N3661 Care of the Adult SU25

N3661 Care of the Adult SU25

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Free N3661 Care of the Adult SU25 Questions

1.

A client with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. The client calls the clinic to report the symptoms and a blood glucose level of 210 mg/dL. Which of the following responses is most appropriate for the nurse advising the client

  • Limit intake to only non-calorie-containing liquids until the glucose is within the usual range.

  • Monitor blood glucose every 4 hours and notify the clinic if it continues to rise

  • Use only the lispro insulin until the symptoms of infection resolve

  • Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%

Explanation

Correct Answer B: Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.

Explanation:

During illness, clients with type 1 diabetes are at increased risk for hyperglycemia and diabetic ketoacidosis (DKA). The recommended practice is to check blood glucose every 4 hours and report persistent elevations or symptoms of DKA. Illness often increases blood glucose levels, even if the client is eating less, due to the stress response.

Why the Other Options Are Incorrect

A. Limit intake to only non-calorie-containing liquids until the glucose is within the usual range.

This could lead to hypoglycemia and dehydration, especially if insulin is still being taken. Clients should maintain adequate caloric and fluid intake.

C. Use only the lispro insulin until the symptoms of infection resolve.

Stopping glargine (basal insulin) is unsafe and may result in severe hyperglycemia or DKA. Both basal and bolus insulins should be continued during illness.

D. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

Glycosylated hemoglobin (HbA1c) reflects long-term glucose control, not short-term illness management. Reducing carbohydrate intake drastically during illness may not be appropriate or safe.


2.

A nurse reviews guidelines to prevent diabetic ketoacidosis (DKA) during periods of illness with a client with type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching

  • Drink 240 to 360 milliliters of calorie-free liquids every 8 hours.

  • Check your urine for ketones when blood glucose levels are greater than 240 mg/dL

  • Withhold your usual daily dose of insulin.

  • Test your blood glucose level every 8 hours.

Explanation

Correct Answer B: Check your urine for ketones when blood glucose levels are greater than 240 mg/dL.

Explanation:

Monitoring urine ketones when blood glucose exceeds 240 mg/dL is a crucial sick day rule for individuals with type 1 diabetes. This helps in the early detection of DKA, allowing for prompt intervention before the condition worsens.

Why the Other Options Are Incorrect:

A. Drink 240 to 360 milliliters of calorie-free liquids every 8 hours.

This is not enough. Clients should drink 8 oz (240 mL) every hour while awake to maintain hydration and prevent dehydration.

C. Withhold your usual daily dose of insulin.

Insulin should never be withheld completely during illness. Even if eating less, basal insulin is still needed to prevent DKA.

D. Test your blood glucose level every 8 hours.

Blood glucose should be tested more frequently — ideally every 3 to 4 hours during illness — to manage levels effectively and adjust insulin dosing.


3.

A nurse is preparing a teaching session on reducing the risk of complications associated with diabetes mellitus. Which information should the nurse plan to include in the teaching

  • Sustain hyperglycemia to reduce the deterioration of nerve cells.

  • Decrease physical activity and daily exercise.

  • Maintain optimal blood pressure to prevent kidney damage.

  • Increase cholesterol and saturated fat intake.

Explanation

Correct Answer C: Maintain optimal blood pressure to prevent kidney damage.

Explanation:

Maintaining optimal blood pressure is crucial for clients with diabetes to reduce the risk of diabetic nephropathy (kidney damage), a common long-term complication. Good blood pressure control helps protect the kidneys and other organs, preventing or slowing the progression of microvascular complications.

Why the Other Options Are Incorrect:

A. Sustain hyperglycemia to reduce the deterioration of nerve cells

This is incorrect and dangerous. Hyperglycemia contributes to nerve damage, leading to diabetic neuropathy. The goal is to maintain blood glucose within the target range.

B. Decrease physical activity and daily exercise

Physical activity helps improve insulin sensitivity and glucose control. Decreasing it can worsen glycemic control and increase the risk of complications.

D. Increase cholesterol and saturated fat intake

This increases the risk of cardiovascular disease, which is already elevated in people with diabetes. The teaching should include guidance on a heart-healthy diet.


4.

 A nurse is assessing a female client who is at risk for developing type 2 diabetes mellitus. The nurse should identify which of the following manifestations increases the client's risk for developing type 2 diabetes

  • Abdominal girth 32 inches

  • Blood pressure is 140/98 mm Hg, and the patient is taking antihypertensive medication

  • Triglyceride level 100 mg/dL

  • Fasting blood glucose 98 mg/dL

Explanation

Correct Answer B: Blood pressure is 140/98 mm Hg, and the patient is taking antihypertensive medication

Explanation:

Hypertension (BP ≥ 140/90 mm Hg) or being on antihypertensive medication is a known risk factor for metabolic syndrome, which is closely associated with insulin resistance and type 2 diabetes. Persistent elevated blood pressure increases the risk of cardiovascular disease and type 2 diabetes.

