Prep u
onset of short acting insulin
30 minutes to an 1 hour
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
CD4+ counts
A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate. The nurse should implement measures to prevent what complication?
DVT
s/s associated with hypothyroidism
Dry skin, bradycardia, and somnolence
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures?
"ill have my wife look at the soles of my feet each day." (examine his feet daily for redness, dryness, or cuts.)
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify?
Client takes medication as prescribed and report's any adverse effects
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?
Epoetin alfa
The nurse is creating a care plan for a client suffering from allergic rhinitis. What outcome should the nurse identify?
Improved coping with lifestyle modifications
Which type of insulin acts most quickly? And the onset or action?
Lispro (rapid-acting-10-15 minutes)
A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, what will the nurse suspect?
MI:often presented mostly in women over men
what is the biomarker that rises 2-3 hours after heart damage during MI
Myoglobin
onset of intermediate acting insulin
NPH insulin is 3 to 4 hours
Which is a symptom of severe thrombocytopenia?
Petechiae (pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.)
Antidote for oral anticoagulants: Warfarin
Phytonadione (vitamin K)
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?
dark, concentrated urine
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet?
sensory neuropathy (poor glucose control and decrease circulation to nerve tissues)
Parathyroid hormone (PTH) has which effects on the kidney?
stimulation of calcium reabsorption and phosphate excretion
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.
-abnormal erythrocyte production -desruction of normally formed red blood cells -blood loss
3 major classes of drugs that treat angina pectoris
Vasodialtors, beta blockers, calcium channel blockers
Which of the following is the most common hematologic condition affecting elderly patients
anemia
The nurse cares for a client with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which question?
are you allergic to shellfish? (contrast agents contain iodine)
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:
continuously monitor the sedated client
The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects:
bleeding and infection until blood count returns to normal
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?
chronic diarrhea (directly effecting the cells lining of the intentional tract)
what does the ELISA test confirm?
detects HIV antibody particles but may yield inaccurate results; a positive ELISA result must be confirmed by the Western blot test.
A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition?
"your body is using protein and fat or energy instead of glucose"
The nurse is providing education to a client who is being discharged with an outpatient treatment plan that includes taking a chemotherapeutic agent. What instructions should the nurse include? Select all that apply.
-The client should seek emergency care if he or she develops a fever. -The client should ensure no one else handles the medication. Hair loss should be expected when taking the medication.
clinical manifestations of pernicious anemia
-anorexia -a smooth, beefy red tongue -wide pulse pressure -palpitations -angina pectoris -fatigue -paresthesia of the hands and feet
Teaching for client with peripheral vascular disease
-avoid hot tubs-because decrease sensation -always wear shoes or slippers when out of bed -stop smoking-causes vasoconstriction and further decreased blood supply
Nurse teaching precautions for client taking nitroglycerin
-change position slowly -climbing up and down stairs carefully -lying down at the first sign of dizziness -Replace tablets every 6 months -store in a tightly closed container in a cool, dark place.
The nurse is preparing to send a client to the OR for a scheduled surgery. What should the nurse ensure is on the chart when it accompanies the client to surgery? Select all that apply.
-nurses notes -verification form -laboratory reports
A client with a malignant brain tumor comes to the clinic for a follow up. During the visit, the client asks the nurse, "Why am I so tired all the time?" When responding to the client, which information would the nurse include as possible causes? Select all that apply.
-tumor -treatment being used -stress
The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply.
-wear a medic alert bracelet -carry Epipen auto injector at all times -identifying ways to manage allergy while dining out -lists symptoms of peanut allergy
Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's regular insulin?
11:15 am (20-30 minutes before a meal)
What increases on the on a couple days following the MI because of inflammation?
CRP, erythrocyte sedimentation rate, and the WBC count increase
The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)
HR, heart rhythm, character of apical and peripheral pulses
A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis?
Powerlessness (because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can't perform even simple daily tasks.)
The nurse is providing discharge instructions for a client who was admitted to the oncology unit due to dehydration and anorexia after chemotherapy treatment. What information should the nurse provide to the client to promote improve the client's nutritional intake at home?
Take prescribed pain medication prior to commencing a meal
A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority?
disturbed body image related to loss of fat in the face and arms
While the nurse is preparing a client for a cardiac catheterization, the client states that they have allergies to seafood. Which of the following medications may the nurse give prior to the procedure?
methylprednisolone
A client with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this client should expect the health care provider to prescribe what medication for the management of the client's diarrhea?
octreotide acetate
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?
platelet count of 9,000/mm3
The nurse's plan of care for a client with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to candidiasis. What nursing intervention best addresses this risk?
providing thorough oral care before and after meals
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?
pruritus
A nurse is caring for a client with human immunodeficiency virus (HIV). What would the nurse expect the health care provider to order to determine the effectiveness of treatment?
quantification of T-lymphocytes
A client recovering from an asthma attack experienced what?
respiratory alkalosis
adverse effects of opioid analgesics that relieve pain
sedation, nausea, vomiting, constipation, respiratory depression
Which is a characteristic of venous insufficiency?
superficial ulcer formation, aching and cramping pain, presence of pulses
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?
thrombocytopenia
Which is a modifiable risk factors for transient ischemic attacks and ischemic strokes?
hypertension, diabetes, cardiac disease, smoking, and excessive alcohol consumption
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time?
ineffective peripheral tissue perfusion related to venous congestion
A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend?
participation in a support group for persons with diabetes
A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 µmol/L). In preparing this client for the procedure, the nurse anticipates what orders?
