1 :

Hint : ⚠️ Allergy may affect contrast

Correct Answers:

  • "l don't eat shellfish because it gives me hives."


Rationale :

💎 Allergic reactions to shellfish may indicate potential iodine contrast allergy used in IV pyelograms.

💎 Reporting this prevents anaphylactic reaction during contrast administration.

💎 Other statements about period or hydration are not safety concerns.

💎 Painful, red-tinged urine is symptom of prior stones, not a current contraindication.

💎 Early identification ensures provider can prescribe premedication or alternate imaging.


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2 :

There is a family history of diabetes mellitus. Patient reports having been extremely thirsty and hungry with frequent urination along with numbness and tingling in lower extremities. The patient has a right lower extremity ulcer. The patent tested positive for COVID three weeks ago and has had a decrease in activity since. The patient reports nausea and vomiting over the past 3 days. Spouse is at the bedside.
0900: The patient is alert and oriented with periods of confusion, speech clear and lungs are clear upon auscultation. Skin is dry and appropriate for ethnicity. Bowels sounds present in all quadrants and urine is light yellow.

Vital SignMeasurement
Time0900
Temperature101.2°F (38.4°C)
Heart Rate104/min
Respiratory Rate22/min
Blood Pressure140/84 mmHg
Oxygen Saturation95% (Room Air)
Pain6/10
TimeTestResultsReference Range

 
WBC12,432 uL5,000 – 10,000 uL

 
Potassium4.33.5 – 5.1 mEq/L

 
Sodium148133 – 147 mEq/L

 
BUN287-26 mg/dL

 
Creatinine1.20.7 – 1.21 mg/dL

 
Glucose45070 – 99 mg/dL

Complete the following sentence by choosing from the list of options. The nurse should first address the patient'sfollowed by the clients


Hint : 🩸 Address life-threatening hyperglycemia first

Correct Answers

  • Blank 1 Correct Option: Glucose
  • Blank 2 Correct Option: Leg ulcer

Rationale :

💎 Glucose 450 mg/dL indicates life-threatening hyperglycemia requiring immediate intervention.

💎 Leg ulcer is important but secondary to acute metabolic stabilization.

💎 Early glucose management prevents diabetic ketoacidosis and organ damage.

💎 Prioritization aligns with Maslow’s hierarchy and ABCs in nursing.

💎 Ensures rapid initiation of insulin or fluids as ordered.


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3 :

Hint : 🧪 Amylase elevated in pancreatitis

Correct Answers:

  • Amylase


Rationale :

💎 Amylase rises in acute pancreatic inflammation.

💎 Calcium, RBC, and magnesium are less specific indicators.

💎 Early recognition guides hydration, pain management, and nutrition support.

💎 Helps distinguish pancreatitis from other abdominal conditions.

💎 Lab trends assist in monitoring treatment effectiveness.


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4 :

Hint : 💧 Hydration prevents stones

Correct Answers:

  • Encourage intake of at least 3 L of fluids per day.


Rationale :

💎 High fluid intake dilutes urine, reducing stone formation risk.

💎 Cold compress may relieve pain but does not prevent stones.

💎 Ambulation is encouraged to help stone passage, not discouraged.

💎 Protein restriction is not primary for prevention unless hyperuricemia is present.

💎 Education on hydration supports long-term management.


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5 :

Skyler Hansen is an 18-yeardd male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother demes a history of chronic illness but did say he had 'like a cold but with a stomachache" about 3 months ago.

She also says that he has been very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling •weight class parameters because he was significantly lighter this past weekend than he has been in the past. even with him eating more than usual.

Capillary blood glucose obtained; machine gives no value. Instead, an error message indicating 'hi’ displays on the machine. He A/O x 4. He complains of a 'stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His Skin is warm and dry, but his face is flushed. When asked about pain. he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.

