Medsurg 1 Final

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? A) 10:00 AM B) 12:00 AM C) 2:00 PM D) 4:00 PM

A. Correct 10:00 AM The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.

A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? A) "Have you had a recent head injury?" B) "Do you have to wear larger shoes now?" C) "Is there a family history of acromegaly?" D) "Are you experiencing tremors or anxiety?"

B. Correct "Do you have to wear larger shoes now?" Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is important for the nurse to communicate to the health care provider before the test? A) Bilateral poor peripheral vision B) Correct Allergies to iodine and shellfish C) Recent weight loss of 20 lb D) Complaint of ongoing headaches

B. Correct Allergies to iodine and shellfish Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

#11 A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. What topic should the nurse plan to teach the patient? A. Bisphosphonates to reduce bone demineralization B. Calcium supplements to normalize serum calcium levels C. Increasing fluid intake to decrease risk for nephrolithiasis D. Including whole grains in the diet to prevent constipation

B. Correct Calcium supplements to normalize serum calcium levels Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

An older patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? A) Draw blood for laboratory testing. B) Correct Check the patient's blood pressure. C) Assess the patient for an abdominal bruit. D) Determine any family history of heart disease.

B. Correct Check the patient's blood pressure. Because the patient appears to be experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure. The other actions may also be done, but they will not provide information to determine what interventions are needed immediately.

A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take? A) Withhold the usual scheduled insulin dose because the patient is NPO. B) Obtain a blood glucose measurement before any insulin administration. C) Give the patient the usual insulin dose because stress will increase the blood glucose. D) Give half the usual dose of insulin because there will be no oral intake before surgery.

B. Correct Obtain a blood glucose measurement before any insulin administration. Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? A) Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL. B) Patient with stable angina whose chest pain has recently increased in frequency. C) Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL. D) Patient with chronic hypertension whose blood pressure today is 172/98 mm H

B. Correct Patient with stable angina whose chest pain has recently increased in frequency The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are more stable.

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. What should the nurse anticipate A) The patient may need a diet higher in calories while receiving prednisone B) The patient may develop acute hypoglycemia while taking the prednisone. C) The patient may require administration of insulin while taking prednisone. D) The patient may have rashes caused by metformin-prednisone interactions.

C) patient will require administration of insulin while taking prednisone Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories

Patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? A) Observe the dressing for bleeding. B) Check the blood pressure and pulse. C) Assess the patient's respiratory effort. D) Support the patient's head with pillows.

C. Correct Assess the patient's respiratory effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post thyroidectomy but are not as high of a priority.

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history focuses on a pertinent risk factor for rheumatic fever? A) "Do you use any illegal IV drugs?" B) "Have you ever injured your chest?" C) "Have you had a recent sore throat?" D) "Do you have a family history of heart disease?"

C. Correct Have you had a recent sore throat Rheumatic fever occurs because of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever, and it would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

#12 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? A. "If I overeat at a meal, I will still take the usual dose of medication." B. "Other medications besides the Glucotrol may affect my blood sugar." C. "When I am ill, I may have to take insulin to control my blood sugar." D. "My diabetes won't cause complications because I don't need insulin."

D

After receiving change of shift report about the following four patient on the cardiac care unit, which patient should the nurse assess first? A) 39 old pt with pericarditis who is complaining of sharp, stabbing pain B) 56 old patient with variant angina who is schedule to receive nifedipine C)65 year old patient who had a myocardial infarction 4 days ago and is anxious about today's planned discharge D) 59 old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

D) 59 old patient After PCI, patient is at risk for hemorrhage from arterial access site. Nurse should assess the patient's BP,P and the access site immediately. The other patients should also be assessed ASAP but assessment of this patient has the highest priority