, KEY:
All un-highlighted questions are required for Medsurg 1
Red Text = Should Understand
Green Text = Absolutely Should Know
SaundersjlMedsurgjlEndocrine
1.jljlThejlhomejlhealthjlnursejlvisitsjlajlclientjlwithjlajldiagnosisjlofjltypejl1jldiabetesjlmellitu
s.jlThejlclientjlrelatesjlajlhistoryjlofjlvomitingjlandjldiarrheajlandjltellsjlthejlnursejlthatjlnojlf
oodjlhasjlbeenjlconsumedjlforjlthejllastjl24jlhours.jlWhichjladditionaljlstatementjlbyjlthejl
clientjlindicatesjlajlneedjlforjlfurtherjlteaching?
1. "Ijlneedjltojlstopjlmyjlinsulin."
2. "Ijlneedjltojlincreasejlmyjlfluidjlintake."
3. "Ijlneedjltojlmonitorjlmyjlbloodjlglucosejleveryjl3jltojl4jlhours."
4. "Ijlneedjltojlcalljlthejlhealthjlcarejlproviderjl(HCP)jlbecausejlofjlthesejlsymptoms."
Answer:
1.jl"Ijlneedjltojlstopjlmyjlinsulin."
Rationale:
Whenjlajlclientjlwithjldiabetesjlmellitusjlisjlunablejltojleatjlnormallyjlbecausejlofjlillness
,jlthejlclientjlstilljlshouldjltakejlthejlprescribedjlinsulinjlorjloraljlmedication.jlThejlclientjls
houldjlconsumejladditionaljlfluidsjlandjlshouldjlnotifyjlthejlHCP.jlThejlclientjlshouldjlm
onitorjlthejlbloodjlglucosejlleveljleveryjl3jltojl4jlhours.jlThejlclientjlshouldjlalsojlmonitorjl
thejlurinejlforjlketonesjlduringjlillness.
2.jljlThejlnursejlisjlperformingjlanjlassessmentjlonjlajlclientjlwithjlajldiagnosisjlofjlhyperthyro
idism.jlWhichajl ssessmentjlfindingjlshouldjlthejlnursejlexpectjltojlnotejlinjlthisjlclient?
1. Dryjlskin
,2. Bulgingjleyeballs
3. Periorbitaljledema
4. Coarsejlfacialjlfeatures
Answer:
2.jlBulgingjleyeballs
Rationale:
Hyperthyroidismjlisjlclinicallyjlmanifestedjlbyjlgoiterjl(increasejlinjlthejlsizejlofjlthejlthyr
oidjlgland)jlandjlexophthalmosjl(bulgingjleyeballs).jlOtherjlclinicaljlmanifestationsjlinclu
dejlnervousness,jlfatigue,jlweightjlloss,m
jl usclejlcramps,jlandjlheatjlintolerance. jlAdditio
naljlsignsjlfoundjlinjlthisjldisorderjlincludejltachycardia;jlshortnessjlofjlbreath;jlexcessiv
ejlsweating;jlfinejlmusclejltremors;jlthin,jlsilkyjlhairjlandjlthinjlskin;jlinfrequentjlblinking;j
l andjlajlstaringjlappearance.
3.jljlThejlnursejlisjlcaringjlforjlajlclientjladmittedjltojlthejlhospitaljlwithjluncontrolledjltypejl
1jldiabetesjlmellitus.jlIntjl hejleventjlthatjldiabeticjlketoacidosisjl(DKA)jldoesjloccur,jlthejlnu
rsejlanticipatesjlthatjlwhichjlmedicationjlwouldm
jl ostjllikelyjlbejlprescribed?
