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The nurse is reviewing data collected on a patient with adrenal insufficiency. Which finding suggests that the patient is experiencing dehydration? 1) Hematocrit 52% 2) Serum cortisol 11 mcg/dL 3) Serum sodium 134 mEq/L 4) Serum potassium 4.8 mEq/L

The nurse is preparing discharge teaching for a patient with hypercortisolism. What should the nurse emphasize to this patient? 1) Increase fluids 2) Increase activity 3) Restrict salt intake 4) Increase salt intake

The nurse notes that a patient has a tumor on the thyroid gland. Where should the nurse expect to palpate this tumor? 1) Anteriorly below the chin 2) At the level of the clavicle 3) Below the cricoid cartilage 4) Slightly above the angle of Louis

The nurse notes that a patient with adrenal insufficiency has muscular weakness. To what should the nurse attribute this finding? 1) Infection 2) Inflammation 3) Hyperkalemia 4) Hypernatremia

The nurse notes that a patient's aldosterone level is elevated. Which structure is responsible for controlling this hormone? 1) Thyroid 2) Hypothalamus 3) Adrenal cortex 4) Adrenal medulla

The nurse plans to evaluate a patient for hypoglycemia and hypernatremia. Which medication did this patient most likely receive? 1) Dexamethasone 2) Potassium chloride 3) Aminoglutethimide 4) Spironolactone (Aldactone)

The results of a patient's MRI show evidence of enlarged adrenal glands. Which health problem is most likely causing this finding? 1) Cancer 2) Stenosis 3) Infection 4) Autoimmunity

A patient recovering from emergency surgery after a motor vehicle crash is demonstrating signs of adrenal insufficiency. What medication should the nurse expect to be prescribed for this patient? 1) Regular insulin 10 units 2) Potassium chloride 20 mEq 3) Intravenous infusion 0.9% normal saline 4) Hydrocortisone sodium succinate (Solu-Cortef)

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: Imbalanced nutrition: less than body requirements Deficient knowledge: disease process and treatment High risk for deficient fluid volume Disabled family coping: compromised

High risk for deficient fluid volume

The nurse is teaching a group of patients about self-administration of insulin. What is important to include about mixing clear and cloudy insulin?

If mixing insulins in one syringe, the clear (regular) insulin is always drawn up in to the syringe first. Patients always need to rotate injection sites. *clear before cloudy-alphabetical order*

Albert refuses his bedtime snack. This should alert the nurse to assess for: Symptoms of hyperglycemia during the peak time of NPH insulin. Sugar in the urine Elevated serum bicarbonate and a decreased blood pH. Signs of hypoglycemia earlier than expected.

Signs of hypoglycemia earlier than expected

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. Slurred speech Diaphoresis Thirst Palpitations Hyperventilation

Slurred speech, diaphoresing and palpitations

Risk factors for type 2 diabetes include all of the following except: Advanced age Obesity Smoking Physical inactivity

Smoking

Diabetics are at increased risk of heart disease if they also: Smoke Have high HDL cholesterol levels Take aspirin Consume a high-fiber diet

smoke

11. Untreated hyperglycemia may lead to all of the following complications except: Hyperosmolar syndrome Vitiligo Diabetic ketoacidosis Coma

vitiligo

The nurse is reviewing patient data. Which information suggests this patient has pheochromocytoma? Select all that apply. 1) Headache 2) Palpitations 3) Weight gain 4) Hypertension 5) Hyperglycemia

1245

A patient's thyroid-stimulating hormone (TSH) is below normal. What should the nurse expect to assess in this patient? Select all that apply. 1) Weight gain 2) Thinning hair 3) Decreased bone density 4) Decreased muscle strength 5) Complaints of decreased libido

125 Manifestations of low growth hormone include decreased bone density and decreased muscle strength

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A antidiuretic hormone (ADH). B thyroid-stimulating hormone (TSH). C follicle-stimulating hormone (FSH). D luteinizing hormone (LH).

A ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? A sulfisoxazole (Gantrisin) B mexiletine (Mexitil) C prednisone (Orasone) D lithium carbonate (Lithobid)

A Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. Read the label before using salt substitutes. b. Do not add salt to your food when you eat. c. Avoid exposure to sunlight. d. Take Tylenol instead of aspirin for pain.

A (Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.)

The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs? A. "I will make sure I eat breakfast within 10 minutes of taking my insulin." B."I will need to carry candy or some form of sugar with me all the time." C."I will eat a snack around three o'clock each afternoon." D. "I can save my dessert from supper for a bedtime snack."

A. "I will make sure I eat breakfast within 10 minutes of taking my insulin." Answer A is correct. Novalog insulin onsets very quickly, so food should be available within 10-15 minutes of taking the insulin. Answer B does not address a particular type of insulin, so it is incorrect. NPH insulin peaks in 8-12 hours, so a snack should be eaten at the expected peak time. It may not be 3 p.m. as stated in answer C. Answer D is incorrect because there is no need to save the dessert until bedtime.

6. A client had a retinal detachment and has undergone surgical correction. What discharge instruction is most important? a. "Avoid reading, writing, or close work such as sewing." b. "Dim the lights in your house for at least a week." c. "Keep the follow-up appointment with the ophthalmologist." d. "Remove your eye patch every hour for eyedrops."

ANS: A After surgery for retinal detachment, the client is advised to avoid reading, writing, and close work because they cause rapid eye movements. Dim lights are not indicated. Keeping a postoperative appointment is important for any surgical client. The eye patch is not removed for eyedrops.

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? "The best time for me to exercise is after my morning snack." "The best time for me to exercise is after breakfast." "The best time for me to exercise is every afternoon." "The best time for me to exercise is right after I eat."

Afternoon

You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern? A. Patient complains of thirst B. Patient has a potassium level of 2.3 C. Patient's skin and mucous membranes are dry D. Patient is nauseous

Which of the following is not a sign or symptom of Diabetic Ketoacidosis? A. Positive ketones in the urine B. Oliguria C. Polydipsia D. Abdominal Pain

B. oliguria

For a male client with hyperglycemia. which assessment finding best supports a nursing diagnosis of Deficient fluid volume? Discuss A. Cool. clammy skin B. Distended neck veins C. Increased urine osmolarity D. Decreased serum sodium level

C In hyperglycemia. urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria. losing body fluids and experiencing fluid volume deficit. Cool. clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess. the opposite imbalance.

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? A Restricting fluids B Restricting sodium C Forcing fluids D Restricting potassium

C The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following therapeutic response should you expect? A Decreased blood pressure. B Decreased attention span. C Decreased urinary output. D Decreased blood sugar.

C The therapeutic response of this medication is decreased urine output because it promotes renal conservation of water. Options A, B, and D are unrelated effect to this medication.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A Infusing I.V. fluids rapidly as ordered B Encouraging increased oral intake C Restricting fluids D Administering glucose-containing I.V. fluids as ordered

C To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: Convey empathy, trust, and respect toward the client Administer a sedative Make sure the client knows all the correct medical terms to understand what is happening Ignore the signs and symptoms of anxiety so that they will soon disappear

Convey empathy, trust, and respect toward the client

The risk factors for type 1 diabetes include all of the following except: Diet Genetic Autoimmune Environmental

Diet

A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A Diabetes mellitus B Diabetes insipidus C Hypoparathyroidism D Hyperparathyroidism

D Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would alert the need to decrease the dosage? A Alopecia. B Jaundice. C Diarrhea. D Drowsiness.

D One of the side effects of taking antidiuretic hormone is water intoxication which is manifested by a headache, drowsiness, light-headedness, and shortness of breath. This could indicate the need to reduce the dosage. Options A, B, and C are not related signs to this medication.

A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). How should the nurse interpret these results? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. Normal pituitary response to insulin

D (Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.)

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a.The patient must receive insulin therapy to prevent ketoacidosis. b.The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. c.The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d.The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should: Protect the patient from sources of infection because of decreased cellular protein deposits Evaluate the patient's sensitivity to low room temperatures because of decreased adipose tissue insulation Document weight changes because of fatty acid mobilization Do all of the above

Do all of the above

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? Increased respirations and an increase in pH Comatose state Elevated blood glucose level and a low plasma bicarbonate Decreased urine output

Elevated blood glucose level and a low plasma bicarbonate

15. Which of the following measures does not help to prevent diabetes complications? Controlling blood glucose Controlling blood pressure and blood lipids Eliminating all carbohydrates from the diet Prompt detection of diabetic eye and kidney disease

Eliminating all carbs from the diet

Glucose is an important molecule in a cell because this molecule is primarily used for: Extraction of energy Formation of cell membranes Synthesis of protein Building of genetic material

Extraction of energy

True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60. True False

False: Yes, RA tends to affect women more than men BUT it can affect all ages...most commonly 20-60 years old.

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: Oxygen Fluid replacement Carbohydrates Dietary instruction

Fluid replacement

10. Among female children and adolescents, the first sign of type 1 diabetes may be: Rapid weight gain Constipation Genital candidiasis Insomnia

Genital candidiasis

When a client is in diabetic ketoacidosis, the insulin that would be administered is: Insulin glargine injection Human NPH insulin Insulin lispro injection Human regular insulin

Human regular insulin

Prediabetes is associated with all of the following except: Increased risk of developing type 2 diabetes Impaired glucose tolerance Increased risk of heart disease and stroke Increased risk of developing type 1 diabetes

Increased risk of developing type 1 diabetes

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: Inhibits gluconeogenesis Increases blood glucose levels Provides more storage of glucose Stimulates the release of insulin

Increases blood glucose levels

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? More insulin No changes Oral antidiabetic agents Less insulin

More insulin

Case Study

Ms. Andrews responds favorably to the IV Pitressin, and after 24 hours she is started on DDAVP intranasally. Her blood pressure is 110/68 mm Hg with a heart rate of 88 bpm. Urine output has decreased to an average of 50 mL/hr, and IV fluids are discontinued because she is taking oral fluids. Discharge planning is initiated, and she is scheduled to be discharged on the fourth postoperative day. She is discharged on DDAVP. The nurse incorporates teaching about activity restrictions related to transsphenoidal hypophysectomy.

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except: Palpation for increased pulse volume in the arteries of the lower extremities Integumentary inspection for the presence of brown spots on the lower extremities Observation for paleness of the lower extremities Observation for blanching of the feet after the legs are elevated for 60 seconds

Palpation for increased pulse volume in the arteries of the lower extremities

A client with DM states, "I cannot eat big meals; I prefer to snack throughout the day." The nurse should carefully explain that the: Salt and sugar restriction is the main concern Regulated food intake is basic to control Small, frequent meals are better for digestion Large meals can contribute to a weight problem

Regulated food intake is basic to control

____________ affects the joints in a symmetrical fashion. A. Osteoarthritis B. Rheumatoid arthritis

The answer is B. RA affects the joints in a symmetrical fashion. It is UNsymmetrical in OA. RA most commonly affects the fingers and wrist but can also affect the neck, shoulders, elbows, ankles, knee, and feet.

The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? 1. Antidiuretic hormone (ADH) 2. Thyroid-stimulating hormone (TSH) 3. Follicle-stimulating hormone (FSH) 4. Luteinizing hormone (LH) Correct: 1 RATIONALES: Clients with diabetes insipidus lack the hormone ADH. The client's TSH, FSH, and LH levels aren't affected. NURSING PROCESS STEP: Planning CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

Which of the following causes of HHNS is most common? Insulin overdose Removal of the adrenal gland Undiagnosed, untreated hyperpituitarism Undiagnosed, untreated diabetes mellitus

Undiagnosed untreated diabetes mellitis

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel. What statement by the AP indicates understanding of this client's care? a. "I will weigh the client carefully before breakfast and compare with yesterday's weight." b. "I will encourage plenty of fluids to promote urination and prevent dehydration." c. "I will teach the client not to select high-sodium or salty foods on the menu." d. "I will assess the client's mucous membranes and skin for signs of dehydration."

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe? a. Large hands and face b. Thin, dry skin c. Short height d. Truncal obesity

A client is admitted with a possible diagnosis of diabetes insipidus (DI). What assessment findings would the nurse expect? (Select all that apply.) a. Hypotension b. Increased urinary output c. Concentrated urine d. Decreased thirst e. Poor skin turgor f. Bradycardia

a-b-e

The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines further instruction is needed when the patient says, a. "I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to normal function with the use of this drug." d. "I will report any chest pain or difficulty breathing to the doctor right away."

b. "I only need to take this drug until my symptoms are improved." Rationale: Levothyroxine is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.

"The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response? "A. Administer a glucagon injection B. Give a small meal C. Administer 10-15 g of a carbohydrate D. Give a small snack of high protein food"

"C The client has low hypoglycemia. This is generally treated with a small snack." **15/15 Rule**

A patient being treated for adrenal insufficiency has a serum potassium level of 5.9 mEq/L. What should the nurse expect to be prescribed for this patient? 1) Kayexalate 2) Hydrocortisone 3) Dexamethasone 4) Dextrose 5% and 0.45% normal saline

A patient is demonstrating signs of low pituitary gland function. Which diagnostic test should the nurse expect to be prescribed for this patient? 1) MRI 2) Lumbar puncture 3) Cerebral angiogram 4) Carotid Doppler studies

1 If a tumor of the brain or pituitary is suspected, a head MRI may be completed.

The nurse is reviewing orders written for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which order should the nurse clarify? 1) No added salt diet 2) Fluid restriction 1L/day 3) IV fluids 0.9% normal saline 125 mL/hr 4) Furosemide (Lasix) 20 mg by mouth every day

1 Medical management is primarily focused on treating the hyponatremia. The nurse should question a no added salt diet.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is experiencing a headache and confusion. Which laboratory test would best explain the reason for this patient's symptoms? 1) Sodium 2) Calcium 3) Potassium 4) Hematocrit

1 The clinical presentation of the patient with SIADH is primarily related to the resultant hyponatremia. The neurological signs associated with the hyponatremia are related to osmotic fluid shifts in the brain that lead to cerebral edema and increased intracranial pressure.

