NUR 304 Med/Surg - Exam 4

Diabetic ketoacidosis pt is frequently non adherent w her dietary and medication regimen. She is drowsy yet responsive. What PRIORITY action should the nurse take?

- I/O through catheter - evaluate serum electrolytes - testing for glycosuria and acetonuria -blood glucose - vitals

Hypoproliferative anemias

- sickle cell disease - thalassemia major

Intermediate acting insulins are effective for how long

16-20 hours

_____________ is the most common risk of insulin pump therapy

Ketoacidosis

Classic clinical manifestations of diabetes include the "three Ps"....

Polyuria Polydipsia Polyphagia

Nephropathy pt urinalysis report should indicate...

albumin

____________ and ___________ should not be taken with iron preparations, because they greatly diminish the absorption of iron.

antacids, dairy products

Diabetes is the leading cause of....

- amputation - blindness - end stage kidney disease

Hemolytic anemias

- aplastic anemia - iron deficiency

A pt w/ sickle cell disease is to begin treatment with hydroxyurea. What does the nurse inform the pt will be the benefits of treatment with this medication? (select all that apply)

- fewer episodes of sickle cell crisis - less incidence of acute chest syndrome - decreased need for blood transfusions

Megaloblastic anemias

- folic acid deficiency - B 12 deficiency

A pt has type 1 diabetes. What clinical characteristics does the nurse expect? (select all that apply)

- ketosis prone - little endogenous insulin - < 30 years old

The nurse is assess a pt with nonproliferative (background) retinopathy. When examining the retina, what would the nurse see? (select all)

-exudates -microaneurysms -focal capillary single closure

Rationale for increasing fiber in diabetes patients (select all)

-improve blood glucose -decrease need for insulin -reduce cholesterol levels

IV fluid for ketoacidosis who has a history of hypertension and congestive heart failure

0.45 % normal saline

What chemical agents may be responsible for producing bone marrow aplasia?

1) Benzene and Benzene Derivatives (airplane gel, paint remover, and dry-cleaning solution) 2) Toxic Materials (inorganic arsenic, glycol ethers, plutonium, and radon)

What are the four most common causes of iron deficiency anemia in men and postmenopausal women?

1) Bleeding from ulcers 2) Gastritis 3) Inflammatory bowel disease (IBD) 4) GI tumors

The 3 major classifications of diabetes are....

1) Type 1 2) Type 2 3) Gestational

What are 6 situations in which the transfusion of red blood cells (RBCs) is highly effective?

1) acute exacerbation of anemia 2) prevention of complications post-op 3) improving infection response 4) acute chest syndrome / multi-organ failure 5) prevention of a stoke / acute neurological defect 6) lowering sickle cell crisis in pregnant women

Describe how anemia impacts the older adult patient (5)

1) decreased mobility / fall risk 2) increased depression 3) delirium 5) HR and CO do not increase as quickly; thus fatigue, dyspnea, & confusion seen earlier

A female pt with diabetes who weighs 130 lbs has an ideal body weight of 116. For weight reduction of 2 lb per week, what should her daily caloric intake be?

1000 cal

Goal for blood glucose levels during pregnancy are _______ or less before meal and ________ or less 2 hours after meals

105 mg/dL or 130 mg/dL

Gestation diabetes occurs in ____% of pregnant women and increases their risk for hypertensive disorders

18%

A woman at average risk for the development of hyperglycemia during pregnancy should be tested at ___________ weeks of gestation

24 to 28

The overall prevalence of anemia increases with age, from ______% in persons aged 65 to 69, to _______% in persons over age 85.

4 - 6% , 13 - 14 %

A healthy person can often tolerate as much as _____% gradual reduction in hemoglobin without pronounced symptoms or significant incapacity.

50%

The nurse expects a pt w type 1 diabetes may receive what % of the usual morning dose of insulin preoperatively?

50-60%

a pt w/ sickle cell disease is brought to the ED by a parent. The pt has a fever of 101.6 F, HR 116, and RR 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this pt is experiencing?

Acute chest syndrome

When the nurse is educating the patient and family about a healthy diet for the treatment or iron deficiency anemia, who and what should be included?

