DOH Nursing Adult Health Nursing 4 — Questions and Answers
Question 1: A patient receiving total parenteral nutrition (TPN) develops sudden fever and chills. What is the priority nursing action?
- Stop the TPN infusion, change the tubing and bag, and notify the physician (Correct answer)
- Slow the TPN rate and administer acetaminophen
- Obtain blood cultures and continue TPN at the same rate
- Flush the central line with heparin and continue monitoring
Correct answer: Stop the TPN infusion, change the tubing and bag, and notify the physician
Fever and chills during TPN suggest catheter-related bloodstream infection (CRBSI) or contaminated solution. The infusion must be stopped immediately and the bag and tubing changed. Blood cultures are drawn from the catheter and peripherally before antibiotics.
Question 2: Which clinical finding distinguishes type 1 from type 2 diabetes mellitus?
- Presence of anti-islet cell antibodies and absolute insulin deficiency (Correct answer)
- Onset exclusively in childhood
- Response to oral antidiabetic agents
- BMI greater than 30 kg/m²
Correct answer: Presence of anti-islet cell antibodies and absolute insulin deficiency
Type 1 DM is an autoimmune destruction of beta cells, evidenced by positive anti-islet cell or anti-GAD antibodies and absolute insulin deficiency. Type 2 involves insulin resistance and relative deficiency. Type 1 requires insulin; Type 2 may respond to oral agents.
Question 3: A patient with asthma is prescribed a short-acting beta-2 agonist (SABA) and an inhaled corticosteroid (ICS). What is the correct order of inhalation?
- SABA first to bronchodilate, then ICS for inflammation control (Correct answer)
- ICS first, then SABA after 5 minutes
- Both simultaneously using a spacer
- ICS only; SABA is not recommended with corticosteroids
Correct answer: SABA first to bronchodilate, then ICS for inflammation control
SABA (e.g., salbutamol) is inhaled first because it bronchodilates the airways within minutes, allowing the subsequently inhaled ICS (e.g., budesonide) to penetrate deeper into the bronchial tree for better therapeutic effect.
Question 4: Which laboratory value indicates adequate control of diabetes mellitus over the past 3 months?
- HbA1c of 6.8% (Correct answer)
- Fasting blood glucose of 180 mg/dL
- Random blood glucose of 220 mg/dL
- HbA1c of 9.5%
Correct answer: HbA1c of 6.8%
HbA1c reflects average blood glucose over 2–3 months. The ADA target for most adults with diabetes is HbA1c <7%. A value of 6.8% is within acceptable control. HbA1c of 9.5% indicates poor long-term control.
Question 5: A patient has serum sodium of 122 mEq/L and is symptomatic with confusion. What is the priority intervention?
- Restrict free water intake and notify physician for hypertonic saline consideration (Correct answer)
- Administer 1 L normal saline IV bolus rapidly
- Encourage oral fluid intake to dilute sodium
- Administer sodium bicarbonate IV
Correct answer: Restrict free water intake and notify physician for hypertonic saline consideration
Severe symptomatic hyponatremia (Na+ <125 mEq/L with neurological symptoms) requires careful correction to prevent cerebral edema. Free water restriction is first-line; hypertonic saline (3% NaCl) may be used for severe symptoms, with correction ≤10–12 mEq/L per 24 hours.
Question 6: What is the most common cause of peptic ulcer disease?
- Helicobacter pylori infection (Correct answer)
- NSAIDs only
- Excess dietary acid consumption
- Stress and anxiety alone
Correct answer: Helicobacter pylori infection
H. pylori infection accounts for approximately 70% of duodenal ulcers and 50% of gastric ulcers. The bacteria disrupts the mucous layer protecting the stomach lining. NSAIDs are the second most common cause.
DOH Nursing Adult Health Nursing 4
A patient receiving total parenteral nutrition (TPN) develops sudden fever and chills.
What is the priority nursing action?