The nurse notes that patient with diabetes insipidus (DI) has a loss of free water. Which nursing diagnosis should the nurse use to guide care for this patient? 1) Fluid Volume Deficit 2) Alteration in Comfort 3) Body Image Disturbance 4) Sensory Perceptual Alteration

1 The diagnosis Fluid Volume Deficit related to loss of free water secondary to lack of ADH would be appropriate for this patient.

An older patient's fluid balance record shows a significant increase in urine output over the last few weeks with no other reported clinical symptoms. For which potential health problem should the nurse plan care for this patient? 1) Diabetes 2) Dehydration 3) Hyponatremia 4) Urinary tract infection

The nurse is preparing to assess a patient with diabetes insipidus (DI). Which manifestations should the nurse expect? Select all that apply. 1) Fatigue 2) Extreme thirst 3) Extreme hunger 4) Large amounts of urine output 5) Waking up to urinate during the night

1245 Fatigue is a sign of fluid volume deficit. Polydipsia or extreme thirst is a primary clinical manifestation of DI. Extreme hunger is a manifestation of diabetes mellitus. Polyuria is a primary clinical manifestation of DI. Nocturia or waking up during the night to void is a primary clinical manifestation of DI.

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is: 90mg/dl 180mg/dl 115mg/dl 126mg/dl

126mg/dl

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: 1730 and 2330 1530 and 2130 1330 and 1930 1130 and 1330

1330 and 1930

A patient is being evaluated for elevated levels of antidiuretic hormone (ADH). What findings would cause ADH to be secreted? Select all that apply. 1) Dehydration 2) Decreased heart rate 3) Decreased blood pressure 4) Increased serum osmolarity 5) Elevated blood glucose level

134

DKA results as insufficient insulin, glucose can not be properly used for energy, body then begins to break down fat stores which leads to ketones in body which cause what three things

1. metabolic acidosis 2. ketones excreted in urine 3. electrolyte depletion

The nurse is reviewing the medical history of a patient with adrenal insufficiency. What should the nurse identify as possible causes for the disorder in this patient? Select all that apply. 1) Cancer 2) Trauma 3) Infection 4) Medications 5) Autoimmune disorder

1235

A patient's vitamin D level is below normal. Which endocrine gland will need additional investigation? 1) Thyroid 2) Parathyroid 3) Hypothalamus 4) Anterior pituitary

Laboratory results have been posted for a male patient experiencing manifestations of diabetes insipidus (DI). Which results would confirm the diagnosis? Select all that apply. 1) Hematocrit 52% 2) White blood cells 8000 3) Serum sodium 150 mEq/L 4) Urine specific gravity 1.002 5) Serum potassium 5.5 mEq/L

134 Hematocrit is increased in DI. White blood cells are not measured specifically for DI. Serum sodium is elevated in DI. Urine specific gravity is decreased in DI. Serum potassium is not measured specifically for DI.

The nurse is preparing a teaching tool that focuses on the endocrine system. How should the nurse explain the negative feedback system? 1) Hormone secretion increases when circulating levels drop. 2) Hormone secretion increases when target organs send signals. 3) Hormone secretion increases when circulating levels increase. 4) Hormone secretion increases when the target tissue does not recognize the level.

The nurse notes that an older patient is wearing a sweater and scarf on a warm summer day. What should this observation indicate to the nurse? 1) The patient's target organs are diseased. 2) The patient's metabolism is slowing down. 3) The patient needs hormone replacement therapy. 4) The patient's endocrine organs are malfunctioning.

The patient is preparing discharge teaching for a patient recovering from surgery to treat hyperpituitarism. Which interdisciplinary team member should be consulted to ensure medication teaching is appropriate? 1) Surgeon 2) Pharmacist 3) Charge nurse 4) Endocrinologist

2 Because of the complexity of the disease process and possible side effects of medications (that may decrease secretion of other anterior pituitary hormones), the patient and family need to understand the specific changes to be reported to the health-care provider. Collaborate with the pharmacist for mediation teaching.

A patient is being evaluated for possible hyperpituitarism. Which manifestation most likely caused this patient to seek medical treatment? 1) Hair loss 2) Headaches 3) Sore throat 4) Muscle cramps

2 Hyperpituitarism is usually related to a hypersecreting tumor. The patient presentation is consistent with clinical manifestations associated to the over-secreted hormone, and the tumor itself may lead to headaches.

A patient has a serum sodium level of 126 mEq/L. What action should the nurse take to ensure for this patient's safety? 1) Apply wrist restraints 2) Implement seizure precautions 3) Prepare for nasogastric tube insertion 4) Plan for intermittent urinary catheterization

2 If the serum sodium level goes below 125 mEq/L, the patient is at risk of seizures.

The nurse is reviewing discharge instructions with a patient being treated for diabetes insipidus (DI). What should the nurse direct the patient to do regarding changes in body weight? 1) Restrict fluids for a day 2) Notify the health-care provider 3) Increase the intake of salty foods 4) Take an extra dose of medication

2 Weight is directly associated with water loss or gain, and changes of more than 2 lb per day should be reported to the health-care provider.

A patient is diagnosed with hypopituitarism. Which additional body structure will most like be examined to determine the root cause of this disorder? 1) Thyroid 2) Cerebrum 3) Hypothalamus 4) Parathyroid glands

3 The etiology of anterior pituitary dysfunction is often secondary to damage to the hypothalamus.

The bone density report for a patient with hypopituitarism shows areas of thinning and demineralization. What teaching should the nurse prepare for this patient? 1) Importance of avoiding extremes in temperature 2) Need to reduce exposure to people with infections 3) Food sources containing high amounts of calcium 4) Strategies to increase rest periods throughout the day

3 The nurse should instruct the patient on ways to increase calcium intake since this helps to treat osteoporosis secondary to decreased growth hormone.

A patient with a history of syndrome of inappropriate antidiuretic hormone (SIADH) reports a low urine output for several days. What should the nurse respond to this patient? 1) "Drink more fluids." 2) "Avoid eating salty foods." 3) "Go to the emergency room now." 4) "Take an over-the-counter NSAID."

3 The patient needs medical attention immediately.

A patient is admitted to determine the cause for adrenal insufficiency. What body structures should the nurse expect to be examined in this patient? Select all that apply. 1) Ovaries 2) Thyroid 3) Hypothalamus 4) Adrenal glands 5) Anterior pituitary gland

345

The nurse suspects that a patient's beta 2 receptors are being stimulated. What did the nurse assess to make this clinical determination? Select all that apply. 1) Diaphoresis 2) Dilated pupils 3) Warm dry skin 4) Urinary incontinence 5) Elevated blood pressure

345

The nurse suspects that an older patient's new diagnosis of hypothyroidism is caused by downregulation. How should the nurse explain this to the patient? 1) "The organ making the hormones is degenerating." 2) "The strength of the hormones being synthesized is weaker." 3) "The body becomes confused about the purpose of the hormones. 4) "There are fewer receptors on the surface of target tissues."

Upon inspection the nurse notes that a patient's face is puffy. Which endocrine gland should the nurse assess for function? 1) Thyroid 2) Pancreas 3) Parathyroid 4) Adrenal cortex

The nurse is preparing medications for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication would most likely be prescribed for this patient? 1) Ampicillin 2) Tetracycline 3) Vancomycin 4) Demeclocycline

4 Demeclocycline (Declomycin), a tetracycline derivative, may also be used because it increases water excretion by the kidneys.

A patient is being treated for diabetes insipidus (DI). Which medication should the nurse prepare to administer? 1) Calcium 2) Synthroid 3) Vitamin D 4) Desmopressin (DDAVP)

4 Desmopressin (DDAVP), a synthetic analog of ADH, is the drug of choice in patients with DI.

The nurse is reviewing orders written for a patient with hypopituitarism. What should the nurse expect to be prescribed for this patient? 1) Diuretics 2) Antibiotics 3) Antihypertensives 4) Electrolyte supplements

4 Supportive therapies such as electrolyte replacement are the key to managing the patient with hypopituitarism.

A patient with diabetes insipidus (DI) is experiencing extreme dehydration. What should be used to guide intravenous fluid replacement therapy for this patient? 1) Skin turgor 2) Urine output total 3) Hemoglobin level 4) Serum sodium level

4 The solution ordered is based upon serum sodium level.

A patient is admitted with hypertension and low potassium level. What information in the medical record indicates that this patient has Conn's syndrome? Select all that apply. 1) Age 35 2) Caucasian 3) Male gender 4) Female gender 5) African American

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A Acromegaly B Type 1 diabetes mellitus C Hypothyroidism D Deficient growth hormone

A Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

A nurse is instructing a client regarding intranasal Vasopressin (Pitressin). The nurse tells the client that which of the following is a side effect specific to the medication? A Runny nose. B Headache. C Flushing. D Nausea.

A Vasopressin administered via intranasal route causes nasal congestion/Runny nose. Options B, C, and D are the side effects of the medication administered intravenously.

An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first? a. Obtain intravenous access. b. Administer hydrocortisone succinate (Solu-Cortef). c. Assess blood glucose. d. Administer insulin and dextrose.

A (All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.)

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands her condition and how to control it? 1. "I should avoid becoming dehydrated and pay attention to my need to urinate, drink, or eat more than usual." 2. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." 3. "I will have to monitor my blood glucose level closely for hypoglycemia." 4. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates." Correct: 1 RATIONALES: Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of nondiet soda would be appropriate for hypoglycemia. The client needs to monitor for hyperglycemia, not hypoglycemia. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low. NURSING PROCESS STEP: Evaluation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Analysis

To assist the nurse in evaluating the patients hydration status, assessment would include a. orthostatic hypotension and neck vein filling. b. pupil checks and Kernig sign. c. Chvostek and Trousseau signs. d. S4 gallop and edema.

ANS: A Assessment for orthostatic hypotension and neck vein filling is an important way to evaluate hydration status.

1. A client has a corneal ulcer. What information provided by the client most indicates a potential barrier to home care? a. Chronic use of sleeping pills b. Impaired near vision c. Slightly shaking hands d. Use of contact lenses

ANS: A Antibiotic eyedrops are often needed every hour for the first 24 hours for corneal ulceration. The client who uses sleeping pills may not wake up each hour or may awaken unable to perform this task. This client might need someone else to instill the eyedrops hourly. Impaired near vision and shaking hands can both make administration of eyedrops more difficult but are not the most likely barriers. Contact lenses should be discarded.

13. A client is brought to the emergency department after a car crash. The client has a large piece of glass in the left eye. What action by the nurse takes priority? a. Administer a tetanus booster shot. b. Ensure the client has a patent airway. c. Prepare to irrigate the client's eye. d. Turn the client on the unaffected side.

ANS: B Airway always comes first. After ensuring a patent airway and providing cervical spine precautions (do not turn the client to the side), the nurse provides other care that may include administering a tetanus shot. The client's eye may or may not be irrigated.

2. A client has Ménière's disease with frequent attacks. About what drugs does the nurse plan to teach the client? (Select all that apply.) a. Broad-spectrum antibiotics b. Chlorpromazine hydrochloride (Thorazine) c. Diphenhydramine (Benadryl) d. Meclizine (Antivert) e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: B, C, D Drugs such as chlorpromazine, diphenhydramine, and meclizine can all be used to treat Ménière's disease. Antibiotics and NSAIDs are not used.

. Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing a. type 1 diabetes. b. type 2 diabetes. c. DI. d. myxedema coma.

ANS: C Any patient who has head trauma or resection of a pituitary tumor has an increased risk of developing DI.

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

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

2. A client is seen in the ophthalmology clinic with bacterial conjunctivitis. Which statements by the client indicate a good understanding of home management of this condition? (Select all that apply.) a. "As long as I don't wipe my eyes, I can share my towel." b. "Eye irrigations should be done with warm saline or water." c. "I will throw away all my eye makeup when I get home." d. "I won't touch the tip of the eyedrop bottle to my eye." e. "When the infection is gone, I can use my contacts again."

ANS: C, D Bacterial conjunctivitis is very contagious, and re-infection or cross-contamination between the client's eyes is possible. The client should discard all eye makeup being used at the time the infection started. When instilling eyedrops, the client must be careful not to contaminate the bottle by touching the tip to the eye or face. The client should be instructed not to share towels. Eye irrigations are not needed. Contacts being used when the infection first manifests also need to be discarded.

11. A nurse cares for a client who is recovering from a parathyroidectomy. When taking the client's blood pressure, the nurse notes that the client's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition? a. Serum potassium: 2.9 mEq/L b. Serum magnesium: 1.7 mEq/L c. Serum sodium: 122 mEq/L d. Serum calcium: 6.9 mg/dL

ANS: D Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.

The diagnosis of SIADH is made when which of the following conditions is present? a. Decreased ADH level and hyperkalemia b. Decreased ADH level and hypernatremia c. Increased ADH level and serum ketones d. Increased ADH level and low serum osmolality

ANS: D SIADH occurs when there are increased levels of ADH in the blood compared with a low serum osmolality.

What is a red flag symptom of type 2 diabetes/insulin resistance?

Acanthosis nigrican aka "dirty neck syndrome"

The client has an order for sliding scale insulin at 1900 hours and Lantus insulin at the same hour. The nurse should: a) Administer the two medications together. b) Administer the medications in two injections. c) Draw up the Lantus insulin and then the regular insulin and administer them together. d) Contact the doctor because these medications should not be given to the same client.

Answer B is correct. Lantus insulin cannot be mixed with other insulins, but can be taken by the client taking regular insulin. A, C, and D are not correct methods of administering Lantus insulin with regular insulin.

The nurse correlates which laboratory value as an indication that desmopressin is effective in the treatment of diabetes insipidus (DI)? A. Serum sodium of 140 mEq/L B. Serum osmolality of 305 mOsm/kg C. Urine specific gravity of 1.004 D. Serum hematocrit of 48%

Answer: A Rationale: Patients with DI are at risk for elevated serum sodium levels due to the loss of water through the kidneys secondary to a lack of antidiuretic hormone. With the administration of pitressin, the serum sodium levels should normalize as diuresis is decreased by this medication. Normal serum sodium is 135 to 145 mEg/L.

