Exam #1
A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. It is more difficult to achieve strict glucose control than in younger patients. b. It usually is not treated unless the patient becomes severely hyperglycemic. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.
a
How does an antigen stimulate an immune response? a. It is captured, processed, and presented to a lymphocyte by a macrophage. b. It circulates in the blood, where it comes in contact with circulating lymphocytes. c. It is a foreign protein that has antigenic determinants different from those of the body. d. It combines with larger molecules that are capable of stimulating production of antibodies.
a
Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.
a
Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).
a
Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal."
a
Priority Decision: When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the patient about? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically
a
Which characteristic describes immunoglobulin E (select all that apply)? a. Assists in parasitic infections b. Responsible for allergic reactions c. Present on the lymphocyte surface d. Assists in B-lymphocyte differentiation e. Predominant in secondary immune response f. Protects body surfaces and mucous membranes
a, b
What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor
a, b, c, d, e, f
What characterizes type 2 diabetes (select all that apply)? a. β -Cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver
a, b, c, d, e, f
Which actions are done primarily by an informatics nurse (select all that apply)? a. Designs and builds computer systems b. Studies the validity of nursing information c. Trains health care providers to provide nursing care d. Communicates and accesses information for nursing staff e. Builds systems that support the processing of nursing information
a, c
What accurately describes passive acquired immunity (select all that apply)? a. Pooled gamma globulin b. Immunization with antigen c. Temporary for several months d. Immediate, lasting several weeks e. Maternal immunoglobulins in neonate f. Boosters may be needed for extended protection
a, c, d
What are the important functions of cell-mediated immunity (select all that apply)? a. Fungal infections b. Transfusion reactions c. Rejection of transplanted tissues d. Contact hypersensitivity reactions e. Immunity against pathogens that survive outside cells
a, c, d
Which quality of care measures influence the payment for health care services by third-party payers (select all that apply)? a. Clinical outcomes b. Regulatory agencies c. Use of evidence-based practice d. Adoption of information technology e. Occurrence of preventable conditions
a, c, d, e
Delegation is a process used by the RN to provide safe and effective care in an efficient manner. Which nursing interventions should not be delegated to unlicensed assistive personnel (UAP) but should be performed by the RN (select all that apply)? a. Administering patient medications b. Ambulating stable patients c. Performing patient assessment d. Evaluating the effectiveness of patient care e. Feeding patients at mealtime f. Performing sterile procedures g. Providing patient teaching h. Obtaining vital signs on a stable patient i. Assisting with patient bathing
a, c, d, f, g
The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue
a, c, e, f
The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Maintain a healthy weight. b. Exercise for 60 minutes each day. c. Have blood pressure checked regularly. d. Assess for visual changes on monthly basis. e. Monitor for polyuria, polyphagia, and polydipsia.
a, e
A 28-year-old male Gulf War veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient's problem? a. He has posttraumatic stress disorder. b. He has multiple chemical sensitivities. c. He needs to wear a mask when he paints. d. He is looking for an excuse to break up with his girlfriend.
b
A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. Testing people under the age of 21 for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese individuals
b
A patient had abdominal surgery 3 months ago and calls the clinic with complaints of severe abdominal pain and cramping, vomiting, and bloating. What should the nurse most likely suspect as the cause of the patient's problem? a. Infection b. Adhesion c. Contracture d. Evisceration
b
A patient with diarrhea has been diagnosed with Clostridium difficile. Along with standard precautions, which kind of transmission-based precautions will be used when the nurse is caring for this patient? a. Droplet precautions b. Contact precautions c. Isolation precautions d. Airborne precautions
b
An 82-year-old male patient with pneumonia who is in the intensive care unit (ICU) is beginning to have decreased cognitive function. What should the nurse first suspect as a potential cause of this change? a. Fatigue b. Infection c. ICU psychosis d. Medication allergy
b
Delegation Decision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose.
b
The following is an example of an evidence-based practice (EBP) clinical question. "In adult seizure patients, is restraint or medication more effective in protecting them from injury during a seizure?" Which word(s) in the question identify(ies) the C part of the PICOT format? a. Restraint b. Or medication c. During a seizure d. Adult seizure patients e. Protecting them from injury
b
The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring? a. Acute b. Chronic c. Delayed d. Hyperacute
b
What is included in the humoral immune response? a. Surveillance for malignant cell changes b. Production of antigen-specific immunoglobulins c. Direct attack of antigens by activated B lymphocytes d. Releasing cytokines responsible for destruction of antigens
b
What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack
b
What type of dressing will the nurse most likely use for the patient in Question 14? a. Dry, sterile dressing b. Absorptive dressing c. Negative pressure wound therapy d. Telfa dressing with antibiotic ointment
b
When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.
