Practice questions for exam 3

The glycosylated hemoglobin (A1C) test shows the overall control of glucose over ______ days.

60-120 days.

The bruit, or "thrill," over the venous access site must be evaluated at least every _______

8 hours

A type 1 diabetic with Ketones in the urine signals? Withholding insulin or eating more carbohydrate in this patient results in?

A type 1 diabetic with ketones in their urine could be in a period of diabetic ketoacidosis, where the body is breaking down fat stores for energy, flooding the urine with ketones. In this situation the body does not have enough insulin to get sugar into the cells, so they are hyperglycemic but are not getting energy from the glucose. Withholding insulin or eating more carbohydrates can result in a worsening of the problem, where the patient is becoming more and more hyperglycemic.

What is the Emergency treatment for a type 1 diabetic with decreased LOC and a finger stick glucose level of 39 mg/dL

Administering 1 ampule of 50% dextrose solution, per physician's order. This intervention should bring the patient's blood sugar back up adequately.

Detemir (Levemir)

Basal (background insulin). Used to manage glucose between meals and overnight. Onset: 0.8 - 4 hours Steady release with no peak action Duration 16 - 24 hours

Glargine (Lantus)

Basal (background insulin). Used to manage glucose between meals and overnight. Administered once or twice a day - not to be mixed with other insulins. Onset: 0.8 - 4 hours Steady release with no peak action Duration 16 - 24 hours

What is most important for the nurse to teach the patient with diabetes mellitus about Beta Blockers?

Beta blockers mask the signs of hypoglycemia because they negate the normal physiological manifestations of hypoglycemia. Normally, someone who is hypoglycemic will release norepinephrine, causing tachycardia, tremors, and diaphoresis. Beta blockers can block these manifestations, negating the tachycardia, tremors, and diaphoresis. A person on beta blockers may not know that they are hypoglycemic because their normal manifestations may not present.

What is the Rule of 15?

Consume 15g of carbohydrates (4 to 6 oz of fruit juice or regular soft drinks), recheck glucose levels in 15 minutes, then repeat if still under 70 mg/dL. Avoid foods with fat, which decrease the absorption of sugar. Avoid over treatment (too much glucose). After recovery, give complex CHO and protein.

An elevated calcium level is not a complication of osteoporosis True or False

False

Estrogen deficiencies result from osteoporosis, not menopause True or False

False

Levemir is a basal insulin and can be given for immediate effect of blood glucose levels? True or False

False

Urine glucose testing is an accurate reflection of blood glucose level and reflects the glucose over a prolonged time. True or False

False

Calcitonin is considered to be a dietary nutrient. True or False

False - This is a hormone secreted by the thyroid that has the effect of lowering blood calcium. The 6 dietary nutrients are carbohydrates, lipids, proteins, water, vitamins, and minerals.

Fasting plasma glucose of 120mg/dL (6.7mmol/L) is interpreted as?

Fasting blood glucose between 100 and 125 mg/dL is interpreted as prediabetes

A patient taking metformin (Glucophage) to manage type 2 DM and also prednisone for a skin rash may experience_________________________

Hyperglycemia. This may need to be managed with insulin or higher metformin levels. Prednisone is a glucocorticoid which raises blood glucose levels.

Why are newly diagnosed diabetics instructed to have a fast-acting sugar source on hand?

In case of acute hypoglycemia a diabetes patient can quickly raise their blood sugar. Newly diagnosed diabetics are more likely to have inadequate blood sugar control.

Individuals who are at high risk of osteomyelitis include:

Indirect entry: Most common in growing bones of young boys. Also happens with adults with genitourinary and respiratory tract infections with vascular insufficiency disorders (chance of infection spreading from primary infection to blood of the bone. Direct entry: Can occur when an open wound (penetrating wounds or fractures) allow microorganisms to enter the body. Can be related to foreign bodies or implants in the body. Osteomyelitis more commonly affects people younger than 20, or adults older than 50 years of age. While there is a higher incidence of bone infections in adults that live in developing countries, hemodialysis patients, injection drug users, and patients with diabetes are also more susceptible to this infection. Risk factors for developing osteomyelitis include a weakened immune system due to a medical condition or medications, cancer, chronic steroid (cortisone) use, sickle cell disease, human immunodeficiency virus (HIV), diabetes, hemodialysis, intravenous drug users, infants, and the elderly.

