Exam 1 - Practice Questions (Heme, Oncology, Diabetes, HIV, Autoimmune) Flashcards

Question

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a. Give the patient a snack of cheese and crackers. b. Have the patient drink a glass of orange juice or nonfat milk. c. Administer a continuous infusion of 5% dextrose for 24 hours. d. Assess the patient for symptoms of hyperglycemia.

Answer 1

A Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

Answer 2

b) Scleroderma Explanation: ## Footnote Scleroderma occurs initially in the skin, but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

Answer 3

b) Red blood cell count Explanation: ## Footnote There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis.

Answer 4

c. diaphoresis and trembling indicates hypoglycemia

Answer 5

B - In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.

Answer 6

a) Pain, b) Numbness, c) Depression, d) Fatigue, e) Spasticity Explanation: The most commonly reported clinical manifestations of MS are pain, fatigue, spasticity, depression, numbness, weakness, difficulty with coordination, and loss of balance. Aphasia is not a commonly reported clinical manifestation.

Answer 7

c) Treatment of HIV infection for an individual patient is based on the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load). Explanation: Although specific therapies vary, treatment of HIV infection for an individual patient is based on three factors: the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load).Treatment should be offered to all patients with the primary infection (acute HIV syndrome). In general, treatment should be offered to individuals with fewer than 350 CD4+ T cells/mm or plasma HIV RNA levels exceeding 55,000 copies/mL (RT-PCR assay).

Answer 8

A Rationale: Patients using intensive insulin therapy must check their glucose level four to six times daily and administer insulin accordingly. A previous episode of ketoacidosis is not a contraindication for intensive insulin therapy. Intensive insulin therapy is not confined to type 2 diabetics and would prevent microvascular changes as well as macrovascular changes. Intensive insulin therapy and an insulin pump are comparable in glucose control.

Answer 9

b) Antiretroviral therapy targets different stages of the HIV life cycle., e) The CD4 count is the major indicator of immune function and guides therapy. Explanation: The CD4 count is the major indicator of immune function. Antiretroviral therapy in HIV targets different stages of the HIV life cycle. Therapy does not prevent opportunistic infections. Medication therapy is effective and most patients respond well to therapy.

Answer 10

b. Noon blood glucose of 52 mg/dl The nurse should assess the patient with a blood glucose level of 52 mg/dl for symptoms of hypoglycemia, and give the patient some carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range for a diabetic patient.

Answer 11

d) systematically rotate insulin injections within one anatomic site Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. Injection sites should be rotated systematically within one anatomic site.

Answer 12

A, C, D - The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.

Answer 13

a) Cloudy synovial fluid Explanation: In a patient with rheumatoid arthritis, arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement

Answer 14

a) “I will eat a meat source such as chicken or pork with each meal.” Explanation: Vitamin B12 is found only in foods of animal origin

Answer 15

Correct answer: C Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon of sugar. When a client has worsening symptoms of hypoglycemia or is unconscious, treatment includes 1 mg of glucagon subcutaneously or intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to three glucose tablets for a hypoglycemic reaction.

Answer 16

c) Aplastic anemia Explanation: Aplastic anemia can be congenital or acquired, but most cases are idiopathic. It can be triggered by infection. The manifestations of aplastic anemia are symptoms of anemia, purpura (bruising), retinal hemorrhages, significant neutropenia, and thrombocytopenia. Other lymphadenopathies and splenomegaly sometimes occur.

Answer 17

a. 0.45% normal saline solution

Answer 18

Answer C. Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia.

Answer 19

C - Blood glucose testing should be performed whenever hypoglycemia is suspected so that immediate action can be taken if necessary.

Answer 20

b) Assess renal function. Explanation: Chemotherapy results in the destruction of cells and tumor lysis syndrome. There is an increase in uric acid and phosphorus levels and the patient is susceptible to renal failure. The nurse should assess renal function if the patient complains of lower back pain as this could be indicative of a kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out priority problems.

Answer 21

a) It is important to monitor for injection site reactions. Explanation: It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs

Answer 22

c) Petechiae Patients with severe thrombocytopenia have petechiae (i.e. pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities)

Answer 23

c) Maintain nutrition. Explanation: Maintaining nutrition is the most important goal after induction therapy because the patient experiences severe diarrhea and can easily become nutritionally deficient as well as develop fluid and electrolyte imbalance. The patient is most likely not in pain at this point, and this is an intervention not a goal.

Answer 24

b) Bleeding Explanation: Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Lack of dietary iron is rarely the sole cause of iron deficiency anemia in adults. The source of iron deficiency should be investigated promptly, because iron deficiency in an adult may be a sign of bleeding in the GI tract or colon cancer.

Answer 25

a. Below 7% A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

Answer 26

c) Low ferritin level Explanation: The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin level.

Answer 27

d) Assess the patient’s hemoglobin and platelets. Explanation: Patients with AML may develop pallor from anemia and bleeding tendencies from low platelet counts. Assessing the patient’s hemoglobin and platelets will help to determine if this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

Answer 28

a) Cardiac assessment Explanation: ## Footnote This medication may cause prolongation of the PR interval and first degree AV block. Patients with underlying conduction deficits may develop problems. A cardiac assessment will assist in determining if the patient has underlying problems that could be exacerbated by this drug therapy. The other interventions are not necessary.