b
Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea
b
Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.
b
How does interferon help the body's natural defenses? a. Directly attacks and destroys virus-infected cells b. Augments the immune response by activating phagocytes c. Induces production of antiviral proteins in cells that prevent viral replication d. Is produced by viral infected cells and prevents the transmission of the virus to adjacent cells
c
Priority Decision: A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. Increase the evening insulin dose to prevent the dawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am , and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect.
c
Priority Decision: Key interventions for treating soft tissue injury and resulting inflammation are remembered using the acronym RICE. What are the most important actions for the emergency department nurse to do for the patient with an ankle injury? a. Reduce swelling, shine light on wound, control mobility, and elicit the history of the injury b. Rub the wound clean, immobilize the area, cover the area protectively, and exercise that leg c. Rest with immobility, apply a cold compress, apply a compress bandage, and elevate the ankle d. Rinse the wounded ankle, image the ankle, carry the patient, and extend the ankle with imaging
c
Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen
c
Priority Decision: What is the most important nursing intervention for the prevention and treatment of pressure ulcers? a. Using pressure-reduction devices b. Massaging pressure areas with lotion c. Repositioning the patient a minimum of every 2 hours d. Using lift sheets and trapeze bars to facilitate patient movement
c
The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture
c
The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.
c
The patient has received a bone marrow transplant. Soon after the transplant there is a rash on the patient's skin. She says her skin is itchy and she has severe abdominal pain. What best summarizes what is happening to the patient and how she will be treated? a. Graft rejection occurring; treat with different immunosuppressive agents b. Dry skin and nausea are side effects of immunosuppresants; decrease the dose c. Transplanted bone marrow is rejecting her tissue; prevent with immunosuppressive agents d. Dry skin from the dry air and nausea from the food in the hospital; treat with humidifier and home food
c
The patient's wound is not healing, so the health care provider is going to send the patient home with negative pressure wound therapy or a "wound vac" device. What will the caregiver need to understand about the use of this device? a. The wound must be cleaned daily. b. The patient will be placed in a hyperbaric chamber. c. The occlusive dressing must be sealed tightly to the skin. d. The diet will not be as important with this sort of treatment.
c
What describes the occurrence of a type IV or delayed hypersensitivity transplant reaction? a. Antigen links with specific IgE antibodies bound to mast cells or basophils releasing chemical mediators b. Cellular lysis or phagocytosis through complement activation following antigen-antibody binding on cell surfaces c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage d. Antigens combined with IgG and IgM too small to be removed by mononuclear phagocytic system deposit in tissue and cause fixation of complement
c
What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis. b. Potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level.
c
What does the mechanism of chemotaxis accomplish? a. Causes the transformation of monocytes into macrophages b. Involves a pathway of chemical processes resulting in cellular lysis c. Attracts the accumulation of neutrophils and monocytes to an area of injury d. Slows the blood flow in a damaged area, allowing migration of leukocytes into tissue
c
What is the most common cause of secondary immunodeficiency disorders? a. Chronic stress b. T-cell deficiency from HIV c. Drug-induced immunosuppression d. Common variable hypogammaglobulinemia
c
Which nutrients aid in capillary synthesis and collagen production by the fibroblasts in wound healing? a. Fats b. Proteins c. Vitamin C d. Vitamin A
c
Which rationale describes treatment of atopic allergies with immunotherapy? a. It decreases the levels of allergen-specific T helper cells. b. It decreases the level of IgE so that it does not react as readily with an allergen. c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell-bound IgE reactions. d. It gradually increases the amount of allergen in the body until it is no longer recognized as foreign and does not elicit an antibody reaction.
