Exam 5-practice questions

A female patient is admitted with a diagnosis of primary hypofunction of the adrenal glands. Which assessment finding supports this diagnosis? 1.Patchy areas of pigment loss over the face 2.Decreased muscle strength 3.Greatly increased urine output 4.Scalp alopecia

Ans: 1 Rationale: Vitiligo, or patchy areas of pigment loss with increased pigmentation at the edges, is seen with primary hypofunction of the adrenal glands and is caused by autoimmune destruction of melanocytes in the skin. The other findings are signs of pituitary hypofunction. Focus: Prioritization

You admit a patient whose assessment reveals prominent brow ridge, large hands and feet, and large lips and nose. Which pituitary hormone do you suspect is elevated? 1.Thyroid-stimulating hormone 2.Growth hormone 3.Adrenocorticotropic hormone 4.Vasopressin antidiuretic hormone

Ans: 2 Rationale: These assessment findings are classic initial manifestations for growth hormone excess. Focus: Prioritization

the nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. the nurse determine that the client understands discharge instructions if the client stated that which signs and symptoms are associated with this diagnosis? select all that apply 1. tremors 2. weight loss 3. feeling cold 4. loss of body hair 5. persistent lethargy 6. puffiness of the face

Answer: 3,4,5,6 Rationale: feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism

A patient with adrenal insufficiency is to be discharged and will take prednisone (Deltasone) 10 mg orally each day. Which instruction would you be sure to teach the patient? 1.Excessive weight gain or swelling should be reported to the physician. 2.Changing positions rapidly may cause hypotension. 3.A diet with foods low in sodium may be beneficial. 4.Signs of hypoglycemia may occur while taking this drug

Ans: 1 Rationale: Rapid weight gain and edema are signs of excessive drug therapy, and the dosage of the drug would need to be adjusted. Hypotension, hyponatremia, hyperkalemia, and hypoglycemia are common in patients with adrenal hypofunction. Focus: Prioritization

When providing care for a patient with Addison disease, you should be alert for which laboratory value change? 1.Decreased hematocrit 2.Increased sodium level 3.Decreased potassium level 4.Decreased calcium level

Ans: 1 Rationale: A patient with Addison disease is at risk for anemia. The nurse should expect this patient's sodium level to decrease, and potassium and calcium levels to increase. Focus: Prioritization

A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to a UAP? 1.Reminding the patient to change positions slowly 2.Assessing the patient for muscle weakness 3.Teaching the patient how to collect a 24-hour urine sample 4.Revising the patient's nursing plan of care

Ans: 1 Rationale: Patients with hypofunction of the adrenal gland often have hypotension and should be instructed to change positions slowly. Once a patient has been so instructed, it is appropriate for the UAP to remind the patient of those instructions. Assessing, teaching, and planning nursing care require more education and should be done by licensed nurses. Focus: Delegation, supervision

Which change in vital signs would you instruct the UAP to report immediately for a patient with hyperthyroidism? 1.Rapid heart rate 2.Decreased systolic blood pressure 3.Increased respiratory rate 4.Decreased oral temperature

Ans: 1 Rationale: The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Respiratory changes are usually not symptomatic of this condition. Focus:Delegation, supervision

You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring by a nurse? 1.Calcium level 2.Sodium level 3.Potassium level 4.White blood cell count

Ans: 1 Rationale: The parathyroid glands are located on the back of the thyroid gland. The parathyroids are important in maintaining calcium and phosphorus balance. The nurse should be attentive to all patient laboratory values, but calcium and phosphorus levels are important to monitor after thyroidectomy because abnormal values could be the result of removal of the parathyroid glands during the procedure. Focus: Prioritization

You are caring for a patient with hyperthyroidism who had a partial thyroidectomy yesterday. Which change in assessment would you report to the health care provider immediately? 1.Temperature elevation to 100.2° F 2.Heart rate increase from 64 beats/min to 76 beats/min 3.Respiratory rate decrease from 26 breaths/min to 16 breaths/min 4.Pulse oximetry reading of 92%

Ans: 1 Rationale: When caring for a patient with hyperthyroidism, even after a partial thyroidectomy, a temperature elevation of 1° must be reported immediately because it may indicate an impending thyroid crisis. The other changes should be monitored, but none is urgent. Focus: Prioritization

Which health care provider orders for the patient with Addison disease should you delegate to the experienced UAP? (Select all that apply.) 1.Weigh the patient every morning. 2.Obtain fingerstick glucose before each meal and at bedtime. 3.Check vital signs every 2 hours. 4.Monitor for cardiac dysrhythmias. 5.Administer oral prednisone 10 mg every morning. 6.Record intake and output.