The nurse monitors for which therapeutic effect as a result of the administration of Pitressin? A. Decreased urine output B. Decreased blood pressure C. Decreased serum glucose D. Decreased thirst

Answer: A Rationale: Pitressin (form of antidiuretic hormone) works by increasing reabsorption of water in the kidneys, and is manifested by a decrease in urine output. Other therapeutic effects include normalizing blood pressure (which may be decreased with DI). Pitressin has no effect of serum glucose level. Thirst may decrease as fluid balance is reestablished.

Which hormones are secreted from the anterior pituitary gland? (Select all that apply.) A. ACTH B. Cortisol C. Follicle stimulating hormone D. Growth hormone E. Pitressin F. Prolactin

Answer: A, C, D, and E

The nurse questions which order in the patient who has undergone transsphenoidal hypophysectomy for a pituitary tumor? A. Offer clear fluids once alert and awake. B. Oxygen 2 L via nasal cannula. C. Maintain head of bed at 45 to 60 degree angle. D. Apply lip balm as needed.

Answer: B Rationale: After transsphenoidal hypophysectomy, the patient has a drip pad under the nose, making breathing through the nose ineffective. Supplemental oxygen and humidity are usually administered via a face tent in these postoperative patients.

The nurse monitors the patient with SIADH for which complication secondary to a serum sodium level of 120 mEq/L? A. Hypotension B. Hyperglycemia C. Seizures D. Bradycardia

Answer: C Rationale: As serum sodium levels decrease in patients with SIADH, the patient may have seizures or become comatose, particularly with serum sodium levels fall below 120 mEq/L. The neurological signs associated with the hyponatremia are related to osmotic fluid shifts in the brain that lead to cerebral edema and increased intracranial pressure.

In reviewing admission orders for a patient admitted with SIADH, the nurse should question which order? A. IV 3% NS at 10 mL/hr B. Seizure precautions C. Sodium-restricted diet D. Fluid restriction of 1000 mL/day

Answer: C Rationale: The patient with SIADH has dilutional hyponatremia secondary to increased water reabsorption in the kidneys secondary to excessive ADH. Elevating the serum sodium is important to decrease the risk of seizures and other complications, so there is no need to restrict sodium in the diet. The patient is usually placed on a fluid restriction. A 3% normal saline is a very hypertonic solution that should be administered via a central line and delivered by an infusion pump.

Secretion of pitressin results in reabsorption of which of the following in the kidneys? A. Calcium B. Potassium C. Sodium D. Water

Answer: D

Which laboratory result does the nurse correlate with a diagnosis of Diabetes Insipidus (DI)? A. Serum osmolality, 285 mOsm/kg B. Serum sodium, 132 mEq/L C. Hematocrit 32% D. Urine specific gravity, 1.001

Answer: D Rationale: The clinical presentation of the patient with DI is dependent upon the significance of water loss. Due to the lack of ADH, the patient excretes large volumes of dilute urine with a low specific gravity. Serum sodium and osmolality levels are increased in DI secondary to hemoconcentration.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? A "You must lie flat for 24 hours after surgery." B "You must avoid coughing, sneezing, and blowing your nose." C "You must restrict your fluid intake." D "You must report ringing in your ears immediately."

B After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? A Tetanic contractions B Neck vein distention C Weight loss D Polyuria

B SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

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

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

The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning. What is this client likely experiencing? Answers: A. Dawn phenomenon B. Somogyi effect C. An insulin spike D. Excessive corticosteroids

B Somogyi effect The Somogyi effect is when blood sugar drops too low in the morning causing rebound hyperglycemia in the morning. The hypoglycemia at 2am is highly indicative. The Dawn phenomenon is similar but would not have the hypoglycemia at 2am.

One benefit of Glargine (Lantus) insulin is its ability to: a.Release insulin rapidly throughout the day to help control basal glucose b. Release insulin evenly throughout the day and control basal glucose levels. c. Simplify the dosing and better control blood glucose levels during the day.

B)Release insulin evenly throughout the day and control basal glucose levels"Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

B, D, E (Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.)

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

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

Polydipsia and polyuria related to diabetes mellitus are primarily due to a.the release of ketones from cells during fat metabolism. b.fluid shifts resulting from the osmotic effect of hyperglycemia c.damage to the kidneys from exposure to high levels of glucose. d.changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

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

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

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

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

A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient's labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next? A. Start the IV fluids and administer the insulin bolus and drip as ordered B. Hold IV fluids and administer insulin as ordered C. Hold the insulin and notify the doctor of the potassium level of 2.5 D. Recheck the glucose level

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a.Call the physician. b.Administer insulin as ordered .c.Check the patient's blood glucose level. d.Assess for other neurologic symptoms.

A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of a.polyuria. b.severe dehydration. c.rapid, deep respirations .d.decreased serum potassium.

C.Correct answer: cRationale: Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: Place the client in a high-fowlers position Assist the client out of bed to the chair Ensure that the client's residual limb is elevated Check the client's serum glucose level

Check the clients serum glucose level

A patient has been prescribed metformin for treatment of type 2 diabetes. Which teaching would the nurse provide? Select all that apply. 1. "You are likely to have one or two episodes of hypoglycemia while your body adjusts to this medication." 2. "If you need any diagnostic testing that requires radiocontrast dye, be certain to report that you are taking metformin." 3. "You may have mild stomach upset at first when taking this medication." 4. "Take this medication just before you begin to eat." 5. "You may develop a persistent cough while taking metformin."

Correct Answer: 2,3 Rationale 1: Metformin is not likely to produce hypoglycemia. Rationale 2: Metformin should be discontinued prior to any procedure using radiocontrast dye. Rationale 3: Gastrointestinal upset is common at the beginning of metformin therapy. Rationale 4: There is no indication that metformin should be taken immediately preceding a meal. It is often taken at night. Rationale 5: A cough is not a side effect of metformin.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (select all that apply)? a.Insulin administration b.Elimination of sugar from diet c.Need to reduce physical activity d.Use of a portable blood glucose monitore.Hypoglycemia prevention, symptoms, and treatment

Correct answers: a, d, eRationale: The nurse ensures that the patient understands the proper use of insulin. The nurse teaches the patient how to use the portable blood glucose monitor and how to recognize and treat signs and symptoms of hypoglycemia and hyperglycemia.

Rotating injection sites when administering insulin prevents which of the following complications? Systemic allergic reactions Insulin edema Insulin lipodystrophy Insulin resistance

INSULIN LIPODYSTROPHY

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? Shallow respirations and severe abdominal pain Kussmaul's respirations and a fruity odor on the breath Decreased respirations and increased urine output Cheyne-stokes respirations and foul-smelling urine

Kussmauls respiration and fruity odor breath

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Monitor blood glucose, and assess for signs of hyperglycemia Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Monitor blood glucose closely, and look for signs of hypoglycemia Give subcutaneous insulin and monitor blood glucose

Monitor blood glucose and look for signs of hypoglycemia

Which patient below is presenting with signs and symptoms of rheumatoid arthritis? Select all that apply: A. A 35 year old patient who has severe morning stiffness for 45 minutes. B. A 45 year old male with crepitus in the right knee. C. A 30 year old female with warm, red, soft joints on the hands and wrist. D. A 40 year old male whose x-ray imaging results showed osteophytes formation and decreased joint space in the left knee.

The answer is A and C. These are common findings in RA. However, options B and D are found in OA.

________________ is a form of arthritis that is an autoimmune condition that causes inflammation within the joints, specifically the synovium. A. Rheumatoid arthritis B. Osteoarthritis

The answer is A. Rheumatoid arthritis is an autoimmune condition that causes inflammation of the synovium. Osteoarthritis is a type of arthritis that causes deterioration of the articular hyaline cartilage of the bone.

The 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. Elevated serum acetone level 2. Serum ketone bodies 3. Serum alkalosis 4. Below-normal serum potassium level Correct: 4 RATIONALES: A client with 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. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

Classic clinical manifestations of diabetes

Three Ps polyuria, polydipsia, and polyphagia

When caring for a client with diabetes insipidus, the nurse expects to administer: 1. vasopressin (Pitressin Synthetic). 2. furosemide (Lasix). 3. regular insulin. 4. 10% dextrose.

When caring for a client with diabetes insipidus, the nurse expects to administer: 1. vasopressin (Pitressin Synthetic). 2. furosemide (Lasix). 3. regular insulin. 4. 10% dextrose. Correct: 1 RATIONALES: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological therapies COGNITIVE LEVEL: Comprehension

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? 1. Tetanic contractions 2. Neck vein distention 3. Weight loss 4. Polyuria Correct: 2 RATIONALES: SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria). NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Comprehension

After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on a. frequent monitoring of serum and urine osmolarity. b. parenteral administration of a GH-receptor antagonist. c. keeping the patient in a recumbent position at all times. d. patient teaching regarding the need for lifelong hormone therapy.

a. frequent monitoring of serum and urine osmolarity. Rationale: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. increase calcium intake to 1500 mg/day. b. perform glucose monitoring for hypoglycemia. c. obtain immunizations due to high risk of infections. d. avoid abrupt position changes because of orthostatic hypotension.

a. increase calcium intake to 1500 mg/day. Rationale: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and institution of a low-impact exercise program.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for repositioning. d. Instruct assistive personnel to measure intake and output.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." How would the nurse respond? a. "I will ask your doctor to order a mental health consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

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

b-d-e

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.

b. monitoring blood glucose levels. e. protecting patient from exposure to infection. Rationale: Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.

Blood sugar is well controlled when Hemoglobin A1C is: Below 7% Between 12%-15% Less than 180 mg/dL Between 90 and 130 mg/dL

below 7 percent

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client's plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the patient. d. Assist the client to dangle before rising.

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

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor? a. Hypertension b. Bradycardia c. Dehydration d. Pulmonary embolus

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor? a. Increased intracranial pressure b. Myocardial infarction c. Rapid-onset hypernatremia d. Bowel perforation

The blood glucose of a patient who is newly diagnosed with type 1 diabetes mellitus has a blood glucose level of 340 mg/dL. Which type of insulin prescribed for the patient is appropriate to administer at this time? Please choose from one of the following options. a) NPH + regular (70/30) b) NPH c) Regular d) Glargine

c) Regular Regular insulin has the fastest onset (30 - 60 min) in this group of insulins.

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: a.Call the physician b.Encourage the intake of fluids c.Administer the insulin as ordered d.Give the client ½ c. of orange juice

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. monitor blood glucose levels. b. restrict fluid and sodium intake. c. administer potassium-sparing diuretics. d. advise the patient to make postural changes slowly.

c. administer potassium-sparing diuretics. Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone, eplerenone) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium supplements may also be necessary.

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. hypernatremia and edema. b. muscle spasticity and hypertension. c. low urine output and hyponatremia. d. weight gain and decreased glomerular filtration rate.

c. low urine output and hyponatremia. Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include headache, vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, seizures, and coma.

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is a. once a day at bedtime. b. every other day on awakening. c. on arising and in the late afternoon. d. at consistent intervals every 6 to 8 hours.

c. on arising and in the late afternoon. Rationale: As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy? a. The need to check the client's urinary specific gravity. b. The need to take blood pressure at least twice a day. c. The need to monitor blood glucose every day. d. The need to weigh every day and report weight gain.

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include? a. "Take this drug on an empty stomach first thing in the morning." b. "You will be starting on a high dose of the drug to ensure it will work." c. "You might experience an increase in blood pressure in about a week." d. "Seek medical attention immediately if you have chest pain and dizziness."

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform? a. Respiratory assessment b. Skin assessment c. Neurologic assessment d. Cardiac assessment

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a.Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. b.Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. d. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

Which of the following chronic complications is associated with diabetes? a.Dizziness, dyspnea on exertion, and coronary artery disease b.Leg ulcers, cerebral ischemic events, and pulmonary infarcts c Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia's d. Retinopathy, neuropathy, and coronary artery disease

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing. d. laryngospasms and tingling in the hands and feet.

d. laryngospasms and tingling in the hands and feet. Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia.

A client's blood gases reflect diabetic acidosis. The nurse should expect: Decreased HCO3 Increased PCO2 Decreased PO2 Increased pH

decreased bicarb

What is the Dawn phenomenon?

early morning (4-8 am) rise in blood glucose without preceding hypoglycemia, attempts to lower glucose levels can cause hypoglycemia in patient if phenomenon isn't recognized

What fluid state is a DKA patient in?

fluid volume deficit

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except: Polyphagia Hyponatremia Ketonuria Hypoglycemia

hypoglycemia

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? IV bolus, followed by continuous infusion Subcutaneous IV bolus only Intramuscular

iV bolus followed by continuous infusion

The insulin that has the most rapid onset of action would be: Ultralente Lispro Lente Humulin N

lispro

Insulin forces which of the following electrolytes out of the plasma and into the cells? Magnesium Phosphorus Calcium Potassium

potassium

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? Allopurinol (Zyloprim) Prednisone (Deltasone) Phenelzine (Nardil) Atenolol (Tenormin)

prednisone

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: Blurred vision Weakness Nausea Diaphoresing

Diaphoresing

A patient is admitted for treatment of Cushing's syndrome. What is the primary reason for this disorder? 1) Elevated glucocorticoid level 2) Elevated aldosterone secretion 3) Decreased glucocorticoid level 4) Decreased aldosterone secretion

A patient is being evaluated for hyperaldosteronism. What should the nurse expect to assess in this patient? 1) Headache 2) Thin, friable skin 3) Dependent edema 4) Fat maldistribution

A patient is diagnosed with a unilateral pheochromocytoma. For which treatment should the nurse prepare this patient? 1) Adrenalectomy 2) Smooth muscle relaxants 3) Beta-adrenergic blocking agents 4) Alpha-adrenergic blocking agents

A patient with an endocrine disorder is being considered for diagnostic tests. What test should the nurse expect to be prescribed for this patient? 1) CT scan 2) Urinalysis 3) Sedimentation rate 4) Hemoglobin and hematocrit

The nurse is preparing to complete a physical assessment on a patient's endocrine system. Which gland should the nurse prepare to palpate? 1) Testes 2) Ovaries 3) Pancreas 4) Parathyroid

A patient's cortisol level is elevated. How will this elevation affect the patient? Select all that apply. 1) Alteration in fat metabolism 2) Enhance secretion of sodium 3) Alteration in protein metabolism 4) Alteration in carbohydrate metabolism 5) Suppression of the immune response

1345

The nurse is planning care for a patient with hypopituitarism. What interventions would be a priority for this patient? Select all that apply. 1) Fertility 2) Skin care 3) Vital signs 4) Bone density 5) Fluid balance

134 Skin care and fluid balance are not identified issues in hypopituitarism

"The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement? "1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

1: ensure the client eats the bedtime snack"1. Humulin N peaks in 6-8 hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia. (Correct)

A 60-year-old patient asks why endocrine testing is being done. Which is the best response for the nurse to make? 1) "Endocrine organs atrophy with aging." 2) "Endocrine function can change through the lifespan." 3) "Endocrine function remains the same through the lifespan." 4) "Endocrine testing identifies which hormone replacement therapy you will need."