Answer 29

ANS: A, B, C, D Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.

Answer 30

c) Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12–intrinsic factor complex is absorbed in the distal ileum. People who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2–4 years. This results in megaloblastic anemia. Some symptoms are smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

Answer 31

ANSWER B – When a hemophiliac client is at high risk for bleeding, for example, after a motor vehicle accident, the priority intervention is to maximize the availability of clotting factors. The other orders also should be implemented rapidly, but do not have as high a priority.

Answer 32

A Rationale: The hypokalemia associated with metabolic acidosis can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Fluid overload, hypovolemia, and cardiovascular collapse are possible complications of DKA, but cardiac monitoring would not detect theses.

Answer 33

A - The patient should select a site on the sides of the fingertips, not on the center of the finger pad as this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

Answer 34

c) “I will call the doctor if my stools turn black.” Explanation: Iron replacement therapy may change the color of stool. Iron is best absorbed on an empty stomach, the patient is instructed to take the supplement an hour before meals. Many patients have difficulty tolerating iron supplements because of gastrointestinal (GI) side effects (primarily constipation). Limit GI side effects by the addition of a stool softener or increase of dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

Answer 35

c) Lymphocyte Explanation: Mature lymphocytes are the principal cells of the immune system, producing antibodies and identifying other cells and organisms as “foreign.” Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

Answer 36

a. Fasting Plasma Glucose (FPG) b. Two-hour Oral Glucose Tolerance Test (OGTT) When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.

Answer 37

B - Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

Answer 38

c) Applying prolonged pressure to needle sites or other sources of external bleeding Explanation: The interventions for a patient with thrombocytopenia are the same as those for a patient with cancer who is at risk for bleeding. For a patient with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage.

Answer 39

A - Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

Answer 40

b) Folic acid deficiency Explanation: Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4 to 5 g/dL, the leukocyte count 2,000 to 3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.

Answer 41

a) Sloughing tissue, b) Effectiveness of antidote, d) Tissue necrosis ## Footnote Explanation: Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle and tendons. To reduce the likelihood/severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a patient who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.

Answer 42

a) Pain, b) Alteration in self-concept, c) Fluid and electrolyte imbalance, e) Fatigue Explanation: Patients with rheumatic diseases, which typically involve joints and muscles, cause problems with mobility, fatigue, and pain. Due to limitations of the disease, the patients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases.

Answer 43

d. Hyperglycemic hyperosmolar non-ketotic coma Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.

Answer 44

A Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Freezing alters the insulin molecule and should not be done.

Answer 45

B - Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

Answer 46

b) Send the patient for x-ray study of the spine. Explanation: The patient with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the patient does not have a fracture of the spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse.

Answer 47

B Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to DKA. Decreasing carbohydrate or caloric intake is not appropriate as the patient will need more calories when ill. Glycosylated hemoglobins are not used to test for short-term alterations in blood glucose.

Answer 48

a) “Your symptoms are a result of your body attacking itself.” Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect “attacking itself.” The other statements do not explain autoimmunity.

Answer 49

ANSWER D – Hypoxia and deoxygenation of the red blood cells are the most common cause of sickling, so administration of oxygen is the priority intervention here. Pain control and hydration are also important interventions for this client and should be accomplished rapidly. Vaccination may help prevent future sickling episodes by decreasing the risk of infection, but it will not help with the current sickling crisis. Focus: Prioritization

Answer 50

a) Increase hydration., b) Administer allopurinol (Zyloprim)., d) Administer rasburicase (Elitek). Explanation: Increased uric acid and phosphorus levels after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Elitek is an enzyme that can also decrease uric acid. Administration of potassium is not indicated as levels are elevated after chemotherapy. Exercise is not initially encouraged because the patient could have weakness and cramping during this time.

Answer 51

A - Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Tighter glycemic control (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk.

Answer 52

B - The osmotic effect of glucose produces the manifestations of polydipsia and polyuria.

Answer 53

C - Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.

Answer 54

A - Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

Answer 55

b) Bleeding Explanation: The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors. Menorrhagia is the most common cause in premenopausal women. Iron malabsorption is another cause, which is seen in patients with celiac disease. Patients with chronic alcoholism often have chronic blood loss from the GI tract.

Answer 56

a) Colonoscopy Explanation: Recommendations for screening for colorectal cancer include screening colonoscopies every 10 years. Fecal occult blood tests should be completed annually in people over age 50. PSA tests for prostate-specific antigen is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

Answer 57

B Rationale: Blood sugar increases after meals, so this will be the best time to exercise. NPH insulin will not peak until mid-afternoon and is safe to take before a morning run. Running can be done in either the morning or afternoon. If the glucose is very elevated, the patient should postpone the run.

