleeding; the patient should avoid it. The remaining statements indicate adequate understanding. The patient should use an electric shaver rather than a razor blade to prevent cuts and bleeding. If the patient gets bumped and may bruise, he or she should apply ice for at least one hour. Participating in contact sports may increase the risk of being bumped, scratched, or scraped, so he or she should avoid them.
The nurse is providing teaching for a patient who will be discharged home to continue therapy with warfarin. Which statement by the patient indicates a correct understanding of the teaching? "I will eat plenty of raw fruits and vegetables." "I should use enemas to help keep my stools soft." "I need to wear soft-soled shoes to protect my feet." "I'll use a soft-bristled toothbrush to brush my teeth."
"I'll use a soft-bristled toothbrush to brush my teeth." Rationale The patient taking warfarin or other anticoagulant therapy is at risk for bleeding and should avoid all activities that increase this risk. Enemas are not recommended due to the increased risk for tissue damage and bleeding. Patients are instructed to wear hard-soled shoes. Patients should avoid hard foods that might scrape the inside of the mouth.
A patient is scheduled for a glycosylated hemoglobin (A1C) test. The patient calls to request the day be changed because he has a family function the weekend before the test and is concerned about following the nutritional plan. What statement by the nurse is most appropriate? "You should discuss this with the registered dietician." "The A1C test will not be affected by what you eat in the days before it." "Following the nutritional requirements is hard, but it is very important that you do so." "I will reschedule it for the next day, but let's plan to sit and discuss your nutritional plan."
"The A1C test will not be affected by what you eat in the days before it." Rationale The A1C test is not affected by what the patient eats in the few days prior to the test. It is okay for the patient to have the exam. Talking to a dietician is not indicated. It is important not to tell a patient what he or she needs to do, such as following the nutritional requirements; the patient stated the understanding of that already. Rescheduling for the next day is not necessary and will not affect the results.
The nurse is teaching the parents of a pediatric patient who has recently been diagnosed with type 1 diabetes mellitus. What statement will the nurse include about the pathophysiology of the disease? "The body starts to attack itself and destroy the cells that convert insulin in the liver." "The body starts to attack itself and destroy the cells that make insulin in the pancreas." "Consistently high insulin levels leads to the inability of the cells to recognize and utilize the insulin." "Consistently high glucose levels leads to the increase in insulin secretion that cannot be utilized by the cells."
"The body starts to attack itself and destroy the cells that make insulin in the pancreas." Rationale Type 1 diabetes mellitus is an autoimmune disorder where the body begins to attack the beta cells, which are the insulin-forming cells, in the pancreas. This type of diabetes does not destroy the cells in the liver. In this type of diabetes insulin levels are absent, not elevated. High glucose levels are not what cause type 1 diabetes mellitus.
The nurse is caring for a patient who is experiencing diabetic ketoacidosis. The patient's family member asks the nurse, "Why is my brother breathing so fast and taking such deep breaths?" What is the nurse's best response? "It is likely the breathing pattern and rate is caused by the fever that the condition causes." "It is likely the breathing pattern and rate is caused by the infection that the condition causes." "The brain is triggered to increase the depth and rate of breaths in order to correct the acid-base balance of the blood." "The brain is triggered to increase the depth and rate of breaths in order to correct the elevated glucose level in the blood."
"The brain is triggered to increase the depth and rate of breaths in order to correct the acid-base balance of the blood." Rationale Diabetic ketoacidosis causes an increase in hydrogen and carbon dioxide levels in the blood, leading to metabolic acidosis. In order to attempt to correct this, the brain is triggered to increase the depth and rate of breaths in order to correct the acid-base balance of the blood. Diabetic ketoacidosis does not cause a fever or infection. The rapid, deep breaths are not an attempt to correct the elevated glucose level in the blood.
A patient with type 2 diabetes has been admitted for surgery, and the health care provider has placed the patient on insulin in addition to the current dose of metformin. The patient wants to know the purpose of taking the insulin. What is the nurse's best response? "You can't take your metformin while in the hospital." "Your diabetes is worse, so you will need to take insulin." "Your body is under more stress, so you'll need insulin to support your medication." "You must take insulin from now on because the surgery will affect your diabetes."
