Final Exam NUR 305 ~ Burcham Fall 2022

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of: a. Antibiotics. b. NPO status. c. Antispasmodics. d. Proton pump inhibitors.

b. NPO status.

•To determine the presence of respiratory alkalosis in the laboring client, what should the nurse evaluate her for? a.A change in the respiratory rate b.A tingling sensation in the hands c.Periodic changes in the fetal heart rate d.A pulse oximetry reading of less than 98%

b.A tingling sensation in the hands

•A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure? a.Remain in the house. b.Avoid holding an infant. c.Save urine in a lead-lined container. Refrain from using a bathroom used by others.

b.Avoid holding an infant.

•An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen? a.Determine what the adolescent has been taught about diabetes. b.Encourage the adolescent to express feelings about having diabetes. c.Explain to the parents that it is their responsibility to demonstrate their acceptance. d.Provide the family with printed materials about the consequences of ineffectively controlled diabetes.

b.Encourage the adolescent to express feelings about having diabetes.

•The nurse will instruct the patient to treat hypoglycemia with which drug? a.Bumetanide b.Glucagon c.Acarbose d.Propranolo

b.Glucagon

•An adolescent with type 1 diabetes is brought to the emergency department unconscious. The blood glucose level is found to be 742 mg/dL. What clinical manifestation does the nurse expect the adolescent to exhibit during the initial assessment? a.Pyrexia b.Hyperpnea c.Bradycardia d.Hypertension

b.Hyperpnea

•A woman who has gestational diabetes gives birth at term to a large-for-gestational age (LGA) infant weighing 9 lb 6 oz (4250 g). For what complication should the newborn be monitored? a.Anemia b.Hypoglycemia c.Increased calcium d.Meconium aspiration

b.Hypoglycemia

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? a.No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus b.Immediate treatment is required because DKA is a life-threatening situation c.DKA is best treated at home d.DKA is best treated at a practitioner's office or clinic

b.Immediate treatment is required because DKA is a life-threatening situation

•A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? a.Arterial blood pH b.Intake and output c.Fasting serum glucose Pulse and respiratory rates

b.Intake and output

•A client's parathyroid glands are removed with total thyroidectomy surgery. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery? a.Constipation b.Muscle spasms c.Hypoactive reflexes d.Increased specific gravity

b.Muscle spasms

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? a.Pioglitazone b.Repaglinide c.Acarbose d.Metformin

b.Repaglinide

What long-term complications can occur with diabetes? Select all that apply. a.Diabetic Ketoacidosis b.Retinopathy c.Neuropathy d.Nephropathy e.Stroke

b.Retinopathy c.Neuropathy d.Nephropathy e.Stroke

•Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) a.Increase hepatic glucose production b.Stimulate insulin secretion from beta cells c.Enhance action of insulin in various tissues d.Inhibit breakdown of insulin by liver

b.Stimulate insulin secretion from beta cells c.Enhance action of insulin in various tissues

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. Withhold the regular dose of insulin. b. Drink cool fluids with high glucose content. c. Check the blood glucose level every 2 to 4 hours. d. Use a less strenuous form of exercise than usual until the illness resolves.

c. Check the blood glucose level every 2 to 4 hours.

The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goals is most appropriate? a. Make all patients responsible for the management of their disease. b. Involve the family and significant others in the care of these patients. c. Enable the patients to become active participants in the management of their disease. d. Provide the patients with as much information as soon as possible to prevent complications.

c. Enable the patients to become active participants in the management of their disease.

•When teaching a patient about insulin glargine, which statement by the nurse about this drug is correct? a."It is often combined with regular insulin to decrease the number of insulin injections per day." b."You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." c."You cannot mix this insulin with regular insulin and thus will have to take two injections." d."The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."

c."You cannot mix this insulin with regular insulin and thus will have to take two injections."

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. What is the most appropriate response by the nurse? a."The pills work with an adult pancreas only." b."The drugs affect fat and protein metabolism, not sugar." c."Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." d."Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

c."Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin."

