N255C Adult Health II Exam 1 Practice Questions

A hospitalized patient with type 1 diabetes received NPH and regular insulin 2 hours ago (at 7:30 am). The patient calls the nurse and say they are feeling hungry, shaky, and weak. The patient ate breakfast at 8am and is due to have lunch at noon. List in order of priority the actions that the nurse would take (1 = first, 5 = last). ____ Give the patient 1/2 cup of fruit juice to drink ____ Check the patient's blood glucose level ____ Take the patient's vital signs ____ Give the patient a small snack of with carbohydrates. ____ Document the patient's complaints, actions taken, and outcome.

1) Check the patient's blood glucose level 2) Give the patient 1/2 cup of fruit juice to drink 3) Take the patient's vital signs 4) Give the patient a small snack of with carbohydrates. 5) Document the patient's complaints, actions taken, and outcome. Rationale: These are sx of hypoglycemia. If hypoglycemic, eat 15-20 grams of glucose first.

A patient's platelet count is 300,000. You would interpret this result as? A) Normal B) Abnormal: thrombocytopenia C) Abnormal: thrombocytosis

A) Normal Rationale: A normal platelet count range is 150,000-400,000.

Which of the following statements are INCORRECT about exercise management for the diabetic patient? A) "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B) "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C) "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D) All of the options are correct statements.

A) "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." Rationale: Diabetics should eat 1 hour prior to exercising.

Which statement by the patient with type 2 DM is accurate? A) "I will limit my alcohol intake to 1 drink each day" B) "I am not allowed to eat any sweets because of my diabetes" C) "I cannot exercise because I take a glucose lowering medication" D) "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar"

A) "I will limit my alcohol intake to 1 drink each day"

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A) Onset: 15 minutes, Duration: 3 hours B) Onset: 2 hours, Duration: 16 hours C) Onset: 30 minutes, Duration: 1 hour D) Onset: 2 hours, Duration: 24 hours

A) Onset: 15 minutes, Duration: 3 hours Rationale: Humalog is a rapid-acting insulin.

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A) "Pernicious anemia is caused by not consuming enough Vitamin B12." B) "Pernicious anemia causes the red blood cells to appear very large and oval." C) "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D) "A red, smooth tongue can be a sign of pernicious anemia."

A) "Pernicious anemia is caused by not consuming enough Vitamin B12." Rationale: Pernicious anemia is caused by the patient lacking intrinsic factor which helps with the absorption of vitamin B12. The patient can consume supplements or foods with vitamin B12, but they will not absorb B12 because they lack intrinsic factor. All the other statements are correct about pernicious anemia.

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A) 1900 B) 1300 C) 1130 D) 1500

A) 1900 Rationale: Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours.

As the nurse you know that there is a risk of a transfusion reaction during the administration of red blood cells. Which patient below it is at most RISK for a febrile (non-hemolytic) transfusion reaction? A) A 38 year old male who has received multiple blood transfusions in the past year. B) A 42 year old female who is immunocompromised. C) A 78 year old male who is B+ that just received AB+ blood during a transfusion. D) A 25 year old female who is AB+ and just received B+ blood.

A) A 38 year old male who has received multiple blood transfusions in the past year. Rationale: A febrile transfusion reaction is where the recipient's WBCs are reacting with the donor's WBCs. This causes the body to build antibodies. It is most COMMON in patients who have received blood transfusions in the past. B) This pt is at risk for GvHD (graft versus host disease). C) this pt is at risk for a hemolytic transfusion reaction (not febrile). The patient is receiving incompatible blood. D) this pt is not at MOST risk compared to option A. Note the patient is receiving compatible blood in this option.

Select the patient below who is at MOST risk for pernicious anemia: A) A 75 year old male who recently had surgery on the ileum. B) A 25 year old female who reports craving ice and clay. C) A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D) All the patients above are at risk for pernicious anemia.

A) A 75 year old male who recently had surgery on the ileum. Rationale: Elderly, patients who've had GI surgery (the ileum is part of the GI system), have endocrine disorders (like Addison's Disease, Diabetes Type 1 etc.), or GI disease are at risk for pernicious anemia. This reason is because as the person ages GI secretions decrease along with intrinsic factor and with GI surgery the parietal cells can be damaged (which are responsible for secreting intrinsic factor). B) & C) These are risk factors for IRON-DEFICIENCY anemia

Analyze the following diagnostic findings from your patient with type 2 DM. Which result will need further assessment? A) A1C 9% B) BP 126/80 mmHg C) FBG 130 mg/dL D) LDL cholesterol 100 mg/dL

A) A1C 9%

A nurse is preparing a teaching plan for a patient with DM regarding proper foot care. Which instruction is included in the plan. A) Apply a moisturizing lotion to dry feet. B) Soak the feet in hot water. C) Avoid using mild soap on the feet. D) Only have a podiatrist cut your toe nails, never cut them yourself.

A) Apply a moisturizing lotion to dry feet. Rationale: Foot care is important to prevent foot ulcers. Use lotion to prevent dryness & cracking. Always wear socks & well-fitting shoes. Notify provider immediately if any foot problem occurs. Schedule regular visits with a podiatrist for foot care.

Which of the following is NOT a typical finding in HHNS? A) Blood pH <7.35 B) Dehydration C) Mental status changes D) Osmotic diuresis

A) Blood pH <7.35 Rationale: Metabolic Acidosis occurs with DKA

The healthcare provider is teaching an adolescent patient how to include iron-rich foods in the diet. Which of these, if selected by the patient, would indicate correct understanding of the teaching? A) Dark green vegetables B) Oranges C) Yogurt D) Bananas

A) Dark green vegetables Rationale: A is the only food listed indicated for any kind of anemia. But, it is specific to iron deficiency anemia

Jerry Potts, a 34-year-old logger, is allergic to wasp stings. Although he tries to avoid exposure to wasps, he has just been stung on the back of his neck by a flying insect he didn't see. He is immediately brought to a rural clinic by a coworker. Upon arrival Mr. Potts is anxious and having difficulty breathing. His vital signs are blood pressure 90/52, pulse 138 and weak, and respirations 40. The nurse recognizes that Mr. Potts's symptoms are caused primarily by the release of: A) Histamine B) Lymphokines C) Interleukin-2 D) Lysosomal enzymes

A) Histamine Rationale: During a Type I hypersensitivity reaction, IgE binds to the antigen which triggers the release of chemical mediators histamine and cytokines

