Final Exam: SG Material 2

Question 1

Intermediate Insulin

• brand name
• peak
• duration
• onset
• what other insulin can it be administered with?

Answer 1

• NPH
• peak: 4-12 hrs
• duration: 18-24 hrs
• onset: 1-2 hrs
• regular or rapid acting

Question 2

Long-acting insulin

• brand name
• peak
• duration
• onset
• when to administer subcutaneous injection?

Answer 2

• Glargine
• NO peak
• duration: 24 hrs
• onset: 1-2 hrs
• administered at bedtime or early in the morning

Question 3

Rapid-acting insulin

• brand name
• peak
• duration
• onset
• when to have a meal?

Answer 3

• Lispro
• peak: 1-2 hrs
• duration: 4-6 hrs
• onset: 5-15 mins
• should have food within 5-15 mins after administration

Question 4

Short-acting insulin

• brand name
• peak
• duration
• onset
• when to have a meal?

Answer 4

• Regular
• peak: 1.5 hrs
• duration: 6-8 hrs
• onset: 30 mins - 1 hr
• should have a meal within 1 hr

Question 5

What test is used to test adherence in diabetic patients?

Answer 5

Hemoglobin A1C (ideal: less than 7%)

Question 6

S/S of hypoglycemia (4) “DISH”

Answer 6

diaphoresis, irritability, shakiness, hunger

Question 7

DKA occurs in? Indicated by?

Answer 7

DM1; indicated by ketones in the urine

Question 8

Hyperosmolar hypoglycemic (HHS) requires similar treatment to DKA including? (4)

Answer 8

• normal saline
• insulin drip
• electrolyte monitor
• check mental status

Question 9

Types of angina? (2)

Answer 9

stable: stopping activity and rest can alleviate pain
unstable: cannot be relieved with nitroglycerin, has a possibility of turning into an MI (happens spontaneously)

Question 10

Patient teaching for nitroglycerin (3)

Answer 10

• vasodilator: take while sitting or standing to prevent dizziness (orthostatic hypotension)
• max of 3 doses, one every 5 mins if pain does not subside after 3rd dose, call 911
• take under the tongue, do not chew or swallow

Question 11

Patient teaching for hypertension (2)

Answer 11

• sodium restriction (2 g/day)

- teach the patient to self-record BP

Question 12

Hypertension and diabetes are associated with what disease process?

Answer 12

Chronic kidney disease

Question 13

Preventions for DVT? (4)

Answer 13

• SCD device on AT ALL TIMES
• compression stockings
• ambulation
• prophylactic blood thinners

Question 14

Lab monitoring for warfarin/coumadin (anticoagulant) (2)

Answer 14

• PT (normal = 10-13 seconds)

- INR (normal = 2-3)

Question 15

Lab monitoring for heparin?

Answer 15

aPTT

Question 16

If a patient’s control is 30 and their aPTT result is 45, is their dose within therapeutic levels? What does it mean if they are below range?

Answer 16

(find the range by x 1.5 and 2 to the control)
range = 45-60 = within therapeutic range

below range = subtherapeutic

Question 17

DVT is most common in which patients?

Answer 17

Periop patients

Question 18

RSHF systemic s/s? (4)

Answer 18

• JVD
• hepatomegaly
• splenomegaly
• peripheral edema

Question 19

LSHF respiratory s/s (4)

Answer 19

• dyspnea
• SOB
• crackles in lungs
• feelings “drowning” at night (unable to breath when lying down flat)

Question 20

Medication treatment for CHF? (2)

Answer 20

• Lasix

- Digoxin

Question 21

Patient teaching for digoxin (2)

Answer 21

• assess apical pulse, hold if less than 60

- s/s of digitalis toxicity: visual halos, nausea, vomiting, diarrhea, headaches

Question 22

Patient teaching for Lasix (2)

Answer 22

• assess electrolytes (esp potassium; normal = 3.5-5)

- assess BP (hold if hypotensive)

Question 23

Congestive heart failure can cause?

