Mock Exam 2

The nurse is conducting allergy skin testing on a client. Which post-procedure interventions are most appropriate? Select all that apply. A. Record site, date, and time of test B. Give the client a list of potential allergens if identified C. Estimate the size of the wheal and document the finding D. Tell the client to return to have the site inspected only if there is a reaction E. Have the client wait in the waiting room for at least 1-2 hours after injection

A, B The site, date, time of the test should be documented and the client should know what allergens were administered.

A client develops an anaphylactic reaction after receiving morphine. The nurse should plan to institute which actions? Select all that apply. A. Administer oxygen B. Quickly assess the clients respiratory status C. Document the event, interventions, and the clients response D. Leave the client briefly to contact a HCP E. Keep the client supine regardless of the blood pressure readings F. Start an IV infusion of D5W and administer 500-mL bolus

A, B, C An anaphylactic reaction requires immediate attention, starting with quickly assessing the clients respiratory status. Oxygen is administered and IV of NS is started. And documentation of the event needs to take place.

In monitoring a clients response to disease modifying antirheumatic drugs (DMARDS), which assessment findings would the nurse consider acceptable responses? Select all that apply. A. Control of symptoms during periods of emotional stress B. Normal white blood cell and neutrophil counts C. Radiological findings that show no progression of joint degeneration D. An increase range of motion in the affected joints 3 months into therapy E. Inflammation and irritation at the injection site 3 days after the injection was given F. A low-grade temperature on rising in the morning that remains throughout the day

A, B, C, D Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow the progression of joint degeneration . In addition improved range of motion and normal lab work is a positive finding.

The home health care nurse is visiting a client who was recently diagnosed with type 2 DM. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply. A. Diarrhea may occur secondary to the metformin B. The repaglinide is not taken if a meal is skipped C. The repaglinide is taken 30 minutes before eating D. A simple sugar food item is carried and used to treat mild hypoglycemia episodes E. Muscle pain is an exprected effect of metformin and may treated with acetaminopen F. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

A, B, C, D Repaglinide,a rapid acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared and carry a simple sugar at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea.

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement? A. Ensure the client eats the bedtime snack B. Determine how much food the client ate at lunch C. Perform a glucometer reading at 0700 D. Offer the client protein after administering insulin

A. Humulin N peaks in 6-8 hours making the client at risk for hypoglycemia around midnight

The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy? A. Hairdressers B. The homeless C. Children in a day care D. Individuals living in a group home

A. Individuals most at risk for developing a latex allergy include healthcare workers and those who have subsequent exposure to the product such as through gloves. Making hairdressers most at risk in this case.

The client with RA has nontender, movable nodules in the subcutaneous tissue over the elbows and shoulders. Which statement is the scientific rationale for the nodules? A. The nodules indicate a rapidly progressive destruction of the affected tissue B. The nodules are small amounts of synovial fluid that have become crystalized C. The nodules are lymph nodes that have proliferated to try to fight the disease D. The nodules present a favorable prognosis and mean the client is better

A. Nodules are associated with rapidly progressive and destructive disease

Which electrolyte replacement should the nurse anticipate being ordered by the HCP in the client diagnosed with diabetic ketoacidosis (DKA) who has just been admitted to the ICU? A. Glucose B. Potassium C. Calcium D. Sodium

B. A client in DKA loses potassium from increased urinary output, acidosis, catabolic state, and vomiting. So it is the priority to replace.

A client arrives the the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which action are most appropriate? Select all that apply. A. Tell the client that testing is not necessary unless arthralgia develops. B. Tell the client to avoid any woody, grassy areas that may contain ticks C. Instruct the client to immediately start to take the antibiotics that are prescribed D. Inform the client to plan to have blood test 4-6 weeks after a bite to detect the presence of the disease E. Tell the client that if this happens again to never remove the tick but to instead vigorously scrub the area with an antiseptic

B, C, D A blood test is available to detect Lyme disease however the test is not reliable if preforming 4-6 weeks after the tick bite. Areas that ticks are found should be avoided.

The nurse teaches a client with DM about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms or symptoms develop? Select all that apply. A. Polyuria B. Shakiness C. Palpitations D. Blurred Vision E. Lightheadedness F. Fruity odor breath

B, C, E Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose.

