Exam #4 NCLEX Qs
The nurse is examining role expectations & boundary issues causing primary sources of conflict within a healthcare unit. Which issue should be addressed by the nursing staff? (Select all that apply.) A.Resistance to change B.Lack of understanding C.Inaccurate information D.Consistent cooperation E.Effective communication
A, B, C. Role expectations & boundary issues are a primary source of conflict within a unit. They may arise from a lack of understanding or awareness of which task each team member is to perform due to miscommunication, inaccurate info, & resistance of some members to change.
The nurse wants to provide collaborative care for a client who has terminal cancer. Which action should the nurse include? A.Giving the physician priority when delivering care B.Consulting an oncology-certified nurse when planning care C.Assessing the client's preferences regarding care D.Providing comfort interventions
B.
Which action by a parent of a 12 YO child with a new dx of type 1 DM indicates a need for further teaching? A.Scheduling a baseline exam with an ophthalmologist B.Counting carbohydrates with the child C.Discouraging after-school sports D.Allowing the child to check blood sugars
C. Exercise is a part of blood glucose & disease management.
The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents used to treat type 2 . Which information should the preceptor include related to how these meds lower blood sugar? (Select all that apply.) A.Prevent breakdown of glycogen B.Increase uptake of glucose by cells C.Increase insulin secretion D.Increase breakdown of insulin E.Stimulate hormones for hemodilution
A, B, C. These meds lower sugar by stimulating or increasing insulin secretion, preventing breakdown of glycogen to glucose by the liver & increasing peripheral uptake of glucose by making cells less resistant to insulin. Peripheral uptake is uptake by muscles & fat in arms & legs rather than in trunk. Some hypoglycemics keep sugar low by blocking absorption of carbs in intestines. most recent pharmacologic therapy in treating type 2 includes incretin effect. Incretin hormones, which are hormones released from the gut endocrine cells during meals, play a significant role in insulin secretion.
The nurse is taking a health history from a client who has type 1 DM. Which client symptom may indicate the development of complications? (Select all that apply.) A.Numbness in the feet B.Vision changes C.Quick wound healing D.Dizziness E.Frequent voiding of urine
A, B, D, E.
The nurse is caring for a child with type 2 DM. Which item in this child's history should the nurse recognize as a risk factor for this disease? (Select all that apply.) A.Race B.High-fat diet C.Sex D.Obesity E.Family history
A, B, D, E. Obesity, high-fat diet & fam hx of DM & race are risk factors for T2DM. Sex is not.
The nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of type 1 DM. Which attendee statement indicates need for further instruction? (Select all that apply.) A."Type 1 DM can be caused by exposure to excessive heat & temps." B."Type 1 DM is caused by exposure to processing of metals & proteins." C."There are genes such as the HLA-DR3 and HLA-DR4 genes that can cause type 1 DM." D."Type 1 DM can be passed on from one recessive gene from one parent." E."I can develop type 1 DM from bacterial infections."
A, B, D, E. PT c type 1 usually inherits the risk factor for disorder from each parent. Environmental factors such as cold weather & exposure to a virus also contribute to the development. The genes HLA-DR3 and HLA-DR4 have been identified in people with type 1.
The nurse is teaching a group of adults at a community health fair about hypothyroidism. Which risk factor should the nurse include in the presentation? (Select all that apply.) A.Autoimmune disease B.Thyroid surgery C.Male sex D.Radioactive iodine treatment E.Radiation of the neck
A, B, D, E. Risk factors for hypothyroidism: having an autoimmune disease, having a fam member with an autoimmune disease, previous tx with radioactive iodine, radiation of the neck, thyroid surgery & female sex
A nurse is planning to teach a class about preventing workplace bullying. Which behavior should be included? (Select all that apply.) A.Encouraging nonthreatening reporting B.Developing acceptable codes of conduct C.Isolating the victim to provide a safe environment D.Educating others about the ramifications of bullying E.Talking about the abuser to make the victim feel betteR
A, B, D. Nonthreatening reporting that is taken seriously, developing acceptable codes of conduct, & education on the impact of bullying all support the prevention of bullying in the workplace
The nurse is teaching colleagues about hyperthyroidism. Which statement by a colleague indicates understanding of an indication for a thyroidectomy? (Select all that apply.) A."A thyroidectomy may be performed if thyroid is placing pressure on the esophagus." B."A thyroidectomy may be performed if it is compromising the airway." C."The client will not need surgery as long as she takes antithyroid med." D."A total thyroidectomy is performed to treat cancer of the thyroid." E."The client may require a thyroidectomy for cosmetic reasons, such as a large goiter."
A, B, D. Total or partial thyroidectomy may be necessary to treat a thyroid that is putting pressure on the esophagus or obstructing the airway. Thyroid cancer tx with thyroidectomy. *Goiter is not removed for purely cosmetic reasons.
The nurse is managing care for a client weighing 165 lbs who was admitted for the treatment of DKA. Which intervention would be most appropriate for the nurse to include? (Select all that apply.) A.Measure intake and output every hour. B.Place the client on a telemetry monitor. C.Administer sliding-scale regular insulin. D.Provide a high-protein diet. E.Give 100 mL of normal saline bolus.
