Nursing 3 exam 3 end of chapter questions, ATI, and NCLEX questions

1. Biological mediators produce: 1. Increased capillary permeability 2. Aspiration 3. Hyperthermia 4. Hypoglycemia

1

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

1

10. Which statement by a client who has received instruction about radioiodine therapy for hyperthyroidism would require further explanation by the nurse? 1. "My infant son breastfeeds every 4 hours." 2. "I am allergic to iodine." 3. "I will need to flush the toilet 3 times after each use." 4. "I will use disposable eating utensils for several days after the treatment."

1

12. Which therapeutic response should the nurse anticipate when vasopressin is administered? 1. The client relates that thirst has resolved. 2. The client reports that he is urinating more often. 3. The client states his headache has subsided. 4. The client demonstrates improvement in appetite

1

25. A 13-year-old girl is being evaluated for delayed puberty. The client says, "The doctor said he was going to do a karyotype. Will that hurt?" What is the best response by the nurse? 1. "A blood sample is needed and insertion of the needle might hurt a little." 2. "The karyotype test is an evaluation of your luteinizing hormone levels." 3. "The doctor has ordered an x-ray of your hand to determine your bone age." 4. "You don't need to worry about that because I will be with you

1

3. When instructing a client who is to have a transsphenoidal hypophysectomy, what information should the nurse include? 1. Nasal passage will be packed with gauze for 24 to 48 hours. 2. A soft bulky head dressing will be present. 3. A pureed diet will be provided immediately after surgery. 4. Teeth will need brushing four to six times daily after surgery.

1

5. A client is admitted with ARF. Which of the following must the nurse continually assess for? 1. Hyponatremia and hyperkalemia 2. Decreased BUN and creatinine 3. Alkalosis 4. Hypercalcemia

1

7. The nurse should assess the client for which of the following immediately following a kidney transplant? 1. Fluid and electrolyte imbalance 2. Infection 3. Hepatotoxicity 4. Respiratory complications

1

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

1

8. Which clinical manifestation should the nurse assess for when caring for a client with a diagnosis of hyperthyroidism? 1. Fine hand tremor 2. Slow, irregular pulse 3. Cool, pale extremities 4. Diminished bowel sound

1

9. What discharge teaching would be most important for the nurse to include for the client who is prescribed methimazole (Tapazole)? 1. Report sore throat and fever to the health care provider 2. Take the medication with a full glass of water before breakfast 3. Weigh yourself daily and record the results 4. Mild headaches should be expected

1

10. Which discharge instructions would the nurse give to a client who will receive an aminoglycoside antibiotic at home to address the risk of nephrotoxicity? Select all that apply. 1. Increase fluid intake to 2000-2500 mL fluid daily. 2. Report sudden weight gain or puffy eyes. 3. Don't be concerned with edema as a normal side effect. 4. Elevated blood pressure is an expected drug effect. 5. Eat a low protein diet while taking this antibiotic.

1,2

1. When assessing a client who is diagnosed as having acromegaly, what signs and symptoms will the nurse most likely assess? Select all that apply. 1. Decrease in peripheral vision 2. Hypotension 3. Muscle weakness 4. Large tongue

1,3,4

13. Which laboratory data is the most accurate indicator that a client with acute renal failure has met the expected outcomes? 1. Decreasing blood urea nitrogen (BUN) levels 2. Decreasing serum creatinine 3. Decreasing neutrophil count 4. Decreasing lymphocyte cou

2

2. The nurse is caring for a client who is admitted to the hospital in acute renal failure. The appearance of a U wave on the electrocardiogram (ECG) should alert the nurse to check for which laboratory values? 1. Hyperkalemia 2. Hypokalemia 3. Hypernatremia 4. Hyponatrem

2

21. A child has been admitted to the unit with nephrotic syndrome. In talking with the mother, she reports that a cousin had acute glomerulonephritis (AGN) last year. The mother asks how these two diseases compare, as they both affect the kidneys. The nurse's response would include which piece of information? 1. Both disorders produce smoky colored urine. 2. Both disorders cause greatly reduced urine output. 3. Both disorders have a genetic basis. 4. Both disorders require treatment with antibiotic therapy.

2

23. A mother is quite concerned about her 7-year-old daughter after noticing some breast development and appearance of a small amount of pubic hair. The mother asks the nurse if this is a cause for concern. What would be the nurse's best response? 1. "No. Some girls just develop earlier than boys." 2. "Yes, she may have precocious puberty. Let's talk to the pediatrician because she may need referral to an endocrinologist." 3. "Yes. She probably doesn't want the other children at school making fun of her." 4. "No. This early development may slow down when she reaches 9 years old."

2

3. The client who is 80 hours post-transsphenoidal hypophysectomy reports numbness on the upper lip and gum, a headache when reclining, and has a tendency to kick around small rugs in the room when walking. What should the home health nurse do next? 1. Explain that these are normal responses and will disappear over 2 to 3 weeks. 2. Assess neuromuscular function and incisional area and report findings to the surgeon. 3. Immediately arrange for client transportation to the hospital for treatment of increased intracranial pressure. 4. Assess vital signs, fluid volume status, bowel function, and nutrition status.

2

3. The nurse is caring for a client who is on hemodialysis. He has an AVF. Which of the following is expected when assessing the fistula? 1. Ecchymotic area 2. Enlarged veins 3. Pulselessness 4. Redness

2

4. Initial diagnostic studies in the client suspected of having an acute MI include an ECG and: 1. Cardiac enzymes 2. Exercise stress test 3. Nuclear stress test 4. MRI

2

4. Which nursing intervention should the nurse anticipate providing for a client with hypercortisolism? 1. Monitoring for hypotension 2. Fall prevention measures 3. Assessing for symptoms of hyperkalemia 4. Dietary instruction to promote weight gain

2

4. Which of the following organ systems is among the most common to fail in severe sepsis? 1. Gastrointestinal system 2. Cardiovascular system 3. Renal system 4. Neurological system

2

6. DIC plays a role in the inflammatory process by: 1. Promoting movement of bacteria into the general system 2. Decreasing oxygen supplies to cells 3. Limiting biological mediator release 4. Increasing vascular resistance

2

7. Which outcome would be most appropriate to in- clude in the plan of care for a client who has been diagnosed with a pheochromocytoma? 1. Fasting glucose will be less than 100 mg/dL 2. Blood pressure will be within normal limits 3. Serum sodium will be greater than 135 mg/dL 4. ECG will demonstrate no ectopy

2

8. While caring for a client the nurse receiving PD, the nurse completes the exchange by draining the dialysate. The nurse notices it is cloudy. How do you interpret this finding? 1. It is the normal appearance of draining dialysate. 2. It is a sign of infection. 3. It is an indication of an impending lower back problem. 4. It is a sign of a vascular access occlusion.

2

26. The nurse is assessing a client with a tentative diagnosis of hyperpituitarism. What assessment findings should the nurse observe for in this client? Select all that apply. 1. Short stature if onset is in childhood 2. Large hands and feet with prominent jawbone 3. Joint changes consistent with arthritis 4. Soft, high-pitched voice 5. Hypertension

2,3,5

16. Which statements made by a client who has received a renal transplant indicates that the desired outcome of discharge teaching has been met? Select all that apply. 1. "I will double my prednisone dose if my urine output is less than 300 mL/day." 2. "I will need to avoid crowds and prevent infection." 3. "Now I can eat whatever I want as long as I watch how much salt I use." 4. "Since I have not yet rejected the transplant, I never have to worry about rejection anymore." 5. "I should check my temperature and report increases to the physician."

2,5

1. A client is admitted to the hospital with a diagnosis of acute renal failure. She is oliguric and has proteinuria. She asks the nurse, "How long will it be before I start to make urine again?" Which would be the correct response? 1. This phase of renal failure will last for one to two days. 2. This phase of renal failure will last for three to seven days. 3. This phase of renal failure will last for one to two weeks. 4. This phase of renal failure will last for three to four weeks.

3

10. Noncardiogenic-pulmonary edema may result from: 1. Decrease in surfactant 2. Shunting of blood to nonventilated areas 3. Alterations in the alveolar-capillary membrane 4. Increased cardiac output

3

11. Following a parathyroidectomy, a client complains of numbness and tingling in the tips of the fingers and around the mouth. The nurse should anticipate the health care provider writing which order? 1. Serum albumin 2. Serum thyroxin 3. Ionized calcium 4. Parathyroid hormone level

3

14. Which statement made by a client with polycystic kidney disease indicates that the desired outcome has been met? 1. "I know these drugs will make the cysts disappear." 2. "The development of renal failure with this disease is very rare." 3. "I will have my family seek genetic counseling and screening." 4. "I sure am glad that hemodialysis will shrink the cysts."

3

18. A client with chronic renal failure asks the nurse why he is anemic. What response by the nurse is best? 1. "The increased metabolic waste products in your body depress the bone marrow." 2. "We will need to review your dietary intake of iron-rich foods." 3. "There is a decreased production by the kidneys of the hormone erythropoietin." 4. "It is most likely that you have hereditary traits for the development of anemia."

