DOH Nursing Adult Health Nursing 4

Question 1

A patient receiving total parenteral nutrition (TPN) develops sudden fever and chills. What is the priority nursing action?

Accepted Answer

Stop the TPN infusion, change the tubing and bag, and notify the physician

Answer

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?

Accepted Answer

Presence of anti-islet cell antibodies and absolute insulin deficiency

Answer

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?

Accepted Answer

SABA first to bronchodilate, then ICS for inflammation control

Answer

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?

Accepted Answer

HbA1c of 6.8%

Answer

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?

Accepted Answer

Restrict free water intake and notify physician for hypertonic saline consideration

Answer

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.

DOH Nursing Practice Test

DOH Nursing Practice Test

DOH Nursing Adult Health Nursing 4