A patient's lipid panel results are back. You're providing education to the patient on how to improve the results. Which results below do the patient need to improve on? Select all that apply: A) LDL 210 mg/dL B) HDL 40 mg/dL C) Total Cholesterol 120 mg/dL D) Triglycerides 375 mg/dL

A) LDL 210 mg/dL B) HDL 40 mg/dL D) Triglycerides 375 mg/dL Rationale: For DM treatment goals for blood lipid levels are normal limits. - Normal LDL should be LESS than 100 mg/dL - HDL should be greater than 40 mg/dL in men or 50 mg/dL in women - Triglycerides should be <150 mg/dL

__________ represents the average size of red blood cells on the CBC result. A) MCV (Mean Corpuscular Volume) B) MCHC (Mean Corpuscular Hemoglobin Concentration) C) MCH (Mean Corpuscular Hemoglobin) D) RDW (Red Cell Distribution)

A) MCV (Mean Corpuscular Volume) Rationale: MCV (mean corpuscular volume) is the average size of the RBCs.

A 55-year-old male has a myocardial infarction requiring admission to the hospital. He is being treated with an anticoagulant. The healthcare provider would be most concerned about which of the following: A) Purpura B) Trouble sleeping C) An elevated creatinine D) Nausea

A) Purpura Rationale: Anticoagulant therapy puts a pt at risk of bleeding, and therefore a reduction in platelets. Purpura are large purple bruises that can occur with thrombocytopenia (low platelet count).

A patient's complete blood count (CBC) results are back. Which result demonstrates polycythemia? A) RBC 10 million B) WBC 15,000 C) Platelets 600,000 D) RBC 2.5 million

A) RBC 10 million Rationale: Polycythemia is an increase in RBCs. Normal range for RBC 4.5-5.5 million.

A male patient's complete blood count results are back from this morning's lab draw. Select all the NORMAL results: A) RBC 4.8 million B) WBC 10,000 C) Platelets 350,000 D) Hbg 12 g/dL E) Hct 37%

A) RBC 4.8 million B) WBC 10,000 C) Platelets 350,000 Rationale: A male's hemoglobin should be 14-18 g/dL and hematocrit 42-52%. D) and E) are normal results for a FEMALE but not a male.

A patient receiving a blood transfusion complains of a headache. Which action should the health professional take first? A) Stop the infusion B) Continue the infusion rate as ordered C) Call for help D) Administer pain medication

A) Stop the infusion Rationale: If any new sx arise after beginning a transfusion, immediately stop the transfusion.

A patient is prescribed Belimumab for treatment of lupus. The patient has been taking the medication for one month. Which finding below during a patient assessment requires further evaluation? A) The patient reports trouble sleeping and loss of energy. B) The patient declines a flu shot via the intranasal route. C) The patient says they have not noticed a change in symptoms. D) The patient administers the medication in the subcutaneous tissue on the abdomen.

A) The patient reports trouble sleeping and loss of energy. Rationale: Belimumab is a Biologic that binds with a protein that supports the activity of B-cells to decrease the activity of B-cells, which decreases antibody attacks and decreases inflammation. Depression and suicide are serious side effects of this medication. A) demonstrates the patient may be experiencing depression and further evaluation is needed. B) Correct because the patient should avoid LIVE vaccines like the flu vaccine via the intranasal route, C) Correct because this medication can take up to 6 months to start working, and D) Correct because this medication can be given via injection (subq fat of the upper legs or abdomen) or infusion.

Which statements are true about the pathogenesis of Systemic Lupus Erythematosus? Select all that apply: A) The phagocytosis process is not occurring properly, which causes the nuclear material inside the dying cell to be seen as a foreign invader and antinuclear antibodies are created. B) During cell death the nucleus of the cell fails to condense, which leads to the development of autoantibodies. C) Immune complexes form and attach within the structures of important organs, joints, and tissues, and this causes inflammation. D) Neutrophil activity is decreased and this causes B-cells to attack phagocytes and nuclear material within the cells, which leads to the activation of the complement cascade system and inflammation.

A) The phagocytosis process is not occurring properly, which causes the nuclear material inside the dying cell to be seen as a foreign invader and antinuclear antibodies are created. C) Immune complexes form and attach within the structures of important organs, joints, and tissues, and this causes inflammation. Rationale: Apoptosis is ineffective (specifically how the macrophages/phagocytes consume the fragmented parts of the dying cell during apoptosis). These fragmented parts of the dying cell are not consumed and the nuclear material inside the small bodies spill into the extracellular space. The immune system recognizes this as an antigen "antinuclear antigens" and forms antinuclear antibodies to attack them. The antibodies attack the antigens and form immune complexes. These immune complexes now start to "float" around in the body and get stuck in various organs, joints, and tissues. This leads to the activation of the complement system and causes inflammation. This inflammation damages the structure (hence the organs/tissues/joints).

Type 1 diabetics typically have the following clinical characteristics when they first seek treatment: A) Thin, young with ketones present in the urine B) Overweight, adult-aged with ketones present in the urine C) Overweight, young with no ketones present in the urine D) Thin, older adult with glycosuria

A) Thin, young with ketones present in the urine Rationale: Type 1 DM onset is abrupt , usually < 30 yrs. Peak incidence occurs during puberty, around age 10-12 in girls, & 12-14 years in boys. Their nutritional status is frequently thin and ketosis is present.

Select all the signs and symptoms below that can present in myasthenia gravis: A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing

A. Respiratory failure C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing Rationale: All of the answers but B

Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction: A. Sweating B. Chills C. Hives D. Poikilothermia E. Tinnitus F. Headache G. Back pain H. Pruritus I. Paresthesia J. Shortness of Breath K. Nausea

A. Sweating B. Chills C. Hives F. Headache G. Back pain H. Pruritus J. Shortness of Breath K. Nausea

Select ALL the signs and symptoms that can present in pernicious anemia: A. Erythema B. Paresthesia of hands and feet C. Racing thoughts D. Extreme hunger E. Depression F. Unsteady gait G. Shortness of breath with activity

B. Paresthesia of hands and feet E. Depression F. Unsteady gait G. Shortness of breath with activity

You're providing education to a patient about how to take their prescribed iron supplement. Which statement by the patient requires you to re-educate the patient on how to take this supplement? A) "I will take this medication on an empty stomach." B) "I will avoid taking this medication with orange juice." C) "I will wait and take my calcium supplements 2 hours after I take my iron supplement." D) "This medication can cause constipation. So, I will drink plenty of fluids and take a stool softer as needed."

