Nokea
An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI). Prescriptions for intravenous antibiotics and an insulin infusion are initiated. Which serum laboratory value warrants the most immediate intervention by the nurse?
- A. Glucose of 350 mg/dl
- B. White blood cell count of 15,000 mm3
- C. Blood PH of 7.30
- D. Potassium of 2.5 mEq/L
Correct Answer: D
Rationale: A potassium level of 2.5 mEq/L is dangerously low and must be corrected immediately to prevent cardiac arrhythmias.
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The nurse is caring for a child with Kawasaki disease. A student nurse who is on the unit asks if there are medications to treat the disease. The nurse’s best response to the student nurse is:
- A. Immunogloulin G and ACE inhibitors
- B. Immunoglobulin and heparin
- C. Immunoglobulin G and aspirin
- D. Immunoglobulin and ibuprofen
Correct Answer: C
Rationale: The standard treatment for Kawasaki disease includes Immunoglobulin G and aspirin to reduce inflammation and prevent coronary artery complications.
A client with type 2 diabetes mellitus (DM) is admitted to the hospital for uncontrolled DM. Insulin therapy is initiated with an initial dose of Humulin N insulin at 0800. At 1600, the client complains of diaphoresis, rapid heartbeat, and feeling shaky. What should the nurse do first?
- A. Determine the client's current glucose level
- B. Administer 10 units of fast-acting insulin.
- C. Offer the client a snack with high protein.
- D. Increase the IV infusion rate of normal saline.
Correct Answer: A
Rationale: The symptoms suggest hypoglycemia. Checking the glucose level confirms the diagnosis and guides appropriate treatment.
What is accurate about the characteristics of high-density lipoproteins (HDLs)?
- A. They have high amounts of triglycerides.
- B. They have only small amounts of protein.
- C. They have little cholesterol.
- D. They aid in steroid production.
Correct Answer: C
Rationale: HDLs have low amounts of triglycerides, large amounts of proteins, low amounts of cholesterol, and are excreted via the liver. They have no role in the production of steroids.
A nurse assesses a client who had a myocardial infarction and is hypotensive. Which additional assessment finding should the nurse expect?
- A. Heart rate of 120 beats/min
- B. Cool, clammy skin
- C. Oxygen saturation of 90%
- D. Respiratory rate of 8 breaths/min
Correct Answer: A
Rationale: A heart rate of 120 beats/min (tachycardia) is a common compensatory response to hypotension following a myocardial infarction, as the body attempts to maintain cardiac output.
Regarding hypogonadotropic hypogonadism:
- A. Kallman syndrome is an example
- B. It is caused by testicular atrophy secondary to trauma
- C. LHRH testing is used to distinguish it from other forms of hypogonadism
- D. It is treated with buserelin sprays
Correct Answer: A
Rationale: Kallman syndrome is a classic example of hypogonadotropic hypogonadism, characterized by delayed puberty and anosmia.