N3661 Care of the Adult SU25
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A client with diabetes has a glycosylated hemoglobin A1C measurement of 5%. Based on this laboratory test result, what should the nurse conclude about this client's needs
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The client requires further teaching regarding nutritional guidelines..
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The client needs a consultation with a healthcare provider to evaluate the therapeutic effects of his insulin regimen.
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The client is experiencing rebound hyperglycemia.
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The client has followed the treatment plan as prescribed.
Explanation
Correct Answer D: The client has followed the treatment plan as prescribed.
Explanation:
An A1C level of 5% is within the normal, non-diabetic range (generally less than 5.7%) and indicates excellent long-term blood glucose control over the past 2–3 months. This suggests that the client has been adhering well to the prescribed treatment plan, including diet, medication, and exercise.
Why the Other Options Are Incorrect:
A. The client requires further teaching regarding nutritional guidelines.
This is incorrect, as the A1C level shows the client’s glucose control is optimal, indicating proper nutritional management.
B. The client needs a consultation with a healthcare provider to evaluate the therapeutic effects of his insulin regimen.
There is no indication that the current insulin regimen is ineffective — the result actually suggests it is working very well.
C. The client is experiencing rebound hyperglycemia.
Rebound hyperglycemia (Somogyi effect) would result in elevated A1C levels, not a normal one. There is no evidence of this here.
A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect
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Decreasing respiratory rate
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Facial flushing
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Increasing dyspnea
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Friction rub
Explanation
Correct Answer C: Increasing dyspnea
Explanation:
Atelectasis is the collapse of alveoli, often occurring postoperatively due to shallow breathing, pain, or immobility. A common clinical sign is increasing dyspnea (shortness of breath) as oxygenation becomes impaired. Other signs may include decreased breath sounds, crackles, and low oxygen saturation.
Why the Other Options Are Incorrect:
A. Decreasing respiratory rate
This is not expected. The respiratory rate typically increases in response to hypoxia caused by atelectasis.
B. Facial flushing
Facial flushing is not associated with atelectasis. Cyanosis or pallor may occur in severe cases due to oxygen deficiency.
D. Friction rub
A friction rub is associated with pleuritis or pericarditis, not atelectasis. Atelectasis causes reduced or absent breath sounds in the affected area.
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.
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 caring for a client post-colon resection assesses the client on the second postoperative day. The nasogastric tube remains patent and is draining moderate amounts of greenish fluid. Which assessment finding would suggest that the client's potassium level is too low
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Diarrhea
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Flaccid paralysis
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Absent P waves
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Polyuria
Explanation
Correct Answer B: Flaccid paralysis
Explanation:
Flaccid paralysis is a classic symptom of severe hypokalemia. Continuous nasogastric suctioning can result in loss of potassium-rich gastric secretions, leading to low potassium levels. Hypokalemia affects neuromuscular function, often resulting in muscle weakness, cramping, and in severe cases, flaccid paralysis.
Why the Other Options Are Incorrect:
A. Diarrhea
Diarrhea is more likely to cause potassium loss than result from it. Constipation is actually a more common symptom of hypokalemia.
C. Absent P waves
Absent P waves are associated with atrial fibrillation, not hypokalemia. Hypokalemia is more likely to cause flattened T waves and the presence of U waves on ECG.
D. Polyuria
While polyuria may occur in hypokalemia, it is less specific than neuromuscular symptoms like flaccid paralysis.
The nurse is preparing discharge instructions for a client with Raynaud's Disease. Which teaching point would the nurse include in the teaching plan
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Use nail polish to protect nail beds from injury
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Stop smoking because it causes cutaneous vasospasm
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Always wear warm clothing even in warm climates to prevent vasoconstriction
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Wear gloves for all activities involving use of both hands
Explanation
Correct Answer B: Stop smoking because it causes cutaneous vasospasm
Explanation:
Smoking is a major risk factor in Raynaud's disease because nicotine causes vasoconstriction, which can worsen the frequency and severity of vasospastic episodes. Therefore, smoking cessation is a critical component of discharge teaching. Educating the client on avoiding tobacco can significantly improve blood flow and reduce symptoms.
Why the Other Options Are Incorrect:
A. Use nail polish to protect nail beds from injury
Using nail polish does not protect the nail beds from injury or improve circulation. In fact, it can hide signs of poor perfusion or cyanosis in the nail bed, which are important clinical indicators in Raynaud’s.
C. Always wear warm clothing even in warm climates to prevent vasoconstriction
While it's important to stay warm, wearing warm clothing in warm climates is unnecessary and could lead to overheating. The key is to keep extremities warm, especially in cold environments, rather than overdressing inappropriately.
D. Wear gloves for all activities involving use of both hands
Gloves are helpful in cold weather to prevent attacks, but wearing gloves for all hand-related activities is impractical and unnecessary. Gloves should be used when exposed to cold or during activities that could provoke symptoms.
In preparation for ambulation, the nurse plans to assist a postoperative client in transitioning from a lying to a sitting position. Which nursing action is most appropriate to maintain the client's safety
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Assist the client to move quickly from the lying position to the sitting position
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Allow the client to rise from the bed to a standing position unassisted
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Elevate the head of the bed quickly to assist the client to a sitting position
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Assess the client for signs of dizziness and hypotension
Explanation
Correct Answer D: Assess the client for signs of dizziness and hypotension
Explanation:
Postoperative clients are at risk for orthostatic hypotension due to anesthesia, immobility, and fluid shifts. The nurse should always assess for dizziness, lightheadedness, and changes in blood pressure before assisting the client to sit or stand. This helps prevent falls and ensure safety during early ambulation.
Why the Other Options Are Incorrect:
A. Assist the client to move quickly from the lying position to the sitting position
This can lead to sudden drops in blood pressure and increase the risk of fainting or falling.
B. Allow the client to rise from the bed to a standing position unassisted
This is unsafe, especially in the immediate postoperative period when the client may be weak or unstable.
C. Elevate the head of the bed quickly to assist the client to a sitting position
Changes in position should be done slowly to allow the body time to adjust and prevent orthostatic hypotension.
A nurse is caring for a client who had a total thyroidectomy and a serum calcium level of 7.6 mg/dL (range 8.8–10.5). Which of the following findings should the nurse expect
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Constipation
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Hypoactive deep tendon reflexes
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Shortened QT intervals
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Tingling of the extremities
Explanation
Correct Answer D: Tingling of the extremities
Explanation:
A serum calcium level of 7.6 mg/dL indicates hypocalcemia, a common complication after total thyroidectomy due to accidental removal or damage to the parathyroid glands, which regulate calcium levels. Tingling (paresthesia) of the fingers, toes, and around the mouth is an early sign of hypocalcemia.
Why the Other Options Are Incorrect:
A. Constipation
Constipation is associated with hypercalcemia, not hypocalcemia.
B. Hypoactive deep tendon reflexes
Hypocalcemia causes hyperactive, not hypoactive, deep tendon reflexes.
C. Shortened QT intervals
Hypocalcemia is associated with a prolonged QT interval, while shortened QT is seen in hypercalcemia.
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
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Furosemide
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Vitamin K
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Vitamin A
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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.
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.
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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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