A patient is having a vanillylmandelic acid (VMA) urine test. What food should the nurse instruct the patient to avoid before undergoing this test? 1) Red meat 2) Chocolate 3) Whole grains 4) Green vegetables

A patient is prescribed to have a cortisol blood level drawn. At which time should this sample be drawn? 1) Midnight 2) 0700 hours 3) 1200 hours 4) 2200 hours

A patient with hypercortisolism has significant fluid retention. Which nursing action would be most appropriate for this patient? 1) Monitor blood glucose level 2) Turn and reposition every two hours 3) Elevate the head of the bed 45 degrees 4) Administer medications that interfere with production/secretion of cortisol

A patient with no predisposing risk factors develops ventricular fibrillation. For which health problem should the patient be evaluated? 1) Hypercortisolism 2) Pheochromocytoma 3) Hyperaldosteronism 4) Cushing's syndrome

The nurse is planning to assess a patient's endocrine system. What should be included in this assessment? 1) Lung sounds 2) Body weight 3) Bowel sounds 4) Peripheral pulses

The nurse is preparing a teaching tool on the major hormones of the body for a community program. Which gland should the nurse identify as controlling calcium levels in the body? 1) Thyroid 2) Parathyroid 3) Hypothalamus 4) Posterior pituitary

The nurse is conducting a physical assessment of a patient's endocrine system. What should the nurse include with auscultation? 1) Lung sounds 2) Bowel sounds 3) Carotid arteries 4) Abdominal aorta

A patient is concerned because facial features are changing and the hands are becoming larger and painful. Which hormone should the nurse suspect is causing this patient's manifestations? 1) Testosterone 2) Growth hormone 3) Thyroid-stimulating hormone 4) Adrenocorticotropic hormone (ACTH)

2 Increased levels of growth hormone in an adult can cause course facial features and alter the bone structure of the hands and feet.

A patient with hypopituitarism is experiencing muscle weakness. Which referral should the nurse make to help this patient? 1) Home care 2) Physical therapy 3) Recreational therapy 4) Occupational therapy

2 Physical therapy would be helpful to maximize this patient's mobility. Osteoporosis increases the risk for falls, and the physical therapist can provide input into safe transfers from bed to chair and measures to decrease the incidence of falls.

The nurse is preparing discharge teaching for a patient recovering from a transsphenoidal hypophysectomy for a pituitary tumor. What should the nurse emphasize in this teaching? Select all that apply. 1) No lifting 2) Avoid coughing 3) Do not bend over 4) Sneeze with an open mouth 5) Avoid driving for several weeks

23 The patient should be instructed to avoid activities that increase pressure at the incision site such as coughing and bending over

A patient is diagnosed with insufficient growth hormone. What effects will this have on the patient? Select all that apply. 1) Change in hair color 2) Alteration in bone density 3) Sluggish protein synthesis 4) Increased use of fatty acids 5) Increase in circulating blood glucose

2345

A patient is experiencing dysfunction of the hypothalamus. Which hormones will be affected by this dysfunction? Select all that apply. 1) Follicle-stimulating hormone (FSH) 2) Thyrotropin-releasing hormone (TRH) 3) Corticotropin-releasing hormone (CRH) 4) Gonadotropin-releasing hormone (Gn-RH) 5) Growth hormone-releasing hormone (GHRH)

2345

A patient is being evaluated for hyperpituitarism. Which laboratory studies should the nurse expect to be prescribed for this patient? Select all that apply. 1) Calcium level 2) Growth hormone 3) Cortrosyn stimulation test 4) Follicle-stimulating hormone level (FSH) 5) Thyroid-stimulating hormone level (TSH)

2345 Calcium level would be appropriate if a parathyroid gland disorder is suspected.

A patient is recovering from surgery to remove a pituitary tumor. Why should the nurse schedule frequent mouth care for this patient? 1) Medications dry mucous membranes 2) Maintenance of nothing by mouth status 3) Mouth breathing because of nasal packing 4) Stomatitis caused by the hormone imbalance

3 Because of the surgical procedure and postoperative packing, the patient breathes primarily through the mouth, increasing the chance of dry mouth.

The nurse is reviewing laboratory values for a female patient who has had minimal urine output over the last shift. Which finding suggests that this patient may be experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? 1) Hematocrit 40% 2) Serum sodium 136 mEq/L 3) Urine specific gravity 1.035 4) Serum potassium 3.9 mEq/ L

3 The urine specific gravity is elevated, which is seen in patients with SIADH. In patients with SIADH, due to excessive ADH secretion, they present with scant urine output and elevated urine specific gravity.

A patient asks for a definition of adrenal insufficiency. Which response should the nurse make? 1) Increased secretion of hormones from the adrenal cortex 2) Decreased secretion of hormones from the adrenal medulla 3) Increased secretion of hormones from the anterior pituitary gland 4) Decreased secretion of hormones from the anterior pituitary gland

A patient is diagnosed with pheochromocytoma. Which manifestation should the nurse expect as a result of catecholamine secretion? 1) Bradycardia 2) Hypotension 3) Hypoglycemia 4) Widening pulse pressure

A patient is having a test to suppress cortisol levels. Which response suggests that additional testing of the adrenal cortex would be required? 1) Increase in urine output 2) Increase in cortisol level 3) Decrease in cortisol level 4) No change in cortisol level

A patient is scheduled for a bilateral adrenalectomy. For which health problem should the nurse prepare this patient? 1) Hypoglycemia 2) Hypercortisolism 3) Hyperaldosteronism 4) Adrenal insufficiency

A patient with adrenal insufficiency asks why the skin looks so tan. What should the nurse respond to this patient? 1) "The darker skin means the hormone from the hypothalamus is low." 2) "The darker skin is caused by the destruction of the cells of the adrenal glands." 3) "The darker skin means that you have too much of the hormones cortisol and aldosterone." 4) "The hormone causing the darker skin shares the same hormone as the one helping to overcome the insufficiency."

The nurse is providing discharge instructions to a patient with adrenal insufficiency. Which statement indicates that additional teaching is required? 1) "I should obtain a MedicAlert bracelet." 2) "I should report changes in urine output." 3) "I should take my medication every day." 4) "I should expect to gain weight every day."

The nurse notes that a patient with pheochromocytoma is prescribed sodium nitroprusside (Nipride). What is the purpose of this medication? 1) Decrease the secretion of catecholamines 2) Increase chronotropic and inotropic effects 3) Limit the development of tachyarrhythmias 4) Reduce blood pressure through vasodilation

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A vasopressin (Pitressin Synthetic). B furosemide (Lasix). C regular insulin. D 10% dextrose.

A Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A Fluid intake is less than 2,500 ml/day. B Urine output measures more than 200 ml/hour. C Blood pressure is 90/50 mm Hg. D The heart rate is 126 beats/minute.

A Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the clients daily chest x-ray.

A (Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.)

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.) a. A 20-year-old female with benign pituitary tumors b. A 32-year-old male with diplopia c. A 41-year-old female with anorexia nervosa d. A 55-year-old male with hypertension e. A 60-year-old female who is experiencing shock f. A 68-year-old male who has gained weight recently

A, C, D, E (Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.)

A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

A, C, D, E, F (Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.)

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a.A1C 9% b.BP 126/80 mm Hg c.FBG 130 mg/dL (7.2 mmol/L) d.LDL cholesterol 100 mg/dL (2.6 mmol/L)

12. A client has been prescribed brinzolamide (Azopt). What assessment by the nurse requires consultation with the provider? a. Allergy to eggs b. Allergy to sulfonamides c. Use of contact lenses d. Use of beta blockers

ANS: B Brinzolamide is similar to sulfonamides, so an allergic reaction could occur. The other assessment findings are not related to brinzolamide.

6. A client is scheduled for a stapedectomy in 2 weeks. What teaching instructions are most appropriate? (Select all that apply.) a. Avoid alcohol use before surgery. b. Blow the nose gently if needed. c. Clean the telephone often. d. Sneeze with the mouth open. e. Wash the external ear daily.

ANS: B, C, D, E It is imperative that the client having a stapedectomy is free from ear infection. Teaching includes ways to prevent such infections, such as blowing the nose gently, cleaning objects that come into contact with the ear, sneezing with the mouth open, and washing the external ear daily. Avoiding alcohol will not help prevent ear infections.

2. A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.) a. Administer levothyroxine (Synthroid). b. Administer propranolol (Inderal). c. Monitor the apical pulse. d. Assess for Trousseau's sign. e. Initiate telemetry monitoring.

ANS: C, E The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia.

Which action by a type 1 diabetic patient indicates that the nurse should implement teaching about exercise and glucose control? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when the glucose is 200 mg/dL. c The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.

11. A client is taking timolol (Timoptic) eyedrops. The nurse assesses the client's pulse at 48 beats/min. What action by the nurse is the priority? a. Ask the client about excessive salivation. b. Assess the client for shortness of breath. c. Give the drops using punctal occlusion. d. Hold the eyedrops and notify the provider.

ANS: D The nurse should hold the eyedrops and notify the provider because beta blockers can slow the heart rate. Excessive salivation can occur with cholinergic agonists. Shortness of breath is not related. If the drops are given, the nurse uses punctal occlusion to avoid systemic absorption.

The nurse incorporates the nursing diagnosis "Fluid volume deficit related to excessive secretion of vasopressin" in the plan of care for the patient with which disorder? A. Acromegaly B. Diabetes insipidus C. Hypopituitarism D. SIADH

Answer: B Rationale: Diabetes insipidus (DI) leads to fluid volume deficit secondary to losses of large amounts of water through the kidneys. Acromegaly is associated with overgrowth of bones secondary to excessive growth hormone secretion. Hypopituitarismis associated with multiple disorders based upon target deficiencies. SIADH is an excess of ADH leading to water retention and fluid volume overload.

The patient just diagnosed with acromegaly is scheduled for a transsphenoidal hypophysectomy. Which statement made by the patient indicates a need for clarification regarding this treatment? A. "I will get to drink fluids once I am awake after surgery." B. "I'm glad there will be no visible incision from this surgery." C. "I hope I can go back to wearing size 8 shoes instead of size 12." D. "I will wear slip-on shoes after surgery so I don't have to bend over."

Answer: C Rationale: Changes to bone thickness are permanent, and the hands and feet sizes will not decrease after treatment of the hypersecreting tumor. Patients are allowed oral intake once awake, alert with an intact gag and swallow. There will not be a visible scar as the surgical approach is transsphenoidal. The patient is discouraged from bending at the waist as this can increase intracranial pressure and place pressure on the graft site at the surgical site.

Ms. Andrews is ordered to receive bromocriptine mesylate (Parlodel) for the treatment of her tumor. The nurse correlates which rationale for this medication? A. Decreases serum glucose levels B. Decreases water reabsorption in the kidneys C. Decreases secretion of growth hormone D. Decreases secretion of ADH

Answer: C Rationale: Dopamine agonists (bromocriptine mesylate [Parlodel]) inhibit the release of anterior pituitary hormones. Medications that inhibit release of growth hormone include somatostatin analogs and growth hormone receptor blockers.

B (Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.)

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond? a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups? d. I will close the door to your room and restrict visitors.

B (Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.)

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions? a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.

B (Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.)

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

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

A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this clients plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to re-position the client. d. Assist the client to dangle before rising.

C (In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.)

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

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

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? Respiration Pulse Temperature BP

Temperature

During a head-to-toe assessment of a patient with arthritis, you note bony outgrowths on the proximal interphalangeal joint. These outgrowths are known as __________ and occur in ______________. A. Heberden's Node, osteoarthritis B. Bouchard's Node, rheumatoid arthritis C. Heberden's Node, rheumatoid arthritis D. Bouchard's Node, osteoarthritis

The answer is D. Bouchard's Node are bony outgrowths on the proximal interphalangeal joint (middle joint of the finger and occur in osteoarthritis). Heberden's Node occur on the distal interphalangeal joint (finger joint closet to the fingernail).

The benefits of using an insulin pump include all of the following except: By continuously providing insulin they eliminate the need for injections of insulin They simplify management of blood sugar and often improve A1C They enable exercise without compensatory carbohydrate consumption They help with weight loss

They help with weight loss

Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes? A single anti-diabetes drugs Once daily insulin injections A combination of oral anti-diabetic medications Three or four injections per day of different types of insulin.

Three or four injections of different types of insulin

Untreated diabetes may result in all of the following except: Blindness Cardiovascular disease Kidney disease Tinnitus

Tinnitis

What is the mechanism that results in Kussmaul respiration?

