NUR 326: ADULT HEALTH EXAM 1
QUESTIONS AND ANSWERS
A diabetic patient has the following presentation: unresponsive to voice or touch,
tachycardia, diaphoresis, and pallor. Which action by the healthcare provider is the
priority?
a) Fluid, electrolyte and glucose resuscitation
b) Administer IV Lantus Insulin per protocol
c) Send UA and CBC to lab STAT
d) Administer Oral Glucose - ANSWER-a) Fluid, electrolyte and glucose resuscitation
Which is not considered characteristic of a type 1 diabetic in DKA?
a) Right lower quadrant pain
b) Plasma glucose greater than 250
c) Ketones in the urine
d) Ketoacidosis - ANSWER-a) Right lower quadrant pain
Which is not considered a risk factor for the development of DKA
a) Increased activity and exercise
b) Concurrent infection
c) Non-adherence to Medication
d) New onset of diabetes - ANSWER-a) Increased activity and exercise
All are differences between DKA and HHS except?
a) HHS is primarily noted in type 1 diabetics
b) In HHS, absence of ketones is noted
c) DKA is primarily noted in type 1 diabetics
d) In HHS early manifestations are often missed - ANSWER-a) HHS is primarily noted
in type 1 diabetics
You are caring for a type 1 diabetic currently being treated for pneumonia. Treatment
has been initiated and the nurse you are assigned with is asking you focus on his
diabetes as his blood glucose is 325. Which nursing diagnosis statement is accurate
related to his diabetic needs?
a) Unstable blood glucose related to stress and infection
,b) compromised blood regulatory mechanism related to stress and infection secondary
to diabetes aeb blood glucose of 325.
c) diabetic crisis related to stress and infection aeb blood glucose of 325 and current
antibiotic therapy
d) risk for compromised immune response related to stress and infection secondary to
diabetes - ANSWER-a) Unstable blood glucose related to stress and infection
You are caring for a patient with cirrhosis of the liver being treated for edema, ascites
and portal hypertension. They are placed on a low sodium diet for support and started
on a higher dose of diuretics alongside scheduled paracentesis for support. Which lab
value would you report to the physician if noted prior to initiating therapy and orders?
a) Potassium of 3.0
b) Sodium of 147
c) Albumin of 3.2
d) Magnesium of 2.0 - ANSWER-a) Potassium of 3.0
A client with cirrhosis is at risk for developing complications. Which condition is most
serious and potentially life threatening?
a) Esophageal varices
b) Ascites
c) Peripheral edema
d) Asterixis - ANSWER-a) Esophageal varices
A patient is transferred to your facility from a rural health clinic due to cirrhosis with an
elevated blood ammonia level. Which medication would you question if ordered by the
transferring physician?
a) Plavix
b) Lactulose
c) Vitamin K
d) Metoprolol - ANSWER-a) Plavix
You are completing an assessment of a client with end stage liver disease. Which
finding is most important to report to the physician?
,a) Expanding ecchymosis
b) Ascites and a serum albumin of 3.2g/dl
c) Occasional disorientation and forgetfulness
d) HCT of 37% and a HGB of 12g/dl - ANSWER-a) Expanding ecchymosis
You are caring for a patient who has cirrhosis and resulting hepatic encephalopathy.
What assessment and findings would you likely not see with the onset of this diagnosis?
a) Glasgow Coma Scale (GCS) of 15
b) nervousness and tremors
c) elevated Ammonia, bilirubin, AST and ALT
d) fatigue and disorientation - ANSWER-a) Glasgow Coma Scale (GCS) of 15
cellulitis - ANSWER-an infection of the dermis and subcutaneous tissue
-can be an extension/stem from pre-existing wound
-injury or a manifestation of its own due to compromised host/vector relationship
risk factors for cellulitis: include but are not limited to - ANSWER--co-morbid conditions
-diabetes
-vascular compromise/poor perfusion
-immunocompromised
-risky behaviors (drugs, alcohol, tobacco_
-poor diet
-inadequate hygiene
-prior known resistant infections
-environmental exposures/hazards
-insect bites
the main culprits for cellulitis - ANSWER-generally bacterial infection: usual suspects
include:
-staphylococcus aureus (SA)
-methicillin sensitive SA (MSSA)
-methicillin resistant SA (MRSA)
-streptococcus pyogens
*these bacterium rapidly reproduce and spread: very common to progress quickly over
24-48 hours
assessment for cellulitis - ANSWER--starts out as a reddened, painful localized area
-warm to touch and often becomes more edematous when comparing bilaterally
, -skin becomes taught, may or may not blister as a result of increased swelling. skin may
peel
-scattered open wounds develop
-systemic symptoms: fever, chills, malaise
-progressive if not treated may turn septic
diagnostics and treatment options for cellulitis: - ANSWER--identify to causative
organism: obtain a culture and sensitivity
-additional diagnostics: ultrasound (US) or
computerized tomography(CT) (abscess?)
