Med Surg 2 Exam 3

Discuss potassium's role in metabolic acidosis

Acidosis causes potassium to move from cells to extracellular fluid (plasma) in exchange for hydrogen ions?

What is included with type 2 diabetes?

Adult-onset or non-insulin dependent DM, Overweight-obese, age, family history, Incidence rising in children, More prevalent in ethnic populations, Inadequate insulin secretion + insulin resistance, Onset is gradual, Polydipsia (thirst), Polyuria (urination), Polyphagia (hunger), Weakness, fatigue, Recurrent infections, Recurrent vaginal yeast or candida infections, Prolonged wound healing and Vision problems

Name two complications of systemic lupus erythematosus

Anemia and renal failure are 2 of many complications with SLE

What is the difference between Somogyi effect and Dawn phenomenon. How will we teach the client to manage their insulin with each?

Dawn phenomenon happens when hormones your body naturally makes in the early morning increase your blood sugar. The Somogyi effect also involves a surge of hormones, but it's due to a low blood sugar episode overnight. Dawn phenomenon doesn't happen because of low blood sugar. We can teach the patients to adjust the time they take their insulin, changing the dose before bedtime, changing the type of insulin, and even eating to adjust better to either somogyi effect or dawn phenomenon

Define humoral and cell-mediated immunity in your own words. What are differences and similarities?

Humoral immunity is mediated by antibody molecules that are secreted by plasma cells. Cell mediated immunity does not invlove antibodies but invloves the destruction of infected cells by cytotoxic T cells, macrophages, and NK cells. Humoral immunity: Invloves B lymphocytes, antibodies, memory cells present, has a protection from bacteria, respiratory and GI pathogens, extracellular viruses, examples: Anaphylactic shock, Atopic diseases, Bacterial infection, and Transfusion reaction. Cell mediated immunity: invloves T lymphocytes, macrophages, Sensitized T cells, cytokines, memory cells present, protection from Chronic infectious agents, Fungi, Tumor cells and Viruses (intracellular), examples: Contact dermatitis, Destruction of cancer cells, Fungal infection, Graft rejection and Tuberculosis

Explain the difference between innate and acquired immunity? Define passive and active immunity.

Innate immunity is the defense system you were born with. Acquired immunity is not present at birth but is developed by either active acquired immunity (exposure to a disease organism triggers the immune system to produce antibodies to that disease or vaccines) or passive acquired immunity (given antibodies to a disease rather than producing them through his/her own immune system)

What is included with type 1 diabetes?

Juvenile-onset diabetes, insulin dependent DM; < 40 years, Autoimmune,Not enough insulin for survival, Genetic predisposition, exposure to virus, Insulin dependent (exogeneous), Risk of DKA, Fast onset, no insulin is being produced, Weight loss (glucose unable to enter cells), Polydipsia (thirst), Polyuria (urination), Polyphagia (hunger) Weakness, and fatigue.

Name two hallmark signs and symptoms of Systemic Lupus erythematosus.

Malar rash "butterfly rash" flat or raised with nasal folds spared, and alopecia. Fatigue, joint pain and stiffness (polyarthritis) are also common

What is metabolic syndrome and how does it relate to diabetes risk?

Metabolic syndrome has 5 components: increased glucose levels, abdominal obesity, high BP, high triglyceride levels, and decreased high-density HDL levels. People with metabolic syndrome have an increased risk of developing type 2 DM. A person with 3 of the 5 components is considered to have metabolic syndrome. Overweight persons with metabolic syndrome can reduce their risk for DM through food choices and regular physical activity

What is the "honeymoon period" in relation to the onset of Type I DM?

Newly diagnosed patients may have a remission for 3 to 12 months after starting treatment. The patient needs little injected insulin because β-cell insulin production is still sufficient for healthy glucose levels. As time goes by, more β cells are destroyed, and glucose levels increase, the honeymoon period ends, and the patient requires insulin on a permanent basis

How do we know if an acid base imbalance is partially or fully compensated?

Partially compensated the value is changing but the pH is still abnormal. Fully compensated the value is changing and the pH is within normal range. Uncompensated the value is within normal range but the pH is still abnormal

What does ROME stand for? Why is this important?

ROME stands for respiratory opposite and metabolic equal. This is important because it is used to interpret ABGs

What is Systemic lupus erythematosus (SLE)? What causes SLE?