"Your body is under more stress, so you'll need insulin to support your medication." Rationale Because of the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for the patient who uses oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides. No evidence suggests that the patient's diabetes has worsened; however, surgery is stressful and may increase insulin requirements. Metformin may be taken in the hospital; however, not on days when the patient is NPO for surgery. When the patient returns to his or her previous health state, oral agents will be resumed.
Consuming which item is appropriate for the patient who becomes hypoglycemic at home? 1 tsp of sugar 1 tbsp of honey 1 oz of skim milk 1 cup of fruit juice
1 tbsp of honey Rationale A patient with hypoglycemia can consume 1 tbsp of honey to adjust his or her blood glucose level. The patient should have 8 oz of skim milk, not just 1 oz, to manage hypoglycemia. Half a cup of fruit juice, not a full cup, is generally sufficient to raise the glycemic level. The patient requires at least 4 tsp, not 1 tsp, of sugar to overcome hypoglycemia.
Which manifestations would the nurse anticipate finding in a patient diagnosed with Cushing's disease? Select all that apply. Acne Moon face Weight loss Hypotension Hyperglycemia Elevated cortisol level
Acne Moon face Hyperglycemia Elevated cortisol level Rationale Acne, "moon face," hyperglycemia, and elevated cortisol levels are common findings in patients diagnosed with Cushing's disease. Weight gain, not weight loss, and hypertension, not hypotension, are expected in Cushing's disease.
The nurse receives an order to start the patient who has a venous thromboembolism in the upper arm on oral warfarin. The nurse is aware the patient has an order to continue receiving an intravenous heparin infusion. What is the nurse's best action? Administer the medications as prescribed. Place the patient on a bed alarm as a safety precaution. Clarify the warfarin and heparin orders with the provider. Hold the dose of warfarin until the patient's partial thromboplastin time (PTT) is within normal range.
Administer the medications as prescribed. Rationale Although both heparin and warfarin are anticoagulants, they have different mechanisms and onsets of action. Because warfarin has a slow onset, it must be started while the patient is still receiving heparin in order to maintain a safe level of anticoagulation for effective treatment of the venous thromboembolism. It is not necessary to clarify the order because the patient must take warfarin while on the heparin because the warfarin is slow-onset. Warfarin should not be held to wait for PTT because PTT is used to measure effectiveness of heparin, not warfarin. Although the nurse may implement use of a bed alarm, it is not a priority.
A patient newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the patient and the patient's family? Dietary control Insulin administration Causes and treatment of hypoglycemia Causes and treatment of hyperglycemia
Causes and treatment of hypoglycemia Rationale The causes and treatment of hypoglycemia must be understood by the patient and family to manage the patient's diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the patient with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation.
What information should be included when teaching a patient with diabetes about foot care? It is important to soak your feet once a week. It is important to wear the same shoes most days. Apply moisturizing cream between your toes and on your feet. Check bath water temperature before stepping in the water.
Check bath water temperature before stepping in the water. Rationale It is important to check bath water temperature prior to stepping into the water. Patients with diabetes should not soak their feet, they should not put moisturizing cream between their toes, and they should avoid wearing the same shoes two days in a row.
A patient with type 2 diabetes is in for a routine physical. The patient has a fasting blood glucose level of 90 mg/dL and a glycosylated hemoglobin (A1C) level of 9%. What action by the nurse is priority? Provide a 10 g carbohydrate snack. Draw a capillary blood glucose level. Request the lab to redraw the sample. Discuss dietary adherence with the patient.
Discuss dietary adherence with the patient. Rationale Discussing dietary adherence is important to determine why the A 1C is so high. Providing a 10 g carbohydrate snack, checking a capillary blood glucose level, and a redraw are not indicated.
A patient is in an education class for diabetes care. What teaching should be provided to a patient regarding alcohol use and diabetes mellitus? Avoid alcohol use. Drink alcohol with meals. Check blood glucose after each drink. Prepare to administer larger doses than normal.
Drink alcohol with meals. Rationale To avoid alcohol-induced hypoglycemia, the nurse should recommend that patients drink alcohol with meals or just after eating. It is not necessary to avoid alcohol. Blood glucose does not need to be checked after each drink. Larger doses of insulin are not indicated.