Ans: 1, 2, 3, 6 Rationale: Weighing patients, recording intake and output, and checking vital signs are all within the scope of practice for a UAP. An experienced UAP would have been trained to perform fingerstick glucose monitoring also. Administering medications and monitoring for cardiac dysrhythmias are within the scope of practice of licensed nurses. Focus: Delegation

You are preparing a care plan for a patient with Cushing disease. Which nursing diagnoses would you be sure to include? (Select all that apply.) 1.Risk for Injury related to the potential for bruising 2.Disturbed Body Image 3.Imbalanced Nutrition: Less than Body Requirements 4.Risk for Injury related to the potential for hypertension 5.Risk for Infection

Ans: 1, 2, 4, 5 Rationale: A patient with Cushing disease experiences body changes affecting body image and is at risk for bruising, infection, and hypertension. Such a patient usually gains weight. Focus: Prioritization

Which actions should you delegate to the LPN/LVN for the care of a patient with hypothyroidism? (Select all that apply.) 1.Assessing and recording the rate and depth of respirations 2.Auscultating lung sounds every 4 hours 3.Creating an individualized nursing care plan for the patient 4.Administering sedation medications every 6 hours 5.Checking blood pressure, heart rate, and respirations every 4 hours 6.Reminding the patient to report any episodes of chest pain or discomfort

Ans: 1, 2, 6 Rationale: Assessment, auscultation, and reminding patients about information that has been taught to them are within the scope of practice of the LPN/LVN. Certainly the LPN/LVN could check the patient's vital signs, but this would be more appropriately delegated to the UAP. Creating nursing care plans falls within the scope of practice of the RN. The use of sedation is discouraged for patients with hypothyroidism because it may make respiratory problems more difficult. If sedation is used, dosage is reduced and it is not given around the clock. Focus: Delegation, supervision

Which patients should you, as the charge nurse, assign to the care of an LPN/LVN, under the supervision of the RN team leader? 1.51-year-old who has just undergone bilateral adrenalectomy 2.83-year-old with type 2 diabetes and chronic obstructive pulmonary disease 3.38-year-old with myocardial infarction preparing for discharge 4.72-year-old with mental status changes admitted from a long-term care facility

Ans: 2 Rationale: The 83-year-old has no complicating factors at the moment. Providing care for patients in stable and uncomplicated condition falls within the LPN/LVN's educational preparation and scope of practice, with the care always being provided under the supervision and direction of an RN. The nurse should assess the patient who has just undergone surgery and the newly-admitted patient. The patient who is preparing for discharge after myocardial infarction may need some complex teaching. Focus: Delegation, supervision, assignment

The LPN/LVN asks you why the patient with Cushing disease has bruising and petechiae across her abdomen. What is your best response? 1."Patients with Cushing disease often have bleeding disorders." 2."Patients with Cushing disease have very fragile capillaries." 3."Please ask the patient if she slipped or fell during the night." 4."Thin and delicate skin can result in development of bruising."

Ans: 2 Rationale: A key cardiovascular feature seen in patients with Cushing disease is capillary fragility, which results in bruising and petechiae. Bleeding disorders are not a sign of Cushing disease, and although these patients have delicate skin, this is not the cause of the bruising. You may want to investigate whether the patient fell, but these patients have bruising and petechiae despite falls. Focus: Supervision, prioritization

For a patient with hyperthyroidism, which task will you delegate to an experienced UAP? 1.Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or chest pain 2.Monitoring the apical pulse, blood pressure, and temperature every 4 hours 3.Drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine, and thyroxine 4.Teaching the patient about side effects of the drug propylthiouracil

Ans: 2 Rationale: Monitoring vital signs and recording their values are within the education and scope of practice of UAPs. An experienced UAP should have been taught how to monitor the apical pulse. However, a nurse should observe the UAP to be sure that the UAP has mastered this skill. Instructing and teaching patients, as well as performing venipuncture to obtain laboratory samples, are more suited to the education and scope of practice of licensed nurses. In some facilities, an experienced UAP may perform venipuncture, but only after special training. Focus: Delegation, supervision, assignment

Two UAPs are assisting a patient with Cushing disease to move up in bed. Which action by the UAPs requires your immediate intervention? 1.Positioning themselves on opposite sides of the patient's bed 2.Grasping under the patient's arms to pull him up in bed 3.Lowering the side rails of the patient's bed before moving him 4.Removing the pillow before moving the patient up in bed

Ans: 2 Rationale: The patient with Cushing disease usually has paper-thin skin that is easily injured. The UAPs should use a lift or a draw sheet to carefully move the patient and prevent injury to the skin. All of the other actions are appropriate to moving this patient up in bed. Focus: Delegation, supervision

