exam4

55. A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate that the treatment he's receiving for SIADH is effective?

1. Decrease in body weight 4. Increase in urine output 5. Decrease in urine osmolarity

57. A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which nursing diagnosis is most appropriate for this client?

1. Deficient fluid volume related to inability to conserve water

50. A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

1. Depression

The nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings should the nurse expect to note during the assessment?

1. Extreme polyuria 2. Excessive thirst 4. Low urine specific gravity

58. Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

1. Fluid intake is less than 2,500 ml/day.

31. On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

1. Hypocalcemia

32. After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

1. Primary hypothyroidism

40. A client is being treated for hypothyroidism. The nurse knows that thyroid replacement therapy has been inadequate when she notes which findings?

1. Prolonged QT interval on electrocardiogram 3. Low body temperature 5. Bradycardia

54. A client is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention would help prevent complications associated with SIADH?

1. Restricting fluids to 800 ml/day

33. The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

1. Tetany

49. When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of:

1. fresh fruits.

47. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience:

1. heat intolerance and systolic hypertension.

34. For the first 72 hours after thyroidectomy surgery, the nurse would assess the client for Chvostek's sign and Trousseau's sign because they indicate:

1. hypocalcemia.

51. In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in:

1. serum glucose level.

56. When caring for a client with diabetes insipidus, the nurse expects to administer:

1. vasopressin (Pitressin Synthetic).

52. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?

2. An irregular apical pulse

36. Which condition would the nurse expect to find in a client diagnosed with hyperparathyroidism?

2. Hypercalcemia

44. Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

2. Thyroid crisis

45. The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?

2. Weight loss, nervousness, and tachycardia

46. A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:

2. protruding eyes and a fixed stare.

42. A client receiving thyroid replacement therapy develops the flu and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which life-threatening complication?

3. Myxedema coma

53. A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

3. Restricting fluids

41. Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis?

3. Weight gain, decreased appetite, and constipation

38. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:

3. forcing fluids.

39. An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

3. myxedema coma.

35. A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which disorder?

4. Hyperparathyroidism

48. When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:

4. a blood pressure of 176/88 mm Hg.

43. The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:

4. decreased body temperature and cold intolerance

37. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:

4. phosphorus.

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy.

ANS: A, D, E Clinical manifestations of Cushing's disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

7. After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will wear dark glasses to prevent sun exposure. b. I'll keep food on upper shelves so I do not have to bend over. c. I must wash the incision with peroxide and redress it daily. d. I shall cough and deep breathe every 2 hours while I am awake.

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client? a. Atropine sulfate b. Levothyroxine sodium (Synthroid) c. Propranolol (Inderal) d. Epinephrine (Adrenalin)

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

ANS: B, D, E The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first? a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe. c. Report clear or light yellow drainage from the nose. d. Apply petroleum jelly to lips to avoid dryness.

ANS: C A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.

After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will no longer need to limit my fluid intake after surgery. b. I am glad no visible incision will result from this surgery. c. I hope I can go back to wearing size 8 shoes instead of size 12. d. I will wear slip-on shoes after surgery to limit bending over.

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.

9. A nurse plans care for a client with Cushing's disease. Which action should the nurse include in this client's plan of care to prevent injury? a. Pad the siderails of the clients bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the clients position. d. Keep suctioning equipment at the clients bedside.

ANS: C Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning

A nurse cares for a client who has hypothyroidism as a result of Hashimotos thyroiditis. The client asks, How long will I need to take this thyroid medication? How should the nurse respond? a. You will need to take the thyroid medication until the goiter is completely gone. b. Thyroiditis is cured with antibiotics. Then you wont need thyroid medication. c. You'll need thyroid pills for life because your thyroid wont start working again. d. When blood tests indicate normal thyroid function, you can stop the medication.

ANS: C Hashimotos thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication

A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

ANS: C Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The clients family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the clients environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety

6. A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first? a. Encourage range-of-motion exercises. b. Document the finding and monitor the client. c. Take vital signs, including temperature. d. Assess pain and administer pain medication.

