Exam 1 Adult Health study questions

Which of the following symptoms do NOT present in hyperglycemia?
-Extreme thirst
-Hunger
-Blood glucose < 60mg/dL
-Glycosuria
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Which of the following symptoms do NOT present in hyperglycemia?
-Extreme thirst
-Hunger
-Blood glucose < 60mg/dL
-Glycosuria
-Blood glucose < 60mg/dL
Type 1 diabetes typically have the following clinical characteristics:
-Thin, young with ketones present in urine
-Overweigh, young with no ketones present in the urine
-Thin, older adult with glycosuria
-Overweight, adult-aged with ketones present in the urine
-Thin, young with ketones present in urine
A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important?
-Recheck the glucose level
-Give the patient 1/2 cup (4oz) of fruit juice
-Call the doctor
Keep the patient nothing by mouth
-Give the patient 1/2 cup (4oz) of fruit juice
Which of the following patients is at most risk for Type 2 diabetes?
-A 6 year old girl recovering from a viral infection with a family history of diabetes
-A 28 year old male with a MBI of 49
-A 76 year old female with a history of a cardiac disease
-None of the options provided
-A 28 year old male with a MBI of 49.

Type 2 diabetes risk factors are related to lifestyle.... being obese is a risk factor (BMI > 30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2
The ______ _______ secrete insulin which are located in the _______.
-Alpha cells, liver
-Alpha cells, pancreas
-Beta cells, liver
-Beta cells, pancreas
-Beta cells, pancreas
A 36 year old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially?
-Diet and exercise regime
-Metformin BID by mouth
-Regular insulin subcutaneous
-None, monitoring at this time is sufficient enough
-Diet and exercise regime
Which of the following statements are true regarding Type 2 diabetes treatment?
-Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes
-Insulin may be needed during times of surgery or illness
-Insulin is taken by the Type 2 diabetic
-Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics
-Insulin may be needed during times of surgery or illness
Which statement or statements are INCORRECT regarding Diabetic Ketoacidosis?
A. DKA occurs mainly in Type 1 diabetics
B. Ketones are preset in the urine in DKA
C. Cheyne-strokes breathing will always present in DKA
D. Severe hypoglycemia is hallmark sign in DKA
E. Option C&D
E. Option C&D
A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The nest nursing intervention would be to:
-Administer Dextrose 50% IV per protocol
-Continue to monitor the glucose
-Give the patient 4 oz of fruit juice
-None, this is a normal blood glucose reading
-Administer Dextrose 50% IV per protocol
A Type 2 diabetic may have all the following signs or symptoms EXCEPT:
-Blurry vision
-Ketones present in the urine
-Glycosuria
-Poor wound healing
-Ketones present in the urine
When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called? A. Hypotonic B. Hypertonic C. Isotonic D. OsmosisC. IsotonicWhich of the following is not a hypertonic fluid? -3% saline -D5W -10% Dextrose in Water (D10W) -5% Dextrose in Lactated Ringers-D5WWhat type of fluid would a patient with severe hyponatremia most likely be started on? -Hypotonic -Hypertonic -Isotonic -Colloid-HypertonicWhen administering a hypertonic solution the nurse should closely watch for? -Signs of dehydration -Pulmonary Edema -Fluid volume deficient -Increased Lactate level-Pulmonary EdemaA patient with cerebral edema would most likely be order what type of solution? A. 3% Saline B. 0.9% Normal Saline C. Lactated Ringer's D. 0.225% Normal SalineA. 3% Saline_________ solutions cause cell dehydration and help increase fluid in the extracellular space -Hypotonic -Osmosis -Isotonic -Hypertonic-HypertonicD5W solutions are sometimes considered a hypotonic solution as well as an isotonic solution because after the body metabolizes the dextrose the solution acts as a hypotonic solution. True FalseTrueWhich solution is NOT a hypertonic solution? -5% Dextrose in 0.9% saline -5% Saline -5% Dextrose in lactated Ringers -0.33% saline (1/3 NS)-0.33% saline (1/3 NS)Which patient below would NOT be a candidate for a hypotonic solutions? -Patient with increased intracranial pressure -Patient with Diabetic Ketoacidosis -Patient experiencing Hyperosmolar Hyperglycemia -All of the options are correct-Patient with increased intracranial pressureWhich condition below could lead to cell lysis, if not properly monitored? -Isotonicity -Hypertonicity -Hypotonicity -None of the options are correct-Hypotonicity________ fluids remove water from the extracellular space into the intracellular space. A. Hypotonic B. Hypertonic C. Isotonic D. ColloidsA. HypotonicIsotonic fluids cause shifting of water from the extracellular space to the intracellular space -True -False-FalseA patient is being admitted with dehydration due to nausea and vomiting. Which fluid would you expect the patient to be started on? -5% Dextrose in 0.0 Saline -0.33% Saline -0.22% Saline -0.9% Normal Saline-0.9% Normal SalineThe doctor orders an isotonic fluid for a patient. Which of the following is not an isotonic fluid? -0.9% Normal Saline -Lactated Ringers -0.45% Saline -5% Dextrose in 0.22% Saline-0.45% SalineWhich of the following is not a sign or symptom of Diabetic Ketoacidosis? -Positive Ketones in the urine -Oliguria -Polydipsia -Abdominal pain-OliguriaA patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then start an insulin drip per protocol. The patient's labs are following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next? -Start the IV fluids and administer the insulin bolus and drip as ordered -Hold the insulin and notify the doctor of the potassium level of 2.5 -Hold IV fluids and administer insulin as ordered -Recheck the glucose level-Hold the insulin and notify the doctor of the potassium level of 2.5Which patient is MOST likely to develop Diabetic Ketoacidosis? -A 25 year old female newly diagnosed with Cushing's Disease taking glucocorticoids -A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin -A 35 year old female newly diagnosed with Type 2 diabetes -None of the above-A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulinTrue or false: When priming the tubing for an insulin infusion it is best practice to waste 50cc to 100cc of insulin prior to starting the infusion because insulin absorbs into the plastic lining of the tubing.trueYou are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms cause concern? -Patient complains of thirst -Patient has a potassium level of 2.3 -Patient skin and mucous membrane is dry -Patient is nauseous-Patient has a potassium level of 2.3Which type of insulin do you expect the doctor to order for treatment of DKA? -IV Novolog -IV Levemir -IV NPH -IV Regular Insulin-IV Regular InsulinA patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about preventing DKA. What statement by the patient demonstrates they understand your teaching about this condition? -I should not be alarmed if ketones are present in urine because this is expected during illness -It is normal for my blood sugar to be 250-300mg/dL while i am sick -It is important I check my blood glucose every 3-4 hours when i am sick and consume liquids -I will hold off taking my insulin while i'm sick-It is important I check my blood glucose every 3-4 hours when i am sick and consume liquidsMagnesium is absorbed by what system of the body? A. Gastrointestinal B. Hepatic C. Lymphatic D. RenalA. GastrointestinalWhich of the following patients is MOST at risk for hypermagnesemia? -A patient with alcoholism -A patient taking a proton-pumping inhibitor -A patient suffering from Crohn's Disease -A patient with a magnesium level of 0.6 mg/dL receiving IV magnesium sulfate-A patient with a magnesium level of 0.6 mg/dL receiving IV magnesium sulfateA patient has a calcium level of 7.2 gm/dL. What sign below is indicative of this lab value? -None, this is a normal calcium level -Shortened ST segment -Hypoactive bowel sounds -Prolonged QT interval on the EKG-Prolonged QT interval on the EKGAn EKG shows a shortened QT interval. Which lab value below would be indicative of this change? A. Calcium level of 8.0 B. Calcium level of 12.0 C. Calcium level of 8.7 D Calcium level of 9.2B. Calcium level of 12.0Which patient below is considered hypernatremic? -A patient with a sodium level of 155 mEq/L A patient with a sodium level of 145 mEq/L -A patient with a sodium level of 120 mEq/L -A patient with a sodium level of 136 mEq/L-A patient with a sodium level of 155 mEq/LA patient has a sodium level of 119. Which of the following is NOT related to this finding? A. Over secretion of ADH (antidiuretic hormone) B. Low salt diet C. Inadequate water intake D. Hypotonic fluid infusion (overload)C. Inadequate water intakeA patient's blood test shows they have a critically low parathyroid hormone (PTH). What effect would this have on phosphate and calcium levels in the blood? -Phosphate levels high, calcium levels low -Phosphate and calcium levels high -Phosphate