You are caring for the following patients with endocrine disorders. Which one must you assess first? 1.21-year-old with diabetes insipidus whose urine output overnight was 2000 mL 2.55-year-old with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who is demanding that the UAP refill his water pitcher 3.65-year-old with Addison disease whose morning potassium level is 6.2 mEq/L 4.48-year-old with Cushing disease with a weight gain of 1.5 lb over the past 4 days

Ans: 3 Rationale: This patient's potassium level is very high, placing the patient at risk for cardiac dysrhythmias that could be life threatening. The other patients need to be seen also, but are not as urgent as this patient. Focus: Prioritization

As the shift begins, you are assigned to care for the following patients. Which patient should you assess first? 1.38-year-old with Graves disease and a heart rate of 94 beats/min 2.63-year-old with type 2 diabetes and fingerstick glucose level of 137 mg/dL 3.58-year-old with hypothyroidism and a heart rate of 48 beats/min 4.49-year-old with Cushing disease and dependent edema rated as 1+

Ans: 3 Rationale: Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of 48 beats/min may have significant implications for cardiac output and hemodynamic stability. Patients with Graves disease usually have a rapid heart rate, but 94 beats/min is within normal limits. The diabetic patient may need sliding-scale insulin dosing. This is important but not urgent. Patients with Cushing disease frequently have dependent edema. Focus: Prioritization

A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding supports this diagnosis? 1.Periorbital edema 2.Bradycardia 3.Exophthalmos 4.Hoarse voice

Ans: 3 Rationale: Exophthalmos (abnormal protrusion of the eyes) is characteristic of patients with hyperthyroidism due to Graves disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization

Assessment findings for a patient with Cushing disease include all of the following. For which finding would you notify the physician immediately? 1.Purple striae present on the abdomen and thighs 2.Weight gain of 1 lb since the previous day 3.Dependent edema rated as 1+ in the ankles and calves 4.Crackles bilaterally in the lower lobes of the lungs

Ans: 4 Rationale: The presence of crackles in the patient's lungs indicate excess fluid volume due to excess water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and dependent edema are common findings in patients with Cushing disease. These findings should be monitored but do not require urgent action. Focus: Prioritization

You are instructing a senior nursing student on the techniques for palpation of the thyroid gland. What precaution would you be sure to include when instructing the student about thyroid palpation? 1.Always stand to the side of the patient. 2.Instruct the patient not to swallow. 3.Palpate using one hand and then the other. 4.Always palpate the thyroid gland gently.

Ans: 4 Rationale: The thyroid gland should always be palpated gently because vigorous palpation can stimulate a thyroid storm in a patient who may have hyperthyroidism. You should stand either behind or in front of the patient and use both hands to palpate the thyroid. Having the patient swallow can help with locating the thyroid gland. Focus: Supervision, delegation

A client has developed Hepatitis A after eating contaminated oysters. The nurse assess the client for which expected assessment finding? 1. Malaise 2. Dark stools 3. weight gain 4. left upper quadrant discomfort

Answer: 1 Rationale: Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, right upper quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light or clay-colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

The client is 6 hours post-thyroid surgery. The unlicensed assistant reports that the client is upset because there is blood on the client's gown. What is the priority action of the nurse? 1. Assess the client's breath sounds and respiratory effort. 2. State that it is normal to have some bleeding and ask the nurse aide to change the gown. 3. Reassure the client that some bleeding is normal, and then assess the client's level of pain. 4. Reinforce the dressing, change the gown, and call the surgeon.

Answer: 1 Rationale: Blood on the gown indicates excessive incisional bleeding. Breath sounds, including auscultating over the tracheal area, and respiratory effort should be assessed first to determine if edema is present in the tissues, thus compromising the airway. After thoroughly assessing the client and reinforcing or changing the dressing per protocol, the nurse should inform the surgeon of the amount of bleeding and all other assessment data. Usually, with thyroid surgery, there is minimal bleeding postoperatively and having the nurse's aide change the gown fails to provide proper client assessment. Focusing on the client's pain level does not address the bleeding, which is excessive rather than normal. Reinforcing the dressing and calling the surgeon fails to address the need for assessing the client's airway, which is a critical oversight.

The client is scheduled for bilateral adrenalectomy as treatment for an adrenal cortex tumor. What is the nurse's highest priority for this client in the immediate postoperative period? 1. Assess fluid and electrolyte balance, signs of hypoglycemia, and hypotension. 2. Assess for signs of hypoxia, cardiac arrhythmias, and peripheral edema. 3. Monitor the incision integrity, peripheral pulses, and magnesium level. 4. Assess for hyperthermia, bed mobility, pupil reaction, and eye movement.

