Ati Adult 2

Front 1

Assessing Pt with diabetes mellitus and reports feeling anxious. Which finding should the RN expect if PT is hypoglycemic?

1. Rapid deep respirations

2. Cool clammy skin

3. Abdominal cramping

4. Orthostatic hypotension

Back 1

1. Rapid deep respirations- would be a finding of hyperglycemia

2. Cool clammy skin- Hypoglycemia causes cool clammy skin in addition to anxiety, nervousness, tachycardia, and confusion.

3. Abdominal cramping- would be a finding of hyperglycemia

4. Orthostatic hypotension- this would be caused by hyperglycemia because of the dehydration= hypotension

Front 2

You are teaching about glycosylated hemoglobin HbA1c testing. Which statement indicates understanding?

1. I need to fats after midnight the night before the test

2. This test is good indicator of my average blood glucose control

3. A level of 8% to 10% suggests adequate blood glucose control.

4. I will use my hemoglobin A1c level to adjust my daily insulin doses

Back 2

1. I need to fats after midnight the night before the test- Does not need to fast, what the Pt eats the day before has no effect on the test.

2. This test is good indicator of my average blood glucose control- it reflects the PTs glucose levels over a 120 day period which is also the life span of the RBC

3. A level of 8% to 10% suggests adequate blood glucose control.- should be lower than 7%

4. I will use my hemoglobin A1c level to adjust my daily insulin doses - Should use capillary glucose levels to adjust daily insulin doses

Front 3

You are planning preoperative care for PT who has pheochromocytoma. which intervention should you anticipate as being priority?

1. Use same arm for BP measurement

2. Avoid palpating the abdomen

3. manage headaches with analgesics

4. Provide a private darkened room

Back 3

1. Use same arm for BP measurement- not 1st

2. Avoid palpating the abdomen- greatest risk is HTN crisis by palpating the abdomen can cause a sudden release of catecholamines=HTN crisis.

3. manage headaches with analgesics- not 1st

4. Provide a private darkened room- not 1st

Front 4

Rn is assessing a PT who has a new dx of cushings disease. Which finding would the RN expect?

1. Decreased BP

2. Weight Loss

3. Hirsutism

4. Increased skin thickness

Back 4

1. Decreased BP- would be elevated

2. Weight Loss- would be weight gain

3. Hirsutism- expected due to increased androgen production.

4. Increased skin thickness- would be skin thinning

Front 5

Rn is reviewing lab values for a PT who has DKA which of the following would the RN expect?

1. Ph 7.32 Paco2 36 HCO3 14

2. Ph 7.38 Paco2 55, HCO3 22

3. Ph 7.44 Paco2 40 HCO3 24

4. Ph 7.5 Paco2 42 HCO3 30

Back 5

1. Ph 7.32 Paco2 36 HCO3 14_---DKA= low ph & low bicarb metabolic acidosis

2. Ph 7.38 Paco2 55, HCO3 22

3. Ph 7.44 Paco2 40 HCO3 24

4. Ph 7.5 Paco2 42 HCO3 30

Front 6

Rn is teaching Pt with diabetic foot ulcer about foot care. Which indicates understanding?

1. I will let my feet air dry after washing

2. I will wear sandals to allow air to circulate around my feet

3. I will buy OTC meds to treat the calluses on my feet

4. I will apply lotion to the dry areas of my feet, avoiding application between my toes

Back 6

1. I will let my feet air dry after washing- should dry right after washing

2. I will wear sandals to allow air to circulate around my feet- should wear closed toe shoes to prevent injury

3. I will buy OTC meds to treat the calluses on my feet- can impair skin integrity

4. I will apply lotion to the dry areas of my feet, avoiding application between my toes- good to dry all areas of feet and should avoid lotion in-between toes as this can harbor bacteria growth.

Front 7

You are teaching a Pt who has diabetes insipidus and is receiving intranasal desmopressin. Which information should you include in teaching?

