acute/chronic exam 2- practice questions

Which patient is of highest priority for the nurse? a) A patient with hyperglycemia. b) A patient with hypoglycemia.

b

What is the priority action for a patient with signs and symptoms of hypoglycemia? a) Call the HCP for orders b) Check the blood glucose level c) Have the patient sit or lie down at once d) Start an IV and give D50

b

The RN observes that a patient with DM returning from X-ray c/o HA, is angry about missing breakfast, and has moist hands. What is the nurse’s priority action? a) Acknowledge his dissatisfaction. b) Administer PRN acetaminophen. c) Call for a snack tray. d) Check the BG level.

d

Your patient is unresponsive and sweaty. His blood glucose is 40. In which position should this patient be placed? a) Head of bed flat, feet elevated b) High Fowlers c) Side-lying d) Supine

c

Your patient is unresponsive and sweaty. His blood glucose is 40. Which nursing diagnosis has highest priority? a) Aspiration, risk for b) Falls, risk for c) Imbalanced nutrition, less than, risk for d) Imbalanced nutrition, more than, risk for

1

A patient with DM is found unconscious at home and a family member calls the clinic. After determining a glucometer is not available, what should the nurse advise them to do? a) Administer 10 units regular insulin subQ. b) Administer glucagon 1 mg IM or subQ. c) Call 911 to transport the patient to the ER. d) Have the patient drink some orange juice.

b

After teaching foot care to a patient with DM, the nurse determines that additional instruction is needed when the patient makes which statement? a) “I should wash my feet daily with soap and warm water.” b) “I should always wear shoes to protect my feet from injury.” c) “If my feet are cold, I should wear socks instead of using a heating pad.” d) “I’ll know if I have sores on my feet because they will be painful.”

4

A patient who is newly diagnosed with Type 1 DM. What nursing diagnosis is least appropriate for this patient? a) Imbalanced nutrition: more than body requirements. b) Risk for injury: hypoglycemia. c) Risk for infection. d) Knowledge deficit.

a

The patient received 5 units of regular and 30 units of NPH @ 0730. When is he at highest risk for a hypoglycemic reaction? Breakfast: 0800 Lunch: 1200 Supper: 1800 a) After breakfast (0930 – 1030) b) After lunch (1330 – 1530) c) After supper (1900 – 2100) d) Bedtime (2200 – 2400)

b

The patient received 5 units of regular and 30 units of NPH @ 0730. When will the insulin first begin to work? a) 15 minutes b) 30 minutes c) 2 hours d) 4 hours

b

A patient with Type 2 DM is hospitalized for pneumonia and placed on prednisone and insulin on a sliding scale. She states “I’ve never taken insulin before!” What is the best response of the nurse? a) “Prednisone may increase your BG levels.” b) “The doctor ordered it for you.” c) “You now have Type 1 diabetes from stress.” d) “You now must take insulin daily.”

a

A patient on metformin is scheduled for an angiogram using contrast dye the day after tomorrow. Which is appropriate? a) Give the metformin tomorrow morning, give it with a sip of water the day of the test, and continue the metformin the day after the procedure. b) Give the metformin tomorrow morning, hold the metformin the day of the test, then restart the metformin the day after the procedure. c) Hold the metformin tomorrow morning and the day of the test, then continue the metformin two days after the procedure.

c

A patient is having signs of hypoglycemia. Place the nurse’s actions in the correct order. 1) Wait 15 min and check BG a second time. 2) If BG is < 70 mg/dL, give ½ cup fruit juice. 3) Recheck BG for a 3rd time in another 15 min. 4) Obtain a fingerstick BG reading. 5) Assess for S/S (sweating, tremors, altered MS). 6) Repeat rapid-acting glucose if BG < 70 mg/dL. 7) Once BG has returned to at least 80 mg/dl, give a more substantial snack (cheese & crackers).

5, 4, 2, 1, 6, 3, 7

A patient with DM is brought to the ER by family because he has had the flu, seems more tired than usual, and does not seem himself. Place the nurse’s actions in the correct order. 1) Establish IV access. 2) Check blood glucose. 3) Ensure patient airway. 4) Begin continuous regular insulin drip. 5) Administer 0.9% NS solution at 1 L/hr.