SLE is a chronic multisystem inflammatory autoimmune disease. It's a complex disorder resulting from interactions among genetic, hormonal, environmental, and immune factors affecting many different parts of the body. The cause of SLE is unknown but it is suspected to have a gentic influence.

What is the purpose of the endocrine system?

The endocrine system regulates how much if each hormone is released. It plays a role in reproductive and central nervous system development in the fetus, stimulating growth and development during childhood and adolescence, maintaining homeostasis, sexual reproduction, maintaining homeostasis, and responding to emergency demands (Harding, 2022, p. 1265).

What is basal-bolus plan

The insulin approach that most closely mimics endogenous insulin production is the basal-bolus plan. It consists of multiple daily insulin injections or an insulin pump together with frequent BGM or CGM. Injections include rapid- or short-acting insulin before meals and intermediate- or long-acting background insulin once or twice a day. The goal is to achieve a glucose level as close to normal as possible, as much of the time as possible

Your client is on corticosteroids. Which statement by the client indicates more teaching is required? a. "I can stop this medication at any time." b. "I need to closely monitor my blood sugar." c. "I need to watch for signs of infection." d. "I should take these medications as prescribed."

a. "I can stop this medication at any time."

Which statement by a patient would alert the nurse to a risk for decreased immune function? a. "I had my spleen removed after a car accident." b. "I usually eat eggs or meat for at least two meals a day." c. "I had a chest x-ray 6 months ago." d. "I take one baby aspirin every day to prevent stroke."

a. "I had my spleen removed after a car accident."

A patient who has a positive test for HIV antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia and a CD4+ count of less than 200 cells/mL. Which statement by the nurse is correct? a. "The patient has developed AIDS." b. "The patient meets the criteria for a diagnosis of acute HIV infection." c. "The patient will likely develop symptomatic HIV infection within 1 year." d. "The patient will be diagnosed with asymptomatic chronic HIV infection."

a. "The patient has developed AIDS."

Which are possible causes of Addison's disease? Select all that apply a. Adrenocortical insufficiency b. Autoimmune disease c. pituitary disease d. Excess of aldosterone e. Tuberculosis

a. Adrenocortical insufficiency b. Autoimmune disease e. Tuberculosis

It is important for the nurse to assess for which manifestation(s) in a patient who has just undergone a total thyroidectomy? (select all that apply) a. Confusion b. Weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek sign

a. Confusion d. Circumoral numbness e. Positive Chvostek sign

The nurse is assessing a patient newly diagnosed with type 1 diabetes. Which symptom reported by the patient correlates with the diagnosis? a. Excessive thirst b. Gradual weight gain c. Overwhelming fatigue d. Recurrent blurred vision

a. Excessive thirst

Which interventions would the nurse include in the care for a patient who underwent transsphenoidal excision of the pituitary gland? (select all that apply) a. Frequent monitoring of serum and urine osmolarity b. Assessment of visual acuity and extraocular movement c. Keeping the patient in a recumbent position at all times d. Teaching the patient about the need for lifelong hormone therapy e. Instructing the patient to blow their nose frequently to relieve cerebral pressure

a. Frequent monitoring of serum and urine osmolarity b. Assessment of visual acuity and extraocular movement d. Teaching the patient about the need for lifelong hormone therapy

Damage to blood vessels; can be macrovascular or microvascular: a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

a. Macrovascular Complications

Includes cerebrovascular, cardiovascular, and peripheral vascular disease: a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

a. Macrovascular Complications

Which factors place the patient at increased risk for severe COVID-19? (select all that apply) a. Obesity b. Thyroid disease c. Cigarette smoking d. Pernicious anemia e. Chronic kidney disease

a. Obesity c. Cigarette smoking e. Chronic kidney disease

A goiter can develop from which of the following? Select All That Apply a. Overproduction of thyroid hormones b. Underproduction of thyroid hormones c. Nodules on the thyroid gland d. Too much sugar in the diet e. Lack of Iodine in the diet

a. Overproduction of thyroid hormones b. Underproduction of thyroid hormones c. Nodules on the thyroid gland e. Lack of Iodine in the diet

What instructions about plasmapheresis should the nurse include in the teaching plan for a patient diagnosed with systemic lupus erythematosus (SLE)? a. Plasmapheresis prevents inflammatory mediators from injuring tissues. b. Plasmapheresis counteracts recovery of IgG production. c. Plasmapheresis removes eosinophils and basophils from the blood. d. Plasmapheresis decreases the damage to organs from T lymphocytes

a. Plasmapheresis prevents inflammatory mediators from injuring tissues.

