Nokea
A diabetic patient presents with hot and dry skin, rapid and deep respirations, and a fruity odor to his breath. As charge nurse, you observe the new graduate RN accomplishing all these patient tasks. Which one requires that you intervene immediately?
- A. The RN checks the patient's fingerstick glucose.
- B. The RN encourages the patient to drink orange juice.
- C. The RN checks the patient's order for sliding scale insulin.
- D. The RN assesses the patient's vital signs every 15 minutes.
Correct Answer: B
Rationale: Encouraging the patient to drink orange juice in the presence of rapid, deep breathing, and fruity breath odor could worsen DKA. The patient needs immediate medical intervention, including IV fluids and insulin, rather than oral intake.
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In relation to noradrenaline, all of the following are true EXCEPT:
- A. It stimulates α and β receptors
- B. It decreases heart rate
- C. It decreases blood pressure
- D. Causes vasoconstriction
Correct Answer: C
Rationale: Rationale:
- Noradrenaline stimulates both α and β receptors, leading to increased heart rate and vasoconstriction.
- It does not decrease heart rate; it actually increases heart rate due to its actions on β receptors.
- Noradrenaline causes vasoconstriction by activating α receptors, leading to increased blood pressure.
- The incorrect statement is C, as noradrenaline actually increases blood pressure by causing vasoconstriction.
ADH will stimulate _____ water reabsorption by the kidneys and ______ of the blood vessels; thus _____ blood pressure.
- A. decrease: constriction: increase
- B. decrease: dilation: decrease
- C. increase: constriction: increase
- D. increase: dilation: decrease
Correct Answer: C
Rationale: The correct answer is C because ADH (antidiuretic hormone) increases water reabsorption by the kidneys (increasing blood volume), causes vasoconstriction (narrowing of blood vessels), and ultimately leads to an increase in blood pressure. Choice A is incorrect because ADH does not decrease water reabsorption. Choice B is incorrect because ADH does not cause dilation of blood vessels, which would decrease blood pressure. Choice D is incorrect because ADH does not cause dilation of blood vessels, which would not lead to a decrease in blood pressure.
After a thyroidectomy, Mr. M begins to show signs of tetany. The nurse should suspect a deficiency of which of the following?
- A. Insulin
- B. Parathyroid hormone
- C. Thyroid hormone
- D. Corticosteroids
Correct Answer: B
Rationale: Tetany is often caused by a decrease in parathyroid hormone, which can lead to hypocalcemia, a common complication after thyroid surgery.
The largest endocrine gland(s) that makes 3 hormones that affect the metabolism is the:
- A. pancreas
- B. adrenal glands
- C. thyroid gland
- D. pituitary gland
Correct Answer: C
Rationale: The correct answer is C: thyroid gland. The thyroid gland is the largest endocrine gland that produces 3 hormones (T3, T4, and calcitonin) that regulate metabolism. T3 and T4 control the body's metabolic rate, while calcitonin helps regulate calcium levels in the blood. The pancreas (A) primarily produces insulin and glucagon to regulate blood sugar levels. The adrenal glands (B) produce hormones like cortisol and adrenaline to regulate stress response. The pituitary gland (D) controls various other endocrine glands but does not primarily produce hormones affecting metabolism.
Which drug is most likely to cause muscle tremor:
- A. Ipratropium
- B. Terbutaline
- C. Atenolol
- D. Nicotinic acid
Correct Answer: B
Rationale: The correct answer is B: Terbutaline. Terbutaline is a beta-2 adrenergic agonist used as a bronchodilator. It can stimulate beta-2 receptors in skeletal muscle, leading to muscle tremors as a common side effect. Ipratropium (A) is an anticholinergic bronchodilator and typically does not cause muscle tremors. Atenolol (C) is a beta-blocker and is not associated with muscle tremors. Nicotinic acid (D) is used to treat dyslipidemia and does not commonly cause muscle tremors. Therefore, Terbutaline is the most likely drug to cause muscle tremor among the options provided.