A client with a diagnosis of diabetic keto-acidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. A. Increase pH B. Comatose state C. Deep, rapid breathing D. Decreased urine output E. Elevated blood glucose

B,C,E Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. If untreated the client will become comatose r/t dehydration, kussmauls respirations, and severe hyperglycemia.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? A. "I should not exercise since I am taking insulin" B. "The best time for for me exercise is after breakfast" C. "The best time for me to exercise is mid-to-late afternoon" D. "NPH is a basal insulin, so I should exercise in the evening"

B. To prevent a hypoglycemic state that patient should exercise right after breakfast before their insulin has kicked in

The nurse is caring for a client who has been taking a sulfamide and should monitor for signs and symptoms of which adverse effects of this medication? Select all that apply. A. Ototoxicity B. Palpitations C. Nephrotoxicity D. Bone Marrow Suppression E. Gastrointestinal effects F. Increased White Blood Cells count

C, D, E Adverse effects include nephrotoxicity, bone marrow suppression, and GI effects

The client diagnosed with acute exacerbation of SLE is being discharged with a prescription of an oral steroid which will be discontinued gradually. Which statement is the scientific rationale for this type of medication dosing? A. Tapering the medication prevents the client from having with drawl symptoms B. So the thyroid gland starts working, because this medication stops it from working C. Tapering the dose allows the adrenal glands to begin to produce cortisol again D. This is the health-care providers personal choice in prescribing the medications

C. Tapering steroids is important because the adrenal gland stop producing cortisol and glucocorticosteriod which alter glucose metabolism and blood pressure.

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse? A. The client has crumbling toenails B. The client has athletic foot C. The client has a necrotic foot D. The client has thickened toenails

C. A necrotic big toe indicates "dead" tissue. The client does not feel pain and doesn't realize the injury therefore doesn't seek treatment.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the health care provider immediately if what occurs? A. Nausea B. Lethargy C. Hearing loss D. Muscle aches

C. Amikacin is an aminoglyceride, an adverse effect of this class of medication includes ototoxicity (hearing problems)

A client is admitted to a hospital with a diagnosis of DKA. The initial blood glucose is 950 mg/dL. A continuous intervenous infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL. The nurse would next prepare to administer which medication? A. An ample of 50% dextrose B. NPH insulin subcutaneous C. IV fluids containing dextrose D. Phenytoin for the prevention of seizures

C. emergency management of DKA focuses on correcting fluid and electrolyte balanced and normalizing serum glucose level.

The client is complaining of joint stiffness, especially in the morning. Which diagnostic test should the nurse expect the HCP to order to R/O osteoarthritis? A. Full-body magnetic resonance imaging scan B. Serum studies for synovial fluid amount C. X-ray of the affected joints D. Serum erythrocyte sedimentation rate (ESR)

C. X-ray reveal loss of joint cartilage which appears as a narrowing of the joint space in the clients diagnosed with OA

The client has been diagnosed with OA for the last seven years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem should the nurse identify? A. Severe pain B. Body image disturbance C. Knowledge deficit D. Depression

D. The client experiencing chronic pain often experiences depression and hopelessness

The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention? A. The client complains of joint stiffness and the knees feel warm to the touch B. The client has experienced one kg weight loss and it very tired C. The client requires a heating pad applied to the hips and back to sleep D. The client is crying, has a flat facial affect, and refuses to speak to the nurse

D. The client has s/s of depression. The nurse should attempt to intervene with therapeutic communication.

The client recently diagnosed with SLE ask the nurse "What is SLE and how do I get it?" Which statement best explains the scientific rationale for the nurse's response? A. SLE occurs because the kidneys do not filter antibodies from the blood B. SLE occurs after a viral illness as a result of damage to the endocrine system C. There is no known identifiable reason for a client to develop SLE D. This is an autoimmune disease that may have a genetic or hormonal component

D. There is evidence for familial and hormonal components to the development SLE.

The client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780 mg/dL. The client's blood glucose level is now 300mg/dL. Which intervention should the nurse implement? A. Increase the regular insulin IV drip B. Check the client's urine for ketones C. Provide the client with a therapeutic diabetic meal D. Notify the HCP to obtain an order to decrease insulin

D. When the glucose level is decreased to around 300mg/dL the regular insulin infusion therapy is decreased. Sub-q insulin will be administered per sliding-scale.

