acute/chronic exam 2- practice questions

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Which patient is of highest priority for the nurse?

a) A patient with hyperglycemia. b) A patient with hypoglycemia.


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Which patient is of highest priority for the nurse?

a) A patient with hyperglycemia. b) A patient with hypoglycemia.


What is the priority action for a patient with signs and symptoms of hypoglycemia?

a) Call the HCP for orders b) Check the blood glucose level c) Have the patient sit or lie down at once d) Start an IV and give D50


The RN observes that a patient with DM returning from X-ray c/o HA, is angry about missing breakfast, and has moist hands. What is the nurse’s priority action?

a) Acknowledge his dissatisfaction. b) Administer PRN acetaminophen. c) Call for a snack tray. d) Check the BG level.


Your patient is unresponsive and sweaty. His blood glucose is 40. In which position should this patient be placed?

a) Head of bed flat, feet elevated b) High Fowlers c) Side-lying d) Supine


Your patient is unresponsive and sweaty. His blood glucose is 40. Which nursing diagnosis has highest priority?

a) Aspiration, risk for b) Falls, risk for c) Imbalanced nutrition, less than, risk for d) Imbalanced nutrition, more than, risk for


A patient with DM is found unconscious at home and a family member calls the clinic. After determining a glucometer is not available, what should the nurse advise them to do?

a) Administer 10 units regular insulin subQ. b) Administer glucagon 1 mg IM or subQ. c) Call 911 to transport the patient to the ER. d) Have the patient drink some orange juice.


After teaching foot care to a patient with DM, the nurse determines that additional instruction is needed when the patient makes which statement?

a) “I should wash my feet daily with soap and warm water.” b) “I should always wear shoes to protect my feet from injury.” c) “If my feet are cold, I should wear socks instead of using a heating pad.” d) “I’ll know if I have sores on my feet because they will be painful.”


A patient who is newly diagnosed with Type 1 DM. What nursing diagnosis is least appropriate for this patient?

a) Imbalanced nutrition: more than body requirements. b) Risk for injury: hypoglycemia. c) Risk for infection. d) Knowledge deficit.


The patient received 5 units of regular and 30 units of NPH @ 0730. When is he at highest risk for a hypoglycemic reaction? Breakfast: 0800 Lunch: 1200 Supper: 1800

a) After breakfast (0930 – 1030) b) After lunch (1330 – 1530) c) After supper (1900 – 2100) d) Bedtime (2200 – 2400)


The patient received 5 units of regular and 30 units of NPH @ 0730. When will the insulin first begin to work?

a) 15 minutes b) 30 minutes c) 2 hours d) 4 hours


A patient with Type 2 DM is hospitalized for pneumonia and placed on prednisone and insulin on a sliding scale. She states “I’ve never taken insulin before!” What is the best response of the nurse?

a) “Prednisone may increase your BG levels.” b) “The doctor ordered it for you.” c) “You now have Type 1 diabetes from stress.” d) “You now must take insulin daily.”


A patient on metformin is scheduled for an angiogram using contrast dye the day after tomorrow. Which is appropriate?

a) Give the metformin tomorrow morning, give it with a sip of water the day of the test, and continue the metformin the day after the procedure. b) Give the metformin tomorrow morning, hold the metformin the day of the test, then restart the metformin the day after the procedure. c) Hold the metformin tomorrow morning and the day of the test, then continue the metformin two days after the procedure.


A patient is having signs of hypoglycemia. Place the nurse’s actions in the correct order.

  1. Wait 15 min and check BG a second time.

  2. If BG is < 70 mg/dL, give ½ cup fruit juice.

  3. Recheck BG for a 3rd time in another 15 min.

  4. Obtain a fingerstick BG reading.

  5. Assess for S/S (sweating, tremors, altered MS).

  6. Repeat rapid-acting glucose if BG < 70 mg/dL.

  7. Once BG has returned to at least 80 mg/dl, give a more substantial snack (cheese & crackers).

5, 4, 2, 1, 6, 3, 7

A patient with DM is brought to the ER by family because he has had the flu, seems more tired than usual, and does not seem himself. Place the nurse’s actions in the correct order.