Additional amounts of iron (up to 2 mg daily) must be absorbed by childbearing age women to replace lost in menstruation

________________ is a condition in which the hemoglobin concentration is lower than normal, reflecting the presence of fewer than the normal number of erythrocytes within the circulatory system.

Anemia

glycosuria

Filtered glucose that the kidney cannot absorb spills over into urine

_____________ is a controversial treatment strategy that treats DIC by interrupting the thrombosis process.

Heparin infusion

_________________ , _________________ , and _________________ are the 3 metabolic derangement that occur in diabetic ketoacidosis

Hyperglycemia, ketosis, and metabolic acidosis

The nurse is preparing to admin intermediate acting insulin, what insulin will she administer?

NPH

A pt had a gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The pt takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this pt at risk for?

Pernicious anemia

Chronic use of ________________ to reduce gastric acid production can inhibit B12 absorption, as can the use of ______________ in managing diabetes.

Proton pump inhibitors (PPIs), metformin (Glucocphage)

The nurse is administering an insulin drip to a pt in ketoacidosis. What insulin does the nurse know is the only one that can be used IV?

Regular

The nurse is preparing the pt for a test to determine the cause of vitamin B12 deficiency. The pt will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive dose of B12. What test is the pt being prepared for?

Schilling test

Which triggers may lead to the development of disseminated intravascular coagulation (DIC)?

Sepsis, shock, trauma, cancer, toxins, abruption placentae, and allergic reactions

What diagnostic findings are present in patients who have sickle cell trait vs those present in patients who have sickle cell disease?

Sickle cell Trait: normal hgb, hemat, and blood smear Sickle cell Disease: low hemat, and sickled cells on smear (Dx is confirmed by hgb electrophoresis)

combine iron foods with ____________ to increase iron absorption

Vitamin C (orange juice)

Which pt does the nurse recognize as being most likely to be affected by sickle cell disease a. 14 y/o African American boy b. 26 y/o easter European jewish woman c. 18 y/o Chinese woman d. 28 y/o Israeli man

a. 14 y/o African American boy

The nurse observes a coworker eating ice frequently. What type of anemia is the nurse concerned the coworker may have? a. Iron deficiency anemia b. Megaloblastic anemia c. Sickle cell disease d. Aplastic anemia

a. Iron deficiency anemia

What condition may be the result of sickling in the small blood vessels in the lungs?

acute chest syndrome

When educating a diabetic about increasing fiber intake, what risks should be mentioned?

adjust dosage of insulin

____________ _____________ is a rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, or replacement of the marrow with fat.

aplastic anemia

The nurse is assessing a patient who comes to the clinic reporting feeling constantly tired and very weak. The patient also has a very sore tongue, and upon observing the patient's oral cavity, the nurse notices the tongue is beefy red. What type of anemia does the nurse know these symptoms indicate? a. Iron deficiency anemia b. Megaloblastic anemia c. Sickle cell disease d. Aplastic anemia

b. Megaloblastic anemia

A patient describes numbness in the arms and hands with tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine may contribute to some of these symptoms? a. Thiamine b. Folate c. B12 d. Iron

c. B12

When the patient has anemia, what medical management goal will the nurse assist the patient and health care team in achieving?

correcting or controlling the cause of anemia

A pt w/ end-stage kidney disease has developed anemia. What laboratory finding does the nurse understand to be significant in the stage of anemia? a. Potassium level of 5.2 mEq/L b. Magnesium level of 2.5 mg/dL c. Calcium level of 9.4 mg/dL d. Creatinine level of 6 mg/100 mL

d. Creatinine level of 6 mg/100 mL (normal = 0.6-1.3)

Insulin resistance referes to a _________ tissue sensitivity to insulin.

decreased

The nurse is educating a pt w/ iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?

eating calf's liver with a glass of orange juice

Warning symptoms of hypoglycemia

emotional, slurred speech and double vision, staggering gait, weakness, diaphoresis, and lack of coordination

Orders an insulin drip to be started at 5 units/hr. When hanging the drip, what should the nurse do prior to connecting the drip to the pt?