3, 2, 1, 5, 4

The nurse teaches a patient with prediabetes ways to prevent or delay the development of Type 2 DM. What information should be included? Select all that apply. a) Assess for visual changes each month. b) Exercise regularly. c) Have BP checked regularly. d) Maintain a healthy weight. e) Monitor for polyuria, polyphagia, & polydipsia.

b, d, e

Lispro insulin (Humalog) with NPH (Humulin N) is ordered for a patient with newly diagnosed Type 1 DM. When should the nurse administer lispro insulin? a) Once a day, before breakfast. b) 1 hour before meals. c) 30 – 45 minutes before meals. d) At mealtime or within 15 minutes of meals.

4

Which of the following interventions can the RN delegate to the unlicensed assistive personnel (UAP)? a) Check that the bath water is not too hot. b) Check the patient’s technique for drawing up insulin. c) Discuss complications of diabetes. d) Teach the patient to use a meter for self-monitoring of blood glucose.

a

The home health nurse must intervene to correct a patient whose insulin administration includes which action? a) Mixing an evening dose of regular insulin with insulin glargine in 1 syringe for administration. b) Storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c) Placing the insulin bottle currently in use in a small container on the bathroom countertop. d) Warming a prefilled refrigerated syringe in the hands before administration.

a

When teaching the patient with Type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a) Complications of insulin therapy are prevented. b) Errors in insulin dosing are less likely to occur. c) Frequent blood glucose monitoring is unnecessary. d) Tight glycemic control can be maintained.

d

The patient taking insulin records BG levels > 200 on awakening for the last 5 mornings. What should the nurse have the patient do first? a) Decrease the evening insulin dosage to prevent nighttime hypoglycemia and the Somogyi effect. b) Increase the evening insulin dose to prevent the Dawn phenomenon. c) Monitor BG at bedtime, between 0200 and 0400, and on arising. d) Use a single-dose insulin regimen with an intermediate-acting insulin.

c

The nurse assesses a newly admitted patient with DM. Which observation should be addressed as the priority by the nurse? a) Areas of lumps and dents on the abdomen. b) Bilateral numbness of both hands. c) Rapid respirations with deep inspiration. d) Stage II pressure injury on the right heel.

c

A patient with DM calls the clinic because she has nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a) Administer the usual insulin dosage. b) Hold fluid intake until the nausea subsides. c) Come to the clinic immediately for evaluation and treatment. d) Monitor BG every 1 – 2 hours and call if it rises > 150.

a

A patient with Type 1 DM is NPO for surgery this AM. He takes 10 units NPH and 19 units of glargine daily, and needs 4 units of regular insulin (BG = 244) this AM. Insulin orders are to be clarified with the HCP. Which interventions are most likely? Select all that apply. a) Give 4 units regular insulin. b) Hold the 4 units regular insulin. c) Give 10 units NPH insulin. d) Hold the 10 units NPH insulin. e) Hold the 19 units glargine insulin tonight.

a, d

interpret the ABG pH 7.38 pCO2 58 HCO3 31

Resp Acidosis Compensated

interpret the ABG pH 7.51 pCO2 40 HCO3 30

Metabolic Alkalosis- uncompensated

interpret the ABG pH 7.40 pCO2 40 HCO3 23

Normal

interpret the ABG pH 7.48 pCO2 30 HCO3 22

Resp Alkalosis- uncompensated

interpret the ABG pH 7.62 pCO2 48 HCO3 30

Metabolic Alkalosis- partially compensated

interpret the ABG pH 7.30 pCO2 60 HCO3 28

Resp. Acidosis- Partially Compensated

Which findings represent greatest risk for pressure ulcer development?

Limited mobility Moisture due to incontinence Risk for fluid volume deficit

stage the pressure ulcer: Non blanching reddened area on heel

stage 1

stage the pressure ulcer: Deep crater with undermining of tissue

stage 3

stage the pressure ulcer: Leathery scab

unstageable

stage the pressure ulcer: Blister on elbow

stage 2

stage the pressure ulcer: Bone visible, purulent discharge

stage 4

Which diagnostic test is most relevant for assessing the risk of developing a pressure ulcer for a 73 year old patient with no major health issues? A. Serum albumin B. White blood cells C. Red blood cells D. Serum potassium

a

Which is the most appropriate nursing intervention for a patient at risk for developing a pressure ulcer? A. Massaging directly over the red area B. Positioning the HOB at 45 degrees to improve circulation C. Using hot soapy water to clean bowel/bladder incontinence D. Repositioning a bedfast patient q2h

d

Which factors may negatively impact wound healing? Select all that apply. a) Family history of pressure ulcers b) Type 2 diabetes mellitus c) Strict vegetarian d) Cigarette smoker e) Long-term use of glucocorticosteroids

b, c, d, e

A patient presents to an outpatient clinic with night sweats and fatigue; nausea, abd pain, diarrhea and a cough. His temperature is 100.6 F. He states he is afraid he has HIV. If the patient has HIV, which stage of infection is he experiencing?