A, B. calculate I&O on hourly basis to determine fluid needs. Place on telemetry to monitor for dysrhythmias related to shifts in K+ levels. PT with DKA would be acutely ill & if able to eat would be on a carb controlled diet. The nurse would admin NS boluses at 10-20 mL/kg. A volume of 100 mL is not sufficient. Insulin would be administered IV, not sliding scale.
A client with type 1 DM is being taught to monitor her blood glucose level. Which factor affecting accurate glucose monitoring should the nurse include in the instruction? (Select all that apply.) A. Medication overdoses B.White blood cell (WBC) count C.Low hematocrit level D.High hematocrit level E.Creatinine level
A, C, D. Factors that affect accurate glucose monitoring include med overdoses, low hematocrit level, & high hematocrit level & supplies. WBC count & creatinine levels do not affect accurate glucose monitoring.
The nurse is teaching a group of older adults with type 2 DM. Which complication of the disease should the nurse include? (Select all that apply.) A.Cognitive impairment B.Pulmonary disease C.Functional disabilities D.Autoimmune diseases E.Polypharmacy
A, C, E. Elderly diagnosed with type 2 are at an increased risk of developing other complications as compared with younger clients. These include polypharmacy, or taking other meds that can increase the risk; functional disabilities that may lead to a slower, more sedentary lifestyle; & cognitive impairment.
The nurse is caring for a 15 YO newly diagnosed with type 2. Which task should the nurse expect to be completed quarterly for this child? (Select all that apply.) A.Discuss alcohol, tobacco, and drug use. B.Refer for an eye exam. C.Make a foot assessment. D.Measure fasting glucose levels. E.Review glucose records.
A, D, E.
The nurse experiences workplace bullying. Which action should the nurse anticipate from the administration to support steps toward successful resolution of this issue? A.Obtaining details of the event before taking action B.Asking the nurse to provide at least three witnesses to the event C.Encouraging the employee to transfer out of the department D.Ignoring the report of bullying until it is reported more than once
A.
The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this diagnosis? A.Prednisone B.Acetaminophen C.Vitamin D supps D.Calcium supps
A. Glucocorticoids such as prednisone may have contributed to the development of osteoporosis
The nurse is teaching an older adult how to manage Graves disease. Which info should the nurse include? A.The administration schedule for an antithyroid drug B.Use of levothyroxine (Synthroid) and lab monitoring C.The schedule for lifelong radioactive iodine treatments D.Preparation for surgical removal of the thyroid
A. Graves = HYPERthyroidism which in the older adult is usually managed with admin of antithyroid drugs & then an eval to determine if radioactive iodine tx necessary. *Thyroidectomies are not usually performed in older adults due to preexisting cardiac & CNS disorders.
The nurse is caring for a client who received a daily intermediate-acting insulin dose at 8 a.m. At which time of the day should the nurse provide the client a snack to prevent hypoglycemia? A.2:00 p.m. B.6:00 p.m. C.9:00 p.m. D.11:00 a.m.
A. Intermediate (NPH-isophane) peaks 6-8 hrs after injection. *If the PT received regular insulin (short-acting) the snack would be required between between 10 & 11 AM
The HCP prescribes metformin (Glucophage) to a client with newly diagnosed type 2 DM. Which info should the nurse provide to the client? A.This med can take up to 3 months to show effectiveness. B.This med is unsafe for use by pregnant and lactating women. C.This med is only used in the adult population due to side effects. D.This med is used for clients who are unable to inject insulin.
A. Metformin is a relatively safe med. It takes up to 3 M to show effects. It stimulates insulin production. It is safe for prego & lactating women & kids >10
The nurse is teaching health promotion behaviors to a client diagnosed c osteoporosis. Which behavior should the nurse include? A.Limiting alcohol intake B.Avoiding foods high in purine C.Exercising four times a week D.Decreasing smoking
A. PT should be instructed to limit alcohol intake. Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intox. Smoking decreases blood supply to bones, & nicotine slows production of osteoblasts & impairs absorption of Ca, contributing to decreased bone density. Weight-bearing exercises are recommended for approx 30 mins 4 times a wk.
A teacher sends a child to the school nurse due to frequent thirst and urination. Upon assessment, the nurse suspects the child has type 1 DM. Which question should the nurse ask to gain data to support this suspicion? A."How is your appetite?" B."When did you last see your healthcare provider?" C."Have you noticed any bruises on your legs?" D."Do you play outside a lot?"
A. Polydipsea, poluria & polyphage = 3 hallmark signs of type 1.
The nurse is reviewing the chart of an older adult client with a BMI of 19 kg/m2. Which implication does this clinical finding have on the risk for osteoporosis? A.The client is at risk for osteoporosis. B.The client is not at risk for osteoporosis. C.The client's age in relation to the BMI should be factored in. D.The client's gender needs to be taken into consideration.