preprocedure hydration and administration of acetylcysteine (high risk-creatine greater than 2 mg/dL)
A client presents to the ED in distress and reporting "crushing" chest pain. What is the nurse's priority for assessment?
prompt initiation of ECG (12-lead-assists in ruling out an acute MI)
The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include?
reduce Na+ intake to no more than 2.4 g daily
When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalize blood pressure?
reduce sodium intake
What should a patient suspected with MI immediately receive?
supplemental oxygen, aspirin, nitroglycerin and morphine
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
sweating, tumors, and tachycardia
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?
the client has eaten and has not taken or received insulin
When assessing a client diagnosed with angina pectoris, it is most important for the nurse to gather what information?
the clients symptoms and the activities that precipitate attacks
What is Hashimoto's thyroiditis?
the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
to restore live glycogen and prevent secondary hypoglycemia
The dressing surrounding a mastectomy client's Jackson-Pratt drain has scant drainage on it. The nurse believes that the amount of drainage on the dressing may be increasing. How can the nurse best confirm this suspicion?
trace the online of the drainage on the dressing for future comparison
A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:
trousseau signs -hypocalemia
initial treatment for hypoglycemia
15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice -followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?
80-110 mg/dL
Nitroglycerin commonly causes
orthostatic hypotension and dizziness
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply.
-physical condition -health status -nutritional status -age
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
-test blood glucose every 3- 4 hours -take insulin or oral anti diabetics as usual -blood glucose above 300 call PCP -client not able to have regular diet: substitute soft foods, such as gelatin, soup, and custard.
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication?
160-190 (normal cholesterol is less than 200)
A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin?
headache, hypotension, dizziness, flushing
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect:
Graves disease
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?
Have you taken your prescribed clonidine today? (a side effect of clonidine is rebound or withdrawn hypertension)
Antidote for Heparin? if the client starts to exhibit excessive bleeding....
Protamine sulfate
What is intermittent claudication?
a muscular, crap type pain in the extremities due to exercise and relieved by rest, experience by clients with peripheral arterial insufficiency
When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind?
accuracy of the dosage
A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea?
administer antidiarrheal medications on scheduled basis
onset of action of very long acting insulin (glargine)
approx 6 hours
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug?
aspirin and clopidogrel-to prevent thromboembolism
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
assess the characteristics of the chest pain
A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action?
assess the clients readiness to learn
When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality?
hyperkalemia (is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves).)
The intraoperative nurse advocates for each client who receives care in the surgical setting. How can the nurse best exemplify the principles of client advocacy?
by maintaining the privacy, and emotional comfort, rights, and dignity of each client
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
hyperphosphatemia
A client in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in the femoral region. What is the nurse's most appropriate action?
call for help and apply pressure to the access site
When a client's ventilation is impaired, the body retains which substance?
carbon dioxide
The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect?
hypocalcemia
A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms?
dehydration
Which is a characteristic of arterial insufficiency?
diminished or absent pulses
While the surgical client is anesthetized, the scrub nurse hears a member of the surgical team make an inappropriate remark about the client's weight. How should the nurse best respond?
discourage the colleague from making such comments
A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching?
do not take aspirin while youre taking warfarin (Because aspirin decreases platelet aggregation and interferes with clotting)
A client comes to the emergency department complaining of visual changes and severe headache and denies past medical history. The nurse measures the client's blood pressure at 210/120 mm Hg. What question will the nurse ask to explore the hypertension situation?
do you have HTN in your family? (Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency).)
How should the nurse best position a client who has leg ulcers that are venous in origin?
elevate clients lower extremities
A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?
elevated ST segments
A client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows:
elevated troponin levels -gold standard for determining heart damage in the early stages
The nurse admits a client to the PACU with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the client's skin is cold, moist, and pale. Of what is the client showing signs?
hypovolemic shock
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?
indicates deficiencies in essential nutrients
A nurse is developing a nursing care plan for a client with peripheral arterial disease. Which of the following will be the priority nursing diagnosis?
ineffective peripheral tissue perfusion (the goal is to increase arterial blood supply to the extremities)
The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and increased body mass index mean that she is at increased risk for what complication in the postoperative period?
infection
A postsurgical client has illuminated her call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the client's left leg is visibly swollen and reddened. What is the nurse's most appropriate action?
inform PCP of clients s/s of VTE
The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which?
insensible fluid loss
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
inspecting the skin for petechiae once every shift
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should:
instructs the client to breathe into a paper bag
The nurse is taking a health history of a new client who reports pain in his left lower leg and foot when walking. This pain is relieved with rest and the nurse observes that the left lower leg is slightly edematous and is hairless. When planning this client's care, the nurse should most likely address what health problem?
intermittent claudication
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this?
iodine
The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?
iron deficiency anemia
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?
limit sodium and water intake (do not want anything that will promote fluid elimination)
Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?
monitor the site for blending or hematoma
The nurse is caring for a client who is having chest pain associated with a myocardial infarction (MI). What medication will the nurse administer intravenously to reduce pain and anxiety?
morphine sulfate (drug of choice to reduce pain and anxiety)
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
myxedema coma-severe hypothyroidism
adverse effects of beta blockers-propranolol
nausea, vomiting, depression, fatigue, impotence
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?
neutropenia
A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse?
numbness and weakness in the left arm
A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron?
orange juice
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH, 7.25; PaCO2 50 mm Hg
classic sig of hypovolemic shock
pallor (rapid, weak, thready pulse, low BP, and rapid breathing)
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
pallor, tachycardia, and sore tongue
The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension?
papilledema
Which glands regulate calcium and phosphorous metabolism?
parathyroid
