N3661 Care of the Adult SU25
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When providing discharge education to a client who had a laparoscopic cholecystectomy, the nurse should instruct the client to notify the provider immediately if which of the following conditions develop
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Right shoulder pain
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Constipation
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Temperature of 101.8°F
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Decreased appetite
Explanation
Correct Answer C: Temperature of 101.8°F
Explanation:
A fever of 101.8°F (38.8°C) may indicate postoperative infection and should be reported immediately. This could be a sign of complications such as a surgical site infection or intra-abdominal infection, and timely intervention is crucial.
Why the Other Options Are Incorrect:
A. Right shoulder pain
This is a common and expected side effect after laparoscopic surgery due to carbon dioxide gas used during the procedure irritating the phrenic nerve. It typically resolves on its own.
B. Constipation
Constipation can occur after surgery due to anesthesia, pain medications, and reduced mobility. It's not an emergency and is usually managed with dietary changes and stool softeners.
D. Decreased appetite
A temporary decrease in appetite is common after surgery and generally resolves as the client recovers. It is not a reason to call the provider unless it persists or worsens significantly.
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L (range: 135–145). Which of the following assessment findings should the nurse anticipate
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Thirst
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Muscle cramps and weakness
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Swollen, dry tongue
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Hallucinations
Explanation
Correct Answer B: Muscle cramps and weakness
Explanation:
SIADH causes water retention and dilutional hyponatremia. A sodium level of 123 mEq/L is significantly low and can lead to symptoms such as muscle cramps, weakness, nausea, headache, and lethargy. These are common early signs of moderate hyponatremia.
Why the Other Options Are Incorrect:
A. Thirst
Thirst is not a prominent feature of SIADH due to fluid retention and euvolemia or hypervolemia, not dehydration.
C. Swollen, dry tongue
A dry tongue is associated with dehydration, which is not characteristic of SIADH, as the body retains too much water.
D. Hallucinations
Hallucinations can occur in severe hyponatremia, typically when sodium levels fall below 120 mEq/L. This client’s level, while low, is more likely to produce neuromuscular symptoms first.
The nurse is about to administer warfarin (Coumadin). Which of the following laboratory studies would be reviewed first
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International Normalized Ratio (INR) level
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Fibrinogen level
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Vitamin K level
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Activated Partial Thromboplastin Time (aPTT) level
Explanation
Correct Answer A: International Normalized Ratio (INR) level
Explanation:
The INR is the standard test used to monitor the effectiveness and safety of warfarin therapy. It reflects the patient’s bleeding risk and therapeutic range (usually between 2.0–3.0 for most indications). Reviewing the INR before administering warfarin ensures that the dose is appropriate and helps avoid complications such as bleeding or clot formation.
Why the Other Options Are Incorrect:
B. Fibrinogen level
Fibrinogen is part of the clotting cascade but is not a standard test for monitoring warfarin. It may be relevant in other clotting disorders but not for routine anticoagulation.
C. Vitamin K level
While vitamin K is the antidote for warfarin, its serum level is not commonly checked before dosing. Instead, its effects are reflected in the INR value.
D. Activated Partial Thromboplastin Time (aPTT) level
aPTT is used to monitor unfractionated heparin, not warfarin. It is not relevant for adjusting warfarin therapy.
The nurse is teaching a client recovering from a laparoscopic cholecystectomy and is being discharged. Which statement indicates that discharge teaching is effective
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I need to avoid lifting objects exceeding 5 lb after surgery, usually for 6 weeks.
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I can drive myself home
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I will call the surgeon if I have a fever of 37.2°C (100°F) or more for two consecutive days
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I need someone to stay with me at home for a week after the surgery
Explanation
Correct Answer A: I need to avoid lifting objects exceeding 5 lb after surgery, usually for 6 weeks.
Explanation:
After a laparoscopic cholecystectomy, patients are generally advised to avoid lifting more than 5 lb for several weeks to allow proper healing and avoid complications such as hernias or delayed wound healing. This response shows understanding of appropriate post-op care.
Why the Other Options Are Incorrect:
B. I can drive myself home.
This is incorrect. Clients should not drive immediately after surgery, especially if they received general anesthesia or are taking narcotics. They need a responsible adult to take them home.
C. I will call the surgeon if I have a fever of 37.2°C (100°F) or more for two consecutive days.
A temperature of 37.2°C (100°F) is not high enough to be concerning. Patients are typically instructed to call if fever exceeds 38°C (100.4°F).
D. I need someone to stay with me at home for a week after the surgery.
While it is ideal to have help for the first 24 hours, needing someone for an entire week is not typically necessary after a laparoscopic procedure unless complications arise.
A 37-year-old client presents at the emergency department (ED), reporting nausea, vomiting, and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for the past two days. The ED nurse should assist in assessing the client for what health problem
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COPD
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Severe pancreatitis with possible peritonitis
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GERD
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Diabetes
Explanation
Correct Answer B: Severe pancreatitis with possible peritonitis
Explanation:
The client’s symptoms — severe abdominal pain, rigid abdomen, nausea/vomiting, flank bruising (Grey-Turner’s sign), and recent alcohol binge — strongly indicate acute pancreatitis, potentially complicated by peritonitis. Alcohol abuse is a common cause of pancreatitis, and the presence of a rigid abdomen and ecchymosis suggests internal bleeding or peritoneal inflammation.
Why the Other Options Are Incorrect:
A. COPD
This is a chronic lung disease and not related to the described gastrointestinal and abdominal findings.
C. GERD
GERD typically causes heartburn and reflux, not severe abdominal pain, rigidity, or bruising.
D. Diabetes
While diabetes can be associated with pancreatitis, it does not present acutely with these symptoms. The findings here point to an acute abdominal condition, not hyperglycemia or diabetic complications.