A. Rationale: Any individual with a BMI less than 20 kg/m2, regardless of age, sex, or weight loss, is at a greater risk for both bone loss & subsequent risk for FX
A client diagnosed with osteoporosis indicates reluctance to taking medication on a daily basis. Which class of medication should the nurse anticipate will be prescribed? A.Bisphosphonate B.Oral calcium supplement C.Tetracycline D.Calcium channel blocker
A. Recent studies suggest that once-weekly dosing with bisphosphonates may give the same bone density benefits as daily dosing because of the extended duration of drug action. Oral calcium supps are typically taken daily
The nurse is caring for an older adult who is visually impaired and at risk for osteoporosis. Which activity is most appropriate to implement for the prevention of osteoporosis? A.Strength and balance training B.Walking on a treadmill C.Swimming D.Aerobics
A. Strength and balance training is the safest, most appropriate plan for exercise for the visually impaired client at risk for osteoporosis. Aerobics and walking on a treadmill are not the safest choices for a visually impaired client
The nurse is reviewing the chart of a client with osteoporosis. Which physical assessment finding should the nurse anticipate? A.Spinal curvature B.Generalized pain C.Unsteady gait D.Poor posture
A. The assessment findings associated with osteoporosis include spinal curvature.
A client newly diagnosed with type 2 asks the nurse how to "get rid of" this disease. How should the nurse respond? A."Type 2 can sometimes be eliminated by wt loss, diet & exercise." B."You will always have type 2 DM. You cannot get rid of it." C."Type 2 DM cannot be cured. It will eventually progress to type 1 diabetes." D."You seem concerned about this diagnosis and we will do our best to help you control it.
A. Type 2 DM occurs in people who live a sedentary lifestyle, are obese, & eat a high-carb diet. Therefore, the nurse would explain to the client that the disease may be eliminated with diet, exercise, and weight loss.
The nurse is preparing a presentation on risk factors for type 2 DM. Which ethnic group should the nurse include as being amongst the highest diagnosed with this disease? A.American Indians B.Caucasian Americans C.African Americans D.Asian Americans
A. ethnicities that have the highest incidence of type 2 DM are the American Indians & Alaska Natives at 15.9%.
An organization has goals to promote mutual respect within the interprofessional team and to improve client outcomes. Which action by the organization supports mutual respect? A.Implementing interprofessional rounding B.Promoting verbal acknowledgment of mutual respect C.Placing physician leaders for each hospital department D.Upholding the tradition of patriarchal nurse?physician relationships
A.Implementing interprofessional rounding. Interprofessional rounding promotes mutual respect through collaboration on client-centered care.
The nurse is caring for a postmenopausal client prescribed estrogen therapy to reduce the risk of osteoporosis. Which client statement indicates need for further teaching? A."I will be sure to maintain all follow-up appts for evaluation." B."I am glad I am not at risk for osteoporosis anymore." C."I have completed my smoking cessation program." D."I understand that I may experience hot flashes."
B
Which activities should the nurse recognize as supporting the building of skills for successful collaboration of interprofessional healthcare teams? (Select all that apply.) A.Focusing care delivery on individual groups B.Advocating for policy change with local legislation C.Role playing scenarios to practice communication skills D.Encouraging clinical problem solving through group work E.Practicing with additional credentials to increase nursing authority
B, C, D, E.
Which manifestation should the nurse monitor when caring for a pt on thyroid hormone (TH) replacement therapy? (Select all that apply.) A.Decrease in appetite B.Improvement of symptoms of hypothyroidism C.Stable vital signs D.Symptoms of hyperthyroidism E.Report of dizziness
B, C, D, E. Appetite would be expected to increase, not decrease.
The nurse is providing teaching to a client with a new diagnosis of type 1 DM. The nurse should instruct the client about incorporating which treatment to help manage the disease? (Select all that apply.) A.Fluid restriction B.Exercise C.Medication D.Nutrition E.Daily weight checking
B, C, D.
The nurse is caring for a pt newly diagnosed with Graves disease. The pt asks the nurse how the goiter occurred. Which factor should the nurse include? (Select all that apply.) A.The thyroid cells become hypoactive. B.The pt's tissues form antibodies. C.Antibodies bind to the thyroid-stimulating hormones. D.The pt's tissues form antigens. E.The thyroid gland enlarges.
B, C, E. Goiters can occur occur when the thyroid gland produces either too much or not enough thyroid hormone. Antibodies bind to the TSH in the thyroid follicles. As gland enlarges, a goiter develops. Thyroid cells become hyperactive. Graves = Hyperthyroidism
The nurse plans to discuss strategies to recognize and manage conflict. Which strategy should be included? (Select all that apply.) A.Calling in sick during conflict B.Addressing issues as they arise C.Ignoring each other when angry D.Treating each other with respect E.Acknowledging each other's accomplishments
B, D, E.
Which situation reflects primary sources of conflict? (Select all that apply.) A.A nurse who is gossiping about a coworker B.A nurse assistant who communicates assessment findings with the healthcare provider C.A nurse and a physical therapist who are collaborating to provide care to an elderly client D.A physician who does not believe that a nurse practitioner can provide "on-call" care to clients E.A nurse who places blame on the respiratory therapist for not administering a medication on time
B, D, E. Primary sources of conflict include role boundary issues like scope of practice & accountability issues. A nursing assistant who communicates nursing assessment findings to the HCP is experiencing role boundary issues. A physician who does not believe a nurse practitioner can provide care to a client is having scope-of-practice issues. A nurse who blames a RT for not being able to admin a med on time is having accountability issues.
PT is admitted with hyperosmolar hyperglycemic state (HHS) & a glucose level of 550 mg/dL. Which intervention should the nurse expect to include in the plan of care? (Select all that apply.) A.Provide education about type 2 DM B.Assess level of orientation. C.Obtain blood for A1C. D.Monitor potassium levels. E.Give normal saline IV.
