NR-325 Adult Health II - Set 1 - Part 3

Correct Answer: Aggressive replacement of intravascular volume with crystalloid

Fluid loss in this crisis runs to nine liters or more, and volume replacement alone brings the glucose down substantially. Insulin follows at a low rate once the potassium is known. Option b is incorrect because a rapid push drops glucose and osmolality far too quickly, and that shift pulls water into brain cells. Insulin here runs as a slow continuous infusion after fluids begin. Option c is incorrect because bicarbonate treats severe acidemia, and this crisis carries no acidosis at all. Even in ketoacidosis it is withheld unless the pH falls below seven, since it worsens hypokalemia. Option d is incorrect because phosphate is replaced only when the level is severely low or muscle weakness appears. Chasing it early distracts from the deficit that is actually killing this client, which is water.

Correct Answer: Obtain a fingerstick blood glucose reading

Any sudden change in mental status in a client on insulin or a sulfonylurea calls for a glucose check. The beta blocker has hidden the tremor and palpitations, leaving diaphoresis as the remaining clue. Option a is incorrect because safety measures alone leave the cause untouched. Side rails may be reasonable later, yet nothing about reorienting a confused client corrects a fuel shortage in the brain. Option b is incorrect because imaging is slow, expensive and aimed at the wrong target. A bedside test that takes seconds should rule out the reversible metabolic cause before anyone pursues a neurologic workup. Option c is incorrect because withholding a cardiac drug does not treat what is happening right now. The beta blocker only masked warning signs; it did not create the episode, and stopping it changes nothing immediately.

Correct Answer: Clear drainage that rings the drip pad

A clear ring encircling blood on the drip pad is the halo sign of cerebrospinal fluid leak. That open route to the brain risks meningitis, so the surgeon hears about it at once. Option a is incorrect because numbness of the lip and nose follows the sublabial incision and the nerves stretched during the approach. It is expected, usually temporary, and worth explaining to the client rather than reporting. Option b is incorrect because nasal packing forces mouth breathing, which dries the oral mucosa within hours. Frequent oral rinses and lip care fix it, and toothbrushing stays off limits while the incision heals. Option d is incorrect because congestion behind the packing is ordinary swelling of an operated sinus. The nurse teaches the client not to blow the nose, since that pressure can push the graft loose.

Correct Answer: The pigmented client has primary adrenal insufficiency

Pigment comes from high ACTH, and high potassium comes from lost aldosterone, so both point to a destroyed adrenal cortex. The pale client with normal potassium has lost pituitary ACTH instead. Option a is incorrect because only one of these clients shows the two markers of adrenal gland failure. Pale skin with an unremarkable potassium says the pituitary is at fault and the gland itself still responds. Option b is incorrect because mineralocorticoid replacement is reserved for the client whose aldosterone is gone. When the pituitary is the problem, renin and angiotensin keep aldosterone working, so fludrocortisone adds nothing but hypertension and edema. Option c is incorrect because the labels are swapped. Without adrenal cortisol there is no feedback, ACTH climbs, and the skin darkens, so pallor is evidence against gland destruction rather than proof of it.

Correct Answer: Question the order and request a reduced dose

Slowed metabolism leaves sedatives circulating far longer and hitting harder, which can push a hypothyroid client into hypoventilation and coma. The nurse raises the concern and asks for a smaller dose. Option a is incorrect because hourly checks do not undo an overdose already swallowed. Respiratory depression in this client can develop quickly, and prevention through a lower dose beats watchful waiting. Option c is incorrect because outright refusal without contacting the prescriber leaves the client sleepless and the safety concern unresolved. Collaboration, not unilateral rejection, is how a nurse handles a questionable dose. Option d is incorrect because altering a prescribed amount on the nurse's own authority is outside legal practice. Even a halved dose may be too much here, and only the prescriber can rewrite it.

Correct Answer: "I will sleep in my own room for about a week."

Sleeping alone for roughly a week keeps the isotope in saliva, sweat and urine away from household members while it clears. Distance and time are the core precautions after treatment. Option b is incorrect because young children are the group most vulnerable to radiation exposure. The client keeps at least three feet away from children and pregnant women for about a week and arranges other caregivers. Option c is incorrect because a single flush leaves radioactive urine in the bowl for the next user. Teaching directs the client to sit to void, flush twice, and rinse the sink and tub. Option d is incorrect because destruction of thyroid tissue is the point of the treatment, and most clients end up hypothyroid. Lifelong levothyroxine with regular thyroid stimulating hormone checks is the expected outcome.

Correct Answer: Inject air into the cloudy NPH vial

Air goes into the cloudy vial first, with the needle held above the fluid. That equalizes pressure for the later withdrawal while keeping any protamine out of the syringe and out of the regular vial. Option a is incorrect because drawing the regular insulin now skips a required step. Air still has to enter the NPH vial, and once regular insulin fills the syringe that entry can no longer be made safely. Option c is incorrect because cloudy insulin is always the second one into the barrel. Pulling NPH first coats the needle with protamine, which then rides into the regular vial and lengthens that drug's action. Option d is incorrect because the clear vial receives its air second, not first. Reversing the order forces a return trip to the NPH vial with regular insulin already loaded, and contamination follows.

Correct Answer: Crackles heard through both posterior lung fields

New crackles during aggressive fluid resuscitation point to volume overload, a real hazard in older clients and anyone with cardiac or kidney disease. Breathing problems come first, so this is reported at once. Option a is incorrect because a drop of roughly sixty points an hour sits inside the fifty to seventy five range that treatment aims for. That pace protects the brain from a rapid osmotic shift. Option b is incorrect because easing Kussmaul breathing signals the acidosis is lifting, which is exactly the response the team wants. Worry belongs to new hypoventilation, not to respirations that are settling. Option d is incorrect because forty milliliters in an hour clears the minimum of thirty and shows the kidneys are perfusing again. Adequate output is also the green light for potassium replacement.

Correct Answer: A value of one hundred thirty four milligrams per deciliter

A fasting plasma glucose at or above one hundred twenty six milligrams per deciliter meets the diabetes threshold. Only the highest value listed crosses that line, and confirmation on a second test is required. Option a is incorrect because a fasting value below one hundred milligrams per deciliter sits in the normal range. Nothing about this reading suggests impaired glucose handling, so no repeat testing would be triggered. Option b is incorrect because readings from one hundred through one hundred twenty five identify impaired fasting glucose. That finding marks prediabetes and calls for lifestyle counseling rather than a diabetes diagnosis. Option c is incorrect because this number also lands inside the prediabetes band, close to its upper edge but still short of the cutoff. Screening would continue annually, yet the diagnosis is not made.

Correct Answer: Presence of ketones with a low pH

Ketone production with a falling pH defines ketoacidosis and is absent in the hyperosmolar state, where residual insulin still suppresses fat breakdown. Kussmaul breathing and acetone odor are the bedside signs of that acidosis. Option b is incorrect because weight loss accompanies both disorders through the same osmotic water loss and cannot sort one from the other. It is a marker of dehydration, not of acid production. Option c is incorrect because thirst rises with any rise in serum osmolality, so both clients report it. Many older adults with the hyperosmolar state have a blunted thirst drive, which makes the symptom unreliable. Option d is incorrect because a raised white count reflects infection or stress and appears in either crisis. Infection precipitates both, so leukocytosis identifies a trigger rather than telling the nurse which crisis developed.