Name that gas?
Which arterial blood gas results should the nurse expect in the client diagnosed with diabetic ketoacidosis?
1. pH 7.34, PaO2 99, PaCO2 48, HCO3 24.
2. pH 7.38, PaO2 95, PaCO2 40, HCO3 22.
3. pH 7.46, PaO2 85, PaCO2 30, HCO3 26.
4. pH 7.30, PaO2 90, PaCO2 30, HCO3 18.
What is #4: 4.This ABG indicates metabolic acidosis, which is expected in a client diagnosed with diabetic ketoacidosis.
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
a. Sulfonylureas
b. Meglitinides
c. Biguanides
d. Alpha-glucosidase inhibitors
c. Biguanides
Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver.
Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin.
Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
A nurse is formulating a plan of care for a client receiving enteral feedings. The nurse identifies which nursing diagnosis as the highest priority for this client?
a) diarrhea
b) risk for aspiration
c) risk for deficient flid volume
d) imbalanced nutrition, less than body requirements
Answer:B
- Any condition in which gastrointestinal motility is slowed or esophageal reflux is possible places a client at risk for aspiration. Although options 1, 3, and 4 may be a concern, these are not the priority.
A head and neck physical examination is completed on a 50-year-old female patient. All physical findings are normal except for fine brittle hair. Based on the physical findings, which of the following laboratory tests would the nurse expect to be ordered?
A. Liver function test
B. Lead level
C. Thyroid-stimulating hormone test
D. Complete blood count
C
(Thyroid-stimulating hormone test)
a client has stated clopidogrel after experiencing a transient ischemic attack (TIA). whats the desired therapeutic effect of this drug
1.anti inflammatory and antipyretic effects
2.to reduce the risk of a stroke from a blood clot
3.analgesic as well as clot-dissolving effects
4.to stop clots from becoming emboli
to reduce the risk of a stroke from a blood clot
You walk into the first room of the day and your co-student tells you his patient ingested a whole bottle of tums. You understand that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?
a.Respiratory alkalosis
b.Respiratory acidosis
c.Metabolic acidosis
d.Metabolic alkalosis
What is Metabolic Alkalosis?
Increases in base components occur as a result of oral or parenteral intake of bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral antacids containing bicarbonate can cause metabolic alkalosis.
You are the nurse monitoring a patient's compliance with the diabetes mellitus treatment regimen. What value indicates compliance with the regimen?
HbA1C of 4%-6%. This is the best indicator of average blood glucose levels for the past 120 days.
The client has chronic atrial fibrillation. Which discharge teaching should the nurse
discuss first with the client?
1. Instruct the client to use a soft-bristle toothbrush.
2. Discuss the importance of getting a monthly partial thromboplastin time (PTT).
3. Teach the client about signs of pacemaker malfunction.
4. Explain to the client the procedure for synchronized cardioversion.
1. chronic A-fib treated with anticoagulant, places patient at risk for bleeding
PQRSTU is a mnemonic that helps the clinician to remember to address characteristics specific to:
A. severity of dementia.
B. substance use and abuse.
C. pain presentation.
D. the ability to perform activities of daily living (ADLs).
C
The eight critical characteristics of pain symptoms reported in the history are: P = provocative or palliative; Q = quality or quantity; R = region or radiation; S = severity scale; T = timing; and U = understand patient's perception.
Tests used to assess for dementia include the Mini-Mental State Examination, the Set Test, the Short Portable Mental Status Questionnaire, the Mini-Cog, and the Blessed Orientation-Memory-Concentration Test.
A functional assessment includes questions on substance use and abuse.
Functional assessment measures a person's self-care ability including the ability to perform ADLs.
The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When obtaining a health history from the patient, the most important information for the nurse to communicate to the health care provider is that the patient has
a.
a history of infectious mononucleosis as a teenager.
b.
a family history of age-related macular degeneration of the retina.
c.
been trying to have a baby before her disease becomes more severe.
d.
been using large doses of vitamins and health foods to treat the RA.
What is C?
C
Rationale: Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.
The nurse has admitted a client who was brought to the hospital after a morphine overdose. What acid base imbalance does the nurse expect to observe in this client?
What is respiratory acidosis?
Morphine is a narcotic that decreases respirations; therefore, this client is most likely hypoventillating. The expected A-B balance would be respiratory acidosis.
A nurse caring for a patient who has diabetic ketoacidosis recognizes which of these characteristics in the patient? (Select all that apply.)
A) Occurs mainly in type 2 diabetes patients
B) Altered fat metabolism leading to ketones
C) Arterial blood pH of 7.35 to 7.45
D) Sudden onset, triggered by acute illness
E) Plasma osmolality of 300 to 320 milliosmoles/L
Answer: B, D, E
B) Altered fat metabolism leading to ketones
D) Sudden onset, triggered by acute illness
E) Plasma osmolality of 300 to 320 milliosmoles/L
The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in sequence.
1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.
Answer: 2,1,5,4,3
2. Glucose enters the bloodstream.
1. Beta cells are stimulated to release insulin.
5. Insulin transports glucose to muscle cells.
4. Glycogen is stored in the liver.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
You are assessing a 20-year-old male suspected of overdosing. He is staring off into space, writhing and babbling. When you start an IV, he cries out incomprehensibly but does not pull away. What is his Glasgow Coma score
What is 9?
