S3 U3 question
when should lispro be injected before meals
10 minutes
signs that iron deficiency has resolved
less fatigue and dyspnea increase in exercise tolerance
Felty Syndrome Triad
1. RA 2. Splenomegaly 3. Neutropenia - deficiency of neutrophils
Leukopenia is associated with what in RA
Abnormally low white blood cell count felty syndrome
NPH insulin
Humulin N, Novolin N intermediate-acting insulin, which has an onset of 1 to 2 hours;
Glargine (Lantus)
Long-acting insulin Onset 1 hour Peak (none) Duration 10-24 hours long-acting insulin, which has an onset of 1.5 hours;
Baker cyst
RA Accumulation of synovial fluid behind the knee
what does a tumor necrosis factor (TNF) inhibitor do
Reduction of inflammatory joint pain in a client with rheumatoid arthritis Tumor necrosis factor (TNF) is produced mainly by macrophages in synovium, resulting in inflammation of synovium, destruction of bone and cartilage, joint stiffness, and pain.
what medication can be given for a child that is anxious
SSRI
Golimumab (Simponi)
TNF inhibitor for RA adverse effects HTN, GI distress, infection
what is self induced starvation
anorexia nervosa
Sjogren's syndrome
destruction of lacrimal and minor salivary glands, often with RA, anti-SSA/SSB mucus glands are dry most common in advanced RA
S/S of anemia
pale,fatigue,shortness of breath
Refeeding syndrome
metabolic alterations that may occur during nutritional repletion of starved patients could lead to seizures
Late s/s of Rheumatoid Arthritis
- Deformities (e.g., swan neck or ulnar deviation) - Moderate-to-severe pain and morning stiffness - Osteoporosis - Severe fatigue - Anemia - Weight loss - Subcutaneous nodules - Peripheral neuropathy - Vasculitis - Pericarditis - Fibrotic lung disease - Sjogren syndrome - Kidney disease - Felty syndrome
Early s/s of Rheumatoid Arthritis
- Inflammation - Low-grade fever - Fatigue - Weakness - Anorexia - Paresthesias - inflammation
Which nursing intervention is appropriate to include in the plan of care for a client with diabetic ketoacidosis (DKA)? 1 Intravenous administration of regular insulin 2 Administer insulin glargine subcutaneously at hour of sleep 3 Maintain nothing prescribed orally (NPO) status 4 Intravenous administration of 10% dextrose
1 A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.
The nurse is monitoring the newborn of a diabetic mother for tremors, periods of apnea, cyanosis, and poor suckling ability. With which complication are these manifestations associated? 1 Hypoglycemia 2 Hypercalcemia 3 Central nervous system edema 4 Congenital depression of the islets of Langerhans
1 The pancreas of a fetus of a diabetic mother responds to the mother's hyperglycemia by secreting large amounts of insulin; this leads to hypoglycemia after birth. Hypoglycemic manifestations are tremors, periods of apnea, cyanosis, and poor suckling ability. Hypocalcemia, not hypercalcemia, occurs in hypoglycemia. Edema may be generalized in hypoglycemia, not specific to the central nervous system. In response to the increased glucose received from the mother, the islets of Langerhans in the fetus may become hypertrophied; these cells are not congenitally depressed.
The nurse is completing the health history of a client admitted to the hospital with osteoarthritis. Which joints would the nurse expect the client will report as having been involved first? Select all that apply. One, some, or all responses may be correct. 1 Hips 2 Knees 3 Ankles 4 Shoulders 5 Metacarpals
12 Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.
The client reports screaming hysterically whenever a spider comes close to her. Which defense mechanism is the client using? 1 Sublimation 2 Displacement 3 Repression 4 Introjection
2 The defense mechanism of displacement is related to phobias; displacement is the release of pent-up feelings onto something or someone else that is less threatening than the original source of the feelings. Sublimation is the channeling of unacceptable impulses into constructive acceptable behaviors. Repression is the unconscious process of blocking awareness of unacceptable ideas or impulses. Introjection is treating something outside the self as if it is inside the self. Sublimation, repression, and introjection are unrelated to phobias.
7.Which foods will the nurse recommend to a client with iron deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1 Grapes 2 Spinach 3 Oranges 4 Beef liver 5 Cantaloupe
24 Spinach and beef liver contain high amounts of iron. Grapes, oranges, and cantaloupe are low in iron.
The nurse is caring for a 15-year-old client who is undergoing chemotherapy for leukemia. Which would the nurse recognize that adolescents with health problems are most concerned about? 1 Missing time at school 2 Limiting social activities 3 Being dependent while enjoying the sick role 4 Feeling different regarding changes in body image
4 The 15-year-old is preoccupied with appearance. The side effects of the antineoplastics and prednisone may result in the adolescent feeling different, which affects body image. Although missing school may be a concern, it is typically not the primary concern. Although limitation of social activities is a concern, it is not the primary concern. Socialization can be facilitated. A 15-year-old enjoys and strives for independence and does not enjoy the sick role.