A client with Cushing's disease should be taught which three priority teachings? (Select 3 that apply) a. Proper Handwashing b. Limit intake of protein c. Monitoring blood glucose levels d. Immediate discontinuation of corticosteriods e. Manifestations of DVT or PE

a. Proper Handwashing c. Monitoring blood glucose levels e. Manifestations of DVT or PE

A client presents with a recent severe anxiety attack. Arterial blood gases are obtained with results of a pH of 7.50, HC03 of 28, and PaCO2: 47. Which interpretation is correct? a. Respiratory Alkalosis partially compensated b. Respiratory Acidosis uncompensated c. Metabolic Alkalosis fully compensated d. Respiratory Alkalosis fully compensated

a. Respiratory Alkalosis partially compensated

Which of the following is true regarding the development of diabetes-related foot complications? (Select all that apply). a. This be the result of a combination of micro & macro -vascular diseases b. Sensory neuropathy and peripheral artery disease (PAD) are risk factors c. Clotting abnormalities, impaired immune function, & autonomic neuropathy play a role d. Smoking decreases the chances of amputation e. Improper footwear & injury from stepping on foreign objects while barefoot are common causes of undetected foot injury f. Annual screening using monofilament is important

a. This be the result of a combination of micro & macro -vascular diseases b. Sensory neuropathy and peripheral artery disease (PAD) are risk factors c. Clotting abnormalities, impaired immune function, & autonomic neuropathy play a role e. Improper footwear & injury from stepping on foreign objects while barefoot are common causes of undetected foot injury f. Annual screening using monofilament is important

Which are appropriate therapies for patients with diabetes? (Select all that apply.) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of β-blockers to treat retinopathy d. Use of serotonin agonists to decrease appetite e. Use of ACE or ARB inhibitors to treat nephropathy

a. Use of statins to reduce CVD risk e. Use of ACE or ARB inhibitors to treat nephropathy

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

a. Viral load testing

A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse expects further diagnostic testing to reveal a. decreased serum PTH. b. increased serum ACTH. c. increased serum glucose. d. decreased serum cortisol levels.

a. decreased serum PTH.

The most common cause of secondary immunodeficiencies is a. drugs. b. stress. c. malnutrition. d. human immunodeficiency virus.

a. drugs.

The nurse would be alerted to possible anaphylactic shock after a patient has received IM penicillin by the development of a. edema and itching at the injection site. b. sneezing and itching of the nose and eyes. c. a wheal-and-flare reaction at the injection site. d. chest tightness and production of thick sputum.

a. edema and itching at the injection site.

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about a. energy level. b. intake of vitamin C. c. employment history. d. frequency of sexual intercourse.

a. energy level.

Abnormal findings during an endocrine assessment include (select all that apply) a. excess facial hair on a woman. b. blood pressure of 100/70 mm Hg. c. soft, formed stool every other day. d. 3-lb weight gain over last 6 months. e. hyperpigmented coloration in lower legs.

a. excess facial hair on a woman. e. hyperpigmented coloration in lower legs.

The nursing care for a patient with hyponatremia and fluid volume excess includes a. fluid restriction. b. administration of hypotonic IV fluids. c. administration of a cation-exchange resin. d. placement of an indwelling urinary catheter.

a. fluid restriction.

Interventions to prevent health care-associated infections include (select all that apply) a. following hand-washing protocols. b. limiting visitors to persons over age 18. c. giving all patients prophylactic antibiotics. d. placing all patients on contact precautions. e. decontaminating equipment used for patient care.

a. following hand-washing protocols. e. decontaminating equipment used for patient care.

The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.

a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.

Factors associated with an increase in reemerging infections include (select all that apply) a. international travel. b. poor immunization rates. c. poor sanitation standards. d. not completing a full course of antibiotics. e. correct use of personal protective equipment.

a. international travel. b. poor immunization rates. c. poor sanitation standards. d. not completing a full course of antibiotics.

