Practice Questions

•The nurse is caring for an immunocompromised patient. Which of the following statements about infection in this patient is TRUE (choose all that apply)? a. Classic symptoms of infection are often absent. b. Fever may be the only symptom of infection. c. Infections with opportunistic pathogens must be assessed. d. The condition is always permanent.

A, B, C

•A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat: •A. within 10 to 15 minutes after the injection •B. 1 hour after the injection •C. at any time because timing of meals with lispro injections is unnecessary •D. 2 hours before the injection

A.

•Following a transphenoidal hypophysectomy the nurse should assess the client for: •A. Cerebrospinal fluid (CSF) fluid •B. Fluctuating blood glucose levels •C. Cushing's Syndrome •D. Cardiac Arrythmias

A.

•The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following? •A. tachycardia •B. bradycardia •C. decreased Paco2 •D. narrowed pulse pressure

A.

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify: A. Dysrhythmias resulting from hypokalemia. B. Fluid overload resulting from aggressive fluid replacement. C. The presence of hypovolemic shock related to osmotic diuresis. D. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.

A. Rationale: Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias such as premature ventricular complexes and bradycardia.

•To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to (select all that apply): a)Increase Ca intake to 1500mg/day b)Perform glucose monitoring for hypoglycemia c)Obtain immunizations due to high risk for infections d)Avoid abrupt position changes b/c of orthostatic hypotension

A. & C.

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

B.

•A client who had received 25 ml of packed red cells has low back pain and pruritis. After stopping the infusion, the nurse should take what action next?: •A. administer prescribed antihistamine and aspirin •B. collect blood and urine samples and send to the lab •C. administer prescribed diuretics •D. administer prescribed vasopressors

B.

•The client with Cushing's needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?: •A. Increase calories •B. Restrict sodium •C. Restrict potassium •D. Reduce fat to 10%

B.

A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to: A. Hold the regular dose of insulin. B. Check the blood glucose level every 2 to 4 hours. C. Drink cool fluids with high glucose content. D. Use a less strenuous form of exercise than usual until the illness resolves.

B. Rationale: If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2-to-4-hour intervals to determine the effects of this stressor on the blood glucose level.

•Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply): a)Restricting protein intake b)Monitoring blood glucose levels c)Observing for signs of hypotension d)Administering medication in equal doses e)Protecting patient from exposure to infection

B. & E.

The patient is admitted with an elevated temperature and general malaise. The nurse suspects that the patient may have an infection. Which laboratory value would be evaluated first? a. Eosinophils b. Erythrocytes c. Leukocytes d. Platelets

C.

•A patient with thrombocytopenia (platelet level of 20,000/mL) is to get multiple transfusions of platelets. The nurse notifies the physician that the patient has a history of febrile reactions whenever she receives blood transfusion. The nurse expects that the physician will most likely: a. cancel the transfusion. b. order a D-Dimer for further evaluation of the patient. c. order diphenhydramine (Benadryl) given before the transfusion. d. proceed with the transfusion as ordered and monitor every 30 minutes.

C.

•An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to: A. Monitor blood glucose levels B. Restrict fluid and sodium intake C. Administer potassium-sparing diuretics D. Advise the patient to make postural changes slowly

C.

•The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is: a)Once a day at bedtime b)Every other day on awakening c)On arising and in the late afternoon d)At constant intervals every 6 to 8 hours

C.

A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmol/L). The nurse explains to the patient that this value: A. Is diagnostic for diabetes. B. Is normal, and diabetes is not a problem. C. Reflects impaired glucose tolerance, which is an early stage of diabetes. D. Indicates an intermediate stage between normal glucose use and diabetes.

C. Rationale: Impaired fasting glucose (fasting blood glucose level between 100 and 126 mg/dL) and impaired glucose tolerance (2-hour plasma glucose level between 140 and 199 mg/dL) represent an intermediate stage between normal glucose homeostasis and diabetes. This stage is called prediabetes.

Ideally, the goal of patient diabetes education is to: A. Make all patients responsible for the management of their disease. B. Involve the patient's family and significant others in the care of the patient. C. Enable the patient to become the most active participant in the management of the diabetes. D. Provide the patient with as much information as soon as possible to prevent complications of diabetes.

C. Rationale: The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.

•After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when a patient develops: a)Muscle weakness and weight loss b)Hyperthermia and severe tachycardia c)Hypertension and difficulty swelling d)Laryngospasms and tingling in the hands and feet

D.

•The client with type 1 diabetes mellitus is taught to take NPH (Humulin N) at 5 pm each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time? •A. 11 am shortly before lunch •B. 1pm shortly after lunch •C. 6 pm shortly after dinner •D. 1 am while sleeping

D.

•The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy: •A. Acromegaly •B. Cushing's disease •C. Diabetes mellitus •D. Hypopituitarism

D.