3

2. The client is post-transsphenoidal hypophysectomy. The client demonstrates understanding of methods for preventing increases in intracranial pressure by stating to perform which activity? 1. Sitting in a soft chair and leaning over slowly to tie shoes 2. Holding breath when reaching down to pick up something from the floor 3. Bending at the knees first before squatting down to reach something on the floor 4. Holding breath while using mouthwash, then leaning head down toward the sink to spit it out

3

2. Typical stable angina symptoms include all of the following except: 1. Chest pressure occurring with activity 2. Chest pressure relieved with rest or nitroglycerin 3. Chest pressure lasting greater than 20 minutes not relieved by rest 4. Chest pressure that occurs with the same onset, duration, and intensity

3

2. Which statement by a 28-year-old female client would support a diagnosis of hyperprolactinemia? 1. "I have progressively become hoarse over the past six months." 2. "I am experiencing deep bone pain." 3. "I have not had a menstrual period in 12 months." 4. "I have had a problem with weight loss."

3

20. A client with chronic renal failure has fluid volume excess. The laboratory report indicates the sodium level to be 120 mEq/L. The nurse interprets this as which of the following? 1. An elevated sodium level that must be reported immediately to the physician 2. An error in the laboratory analysis 3. A possible hemodilution effect secondary to excessive water retention 4. An expected reduced number of sodium ions in clients with chronic renal failure

3

5. The primary purpose for providing crystalloid solutions is to: 1. Supplement hemoglobin concentrations 2. Prevent right ventricular failure 3. Restore fluid volumes and increase preload 4. Minimize organ oxygen demand

3

6. A client with CRF complains of irritating white crystals on his skin. The nurse recognizes this finding as uremic frost. Which nursing actions should be taken? 1. Administer an antihistamine because the health care provider would prescribe one to relieve itching 2. Increase fluids to prevent crystal formation and decrease itching 3. Provide skin care with tepid water and apply lo- tion to the skin to relieve itching 4. Permit the client to soak in a bathtub to remove crystals

3

6. When presenting an inservice on endocrine disease, which statement by the nurse would be correct? 1. Clients who have acromegaly have primary in- volvement of the soft tissues and joint. Major organs are spared. 2. Clients who have diabetes insipidus should be monitored for fluid overload. 3. Clients with hyperprolactinemia may experience breast engorgement. 4. Clients with Cushing's syndrome often have episodes of hypotension.

3

8. A male client who presents to the emergency department with coffee-colored urine and edema states he had a bad sore throat a few weeks ago. His blood pressure is elevated, and urinalysis shows blood and protein in the urine. The nurse interprets that this clinical picture is consistent with which developing health problem? 1. Urinary tract infection 2. Urinary calculi 3. Acute glomerulonephritis 4. Acute prostatitis

3

8. All of the individuals below are at risk for developing MODS as the result of a severe insult to the body. Which one would have the greatest risk? 1. A person who smokes 2. A 75-year-old individual 3. A person with congestive heart failure 4. A person with renal dysfunction

3

9. A client in the intensive care unit develops prerenal failure following surgery. Which of the following causes should the nurse suspect? 1. Vascular disease 2. Urethral obstruction 3. Hypovolemia 4. Glomerulonephritis

3

1. A client has been admitted to the emergency department with reports of chest pain for the past 2 hours. There are no clear changes on the 12-lead electrocardiogram (ECG). The nurse would expect which laboratory tests to provide confirmation of a myocardial infarction (MI)? Select all that apply. 1. Potassium of 5.2 mEq/L 2. Creatinine kinase (CK) of 545 3. CK of 460 with MB of 11% 4. WBC of 11,400/mm3 5. CK-MB isoenzyme of 6%

3,5

1. Which of the following are risk factors for CAD? 1. Obesity 2. Hyperlipidemia 3. Cigarette smoking 4. All of the above

4

2. A client scheduled for discharge after coronary artery bypass grafting (CABG) reports new onset of anorexia and nausea. The client's new medications include digoxin (Lanoxin), metoprolol (Lopressor), and furosemide (Lasix). The nurse plans to report this finding to the health care provider after checking the result of which laboratory test drawn earlier in the morning? 1. Potassium level 2. Sodium level 3. Creatinine kinase level 4. Digoxin level

4

2. Hypovolemic shock state is produced by: 1. Pulmonary emboli 2. Anemia 3. Carbon monoxide poisoning 4. Third spacing of body fluids

4

2. What type of renal failure would the nurse expect to see in a client who overdosed accidentally on tobramycin (Nebcin)? 1. Prerenal failure 2. Postrenal failure 3. Extrarenal failure 4. Intrarenal failure

4

3. Manifestations of anaphylactic shock include: 1. Systolic blood pressure greater than 100 mm Hg 2. Warm, moist skin 3. Bradycardia and hypotension 4. Stridor and wheezing

4

3. The clinical spectrum of ACS includes: 1. Stable angina and STEMI 2. Stable angina and NSTEMI 3. Unstable angina and SCD 4. Unstable angina, STEMI, and NSTEMI

4

4. A client with end-stage renal disease receives HD three times a week. The nurse concludes that dialysis is effective when: 1. The client does not have a large weight gain. 2. The client has no signs and symptoms of infection. 3. The client says that he can catch up on his rest while on dialysis. 4. The client is able to return to work

4

5. The following are common medications used for CAD and ACS: 1. Aspirin 2. Beta blockers 3. Nitroglycerin 4. All of the above

4

6. The nurse is caring for a client with a history of renal failure and a new myocardial infarction. The nurse who is reviewing laboratory findings would call the physician to report which result? 1. Potassium level of 5.0 mEq/L 2. Sodium level of 145 mEq/L 3. Calcium level of 7.0 mg/dL 4. Digoxin level of 0.8 ng/mL

4

7. What manifestations would indicate a reversal of the shock process? 1. A heart rate of 90 beats per minute 2. A blood pressure of 130/70 3. A respiratory rate of 24 per minute 4. A urine output of 225 mL per hour

4

9. The nurse is providing client education to a client on CAPD. The nurse determine that he under- stands his treatment when he states: 1. I must increase my carbohydrate intake daily. 2. I must maintain a positive nitrogen balance by decreasing protein 3. I must take prophylactic antibiotics to prevent infection. 4. I must be aware of the signs and symptoms of peritonitis.

4

9. Which of the following is the most important factor for increasing oxygen supply? 1. Decreasing cardiac preload 2. Administration of appropriate fluids 3. Administration of vasoconstrictor medications 4. Maximizing optimal cardiac output

4

18. A client with a history of Cushing's syndrome is admitted with multiple contusions, lacerations and blood loss following a motor vehicle accident. Current laboratory values are BUN 30 mg/dL, creatinine 1.0 mg/dL, sodium 148 mEq/L, potassium 4.8 mEq/L, chloride 108 mEq/L, and cortisol 29 mcg/dL. Which nursing diagnoses would the nurse include when initiating the client's plan of care? Select all that apply. 1. Impaired Urinary Elimination 2. Risk for Disuse Syndrome 3. Ineffective Airway Clearance 4. Risk for Infection 5. Deficient Fluid Volume

4,5

5. A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? SATA A. Older than 70 years of age. B. Has a BMI of 41 C. Administers NPH insulin each morning D. Past history of lymphoma E. Blood pressure averages 120/70 mm Hg

A. CORRECT: A client older than 70 years of age is placed at a greater risk from complication of surgery, lifelong immunosuppression, and organ rejection. B. CORRECT: A client with a BMI of 41 is morbidly obese and is placed at a greater risk for complication of surgery, lifelong immunosuppression, and organ rejection. C. CORRECT: A client who requires NPH insulin for Type 1 diabetes mellitus is placed at a greater risk from complication of surgery, lifelong immunosuppression, and organ rejection. D. CORRECT: A client with a past history of cancer such as lymphoma is placed at a greater risk for complication of surgery, lifelong immunosuppression, and organ rejection.

3. A nurse is assessing a client who has a diagnosis of acute glomerulonephritis. Which of the following is an expected finding? (Select all that apply.) A. Fever B. Peripheral edema C. Polyuria D. Dyspnea E. Proteinuria

A. CORRECT: A client who has acute glomerulonephritis may have a low-grade fever because of the possible streptococcus infection. B. CORRECT: Peripheral edema indicates fluid retention caused by fluid and sodium retention with acute glomerulonephritis. D. CORRECT: A client who has acute glomerulonephritis may display dyspnea because of fluid retention, causing pulmonary edema or congestive heart failure. E. CORRECT: A client who has acute glomerulonephritis will have protein loss in the urine because of glomeruli involvement.

A nurse on a medical unit is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.) A. A client who is 32 weeks of gestation B. A client who has kidney calculi C. A client who has a urine pH of 4.2 D. A client who has a neurogenic bladder E. A client who has diabetes mellitus

A. CORRECT: A client who is at 32 weeks of gestation is at risk for developing pyelonephritis because of increased pressure on the urinary system during pregnancy causing reflux or retention of urine. B. CORRECT: A client who has kidney calculi is at risk for pyelonephritis because stones harbor bacteria. D. CORRECT: The client who has a neurogenic bladder may retain urine, promoting bacterial growth and causing pyelonephritis. E. CORRECT: The client who has diabetes mellitus is at risk of pyelonephritis because glucose that may be in the urine promotes bacterial growth.

