Adult 3 Final Exam Practice Questions A

The nurse is teaching the patient about the preparation for a percutaneous liver biopsy. Which statement by the patient indicates the teaching was effective?

"I won't be able to eat or drink for 6 hours before the examination."

A patient in acute liver failure questions a nurse about why he has to keep taking "this laxative" (lactulose) because he has diarrhea. Which response is the most accurate and appropriate?

"This medication helps draw ammonia out of the portal circulation."

The initial intravenous (IV) fluid administered for Diabetic Ketoacidosis (DKA) to counteract dehydration is?

0.9% Normal Saline

The patient has a glycosylated hemoglobin of 8. This value indicates that the patient's blood sugar has been elevated for how long?

120 days

What is the target blood glucose level when a patient is on a continuous insulin infusion for management of hyperglycemia in critical illness?

140-180 mg/dL

Regular insulin peaks in:

2-3 hours.

Which signs and symptoms indicate a mild hemorrhage associated with a GI bleed?

25-30 mL/hr. urine output, increased heart rate, confusion

A patient who recently had a craniotomy has a serum osmolality of 320 mOsm/L and urine output of 400 mL/hr for the past 3 hours with a urine specific gravity of 1.003. The nurse anticipates an order for which treatment?

3 mcg desmopressin acetate (DDAVP) subcutaneously every 12 hours

Which of the following will require antidiabetic pharmacological therapy?

45-year-old obese woman with FSBS of 138

This would alert the nurse that the patient may be experiencing diabetes insipidus (DI).

800 mL of urine output in 3 hours

A patient is admitted with abdominal pain and jaundice secondary to a biliary obstruction. Biliary disease is of concern because it is a common cause of which disorder?

Acute pancreatitis

Addison's disease treatment includes:

Administering steroids

A chronic alcoholic is admitted with hepatic encephalopathy, which laboratory study best confirms this?

Ammonia

Which diagnosis supports abdominal pain with right lower quadrant guarding, fever, and an elevated WBC count?

Appendicitis

How do you assess for asterixis in a patient with cirrhosis?

Ask the patient to extend their arms.

Management of a thyroid storm includes all of the following except:

Aspirin (includes oxygen, ice packs or cooling blankets, and IV fluids with dextrose)

The nurse is trying to decrease the patient's temperature in thyroid storm. Which of the following treatments should the nurse question?

Aspirin suppository

A patient has been admitted with a brain mass. The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT) scan. Which area of the brain should be scanned to confirm this diagnosis?

Base of the skull

A patient reports blurred vision, fatigue, and nausea. The patient's face is flushed, heart rate is 125 beats/min, and blood pressure is 80/40 mm Hg. Which action should be taken next?

Check a capillary blood glucose level.

A patient is diagnosed with a lower GI bleed, which procedure do you anticipate?

Colonoscopy

Which of the following is NOT a hallmark sign of gastric perforation?

Constipation (includes fever, GI bleeding, and abdominal distention)

You notice blue discoloration to the umbilicus region. This is an indicator of retroperitoneal bleeding and called?

Cullen Sign

Vasopressin may be used in patients with gastrointestinal bleeding. Which response best describes the mechanism of action for this medication?

Decreases portal venous blood flow to decrease bleeding

The nurse is developing a care plan for the patient in cardiogenic shock. The goals of therapy include which outcome?

Decreasing afterload

Which of the following is the most common treatment for this type of DI?

Desmopressin (DDAVP)

Which test is used to differentiate the cause of jaundice?

Direct and indirect bilirubin

The nurse is auscultating bowel sounds and notes high-pitched gurgling sounds every 10 seconds. Which action should the nurse take?

Document the normal finding.

A male patient is admitted with acute epigastric pain that radiates to his back. According to the patient, he drinks a six-pack of beer each night. Acute pancreatitis is suspected. Which laboratory findings are consistent with this diagnosis?

Elevated serum amylase, elevated serum lipase, and decreased serum albumin

Highest priority for a patient with a hemorrhage from esophageal varices is:

Ensure a patent airway.

Endoscopy is the golden standard for identification of gallstones. T or F

False

Oral antidiabetic medications are for Type 1 diabetes. T or F

False

The nurse assesses the patient with a diagnosis of thyroid storm. Which classic signs and symptoms associated with thyroid storm indicate the priority need for immediate nursing intervention?

Fever, tachycardia, systolic hypertension

A patient experiencing HHS (hypoglycemia hyperosmolar state) would most likely be experiencing.

Fluid volume overload

The nurse observes that the patient's arterial blood gases reflect hypoxemia, respiratory alkalosis, scattered crackles, and distended jugular veins. Heart tones are distant, and S3 and S4 are heard. The patient has scant amounts of concentrated urine output. The nurse anticipates the administration of which intravenous pharmacologic or parenteral therapies?

Furosemide

A patient with hypothyroidism can experience all of the following except:

Heat intolerance (includes hypotension, bradycardia, and constipation)

The nurse is caring for a patient with multiple organ dysfunction syndrome (MODS). The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss. The weight loss is due to which situation?

Hypermetabolism

SIADH (syndrome of inappropriate ADH) can result in:

Hyponatremia

A patient has an elevated thyroid-stimulating hormone (TSH) level and low T4 values. This finding is characteristic of which disorder?

