Fox Valley Technical College Nursing Health Alterations Section 1.
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Free Fox Valley Technical College Nursing Health Alterations Section 1. Questions
A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patient's daily dose of metformin, the nurse should prioritize which of the following assessments?
- Monitoring the patient's neutrophil levels
- Assessing the patient for constipation
- Monitoring the patient's level of consciousness and behavior
- Reviewing the patient's creatinine and BUN levels
Explanation
Correct Answer: D) Reviewing the patient's creatinine and BUN levels.
Metformin is primarily excreted by the kidneys, and its use is contraindicated or requires dose adjustment in patients with renal impairment. When metformin accumulates due to decreased renal clearance, it increases the risk of lactic acidosis — a rare but potentially fatal complication. Reviewing creatinine and BUN levels assesses kidney function and ensures it is safe to increase the metformin dose.
Neutrophil levels are not affected by metformin and are not a relevant monitoring parameter. Constipation is not a common side effect of metformin — gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort are more typical. Monitoring level of consciousness is important in hypoglycemia, but metformin alone rarely causes hypoglycemia, making this less of a priority than renal function assessment.
A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
- Gradually increase levels of physical exertion.
- Change filters on heaters and air conditioners frequently.
- Take prescribed medications as scheduled.
- Avoid goose-down pillows.
Explanation
Correct Answer: C) Take prescribed medications as scheduled.
Medication adherence is the highest priority teaching point in asthma management. Asthma is a chronic inflammatory airway disease that requires consistent use of both controller medications (such as inhaled corticosteroids) to prevent inflammation and rescue medications (such as short-acting beta-agonists) for acute episodes. Non-adherence to the medication regimen is the leading cause of uncontrolled asthma, preventable exacerbations, emergency department visits, and hospitalizations. All other teaching points, while important, are secondary to ensuring the patient understands and consistently follows their prescribed medication schedule.
A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD?
- Lung cancer
- Cystic fibrosis
- Respiratory failure
- Hemothorax
Explanation
Correct Answer: C) Respiratory failure
Respiratory failure is a well-recognized and serious complication of COPD. As the disease progresses, the lungs become increasingly unable to maintain adequate gas exchange, leading to hypoxemia and hypercapnia. Acute exacerbations can precipitate acute-on-chronic respiratory failure, often requiring supplemental oxygen, non-invasive ventilation, or mechanical ventilation. This is a direct consequence of the progressive airflow obstruction and lung destruction characteristic of COPD.
Which client is at highest risk of compromised immunity?
- A client who has just had surgery due to an open femur fracture
- A client with diabetes with fasting blood glucose of 102 and A1C of 5.5%
- A client who has an elevated BNP
- A client who has atrial fibrillation.
Explanation
Correct Answer: A) A client who has just had surgery due to an open femur fracture.
An open femur fracture with surgery presents the highest risk for compromised immunity due to multiple compounding factors: the open wound creates a direct portal of entry for pathogens, surgical stress suppresses immune function, blood loss reduces immune cell availability, and the trauma itself triggers an inflammatory response that can overwhelm the immune system.
A client with a fasting glucose of 102 and A1C of 5.5% is at the pre-diabetic borderline but does not yet have significant immunocompromise. An elevated BNP indicates cardiac stress or heart failure but does not directly compromise immunity. Atrial fibrillation is a cardiac arrhythmia that does not primarily affect immune function.
An intervention for both DKA and HHS is:
- Administering dextrose IV push
- Administration of glucagon
- Administration of Lantus (glargine)
- Hydration
Explanation
Correct Answer: D) Hydration
Both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) involve severe dehydration due to osmotic diuresis caused by hyperglycemia. IV fluid replacement is the cornerstone and first priority of treatment for both conditions, as it restores circulating volume, improves perfusion, and begins to lower blood glucose levels.
Option A is incorrect as dextrose IV would worsen hyperglycemia in both conditions. Option B is incorrect because glucagon raises blood glucose and is used for hypoglycemia, which is the opposite of what is needed in DKA and HHS. Option C is incorrect because Lantus (glargine) is a long-acting basal insulin not used in the acute management of DKA or HHS, where short-acting regular insulin infusions are used instead.
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?
- Fasting plasma glucose greater than or equal to 126 mg/dL
- Hemoglobin A1C 6.4
- Fasting glucose less than 102 mg/dL on 2 separate occasions
- Random plasma glucose 50 mg/dL
Explanation
Correct Answer: A) Fasting plasma glucose greater than or equal to 126 mg/dL.