B) "I will avoid taking this medication with orange juice." Rationale: The patient should be encouraged to take their iron supplement with Vitamin C (hence orange juice) because Vitamin C increases the absorption of iron. All the other statements are correct in how to take an iron supplement.

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern? A) "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B) "I will consume no more than 8 oz. of alcohol per week." C) "I will continue monitoring my diet and participating in exercise while taking this medication." D) "This medication works by stimulating the beta cells in the pancreas to make insulin."

B) "I will consume no more than 8 oz. of alcohol per week." Rationale: Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A) "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B) "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C) "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D) "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B) "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." Rationale: A patient with pernicious anemia cannot absorb vitamin B12 through the GI system. So, eating foods or taking supplements of vitamin B12 are pointless because the patient lacks intrinsic factor to absorb vitamin B12. Therefore, the typical regime for a patient with pernicious anemia is to receive vitamin B12 through intramuscular injections. Normally, the physician will order weekly injections and then monthly as maintenance, which is usually a lifelong treatment.

Your patient is a 39-year-old male. What is considered a normal Hemoglobin level for this patient? A) 35% B) 17 g/dL C) 11 g/dL D) 50%

B) 17 g/dL Rationale: Normal Hgb for men: 14-18 g/dL and women: 12-16 g/dL.

Select all the patients who are at MOST risk for iron-deficiency anemia: A) A 55 year old male who reports taking Ferrous Sulfate regularly. B) A 25 year old female who was recently diagnosed with Celiac Disease. C) A 35 year old female who is 36 weeks pregnant that reports craving ice. D) A 67 year old female with a Hemoglobin level of 14.

B) A 25 year old female who was recently diagnosed with Celiac Disease. C) A 35 year old female who is 36 weeks pregnant that reports craving ice. Rationale: Patients who have GI issues, such as Celiac Disease, are at risk for iron-deficiency anemia due to damage to the intestines, which play a huge role in absorbing iron. In addition, females who are pregnant are at risk for this condition because of fetal demands on the body for iron. Also, this patient is craving ice which is a sign that the body is low on iron. A) Ferrous Sulfate is an iron supplement, therefore decreasing the patient's chances of developing this condition D) The patient's hemoglobin level is normal (normal Hgb level for a female is 12 to 15.5 women & 13.5-17.5 for men.

Which of the following patients is at most risk for Type 2 diabetes? A) A 6 year old girl recovering from a viral infection with a family history of diabetes. B) A 28 year old male with a BMI of 49. C) A 76 year old female with a history of cardiac disease. D) None of the options provided.

B) A 28 year old male with a BMI of 49. Rationale: Type 2 diabetes risk factors are related to lifestyle. Being obese is a risk factor (BMI >30 in males is considered obese).

Which patient is MOST likely to develop Diabetic Ketoacidosis? A) A 25 year old female newly diagnosed with Cushing's Disease taking glucocorticoids. B) A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin. C) A 35 year old female newly diagnosed with Type 2 diabetes. D) None of the options are correct.

B) A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin. Rationale: DKA is precipitated by illness, infection, or poor mgmt

Which patient below is experiencing thrombocytopenia based on their complete blood count? A) A patient with a WBC level of 15,000. B) A patient with a platelet level of 100,000. C) A patient with a WBC level of 4,000. D) A patient with a platelet level of 350,000.

B) A patient with a platelet level of 100,000. Rationale: Thrombocytopenia is defined as a low platelet count. A normal platelet count is 150,000-400,000.

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? A) Plasmapheresis B) Cholinesterase medications C) Thymectomy D) Corticosteroids

B) Cholinesterase medications Rationale: These medications are not used to treat MG, but anticholinesterase medications (like Pyridostigmine) are used to treat this condition.

The healthcare provider is teaching their patient about the characteristics of type 1 diabetes mellitus. Which of the following describe the underlying cause of the disease? A) Atrophy of pancreatic alpha cells B) Destruction of pancreatic beta cells C) Cellular resistance to insulin D) Increased hepatic glycogenesis

B) Destruction of pancreatic beta cells Rationale: Type I DM is an autoimmune disorder in which the body develops antibodies against insulin and/or pancreatic β cells that produce insulin.

Your patient is having a blood transfusion reaction. You immediately stop the transfusion. Next you will: A) Notify the physician. B) Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. C) Collect urine sample. D) Send the blood tubing and bag to the blood bank.

B) Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. Rationale: This question wants to know your NEXT nursing action. AFTER stopping the transfusion, the nurse will DISCONNECT the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. This will limit any more blood from entering the patient's system. THEN the nurse will notify the MD and blood bank.

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A) These insulins cannot be mixed, therefore, should be drawn up in different syringes. B) Draw-up the Humulin R insulin first and then the NPH insulin. C) Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D) Draw-up the NPH insulin first and then the Humulin R insulin.

B) Draw-up the Humulin R insulin first and then the NPH insulin. Rationale: Remember when drawing up regular and intermediate insulins you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.

True or False: DKA and HHNS mainly occur in type 2 diabetics.

B) False Rationale: DKA is most common in Type 1 diabetics, whereas HHNS is most common in Type 2 diabetics.

Polydipsia and polyuria related to diabetes are primarily due to: A) The release of ketones from cells during fat metabolism B) Fluid shifts resulting from the osmotic effect of hyperglycemia C) Damage to the kidneys from exposure to high levels of glucose D) Changes in RBCs resulting from attachment to excess glucose to hemoglobin

B) Fluid shifts resulting from the osmotic effect of hyperglycemia

A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important? A) Recheck the glucose level B) Give the patient ½ cup (4 oz) of fruit juice C) Call the doctor D) Keep the patient nothing by mouth

B) Give the patient ½ cup (4 oz) of fruit juice Rationale: This is the first intervention for hypoglycemia

The healthcare provider is assessing the glucose level of a patient with a diagnosis of diabetes. Which of these is most helpful in evaluating this patient's long-term glucose management? A) Urine specific gravity B) Hemoglobin A1c C) Glucose tolerance test D) Fasting blood glucose

B) Hemoglobin A1c Rationale: A1c is the average of blood glucose levels taken over 3 months. It's used to diagnose, monitor response to therapy, and screen patients with prediabetes

A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient's labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next? A) Start the IV fluids and administer the insulin bolus and drip as ordered B) Hold the insulin and notify the doctor of the potassium level of 2.5 C) Hold IV fluids and administer insulin as ordered D) Recheck the glucose level

B) Hold the insulin and notify the doctor of the potassium level of 2.5 Rationale: When insulin is given it helps take potassium back into the cell which will cause potassium blood levels to fall. Insulin therapy is to be started only if the patient's potassium level is 3.3 or greater.