1. Glucagon
2. Glyburide
3. Regularjlinsulin
4. NeutraljlprotaminejlHagedornjl(NPH)jlinsulin
Answer:
3.jlRegularjlinsulin
, Rationale:
GivingjlregularjlinsulinjlbyjlthejlintravenousjlroutejlisjlthejltreatmentjlofjlchoicejlforjlDKA
.jlAjlshort-
actingjlinsulinjlisjlthejlonlyjlinsulinjlthatjlcanjlbejlgivenjlintravenouslyjlbecausejlitjlcanjlbejl
titratedjltojlthejlclient'sjlbloodjlglucoseljl evels.jlGlucagonjlisjlusedjltojltreatjlhypoglycemi
ajlbecausejlitjlincreasesjlbloodjlglucosejllevels,jlandjlglyburidejlisajl njloraljlhypoglycemicjla
gentjlusedjltojltreatjltypejl2jldiabetesjlmellitus;jlbothjlagentsjlarejlinappropriate.jlNPHjli
nsulinjlisjlanjlintermediate-
actingjlinsulinjlandjlthereforejlisjlnotjlappropriatejlforjltreatmentjlofjlDKA.
.
4.jlAjlclientjlwithjltypejl1jldiabetesjlmellitusjlisjladmittedjltojlthejlhospitaljlwithjldiabeticjlke
toacidosisjlandjlajlserumjlglucosejlleveljlofjl789jlmg/dLjl(45jlmmol/L).jlThejlhealthjlcarejlpr
oviderjl(HCP)jlprescribesjl10jlunitsjlofjlregularjlinsulinjlbyjlintravenousjl(IV)jlbolus,jlfollow
edjlbyjlajlcontinuousjlinsulinjlinfusionjlatjlajlratejlofjl5jlunits/hr.Tjl hejlpharmacyjlsendsjl500jl
mLjlofjlnormaljlsalinejlsolutionjlcontainingjl50jlunitsjlofjlregularjlinsulin.jlAfterjladminister
ingjlthejlIVjlbolusjlofjl10jlunitsjlofjlregularjlinsulin,jlthejlnursejlsetsjlthejlinfusionjlpumpjlflowjl
ratejlofjlthen
jl ormaljlsalinejlsolutionjlcontainingjl50jl unitsjlofjlregularjlinsulinjl tojlinfusejlatjl
howjlmanyjlmillilitersjlperjlhourjltojldeliverjl5jlunits/hr?jlFilljlinjlthejlblank.
Answer:
50jlmL
Formula:
Hjl(onjlhand):
Vjl(vehicle)::(desiredjldose):Xjl(u
All un-highlighted questions are required for Medsurg 1
Red Text = Should Understand
Green Text = Absolutely Should Know
SaundersjlMedsurgjlEndocrine
1.jljlThejlhomejlhealthjlnursejlvisitsjlajlclientjlwithjlajldiagnosisjlofjltypejl1jldiabetesjlmellitu
s.jlThejlclientjlrelatesjlajlhistoryjlofjlvomitingjlandjldiarrheajlandjltellsjlthejlnursejlthatjlnojlf
oodjlhasjlbeenjlconsumedjlforjlthejllastjl24jlhours.jlWhichjladditionaljlstatementjlbyjlthejl
clientjlindicatesjlajlneedjlforjlfurtherjlteaching?
1. "Ijlneedjltojlstopjlmyjlinsulin."
2. "Ijlneedjltojlincreasejlmyjlfluidjlintake."
3. "Ijlneedjltojlmonitorjlmyjlbloodjlglucosejleveryjl3jltojl4jlhours."
4. "Ijlneedjltojlcalljlthejlhealthjlcarejlproviderjl(HCP)jlbecausejlofjlthesejlsymptoms."
Answer:
1.jl"Ijlneedjltojlstopjlmyjlinsulin."
Rationale:
Whenjlajlclientjlwithjldiabetesjlmellitusjlisjlunablejltojleatjlnormallyjlbecausejlofjlillness
,jlthejlclientjlstilljlshouldjltakejlthejlprescribedjlinsulinjlorjloraljlmedication.jlThejlclientjls
houldjlconsumejladditionaljlfluidsjlandjlshouldjlnotifyjlthejlHCP.jlThejlclientjlshouldjlm
onitorjlthejlbloodjlglucosejlleveljleveryjl3jltojl4jlhours.jlThejlclientjlshouldjlalsojlmonitorjl
thejlurinejlforjlketonesjlduringjlillness.
2.jljlThejlnursejlisjlperformingjlanjlassessmentjlonjlajlclientjlwithjlajldiagnosisjlofjlhyperthyro
idism.jlWhichajl ssessmentjlfindingjlshouldjlthejlnursejlexpectjltojlnotejlinjlthisjlclient?