The patient asks the nurse why they need viral load testing. The nurse responds that an undetectable HIV viral load (select all that apply) a. is the goal of HIV therapy. b. occurs with drug resistance. c. is a sign of disease progression. d. means that person is cured of HIV. e. means that someone is unable to sexually transmit HIV.

a. is the goal of HIV therapy. e. means that someone is unable to sexually transmit HIV.

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is (recognize) a. osmosis. b. diffusion. c. active transport. d. facilitated diffusion.

a. osmosis.

When distinguishing between persons with type 1 diabetes from type 2 diabetes, the nurse is aware that a. persons with type 1 diabetes require insulin therapy. b. autoantibodies to pancreatic β-cells are found in type 2 diabetes. c. persons with type 1 diabetes may be managed with metformin alone. d. hyperosmolar hyperglycemia syndrome is more common in type 1 diabetes.

a. persons with type 1 diabetes require insulin therapy.

A patient has a serum sodium level of 152 mEq/L (152 mmol/L). The normal hormonal response to this situation is a. release of ADH. b. release of ACTH. c. secretion of aldosterone. d. secretion of corticotropin-releasing hormone.

a. release of ADH.

Endocrine problems often go unrecognized in the older adult because a. symptoms are often attributed to aging. b. older adults rarely have identifiable symptoms. c. endocrine problems are uncommon in an older adult. d. older adults usually have endocrine problems with lesser symptoms.

a. symptoms are often attributed to aging.

An older adult is admitted to the medical unit with GI bleeding. Assessment findings that occur with fluid volume deficit include (select all that apply) a. weight loss. b. dry oral mucosa. c. full bounding pulse. d. engorged neck veins. e. orthostatic f. hypotension. g. increased central venous pressure.

a. weight loss. b. dry oral mucosa. e. orthostatic

What is autonomic neuropathy?

affects nearly all body systems and lead to hypoglycemia unawareness, bowel incontinence and diarrhea, and urinary retention. Gastroparesis is a complication of autonomic neuropathy that can cause anorexia, nausea, vomiting, gastroesophageal reflux, and persistent feelings of fullness. Gastroparesis can trigger hypoglycemia by delaying food absorption. Cardiovascular problems from autonomic neuropathy include postural hypotension, resting tachycardia, and painless MI. We should assess the patient for risk for falls and teach the patient with postural hypotension to change from a lying or sitting position slowly. DM can also affect sexual function, erectile dysfunction in men with DM is common.

In a person having an acute rejection of a transplanted kidney, what would help the nurse understand the course of events? (select all that apply) a. A new transplant should be considered. b. Acute rejection can be treated with mycophenolate. c. Repeated episodes of acute rejection can lead to chronic rejection. d. Corticosteroids are the most successful drugs used to treat acute rejection. e. Acute rejection is common after a transplant and can be treated with drug therapy.

b. Acute rejection can be treated with mycophenolate. c. Repeated episodes of acute rejection can lead to chronic rejection. e. Acute rejection is common after a transplant and can be treated with drug therapy.

Which example should the nurse use to explain an infant's "passive immunity" to a new mother? a. Vaccinations b. Breastfeeding c. Exposure to communicable diseases d. Stem cells in peripheral blood

b. Breastfeeding

What causes a thyroid storm? a. Reaction to stormy weather b. Excess amounts of thyroid hormones are released into the circulation c. Unresolved tachycardia d. Increased intake of corticosteriods

b. Excess amounts of thyroid hormones are released into the circulation

A patient's arterial blood gas (ABG) report was pH 7.48, PaCO2: 38, and HCO3: 30. For which acid-base imbalance would the nurse plan the patient's care? a. Metabolic Acidosis b. Metabolic Alkalosis c. Respiratory Acidosis d. Respiratory Alkalosis

b. Metabolic Alkalosis

Thickening of small vessel membranes; includes retinopathy, nephropathy, neuropathy: a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

b. Microvascular Complications

The nurse is caring for a client with COPD exacerbation. The current ABG values are: pH: 7.30, PaCO2: 49 mm Hg, and HC03: 22. Which condition would the nurse interpret this being? a. Respiratory Alkalosis b. Respiratory Acidosis c. Metabolic Alkalosis d. Metabolic Acidosis

b. Respiratory Acidosis

A surgical unit's quality improvement committee notes the number of new catheter-associated urinary tract infections (CAUTIs) increased over the past 6 months. The nurse understands that this means: a. There is CAUTI pandemic on the unit. b. There is a need to review unit practices. c. Droplet precautions are needed to prevent CAUTIs. d. The prevalence of antibiotic resistant CAUTI infections is decreasing.

b. There is a need to review unit practices.