Answer: 1 Rationale: During the first 48 hours after adrenalectomy, clients are at risk for adrenal insufficiency and hypovolemic shock. The lack of cortisol production can cause fluid and electrolyte loss and hypoglycemia. Peripheral edema is more likely associated with excess fluid volume but the risk after adrenalectomy is deficient fluid volume caused by sudden decrease in circulating corticosteroids and mineralocorticoids. Incision integrity and peripheral pulses are routine assessments, and magnesium level is not of particular concern at this time. Assessing for hyperthermia, bed mobility are part of routine postoperative assessments, and neurological assessment of pupils and eye movements is not of particular concern after adrenalectomy.

A client who underwent adrenal gland radiation therapy for benign tumors is receiving fludrocortisone acetate for mineralocorticoid and glucocorticoid replacement. What is a priority nursing concern for this client? 1. Risk for fluid overload 2. Risk for infection related to radiation damage 3. Risk for becoming constipated 4. Risk for ineffective respirations

Answer: 1 Rationale: Fludrocortisone and other adrenal replacement drugs cause sodium and fluid retention. Clients are at risk for excess sodium and fluid retention leading to fluid overload. The client could be at risk for secondary infection but this is not timely if the client has completed this course of therapy. There is no evidence that the client is at greater risk for developing constipation. The client could have ineffective respirations if fluid overload impairs alveolar ventilation, but the primary problem to address would be the fluid volume status.

A female client has been taking propylthiouracil (PTU) for 5 months to treat hyperthyroidism. After falling and spraining her ankle, she is treated and is given crutch-walking instructions. She says she will never have enough energy to get around on crutches and is upset about the 4.5 kg (10 lb) she gained this winter. What should be the nurse's first action? 1. Document the client's statements and consult the healthcare provider to order a serum T4. 2. Discharge the client to home and encourage her to have a TSH level drawn. 3. Encourage the client to rest at home until the sprain is healed, then increase activity. 4. Investigate the availability of a walking splint instead of using the crutches.

Answer: 1 Rationale: The client's reports of lack of energy and weight gain are consistent with hypothyroidism, which is diagnosed with a serum T4. Considering the client's complaints of energy deficit, the recent fall causing the sprain, and information about the thyroid medication, the nurse is obligated to consult the healthcare provider for T4 evaluation to prevent further injury. Discharging the client ignores the client's concern and a TSH level is expected to be high in hyperthyroidism and may not be of use. Encouraging the client to rest is appropriate after the client's physiological signs have been addressed. Investigating the need for a walking splint is an appropriate action but is not the first priority.

a client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. which findings will the interprofessional health care team focus on? select all that apply 1. hypotension 2. leukocytosis 3. hyperkalemia 4. hypercalcemia 5. hypernatremia

Answer: 1, 3 Rationale: in Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as an acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor.

The nurse is assessing the laboratory data of a client diagnosed with Cushing's syndrome. The nurse would expect to note which laboratory values prior to initiation of drug therapy? Select all that apply. 1. Elevated plasma cortisol level 2. Decreased blood glucose level 3. Increased white blood cell count 4. Increased sodium level 5. Increased potassium level

Answer: 1, 3, 4 Rationale: Clients with Cushing's syndrome or hypercortisolism have elevated levels of cortisol; drug therapy will reduce serum cortisol levels when given as directed. Clients with Cushing's syndrome or hypercortisolism have elevated white blood cell counts. Clients with Cushing's syndrome or hypercortisolism have increased sodium levels. Decreased blood glucose levels are opposite of what would be expected in Cushing's syndrome. An increased serum potassium level is opposite of what would be expected in Cushing's syndrome.

Which assessments made by the nurse could indicate the development of portal hypertension in a client with cirrhosis? Select all that apply. 1. Hemorrhoids 2. Bleeding gums 3. Muscle wasting 4. Splenomegaly 5. Ascites

Answer: 1, 4, 5 Rationale: Obstruction to portal blood flow causes a rise in portal venous pressure, which can lead to development of hemorrhoids. Splenomegaly can occur because of increased pressure in the portal system. Ascites occurs with portal blood flow obstruction because the increased pressure in the blood vessels leads to fluid accumulation in the abdomen because of pressure dynamics. Bleeding gums would indicate insufficient vitamin K production in the liver. Muscle wasting commonly accompanies the poor nutritional intake commonly seen in clients with cirrhosis

The nurse should evaluate the results of which laboratory tests while caring for a client who has cirrhosis of the liver? Select all that apply. 1. Prothrombin time 2. Urinalysis 3. Serum lipase 4. Serum troponin 5. Serum albumin

Answer: 1, 5 Rationale: Many clotting factors are produced in the liver, including fibrinogen (factor I), prothrombin (factor II), factor V, serum prothrombin conversion accelerator (factor VII), factor IX, and factor X. The client's ability to form these factors may be impaired with cirrhosis, putting the client at risk for bleeding. The prothrombin time will evaluate blood-clotting ability. One function of the liver is to synthesize protein, which may be impaired with cirrhosis. Urinalysis is a general screening measure or can be used to diagnose problems with the urinary tract. Serum lipase is a useful indicator of disorders of the pancreas. Serum troponin is a common laboratory test used to diagnose myocardial infarction.

the nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. which findings indicate the presence of a side effect associated with this medication? select all that apply 1. insomnia 2. weight loss 3. bradycardia 4. constipation 5. mild heat intolerance

Answer: 1,2, 5 Rationale: insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

a client has been diagnosed with hyperthyroidism. the nurse monitors for which signs and symptoms indicating a complication of this disorder? select all that apply 1. fever 2. nausea 3. lethargy 4. tremors 5. confusion 6. bradycardia

Answer: 1,2,4,5 Rationale: thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. signs and symptoms of a thyroid storm include elevated temperature, nausea, and tremors. in addition, as the condition progresses, the client becomes confused. the client is restless and anxious and experiences tachycardia.

The client with hyperthyroidism has been given methimazole. which nursing considerations are associated with this medication? 1. administer methimazole with food 2. place the client on a low-calorie, low protein diet 3. assess the client for unexplained bruising or bleeding 4. instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

Answer: 1,3,4 Rationale: common side effects of methimazole include nausea for meeting and diarrhea. to address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Anti-thyroid medication can cause the granulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the healthcare provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

the nurse should tell the client, who is taking levothyroxine, to notify the health care provider if which problem occurs? 1. fatigue 2. tremors 3. cold intolerance 4. excessively dry skin

Answer: 2 Rationale: excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. these include tachycardia, chest pains, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. the client should be instructed to notify the HCP if these occur. otions 1, 3, and 4 are signs of hypothyroidism.

The healthcare provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis? 1. " I have had unprotected sex with multiple partners." 2. " I ate shellfish about 2 weeks ago at a local restaurant." 3. "I was intravenous drug abuser in the past and shared needles." 4. I had a blood transfusion 30 years ago after major abdominal surgery."

Answer: 2 Rationale: hepatitis A is transmitted by the fecal-oral route via contaminated water or food, or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids, such as in the case of intravenous drug abuse, history of blood transfusion, or unprotected sex with multiple partners.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. which action should the nurse prepare to carry out initially? 1. warm the client 2. maintain a patent airway 3. administer thyroid hormone 4. administer fluid replacement

Answer: 2 Rationale: myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by an acute illness, rapid withdrawal for thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid and analgesics. in myxedema coma, the initial nursing action is to maintain patent airway. oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

A client newly diagnosed with adrenal insufficiency is to begin therapy with fludrocortisone. What therapeutic effect of this medication should the nurse explain to the client? 1. Decreases resorption of sodium by decreasing hydrogen and potassium excretion in the distal tubule 2. Increases resorption of sodium by increasing hydrogen and potassium excretion in the distal tubule 3. Decreases inflammation by suppressing migration of leukocytes and eliminating the body's immune response to certain stimuli 4. Increases inflammation by stimulating the production of leukocytes and enhancing the body's immune response to many stimuli

Answer: 2 Rationale: Adrenocortical replacement therapy medications are divided into mineralocorticoids and glucocorticoids. Mineralocorticoids such as fludrocortisone increase resorption of sodium by increasing hydrogen and potassium excretion in the distal tubule. Glucocorticoids decrease inflammation by suppressing leukocyte migration, but they do not eliminate the body's immune response. Glucocorticoids decrease inflammation by suppressing leukocyte migration and modifying the body's immune response

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1. select foods high in fat. 2. increase intake of fluids, including juices. 3. eat a good supper when anorexia is not as severe. 4. eat less often, preferable only 3 large meals daily.

Answer: 2 Rationale: Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet, as fat may be tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL per day that includes nutritional juices is also important.

A client with cardiovascular disease has been recently diagnosed with hypothyroidism, and levothyroxine has been prescribed. Which manifestation related to this medication is most important for the client to report to the prescriber? 1. Increased urine output 2. Chest pain 3. Increase in appetite 4. Loose stools

Answer: 2 Rationale: Clients with known cardiovascular disease who are prescribed thyroid hormone replacement therapy can develop chest pain that could lead to myocardial infarction. For this reason, it is the most important manifestation for the client to report. Increased urine output, increased appetite, and loose stools should be reported, but are of lesser priority.