1. Dryjlskin
,2. Bulgingjleyeballs
3. Periorbitaljledema
4. Coarsejlfacialjlfeatures
Answer:
2.jlBulgingjleyeballs
Rationale:
Hyperthyroidismjlisjlclinicallyjlmanifestedjlbyjlgoiterjl(increasejlinjlthejlsizejlofjlthejlthyr
oidjlgland)jlandjlexophthalmosjl(bulgingjleyeballs).jlOtherjlclinicaljlmanifestationsjlinclu
dejlnervousness,jlfatigue,jlweightjlloss,m
jl usclejlcramps,jlandjlheatjlintolerance. jlAdditio
naljlsignsjlfoundjlinjlthisjldisorderjlincludejltachycardia;jlshortnessjlofjlbreath;jlexcessiv
ejlsweating;jlfinejlmusclejltremors;jlthin,jlsilkyjlhairjlandjlthinjlskin;jlinfrequentjlblinking;j
l andjlajlstaringjlappearance.
3.jljlThejlnursejlisjlcaringjlforjlajlclientjladmittedjltojlthejlhospitaljlwithjluncontrolledjltypejl
1jldiabetesjlmellitus.jlIntjl hejleventjlthatjldiabeticjlketoacidosisjl(DKA)jldoesjloccur,jlthejlnu
rsejlanticipatesjlthatjlwhichjlmedicationjlwouldm
jl ostjllikelyjlbejlprescribed?
1. Glucagon
2. Glyburide
3. Regularjlinsulin
4. NeutraljlprotaminejlHagedornjl(NPH)jlinsulin
Answer:
3.jlRegularjlinsulin
, Rationale:
GivingjlregularjlinsulinjlbyjlthejlintravenousjlroutejlisjlthejltreatmentjlofjlchoicejlforjlDKA
.jlAjlshort-
actingjlinsulinjlisjlthejlonlyjlinsulinjlthatjlcanjlbejlgivenjlintravenouslyjlbecausejlitjlcanjlbejl
titratedjltojlthejlclient'sjlbloodjlglucoseljl evels.jlGlucagonjlisjlusedjltojltreatjlhypoglycemi
ajlbecausejlitjlincreasesjlbloodjlglucosejllevels,jlandjlglyburidejlisajl njloraljlhypoglycemicjla
gentjlusedjltojltreatjltypejl2jldiabetesjlmellitus;jlbothjlagentsjlarejlinappropriate.jlNPHjli
nsulinjlisjlanjlintermediate-
actingjlinsulinjlandjlthereforejlisjlnotjlappropriatejlforjltreatmentjlofjlDKA.
.
4.jlAjlclientjlwithjltypejl1jldiabetesjlmellitusjlisjladmittedjltojlthejlhospitaljlwithjldiabeticjlke
toacidosisjlandjlajlserumjlglucosejlleveljlofjl789jlmg/dLjl(45jlmmol/L).jlThejlhealthjlcarejlpr
oviderjl(HCP)jlprescribesjl10jlunitsjlofjlregularjlinsulinjlbyjlintravenousjl(IV)jlbolus,jlfollow
edjlbyjlajlcontinuousjlinsulinjlinfusionjlatjlajlratejlofjl5jlunits/hr.Tjl hejlpharmacyjlsendsjl500jl
mLjlofjlnormaljlsalinejlsolutionjlcontainingjl50jlunitsjlofjlregularjlinsulin.jlAfterjladminister
ingjlthejlIVjlbolusjlofjl10jlunitsjlofjlregularjlinsulin,jlthejlnursejlsetsjlthejlinfusionjlpumpjlflowjl
ratejlofjlthen
jl ormaljlsalinejlsolutionjlcontainingjl50jl unitsjlofjlregularjlinsulinjl tojlinfusejlatjl
howjlmanyjlmillilitersjlperjlhourjltojldeliverjl5jlunits/hr?jlFilljlinjlthejlblank.
Answer:
50jlmL
Formula:
Hjl(onjlhand):
Vjl(vehicle)::(desiredjldose):Xjl(u