•The nurse is providing education to a patient for the prescription glipizide. The nurse explains this medication is more effective when administered at which time? a.15 minutes postprandial b.At bedtime c.30 minutes before a meal d.In the morning

c.30 minutes before a meal

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a.Potassium is returned to extracellular fluid when metabolic acidosis is corrected. b.Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells. c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells. d.In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.

c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells.

•Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? a.Providing oxygen b.Encouraging carbohydrates c.Administering fluid replacement d.Teaching facts about dietary principles

c.Administering fluid replacement

•A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis? a.An elevated pH, elevated PCO2 b.A decreased pH, elevated PCO2 c.An elevated pH, decreased PCO2 d.A decreased pH, decreased PCO2

c.An elevated pH, decreased PCO2

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that: a.Exercise is contraindicated in the type 1 diabetic child b.Soccer and baseball are too strenuous, but swimming is acceptable c.Exercise is not restricted unless indicated by other health conditions d.The level of activity depends on the type of insulin required

c.Exercise is not restricted unless indicated by other health conditions

When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug? a.Insulin glargine b.Insulin glulisine c.Glipizide d.NPH insulin

c.Glipizide

•A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis

c.Metabolic acidosis

•What is a nursing priority to prevent complications in clients with respiratory acidosis? a.Assessing the nail beds b.Listening to breath sounds c.Monitoring breathing status d.Checking muscle contractions

c.Monitoring breathing status

•A nurse is caring for an 11-year-old child with type 1 diabetes. Two hours after breakfast the child becomes pale, diaphoretic, and shaky. What action should the nurse take? a.Notifying the practitioner b.Administering supplemental insulin c.Obtaining a current blood glucose level d.Giving orange juice with a slice of bread

c.Obtaining a current blood glucose level

•Pramlintide is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication? a.Pramlintide stimulates glucose production. b.Pramlintide increases glucagon excretion. c.Pramlintide slows gastric emptying. d.Pramlintide corrects insulin receptor sensitivity.

c.Pramlintide slows gastric emptying.

Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) a.Explain dietary changes are not necessary. b.Instruct that it is okay to skip breakfast 1 to 2 times per week. c.Report symptoms of anorexia and fatigue. d.Advise to avoid smoking and alcohol consumption. e.Take your medication only as needed.

c.Report symptoms of anorexia and fatigue. d.Advise to avoid smoking and alcohol consumption.

•A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? a.Skeletal and nervous b.Circulatory and urinary c.Respiratory and urinary d.Muscular and endocrine

c.Respiratory and urinary

•A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? a.pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg b.pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg d.pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg

c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg

A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. What is the most appropriate intervention by the nurse? a.tell the adolescent not to drink alcohol. b.ask the adolescent about the reasons for drinking alcohol. c.teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. d.recommend counseling so that the adolescent understands the serious consequences of alcohol consumption.

c.teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "The laboratory test result is positive for type 2 diabetes." b. "You will develop type 2 diabetes within 5 years." c. "The test reis normal, and diabetes is not a problem." d. "You are at increased risk for developing diabetes."

d. "You are at increased risk for developing diabetes."

•Which insulin can be administered by continuous intravenous (IV) infusion? a.. Insulin aspart b. Insulin detemir c. Insulin glargine d. Regular insulin

d. Regular insulin

The nurse is caring for a female patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. d. The patient makes harsh, vibratory sounds when breathing.

d. The patient makes harsh, vibratory sounds when breathing.

•A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? a.7.20 and 60 mg/dL b.7.50 and 60 mg/dL c.7.50 and 460 mg/dL d.7.20 and 460 mg/dL

d.7.20 and 460 mg/dL

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? a.A patient with a traumatic brain injury b.A patient with type 1 diabetes mellitus c.A patient with acute respiratory failure d.A patient with nasogastric tube suction

d.A patient with nasogastric tube suction

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? a.Regular insulin b.Insulin glargine c.Insulin detemir d.Insulin aspart

d.Insulin aspart

•A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? a.Fluid loss b.Glycosuria c.Increased blood glucose level d.Kussmaul respirations