Late chronic/ AIDS

what are the signs and symptoms of rheumatoid arthritis

joint tenderness and swelling nodules in joints

Prioritize nursing diagnoses for a patient with exacerbated rheumatoid arthritis in order 1) Disturbed body image 2) Risk for injury 3) Impaired physical mobility 4) Pain: Chronic 5) Deficient knowledge

2, 3, 4, 5, 1

You are caring for a 32 yr old female with an exacerbation of SLE. She presents with c/o fatigue, joint tenderness, and anorexia. A physical exam reveals: swollen knees, an elevated temperature of 100.8, BP of 152/90, and the medical record notes that renal impairment is suspected. Which abnormal lab findings should you expect? Select all that apply. a) Positive ANA b) Elevated K+ c) 2+ urine protein d) Increased hemoglobin e) Decreased WBC count f) Elevated BUN g) Increased hematocrit h) Decreased serum complement

a, b, c, e, f, h

The patient will be discharged on prednisone (Deltasone) until symptoms improve. Which side effects of this medication will you include in your discharge teaching? Select all that apply. a) Orthostatic hypotension b) Weight gain c) Loss of appetite d) Buffalo hump e) Moon face f) Abdominal striae g) Hair loss h) Elevated blood glucose

b, d, e, f, g, h

Which medication will the nurse teach a patient with asthma to use when experiencing an acute asthma attack? a. albuterol (Ventolin), a SABA b. salmeterol (Serevent), a LABA c. theophylline (Theo-Dur), a xanthine derivative d. montelukast (Singulair), an LRA

1

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situations? Select all that apply. 1. Tachypnea 2. Cardiac arrest 3. Angina 4. Severe hypertension 5. Bradycardia 6. Anaphylaxis

2, 5, 6

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a) Epinephrine b) Ephedra c) Phenylephrine d) Pseudoephedrine

a

The nurse is preparing to administer medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, “Why do I have to take so many different drugs?” Which responses by the nurse are correct? Select all that apply. 1. “Multiple drugs work in different ways to attack the bacteria.” 2. “Taking multiple drugs reduces the chance that tuberculosis will become drug resistant.” 3. “Using more than one drug can help to reduce side effects.” 4. “Using multiple drugs enhances the effect of each drug.” 5. “You can take lower doses of each drug and they will still be effective.”

1, 2, 3, 5

The nurse is providing patient teaching for a patient who is starting anti-tubercular drug therapy. Which of these statements should be included? Select all that apply. 1. “Take the medications until the symptoms disappear.” 2. “Take the medications at the same time every day.” 3. “You are considered contagious all throughout your illness.” 4. “Stop taking the medications if you have severe adverse effects.” 5. “Avoid alcoholic beverages while on this therapy.” 6. “If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your HCP right away.” 7. “If you experience a burning or tingling in your fingers or toes, report it to your HCP immediately.” 8. “Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.”

2, 5, 7, 8

The nurse will assess the patient for which potential contraindication to anti-tubercular therapy? a) Glaucoma b) Anemia c) Heart failure d) Hepatic impairment

d

Which statement indicates the patient with asthma requires further teaching about self-care? a) “I use my corticosteroid inhaler when I feel short of breath.” b) “I get a flu shot every year and see my HCP if I have an upper respiratory tract infection.” c) “I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies.” d) “I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath.”

a

The plan of care for the patient with chronic obstructive pulmonary disease (COPD) should include which interventions? Select all that apply. 1. exercise such as walking. 2. high flow rate of O2 administration. 3. low-dose chronic oral corticosteroid therapy. 4. use of peak flow meter to monitor the progression of COPD. 5. breathing exercises, such as pursed-lip breathing that focus on exhalation.