1. A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolves in less than 15 min. C. The type of activity that causes an MI can be identified. D. Angina can occur for longer than 30 min.

A. CORRECT: Angina can be relieved by rest and nitroglycerin.

1. A nurse who is a member of the transplant team is assessing information on a client who has end-stage kidney disease. Which of the following client indications should the nurse expect to find? A. Anuria B. Marked azotemia C. Crackles in the lungs D. Increased calcium level E. Proteinuria

A. CORRECT: Anuria indicates the client has end-stage kidney disease, necessitating kidney transplantation as a treatment. B. CORRECT: Marked azotemia is elevated BUN and serum creatinine, indicates the client has end‑stage kidney disease, necessitating kidney transplantation as a treatment. C. CORRECT: Crackles in the lungs can indicate the client has pulmonary edema, caused from end‑stage kidney disease necessitating kidney transplantation as a treatment. E. CORRECT: Proteinuria indicates the client has end-stage kidney disease, necessitating kidney transplantation as a treatment.

3. A nurse is caring for a client in a clinic who asks the nurse why her provider prescribed 1 aspirin per day. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C. "Aspirin dissolves clots that are forming in your coronary arteries." D. "Aspirin relieves headaches that are caused by other medications."

A. CORRECT: Aspirin decreases platelet aggregation that can cause a myocardial infarction.

5. A nurse is assessing a client who has prerenal acute kidney injury (AKI). Which of the following should the nurse include in the assessment? (Select all that apply.) A. Blood pressure B. Cardiac enzymes C. Urine output D. Serum creatinine E. Serum electrolytes

A. CORRECT: Assessment of blood pressure for hypotension in a client who has prerenal AKI should assist in determining hypovolemia. C. CORRECT: Assessment of urine output in a client who has prerenal AKI should assist in determining oliguria. D. CORRECT: Assessment of serum creatinine should assist in determining the extent of the AKI and the need for intervention. E. CORRECT: Assessment of serum electrolytes should assist in determining the extent of the AKI and the need for intervention.

2. A nurse is planning postoperative care for a client who had kidney transplant surgery. Which of the following should the nurse include in the plan of care? (Select all that apply.) A. Obtain daily weights B. Assess dressings for bloody drainage C. Replace hourly urine output with IV fluids D. Position in semi-Fowler's E. Monitor serum electrolytes

A. CORRECT: Daily weights should be obtained by the nurse to assess the client's fluid status. B. CORRECT: Bloody drainage should be assessed by the nurse, which can indicate hemorrhage or hematoma. C. CORRECT: Hourly urine output with IV fluid replacement should be monitored by the nurse to detect abrupt decrease in urine output, which may indicate rejection or other serious conditions of the transplant kidney. E. CORRECT: Serum electrolytes should be monitored by the nurse, because electrolytes loss may occur with postoperative diuresis.

5. A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole (Tapazole). Which of the following should the nurse include in the plan of care? (Select all that apply.) A. Monitor CBC. B. Monitor triiodothyronine (T3). C. Inform the client that the medication should not be taken for more than 3 months. D. Advise the client to take the medication at the same time every day. E. Inform the client that an adverse effect of this medication is iodine toxicity.

A. CORRECT: Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Therefore, the nurse should monitor the client's CBC. B. CORRECT: Methimazole reduces thyroid hormone production. Therefore, the nurse should monitor the client's T3. D. CORRECT: Methimazole should be taken at the same time every day to maintain blood levels.

1. A nurse is caring for a client and reviewing a new prescription for an afterload-reducing medication. The nurse should recognize that this medication is administered for which of the following types of shock? A. Cardiogenic B. Obstructive C. Hypovolemic D. Distributive

A. CORRECT: Reducing afterload will allow the heart to pump more effectively, which is needed for the client who has cardiogenic shock.

1. A nurse is planning care for a client who has Cushing's disease. In planning care, the nurse should recognize that clients who have Cushing's disease are at increased risk for which of the following? (Select all that apply.) A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia

A. CORRECT: Suppression of the immune system places the client at risk for infection. B. CORRECT: Overproduction of gastric acid places the client at risk for gastric ulcers. D. CORRECT: Client's who have Cushing's disease are at risk for bone fracture because decreased calcium absorption leads to osteoporosis.

4. A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply.) A. Suction equipment B. Humidified air C. Flashlight D. Tracheostomy tray E. Oxygen delivery equipment

A. CORRECT: The client may require oral or tracheal suctioning. Therefore, the nurse should ensure that this equipment is available. B. CORRECT: Humidified air thins secretions and promotes respiratory exchange. Therefore, this equipment should be available. D. CORRECT: The client may experience respiratory obstruction. Therefore, this equipment should be available. E. CORRECT: The client may require supplemental oxygen due to respiratory complications. Therefore, this equipment should be available.

4. A nurse is monitoring a client who is receiving plasmapheresis. Which of the following should indicate to the nurse that the client is experiencing side effects from the procedure? (Select all that apply.) A. Heart rate 140/min B. Vertigo C. Muscle cramps D. Blood pressure 90/56 mm Hg E. Tinnitus

A. CORRECT: The client's heart rate of 140/min indicates tachycardia, which is a sign of hypovolemia caused by the removal of blood plasma, which decreases fluid volume. B. CORRECT: Vertigo is a sign of hypovolemia caused by the removal of blood plasma, which decreases fluid volume. C. CORRECT: Muscle cramping is a sign of tetany caused by the removal of calcium with the blood plasma. D. CORRECT: The client's blood pressure of 90/56 mm Hg is a sign of hypovolemia caused by the removal of blood plasma, which decreases fluid volume.

3. A nurse at the beginning of a shift is assessing a client who has Cushing's disease. Which of the following is the priority assessment? A. Daily weights B. Fatigue C. Fragile skin D. Joint pain

A. CORRECT: The greatest risk to a client who has Cushing's disease is fluid retention, which can lead to hypertension and heart failure. Therefore, this is the priority assessment.

3. A nurse is planning care for a client who has stage 4 chronic kidney disease. Which of the following should the nurse include in the plan of care? (Select all that apply.) A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. D. Assess using the Glasgow Coma Scale. E. Monitor for dysrhythmias.

A. CORRECT: The nurse should assess for jugular vein distention, which may indicate fluid overload and congestive heart failure. B. CORRECT: The nurse should provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. C. CORRECT: The nurse should auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. E. CORRECT: The nurse should monitor for dysrhythmias related to increased serum potassium, which is not being excreted by the kidneys.

2. A nurse is planning care for a client who has postrenal acute kidney injury due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Provide a high-protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria. D. Administer diuretic medication. E. Provide NSAIDs for pain.

A. CORRECT: The nurse should provide the client with a high-protein diet because of the high rate of protein breakdown that occurs with acute kidney injury. B. CORRECT: The nurse should assess the client's urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. C. CORRECT: The nurse should assess the client for intermittent anuria because of possible bilateral obstruction of the urinary structures that leave the kidney.

2. A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings are expected for this client? (Select all that apply.) A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL D. Lymphocyte count 35% E. Fasting glucose 145 mg/dL

A. CORRECT: This finding is above the expected reference range. Hypernatremia is an expected finding for clients who have Cushing's disease. B. CORRECT: This finding is below the expected reference range. Hypokalemia is an expected finding for clients who have Cushing's disease. C. CORRECT: This finding is below the expected reference range. Hypocalcemia is an expected finding for clients who have Cushing's disease. E. CORRECT: This finding is above the expected reference range. Clients who have Cushing's disease have an elevated fasting blood glucose because glucose metabolism is affected.

ATI Ch. 60

Acute Kidney Injury and Chronic Kidney Disease

ATI Ch. 31

Angina and MI

5. A nurse in a cardiac unit is assisting with the admission of a client who is to undergo hemodynamic monitoring. Which of the following actions should the nurse anticipate performing? A. Administer large volumes of IV fluids. B. Assist with insertion of pulmonary artery catheter. C. Obtain Doppler pulses of the extremities. D. Gather supplies for insertion of a peripheral IV catheter.

B. CORRECT: A pulmonary artery catheter and pressure-monitoring system are inserted for hemodynamic monitoring of a client.

4. A nurse is providing information to a client who has chronic rejection of a transplanted kidney. Which of the following statements should the nurse include? SATA A. "Immediate removal of the donor kidney is planned." B. "Monitoring electrolytes frequently determines kidney status." C. "Scheduled kidney biopsies determine kidney status." D. "Restarting dialysis depends on marked azotemia." E. "Plan to have the immunosuppressive medication increased."

B. CORRECT: Frequent monitoring of electrolyte studies determines the progression of kidney failure and the need for dialysis. C. CORRECT: Kidney biopsies do determine the progression of kidney failure and the need for dialysis. D. CORRECT: Marked azotemia does determine the progression of kidney failure and the need to restart this treatment. E. CORRECT: Increasing immunosuppressive medication may suppress the progression of kidney failure and the need to restart this dialysis.

2. A nurse is reviewing the clinical manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply.) A. Dry skin B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia

B. CORRECT: Hyperthyroidism increases the client's metabolism. Therefore, heat intolerance is an expected finding. D. CORRECT: Hyperthyroidism increases the client's metabolism. Therefore, palpitations are an expected finding for the client who has hyperthyroidism. E. CORRECT: Hyperthyroidism increases the client's metabolism. Therefore, weight loss is an expected finding for the client who has hyperthyroidism.