According to the American Diabetes Association diagnostic criteria, a fasting plasma glucose of 126 mg/dL or greater on two separate occasions is diagnostic of diabetes mellitus. This threshold reflects impaired fasting glucose regulation consistent with the disease.
A Hemoglobin A1C of 6.4% falls in the prediabetes range (5.7–6.4%), not the diabetic range (≥6.5%). A fasting glucose less than 102 mg/dL is within or near normal range and does not support a diagnosis of diabetes. A random plasma glucose of 50 mg/dL indicates hypoglycemia, not diabetes.
The child weighs 77 pounds. The safe dose of the medication is 50-60mg/kg/day. The order is for 150mg BID. Is this a safe dose? How much would you prepare if the medication were available in 50mg scored tablets?
Explanation
Correct Answer:
Step 1 — Convert weight from pounds to kg: 77 lbs ÷ 2.2 = 35.0 kg (rounded to the tenth)
Step 2 — Calculate the safe daily dose range:
- Minimum: 35.0 kg × 50 mg/kg/day = 1,750 mg/day
- Maximum: 35.0 kg × 60 mg/kg/day = 2,100 mg/day
Step 3 — Calculate the ordered daily dose: 150 mg BID (twice daily) = 150 × 2 = 300 mg/day
Step 4 — Is the dose safe? 300 mg/day falls far below the minimum safe dose of 1,750 mg/day.
Answer: No — the ordered dose is below the safe therapeutic range and is therefore not a safe (subtherapeutic) dose.
Step 5 — Number of tablets for the morning dose: Each tablet = 50 mg. Morning dose = 150 mg. 150 mg ÷ 50 mg/tablet = 3 tablets
Summary of Answers:
- Is the dose safe? → No
- Child's weight in kg → 35.0
- Number of tablets for the morning dose → 3
A patient has been diagnosed with uterine and ovarian cancer. The nurse is preparing her for surgery prior to her hysterectomy and oophorectomy. The nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent?
- "I know I'll be fine because the physician said he has done this procedure hundreds of times."
- "I know I'll have pain after the surgery but they'll do their best to keep it to a minimum."
- "The physician is going to remove my uterus and ovaries and told me about the risk of bleeding."
- "Because the physician isn't taking my ovaries, I'll still be able to have children."
Explanation
Correct Answer: C) "The physician is going to remove my uterus and ovaries and told me about the risk of bleeding."
Informed consent requires that the patient understands the nature of the procedure, the expected outcomes, and the associated risks. This statement demonstrates that the patient correctly understands what organs will be removed and has been informed of a specific risk, satisfying the core elements of informed consent.
Option A reflects confidence in the surgeon's experience but does not demonstrate understanding of the procedure or its risks. Option B shows awareness of post-operative pain management but lacks understanding of the procedure itself. Option D reveals a critical misunderstanding — an oophorectomy involves removal of the ovaries, meaning the patient has not been properly informed or has not retained key information, which invalidates informed consent.
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment?
- The patient did not eat adequate protein and carbohydrates.
- The patient is drinking too much water.
- The patient's insulin administration is not adequate.
- The patient is taking too high of a dose of metformin (Glucophage).
Explanation
Correct Answer: C) The patient's insulin administration is not adequate.
In Type 1 diabetes, when there is insufficient insulin, the body cannot use glucose for energy and instead breaks down fat as an alternative fuel source. This process of fat metabolism produces ketones as a byproduct, which spill into the urine causing ketonuria.
A positive urine ketone test in a Type 1 diabetic is a strong indicator of inadequate insulin coverage, as sufficient insulin would allow glucose utilization and prevent fat breakdown.
Inadequate protein or carbohydrate intake does not directly cause ketonuria in this context. Excess water intake would dilute urine, not cause ketones. Metformin is not used in Type 1 diabetes and does not cause ketone production.
The nurse is assessing a patient with chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
- A hypersternal chest
- A kyphotic chest
- A barrel chest
- A pigeon chest
Explanation
Correct Answer: C) A barrel chest.
Chronic hyperinflation of the lungs, as seen in conditions like COPD and emphysema, causes the anteroposterior (AP) diameter of the chest to increase, resulting in a barrel chest appearance. This occurs because the lungs remain chronically overinflated, pushing the chest wall outward and increasing the AP to lateral diameter ratio to approximately 1:1.
A hypersternal chest is not a recognized clinical finding associated with hyperinflation. A kyphotic chest refers to an exaggerated posterior curvature of the thoracic spine, not lung hyperinflation. A pigeon chest (pectus carinatum) is a congenital deformity where the sternum protrudes outward and is unrelated to hyperinflation.
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