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WorksheetsConcept 5 Exam
Total questions: 185
Worksheet time: 2hrs 36mins
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
Insulin is not used to control blood glucose in patients with
type 2 diabetes.
Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
Type 2 diabetes is usually diagnosed when the patient is
admitted with a hyperglycemic coma.
Complications of type 2 diabetes are less serious than those of
type 1 diabetes.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
using low doses of regular insulin.
effects of oral hypoglycemic medications.
self-monitoring of blood glucose.
lifestyle changes to lower blood glucose.
A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?
The patient goes for a vigorous walk when his glucose is 200
mg/dL.
The patient has a peanut butter sandwich before going for a
bicycle ride.
The patient always carries hard candies when engaging in
exercise.
The patient increases daily exercise when ketones are present in
the urine.
The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response?
“Are you anorexic?”
“Is your urine dark colored?”
“Do you crave sugary drinks?”
“Have you lost weight lately?”
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?
Fasting blood glucose
Oral glucose tolerance
Urine dipstick for glucose
Glycosylated hemoglobin
The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient?
The patient will follow a diet and exercise plan that results in
weight loss.
The patient will reach a glycosylated hemoglobin level of less
than 7%.
The patient will state the reasons for eliminating simple sugars
in the diet.
The patient will choose a diet that distributes calories
throughout the day.
A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to
check glucose level before, during, and after swimming.
time the morning insulin injection so that the peak occurs while
swimming.
delay eating the noon meal until after the swimming class.
increase the morning dose of neutral protamine Hagedorn (NPH)
insulin.
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?
“I will need a bedtime snack because I take an evening dose of
NPH insulin.”
“I can have an occasional beverage with alcohol if I include it
in my meal plan.”
“I will eat something at meal times to prevent hypoglycemia,
even if I am not hungry.”
“I can choose any foods, as long as I use enough insulin to
cover the calories.”
To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take?
Remind the patient that exercise improves self-esteem.
Teach the patient about the effects of exercise on glucose
level.
Determine what types of activities the patient enjoys.
Give the patient a list of activities that are moderate in
intensity.
Which statement by the patient indicates a need for additional instruction in administering insulin?
“I can buy the 0.5-mL syringes because the line markings will be
easier to see.”
“I need to rotate injection sites among my arms, legs, and
abdomen each day.”
“I should draw up the regular insulin first, after injecting air
into the NPH bottle.”
“I do not need to aspirate the plunger to check for blood before
injecting insulin.”
Which patient action indicates good understanding of the nurse’s teaching about administration of aspart (NovoLog) insulin?
The patient avoids injecting the insulin into the upper
abdominal area.
The patient cleans the skin with soap and water before insulin
administration.
The patient pushes the plunger down while removing the syringe
from the injection site.
The patient stores the insulin in the freezer after
administering the prescribed dose.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?
12:00 AM
4:0 PM
10:00 AM
2:00 PM
Which patient action indicates a good understanding of the nurse’s teaching about the use of an insulin pump?
The patient changes the location of the insertion site every
week.
The patient programs the pump for an insulin bolus after eating.
The patient plans a diet with more calories than usual when
using the pump.
The patient takes the pump off at bedtime and starts it again
each morning.
A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?
Glargine (Lantus)
Detemir (Levemir)
Lispro (Humalog)
NPH (Humulin N)
Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide ?
Glyburide decreases glucagon secretion from the pancreas.
Glyburide should be taken even if the morning blood glucose
level is low.
Glyburide should not be used for 48 hours after receiving IV
contrast media.
Glyburide stimulates insulin production and release from the
pancreas.
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching?
“Other medications besides the Glucotrol may affect my blood
sugar.”
“If I overeat at a meal, I will still take the usual dose of
medication.”
“When I am ill, I may have to take insulin to control my blood
sugar.”
“My diabetes won’t cause complications because I don’t need
insulin.”
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may
need a diet higher in calories while receiving prednisone.
require administration of insulin while taking prednisone.
have rashes caused by metformin-prednisone interactions.
develop acute hypoglycemia while taking the prednisone.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
save the lunch tray for the patient’s later return to the unit.
send a glass of milk or orange juice to the patient in the
diagnostic testing area.
ask that diagnostic testing area staff to start a 5% dextrose
IV.
request that if testing is further delayed, the patient be
returned to the unit to eat.
The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose
washes the puncture site using warm water and soap.
hangs the arm down for a minute before puncturing the site.
chooses a puncture site in the center of the finger pad.
says the result of 120 mg indicates good blood sugar control.
The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?
Ask the patient’s family to participate in the diabetes
education program.
Demonstrate how to check glucose using capillary blood glucose
monitoring.
Discuss the need for the patient to actively participate in
diabetes management.
Assess the patient’s perception of what it means to have
diabetes mellitus.
An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to
give 50% dextrose.
initiate O2 by nasal cannula.
insert an IV catheter.
administer glargine (Lantus) insulin.
A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to
use only the lispro insulin until the symptoms are resolved.
monitor blood glucose every 4 hours and notify the clinic if it
continues to rise.
decrease intake of carbohydrates until glycosylated hemoglobin
is less than 7%.
limit intake of calories until the glucose is less than 120
mg/dL.
The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
Avoid snacking at bedtime.
Check the blood glucose during the night
Increase the rapid-acting insulin dose.
Administer a larger dose of long-acting insulin.
Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
Assess the patient for symptoms of hyperglycemia.
Have the patient drink a glass of orange juice or nonfat milk.
Give the patient a snack of peanut butter and crackers.
Administer a continuous infusion of 5% dextrose for 24 hours.
Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?
“Do you feel bloated after eating?”
“
“Do you need to increase your insulin dosage when you are
stressed?”
“Have you noticed any painful new ulcerations or sores on your
feet?”
Have you seen any skin changes?”
Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
Set heating pads on a low temperature.
Use callus remover for corns or calluses.
Soak feet in warm water for an hour each day.
Choose flat-soled leather shoes.
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?
The patient’s blood glucose level is 174 mg/dL.
The patient’s blood urea nitrogen (BUN) level is 52 mg/dL.
The patient has gained 2 lb (0.9 kg) in the past 24 hours.
The patient is scheduled for a chest x-ray in an hour.
A patient who has diabetes and reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline ?
Amitriptyline decreases the depression caused by your foot pain.
Amitriptyline corrects some of the blood vessel changes that
cause pain.