The nurse is caring for a 90-year-old patient who is on antipsychotic drug therapy. For which adverse side effects will the nurse monitor the patient? Select all that apply. Dry mouth Parkinsonism Hypertension Hypoglycemia Urinary incontinence Orthostatic hypotension
Dry mouth Parkinsonism Orthostatic hypotension Rationale While monitoring a patient receiving antipsychotic drugs, the nurse should assess the patient for adverse side effects including dry mouth, parkinsonism, and orthostatic hypotension. Antipsychotic drugs may cause hypotension, not hypertension, and hyperglycemia, not hypoglycemia. The anticholinergic effects of the drug lead to urinary retention, not urinary incontinence. p. 42
A patient is admitted with severe diabetic ketoacidosis. Arterial blood gas results reveal a pH of 7.21. What is this patient's acidosis most likely in response to? Anaerobic metabolism Excessive intake of insulin Excessive breakdown of fatty acids Excessive intake of alcoholic beverages
Excessive breakdown of fatty acids Rationale Metabolic acidosis can result from the overproduction of hydrogen ions, underelimination of hydrogen ions, or insufficient bicarbonate ions. Excessive breakdown of fatty acids that occurs with diabetic ketoacidosis or starvation results in overproduction of hydrogen ions and metabolic acidosis. Anaerobic metabolism produces lactic acid as a cause of metabolic acidosis. Excessive intake of alcoholic beverages will also cause metabolic acidosis because of the high concentration of hydrogen ions in alcohol. Excessive intake of insulin will not result in diabetic ketoacidosis.
Which laboratory assessment finding may be indicative of diabetes mellitus? Glycosylated hemoglobin of 7.5% in a 30-year-old adult Fasting blood glucose of 100 mg/dL in an 80-year-old adult Glucose tolerance test of 139 mg/dL in a 23-year-old pregnant woman Random blood glucose level of 126 mg/dL in a patient asymptomatic for hyperglycemia
Glycosylated hemoglobin of 7.5% in a 30-year-old adult Rationale A glycosylated hemoglobin of 6.5% or greater is indicative of diabetes mellitus. A fasting blood glucose level of 100 mg/dL in an 80-year-old may be normal, as the normal is less than 100 mg/dL with an elevation of less than 1 mg/dL per decade of age in an older adult. A glucose tolerance level of 140 to 200 mg/dL would indicate impaired glucose tolerance, but not necessarily diabetes. A random blood glucose level of 126 mg/dL in a patient with no symptoms of hyperglycemia may be normal.
A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with intravenous (IV) fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves? Hyponatremia Hypokalemia Hyperkalemia Hypernatremia
Hypokalemia Rationale In acidosis, extracellular hydrogen ions move into the cell and potassium moves out, causing hyperkalemia. In diabetic ketoacidosis, by treating the elevated serum glucose with insulin and IV fluids, the acid-base imbalance resolves. As the acidosis resolves, the hydrogen ions move out of the cell, and potassium moves back into the cell, causing hypokalemia in the plasma. Sodium levels are not affected by diabetic ketoacidosis.
The community health nurse is preparing a presentation for a group of middle-aged adults. Which factors that impair the level of consciousness should be included? Select all that apply. Hypoxia Illicit drugs Cardiac arrest Blood pressure Neurologic injury Severe hypoglycemia
Hypoxia Illicit drugs Neurologic injury Severe hypoglycemia Rationale Hypoxia, illicit drugs, neurologic injury, and metabolic abnormalities (severe hypoglycemia) can impair the level of consciousness. Cardiac arrest and blood pressure are related to circulation.
What information does the nurse include when planning teaching for a patient with diabetes? Select all that apply. Importance of foot care Need to avoid exercise Correct storage for insulin Protein sources for periods of hypoglycemia Understanding of why the insulin is being prescribed
Importance of foot care Correct storage for insulin Understanding of why the insulin is being prescribed Rationale It is important for a patient to have regular foot care, understand where and how to store insulin, and understand why the insulin is prescribed. Exercise should not be avoided, and proteins are not given for hypoglycemia.
A patient newly diagnosed with type 1 diabetes is receiving education about the types of premeal insulin. What selection by the patient indicates the teaching was effective? Insulin aspart Insulin detemir Insulin glargine Isophane insulin NPH
Insulin aspart Rationale Insulin aspart is a rapid-acting insulin administered for premeal insulin control. Insulin detemir and glargine are long-acting insulins that are administered for basal regulation. NPH is an intermediate-acting insulin and is not indicated for premeal glucose coverage.