A client, just diagnosed with hypothyroidism, also takes sodium warfarin. Before giving any thyroid replacement hormone, the nurse should check the results of what laboratory value? 1. Complete blood count (CBC) 2. Prothrombin time (PT) or international normalized ratio (INR) 3. Activated partial thromboplastin time (APTT) 4. Warfarin level

Answer: 2 Rationale: Thyroid hormones increase the effects of anticoagulants. Assessment of PT or INR will determine if the anticoagulant dosage must be decreased. The nurse also assesses the client for evidence of bruising or bleeding. A CBC could detect anemia caused by bleeding as a complication of excessive warfarin therapy, which should be monitored on a regular basis; however, it is not an essential test prior to thyroid replacement hormone therapy. APTT measures the effectiveness of heparin, and would not be appropriate for a client on Coumadin therapy. Thyroid hormones increase the effects of anticoagulants. Assessment of PT or INR will determine if the anticoagulant dosage must be decreased. Warfarin levels are not drawn.

A client with acute adrenal insufficiency (adrenal crisis) is admitted to the hospital. The nurse monitors for resolution of which manifestation to determine that drug therapy with cortisone has been effective? Select all that apply. 1. Restlessness 2. Weight loss 3. Vitiligo 4. Hypertension 5. Cardiac angina episodes

Answer: 2, 3, 5 Rationale: Clients with acute adrenal insufficiency will report anorexia, which generally leads to weight loss. Clients with acute adrenal insufficiency will exhibit integumentary symptoms such as vitiligo. Clients with acute adrenal insufficiency will exhibit cardiovascular symptoms related to anemia, such as angina. Lethargy, not restlessness, is seen with adrenal insufficiency. Hypotension, not hypertension, is seen with adrenal insufficiency.

The nurse is reviewing the laboratory results for a client with psoriasis and notes that the ammonia level is 85 mcg/dL. Which dietary selection does the nurse suggest to the client? 1. roast pork 2. cheese omelet 3. pasta with sauce 4. tuna fish sandwich

Answer: 3 Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes. The serum ammonia level assesses the ability of the liver to deaminate proteins byproducts. Normal reference interval is 10 to 80 mcg/dL. Most of the ammonia in the body is found in the gastrointestinal tract. Protein provided by the diet is transported to the liver by the portal vein. The liver breaks down proteins, which results in the formation of ammonia. Foods high in protein should be avoided since the client's ammonia level is elevated above the normal range; therefore, pasta with sauce should be the best selection.

A female client newly diagnosed with hypothyroidism indicates that she no longer participates in evening social activities, stating, "There is too much walking, and I prefer to go to bed early. I see enough of my friends at work everyday." What is the best interpretation of this statement by the nurse? 1. The client is experiencing social isolation 2. The client is not getting sufficient sleep on a regular basis 3. The client is experiencing fatigue related to the diagnosis 4. The client is at risk for cardiac issues triggered by the diagnosis

Answer: 3 Rationale: Hypothyroidism is associated with fatigue, weight gain, and decreased activity tolerance. The client states she is able to socialize during the day at work. There is no data to indicate the client is not getting enough sleep. The client's symptoms are not specific to cardiac disease.

the nurse provides instructions to a client who is taking levothyroxine. the nurse should tell the client to take this medication in which way? 1. with food 2. at lunchtime 3. on an empty stomach 4. at bedtime with a snack

Answer: 3 Rationale: oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. dosing should be done in the morning before breakfast.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. hypoglycemia 2. level of hoarseness 3. respiratory distress 4. edema at the surgical site

Answer: 3 Rationale: thyroidectomy is the removal of the thyroid gland, which is located in the interior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

Which of the following assessment findings would cause the nurse to withhold the patient's regularly scheduled dose of levothyroxine (Synthroid)? 1. A 1-kg (2-lb) weight gain 2. A blood pressure reading of 90/62 mmHg 3. A heart rate of 110 beats/minute 4. A temperature of 37.9°C (100.2°F)

Answer: 3 Rationale: A heart rate of 110 beats/min may indicate that the dosage may be too high. The nurse should withhold the dose and notify the health care provider. Options 1, 2, and 4 are incorrect. Low levels of thyroid hormone would cause weight gain and decreased BP. These are symptoms of hypothyroidism and are not reasons to withhold the medication. An elevated temperature without other signs of hyperthyroidism would not warrant holding the medication.

A client with a history of cardiac disease is exhibiting severe symptoms of hypothyroidism, and is started on medication therapy with levothyroxine. The nurse anticipates that which principle will be followed for initiation of drug therapy? 1. Start with the highest dose, and titrate according to the client's response. 2. Start with the highest dose and give a beta blocker to prevent tachycardia. 3. Start with a low dose and gradually increase the dose over a period of weeks. 4. Administer a fixed dose calculated by client's weight; adjust as necessary

Answer: 3 Rationale: Clients with severe symptoms of hypothyroidism and a history of cardiac disease must be started on the lowest dose possible of hormone therapy and have the dose gradually increased in order to prevent onset of severe hypertension, heart failure, and myocardial infarction (MI). Weight would not be an appropriate calculation factor. The highest possible starting dose, with or without a beta blocker, puts the client at risk for chest pain and subsequent MI.