A patient with lung cancer develops SIADH. Which are anticipated findings? a. Hypernatremia and hyperkalemia b. Thirst, muscle cramping, and headache c. High urine output, weight gain, and vomiting d. Weight gain and decreased glomerular filtration rate

b. Thirst, muscle cramping, and headache

The nurse reviews the laboratory results of a patient with primary hypothyroidism. The nurse would expect to find a. a low TSH. b. an elevated TSH. c. an elevated free T4. d. decreased low-density lipoproteins (LDLs).

b. an elevated TSH.

The nurse expects the long-term treatment of a patient with hyperphosphatemia from renal failure will include a. fluid restriction. b. calcium supplements. c. magnesium supplements. d. increased intake of dairy products

b. calcium supplements.

A client presents to your unit with a moon face and a hump on their back. What medications should you ask if they have a history of taking? a. topical analgesic ointments b. corticosteroids c. antibiotics d. antiemetics

b. corticosteroids

A characteristic common to all hormones is that they a. circulate in the blood bound to plasma proteins. b. influence cellular activity of specific target tissues. c. accelerate the metabolic processes of all body cells. d. enter a cell and change the cell's metabolism or gene expression.

b. influence cellular activity of specific target tissues.

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. limit calcium intake. b. perform glucose monitoring for hyperglycemia. c. avoid immunizations due to high risk for infections. d. stop steroids immediately if the patient gains weight.

b. perform glucose monitoring for hyperglycemia.

Goals of managing the patient with diabetes include (select all that apply) a. keeping the target A1C greater than 9%. b. teaching self-monitoring of glucose levels. c. preventing complications of hypoglycemia. d. monitoring for ophthalmologic complications.

b. teaching self-monitoring of glucose levels. c. preventing complications of hypoglycemia. d. monitoring for ophthalmologic complications

A basic principle to consider when planning treatment for HIV is a. stimulating the immune system to increase viral load. b. using a combination of drugs from more than one class. c. suppressing the replication of virus by decreasing the CD4+ count. d. encouraging patients to use natural supplements, such as St. John's Wort.

b. using a combination of drugs from more than one class.

The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching about this drug, the nurse determines that further instruction is needed when the patient says a. "I will report any chest pain or difficulty breathing to the doctor right away." b. "I can expect to return to normal function with the use of this drug." c. "I only need to take this drug until my symptoms are improved." d. "I can expect the medication dose may need to be adjusted."

c. "I only need to take this drug until my symptoms are improved."

The nurse teaching the patient with Addison disease determines additional teaching is needed when the patient states a. "I should take my prednisone twice a day." b. "I should call my HCP if I develop vomiting or diarrhea." c. "If I get influenza, I should decrease my prednisone dose." d. "I will pick up my emergency hydrocortisone from the pharmacy."

c. "If I get influenza, I should decrease my prednisone dose."

Which patient is at greatest risk for developing hypermagnesemia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old woman with hypertension taking β-adrenergic blockers c. 42-year-old woman with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

c. 42-year-old woman with systemic lupus erythematosus and renal failure

What is the priority action for the nurse to take if the patient with type 2 diabetes reports headache, nervousness, and dizziness? a. Administer glucagon. b. Give insulin as ordered. c. Check the patient's glucose level. d. Assess for other signs of neurologic stroke.

c. Check the patient's glucose level.

Newborns are protected for the first 3 months of life from bacterial infections because of the maternal transmission of a. IgA. b. IgE. c. IgG. d. IgM.

c. IgG.