A patient has received teaching about the use of basal insulin for glucose stabilization. What selection indicates the teaching has been effective? Insulin lispro Insulin aspart Insulin glargine Insulin glulisine
Insulin glargine Rationale Insulin glargine is given for basal regulation because it lasts for 24 hours and controls the blood glucose levels. Insulin lispro, insulin aspart, and insulin glulisine are used for supplemental or prandial glucose correction because they are short-acting insulins.
Which medication taken by a patient with diabetes mellitus will protect the kidneys and help prevent diabetic nephropathy? Digoxin Lisinopril Propranolol Metoclopramide
Lisinopril Rationale Drugs that protect the kidneys are the angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs); lisinopril is an ACE inhibitor. Propranolol is a beta-adrenergic blocking agent, which can be used for hypertension, but does not possess protective effects for the kidneys. Metoclopramide is used to promote gastric emptying for diabetic patients with gastroparesis. Digoxin is a glycoside to slow and/or strengthen the force of cardiac contraction in patients with atrial fibrillation or heart failure; it does not protect the kidneys from diabetic nephropathy.
Which goal for a patient with diabetes mellitus will best help prevent diabetic nephropathy? Maintaining HbA 1C at 7% or less Emptying the bladder regularly Avoiding carbohydrates in the diet Taking insulin at the same time every day
Maintaining HbA 1C at 7% or less Rationale Long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Maintaining HbA 1C levels at or below 7% accomplishes this goal. Voiding when the patient has the urge prevents the backflow of urine and infection, but does not prevent diabetic nephropathy. The diabetic diet is composed of carbohydrates, proteins, and fats. Avoidance of carbohydrates is not recommended and will not prevent diabetic nephropathy. Although taking insulin at the same time each day may indirectly help control blood glucose, it does not directly prevent diabetic nephropathy, so is not the best goal.
Which musculoskeletal problem would a nurse expect to find in a patient with Cushing syndrome? Striae Osteoporosis Osteoarthritis Rheumatoid arthritis
Osteoporosis Rationale Excess cortisol levels deplete calcium from the bones causing weakness and osteoporosis. Striae are skin changes that happen due to weight gain. Osteoarthritis and rheumatoid arthritis are disorders of the joints less likely to be found with Cushing syndrome.
A patient with type 2 diabetes experiences a stroke and the nurse is caring for the patient in the intensive care unit (ICU). What factor puts this patient at greater risk for a poor clinical outcome? Patients with diabetes do not seek the care needed when having a stroke. Patients with diabetes experience increased vessel damage to the brain during a stroke due to elevated insulin levels. Patients with diabetes do not present the same way as other patients without diabetes who are having a stroke. Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes.
Patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes. Rationale Patients with diabetes who experience a stroke often have poorer outcomes than those without diabetes. Patients with diabetes mellitus are likely to suffer irreversible brain damage with carotid emboli that produce only transient ischemic attacks in people without DM. Thus, patients with diabetes experience brain damage that would normally not cause damage in a patient without diabetes. Patients with diabetes are no less likely to seek care than others. Elevated insulin levels do not increase vessel damage and are not a pathophysiological factor of diabetes. Patients with diabetes who are experiencing a cardiovascular event such as a myocardial infarction may not present the same way as other patients without diabetes; however, this is not true regarding stroke.
A patient with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the patient's plan of care for which reason? Patients who are diagnosed with diabetes have increased anxiety. Patients with postoperative hyperglycemia are prone to poor wound healing. Patients with diabetes who undergo surgery are likely to develop hypoglycemia. Patients with diabetes should not receive insulin when they do not eat a meal.
Patients with postoperative hyperglycemia are prone to poor wound healing. Rationale Postoperative hyperglycemia is associated with increased mortality and morbidity after surgical procedures. Preoperative hyperglycemia may cause neutrophil dysfunction and increased infection rates. Pain triggers an increase in blood glucose levels and an increased need for insulin. There is no evidence that patients with diabetes have more anxiety than others. Patients with diabetes receive insulin postoperatively to maintain blood glucose levels between 140 and 180 mg/dL regardless of oral intake.