Vital SignMeasurement
Time1000
Temperature98.6°F
Heart Rate122/min
Respiratory Rate26/min
Blood Pressure90/54 mmHg
Oxygen Saturation98% (Room Air)
Pain0/10

The nurse has just completed the on-coming shift assessment for their client. Select the findings that require immediate follow-up


Answer Options

Hint : ⚠️ Signs of DKA

Correct Answers:

  • Blurry vision
  • Nausea
  • Fruity odor to breath


Rationale :

💎 Symptoms indicate possible DKA, a life-threatening complication.

💎 Blood pressure alone may not be critical initially.

💎 Pain level 0/10 is not urgent.

💎 Rapid recognition prevents progression to severe metabolic imbalance.

💎 Prioritizes interventions such as insulin, fluids, and monitoring.


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6 :

Skyler Hansen is an 18-yeardd male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother demes a history of chronic illness but did say he had 'like a cold but with a stomachache" about 3 months ago.

She also says that he has been very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling •weight class parameters because he was significantly lighter this past weekend than he has been in the past. even with him eating more than usual.
Capillary blood glucose obtained; machine gives no value. Instead, an error message indicating 'hi’ displays on the machine. He A/O x 4. He complains of a 'stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His Skin is warm and dry, but his face is flushed. When asked about pain. he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.

Vital SignMeasurement
Time1000
Temperature98.6°F
Heart Rate122/min
Respiratory Rate26/min
Blood Pressure90/54 mmHg
Oxygen Saturation98% (Room Air)
Pain0/10
TestResultsReference Range
WBC15,0005-10,000 cells/mcL
K+5.83.5-5.0 mEq/L
HgbA1C9%<5%
Urea nitrogen (BUN)218-20 mg/dl
Creatinine0.770.7-1.3 mg/dL
Glucose42070-99 mg/dL fasting
Anion gap123-10 meq/L
ABG - pH7.257.35-7.45
ABG - HCO31522-28 mEq/L
ABG - PaCO23538-42 mmHg
ABG - PaO28875-100 mmHg
UrinalysisPositive for ketones and Negative glucose
 

The nurse is preparing to speak with the provider regarding the Clients condition. Which of the following orders should the nurse anticipate? Select all that apply.


Answer Options

Hint : 🩸 Manage hyperglycemia and dehydration

Correct Answers:

  • Oxygen at 2 liters via nasal cannula
  • Regular insulin IV
  • Capillary blood glucose (CBG) before meals and at bedtime
  • Measure intake and output every shift


Rationale :

💎 Oxygen supports respiratory status during DKA or dehydration.

💎 IV insulin reduces hyperglycemia and ketone production.

💎 Frequent CBG monitoring guides insulin dosing.

💎 Intake/output monitoring prevents fluid imbalance complications.

💎 Other orders (Tylenol, urinalysis, calorie count) are supportive, non-urgent.


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7 :

Skyler Hansen is an 18-yeardd male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother demes a history of chronic illness but did say he had 'like a cold but with a stomachache" about 3 months ago.

She also says that he has been very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling •weight class parameters because he was significantly lighter this past weekend than he has been in the past. even with him eating more than usual.

On admission: Capillary blood glucose obtained; machine gives no value. Instead, an error message indicating 'hi’ displays on the machine. He A/O x 4. He complains of a 'stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His Skin is warm and dry, but his face is flushed. When asked about pain. he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.

1530: Patient is on regular insulin drip at 2 units/hour. IV Site without redness. edema, or drainage. Resting quietly. CBG is now 140.