Answer 23

LOC changes due to oxygenation and perfusion deficiency

Question 24

Diet for patients with kidney failure?

Answer 24

• low sodium and low potassium renal diet

Question 25

End-stage renal disease can cause issues in?

Answer 25

mental status / changes in LOC

Question 26

Which dietary selection should lead the nurse to conclude that the dietary teaching is successful for a patient on a low-sodium diet?

Answer 26

Baked chicken, white rice, apple juice

Question 27

When should we anticipate the HCP ordering an anticoagulant?

Answer 27

To decrease or prevent clotting (eg: DVT)

Question 28

If a clot breaks in the left leg, where is it most likely to travel to?

Answer 28

To the lungs

Question 29

If a clot forms in the atrium from atrial defibrillation, it is most likely to travel to which organ?

Answer 29

The brain

Question 30

Antiplatelet vs anticoagulant

Answer 30

Antiplatelet: keeps platelets from sticking together (eg: aspirin, clopidogrel) Anticoagulant: works on the coagulation cascade (eg: warfarin, heparin)

Question 31

Common side effect of aspirin?

Answer 31

GI bleed

Question 32

What is the onset of warfarin?

Answer 32

3-4 days (risk for DVT enlargement)

Question 33

What are the two types of heparin?

Answer 33

Unfractionated and LMW Low-molecular-weight: Lovenox, can be used as a preventative measure for patients who are immobile for long periods of time; has a FASTER onset

Question 34

Heparin is measured in?

Answer 34

units

Question 35

A nursing student who is preparing to care for a postop patient with DVT asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

Answer 35

Warfarin has a delayed 3-4 day onset

Question 36

A 50 yr old female patient asks the nurse about taking aspirin to prevent heart disease. The patient does not have a hx of MI. Her cholesterol and BP are normal and she does not smoke. What will the nurse tell the patient?

Answer 36

There is most likely no protective benefit for patients of her age

Question 37

A patient who is taking clopidogrel (Plavix) calls the nurse to report black, tarry stools and coffee-ground emesis. the nurse will tell the patient to?

Answer 37

Continue taking the clopidogrel until talking to the provider

Question 38

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?

Answer 38

Anticoagulants (eg: heparin, abciximab (ReoPro); antiplatelets would not be strong enough

Question 39

A postop patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?

Answer 39

Warmth to the touch, swelling are indications of DVT. Will anticipate administering an anticoagulant like enoxaparin (lovenox)

Question 40

A patient who is taking warfarin (coumadin) has just vomited blood. The nurse notifies the provider who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer?

Answer 40

Vitamin K (antidote for warfarin)

Question 41

A patient is receiving heparin post-op to prevent DVT. The nurse notes that the patient has a BP of 90/50, HR of 98. The patient's most recent aPTT is greater than 90 seconds. The nurse reports lumbar pain. What should the nurse request to put an order for?

Answer 41

Protamine sulfate (antidote for heparin) normal aPTT = 60-80 seconds

Question 42

Which vital sign should be taken for a patient with a gastroesophageal balloon in place?

Answer 42

Respiratory rate

Question 43

Aldosterone regulates? (2)

Answer 43

- fluid volume | - sodium

Question 44

RAAS

Answer 44

renin aldosterone angiotensin system

Question 45

Describe the steps of RAAS in response to low BP (5)

Answer 45

1. low BP is sensed by baroreceptors 2. kidneys release renin 3. renin secretes aldosterone 4. aldosterone secretes angiotensin 1 5. angiotensin-converting enzyme converts angiotensin 1 to 2 (potent vasodilator, culprit for increasing BP)

Question 46

ACE inhibitors end in? Effects?

Answer 46

-pril; decreases BP

Question 47

Patient teaching for ACE inhibitor medications? (3)

Answer 47

- change positions slowly when sitting to standing (orthostatic hypotension) - should take the first dose when sitting down (can have first dose hypotension) - ACE non-prod cough can cause patient to stop adherence to medication