NPH (Humulin N)

Intermediate acting. Can be mixed with short and rapid acting insulins. Cloudy. Onset: 1.5 - 4 hours Peak 4 - 12 hours Duration: 12 - 18 hours

Patients undergoing surgery or any radiologic procedures that involve the use of contrast are usually instructed to temporarily discontinue metformin a day or two before surgery or the procedure. Why? a. They can resume metformin immediately True or False

Metformin is held one to two days before IV contrast media is given and for 48 hours after the procedure. Contrast medium can slow down how quickly your kidneys work. This can cause a build-up of metformin in your body and cause lactic acidosis. a. False

Sciatica nerve pain travels:

Pain in low back radiates to buttock and leg as a result of irritation of the nerve root

What are the cardinal symptoms of diabetes?

Polyuria, polydipsia, polyphagia

Lispro (Humalog)

Rapid acting insulin. Injected within 15 minutes of mealtime Onset: 10-30 minutes Peaks: 30 minutes - 3 hours Duration: 3 - 5 hours

Aspart (Novolog)

Rapid acting. Injected within 15 minutes of mealtime Onset: 10-30 minutes Peaks: 30 minutes - 3 hours Duration: 3 - 5 hours

Glyburide belongs to a class of medications called_______. It acts by ______________________

Sulfonylureas. Sulfonylureas stimulate the release of insulin from pancreatic islets and enhance cellular sensitivity to insulin.

Why do patients with Type 1 diabetes experience weight loss?

The bodies of patients with type 1 diabetes fail to adequately usher glucose into their cells. As a result, the blood sugar generated by eating goes unused, and the body breaks down glycogen/protein/fat stores instead for energy. The patient then will lose weight as a result until they get adequate exogenous insulin levels.

Patient teaching for type 2 diabetes and sensory neuropathy of the legs and feet includes__________________________________________________________________

They have a loss of sensation, leading to problems with feet that can go undetected. They also have an increased risk of infection, so wounds occur on feet which don't heal and develop infection. Foot care should involve inspecting daily, avoiding going barefoot, proper footwear, and knowing how to treat cuts. Skin and nail care should happen daily. Small problems should be promptly treated.

Acetaminophen and non-steroidal anti-inflammatory drugs are helpful for some patients in treating OA True or False

True

Bisphosphonates such as alendronate increase bone mass and decrease bone loss by inhibiting osteoclast function. These drugs do not treat infection, pain, or tumors True or False

True

Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 5 hours per treatment? True or False

True

Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake: 50% to 60% of calories come from carbohydrates, 20% to 30 True or False

True

For SLE the classic butterfly rash over the cheeks and bridge of the nose occurs in 55% to 85% of patients at some time during the disease. True or False

True

For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control True or False

True

If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate. True or False

True

Methotrexate is a Disease-modifying antirheumatic drug (DMARDs) prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. It is important to start DMARDs as quickly as possible. True or False

True

Meticulous foot care can help mitigate the risk of osteomyelitis True or False

True

OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting True or False

True

Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control after diabetes has been diagnosed True or False

True

Osteomyelitis, osteoporosis, and Paget disease do not involve the development of excess bone tissue. True or False

True

Patients with SLE should avoid fatigue by balancing exercise with rest periods as needed True or False

True

Rheumatoid arthritis is an autoimmune disorder and related to osteoporosis True or False

True

S. Aureus causes over 50% of bone infections. Proteus, Pseudomonas, and E. coli are also causes, but to a lesser extent. True or False

True

Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. True or False

True

The first sign of peritonitis in a client receiving CAPD is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted True or False

True

The primary action of metformin is to reduce glucose production by the liver. It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cells. Additionally, it has beneficial effects on plasma lipids. True or False

True

Hypoglycemia (low blood glucose) is most likely to occur during insulin peak action times. True or False When the effect of insulin is _______________

True at its highest/peak

For patients with ESKD restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. True or False Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur True or False Sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation True or False

True True True

Intake of vitamin B12 and sodium directly influence the risk for osteoporosis True or False

True - High sodium intake can weaken bones and cause osteoporosis. Increased vitamin B12 levels can help patients manage or prevent osteoporosis.