A patient has been receiving heparin subcutaneously for 4 days. Which laboratory blood test value does the nurse report immediately to the provider? Hemoglobin of 14.2 g/dL Platelet count of 50,000/mm 3 International normalized ratio (INR) of 1.7 Activated partial thromboplastin time of 46 seconds
Platelet count of 50,000/mm 3 Rationale The normal range for platelets is 200,000 to 400,000/mm 3. Platelets are needed for blood clotting. This patient's platelet count is extremely low and he or she is at risk for bleeding. The low platelet count may be an indication of an adverse reaction to heparin known as heparin-induced thrombocytopenia (HIT). The heparin must be discontinued and the patient may need to receive platelet therapy before life-threatening hemorrhage occurs. Safety measures should also be implemented to prevent bleeding.
Which action is correct when drawing up a single dose of insulin? Wash hands thoroughly and don sterile gloves. Shake the bottle of insulin vigorously to mix the insulin. Recap the needle and save the syringe for the next dose of insulin. Pull back plunger to draw air into the syringe equal to the insulin dose.
Pull back plunger to draw air into the syringe equal to the insulin dose. Rationale The plunger is pulled back to draw an amount of air into the syringe that is equal to the insulin dose. The air is then injected into the insulin bottle before withdrawing the insulin dose. Although handwashing is important before any medication administration, sterile gloves are not required. The bottle of insulin should be rolled gently in the palms of the hands to mix the insulin, not shaken. Insulin syringes are never recapped or reused; the syringe and needle should be disposed of (without recapping) in a puncture-proof container.
The nurse is caring for a patient with diabetes who has autonomic neuropathy of the feet. What is the effect of this condition? Claw toe deformity Diabetic foot ulcer Reduced sensation Skin cracks and fissures
Skin cracks and fissures Rationale Autonomic neuropathy causes loss of normal sweating and skin temperature regulation, resulting in dry, thinning skin. Skin cracks and fissures increase the risk for infection. Motor neuropathy causes claw toe deformity; toes are hyperextended and increase pressure on the metatarsal heads, resulting in ulceration. Sensory neuropathy causes numbness and reduced sensation; as a result, the patient does not notice injuries to the foot.
Which laboratory value does the nurse recognize as consistent with a patient diagnosis of Addison disease? Calcium: 8 mg/dL Sodium: 128 mEq/L Potassium: 2.5 mEq/L Bicarbonates: 20mEq/L
Sodium: 128 mEq/L Rationale The normal range of sodium is 136 to 145 mEq/L. Adrenal insufficiency results in the decreased secretion of cortisol and aldosterone. One of the major functions of aldosterone is to increase urinary sodium excretion; therefore, hypofunctioning of the adrenal gland is complicated by hyponatremia. When there is a hypofunction of the adrenal gland, sodium levels are decreased. Hyperfunction of the adrenal gland decreases the level of calcium excreted. The normal range of calcium is 9 to 10.5 mg/dL. A decrease in calcium levels indicates hyperfunctioning of the adrenal gland. One of the functions of the adrenal gland is to increase the urinary excretion of potassium. If there is hypofunctioning of the adrenal gland, it is indicative of hyperkalemia. The normal range of potassium is 3.5 to 5.0 mEq/L; a decrease in the potassium level indicates hyperfunctioning of the adrenal gland. The normal range of bicarbonates is 23 to 30 mEq/L; a decrease in the bicarbonate level indicates hyperfunction of the adrenal gland.
A patient diagnosed with Cushing's disease has received teaching about nutrition. What food selection by the patient indicates effective teaching? Saltines Spinach Cabbage Canned soup
Spinach Rationale Spinach is a food choice that is high in potassium and is indicated for patients with Cushing's disease. Cabbage is low in potassium, and patients with Cushing's may be taught to eat foods high in potassium. Saltines and canned soup are high in sodium. Nutrition therapy for patients with hypercortisolism may involve sodium restriction.