d.Kussmaul respirations

The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure? a.Pioglitazone b.Acarbose c.Repaglinid d.Metformin

d.Metformin

What is the peak of Insulin glargine? a.1 hour after administration b.3 hours after administration c.6 hours after administration d.No peak for this medication

d.No peak for this medication

•One week after beginning anti-thyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis (thyroid storm). The nurse determines that the most important intervention for this client is: a.Limiting fluid intake b.Observing for an exaggerated response to sedatives c.Treating the associated hyperglycemia and ketoacidosis d.Reducing body temperature and heart rate

d.Reducing body temperature and heart rate

During an acute exacerbations of SLE, the patient has a nursing diagnosis of impaired skin integrity. What intervention would be appropriate? 1. Clean skin with mild soap and water and keep it dry 2. Apply moisturizing lotion to the skin several times a day 3. Use a mild astringent on the face to stimulate circulation. 4. Teach the patient to use cosmetics to minimize the skin changes.

1. Clean skin with mild soap and water and keep it dry

What would the nurse include in the teaching plan for a patient with SLE? 1. Ways to avoid exposure to sunlight 2. Increasing dietary protein and carbohydrate intake. 3. The necessary of genetic counseling before planning a family 4. The use of nonpharmacologic pain interventions

1. Ways to avoid exposure to sunlight

The nurse is caring for a patient who is receiving antiretroviral therapy (ART) for treatment of AIDS. Which assessment best indicates that the patient's condition is improving? • 1.Decreased viral load 2.Increased drug resistance 3.Decreased CD4+ T-cell count 4.Increased aminotransferase levels

1.Decreased viral load

The nurse working in an HIV testing and treatment clinic plans teaching about antiretroviral therapy for a 1.patient who tested positive for HIV 3 years ago and has developed tuberculosis. 2.male health care worker who is HIV negative but has unprotected sex with men. 3.patient who was infected with HIV 10 years ago and has a CD4+ T-cell count of 650/μL. 4.patient with persistent generalized lymphadenopathy who was exposed to HIV 2 years previously.

1.patient who tested positive for HIV 3 years ago and has developed tuberculosis.

A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. What is the best response by the nurse? 1. "You can plan to have a near normal life as SLE rarely causing death." 2. " It is difficult to tell because the disease is so variable in its severity and progression." 3. "Life span is shortened somewhat in people with SLE, but the disease can be controlled with long term use of corticosteroids." 4. "Most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage"

2. " It is difficult to tell because the disease is so variable in its severity and progression."

The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is 1. antibiotics should have been used to prevent pneumonia. 2.all of the supplied antibiotics should be taken even when symptoms have resolved. 3.enough antibiotics for 2 days' treatment should be reserved in case symptoms recur. 4.patients should request antibiotics for upper respiratory infections to prevent development of streptococcal-related diseases.

2.all of the supplied antibiotics should be taken even when symptoms have resolved.

During an acute exacerbation, a patient with SLE is treated with corticosteroids. What would the nurse expect the steroids to begin to be tapered when the serum laboratory results to indicate? 1. Increased RBC 2. Decreased ESR 3. Decreased anti-DNA 4. Increased complement

3. Decreased anti-DNA

What is the best statement to describe a nurse who develops a contact dermatitis from wearing latex gloves? 1.Is demonstrating an allergy to natural latex proteins 2.Can use powder-free latex gloves to prevent the development of symptoms 3.Should use an oil-based hand cream when wearing gloves to prevent latex allergy. 4.Has a type IV allergic reaction to chemicals used in the manufacturing of latex gloves

4.Has a type IV allergic reaction to chemicals used in the manufacturing of latex gloves

A patient is undergoing diagnostic testing for symptoms of polyarthralgia, fatigue, and hair loss. Laboratory results include the presence of anti-DNA, antinuclear antibodies, and anti-Smith in the blood. The nurse recognizes that these findings are most likely to be related to which diagnosis? • 1.Systemic sclerosis 2.Rheumatoid arthritis 3.Chronic fatigue syndrome 4.Systemic lupus erythematosus

4.Systemic lupus erythematosus

A diagnosis of AIDS can be made for a patient with HIV with 1.a CD4+ T-cell count <500/µL. 2.a WBC count <3000/µL (3 × 109/L). 3.development of oral candidiasis (thrush). 4.onset of Pneumocystis jiroveci pneumonia.