Amitriptyline helps prevent transmission of pain impulses to the
brain.
Amitriptyline improves sleep and makes you less aware of
nighttime pain.
A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?
The patient’s most recent A1C was 6.5%.
The patient took the prescribed metformin today.
The patient took the prescribed captopril this morning.
The patient’s blood glucose is 128 mg/dL.
Which action by a patient indicates that the home health nurse’s teaching about glargine and regular insulin has been successful?
The patient administers the glargine 30 minutes before each
meal.
The patient discards the open vials of glargine and regular
insulin after 4 weeks.
The patient draws up the regular insulin and then the glargine
in the same syringe.
The patient’s family prefills the syringes with the mix of
insulins weekly.
A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin?
thigh.
buttock.
abdomen.
upper arm.
The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication?
The patient’s blood pressure is 154/92.
The patient has chest pressure when walking.
The patient reports a history of emphysema.
The patient’s blood glucose is 86 mg/dL.
The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take?
Teach the patient about administering regular insulin.
Schedule the patient for a fasting blood glucose level.
Teach about an increased risk for fetal problems with
gestational diabetes.
Schedule an oral glucose tolerance test for the twenty-fourth
week of pregnancy.
A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?
Administer IV potassium supplements.
Place the patient on a cardiac monitor.
Start an insulin infusion at 0.1 units/kg/hr.
Ask the patient about home insulin doses.
A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?
Give sodium bicarbonate 50 mEq IV push.
Infuse 1 L of normal saline per hour.
Start a regular insulin infusion at 0.1 units/kg/hr.
Administer regular insulin 10 U by IV push.
A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
Infuse dextrose 50% by slow IV push.
Obtain a glucose reading using a finger stick.
Administer 1 mg glucagon subcutaneously.
Have the patient drink 4 ounces of orange juice.
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient’s health history is important for the nurse to communicate to the health care provider regarding this test?
The patient runs several days a week.
The patient has been pregnant three times.
The patient has a family history of diabetes.
The patient uses oral contraceptives.
Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse’s assessment of the patient?
Bedtime glucose of 140 mg/dL
Noon blood glucose of 52 mg/dL
2-hr postprandial glucose of 220 mg/dL
Fasting blood glucose of 130 mg/dL
When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
Communicate the blood glucose level and insulin dose to the
circulating nurse in surgery.
Administer the prescribed lispro (Humalog) insulin before
transporting the patient to surgery.
Plan strategies to minimize the risk for hypoglycemia or
hyperglycemia during the postoperative period.
Discuss the reason for the use of insulin therapy during the
immediate postoperative period.
An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?
Hemoglobin A1C level of 6.2%
Heart rate at rest of 58 beats/minute
High density lipoprotein (HDL) level of 65 mg/dL
Blood pressure of 140/88 mmHg
A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination
every 2 years.
as soon as possible.
when the patient is 39 years old.
within the first year after diagnosis.
After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective?
“I may feel hungrier than usual when I take this medicine.”
“I should take my daily aspirin at least an hour before the
Byetta.”
“I will take the pill at the same time I eat breakfast in the
morning.”
“I will not need to worry about hypoglycemia with the Byetta.”
A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?
Hemoglobin A1C level is 7.9%.
Glomerular filtration rate is decreased.
Patient has questions about the prescribed diet.
Last eye examination was 18 months ago.
The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?
Administer the PRN glucagon (Glucagon) 1 mg IM.
Give the patient 4 to 6 oz more orange juice.
Notify the health care provider about the hypoglycemia.
Have the patient eat some peanut butter with crackers.
Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic?
Ask the patient about symptoms of depression.
Measure the ankle-brachial index.
Check for changes in skin pigmentation.
Assess for unilateral or bilateral foot drop.
After change-of-shift report, which patient will the nurse assess first?
A 19-yr-old patient with type 1 diabetes who was admitted with
possible dawn phenomenon
A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who
has poor skin turgor and dry oral mucosa
A 68-yr-old patient with type 2 diabetes who has severe
peripheral neuropathy and complains of burning foot pain
A 35-yr-old patient with type 1 diabetes whose most recent blood
glucose reading was 230 mg/dL
After change-of-shift report, which patient should the nurse assess first?
A 19-yr-old patient with type 1 diabetes who has a hemoglobin
A1C of 12%
A 23-yr-old patient with type 1 diabetes who has a blood glucose
of 40 mg/dL
A 50-yr-old patient who uses exenatide (Byetta) and is
complaining of acute abdominal pain
A 40-yr-old patient who is pregnant and whose oral glucose tolerance
test is 202 mg/dL
To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)?
Chest x-ray
Blood pressure
Serum creatinine
Monofilament testing of the foot
Urine for microalbuminuria
A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?
“Have you had a recent head injury?”
“Do you have to wear larger shoes now?”
“Is there a family history of acromegaly?”
“Are you experiencing tremors or anxiety?”
A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to
cough and deep breathe every 2 hours postoperatively.
remain on bed rest for the first 48 hours after the surgery.
avoid brushing teeth for at least 10 days after the surgery.
be positioned flat with sandbags at the head postoperatively.
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?
Palpate extremities for edema.
Check hematocrit every 2 hours for 8 hours.
Measure urine volume every hour.
Monitor continuous pulse oximetry for 24 hours.
The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include
decreased facial hair.
elevated blood glucose.
tachycardia and palpitations.
high blood pressure.
Which information will the nurse include when teaching a 50-yr-old male patient about somatropin (Genotropin)?
The medication will be needed for 3 to 6 months.
Inject the medication subcutaneously every day.
Stop taking the medication if swelling of the hands or feet
occurs.
Blood glucose levels may decrease when taking the medication.
The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s
weight has increased.
urinary output is increased.
peripheral edema is increased.
urine specific gravity is increased.
The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement?
“I should weigh myself daily and report any sudden weight loss
or gain.”
“I need to shop for foods low in sodium and avoid adding salt to
food.”
“I should eat foods high in potassium because diuretics cause
potassium loss.”
“I need to limit my fluid intake to no more than 1 quart of
liquids a day.”
A 56-yr-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
decreased serum sodium.
elevated hematocrit.
low urine specific gravity.
increased serum chloride.
An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is
excess fluid volume related to intake greater than output.
sleep pattern disturbance related to frequent waking to void.
impaired gas exchange related to fluid retention in lungs.
risk for impaired skin integrity related to generalized edema.