  1. Establish IV access.

  2. Check blood glucose.

  3. Ensure patient airway.

  4. Begin continuous regular insulin drip.

  5. Administer 0.9% NS solution at 1 L/hr.

3, 2, 1, 5, 4

The nurse teaches a patient with prediabetes ways to prevent or delay the development of Type 2 DM. What information should be included? Select all that apply.

a) Assess for visual changes each month. b) Exercise regularly. c) Have BP checked regularly. d) Maintain a healthy weight. e) Monitor for polyuria, polyphagia, & polydipsia.

b, d, e

Lispro insulin (Humalog) with NPH (Humulin N) is ordered for a patient with newly diagnosed Type 1 DM. When should the nurse administer lispro insulin?

a) Once a day, before breakfast. b) 1 hour before meals. c) 30 – 45 minutes before meals. d) At mealtime or within 15 minutes of meals.


Which of the following interventions can the RN delegate to the unlicensed assistive personnel (UAP)?

a) Check that the bath water is not too hot. b) Check the patient’s technique for drawing up insulin. c) Discuss complications of diabetes. d) Teach the patient to use a meter for self-monitoring of blood glucose.


The home health nurse must intervene to correct a patient whose insulin administration includes which action?

a) Mixing an evening dose of regular insulin with insulin glargine in 1 syringe for administration. b) Storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c) Placing the insulin bottle currently in use in a small container on the bathroom countertop. d) Warming a prefilled refrigerated syringe in the hands before administration.


When teaching the patient with Type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump?

a) Complications of insulin therapy are prevented. b) Errors in insulin dosing are less likely to occur. c) Frequent blood glucose monitoring is unnecessary. d) Tight glycemic control can be maintained.


The patient taking insulin records BG levels > 200 on awakening for the last 5 mornings. What should the nurse have the patient do first?

a) Decrease the evening insulin dosage to prevent nighttime hypoglycemia and the Somogyi effect. b) Increase the evening insulin dose to prevent the Dawn phenomenon. c) Monitor BG at bedtime, between 0200 and 0400, and on arising. d) Use a single-dose insulin regimen with an intermediate-acting insulin.


The nurse assesses a newly admitted patient with DM. Which observation should be addressed as the priority by the nurse?

a) Areas of lumps and dents on the abdomen. b) Bilateral numbness of both hands. c) Rapid respirations with deep inspiration. d) Stage II pressure injury on the right heel.


A patient with DM calls the clinic because she has nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient?

a) Administer the usual insulin dosage. b) Hold fluid intake until the nausea subsides. c) Come to the clinic immediately for evaluation and treatment. d) Monitor BG every 1 – 2 hours and call if it rises > 150.


A patient with Type 1 DM is NPO for surgery this AM. He takes 10 units NPH and 19 units of glargine daily, and needs 4 units of regular insulin (BG = 244) this AM. Insulin orders are to be clarified with the HCP. Which interventions are most likely? Select all that apply.

a) Give 4 units regular insulin. b) Hold the 4 units regular insulin. c) Give 10 units NPH insulin. d) Hold the 10 units NPH insulin. e) Hold the 19 units glargine insulin tonight.

a, d

interpret the ABG pH 7.38 pCO2 58 HCO3 31

Resp Acidosis Compensated

interpret the ABG pH 7.51 pCO2 40 HCO3 30

Metabolic Alkalosis- uncompensated

interpret the ABG pH 7.40 pCO2 40 HCO3 23


interpret the ABG pH 7.48 pCO2 30 HCO3 22

Resp Alkalosis- uncompensated

interpret the ABG pH 7.62 pCO2 48 HCO3 30

Metabolic Alkalosis- partially compensated

interpret the ABG pH 7.30 pCO2 60 HCO3 28

Resp. Acidosis- Partially Compensated

Which findings represent greatest risk for pressure ulcer development?