B, D, E. hyperosmolarity of the blood causes severe dehydration & depletion of electrolytes. Therefore priority care for HHS is to provide isotonic or colloid solutions IV. K+ is depleted, so it must not only be monitored, but also replaced.
Which physical assessment is most appropriate to include when identifying thyroid problems? (Select all that apply.) A.Percussion B.Palpation C.Auscultation D.Observation E.Medication history
B, D. Observation, palpation & taking fam history are useful ways to ID thyroid probs. Palpitation is used to determine location, size & nodules of thyroid.
Which statement made by a client with type 1 DM indicates an understanding of instruction provided regarding disease management? (Select all that apply.) A."I should maintain my hemoglobin A1C levels at or below 8%." B."I should administer insulin during the day in multiple injections." C."I should count calories consumed to determine insulin needs for each day." D.I should obtain blood glucose levels prior to each insulin injection." E."I should trim my toenails at an angle to prevent cutting the skin."
B, D. PT should count carbs, not calories. A1C should be below 6.5%. Cut toenails straight across
The nurse is caring for a child who is hospitalized for the tx of DKA. The child's parents ask why their child is receiving potassium. Which response by the nurse is accurate? A."Potassium is administered to treat acidosis." B."Potassium is administered to treat hypokalemia." C."Potassium is administered to decrease blood glucose levels." D."Potassium is administered to treat cerebral edema."
B.
The nurse wants to improve collaborative decision-making skills. Which action promotes collaboration between nurses and the interprofessional team? A.Removing the client from the decision-making process B.Sharing responsibility of the outcome of the decision C.Delaying feedback on results to ensure that all collected data were reviewed by the team first D.Depending on physician leadership to ultimately make the decision for the team
B. Collaboration in decision making results in shared responsibility of the outcome of the decision.
The nurse is involved in a situation of hostility with a co-worker that is escalating in an open area.Which action should the nurse take to best address the situation? A.Continuing the interaction in the current location B.Taking the interaction to a private place C.Walking away from the employee and ignoring the situation D.Calling for upper-level administration to assist
B. Conflict should not take place in open areas. It is best to move the conflict to a private area.
Which act should the nurse recognize as horizontal violence? A.Maltreatment of a housekeeper by the nurse B.Gossiping by one nurse against another nurse C.Physical threats by a nurse against a nursing assistant D.Battery of a client by a nurse
B. Horizontal violence involves acts, like gossiping, by one nurse against another nurse. Battery of a client is criminal abuse. Maltreatment and threats to other team members or insubordinates is bullying.
The nurse is teaching a group of clients newly diagnosed with type 1 DM. Which info should the nurse include in the teaching? A."Have routine pedicures performed." B."Schedule regular ophthalmology visits." C."Take beta blockers daily to control blood pressure." D."Monitor blood glucose levels weekly."
B. PT c type 1 is at high risk for retinal damage. So the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. PT would be prescribed angiotensin-converting enzyme (ACE) inhibitors to protect kidneys from vascular damage.
The nurse is reviewing the orders for a client with osteoporosis who has been prescribed a bisphosphonate. Which test should the nurse anticipate will be ordered while the client is on the medication? A.Ultrasound B.Serum bone Gla protein (osteocalcin) C.Alkaline phosphatase D.Dual-energy x-ray absorptiometry (DEXA)
B. Serum bone Gla protein (osteocalcin) is most useful for evaluating effects of tx rather than to indicate severity of the disease. . Dual-energy x-ray absorptiometry (DEXA) and ultrasound both measure bone density, not efficacy of tx.
A PT with hypothyroidism asks the nurse why the thyroid-stimulating hormone (TSH) level is increased if the thyroid is not working properly. Which response is accurate? A."Your TSH level is increased due to an increase in metabolism noted in clients with hypothyroidism." B."Your TSH level is increased due to an inadequately functioning negative hormonal feedback process." C."Your TSH level is increased because the thyroid is working harder to produce more hormone."
B. TSH level increases in PTs c hypothyroidism due to a loss of the negative hormonal feedback system.
The nurse is teaching a client with osteoporosis who has been prescribed calcium citrate supps. Which info should the nurse include in the teaching? A.Take the calcium on an empty stomach. B.Take the calcium with meals. C.Take the calcium within 2 hours after meals. D.Take the calcium in the morning.
B. The client prescribed calcium citrate supp should be instructed to take the calcium with meals. It does not matter what time of day the client takes the calcium.
