Diabetes
Respiratory
Cardiac
Neurological
Musculoskeletal
100
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (KDA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? (1) Ampule of 50% dextrose. (2) NPH insulin subcutaneously. (3) Intravenous fluids containing dextrose. (4) Phenytoin (Dilantin) for the prevention of seizures.
What is 3 During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis.
100
An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? (1) Face tent (2) Venturi mask (3) Aerosol mask (4) Tracheostomy collar
What is 2 The Venturi mask delivers the most accurate oxygen concentration
100
The nurse has given suggestions to a client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs further education if the client makes which statement? (1) "I will wash my face with cotton pads (2) I'll have to start chewing on my unaffected side"" (3) I'll try to eat my food either very warm or very cold" (4) I should rinse my mouth if toothbrushing is painful"
What is 3 Facial pain can be minimized by using cotton pads tow ash the face and using room temperature water.
100
The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? (1) a 25-year-old woman who jogs (2) A 36-year-old man who has asthma (3) A 70-year-old man who consumes excess alcohol (4) A sedentary 65-year-old woman who smokes cigarettes
What is 4 Risk factors for osteoporosis include female gender, being postmenopausal, advanced age, a low-calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes.
200
Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone. (1) An additional dose of prednisone daily (2) A decreased amount of daily Humulin NPH insulin (3) An increased amount of daily Humulin NPH insulin (4) The addition of an oral hypoglycemic medication daily.
What is 3 Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoids therapy.
200
The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome? (1) Promote oxygen intake (2) Strengthen the diaphragm (3) Strengthen the intercostal muscles (4) Promote carbon dioxide elimination
What is 4 Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.
200
A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse bet describe this type of angina pain? (1) Stable angina (20 Variant angina (3) Unstable angina (4) Nonanginal pain
What is 2 Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tables. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.
200
The client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. Which past medical history finding makes the client most at risk for this disease? (1) Meningitis or encephalitis during the last 5 years (2) Seizures or trauma to the brain within the last year (3) Back injury or trauma to the spinal cord during the last 2 years (4) Respiratory or gastrointestinal infection during the previous month.
What is 4 Guillain-Barre syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many client report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits.
200
the nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? (1) I can resume regular exercise tomorrow (2) I can't eat food for the remainder of the day (3) I need to stay off the leg entirely for the rest of the day (4) I need to report a fever or site inflammation to my healthcare provider.
What is 4 After arthroscopy, the client usually can walk carefully on the leg once sensation has returned. The client is instructed to avoid strenuous exercise for a least a few days. The may resume the usual diet. Signs and symptoms of infection should be reported to the health care provider.
300
A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. (1) Hypoglycemia may be experienced before dinnertime. (2) The insulin dose should be decreased if illness occurs. (3) The insulin should be administered at room temperature. (4) The insulin vial needs to be shaken vigorously to break up the precipitates. (5) The NPH insulin should be drawn into the syringe first, then the regular insulin.
What is 1,3 Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 0.5 hours, it peaks in 2 to 5.5 hours, and its duration is 5 to 8 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered.
300
The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and declomethason dipropoinate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? (1) Beclomethason first and then the salmeterol (2) Salmeterol first and then the declomethason (3) Alternating a single puff of each, beginning with the salmeterol (4) Alternating a single puff of each , beginning with the declomethason
What is 2 Salmeterol (Serevent Diskus) is an adrenergic type of bronchodilator and beclomethasone dipropoinate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids.
300
The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous infusion at a rate of 150 ml/hour, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 ml (28ml most recent). The client's blood urea nitrogen level is 35 mg/dL and the serum creatinine level is 1.8 mg/dL, measured this morning. Which nursing action is the priority? (1) Check the urine specific gravity. (2) Call the health care provider (HCP) (3) Check to see if the client had a sample for a serum albumin level drawn (4) Put the intravenous (IV) line on a pump so that the infusion rate is sure to stay stable.
What is 2 Following abdominal aortic aneurysm resection or repair. the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery.
300
A client has a neurological deficit involving the limbic system. Which assessment finding is specific to this type of deficit? (1) Is disoriented to person, place, and time (2) Affect is flat, with periods of emotional lability (3) Cannot recall what was eaten for breakfast today (4) Demonstrates inability to add and subtract; does not know who is the president of the United States.
What is 2 The limbic system is responsible for feelings (affect) and emotions. Calculation ability and knowledge of current events related to function of the frontal lobe.