The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia? A) Hyperchromic and macrocytic B) Hypochromic and microcytic C) Hyperchromic and macrocytic D) Hypochromic and macrocytic

B) Hypochromic and microcytic Rationale: The cells would be pale and small.

A home health nurse visits a client with type 1 DM. The client tells the nurse they have been vomiting and having diarrhea and have not had any food or medications for the past 36 hours. Which additional statement by the client indicated the need for further teaching? A) I should monitor my blood glucose ever 3-4 hours. B) I need to stop my insulin. C) I should call my physician because of these symptoms. D) I need to increase my fluid intake.

B) I need to stop my insulin. Rationale: This pt is likely experiencing DKA caused by profound deficiency of insulin and precipitated by poor mgmt, illness, or infection. Priority treatment is IV fluids then continuous low dose insulin.

Jerry Potts, a 34-year-old logger, is allergic to wasp stings. After being stung he is brought to the clinic. Mr. Potts is anxious and having difficulty breathing. His vital signs are blood pressure 90/52, pulse 138 and weak, and respirations 40. Mr. Potts has stabilized and been prepared for discharge from the clinic. During discussion of prevention and management of further allergic reactions, the nurse identifies a need for additional teaching based on which comment by Mr. Potts? A) I will have the same or stronger reaction if I'm stung again. B) I will need to take a maintenance dose of corticosteroids daily to prevent reactions to stings in the future. C) I should wear a Medic Alert bracelet indicating my allergy to insect stings. D) I need to learn how to administer epinephrine so that I will be prepared if I am stung again.

B) I will need to take a maintenance dose of corticosteroids daily to prevent reactions to stings in the future. Rationale: Corticosteroids while they are a medication option for treating allergic reactions, they are not to be used on a daily basis.

Newborns are protected for the first 6 months of life from some bacterial infections due to maternal transmission of which type of antibodies? A) IgM B) IgD C) IgE D) IgG

B) IgD Rationale: IgD is a class of immunoglobulin that are a differentiation of B cells. They primary activate B cells to begin an immune response but also have a role in protection against pathogenic bacteria and viruses A) IgM are primary antibodies released at every antigen exposure C) IgE are antibodies that cause allergic reactions D) IgG can cross the placenta, but are secondary antibodies that react to other human cell antigens and can form immune complexes. Vocab: - Immunoglobulins = antibodies - B cell = lymphocyte that makes antibodies against specific antigens - Antibody-mediated (humoral) immunity response = B cells create antibodies and memory T cells to the specific antigen to create sustained immunity to the antigen

Rotating injection sites when administering insulin prevents which of the following complications? A) Insulin edema B) Insulin resistance C) Lipodystrophy D) Systemic allergic reactions

C) Lipodystrophy Rationale: Lipodystrophy is a loss of fat at the injection site which can occur if sites are not rotated and scarring begins

The nurse teaches a patient with Type 1 diabetes about the Somogyi effect and dawn phenomenon, emphasizing which difference? A) The Somogyi effect is characterized by hyperglycemia; the dawn phenomenon by hypoglycemia B) In the Somogyi effect, hyperglycemia results from too much insulin; the dawn phenomenon results from too little insulin C) The Somogyi effect occurs when the patient is asleep; the dawn phenomenon occurs after the patient awakens D) The Somogyi effect occurs early at night; the dawn phenomenon occurs on arising

B) In the Somogyi effect, hyperglycemia results from too much insulin; the dawn phenomenon results from too little insulin Rationale: The Somogyi Effect is night time hypoglycemia (more specifically rebound hyperglycemia secondary to counterregulatory hormone release) due to too much insulin admin prior to bed. The Dawn Phenomenon is morning hyperglycemia due to too little insulin admin prior to bed

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (select all that apply)? A) Elimination of sugar from the diet B) Insulin administration C) Need to reduce physical activity D) Hypoglycemia prevention, symptoms, and treatment E) Use of a portable blood glucose monitor

B) Insulin administration D) Hypoglycemia prevention, symptoms, and treatment E) Use of a portable blood glucose monitor Rationale: A) Pts with DM still require sugar in their diet. C) Moderate exercise is part of treatment of DM

Which of the following statements are true regarding Type 2 diabetes treatment? A) Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B) Insulin may be needed during times of surgery or illness. C) Insulin is never taken by the Type 2 diabetic. D) Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.

B) Insulin may be needed during times of surgery or illness. Rationale: This is the only indication for insulin admin to Type 2 DM pts.

A patient with Systemic Lupus Erythematosus is prescribed Hydroxychloroquine. Select all the educational points you will include in the patient's education about this medication: A) Hydroxychloroquine is considered a Biologic medication. B) It is used long-term to help prevent flares. C) This medication doesn't produce results immediately. Therefore, the patient may not see results for a couple of months. D) This medication binds with a protein that supports the activity of B-cells, which decreases the activity of B-cells. E) The patient must have their eyes checked regularly to monitor the retina while taking this medication.

B) It is used long-term to help prevent flares. C) This medication doesn't produce results immediately. Therefore, the patient may not see results for a couple of months. E) The patient must have their eyes checked regularly to monitor the retina while taking this medication. Rationale: Hydroxychloroquine is an antimalarial medication. It decreases antibodies attacking the body (option D describes a biologic like Belimumab). If used long-term it can damage the retinas of the eyes (the patient needs a minimum of 1 eye exam per year while taking this med). It also takes a couple of months to start working.

A patient is diagnosed with Systemic Lupus Erythematous (SLE). You note the patient has a red rash that starts on the nose and expands onto the cheeks of the face. This is known as what type of rash? A) Discoid B) Malar C) Miliaria D) Eczema

B) Malar Rationale: The Malar rash is also called a butterfly rash. A) Discoid is a type of lesion that is also a sx of Lupus.

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks? A) Mid-afternoon B) Morning C) Evening D) Before bedtime

B) Morning Raitonale: Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

A patient had a complete blood count (CBC) with differential test ordered. You asses the white blood cell count results and know that this laboratory test will also assess the count of what other types of WBCs? Select all that apply: A) Thrombocytes B) Neutrophils C) Lymphocytes D) Eosinophils E) Erythrocytes F) Basophils G) Monocytes

B) Neutrophils C) Lymphocytes D) Eosinophils F) Basophils G) Monocytes Rationale: These are the 5 types of WBCs.