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

D. an insulin pump provides small continuous dose of short-acting insulin sub-q through out the day and night

The occupational health nurse is teaching a class on risk factors for developing osteoarthritis. Which is a modifiable risk factor for developing OA? A. Being overweight B. Increasing age C. Previous joint damage D. Genetic susceptibility

A. Obesity is a well-recognized risk factor for the development of OA and it is modifiable because the client can lose weight.

The nurse identified a concept of metabolism for a client diagnosed with DM type 1. Which interventions should the nurse include in the plan of care? Select all that apply. A. Teach the client to preform self-glucose monitoring B. Instruct the client about complications of high-glucose levels C. Instruct the client to inspect the feet daily D. Explain the need to carry a source of quick-acting proteins E. Encourage the client to have regular eye exams

A, B, C, E Client should be taught to preform self-glucose monitoring and should be aware of the consequences of not controlling blood glucose. The feet and retinas are largely affected by DM.

A client with DM visit a health care clinic. Th client's DM previously had been well controled with glyburide daily, but recently the fasting blood glucose level had been 180-200 mg/dL. Which medication, if added to the client's regime, may have contributed to the hyperglycemia? A. Predinisone B. Atenolol C. Phenelzine D. Allopurinol

A. Predinisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

The client diagnosed with SLE is being discharged with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply. A. Use a sunscreen of SPF 30 or greater when in the sunlight B. Some dyspnea is expected and does not need immediate attention C. The hands and feet may change color if exposed to cold or heat D. Explain the client can be cured with continued therapy

A, B, D Sunlight and UV exacerbate SLE, fever may be the first sign of this. Raynaud's phenomenon can indicate exacerbation as well.

Which interventions apply in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply. A. Use non-latex gloves B. Use medications from glass ampules C. Place the client in a private room only D. Keep latex safe supple cart available in the clients area E. Avoid use of medication vials that have rubber stoppers F. Use a blood pressure cuff from an electronic device only to measure the blood pressure.

A, B, D, E If a client is allergic to latex and is at high risk for an allergic response the nurse would use non-latex gloves and latex safe supplies, any materials that contain latex should be avoided this includes blood pressure cuffs and rubber medication vial stoppers.

The diabetic educator is teaching a class of diabetes type 1 and is discussing sick-day rules. Which intervention should the diabetes educator include in the discussion? Select all that apply. A. Take diabetic medication even if unable to eat the client's normal diabetic diet B. If unable to eat, drink liquids equal to the client's normal caloric intake C. It is not necessary to notify the HCP if ketones are in the urine D. Test blood glucose levels and test urine ketones once a day to keep a record E. Call the HCP if glucose levels are higher than 180 mg/dL

A, B, E Teach to take insulin even if client cannot eat and to drink fruit juices or soda. HCP should be notified if BG is high.

The nurse is monitoring a client who was diagnosed with type 1 DM and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of possible hypoglycemic reaction? select all that apply. A. Tremors B. Anorexia C. Irritability D. Nervousness E. Hot, dry skin F. Muscle cramps

A, C, D Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors.

The client in the emergency department begins to experience a severe anaphylactic reaction after an initial dose of IV penicillin. Which interventions should the nurse implement? Select all that apply. A. Prepare to administer Solu-Medrol, a glucocorticoid, IV B. Request to obtain a STAT chest X-ray C. Initiate the rapid response team D. Administer epinephrine SQ then IV continuous E. Assess the clients pulses and respirations

A, C, D, E Steroid medications decrease inflammatory response, rapid response should be called, epinephrine should be administered to try to reverse the anaphylactic shock by acting on the beta and alpha receptors, lastly a cardiopulmonary assessment needs to be done to assess status of client.

A client taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. A. Hypoglycemia may be experienced before dinnertime B. The insulin dose should be decreased if illness occurs C. The insulin should be administered at room temperature D. The insulin vial needs to be shaken vigorously to break up the precipitates E. The NPH insulin should be drawn into the syringe first, then the regular insulin.

A, C. Humulin NPH is an intermediate acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6-14 hours, and duration is 16-24 hours. Regular insulin is a short acting insulin the onset is 30-60 minutes, peak in 1-5 hours, and duration is 6-10 hours. Hypoglycemic reactions most likely occur during peak time.

