exam 3

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?

Place the patient on a cardiac monitor

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

The patient took the prescribed metformin today.

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication?

The patient has chest pressure when walking

A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding by the nurse is important to report to the health care provider?

The patient has painful hematuria.

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump?

The patient programs the pump for an insulin bolus after eating.

A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine indicates a need for teaching regarding gout management?

The patient takes one aspirin a day to prevent angina.

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective

"I will begin doing exercises to strengthen and support my back."

Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?

Discomfort with joint movement

After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective?

"I should take my daily aspirin at least an hour before the Byetta."

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?

"Do you feel bloated after eating?

the nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response?

"Have you lost weight lately?"

Which information will the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?

A gradual increase in daily exercise may help decrease fatigue.

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]) a. Rotate NPH vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial.

A, D, E, B, C

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)?

Blood pressure Serum creatinine Urine for microalbuminuria Monofilament testing of the foot

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis?

C-reactive protein

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?

Infuse 1 L of normal saline per hour.

A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care?

Keep the environment warm and draft free

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2 .Which goal in the plan of care is most important for this patient?

The patient will reach a glycosylated hemoglobin level of less than 7%.

Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

The patient's blood glucose is 165 mg/dL

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

An assessment finding for a 55-yr-old patient that alerts the nurse to the presence of osteoporosis is

a loss of height.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin?

abdomen

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse identifies a need for additional teaching related to health maintenance when the nurse finds that the patient

is unable to plantar flex the foot on the affected side

An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to

keep the head elevated slightly and flex the knees when resting in bed

A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor

blood pressure

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about

lifestyle changes to lower blood glucose

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman, the nurse explains that

calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to

check glucose level before, during, and after swimming

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action the nurse should take is to

check the chart for preoperative assessment data

A patient hospitalized with a fever and red, hot, painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient

is sexually active with multiple partners.

A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with

doxycycline (Vibramycin)

After the nurse has finished teaching a patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?

i will take 1 g of acetaminophen (Tylenol) every 4 hours."

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. The safety priority for the patient is addressing the

risk for aspiration

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?

Changes in diet and exercise may control blood glucose levels in type 2 diabetes

which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin?

The patient cleans the skin with soap and water before insulin administration.

The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

"I should lie down for an hour after each meal."

After the nurse has taught a 28-yr-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management?

"I will need to stop drinking so much coffee and soda."

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is

"It is important to start methotrexate early to decrease the extent of joint damage."

A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?

"Tell me more about the situations that are causing you stress."

Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)?

-Expect symptoms of acute low back pain to improve in a few weeks. -Avoid activities that require twisting of the back or prolonged sitting. -Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication?

Blurred vision

Which actions will the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur (select all that apply)?

-Monitor serum calcium. -Support the left leg when repositioning the patient. -Support family and patient as they discuss the prognosis

A patient with osteomyelitis is to receive vancomycin (Vancocin) 500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse will set the IV pump for how many milliliters per minute? (Round to the nearest hundredth.)

1.67

After change-of-shift report, which patient will the nurse assess first?

A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates additional patient teaching is needed?

"I did not have this bone cancer until my leg broke a week ago."

Which statement by the patient indicates a need for additional instruction in administering insulin?

"I need to rotate injection sites among my arms, legs, and abdomen each day."

Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

Encourage the patient to take a nap in the afternoon

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?

10:00 AM The rapid-acting insulins peak in 1 to 3 hours

After change-of-shift report, which patient should the nurse assess first?

A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL

Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce the risk for osteoarthritis (OA)?

A 56-yr-old woman who works on an automotive assembly line

In which order will the nurse implement these interprofessional interventions prescribed for a patient admitted with acute osteomyelitis with a temperature of 101.2° F? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain blood cultures from two sites. b. Administer dose of gentamicin 60 mg IV. c. Send to radiology for computed tomography (CT) scan of right leg. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for feve

A, B, D, C

When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will

assist the patient to sit up at the bedside.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question?

Administer varicella vaccine

Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?

Advise the patient to sleep on the back with a flat pillow.

A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline ?

Amitriptyline helps prevent transmission of pain impulses to the brain.

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?

Anti-Smith antibody (Anti-Sm)

Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?

Applying cold packs before exercise may decrease joint pain

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain?