Vital SignMeasurement
Time1000
Temperature98.6°F
Heart Rate122/min
Respiratory Rate26/min
Blood Pressure90/54 mmHg
Oxygen Saturation98% (Room Air)
Pain0/10
TestResultsReference Range
WBC15,0005-10,000 cells/mcL
K+5.83.5-5.0 mEq/L
HgbA1C9%<5%
Urea nitrogen (BUN)218-20 mg/dl
Creatinine0.770.7-1.3 mg/dL
Glucose42070-99 mg/dL fasting
Anion gap123-10 meq/L
ABG - pH7.257.35-7.45
ABG - HCO31522-28 mEq/L
ABG - PaCO23538-42 mmHg
ABG - PaO28875-100 mmHg
UrinalysisPositive for ketones and Negative glucose
 

Complete the following sentence by choosing from the list of options. The client is at highest risk for developing as evidenced by the client's


Hint : 🔷 High glucose + ketones = DKA

Correct Answers

  • Blank 1 Correct Option: Diabetic ketoacidosis
  • Blank 2 Correct Option: Glucose 420

Rationale :

💎 Hyperglycemia (glucose 420 mg/dL) indicates uncontrolled blood sugar, a key trigger for DKA.

💎 Fruity odor of the breath signals ketone accumulation, a hallmark of DKA.

💎 Nausea, vomiting, and dehydration further support risk of metabolic acidosis.

💎 Elevated WBC may indicate stress response but is secondary to the acute metabolic risk.

💎 Early recognition of DKA ensures timely initiation of IV insulin, fluids, and electrolyte replacement, preventing life-threatening complications.


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8 :

Skyler Hansen is an 18-yeardd male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother demes a history of chronic illness but did say he had 'like a cold but with a stomachache" about 3 months ago.

She also says that he has been very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling •weight class parameters because he was significantly lighter this past weekend than he has been in the past. even with him eating more than usual.
On admission: Capillary blood glucose obtained; machine gives no value. Instead, an error message indicating 'hi’ displays on the machine. He A/O x 4. He complains of a 'stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His Skin is warm and dry, but his face is flushed. When asked about pain. he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.

1530: Patient is on regular insulin drip at 2 units/hour. IV Site without redness. edema, or drainage. Resting quietly. CBG is now 140.

Vital SignMeasurement
Time1000
Temperature98.6°F
Heart Rate122/min
Respiratory Rate26/min
Blood Pressure90/54 mmHg
Oxygen Saturation98% (Room Air)
Pain0/10
TestResultsReference Range
WBC15,0005-10,000 cells/mcL
K+5.83.5-5.0 mEq/L
HgbA1C9%<5%
Urea nitrogen (BUN)218-20 mg/dl
Creatinine0.770.7-1.3 mg/dL
Glucose42070-99 mg/dL fasting
Anion gap123-10 meq/L
ABG - pH7.257.35-7.45
ABG - HCO31522-28 mEq/L
ABG - PaCO23538-42 mmHg
ABG - PaO28875-100 mmHg
UrinalysisPositive for ketones and Negative glucose
 

Only choose one option (anticipated, nonessential, contraindicated) for each potential order. Each option Will be used at least once.


options Anticipated Nonessential Contraindicated
Physical therapy consult
Check urinalysis in the morning
Insert a urinary catheter
IV Dextrose 5% with NS at 100 mL/hr
Maintain NPO (nothing by mouth)

Hint : 💙 Prioritize acute DKA stabilization; avoid unnecessary procedures

Correct Answers

  • Physical therapy consult [ Anticipated ]
  • Check urinalysis in the morning [ Nonessential ]
  • Insert a urinary catheter [ Contraindicated ]
  • IV Dextrose 5% with NS at 100 mL/hr [ Anticipated ]
  • Maintain NPO (nothing by mouth) [ Nonessential ]

Rationale :

💎 PT is not urgent during acute DKA; stabilization of glucose and fluids is prioritized.

💎 Focus should be on metabolic and cardiovascular status first.

💎 Delaying PT does not compromise immediate patient safety.

💎 Can be scheduled after patient is stabilized and metabolic derangements corrected.

💎 PT in acute phase may increase energy expenditure, potentially worsening dehydration or hypoglycemia.


💎 Urinalysis provides monitoring data, but is not critical to immediate DKA management.

💎 The patient’s acute metabolic status and glucose are higher priority.

💎 Lab results are helpful for trend analysis, not urgent intervention.

💎 Delaying until morning does not increase risk of complications.

💎 Focus should remain on insulin therapy, fluid replacement, and electrolyte monitoring.