Which medication below used to treat Systemic Lupus Erythematosus decreases inflammation quickly, is not for long-term usage, and can lead to weight gain, susceptibility to infection, diabetes, and osteoporosis? A) Hydroxychloroquine B) Prednisone C) Azathioprine D) Belimumab

B) Prednisone Rationale: The question is describing a steroid medication, which prednisone is. These are medications used to treat lupus. They decrease inflammation quickly, are not for long-term usage, and can lead to weight gain, susceptibility to infection, diabetes, and osteoporosis.

A client with DM had previously been well controlled with glyburide (DIaBeta), 5mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? A) Atenolol (Tenormin) B) Prednisone (Deltasone) C) Allopurinol (Zyloprim) D) Phenelzine (Nardil)

B) Prednisone (Deltasone) Rationale: A) Atenolol is a beta blocker B) Prednisone is a corticosteroid. Steroids can change how your body handles carbohydrates and sugars, therefore they can raise your blood sugar level by blocking the action of your insulin. C) Allopurinol is a uric acid reducer D) Phenelzine is an MAOI antidepressant.

Which type of insulin may be given IV? A) Glargine (Lantus) insulin B) Regular (Humulin R) insulin C) NPH (Humulin N) insulin D) Lispro (Humalog) insulin

B) Regular (Humulin R) insulin Rationale: Short acting insulin (Regular) can be given SQ or IV.

Insulin secretion is stimulated by all of these, except: A) Elevated serum glucose levels B) Sympathetic stimulation of alpha cells C) Parasympathetic stimulation of beta cells D) Increased amino acids and fatty acids

B) Sympathetic stimulation of alpha cells Rationale: Insulin secretion is inhibited by sympathetic stimulation of alpha cells

The nurse who is providing care to a group of clients concludes that the client with which health problem exhibits a type III immune-complex-mediated hypersensitivity reaction? A) Goodpasture's syndrome B) Systemic lupus erythematosus C) Transplant rejection D) Transfusion reaction

B) Systemic lupus erythematosus Rationale: Lupus is an autoimmune connective tissue disease in which auto-antibodies & auto-sensitized T-cells bind to self proteins, forming immune complexes which accumulate in tissue causing damage. A) Goodpasture's is Type II C) Transplant rejection is Type II D) Transfusion reaction is Type II Vocab: - Auto-antibody = antibody produced by the immune system that is directed against one or more of the individual's own proteins

A nurse performs a physical assessment of a patient with type 2 DM. Findings include a fasting blood glucose of 120 mg/dL, temperature 101 degrees F, heart rate 88, respirations 22, and blood pressure 140/84 mmHg. Which finding would be of most concern to the nurse? A) Blood pressure B) Temperature C) Blood glucose D) Respirations

B) Temperature Rationale: The FBG and HR are WNL, BP is hypertensive, and the temp indicates fever. Fever is a sx of DKA which is a medical emergency.

A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A) None, this is a normal blood glucose reading. B) The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C) A bedtime snack may prevent this phenomenon. D) This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

B) The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. Rationale: This is known as the DAWN PHENOMENON and is best treated with a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

The healthcare provider is seeing four patients at the neighborhood clinic. Which of these patients should the healthcare provider identify to be most at risk for iron-deficiency anemia? A) The patient who has a diagnosis of chronic renal failure. B) The woman of childbearing age reporting a craving for ice. C) The obese patient with a history of gastric bypass surgery. D) The patient who follows a strict vegan diet

B) The woman of childbearing age reporting a craving for ice. Rationale: Etiologies of iron deficiency anemia include chronic blood loss (GI bleed, menstruation), inadequate intake or absorption, drugs (may interfere with normal fx like chemo), and increased energy demand. A) Renal disease risks tendency for bleeding C) Gastric bypass surgery risks acquired hemolytic anemia. D) Vegans are at risk of Vit B12 anemia

You're assessing the red blood cell indices on the complete blood count (CBC). What part of the indices represents the concentration of Hgb on the RBC? A) MCV B) MCH C) MCHC D) RDW

C) MCHC Rationale: MCHC (mean corpuscular hemoglobin concentration) assesses RBC color/saturation. Hgb is what make RBCs red.

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (RBCs). Shortly after the first unit of RBCs starts to infuse, the patient develops signs and symptoms of a transfusion reaction. Which type of hypersensitivity reaction has the patient experienced? A) Type I B) Type II C) Type III D) Type IV

B) Type II Rationale: Transfusion reactions are a Type II hypersensitivity because host antibodies are reacting to self human leukocyte antigens (HLAs) on the transplanted RBC surface.

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________. A) metabotropic; muscle weakness B) nicotinic acetylcholine; muscle weakness C) dopaminergic adrenergic; muscle contraction D) nicotinic adrenergic; muscle contraction

B) nicotinic acetylcholine; muscle weakness Rationale: In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.

Which of the following statements is INCORRECT about Hyperglycemic Hyperosmolar Nonketotic Syndrome? A) HHNS occurs mainly in type 2 diabetics. B) This condition presents without ketones in the urine. C) Metabolic alkalosis presents in severe HHNS. D) Intravenous Regular insulin is used to treat hyperglycemia.

C) Metabolic alkalosis presents in severe HHNS. Rationale: No pH disturbances occur with HHNS

In pernicious anemia, intrinsic factor is not being secreted by the _______ cells which are found in the gastric mucosa. A) Visceral B) Langerhan C) Parietal D) Chief

C) Parietal Rationale: Parietal cells in the GI system secrete intrinsic factor.

A 15 year old weighing 250 pounds has started to experience increased thirst, increased appetite, and frequent urination. After medical testing, it was determined the teen has type 2 diabetes and will be started on oral medications. What information should the nurse give the adolescent about medications as a treatment option? A) "Insulin is used when diabetics won't take oral pills, so you can avoid this by taking your medication as ordered." B) "You are being prescribed this oral medication now, and will need insulin in the future." C) "Being overweight can contribute to the development of development of type 2 diabetes, which can be treated with an oral medication. You may or may not need insulin in the future." D) "Your diabetes is mild since you're only having oral medication, it will go away if you stop eating sweets."