Why the Other Options Are Incorrect:

A. Abdominal girth 32 inches

A waist circumference of ≥35 inches in women is considered a risk factor for type 2 diabetes. A measurement of 32 inches is not elevated.

C. Triglyceride level 100 mg/dL

This is within the normal range. A triglyceride level of ≥150 mg/dL is considered a risk for metabolic syndrome and type 2 diabetes.

D. Fasting blood glucose 98 mg/dL

This is within the normal fasting range (70–99 mg/dL) and does not indicate increased risk on its own.


5.

A client has superficial varicose veins. Which of the following symptoms would the nurse expect the client to report

  • Numbness and tingling in both feet.

  • Calf pain on dorsiflexion of the foot.

  • Intermittent claudication of the legs.

  • Feeling of heaviness in both legs.

Explanation

Correct Answer D: Feeling of heaviness in both legs.

Explanation:

Clients with superficial varicose veins often report symptoms of aching, heaviness, or fatigue in the legs, especially after prolonged standing or sitting. These veins result from venous valve incompetence, leading to blood pooling in the superficial veins and causing discomfort, swelling, and visible vein distension.

Why the Other Options Are Incorrect:

A. Numbness and tingling in both feet

This is more suggestive of neuropathy, such as from diabetes or nerve compression, not varicose veins.

B. Calf pain on dorsiflexion of the foot

Known as Homan’s sign, this may suggest deep vein thrombosis (DVT) rather than superficial varicose veins, although it's not a reliable diagnostic indicator.

C. Intermittent claudication of the legs

This is a hallmark of peripheral arterial disease (PAD), where there’s cramping or pain in the legs during activity that subsides with rest — not typically associated with varicose veins.


6.

 A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia

  • Vomiting

  • Fruity odor on the client's breath

  • Cool, clammy skin

  • 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.


7.

A nurse is teaching a client with diabetes who has a new prescription for insulin glargine detemir. Which instruction should the nurse provide regarding this type of insulin

  • Insulin glargine detemir has a duration of 3 to 6 hr.

  • Insulin glargine detemir has a duration of 6 to 10 hr.

  • Insulin glargine detemir has a duration of 16 to 24 hr

  • Insulin glargine detemir has a duration of 24 hr.

Explanation

Correct Answer C: Insulin glargine detemir has a duration of 16 to 24 hr

Explanation:

Insulin detemir is a long-acting basal insulin that maintains blood glucose control over an extended period. Its duration ranges from 16 to 24 hours, depending on the dose and individual patient factors. It is often administered once or twice daily and provides a steady release of insulin without pronounced peaks, reducing the risk of hypoglycemia.

Why the Other Options Are Incorrect:

A. Insulin glargine detemir has a duration of 3 to 6 hr.

This duration describes short-acting insulin, such as regular insulin, and does not apply to long-acting detemir.

B. Insulin glargine detemir has a duration of 6 to 10 hr.

This is more consistent with intermediate-acting insulins, like NPH, not with insulin detemir.

D. Insulin glargine detemir has a duration of 24 hr.

While detemir can last up to 24 hours, it does not consistently provide full 24-hour coverage for all individuals, making 16 to 24 hours the most accurate range.


8.

A nurse reviews the medication list for a client with a new warfarin prescription. The nurse should recognize which of the following medications is incompatible with warfarin

  • Furosemide

  • Vitamin K

  • Vitamin A

  • Alprazolam

Explanation

Correct Answer B: Vitamin K

Explanation:

Vitamin K directly antagonizes the effects of warfarin, which works by inhibiting the synthesis of vitamin K–dependent clotting factors. Taking vitamin K supplements can significantly reduce the anticoagulant effect of warfarin, increasing the risk for clot formation. Therefore, it is considered incompatible unless specifically prescribed to reverse warfarin effects (e.g., during bleeding or high INR).

Why the Other Options Are Incorrect:

A. Furosemide

Furosemide is a loop diuretic and does not directly interact with warfarin’s anticoagulant effects. However, close monitoring is still needed for electrolyte imbalances and kidney function.

C. Vitamin A

Vitamin A does not have a known significant interaction with warfarin. Unlike vitamin K, it does not affect clotting factors.

D. Alprazolam

Alprazolam, an anti-anxiety medication, is metabolized by the liver but does not have a direct interaction with warfarin. It may increase fall risk but doesn’t alter INR levels significantly.


9.

 The nurse is about to administer warfarin (Coumadin). Which of the following laboratory studies would be reviewed first

  • International Normalized Ratio (INR) level

  • Fibrinogen level

  • Vitamin K level

  • 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.


10.

 The nurse is teaching a client recovering from a laparoscopic cholecystectomy and is being discharged. Which statement indicates that discharge teaching is effective

  • I need to avoid lifting objects exceeding 5 lb after surgery, usually for 6 weeks.

  • I can drive myself home

  • I will call the surgeon if I have a fever of 37.2°C (100°F) or more for two consecutive days

  • 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.


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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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