The nurse is teaching the parents of a child with a new diagnosis of type 1. Which info should the nurse include regarding the pathophysiology of the disease? A.Beta cells need help producing insulin. B.Beta cells are destroyed. C.Hyperglycemia happens when 50% of alpha cells are damaged. D.Delta cell destruction causes type 1 DM
B. Type 1 DM has a slow onset & symptoms are not evident until 80-90% of beta cells are destroyed, causing hyperglycemia
The nurse in the fertility clinic is working with a female client who has had repeated miscarriages. Which information in the client's history may be a precipitating factor? A.Hyperemesis gravidarum B.Uncontrolled hypothyroidism C.History of toxic multinodular goiter D.Type 2 DM
B. Uncontrolled hypothyroidism can lead to miscarriages, stillbirths, preeclampsia & low birth wts.
The nurse is caring for a client with osteoporosis with a primary focus on preventing injury at night. Which is the best nursing intervention for the nurse to implement to maintain the safety of the client? A.Increasing the client's use of assistive devices B.Providing lighting in toilet facilities C.Restricting fluids at night to decrease nocturia D.Keeping the side rails up on the bed at all times
B.Providing lighting in toilet facilities
Nurse attended a class about preventing horizontal violence in the workplace. Which action by the nurse indicates that learning occurred? A.Allowing nurses who have been victims to approach and humiliate their abusers B.Ignoring negative statements of others about nurses on the unit C.Teaching others through unit presentations about the ramifications of workplace violence D.Encouraging gossip about peers and other staff members
C
The nurse is teaching the caregivers of an adolescent with a new diagnosis of type 2 DM what they should do every 3 months to monitor it. The adolescent is currently taking metformin (Glucophage). Which info should be included? (Select all that apply.) A.Assess injection sites. B.Obtain an eye exam. C.Discuss alcohol and drug use. D.Review blood glucose logs. E.Monitor hemoglobin A1C.
C, D, E. Adolescent with type 2 who takes metformin should monitor A1C & blood glucose logs every 3 M. The nurse should also discuss alcohol & drug abuse & its effects on type 2 every 3 M. An eye exam should be obtained annually, not quarterly.
A young client is admitted for lethargy & weight loss. Which clinical manifestation supports the nurse's suspicion of diagnosis of type 1 DM? (Select all that apply.) A.Fever B.Weight gain C.Polyuria D.Glucosuria E.Blurred vision
C, D, E. Manifestations of type 1 caused by lack of insulin to transport glucose intocells. hyperglycemia leads to polyuria, glucosuria, blurred vision. Polyuria occurs because water is drawn into general circulation, increasing renal blood flow. Once glucose exceeds renal threshold, 180 mg/dL, glucose will spill into urine. Blurred vision is caused by swelling of lenses of the eyes in response to increased fluid volume. pts c type 1 usually lose wt, because proteins & fats metabolized for energy & water is lost in the urine. In addition, pts c type 1 frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.
A pt tells the nurse that the pain med is ineffective & causes too many side effects. Which interprofessional team member should the nurse consult? (Select all that apply.) A.Dentist B.Dietician C.Physician D.Pharmacist E.Complementary healthcare provider
C, D, E. The complementary healthcare provider can provide adjunct therapies for pain like massage and reflexology.
The nurse is caring for a newborn diagnosed with hyperthyroidism after birth. Ongoing assessments during the first year of life should be conducted to monitor for which alteration? (Select all that apply.) A.Bradycardia B.Nonpalpable thyroid gland C.Respiratory difficulties D.Premature fontanelle closure E.Heart failure
C, D, E. infant C hyperthyroidism would have higher metabolic rates, leading to tachycardia & HF. infant may develop resp difficulties from enlarged thyroid pressing on the trachea. The fontanelles will close prematurely. Thyroid gland will be palpable.
The nurse is preparing a client with hyperthyroidism for radioactive iodine tx. Which info should the nurse provide prior to this procedure? (Select all that apply.) A.That hospitalization is usually required B.That radioactive iodine is given intravenously C.That the client may need lifelong thyroid replacement D.How to measure the radial pulse E.That the end results are immediately seen
C, D. PTs are instructing on measuring their own pulse until stores of thyroid hormone are depleted & notifying the HCP if the HR is over 100 bpm. PT will likely require lifelong thyroid replacement due to radiation effects on remaining thyroid tissue. Results may take up to 6-8 wks. Radioactive iodine done with oral contrast on an outpatient basis.
The collaborative team treating a pt includes the cardiologist, dietician, social services & nurse case manager. The team works together to establish a plan of care based on the pt's goals. Which outcome is likely to result from this type of collab for the client? A.Improved relationship between the physician and the client B.Increased healthcare costs C.Enhanced continuity of care D.Decreased adherence with the plan of care
C.
A pt with a family history of hyperthyroidism asks the nurse, "What can increase my risk of developing this disorder?" Nurse says: A."Arthritis can lead to the development of hyperthyroidism." B."Smoking can increase your risk for acquiring this disease. C."Viral infections can cause the onset of hyperthyroidism." D."Invasive neck surgery can impact thyroid functioning."
C. A viral infection can increase risk of hyperthyroidism. Other risks include having an autoimmune disease, pregnancy, female sex, & being under 40 YO. *Surgery in the neck increases the risk of hypothyroidism
The nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 DM? A.BP of 110/78 mmHg B.Body mass index 21 kg/m2 C.Presence of acanthosis nigricans D.Pale mucous membranes
C. Acanthosis nigricans is a condition in which the skin is velvety in texture & brownish black in color with hyperkeratotic plaques; it is usually found in skin folds. This condition is often found in clients with type 2 DM and should be reported to the HCP
The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 DM. Which statement from the client indicates additional teaching is needed? A."I need to stay hydrated during the day." B."I need to be alert for infections." C."As long as I'm in my house, I can walk barefoot." D."It is important to test my blood sugar at least four times a day."
C. Clients with diabetes should always wear shoes to protect their feet. The client should be alert for infection or injuries, stay well hydrated, &test the blood sugar 4x a day.
