Nur Medical Surg 203
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Free Nur Medical Surg 203 Questions
The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention?
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Increasing drowsiness and lethargy
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Mild confusion and forgetfulness
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A shiny, tight abdomen
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Yellow sclera
Explanation
The Correct Answer is:
A. Increasing drowsiness and lethargy
Detailed Explanation:
Increasing drowsiness and lethargy in a patient with cirrhosis indicate possible progression to hepatic encephalopathy, a serious complication caused by elevated ammonia levels affecting brain function. This can quickly progress to coma if untreated. Immediate interventions include notifying the provider, assessing ammonia levels, and administering lactulose or rifaximin as prescribed to reduce ammonia. While jaundice, ascites (shiny abdomen), and mild confusion are expected in cirrhosis, sudden or worsening lethargy is a critical and life-threatening sign requiring urgent medical attention.
A patient is diagnosed with the type of diabetes in which the plasma beta cells fail to respond to insulin. Which type of diabetes is this patient experiencing?
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Gestational diabetes
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Type 1 diabetes mellitus
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Type 2 diabetes mellitus
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Impaired glucose intolerance
Explanation
The Correct Answer is:
C. Type 2 diabetes mellitus
Detailed Explanation:
Type 2 diabetes mellitus is characterized by insulin resistance, meaning the body’s cells fail to respond properly to insulin produced by pancreatic beta cells. Over time, the pancreas compensates by producing more insulin, but eventually, beta cells become exhausted, and insulin production decreases. This leads to elevated blood glucose levels. Type 2 diabetes is commonly associated with obesity, sedentary lifestyle, and genetics, and it is managed through diet, exercise, oral hypoglycemics, and sometimes insulin therapy.
A nurse is collecting data from a patient who takes metformin for type 2 diabetes. Which medication is contraindicated for this patient due to its effect on blood glucose levels?
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Prednisone
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Ranitidine
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Cephalexin
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Levothyroxine
Explanation
The Correct Answer is:
A. Prednisone
Detailed Explanation:
Prednisone, a corticosteroid, is contraindicated or used with caution in patients taking metformin because it can increase blood glucose levels by promoting gluconeogenesis and decreasing insulin sensitivity. This effect counteracts metformin’s glucose-lowering action, making blood sugar control difficult. When steroids are necessary, close monitoring of blood glucose and potential medication adjustments are required. Other options—ranitidine, cephalexin, and levothyroxine—do not significantly interfere with metformin’s glycemic effects.
The nurse misreads the 0700 POC blood glucose result as 210 mg/dL instead of 120 mg/dL on a patient with type I DM. The sliding scale regular insulin is given based on the incorrect reading. The nurse realizes the mistake 45 minutes later. What is the nurse’s priority action?
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Contact the provider
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Administer a snack with 15 grams of carbohydrates
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Complete an incident report
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Check the blood glucose level
Explanation
The Correct Answer is:
D. Check the blood glucose level
Detailed Explanation:
The priority action is to check the patient’s current blood glucose level to assess for potential hypoglycemia after the insulin administration error. Regular insulin peaks in about 2–4 hours, and verifying the glucose level immediately helps determine if corrective action (such as giving a carbohydrate snack or glucose) is needed to prevent or treat hypoglycemia. Once the patient’s safety is ensured, the nurse should notify the provider and document the error per policy.
A nurse is collecting data from a client who has diabetes mellitus. The client is confused, flushed, and has an acetone odor on his breath. The nurse should anticipate a prescription for which of the following types of insulin to treat the client?
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Glargine
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Regular
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NPH
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Detemir
Explanation
The Correct Answer is:
B. Regular
Detailed Explanation:
The patient’s symptoms—confusion, flushed skin, and an acetone (fruity) odor on the breath—are classic signs of diabetic ketoacidosis (DKA), a life-threatening complication of severe insulin deficiency. The treatment for DKA requires rapid-acting intravenous insulin, and Regular insulin is the only insulin type approved for IV administration. It quickly lowers blood glucose and stops ketone production by facilitating glucose uptake into cells. Long-acting insulins like glargine, detemir, or NPH are not used for acute DKA management.