The nurse is assessing a client with thyroid disease and palpates the anterior neck. The nurse feels an enlarged, smooth lump that is nontender. What is most likely the cause of this finding? a. Impaired esophageal peristalsis b. Lack of sodium in their diet c. Lack of iodine in their diet d. Excessive use of proton pump inhibitors

c. Lack of iodine in their diet

A client with severe nausea, vomiting, and diarrhea for the last two days is seen in the emergency department. ABG pH 7.50 PaCO2 40 mm Hg HCO3− 34 mEq/L. Based on the ABG's interpretation, the nurse would expect which condition? a. Metabolic Acidosis b. Respiratory Acidosis c. Metabolic Alkalosis d. Respiratory Alkalosis

c. Metabolic Alkalosis

Microvascular damage to the retina due to hyperglycemia, nephropathy, and HTN: a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

c. Retinopathy

You are caring for a patient with newly diagnosed type 2 diabetes who was started on metformin. What information should you include in discharge teaching? (Select all that apply.) a. Need to reduce physical activity b. Eliminate all forms of sugar from diet c. Use of a portable blood glucose meter d. Hypoglycemia prevention, symptoms, and treatment e. Procedures that require IV contrast media are contraindicated

c. Use of a portable blood glucose meter d. Hypoglycemia prevention, symptoms, and treatment

The nurse should be alert for which manifestations in a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms

c. Weak, irregular pulse and poor muscle tone

A patient is receiving radiation therapy for renal cancer. The nurse monitors the patient for signs and symptoms of damage to the a. pancreas. b. thyroid gland. c. adrenal glands. d. posterior pituitary gland.

c. adrenal glands.

A nursing priority for a patient who underwent removal of a pheochromocytoma includes a. assessing for weight gain. b. administering IV calcium. c. close monitoring of blood pressure. d. restricting fluid and sodium intake.

c. close monitoring of blood pressure.

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in treatment to a. remove T lymphocytes in her blood that are producing antinuclear antibodies. b. remove normal particles in her blood that are being damaged by autoantibodies. c. exchange her plasma that contains antinuclear antibodies with a substitute fluid. d. replace viral-damaged cellular components of her blood with replacement whole blood.

c. exchange her plasma that contains antinuclear antibodies with a substitute fluid.

An appropriate technique to use during physical assessment of the thyroid gland is a. asking the patient to hyperextend the neck during palpation. b. percussing the neck for dullness to define the size of the thyroid. c. having the patient swallow water during inspection and palpation of the gland. d. using deep palpation to determine the extent of a visibly enlarged thyroid gland.

c. having the patient swallow water during inspection and palpation of the gland.

The typical fluid replacement for the patient with a fluid volume deficit is a. dextran. b. 0.45% saline. c. lactated Ringer's solution. d. 5% dextrose in 0.45% saline.

c. lactated Ringer's solution.

After thyroid surgery, the nurse suspects damage of the parathyroid glands when the patient develops a. hyperthermia and severe tachycardia. b. hypercalcemia and shortness of breath. c. laryngospasms and tingling in the hands and feet d. hypophosphatemia, hypertension, vomiting, and chest pain.

c. laryngospasms and tingling in the hands and feet

Which organs are involved with regulating acid base balance? a. heart and liver b. spleen and appendix c. lungs and kidneys d. Lungs and heart

c. lungs and kidneys

Opportunistic diseases in HIV infection a. are usually benign. b. are slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

c. occur in the presence of immunosuppression.

When working with a patient who has suspected tuberculosis, the nurse would a. wear a cloth mask. b. only use standard precautions. c. place the patient on airborne precautions. d. wear a new gown each time they enter the room.

c. place the patient on airborne precautions.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

c. rapid, deep respirations.

Which patient statement demonstrates an understanding of the role of exercise in managing diabetes? a. "I cannot exercise if I am taking insulin and metformin." b. "Exercise increases insulin resistance, so I will need a higher dose of insulin." c. "It is better to exercise before a meal if I take medication that causes hypoglycemia." d. "My insulin dose may need to be changed if I have low glucose levels after exercising."

d. "My insulin dose may need to be changed if I have low glucose levels after exercising."

What is the most appropriate nursing intervention to help patients with HIV adhere to their treatment plan? a. Set up a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that side effects of ART are bad but that they go away. d. Assess the patient's routines and find adherence cues that fit into their life circumstances.

d. Assess the patient's routines and find adherence cues that fit into their life circumstances.

Association between HLA antigens and diseases is most often found in what disease conditions? a. Cancers b. Infectious diseases c. Neurologic diseases d. Autoimmune disorders

d. Autoimmune disorders

What accurately describes rejection after transplantation? a. Hyperacute rejection can be treated with antimetabolites. b. Acute rejection can be treated with sirolimus or tacrolimus. c. Chronic rejection can be treated with tacrolimus or cyclosporine. d. Hyperacute reaction can be avoided if crossmatching is done before transplantation.

d. Hyperacute reaction can be avoided if crossmatching is done before transplantation.

