Know that Drug
The nurse is administering lispro insulin and should keep in mind that this insulin will have an effect within which time frame?
a. 15 min
b. 1-2 hours
c. 80 minutes
d. 3-5 hours
a. 15 min
The onset of action for lispro insulin is 15 min. The peak plasma concentration is 1-2 hours. The elimination half life is 80 minutes and the duration is 3-5 hours.
Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease?
1. History of side effects experienced from all medications
2. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
3. If the client has gained weight recently
4. What the client has eaten over the last several days
2. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms?*
A. Thyroiditis
B. Deficiency of iodine consumption
C. Grave's Disease
D. Hypothyroidism
C. Grave's Disease
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 48-year-old woman with a hemoglobin A1C of 8.4%
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 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a. A 48-year-old woman with a hemoglobin A1C of 8.4%
Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL
Which of the following actions is the first priority of care for a patient exhibiting signs & symptoms of coronary artery disease?
1. Decrease anxiety
2. Enhance myocardial oxygenation
3. Administer sublingual nitroglycerin
4. Educate the pt about his symptoms
2. Enhancing myocardial oxygenation is always the first priority when a patient exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the pt & decreasing anxiety are important in care delivery, neither are priorities when a pt is compromised.
A client with a gastric ulcer has an order for sucralfate (Carafate), 1 g orally four times a day. The nurse schedules the medications for which of the following times?
A. With meals and at bedtime
B. Every 6 hours around the clock
C. One hour after meals and at bedtime
D. One hour before meals and at bedtime
D. one hour before meals and at bedtime
After bariatric surgery, a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which response by the nurse is best?
a. "I hope you change your mind so that I can suggest a group for you."
b. "Tell me what types of resources you think you might use after this surgery."
c. "Support groups have been found to lead to more successful weight loss after surgery."
d. "Because there are many lifestyle changes after surgery, we recommend support groups."
ANS: B
This statement allows the nurse to assess the individual patient's potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patient's preferences.
The nurse is providing an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the United States get goiters as often?" Which statement by the nurse is the best response?
1. "It is because of the screening techniques used in the United States"
2. "It is a genetic predisposition rare in North Americans"
3. "The medications available in the United States decrease goiters"
4. Iodized salt helps prevent the development of goiters in the United States"
4. Iodized salt helps prevent the development of goiters in the United States"
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse?
a. "I will discard any insulin bottle that is cloudy in appearance."
b. "The best injection site for insulin administration is in my abdomen."
c. "I can wash the site with soap and water before insulin administration."
d. "I may keep my insulin at room temperature (75o F) for up to a month."
a. "I will discard any insulin bottle that is cloudy in appearance."
Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.
Which of the following blood tests is most indicative of cardiac damage?
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
3. Troponin I levels rise rapidly & are detectable w/in 1 hour of myocardial injury. Troponin I levels aren't detectable in people w/out cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues & not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, & a complete chemistry is obtained to review electrolytes. Because CK levels may rise w/ skeletal muscle injury, CK isoenzymes are required to detect cardiac injury
The client diagnosed with hypothyroidism is prescribe the thyroid hormone levothyroxine (Synthroid). Which assessment data indicate the medication has been effective?
1. The client has a three pound weight gain
2. The client has a decreased pulse rate
3. The client's temperature is WNL
4. The client denies any diaphoresis
3. The client's temperature is WNL
When patients undergo diagnostic tests of the gastrointestinal system, elderly patients in particular must be closely watched for:
a. dehydration and electrolyte imbalance
b. nausea and vomiting
c. diarrhea
d. constipation from contrast media
a. dehydration and electrolyte imbalance
Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism?
1. "I just don't seem to have any appetite anymore"
2. "I have a bowel movement about every 3 to 4 days"
3. "My skin is really becoming dry and coarse"
4. "I have noticed all my collars are getting tighter"
4. "I have noticed all my collars are getting tighter"
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. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
c. "I should include more fiber in my diet than a person who does not have diabetes."
d. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."
b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
1. Left-sided heart failure
2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction
1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure.
Which of the following classes of meds protects the ischemic myocardium by blocking catecholamines & sympathetic nerve stimulation?
1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Narcotics
4. Nitrates
1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines & sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand promote vasodilation, & decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) & systemic vascular resistance (afterload).
The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?
A. Immediately start enteral feeding to prevent malnutrition.
B. Insert an NG and maintain NPO status to allow pancreas to rest.
C. Initiate early prophylactic antibiotic therapy to prevent infection.
D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.
B. Insert an NG and maintain NPO status to allow pancreas to rest.
Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.
Which of the following assessment findings characterize thyroid storm?
a) increased body temperature, decreased pulse, and increased blood pressure
b) increased body temperature, increased pulse, and increased blood pressure
c) increased body temperature, decreased pulse, and decreased blood pressure
d) increased body temperature, increased pulse, and decreased blood pressure
b) increased body temperature, increased pulse, and increased blood pressure
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness?
a. A 58-year-old patient with diabetic retinopathy
b. A 73-year-old patient who takes propranolol (Inderal)
c. A 19-year-old patient who is on the school track team
d. A 24-year-old patient with a hemoglobin A1C of 8.9%
b. A 73-year-old patient who takes propranolol (Inderal)
Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output?
1. Angina pectoris
2. Cardiomyopathy
3. Left-sided heart failure
4. Right-sided heart failure
4. Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.
Which of the following classes of meds maximizes cardiac performance in pts with heart failure by increasing ventricular contractibility?
1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Diuretics
4. Inotropic agents
4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility & ultimately increasing cardiac output.
A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider?
A. History of cholelithiasis
B. Serum amylase levels three times greater than the expected value
C. Client report of severe pain radiating to the back that is rated at an "8"
D. Hand spasms present when blood pressure is checked
D. The greatest risk to the client is hypocalcemia due to the risk of cardiac dysrhythmia. Hand spasms when taking a blood pressure is an indication of hypocalcemia and is the priority finding to report to the provider
Fill in the blank regarding the negative feedback loop for thyroid hormone production:
The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______.*
A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4
B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4
D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH
B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?
a. "With type 2 diabetes, the body of the pancreas becomes inflamed."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
c. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress?
1. Anxiety
2. Stable angina
3. Unstable angina
4. Variant angina
2. The pain of stable angina is predictable in nature, builds gradually, & quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, & lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress.