NURS123 Final Exam

A client with a fractured femur who has had an open reduction-internal fixation is receiving ketorolac. Which assessment measurement will assist the nurse in determining the effectiveness of this medication? 1. Pain rating 2. Temperature 3. Serum calcium level 4. White blood cell count

1

The nurse is monitoring the status of a postoperative client in the immediate postoperative period. The nurse would become most concerned with which sign that could indicate an evolving complication? 1. Increasing restlessness 2. A pulse of 86 beats/minute 3. Blood pressure of 110/70 mm Hg 4. Hypoactive bowel sounds in all 4 quadrants

1

The nurse is reviewing a surgeon's prescription sheet for a preoperative client that states that the client must be nothing by mouth (NPO) after midnight. The nurse should call the surgeon to clarify that which medication should be given to the client and not withheld? 1. Prednisone 2. Ferrous sulfate 3. Cyclobenzaprine 4. Conjugated estrogen

1

The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find? 1. Decreased serum osmolarity 2. Elevated urine calcium levels 3. Decreased urine sodium levels 4. Elevated serum sodium levels

1

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? 1. Promote absorption. 2. Minimize discomfort. 3. Prevent muscle destruction. 4. Avoid infection.

1

he nurse is reviewing the health care provider's prescription sheet for a preoperative client, which states that the client must be NPO (nothing by mouth) after midnight. Which medication should the nurse clarify to be given and not withheld? 1. Atenolol 2. Atorvastatin 3. Cyclobenzaprine 4. Conjugated estrogen

1

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1. Irritability 2. Complaints of nausea 3. Sodium level of 128 mEq/L (128 mmol/L) 4. Potassium level of 3.2 mEq/L (3.2 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1 2 3 5

Which of the following is an age-related change that may affect diabetes? Select all that apply. 1. Decreased vision 2. Taste changes 3. Increased proprioception 4. Decreased renal function 5. Increased bowel motility

1 2 4

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

1 2 4 5

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply. 1. "Include adequate fiber and fluids in your diet." 2. "Wear slip-on shoes rather than those that need to be tied." 3. "A postnasal drip may be expected for several weeks after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5. "Contact your health care provider immediately if you develop any headache, fever, or neck stiffness."

1 2 4 5

A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. 1. Strict intake and output 2. Urine and blood chemistry 3. Signs of dehydration 4. Liver function tests 5. Neurologic function

1 2 5

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

1 3

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hour 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats/minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

3

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client? 1. Maintain a high-carbohydrate diet. 2. Increase fluid intake, particularly at mealtime. 3. Maintain a low Fowler's position while eating. 4. Ambulate for at least 30 minutes following each meal.

3

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? 1. Biguanides 2. Thiazolidinediones 3. Sulfonylureas 4. Alpha-glucosidase inhibitors

3

Which of the following would the nurse most likely assess in a client with diabetes who is experiencing autonomic neuropathy? 1. Paresthesias 2. Skeletal deformities 3. Erectile dysfunction 4. Soft tissue ulceration

3

A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take all of my hydrocortisone in the morning, right after I wake up." 2. "I'll take the entire dose at bedtime." 3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 4. "I'll take my hydrocortisone in the late afternoon, before dinner."

3 (Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; this dosage schedule reduces adverse effects.)

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3 (IV fluids + REG insulin)

A client is being started on tramadol therapy for pain management after a back injury. When educating this client on tramadol therapy, what is the priority? 1. The client cannot drink alcohol while taking tramadol. 2. The client cannot smoke cigarettes while taking tramadol. 3. The client should increase the intake of calcium-rich foods. 4. The client should avoid additional over-the-counter cough syrups.

1 (further depresses CNS)

The clinic nurse is caring for a client who has been prescribed fentanyl, a potent opioid, for chronic pain. In what forms is it available for chronic pain administration in the at-home setting? Select all that apply. 1. Intranasal spray 2. Intravenous push 3. Fentanyl via a patient-controlled analgesia pump 4. Oral transmucosal lozenge 5. 72-hour transdermal patch 6. Effervescent buccal oralets

1 4 5 6

GERD? barium swallow + EGD w/ biopsy for barretts esophagus

lactated ringer solution (isotonic w/ electrolytes)

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium

1

The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. The client's pain rating 2. Nonverbal cues from the client 3. The nurse's impression of the client's pain 4. Pain relief after appropriate nursing intervention

1

The nurse is caring for a client who is receiving morphine sulfate by the intravenous route for acute pain. The nurse ensures that which medication is available in the event that the client's respiratory status and level of consciousness deteriorate? 1. Naloxone 2. Promethazine 3. Atropine sulfate 4. Protamine sulfate

1

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload? 1. dyspnea and hypertension 2. confusion and diarrhea 3. pulmonary congestion and muscle cramps 4. hypertension and weight gain without edema

1 (fluid overload sx: confusion, dyspnea, pulmonary congestion, and hypertension. vs. Muscle cramps, diarrhea, and weight gain without edema ---> indicative of hyponatremia)

A 61-year-old man who has achieved great success in the areas of business and community influence is frustrated that he has received a diagnosis of type 2 diabetes. The man tells the nurse, "I'm not at all obese, so I don't see how this could have developed." When discussing the risk factors for diabetes, which of the following factors should the nurse identify? Select all that apply. 1. Age greater than 45 years 2. Hypertension 3. Family history 4. History of angina or myocardial infarction 5. High-stress lifestyle

1 2 3

The nurse is preparing a client for surgery scheduled in two hours. Which interventions are appropriate in the preoperative period? Select all that apply. 1. Assist the client to void before transfer to the operating room. 2. Check all surgeon's prescriptions to ensure they have been carried out. 3. Teach postoperative breathing exercises before the client is premedicated. 4. Review the client's record for a history and physical report and laboratory reports. 5. Administer all the daily medications 2 hours before the scheduled time of the surgery.

1 2 4

A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform PREoperatively? 1. Initiate intravenous access for fluid therapy. 2. Begin administering prescribed corticosteroid. 3. Monitor blood pressure (BP) frequently. 4. Check for the signs of adrenal insufficiency.

3 (emphasized mostly as closely mntr DURING/after surg b/c of adrenal manipulation)

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

3 (mntr swelling at surgical site b/c = anterior neck, could ---> resp. distress)

Which of the following is considered a late symptom of hypothyroidism? 1. Brittle nails 2. Cold intolerance 3. Loss of libido 4. Physical sluggishness

2

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? 1. Folate 2. B12 3. C 4. A

2 (inhibits absorption)

segmental systolic pressure measurements via plethysmography revealing what are diagnostic of arterial narrowing: 1. <0.91 index 2. >30 mmHg difference 3. strictures on uss images

2 (option 1: ankle brachial index or ABI finding used for dx - <0.91 represents decreased blood flow)

what would the RN expect to be ordered if assessment finding shows that following depression of both radial and ulnar arteries simultaneously, color is slow to return?

ABGs (Allen test)

most common site for peptic ulcer formation?

duodenum

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test

endoscopy

anticipated Rx for stomach bleed? (PUD)

NGT insertion . - post NGT removal, pt teach "i can eat foods that dont cause me stomach pain"

DM diet?

low sodium low protein

Most important lifestyle modification for improving outcomes in hypertension is?

weight loss

The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? 1. Decreased serum osmolarity 2. Elevated urine calcium levels 3. Elevated serum sodium levels 4. Decreased urine sodium levels

1

The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones? 1. Radioimmunoassay 2. Magnetic resonance imaging 3. Cortisol level determination 4. Computed tomography (CT)

1

Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast? 1. Encourage midday snack. 2. Make sure breakfast is not delayed. 3. Delay dinner meal. 4. Provide fewest amount of carbohydrates at lunch meal.

1

A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

1 (3 P's of hyperBG)

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively? 1. Low fiber 2. Low calorie 3. High protein 4. High carbohydrate

1 (After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food)

SATA RN interventions for pt post-op transphenoidal hypophysectomy 1) restrict sodium intake 2) keep HOB elevated to 30 degrees 3) assist patient with I/S and deep breathing 4) maintain flat hob

1 2 3 (exam 3)

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1 2 4 5

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1 3 4 (Decreased blood glucose levels produce autonomic nervous system symptoms; option 5 is hyper)

A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. 1. Hypertension 2. Weight loss 3. Poor wound healing 4. Alterations in glucose metabolism 5. Hypotension

1 3 4 (also weight gain)

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.

2

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems? 1. Gastric ulcer 2. Acute gastritis 3. Duodenal ulcer 4. Chronic Gastritis

2

A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? 1. Bumetanide 2. Metolazone 3. Hydrochlorothiazide 4. Furosemide

3

A client is admitted to the ambulatory surgery center for elective surgery. The nurse asks the client whether any food, fluid, or medication was taken today. Which medication, if taken by the client, should indicate to the nurse the need to contact the health care provider? 1. metoprolol 2. ciprofloxacin 3. warfarin 4. amlodipine

3

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? 1. Perform capillary blood glucose monitoring four times daily. 2. Drink 8 oz of fluids. 3. Administer hydrocortisone I.M. 4. Continue to take his usual dose of hydrocortisone.

3

The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence? 1. Increased use of glucose 2. Overproduction of insulin 3. Increased production of glucose 4. Increased osmotic movement of water

3

The nurse assesses a client's surgical incision for signs of infection. Which finding by the nurse would be interpreted as a normal finding at the surgical site? 1. Red, hard skin 2. Serous drainage 3. Purulent drainage 4. Warm, tender skin

3

The nurse cares for a client prior to surgery. The client asks the nurse, "What is the advantage of spinal anesthesia over general anesthesia for controlling my pain?" Which is the best response by the nurse? 1. "There is less risk of developing a low blood pressure." 2. "Itching, a side effect of the morphine, will be minimized." 3. "Your pain can be managed without making you as sleepy." 4. "You will be able to maintain control of your bladder function.

3

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1. Ambulate following a meal. 2. Eat high-carbohydrate foods. 3. Limit the fluids taken with meals. 4. Sit in a high Fowler's position during meals.

3

When caring for a client who's being treated for hyperthyroidism, the nurse should: 1. provide extra blankets and clothing to keep the client warm. 2. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. 3. balance the client's periods of activity and rest. 4. encourage the client to be active to prevent constipation.

3

When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? 1. Depression 2. Hypoglycemia 3. Angina 4. Mental confusion

3

A client has received atropine sulfate intravenously during a surgical procedure. The nurse should monitor the client for which side effect of the medication in the immediate postoperative period? 1. Diarrhea 2. Bradycardia 3. Urinary retention 4. Excessive salivation

3 (also causes tachycardia, drowsiness, blurred vision, dry mouth, constipation)

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. 1. Ranitidine (Zantac) 2. Cimetidine (Tagamet) 3. Famotidine (Pepcid) 4. Omeprazole (Prilosec)

4

A staff nurse is precepting a new graduate nurse and the new graduate is assigned to care for a client with chronic pain. Which statement, if made by the new graduate nurse, indicates the need for further teaching regarding pain management? 1. "I will be sure to ask my client what his pain level is on a scale of 0 to 10." 2. "I know that I should follow up after giving medication to make sure it is effective." 3. "I know that pain in the older client might manifest as sleep disturbances or depression." 4. "I will be sure to cue in to any indicators that the client may be exaggerating their pain."

4

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 1. Pancreatic cells 2. Serum insulin levels 3. Adipose tissue 4. Red blood cells (RBCs)

4

To prevent postoperative atelectasis in a client recovering from an open cholecystectomy, what should the nurse do first? 1. Request a cardiopulmonary consult. 2. Teach the client to splint the incision. 3. Teach the proper technique for huff coughing. 4. Ensure that the client is experiencing adequate pain control.

4 (Coughing is needed in the postoperative client to mobilize secretions and expel them from the airways and prevent atelectasis. The client with an abdominal incision is hesitant to cough unless pain control is adequate. The nurse should first ensure that pain control is adequate so that pulmonary hygiene measures are maximally effective. Huff coughing, although it can be used in the postoperative client, usu. recommended for COPD)

PAD sx show up at

60% occlusion

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Nasogastric tube insertion Oral contrast Pelvic x-ray Stool specimen

NGT

RN completed med admin of nitroglycerin - within minutes, pt c/o H/A. Priority action?

administer prescribed analgesic (NG --> vasodilation; main side effect = h/a, an expected med response)

theophylline (xanthine)

caffeine side fx

ABG finding assc. w/ status asthmatics?

respiratory alkalosis

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which characteristic would the nurse be most likely to find? 1. Green color and texture 2. Black and tarry appearance 3. Clay-like quality 4. Bright red blood in stool

2

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL (2.28 mmol/L). Which medication should the nurse anticipate will be prescribed for the client? 1. Glucagon 2. Glyburide 3. Metformin 4. Regular insulin

1

A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: 1. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. 2. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. 3. Decreased cardiac output related to hypotension secondary to Cushing's syndrome 4. Risk for imbalanced fluid volume related to excessive sodium loss.

1

A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse should assess the client for a hypoglycemic reaction at which times? 1. Between 1:00 and 3:00 p.m. 2. 10 minutes after administration 3. Between 4:00 p.m. and 12:00 a.m. 4. Between 8:00 and 10:00 p.m.

1

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: 1. depression. 2. hypoglycemia. 3. hyperthyroidism. 4. neuropathy.

1

A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? 1. glycosylated hemoglobin 2. postprandial glucose 3. fasting glucose 4. hematocrit A1c

1

A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of: 1. hyponatremia and hyperkalemia. 2. hypernatremia and hyperkalemia 3.. hyponatremia and hypokalemia 4.. hypernatremia and hypokalemia.

1

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

1

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Consuming small, frequent, bland meals 3. Taking H2-receptor antagonist medication 4. Raising the head of the bed on 6-inch (15 cm) blocks

1

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1. Below-normal urine osmolality level, above-normal serum osmolality level 2. Below-normal urine and serum osmolality levels 3. Above-normal urine osmolality level, below-normal serum osmolality level 4. Above-normal urine and serum osmolality levels

1

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: 1. rapid-acting insulin only. 2. short- and intermediate-acting insulins. 3. intermediate- and long-acting insulins. 4. short- and long-acting insulins.

1

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? 1. Below-normal serum potassium level 2. Serum alkalosis 3. Serum ketone bodies 4. Elevated serum acetone level

1

A nurse is assigned to care for a client with type 1 diabetes mellitus. During the shift, the nurse should monitor for which manifestation as a sign of hypoglycemia? 1. Tremors 2. Anorexia 3. Hot, dry skin 4. Muscle cramps

1

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. The antral portion of the stomach is removed and a vagotomy is performed. A sectioned portion of the stomach is joined to the jejunum. The vagus nerve is cut and gastric drainage is established.

1

A student nurse is developing a teaching plan for a patient with chronic obstructive pulmonary disease (COPD). What should the student include as a priority area of teaching? 1. Setting and accepting realistic short-term and long-range goals 2. Adopting a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity 3.Avoiding emotional disturbances and stressful situations that might trigger a coughing episode 4. Avoiding extremes of heat and cold

1

An older adult patient with a diagnosis of chronic gastritis has achieved acceptable control of his condition with the use of an H2 receptor antagonist. This patient's symptom control is a result of what therapeutic action of this drug? 1. A decrease in HCl production by parietal cells 2. The occlusion of parietal cells 3. Activation of the gastric buffer system and release of alkaline gastric secretions 4. An increase in the pH of gastric secretions

1

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 1. 70% NPH insulin and 30% regular insulin 2. 70% regular insulin and 30% NPH insulin 3. 70 units of regular insulin and 30 units of NPH insulin 4. 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin

1

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? 1. The incidence and prevalence of hypertension increase with age. 2. The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. 3. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. 4. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

1

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? 1. Heart and blood vessels 2. Brain and sympathetic nervous system 3. Lung and arteries 4. Kidneys and autonomic nervous system

1

The nurse is discussing pain management with a student who is caring for a 1-day postoperative abdominal surgery client who is a known opioid substance abuser. What comment by the student indicates a need for further education? 1. Opioid substance abusers are less tolerant to opioids and require decreased doses. 2. These clients should be allowed to choose their pain medications and dosing regimen. 3. Nonopioid therapies such as cutaneous stimulation are generally effective if used alone. 4. These clients are at an increased risk for abrupt physiological withdrawal when opioid agonists are abruptly withdrawn.

1

The nurse is making initial rounds on the nursing unit to check the condition of assigned clients. The client complains of discomfort at the intravenous (IV) site, and the nurse notes that the site is cool, pale, and swollen and that the solution is infusing slowly. What action should the nurse take first? 1. Stop the IV infusion. 2. Apply saline-soaked dressing to site immediately and call the HCP 3. Contact HCP to obtain a prescription for heat pack to be applied intermittently 4. Slow the rate of IV administration.

1

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1 (Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of DM - the 3 poly's - option 2 is hypo, 3 and 4 not r/t DM)

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? 1. "I should increase the fiber in my diet." 2. "I will need to avoid caffeinated beverages." 3. "I'm going to learn some stress reduction techniques." 4. "I can have exacerbations and remissions with Crohn's disease."

1 (LOW fiber diet Rx'd for crohn)

A child is seen in the school nurse's office with complaints of pain in his right forearm. In reviewing the child's record the nurse notes that he has a history of being physically abused by the mother. Which should be the initial intervention with this child? 1. Assess the child's physical status. 2. Ask the child how the injury occurred. 3. Report the case as suspected child abuse. 4. Observe the interactions between the child and his friends.

1 (assessed for injury to the right arm and for bruises, burns, scars, and any other signs of abuse)

A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1. Laryngeal stridor 2. Difficulty voiding 3. Mild incisional pain 4. Absence of bowel sounds

1 (compressed trach ---> emergency r/t potential to occlude airway; high-pitched sound on inspiration)

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1. Hypotension and fever 2. Mental status changes and hypertension 3. Subnormal temperature and hypotension 4. Complaints of weakness and hypertension

1 (hypoTN, fever, weakness, mental status changes)

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate education before discharge. 2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 3. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. 4. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.

1 (if pt becomes ill and cannot retain food or fluids for more than 4 hours, HCP should be notified)

A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? 1. A 24-year-old client with unstable hyperthyroidism with sinus tachycardia 2. An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy 3. A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) 4. A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes

1 (likely to be irritable, anxious - needs uninterrupted rest, thus keep away from noise of RN station)

The nurse is instructing a client about receiving patient-controlled analgesia to control postoperative pain. What comment by the client indicates that further instruction is needed? 1. "That's great that overdosing can't happen." 2. "It will keep my pain at a pretty consistent level." 3. "I feel a lot less nervous because I can control my own pain." 4. "I'm glad I can give myself some medication and not have to wait for the nurse to give me something."

1 (per Samour lecture, advantage of PCA is that any risk of overdoing is prevented by maximum doses set within certain time frame)

The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the client's medication history, and determines it is necessary to contact the health care provider (HCP) if the client is also taking which medications, that are contraindicated for use with ibuprofen? Select all that apply. 1. Warfarin 2. Glimepiride 3. Amlodipine 4. Simvastatin 5. Hydrochlorothiazide

1 2 3 (NSAIDs amplify anticoagulants i.e. warfarin, concurrent use of ibuprofen w/ oral antidiabetic meds i.e. glimepiride can result in hypoglycemial ibuprofen w/ calcium channel blockers can ---> toxicity)

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema. 4. Maintain a high-sodium diet. 5. Maintain a low-potassium diet.

1 2 3 (low Na, high K; excess fluid volume)

The nurse is assessing the status of pain in an alert elderly client who was recently admitted to the hospital with a diagnosis of ruptured lumbar disc. What are some of the beliefs and concerns older adults have about pain? Select all that apply. 1. Pain is something that must be lived with. 2. Nurses are too busy to listen to reports of pain. 3. Pain signifies a serious illness or impending death. 4. Reporting pain will result in being labeled as a "bad" client. 5. Expressing pain is only done by people who want attention. 6. Nurses and other caregivers often give too much medication to older clients.

1 2 3 4

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care 5. A reminder to read the labels on over-the-counter medications before purchase

1 2 3 4 (consult HCP before purchasing otc meds)

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. 1. Prevent airway collapse 2. Strengthen the diaphragm 3. Control the rate and depth of respirations 4. Release air trapped in the lungs

1 3 4

The nurse is assessing a client's postoperative pain using the PQRSTU method. Using this method, which questions would the nurse ask the client? Select all that apply. Click on the Question Video button to view a video showing preparation procedures. 1. "Where is the pain located?" 2. "Does pain medication help?" 3. "What does the pain feel like?" 4. "How does the pain affect you?" 5. "Do you have the pain when you sleep?" 6. "What makes your pain better or worse?"

1 3 4 6 (Provocative/palliative, Quality of the pain, Region or Radiation of the pain, Severity of the pain, Timing of the pain (continuous or intermittent), How the pain affects yoU )

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high Fowler's. 5. Administer a vasopressin antagonist as prescribed.

1 3 5

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hypoactive bowel sounds

2

A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? 1. Increase the suction level. 2. Notify the health care provider. 3. Irrigate the tube. 4. Reposition the tube.

2

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? 1. "These medications will coat the ulcer and decrease the acid producation in my stomach." 2. "The medications will kill the bacteria and stop the acid production." 3. "My ulcer will heal because these medications will kill the bacteria." 4. "I should take these medications only when I have pain from my ulcer."

2

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? 1. Itching, rash, and jaundice 2. Dyspnea, tachycardia, and pallor 3. Nights sweats, weight loss, and diarrhea 4. Nausea, vomiting, and anorexia

2

A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: 1. notify the primary physician immediately. 2. give the nebulizer treatment herself. 3. stay with the client until the therapist arrives. 4. administer the treatment by metered-dose inhaler.

2

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "NPH is a basal insulin, so I should exercise in the evening."

2

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? 1. Serum ketone test 2. Fluid deprivation test 3. Urine glucose test 4. Capillary blood glucose test

2

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: 1. checking for the presence of ketones with each void. 2. providing client education at every opportunity. 3. monitoring blood glucose every 4 hours and as needed. 4. administering insulin routinely and as needed via a sliding scale.

2

A patient who is receiving treatment for hyperthyroidism is being monitored closely by the care team. When observing this patient for signs and symptoms of thyroid storm (thyrotoxicosis), the nurse should prioritize which of the following assessments? 1. Deep tendon reflexes and peripheral pulses 2. Temperature and heart rate 3. Assessment for visual and auditory disturbances 4. Pain and level of consciousness (LOC)

2

A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels? 1. Reduces the production of glucose by the liver 2. Helps tissues use insulin more efficiently 3. Stimulates insulin release 4. Delays digestion of carbohydrates

2

Symptoms associated with pyloric obstruction include all of the following except: 1. Anorexia 2. Diarrhea 3. Epigastric fullness 4. Nausea and vomiting

2

The nurse advises the patient who has just been diagnosed with acute gastritis to: 1. Restrict all food for 72 hours to rest the stomach. 2. Refrain from food until the GI symptoms subside. 3. Restrict food and fluids for 12 hours. 4. Take an emetic to rid the stomach of the irritating products.

2

The nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a patient-controlled analgesia (PCA) pump for pain control. The nurse enters the client's room and finds the client drowsy and records the following vital signs: temperature 97.2°F (36.2°C) orally, pulse 52 beats per minute, blood pressure 101/58 mm Hg, respiratory rate 11 breaths per minute, and SpO2 of 93% on 3 liters of oxygen via nasal cannula. Which action should the nurse take next? 1. Document the findings. 2. Attempt to arouse the client. 3. Contact the health care provider (HCP) immediately. 4. Check the medication administration history on the PCA pump.

2

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication should be included on the list? 1. Shakiness 2. Increased thirst 3. Profuse sweating 4. Decreased urine output

2 (3 P's)

The nurse has a prescription to remove the nasogastric (NG) tube from a client on the first postoperative day after cardiac surgery. The nurse should question the prescription if which finding was noted on assessment of the client? 1. The client is drowsy. 2. Bowel sounds are absent. 3. The abdomen is slightly distended. 4. NG tube drainage is Hematest negative.

2 (72 hrs for bs to return post gast op - small bowel normally resumes activity several hours after surgery, the stomach 24 to 48 hours after surgery, and the colon 3 to 5 days after surgery)

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention should the nurse anticipate to be prescribed initially for the client? 1. Potassium chloride via the intravenous (IV) route 2. 0.9% NS intravenous infusing at 0.5-1 L/hr 3. Insulin aspart via the subcutaneous route 4. Regular insulin via IV drip

2 (ALWAYS NS first, then regular IVP initially, followed by insulin drip continuous infusion, then potassium (after BG is < or = 250) to address hypokalemia r/t acidosis and high glucose levels in blood collectively drawing potassium and fluid out of cells, into circulation --per picmonic, hypERkalemia assc. w/ dka episode)

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? 1. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." 2. "I can't use a spacer or holding chamber with the MDI." 3. "I will take a slow, deep breath in after pushing down on the MDI." 4. "I will shake the MDI container before I use it."

2 (CAN use spacer or holding chamber w/ MDI)

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2 (CSF leak)

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? 1. Serum alkalosis 2. Below-normal serum potassium level 3. Elevated serum acetone level 4. Serum ketone bodies

2 (HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.)

A client who had abdominal surgery is receiving epidural analgesia. The nurse monitors the client closely, knowing that which is a potential complication of this therapy? 1. Constipation because of the location of the epidural catheter 2. Dislodgment of the epidural catheter because the catheter is not sutured in place 3. Permanent lower motor weakness because of the proximity of the catheter to the sciatic nerve 4. Chronic addiction to the epidural medication because epidural analgesia is a more powerful means of pain relief than patient-controlled analgesia therapy

2 (epidural analgesic: instillation of a pain-blocking agent into the epidural space. Complications that occur with epidural analgesia are directly related to catheter placement, catheter maintenance, and the type of analgesia. Epidural catheters are not sutured in position and must be taped in place to help prevent dislodgment. Low concentrations of medications are used to avoid any sensory and motor deficits that can accompany epidural analgesia)

Which of the following actions would the nurse carry out in preparation of a patient who is having doppler uss done? 1) obtain informed consent 2) remind patient not to smoke 30 minutes prior to procedure 3) reassure patient that they will be able to drive themselves home 4) catheterize bladder

2 (noninvasive, consent not needed)

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? 1. Blood sugar 170 mg/dL 2. Fruity breath 3. cloudy urine 4. ptosis

2 (option 3 is uti - option 1 not ideal but not r/t ketosis, not priority)

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. 1. Limit meal size to 450 to 500 mL. 2. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. 3. Avoid fruit drinks and soda. 4. Do not eat and drink at the same time. 5. Eat six meals a day.

2 3 4 (Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.)

The nurse is discharging a client after an arthroscopy. The nurse needs to teach the client to watch for which potential complications? Select all that apply. 1. Backache 2. Infection 3. Swelling 4. Thrombophlebitis 5. Decreased appetite 6. Increased joint pain related to mechanical injury

2 3 4 6

The nurse is reviewing the blood tests of a generally healthy client who is scheduled for orthopedic surgery under general anesthesia. Besides a complete blood count (CBC), what preadmission blood tests would the preoperative nurse expect to be prescribed? Select all that apply. 1. D-dimer assay 2. Clotting studies 3. Glucose fasting 4. Electrolyte levels 5. Arterial blood gas (ABG) 6. Serum creatinine and blood urea nitrogen (BUN) levels

2 3 4 6 (stress of surg/anesthesia ---> incr. glucose; hypo/hyperK, underlying renal)

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

2 3 5

The nurse is teaching a client diagnosed with peptic ulcer disease about how to make the necessary dietary changes to decrease acid secretion. The client demonstrates understanding of the information by identifying the need to avoid which substance? Select all that apply. 1. water 2. decaffeinated coffee 3. milk products 4. carbonated water 5. creamy sauces

2 3 5

What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply. 1. A pulse rate slower than 90 bpm 2. An elevated systolic blood pressure 3. Muscular fatigability 4. Intolerance to cold 5. Weight loss.

2 3 5

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2 3 5 (versus polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia)

A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. 1. Offer the client a straw when drinking liquids. 2. Closely monitor nasal packing and postnasal drainage. 3. Encourage deep breathing and coughing. 4. Assess for neurologic changes.

2 4

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) 1. "It is probably your nerves." 2. "Is it possible that you are overusing aspirin." 3. "It is a hereditary disease." 4. "You may have ingested some irritating foods." 5. "It can be caused by ingestion of strong acids."

2 4 5

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hour 5. Clear drainage on nasal dripper pad

2 4 5 (is a type of brain surgery thus infection = major concern, and postop complication is risk for DI)

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

3

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, what action should the nurse take? 1. Administer each unit slowly over 3-4 hours. 2. Monitor vital signs closely before transfusion and once per shift. 3. Infuse each unit over 30-60 minutes per client tolerance. 4. Flush the intravenous line with a liter of saline between units.

3

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action? 1. Measure abdominal girth. 2. Irrigate the nasogastric tube. 3. Continue to monitor the drainage. 4. Notify the health care provider (HCP).

3

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? 1. Normothermia 2. Increased sputum production 3. Decreased oxygen requirements 4. Decreased activity tolerance

3

A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? 1. Maintain activity level of walking to the mailbox. 2. Continue with current level of mobility at home. 3. Increase walking distance around a city block without shortness of breath. 4. Relieve shortness of breath to a level as close as possible to tolerable.

3

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? 1. Notify the physician. 2. Obtain a serum glucose level. 3. Obtain a repeat fingerstick glucose level. 4. Give the client 4 oz of milk and a graham cracker with peanut butter.

3

An elderly patient has been admitted to the emergency department (ED) after accidentally overdosing on warfarin, and the patient's initial blood work reveals a dangerously high international normalized ratio (INR). The ED nurse should anticipate the need to administer: 1. Protamine aspartate 2. Fresh frozen plasma 3. Vitamin K 4. Calcium gluconate

3

The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid. The nurse determines that the client needs additional teaching if the client makes which statement? 1. "Aspirin can cause bleeding after surgery." 2. "Aspirin can cause my ability to clot blood to be abnormal." 3. "I need to continue to take the aspirin until the day of surgery." 4. "I need to check with my health care provider about the need to stop the aspirin before the scheduled surgery."

3

The nurse is assessing a client who had abdominal surgery earlier in the day. Which preexisting medical condition would place the client at most risk for postoperative complications? 1. Pacemaker 2. Osteoporosis 3. Alcohol abuse 4. Peptic ulcer disease

3

The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: 1. Intractable ulcer 2. Pyloric obstruction 3. Hemorrhage 4. Perforation

3

An operating room nurse is positioning a client on the operating room table to prevent the client's extremities from dangling over the sides of the table. A nursing student who is observing for the day asks the nurse why this is so important. The nurse responds that this is done primarily to prevent which condition? 1. An increase in pulse rate 2. A drop in blood pressure 3. Nerve and muscle damage 4. Muscle fatigue in the extremities

3 (Part of the operating room nurse's role is to ensure that the safety needs of the client are met, which includes proper positioning - dangling impairs circulation to affected area and can cause answer selected)

The nurse is caring for a client with a back injury sustained 1 year ago. To obtain the most complete assessment data about the client's chronic pain pattern, what should the nurse ask the client? 1. "Can you describe what makes your pain worse?" 2. "What is the intensity of your pain on a scale of 0 to 10?" 3. "Can you describe your daily activities in relation to your pain?" 4. "Would you describe your pain as aching, throbbing, or stabbing?"

3 (affects quality of life and is disruptive to even the simplest of tasks such as eating, bathing, or shopping, thus priority is to ask about these issues)

Hypophysectomy is the treatment of choice for which endocrine disorder? 1. Hyperthyroidism 2. SIADH 3. Cushing syndrome 4. Pheochromocytoma

3 (b/c excessive production of adrenocorticotropic hormone (ACTH) being caused by a tumor of the pituitary gland)

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1. Leg exercises 2. Early ambulation 3. Irrigating the nasogastric tube 4. Coughing and deep-breathing exercises

3 (gastrojejunostomy ---> proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription)

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A blood glucose level of 110 mg/dL (6.28 mmol/L) 2. A sodium (Na+) level of 125 mEq/L 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 5000 mm3 (5 × 109/L)

3 (incr. Na, decr. K, incr. BG, incr. infection risk/elevated WBC count, elevated plasma cortisol and adrenocorticotropic hormone levels)

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101°F (38.3°C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3 (indicative of possible infection which is #1 cause of HHNS)

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? 1. Systemic inflammatory response syndrome 2. Diabetic ketoacidosis 3. Hyperglycemic hyperosmolar syndrome 4. Multiple-organ dysfunction syndrome

3 (most often in older people 50-70 y/o who have no known history of diabetes or who have type 2 diabetes )

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

3 (on exam 3; Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs)

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? 1. Minimize discomfort. 2. Prevent muscle destruction. 3. Promote absorption. 4. Avoid infection.

3 (repeat site --> breakdown and/or buildup of subq fat, interfering w/ absorption)

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for during the client's focused assessment? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypovolemia 4. Signs and symptoms of hypocalcemia

3 (role in fluid volume balance/retention of Na and H2O - think RAA system)

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse should instruct the client that which is the first step in this procedure? 1. Draw up the correct dosage of NPH insulin into the syringe. 2. Draw up the correct dosage of regular insulin into the syringe. 3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

3 (this Q was on exam 1)

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

3 4

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

3 4 5 6

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states 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

3 4 5 6 (metabolism slowed)

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

3 4 6 (constipation; chest pain = over replacement of thyroid hormone)

A client has just returned to a nursing unit after an above-knee amputation of the right leg. The nurse should place the client in which position? 1. Prone 2. Reverse Trendelenburg's 3. Supine, with the residual limb flat on the bed 4. Supine, with the residual limb supported with pillows

4

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? 1. Between 8:00 and 10:00 a.m. 2. Between 4:00 and 6:00 p.m. 3. Between 7:00 and 9:00 p.m. 4. This insulin has no peak action and does not cause a hypoglycemic reaction.

4

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? 1. "Eat three balanced meals every day." 2. "Stop taking the drugs when your symptoms subside." 3. "Increase your intake of fluids containing caffeine." 4. "Avoid aspirin and products that contain aspirin."

4

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? 1. Infuse 500 ml of normal saline solution over 1 hour. 2.Hold insulin infusion for 30 minutes. 3. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. 4. Change the second IV solution to dextrose 5% in water.

4

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? 1. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

4

The health care provider (HCP) writes a prescription for acetylsalicylic acid, or aspirin, for a client who was admitted to the hospital with joint pain from rheumatoid arthritis. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data? 1. Renal colic 2. Hypertension 3. Diabetes mellitus 4. Gastric ulceration

4

The nurse has been asked to give a workshop on chronic obstructive pulmonary disease (COPD) for a local community group. When talking about what can be done for patients with COPD, the nurse encourages a COPD patient not to smoke because smoking has what effect? 1. Deoxygenates the hemoglobin 2. Shrinks the alveoli in the lungs 3. Collapses the alveoli in the lungs 4. Increases the amount of mucus production

4

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously.

4

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4

The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? 1. Takes over-the-counter antacids frequently 2. Reports a history of social drinking on a weekly basis 3. Consumes one or more protein drinks daily 4. Smokes two packs of cigarettes daily

4

The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? 1. The cardiac sphincter is unable to dilate quickly after bariatric surgery. 2. Eating too quickly can cause gastric ulceration. 3. Eating quickly is associated with weight gain. 4. Nausea and esophageal distention can result from eating too fast.

4

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1. Glycosuria 2. Diaphoresis 3. Weight loss 4. Hypertension

4

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

4

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? 1. 9 AM 2. 7 AM 3. 5 AM 4. 3 AM

4

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? 1. hyperkalemia and hyperglycemia 2. hyperkalemia and hypoglycemia 3. hypokalemia and hyperglycemia 4. hypokalemia and hypoglycemia

4

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? 1. low-calorie diet 2. carbohydrates 3. sodium intake 4. weight loss

4

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? 1. Patient's ability to self-administer insulin 2. Cognitive problems 3. Patient's history 4. Patient's eating and sleeping habits

4

A patient is diagnosed with a deficiency in vasopressin, which finding would be of most concern to the nurse related to this diagnosis: 1. serum sodium 129 mEq 2.. Glycosuria 3. Serum calcium 8.4 mEq 4.. poor skin turgor

4 (Indicators of dehydration)

The nurse is reviewing the health care provider's (HCP's) prescriptions for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the HCP's prescriptions? 1. A decreased-calorie diet 2. An increased-calorie diet 3. A decreased amount of NPH insulin daily insulin 4. An increased amount of NPH insulin daily insulin

4 (Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infection is present, an increase in the dose of insulin will be required to facilitate the transport of excess glucose into the cells. The client will not necessarily need an adjustment in the daily diet.)

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

4 (PRIMARY assc. problems: sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure)

Long-term use of propylthiouracil leads to which adverse effects? 1. renal disease and mental confusion 2. hypotension and hypoglycemia 3. hypertension and hypoglycemia 4. agranulocytosis and rash

4 (antithyroid med)

Pulse oximetry (SpO2) is a useful tool in measuring which of the following? 1. bilateral pulse symmetry 2. gas exchange function 3. perfusion effectiveness 4. oxygenation

4 (cannot diagnose gas exchange disorders i.e. asthma, COPD - only issues w/ oxygenation aka O2 saturation)

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? 1. Hypercalcemia 2. Hypernatremia 3. Frothy, fatty stools 4. Decreased hemoglobin

4 (diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia )

The nurse plans care for an older client admitted with a fractured hip. Which analgesic prescribed by the health care provider at standard doses and frequencies would the nurse question? 1. Ibuprofen by oral route 2. Morphine sulfate by intravenous route 3. Tramadol hydrochloride by oral route 4. Meperidine hydrochloride by intramuscular route

4 (neurotoxic metabolite; should be used only short term and is not recommended for use in older pts)

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity

4 (only notify HCP if results <1.005)

A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first? 1. "What medications are you prescribed?" 2. "Are you having trouble paying for your medications?" 3. "Are you able to get to your pharmacy to pick up your medications?" 4. "Why are you not taking your medications?"

4 (rest address the same thing)

The nurse cares for a client who is at risk for wound dehiscence after abdominal surgery. Which action is the priority to minimize this risk? 1. Administer prescribed antibiotics. 2. Use sterile technique for dressing changes. 3. Keep sterile saline and sterile dressings at the bedside. 4. Place a pillow over the incision site during deep breathing and coughing.

4 (use pillow to splint)

leading cause of PAD?

atherosclerosis