c
Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis? a. Type I or IgE-mediated hypersensitivity reaction b. Type II or cytotoxic hypersensitivity reaction c. Type III or immune-complex mediated hypersensitivity reaction d. Type IV or delayed hypersensitivity reaction
c
A 69-year-old woman asks the nurse whether it is possible to "catch" cancer because many of her friends of the same age have been diagnosed with different kinds of cancer. In responding to the woman, the nurse understands that what factor increases the incidence of tumors in older adults? a. An increase in autoantibodies b. Decreased activity of the bone marrow c. Decreased differentiation of T lymphocytes d. Decreased size and activity of the thymus gland
d
A patient with a seizure disorder is admitted to the hospital after a sustained seizure. When she tells the nurse that she has not taken her medication regularly, the nurse makes a nursing diagnosis of ineffective self-health management related to lack of knowledge regarding medication regimen and identifies the Nursing Outcomes Classification (NOC) outcome of Compliance behavior, with the indicator Performs treatment regimen as prescribed, at a target rate of 3 (sometimes demonstrated). When the nurse tries to teach the patient about the medication regimen, the patient tells the nurse that she knows about the medication but she does not always have the money to refill the prescription. Where was the mistake made in the nursing process with this patient? a. Planning b. Diagnosis c. Evaluation d. Assessment e. Implementation
d
Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch indicate? a. Matches tissue types for a successful transplantation b. Determines paternity and predicts risk for certain diseases c. Establishes racial background and predicts risk for certain diseases d. Cytotoxic antibodies to the donor contraindicate transplanting this donor's organ
d
Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."
d
For the patient with allergic rhinitis, which therapy should the nurse expect to be ordered first? a. Corticosteroids b. Immunotherapy c. Antipruritic drugs d. Sympathomimetic/decongestant drugs
d
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and gluconeogenesis c. Prevents the transport of triglycerides into adipose tissue d. Accelerates the transport of amino acids into cells and their synthesis into protein
d
The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.
d
The nurse realizes that the patient understands the teaching about decreasing the risk for antibiotic-resistant infection when the patient says which of the following? a. "I know I should take the antibiotic for one day after I feel better." b. "I want an antibiotic ordered for my cold so I can feel better sooner." c. "I always save some pills because I get the illness again after I first feel better." d. "I will follow the directions for taking the antibiotic so I will get over this infection."
d
The nurse working in a health care facility where uniform electronic health records are used explains to the patient that the primary purpose of such a record is to a. reduce the cost of health care by eliminating paper records. b. prevent medical errors associated with traditional paper records and handwritten orders and prescriptions. c. force the use of standardized medical vocabularies and nursing terminologies so that outcomes of patient care can be measured. d. provide a single record in which all aspects of a patient's medical information are readily available to any health care provider involved in the patient's care.
d
The patient is admitted from home with a stage II pressure ulcer. This wound is classified as a yellow wound using the red-yellow-black concept of wound care. What is the nurse likely to observe when she does her wound assessment? a. Serosanguineous drainage b. Adherent gray necrotic tissue c. Clean, moist granulating tissue d. Creamy ivory to yellow-green exudate
d
The patient is transferring from another facility with the description of a sore on her sacrum that is deep enough to see the muscle. What stage of pressure ulcer does the nurse expect to see on admission? a. Stage I b. Stage II c. Stage III d. Stage IV
d
Two nurses are establishing a smoking cessation program to assist patients with chronic lung disease to stop smoking. To offer the most effective program with the best outcomes, the nurses should initially a. search for an article that describes nursing interventions that are effective for smoking cessation. b. develop a clinical question that will allow them to compare different cessation methods during the program. c. keep comprehensive records that detail each patient's progress and ultimate outcomes from participation in the program. d. use evidence-based clinical practice guidelines developed from reviews of randomized controlled trials of smoking cessation methods.
d
What accurately describes the health care system in which future nurses will be employed? a. With improvements in medicine there will be fewer patients with chronic illnesses. b. Rapidly changing technology and expanding knowledge will simplify the health care environment. c. The Quality and Safety Education for Nurses (QSEN) project measures the ability of nursing graduates to be prepared for the reality of practice. d. The Joint Commission establishes National Patient Safety Goals and evidence-based solutions for nurses to promote meeting these goals by all caring for the patient.
d
What are the most common immunosuppressive agents used to prevent rejection of transplanted organs? a. Cyclosporine, sirolimus, and muromonab-CD3 b. Prednisone, polyclonal antibodies, and cyclosporine c. Azathioprine, mycophenolate mofetil, and sirolimus d. Tacrolimus, prednisone, and mycophenolate mofetil
d
What effect does the action of the complement system have on inflammation? a. Modifies the inflammatory response to prevent stimulation of pain b. Increases body temperature, resulting in destruction of microorganisms c. Produces prostaglandins and leukotrienes that increase blood flow, edema, and pain d. Increases inflammatory responses of vascular permeability, chemotaxis, and phagocytosis
d
What role do the B-complex vitamins play in wound healing? a. Decrease metabolism b. Protect protein from being used for energy c. Provide metabolic energy for the inflammatory process d. Coenzymes for fat, protein, and carbohydrate metabolism
d
Which T lymphocytes are involved in direct attack and destruction of foreign pathogens? a. Dendritic cells b. Natural killer cells c. T helper (CD4) cells d. T cytotoxic (CD8) cells
d
Which description about a nurse who develops a contact dermatitis from wearing latex gloves is accurate? a. This demonstrates a type I allergic reaction to natural latex proteins. b. Use powder-free latex gloves to prevent the development of symptoms. c. Use an oil-based hand cream when wearing gloves to prevent latex allergy. d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves.
