N3661 Care of the Adult SU25
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Topics include peripheral vascular conditions, anticoagulant therapy, PAD, venous ulcers, and patient education
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Free N3661 Care of the Adult SU25 Questions
A client is demonstrating confusion, hallucinations, and a positive Chvostek sign. Which medication(s) should the nurse anticipate administering to this client
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Calcium chloride
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Insulin and glucose
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Potassium chloride
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Sodium bicarbonate
Explanation
Correct Answer A: Calcium chloride
Explanation:
Confusion, hallucinations, and a positive Chvostek sign are signs of hypocalcemia, which may occur after procedures like thyroidectomy or in critical illness. Calcium chloride (or calcium gluconate) is administered to correct low serum calcium levels and reverse neuromuscular irritability and cognitive symptoms.
Why the Other Options Are Incorrect:
B. Insulin and glucose
Used to treat hyperkalemia, not hypocalcemia.
C. Potassium chloride
Used to treat hypokalemia, but this client shows signs specific to low calcium, not low potassium.
D. Sodium bicarbonate
Used in metabolic acidosis or certain types of drug overdoses, but not for treating hypocalcemia.
A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia
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Vomiting
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Fruity odor on the client's breath
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Cool, clammy skin
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Bradycardia
Explanation
Correct Answer C: Cool, clammy skin
Explanation:
Cool, clammy skin is a classic sign of hypoglycemia. As blood glucose drops, the body activates the sympathetic nervous system, causing symptoms like sweating, shakiness, irritability, and pale, clammy skin. These signs indicate the need for immediate carbohydrate intake.
Why the Other Options Are Incorrect:
A. Vomiting
While vomiting can occur with many conditions, it is more commonly associated with hyperglycemia and diabetic ketoacidosis (DKA), not hypoglycemia.
B. Fruity odor on the client's breath
A fruity or acetone-like odor is a hallmark of DKA, a complication of severe hyperglycemia, not hypoglycemia.
D. Bradycardia
Bradycardia is not typically associated with hypoglycemia. Tachycardia is more common due to the stress response triggered by low blood sugar.
A nurse is caring for a client with a deep vein thrombosis who has been receiving a heparin drip for one week. The client's condition is improving. Two days ago, the primary care provider also prescribed warfarin (Coumadin). The client inquires about receiving both heparin and warfarin simultaneously. Which of the following responses is appropriate
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Your provider must have forgotten that you were already taking heparin. I’ll remind her.
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Only one of these medications is being given to treat your deep vein thrombosis.
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Warfarin takes three to four days to achieve therapeutic anticoagulant effects. Heparin will be discontinued soon.
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Your blood was so thick that two anticoagulants were needed
Explanation
Correct Answer C: Warfarin takes three to four days to achieve therapeutic anticoagulant effects. Heparin will be discontinued soon.
Explanation:
Warfarin has a delayed onset of action, typically taking 3–5 days to reach a therapeutic INR. During this period, heparin is continued to ensure the client remains anticoagulated and protected against clot progression. Once warfarin reaches a therapeutic level (INR 2.0–3.0), heparin can safely be discontinued.
Why the Other Options Are Incorrect
A. Your provider must have forgotten that you were already taking heparin. I’ll remind her.
This is inappropriate and undermines the provider’s judgment. The concurrent use of heparin and warfarin is standard practice during the transition period.
B. Only one of these medications is being given to treat your deep vein thrombosis.
Incorrect. Both medications are being used temporarily together for DVT treatment, each playing a role at different stages of anticoagulation therapy.
D. Your blood was so thick that two anticoagulants were needed.
This is misleading and medically inaccurate. The reason for dual therapy is related to onset timing, not blood viscosity.
An elderly client is in the emergency department, diagnosed with severe HHNK (Hyperosmolar Hyperglycemic Non-Ketotic Syndrome). Which intervention should the nurse include in the plan of care
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Infuse 0.9% normal saline intravenously
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Perform blood glucometer checks every 8 hours
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Monitor arterial blood gas (ABG) results
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Administer intermediate-acting insulin
Explanation
Correct Answer A: Infuse 0.9% normal saline intravenously
Explanation:
The priority intervention for a client with HHNK (now called HHS – Hyperosmolar Hyperglycemic State) is rapid rehydration with isotonic fluids like 0.9% normal saline. These clients often present with severe dehydration due to high blood glucose levels and osmotic diuresis. Restoring volume is critical to stabilize blood pressure, improve renal perfusion, and begin glucose control.
Why the Other Options Are Incorrect:
B. Perform blood glucometer checks every 8 hours
This frequency is too low for critically ill clients with HHS. Glucose should be monitored hourly or every 1–2 hours initially.
C. Monitor arterial blood gas (ABG) results
ABGs are not typically needed in HHS unless there's concern for respiratory compromise or acidosis, which is more common in DKA, not HHS.
D. Administer intermediate-acting insulin
Regular (short-acting) insulin is preferred initially for IV insulin therapy in HHS. Intermediate-acting insulin is not used in emergency management.
A nurse observes mild hand tremors in a client who has diabetes mellitus. What action should the nurse take after obtaining a glucose meter reading of 60 mg/dL
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Administer 15 g of carbohydrates
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Retest the blood glucose level
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Administer IV dextrose
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Administer 1 mg of glucagon IM
Explanation
Correct Answer A: Administer 15 g of carbohydrates
Explanation:
A blood glucose level of 60 mg/dL indicates mild hypoglycemia, especially in a client with symptoms like hand tremors. The appropriate first action is to follow the "15-15 rule": give 15 grams of fast-acting carbohydrates (such as glucose tablets, juice, or regular soda), then recheck blood glucose in 15 minutes. This is a safe and effective first-line intervention.
