Nur 134 Final Exam UPDATED Exam
Questions and CORRECT Answers
An adult with type II diabetes is taking metformin (Glucophage) 1,000 mg two times every day.
After the nurse provides instructions regarding the interaction of alcohol and metformin, the
nurse evaluates that the client understands the instructions when the client says:
A."If I know I'll be having alcohol, I must not take metformin, I could develop lactic acidosis."
B."If my physician approves, I may drink alcohol with my metformin."
C."Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness,
low back pain, and a rapid heartbeat."
D."If I feel bloated, I should call my physician." - CORRECT ANSWER Rationale A. A
rare but serious adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are
fatal. Ideally metformin should be held 2 days before and after alcohol. S/S of lactic acidosis are
weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light
headedness, bradycardia and cardiac arrhythmia. Bloating is NOT an adverse effect but a side
effect.
The client with type I diabetes mellitus is taught to take isophane insulin suspension NPH
(Humulin N) at 5 pm each day. The client should be instructed that the greatest risk of
hypoglycemia will occur at about what time?
A.11 am, shortly before lunch
B.1 pm, shortly after lunch
C.6 pm, shortly after dinner
D.1 am, while sleeping - CORRECT ANSWER Rationale D The client with diabetes who
is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly
after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to
help prevent hypoglycemia while sleeping.
Which of the following findings should the nurse report to the client's physician for a client with
unstable type 1 diabetes mellitus? (Select all that apply)
A.Systolic B/P 145 mm HG
,B.Diastolic B/P 87 mm HG
C.High-density lipoprotein (HDL) 30 mg/dL
D.Glycosylated hemoglobin (HBA1c) 10.2%
E.Triglycerides 425 mg/dL
F.Urine ketones, negative - CORRECT ANSWER Rationale a, b, c, d, e The client with
unstable diabetes mellitus is at risk for many microvascular and macrovascular complications.
Goal B/P for someone with diabetes is 130/80. Goal HbA1c is less then 7%. HDL should be
greater then 40 and triglycerides less than 150
The client has been recently diagnosed with type 2 diabetes and is taking metformin
(Glucophage) two times per day, 1,000 mg before breakfast and 1,000 mg before dinner. The
client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission
to the hospital. The admission prescriptions include metformin (Glucophage). The nurse should
do which of the following? (Select all that apply)
A.Discontinue the metformin (Glucophage)
B.Administer glargine (Lantus) insulin rather than the metformin (Glucophage)
C.Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually
subside over time.
D.Assess the client's renal function
E.Monitor the client's glucose value prior to each meal. - CORRECT ANSWER Rationale
C,D,E cannot change rx. Review sick day rules.
A patient recently diagnosed with hypothyroidism demonstrates understanding of prescribed
levothyroxine (Synthroid) medication when she makes which of the following statements.
A."I should be able to become pregnant in a couple of months."
B."This medication will help me lose all this excess weight."
C."I should notify the physician for nervousness, diarrhea or increased pulse."
D."This medication should be taken with food, preferably dairy products." - CORRECT
ANSWER Rationale C. Side effects of thyroid hormone replacement medication may
mimic symptoms of hyperthyroidism. After the client has reached normal serum T4 levels, the
, normal metabolic rate may help the client lose the weight gained during the hypothyroid state,
but this is not the purpose of replacement. Take medication on empty stomach 1 hour before or 2
after a meal.
The nurse is completing a health assessment of a 42 year old female with suspected Grave's
disease. The nurse should assess this client for:
A.Anorexia
B.Tachycardia
C.Weight gain
D.Cold skin - CORRECT ANSWER Rationale B Graves disease is a hyperthyroid state,
the others are s/s hypothyroid
A 34 year old female is diagnosed with hypothyroidism. The nurse should assesses the client for
which of the following? (Select all that apply)
A.Rapid pulse
B.Decreased energy and fatigue
C.Weight gain of 10 pounds
D.Fine, thin hair with hair loss
E.Constipation
F.Menorrhagia - CORRECT ANSWER Rationale b, c, e, f Bradycardia, decreased energy
and lethargy, memory problems, weight gain, coarse hair (not fine), constipation and
menorrhagia are common signs and symptoms of hypothyroidism.
Which of the following instructions should the nurse include in the teaching plan for a client who
is experiencing gastroesophageal reflux disease (GERD)?
A.Limit caffeine intake to 2 cups of coffee per day
B.Do not lie down for 2 hours after eating
C.Follow a low-protein diet
D.Take medications with milk to decrease irritation - CORRECT ANSWER Rationale B.
no caffeine-decreases sphincter tone, milk increases acid production
Questions and CORRECT Answers
An adult with type II diabetes is taking metformin (Glucophage) 1,000 mg two times every day.