A client reports hoarseness & feelings of tightness in the throat. During the exam, the nurse notes visible swelling at the base of the neck, neck vein distention, a rapid pulse, & sweating. The nurse should suspect which condition in this client? A.Exophthalmos B.Pretibial myxedema C.Graves disease D.Toxic multinodular goiter
C. Graves disease involves enlargement of the thyroid gland due to overproduction of thyroid hormones. **Pretibial myxedema is nonpitting edema & would be noted in hypothyroidsim.
A heel-stick screening of a newborn reveals presence of T4 deficiency along with elevated thyroid-stimulating hormone (TSH). The infant is diagnosed with hypothyroidism. Which info should the nurse provide the parents? A.The child will eventually grow out of this & no longer need trx. B.The child will be involved in infertility tx later in life. C.The child will need lifelong thyroid medication supp. D.The child will require evaluation for radioactive iodine.
C. Hypothyroidism detected in neonates requires lifelong supp of thyroid hormone. Drug of choice for children is oral levothyroxine. Child would not require radioactive iodine - this is for hyperthyroidism. Infertility is a possibility for women c hypothyroidism who do not ovulate.
The nurse is planning a presentation on osteoporosis to clients in an assisted-living center. Which group would be appropriate for the nurse to exclude from the presentation as being at risk of developing this disease process? A.Smokers B.Postmenopausal women C.Men with high testosterone levels D.Asian American women
C. Men c high testosterone levels are not at risk of developing osteoporosis; therefore, this should not be included in the presentation. Women, especially those who are postmenopausal & of Asian descent, are much more likely to develop osteoporosis. Smoking increases risk of osteoporosis.
The nurse is developing a teaching plan for carb counting for a client newly diagnosed with type 1 DM. Which type of carb should the nurse instruct the client to restrict? A.Complex carbohydrates B.Dietary fructose C.Refined sugars D.Simple sugars
C. Refined sugars come from sugar cane & are used as natural sweeteners. Simple sugars are found in fruit, honey & dairy products. Dietary fructose comes from fruit & veg & causes slower rise in glucose levels. Complex carbs: peas, beans, whole grains & veg
The nurse reviews the lab results for a client & notes that the T4 level is low. Which RX should the nurse anticipate the HCP to prescribe? A.Antithyroid medications B.Beta blocker C.Thyroid replacement D.Radioactive iodine
C. TX of choice for hypothyroidism is levothyroxine. Radioactive iodine & antithyroid meds are used in the tx of hyperthyroidism. A beta blocker, such as propranolol, is used to lower the HR in clients with hyperthyroidism.
The nurse is caring for several clients on the unit. Which client is at the greatest risk for osteoporosis? A.The client with impaired vision B.The client treated for an eating disorder C.The client treated for withdrawal delirium tremens D.The client with early onset Alzheimer disease
C. The client being treated for withdrawal delirium tremens is at the greatest risk for osteoporosis. Delirium tremens occurs as a result of alcohol withdrawal. The client who is an alcoholic is at risk for osteoporosis
The nurse is caring for a pt with a long-term hx of type 1 who has developed PVD. The nurse is unable to palpate pedal pulses & the skin is cold to the touch. Which long-term goal is most appropriate? A.Fasting blood glucose levels will stay between 70-110 mg/dL. B.The client will remain free from infection. C.The client's skin integrity will remain intact. D.The client will remain free of injury.
C. client has impaired circulation as evidenced by cold skin & absent pedal pulses that indicate a risk for impaired skin integrity due to gangrene. There is no evidence the client is at risk for injury or has an infection.
The nurse has ideas on how to streamline charting in the EMR. Which inter professional team member should the nurse consult? A.Paramedical technologist B.Complementary healthcare provider C.Unlicensed assistive personnel D.Information technology expert
D
The nurse is caring for a client with advanced osteoporosis who implemented the use of a heating pad in the tx of pain. Which action by the nurse demonstrates appropriate use of the heating pad? A.Utilizing the heat if the prescribed pain medication does not work B.Alternating the heat with an ice pack every 30 minutes C.Encouraging the use of the heat before the client ambulates D.Removing the heat every 20 to 30 mits
D
The nurse is caring for a client newly diagnosed with type 2 DM. Prior to any teaching about meds, the client informs the nurse, "I cant give myself any injections." How should the nurse respond? A."It is understandable to be upset about a new medical diagnosis." B."Insulin administration helps with better blood glucose management." C."Why do you think you will have to give yourself injections?" D."Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise."
D.
The nurse is caring for an older adult with a hx of fractures as a result of osteoporosis. The client currently has a right radial fx. Which is the priority nursing diagnosis for the client? A.Pain, Chronic B.Nutrition, Imbalanced: Less than Body Requirements C.Mobility: Physical, Impaired D.Activity Intolerance
D.
The nurse is teaching a child with type 1 diabetes mellitus and his family about sick day guidelines. Which statement by the family indicates successful teaching? A."We will test for ketones when glucose reaches 180mg/dL." B."We will test for ketones when glucose reaches 200 mg/dL." C."We will test for ketones when glucose reaches 160 mg/dL." D."We will test for ketones when glucose reaches 240 mg/dL."
D.