1, 5

Which guideline should the nurse include when teaching a patient how to use a metered-dose inhaler (MDI)? a) After activating the MDI, breathe in as quickly as you can. b) Estimate the amount of remaining medicine in the MDI by floating the canister in water. c) Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week. d) To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.

d

Which findings indicate that a patient is developing status asthmaticus? Select all that apply. 1) PEFR <300 L/min 2) Positive sputum culture 3) Unable to speak in complete sentences 4) Lack of response to conventional treatment 5) Chest x-ray shows hyperinflated lungs and a flattened diaphragm

1, 3, 4

Which medications would be most appropriate to administer to a patient experiencing an acute asthma attack? Select all that apply. 1. montelukast (Singulair) 2. inhaled hypertonic saline 3. albuterol (Proventil HFA) 4 .ipratropium (Atrovent HFA) 5. salmeterol (Serevent Diskus)

3, 4

When caring for a patient with acute bronchitis, the nurse will prioritize which intervention? A) auscultating lung sounds. B) encouraging fluid restriction. C) administering antibiotic therapy. D) teaching the patient to avoid cough suppressants.

a

An appropriate nursing intervention to assist a patient with pneumonia manage thick secretions and fatigue would be which intervention? a) perform postural drainage every hour. b) provide analgesics as ordered to promote patient comfort. c) administer O2 as prescribed to maintain optimal O2 levels. d) teach the patient how to cough effectively and expectorate secretions.

d

on airborne precautions and in an isolation room. What should the nurse teach the patient? Select all that apply. 1. Expect routine TB testing to evaluate the infection. 2. No visitors will be allowed while in airborne isolation. 3. Adherence to precautions includes coughing into a paper tissue. 4. Take all medications for full length of time to prevent multidrug-resistant TB. 5. Wear a standard isolation mask if leaving the airborne infection isolation room.

3, 4, 5

The nurse notes tidaling of the water level in the water-seal chamber in a patient with closed chest tube drainage. The nurse should a) continue to monitor the patient. b) check all connections for a leak in the system. c) lower the drainage collector further from the chest. d) clamp the tubing at a distal point away from the patient.

a

After a pneumonectomy, an appropriate nursing intervention is a) monitoring chest tube drainage and functioning. b) positioning the patient on the unaffected side or back. c) doing range-of-motion exercises on the affected upper limb. d) auscultating frequently for lung sounds on the affected side.

3

When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes a) maintaining the patient on bed rest. b) using intermittent pneumatic compression devices. c) encouraging the patient to cough and deep breathe. d) teaching the patient how to use the incentive spirometer.

2

A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudate, and headache. The nurse anticipates that the interprofessional management will include which interventions? Select all that apply. 1. antiviral agents to treat influenza. 2. treatment with antibiotics starting ASAP. 3. a throat culture or rapid strep antigen test. 4. supportive care, including cool, bland liquids. 5. comprehensive history to determine possible cause.

3, 4, 5

Which nursing action would be of highest priority when suctioning a patient with a tracheostomy? a) Auscultating lung sounds after suctioning is complete b) Giving antianxiety medications 30 minutes before suctioning c) Instilling 5 mL of normal saline into the tracheostomy tube before suctioning d) Assessing the patient’s oxygen saturation before, during, and after suctioning

d

While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? Select all that apply. 1. Notify the health care provider at once. 2. Place the patient in semi-Fowler’s position. 3. Use a bag-valve-mask (BVM) and begin rescue breathing for the patient 4. Instill 10 mL of normal saline into the tracheostomy tube to loosen secretions. 5. Continue patient assessment, including O2 saturation, respiratory rate, and breath sounds.

5

Appropriate discharge teaching for the patient with a permanent tracheostomy after a total laryngectomy for cancer would include which items? Select all that apply. 1. encouraging regular exercise such as swimming. 2. washing around the stoma daily with a moist washcloth. 3. encouraging participation in postlaryngectomy support group. 4. providing pictures and “hands-on” instruction for tracheostomy care. 5. teaching how to hold breath and trying to gag to promote swallowing reflex.

2, 3, 4

The nurse completes a focused assessment of the client. In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional manifestations of RA might the client exhibit? (Select all that apply. One, some, or all options may be correct.) 1.Weight Gain 2.Joints Tender/Painful and warm to touch 3.Joint stiffness on rising that lasts 30 min 4.Fever 5.Swan Neck Deformity of fingers 6.Bilateral Symmetrical Joint Involvement

2, 3, 5

Which assessment findings may indicate aspirin toxicity(salicylism)? Select all that apply. 1. Anorexia and weakness. 2. Hypoventilation and bradycardia. 3. Tachycardia and anxiety. 4. Tinnitus and headache. 5. Sweating and Dizziness

4, 5