After the nurse provides instructions regarding the interaction of alcohol and metformin, the
nurse evaluates that the client understands the instructions when the client says:
A."If I know I'll be having alcohol, I must not take metformin, I could develop lactic acidosis."
B."If my physician approves, I may drink alcohol with my metformin."
C."Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness,
low back pain, and a rapid heartbeat."
D."If I feel bloated, I should call my physician." - CORRECT ANSWER Rationale A. A
rare but serious adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are
fatal. Ideally metformin should be held 2 days before and after alcohol. S/S of lactic acidosis are
weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light
headedness, bradycardia and cardiac arrhythmia. Bloating is NOT an adverse effect but a side
effect.
The client with type I diabetes mellitus is taught to take isophane insulin suspension NPH
(Humulin N) at 5 pm each day. The client should be instructed that the greatest risk of
hypoglycemia will occur at about what time?
A.11 am, shortly before lunch
B.1 pm, shortly after lunch
C.6 pm, shortly after dinner
D.1 am, while sleeping - CORRECT ANSWER Rationale D The client with diabetes who
is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly
after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to
help prevent hypoglycemia while sleeping.
Which of the following findings should the nurse report to the client's physician for a client with
unstable type 1 diabetes mellitus? (Select all that apply)
A.Systolic B/P 145 mm HG
,B.Diastolic B/P 87 mm HG
C.High-density lipoprotein (HDL) 30 mg/dL
D.Glycosylated hemoglobin (HBA1c) 10.2%
E.Triglycerides 425 mg/dL
F.Urine ketones, negative - CORRECT ANSWER Rationale a, b, c, d, e The client with
unstable diabetes mellitus is at risk for many microvascular and macrovascular complications.
Goal B/P for someone with diabetes is 130/80. Goal HbA1c is less then 7%. HDL should be
greater then 40 and triglycerides less than 150
The client has been recently diagnosed with type 2 diabetes and is taking metformin
(Glucophage) two times per day, 1,000 mg before breakfast and 1,000 mg before dinner. The
client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission
to the hospital. The admission prescriptions include metformin (Glucophage). The nurse should
do which of the following? (Select all that apply)
A.Discontinue the metformin (Glucophage)
B.Administer glargine (Lantus) insulin rather than the metformin (Glucophage)
C.Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually
subside over time.
D.Assess the client's renal function
E.Monitor the client's glucose value prior to each meal. - CORRECT ANSWER Rationale
C,D,E cannot change rx. Review sick day rules.
A patient recently diagnosed with hypothyroidism demonstrates understanding of prescribed
levothyroxine (Synthroid) medication when she makes which of the following statements.
A."I should be able to become pregnant in a couple of months."
B."This medication will help me lose all this excess weight."
C."I should notify the physician for nervousness, diarrhea or increased pulse."
D."This medication should be taken with food, preferably dairy products." - CORRECT
ANSWER Rationale C. Side effects of thyroid hormone replacement medication may
mimic symptoms of hyperthyroidism. After the client has reached normal serum T4 levels, the
, normal metabolic rate may help the client lose the weight gained during the hypothyroid state,
but this is not the purpose of replacement. Take medication on empty stomach 1 hour before or 2
after a meal.
The nurse is completing a health assessment of a 42 year old female with suspected Grave's
disease. The nurse should assess this client for:
A.Anorexia
B.Tachycardia
C.Weight gain
D.Cold skin - CORRECT ANSWER Rationale B Graves disease is a hyperthyroid state,
the others are s/s hypothyroid
A 34 year old female is diagnosed with hypothyroidism. The nurse should assesses the client for
which of the following? (Select all that apply)
A.Rapid pulse
B.Decreased energy and fatigue
C.Weight gain of 10 pounds
D.Fine, thin hair with hair loss
E.Constipation
F.Menorrhagia - CORRECT ANSWER Rationale b, c, e, f Bradycardia, decreased energy
and lethargy, memory problems, weight gain, coarse hair (not fine), constipation and
menorrhagia are common signs and symptoms of hypothyroidism.
Which of the following instructions should the nurse include in the teaching plan for a client who
is experiencing gastroesophageal reflux disease (GERD)?
A.Limit caffeine intake to 2 cups of coffee per day
B.Do not lie down for 2 hours after eating
C.Follow a low-protein diet
D.Take medications with milk to decrease irritation - CORRECT ANSWER Rationale B.
no caffeine-decreases sphincter tone, milk increases acid production