4.onset of Pneumocystis jiroveci pneumonia.

•What food allergy may a client with a latex allergy also have? Select all the apply. A. Avocado B. Banana C. Chestnut D. Kiwi E. Passion fruit

A. Avocado B. Banana C. Chestnut D. Kiwi E. Passion fruit ALL OF THEM ARE CORRECT

During a health history assessment, a patient with rheumatoid arthritis, chronic hypertension, and diagnosis of a recent cerebrovascular accident states that she takes 2 fish oil capsules (5 g) daily as a supplement for her RA. What additional question(s) should the nurse ask? (Select all that apply.) A."Are you taking anticoagulant medications?" B."Have you found the fish oil to help your RA?" C."What other supplements do you currently take?" D."How long have you been taking fish oil capsules?" E."Have you notified your physician about taking fish oil capsules?"

A."Are you taking anticoagulant medications?" B."Have you found the fish oil to help your RA?" C."What other supplements do you currently take?" D."How long have you been taking fish oil capsules?" E."Have you notified your physician about taking fish oil capsules?"

The nurse has educated the patient with a shellfish allergy about signs and symptoms of angioedema. Which patient statement requires further nursing education? A."I can eat shrimp because it is not a shellfish." B."There is an epinephrine injector in my purse at all times." C."Symptoms of angioedema include swelling of eyes, lips, and tongue." D."When I see a new physician, I will report that I have a shellfish allergy."

A."I can eat shrimp because it is not a shellfish."

Which patient with Cushing's disease is at greatest risk for developing heart failure? A.42-year-old with a serum creatinine level of 3.7 mg/dL B.59-year-old with a history of hypertension C.32-year-old with a history of hepatitis B infection D.60-year-old with pneumonia

A.42-year-old with a serum creatinine level of 3.7 mg/dL

•The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. A.Administer antacids as prescribed. B.Encourage coughing and deep breathing. C.Administer anticholinergics as prescribed. D.Give small, frequent high-calorie feedings. E.Maintain the client in a supine and flat position. F.Give morphine sulfate as prescribed for pain.

A.Administer antacids as prescribed. B.Encourage coughing and deep breathing. C.Administer anticholinergics as prescribed. F.Give morphine sulfate as prescribed for pain.

A patient has been admitted to the ED with bilateral eyelid swelling and subsequent difficulty seeing. What is the priority nursing assessment? A.Airway B.Nasal cavity C.Home medications D.History of visual disturbances

A.Airway

A postoperative plan of care for a patient after a total thyroidectomy should include which intervention? A.Avoiding extending the patient's neck B.Administering oxygen via nasal cannula as needed C.Assessing the patient's voice once per shift D.Encouraging the patient to be out of bed in a chair

A.Avoiding extending the patient's neck

A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis? A.Burning and aching, located in the left lower quadrant and radiating to the hip B.Severe and unrelenting, located in the epigastric area and radiating to the back C.Burning and aching, located in the epigastric area and radiating to the umbilicus D.Severe and unrelenting, located in the left lower quadrant and radiating to the groin

A.Burning and aching, located in the left lower quadrant and radiating to the hip

Which symptom requires immediate intervention during a hypoglycemic episode? A.Confusion B.Hunger C.Headache D.Tachycardia

A.Confusion

When providing teaching for the patient being discharged home on antiretroviral therapy for HIV, which statement will the nurse include? A.Do not eat raw fish. B.Limit food intake to proteins only. C.Avoid ingesting bananas. D.Applesauce may cause you to experience side effects of the medication.

A.Do not eat raw fish.

