Exam (elaborations)
NUR 2474 Exam
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Exam of 42 pages for the course NUR 2474 at NUR 2474 (NUR 2474 Exam)
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NUR 2474 Exam1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four
patients who were just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units
of 70/30 Novolin insulin.
b. The patient with a pulse of 58 beats per minute who is about to receive digoxin
(Lanoxin)
c. The patient with a blood pressure of 136/92 mm Hg who complains of having a
headache
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin
(Vancocin) - ANSWER a. The NPO patient with a blood glucose level of 80 mg/dL
who just received 20 units of 70/30 Novolin insulin.
*low/normal BGL and insulin will continue to drop glucose level. At risk for
hypoglycemia.
2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on
a sliding scale and are ordered before a meal and at bedtime. The patient's blood
sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to
administer?
a. No insulin should be administered.
b. NPH
c. 70/30 mix
d. Lispro (Humalog) - ANSWER d. Lispro (Humalog)
*high blood sugar needs rapid acting insulin.
3. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood
glucose testing schedule for her. What is the recommended monitoring schedule?
a. Before each meal and before bed
b. In the morning for a fasting level and at 4 PM for the peak level
c. Six or seven times a day
d. Three times a day, along with urine glucose testing - ANSWER c. Six or seven
times a day
*pregnancy can effect glucose levels. Frequent monitoring required.
4. An adolescent patient recently attended a health fair and had a serum glucose
test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that
mean I have diabetes?" What is the nurse's most accurate response?
a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean
you have diabetes."
,b. "At this level, you probably have diabetes. You will need an oral glucose tolerance
test this week."
c. "This level is conclusive evidence that you have diabetes."
d. "This level is conclusive evidence that you do not have diabetes." - ANSWER a.
"Unless you were fasting for longer than 8 hours, this does not necessarily mean you
have diabetes."
*could be a normal level without fasting and does not mean diabetes unless it was
high for a fasting blood glucose level.
5. Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will
the nurse administer this drug?
a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4 PM
c. Once daily at bedtime
d. After meals and at bedtime - ANSWER c. Once daily at bedtime
*goodnight glargine
6. A patient with type 1 diabetes who takes insulin reports taking propranolol for
hypertension. Why is the nurse concerned?
a. The beta blocker can cause insulin resistance.
b. Using the two agents together increases the risk of ketoacidosis.
c. Propranolol increases insulin requirements because of receptor blocking.
d. The beta blocker can mask the symptoms of hypoglycemia. - ANSWER d. The
beta blocker can mask the symptoms of hypoglycemia.
*beta blockers block adrenaline which signals the liver to release glucose in the
blood when glucose is low to avoid hypoglycemia.
7. Which statement is correct about the contrast between a carbose and miglitol?
a. Miglitol has not been associated with hepatic dysfunction.
b. With miglitol, sucrose can be used to treat hypoglycemia.
c. Miglitol is less effective in African Americans.
d. Miglitol has no gastrointestinal side effects. - ANSWER a. Miglitol has not been
associated with hepatic dysfunction.
*key difference is that acarbose has been associated with rare cases of hepatic
dysfunction
8. A nurse counsels a patient with diabetes who is starting therapy with an alpha-
glucosidase inhibitor. The patient should be educated about the potential for which
adverse reactions? (Select all that apply.)
a. Hypoglycemia
b. Flatulence
c. Elevated iron levels in the blood
,d. Fluid retention
e. Diarrhea - ANSWER b. Flatulence
e. Diarrhea
*due to build up of gasses (flatulence) from to undigested carbohydrates reaching
the colon and causing an osmotic effect (diarrhea)
9. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism.
The patient tells the nurse she does not want to take medications while she is
pregnant. What will the nurse explain to this patient?
a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
b. Neuropsychologic deficits in the fetus can occur if the condition is not treated.
c. No danger to the fetus exists until the third trimester.
d. Treatment is required only if the patient is experiencing symptoms. - ANSWER b.
Neuropsychologic deficits in the fetus can occur if the condition is not treated.
*Thyroid hormones are crucial for the normal development of the fetal brain and
nervous system and must be treated in pregnancy.
10. A nurse is teaching a patient who has been diagnosed with hypothyroidism about
levothyroxine (Synthroid). Which statement by the patient indicates a need for further
teaching?
a. "I should not take heartburn medication without consulting my provider."
b. "I should report insomnia, tremors, and an increased heart rate to my provider." c.
"If I take a multivitamin with iron, I should take it 4 hours after the Synthroid."
d."If I take calcium supplements, I may need to decrease my dose of Synthroid." -
ANSWER d."If I take calcium supplements, I may need to decrease my dose of
Synthroid."
*this statement is incorrect since calcium interferes with the absorption of Synthroid,
it may need to be increased not decreased.
11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The
nurse assesses the patient at the beginning of the shift and notes a heart rate of 62
beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to
arouse. The nurse will contact the provider to request an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole (Tapazole) - ANSWER c. Intravenous levothyroxine
*IV allows for a more rapid correction of thyroid hormone levels especially
hypothyroidism with symptoms of myxedema coma or severe hypothyroidism. This is
considered a medical emergency.
, 12. A patient is admitted to the hospital and will begin taking levothyroxine
(Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The
nurse will notify the provider to discuss _____ the _____ dose.
a. reducing levothyroxine
b. reducing warfarin
c. increasing levothyroxine
d. increasing warfarin - ANSWER b. reducing warfarin
*Levothyroxine (Synthroid) can potentially increase the effects of warfarin, leading to
an increased risk of bleeding.
13. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level
is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders
levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do?
a. Administer the medication as ordered.
b. Contact the provider to discuss giving the levothyroxine IV.
c. Request an order to give desiccated thyroid (Armour Thyroid).
d. Suggest that the provider lower the dose. - ANSWER d. Suggest that the provider
lower the dose.
*normal TSH is 0.4-4.
14. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of
levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The
nurse will expect the provider to:
a. change the dose of levothyroxine to 6 mcg/kg/day.
b. discontinue the drug if the child's physical and mental development is normal.
c. increase the dose to accommodate the child's increased growth.
d. stop the drug for 4 weeks and check the child's TSH level. - ANSWER a. change
the dose of levothyroxine to 6 mcg/kg/day.
*after 1 year of age, the organs are developed and higher does is no longer needed.
15. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins
to complain of pain and irritation at the infusion site. The nurse observes signs of
redness at the IV insertion site and along the vein. What is the nurse's priority
action?
a. Apply warm packs to the arm, and infuse the medication at a slower rate.
b. Continue the infusion while elevating the arm.
c. Select an alternate intravenous site and administer the infusion more slowly. d.
Request central venous access. - ANSWER c. Select an alternate intravenous site
and administer the infusion more slowly.
*infiltration
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