C) "Being overweight can contribute to the development of development of type 2 diabetes, which can be treated with an oral medication. You may or may not need insulin in the future." Rationale: Oral medication work on 3 defects of Type II DM: insulin resistance, decreased insulin production, and increased hepatic glucose production. SQ Insulin is indicated for Type I DM and when there is inadequate insulin to meet metabolic needs. Some pts with Type II DM may need insulin with illness, stress, or surgery.

You're providing education to a Systemic Lupus Erythematosus support group about preventing flares. Which statement by a participant requires re-education about this topic? A) "Emotional stress and illness are triggers for a flare-up." B)"I always wear large-brimmed hats and long sleeves when I'm outside." C) "Exercise should be avoided due to the physical stress it causes on the body." D) "I will make it priority to receive my yearly influenza vaccine.

C) "Exercise should be avoided due to the physical stress it causes on the body." Rationale: Exercise is a very important step in preventing lupus flares. It helps maintain joint stability and manages weight. Exercise should not be limited but encouraged to as much as the patient can tolerate. Remember LESS for less flares: Lower stress (avoid overworking, emotional, illness, and use techniques to have prevent stress), Exercise (helps joints and manages weight), Sleep (need more than 8 hours to prevent the body from getting too exhausted), Sun Protection (sunscreen and large-brimmed hats...sunlight can activate a flare).

Which statement by the client supports the diagnosis of myasthenia gravis (MG)? A) "I get chest pain and faint after I walk in the hall." B) "I gained 3 pounds this week, and I am spitting up pink frothy sputum." C) "My eyelids droop, and I see double everything." D) "I have weakness and fatigue in my feet and legs."

C) "My eyelids droop, and I see double everything." Rationale: MG is an organ-specific autoimmune disorder characterized by muscle weakness that ↑ during activity & improves after rest. Early sx of MG are ptosis (droopy eyelids) and diplopia (blurry or double vision)

A patient is on a continuous IV Heparin drip for the treatment of a pulmonary embolism. The patient's aPTT should be _____________ to ensure that the medication is successful in treating the patient's condition. A) Less than 1 B) 2-3 seconds C) 1.5-2.5 times the normal range D) 30-40 seconds

C) 1.5-2.5 times the normal range Rationale: A normal aPTT is 30-40 seconds in someone who is NOT taking Heparin. However, in order for Heparin to be therapeutic for the treatment of blood clots, the aPTT should be 1.5-2.5 times the normal range...which is about 60-80 seconds.

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A) 1300 B) 0930 C) 1100 D) 1700

C) 1100 Rationale: Humulin-R is a SHORT-ACTING insulin which has a PEAK time of 2 hours. If you gave the medication at 0900...it would peak at 1100.

A 37-year-old female has received 2 units of packed red blood cells. What is the desired hemoglobin level range for this patient? A) 42-52% B) 37-47% C) 12-16 g/dL D) 14-18 g/dL

C) 12-16 g/dL Rationale: Females should have a hemoglobin range of 12-16 g/dL. Men should have a hemoglobin range of 14-18 g/dL.

Fasting glucose above ____ mg/dL is indicative of diabetes. A) 110 B) 200 C) 126 D) 156

C) 126 Rationale: One diagnostic criteria for DM is a fasting plasma glucose of 126 mg/dL or higher

Which of the following patients is MOST LIKELY experiencing Hyperglycemic Hyperosmolar Nonketotic Syndrome based on their symptoms? A) A 72 year old with a health history of diabetes who has a blood glucose of 300 mg/dL and is complaining of thirst and frequent urination. B) A 66 year old with type I diabetes that has ketones present in their urine. C) A 69 year old admitted with an infection of the right foot with a health history of diabetes that reports missing several doses of Metformin and has a blood glucose of 600 mg/dL. D) A 6 year old that is presenting with polyuria, polydipsia, abdominal pain, and vomiting.

C) A 69 year old admitted with an infection of the right foot with a health history of diabetes that reports missing several doses of Metformin and has a blood glucose of 600 mg/dL. Rationale: Hallmarks of HHNS are EXTREME high blood glucose (>600 mg/dL), precipitated by infection, and more common in type 2 diabetics. The 69 year old is a type 2 diabetic due to the clue that the option states the patient has missed doses of Metformin (which is an oral type 2 diabetic medication). DKA presents with elevated blood glucose >300 mg/dL and ketones which HHNS does not.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A) An atopic reaction is causing the patient's symptoms. B) The patient's body is rejecting the bone marrow. C) Cells from the transplanted bone marrow are attacking the host tissue. D) The patient is experiencing a type I allergic reaction.

C) Cells from the transplanted bone marrow are attacking the host tissue. Rationale: Notice the sx listed are not indicative of an acute transplant rejection (fever, HTN, malaise). Instead, the sx involve the skin, GI tract, and liver which means this is graft-versus-host-disease in which transplanted cells attack the host.

The healthcare provider is reviewing a patient's laboratory results and notes the hemoglobin is 9 g/dL (90g/L) and the hematocrit is 28% (0.28). Which of the following orders will the healthcare provider expect to implement first. A) Administer cyanocobalamin (B12) IM. B) Type and crossmatch for a blood transfusion. C) Draw blood for RBC indices (e.g., MCV, MCH, MCHC). D) Administer PO ferrous sulfate (iron).

C) Draw blood for RBC indices (e.g., MCV, MCH, MCHC). Rationale: The Hgb and Hct are below normal limits. A) You do not know if this pt has pernicious anemia in order to treat it with B12 B) Blood transfusions are indicated when Hgb is < 7 and the pt is symptomatic D) You do not know if this pt has iron deficiency anemia to treat it with ferrous sulfate. Vocab: - Hgb are blood cells that transport O2 and make RBCs red (Normal values = Female 11.7-16.0 g/dL; Male 13.2-17.3 g/dL) - Hct is the proportion of Hbg in blood (Normal values = Female 35-47%; Male 39-50%) - Mean corpuscular volume (MCV) is the RCB volume. - Mean corpuscular Hgb (MCH) is the RBC weight. - Mean corpuscular Hgb saturation (MCHC) is the RCB color (↑ Hgb = more color)

Jerry Potts, a 34-year-old logger, is allergic to wasp stings. Although he tries to avoid exposure to wasps, he has just been stung on the back of his neck by a flying insect he didn't see. He is immediately brought to a rural clinic by a coworker. Upon arrival Mr. Potts is anxious and having difficulty breathing. His vital signs are blood pressure 90/52, pulse 138 and weak, and respirations 40. On inspection of Mr. Potts' neck, the nurse would expect: A) Absences of local response B) Pallor around the sting site C) Edema and itching at the site D) Blisters