To compensate for metabolic acidosis, the respiration are deep and rapid

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values would the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L (150 mmol/L) b. Sodium: 130 mEq/L (130 mmol/L) c. Potassium: 2.5 mEq/L (2.5 mmol/L) d. Potassium: 5.0 mEq/L (5.0 mmol/L) e. pH 7.28 f. pH 7.50

a-c-e

A nurse assesses a client with Cushing disease. Which assessment findings would the nurse expect? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

a-d-e

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? A "Administer desmopressin while the suspension is cold." B "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." C "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." D "You won't need to monitor your fluid intake and output after you start taking desmopressin."

c Question 27 Explanation: Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority? Please choose from one of the following options. a) Send blood to the laboratory for analysis b) Administer oxygen per nasal cannula c) Administer 50% dextrose IV per protocol d) Administer the prescribed insulin

c) Administer 50% dextrose IV per protocol Medical emergencies that occur with diabetic patients are often due to either hyperglycemia or hypoglycemia.

The nurse is preparing to palpate a patient's thyroid gland. Which technique should be used for this assessment? 1) Palpate the left lobe with the patient's head turned to the right 2) Palpate the right lobe with the patient's head turned to the left 3) Stand behind the patient and place fingers on both sides of the neck 4) Stand in front of the patient and palpate the lobes when the patient swallows

After a patient has been diagnosed with SIADH, the nurse would expect the first line of treatment to include a. fluid restriction. b. hypotonic intravenous fluid. c. D5W. d. fluid bolus.

ANS: A Reduction in fluid intake is one component of the treatment plan for SIADH.

A patient is being discharged after surgery for hyperpituitarism. What should the nurse emphasize to reduce the risk of postoperative infection? 1) Restrict fluids 2) Avoid straining the suture line 3) Maintain bedrest for several days 4) Expect clear nasal drainage to occur

2 Strain on the suture line could introduce microorganisms into the surgical site and enter the central nervous system. Cerebrospinal fluid leak could lead to meningitis.

The nurse is caring for a female patient with Cushing's syndrome. What should the nurse expect to assess in this patient? Select all that apply. 1) Leg cramps 2) Amenorrhea 3) Breast atrophy 4) Menstrual pain 5) Deepening of the voice

235

The nurse is visiting the home of a patient with adrenal insufficiency. Which observation indicates that the patient needs to be seen by the health-care provider immediately? Select all that apply. 1) Fatigue 2) Poor skin turgor 3) Skin hyperpigmentation 4) Dry mucous membranes 5) Blood pressure 90/50 mm Hg

245

A patient has not eaten for 18 hours because of diagnostic testing. Which pancreatic hormone is maintaining this patient's blood glucose level? 1) Insulin 2) Cortisol 3) Glucagon 4) Epinephrine

A patient is being evaluated for hypercortisolism. Which laboratory test should the nurse expect to be prescribed initially for this patient? 1) Serum sodium level 2) Serum potassium level 3) 24-hour urine for cortisol 4) Fasting blood glucose level

A patient is diagnosed with a disorder of the hypothalamus. To which other gland is this structure attached? 1) Thyroid 2) Thalamus 3) Pituitary gland 4) Adrenal glands

An adolescent is experiencing delayed puberty. Which gland function should be evaluated? 1) Pancreas 2) Adrenal cortex 3) Anterior pituitary 4) Posterior pituitary

An older patient with several chronic diseases asks why some of the health problems are being caused by hormone imbalances. What explanation should the nurse provide to this patient? 1) "The hormone imbalance caused the chronic disease." 2) "The chronic diseases exposed the underlying hormone imbalance." 3) "Other health problems can affect the normal production and response of hormones." 4) "The treatment for the chronic diseases adversely affected the organs and hormone production."

A patient with osteoarthritis develops the syndrome of inappropriate antidiuretic hormone (SIADH). What information in the patient's history should the nurse identify as being the best reason for the development of this disorder? 1) Male gender 2) Age 70 years 3) Use of NSAIDs 4) African American

3 Causes of SIADH vary and include side effects of medications such as non-steroidal anti-inflammatory drugs (NSAIDs).

A patient is suspected of having a disorder of the posterior pituitary gland. For which additional health problem should the nurse anticipate planning care for this patient? 1) Acromegaly 2) Osteoporosis 3) Diabetes insipidus 4) Type 1 diabetes mellitus

3 Central diabetes insipidus is caused by a decreased secretion of antidiuretic hormone (ADH) from the posterior pituitary gland.

The nurse suspects that a patient with Conn's syndrome has a decreased potassium level. What finding did the nurse use to make this clinical decision? 1) Muscle wasting 2) Elevated blood glucose 3) Abnormal fat distribution 4) Development of U waves on the cardiac monitor

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? 1. Infusing I.V. fluids rapidly as ordered 2. Encouraging increased oral intake 3. Restricting fluids 4. Administering glucose-containing I.V. fluids as ordered Correct: 3 RATIONALES: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Analysis

A client is admitted with a serum glucose level of 618 mg/dl. The client is awake and oriented, with hot, dry skin; a temperature of 100.6° F (38.1° C); a heart rate of 116 beats/minute; and a blood pressure of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority? 1. Deficient fluid volume related to osmotic diuresis 2. Decreased cardiac output related to increased heart rate 3. Imbalanced nutrition: Less than body requirements related to insulin deficiency 4. Ineffective thermoregulation related to dehydration Correct: 1 RATIONALES: A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and deficient fluid volume. In this client, tachycardia is more likely to result from deficient fluid volume than decreased cardiac output because his blood pressure is normal. Although the client's serum glucose level is elevated, food isn't a priority because fluids and insulin should be administered to lower the serum glucose level. Therefore, Imbalanced nutrition: Less than body requirements isn't an appropriate nursing diagnosis. A temperature of 100.6° F (38.1° C) isn't life-threatening, which eliminates Ineffective thermoregulation as the top priority. NURSING PROCESS STEP: Planning CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? 1. Cerebral edema 2. Hypovolemic shock 3. Severe hyperkalemia 4. Tetany Correct: 1 RATIONALES: Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk of cerebral edema. Hypovolemic shock results from severe fluid volume deficit; in contrast, SIADH causes excessive fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH. NURSING PROCESS STEP: Evaluation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Analysis

A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by: 1. testing for ketones in the urine. 2. testing urine specific gravity. 3. checking temperature frequently. 4. performing capillary glucose testing frequently. Correct: 4 RATIONALES: The nurse should perform capillary glucose testing frequently because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia. Urine ketone testing isn't indicated because the client does secrete insulin and, therefore, isn't at risk for ketosis. Urine specific gravity isn't indicated because although fluid balance can be compromised, it usually isn't dangerously imbalanced. Temperature regulation may be affected by excess cortisol and isn't an accurate indicator of infection. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? 1. Cool, moist skin 2. Rapid, thready pulse 3. Trembling arms and legs 4. Slow, shallow respirations Correct: 2 RATIONALES: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of a fluid volume deficit, such as a rapid, thready pulse, decreased blood pressure, and rapid respirations. Cool, moist skin trembling arms and legs are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? 1. "You must lie flat for 24 hours after surgery." 2. "You must avoid coughing, sneezing, and blowing your nose." 3. "You must restrict your fluid intake." 4. "You must report ringing in your ears immediately." Correct: 2 RATIONALES: After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes, which is controlled by tolazamide (Tolinase). What is the most important laboratory test for confirming HHNS? 1. Serum potassium level 2. Serum sodium level 3. Arterial blood gas (ABG) values 4. Serum osmolarity Correct: 4 RATIONALES: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Comprehension

A client with primary diabetes insipidus is prescribed desmopressin (DDAVP). Which instruction should the nurse provide before the client is discharged? 1. "Administer desmopressin while the suspension is cold." 2. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." 3. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." 4. "You won't need to monitor your fluid intake and output after you start taking desmopressin." Correct: 3 RATIONALES: Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological therapies COGNITIVE LEVEL: Application

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? 1. Initiate fluid replacement therapy. 2. Administer insulin. 3. Correct diabetic ketoacidosis. 4. Determine the cause of diabetic ketoacidosis. Correct: 1 RATIONALES: The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively. Therefore, insulin administration follows fluid replacement therapy. Determining and correcting the cause of diabetic ketoacidosis are important steps, but the client's condition must be stabilized first to prevent life-threatening complications. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological therapies COGNITIVE LEVEL: Application

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50

A, C, F (Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.)

17. A client is scheduled to have a tumor of the middle ear removed. What teaching topic is most important for the nurse to cover? a. Expecting hearing loss in the affected ear b. Managing postoperative pain c. Maintaining NPO status prior to surgery d. Understanding which medications are allowed the day of surgery

ANS: A Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client.

6. An older adult in the family practice clinic reports a decrease in hearing over a week. What action by the nurse is most appropriate? a. Assess for cerumen buildup. b. Facilitate audiological testing. c. Perform tuning fork tests. d. Review the medication list.

ANS: A All options are possible actions for the client with hearing loss. The first action the nurse should take is to look for cerumen buildup, which can decrease hearing in the older adult. If this is normal, medications should be assessed for ototoxicity. Further auditory testing may be needed for this client.

13. While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1° F. Which action should the nurse take first? a. Turn the lights down and shut the client's door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client's apical-radial pulse deficit. d. Administer a dose of acetaminophen (Tylenol).

ANS: A A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.

16. An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first? a. Obtain intravenous access. b. Administer hydrocortisone succinate (Solu-Cortef). c. Assess blood glucose. d. Administer insulin and dextrose.

ANS: A All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

13. A nurse is teaching a community group about preventing hearing loss. What instruction is best? a. Always wear a bicycle helmet. b. Avoid swimming in ponds or lakes. c. Don't go to fireworks displays. d. Use a soft cotton swab to clean ears.

ANS: A Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss if the client has repeated infections. Fireworks displays are loud, but usually brief and only occasional. Nothing smaller than the client's fingertip should be placed in the ear canal.

1. A nurse is teaching a client about ear hygiene and health. What client statement indicates a need for further teaching? a. "A soft cotton swab is alright to clean my ears with." b. "I make sure my ears are dry after I go swimming." c. "I use good earplugs when I practice with the band." d. "Keeping my diabetes under control helps my ears."

ANS: A Clients should be taught not to put anything larger than their fingertip into their ears. Using a cotton swab, although soft, can cause damage to the ears and cerumen buildup. The other statements are accurate.

13. A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the client's daily chest x-ray.

ANS: A Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the client's risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

4. A client does not understand why vision loss due to glaucoma is irreversible. What explanation by the nurse is best? a. "Because eye pressure was too high, the tissue died." b. "Glaucoma always leads to permanent blindness." c. "The traumatic damage to your eye was too great." d. "The infection occurs so quickly it can't be treated."

ANS: A Glaucoma is caused when the intraocular pressure becomes too high and stays high long enough to cause tissue ischemia and death. At that point, vision loss is permanent. Glaucoma does not have to cause blindness. Trauma can cause glaucoma but is not the most common cause. Glaucoma is not an infection.

A patient presenting with diabetes insipidus (DI) exhibits a. hyperosmolality and hypernatremia. b. hyperosmolality and hyponatremia. c. hypo-osmolality and hypernatremia. d. hypo-osmolality and hyponatremia.

ANS: A In central DI, there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin) in response to an osmotic or nonosmotic stimuli, resulting in inappropriately dilute urine. Hypernatremia is usually associated with serum hyperosmolality.

15. A client has labyrinthitis and is prescribed antibiotics. What instruction by the nurse is most important for this client? a. Immediately report headache or stiff neck. b. Keep all follow-up appointments. c. Take the antibiotics with a full glass of water. d. Take the antibiotic on an empty stomach.

ANS: A Meningitis is a complication of labyrinthitis. The client should be taught to take all antibiotics as prescribed and to report manifestations of meningitis such as fever, headache, or stiff neck. Keeping follow-up appointments is important for all clients. Without knowing what antibiotic was prescribed, the nurse cannot instruct the client on how to take it.

Patients with central DI are treated with a. vasopressin. b. insulin. c. glucagon. d. propylthiouracil.

ANS: A Patients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.

12. A client hospitalized for a wound infection has a blood urea nitrogen of 45 mg/dL and creatinine of 4.2 mg/dL. What action by the nurse is best? a. Assess the ordered antibiotics for ototoxicity. b. Explain how kidney damage causes hearing loss. c. Use ibuprofen (Motrin) for pain control. d. Teach that hearing loss is temporary.

ANS: A Some medications are known to be ototoxic. Diminished kidney function slows the excretion of drugs from the body, worsening the ototoxic effects. The nurse should assess the antibiotics the client is receiving for ototoxicity. The other options are not warranted.

12. A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. "Read the label before using salt substitutes." b. "Do not add salt to your food when you eat." c. "Avoid exposure to sunlight." d. "Take Tylenol instead of aspirin for pain."

ANS: A Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the client's potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

7. A client had a myringotomy. The nurse provides which discharge teaching? a. Buy dry shampoo to use for a week. b. Drink liquids through a straw. c. Flying is not allowed for 1 month. d. Hot water showers will help the pain.

ANS: A The client cannot shower or get the head wet for 1 week after surgery, so using dry shampoo is a good suggestion. The other instructions are incorrect: straws are not allowed for 2 to 3 weeks, flying is not allowed for 2 to 3 weeks, and the client should not shower.

10. A client had proxymetacaine (Ocu-Caine) instilled in one eye in the emergency department. What discharge instruction is most important? a. Do not touch or rub the eye until it is no longer numb. b. Monitor the eye for any bleeding for the next day. c. Rinse the eye with warm saline solution at home. d. Use all the eyedrops as prescribed until they are gone.

ANS: A This drug is an ophthalmic anesthetic. The client can injure the numb eye by touching or rubbing it. Bleeding is not associated with this drug. The client should not be told to rinse the eye. This medication was given in the emergency department and is not prescribed for home use.

8. A client has a foreign body in the eye. What action by the nurse takes priority? a. Administering ordered antibiotics b. Assessing the client's visual acuity c. Obtaining consent for enucleation d. Removing the object immediately

ANS: A To prevent infection, antibiotics are provided. Visual acuity in the affected eye cannot be assessed. The client may or may not need enucleation. The object is only removed by the ophthalmologist.