Answer 58

b) Multiple sclerosis (MS) Explanation: The cause of MS is not known and the disease affects twice as many women as men. Parkinson's disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

Answer 59

b) Monitoring the temperature every 4 hours Explanation: For a patient with neutropenia, monitoring the temperature every 4 hours is essential. If the patient develops a fever, the patient is considered to have an infection and is usually admitted to the hospital. Cultures of blood, urine, and sputum, as well as a chest x-ray, are obtained.

Answer 60

C - In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

Answer 61

D - The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.

Answer 62

b) Sickle cell anemia Explanation: Hemolytic anemia has various forms. Inherited forms include sickle cell anemia, thalassemia and thalassemia major, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, and hereditary spherocytosis

Answer 63

A - The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

Answer 64

D - A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

Answer 65

a) Evaluate the patient’s platelet count. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000 x mm3. The bleeding is usually unrelated to falling. Keeping the patient on bed rest will not prevent bleeding when the patient has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.

Answer 66

c. African-American woman. Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.

Answer 67

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

Answer 68

C Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes are also appropriate but are not as high in priority.

Answer 69

A - Alcohol should be consumed with food to reduce the risk of hypoglycemia.

Answer 70

a) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat is used to relieve pain rather than ice packs. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional. It is not an intervention specific to relieving pain.

Answer 71

d) Testing for Stevens-Johnson syndrome potential Explanation: A patient should be tested for the gene for Stevens-Johnson syndrome prior to receiving any drugs that potentially can cause this condition. The patient does not have to receive Benadryl or have renal function tests. There are no particular foods that should be restricted.

Answer 72

d) Primary infection (acute HIV infection or acute HIV syndrome) Explanation: More than 500 CD4+ T lymphocytes/mm indicates CDC stage 1

Answer 73

a) 4:00 pm Explanation: When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth

Answer 74

D. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia Alcohol and/or aspirin taken with a sulfonylurea can cause development of hypoglycemia.

Answer 75

b) Beans, dried fruits, and leafy green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf’s liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

Answer 76

d) Low hematocrit Explanation: The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear

Answer 77

C - This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

Answer 78

A, C, E - In patients with diabetes who have microalbuminuria or macroalbuminuria, angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) should be used. Both classes of drugs are used to treat hypertension and have been found to delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipid-lowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, in those with macular edema, and in some cases of nonproliferative retinopathy.

Answer 79

b) Educate the family about medications and side effects., c) Suggest support for household maintenance., d) Allow family members to express feelings. Explanation: Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the over-burdened family. Anti-anxiety medications and church attendance have not been shown to reduce caregiver stress.

Answer 80

C - Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

Answer 81

b) Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing Explanation: The following steps are taken to determine the type and severity of the reaction: Stop the transfusion. Maintain the IV line with normal saline solution through new IV tubing, administered at a slow rate. Assess the patient carefully. Notify the physician. Continue to monitor the patient’s vital signs and respiratory, cardiovascular, and renal status. Notify the blood bank that a suspected transfusion reaction has occurred and send the blood container and tubing to the blood bank for repeat typing and culture.

Answer 82

C - When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose

Answer 83

b) Epoetin alfa (Epogen) Explanation: Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis.

Answer 84

c) Pancytopenia Explanation: Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. It may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Answer 85

a) Medication dosages and side effects, b) Assistive devices, d) Safe exercise Explanation: The patient who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints or even walkers and canes, may assist the patient to care safely for him- or herself. Narcotics are not commonly used and there would be no reason for dressings.

Answer 86

D - Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

Answer 87

A Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclics also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are not affected by tricyclics.

Answer 88

a. Age over 45 years b. Overweight with a waist/hip ratio \>1 d. Maintaining a sedentary lifestyle Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Answer 89

ANSWER A – An elevation in white blood cells may indicate that the client has an infection, which would likely require rescheduling of the surgical procedure. The other values are slightly abnormal, but would not be likely to cause post-operative problems for a knee arthroscopy. Focus: Prioritization

Answer 90

b) His body has not produced antibodies to the AIDS virus. Explanation: A negative test result indicates that antibodies to the AIDS virus are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that, if infected, the body has not produced antibodies (which takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.

Answer 91

c) Adjusting meal plan before/after chemotherapy Explanation: The nurse should readjust the patient's meal plan before/after chemotherapy administration. The nurse should take into consideration the patient’s likes and dislikes and avoid foods with strong odors. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the patient has side effects of nausea and vomiting. Administration of fresh fruits is not recommended when the patient is at risk of infection, such as during chemotherapy. Beta blockers are not administered for control of nausea and vomiting.

Answer 92

a) Stomatitis Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.

Answer 93

a) Integumentary Explanation: Scleroderma begins with skin involvement. The disease does not begin with respiratory, urinary, or cardiovascular involvement

Answer 94

c) Hematocrit Explanation: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is development of functions and characteristics that are different from those of the parent stem cell. ESR is a lab test that measures the rate of settling of RBCs and elevation is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

Answer 95

B. It has a higher mortality rate than Diabetic Ketoacidosis HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.

Answer 96

a)Enzyme-linked immunosorbent assay (ELISA)

Exam 1 - Practice Questions (Heme, Oncology, Diabetes, HIV, Autoimmune) Flashcards

(120 cards)