and calcium levels low -Phosphate levels low, calcium levels high-Phosphate levels high, calcium levels lowA patient has a potassium level of 1.5 mEq/L. Which of the following is NOT typically a sign with this condition? -None, this is a normal potassium level -Decreased respirations -Decreased deep tendon reflex -Tall T-Waves-Tall T-WavesWhich of the following does Chloride NOT play a role in? -Digestion -Acid-base balance -Fluid balance -Bone health-Bone healthThis complication is found in type 2 diabetics? -Diabetic Ketoacidosis -Hyperglycemic Hyperosmolar Nonketotic Syndrome-Hyperglycemic Hyperosmolar Nonketotic SyndromeA patient is found to have a blood glucose of 375mg/dL, positive ketones in the urine, and a blood pH of 7.25. Which condition is this? -Diabetic Ketoacidosis -Hyperglycemic Hyperosmolar Nonketotic Syndrome-Diabetic KetoacidosisHHNK would have all the following signs and symptoms EXCEPT? -Dry mucous membranes -Polyuria -Blood glucose > 600mg/dL -Kussmaul breathing-Kussmaul breathingThis condition happens gradually and is more likely to affect older adults? -HHNS -DKAHHNSA patient has an infection and reports not checking their blood glucose or regularly taking Metformin. What condition is this patient MOST at risk for -HHNS -DKA -Metabolic alkalosis -Metabolic acidosisHHNSWhich patient population is most at risk for DKA? -A middle-aged adults who are obese -Older-adults with Type 2 diabetes -Newly diagnosed diabetes -None of the options-Newly diagnosed diabetesTrue or False: Osmotic diuresis is present in HHNS and DKA due to the kidney's inability to reabsorb the excessive glucose which causes glucose to leak into the urine which in turn causes extra water and electrolytes to be excretedTrueWhich of the following is NOT a medical treatment for DKA and HHNS? -IV regular insulin -Isotonic fluids -Bicarbonate -IV potassium Solution-BicarbonateWhich of the following is not a sign or symptom of Diabetic Ketoacidosis? -Positive Ketones in the urine -Polydipsia -Oliguria -Abdominal pain-OliguriaYou are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition, to the insulin drip, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern? -Patient has a potassium level of 2.3 -Patient complains of thirst -Patient is nauseous -Patient is nauseous -Patient's skin and mucous membranes are dry-Patient has a potassium level of 2.3A patient is being discharged home after recovering from HHNS. Which statement by the patient requires patient re-education about this condition? -"I will monitor my blood glucose levels regularly" -"This condition happens suddenly without any warning signs" -"If I become sick I will monitor my blood glucose more frequently and drink logs of fluids" -"It is important I take my medication as prescribed "-"This condition happens suddenly without any warning signs"A hypovolemic hyponatremic patient is started on IV fluids. Which iv fluid do you expect the patient to be started on? -3% Saline -0.45% Saline -D5W -0.33% Saline-3% SalineWhat stimulates aldosteron secretion from the adrenal cortex? -Excessive water intake -Increased serum osmolality -Decreased serum potassium -Decrease sodium and water-Decrease sodium and waterCortisol, glucagon, epinephrine, and growth hormone are referred to as counterregulatory hormones because they -Decrease glucose production -Stimulate glucose output by the liver -Increase glucose transport into the cell -Independently regulate glucose level in the blood-Stimulate glucose output by the liverWhich laboratory results indicate the patient has predicates? -Glucose tolerance result of 132 -Glucose tolerance result of 240 -Fasting blood glucose result of 80 -Fasting blood glucose result of 120-Fasting blood glucose result of 120The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has -Diabetes -Elevated A1C -Impaired fasting glucose -Impaired glucose tolerance-Impaired glucose toleranceWhen teaching the patient with diabetes about insulin administration, the nurse should include which instructions? -Pull back of the plunger after inserting the needle to check for blood sugar -Consistently use the same size of insulin syringe to avoid dosing errors -Clean the skin at the injection site with an alcohol swab before each injection -Rotate injection site from arms to thigh to abdomen with each injection to prevent lipodystrophies-Consistently use the same size of insulin syringe to avoid dosing errorsWhich class of oral glucose-lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylureab. BiguanideA patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last 5 mornings. What should the nurse have the patient do first? -Increase the evening insulin dose to prevent the dawn phenomenon -Use a single-dose insulin regimen with an intermediate-acting insulin -Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising -Decrease the evening insulin dosage to prevent nigh hypoglycemia and the Somogi effect-Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising"Polydipsia and polyuria related to diabetes mellitus are primarily due to: a. The release of ketones from cells during fat metabolism b. Fluid shifts resulting from the osmotic effect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin"b. Fluid shifts resulting from the osmotic effect of hyperglycemiaWhich statement would be correct for a patient with type 2 diabetes who was admitted to the pneumonia? -The patient must receive insulin therapy to prevent ketoacidosis -The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin -The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections -The patient may have enough endogenous insulin to prevent ketones but is risk for hyperosmolar hyperglycemia syndrome-The patient may have enough endogenous insulin to prevent ketones but is risk for hyperosmolar hyperglycemia syndromeAnalyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A) BP 126/80 B) A1C 9% C)FBG 130mg/dL D) LDL cholesterol 100mg/dLB) A1C 9%Which statement by the patient with type 2 diabetes is accurate? -I will limit my alcohol intake to 1 drink each day -I am not allowed to eat any sweets because of my diabetes -I cannot exercise because I take a blood glucose-lowering medication -The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar-I will limit my alcohol intake to 1 drink each dayYou are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (Select all that apply) -Insulin administration -Elimination of sugar from diet -Need to reduce physical activity -Use of a portable blood glucose monitor -Hyperglycemia prevention, symptoms, and treatment-Insulin administration -Use of a portable blood glucose monitor -Hyperglycemia prevention, symptoms, and treatmentWhat is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. call the physician b. administer insulin as ordered c. check the patient's blood glucose level d. assess for other neurologic symptomsc. check the patient's blood glucose levelA patient with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding -Polyuria -Severe dehydration -Rapid deep respirations -Decreased serum potassium-Rapid deep respirationsWhich are appropriate therapies for patients with diabetes mellitus (select all that apply)? -use of statins to reduce CVD risk -use of diuretics to treat nephropathy -use of ACE inhibitor to treat nephrophathy -use of serotonin agonist to decrease appetite -use of laser photocoagulation to treat retinopathy-use of statins to reduce CVD risk -use of ACE inhibitor to treat nephrophathy -use of laser photocoagulation to treat retinopathyThe typical fluid replacement for the patient with a fluid volume deficit is: a. dextran b. 0.45% saline c. lactated Ringer's d. 5% dextrose in 0.45% salinec. lactated Ringer'sThe nurse expects the long-term treatment of a patient with hyperphosphatemia secondary to renal failure will include a. fluid restriction. b. calcium supplements. c. magnesium supplements. d. increased intake of dairy products.b. calcium supplements.During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because: a. older adults have an impaired thirst mechanism and need reminding to drink fluids b. water accounts for a greater percentage of body weight in the older adult than in younger adults c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures d. small losses of fluid are more significant because body fluids account for 45% to 50% of body weight in older adultsd. small losses of fluid are more significant because body fluids account for 45% to 50% of body weight in older adultsDuring administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is: a. osmosis b. diffusion c. active transport d. facilitated diffusiona. osmosisThe nursing care for a patient with hyponatremia and fluid volume excess includes -Fluid restriction -Administration of hypotonic IV solution -Administration of a cation-exchange resin -Placement of an indwelling urinary catheter-Fluid restrictionThe nurse should be alert for which manifestations n a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasmsc. Weak, irregular pulse and poor muscle tone