4. A nurse has delegated applying a warm compress to a client's eye. What actions by the unlicensed assistive personnel (UAP) warrant intervention by the nurse? (Select all that apply.) a. Heating the wet washcloth in the microwave b. Holding the cloth on the client using an Ace wrap c. Turning the cloth so it remains warm on the client d. Using a clean washcloth for the compress e. Washing the hands on entering the client's room

ANS: A, B The washcloth should be warmed under running warm water. Microwaving it can lead to burns. Gentle pressure is used to hold the compress in place. The other actions are correct.

3. A client had cataract surgery. What instructions should the nurse provide? (Select all that apply.) a. Call the doctor for increased pain. b. Do not bend over from the waist. c. Do not lift more than 10 pounds. d. Sexual intercourse is allowed. e. Use stool softeners to avoid constipation.

ANS: A, B, C, E The client should be taught to call the physician for increased pain as this might indicate infection or other complication. To avoid increasing intraocular pressure, clients are taught to not lift more than 10 pounds, to avoid bending at the waist, to avoid straining at stool, and to avoid sexual intercourse for a time after surgery.

The neuroendocrine stress response produces which of the following? (Select all that apply.) a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia d. Heightened pain awareness e. Increased glucose

ANS: A, B, C, E The fight-or-flight response, or sympathetic nervous response, releases catecholamine that causes an increased heart rate and blood pressure. Blood is shunted form nonessential organs such as the stomach, glucose is made available to the brain cells, and pain awareness is decreased.

The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that: A. The client can have a higher-calorie diet. B. The client has good control of her diabetes. C. The client requires adjustment in her insulin dose. D. The client has poor control of her diabetes.

Answer B is correct. The client's diabetes is well under control. Answer A is incorrect because it will lead to elevated blood sugar levels and poorer control of the client's The desired range for glycosylated hemoglobin in the adult client is 2.5%-5.9%.

4. A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the client's level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.) a. Infuse intravenous fluids. b. Cover the client with warm blankets. c. Monitor blood pressure every 4 hours. d. Maintain a patent airway. e. Administer oral glucose as prescribed.

ANS: A, B, D A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

6. A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal insufficiency? (Select all that apply.) a. A 22-year-old female with metastatic cancer b. A 43-year-old male with tuberculosis c. A 51-year-old female with asthma d. A 65-year-old male with gram-negative sepsis e. A 70-year-old female with hypertension

ANS: A, B, D Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key manifestation of Cushing's disease. These are not risk factors for adrenal insufficiency.

3. A client is scheduled for a tympanoplasty. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer preoperative antibiotics. b. Assess for allergies to local anesthetics. c. Ensure that informed consent is on the chart. d. Give ordered antivertigo medications. e. Teach that hearing improves immediately.

ANS: A, C Preoperatively, the nurse administers antibiotics and ensures that informed consent is on the chart. Local anesthetics can be used, but general anesthesia is used more often. Antivertigo medications are not used. Hearing will be decreased immediately after the operation until the ear packing is removed.

4. A client has a hearing aid. What care instructions does the nurse provide the unlicensed assistive personnel (UAP) in the care of this client? (Select all that apply.) a. Be careful not to drop the hearing aid when handling. b. Soak the hearing aid in hot water for 20 minutes. c. Turn the hearing aid off when the client goes to bed. d. Use a toothpick to clean debris from the device. e. Wash the device with soap and a small amount of warm water.

ANS: A, C, D, E All these actions except soaking the hearing aid are proper instructions for the nurse to give to the UAP. While some water is used to clean the hearing aid, excessive wetting should be avoided.

2. A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.) a. A 20-year-old female with benign pituitary tumors b. A 32-year-old male with diplopia c. A 41-year-old female with anorexia nervosa d. A 55-year-old male with hypertension e. A 60-year-old female who is experiencing shock f. A 68-year-old male who has gained weight recently

ANS: A, C, D, E Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushing's disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.

1. A nursing student studying the auditory system learns about the structures of the inner ear. What structures does this include? (Select all that apply.) a. Cochlea b. Epitympanum c. Organ of Corti d. Semicircular canals e. Vestibule

ANS: A, C, D, E The cochlea, organ of Corti, semicircular canals, and vestibule are all part of the inner ear. The epitympanum is in the middle ear.

1. A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

ANS: A, C, D, E, F Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

3. A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

3. A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's teaching? (Select all that apply.) a. Increased carbohydrates b. Decreased fats c. Increased calorie intake d. Supplemental vitamins e. Increased proteins

ANS: A, C, E The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

1. The nurse working in the ophthalmology clinic sees clients with eyelid and eye problems. What information should the nurse understand about these disorders? (Select all that apply.) a. A chalazion is an inflammation of an eyelid sebaceous gland. b. An ectropion is the eyelid turning inward. c. An entropion is the eyelid turning outward. d. A hordeolum is an infection of the eyelid sweat gland. e. Keratoconjunctivitis sicca is caused by drugs or diseases.

ANS: A, D, E A chalazion is an inflammation of one of the sebaceous glands in the eyelid. A hordeolum is an infection of a sweat gland in the eyelid. Keratoconjunctivitis sicca can be caused by drugs or diseases. An ectropion is an outward turning and sagging eyelid, while an entropion is an inward turning of the eyelid.

5. A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this client's education? (Select all that apply.) a. "Do not share utensils, plates, and cups with anyone else." b. "You can play with your grandchildren for 1 hour each day." c. "Eat foods high in vitamins such as apples, pears, and oranges." d. "Wash your clothing separate from others in the household." e. "Take a laxative 2 days after therapy to excrete the radiation."

ANS: A, D, E A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other people's clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.

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

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

5. A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

ANS: A, D, F Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a. glitazone b. insulin c. metformin (Glucophage)

ANS: B Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

14. A nurse is seeing clients in the ophthalmology clinic. Which client should the nurse see first? a. Client with intraocular pressure reading of 24 mm Hg b. Client who has had cataract surgery and has worsening vision c. Client whose red reflex is absent on ophthalmologic examination d. Client with a tearing, reddened eye with exudate

ANS: B After cataract surgery, worsening vision indicates an infection or other complication. The nurse should see this client first. The intraocular pressure is slightly elevated. An absent red reflex may indicate cataracts. The client who has the tearing eye may have an infection.

14. After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction? a. "I may need calcium replacement after surgery." b. "After surgery, I won't need to take thyroid medication." c. "I'll need to take thyroid hormones for the rest of my life." d. "I can receive pain medication if I feel that I need it."

ANS: B After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively.

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

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

12. A nurse cares for a client newly diagnosed with Graves' disease. The client's mother asks, "I have diabetes mellitus. Am I responsible for my daughter's disease?" How should the nurse respond? a. "The fact that you have diabetes did not cause your daughter to have Graves' disease. No connection is known between Graves' disease and diabetes." b. "An association has been noted between Graves' disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves' disease." c. "Graves' disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus." d. "Unfortunately, Graves' disease is associated with diabetes, and your diabetes could have led to your daughter having Graves' disease."

ANS: B An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mother's diabetes did not cause her daughter's Graves' disease. The other statements are inaccurate.

9. A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? a. A 29-year-old female with pregnancy-induced hypertension b. A 41-year-old male receiving dialysis for end-stage kidney disease c. A 66-year-old female with moderate heart failure d. A 72-year-old male who is prescribed home oxygen therapy

ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

Decreased urine osmolality is a sign of a. hyperglycemia. b. diabetes insipidus. c. thyroid crisis. d. SIADH.

ANS: B Decreased urine osmolality is a sign of DI.

1. A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

11. A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." How should the nurse respond? a. "I will ask your doctor to order a psychiatric consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

ANS: B Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

10. A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care? a. Ask the client to ambulate in the hallway twice a day. b. Use a lift sheet to assist the client with position changes. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the unlicensed assistive personnel to strain the client's urine for stones.

ANS: B Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client.

1. A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy? a. Blurred and double vision b. Increased thirst and urination c. Profuse nausea and diarrhea d. Decreased attention and insomnia

ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.

2. An older client has decided to give up driving due to cataracts. What assessment information is most important to collect? a. Family history of visual problems b. Feelings related to loss of driving c. Knowledge about surgical options d. Presence of family support

ANS: B Loss of driving is often associated with loss of independence, as is decreasing vision. The nurse should assess how the client feels about this decision and what its impact will be. Family history and knowledge about surgical options are not related as the client has made a decision to decline surgery. Family support is also useful information, but it is most important to get the client's perspective on this change.

10. A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The client's symptoms have now resolved and the client asks, "When can I stop taking these medications?" How should the nurse respond? a. "It is possible for the inflammation to recur if you stop the medication." b. "Once you start corticosteroids, you have to be weaned off them." c. "You must decrease the dose slowly so your hormones will work again." d. "The drug suppresses your immune system, which must be built back up."

ANS: B One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the client's immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

. During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH, the serum sodium should be raised no more than a. 5 mEq/day. b. 12 mEq/day. c. 20 mEq/day. d. 25 mEq/day.

ANS: B One recommended regimen is an IV rate that provides sufficient sodium to raise serum sodium levels by up to 12 mEq/day for the first 24 hours (no more than 0.5 mEq each hour), with a total increase of 18 mEq/L in the initial 48 hours.

In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is a. massive diuresis, leading to hemoconcentration. b. dilutional hyponatremia, reducing sodium concentration to critically low levels. c. hypokalemia from massive diuresis. d. serum osmolality greater than 350 mOsm/kg.

ANS: B Patients with SIADH have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.

The major electrolyte disturbances that result from diuresis are a. low calcium and high phosphorus levels. b. low potassium and low sodium levels. c. high sodium and low phosphorus levels. d. low calcium and low potassium levels.

ANS: B Serum sodium may be low as a result of the movement of water from the intracellular space into the extracellular (vascular) space. The serum potassium level is often normal; a low serum potassium level in diabetic ketoacidosis suggests that a significant potassium deficiency may be present.

15. A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this client's instructions? a. "You will need to learn how to rotate the injection sites." b. "If you work outside in the heat, you may need another drug." c. "You need to follow a diet with strict sodium restrictions." d. "Take one tablet in the morning and two tablets at night."

ANS: B Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

3. A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement therapy. The client asks, "How long will I need to take this medication?" How should the nurse respond? a. "When your blood levels of testosterone are normal, the therapy is no longer needed." b. "When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever." c. "When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy." d. "With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old."

ANS: B Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm counts are high.

2. The student nurse is performing a Weber tuning fork test. What technique is most appropriate? a. Holding the vibrating tuning fork 10 to 12 inches from the client's ear b. Placing the vibrating fork in the middle of the client's head c. Starting by placing the vibrating fork on the mastoid process d. Tapping the vibrating tuning fork against the bridge of the nose

ANS: B The Weber tuning fork test includes placing the vibrating tuning fork in the middle of the client's head and asking in which ear the client hears the vibrations louder. The other techniques are incorrect.

An older patient presents with a serum glucose level of 900 mg/dL, hematocrit of 55%, and no serum ketones. Immediate attention must be given to a. clotting factors. b. rehydration. c. administration of insulin. d. sodium replacement.

ANS: B The physical examination may reveal a profound fluid deficit. Signs of severe dehydration include longitudinal wrinkles in the tongue, decreased salivation, and decreased central venous pressure, with increases in heart rate and rapid respirations (Kussmaul air hunger does not occur). In older patients, assessment of clinical signs of dehydration is challenging.

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

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

8. A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium.

1. A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol)

ANS: B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

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

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

7. A client is admitted to the nursing unit after having a tympanoplasty. What activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Administer prescribed antibiotics. b. Keep the head of the client's bed flat. c. Remind the client to lie on the operative side. d. Remove the iodoform gauze in 8 hours. e. Take and record postoperative vital signs.

ANS: B, E The UAP can keep the head of the client's bed flat and take/record vital signs. The nurse administers medications. The client should lie flat with the head turned so the operative side is up. The nurse or surgeon removes the gauze packing.

5. A hospitalized client has Ménière's disease. What menu selections demonstrate good knowledge of the recommended diet for this disorder? (Select all that apply.) a. Chinese stir fry with vegetables b. Broiled chicken breast c. Chocolate espresso cookies d. Deli turkey sandwich and chips e. Green herbal tea with meals

ANS: B, E The diet recommendations for Ménière's disease include low-sodium, caffeine-free foods and fluids distributed evenly throughout the day. Plenty of water is also needed. The broiled chicken breast and herbal tea are the best selections. The stir fry is high in sodium and possibly monosodium glutamate (MSG, also not recommended). The cookies have caffeine, and the sandwich and chips are high in sodium.

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? a." I will call my doctor right away." b. "I will give myself the regular insulin." c."I will take an oral form of glucose."

ANS: C Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more.

15. A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client's plan of care? a. Monitor the client's intravenous site every shift. b. Administer acetaminophen (Tylenol) for fever. c. Ensure that working suction equipment is in the room. d. Assess the client's vital signs every 4 hours.

ANS: C A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the client's room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.

A patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium level of 120 mEq/L, a serum osmolality level of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse would suspect a. diuresis. b. DI. c. SIADH. d. hyperaldosteronism.

ANS: C A decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of SIADH. Oat cell carcinoma is a precipitating factor for SIADH.

5. A client has external otitis. On what comfort measure does the nurse instruct the client? a. Applying ice four times a day b. Instilling vinegar-and-water drops c. Use of a heating pad to the ear d. Using a home humidifier

ANS: C A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted.

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

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

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

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

16. A client with Ménière's disease is in the hospital when the client has an attack of this disorder. What action by the nurse takes priority? a. Assess vital signs every 15 minutes. b. Dim or turn off lights in the client's room. c. Place the client in bed with the upper siderails up. d. Provide a cool, wet cloth for the client's face.

ANS: C Clients with Ménière's disease can have vertigo so severe that they can fall. The nurse should assist the client into bed and put the siderails up to keep the client from falling out of bed due to the intense whirling feeling. The other actions are not warranted for clients with Ménière's disease.