The nurse is caring for a child with a history of severe diarrhea. Which notation about acid-base imbalance would the nurse expect to find in the medical record? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

Answer: 3 Rationale: In severe diarrhea, excess bicarbonate (base) is lost, which predisposes to metabolic acidosis. There is also carbohydrate malabsorption and depletion of glycogen stores, resulting in fat metabolism. Ketoacids are the by-products of fat metabolism, which adds to the metabolic acidosis. Diarrhea is not a respiratory problem, although diarrhea can lead to acidosis. Diarrhea is not a respiratory problem and it does not lead to alkalosis. Diarrhea is a metabolic problem but does not lead to alkalosis.

A patient is being treated with propylthiouracil (PTU) for hyperthyroidism, pending thyroidectomy. While the patient is taking this drug, what symptoms will the nurse teach the patient to report to the health care provider? 1. Tinnitus, altered taste, thickened saliva 2. Insomnia, nightmares, night sweats 3. Sore throat, chills, low-grade fever 4. Dry eyes, decreased blinking, reddened conjunctiva

Answer: 3 Rationale: Low-grade fever, chills, and sore throat are signs of possible infection. Because PTU may cause leukopenia or agranulocytosis, these symptoms should be reported to the health care provider for further assessment. Options 1, 2, and 4 are incorrect. Tinnitus, altered taste, thickened saliva, nightmares or night sweats, insomnia, dry eyes, decreased blinking, or reddened sclera are not symptoms related to PTU therapy

A client recently diagnosed with hypothyroidism demonstrates understanding of prescribed levothyroxine medication when she makes which statement? 1. "I should be able to become pregnant in a couple of months." 2. "This medication will help me lose all this excess weight." 3. "I should call the healthcare provider for nervousness, diarrhea, or increased pulse." 4. "This medication should be taken with food, preferably dairy products."

Answer: 3 Rationale: Nervousness, diarrhea, and increased pulse are indications of excessive effect of the medication, and the dosage may need to be adjusted downward. The client should report these to the healthcare provider. Levothyroxine is not prescribed to affect pregnancy. After the client has reached normal serum T4 levels, the normal metabolic rate may help the client lose the weight gained during the hypothyroid state, but this is not the purpose of the replacement medication. Usually, the medication should be taken on an empty stomach, 1 hour prior to a meal or 2 hours after a meal.

The nurse is caring for a client who has ascites, and the healthcare provider prescribes spironolactone. When the client asks why this drug is being used, what is the best response by the nurse? 1. "This drug will help increase the level of protein in your blood." 2. "The drug will cause an increase in the amount of the hormone aldosterone your body produces." 3. "This medication is a diuretic but does not make the kidneys excrete potassium." 4."This will help you excrete larger amounts of ammonia."

Answer: 3 Rationale: Spironolactone is used in clients with ascites who show no improvement with bedrest and fluid restriction. It inhibits sodium reabsorption in the distal tubule and promotes potassium retention by inhibiting aldosterone. Spironolactone does not increase protein levels in the blood. Spironolactone does not increase production of aldosterone. Spironolactone does not aid in excreting ammonia, although lactulose will have this effect.

A client with Graves' disease has been taking medication therapy as prescribed. Which finding, noted on cardiac assessment, indicates to the nurse that the client has not had a sufficient response to medication therapy? 1. Decreased systolic blood pressure 2. Narrowed pulse pressure 3. Bradycardia 4. Tachycardia

Answer: 4 Rationale: Cardiac problems related to Graves' disease and hyperthyroidism include increased systolic blood pressure, a widened pulse pressure, tachycardia, and other dysrhythmias. Appropriate control of the disorder with medication therapy would prevent these manifestations from occurring.

When caring for a client who has cirrhosis, the nurse notices flapping tremors of the wrist and fingers. How should the nurse chart this finding? 1. "Trousseau's sign noted." 2. "Caput medusa noted." 3. "Fetor hepaticus noted." 4. "Asterixis noted."

Answer: 4 Rationale: Asterixis is a flapping tremor of the hands when the arms are extended. Trousseau's sign reflects hypocalcemia. Caput medusa refers to spiderlike abdominal veins that are also commonly found in clients with cirrhosis who have portal hypertension as a complication. Fetor hepaticus is a specific odor noted in liver failure.

The nurse is caring for a client who has just been diagnosed with Graves' disease. During client education, the nurse should include what information? 1. Atropine-like medications are safe to use. 2. Thyroid hormone replacement therapy is necessary. 3. A low-calorie diet will be ordered. 4. Propylthiouracil (PTU) will be prescribed.