Which information will the nurse teach a patient who has been newly diagnosed with Graves’ disease?
Exercise is contraindicated to avoid increasing metabolic rate.
Antithyroid medications may take several months for full effect.
Surgery will eventually be required to remove the thyroid gland.
Restriction of iodine intake is needed to reduce thyroid
activity.
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?
Suction the patient’s airway.
Plan for emergency tracheostomy.
Prepare for endotracheal intubation.
Administer IV calcium gluconate.
Which nursing action will be included in the plan of care for a patient with Graves’ disease who has exophthalmos?
Place cold packs on the eyes to relieve pain and swelling.
Elevate the head of the patient’s bed to reduce periorbital
fluid.
Teach the patient to blink every few seconds to lubricate the
corneas.
Apply alternating eye patches to protect the corneas from
irritation.
A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient
about radioactive precautions to take with all body secretions.
that symptoms of hypothyroidism may occur as the RAI therapy
takes effect.
to discontinue the antithyroid medications taken before the
radioactive therapy.
that symptoms of hyperthyroidism should be relieved in about a week.
Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
Fluid balance
Nutritional intake
Orientation and alertness
Apical pulse rate
An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed
docusate (Colace).
ibuprofen (Motrin).
diazepam (Valium).
cefoxitin (Mefoxin).
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?
Delay teaching until closer to discharge date.
Provide written reminders of information taught.
Ensure privacy for teaching by asking the family to leave.
Offer multiple options for management of therapies.
A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?
Restrict the patient to bed rest.
Assess for positive Chvostek’s sign.
Encourage 4000 mL of fluids daily.
Institute routine seizure precautions.
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms?
Administer the prescribed muscle relaxant.
Start the PRN O2 at 2 L/min per cannula.
Have the patient rebreathe from a paper bag.
Stretch the muscles with passive range of motion.
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about
bisphosphonates to reduce bone demineralization.
increasing fluid intake to decrease risk for nephrolithiasis.
including whole grains in the diet to prevent constipation.
calcium supplements to normalize serum calcium levels.
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?
Blood pressure 112/62 mm Hg
Increased thyroxine (T4) level
Elevated thyroid stimulating hormone level
Distant and difficult to hear heart sounds
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?
Bronzed appearance of the skin
Chronically low blood pressure
Decreased axillary and pubic hair
Purplish streaks on the abdomen
A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance?
Reassure the patient that the physical changes are very common
in patients with Cushing syndrome.
Remind the patient that most of the physical changes caused by
Cushing syndrome will resolve after surgery.
Teach the patient that the metabolic impact of Cushing syndrome
is of more importance than appearance.
Discuss the use of diet and exercise in controlling the weight
gain associated with Cushing syndrome.
Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?
Increasing serum sodium levels
Decreasing blood glucose levels
Decreasing serum chloride levels
Increasing serum potassium levels
The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching?
“I frequently eat at restaurants, and my food has a lot of added
salt.”
“I had the flu earlier this week, so I couldn’t take the
hydrocortisone.”
“I always double my dose of hydrocortisone on the days that I go
for a long run.”
“I take twice as much hydrocortisone in the morning dose as I do
in the afternoon.”
A 29-yr-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include?
“Weigh yourself daily to monitor for weight gain.”
“Call the health care provider if you have mood changes with the
prednisone.”
“The prednisone dose should be decreased gradually.”
“A weight-bearing exercise program will help minimize risk for
osteoporosis.”
The nurse providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism should
elevate the patient’s legs to relieve edema.
monitor blood glucose level every 4 hours.
order the patient a potassium-restricted diet.
monitor the blood pressure every 4 hours.
The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for
flushing.
bradycardia.
hypoglycemia.
headache.
After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for
insulin to maintain normal blood glucose levels.
sodium restriction to prevent fluid retention.
oral corticosteroids to replace endogenous cortisol.
chemotherapy to prevent malignant tumor recurrence.
Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
Encourage fluids to 2 to 3 L/day.
Monitor for increasing peripheral edema.
Offer the patient hard candies to suck on.
Keep head of bed elevated to 30 degrees.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
Observe the dressing for bleeding.
Support the patient’s head with pillows.
Assess the patient’s respiratory effort.
Check the blood pressure and pulse.
The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to
monitor for signs of infection.
prevent emotional disturbances.
protect the patient’s skin.
balance fluids and electrolytes.
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
The patient reports a recent head injury.
The patient is confused and lethargic.
The patient’s urine specific gravity is 1.003.
The patient has a urine output of 400 mL/hr.
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm?
Iodine
Methimazole
Propranolol (Inderal)
Propylthiouracil
Which assessment finding for a 33-yr-old female patient admitted with Graves’ disease requires the most rapid intervention by the nurse?
Severe bilateral exophthalmos
Temperature 103.8° F (40.4° C)
Blood pressure 166/100 mm Hg
Heart rate 136 beats/min
A 37-yr-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon?
Difficult to awaken.
Reports 7/10 incisional pain.
Increasing neck swelling.
Cardiac rate 112 beats/minute.
Which assessment finding of a 42-yr-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse?
The blood glucose is 192 mg/dL.
The blood pressure (BP) is 88/50 mm Hg.
The patient reports 6/10 incisional pain.
The lungs have bibasilar crackles.
A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
Titrate the infusion of 5% dextrose in water.
Administer prescribed subcutaneous DDAVP.
Teach the patient how to use desmopressin (DDAVP) nasal spray.
Assess the patient’s overall hydration status every 8 hours.
Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?
The patient has a recent weight gain of 9 lb.
The patient has a serum sodium level of 118 mEq/L.
The patient has a urine specific gravity of 1.025.
The patient complains of dyspnea with activity.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
A 31-yr-old female patient with Cushing syndrome and a blood
glucose level of 244 mg/dL
A 70-yr-old female patient taking levothyroxine (Synthroid) who
has an irregular pulse of 134
A 53-yr-old male patient who has Addison’s disease and is due
for a prescribed dose of hydrocortisone (Solu-Cortef).
A 22-yr-old male patient admitted with syndrome of inappropriate
antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
Which question will the nurse in the endocrine clinic ask to help determine a patient’s risk factors for goiter?
“How much milk do you drink?”
“What medications are you taking?”