The health care provider prescribes exenatide for a client with type 1 DM who takes insulin. The nurse should plan to take which most appropriate intervention? A. With hold the medication and call the HCP questioning the prescription for the client B. Administer the medication within 60 minutes before the morning and evening meal. C. Monitor the client for gastrointestinal side effects after administering the medication D. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

A. Exenatide is an incretin mimetic used for type 2 DM only. It is not recommended for clients taking insulin. Therefore the nurse should hold the medication and question the HCP order.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care? A. Assess the client's ability to read small print B. Monitor the client's serum prothrombin (PT) time level C. Teach the client how to preform a hemoglobin A1C test daily D. Instruct the client to check the feet weekly

A. Age- related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosages correctly

The nurse is monitoring a client newly diagnosed with DM for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? A. Polyuria B. Diaphoresis C. Pedal edema D. Decreased respiratory rate

A. Chronic hyperglycemia resulting from poor glycemic control, contributes to micro and macrovascular complications of DM.

The client diagnosed with a bee sting allergy is being discharged from the emergency department. Which priority discharge instruction should be taught to the client? A. Demonstrate how to use an EpiPen, an adrenergic agonist B. Teach the client to never go outdoors in the spring and summer C. Have the client buy diphenhydramine over the counter to use when stung D. Discuss wearing a Medic Alert bracelet when going outside

A. Client who are allergic to bee sting venom should be taught to keep an EpiPen with them at all times

A nurse provides home care instructions to a client with systemic lupus erythmatosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? A. "I should take hot baths because they are relaxing" B. "I should sit whenever possible to conserve energy" C. "I should avoid long periods of rest because it causes joint stiffness" D. I should do some exercising

A. Hot baths should be avoided because they exacerbate fatigue.

The nurse is assisting in planning care for a client with a diagnoses of immunodeficiency and should incorporate which action as a priority in the plan? A. Protecting the client from infection B. Providing emotional support to decrease fear C. Encouraging discussion about lifestyle changes D. Identifying factors that decrease the immune function

A. The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be protect the client from infection.

The elderly client is admitted to the intensive care development diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? A. Infuse 0.9% normal saline intravenously B. Administer intermediate-acting insulin C. Perform blood glucometer checks daily D. Monitor arterial blood gas (ABG) results

A. The initial fluid replacement is 0.9% normal saline IV followed by 0.45% saline.

The home health nurse visits a client with a diagnosis of Type 1 DM. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? A. "I need to stop my insulin" B. " I need to increase my fluid intake" C. "I need to monitor my blood glucose every 3-4 hours" D. "I need to call the health care provider because of these symptoms"

A. The patient should not stop their insulin dosages when they are unable to eat. This will set up the opportunity for DKA to set in.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if preformed by the client, indicates the need for further teaching? A. Withdraws the NPH insulin first B. Withdraws the regular insulin first C. Injects air into NPH insulin vial first D. Injects an amount of air equal to the desired dose of insulin into each vial

A. When mixing insulin it goes clear to cloudy. Rapid and short acting insulin are clear and intermediate acting insulin is cloudy.

The nurse is discussing the importance of an exercise program for pain control to a client diagnosed with OA. Which intervention should the nurse include in the teaching? A. Wear supportive tennis shoes with white socks when walking B. Carry a complex carbohydrate while exercising C. Alternate walking briskly and jogging when exercising D. Walk at least 30 minutes three times a week

A. Safety should always be discussed when teaching about exercises

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? A. Administer 50% dextrose (IVP) B. Notify the health-care provider C. Move the client to the ICU D. Check the serum glucose level

A. The nurse should assume the client is hypoglycemic and administer IV dextrose, which will rouse the client immediately.

Ketoconazole is prescribed for a client with a diagnoses of candidiasis. Which interventions should the nurse include when administering this medication? Select all that apply. A. Restrict fluid intake B. Monitor liver function studies C. Instruct the client to avoid alcohol D. Administer the medication with an antacid E. Instruct the patient to avoid exposure tot he sun F. Administer the medication on an empty stomach

B, C, F Ketoconazole is an antifungal medication, which is processed by the liver so liver function needs to be optimal to avoid toxicity. Medication needs to be taken on an empty stomach for optimal absorption and patient should avoid alcohol.