Which statement by the patient with type 2 diabetes 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 blood 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."

The percentage of daily calories for a healthy person consists of a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.

a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.

Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine e. A 28-yr-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb

a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mmHg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

a. A1C 9%

For which of the following medication will the nurse give the following instructions: Take with a full 8-ounce glass of water, take 30 min before food or other medications, and remain upright for at least 30 min after taking the medication a. Bisphosphonates b. Calcitonin c. Aspirin d. Vitamin D

a. Bisphosphonates

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. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

a. Insulin administration d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

A patient is scheduled to receive Humalog (Lispro) during lunchtime. Which of the following action by the nurse is most important? a. Make sure the patient eats within 10-15 minutes after the insulin is administered b. Make sure the patient eats a high carbohydrate meal because Humalog is a basal insulin c. Make sure the patient eats within 1.5 hour after administering the insulin

a. Make sure the patient eats within 10-15 minutes after the insulin is administered

Which of the menu choice would the nurse instruct a patient with osteoporosis to select and why? a. Oatmeal, skim milk, fruit yogurt b. Pancake with syrup and bacon c. Egg white omelet and half grapefruit d. Whole wheat toast and fresh fruit

a. Oatmeal, skim milk, fruit yogurt - contains calcium, unlike the other options

What is the best way to assess the patient's ability to prepare and self-administer insulin after discharge from the hospital? a. Observe the patient drawing up and administering insulin b. Ask the patient to describe the process of administering insulin c. Provide a health education session reviewing the main points of insulin delivery

a. Observe the patient drawing up and administering insulin

Which finding should alert the nurse to contact the HCP before administering Metformin (Glucophage) a. Serum creatinine has increased from 1.0 to 2.2mg/dL b. Blood glucose level is 114mg/dL c. The patient has gained 2lb (0.9kg)

a. Serum creatinine has increased from 1.0 to 2.2mg/dL

Teach the patient with fibromyalgia the importance of limiting intake of which foods? (select all that apply) a. Sugar b. Alcohol c. Caffeine d. Red meat e. Root vegetables

a. Sugar b. Alcohol c. Caffeine

Which are appropriate therapies for patients with diabetes? (select all that apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

a. Use of statins to reduce CVD risk c. Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy

Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate

a. X-ray

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.

a. hypokalemia. d. hypomagnesemia. e. hypophosphatemia.

A patient who has had surgical correction of bilateral hallux valgus is being discharged from the same-day surgery unit. The nurse will teach the patient to a. rest frequently with the feet elevated. b. wear shoes continually except when bathing. c. soak the feet in warm water several times a day. d. expect the feet to be numb for the next few days.

a. rest frequently with the feet elevated.

A patient with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply) a. "Oral or IV antibiotics are not effective in most cases of bone infection." b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection." d. "This is the safest method to deliver long-term antibiotic therapy for bone infection." e. "Ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics."

b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection."

A patient with osteosarcoma of the humerus shows understanding of his treatment options when he states a. "I accept that I have to lose my arm with surgery." b. "The chemotherapy before surgery will shrink the tumor." c. "This tumor is related to the melanoma I had 3 years ago." d. "I'm glad they can take out the cancer with such a small scar."

b. "The chemotherapy before surgery will shrink the tumor."

A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

b. 5% dextrose solution.