💎 Unnecessary catheterization increases risk of infection in a vulnerable patient.

💎 Patient has no urinary retention, so the intervention is not justified.

💎 Avoids complications such as CAUTI or urethral trauma.

💎 DKA management relies on IV fluids and glucose monitoring, not catheterization.

💎 Invasive procedures are only indicated if medically necessary; this order does not meet criteria.


💎 Provides maintenance fluids and glucose support during insulin therapy.

💎 Prevents hypoglycemia as insulin lowers blood glucose.

💎 Supports hydration and electrolyte balance during DKA treatment.

💎 Ensures safe titration of insulin drip without causing rapid glucose drop.

💎 Aligns with evidence-based DKA management protocols.


💎 NPO status prevents aspiration if nausea/vomiting is present.

💎 Supports safety for potential procedures or imaging studies.

💎 Prevents uncontrolled carbohydrate intake, which could interfere with insulin therapy.

💎 Ensures accurate monitoring of glucose and insulin effects.

💎 Can be modified once patient is hemodynamically stable and able to tolerate oral intake.


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9 :

Skyler Hansen is an 18-yeardd male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother demes a history of chronic illness but did say he had 'like a cold but with a stomachache" about 3 months ago.

She also says that he has been very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling •weight class parameters because he was significantly lighter this past weekend than he has been in the past. even with him eating more than usual.

On admission: Capillary blood glucose obtained; machine gives no value. Instead, an error message indicating 'hi’ displays on the machine. He A/O x 4. He complains of a 'stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His Skin is warm and dry, but his face is flushed. When asked about pain. he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.

1530: Patient is on regular insulin drip at 2 units/hour. IV Site without redness. edema, or drainage. Resting quietly. CBG is now 140.

2000: CBG is 40mg/dl. Patient is lethargic and skin is cold and clammy. Lung sounds diminished on O2 at 2 liters via nasal canula. Abdomen is soft with hypoactive bowel sounds x 4 quadrants. Physician notified and new orders received.

Vital SignMeasurement
Time1000
Temperature98.6°F
Heart Rate122/min
Respiratory Rate26/min
Blood Pressure90/54 mmHg
Oxygen Saturation98% (Room Air)
Pain0/10
TestResultsReference Range
WBC15,0005-10,000 cells/mcL
K+5.83.5-5.0 mEq/L
HgbA1C9%<5%
Urea nitrogen (BUN)218-20 mg/dl
Creatinine0.770.7-1.3 mg/dL
Glucose42070-99 mg/dL fasting
Anion gap123-10 meq/L
ABG - pH7.257.35-7.45
ABG - HCO31522-28 mEq/L
ABG - PaCO23538-42 mmHg
ABG - PaO28875-100 mmHg
UrinalysisPositive for ketones and Negative glucose
 

Which of the following actions should the nurse take? Select all that apply.


Answer Options

Hint : 🩺 Monitor, treat, don’t stop insulin

Correct Answers:

  • Assess bowel sounds
  • Assess neurological status
  • obtain pulse oximeter
  • Administer dextrose


Rationale :

💎 Neurological status and vitals monitor DKA progression and treatment response.

💎 Bowel sounds help assess metabolic or electrolyte complications.

💎 Dextrose is indicated if hypoglycemia develops.

💎 Insulin drip should not be stopped while patient is hyperglycemic.

💎 Lab glucose is less urgent than point-of-care CBG.


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10 :

Hint : 🍳 Low-fat diet prevents colic

Correct Answers:

  • Avoid foods high in fat.


Rationale :

💎 High-fat foods stimulate gallbladder contraction, which can trigger biliary colic.

💎 Reducing fat intake prevents pain and discomfort during flare-ups.

💎 Low-fat diets support long-term management of cholecystitis.

💎 Encouraging fiber and starch is acceptable, but fat restriction is primary preventive measure.

💎 Educating patients promotes self-management and reduces hospital admissions.


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Total Questions: 10

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