Glimpiride is prescribed for a client with DM. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. A. Alcohol B. Red Mans C. Whole-grain cereals D. Low-calorie desserts E. Carbonated beverages

B,C,E When alcohol is combined with glimepride, a disulfiram-like reaction may occur. Clients should also avoid low-calorie desserts.

A client with DM demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? A. Administer a sedative B. Convey empathy, trust, and respect toward the client C. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear D. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening

B. Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the clients feeling relating to the anxiety.

The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places priority on which client problem? A. Lack of knowledge B. Inadequate fluid volume C. Compromised family coping D. Inadequate consumption of nutrients

B. Inadequate fluid volume can lead to dehydration and set up fatal problems

The 26-year-old female client is complaining of a low-grade fever, arthralgias, fatigue, and a facial rash. Which laboratory tests should the nurse expect the HCP to order if SLE is suspected? A. Complete metabolic panel and liver function test B. Complete blood count and antinuclear antibody test C. Cholesterol and lipid profile test D. Blood urea nitrogen and glomerular filtration test

B. No single lab test diagnoses SLE, but client typically appears with moderate leukopenia to severe anemia, thrombocytopenia, leukopenia, and positive ANA test

The home care nurse visits a client recently diagnosed with DM who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? A. Freeze the insulin B. Refrigerate the insulin C. Store the insulin in a dark, dry place D. Keep the insulin at room temperature

B. Vials should be refrigerated.

The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? A. Provide high fat diet 24 hours prior to test B. Hold the biguanide medication for 48 hours prior to test C. Obtain an informed consent form for the test D. Administer pancreatic enzymes prior to the test

B. Biguanide medication must be held for a test with contrast medium because it increases the risk of lactic acidosis, which leads to renal problems.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder? A. Myxedema B. Kidney disease C. Hypothyroidism D. Diabetes Mellitus

B. Colchicine is contraindicated for elderly patients and patients with kidney, cardiac, or GI problems.

A client calls the nurse in the emergency department and states that he was just stung by a bumblebee while gardening. The client is afraid of severe reaction because the client's neighbor experienced such a reaction just 1 week ago. Which action should the nurse take? A. Advise the client to soak the site in hydrogen peroxide. B. Ask the client if he ever sustained a bee sting in the past C. Tell the client to call an ambulance for transport to the emergency department D. Tell the client not to worry about the sting unless difficulty with breathing occurs.

B. In some types of reactions a reaction only occurs on the second and subsequent contacts with the allergen. Therefore getting the patients history is the most appropriate.

A client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, which is the most important for the nurse to assess? A. The injection site for itching and edema B. The white blood cell counts and platelet counts C. Whether the client is experiencing fatigue and joint pain D Whether the client is experiencing a metallic taste in mouth, and loss of appetite

B. Infection and pancytopenia are adverse effects of etanercept.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 DM who has been prescribed metformin. Which client statement indicates the need for further teaching? A. "It is okay if I skip meals now and again." B. "I need to constantly watch for signs of low blood sugar" C. "I need to let my healthcare provider know if I get usually hard" D. "I will be sure to not drink alcohol excessively while on this medication"

B. Metformin is classified as a biguanide and is the most commonly used medication for type II DM initially. When used alone metformin lowers blood sugar after meal intake as well as fasting blood glucose levels.

The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit? A. Severe bone deformity B. Joint stiffness C. Waddling gait D. Swan-neck fingers

B. Pain, stiffness, and functional impairment are the primary clinical manifestations of OA.

An 18-year-old female client, 5'4 tall weighing 248.6 lbs, comes to the clinic for a non-wound on her leg, which she has had for two weeks. Which disease process should the nurse suspect the client has developed? A. Type 1 diabetes B. Type 2 diabetes C. Gestational Diabetes D. Acanthosis nigricans

B. Patient is overweight and non-healing wound is a tail-tail sign of diabetes.

The nurse is providing instructions to the client newly diagnosed with DM who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? A. "Inject the pramlintide at the same time you take your other medication" B. "Take your prescribed pills 1 hour before 2 hours after the injection" C. "Be sure to take the pramlintide with food so you don't upset your stomach" D. "Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar"

B. Pramlintide is used for clients with types 1 and 2 DM who use insulin. It is administer sub-q before meals to lower blood glucose level after meals, leading to less fluctuation through-out the day and better glucose control.