aspart is administered at 7 am. when should hypoglycemia signs be checked
9 am 1-3 h
what should you do if someone has multiple hypoglycemic episodes
only use finger tips for testing do not limit rapid insulin
long term rape-trauma syndrome
flashbacks, depression, suicidal thought
after-drop
_______ is a continued decrease in core body temperature after the victim is removed from the cold environment heating blankets can cause this because of the return of cold blood from the periphery to the central circulation
what is sublimation
channeling of unacceptable impulses into constructive acceptable behaviors.
what effect does y-hydroxybutyric acid have
euphoria, N/V, hypotonia, resp depression rape drug
Insulin Detemir (Levemir)
long acting insulin
what nutritional deficiency can cause decreased pigment in hair
protein
what effect does ketamine have
rape drug dream like state and analgesia drooling hallucinations shprtest duration of 30-60 min
what effect does flunitrazepam have
rape drug n/v, respiratory depression, not euphoria and hypotonia
Insulin Aspart (Novolog)
rapid acting insulin
Insulin Aspart (Novolog)
rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs.
acute rape-trauma syndrome
shock, numb, hysteria,
what happens when water is aspirated into the lungs of a drowning person
sufactant washes out of the lungs causing increased airway resistance and increased RR
what is introjection
treating something outside the self as if it is inside the self.
The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia? 1 It liberates glucose from hepatic stores of glycogen. 2 It provides a glucose source that is rapidly absorbed. 3 Insulin action is blocked as it competes for tissue sites. 4 Glycogen is supplied to the brain as well as other vital organs.
2 The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon. It is a medication that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.
Regular insulin (Humulin R, Novolin R)
Short-acting insulin ☐ Administer 30 to 60 min before meals to control postprandial hyperglycemia.
Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? 1 Glargine 2 NPH insulin 3 Insulin aspart
3 Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.
10.A client with type 1 diabetes mellitus has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. Which would the nurse do? 1 Call the health care provider. 2 Encourage intake of fluids. 3 Administer the insulin as prescribed. 4 Give the client 4 ounces of orange juice
3 A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6-5.6 mmol/L); the nurse would administer the regular insulin as prescribed.
The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia would the nurse assess the newborn? Select all that apply. One, some, or all responses may be correct. 1 Pallor 2 Irritability 3 Hypotonia 4 Ineffective suckling 5 Excessive birth weight
1234 An inadequate amount of cerebral glucose causes irritability and restlessness. Hypoglycemia affects the central and peripheral nervous systems, resulting in hypotonia. Feeding difficulties such as ineffective suckling can result from hypoglycemic effects on the fetal central nervous system. Hypoglycemia also causes cyanosis or pallor in the newborn. Excessive birth weight is common among neonates whose mothers have diabetes, but this does not indicate hypoglycemia.
A newborn is admitted to the nursery and classified as small for gestational age (SGA). Which is the priority nursing intervention for this infant? 1 Testing the infant's stools for occult blood 2 Monitoring the infant's blood glucose level 3 Placing the infant in the Trendelenburg position 4 Comparing the infant's head circumference and chest circumference
2 SGA infants are prone to hypoglycemia, because they have little subcutaneous fat or glycogen stores; monitoring blood glucose level is a priority. Occult blood would indicate Intestinal bleeding, which is not common in SGA infants. Placing an SGA infant in the Trendelenburg position is of no therapeutic value. Hydrocephalus or microcephaly is not a characteristic of SGA infants; monitoring head and chest circumference is not a priority.
Which action would the nurse take to minimize psychological stress in an anxious client who has been admitted to the psychiatric unit? 1 Explain in detail the therapies being used. 2 Learn what is of particular importance to the client. 3 Advise the client that the nurse is in charge of the client's situation. 4 Avoid the discussion of any areas that may be emotionally charged.
2 The nurse would learn what is of particular importance to the client. Providing support, understanding, and acceptance of feelings that the client is experiencing is essential for reducing stress. Explaining in detail the therapies being used most likely will have the effect of increasing the client's anxiety. Advising the client that the nurse is in charge of the client's situation is an authoritarian approach. The psychiatric unit provides the client with a safe, accepting environment in which to face problems and discuss emotionally charged areas.
The nurse watches as a new mother timidly approaches her critically ill preterm son for the first time in the neonatal intensive care unit. Which statement by the nurse would best foster the bonding process between the mother and her baby? 1 "I'll teach you how to take care of him." 2 "He'll gain weight gradually, and it won't be long until he'll start to look better." 3 "I know it's hard for you to see him like this, hooked up to so many machines, and you don't know what to expect." 4 "Many mothers are shocked when they first see their babies; you'll see him grow."
3 Focusing on the client's feelings permits her to work through her fears, which she must do before she can focus on her son and his care. Telling the mother that she will be taught how to take care of the infant does not address the client's feelings at the moment. Telling the client that the infant will gain weight and look better gradually or that that she will see her baby grow is false reassurance; the focus should be on the mother's feelings at this time, not her infant's future.