“Have you had any recent neck injuries?”
“Are your immunizations up to date?”
Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?
Milk leaking from breasts
Changes in visual field
Blood glucose 150 mg/dL
Nausea and projectile vomiting
Which finding by the nurse when assessing a patient with Hashimoto’s thyroiditis and a goiter will require the most immediate action?
Elevation in the patient’s T3 and T4
levels
New-onset changes in the patient’s voice
Resting apical pulse rate 112 beats/minute
Bruit audible bilaterally over the thyroid gland
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
Patient’s blood pressure is 148/94 mm Hg.
Patient stopped taking the medication 2 days ago.
Patient has not been taking the prescribed vitamin D.
Patient has bilateral 2+ pitting ankle edema.
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
Patient with Hashimoto’s thyroiditis and a heart rate of 102
Patient with tetany who has a new order for IV calcium chloride
Patient with Addison’s disease who takes hydrocortisone twice
daily
Patient with Cushing syndrome and a blood glucose of 140 mg/dL
A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. Urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?
Increase normal saline infusion to 250 mL/hr.
Give hydrocortisone (Solu-Cortef) 100 mg IV.
Administer furosemide (Lasix) 40 mg IV.
Titrate norepinephrine to keep systolic blood pressure (BP)
above 90 mm Hg.
A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of 92/54 mm Hg, a pulse of 64 beats/min, and an elevated pulmonary artery wedge pressure (PAWP). Which intervention ordered by the health care provider should the nurse question?
Elevate head of bed to 30 degrees.
Infuse normal saline at 250 mL/hr.
Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
Hold nitroprusside if systolic BP is less than 90 mm Hg.
A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?
Inspiratory crackles
Temperature 101.2°F (38.4°C)
Cool, clammy extremities
Heart rate 45 beats/min
An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
Increase the rate for the dopamine infusion.
Decrease the rate for the nitroglycerin infusion.
Decrease the rate for the 5% dextrose in normal saline (D5/.9
NS) infusion.
Increase the rate for the sodium nitroprusside infusion.
After receiving 2 L of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for
norepinephrine .
sodium nitroprusside .
furosemide .
nitroglycerin .
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform?
Palpate for abdominal tenderness.
Check stools for occult blood.
Auscultate bowel sounds.
Ask the patient about nausea.
A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is increased, and cardiac output is low. The nurse will anticipate an order for which medication?
5% albumin infusion
epinephrine (Adrenalin) drip
hydrocortisone (Solu-Cortef)
furosemide (Lasix) IV
The emergency department (ED) nurse receives report that a seriously injured patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 5 minutes. In preparation for the patient’s arrival, the nurse will obtain
a hypothermia blanket.
a dopamine infusion.
lactated Ringer’s solution.
two 16-gauge IV catheters.
Which finding is the best indicator that the fluid resuscitation for a 90-kg patient with hypovolemic shock has been effective?
Hemoglobin is within normal limits.
Urine output is 65 mL over the past hour.
Mean arterial pressure (MAP) is 72 mm Hg.
Central venous pressure (CVP) is normal.
Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?
Check temperature every 2 hours.
Monitor breath sounds frequently.
Maintain patient in supine position.
Assess skin for flushing and itching.
Monitor breath sounds frequently.
Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which patient data indicate that the nurse should consult with the health care
The patient’s central venous pressure is 3 mm Hg.
The patient is receiving low dose dopamine.
The patient has had no urine output since being admitted.
The patient is in sinus tachycardia at 120 beats/min.
A nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which finding indicates that the drug is effective?
Decreased troponin level
No new heart murmurs
Warm, pink, and dry skin
Blood pressure of 92/40 mm Hg
Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic shock has been effective?
Heart rate
Blood pressure
Oxygen saturation
Orientation
Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the patient may be developing multiple organ dysfunction syndrome (MODS)?
The patient complains of intermittent chest pressure.
The patient’s serum creatinine level is elevated.
The patient has bilateral crackles throughout lung fields.
The patient’s extremities are cool and pulses are weak.
A patient with septic shock has a BP of 70/46 mm Hg, pulse of 136 beats/min, respirations of 32 breaths/min, temperature of 104°F, and blood glucose of 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?
Give acetaminophen (Tylenol) 650 mg rectally.
Start insulin drip to maintain blood glucose at 110 to 150
mg/dL.
Start norepinephrine to
keep systolic blood pressure above 90 mm Hg.
Give normal saline IV at 500 mL/hr.
When the nurse educator is evaluating the skills of a new registered nurse (RN) caring for patients experiencing shock, which action by the new RN indicates a need for more education?
Placing the pulse oximeter on the ear for a patient with septic
shock
Keeping the head of the bed flat for a patient with hypovolemic
shock
Increasing the nitroprusside infusion rate for a patient with a
very high SVR
Maintaining a cool room temperature for a patient with
neurogenic shock
The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?
Heart rate of 118 beats/min
O2 saturation of 93% on room air
Skin cool and clammy
Blood pressure of 92/56 mm Hg
A patient is admitted to the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to
obtain the blood pressure.
administer supplemental oxygen.
obtain a 12-lead electrocardiogram.
check the level of orientation.
During change-of-shift report, the nurse is told that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse to report to the health care provider?
Decreased bowel sounds
New onset of confusion
Pale, cool, and dry extremities
Heart rate 112 beats/min
A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which intervention ordered by the health care provider should the nurse implement first?
Insert two large-bore IV catheters.
Provide O2 at 100% per non-rebreather mask.
Draw blood to type and crossmatch for transfusions.
Initiate continuous electrocardiogram (ECG) monitoring.
A patient who has neurogenic shock is receiving a phenylephrine infusion through a right forearm IV. Which assessment finding obtained by the nurse indicates a need for immediate action?
The patient’s heart rate is 58 beats/min.
The patient’s IV infusion site is cool and pale.
The patient’s urine output is 28 mL over the past hour.
The patient’s extremities are warm and dry.
The following interventions are ordered by the health care provider for a patient who has respiratory distress and syncope after eating strawberries. Which will the nurse complete first?
Administer diphenhydramine.
Give epinephrine.
Draw blood for complete blood count (CBC)
Start continuous ECG monitoring.
Which finding about a patient who is receiving vasopressin to treat septic shock indicates an immediate need for the nurse to report the finding to the health care provider?
The patient’s urine output is 18 mL/hr.