flush the insulin thought he entire IV insulin set and discard the first 50 ml of fluid.

glycogenolysis

glycogen breaks down in the liver through the action of glucagon

General complications of severe anemia include _____________ , _______________ , and ______________ .

heart failure, paresthesias, delirium

A pt w/ ESRD is taking recombinant erythropoietin for the treatment of anemia. What lab study does the nurse determine will have to be assessed at least monthly related to this medication?

hemoglobin level

A finding of ___________ is the basic criterion for the Dx of diabetes

high blood glucose

Older adult sepsis from UTI started to have an alerted sense of awareness, profound dehydration and hypotension. What condition is the pt experiencing?

hyperglycemic hyperosmolar syndrome

Uncontrolled type 2 diabetes ay lead to an acute problem ___________ .

hyperglycemic hyperosmolar syndrome

When the nurse is caring for a pt w type 1 diabetes, what is the PRIORITY to monitor for?

hypoglycemia

A _____________ assessment should be preformed for patients with known megaloblastic anemia.

neurologic

Gluconeogenesis

new glucose is produced from amino acids

A pt is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The pt has developed lymphopenia with a ;lymphocyte count of < 1500. What should the nurse monitor the client for?

onset of bacterial infection

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluid and electrolytes, which is called _______________.

osmotic diuresis

How is insulin regulation altered in diabetes?

pancreas stops producing insulin or the cells stop responding to insulin

An older adult w diabetes type 2 comes to th ED with second-degree burns to the bottom of both feet and states "It didn't feel too hot". What does the nurse expect is the reason for decrease in temp sensation?

peripheral neuropathy

Pt is given 1 mg of glucagon in the ED. What latent symptoms should the nurse monitor for related to the action of glucagon?

rebound hypoglycemia

________________ is a severe hemolytic anemia that results from inheritance of the sickle hemoglobin gene, which causes the hemoglobin molecule to be defective.

sickle cell disease

Assessment of patients who have or are at risk for megaloblastic anemia includes inspection of the ______________ , ______________ , and ________________ .

skin, mucous membranes, tongue

nephropathy

small vessel disease affects the kidneys

How do sulfonylureas act for pt with type 2 diabetes?

stimulating the beta cells of the pancreas to secrete insulin (can NOT be used in type 1)

Pernicious anemia is a decrease in RBCs when the body can't absorb enough _________________ due to the lack of intrinsic factor (IF) in the gastric mucosa.

vitamin B-12

A pt w/ sickle cell disease comes to the ED reporting severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide?

Start an IV with dextrose 5% in 0.24 normal saline

Diabetic ketoacidosis pt is frequently non adherent w her dietary and medication regimen. She is drowsy yet responsive. What lab results should the nurse expect?

hyperkalemia

Diabetic ketoacidosis pt is frequently non adherent w her dietary and medication regimen. She is drowsy yet responsive. What rehydrating IV solution does the nurse expect to infuse?

0.9 % sodium chloride

Type 2 diabetes is the _____________ leading cause of death and affects approximately _____% of older adults

7th , 20

The nurse is caring for a pt with an abnormally low blood glucose concentration. What level will the nurse observe will assessing lab results?

< 50 to 60

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? a. Iron deficiency anemia b. Megaloblastic anemia c. Sickle cell disease d. Aplastic anemia

b. Megaloblastic anemia

A pt with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potion complication should the nurse monitor for?

hypokalemia

As blood glucose levels approach normal in diabetic ketoacidosis pt, what electrolyte imbalance should the nurse assess for?

hypokalemia

Clinical manifestations of hyperglycemia hyperosomolar syndrome

hypotension, profound dehydration, tachycardia, neurological signs

Bc insulin normally inhibits ___________ and __________ the processes occur in an unrestrained fashion in people w/ insulin deficiency and contribute further to hyperglycemia.

insulin inhibits glycogenolysis and gluconogensesis

What are two main problems w insulin in type 2 diabetes?

insulin resistance and impaired insulin secretion

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusion administered. Why would the nurse need to include a nutritional assessment for this patient?

it may indicate deficiencies in essential nutrients