Med-Surg Exam 4 Nclex
A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.
4. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.
What insulin type can be given by IV? Select all that apply: A. Glipizide (Glucotrol) B. Lispro (Humalog) C. NPH insulin D. Glargine (Lantus) E. Regular insulin
E Regular insulin The only insulin that can be given by IV is regular insulin.
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? a. A 48-year-old woman with a hemoglobin A1C of 8.4% b. A 58-year-old man with a fasting blood glucose of 111 mg/dL c. A 68-year-old woman with a random plasma glucose of 190 mg/dL d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a. A 48-year-old woman with a hemoglobin A1C of 8.4% Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.
the male client dx with chronic pancreatitis calls and reports to the clinic nurse he has been having a lot of gas along with frothy and very foul smelling stools. which intervention should the nurse implement? 1. explain this is common for chronic pancreatitis 2. ask the client to bring in a stool specimen to the clinic 3. arrange an appointment with the hcp for today 4. discuss the need to decrease fat in the diet so this wont happen
Ans 3 steatorrhea (fatty, frothy, foul smelling stool) is caused by a decrease in pancreatic enzyme secretion and indicates impaired digestion and possibly an increase in the severity of the pancreatitis. the client should see the hcp
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors
C: Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate
CORRECT ANSWER: 3. Intravenous infusion of normal saline Rationale: The primary goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
An unresponsive patient who has diabetes is brought to the emergency department with slow, deep respirations. Additional findings include: blood glucose 450 mg/dL (24.9 mmol/L), arterial pH 7.2, and urinalysis showing presence of ketones and glucose. Which of the following statements best describes the the underlying cause of this patient's presentation? Please choose from one of the following options. a) Hypoglycemia causes release of glucagon resulting in glycogenolysis and hyperglycemia b) Nocturnal elevation of growth hormone results in hyperglycemia in the morning c) Hyperglycemia causes oxidative stress, renal dysfunction, and acidosis d) Lack of insulin causes increased counterregulatory hormones and fatty acid release
d) Lack of insulin causes increased counterregulatory hormones and fatty acid release The cells of this patient are in a state of "starvation." Hint #2 Think of why the cells of diabetic patients are not able to utilize glucose. Hint #3 This patient is suffering from diabetic ketoacidosis, caused by insulin deficiency. The body responds by releasing an counterregulatory hormones and undergoing lipolysis to increase glucose, resulting in hyperglycemia, ketogenesis, and acidosis.
"A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply: "1. Excessive thirst 2. Weight gain 3. Constipation 4. Excessive hunger 5. Urine retention 6. Frequent, high-volume urination
1, 4, 6 Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose the cells are using for energy, the client has weight loss, not weight gain. Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a problem is the patient has another renal-related condition
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify: 1. Dysrhythmias resulting from hypokalemia. 2. Fluid overload resulting from aggressive fluid replacement. 3. The presence of hypovolemic shock related to osmotic diuresis. 4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.
1. Dysrhythmias resulting from hypokalemia. Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias such as premature ventricular complexes and bradycardia.
A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.
2, 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.
3, 4, 5. Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.
A client with type one DM calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 1.the best time for me to exercise after I eat. 2.the best time for me to exercise is after breakfast. 3.The best time for me to exercise is mid to late afternoon 4.the best time for me to exercise is after my morning snack.
3. A Hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4-12 hours; therefore, afternoon exercise takes place during the peak of medication.
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to: 1. Hold the regular dose of insulin. 2. Drink cool fluids with high glucose content. 3. Check the blood glucose level every 2 to 4 hours. 4. Use a less strenuous form of exercise than usual until the illness resolves.
3. Check the blood glucose level every 2 to 4 hours. If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2-to-4-hour intervals to determine the effects of this stressor on the blood glucose level.
The nurse is caring for a client admitted to the ED with DKA. In the acute phase, the nurse plans for which priority intervention? 1.correct the acidosis 2.administer 5% dextrose intravenously 3.apply a monitor for an electrocardiogram 4.administer short - duration insulin intravenously
4. Lack of insulin is the primary cause of DKA. Treatment consists of insulin administration (short of rapid acting), intravenous fluid administration (NS initially), and K+ replacement, followed by correcting the acidosis. Applying in ECG monitor is not the priority action.
A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? A. Lispro (Humalog) B. Glargine (Lantus) C. Detemir (Levemir) D. NPH (Humulin N)
A - Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? A. The patient will reach a glycosylated hemoglobin level of less than 7%. B. The patient will follow a diet and exercise plan that results in weight loss. C. The patient will choose a diet that distributes calories throughout the day. D. The patient will state the reasons for eliminating simple sugars in the diet.