•The health care provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A.Hepatitis A B.Hepatitis B C.Hepatitis C D.Hepatitis D

A.Hepatitis A

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? A.Malaise B.Dark stools C.Weight gain D.Left upper quadrant discomfort

A.Malaise

Which of the following is a priority nursing intervention for a patient with primary adrenal cortex dysfunction? A.Monitor vital signs and the patient's physiologic response to stress. B.Closely measure fluid intake and output. C.Provide emotional support during stressful situations. D.Weigh the patient daily.

A.Monitor vital signs and the patient's physiologic response to stress.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? A.Notify the health care provider (HCP). B.Administer the prescribed pain medication. C.Call and ask the operating room team to perform the surgery as soon as possible. D.Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A.Notify the health care provider (HCP).

Which interventions should the nurse include when preparing a care plan for a child with hepatitis? Select all that apply. A.Providing a low-fat, well-balanced diet. B.Teaching the child effective hand-washing techniques. C.Scheduling playtime in the playroom with other children. D.Notifying the health care provider (HCP) if jaundice is present. E.Instructing the parents to avoid administering medications unless prescribed. F.Arranging for indefinite home schooling because the child will not be able to return to school

A.Providing a low-fat, well-balanced diet. B.Teaching the child effective hand-washing techniques. E.Instructing the parents to avoid administering medications unless prescribed.

A patient is diagnosed with small cell lung cancer. Which endocrine condition is consistent with this diagnosis? A.Syndrome of inappropriate antidiuretic hormone (SIADH) B.Diabetes insipidus (DI) C.Cushing's syndrome D.Adrenal crisis

A.Syndrome of inappropriate antidiuretic hormone (SIADH)

A client with severe Crohn's disease develops a small bowel obstruction. Which clinical finding should the nurse expect the client to report? A)Bloody vomitus B)Projectile vomiting C)Bleeding with defecation D)Pain in the left lower quadrant

B)Projectile vomiting

Which assessment finding should trigger a more detailed assessment of the patient's endocrine system? A.Weight gain B.Changes in hair texture and distribution C.Fatigue D.Poor peripheral pulses

B.Changes in hair texture and distribution

A patient asks the nurse what part of the body is most affected by the HIV virus. The nurse informs the patient that HIV primarily affects which system? A.Cardiovascular B.Immune C.Renal D.Hepatic

B.Immune

A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? A.Select foods high in fat. B.Increase intake of fluids, including juices. C.Eat a good supper when anorexia is not as severe. D.Eat less often, preferably only three large meals daily.

B.Increase intake of fluids, including juices.

•Which common initial clinical effects should the nurse expect a client with multiple sclerosis to exhibit? Select all that apply. A.Headaches B.Nystagmus C.Skin infections D.Scanning speech E.Intention tremors

B.Nystagmus D.Scanning speech E.Intention tremors

A nurse is administering a new medication intravenously to a patient. The patient becomes short of breath and begins to experience itching and hives. What is the priority nursing response? A.Assess blood pressure B.Stop the intravenous infusion C.Discuss anxiety with the patient D.Review the patient's allergies

B.Stop the intravenous infusion

A client with the diagnosis of ulcerative colitis has surgery for the creation of an ileostomy. Postoperatively, for which potential life-threatening complication should the nurse assess the client? A) Wound infection B) Ischemia of the stoma C) Electrolyte imbalances D) Excoriation of skin around the stoma

C) Electrolyte imbalances

A client develops acute appendicitis. Prior to arrival to the hospital, the client attempted self-care at home. Which self-care measures could potentially lead to rupture of the appendix? A)Refusing food and liquids B)Applying an ice pack to the abdomen C)Taking a small volume enema D)Taking acetaminophen for pain

C)Taking a small volume enema

•A 13-year-old has just been diagnosed with type 1 diabetes mellitus and is interested in "getting on with my life." He asks how he will know that he is doing a good job if he is "going to be in charge of this thing." What response by the nurse would be most accurate? A. "Maintain your glucose levels below 154 mg/dL and your hemoglobin A1c at 8% or less." B. "You're fine as long as you are feeling well and maintaining your everyday schedule as before." C. "Maintain your glucose levels below 126 mg/dL and your hemoglobin A1c at 7% or less." D. "Your diabetes is in control once you stop losing the weight and stop getting up at night to urinate."