The nurse instructs the patient to discontinue metformin for 24 hours before performing a kidney test using a contrast medium. What is the rationale for this instruction? To prevent hematuria To prevent lactic acidosis To prevent contrast-induced nephropathy To prevent a burning sensation upon urination
To prevent lactic acidosis Rationale Metformin, an oral antidiabetic medication, increases metabolism of pyruvate to lactate and results in lactic acidosis when administered with a contrast medium. Therefore, to prevent lactic acidosis, the nurse instructs the patient to discontinue metformin for 24 hours prior to the procedure. Metformin does not reduce the risk of hematuria. Oral acetylcysteine is administered to prevent contrast-induced nephropathy. The patient should be encouraged to consume fluids to prevent a burning sensation upon urination.
Which drug is used as an antidote for warfarin? Lepirudin Vitamin K Bivalirudin Argatroban
Vitamin K Rationale Vitamin K reverses the anticoagulant action of warfarin so it can be used as an antidote for warfarin. Lepirudin, bivalirudin, and argatroban are highly selective direct thrombin inhibitors used as alternatives to heparin.
Which assessment findings are consistent with hypoglycemia in a patient? Select all that apply. a. Cool and clammy skin b. Fruity odor in the breath c. Glucose level of 35 mg/dL d. Heart rate of 150 beats/min e. Presence of ketones in the urine
a, c Rationale Hypoglycemia is a hormonal disorder in which clinical manifestations include cool and clammy skin and blood glucose values lower than 70 mg/dL. Fruity odor in the breath and tachycardia are clinical manifestations of hyperglycemia. Ketones would be absent in the urine of a patient with hypoglycemia.
Which statements by the student nurse indicate effective learning about precautionary measures to be taken while a patient is on heparin sodium therapy? Select all that apply. a. "I must monitor the platelet count." b. "I must have the antidote, vitamin K, readily available." c. "I must monitor the partial thromboplastin time (PTT)." d. "I must monitor the international normalized ratio (INR)." e. "I must have the antidote, protamine sulfate, readily available."
a, c, e Rationale Monitoring the platelet count daily helps detect any heparin-induced thrombocytopenia, because a decrease in platelet count is a common adverse effect caused by the use of heparin sodium. Regular monitoring of PTT is necessary since it helps detect side effects and prevent complications. Protamine sulfate is used as an antidote in emergency situations caused by heparin overdose because it reverses the anticoagulation effect by binding to heparin. While using warfarin, patients may experience adverse effects of the drug; vitamin K is used as an antidote because of its coagulating effect. Regular monitoring of INR is recommended when a patient is on warfarin therapy. INR results show whether the dose is optimal, supratherapeutic, or subtherapeutic.
What laboratory findings are consistent with a diagnosis of Cushing's disease? Select all that apply. a. Elevated serum cortisol b. Decreased urine cortisol c. Increased serum sodium d. Increased serum calcium e. Decreased serum potassium
a, c, e Rationale Patients diagnosed with Cushing's disease have an elevated serum cortisol, elevated serum sodium, and a decreased serum potassium level. The urine cortisol level would be increased, and the serum calcium would be decreased.
The nurse is assessing a patient with a family history of type 2 diabetes. What does the nurse instruct the patient, considering the patient's risk for this disease? Select all that apply. a. "Engage in regular exercise." b. "Consume a high-carbohydrate diet." c. "Include concentrated simple sugars in the diet." d. "Maintain body weight within 10 lb of ideal weight." e. "Report failure of a wound to heal in within less than 2 weeks."
a, d, e Rationale A patient at risk for type 2 diabetes should engage in regular exercise to maintain a body weight within 10 lb of ideal weight because obesity is a risk factor for diabetes mellitus. The patient must report failure of a wound to heal in within less than 2 weeks; patients with diabetes are known to recover slowly from injuries and are prone to ulcer formation. The patient must reduce his or her intake of concentrated simple sugars and high-carbohydrate content in the diet because this may lead to elevated glucose in the blood because of poor metabolism.
What techniques should a patient with diabetes use to administer insulin injections? Select all that apply. a. Avoid injecting insulin on scarred sites. b. Inject insulin on the thigh for faster absorption. c. Inject insulin into a different anatomic site every day. d. Avoid injecting within a 2-inch radius around the navel. e. Grasp a fold of the skin and inject insulin subcutaneously.
a, d, e Rationale Scarred sites are less sensitive to pain, but are not preferred for insulin injections because insulin absorption is slow. When injecting insulin into the abdomen, avoid a 2-inch radius around the navel. Insulin is injected subcutaneously in a fold of the skin at an angle of 90 degrees. An angle of 45 degrees is appropriate for a thin patient to prevent intramuscular (IM) injection, which has a faster absorption rate and is not used for routine insulin use. Insulin is absorbed fastest when injected into the abdomen, followed by the deltoid, thigh, and buttocks. The patient must rotate injection sites to prevent lipohypertrophy (increased fat deposits in the skin) and lipoatrophy (loss of fatty tissue). However, rotation within one anatomic site is preferred to rotation from one area to another to prevent day-to-day changes in absorption.