A - The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? A. 10:00 AM B. 12:00 AM C. 2:00 PM D. 4:00 PM
A - The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. E. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.
A, C, D. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.
Histamine2-receptor antagonists: A- Compete with histamine for binding sites on the parietal cells B- Irreversibly bind to H+/K+ATPase C- Cause a decrease in stomach pH D- Decrease signs and symptoms of allergies related to histamine release cells.
ANS A Histamine receptor blocking agents decrease gastric acid by competing with histamine for binding sites on the parietal
Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)? A- Increased risk for infection due to immunosuppression B- Pot risk for bleeding related to thrombocytopenia C- Alteration in urinary elimination related to retention D- Alteration in tissue perfusion related to hypertension
ANS B A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding.
The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies? A- Vitamin A B- Vitamin B12 C- Vitamin C D- Vitamin E
ANS B Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.
Which of the following symptoms is associated with ulcerative colitis? A- Dumping syndrome B- Rectal bleeding C- Soft stools D- Fistulas
ANS B In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease.
Which of the following factors is believed to cause ulcerative colitis? A- Acidic diet B- Altered immunity C- Chronic constipation D- Emotional stress
ANS B Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause.
For Janet who is taking antacids, which instruction would be included in the teaching plan? A- "Take the antacids with 8 oz of water." B- "Avoid taking other medications within 2 hours of this one." C- "Continue taking antacids even when pain subsides." D- "Weigh yourself daily when taking this medication."
ANS B : Antacids neutralize gastric acid and decrease the absorption of other medications. The client should be instructed to avoid taking other medications within 2 hours of the antacid. Water, which dilutes the antacid, should not be taken with antacid. A histamine receptor antagonist should be taken even when pain subsides. Daily weights are indicated if the client is taking a diuretic, not an antacid.
Which of the following associated disorders may the client with Crohn's disease exhibit? A- Ankylosing spondylitis B- Colon cancer C- Malabsorption D- Lactase deficiency
ANS C Because of the transmural nature of Crohn's disease lesions, malaborption may occur with Crohn's disease. Ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn't present.
Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? A- 4-6 small meals of low-carbohydrate foods daily B- High-fat, high-carbohydrate meals C- Low-fat, high-carbohydrate meals D- High-fat, low protein meals
ANS C For the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis.
The nurse would question an order for which type of antacid in patients with chronic renal failure? A- Aluminum-containing antacids B- Calcium-containing antacids C- Magnesium-containing antacids D- All of the above.
ANS C Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. Calcium-containing antacids are also appropriate because these patients may be hypocalcemic.
A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously? A- lansoprazole (Prevacid) B- omeprazole (Prilosec) C- pantoprazole (Protonix) D- esomeprazole (Nexium) administered orally.
ANS C Pantoprazole is the only proton pump inhibitor that is available for intravenous administration. The other medications in this category may only be
Which of the following medications is most effective for treating the pain associated with irritable bowel disease? A- Acetaminophen B- Opiates C- Steroids D- Stool softeners
ANS C The pain with irritable bowel disease is caused by inflammation, which steroids can reduce. Stool softeners aren't necessary. Acetaminophen has little effect on the pain, and opiate narcotics won't treat its underlying cause
Which of the following factors is believed to be linked to Crohn's disease? A- Constipation B- Diet C- Hereditary D- Lack of exercise
ANS C Although the definite cause of Crohn's disease is unknown, it's thought to be associated with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may have a genetic cause.
If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? A- ominal computed tomography (CT) scan B- Abdominal x-ray C- Barium swallow D- Colonoscopy with biopsy
ANS D A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine.
A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A- Metabolic acidosis with hyperkalemia B- Metabolic acidosis with hypokalemia C- Metabolic alkalosis with hyperkalemia D- Metabolic alkalosis with hypokalemia
ANS D Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and hypokalemia.
Which of the following symptoms may be exhibited by a client with Crohn's disease? A- Bloody diarrhea B- Narrow stools C- N/V D- Steatorrhea
ANS D Steatorrhea from malabsorption can occur with Crohn's disease. N/V, and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.
The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A- Bloody diarrhea B- Hypotension C- A hemoglobin of 12 mg/dL D- Rebound tenderness
ANS D Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.
A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg
ANS: D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.
36 year old man presents with sudden onset severe epigastric pain following an alcohol binge. Pain is referred to his back. Pain is alleviated when he sits and leans forward. There is also nausea and vomiting. Physical examination revealed upper abdominal tenderness, bluish discoloration around the umbilicus, bowel sounds are absent. What is the most likely diagnosis? A. Acute pancreatitis B Acute appendicitis C Acute cholecystitis D Acute gastroenteritis
Ans A Explanation: Sudden severe epigastric pain (following alcohol binge) that is referred to the back and relieved by sitting and leaning forward with Cullen's sign (periumbilical ecchymosis) strongly suggest acute pancreatitis.