1. Daily fluid intake should be at least 3L

2. Obtain weight weekly wearing similar clothing at the same time of day

3. Notify the provider if a weight loss of 0.45kg or more per week is noted

4. Occurrence of nocturia indicates the need for a dosage adjustment.

Back 7

1. Daily fluid intake should be at least 3L- should be no more than 3L a day

2. Obtain weight weekly wearing similar clothing at the same time of day- should obtain weight daily to detect dehydration in the early stage

3. Notify the provider if a weight loss of 0.45kg or more per week is noted- this is not suggestive of over hydration or dehydration

4. Occurrence of nocturia indicates the need for a dosage adjustment.- this medication will need to be adjusted if still experiencing Nocturia

Front 8

Rn is teaching Pt who has autoimmune disease about the adverse effects of long term corticosteroid therapy which following effect should the Rn include? Select all

1. Osteoporosis

2. Moon shaped face

3. Increased risk of infection

4. Hearing loss

5. Weight loss

Back 8

1. Osteoporosis- due to suppression of bone formation and the acceleration of bone resorption

2. Moon shaped face- long term causes characteristics of the iatrogenic syndrome characterized by moon shaped face, potbelly, buffalo hump.

3. Increased risk of infection- decreases the number of circulation lymphocytes causing PT to be immunosuppressive.

4. Hearing loss

5. Weight loss

Front 9

Rn is assessing a Pt who has diabetes insidious. The Rn should expect the following finding.

1. Decreased HR

2. Increased Hct

3. High urine Specific gravity

4. Decreased BUN

Back 9

1. Decreased HR- would be tachycardic

2. Increased Hct- increased Hct r/t dehydration

3. High urine Specific gravity- would be diluted

4. Decreased BUN would be increased r/t dehydration

Front 10

You are screening a Pt for pheochromocytoma The RN schedules a vanillylmadelic acid test. When teaching about this test what instruction do you need to include?

1. Start fasting at midnight prior to the day of the test

2. Begin the 24 hr urine collection with the first morning urination

3. Take low dose aspirin for pain during the testing period

4. Restrict coffee intake 2-3 days prior to the test.

Back 10

1. Start fasting at midnight prior to the day of the test- does not have to fast prior

2. Begin the 24 hr urine collection with the first morning urination-discard the first urine then start collecting

3. Take low dose aspirin for pain during the- testing period- should avoid can affect results

4. Restrict coffee intake 2-3 days prior to the test.- should avoid coffee and tea, bananas, chocolate and vanilla 2-3 days prior

Front 11

You caring for a PT who is taking propylthiouracil PTU You recognize the PT has met the treatment goal when she reports?

1. Sweating

2. Stools

3. Weight

4. Appetite

Back 11

1. Sweating- should decrease it

2. Stools- should decrease

3. Weight- suppresses the production of thyroid hormones and this allows for weight gain

4. Appetite- cause a reduction in appetite.

Front 12

Rn is caring for a PT with type 2 diabetes and is admitted with hyperglycemic hyperosmolar state HHS which lab finding should you expect?

1. Blood glucose496 and serum ph 7.32

2. Blood glucose 550 and serum ph 7.02

3. Blood glucose 702 and serum ph 6.11

4. Blood glucose 846 and serum ph of 7.40

Back 12

1. Blood glucose496 and serum ph 7.32- DKA

2. Blood glucose 550 and serum ph 7.02- DKA

3. Blood glucose 702 and serum ph 6.11- DKA

4. Blood glucose 846 and serum ph of 7.40- with HHS Pt produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia so typically BG is higher than 600

Front 13

Rn is caring for a client following a thyroidectomy. The Rn should assess for which of the following findings as an indication of hypocalcemia?

1. Strong, bounding pulse

2. Decreased bowel sounds

3. Tingling and numbness of the hands and feet

4. Diminished deep-tendon reflexes

Back 13

1. Strong, bounding pulse- causes weak and thready pulse

2. Decreased bowel sounds- would increase gastrointestinal motility

3. Tingling and numbness of the hands and feet- hypocalcemia causes paresthesias

4. Diminished deep-tendon reflexes- hypocalcemia would cause hyperactive DTRS

Front 14

You are making a teaching planner a PT who had a thyroidectomy and takes a thyroid hormone replacement. Which of the instructions would you include?