-If found- may need aspiration or incision and drainage (I&D) which is also done using
US or CT
-Progressive infections not responsive with oral or IV antibiotics may also be I&D'd
bedside or in surgery.
-Common Antibiotics: Until culprit is identified: treated with broad spectrum antibiotics
(Quinolones, Carbapenems, Cephalosporins, Glycopeptides)
-Once organism(s) identified: goal is to treat based on patient needs and ability to follow
through
-Monitor Labs: CBC (complete blood count), CMP (comprehensive metabolic panel),
repeat culture?
local care for cellulitis - ANSWER--Mark the area to monitor progression and
responsiveness to treatment
-If drainage or wound(s) are present: local topical treatments, dressing and support
-Monitor edema progression
-Warm (moist) or cool compresses
-Elevation
-Allow to drain on own; avoid squeezing and manipulation
-Ensure patient education provided
patient education for cellulitis - ANSWER--Continuation of antibiotics until completed or
advised to stop
-Monitoring of site at least daily if not more
-Avoidance of certain activities depending on location of infection (ex: if on lower
extremity no swimming, hot tubs etc.)
-Resist the urge to scratch, pick, rub and agitate
-Dressing change needs
-Follow up appointments
-Mitigating (prevent) those risk factors : Tighter glucose control, changing the
environment, diet improvement- refer to the list at the beginning of this presentation
concept: infection - ANSWER-Infection is defined as the invasion and multiplication of
microorganisms in body tissues, which may be clinically unapparent or result in local
cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-
antibody response.
QUESTIONS AND ANSWERS
A diabetic patient has the following presentation: unresponsive to voice or touch,
tachycardia, diaphoresis, and pallor. Which action by the healthcare provider is the
priority?
a) Fluid, electrolyte and glucose resuscitation
b) Administer IV Lantus Insulin per protocol
c) Send UA and CBC to lab STAT
d) Administer Oral Glucose - ANSWER-a) Fluid, electrolyte and glucose resuscitation
Which is not considered characteristic of a type 1 diabetic in DKA?
a) Right lower quadrant pain
b) Plasma glucose greater than 250
c) Ketones in the urine
d) Ketoacidosis - ANSWER-a) Right lower quadrant pain
Which is not considered a risk factor for the development of DKA
a) Increased activity and exercise
b) Concurrent infection
c) Non-adherence to Medication
d) New onset of diabetes - ANSWER-a) Increased activity and exercise
All are differences between DKA and HHS except?
a) HHS is primarily noted in type 1 diabetics
b) In HHS, absence of ketones is noted
c) DKA is primarily noted in type 1 diabetics
d) In HHS early manifestations are often missed - ANSWER-a) HHS is primarily noted
in type 1 diabetics
You are caring for a type 1 diabetic currently being treated for pneumonia. Treatment
has been initiated and the nurse you are assigned with is asking you focus on his
diabetes as his blood glucose is 325. Which nursing diagnosis statement is accurate
related to his diabetic needs?
a) Unstable blood glucose related to stress and infection
,b) compromised blood regulatory mechanism related to stress and infection secondary
to diabetes aeb blood glucose of 325.
c) diabetic crisis related to stress and infection aeb blood glucose of 325 and current
antibiotic therapy
d) risk for compromised immune response related to stress and infection secondary to
diabetes - ANSWER-a) Unstable blood glucose related to stress and infection
You are caring for a patient with cirrhosis of the liver being treated for edema, ascites
and portal hypertension. They are placed on a low sodium diet for support and started
on a higher dose of diuretics alongside scheduled paracentesis for support. Which lab
value would you report to the physician if noted prior to initiating therapy and orders?