Which assessment data indicate the client diagnosed with diabetic ketoacidosis is responding to medical treatment? A. The client has tented skin turgor and dry mucous membranes B. The client is alert and oriented to date, time, and place C. The client's ABG results are pH 7.29, Paco2 44, HCO3 15 D. The client's serum potassium level is 3.3 mEq/L

B. The client's level of consciousness can be altered because of dehydration and acidosis.

The client diagnosed with RA who has been prescribed etanercept shows marked improvement. Which intervention regarding the use of this medication should the nurse teach? A. Explain the medication loses its efficacy after a few months B. Continue to have checkups and laboratory work while taking the medication C. Have yearly magnetic resonance imaging to follow the progress D. Discuss the drug is taken for three weeks and then stopped for a week

B. The drug requires close monitoring to prevent organ damage

A client presents at the HCP office with complaints of ring-like rash on his upper leg. Which question should the nurse ask first? A. "Do you have any cats in your home?" B. "Have you been camping in the last month?" C. "Have you had flu-like symptoms in the past few weeks?" D. "Have you been in contact with anyone who has the same kind of rash?"

B. The nurse should ask questions to assist in identifying a cause of Lyme disease

Which client goal is most appropriate for a client diagnosed with OA? A. Preform passive range of movement exercises B. Maintain optimal functional ability C. Client will walk three miles everyday D. Client will join a health club

B. The two main goals of OA are pain management and optimizing functional ability of the joints to ensure movement

The nurse is caring for a cleitn with a diagnoses of gout. Which lab value would the nurse expect to note in the client? A. Calcium level of 9.0 mg/dL B. Uric acid level of 9.0 mg/dL C. Potassium level of 4.1 mEq/L D. Phosphorus level of 3.1 mg/dL

B. There are elevated Uric Acid levels in Gout. Normal ranges for a male is 4.0-8.5 and for a female is 2.7-7.3

The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA. What is the scientific rationale for prescribing this medication? A. It will help decrease the inflammation in the joints B. It improves tissue function and retards breakdown of cartilage C. It is a potent medication which decreases the client's joint pain D. It increases the production of synovial fluid in the joint

B. This is the rationale for administering this medication.

The client in the HCP's office has a red, raised rash covering the forearms, neck, and face and is experiencing extreme itching which is diagnosed as an allergic reaction to poison ivy. Which discharge instructions should the nurse teach? A. Tell the client never to scratch the rash B. Instruct the client in administering IM Benadryl C. Explain how to take a steroid dose pack D. Have the client wear shirts with long sleeves and high socks

C. Clients with poison ivy are frequently prescribed steroid dose pack.

The client diagnosed with type 2 diabetes is admitted to the intensive care unit with hyperosmolar hyperglycemic nonketonic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? A. Kussmaul's respirations B. Diarrhea and epigastric pain C. Dry mucus membranes D Ketone breath odor

C. Dry mucus membranes are a result of hyperglycemia and occur with both HHNS and DKA

The nurse is the emergency department is allergic to latex. Which interventions should the nurse implement regarding the use of nonsterile gloves? A. Use only sterile, nonlatex gloves for any procedure requiring gloves B. Don't use gloves when starting an IV or preforming a procedure C. Keep a pair of nonsterile, nonlatex gloves in pocket of uniform D. Wear white cotton gloves at all times to protect hands

C. If not provided by the health care facility the nurse should carry nonlatex gloves with him or her

The nurse is preparing a group of cub scouts for an overnight camping trip and instructs the Scouts about the methods to prevent Lyme disease. Which statement by one of the Scouts indicates the need for further teaching? A. "I need to bring a hat to wear during the trip" B. "I should wear long sleeves and long pants" C. "I should not use insect repellents because it will attract ticks" D. "I need to wear closed toed shoes and socks that can be pulled up over my pants"

C. Insect repellent repeals ticks not attract them

The nurse is discussing autoimmune diseases with a class of nursing students. Which signs and symptoms are shared by rheumatoid arthritis and systemic lupus erythematosus? A. Nodules in the subcutaneous layer and bone deformity B. Renal involvement and pleural effusions C. Joint stiffness and pain D. Raynaud's phenomenon and skin rash

C. Joint stiffness and pain are symptoms occurring in both diseases

The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits? A. Preform joint x-rays to determine progression of the disease B. Send blood to the laboratory for an erythrocyte sedimentation rate C. Recommend the flu and pneumonia vaccines D. Assess the client for increasing joint involvement

C. RA is a disease with many immunological abnormalities. Therefore the clients are at increased risk for disease and infection.