Which of the radiologic imaging techniques is the most sensitive in diagnosis of acute pancreatitis and pancreatic pseudocyst? A. trans Abdominal ultrasonography B. contrast-enhanced CT of the abdomen C magnetic resonance cholangiopancreatography D plain radiograph (abdominal series)
Ans B Explanation: Contrast-enhanced CT has become the standard imaging technique for detection of acute pancreatitis and pseudocyst formation. Not only does it help in diagnosis, but some studies have shown that a CT severity index is helpful in predicting the severity of acute pancreatitis compared with the Ranson criteria and the APACHE II scale. Transabdominal ultrasonography is a better tool for diagnosis of cholelithiasis. Bowel gas can often limit the accuracy of pancreatic imaging by ultrasonography. Plain radiograph of the abdomen can demonstrate the sentinel loop in two thirds of patients but is not sensitive or specific enough for diagnosis. Magnetic resonance cholangiopancreatography can be used as a noninvasive test to determine which patients will need endoscopic retrograde cholangiopancreatography (ERCP). It is no more sensitive than a CT scan in determining the severity of acute pancreatitis, and it is much more expensive and not always available.
The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? A- Ask the patient's family to participate in the diabetes education program. B- Assess the patient's perception of what it means to have diabetes mellitus. C- Demonstrate how to check glucose using capillary blood glucose monitoring. D- Discuss the need for the patient to actively participate in diabetes management.
B - Before planning teaching, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.
Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)? A. Glyburide decreases glucagon secretion from the pancreas. B. Glyburide stimulates insulin production and release from the pancreas. C. Glyburide should be taken even if the morning blood glucose level is low. D. Glyburide should not be used for 48 hours after receiving IV contrast media.
B - The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.
"A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the mostlikely time for a hypoglycemic reaction to occur is: A) 2-4 hours after administration B) 4-12 hours after administration C) 16-18 hours after administration D) 18-24 hours after administration.
B: Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most likely to occur during the peak time
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may A. Need a diet higher in calories while receiving prednisone. B. Develop acute hypoglycemia while taking the prednisone. C. Require administration of insulin while taking prednisone. D. Have rashes caused by metformin-prednisone interactions.
C - Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone, but will not need a diet that is higher in calories.
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask? A. "Are you anorexic?" B. "Is your urine dark colored?" C. "Have you lost weight lately?" D. "Do you crave sugary drinks?"
C - Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM
C. 10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10-30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.
A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration.
C. Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.
Nurse is caring for a patient with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the Dr? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. Hemoglobin of 12 mg/ dl
C. Rebound tenderness because this could indicate peritonitis.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.
C. Reduces glucose production by the liver and enhances insulin sensitivity. Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.
When does regular insulin generally have peak action after application? A. 30-45 minutes B. 45-60 minutes C. 1-2 hours D. 2-3 hours
D The exact details depend on various factors, but 2-3 hours for peak action of regular insulin is an accepted range.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to A. Save the lunch tray for the patient's later return to the unit. B. Ask that diagnostic testing area staff to start a 5% dextrose IV. C. Send a glass of milk or orange juice to the patient in the diagnostic testing area. D. Request that if testing is further delayed, the patient be returned to the unit to eat.
D - Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.
A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? A. The patient always carries hard candies when engaging in exercise. B. The patient goes for a vigorous walk when his glucose is 200 mg/dL. C. The patient has a peanut butter sandwich before going for a bicycle ride. D. The patient increases daily exercise when ketones are present in the urine.
D - When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.
A client with acute ulcerative colitis requests a snack. Which of the following foods is the most appropriate to give the client? A. Carrots and ranch dip B. Whole grain cereal and milk C. A cup of popcorn and a cola D. Applesauce and a graham cracker
D, appelsauce and graham cracker, The diet for a client with ulcerative coliits should be a low-fiber, low residue diet. The nurse should avoid foods such as whole grains, nuts and fresh fruit or vegetables. Typically lactose containing foods are also poorly tolerated. The client should also avoid caffeine, pepper, and alcohol.
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? a. Eat a piece of pizza. b. Drink some diet pop. c. Eat 15 g of simple carbohydrates. d. Take an extra dose of rapid-acting insulin.
c. Eat 15 g of simple carbohydrates. When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.
he nurse is collecting data for a pt who develops jaundice and dark, amber colored urine. the nurse recognizes that which of the following is most likely the cause? a. encephalopathy b. pancreatitis c. bile duct obstruction d. cholecystitis
c: bile duct obstruction can result in jaundice and dark aber colored urine due to bile blockage