C. "Maintain your glucose levels below 126 mg/dL and your hemoglobin A1c at 7% or less."

The client newly diagnosed with diabetes asks why he is always so thirsty. What is the nurse's best response? A. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." B. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." D. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys,

C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography procedure. The nurse determines that the client needs further information if the client makes which statement? A."I know I must sign the consent form." B."I hope the throat spray keeps me from gagging." C."I'm glad I don't have to lie still for this procedure." D."I'm glad some IV medication will be given to relax me."

C."I'm glad I don't have to lie still for this procedure."

After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record has not been signed by the nurse. The patient is confused and says she "thinks" the night nurse gave her the insulin. The patient's blood glucose level is 142 mg/dL. What will the day shift nurse do? A.Give the insulin because it was not signed off. B.Hold the insulin because the patient thinks she received it, and it is recorded in the machine. C.Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given. D.Report this to the nursing supervisor.

C.Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given.

Which is a possible outcome for the patient experiencing an age-related decrease in antidiuretic hormone? A.Constipation, lethargy, and dry skin B.Greater-than-ideal body weight C.Diluted urine and dehydration D.Yeast infection and polydipsia

C.Diluted urine and dehydration

What parameter should be critically evaluated when providing care to a patient with Graves' disease? A.Irregular heart rate and rhythm B.Elevated blood pressure C.Elevated temperature D.Change in respiratory rate

C.Elevated temperature

The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin? A.Insulin glulisine (Apidra) B.Insulin isophane suspension (NPH) C.Insulin detemir (Levemir) D.Regular insulin (Humulin R)

C.Insulin detemir (Levemir)

The nurse enters the patient's room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. What is the most appropriate response by the nurse? A.Place a packet of table sugar in the patient's mouth. B.Start cardiopulmonary resuscitation (CPR). C.Roll the patient to the side and administer the ordered glucagon. D.Have the patient drink orange juice.

C.Roll the patient to the side and administer the ordered glucagon.

A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? A.She should continue the antidiabetic medication at the same dosage. B.The antidiabetic medication dosage will be increased gradually throughout her pregnancy. C.She will be switched to insulin therapy while she is pregnant. D.She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.

C.She will be switched to insulin therapy while she is pregnant.

When should a patient with type 1 diabetes avoid exercise? A.When serum glucose is less than 150 B.During colder months C.When ketones are present in the urine D.When emotional stressors are high for the patient

C.When ketones are present in the urine

A male patient who has a history of type 2 DM is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about HbA1C. The nurse will inform the patient that HbA1C provides information regarding A.which type of DM the patient has. B.if he has an infection. C.patient compliance with treatment regimen for several months previously. D.current fasting blood glucose level.

C.patient compliance with treatment regimen for several months previously.

A health care provider has been exposed to HIV while caring for a patient. Following the postexposure prophylaxis regimen (PEP), the health care provider will most likely receive treatment for how long? A.1 week B.2 weeks C.3 weeks D.4 weeks

D. 4 weeks

The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient? A.Store the insulins in the refrigerator. B.Shake the insulins for 1 full minute before use. C.Administer the injection at a 30-degree angle to your skin. D.Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe.

D.Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe.

The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? A.Inform the patient of the delay. B.Check the patient's blood glucose levels. C.Call the dietary department to send a tray immediately. D.Give the patient food, such as cereal and skim milk, and juice.

D.Give the patient food, such as cereal and skim milk, and juice.