300
The nurse is one of several persons who witnessed a vehicle hit a pedestrian at fairly low speed on a small street The victim is dazed and tries to get up. The leg appears fractured. Which intervention should the nurse take? (1) try to reduce the fracture manually. (2) Assist the victim to get up and walk to the sidewalk (3) Leave the victim for a few moments to call an ambulance (4) stay with the victim and encourage the person to remain still.
What is 4 With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot. The nurse should remain with the victim and have someone else call for emergency help. A fracture is not reduced at the scene. Before the victim is moved, the site of fracture is immobilized to prevent further injury
400
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. (1) Increase in pH (2) Comatose state (3) Deep, rapid breathing (4) Decreased urine output (5) Elevated blood glucose level (6) Low plasma bicarbonate level
What is 3,5,6 In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 25omg/dL, and ketones are present in the blood and urine.
400
Terbutaline is prescribed for a client with bronchitis. The nurse understand that this medication should be used with caution if which medical condition is present in the client? (1) Osteoarthritis (2) Hypothyroidism (3) Diabetes mellitus (4) Polycystic disease
What is 3 Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetic.
400
A client with myocardial infarction suddenly become tachycardic, shows signs of air hunger, and beings coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds. (1) Stridor (2) Crackles (3) Scattered rhonchi (4) Diminished breath sounds?
What is 2 Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles.
400
The nurse is admitting a client with Guillain-Barre syndrome to the nursing unit. The client has ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse should bring which most essential items into the client's room? (10 Nebulizer and pulse oximeter (2) Blood pressure cuff and flashlight (3) Flashlight and incentive spirometer (4) Electrocardiographic monitoring electrodes and intubation tray.
What is 4 The client with Guillain-Barre syndrome is at risk for respiratory failure because of ascending paralysis. An intubation tray should be available for use.
400
The nurse is caring for a client being treated for fat embolus after multiple fractures Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? (1) Clear mentation (2) Minimal dyspnea (3) Oxygen saturation of 85% (4) Arterial oxygen level of 78 mm Hg
What is 1 An altered mental state is an early induction of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving.
500
The nurse teaches a client with diabetes with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply (1) Polyuria (2) Shakiness (3) Palpitations (4) Blurred vision (5) Lightheadedness (6) Fruity breath odor
What is 2,3, 5 Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.
500
A client has experienced pulmonary embolism. the nurse should assess for which symptom, which is most commonly reported? (1) Hot, flushed feeling (2) Sudden chills and fever (3) Chest pain that occurs suddenly (4) Dyspnea when deep breaths are taken
What is 3 The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea.
500
The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse immediately asks another nurse to contact the health care provider and prepares to implement which priority interventions? Select all that apply. (1) Administering oxygen (2) Inserting a Foley catheter (3) Administering furosemide (Lasix) (4) Administering morphine sulfate intravenously (5) Transporting the client to the coronary care unit (6) Placing the client in a low Fowler's side-lying position
What is 1,2,3,4 Pulmonary edema is a life-threatening event that can result from severe heart failure In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increase in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's position to ease the work of breathings. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing.
500
The nurse is planning to institute seizure precautions for a client who is being admitted form the emergency department. Which measures should the nurse include in planning for the client's safety? Select all that apply (1) Padding the side rails of the bed (2) Placing an airway at the bedside (3) Placing the bed in the high position (4) Putting a padded tongue blade at the head of the bed (5) Placing oxygen and suction equipment at the bedside (6) Having intravenous equipment read for insertion of an intravenous catheter.
What is 1,2,5,6 Seizure precautions may vary from agency to agency, but they generally have some common features. Usually, an airway, oxygen, and suctioning equipment are kept available at the bedside. The side rails of the bed are padded, and the bed is kept in the lowest position. The client has an intravenous access in place to have a readily accessible route if anticonvulsant medications must be administered.
500
The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? Select all that apply. (1) I should not use someone else's crutches. (2) I need to remove any scatter rugs at home (3) I can use crutch tips even when they are wet (4) I need to have spare crutches and tips available (5) When I'm using the crutches my arms need to be completely straight.
What is 1, 2 ,4 The client should use only crutches measured for the client. When assessing for home safety, make sure the client knows to remove any scatter rugs and does not walk on highly waxed floors. The tips should be inspected for wear, and spare crutches and tips should be available if needed. Crutch tips should remain dry. If crutch tips get wee, the client should dry them with a cloth or paper towel. When walking with crutches, both elbow need to be flexed not more than 30 degrees when the palms are on the handle.
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