Why the Other Options Are Incorrect:
B. Retest the blood glucose level
Retesting immediately is unnecessary after a confirmed reading and observed symptoms. Treatment should not be delayed.
C. Administer IV dextrose
IV dextrose is reserved for severe hypoglycemia or if the patient is unconscious or unable to swallow. It’s not indicated in this mild, symptomatic case.
D. Administer 1 mg of glucagon IM
Glucagon is also reserved for severe hypoglycemia, especially when IV access is unavailable and the client is unconscious or seizing. It’s not appropriate for mild cases.
While assessing a client's peripheral IV site, the nurse observes edema and coolness around the insertion site. How should the nurse document this observation
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Phlebitis
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Fluid overload
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Infiltration
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Air embolism
Explanation
Correct Answer C: Infiltration
Explanation:
Infiltration occurs when IV fluid leaks into the surrounding tissue instead of the vein. Common signs include edema, coolness, pallor, and discomfort at the IV site. These findings indicate that the IV catheter may have dislodged from the vein, and the infusion should be stopped immediately.
Why the Other Options Are Incorrect:
A. Phlebitis
Phlebitis presents with warmth, redness, swelling, and a palpable cord along the vein, not coolness or edema alone.
B. Fluid overload
Fluid overload affects the entire body systemically, not just the IV site. Symptoms include crackles in lungs, edema, and increased blood pressure.
D. Air embolism
Air embolism is a systemic emergency involving air entering the bloodstream. It presents with chest pain, dyspnea, hypotension, not localized swelling or coolness.
Which action most effectively prevents pneumonia and promotes healthy pulmonary function after surgery
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Ambulate the client as soon as possible and assist with incentive spirometry.
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Encourage bed rest
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Ask the client to turn, cough, and deep breathe every four hours
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Assess breath sounds at least every two hours and perform frequent oral hygiene.
Explanation
Correct Answer A: Ambulate the client as soon as possible and assist with incentive spirometry.
Explanation:
Early ambulation and use of an incentive spirometer are the most effective interventions to prevent postoperative pneumonia and maintain healthy lung function. Ambulation promotes deep breathing, improves circulation, and prevents atelectasis. Incentive spirometry encourages the client to take slow, deep breaths, expanding the lungs and helping to clear secretions.
Why the Other Options Are Incorrect:
B. Encourage bed rest
Prolonged bed rest leads to lung stasis, increasing the risk of atelectasis and pneumonia. It is not recommended postoperatively unless medically necessary.
C. Ask the client to turn, cough, and deep breathe every four hours
While helpful, the frequency is insufficient. These exercises are more effective when done every 1 to 2 hours while awake.
D. Assess breath sounds at least every two hours and perform frequent oral hygiene
These are supportive measures, but they do not actively expand the lungs or mobilize secretions like ambulation and incentive spirometry do.
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.
The nurse is caring for a client who has a history of chronic alcoholism and is experiencing increased blood pressure, hyperactive deep tendon reflexes, abdominal distention, and mood changes. Which electrolyte imbalance does the client have
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Hypercalcemia
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Hypocalcemia
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Hypermagnesemia
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Hypomagnesemia
Explanation
Correct Answer D: Hypomagnesemia
Explanation:
Chronic alcoholism is a leading cause of hypomagnesemia, which often presents with neuromuscular irritability, such as hyperactive deep tendon reflexes, hypertension, abdominal distention, and mood changes. Magnesium is essential for neuromuscular and cardiovascular stability, and its deficiency can lead to increased excitability and mood disturbances.
Why the Other Options Are Incorrect:
A. Hypercalcemia
Usually causes muscle weakness, lethargy, and decreased reflexes, not hyperactive reflexes or mood changes.
B. Hypocalcemia
While it can cause neuromuscular excitability, it typically presents with positive Chvostek and Trousseau signs; the client's history of alcoholism points more toward magnesium deficiency.
C. Hypermagnesemia
Characterized by muscle weakness, hypoactive reflexes, and hypotension—opposite of this client’s presentation.
The nurse is caring for a client who receives an intermediate-acting insulin, Humulin N (Novolin N, Neutral Protamine Hagedorn insulin, isophane, NPH), 25 units daily at 7 a.m. When is hypoglycemia most likely to occur
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5 a.m.
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10 a.m.
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2 p.m.
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10 p.m.
Explanation
Correct Answer C: 2 p.m.
Explanation:
Humulin N (NPH insulin) is an intermediate-acting insulin with an onset of 1 to 2 hours, a peak effect between 4 to 12 hours, and a duration of up to 24 hours. When administered at 7 a.m., the insulin typically peaks between 11 a.m. and 3 p.m., placing the client at greatest risk for hypoglycemia around 2 p.m., during the peak action time.
Why the Other Options Are Incorrect:
A. 5 a.m.
This is much earlier than the expected peak time and would not be associated with a morning dose of NPH insulin.
B. 10 a.m.
Although this is closer to the beginning of the peak window, significant hypoglycemia is more likely slightly later, during the actual peak.
D. 10 p.m.
This is too late in the day to be affected by a 7 a.m. dose. The insulin's peak action would have passed by this time.
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The package offers over 150 practice questions tailored specifically for the N3661 Care of the Adult SU25 Exam 4. These questions cover key nursing topics such as peripheral vascular conditions, anticoagulant therapy, peripheral artery disease (PAD), venous ulcers, and patient education. Each question comes with clear, step-by-step explanations to help deepen your understanding.
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