Diabetes
Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include?
Correct Answer: C. The alcohol could predispose you to hypoglycemia.
Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. When the client drinks alcohol, the alcohol can inhibit the liver’s ability to release glucose into the blood. This can be particularly significant for people on stronger medication such as insulin because it can mean that the liver is not able to release enough glycogen to keep the blood glucose levels from going too low under the influence of insulin in the body.
A nurse is assessing an older client for the presence of infection. The client's temperature is 97.6° F (36.4° C). What response by the nurse is best?
a. Assess the client for more specific signs.
b. Conclude that an infection is not present.
c. Document findings and continue to monitor.
d. Request the primary health care provider order blood cultures
ANS: A
Because older adults have decreased immune function, including reduced neutrophil function, fever may not be present during an episode of infection. The nurse would assess the client for specific signs of infection. Documentation needs to occur, but a more thorough assessment comes first. Blood cultures may or may not be needed depending on the results of further assessmen
A primary health care provider notifies the nurse that a client has a "bandemia." What action does the nurse anticipate?
a. Administer antibiotics.
b. Place the client in isolation.
c. Administer IV leukocytes.
d. Obtain an immunization history.
ANS: A
A bandemia, or shift to the left, in the white count differential means that an acute, continuing infection has placed so much stress on the immune system that the most numerous type of neutrophil in circulation are immature, or band cells. The nurse would anticipate administering antibiotics. The client may or may not need isolation. Leukocyte infusion and immunization history are not relevant.
The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia?
A)Stool softeners are contraindicated.
B)Laxatives should be taken daily.
C)Consume 2 to 4 L of fluid daily.
D)Restrict calcium intake.
C - The nurse should identify patients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the patient and family. The nurse should teach at-risk patients to recognize and report signs and symptoms of hypercalcemia and encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise patients to maintain nutritional intake without restricting normal calcium intake.
Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?
Correct Answer: B. Somogyi phenomenon
The Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and an increase in ketones. The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia.
During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician?
Correct Answer: D. Lantus insulin 20U BID.
Lantus insulin is usually prescribed once a day so an order for BID dosing should be validated with the physician. Lantus is designed to give a steady level of insulin over 24 hours, even when you are not eating such as between meals and overnight. This helps keep blood glucose levels consistent during the day and at night.
A clinic nurse is working with an older client. What action is most important for preventing infections in this client?
a. Assessing vaccination records for booster shot needs b. Encouraging the client to eat a nutritious diet
c. Instructing the client to wash minor wounds carefully
d. Teaching hand hygiene to prevent the spread of microbes
ANS: A
Older adults may have insufficient antibodies that have already been produced against microbes to which they have been exposed. Therefore, older adults need booster shots for many vaccinations they received as younger people. A nutritious diet, proper wound care, and hand hygiene are relevant for all populations.
The public health nurse is teaching community members about the reasons to get an annual flu shot. Which reason should the nurse include? (select all that apply)
A. People without health insurance are at higher risk of getting the flu
B. The predominant flu virus strain changes from year to year
C. Infants, young children, and people aged 50 or older are more likely to get the flu
D. The new vaccine has specific antigens predicted for that year
E. People living in apartment buildings have a higher probability of getting the flu
B. the predominant flu virus strain changes from year to year
C. Infants, young children, and people age 50 or older are more likely to get the flu
D. The new vaccine has specific antigens predicted for the that year
A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patients family and friends?
A)Your family should likely gather at the bedside in case theres a negative outcome.
B)Make sure she doesnt eat any food in the 24 hours before the procedure.
C)Wear a hospital gown when you go into the patients room.
D)Do not visit if youve had a recent infection.
D - Before HSCT, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the patients contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.
A nurse learning about antibody-mediated immunity learns that the cell with the most direct role in this process begins development in which tissue or organ?
a. Bone marrow
b. Spleen
c. Thymus
d. Tonsils
ANS: A
The B-cell is the primary cell in antibody-mediated immunity and is released from the bone marrow. These cells then travel to other organs and tissues, known as the secondary lymphoid tissues for B-cells.
Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement?
Correct Answer: D. “My cells cannot use the insulin my pancreas makes.”
With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. T2DM is an insulin-resistance condition with associated beta-cell dysfunction. Initially, there is a compensatory increase in insulin secretion, which maintains glucose levels in the normal range. As the disease progresses, beta cells change, and insulin secretion is unable to maintain glucose homeostasis, producing hyperglycemia.
SIRS
Sepsis
Severe Sepsis
Septic Shock
During HIV infection
a. reverse transcriptase helps HIV fuse with the CD4+ T cell.
b. HIV RNA uses the CD4+ T cell's mitochondria to replicate.
c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.
d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.
Correct answer: c
Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).
A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?
A)Pruritis (itching)
B)Nausea and vomiting
C)Altered glucose metabolism
D)Confusion
B - Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Confusion, alterations in glucose metabolism, and pruritis are not common adverse effects.
What type of isolation is TB?
Airborne
A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia. The gerontology nurse should anticipate which of the following secondary medical diagnoses?
Correct Answer: D. Pancreatic tumor
The onset of hyperglycemia in older adults can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumors. Weight loss occurs in about 90% of patients. Approximately 90% of all cases of pancreatic cancer are among people over 55 years of age.
The nurse understands that which type of immunity is the longest acting?
a. Artificial active
b. Inflammatory
c. Natural active
d. Natural passive
ANS: C
Natural active immunity is the most effective and longest acting type of immunity. Artificial and natural passive do not last as long. "Inflammatory" is not a type of immunity.
The patient is diagnosed with vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to others?
A. Droplet precautions
B. Contact precautions
C. Airborne precautions
D. Standard precautions
B
Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., tuberculosis, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.
The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
A)Impaired nutritional status
B)Cognitive changes
C)Diarrhea
D)Alopecia
A - Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this patient. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which blood tests should be done to further explore this clinical sign?
A)Liver function tests (LFTs)
B)Complete blood count (CBC)
C)Platelet count
D)Blood urea nitrogen and creatinine
A - Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.
An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client’s intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient?
Correct Answer: D. Hyperglycemic hyperosmolar nonketotic syndrome.
Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNS. The most frequent reason for this complication is infection. The infectious process in the respiratory, gastrointestinal, and genitourinary systems can act as the causative factor. The reason for this is the insensible water loss and the release of endogenous catecholamines. Approximately 50% to 60% of HHS is attributable to infectious etiology.
The nurse working with clients who have autoimmune diseases understands that what component of cell-mediated immunity is the problem?
a. CD4+ cells
b. Cytotoxic T-cells
c. Natural killer cells
d. Regulator T-cells
ANS: D
Regulator T-cells help prevent hypersensitivity to one's own cells, which is the basis for autoimmune disease. CD4+ cells are also known as helper/inducer cells, which secrete cytokines. Natural killer cells have direct cytotoxic effects on some non-self cells without first being sensitized. Regulator T-cells have an inhibitory action on the immune system. Cytotoxic T-cells are effective against self cells infected by parasites such as viruses or protozoa
A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother?
A. There is currently no need for those older vaccines.
B. There is a reemergence of some of the infections, such as pertussis.
C. There is no longer an immunization available for some of those diseases.
D. The only way to protect your child is to have the federally required vaccines.
B
Teaching the parent that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.
The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?
A)Monthly self-breast exams
B)Smoking cessation
C)Annual colonoscopies
D)Monthly testicular exams
B - Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 570,000 Americans were expected to die from a malignant process in 2011. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer.
A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs?
A)Administration of parenteral feeds via a peripheral IV
B)TPN administered via a peripherally inserted central catheter
C)Insertion of an NG tube for administration of feeds
D)Maintaining NPO status and IV hydration until treatment completion
B - If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is administered by way of a central line, not a peripheral IV. An NG would be contraindicated for this patient. Long-term NPO status would result in malnutrition.