d
Which immunoglobulin is responsible for the primary immune response and forms antibodies to ABO blood antigens? a. IgA b. IgD c. IgG d. IgM
d
Which laboratory results would indicate that the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL b. Glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80 mg/dL d. Fasting blood glucose result of 120 mg/dL
d
What are the recommended measures to prevent the transmission of health care-associated infections (HAIs) (select all that apply)? a. Empty bedpans as soon as possible b. Limit fresh flowers in patient rooms c. Remove urinals from bedside tables d. Use personal protective equipment e. Hand washing or alcohol-based sanitizing f. Have patients wear sandals in the shower
d, e
Which characteristics are seen with acute transplant rejection (select all that apply)? a. Treatment is supportive b. Only occurs with transplanted kidneys c. Organ must be removed when it occurs d. The recipient's T cytotoxic lymphocytes attack the foreign organ e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy
d, e, f
Which standardized nursing terminologies specifically relate to the steps of the nursing process (select all that apply)? a. Omaha System b. Nursing Minimum Data Set (NMDS) c. Perioperative Nursing Data Set (PNDS) d. Nursing Outcomes Classification (NOC) e. Nursing Interventions Classification (NIC) f. NANDA International: Nursing Diagnoses
d, e, f
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose
a
During the healing phase of inflammation, which cells would be mostly likely to regenerate? a. Skin b. Neurons c. Cardiac muscle d. Skeletal muscle
a
When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary.
a
During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG >126 mg/dL (7.0 mmol/L). d. Random blood glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)
a, c
Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood
b
Identify the five rights of delegating nursing care (select all that apply). a. Right time b. Right task c. Right patient d. Right person e. Right dosage f. Right circumstance g. Right supervision and evaluation h. Right direction and communication
b, d, f, g, h
A patient with type 1 diabetes uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 pm . When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. Flexibility in food intake is possible because insulin is available 24 hours a day. c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. d. Premeal glucose checks are required to determine needed changes in daily dosing.
c
A patient's documentation indicates he has a stage III pressure ulcer on his right hip. What should the nurse expect to find on assessment of the patient's right hip? a. Exposed bone, tendon, or muscle b. An abrasion, blister, or shallow crater c. Deep crater through subcutaneous tissue to fascia d. Persistent redness (or bluish color in darker skin tones)
c
The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening? a. DKA b. HHS c. Hypoglycemia d. Hyperglycemia
c
What is the primary difference between healing by primary intention and healing by secondary intention? a. Secondary healing requires surgical debridement for healing to occur. b. Primary healing involves suturing two layers of granulation tissue together. c. Presence of more granulation tissue in secondary healing results in more scarring. d. Healing by secondary intention takes longer because more steps in the healing process are necessary.
c
Which patient is at the greatest risk for developing pressure ulcers? a. A 42-year-old obese woman with type 2 diabetes b. A 78-year-old man who is confused and malnourished c. A 30-year-old man who is comatose following a head injury d. A 65-year-old woman who has urge and stress incontinence
c
Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 50-year-old Hispanic woman b. A child whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY)
c
Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals
d
Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions (select all that apply)? a. Younger age b. Male gender c. Inheritance of susceptibility genes d. Initiation of autoreactivity by triggers e. Frequent viruses throughout the lifetime
c, d
A 78-year-old patient has developed Haemophilus influenzae . In addition to standard precautions, what should the nurse use to protect herself and other patients when working within 3 feet of the patient? a. Mask b. Gown c. Gloves d. Shoe covers
a
What are examples of type I or IgE-mediated hypersensitivity reactions (select all that apply)? a. Asthma b. Urticaria c. Angioedema d. Allergic rhinitis e. Atopic dermatitis f. Contact dermatitis g. Anaphylactic shock h. Transfusion reactions i. Goodpasture syndrome
a, b, c, d, e, g
To what is the increase in emerging and untreatable infections attributed (select all that apply)? a. The evolution of new infectious agents b. Use of antibiotics to treat viral infections c. Human population encroachment into wilderness areas d. Transmission of infectious agents from humans to animals e. An increased number of immunosuppressed and chronically ill people
a, b, c, e
A nurse who has worked on an orthopedic unit for several years is encouraged by the nurse manager to become certified in orthopedic nursing. What will certification in nursing require and/or provide (select all that apply)? a. A certain amount of clinical experience b. Successful completion of an examination c. Membership in specialty nursing organizations d. Professional recognition of expertise in a specialty area e. An advanced practice role that requires graduate education
a, b, d
A patient was given an IM injection of penicillin in the gluteus maximus and developed dyspnea and weakness within minutes following the injection. Which additional assessment findings indicate that the patient is having an anaphylactoid reaction (select all that apply)? a. Wheezing b. Hypertension c. Rash on arms d. Constricted pupils e. Slowed strong pulse f. Feeling of impending doom
a, f
In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections
b
To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Only after a 15-g carbohydrate snack is eaten b. About 1 hour after eating when blood glucose levels are rising c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect
b
What is characteristic of chronic inflammation? a. It may last 2 to 3 weeks. b. The injurious agent persists or repeatedly injures tissue. c. Infective endocarditis is an example of chronic inflammation. d. Neutrophils are the predominant cell type at the site of inflammation.