The patient’s peripheral pulses are weak.
The patient is complaining of chest pain.
The patient’s heart rate is 110 beats/minute.
After change-of-shift report in the progressive care unit, who should the nurse care for first?
Patient who had an inferior myocardial infarction 2 days ago and
has crackles in the lung bases
Patient with suspected urosepsis who has new orders for urine
and blood cultures and antibiotics
Patient admitted with anaphylaxis 3 hours ago who now has clear
lung sounds and a blood pressure of 108/58 mm Hg
Patient who had a T5 spinal cord injury 1 week ago and currently
has a heart rate of 54 beats/minute
A patient with suspected neurogenic shock after a diving accident has arrived in the emergency department. A cervical collar is in place. Which actions should the nurse take (select all that apply)?
Obtain baseline body temperature.
Prepare to administer atropine IV.
Provide high-flow O2 (100%) by nonrebreather mask.
Prepare for emergent intubation and mechanical ventilation.
Infuse large volumes of lactated Ringer’s solution.
Which preventive actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS) in patients admitted to the hospital (select all that apply)?
Ambulate postoperative patients as soon as possible after
surgery.
Remove indwelling urinary catheters as soon as possible after
surgery.
Administer prescribed antibiotics within 1 hour for patients
with possible sepsis.
Use aseptic technique when manipulating invasive lines or
devices.
Advocate for parenteral nutrition for patients who cannot take
in adequate calories.
The nurse is caring for a patient admitted with hypovolemic shock. The nurse palpates thready brachial pulses but is unable to auscultate a blood pressure. What is the best nursing action?
Estimate the systolic pressure as 60 mm Hg.
Record the blood pressure as “not assessable.”
Assess the blood pressure by Doppler.
Estimate the systolic pressure as 60 mm Hg.
Obtain an electronic blood pressure monitor.
The nurse has just completed an infusion of a 1000 mL bolus of 0.9% normal saline in a patient with severe sepsis. One hour later, which laboratory result requires immediate nursing action?
Creatinine 1.0 mg/dL
Potassium 3.8 mEq/L
Sodium 140 mEq/L
Lactate 6 mmol/L
The nurse has been administering 0.9% normal saline intravenous fluids in a patient with severe sepsis. To evaluate the effectiveness of fluid therapy, which physiological parameters would be most important for the nurse to assess?
Breath sounds and capillary refill
Blood pressure and oral temperature
Oral temperature and capillary refill
Right atrial pressure and urine output
A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postoperatively, the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; urine output is 250 mL/hr; chest drainage is 200 mL/hr. What is the best interpretation by the nurse?
The assessed values are within normal limits.
The patient is at risk for developing hypovolemic shock.
The patient is at risk for developing fluid volume overload.
The patient is at risk for developing cardiogenic shock.
A patient is admitted after collapsing at the end of a summer marathon. The patient is lethargic, with a heart rate of 110 beats/min, respiratory rate of 30 breaths/min, and a blood pressure of 78/46 mm Hg. The nurse anticipates administering which therapeutic intervention?
Human albumin infusion
Lactated Ringer’s bolus
Hypotonic saline solution
Packed red blood cells
The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values is the nurse most likely to assess?
High pulmonary artery occlusive pressure and high cardiac output
High systemic vascular resistance and low cardiac output
Low pulmonary artery occlusive pressure and low cardiac output
Low systemic vascular resistance and high cardiac output
The nurse is caring for a patient admitted with severe sepsis. Vital signs assessed by the nurse include blood pressure 80/50 mm Hg, heart rate 120 beats/min, respirations 28 breaths/min, oral temperature of 102° F, and a right atrial pressure (RAP) of 1 mm Hg. Which intervention should the nurse carry out first?
Acetaminophen suppository
Isotonic fluid challenge
IV antibiotic administration
Blood cultures from two sites
Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock?
A patient admitted with abdominal pain and an elevated white
blood cell count
A patient with a temperature of 102° F and a general dermal rash
A patient with a 2-day history of nausea, vomiting, and diarrhea
A patient with slight rectal bleeding from inflamed hemorrhoids
The nurse is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP) of 18 mm Hg and a cardiac index (CI) of 1.0 L/min/m2. What is the priority pharmacological intervention?
Furosemide
Dobutamine
Phenylephrine
Sodium nitroprusside
Ten minutes following administration of an antibiotic, the nurse assesses a patient to have edematous lips, hoarseness, and expiratory stridor. Vital signs assessed by the nurse include blood pressure 70/40 mm Hg, heart rate 130 beats/min, and respirations 36 breaths/min. What is the priority intervention?
Diphenhydramine 50 mg intravenously
Epinephrine 3 to 5 mL of a 1:10,000 solution intravenously
Ranitidine 50 mg intravenously
Methylprednisolone 125 mg intravenously
A patient is admitted to the cardiac care unit with an acute anterior myocardial infarction. The nurse assesses the patient to be diaphoretic and tachypneic, with bilateral crackles throughout both lung fields. Following insertion of a pulmonary artery catheter by the physician, which hemodynamic values is the nurse most likely to assess?
Low pulmonary artery occlusive pressure and low cardiac output
High pulmonary artery diastolic pressure and low cardiac output
Normal cardiac output and low systemic vascular resistance
Low systemic vascular resistance and high cardiac output
During the initial stages of shock, what are the physiological effects of decreased cardiac output?
Increased sympathetic stimulation
Arterial vasodilation
Increased parasympathetic stimulation
High urine output
While monitoring a patient for signs of shock, the nurse understands which system assessment to be of priority?
Gastrointestinal system
Central nervous system
Respiratory system
Renal system
The nurse is caring for a patient in cardiogenic shock being treated with an intraaortic balloon pump (IABP). The family inquires about the primary reason for the device. What is the best statement by the nurse to explain the IABP?
“The machine will beat for the damaged heart with every beat
until it heals.”
“The action of the machine will improve blood supply to the
damaged heart.”
“The machine will remain in place until the patient is ready for
a heart transplant.”
“The machine will help cleanse the blood of impurities that
might damage the heart.”
The nurse is caring for a patient following insertion of an intraaortic balloon pump (IABP) for cardiogenic shock unresponsive to pharmacotherapy. Which hemodynamic parameter best indicates an appropriate response to therapy?
