HESI RN PHARMACOLOGY PROCTORED EXAM Questions and answers

HESI RN PHARMACOLOGY PROCTORED EXAM Questions and answers 1. A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than L/minute ANS: 320 A PEFR less than 80% of the personal best indicates that the patient is in the yellow zone where changes in therapy are needed to prevent progression of the airway narrowing. Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a) Insulin is not used to control blood glucose in patients with type 2 diabetes. b) Complications of type 2 diabetes are less serious than those of type 1 diabetes. c) Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d) Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. ANS: C For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections. 2. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a) self-monitoring of blood glucose. b) using low doses of regular insulin. c) lifestyle changes to lower blood glucose. d) effects of oral hypoglycemic medications. ANS: C The patient’s impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose. 3. A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a) The patient always carries hard candies when engaging in exercise. b) The patient goes for a vigorous walk when his glucose is 200 mg/dL. 1 c) The patient has a peanut butter sandwich before going for a bicycle ride. d) The patient increases daily exercise when ketones are present in the urine. ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other statements are correct. 4. The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? a) “Are you anorexic?” b) “Is your urine dark colored?” c) “Have you lost weight lately?” d) “Do you crave sugary drinks?” ANS: C Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute. 5. A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a) Fasting blood glucose b) Oral glucose tolerance c) Glycosylated hemoglobin d) Urine dipstick for glucose ANS: C The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control after diabetes has been diagnosed. 6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? a) The patient will reach a glycosylated hemoglobin level of less than 7%. b) The patient will follow a diet and exercise plan that results in weight loss. c) The patient will choose a diet that distributes calories throughout the day. 2 d) The patient will state the reasons for eliminating simple sugars in the diet. ANS: A The complications of diabetes are related to elevated blood glucose and the most important patient outcome is the reduction of glucose to near-normal levels. A BMI of 30?9?kg/m2 or above is considered obese, so the other outcomes are appropriate but are not as high in priority. 7. A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to a) check glucose level before, during, and after swimming. b) delay eating the noon meal until after the swimming class. c) increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d) time the morning insulin injection so that the peak occurs while swimming. ANS: A The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.