4. The nurse works with clients who have hearing problems. Which action by a client best indicates goals for an important diagnosis have been met? a. Babysitting the grandchildren several times a week b. Having an adaptive hearing device for the television c. Being active in community events and volunteer work d. Responding agreeably to suggestions for adaptive devices

ANS: C Clients with hearing problems can become frustrated and withdrawn. The client who is actively engaged in the community shows the best evidence of psychosocial adjustment to hearing loss. Babysitting the grandchildren is a positive sign but does not indicate involvement outside the home. Having an adaptive device is not the same as using it, and watching TV without evidence of other activities can also indicate social isolation. Responding agreeably does not indicate the client will actually follow through.

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

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

8. A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How should the nurse respond? a. "You will need to take the thyroid medication until the goiter is completely gone." b. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication." c. "You'll need thyroid pills for life because your thyroid won't start working again." d. "When blood tests indicate normal thyroid function, you can stop the medication."

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

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

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

14. A client has severe tinnitus that cannot be treated adequately. What action by the nurse is best? a. Advise the client to take antianxiety medication. b. Educate the client on nerve cutting procedures. c. Refer the client to online or local support groups. d. Teach the client side effects of furosemide (Lasix).

ANS: C If the client's tinnitus cannot be treated, he or she will have to learn to cope with it. Referring the client to tinnitus support groups can be helpful. The other options are not warranted.

2. A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this client's plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to re-position the client. d. Assist the client to dangle before rising.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

3. A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for Chvostek's sign. d. Ask the client orientation questions.

ANS: C Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

A patient is admitted with a long history of mental illness. Her husband states she has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects a. central diabetes insipidus (DI). b. nephrogenic DI. c. psychogenic (dipsogenic) DI. d. iatrogenic DI.

ANS: C Psychogenic diabetes insipidus (DI) is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day. Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.

3. The client's chart indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause? a. "Do you feel like something is in your ear?" b. "Do you have frequent ear infections?" c. "Have you been exposed to loud noises?" d. "Have you been told your ear bones don't move?"

ANS: C Sensorineural hearing loss can occur from damage to the cochlea, the eighth cranial nerve, or the brain. Exposure to loud music is one etiology. The other questions relate to conductive hearing loss.

8. A client is going on a cruise but has had motion sickness in the past. What suggestion does the nurse make to this client? a. Avoid alcohol on the cruise ship. b. Change positions slowly on the ship. c. Change your travel plans. d. Try scopolamine (Transderm Scop).

ANS: D Scopolamine can successfully treat the vertigo and dizziness associated with motion sickness. Avoiding alcohol and changing positions slowly are not effective. Telling the client to change travel plans is not a caring suggestion.

7. A client has been taught about retinitis pigmentosa (RP). What statement by the client indicates a need for further teaching? a. "Beta carotene, lutein, and zeaxanthin are good supplements." b. "I might qualify for a retinal transplant one day soon." c. "Since I'm going blind, sunglasses are not needed anymore." d. "Vitamin A has been shown to slow progression of RP."

ANS: C Sunglasses are needed to prevent the development of cataracts in addition to the RP. The other statements are accurate.

Characteristics of diabetes insipidus (DI) are a. hyperglycemia and hyperosmolarity. b. hyperglycemia and peripheral edema. c. intense thirst and passage of excessively large quantities of dilute urine. d. peripheral edema and pulmonary crackles.

ANS: C The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.

Which of the following nursing interventions should be initiated on all patients with SIADH? a. Placing the patient on an air mattress b. Forcing fluids c. Initiating seizure precautions d. Applying soft restraints

ANS: C The patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.

The onset of seizures in the patient with DI indicates a. increased potassium levels. b. hyperosmolality. c. severe dehydration. d. toxic ammonia levels.

ANS: C This excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration. In the person with decreased level of consciousness, the polyuria leads to severe hypernatremia, dehydration, decreased cerebral perfusion, seizures, loss of consciousness, and death.

5. A client's intraocular pressure (IOP) is 28 mm Hg. What action by the nurse is best? a. Educate the client on corneal transplantation. b. Facilitate scheduling the eye surgery. c. Plan to teach about drugs for glaucoma. d. Refer the client to local Braille classes.

ANS: C This increased IOP indicates glaucoma. The nurse's main responsibility is teaching the client about drug therapy. Corneal transplantation is not used in glaucoma. Eye surgery is not indicated at this time. Braille classes are also not indicated at this time.

9. A client who is near blind is admitted to the hospital. What action by the nurse is most important? a. Allow the client to feel his or her way around. b. Let the client arrange objects on the bedside table. c. Orient the client to the room using a focal point. d. Speak loudly and slowing when talking to the client.

ANS: C Using a focal point, orient the client to the room by giving descriptions of items as they relate to the focal point. Letting the client arrange the bedside table is a good idea, but not as important as orienting the client to the room for safety. Allowing the client to just feel around may cause injury. Unless the client is also hearing impaired, use a normal tone of voice.

9. A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection should the nurse refer to an audiologist as the priority? a. Client with an hour car commute on the freeway each day b. Client who rides a motorcycle to work 20 minutes each way c. Client who sat in the back row at a rock concert recently d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day

ANS: D A chainsaw becomes dangerous to hearing after 2 hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic is safe for more than 8 hours. Motorcycle noise is safe for about 8 hours. The safe exposure time for a front-row rock concert seat is 3 minutes, but this client was in the back, and so had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.

4. A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism? a. "My sister has thyroid problems." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even with 12 hours of sleep."

ANS: D Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.

3. A client is in the preoperative holding area waiting for cataract surgery. The client says "Oh, yeah, I forgot to tell you that I take clopidogrel, or Plavix." What action by the nurse is most important? a. Ask the client when the last dose was. b. Check results of the prothrombin time (PT) and international normalized ratio (INR). c. Document the information in the chart. d. Notify the surgeon immediately.

ANS: D Clopidogrel is an antiplatelet aggregate and could increase bleeding. The surgeon should be notified immediately. The nurse should find out when the last dose of the drug was, but the priority is to notify the provider. This drug is not monitored with PT and INR. Documentation should occur but is not the priority.

A priority for patient education when discharged with long-term antidiuretic hormone deficiency is a. daily intake and output. b. attention to thirst. c. a low-sodium diet. d. daily weights.

ANS: D Daily weights on the same scale are an excellent assessment of fluid status. A weight gain or loss of 1 kg (2.2 lb) is equal to 1 L of fluid.

11. A nurse is irrigating a client's ear when the client becomes nauseated. What action by the nurse is most appropriate for client comfort? a. Have the client tilt the head back. b. Re-position the client on the other side. c. Slow the rate of the irrigation. d. Stop the irrigation immediately.

ANS: D During ear irrigation, if the client becomes nauseated, stop the procedure. The other options are not helpful.

While a patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These signs would include a. decreased CVP and decreased PAP. b. bradycardia and thirst. c. hypotension and wheezing. d. hypertension and lung crackles.

ANS: D Hypertension and lung crackles are signs of fluid overload. The hypertonic solution may pull fluid out of cells and tissues. Whereas weight gain signifies continual fluid retention, weight loss indicates loss of body fluid.

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

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

4. A nurse cares for a client after a pituitary gland stimulation test using insulin. The client's post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). How should the nurse interpret these results? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. Normal pituitary response to insulin

ANS: D Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.

2. A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first? a. Reassure the client that the voice change is temporary. b. Document the finding and assess the client hourly. c. Place the client in high-Fowler's position and apply oxygen. d. Contact the provider and prepare for intubation.

ANS: D Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.

10. A nursing student is instructed to remove a client's ear packing and instill eardrops. What action by the student requires intervention by the registered nurse? a. Assessing the eardrum with an otoscope b. Inserting a cotton ball in the ear after the drops c. Warming the eardrops in water for 5 minutes d. Washing the hands and removing the packing

ANS: D The student should wash his or her hands, don gloves, and then remove the packing. The other actions are correct.

The patient at risk for developing SIADH may be taking a. adenosine (Adenocard). b. diltiazem (Cardizem). c. heparin sodium. d. acetaminophen.

ANS: D Tylenol increases the release of ADH.

After falling off a ladder and suffering a brain injury, a client develops syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment he's receiving is effective? Select all that apply: 1. Decrease in body weight 2. Rise in blood pressure and drop in heart rate 3. Absence of wheezes in his lungs 4. Increased urine output 5. Decreased urine osmolarity Correct: 1, 4, 5 RATIONALES: SIADH is an abnormality in which there is an abundance of the antidiuretic hormone. The predominant features are hyponatremia, oliguria, edema, and weight gain. Evidence of successful treatment includes a reduction in weight, an increase in urine output, and a decrease in the urine's concentration (urine osmolarity). NURSING PROCESS STEP: Evaluation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication: A. At bedtime B. With breakfast C. Before lunch D. After dinner

Answer B is correct. Glucotrol XL is given once a day with breakfast. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Answers C and D are incorrect because the client would develop hypoglycemia later in the day or evening.

The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the *peak action* of the insulin occurs? a) "I will make sure I eat breakfast within two hours of taking my insulin." b) "I will need to carry candy or some form of sugar with me all the time." c) "I will eat a snack around three o'clock each afternoon." d) "I can save my dessert from supper for a bedtime snack."

Answer C is correct. NPH insulin peaks in 8-12 hours, so a snack should be offered at that time. NPH insulin onsets in 90-120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect, but the client should eat a bedtime snack.

A client with insulin-dependent diabetes takes 20 units of NPH insulin at 7 a.m. The nurse should observe the client for signs of hypoglycemia at: A. 8 a.m. B. 10 a.m. C. 3 p.m. D. 5 a.m.

Answer C is correct. The client taking NPH insulin should have a snack midafternoon to prevent hypoglycemia. Answers A and B are incorrect because the times are too early for symptoms of hypoglycemia. Answer D is incorrect because the time is too late and the client would be in severe hypoglycemia.

The client taking Glyburide (Diabeta) should be cautioned to: a) Avoid eating sweets. b) Report changes in urinary pattern. c) Allow three hours for onset. d) Check the glucose daily.

Answer D is correct. Diabeta is an antidiabetic medication that can result in hypoglycemia. A, B, and D are incorrect because they are not related to Diabeta.

Growth hormone is secreted from which of the following structures? A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Pons

Answer: A

The nurse correlates which clinical manifestation to the pathophysiology of decreased ACTH production from the anterior pituitary gland? A. Hypotension B. Polyuria C. Diarrhea D. Pruritus

Answer: A Rationale: Hypotension and tachycardia develop secondary to decreased secretion of ACTH leading to decreased secretion of glucocorticoid and mineralocorticoid, resulting in sodium and water loss.

Upon review of Ms. Andrews' admission clinical presentation, which clinical manifestations are most related to excessive growth hormone? A. Headache B. Enlarged hands C. Visual changes D. Nausea

Answer: B Rationale: An excess of growth hormone in adults does not affect bone length because of closure of the epiphyses but does affect bone density, and acromegaly (thickening of bones, particularly of the hands, feet, and facial bones) may develop.

The patient experiencing DI is ordered to receive DDAVP. The nurse monitors for which therapeutic effect of these medications? A. Increased urine output B. Increased urine specific gravity C. Increased serum sodium D. Increased serum potassium

Answer: B Rationale: The urine output in the patient with DI is in- creased with a low specific gravity as water is not reabsorbed in the kidney; there are large amounts of dilute urine output in patients with DI. The therapeutic effect of DDAVP (a synthetic form of antidiuretic hormone) leads to reabsorption of water, leading to a decrease in urine output and an increase in specific gravity.

In evaluating the therapeutic effects of vasopressin, the nurse monitors for which finding? A. Urine specific gravity of 1.050 B. Urine output of 30 to 50 mL/hr C. Serum sodium of 148 mEq/L D. Serum osmolality of 310 mOsm/kg

Answer: B Rationale: Vasopressin is used to treat Diabetes Insipidus (DI) and works like antidiuretic hormone to increase water reabsorption in the kidneys. The therapeutic effect of this medication leads to decreased urine output. Both the serum sodium and osmolality are increased with DI.

The nurse recognizes that which hormones are produced by the posterior pituitary gland? (Select all that apply.) A. ACTH B. Vasopressin C. Thyroid stimulating hormone D. Oxytocin E. Growth hormone

Answer: B and D Rationale: Vasopressin (antidiuretic hormone) and oxytocin are secreted by the posterior pituitary gland. ACTH, TSH, and growth hormone are released from the anterior pituitary gland.

In providing care to Ms. Andrews after she undergoes a transsphenoidal hypophysectomy, the nurse prioritizes which intervention? A. Maintaining the patient in a flat, supine position B. Instructing the patient to cough and deep breathe C. Monitoring for clear fluid drainage from the nose D. Limiting exposure to bright lights

Answer: C Rationale: Clear fluid drainage from the nose in the patient after transsphenoidal hypophysectomy may indicate a cerebrospinal fluid (CSF) leak that can lead to meningitis. The patient is usually placed with the head of bed elevated 45°, and coughing is minimized to avoid pressure on the operative site. Bright lights may be limited to decrease environmental stimuli, but this is not as high of a priority as monitoring for a CSF leak.

The nurse correlates which finding to a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH)? A. Polyuria B. Polyphagia C. Decreased urine output D. Glucosuria

Answer: C Rationale: SIADH is characterized by increased secretion of ADH leading to water reabsorption, decreased urine output, and dilutional hyponatremia. Polyphagia, polyuria, and glucosuria are common clinical manifes- tations of diabetes mellitus.

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications? How should the nurse respond? a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.

B (One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the clients immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.)

A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement therapy. The client asks, How long will I need to take this medication? How should the nurse respond? a. When your blood levels of testosterone are normal, the therapy is no longer needed. b. When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever. c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy. d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old

B (Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm counts are high.)

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

B (With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.)

A diabetic patient complains of frequent corns and asks for information about managing the condition. What is the nurse's best response? 1. "Make sure you select shoes that fit correctly." 2. "You can use corn pads to gradually remove the growths." 3. "Corns are best treated by shaving them off." 4. "Apply a generous amount of emollient lotion on and between the toes twice daily."

Correct Answer: 1 Rationale 1: Corns can be prevented by wearing correctly fitting shoes. Rationale 2: Corn pads are not an option for the diabetic patient. Rationale 3: Shaving treatments to remove corns are not an option for the diabetic patient. Rationale 4: Lotion between the toes should ALWAYS be avoided.