C) Edema and itching at the site Rationale: Sx of an allergic reaction include eczema, rhinitis, asthma, urticaria, and anaphylaxis

You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly? A) Herbal tea, apples, and watermelon B) Sweet potatoes, artichokes, and packaged meat C) Egg yolks, beef, and legumes D) Chocolate, cornbread, and cabbage

C) Egg yolks, beef, and legumes

Which of the following insulins can be administered intravenously? A) NPH B) Lantus C) Humulin R D) Novolog

C) Humulin R Rationale: All others are given SQ (Regular insulin is given SQ also)

Which of the following insulins has no peak but a duration of 24 hours? A) NPH B) Novolog C) Lantus D) Humulin N

C) Lantus Rationale: Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

A 68-year-old patient with Type 2 diabetes is brought to the ER in an unresponsive state. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNS) is made. The nurse prepares for the administration of which initial therapy? A) Long-acting IV insulin B) Oxygen by nasal cannula C) Large amounts of IV saline solution D) IV dextran as a source of complex carbohydrates

C) Large amounts of IV saline solution Rationale: With HHNS, serum osmolarity is greater than normal limits, so dilution with fluids is necessary. Treatment for HHNS is 1) Restore plasma volume with large amounts of IV fluids 2) Correct electrolytes deficits and high blood glucose 3) Treat the underlying condition A) Initiate insulin continuous IV after rehydration

A patient is admitted with iron- deficiency anemia and has been receiving iron supplementation. The patient voices concern about how their stool is dark black. As the nurse, you would? A) Notify the doctor B) Hold the next dose of iron C) Reassure the patient this is a normal side effect of iron supplementation D) None of the options are correct

C) Reassure the patient this is a normal side effect of iron supplementation Rationale: This is a normal side effect of iron supplementation and demonstrates the body is absorbing the iron.

A patient with diabetes asks you about what type of exercise they should perform throughout the week. The best response is: A) Lifting weights B) Sprinting C) Swimming D) Jumping

C) Swimming Rationale: Aerobic exercise is the best and swimming is the only option that is an aerobic exercise.

The healthcare provider is teaching parents of a child who has a diagnosis of iron-deficiency anemia how to increase their child's absorption of dietary iron. Which of these supplements should the healthcare provider recommend? A) Vitamin D B) Folic Acid C) Vitamin C D) Vitamin B12

C) Vitamin C Rationale: Iron deficiency anemia may be causes by inadequate absorption of iron. Vitamin C aids iron absorption.

You're assessing the patient's complete blood count (CBC). Which lab result below demonstrates leukopenia? A) WBC 7,000 B) Platelets 90,000 C) WBC 3,000 D) Platelets 500,000

C) WBC 3,000 Rationale: WBC range is 5,000-10,000. Leukopenia is a low white blood count.

A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A) 1 hour prior to eating B) 1 hour after eating C) With the first bite of food D) At bedtime

C) With the first bite of food Rationale: Precose is an alpha-glucoside inhibitor that works by lowering the blood sugar by slowly breaking down starchy foods in the GI system which helps slowly rise the blood sugar.

A patient's complete blood count (CBC) with differential shows an elevated Eosinophil count at 10%. As the nurse you know the Eosinophils ____________? A) fight viral infections B) fight bacterial infections C) play a role in allergic reactions and parasitic infections D) play a role in clotting

C) play a role in allergic reactions and parasitic infections Rationale: Lymphocytes fight viruses and bacteria. Neutrophils fight bacteria and fungi.

The healthcare provider is planning are for four patients. Which patient is MOST in need of interventions aimed at preventing anemia? The patient... A) who is vegetarian B) with a Jackson-Pratt drain C) with renal failure on hemodialysis D) who has been NPO for 3 days

C) with renal failure on hemodialysis Rationale: All of these are risk factors. However, chronic disease (renal failure included) is one risk factor for anemia. Combining that with dialysis which puts RBCs at risk of hemolysis, C is the correct answer.

The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A) "I plan to lose 25 pounds this year by following a high-protein diet." B) "If I use an insulin pump, I can eat whatever I want and not worry about diet planning." C) "I should include less fiber in my diet than a person who does not have diabetes." D) "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."

D) "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Rationale: Alcohol inhibits the liver's ability to contribute to glucose regulation which can cause severe hypoglycemia

A patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about preventing DKA. What statement by the patient demonstrates they understood your teaching about this condition? A) "I should not be alarmed if ketones are present in my urine because this is expected during illness." B) "It is normal for my blood sugar to be 250-350 mg/dL while I'm sick." C) "I will hold off taking my insulin while I'm sick." D) "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids."

D) "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids." Rationale: Illness and not administering your insulin can precipitate DKA

What is a NORMAL aPTT for a patient who is NOT taking an anticoagulant? A) 60-80 seconds B) 2-3 C) 10-12 seconds D) 30-40 seconds

D) 30-40 seconds Rationale: aPTT normal range is 30-40 seconds

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A) A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL B) A 58-year-old man with a fasting blood glucose of 111 mg/dL C) A 68-year-old woman with a random plasma glucose of 190 mg/dL D) A 48-year-old woman with a hemoglobin A1C of 8.4%

D) A 48-year-old woman with a hemoglobin A1C of 8.4% Rationale: Type I DM diagnostic test results are a 1) Hgb A1c = 6.5% or higher, 2) Fasting plasma glucose = 126 mg/dL or higher; 3) 2 hr plasma glucose level = 200 mg/dL 4) Classic symptoms of hyperglycemia with random plasma glucose level of 200 mg/dL or higher

Which patient below is experiencing leukopenia based on their complete blood count? A) A patient with a platelet level of 100,000. B) A patient with a WBC level of 9,000. C) A patient with a platelet level of 150,000. D) A patient with a WBC level of 3,000.