Pulmonary artery diastolic pressure of 26 mm Hg
Pulmonary artery occlusion pressure (PAOP) of 22 mm Hg
Systemic vascular resistance (SVR) of 1600 dynes/sec/cm-5
Cardiac index (CI) of 2.5 L/min/m2
The nurse is caring for an athlete with a possible cervical spine (C5) injury following a diving accident. The nurse assesses a blood pressure of 70/50 mm Hg, heart rate 45 beats/min, and respirations 26 breaths/min. The patient’s skin is warm and flushed. What is the best interpretation of these findings by the nurse?
The patient is experiencing an allergic reaction.
The vital signs are normal for this patient.
The patient is developing neurogenic shock.
The patient most likely has an elevated temperature.
The nurse is caring for a patient in spinal shock. Vital signs include blood pressure 100/70 mm Hg, heart rate 70 beats/min, respirations 24 breaths/min, oxygen saturation 95% on room air, and an oral temperature of 94.8° F. Which intervention is most important for the nurse to include in the patient’s plan of care?
Administration of atropine sulfate (Atropine)
Application of slow rewarming measures
Infusion of IV phenylephrine (Neo-Synephrine)
Application of 100% oxygen via face mask
The nurse has just completed administration of a 500 mL bolus of 0.9% normal saline in a patient with hypovolemic shock. The nurse assesses the patient to be slightly confused, with a mean arterial blood pressure (MAP) of 50 mm Hg, a heart rate of 110 beats/min, urine output of 10 mL for the past hour, and a central venous pressure (CVP/RAP) of 3 mm Hg. What is the best interpretation of these results by the nurse?
More time is needed to assess response.
Additional interventions are indicated.
Values are normal for the patient condition.
Patient response to therapy is appropriate.
The emergency department nurse admits a patient following a motor vehicle collision. Vital signs include blood pressure 70/50 mm Hg, heart rate 140 beats/min, respiratory rate 36 breaths/min, temperature 101° F and oxygen saturation (SpO2) 95% on 3 L of oxygen per nasal cannula. Laboratory results include hemoglobin 6.0 g/dL, hematocrit 20%, and potassium 4.0 mEq/L. Based on this assessment, what is most important for the nurse to include in the patient’s plan of care?
Application of cushioned heel protectors
Insertion of an 18-gauge peripheral intravenous line
Implementation of universal precautions
Implementation of fall precautions
The nurse is starting to administer a unit of packed red blood cells (PRBCs) to a patient admitted in hypovolemic shock secondary to hemorrhage. Vital signs include blood pressure 60/40 mm Hg, heart rate 150 beats/min, respirations 42 breaths/min, and temperature 100.6° F. What is the best action by the nurse?
Administer blood transfusion over at least 4 hours.
Titrate rate of blood administration to patient response.
Notify the physician of the patient’s heart rate.
Notify the physician of the elevated temperature.
The nurse is caring for a patient in septic shock. The nurse assesses the patient to have a blood pressure of 105/60 mm Hg, heart rate 110 beats/min, respiratory rate 32 breaths/min, oxygen saturation (SpO2) 95% on 45% supplemental oxygen via Venturi mask, and a temperature of 102° F. The physician orders stat administration of an antibiotic. Which additional physician order should the nurse complete first?
Chest x-ray
Blood cultures
Serum electrolytes
Foley insertion
The nurse is caring for a patient admitted to the critical care unit 48 hours ago with a diagnosis of severe sepsis. As part of this patient’s care plan, what intervention is most important for the nurse to discuss with the multidisciplinary care team?
Enteral feedings
Monitoring intake and output
Frequent turning
Pain management
The nurse is administering both crystalloid and colloid intravenous fluids as part of fluid resuscitation in a patient admitted in severe sepsis. What findings assessed by the nurse indicate an appropriate response to therapy?
Normal body temperature
Urine output of 0.5 mL/kg/hr
Adequate pain management
Balanced intake and output
The nurse is caring for a 70-kg patient in hypovolemic shock. Upon initial assessment, the nurse notes a blood pressure of 90/50 mm Hg, heart rate 125 beats/min, respirations 32 breaths/min, central venous pressure (CVP/RAP) of 3 mm Hg, and urine output of 5 mL during the past hour. Following physician rounds, the nurse reviews the orders and questions which order?
Administer acetaminophen 650-mg suppository prn every 6 hours
for pain.
Complete neurological assessment every 4 hours for the next 24
hours.
Administer furosemide 20 mg IV every 4 hours for a CVP greater
than or equal to 20 mm Hg.
Titrate dopamine intravenously for blood pressure less than 90
mm Hg systolic.
The nurse is administering intravenous norepinephrine at 5 mcg/kg/min via a 20-gauge peripheral intravenous (IV) catheter. Which assessment finding requires immediate action by the nurse?
Blood pressure 100/60 mm Hg
Heart rate of 110 beats/min
Swelling at the IV site
Central venous pressure (CVP) of 8 mm Hg
The nurse is caring for a patient in cardiogenic shock experiencing chest pain. Hemodynamic values assessed by the nurse include a cardiac index (CI) of 2.5 L/min/m2, heart rate of 70 beats/min, and a systemic vascular resistance (SVR) of 2200 dynes/sec/cm-5. Upon review of physician orders, which order is most appropriate for the nurse to initiate?
Furosemide 20 mg intravenous (IV) every 4 hours as needed for
CVP greater than or equal to ³20
mm Hg
Nitroglycerin infusion titrated at a rate of 5 to 10 mcg/min as
needed for chest pain
Dopamine infusion at a rate of 5 to 10 mcg/kg/min to maintain a
systolic BP of at least 90 mm Hg
Dobutamine infusion at a rate of 2 to 20 mcg/kg/min as needed
for CI less than 2 L/min/m2
The nurse is caring for a mechanically ventilated patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best protects against the development of a central line–associated bloodstream infection (CLABSI)?
Elevation of the head of the bed
Assessment for weaning readiness
Documentation of insertion date
Appropriate sedation management
The nurse is caring for a patient admitted with the early stages of septic shock. The nurse assesses the patient to be tachypneic, with a respiratory rate of 32 breaths/min. Arterial blood gas values assessed on admission are pH 7.50, CO2 28 mm Hg, HCO3 26. Which diagnostic study result reviewed by the nurse indicates progression of the shock state?
pH 7.40, CO2 40, HCO3 24
pH 7.35, CO2 40, HCO3 22
pH 7.45, CO2 45, HCO3 26
pH 7.30, CO2 45, HCO3 18
The nurse is caring for a patient admitted following a motor vehicle crash. Over the past 2 hours, the patient has received 6 units of packed red blood cells and 4 units of fresh frozen plasma by rapid infusion. To prevent complications, what is the priority nursing intervention?