When administering medications to the patient with chronic gout, the nurse recognizes which drug is used as a treatment for this disease? a. Colchicine b. Allopurinol c. Sulfasalazine d. Cyclosporine

b. Allopurinol

What is most important to include in the teaching plan for a patient with osteopenia? a. Lose weight. b. Stop smoking. c. Eat a high-protein diet. d. Start swimming for exercise.

b. Stop smoking.

In caring for a patient after a spinal fusion, the nurse would report which finding to the health care provider? a. The patient has a single episode of emesis. b. The patient is unable to move the lower extremities. c. The patient is nauseated and has not voided in 4 hours. d. The patient reports of pain at the bone graft donor site.

b. The patient is unable to move the lower extremities.

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 of excess glucose to hemoglobin.

b. fluid shifts resulting from the osmotic effect of hyperglycemia.

Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. skeletal protein b. glycogen c. visceral protein d. fat stores

b. glycogen a. skeletal protein c. visceral protein d. fat stores

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the PIP joints. c. are the result of pannus formation at the DIP joints. d. occur from deterioration of cartilage by proteolytic enzymes.

b. indicate osteophyte formation at the PIP joints.

A patient with rheumatoid arthritis has articular involvement. The nurse recognizes these characteristic changes include (select all that apply) a. bamboo-shaped fingers. b. metatarsal head dislocation in feet. c. noninflammatory pain in large joints. d. asymmetric involvement of small joints. e. morning stiffness lasting 60 minutes or more.

b. metatarsal head dislocation in feet. e. morning stiffness lasting 60 minutes or more.

The nurse should teach the patient with ankylosing spondylitis the importance of a. avoiding extremes in environmental temperatures b. regularly exercising and maintaining proper posture. c. maintaining patient's usual physical activity during flares. d. applying hot and cool compresses for relief of local symptoms.

b. regularly exercising and maintaining proper posture.

In teaching a patient with Sjögren's syndrome about drug therapy for this disorder, the nurse includes instruction about the use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis)

Methotrexate (Rheumatrex) is the preferred drug for early treatment for Rheumatoid Arthritis (RA). This drug belongs to the class of medication that slows the disease progression and has lower risk of toxicity. Select the class for this drug. a. Bisphosphonates b. Steroids c. Disease -modifying antirheumatic drugs (DMARDS)

c. Disease -modifying antirheumatic drugs (DMARDS)

Which lab result support the diagnosis of diabetes? a. Glucose tolerance test less than 116 mg/dL b. Fasting blood glucose less than 100 mg/dL c. Fasting plasma glucose greater than or equal to 126 mg/dL

c. Fasting plasma glucose greater than or equal to 126 mg/dL

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

c. rapid, deep respirations.

Chronic condition is defined as____________________________

conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

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.

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.

A patient with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days. b. teach principles of back strengthening exercises. c. stress the importance of straight-leg raises to decrease pain. d. promote use of cold and hot compresses and pain medication.

d. promote use of cold and hot compresses and pain medication.

A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. reports episodes of nightly nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

d. reports an unintentional weight loss of 10 lb in 2 months.

In teaching a patient with systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. d. the production of a variety of autoantibodies directed against components of the cell nucleus.

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

Stages of chronic kidney disease are based on the ______________

eGFR results. Stage 1: 90 or higher Stage 2: 60-89 Stage 3a: 45-59 Stage 3b: 30-44 Stage 4: 15-29 Stage 5: Less than 15

A diet rich in calcium and vitamin D protects against

osteoporosis

A fasting blood level indicates only the glucose level at _________ time. A patient must wait 8 hours after eating for a fasting blood level.

preprandial

Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the ________________ a. The thigh, buttock, and arm are all exercised by riding a bicycle. True or False

rate of absorption, possibly causing hypoglycemia True

If the Somogyi effect is causing the patient's increased morning glucose level, the patient will experience_______________________________________ a. The dose of insulin will be increased True or False b. Bedtime snacks prevent hypoglycemic episodes during the night True or False

rebound hyperglycemia following night time hypoglycemia between 2 - 4am. In order to treat, reduce insulin dosage at night or add a bedtime snack. Goal is to raise night time glucose levels. a. False b. True