1. Take this medication on an empty stomach

2. Take this medication with an antacid

3. Change position slowly while taking this medication

4. Limit your fluid intake while taking this medication.

Back 14

1. Take this medication on an empty stomach-to promote proper absorption

2. Take this medication with an antacid- will reduce effectiveness

3. Change position slowly while taking this medication- not r/t

4. Limit your fluid intake while taking this medication. - should drink 2-3 L daily

Front 15

Rn is monitoring lab values for a PT who has diabetes mellitus and is taking insulin. Which results indicates a therapeutic insulin therapy?

1. Fasting BG 96

2. Post prandial BG 195

3. Causal BG 210

4. Pre prandial BG 60

Back 15

1. Fasting BG 96

2. Post prandial BG 195

3. Causal BG 210

4. Pre prandial BG 60

Front 16

Rn is preparing insulin for a PT with diabetes mellitus. Pt is to receive evening doses of insulin glargine and regular insulin. Which action should the RN take to administer these two medications safely?

1. Draw up the insulin glargine into syringe first, and then draw up the regular insulin

2. Draw up the regular insulin into the syringe first, and then draw up the insulin glargine

3. Draw up the insulin glargine and the regular into separate syringes.

4. Draw up either insulin into the syringe first b/c both insulins are clear.

Back 16

1. Draw up the insulin glargine into syringe first, and then draw up the regular insulin

2. Draw up the regular insulin into the syringe first, and then draw up the insulin glargine-RN should draw the short acting insulin first BUT there is only one longer acting insulin that can be mixed with short acting insulin and that is NPH

3. Draw up the insulin glargine and the regular into separate syringes. should not mix glargine with any other insulin

4. Draw up either insulin into the syringe first b/c both insulins are clear.

Front 17

Rn is admitting a PT who has hyperthyroidism. When assessing the PT the RN should expect which finding?

1. Cold intolerance

2. Lethargy

3. Tremors

4. Sunken eyes

Back 17

1. Cold intolerance- would have heat intolerance

2. Lethargy- Pt has hyperthyroidism is restless and irritable

3. Tremors- expected also will have diaphoresis, insomnia

4. Sunken eyes- will have exophthalmos

Front 18

You are assessing a PT on a lifelong hormone therapy for treatment of hypothyroidism. The PT has not been taking his meds regularly. Which of the following findings should you expect?

1. Significant weight loss

2. Persistent diarrhea

3. Tachycardia

4. Hypotension

Back 18

1. Significant weight loss- will cause weight gain

2. Persistent diarrhea- will cause constipation

3. Tachycardia- will cause bradycardia

4. Hypotension - is expected

Front 19

RN is performing an assessment on a PT who has syndrome of inappropriate antidiuretic hormone SIADH which of the following assessment data should the RN report?

1. Serum sodium 110

2. +2 DTRs

3. K 3.7

4. urine specific gravity 1.025

Back 19

1. Serum sodium 110-SIADH will retain fluids which will cause dilutional hyponatremia

2. +2 DTRs- WNL

3. K 3.7- WNL

4. urine specific gravity 1.025- WNL

Front 20

RN is giving info on an adrencorticotropic hormone ACTH stimulation test. The RN should explain that the purpose of this test to assess for which if the following disorders?

1. Cushings syndrome

2. Hyperthyroidism

3. Pheochromoctoma

4. Addisons disease

Back 20

1. Cushings syndrome- urine and serum cortisol levels are checked for this

2. Hyperthyroidism- t3 and t4 levels are checked

3. Pheochromoctoma- 24hr urine collection to test for catecholamines and other substances that can indicate pheochromocytoma

4. Addisons disease- ACTH stimulation test is standard test for addison disease. measures cortisol response to ACTH

Front 21

RN is caring for a PT who has diabetes mellitus and developed peripheral neuropathy. Which of the following measures should the RN recommend to prevent injuries to his feet?