The nurse manager wants to promote communication skills for successful collaboration among the nursing staff. Which communication style should the nurse use? A.Parallel communication B.Dominance in conversation C.Status-based communication D.Active listening
D. Active listening is attentive communication that decreases miscommunication
The nurse is conducting a health fair to screen for type 2 DM. Which participant should the nurse consider to be at highest risk? A.40-year-old kindergarten teacher who works in a classroom B.60-year-old retired architect who works at job site C.30-year-old nurse who works in an intensive care unit D.50-year-old office worker who sits at the computer
D. All the other participants are physically active
The nurse is working a health fair and teaching the public about risk factors for type 1 DM. Which ethnicity would the nurse include as having the highest risk in the US? A.Asian American B.Hispanic C.African American D.Caucasian American
D. Caucasian Americans have a higher risk of developing type 1 than Asian Americans, African Americans, or Hispanics.
Which tx should the nurse anticipate for a client who is newly diagnosed with hypothyroidism? A.Partial thyroidectomy B.Nonsteroidal anti-inflammatory medications C.Radiation D.Treatment with synthetic hormone
D. Expected tx of hypo is replacement c synthetic thyroid hormone. Surgical & radiation management is for hyperthyroidism.
Which info should the school nurse provide when teaching a group of adolescents the risk factors for type 2 DM? A.Limit the amount of protein intake. B.Increase carbohydrate intake. C.Monitor blood glucose levels. D.Get sufficient exercise and activity.
D. Frequently, children with type 2 develop the disease from a sedentary lifestyle & obesity. Children should limit carbs & include a normal amount of protein.
The nurse is seeing 4 clients today in the endocrinology clinic. Which client would the nurse expect to be at highest risk for Hashimoto disease? A.A 50 YO man with hypothyroidism B.A 10 YO child with congenital hypothyroidism C.A 60 YO African American man D. A 40 YO woman with a goiter
D. Hashimoto occurs twice as often in women as in men. It is NOT commonly seen in children & is more commonly seen in African Americans
Which nursing intervention is most appropriate for a client experiencing a thyroid storm? A.Cooling the client B.Replacing lost fluids C.Administering antithyroid medication D.Padding the side rails
D. PT in a thyroid storm is at high risk of developing seizures. **Cooling PT, replacing fluids & admin. of antithyroid meds are appropriate but safety is #1.
A client recently diagnosed with type 2 reports difficulty managing the disease. To which professional should the nurse refer the client for help with caloric intake? A.Primary healthcare provider B.Dietitian C.Personal trainer D.Social worker
D. The dietitian would best be able to help the client develop meal plans and incorporate foods that the client likes
The nurse is caring for a client with advanced osteoporosis who implemented the use of a heating pad in the treatment of pain. Which action by the nurse demonstrates appropriate use of the heating pad? A.Alternating the heat with an ice pack every 30 minutes B.Encouraging the use of the heat before the client ambulates C.Utilizing the heat if the prescribed pain medication does not work D.Removing the heat every 20 to 30 minutes
D. The heat should be removed every 20 to 30 minutes to avoid a rebound effect from too much heat.
The nurse is caring for an older adult with a history of fractures as a result of osteoporosis. The client currently has a right radial fracture. Which is the priority nursing diagnosis for the client? A.Pain, Chronic B.Nutrition, Imbalanced: Less than Body Requirements C.Mobility: Physical, Impaired D.Activity Intolerance
D. The pain the client will experience with a new fracture is acute. The client's mobility should not be impaired with a right radial fracture.
The nurse is caring for a postmenopausal client prescribed estrogen therapy to reduce the risk of osteoporosis. Which client statement indicates the need for further teaching? A."I will be sure to maintain all follow-up appts for evaluation." B."I understand that I may experience hot flashes." C."I have completed my smoking cessation program." D."I am glad I am not at risk for osteoporosis anymore."
D. The pt prescribed a selective estrogen receptor modulator to reduce risk of osteoporosis should address other modifiable risk factors attributed to osteoporosis. Medication alone will not prevent osteoporosis.
The nurse is caring for a client newly diagnosed with osteoporosis who states, "I know I need the extra ca, but I don't eat any dairy products." Which statement by the nurse provides the Pt with info for obtaining additional dietary ca? A."Many types of pasta are an excellent source of calcium." B."Seafood is an excellent source of calcium." C."You can increase your consumption of meat." D."Increase your consumption of vegetables."
D. The statement, "Increase your consumption of vegetables," provides information on an excellent source of calcium
The nurse is preparing medication teaching on a bisphosphonate for a client newly diagnosed with osteoporosis. The nurse should teach the client to monitor for which adverse effect? A.Anorexia B.Headaches C.Tinnitus D.Vomiting
D. Vomiting. Adverse effects that may occur c bisphosphonate include GI problems such as nausea, vomiting, abd pain, and esophageal irritation. Biphosphonates are taking once a wk.
Which finding in the medical record indicates a client has good control of type 1 DM? A.Free of amputations B.Fasting blood sugar 200 mg/dL C.Blood pressure 150/90 mmHg D.Hemoglobin A1C 5.4%
D. he fasting blood sugar should be under 125 mg/dL for DM PT. The finding of 200 mg/dL is elevated.
The nurse is planning care for a pt following a surgical procedure. Which collab action should the nurse include? a. Changing med order after speaking c the pt about adverse effects b. Informing the dietitian that the client is on a special diet & needs reteaching about the diet c. Consulting pharmacist regarding interactions between meds the pt is prescribed d. Informing pharmacist that the pt's BP is low & to hold BP med e. Updating the physical therapist regarding the client's physical activity & tolerance earlier in the day
b, c, e.