1. A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. Which of the following is an expected laboratory finding for this client? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid stimulating hormone C. Decreased free thyroxine index D. Decreased triiodothyronine

B. CORRECT: In the presence of Graves' disease, low thyroid stimulating hormone (TSH) is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated.

5. A nurse is providing teaching on the manifestation of complications to a client who has acute glomerulonephritis. Which of the following complications should the client report to the provider? A. Dry cough B. Pitting edema C. Weight gain of 2 lb in 1 week D. Temperature of 36.8° C (98.4° F)

B. CORRECT: Pitting edema is an indication of fluid overload, a manifestation of a complication of acute glomerulonephritis.

3. A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol (Inderal). Which of the following information should the nurse include? A. An adverse effect of this medication is jaundice. B. Take your pulse before each dose. C. The purpose of this medication is to decrease production of thyroid hormone. D. You should stop taking this medication if you have a sore throat.

B. CORRECT: Propranolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult his provider.

4. A nurse in the emergency department is completing an assessment of a client who is in shock. Which of the following findings should the nurse expect? (Select all that apply.) A. Heart rate 60/min B. Seizure activity C. Respiratory rate 42/min D. Increased urine output E. Weak, thready pulse

B. CORRECT: Seizure activity may be present in a client who is in shock. C. CORRECT: Tachypnea is an expected finding in a client who is in shock. E. CORRECT: A weak, thready pulse is an expected finding in a client who is in shock.

4. A nurse is caring for a client who has stage 4 chronic kidney disease. Which of the following is an expected laboratory finding? A. Blood urea nitrogen (BUN) 54 mg/dL B. Glomerular filtration rate (GRF) 20 mL/min C. Serum creatinine 1.2 mg/dL D. Serum potassium 5.0 mEq/L

B. CORRECT: The GRF is severely decreased to approximately 20 mL/min, which is indicative of stage 4 chronic kidney disease.

A nurse is reviewing the laboratory findings for urinalysis (UA) of a client who reports urgency and nocturia. Which of the following findings should the nurse report to the provider? A. Positive for casts B. Positive leukocyte esterase C. Positive for epithelial cells D. Positive for crystals

B. CORRECT: The client who has positive leukocyte esterase indicates 68% to 88% positive urine for UTI, and the nurse should report this finding to the provider.

A nurse is planning care for a client who has chronic pyelonephritis. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Administer antipyretic for temperature of 99.9° F (37.3° C). B. Encourage daily fluid intake of 3 L. C. Palpate the costovertebral angle. D. Monitor urinary output. E. Administer anti-infective medication.

B. CORRECT: The nurse should encourage fluid intake greater than 2 to 3 L daily to maintain dilute urine during the day and night. C. CORRECT: The nurse should gently palpate the costovertebral angle for flank tenderness, which may indicate inflammation and infection. D. CORRECT: The nurse should monitor urinary output to determine that 1 to 3 L of urine is excreted daily. E. CORRECT: The nurse should administer anti-infective medication to treat the bacteriuria and decrease progressive damage to the kidney.

2. A nurse is planning care for a client who has septic shock. Which of the following is the priority action for the nurse to take? A. Maintaining adequate fluid volume with IV infusions B. Administering antibiotic therapy C. Monitoring hemodynamic status D. Administering vasopressor medication

B. CORRECT: Using the safety and risk reduction framework, administration of antibiotics is the priority action by the nurse. Eliminating endotoxins and mediators from bacteria will reduce the vasodilation that is occurring.

5. A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A. Diet modification B. Relaxation exercises C. Smoking cessation D. Taking omega-3 capsules

C. CORRECT: According to the airway, breathing, and circulation (ABC) priority-setting framework, adequate oxygenation is the priority. Nicotine causes vasoconstriction, elevates blood pressure, and narrows coronary arteries. Therefore, smoking cessation should be the first recommended lifestyle change.

4. A nurse is caring for a client who is 6 hr postoperative following a transsphenoidal hypophysectomy. The nurse should test the client's nasal drainage for the presence of which of the following? A. RBCs B. Ketones C. Glucose D. Streptococcus

C. CORRECT: Cerebral spinal fluid contains glucose. Therefore, the nurse should test nasal drainage for glucose to determine whether the nasal drainage contains glucose.