Assess core body temperature.
Apply bilateral heel protectors.
Administer pain medication.
Turn patient every 2 hours.
The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine. The physician’s order calls for the nurse to titrate the infusion to achieve a cardiac index of greater than or equal to 2.5 L/min/m2. The nurse measures a cardiac output, and the calculated cardiac index for the patient is 4.6 L/min/m2. What is the best action by the nurse?
Reduce the rate of dobutamine.
Order a stat 12-lead electrocardiogram.
Obtain a stat serum potassium level.
Assess the patient’s hourly urine output.
After receiving a handoff report from the night shift, the nurse completes the morning assessment of a patient with severe sepsis. Vital signs are: blood pressure 95/60 mm Hg, heart rate 110 beats/min, respirations 32 breaths/min, oxygen saturation (SpO2) 96% on 45% oxygen via Venturi mask, temperature 101.5° F, central venous pressure (CVP/RAP) 2 mm Hg, and urine output of 10 mL for the past hour. The nurse initiates which provider prescription first?
Increase supplemental oxygen therapy to maintain SpO2
greater than 94%.
Administer infusion of 500 mL 0.9% normal saline every 4 hours
as needed if the CVP is less than 5 mm Hg.
Administer 40 mg furosemide (Lasix) intravenous as needed if the
urine output is less than 30 mL/hr.
Administer acetaminophen (Tylenol) 650-mg suppository per rectum
as needed to treat temperature greater than 101° F.
The nurse is caring for a patient with severe sepsis who was resuscitated with 3000 mL of lactated Ringer’s solution over the past 4 hours. Morning laboratory results show a hemoglobin of 8 g/dL and hematocrit of 28%. What is the best interpretation of these findings by the nurse?
Blood transfusion with packed red blood cells is required.
Fluid resuscitation has resulted in fluid volume overload.
Hemoglobin and hematocrit results indicate hemodilution.
Fluid resuscitation has resulted in third-spacing of fluid.
Fifteen minutes after beginning a transfusion of O negative blood to a patient in shock, the nurse assesses a drop in the patient’s blood pressure to 60/40 mm Hg, heart rate 135 beats/min, respirations 40 breaths/min, and a temperature of 102° F. The nurse notes the new onset of hematuria in the patient’s Foley catheter. What are the priority nursing actions? (Select all that apply.)
Administer acetaminophen.
Document the patient’s response.
Increase the rate of transfusion.
Notify the provider.
Stop the transfusion.
Notify the blood bank.
The nurse is caring for a patient admitted with shock. The nurse understands which assessment findings best assess tissue perfusion in a patient in shock? (Select all that apply.)
Heart rate
Pupil response
Blood pressure
Urine output
Respirations
Level of consciousness
A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of:
adrenal insufficiency.
diabetic ketoacidosis.
hyperosmolar, hyperglycemic state.
hypoglycemia.
Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?
An 18-year-old college student with type 1 diabetes who
exercises excessively
An 83-year-old, long-term care resident with type 2 diabetes and
advanced Alzheimer’s disease who recently developed influenza
A 75-year-old man with type 2 diabetes and coronary artery
disease who has recently started on insulin injections
A 45-year-old woman with type 1 diabetes who forgets to take her
insulin in the morning
Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
Blood glucose >1000 mg/dL
pH 7.24
Normal anion gap
Negative ketones in the urine
Which of the following is a high-priority nursing diagnosis for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome?
Activity intolerance
Fluid volume deficient
Impaired nutrition, more than body requirements
Hyperthermia
The nurse is assigned to care for a patient who presented to the emergency department with diabetic ketoacidosis. A continuous insulin intravenous infusion is started, and hourly bedside glucose monitoring is ordered. The targeted blood glucose value after the first hour of therapy is
70 to 120 mg/dL.
a decrease of 35 to 90 mg/dL compared with admitting values.
less than 200 mg/dL.
a decrease of 25 to 50 mg/dL compared with admitting values.
A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
He will go into thyroid storm.
Nothing; it is appropriate to stop the medication for 3 days.
He will go into adrenal crisis.
His autoimmune disease will go into remission.
The nurse is caring for a patient with a diagnosis of head trauma. The nurse notes that the patient’s urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing
diabetic ketoacidosis.
diabetes insipidus.
syndrome of inappropriate secretion of antidiuretic hormone.
hyperosmolar hyperglycemic syndrome.
A patient is receiving hydrocortisone sodium succinate for adrenal crisis. What other medication does the nurse prepare to administer?
Regular insulin
Canagliflozin
Propranolol
A proton pump inhibitor
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
Never; normal saline is the only appropriate solution in
diabetes management
When the blood sugar reaches 70 mg/dL
When the blood sugar reaches 150 mg/dL
When the blood glucose reaches 250 mg/dL
A patient is admitted to the critical care unit with a diagnosis of diabetic ketoacidosis. Following aggressive fluid resuscitation and intravenous (IV) insulin administration, the blood glucose begins to normalize. In addition to glucose monitoring, which of the following electrolytes requires close monitoring?
Sodium
Calcium
Chloride
Potassium
A patient is admitted to the oncology unit with a small-cell lung carcinoma. During the admission, the patient is noted to have a significant decrease in urine output accompanied by shortness of breath, edema, and mental status changes. The nurse is aware that this clinical presentation is consistent with
adrenal crisis.
syndrome of inappropriate secretion of antidiuretic hormone
(SIADH).
myxedema coma.
diabetes insipidus.
In hyperosmolar hyperglycemic syndrome, the laboratory results are similar to those of diabetic ketoacidosis, with three major exceptions. What differences would you expect to see in patients with hyperosmolar hyperglycemic syndrome?
Lower serum glucose, lower osmolality, and milder ketosis
Higher serum glucose, higher osmolality, and greater ketosis
Higher serum glucose, higher osmolality, and no ketosis
Lower serum glucose, lower osmolality, and greater ketosis
Which of the following statements is true about the medical management of diabetic ketoacidosis?
Sodium bicarbonate is a first-line medication for treatment.