The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for the client? A. The client will maintain reproductive ability B. The client will verbalize feelings of body image changes C. The client will have no deterioration of organ function D. The client's skin will remain intact and have no irritation

C. SLE can invade and destroy any body system or organ. Maintaining organ function is a priority goal of SLE.

Which client problem is the priority for a client diagnosed with RA? A. Activity intolerance B. Fluid and electrolyte imbalance C. Alternation in comfort D. Excessive nutritional intake

C. The client diagnosed with RA has chronic pain, therefore, alternation in comfort is a priority problem

The client comes to the emergency department complaining of dyspnea and wheezing after eating at a seafood restraint. The client cannot speak and has a bluish color around the mouth. Which intervention should the nurse implement first? A. Initiate an IV with normal saline B. Prepare to intubate the client C. Administer oxygen at 100% D. Ask the client about an iodine allergy

C. The client is cyanotic with dyspnea and wheezing. The nurse should administer oxygen first.

The client diagnosed with acute exacerbation of SLE is prescribed high-dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE? A. The steroids will increase the body's ability to fight the infection B. The steroids will decrease the chance of the SLE spreading to other organs C. The steroids will suppress tissue inflammation, which reduces damage to organs D. The steroids will prevent scarring of skin tissues associated with SLE

C. The main function of steroid medications is to suppress the inflammatory response of the body.

To which member of the health care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub? A. Physiatrist B. Social Worker C. Physical Therapist D. Counselor

C. The physical therapist is able to help the client with transferring, ambulation, and lower extremity difficulties

A client is brought into the ED in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepared to initiate which anticipated healthcare provider's prescription? A. Endotracheal intubation B. 100 u of NPH insulin C. IV infusion of normal saline D. IV infusion of sodium bicarbonate

C. The primary goal for HHNS is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency.

The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1C) of 8.1%. Which interpretation should the nurse make based on results? A. This result is below normal levels B. This result is within acceptable levels C. This result is above recommended levels D. This result is dangerously high

C. This A1C would reflect a blood glucose of around 180-200 mg/dL .

The nurse preforms a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101 F, pulse of 102 beats/minute, respiration of 22 breaths/minute, and blood pressure of 142/72 mmHg. Which finding would be the priority concern to the nurse? A. Pulse B. Respiration C. Temperature D. Blood Pressure

C. With a client with Type II DM an elevated temp may indicate an infection (which is the main cause of HHNS).

Which priority intervention should the day surgery nurse implement for a client who has had right knee arthroscopy? A. Encourage the client to perform range-of-motion exercises B. Monitor the amount and color of the urine C. Check the client's pulses distally and assess the toes D. Monitor the clients vital signs

C. a neurovascular assessment is the priority because the nurse needs to make sure circulation is getting past the surgical site

The nurse provides instructions to a client newly diagnosed with Type 1 DM. The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement? A. "I will stop taking my insulin if I'm too sick to eat." B. "I will decrease my insulin dose during times of illness" C. "I will adjust my insulin dose according to the level of glucose in my urine." D. "I will notify my HCP if my blood glucose level is higher than 250 mg/dL"

D. During illness, the client with type 1 DM is at an increased risk of DKA, due to hyperglycemia associated with stress response due to a typically decreased caloric intake. Pt should notify their HCP if their BG is higher than 250 mg/dL

The client with early-stage RA is being discharged form the outpatient clinic. Which discharge instruction should the nurse teach regarding the use of NSAIDs? A. Take with over-the-counter medication for the stomach B. Drink a full glass of water with each pill C. If a dose is missed double the medication at the next dosing time D. Avoid taking NSAID on an empty stomach

D. NSAIDs decrease prostaglandin production in the stomach, resulting in less mucus secretion, which creates a risk for development of ulcers.