6. A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings are indicative of thyroid crisis? (Select all that apply.) A. Bradycardia B. Hypothermia C. Tremors D. Abdominal pain E. Mental confusion

C. CORRECT: Excessive levels of thyroid hormone can cause the client to experience tremors. D. CORRECT: When thyroid crisis occurs, the client can experience gastrointestinal conditions, such as vomiting, diarrhea, and abdominal pain. E. CORRECT: Excessive thyroid hormone levels can cause the client to experience mental confusion.

2. A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the infarction occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin

C. CORRECT: The Troponin T level will still be evident 14 to 21 days following an MI.

3. A nurse is teaching diet recommendations to a client who had a kidney transplant and is taking cyclosporine (Neoral). Which of the following recommendations should the nurse include in the teaching? A. Decrease protein rich foods B. Drink grapefruit juice C. Take a magnesium supplement D. Restrict intake of bananas and raisins

C. CORRECT: The client should take a magnesium supplement, because magnesium is lost when taking cyclosporine.

2. A nurse is assessing laboratory values for a client who may have acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A. Urine specific gravity of 1.022 B. BUN of 16 mg/dL C. Creatinine clearance of 48 mL/min/m2 D. Potassium level of 4.2 mEq/L

C. CORRECT: The creatinine clearance 24 hr urine is not within the expected reference range, indicating possible renal failure, and needs to be reported to the provider.

1. A nurse is planning care for a client who has prerenal acute kidney injury following abdominal aortic aneurysm repair. The client's urinary output is 80 mL in the past 4 hr, and blood pressure is 92/58 mm Hg. Which of the following should be included in the plan of care? A. Prepare the client for a CAT scan with contrast dye. B. Anticipate urine specific gravity to be 1.010. C. Plan to administer a fluid challenge. D. Place client in Trendelenburg position.

C. CORRECT: The nurse should plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure.

5. A nurse is providing discharge instructions to a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? (Select all that apply.) A. Brush teeth after every meal or snack. B. Avoid bending at the knees. C. Eat a high-fiber diet. D. Notify the provider if he has sweet-tasting drainage. E. Notify the provider if he has diminished sense of smell.

C. CORRECT: To avoid constipation, which contributes to increased intracranial pressure, the client should eat a high-fiber diet. Docusate sodium (Colace) can be used to prevent constipation. D. CORRECT: Sweet-tasting fluid is an indication of a cerebral spinal fluid leak. The client should notify the provider.

3. A nurse in the emergency department is caring for a client who has an allergic reaction to a bee sting. The client is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse expect to administer first? A. Methylprednisolone (Solu-Medrol) IV bolus B. Diphenhydramine (Benadryl) subcutaneously C. Epinephrine (Adrenaline) IV D. Albuterol (Proventil) inhaler

C. CORRECT: Using the airway-breathing-circulation (ABC) priority-setting framework, epinephrine is administered first. It is a rapid-acting medication that promotes effective oxygenation and is used to treat anaphylactic shock.

1. A nurse is presenting information to a client who has a new diagnosis of chronic glomerulonephritis. Which of the following nursing statements is appropriate? A. "A high-sodium diet is recommended." B. "The destruction of the glomeruli occurs rapidly." C. "The cause of the disease is not known." D. "To compensate, the number of functioning nephrons is increased."

C. CORRECT: With chronic glomerulonephritis, the kidney atrophies, and tissue is not available for biopsy and diagnosis, making it difficult to determine the cause.

Med Surg

Ch. 24

Med Surg

Ch. 54

Med Surg

Ch. 56

Pearson NCLEX

Ch. 57

NCLEX

Ch. 59

NCLEX

Ch. 61

Med Surg

Chapt 65

ATI Ch. 81

Cushing's Disease/Syndrome

4. A nurse is instructing a client who has angina about a new prescription for metoprolol tartrate (Lopressor). Which of the following statements by the client indicates understanding of the teaching? A. "I should place the tablet under my tongue." B. "I should have my clotting time checked weekly." C. "I will report any ringing in my ears." D. "I will call my doctor if my pulse rate is less than 60."

D. CORRECT: The client is advised to notify the provider if bradycardia (pulse rate less than 60) occurs.

ATI Chapter 37

Hemodynamic Shock

ATI Ch. 79

Hyperthyroidism (Graves, Thyroid Storm)

ATI Ch. 59

Glomerulonephritis

ATI Ch. 61

Infections of the Renal and Urinary System

ATI Ch. 58

Kidney Transplant

8. The goals of therapy for stable angina are to improve the ______________ of life by ______________ and ______________ of life by ____________________.

blank 1. Quality, blank 2. decreasing episodes of angina and ischemia blank 3. increase the quality blank 4. preventing progression to myocardial infarction and death

9. The goals of therapy for acute Mi are to ____________ and prevent _____________.

blank 1. limit myocardial damage blank 2. complications and recurrent events