Ask about numbness or tingling of the hands and arms

The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding?

Ask the patient about recent outdoor activities.

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take?

Assess the nodules for skin breakdown or infection

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?

Assess the patient's perception of what it means to have diabetes mellitus.

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

Assist the patient with ambulation

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

Blood pressure of 140/88 mmHg

Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma?

Document the patient's oral intake

The nurse will anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?

Capsaicin cream (Zostrix)

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take

Check the blood glucose during the night

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?

Choose flat-soled leather shoes

A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider?

Crackles are auscultated in the lung bases

Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider?

Elevated blood urea nitrogen (BUN)

When reviewing the health record for a new patient with rheumatoid arthritis, the nurse reads that the patient has swan neck deformities. Which deformity will the nurse expect to observe when assessing the patient?

D

To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take?

Determine what types of activities the patient enjoys.

. Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about management of the condition?

Do daily deep-breathing exercises

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?

Give the patient 4 to 6 oz more orange juice

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

Give the patient a snack of peanut butter and crackers

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?

Glomerular filtration rate is decreased.

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide ?

Glyburide stimulates insulin production and release from the pancreas

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

Glycosylated hemoglobin

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching?

How to monitor and care for a long-term IV catheter

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?

I can choose any foods, as long as I use enough insulin to cover the calories

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition?

I will use sunscreen when I am outside

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will the nurse include in the initial plan of care?

Immobilization of the left leg

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information requires a discussion with the health care provider about an urgent change in the treatment plan?

Laboratory results indicate blood urea nitrogen (BUN) is elevated.

. A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Lispro (Humalog) Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

Log roll the patient from side to side every 2 hours

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic?

Measure the ankle-brachial index

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching

My diabetes won't cause complications because I don't need insulin.

Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse's assessment of the patient?

Noon blood glucose of 52 mg/dL

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?

Oatmeal with skim milk and fruit yogurt

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

Obtain a glucose reading using a finger stick.

A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?

Patient who has not voided 10 hours after a laminectomy

Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?

Review the patient's serum creatinine

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take?

Schedule the patient for a fasting blood glucose level

During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)

Sleep disturbances Multiple tender points Widespread bilateral, burning musculoskeletal pain

A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate?

Suggest the patient use over-the-counter (OTC) artificial tears.

Which action will the nurse take when caring for a patient with osteomalacia?

Teach about the use of vitamin D supplements.

Which assessment finding for a patient who has had surgical reduction of an open fracture of the right radius requires notification of the health care provider?

Temperature 101.4° F (38.6° C)

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

The blood pressure is 86/50 mm Hg

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful?

The patient discards the open vials of glargine and regular insulin after 4 weeks.

Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication?

The patient has dark-colored stools.

A 28-yr-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?

The patient increases daily exercise when ketones are present in the urine.

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate?

The patient is trying to get pregnant before her disease becomes more severe

The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed?

The patient sleeps with two pillows under the head.

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test?

The patient uses oral contraceptives.

Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)?

The white blood cell (WBC) count is 1500/µL.

The nurse is planning care for a patient with hypertension and gout who has a red, painful right great toe. Which nursing action will be included in the plan of care?

Use a footboard to hold bedding away from the toe

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with

a warm bath followed by a short rest.

A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination

as soon as possible

The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should

avoid activities requiring repetitive use of the same muscles and joints

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose

chooses a puncture site in the center of the finger pad

A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of

social isolation

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to

insert an IV catheter.

A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to

monitor blood glucose every 4 hours and notify the clinic if it continues to rise

The nurse will determine more teaching is needed if a patient with discomfort from a bunion says, "I will

only wear sandals, no closed-toe shoes.

The nurse evaluating effectiveness of prescribed calcitonin and ibandronate (Boniva) for a patient with Paget's disease will consider the patient's

pain intensity

The nurse should reposition the patient who has just had a laminectomy and diskectomy by

placing a pillow between the patient's legs and turning the entire body as a unit.

The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding

reduced joint pain

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

request that if testing is further delayed, the patient be returned to the unit to eat.

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. The nurse will anticipate that the patient may

require administration of insulin while taking prednisone.

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about

self-administration of subcutaneous injections

A patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of

sertraline (Zoloft)