1. Examine the skin and feet weekly for alterations in skin integrity

2. Monitor the temp of bath water with a thermometer

3. Shop for shoes early in the day

4. Round the edges of toenails when trimming

Back 21

1. Examine the skin and feet weekly for alterations in skin integrity- should be daily

2. Monitor the temp of bath water with a thermometer- these PTs have hard time determining if water it too hot

3. Shop for shoes early in the day- shop for show later in the day when feet are swollen to make sure the shoes fit

4. Round the edges of toenails when trimming- cut toenails straight across and smooth edges with emery board

Front 22

Rn is providing teaching for a PT who has type 1 diabetes about how to prevent complications during illness. Which of the following statements indicates understanding?

1. I should stop taking my insulin if I feel nauseous

2. I will test my urine for protein when i start to feel ill

3. I will call the DR if my BG is more than 250

4. I should check my BG every 8 hr

Back 22

1. I should stop taking my insulin if I feel nauseous- take it whether you feel good or not

2. I will test my urine for protein when i start to feel ill- check for ketones when BG is greater than 240

3. I will call the DR if my BG is more than 250- should call if it exceeds 250

4. I should check my BG every 8 hr - should be Q4 during illness

Front 23

Rn is providing teaching for a PT who has diabetes insidious and has a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?

1. Breathe deeply while using the nasal spray

2. Blow nose gently prior to using spray

3. administer the nasal spray while in a side lying position

4. Instill the medication four times a day

Back 23

1. Breathe deeply while using the nasal spray- should hold breath as this is absorbed through the nasal mucosa

2. Blow nose gently prior to using spray- this avoids dilution of the medication by nasal secretions or improper absorption of the med due to nasal blockage

3. administer the nasal spray while in a side lying position- should sit upright

4. Instill the medication four times a day- Q8-24 hrs as prescribed

Front 24

You are caring for PT who is postoperative and experiencing acute adrenal insufficiency. Which of the following actions should you take?

1. Administer IV hydrocortisone sodium succinate

2. Give oral spironolactone

3. Infuse 1 unit of PLT

4. Restrict daily fluid intake

Back 24

1. Administer IV hydrocortisone sodium succinate- is needed to replace the cortisol deficiency that occurs with adrenal insufficiency

2. Give oral spironolactone- will further increase K level

3. Infuse 1 unit of PLT- not needed

4. Restrict daily fluid intake- needs rapid fluid replacement due to hypovolemia

Front 25

RN is caring for PT who is undergoing screening for primary Cushings disease. The Rn should expect that which of the following labs to be elevated?

1. Lymphocyte

2. K

3. Ca

4. BG

Back 25

1. Lymphocyte- decreased

2. K- decreased

3. Ca- decreased

4. BG- elevated

Front 26

Rn is assessing a PT who has adrenal insufficiency. Which of the following findings should the RN expect?

1. Moon face

2. Weight gain

3. Ca 12.8

4. Sodium 150

Back 26

1. Moon face- expected for cushings syndrome

2. Weight gain- weight loss would be expected

3. Ca 12.8 - The PT has adrenal insufficiency has a serum calcium level above the expected range

4. Sodium 150- should be below the ref range

Front 27

You are checking the PTs status 24hr after a total thyroidectomy. Which findings should you report?

1. Laryngeal stridor

2. Productive cough

3. Pain with hyperextension of the neck

4. Hoarse, weak voice

Back 27

1. Laryngeal stridor- stridor is a harsh high pitched sound upon inspiration that indicates resp. obstruction. ABCs

2. Productive cough- can occur due to endotracheal tube

3. Pain with hyperextension of the neck- is expected

4. Hoarse, weak voice- common after general anesthesia

Front 28

RN is providing teaching to PT who has diabetes mellitus. Which finding is associated with DKA?