A patient with RA states, "I can't do as much as I used too because my joints hurt so much." What should the nurse teach to promote mobility? A.Avoid use of the painful joints B.Avoid the use of canes because they can increase range of motion C.Decrease range of motion exercises and any aerobic exercise D.Take medication as prescribed so that activities can be continued

D.Take medication as prescribed so that activities can be continued

A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? A.The albuterol B.The antibiotics C.The proton pump inhibitor D.The corticosteroid

D.The corticosteroid

The nurse identifies which condition as a common bacterial opportunistic infection seen in patients with HIV? A.Cytomegalovirus B.Candidiasis C.Toxoplasmosis D.Tuberculosis

D.Tuberculosis

What does clinical findings does the nurse expect with metabolic syndrome? Select all that apply. a. Abdominal Obesity b. Hyperlipidemia c. Hypotension d. Hyperglycemia e. Truncal Obesity

a. Abdominal Obesity b. Hyperlipidemia d. Hyperglycemia

The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? a. Hypokalemia b. Fluid overload c. Hypoglycemia d. Hyperphosphatemia

a. Hypokalemia

•Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 AM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time? a.5:00 PM b.2:00 PM c.10:00 AM d.8:00 PM

a.5:00 PM

•A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? a.7.20 b.7.35 c.7.45 7.48

a.7.20

•The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a.Acid-base balance b.Fluid balance c.Oxygen depletion d.Metabolic acidosis

a.Acid-base balance

•A nurse is caring for a client with Addison disease. What should the nurse teach the client to do regarding an appropriate diet? a.Add extra salt to food b.Limit intake to 1200 calories c.Omit protein foods at each meal d.Restrict the daily intake of fluids to 1 L

a.Add extra salt to food

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? Select all that apply. a.Do not reuse needles b.Inject insulin when it is cold c.Flex or tense the muscle during injection d.Remove all bubbles from the syringe prior to injection e.Do not move the direction of the needle-syringe during insertion or withdrawal

a.Do not reuse needles d.Remove all bubbles from the syringe prior to injection e.Do not move the direction of the needle-syringe during insertion or withdrawal

•The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? a.Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." b."Inject the needle at a 30-degree angle." c."Rotate sites at least once or twice a week." d."Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption."

a.Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? a.Increased food intake b.Decreased food intake c.Increased risk of hyperglycemia d.Decreased risk of insulin shock

a.Increased food intake

•The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? a.Insulin needs will increase during the second trimester. b.Insulin needs will decrease during the second trimester. c.Insulin needs will not change during the second trimester. d.Insulin will be switched to an oral antidiabetic medication during the second trimester.

a.Insulin needs will increase during the second trimester.

What signs and symptoms would alert the nurse for the possible complication of diabetic ketoacidosis? Select all that apply. a.Kussmaul respirations b.Large amount of urine output c.Extreme thirst d.Fruity breath e.Confusion f.Nausea

a.Kussmaul respirations b.Large amount of urine output c.Extreme thirst d.Fruity breath e.Confusion f.Nausea ALL ARE CORRECT

•A nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply. a.Leg ulcers b.Loss of visual acuity c.Increased creatinine clearance d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

a.Leg ulcers b.Loss of visual acuity d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis

a.Metabolic acidosis

•After receiving levothyroxine for 3 months for congenital hypothyroidism an infant is brought to the pediatric clinic for a checkup. What does the mother tell the nurse about her baby that indicates that the drug is effective? a.The infant's stools are soft. b.The skin is cool to the touch. c.The baby's fine tremor has ceased. d.The baby's activity level has decreased.

a.The infant's stools are soft.

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? a.Type 1 diabetes b.Type 2 diabetes c.Impaired glucose tolerance d.Gestational diabetes

a.Type 1 diabetes

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have • a.Muscle cramping b.Warm, flushed skin c.Respiratory rate of 36 d.Blood pressure of 94/52

• a.Muscle cramping

•Which precaution is most important for the nurse to teach a client who is prescribed oral corticosteroids for hormone replacement therapy after a unilateral adrenalectomy? •A. "Do not stop taking this drug without consulting your prescriber." •B. "Avoid crowds and people who are ill." •C. "Be sure to take this drug with food." •D. "Reduce your salt intake."

•A. "Do not stop taking this drug without consulting your prescriber."

Why is controlling blood glucose levels important? •A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure. •B. High blood glucose levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures. •C. Low blood glucose levels increase the risk for peripheral neuropathy, Alzheimer's disease, and premature aging. •D. Low blood glucose levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.

•A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure.