A client is brough to the ED after an overdose has an arterial blood gas results that indicate respiratory acidosis. For which substance should the nurse plan to care for this client?
a) Cocaine
b) Marijuana
c) Oxycodone
d) PCP
What is Oxycodone (C)?
Excessive use of narcotics can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant; Marijuana is not considered a drug that depress the CNS or respiratory center; PCP is a hallucinogenic
the nurse is preparing to administer the first dose of enalapril (Vasotec). identify the potential adverse effects of this medication (select all)
1.reflex hypertension
2.hyperkalemia
3..persistent cough
4.angiodema
5.Hypotension
-hyperkalemia
-persistent cough
-angioedema
-Hypotension
Which of the following patients is MOST LIKELY experiencing Hyperglycemic Hyperosmolar Nonketotic Syndrome based on their symptoms?
A. A 72 year old with a health history of diabetes who has a blood glucose of 300 mg/dL and is complaining of thirst and frequent urination.
B. A 66 year old with type I diabetes that has ketones present in their urine.
C. A 69 year old admitted with an infection of the right foot with a health history of diabetes that reports missing several doses of Metformin and has a blood glucose of 600 mg/dL.
D. A 6 year old that is presenting with polyuria, polydipsia, abdominal pain, and vomiting.
What is C
Hallmark of HHNS is an EXTREME high blood glucose (>600 mg/dL), is precipitated by infection, and is more common in type 2 diabetics. The 69 year old is a type 2 diabetic due to the clue that the option states the patient has missed doses of Metformin (which is an oral type 2 diabetic medication). DKA presents with elevated blood glucose >300 mg/dL and ketones which HHNS does not.
After receiving change-of-shift report on the following four patients, which patient should the nurse see first?
a. A 60-year-old patient with right-sided weakness who has an infusion of tPA prescribed
b. A 50-year-old patient who has atrial fibrillation and a new order for warfarin (Coumadin)
c. A 40-year-old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due
d. A 30-year-old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine (Nimotop) scheduled
A. tPA needs to be infused within the first few hours after stroke symptoms start in order to be effective in minimizing brain injury. The other medications should also be given as quickly as possible, but timing of the medications is not as critical.
The nurse is observing the unlicensed assistive personnel (UAP) helping a client with unilateral neglect of the right side perform self-care. Which statement by the UAP requires an intervention by the nurse?
"When getting dressed, first put clothing on the left side."
"Use the left arm to bathe, brush teeth, comb hair, and eat."
"The occupational therapist will teach you how to promote upper extremity strength."
"The occupational therapist will assist you in learning to walk using a walker."
What is "When getting dressed, first put clothing on the left side."
The client should be taught to dress the affected extremities first and then the unaffected extremities. This will enable the client to dress herself with minimal assistance. The other options are all appropriate instructions to teach the client to perform self-care.
Ms. Krablin is a 54 year old male admitted for pain. He shares with you that he has a systemic, connective tissue disease which results in chronic pain, swelling and tenderness of the joints and tendon sheaths as well as permanent changes in the joint structure for which is prescribed DMARDs. Give me examples of these drugs and the disease they are most often treating.
What are Disease-modifying antirheumatic drugs (DMARDs) are a class of drugs indicated for the treatment of inflammatory arthritides including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).
Commonly used conventional DMARDs include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine.
The client is seen in the Emergency Department with symptoms of a panic attack, including hyperventilation. The nurse suspects that the client may be at risk for which health problem on admission?
A) Hypoventilation
B) Vomiting
C) Respiratory alkalosis
D) Memory loss
What is respiratory alkalosis (C)?
C
(Anxiety disorders increase the risk for the acid-base imbalance respiratory alkalosis, due to hyperventilation that accompanies anxiety and panic attacks. The client with anxiety does not necessarily have vomiting or memory loss as risk factors. Anxiety and panic attacks will lead to hyperventilation, not hypoventilation.)
Glimepiride (Amaryl) is prescribed for a client with DM. The nurse instructs the client to avoid consuming which food while taking this medication?
1.alcohol
2.organ meats
3.whole-grain cereals
4.carbonated beverages
What is Alcohol?
a.When this medication is combined with alcohol, a disulfiram-like reaction may occur. This syndrome includes Flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication.
Advise clients not to drink alcohol while on this medication.
A client is scheduled for an arteriogram using a radiopaque dye. The nurse assesses which most critical item before the procedure?
a) vital signs
b) intake and output
c) height and weight
d) allergy to iodine or shellfish
Answer: D
- Allergy to iodine or seafood is associated with allergy to the radiopaque dye that is used for medical imaging examinations. Informed consent is necessary, because an arteriogram requires the injection of a radiopaque dye into the blood vessel. Although options A, B, and C are components of the preprocedure assessment, the risks of allergic reaction and possible anaphylaxis are the most critical.
When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication?
a.
The patient complains of a "pounding" headache.
b.
The patient becomes restless and agitated.
c.
The patient has not voided for over 10 hours.
d.
The patient has cramping abdominal pain.
The patient has not voided for over 10 hours
Part 1: Lovenox, Heparin and Coumadin
Part 2: Discern which have prophylactic indications versus treatment only
Part 1: Anticoagulants
Part 2: Lovenox and Heparin have Prophylactic and Treatment doses while Coumadin is not used prophylactically