The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?
a.
The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin
b.
The patient with a pulse of 60 beats per minute who is about to receive digoxin (Lanoxin)
c.
The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
d.
The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group’s understanding, the nurse asks, “Which sign, and symptoms would NOT be consistent with ketoacidosis?” The group gives which correct answer?
a.
Blood glucose level of 600 mg/dL
b.
Ketones in the urine
c.
Serum Acidosis
d.
Blood glucose level of 60 mg/dL
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug?
a.
Approximately 15 to 30 minutes before each meal
b.
In the morning and at 4 PM
c.
Once daily at bedtime
d.
Before meals and as neceessary
Give Regular insulin by continuous I.V. infusion at 20 units/hr. The solution is 250 mL NS with 100 units of Regular insulin. What rate on the infusion pump will deliver the correct dose?
Group of answer choices
5 ML/HR
8 ML/HR
100 ML/HR
50 ML/HR
The nurse is caring for a critically ill client who has diabetic ketoacidosis (DKA). The nurse finds the following assessment data: blood pressure, 90/62; pulse, 120 beats/min; respirations, 28 breaths/min; urine output, 20 mL/1 hour per catheter; serum potassium, 2.6 mEq/L. The health care provider orders a 40 mEq potassium bolus and an increase in the IV flow rate. Which action by the nurse is most appropriate?
a.
Give the potassium after increasing the IV flow rate.
b.
Increase the IV rate; consult the provider about the potassium.
.c
d
Increase the IV rate; hold the potassium for now.
potassium first before increasing the IV flow rate
A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 a.m. The nurse expects that a hypoglycemic reaction is most likely to occur between
a.
0800 and 1000.
b.
1600 and 1800.
c.
1900 and 2100.
d.
2200 and 2400.
When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says
a.
“I need to maintain a sodium-restricted diet at home.”
b.
“I should weigh myself daily and report a sudden loss or gain.”
c.
“I need to limit my fluid intake to no more than 1 quart of liquids a day.”
D. “I will eat foods high in potassium because the diuretics cause potassium loss.”
A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find includes
a.
hypotension.
b.
decreased axillary and pubic hair.
c.
purplish red striae on the abdomen.
d.
bronzed hyperpigmentation of the skin.
A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing. During an attack, the nurse would expect the patient to experience
a.
persistent hypoglycemia.
b.
severe bradycardia refractory to drug therapy.
c.
severe hypotension with sympathoadrenal blockade.
d.
severe pounding headache, tachycardia, and profuse sweating.
hyperthyroid patient arrives in the emergency department with a heart rate of 150 beats per minute and a temperature of 105° F. The patient’s skin feels hot and moist. The nurse caring for this patient will expect to administer:
a.
intravenous levothyroxine.
b.
iodine-131 (131I).
c.
methimazole (Tapazole).
d.
propylthiouracil (PTU).
A 36 year-old male patient is admitted for observation after a motor vehicle accident (MVA). He is suspected to have a head injury but has been physiologically stable. The nurse would suspect Diabetes Insipidus if he displays which of the following?
Blood glucose of 135 mg/dl
Increased urinary output
Decreased urinary output
Blood glucose of 445 mg/dl
A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching?
a.
“I should not take heartburn medication without consulting my provider.”
b.
“I should report insomnia, tremors, and an increased heart rate to my provider.”
c.
“If I take a multivitamin with iron, I should take it 4 hours after the Synthroid.”
d.
“If I take calcium supplements, I may need to decrease my dose of Synthroid.”
A diagnosis of hyperglycemic hyperosmolar nonketotic coma is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse anticipates that initial treatment of the patient will include
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 carbohydrate.
The nurse determines that which arterial blood gas values are consistent with effective correctio of ketoacidosis in the client with diabetes?
a.
pH 7.36, HCO3- 22 mEq/L, PCO2 46 mm Hg, PO2 98 mm Hg
b.
pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg
c.
pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg
d.
pH 7.28, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg
A Type I client on an intensified insulin regimen consistently has a fasting blood glucose level between 190 and 210 mg/dL, a postprandial blood glucose level above 280 mg/dL, and a hemoglobin A1c level of 7.5%. Which is the nurse’s interpretation of these findings?
a.
Increased risk for developing ketoacidosis
b.
Increased risk for developing hyperosmolar non-ketonic hyperglycemia
c.
Signs of insulin resistance
d.
Good control of blood glucose
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. When preparing the one injection, the sequence should be?
a.
These two forms of insulin should include regular insulin is drawn up first and then NPH. .
b.
These two forms of insulin should include NPH insulin is drawn up first and then regular insulin.
c.
Mixing these two forms of insulin are not compatibles and cannot be mixed
d.
NPH insulin should only be mixed with insulin glargine.
A patient with arthritis is admitted to the hospital. The patient’s serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient’s face appears rounded and puffy. The patient complains of feeling weak. What will the nurse do?
a.
Ask which drugs the patient takes for arthritis.
b.
Contact the provider to discuss whether the patient has a pituitary carcinoma.
c.
Request an order for ketoconazole (Nizoral).
D. Suspect that this patient has Addison’s disease.
A patient with arthritis is admitted to the hospital. The patient’s serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient’s face appears rounded and puffy. The patient complains of feeling weak. What will the nurse do?
a.
Ask which drugs the patient takes for arthritis.
b.
Contact the provider to discuss whether the patient has a pituitary carcinoma.
c.
Request an order for ketoconazole (Nizoral).
D. Suspect that this patient has Addison’s disease.
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include?
a.
Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis
b.
Cranial nerve testing for peripheral neuropathy
c.
Pedal pulse palpation for arterial insufficiency
d.
Auscultation of the carotids for bruits associated with atherosclerosis
The nurse is providing patient education to a patient who will begin taking fludrocortisone (Florinef) as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching?
a.
“I should move from sitting to standing slowly.”
b.
“I should report any swelling of my hands and feet.”
c.
“I should report weight loss to my provider.”
d.
“I should report excessive urine output.”
