PCCN Revision Questions and Rationale

b. <50mg/dL A nurse in the emergency department assesses a patient with a hand laceration and notices that the patient smells strongly of alcohol. The patient is diabetic, irritable, and pale and reports headache. The nurse is waiting for laboratory results. What serum glucose level might the nurse expect to find? a. 50 to 60 mg/dL b. <50 mg/dL c. >1000 mg/dL d. 80 to 110 mg/dL d. "Administer intravenous (IV) fluids based on corrected sodium levels" and "Administer prescribed insulin via IV bolus, then continuous drip". Following a chest infection, a patient with type 1 diabetes reports fatigue and nausea. Assessment reveals a blood glucose level of 450 mg/dL. Which of the following pharmacologic interventions are priorities for patient care? a. Administer intravenous (IV) fluids at the prescribed rate to correct sodium levels. b. Administer intravenous (IV) fluids based on corrected sodium levels. c. Administer prescribed insulin via IV bolus, then continuous drip. d. "Administer intravenous (IV) fluids based on corrected sodium levels" and "Administer prescribed insulin via IV bolus, then continuous drip". b. Metabolic acidosis MA- caused by ketosis resulting from insulin deficiency and stress hormone excess. Hyperkalemia is caused by higher than normal levels of potassium, usually through impaired renal function. Hyponatremia is a low level of nitrogen in the blood associated with protein malnutrition or overhydration. Metabolic alkalosis is an acid-base imbalance, like metabolic acidosis, but is caused by an increase in serum bicarbonate (HCO3) concentration. Which of the following are possible complications from diabetic ketoacidosis? a. Hyponitremia b. Metabolic acidosis c. Hyperkalemia d. Metabolic alkalosis c. phlebitis Hypoglycemia resulting from insulin excess or other causes in adults and children is typically treated with 20 to 50 mL of 50% dextrose injection administered slowly (eg, 3 mL/minute) IV. Hypertonic dextrose commonly causes phlebitis if a peripheral vein is used and should therefore be administered slowly An unconscious patient with hypoglycemia is being treated with IV glucose (50 mL of 50% dextrose IV bolus) to correct serum glucose levels of 40 mg/dL. Which of the following is a possible complication of administering hypertonic dextrose? a. Myocardial infarction b. Cardiac arrest c. Hypokalemia d. Phlebitis a. administered too quickly Circulatory overload can happen any time during a transfusion and is likely when it is administered too quickly. It causes hypertension, bounding pulse, and restlessness. Treatment involves slowing the transfusion and monitoring the patient's progress. Hemolytic, bacterial, and allergic reactions typically occur soon after transfusion is initiated; hemolytic and bacterial reactions are accompanied by tachycardia, and allergic reaction is accompanied by hypotension A 27-year-old patient with rheumatoid arthritis is admitted with anemia. During administration of 200 mL packed red blood cells (PRBCs) over 1 hour, the patient becomes restless. Her pulse is bounding, and her blood pressure is elevated. The most likely explanation is: a. The transfusion was administered too quickly b. The PRBCs are contaminated with gram-negative organisms c. Allergic response to the transfusion d. Hemolytic reaction to the transfusion b. Alloimmunization- Occurs when the patient develops antibodies against a range of antigens following repeated blood product transfusions. The transfused cells are destroyed and the transfusion fails to correct the patient's blood counts. The other answer choices are all complications of sickle cell anemia Complications associated with long-term transfusions for sickle cell anemia patients include: a. Renal dysfunction b. Alloimmunization c. Stroke d. Acute chest syndrome d. Although HIT is rare, it is triggered by the immune system 5 to 14 days following initiation of heparin therapy and causes a low platelet count. A decrease in platelet count that occurs before 5 days following heparin therapy is typically a transient condition called nonautoimmune heparin-associated thrombocytopenia. Complications include deep venous thrombosis. Which of the following laboratory results would the nurse expect to find with a patient who has heparin-induced thrombocytopenia (HIT)? a. 5 to 14 days following initiation of heparin therapy, platelet count increases 30% to 50% from the patient's baseline. b. Following initiation of heparin therapy, red blood cell count levels are decreased. c. Following initiation of heparin therapy, red blood cell count levels are increased. d. 5 to 14 days following initiation of heparin therapy, platelet count drops 30% to 50% from the patient's baseline. b. Although anti-pyretics may be ordered by the physician, they may mask fever and should not be initiated by the nurse. Assessment and history suggest neutropenia and the patient is at risk of infection and septic shock A patient with rheumatoid arthritis and acute leukemia is admitted with a cough following a first cycle of chemotherapy. Assessment reveals hypotension, temperature of 38.4 degrees Celsius, and absolute neutrophil count of <500 cells/µL. The MOST ESSENTIAL nursing action is: a. Provide and encourage meticulous skin, peri-anal, and oral hygiene for the patient. b. "Provide and encourage meticulous skin, peri-anal, and oral hygiene for the patient" and "leanse hands thoroughly before and after all direct patient contact. Ensure that staff caring for the patient have no signs and symptoms of infection." c. Administer antipyretics d. Cleanse hands thoroughly before and after all direct patient contact. Ensure that staff caring for the patient have no signs and symptoms of infection. c. Myelosuppression Hemorrhage is associated with thrombolytics and anti-platelet agents; myopathy and tinnitus are associated with anti-fibrinolytics; and myelosuppression is associated with hydroxyurea What life-threatening reaction is associated with sickle cell anemia treatment agents? a. Myopathy b. Tinnitus c. Myelosuppression d. Hemorrhage c. Alveolar ventilation is one component of minute ventilation, which comprise of alveolar ventilation and physiologic dead space ventilation (VE = VD+ VA). Minute ventilation is equal to exhaled tidal volume (VT) multiplied by respiratory rate (RR) Minute ventilation (VE) is composed of: a. Tidal volume + respiratory rate b. Tidal volume c. Alveolar ventilation (VA) + physiologic dead space ventilation (VD) d. Alveolar ventilation (VA)