Which statement by the nurse indicates an understanding of the effects of vitamin D and calcium on osteoporosis? A."Impaired vitamin D activation reduces the serum calcium level." B."high intake of high-phosphate foods can help increase serum ca." C."Vit D is needed for renal absorption of phosphorus and calcium." D."Acidosis causes calcium to be deposited into bone."
a. Impaired vit D activation reduces serum Ca level. Vit D is essential because it facilitates ca absorption from the intestines into the blood.
The nurse is screening clients in the clinic for osteoporosis. Which client has the greatest risk factor for osteoporosis? A.The client taking selective serotonin reuptake inhibitors (SSRIs) B.The client who walks at the park for 30 minutes each day C.The client who occasionally drinks a diet soda D.The client with a BMI greater than 25 kg/m2
a. Prolonged use of certain meds such as SSRIs increases the risk of developing osteoporosis. Underweight individuals have a two-fold increased risk for fx when compared to people with a BMI greater than 25
The nurse is reviewing the chart of a pediatric client at risk for osteoporosis. Which factor in the client's HX should the nurse identify as placing the client at risk for osteoporosis? A.Cystic fibrosis B.Diabetes C.Congenital cardiac disease D.Systemic lupus erythematosus
b. DM is associated with a lower bone mass, placing the client at risk for osteoporosis.
Two hospitals in a small town are trying to increase their nursing staff. In the hopes of attracting more applicants, one is offering sign-on bonuses to entice BSN-prepared staff members to join their team. Which type of conflict could occur in this situation? A.Intrapersonal conflict B.Interorganizational conflict C.Interpersonal conflict D.Intergroup conflict
b. Interorganizational conflict occurs when one organization within the same market is in direct competition with another. If one organization is able to offer sign-on bonuses & other benefits that create a competitive advantage, this may alter the ability of other organizations to recruit & retain staff, creating conflict. Intergroup conflict is conflict between teams that are in competition for rewards or resources.
Nurses are utilizing an approach that involves addressing an issue of conflict with a resolution that satisfies both parties. Which approach is being used? A.Avoiding B.Accommodating C.Compromising D.Competing
c. Compromising involves addressing the conflict with a solution that satisfies all parties. Accommodating neglects the desires of one side to allow the other party satisfactory resolution.
Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible hyperthyroidism? (Select all that apply.) A.Vision test B.Weight loss C.Deep tendon reflexes D.Confusion E.Vital signs
A, B, C, E. *Confusion is associated with hypothyroidism
After performing a health history and physical assessment for a client, the nurse suspects type 2 DM. Which assessment finding is consistent with the nurse's suspicion? (Select all that apply.) A.Acanthosis nigricans B.Hyperglycemia C.Extreme thirst D.Decreased urination E.Hypertension
A, B, C, E. PT would have increased urination (polyuria)
The nurse is providing teaching on the prevention of osteoporosis. Which modifiable risk factor can increase a client's risk of developing osteoporosis? (Select all that apply.) A.Sedentary lifestyle B.Excessive alcohol consumption C.Smoking D.Consumption of milk products E.Moderate exercise
A, B, C.
The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this diagnosis? A.Prednisone B.Calcium supplements C.Acetaminophen D.Vitamin D supplements
A
Which priority should the nurse include in the teaching plan for a client with Graves disease? (Select all that apply.) A.Drink six to eight glasses of water a day. B. Tape your eyelids closed at night. C.Take antithyroid drugs as prescribed. D.Weigh yourself daily. E.Eat a low-calorie diet.
A, B, C, D, E. PT prescribed anti-thyroid med like proplithiouracil, must take as prescribed. Due to wt loss, wt monitored closely. Due to exophthalmos - must protect eyes, apply eye drops, wear sunglasses when outside, tape them closed at night. PT will have a decreased appetite & wt loss, high cal diet needed. May have frequent diarrhea - maintain hydration
The nurse is designing activities to promote skill building for nursing collaboration. Which activity should be included? A.Reviewing scope of practice for nurses B.Performinga self-assessment of strengths C.Analyzing different communication styles D.Explaining how authority impacts care delivery E.Acknowledging that barriers to team building will never change
A, B, C, D.
The nurse is reviewing the chart of a client with osteoporosis. Which physical assessment finding should the nurse anticipate? A. Spinal curvature B.Generalized pain C.Poor posture D.Unsteady gait
A.
An adult client reports a weight gain & feeling cold all the time. Which condition should the nurse suspect? A.Hypothyroidism B.Hyperthyroidism C.Depression D.Chronic renal failure
A. Wt gain & feeling cold (cold intolerance) can be symptoms of hypothyroidism. *Hyperthyroidism presents with wt loss & increased sweating
The nurse is caring for a child diagnosed with type 1 DM. The nurse should teach the child & parents that insulin dosing is based on which item? A.Age B.Diet C.Weight D.Urine output
B. Insulin dose is based on diet, specifically carb intake