Which manifestations would the nurse anticipate finding in a patient diagnosed with Addison's disease? Select all that apply. a. Vitiligo b. Weight gain c. Hypertension d. Hyperkalemia e. Hyperpigmentation
a, d, e Rationale Vitiligo, hyperkalemia, and hyperpigmentation are common findings in Addison's disease, caused by adrenal insufficiency. Weight loss, not weight gain, is consistent with Addison's disease. Hypotension, not hypertension, is present.
What symptoms should be assessed for in a patient diagnosed with hypoglycemia? Select all that apply. a. Ketones b. Confusion c. Weakness d. Dehydration e. Cool, clammy skin
b, c, e Rationale Confusion, weakness, and cool, clammy skin would indicate hypoglycemia and should be assessed for in this patient. Ketones would not be found in hypoglycemia. Dehydration is not found in hypoglycemia.
The nurse is teaching a patient being discharged about managing hypoglycemia at home. Once at home, the patient has a blood glucose level of less than 60 mg/dL. What food selections by the patient demonstrate that the teaching was effective? Select all that apply. a. 2 hard candies b. 6 saltine crackers c. 1 cup of fruit juice d. 3 graham crackers e. 4 teaspoons of sugar
b, d, e Rationale A blood glucose level of less than 60 mg/dL is hypoglycemia. Food selections that include 6 saltine crackers, 3 graham crackers, or 4 teaspoons of sugar are indicated for treatment of hypoglycemia. Two hard candies is not enough. One cup of fruit juice is too much.
A nurse is caring for a transgender patient who has been abusing alcohol and other substances in the community health care setting. Which core principles must the nurse apply to minimize health disparities in caring for this patient? Select all that apply. a. Assume that all the transgender patients are alike. b. Act as patient advocate for families and communities. c. Seek informed consent from families of transgender patients. d. Show respect for patients with nonconforming gender identities. e. Provide continuity of care or refer patients who need constant quality health care.
b, d, e Rationale When caring for a transgender patient who has been abusing alcohol and other substances in the community health care setting, the nurse should act as an advocate for the patient with the family and the community. The nurse should show respect for patients with nonconforming gender identities. The nurse should provide continuity of care or refer patients who need constant quality health care. All of these actions help minimize health disparities. Health care providers should not assume that all transgender patients are the same; instead, they should develop an individualized plan of care for each patient. Health care providers should always seek informed consent from transgender patients, not their families, if they are capable of giving consent, before starting treatment.
What macrovascular complications may occur as a result of diabetes mellitus? Select all that apply. a. Retinopathy b. Neuropathy c. Nephropathy d. Cardiovascular disease e. Cerebrovascular disease
d, e Rationale Macrovascular complications, damage to the large blood vessels, occur in diabetes mellitus. Both cardiovascular disease and cerebrovascular disease are macrovascular complications of diabetes mellitus. Retinopathy, neuropathy, and nephropathy are microvascular complications of diabetes. Microvascular complications occur due to damage to the small blood vessels of the body.
A diabetic patient is admitted to the health care facility with a foot ulcer. The nurse teaches wound care to the patient and the caregiver to prevent the risk for which condition? Osteoarthritis Osteoporosis Osteomyelitis Osteomalacia
osteomyelitis Rationale The diabetic patient with a foot ulcer is at high risk for osteomyelitis or bone infection. Diabetes also slows down the healing process. As a person ages, the cartilages at the synovial joints lose their elasticity and become compressible which leads to osteoarthritis. Joint dislocations and joint traumas also lead to osteoarthritis. Osteoporosis may occur due to age-related bone loss, or decreased intake of calcium and vitamin D. Osteomalacia or softening of the bone is caused by the deficiency of vitamin D in the body.