Hypothyroidism

A patient who has recently returned from surgery has a heart rate of 110 beats/min and blood pressure of 100/80 mm Hg. Urine output has been 20 mL/hr for the past 3 hours, capillary filling time is 5 seconds, the skin is cool, the neck veins are flattened, and the patient reports thirst. The nurse suspects the patient is experiencing which disorder?

Hypovolemic shock

Which pathophysiologic consequence is the outcome for all patients in shock regardless of the etiology?

Inadequate tissue perfusion

The nurse is caring for a patient with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Which findings would confirm this diagnosis?

Increased ADH level and low serum osmolality

Priority nursing interventions regarding pancreatitis include all of the following, except:

Initiate TPN immediately (includes continuous IV fluids, monitoring glucose levels, and pain management)

The nurse performs an abdominal assessment on a patient recently admitted to the unit. In what order should the patient's abdomen be assessed?

Inspection, auscultation, percussion, palpation

In which order would the nurse perform an assessment of the GI system?

Inspection, auscultation, percussion, palpation.

NPH (Humulin N, Novolin N). • Onset (2-4 hrs), Peak (4-12 hrs), Duration (12-18 hrs).

Intermediate Acting

Which of the following is an example of a long-acting insulin?

Levemir

An older female patient admitted with weight gain, depression, and cold intolerance has respiratory acidosis and hypoventilation. She is unarousable. The nurse anticipates an order for which medication?

Levothyroxine 300 mcg IV followed by 75 mcg/day

Insulin glargine (Lantus), insulin detemir (Levemir). • Onset (3-4 hrs), Peak (none), Duration (24 hrs).

Long-Acting

What type of insulin is Levemir?

Long-acting insulin

A client is admitted for myxedema coma, which priority action should the nurse perform?

Maintain a patent airway.

Your patient has an upper GI bleed that is evidenced by black, tarry stool. This finding is termed:

Melena

Which antidiabetic drug blocks glucose production by the liver and improves insulin sensitivity?

Metformin

Which of the following oral antihyperglycemic medications is an insulin sensitizer that may be given on its own or with other oral medications?

Metformin

A patient was admitted with diabetic ketoacidosis (DKA). Glucose is 349 mg/dL, K+ is 3.7 mEq/L, and pH is 7.10. The nurse should anticipate orders for which pharmacologic agents? (Select all that apply.)

NS 1.5 L IV fluid bolus Insulin infusion at 5 units/hr Potassium 20 mEq/L of IV fluid

Which medication below is classified as a Somatostatin and is used to reduce portal pressure?

Octreotide (Sando statin)

A patient with type 2 diabetes has recently been diagnosed with heart failure. Which of the following medications should the nurse discuss with the healthcare provider due to the side effects of fluid retention and edema as well as contraindication with heart failure?

Pioglitazone (Actos)

After a liver biopsy, which is not a priority nursing intervention?

Position on LEFT side for 2 hours. (includes monitoring coagulation studies closely, monitoring for bleeding, and positioning the client on the RIGHT side for 2 hours)

Insulin lispro (Humalog), insulin aspart (Novolog). • Onset (15 min), Peak (1 hr), Duration (2-4 hrs).

Rapid-Acting

The nurse is performing an abdominal assessment on a newly admitted patient and observes a bluish discoloration around the umbilicus. The nurse suspects the patient may have which condition?

Retroperitoneal Bleed

Which of the following classifications of medications should not be given to a patient in a thyroid storm?

Salicylates (aspirin)

A condition characterized by inadequate tissue perfusion.

Shock syndrome

Regular insulin (Humulin R, Novolin R). • Onset (30 min), Peak (2-3 hrs), Duration (3-6 hrs).

Short Acting

A patient is vomiting blood that appears like coffee grounds. The nurse knows that the vomitus's appearance indicates that the bleeding's source is most likely from which area?

Stomach

A patient who is postoperative after a craniotomy has a serum osmolality of 260 mOsm/kg and a urine osmolality of 1500 mOsm/kg. The nurse suspects that the patient is experiencing which disorder?

Syndrome of inappropriate ADH secretion

A patient with hyperthyroidism is experiencing a fever and tachycardia. The nurse suspects:

Thyroid Storm

Hallmark signs of anastomotic leak are tachycardia, tachypnea, fever, abdominal pain, and anxiety. T or F

True

The priority assessment for a patient diagnosed with pheochromocytoma is:

Vital signs

With diabetic ketoacidosis (DKA), which of the following may be precipitating causes? (Select all that apply).

a. Infection b. Surgery c. Trauma d. eating disorders e. Acute pancreatitis

When rehydrating patient with hyperglycemic hyperosmolar state (HHS), the nurse must carefully monitor which of the following? (Select all that apply)

blood pressure, intake and output, lung sounds

Clinical manifestations of hyperglycemic hyperosmolar state (HHS) include which of the following?

blurred vision, mental confusion, wrinkles in tongue, and weakness.

With diabetes insipidus, the nurse expects the urine to be.

dilute

Which of the following electrolyte abnormalities is commonly seen in syndrome of inappropriate secretion of antidiuretic hormone (SIADH)?

hyponatremia