A pregnant woman with asymptomatic chronic HIV infection is seen at the clinic. The patient says I am very nervous about making my baby sick. Which information will the nurse include when teaching patient? a. Her newborn will be born with HIV unless she uses ART b. The antiretroviral medications used to treat HIV infection are teratogenic c. Because it is an early stage of HIV infection, the infant will not contract HIV d. Most infants born to HIV-positive mothers are not infected with the virus

d. Most infants born to HIV-positive mothers are not infected with the virus

Microvascular damage to the small blood vessels that supply the glomeruli of the kidney: a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

d. Nephropathy

What is an anion gap? a. The number of anions in the ECF b. The measurement to determine how acidic the environment is c. The difference between the acid and base from normal values d. The difference between the measured serum cations and anions in ECF

d. The difference between the measured serum cations and anions in ECF

The nurse caring for a patient with HIV who has been on ART for many years plans care with the knowledge that the patient a. will inevitably develop drug resistance. b. is less likely to develop problems such as hyperlipidemia. c. is more likely to require treatment of opportunistic infections. d. can develop other chronic conditions at an earlier age than someone without HIV.

d. can develop other chronic conditions at an earlier age than someone without HIV.

A patient with a low number of monocytes would have a decreased ability to a. stimulate the production of T and B lymphocytes. b. make antibodies after exposure to foreign substances. c. bind antigens and stimulate natural killer cell activation. d. capture antigens by phagocytosis and present them to lymphocytes.

d. capture antigens by phagocytosis and present them to lymphocytes.

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site. b. try to force 10 mL of normal saline into the device. c. place the patient on the left side with the head down. d. have the patient change positions, raise arm, and cough.

d. have the patient change positions, raise arm, and cough.

The nurse tells a friend who asks him to administer his allergy shots that a. it is illegal for nurses to administer injections outside of a medical setting. b. he is qualified to do it if the friend has epinephrine in an injectable syringe provided with his extract. c. avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. d. immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

d. immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

The nurse is assessing a client with hyperthyroidism, what is an expected finding with this disease? a. Client reports excessive weight gain b. enlarged scaly tongue c. puffy face d. protruding eyeballs

d. protruding eyeballs

In a type I hypersensitivity reaction the primary immunologic disorder appears to be a. binding of IgG to an antigen on a cell surface. b. deposit of antigen-antibody complexes in small vessels. c. release of cytokines used to interact with specific antigens. d. release of chemical mediators from IgE-bound mast cells and basophils.

d. release of chemical mediators from IgE-bound mast cells and basophils.

A patient has the following arterial blood gas results: pH 7.52, PaCO2 30 mm Hg, 24 mEq/L. The nurse determines that these results indicate a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

d. respiratory alkalosis.

During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because a. older adults have an impaired thirst mechanism and need reminding to drink fluids. b. older adults are more likely than younger adults to lose extracellular fluid during surgeries. c. water accounts for a greater percentage of body weight in the older adult than in younger adults. d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.

d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.

What is sensory neuropathy?

distal symmetric polyneuropathy affects the hands and/or feet bilaterally (stocking-glove neuropathy). Characteristics include loss of sensation, abnormal sensations, pain, and paresthesias. Pain described as burning, cramping, crushing, or tearing, usually worse at night and may occur only at that time. The paresthesias may be associated with tingling, burning, and itching sensations. Patient's may report a feeling of walking on pillows or numb feet. The skin can become so sensitive that the patient cannot tolerate even light pressure from bed sheets. Complete or partial loss of sensitivity to touch and temperature is common. Foot injury and ulcerations can occur without the patient ever having pain. Neuropathy can also cause atrophy of the small muscles of the hands and feet, causing deformity and limiting fine movement. Managing glucose is the only treatment for DM-related neuropathy.

Nerve damage that occurs because of the metabolic imbalances associated with diabetes. a. Macrovascular Complications b. Microvascular Complications c. Retinopathy d. Nephropathy e. Neuropathy

e. Neuropathy

What does the A1C laboratory value measure?

measures the amount of hemoglobin with attached glucose which reflects your average blood glucose levels over the past 3 months

When doing ABG interpretation, which main three components are we comparing?

pH, PaCO2, and HCO3