Med/Surg. 3 Exam 2
A patient with HHS is experiencing signs of dehydration. What IV solution does the nurse anticipate to be ordered?
0.9% Na
0.9% sodium chloride IV bolus
A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?
Left lower abdomen
A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point.
weak, irregular pulse
A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea. Which of the following findings should the nurse expect?
Hard palate
A nurse is assessing a client who is African-American and has jaundice. Which of the following areas is the most reliable for the nurse to inspect the client for jaundice?
Prior to percussing the abdomen
A nurse is assessing a client's bowel sounds. At which of the following points in the assessment should the nurse auscultate the client's abdomen?
Regular insulin
A nurse is caring for a an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?
Oral rehydration solution
A nurse is caring for a child who has acute gastroenteritis but is able to tolerate oral fluids. The nurse should anticipate providing which of the following types of fluid?
Sudden decrease in abdominal pain
A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated?
Withhold oral fluids and food
A nurse is caring for a client who has acute pancreatitis. After treating the client's pain, which of the following should the nurse address as the priority intervention?
Coffee-ground drainage
A nurse is caring for a client who has an active upper gastrointestinal bleed. After inserting a NG tube into the client, which of the following findings should the nurse anticipate?
Acetone odor to breath
A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?
Decrease the client's fluid intake
A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care?
High-Fowler's
A nurse is preparing a client who is scheduled to undergo a paracentesis. Into which of the following positions should the nurse assist the client for this procedure?
- Lubricate index finger - Insert suppository just beyond internal sphincter
A nurse is preparing to administer Bisacodyl suppository to a client. Which of the following actions should the nurse take?
Senna
A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction. The nurse should withhold which of the following medications?
false
Barium enemas are fun because they can constipate you
True
Black poop is normal in a patient with a duodenal ulcer
false
Bloody stools are common with irritable bowel syndrome (IBS)
A type 2 diabetes admitted to the hospital with severe dehydration and dry mucous membranes. What diagnosis is suspected?
HHS
What electrolyte must be closely monitored in a patient with DKA?
Potassium
HHS typically is not accompanied by acidosis or ketone production
True
Coffee ground emesis
What is a common sign for a patient with an acute upper GI bleed?
Rigid abdomen
What is an emergency assessment finding for a patient with an acute appendicitis
esophageal varices
What is major complication from cirrhosis of the liver
Decompress the stomach
What is the purpose of an NG tube for a patient with an obstruction?
B 12
What vitamin deficiency is associated with gastritis?
Absent bowel sounds
What would indicate a worsening of a bowel obstruction
Lower left quadrant
Where is pain typically felt in a patient with diverticulitis?
Ecchymosis is noted on a patient's abdomen who has sudden onset DKA. What should the nurse monitor for?
acute pancreatitis
A patient being discharged after having DKA will no longer have to check their urine for ketones
false
Metabolic alkalosis can occur with DKA
false
The major difference between DKA and HHS develops over a couple days whereas DKA is several days
false
Top priority for a patient with DKA, blood glucose of 688 is:
maintain adequate ventilation
What do I have: pH 7.25, PaCO2 60, PaO2 70, HCO3 25
uncompensated respiratory acidosis