ANS: C Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of- motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all assessments are completed and should not be the only action. Although pain medication may be a palliative measure, it is not the most appropriate initial action.

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3. d. Heart rate is 70 beats/min and regular.

ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a clients heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

60. A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

B. You must avoid coughing, sneezing, and blowing your nose

Hypertension is key manifestation of

Cushing's disease

59. A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

D. Performing capillary glucose test every 4 hours

SIADH treatment

FLUID RESTRICTION

24. Which hormone is lacking in pt with diabetes insipidus?

a. ADH

16. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?

a. Albumin level of 2.5 g/dL

6. A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?

a. Check the clients digoxin (Lanoxin) level.

21. The RN is assessing a pt with Cushing syndrome. What would the nurse expect to find?

a. Deposits of adipose tissue in the trunk, face, and dorsocervical area

17. A marathon runner comes into the clinic and states I have not urinated very much in the last few days. The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?

a. Give the client a bottle of water immediately.

15. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this clients history?

a. Have you been taking any aspirin, ibuprofen, or naproxen recently?

28. After thyroidectomy surgery, why would the nurse assess for Chvostek sign and trousseau sign?

a. Hypocalcemia

8. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

a. I am thrilled that I can continue to eat fast food.

19. Which of the following assessment findings characterize thyroid storm?

a. Increased body temp

11. A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?

a. Obtain daily weights of the client.

14. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?

a. Place the client on a cardiac monitor immediately.

22. The RN should expect a pt with hypothyroidism to report what to the dr?

a. Puffiness of the face and hands

26. In the administration of a drug such as levothyroxine the nurse should teach pt:

a. Report WL, anxiety, insomnia, and palpitation

30. A Patient with SIADH has a serum sodium level 114 mEq/L. which action should nurse take first?

a. Restrict the clients fluid intake

25. For a pt with SIADH, which nursing intervention is appropriate?

a. Restricting fluids

29. Pt who is recovering from transsphenoidal hypophysectomy and RN notes nuchal rigidity what action should the nurse take first?

a. Take VS, including tempa.

23. A Patient had subtotal thyroidectomy and now has nausea, Vomiting, tachycardia, a temperature of 105F, and restlessness what is the cause of this sign and symptom?

a. Thyroid crisis

20. When caring for a male pt with diabetes insipidus, nurse expects to administer what med?

a. Vasopressin (Pitressin Snythetic)

12. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding?

b. Client with Kussmaul respirations

4. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?

b. Dialysis works by movement of wastes from lower to higher concentration.

18. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the clients recent history?

b. Myocardial infarction

3. The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

c. Administering intravenous fluids through the AV fistula

10. A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?

c. Maintaining a balanced intake and output

5. The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8 F (37.6 C). What is the most appropriate action by the nurse?

c. Monitor the clients temperature.

7. A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the clients fluid balance is stable at this time?

c. No adventitious sounds in the lungs

61. A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first?

c. Report clear or light yellow drainage from the nose.

Hyponatremia provoques

cerebral edema that creates confusion LOC

9. A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

d. Angiotensin-converting enzyme (ACE) inhibitor

1. A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best?

d. Hold all medications since both cefazolin and vitamins are dialyzable.

27. Which of the following nursing implications is most important for a pt being medicated for Addison's disease?

d. Instruct the client to never abruptly discontinue the medication

13. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?

d. Place a heparin or heparin/saline dwell after hemodialysis.

2. A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the clients nose and around the intravenous catheter. What action by the nurse is the priority?

d. Prepare protamine sulfate for administration.

too much water equals

dilution in the body specially Na

Diabetes insipidus (decreased ADH) for acute care

excessive UO and thirst, dehydration, weakness. give Desmopressin Acetate DDAVP in injection

removal of the pituitary gland

life long replacement hormones

loss of ADH

loss of regulation of water due to the pituitary gland being removed

(clear or yellow liquid) if halo appears you test what

test for glucose positive

monitor weight when taking vasopressin

to avoid pulmonary edema

ADH same as

vasopressin

diabetes insipidus life long

vasopressin

ADH equals

water reabsorption