Serum lactate levels are used to guide insulin administration.
Volume replacement and insulin infusion often correct the
acidosis.
The degree of acidosis is assessed through continuous pulse
oximetry.
An individual with type 2 diabetes who takes glipizide has begun a formal exercise program at a local gym. While exercising on the treadmill, the individual becomes pale, diaphoretic, shaky, and has a headache. The individual feels as though she is going to pass out. What is the individual’s priority action?
Drink additional water to prevent dehydration.
Eat something with 15 g of simple carbohydrates.
Take another dose of the oral agent.
Go to the first-aid station to have glucose checked.
Acute adrenal crisis is caused by
acute renal failure.
high doses of corticosteroids.
overdose of testosterone.
deficiency of corticosteroids.
The most significant clinical finding of acute adrenal crisis associated with fluid and electrolyte imbalance is
fluid volume excess.
hyperkalemia
hypernatremia
hyperglycemia.
A patient presents to the emergency department with suspected thyroid storm. The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?
Idioventricular rhythm
Atrial fibrillation
Sinus bradycardia
Junctional rhythm
An elderly female patient has presented to the emergency department with altered mental status, hypothermia, and clinical signs of heart failure. Myxedema is suspected. Which of the following laboratory findings support this diagnosis?
Elevated cortisol levels
Elevated adrenocorticotropic hormone
Elevated T3 and T4
Elevated thyroid-stimulating hormone
Which of the following would be seen in a patient with myxedema coma?
Hyperthermia
Decreased reflexes
Tachycardia
Hyperventilation
The nurse is caring for a patient who underwent pituitary surgery 12 hours ago. The nurse will give priority to monitoring the patient carefully for which of the following?
Congestive heart failure
Hypovolemic shock
Volume overload
Infection
The nurse is caring for a patient with head trauma who was admitted to the surgical intensive care unit following a motorcycle crash. What is an important assessment that will assist the nurse in early identification of an endocrine disorder commonly associated with this condition?
Daily weight
Urine osmolality
Lung sound auscultation
Fingerstick glucose
Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone?
Fasting blood glucose 156 mg/dL
Serum sodium 115 mEq/L
Serum sodium 152 mEq/L
Serum potassium 5.8 mEq/L
A patient with pancreatic cancer has been admitted to the critical care unit with clinical signs consistent with syndrome of inappropriate secretion of antidiuretic hormone. The nurse anticipates that clinical management of this condition will include
administration of exogenous vasopressin.
administration of 3% normal saline.
fluid restriction.
low sodium diet.
The nurse is providing insulin education for an elderly patient with long-standing diabetes. A prescription has been written for the patient to take 20 units of insulin glargine at 10 PM nightly. The nurse should instruct the patient that the peak of the insulin action for this agent is
0200.
0800.
0400.
peakless.
The nurse is caring for a patient who suffered a head trauma following a fall. The patient’s heart rate is 112 beats/min and blood pressure is 88/50 mm Hg. The patient has poor skin turgor and dry mucous membranes. The patient is confused and restless. The following laboratory values are reported: serum sodium is 115 mEq/L; blood urea nitrogen (BUN) 50 mg/dL; and creatinine 1.8 mg/dL. The findings are consistent with which disorder?
Diabetes insipidus
Cerebral salt wasting
Syndrome of inappropriate secretion of antidiuretic hormone
Thyroid storm
A patient with newly diagnosed type 1 diabetes is being transitioned from an infusion of intravenous (IV) regular insulin to an intensive insulin therapy regimen of insulin glargine and insulin aspart. How should the nurse manage this transition in insulin delivery?
Administer the insulin glargine and continue the IV insulin
infusion for 24 hours.
Administer the insulin glargine and discontinue the IV infusion
in several hours.
Discontinue the IV infusion and administer the Lantus insulin at
bedtime.
Discontinue the IV infusion and administer the insulin aspart
with the next meal.
Which of the following are appropriate nursing interventions for the patient in myxedema coma? (Select all that apply.)
Administer levothyroxine as prescribed.
Encourage the intake of foods high in sodium.
Initiate passive rewarming interventions.
Monitor airway and respiratory effort.
Monitor urine osmolality.
Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.)
ADH deficiency
ADH excess
Water deprivation
ADH replacement therapy
ADH insensitivity
A college student was admitted to the emergency department after being found unconscious by a roommate. The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms, including vomiting, since yesterday. The patient had been up all night studying for exams. The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies. Based upon the history, which laboratory findings would be anticipated in this client? (Select all that apply.)
Blood glucose: 43 mg/dL
Blood glucose: 524 mg/dL
PaCO2: 37 mm Hg
pH: 7.23
HCO3—: 10 mEq/L
What psychosocial factors may potentially contribute to the development of diabetic ketoacidosis? (Select all that apply.)
Altered sleep/rest patterns
Lack of financial resources
High levels of stress
Exposure to influenza
Eating disorder
Factors associated with the development of nephrogenic diabetes insipidus include which of the following? (Select all that apply.)
Medications
Heredity
Pituitary tumors
Meningitis
Sickle cell disease
The nurse has been assigned the following patients. Which patients require assessment of blood glucose control as a nursing priority? (Select all that apply.)
29-year-old female who is undergoing evaluation for
pheochromocytoma
43-year-old male with acute pancreatitis who is receiving total
parenteral nutrition (TPN)
62-year-old morbidly obese female who underwent a hysterectomy
for ovarian cancer
18-year-old male who has undergone surgical correction of a
fractured femur
72-year-old female who is receiving intravenous (IV) steroids
for an exacerbation of chronic obstructive pulmonary disease (COPD)
A patient with long-standing type 1 diabetes presents to the emergency department with a loss of consciousness and seizure activity. The patient has a history of renal insufficiency, gastroparesis, and peripheral diabetic neuropathy. Emergency personnel reported a blood glucose of 32 mg/dL on scene. When providing discharge teaching for this patient and family, the nurse instructs on the need to do which of the following? (Select all that apply.)
Administer glucagon 1 mg intramuscularly any time the blood
glucose is less than 70 mg/dL.
Administer 15 grams of carbohydrate orally for severe episodes
of hypoglycemia.
Perform blood glucose monitoring before exercising and driving.
Increase home blood glucose monitoring and report patterns of
hypoglycemia to the provider.
Discontinue the insulin pump by removing the infusion set
catheter.