•At the patient's next visit, his A1C level is 6%. How will the nurse interpret this finding?

•An A1C level of 6% is a normal result. This indicates that the patient has had good glycemic control over the past several months.

•Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? •A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." •B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." •C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." •D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

•B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level."

•Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? •A. A history of taking oral contraceptives for more than 2 years •B. A weight loss of 15 lbs in the past 6 weeks without dieting •C. The client's father's diagnosis of prostate cancer •D. A recent need for corrective lenses

•B. A weight loss of 15 lbs in the past 6 weeks without dieting

•The serum electrolyte values for a client with syndrome of inappropriate antidiuretic hormone being treated with tolvaptan indicate the following changes within the past 12 hours. Which change does the nurse report immediately to the health care provider? •A. Serum potassium decrease from 4.2 mEq/L to 3.8 mEq/L •B. Serum sodium increase from 122 mEq/L to 140 mEq/L •C. Serum calcium increase from 9.5 mg/dL to 10.2 mg/dL •D. Serum chloride decrease from 109 mEq/L to 99 mEq/L

•B. Serum sodium increase from 122 mEq/L to 140 mEq/L

•Which response in a client with diabetes insipidus indicates to the nurse that another dose of desmopressin acetate (DDAVP) is needed? •A. Urine output and specific gravity are increased. •B. Urine output is increased and urine specific gravity is decreased. •C. Urine output and specific gravity are decreased. •D. Urine output is decreased and urine specific gravity is increased.

•B. Urine output is increased and urine specific gravity is decreased.

•The client newly diagnosed with type 1 diabetes asks why insulin is given only by injection and not as an oral drug. What is the nurse's best response? •A. "Injected insulin works faster than oral drugs to lower blood glucose levels." •B. "Oral insulin is so weak that it would require very high dosages to be effective." •C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes." •D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

•C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes."

•A client with type 2 diabetes who also has heart failure is prescribed metformin extended-release (Glucophage XR) once daily. On assessment, the nurse finds that the client now has muscle aches, drowsiness, low blood pressure, and a slow, irregular heartbeat. What is the nurse's best action? •A. Assess the client's blood glucose level and prepare to administer IV glucose. •B. Reassure the client that these symptoms are normal effects of this drug. •C. Hold the dose and notify the prescriber immediately. •D. Administer the drug at bedtime to prevent falls.

•C. Hold the dose and notify the prescriber immediately.

The client newly diagnosed with type 2 diabetes asks how diabetes type 1 and diabetes type 2 are different. What is the nurse's best response? •A. "Diabetes type 1 develops in people younger than 40 years and diabetes type 2 develops only in older people." •B. "Diabetes type 2 develops in people younger than 40 years and diabetes type 1 develops only in older people." •C. "Patients with type 1 diabetes are at higher risk for obesity and heart disease, whereas patients with type 2 diabetes are at higher risk for strokes." •D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

•D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. •Increased pH •Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions

•Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions •Increased pH

•N.B. asks why her insulin dose continues to increase after 20 weeks of gestation and is worried something is What information should be provided to N.B.?

•It is expected that as pregnancy progresses (in the second and third trimesters) that insulin needs will go up. This is normal. The nurse will tell N.B., "We would be worried if your insulin needs did not increase."

•N.B., who has type 2 diabetes, is 26 weeks pregnant and placed on insulin therapy during pregnancy. She asks about why she is unable to take her oral medication as usual. •Question 1 •What is the nurse's best response?

•Oral medications are not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes.

•N.B. is concerned about how her diabetes can affect her baby. What teaching points would the nurse provide?

•Pregnant women who have diabetes require special care with regard to diabetes management and have increased risks for a number of things, including having babies with large birth weight, a higher risk of having low blood sugar after birth, birth defects, or being stillborn. However, the nurse will tell her, "We will do everything possible to help you have a healthy baby."

•The patient asks how a pill will lower his blood sugar. How will the nurse respond?

•The nurse will tell the patient that glimepiride will stimulate cells in the pancreas to secrete more insulin, which will help lower the patient's blood sugar.