A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take
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Assess for hypoglycemia four hours after the lispro insulin injection.
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The client should eat no more than 5–15 minutes after the injection.
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Administer lispro insulin and long-acting insulin in the same syringe.
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Monitor for polyuria.
Explanation
Correct Answer B: The client should eat no more than 5–15 minutes after the injection.
Explanation:
Lispro insulin is a rapid-acting insulin with an onset of action in about 15 minutes. To prevent hypoglycemia, the client should eat within 5 to 15 minutes after the injection. This timing ensures that glucose is available in the bloodstream when the insulin starts to work.
Why the Other Options Are Incorrect:
A. Assess for hypoglycemia four hours after the lispro insulin injection
This is too late. Hypoglycemia from lispro typically occurs 1 to 2 hours after administration when its action peaks.
C. Administer lispro insulin and long-acting insulin in the same syringe
Lispro insulin should not be mixed with long-acting insulin like glargine (Lantus) in the same syringe. They must be administered separately.
D. Monitor for polyuria
Polyuria is a sign of hyperglycemia, not a typical immediate concern after insulin administration. The focus after giving insulin should be on monitoring for hypoglycemia.
While hospitalized and recovering from an episode of diabetic ketoacidosis, the client calls the nurse and reports feeling anxious, nervous, and sweaty. What is the nurse's priority action based on the client's report
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Administer a glucose tablet.
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Administer 1 mg of glucagon subcutaneously.
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Obtain a glucose reading using a finger stick.
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Have the client drink 8 ounces of Coca-Cola.
Explanation
Correct Answer C: Obtain a glucose reading using a finger stick.
Explanation:
The client is showing early symptoms of hypoglycemia (anxious, nervous, sweaty), which can occur during DKA recovery due to insulin administration. The nurse’s priority is to confirm the blood glucose level with a finger stick reading before taking further action. This ensures the symptoms are due to hypoglycemia and guides the next appropriate intervention.
Why the Other Options Are Incorrect:
A. Administer a glucose tablet.
While appropriate if hypoglycemia is confirmed, the nurse must first check the glucose level to ensure this is the correct action.
B. Administer 1 mg of glucagon subcutaneously.
Glucagon is used for severe hypoglycemia, especially when the client is unconscious or unable to swallow — not appropriate for mild symptoms.
D. Have the client drink 8 ounces of Coca-Cola.
This can be effective treatment for hypoglycemia, but again, it should only be given after confirming low blood glucose. Administering sugar without confirmation may cause unnecessary hyperglycemia.
A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect
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Bradycardia
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Hypertension
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Weight loss
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Hematuria
Explanation
Correct Answer C: Weight loss
Explanation:
Weight loss is a common symptom of uncontrolled type 1 diabetes mellitus. Due to insulin deficiency, the body is unable to use glucose for energy and begins breaking down fat and muscle for fuel, leading to unintended weight loss even with normal or increased appetite.
Why the Other Options Are Incorrect:
A. Bradycardia
Bradycardia is not typically associated with uncontrolled diabetes. In fact, tachycardia may occur during episodes of diabetic ketoacidosis (DKA).
B. Hypertension
Although type 2 diabetes is often associated with hypertension, uncontrolled type 1 diabetes more commonly presents with hypotension in severe cases like DKA due to dehydration.
D. Hematuria
Hematuria is not a classic sign of uncontrolled type 1 diabetes. It may indicate a urinary tract infection, kidney stones, or glomerular disease, but it's not directly tied to hyperglycemia.
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for a CT scan with contrast. Which medication must be withheld 24–48 hours before and restarted 48 hours after the procedure
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Metformin (Glucophage)
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Regular insulin
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Repaglinide (Prandin)
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Glipizide
Explanation
Correct Answer A: Metformin (Glucophage)
Explanation:
Metformin must be withheld 24–48 hours before and not restarted until 48 hours after the administration of iodinated contrast dye, due to the risk of lactic acidosis, especially in patients with compromised renal function. Kidney function should be reassessed before restarting the drug.
Why the Other Options Are Incorrect:
B. Regular insulin
Insulin dosing may be adjusted based on intake and glucose levels but is not contraindicated with contrast dye.
C. Repaglinide (Prandin)
This oral hypoglycemic agent does not have the same renal clearance concerns with contrast dye and does not require withholding unless clinically indicated.
D. Glipizide
While hypoglycemia is a concern, glipizide does not need to be withheld solely due to contrast exposure. Metformin is the specific concern in this scenario.
A nurse is caring for a client who has type 2 diabetes mellitus, and their glucose levels are rising. Which of the following would indicate the client is in a hyperosmolar hyperglycemic state (HHS)
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Glucose level of 400 mg/dL
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Hypertension
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Serum osmolarity of 350 mOsm/L
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Ketosis
Explanation
Correct Answer C: Serum osmolarity of 350 mOsm/L
Explanation:
A serum osmolarity of 350 mOsm/L is a key diagnostic indicator of hyperosmolar hyperglycemic state (HHS), a serious complication of type 2 diabetes. HHS is characterized by extremely high blood glucose, severe dehydration, and elevated serum osmolarity, typically >320 mOsm/L, without significant ketosis. It often develops slowly and may be triggered by infection or illness.
Why the Other Options Are Incorrect:
A. Glucose level of 400 mg/dL
While elevated, this level alone is not high enough to confirm HHS, which often presents with glucose levels over 600 mg/dL.
B. Hypertension
Hypertension is not a defining feature of HHS. Clients are often hypotensive due to dehydration.
D. Ketosis
Ketosis is absent or minimal in HHS, which distinguishes it from diabetic ketoacidosis (DKA), where ketosis is a hallmark feature.
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