a) Potassium of 3.0
b) Sodium of 147
c) Albumin of 3.2
d) Magnesium of 2.0 - ANSWER-a) Potassium of 3.0
A client with cirrhosis is at risk for developing complications. Which condition is most
serious and potentially life threatening?
a) Esophageal varices
b) Ascites
c) Peripheral edema
d) Asterixis - ANSWER-a) Esophageal varices
A patient is transferred to your facility from a rural health clinic due to cirrhosis with an
elevated blood ammonia level. Which medication would you question if ordered by the
transferring physician?
a) Plavix
b) Lactulose
c) Vitamin K
d) Metoprolol - ANSWER-a) Plavix
You are completing an assessment of a client with end stage liver disease. Which
finding is most important to report to the physician?
,a) Expanding ecchymosis
b) Ascites and a serum albumin of 3.2g/dl
c) Occasional disorientation and forgetfulness
d) HCT of 37% and a HGB of 12g/dl - ANSWER-a) Expanding ecchymosis
You are caring for a patient who has cirrhosis and resulting hepatic encephalopathy.
What assessment and findings would you likely not see with the onset of this diagnosis?
a) Glasgow Coma Scale (GCS) of 15
b) nervousness and tremors
c) elevated Ammonia, bilirubin, AST and ALT
d) fatigue and disorientation - ANSWER-a) Glasgow Coma Scale (GCS) of 15
cellulitis - ANSWER-an infection of the dermis and subcutaneous tissue
-can be an extension/stem from pre-existing wound
-injury or a manifestation of its own due to compromised host/vector relationship
risk factors for cellulitis: include but are not limited to - ANSWER--co-morbid conditions
-diabetes
-vascular compromise/poor perfusion
-immunocompromised
-risky behaviors (drugs, alcohol, tobacco_
-poor diet
-inadequate hygiene
-prior known resistant infections
-environmental exposures/hazards
-insect bites
the main culprits for cellulitis - ANSWER-generally bacterial infection: usual suspects
include:
-staphylococcus aureus (SA)
-methicillin sensitive SA (MSSA)
-methicillin resistant SA (MRSA)
-streptococcus pyogens
*these bacterium rapidly reproduce and spread: very common to progress quickly over
24-48 hours
assessment for cellulitis - ANSWER--starts out as a reddened, painful localized area
-warm to touch and often becomes more edematous when comparing bilaterally
, -skin becomes taught, may or may not blister as a result of increased swelling. skin may
peel
-scattered open wounds develop
-systemic symptoms: fever, chills, malaise
-progressive if not treated may turn septic
diagnostics and treatment options for cellulitis: - ANSWER--identify to causative
organism: obtain a culture and sensitivity
-additional diagnostics: ultrasound (US) or
computerized tomography(CT) (abscess?)
-If found- may need aspiration or incision and drainage (I&D) which is also done using
US or CT
-Progressive infections not responsive with oral or IV antibiotics may also be I&D'd
bedside or in surgery.
-Common Antibiotics: Until culprit is identified: treated with broad spectrum antibiotics
(Quinolones, Carbapenems, Cephalosporins, Glycopeptides)
-Once organism(s) identified: goal is to treat based on patient needs and ability to follow
through
-Monitor Labs: CBC (complete blood count), CMP (comprehensive metabolic panel),
repeat culture?
local care for cellulitis - ANSWER--Mark the area to monitor progression and
responsiveness to treatment
-If drainage or wound(s) are present: local topical treatments, dressing and support
-Monitor edema progression
-Warm (moist) or cool compresses
-Elevation
-Allow to drain on own; avoid squeezing and manipulation
-Ensure patient education provided
patient education for cellulitis - ANSWER--Continuation of antibiotics until completed or
advised to stop
-Monitoring of site at least daily if not more
-Avoidance of certain activities depending on location of infection (ex: if on lower
extremity no swimming, hot tubs etc.)
-Resist the urge to scratch, pick, rub and agitate
-Dressing change needs
-Follow up appointments
-Mitigating (prevent) those risk factors : Tighter glucose control, changing the
environment, diet improvement- refer to the list at the beginning of this presentation
concept: infection - ANSWER-Infection is defined as the invasion and multiplication of
microorganisms in body tissues, which may be clinically unapparent or result in local
cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-
antibody response.