The nurse carefully assesses a patient who has hyperglycemic hyperosmolar syndrome (HHS). Which sign or symptom is most likely NOT to be associated?
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Polycystic
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Polyphagia
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Polydipsia
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Polyuria
Explanation
The Correct Answer is:
A. Polycystic
Detailed Explanation:
Polycystic is not a symptom of hyperglycemic hyperosmolar syndrome (HHS). HHS is characterized by extremely high blood glucose levels, profound dehydration, and elevated serum osmolality without significant ketoacidosis. Typical manifestations include polyuria (excessive urination), polydipsia (excessive thirst), and sometimes polyphagia (increased hunger). These result from osmotic diuresis and the body’s attempt to restore fluid balance. “Polycystic” refers to cyst formation, such as in polycystic ovary syndrome (PCOS), and is unrelated to HHS.
A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect?
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Decreased blood amylase level
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Decreased blood lipase level
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Increased blood calcium level
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Increased blood glucose level
Explanation
The Correct Answer is:
D. Increased blood glucose level
Detailed Explanation:
In acute pancreatitis, inflammation and injury to the pancreatic cells impair insulin production, resulting in elevated blood glucose levels. Additionally, pancreatic enzymes (amylase and lipase) are typically increased due to cell damage, but glucose elevation is a key indicator of impaired endocrine function in severe inflammation of the pancreas. Monitoring glucose helps evaluate disease severity and metabolic stability.
A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopic cholecystectomy. Which of the following statements should the nurse make?
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"The pain results from lying in one position too long during surgery."
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"The pain is caused from the nitrous dioxide injected into the abdomen."
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"The pain will dissipate if you ambulate frequently."
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"The pain occurs as a residual pain from cholecystitis."
Explanation
The Correct Answer is:
C. "The pain will dissipate if you ambulate frequently."
Detailed Explanation:
After a laparoscopic cholecystectomy, right shoulder pain commonly occurs due to carbon dioxide (CO₂) gas used to insufflate the abdomen during surgery. The gas irritates the phrenic nerve, causing referred pain to the shoulder. The most effective relief is early and frequent ambulation, which helps the body absorb and expel the remaining CO₂ through respiration. This pain is temporary and usually resolves within 24–48 hours as the gas is reabsorbed.
A client with acute pancreatitis is experiencing severe abdominal pain. Which additional finding would concern the nurse the most?
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Nausea and vomiting
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Low-grade fever
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Tachycardia
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Absent bowel sounds
Explanation
The Correct Answer is:
D. Absent bowel sounds
Detailed Explanation:
Absent bowel sounds in a client with acute pancreatitis indicate paralytic ileus or possible peritonitis, both of which signal a worsening condition. These complications suggest that inflammation has spread beyond the pancreas, leading to decreased intestinal motility or severe infection. This finding requires immediate provider notification and further assessment for potential complications such as hemorrhage or shock. Nausea, vomiting, mild fever, and tachycardia are expected findings but less immediately life-threatening than absent bowel sounds.
A nurse is collecting data from a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis?
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Gray-blue discoloration of the skin around the umbilicus
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Generalized cyanosis
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Hyperactive bowel sounds
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Wheezing in the lower lung fields
Explanation
The Correct Answer is:
A. Gray-blue discoloration of the skin around the umbilicus
Detailed Explanation:
A gray-blue discoloration around the umbilicus, known as Cullen’s sign, is a classic indicator of acute pancreatitis. It results from internal bleeding caused by pancreatic enzyme leakage that leads to subcutaneous tissue discoloration. This finding signals severe disease and possible hemorrhagic pancreatitis, requiring urgent medical attention. Other signs may include epigastric pain radiating to the back, nausea, vomiting, and elevated serum amylase and lipase levels. Immediate supportive care and close monitoring are critical for recovery.
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