D) A patient with a WBC level of 3,000. Rationale: Leukopenia is defined as a low WBC count. A normal WBC count is 5,000-10,000.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? A) Call the provider B) Give insulin as ordered C) Assess for other neurologic symptoms D) Check the patient's blood glucose level

D) Check the patient's blood glucose level

On the second postoperative day, the healthcare provider notes the patient's hemoglobin has remained steady but the hematocrit has decreased from 48% (0.48) to 46% (0.46). Which intervention is most appropriate for the healthcare provider to implement? A) Check the surgical site for increased bleeding B) Administer oxygen at 2 L/min C) Increase the IV flow rate D) Continue to monitor the patient

D) Continue to monitor the patient Rationale: This Hct level is within normal limits (Female 35-47%; Male 39-50%). A) If the pt was bleeding, Hgb would fall as well B) O2 isn't indicated for decreases in Hct C) You need a physicians order to manipulate IV flow rate

Which result in the complete blood count (CBC) reflects the protein found on the red blood cell that helps carry oxygen throughout the body? A) MCH B) RDW C) Hct D) Hgb

D) Hgb Rationale: Hemoglobin are the blood cells that transport O2

What type of insulin do you expect the doctor to order for treatment of DKA? A) IV Novolog B) IV Levemir C) IV NPH D) IV Regular Insulin

D) IV Regular Insulin Rationale: This is the only type of insulin that can be given IV.

The nurse writing a care plan determines that which nursing diagnosis is a priority early in the care of a client with scleroderma? A) Disturbed body image B) Hopelessness C) Activity intolerance D) Impaired skin integrity

D) Impaired skin integrity Rationale: Skin manifestations are a common finding in clients with scleroderma and therefore require preventative and supportive nursing care as priority

A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder? A) Intravenous B) Orally C) Through a central line D) Intramuscular

D) Intramuscular Rationale: Patients with Vitamin B12 do NOT absorb vitamin B12 through the GI system due to lacking intrinsic factor (which helps with the absorption of vitamin B12), therefore, you would not give it orally. The best route for administering vitamin B12 is via the muscle (intramuscular).

A 65-year-old male patient, who is diabetic, has a hemoglobin A1C level drawn. What is the target hemoglobin A1C for this patient? A) Less than 4% B) Greater than 6% C) Less than 10% D) Less than 7%

D) Less than 7% Rationale: Patients who are diabetic should try to have a target hemoglobin A1C less than 7%.

Jerry Potts, a 34-year-old logger, is allergic to wasp stings. Although he tries to avoid exposure to wasps, he has just been stung on the back of his neck by a flying insect he didn't see. He is immediately brought to a rural clinic by a coworker. Upon arrival Mr. Potts is anxious and having difficulty breathing. His vital signs are blood pressure 90/52, pulse 138 and weak, and respirations 40. Which action by the nurse is most appropriate initially? A) Place him in recumbent position with his legs elevated B) Remove the stinger from the site C) Administer subcutaneous epinephrine D) Maintain his airway

D) Maintain his airway Rationale: The #1 priority of allergic reactions is to ensure pt airway (ABCs) C) Epinephrine is secondary to ABCs

A 20-year-old college student has Type 1 diabetes and normally walks each evening as part of her exercise routine. She now plans to enroll in a swimming class to meet her physical education requirement. Which adjustment in her treatment plan will the nurse help the patient make? A) Delay the meal before the swimming class until the session is over B) Time her morning insulin injection so that the peak action will occur during her swimming class C) Add 10 units of regular insulin to her usual morning dose on the days she plans to swim D) Monitor her glucose level before, during, and after swimming to determine the need for alterations in food or insulin

D) Monitor her glucose level before, during, and after swimming to determine the need for alterations in food or insulin Rationale: Exercise decreases blood glucose and can have that effect for up to 48 hours. Monitoring blood glucose with exercise is indicated. A) Pts should exercise 1 hour after a meal C) Increasing insulin is not appropriate with the glucose-lowering effect already happening

Which lab result on a patient's record from the complete blood count (CBC) represents thrombocytopenia? A) Platelets 275,000 B) WBC 3,000 C) WBC 15,000 D) Platelets 80,000

D) Platelets 80,000 Rationale: A normal platelet count range is 150,000-400,000. Thrombocytopenia means a low platelet count.

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A) Glyburide B) Atenolol C) Bactrim D) Prednisone

D) Prednisone

A nurse teaches a patient with DM about differentiating between hypoglycemia and ketoacidosis. The patient demonstrates an understanding of the teaching by stating that glucose or food should be taken if which of the following symptoms develops? A) Fruity breath odor B) Polyuria C) Blurred vision D) Shakiness

D) Shakiness Rationale: Sx of hypoglycemia include shakiness, hunger, headache, cold/clammy skin, pallor, palpitations, and LOC change. It can be treated with 15-20 grams of glucose. Sx of DKA include dehydration, electrolyte imbalance, and metabolic acidosis. Treatment includes fluid and electrolyte replacement and insulin.

A patient is receiving ferrous sulfate to treat iron-deficiency anemia. When reviewing the laboratory report, the healthcare provider notes the patient's reticulocyte count has increased. How should the healthcare provider interpret these findings? A) The ferrous sulfate dosage should be increased B) The ferrous sulfate dosage should be discontinued C) The patient is not responding to treatment D) The patient is beginning to recover from the anemia

D) The patient is beginning to recover from the anemia Rationale: Reticulocytes are immature RBCs. An increase in number indicates blood loss or anemia recovery.

Which statement would be correct for a patient with type 2 DM who was admitted to the hospital with pneumonia? A) The pt must receive insulin therapy to prevent ketoacidosis B) The pt has islet cell antibodies that have destroyed the pancreas-s ability to make insulin C) The pt has minimal or absent endogenous insulin secretion and required daily insulin injections D) The pt may have enough endogenous insulin to prevent ketosis but is ae risk for hyperosmolar hyperglycemia syndrome

D) The pt may have enough endogenous insulin to prevent ketosis but is ae risk for hyperosmolar hyperglycemia syndrome

Which of these would be most important to include in discharge teaching for a patient with a platelet count of 40,000 mcL? A) You may resume shaving with a straight edge razor B) You should take a multivitamin daily C) Be sure to take your aspirin with meals daily D) Use a soft toothbrush and floss gently

D) Use a soft toothbrush and floss gently Rationale: Normal limits for platelet count is 150,000-400,000 mcL. With thrombocytopenia, nursing care includes preventing injury that can cause bleeding and avoiding aspirin and garlic.

True or False: Hypertonic fluids, such as 3% saline, are the first line of treatment to correct dehydration in HHNS.

False Rationale: Isotonic (0.9% NS) solutions are usually the first-line treatment or the physician may order a hypotonic solution such 0.45% NS to replenish the dehydrated cell. ....this depends on the severity of dehydration. A 5% Dextrose 0.45% NS may be added when the glucose has reached 300 mg/dL, but is not first-line treatment. However, 3% Saline is never used.

True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am.

False Rationale: The Somogyi effect causes the patient to experience a DECREASE in their blood glucose during the hours of 2-3 am.