The nurse is caring for a patient with no history of diabetes who has a new laboratory finding of a glycosylated hemoglobin (A1C) level of 6.0%. Which nursing diagnoses should receive priority for this patient? 1. Deficient Knowledge regarding disease process 2. Risk for Deficient Fluid Volume 3. Risk for Impaired Skin Integrity 4. Ineffective Tissue Perfusion

Correct Answer: 1 Rationale 1: The normal range of hemoglobin A1C is 2% to 5% for a nondiabetic. This patient's level is elevated, so the patient may have prediabetes or diabetes. The nurse's priority is to ensure the patient obtains the information necessary to make healthful lifestyle choices.

A patient has been admitted for treatment of diabetic ketoacidosis (DKA). The nurse should include which intervention in the patient's plan of care? 1. Place the patient on strict bed rest. 2. Monitor intravenous fluid administration. 3. Review the diabetic diet with the patient. 4. Administer oral hypoglycemics on schedule.

Correct Answer: 2 Rationale 1: Activity level will depend on the patient's condition. Bed rest is not required. Rationale 2: Hyperglycemia creates an osmotic diuresis and leads to dehydration. Treatment will include fluid replacement. Rationale 3: Dietary teaching is not the priority at this time. Rationale 4: It is more likely that this patient will be treated with insulin.

Which of these statements by a patient who has a new diagnosis of diabetes mellitus requires immediate nursing intervention? 1. "I am allergic to eggs." 2. "I will take my lispro insulin 15 minutes before I eat breakfast." 3. "I will adjust the amounts of my premixed insulin according to my food intake."

Correct Answer: 3 Rationale 1: An allergy to eggs does not require immediate nursing intervention. Rationale 2: Lispro insulin is properly administered 15 minutes prior to a meal. Rationale 3: One of the problems associated with premixed insulin is that it does not allow easy adjustment of premeal and basal insulin.

The nurse recognizes that which factor in a patient's history increases the risk for type 2 diabetes mellitus (DM)? 1. Body mass index of 23 2. Blood pressure of 130/80 3. Physical inactivity

Correct Answer: 3 Rationale 1: Having a body mass index over 25 increases the risk of developing type 2 DM. Rationale 2: Blood pressure of 140/90 mmHg or above places the patient at risk for type 2 DM. Rationale 3: Physical inactivity is a major risk factor for type 2 DM.

The nurse is preparing patients newly diagnosed with diabetes mellitus (DM) for discharge from an acute care facility. What should the nurse include in patient teaching regarding medications to treat DM? 1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications. 2. Type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled. 3. Patients with type 1 diabetes will always need an exogenous source of insulin. 4. Patients with type 2 diabetes generally need a combination of oral medications and insulin to achieve normal blood glucose levels.

Correct Answer: 3 Rationale 1: People with type 1 DM must have insulin. Rationale 2: Patients with diabetes do not progress from type 1 to type 2. Rationale 3: The person with type 1 DM requires a lifelong exogenous source of insulin to maintain life. Rationale 4: Patients with type 2 DM are usually able to control glucose levels with an oral hypoglycemic medication, but they may require insulin if control is inadequate.

The nurse is caring for a patient with a diagnosis of diabetes. The nurse notes the patient's toenails are thick and ingrown. Which instruction should the nurse provide? 1. Soak feet in Epsom salts daily. 2. Use a clean, sharp razor blade to trim the toenails. 3. Make an appointment with a foot care specialist. 4. Trim nails to follow the curve of the toe.

Correct Answer: 3 Rationale 1: Soaking of the feet is not advisable. Rationale 2: Sharp instruments or razor blades should never be used to self-treat foot problems. Rationale 3: The toenails of the patient with diabetes require careful attention. Problems should be addressed by a foot care specialist.

Which information should the nurse include when teaching a patient about fasting blood glucose level testing? 1. "Your test is scheduled for 6:00 a.m., so do not eat or drink anything after midnight." 2. "After the sample is drawn you will be asked to drink a sweet liquid." 3. "This test will indicate your average blood sugar over the last 2 months." 4. "The fasting glucose must be 110 or under to be normal."

Correct Answer: 4 Rationale 1: Fasting blood glucose testing requires fasting for at least 10 hours before the sample is drawn. Rationale 2: Drinking a sweet liquid is required for a glucose tolerance test. Rationale 3: Hemoglobin A1C indicates average blood sugar over the last 1 to 3 months. Rationale 4: The normal value for fasting glucose is 70 to 110 mg/dL.

At a community health screening for blood glucose testing, the nurse would expect which person to have the highest risk for having type 2 diabetes? 1. A 30-year-old Caucasian patient who recently had a baby 2. A patient who lives in a nearby rural farming town 3. A patient following a high-protein diet 4. A 40-year-old with weight centered in the abdomen

Correct Answer: 4 Rationale 1: Postpartum status does not appear to be a risk factor for type 2 diabetes. Rationale 2: Individuals living in urban areas, perhaps due to more sedentary lifestyles, may be at higher risk for type 2 diabetes. Rationale 3: Consuming a high-protein diet does not appear to be a risk factor for type 2 diabetes. Rationale 4: The risk factors for type 2 diabetes include obesity, especially "apple" shape or abdominal obesity.

For a client with hyperglycemia, which data collection finding best supports a nursing diagnosis of Deficient fluid volume? 1. Cool, clammy skin 2. Distended neck veins 3. Increased urine osmolarity 4. Decreased serum sodium level Correct: 3 RATIONALES: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Application

A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure? A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

The answer is A. A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.

A patient with severe rheumatoid arthritis is scheduled for a procedure called an arthrodesis. The nursing student you are precepting asks what type of procedure this is. Your response is: A. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together." B. "It is a procedure that involves replacing the joint with an artificial one." C. "It is a procedure where the surgeon goes in with a scope and cleans out the affected joint." D. "It is a procedure where the synovium is completely removed within the joint, which helps decrease inflammation of the joint.

The answer is A. An arthrodesis (also called joint fusion) is where the affected joint is removed and the bones within it are fused together. Option B describes a joint replacement. Option C is known as a surgical cleaning. Option D is known as a synovectomy.

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage? A. Hydroxychloroquine (Plaquenil) B. Lefluomide (Arava) C. Sulfasalazine (Azulfidine) D. Methylprednisolone (Medrol)

The answer is A. This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

The answer is B. Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct? A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." C. "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." D. "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

The answer is B. During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health.

Your patient has arthritis that affects the weight-bearing joints such as the hands, knees, hips, and spine. This type of arthritis is most likely: A. Rheumatoid arthritis B. Osteoarthritis

The answer is B. Osteoarthritis is a form of arthritis that causes deterioration of the articular hyaline cartilage of the bones. It affects the weight-bearing joints. This can include the hands, knees, hips, and spine because these joints experience a lot of stress.

You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis? A. Potassium 3.2 mEq/L B. Hemoglobin 7 g/dL C. Sodium 135 mEq/L D. WBC count 6,500

The answer is B. Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient's signs and symptoms above are classic findings in anemia.

You are assessing the diagnostic testing results for a patient that has rheumatoid arthritis. What result is NOT an indicator of this disease? A. Elevated erythrocyte sedimentation B. X-ray imaging showing osteophyte formation C. Positive c-reactive protein D. Positive rheumatoid factor

The answer is B. This is found in osteoarthritis NOT rheumatoid arthritis. Osteophytes (bones spurs) are only found in OA.

Which statement is FALSE concerning rheumatoid arthritis? A. Rheumatoid arthritis most commonly affects the fingers and wrist. B. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. C. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). D. Ankylosis can occur in severe cases of rheumatoid arthritis.

The answer is B. This statement is false. It should say that, "Rheumatoid arthritis is different from osteoarthritis in that it DOES (not doesn't) affect other systems of the body. RA is systemic, while OA only affects the joints. This is why a fever and anemia can present in RA.

A patient is newly diagnosed with osteoarthritis. Which medication below is NOT ordered to treat this condition? A. NSAIDs B. Intra-articular corticosteroids C. DMARDs D. Glucosamine

The answer is C. DMARDs (disease-modifying antirheumatic drugs) are ordered in rheumatoid arthritis NOT osteoarthritis. These drugs suppress the immune system from attacking the joint along with helping slow down the destruction of the disease on the joints and bones. All the other options are drugs that can be prescribed in OA.

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

The answer is C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

Identify the correct sequence in how rheumatoid arthritis develops: A. Development of pannus, synovitis, ankylosis B. Anklyosis, development of pannus, synovitis C. Synovitis, development of pannus, anklyosis D. Synovitis, anklyosis, development of pannus

The answer is C. The body attacks (specifically the WBCs) the synovium of the joint. The synovium becomes inflamed and this process is called synovitis. The inflammation of the synovium leads to thickening and the formation of a pannus, which is a layer of vascular fibrous tissue. The pannus will grow so large it will damage the bone and cartilage within the joint. The space in between the joints will disappear and anklyosis will develop, which is the fusion of the bone.

Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion. True False

The answer is FALSE: Osteoarthritis is the most common type of arthritis that develops due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone. This can lead to bone break down, sclerosis of the bone, and osteophytes formation (bone spurs).

Which patients below are at risk for developing osteoarthritis? Select-all-that-apply: A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

The answers are A and C. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.

You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition: A. Herberden's Node B. Morning stiffness for less than 30 minutes C. Soft, tender, warm joints D. Fever E. Anemia F. Hard and bony joints G. Crepitus H. Bouchard's Node

The answers are A, B, F, G, and H. These are common findings found in osteoarthritis. Options C, D, and E are found in rheumatoid arthritis.

A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply: A. Rheumatoid factor B. Uric acid level C. Erythrocyte sedimentation D. Dexa-Scan E. X-ray imaging

The answers are A, C, and E. These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis.

During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply: A. "Does the pain and stiffness tend to be the worst before bedtime?" B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" D. "Is your pain and stiffness aggravated by extreme temperature changes?"

The answers are B and C. Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: "I need to rub my forearm vigorously until warm before testing at this site." "I have to make sure that my current glucose monitor can be used at an alternate site." "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."

The fingertip one

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

The answers are B and C. The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While assisting the patient with her morning routine, the patient verbalizes a pain rating of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing interventions can you provide to this patient to help alleviate pain and stiffness? Select-all-that-apply: A. Exercise the affected joints B. Assist the patient with a warm shower or bath C. Perform deep massage therapy to the wrist joints D. Assist the patient with applying wrist splints

The answers are B and D. During flare-ups of RA the joint should be rested (not exercised) and should not be deep massaged because this can further damage the joint (in addition cause the patient more pain). Heat therapy, like a warm shower or bath, will help alleviate the stiffness. Furthermore, cold therapy can be used to reduce the inflammation along with splinting the affected joints to protect and rest them.

A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient: A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

The answers are B, C, E. The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

Select all the risk factors for developing osteoarthritis: A. Malnutrition B. Obesity C. Manual labor jobs D. Premature birth E. Older age F. Diabetes

The answers are B, C, and E. These are risk factors for developing OA. In addition, repeated joint injuries and genetics can play a role in developing OA.

Disease-modifying antirheumatic drugs (DMARDS) are used to treat rheumatoid arthritis. Select-all-the drugs below that are DMARDS: A. Dexamethasone (Decadron) B. Hydroxychloroquine (Plaquenil) C. Teriparatide (Forteo) D. Calcitonin E. Leflunomide (Arava) F. Methotrexate (Trexall)

The answers are B, E, and F. These are DMARDs that can be prescribed for RA. Option A is a corticosteroid. Option C and D are sometimes prescribed in osteoporosis.

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply: A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

The answers are: A, C, D. These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame?

The onset of action for lispro (Humalog) insulin is 15 minutes. The peak plasma concentration is 1 hour; and the duration of action is 3 hours. **ends in -LOG=rolls FAST** **"15 minutes feels like an hour during 3 rapid responses."

Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? 1. Confusion and seizures 2. Sunken eyeballs and spasticity 3. Flaccidity and thirst 4. Tetany and increased blood urea nitrogen (BUN) levels. Correct: 1 RATIONALES: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1. Fluid intake is less than 2,500 ml/day. 2. Urine output measures more than 200 ml/hour. 3. Blood pressure is 90/50 mm Hg. 4. The heart rate is 126 beats/minute. Correct: 1 RATIONALES: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective. NURSING PROCESS STEP: Evaluation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Analysis

Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? 1. Administer 2 to 3 L of I.V. fluid over 2 to 3 hours. 2. Administer 6 L of I.V. fluid over the first 24 hours. 3. Administer a dextrose solution containing normal saline solution. 4. Administer I.V. fluid slowly to prevent circulatory overload and collapse. Correct: 1 RATIONALES: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Therefore, 2 to 3 L of I.V. fluid should be given over 2 to 3 hours. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly prescribed fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution. NURSING PROCESS STEP: Implementation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Pharmacological therapies COGNITIVE LEVEL: Application

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

The healthcare provider is teaching a group of students about the characteristics of type 1 diabetes mellitus. Which of the following describe the underlying cause of the disease? Please choose from one of the following options. a) Atrophy of pancreatic alpha cells b) Destruction of pancreatic beta cells c) Cellular resistance to insulin d) Increased hepatic glycogenesis

b) Destruction of pancreatic beta cells The beta cells in a patient with type 1 diabetes mellitus are destroyed, so the patient has no endogenous insulin.

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? A It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. B It interacts with plasma membrane receptors to inhibit enzymatic actions. C It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. D It regulates the threshold for water resorption in the kidneys.

c Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: a.Apply an electrocardiogram monitor b. Correct the acidosis c. Administer regular insulin intravenously d. Administer 5% dextrose intravenously

The nurse assisting in the admission of a client with diabetic ketoacidosis will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take any fluids orally? "a. 0.45% normal saline solution b. Lactated Ringer's solution c.0.9 normal saline solution d. 5% dextrose in water (D5W)

PCC E 4

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