b
Where and into what do activated B lymphocytes differentiate? a. Spleen; natural killer cells that destroy infected cells b. Bone marrow; plasma cells that secrete immunoglobulins c. Thymus; memory B-cells that retain a memory of the antigen d. Bursa of Fabricius; helper cells that in turn activate additional B lymphocytes
b
Which type of immunity is the result of contact with the antigen through infection and is the longest lasting type of immunity? a. Active innate immunity b. Passive innate immunity c. Active acquired immunity d. Passive acquired immunity
c
Why is plasmapheresis indicated in the treatment of autoimmune disorders? a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system
c
In a patient with leukocytosis with a shift to the left, what does the nurse recognize as causing this finding? a. The complement system has been activated to enhance phagocytosis. b. Monocytes are released into the blood in larger-than-normal amounts. c. The response to cellular injury is not adequate to remove damaged tissue and promote healing. d. The demand for neutrophils causes the release of immature neutrophils from the bone marrow.
d
A diabetic patient is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.
d
A patient had a complicated vaginal hysterectomy. The student nurse provided perineal care after the patient had a bowel movement. The student nurse tells the nurse there was a lot of light brown, smelly drainage seeping from the perianal area. What should the nurse suspect when assessing this patient? a. Dehiscence b. Hemorrhage c. Keloid formation d. Fistula formation
d
Priority Decision: During care of patients, what is the most important precaution for preventing transmission of infections? a. Wearing face and eye protection during routine daily care of the patient b. Wearing nonsterile gloves when in contact with body fluids, excretions, and contaminated items c. Wearing a gown to protect the skin and clothing during patient care activities likely to soil clothing d. Hand washing after touching fluids and secretions and removing gloves, as well as between patient contacts
d
The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has a. diabetes. b. elevated A1C. c. impaired fasting glucose. d. impaired glucose tolerance.
d
Which immunoglobulins will initially protect a newborn baby of a breastfeeding mother (select all that apply)? a. IgA b. IgD c. IgE d. IgG e. IgM
a, d
The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know why she is taking it. What should the nurse include in this patient's teaching (select all that apply)? a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract.
a, d, e
What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes
b, d
During the diagnosis phase of the nursing process, both nursing diagnoses and collaborative problems are identified. Which are collaborative problem statements (select all that apply)? a. Fatigue related to sleep deprivation b. Infection related to immunosuppression c. Excess fluid volume related to high sodium intake d. Constipation related to irregular defecation habits e. Hypoxia related to chronic obstructive pulmonary disease f. Risk for cardiac dysrhythmias related to potassium deficiency
b, e, f
The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction
b, e, f
Which nursing actions are in response to the National Patient Safety Goals (select all that apply)? a. Use restraints to prevent patient falls. b. Administer all medications ordered by physicians. c. Wash hands before and after every patient contact. d. Conduct a "time-out" when too tired to provide care. e. Use SBAR for communicating with health professionals. f. Evaluate the initial existence of pressure ulcers before patient dismissal.
c, e
Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)? a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle
c, e
Delegation Decision: Which nursing interventions for a patient with a Stage IV sacral pressure ulcer are mostappropriate to assign or delegate to a licensed practical nurse (LPN) (select all that apply)? a. Assess and document wound appearance. b. Teach the patient pressure ulcer risk factors. c. Choose the type of dressing to apply to the ulcer. d. Measure the size (width, length, depth) of the ulcer. e. Assist the patient to change positions at frequent intervals.
d, e