1. Decreased urine output

2. Weight gain of 0.45 alb in 24 hr

3. Rapid shallow respirations

4. BG levels greater than 300

Back 28

1. Decreased urine output- would be increased UOP

2. Weight gain of 0.45 alb in 24 hr- weight loss is expected

3. Rapid shallow respirations- would be deep Kussmaul respirations

4. BG levels greater than 300- expected finding

Front 29

RN is preparing to administer propranolol by IV bolus to a PT experiencing a thyriod storm. Which of the following indicates the PT is having a therapeutic response?

1. Reduction of the effects of thyroid hormone on the heart

2. Blockage of the release of thyroid hormone from the thyroid gland

3. Increase of the Hearts sensitivity to thyroid hormone

4. Increase of the uptake of thyroid hormone by the thyroid gland.

Back 29

1. Reduction of the effects of thyroid hormone on the heart- Propranolol is a B2 agonist that decreases HR.

2. Blockage of the release of thyroid hormone from the thyroid gland- not affected

3. Increase of the Hearts sensitivity to thyroid hormone- not affected

4. Increase of the uptake of thyroid hormone by the thyroid gland.- not affected

Front 30

RN is planning dietary teaching for a PT who has type 1 diabetes mellitus. Which of the following information should the nurse include regarding alcohol consumption?

1. Substitute two carb exchanges for every one alcoholic beverage

2. Ingest alcohol with meals to reduce alcohol-induced hypoglycemia

3. Consuming alcohol decreases blood triglyceride levels.

4. Expect to increase insulin dosage when consuming alcohol.

Back 30

1. Substitute two carb exchanges for every one alcoholic beverage. should sub two fat exchanges for every beverage containing alcohol.

2. Ingest alcohol with meals to reduce alcohol-induced hypoglycemia- Alcohol prevents liver production of glucose. Consuming carbs while drinking alcoholic beverages helps prevent hypoglycemia

3. Consuming alcohol decreases blood triglyceride levels.- Consuming alcohol increase triglyceride levels

4. Expect to increase insulin dosage when consuming alcohol.- Pt may need to decrease insulin dosage due to the hypoglycemic effect of alcohol.

Front 31

What is a thyroid storm?

Back 31

sudden surge of large amounts of thyroid hormones into blood stream causing an even greater increase in body metabolism.

Front 32

Findings that indicate a thyroid storm? select all

1. HTN

2. Hyperthermia

3. Delirium

4. Vomiting

5. Abdominal pain

6. Hyperglycemia

Back 32

1. HTN

2. Hyperthermia

3. Delirium

4. Vomiting

5. Abdominal pain

6. Hyperglycemia

Front 33

Is TSH increased or decreased with Graves disease?

Back 33

Decreased t3 is increased

Front 34

If you have a deficiency of ADH causing excessive thirst and excessive fluid intake and excessive diluted urine. You would assume the PT has?

1. SIADH syndrome of inappropriate antidiuretic hormone

2. Diabetes insipidus

3. Cushings syndrome

4. Hypercortisolism

Back 34

1. SIADH syndrome of inappropriate antidiuretic hormone- this would be a result of an increase SIADH kidneys RETAIN water and urine will be concentrated UOP decreases and extracellular fluid increases

2. Diabetes insipidus - the excretion of a large quantity of DILUTED urine. would be a result if a decrease

3. Cushings syndrome- this is hypercortisolism

4. Hypercortisolism- r/t cushings syndrome

*Norm electrolytes:

Na 136-145 Cl 98-106

K 3.5-5 Mag 1.3-2.1

Front 35

Why would you give a diabetes insipidus PT desmopressin?

Back 35

It is a synthetic posterior pituitary hormone which allows increased water absorption from kidneys and decreased urine output.

Front 36

You are reviewing the clinical manifestations of hyperthyroidism with a PT. Which of the following finding should the RN include?

1. Dry Skin

2. Heat intolerance

3. Constipation

4. Palpations

5. Weight loss

6. Bradycardia

Back 36

1. Dry Skin- would be moist skin

2. Heat intolerance- expected

3. Constipation- would be diarrhea

4. Palpations- expected due to increased metabolism

5. Weight loss- expected

6. Bradycardia- would be tachycardia