Answer: 4 Rationale: Graves' disease is caused by elevated levels of thyroid hormone. Clients experience tachycardia, nervousness, insomnia, increased heat production, and weight loss. Medication therapy with an agent such as propylthiouracil will help control the disorder. Atropine-like drugs are contraindicated for clients with hyperthyroidism. Initiation of thyroid hormone replacement therapy would be indicated for hypothyroidism. A client with Graves' disease needs a high-calorie diet, not a low-calorie one; behavioral and metabolic activity increases, which results in weight loss.

A recently retired client who lives alone is admitted with myxedema coma, which occurred because of inability to pay for the medication. What is the highest priority of the nurse at the time of admission? 1. Assist the client to chair every 4 hours to promote oxygenation and prevent skin breakdown. 2. Prevent injury related to mental confusion and elevated blood pressure (BP). 3. Prevent skin breakdown and promote nutrition with low-fiber foods. 4. Monitor for signs of decreased cardiac output and airway obstruction.

Answer: 4 Rationale: Myxedema is characterized by severely decreased cardiac output, fluid and electrolyte imbalance, acidosis, decreased respiratory function, tongue edema, and hypothermia. The client's airway, breathing, and circulation needs must be attended to first. The client would be on bedrest immediately after admission. The BP would be decreased, rather than elevated, because of reduced cardiac output. The client in myxedema coma has generally lost consciousness. Skin breakdown is a significant risk that needs to be managed concurrently with promotion of oxygenation, but the diet should be high in fiber once the client is stable enough to eat.

A patient has been prescribed orlistat (Xenical). Which of the following will the nurse teach this patient? 1. Take the drug once in the morning. 2. Take the drug only when feeling hungry. 3. Take the drug before exercising daily but no more than three times per day. 4. Take the drug with or just before a meal containing fats.

Answer: 4 Rationale: Orlistat (Xenical) should be taken with, or right before, meals containing fats. Options 1, 2, and 3 are incorrect. Orlistat is taken throughout the day with meals and does not decrease appetite. Exercise is an important part of a healthy lifestyle but the drug does not need to be administered before exercise.

The nurse is assisting a patient with chronic adrenal insufficiency to plan for medication consistency while on a family vacation trip. He is taking hydrocortisone (Cortef) and fludrocortisones (Florinef) as replacement therapy. What essential detail does this patient need to remember to do? 1. Take his blood pressure once or twice daily. 2. Avoid crowded indoor areas to avoid infections. 3. Have his vision checked before he leaves. 4. Carry an oral and injectable form of both drugs with him on his trip.

Answer: 4 Rationale: Patients who are taking replacement therapy for adrenal insufficiency mustcarry emergency supplies of both oral and injectable forms of the drugs they are prescribed in case of emergencies where the drug may not be readily available. Options 1, 2, and 3 are incorrect. Checking blood pressure, avoiding crowds, and monitoring for visual changes are appropriate for high-dose (i.e., hyperphysiological) doses of corticosteroids, but this patient is on replacement therapy. The goal of replacement therapy is to maintain normal levels of these hormones

A client with a history of Cushing's syndrome is admitted with multiple contusions, lacerations, and blood loss following a motor vehicle accident. Current laboratory values are BUN 30 mg/dL, creatinine 1.0 mg/dL, sodium 148 mEq/L, potassium 4.8 mEq/L, chloride 108 mEq/L, and cortisol 29 mcg/dL. Which problems should the nurse address when initiating the client's plan of care? Select all that apply. 1. Urinary elimination 2. Musculoskeletal disuse 3. Possible difficulty with airway clearance 4. Increased susceptibility to infection 5. Possible dehydration

Answer: 4, 5 Rationale: Clients with Cushing's syndrome are more susceptible to infection because of impaired immune function from elevated cortisol level. The BUN and sodium are elevated because of dehydration caused by blood loss, and a potassium and chloride at the higher end of the normal range add further support to this conclusion. The client has no risk factors for problems with urinary elimination. The client's injuries do not predispose the client to be at risk for musculoskeletal disuse. The client is not experiencing any difficulty with the airway.

The client is being treated for Addison's disease with glucocorticoid replacement medication. The nurse evaluates that the client understands medication therapy when the client makes which statement? Select all that apply. 1. "I should take this medication every evening at bedtime." 2. "My irregular pulse should convert to a regular rate and rhythm." 3. "This medication will help me control my increased blood pressure." 4. "I should call my doctor if I gain 0.9 kg (2 lb)." 5. "I should call my doctor if I feel weak or have a cold."

Answer: 4, 5 Rationale: Glucocorticoid replacement medication can cause fluid and sodium retention, leading to weight gain and fluid volume excess. Doses need to be increased during times of stress and can impair the body's ability to recover from an infection. Therefore, the healthcare provider must be consulted for signs of a cold or infection. Glucocorticoids should be taken in the morning with food. The medication will not affect cardiac rhythm. Glucocorticoids will increase BP and thus are not safe for clients with hypertension.