Limited mobility Moisture due to incontinence Risk for fluid volume deficit

stage the pressure ulcer: Non blanching reddened area on heel

stage 1

stage the pressure ulcer: Deep crater with undermining of tissue

stage 3

stage the pressure ulcer: Leathery scab


stage the pressure ulcer: Blister on elbow

stage 2

stage the pressure ulcer: Bone visible, purulent discharge

stage 4

Which diagnostic test is most relevant for assessing the risk of developing a pressure ulcer for a 73 year old patient with no major health issues? A. Serum albumin B. White blood cells C. Red blood cells D. Serum potassium


Which is the most appropriate nursing intervention for a patient at risk for developing a pressure ulcer?

A. Massaging directly over the red area B. Positioning the HOB at 45 degrees to improve circulation C. Using hot soapy water to clean bowel/bladder incontinence D. Repositioning a bedfast patient q2h


Which factors may negatively impact wound healing? Select all that apply. a) Family history of pressure ulcers b) Type 2 diabetes mellitus c) Strict vegetarian d) Cigarette smokere) Long-term use of glucocorticosteroids

b, c, d, e

A patient presents to an outpatient clinic with night sweats and fatigue; nausea, abd pain, diarrhea and a cough. His temperature is 100.6 F. He states he is afraid he has HIV. If the patient has HIV, which stage of infection is he experiencing?

Late chronic/ AIDS

what are the signs and symptoms of rheumatoid arthritis

joint tenderness and swelling nodules in joints

Prioritize nursing diagnoses for a patient with exacerbated rheumatoid arthritis in order

  1. Disturbed body image

  2. Risk for injury

  3. Impaired physical mobility

  4. Pain: Chronic

  5. Deficient knowledge

2, 3, 4, 5, 1

You are caring for a 32 yr old female with an exacerbation of SLE. She presents with c/o fatigue, joint tenderness, and anorexia. A physical exam reveals: swollen knees, an elevated temperature of 100.8, BP of 152/90, and the medical record notes that renal impairment is suspected. Which abnormal lab findings should you expect? Select all that apply.

a) Positive ANA b) Elevated K+ c) 2+ urine protein d) Increased hemoglobin e) Decreased WBC count f) Elevated BUN g) Increased hematocrit h) Decreased serum complement

a, b, c, e, f, h

The patient will be discharged on prednisone (Deltasone) until symptoms improve. Which side effects of this medication will you include in your discharge teaching? Select all that apply.

a) Orthostatic hypotension b) Weight gain c) Loss of appetite d) Buffalo hump e) Moon face f) Abdominal striae g) Hair loss h) Elevated blood glucose

b, d, e, f, g, h

Which medication will the nurse teach a patient with asthma to use when experiencing an acute asthma attack? a. albuterol (Ventolin), a SABA b. salmeterol (Serevent), a LABA c. theophylline (Theo-Dur), a xanthine derivative d. montelukast (Singulair), an LRA


The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situations? Select all that apply.

  1. Tachypnea

  2. Cardiac arrest

  3. Angina

  4. Severe hypertension

  5. Bradycardia

  6. Anaphylaxis

2, 5, 6

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

a) Epinephrine b) Ephedra c) Phenylephrine d) Pseudoephedrine


The nurse is preparing to administer medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, “Why do I have to take so many different drugs?” Which responses by the nurse are correct? Select all that apply.

  1. “Multiple drugs work in different ways to attack the bacteria.”

  2. “Taking multiple drugs reduces the chance that tuberculosis will become drug resistant.”

  3. “Using more than one drug can help to reduce side effects.”

  4. “Using multiple drugs enhances the effect of each drug.”

  5. “You can take lower doses of each drug and they will still be effective.”

1, 2, 3, 5

The nurse is providing patient teaching for a patient who is starting anti-tubercular drug therapy. Which of these statements should be included? Select all that apply.

  1. “Take the medications until the symptoms disappear.”

  2. “Take the medications at the same time every day.”

  3. “You are considered contagious all throughout your illness.”

  4. “Stop taking the medications if you have severe adverse effects.”

  5. “Avoid alcoholic beverages while on this therapy.”

  6. “If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your HCP right away.”

  7. “If you experience a burning or tingling in your fingers or toes, report it to your HCP immediately.”

  8. “Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.”

2, 5, 7, 8

The nurse will assess the patient for which potential contraindication to anti-tubercular therapy?

a) Glaucoma b) Anemia c) Heart failure d) Hepatic impairment