Practice exam 2

Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply.

diarrhea and weight loss Diarrhea and weight loss are the characteristic manifestations of a hyperfunctional thyroid gland. Anemia is seen in a client with a hypofunctional thyroid and decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.

8. A nurse is teaching a larger female patient about alcohol intake and how it affects hypertension. The patient asks if drinking two beers a night is an acceptable intake. What answer by the nurse is best?

"No, women should only have one beer a day as a general rule." Alcohol intake should be limited to two drinks a day for men and one drink a day for women. A "drink" is classified as one beer, 1.5 ounces of hard liquor, or 5 ounces of wine. Limited alcohol intake is acceptable with hypertension. The woman's size does not matter.

16. After teaching a patient who is recovering from a complete thyroidectomy, the nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional instruction?

"After surgery, I won't need to take thyroid medication." After the patient undergoes a thyroidectomy, the patient must take 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.

13. A nurse is assessing a patient with peripheral artery disease (PAD). The patient states that walking five blocks is possible without pain. What question asked next by the nurse will give the best information?

"Could you walk further than that a few months ago?" As PAD progresses, it takes less oxygen demand to cause pain. Needing to cut down on activity to be pain free indicates that the patient's disease is worsening. The other questions are useful, but not as important.

13. A nurse teaches a patient with diabetes mellitus about foot care. Which statements would the nurse include in this patient's teaching? Select all that apply.

"Do not walk around barefoot." "Trim toenails straight across with a nail clipper." Patients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The patient would be instructed to not walk around barefoot or wear sandals with open toes. These actions place the patient at higher risk for skin breakdown of the feet. The patient would be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The patient should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

14. A patient has periopheral arterial disease (PAD). What statement by the patient indicates misunderstanding about self-management activities?

"I can use a heating pad on my legs if it's set on low." Patients with PAD should never use heating pads as skin sensitivity is diminished and burns can result. The other statements show good understanding of self-management.

After teaching a patient who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional teaching?

"I should decrease my intake of protein and eliminate carbohydrates from my diet." The patient should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The patient should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

After providing discharge teaching, a nurse assesses the patient's understanding regarding increased risk for metabolic alkalosis. Which statement indicates that the patient needs additional teaching?

"I take sodium bicarbonate after every meal to prevent heartburn : Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids can cause metabolic alkalosis. Avoiding milk, taking digoxin, and sweating would not lead to increased risk of metabolic alkalosis.

After teaching a patient who is recovering from an endoscopic transnasal hypophysectomy, the nurse assesses the patient's understanding. Which statement made by the patient indicates a correct understanding of the teaching?

"I will keep food on upper shelves so I do not have to bend over." After this surgery, the patient must take care to avoid activities that can increase intracranial pressure. The patient 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

Which statements by the patient indicate good understanding of foot care in peripheral vascular disease? Select all that apply.

"I will keep my feet dry, especially between the toes." "Lotion is important to keep my feet smooth and soft." "Washing my feet in room-temperature water is best." Good foot care includes appropriate hygiene and injury prevention. Keeping the feet dry; wearing good, comfortable shoes; using lotion; washing the feet in room-temperature water; and cutting the nails straight across are all important measures. Abrasive material such as pumice stones would not be used. Cheap flip-flops may not fit well and won't offer much protection against injury.

9. A nurse is caring for a patient who was prescribed high-dose corticosteroid therapy for 1 month to treat a sever inflammatory condition. The patient's symptoms have now resolved and the patient asks, "When can I stop taking these medications?" How would the nurse respond?

"Once you start corticosteroids, you have to be weaned off them." 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 patient's immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

A nurse teaches a patient with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this patient's teaching to prevent injury?

"Use a bath thermometer to test the water temperature." Patients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

A nurse teaches a patient with diabetes mellitus and a body mass index of 42 who is at high risk for coronary artery disease. Which statement related to nutrition would the nurse include in this patient's teaching?

"You should balance weight loss with consuming necessary nutrients." Patients at risk for cardiovascular diseases should follow the American Heart Association guidelines to combat obesity and improve cardiac health. The nurse would encourage the patient to eat vegetables, fruits, unrefined whole-grain products, and fat-free dairy products while losing weight. High-protein food items are often high in fat and calories. Although the nutritionist can assist with patient education, the nurse would include nutrition education and assist the patient to make healthy decisions. Exercising and eating nutrient-rich foods are both important components in reducing cardiovascular risk.

6. A nurse is teaching a patient with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How would the nurse respond?

"Your brain needs a constant supply of glucose because it cannot store it." Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

A nurse cares for a patient who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time would the nurse assess the patient for potential problems related to the NPH insulin?

1600 Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the patient at 08:00 would be too soon. Checking the patient at 20:00 and 23:00 would be too late. The nurse would check the patient at 16:00

A nurse cares for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition?

Increased pulse Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.

A client has undergone nasal hypophysectomy surgery. During post-operative care, which finding indicates cerebrospinal leakage?

A yellow edge around nasal discharge Nasal hypophysectomy is a surgical procedure performed to treat hyperpituitarism due to pituitary gland tumors. During postoperative care and follow-up, the appearance of light-yellow at the edge of otherwise clear nasal discharge in the dressing indicates leakage of cerebrospinal fluid (CSF). This is called the "halo sign" and is indicative of a CSF leak. Dry mouth after nasal hypophysectomy is normal due to the client breathes trough their mouth due to nasal packing. Neck rigidity could be an indication of infection, such as meningitis following surgery. A fall in blood pressure upon standing is called orthostatic hypotension and is a side effect of bromocriptine.

12. A nurse assesses a patient who has diabetes mellitus and notes that the patient is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the patient's clinical manifestations have not changed. What action would the nurse take next?

Administer another half-cup (120 mL) of orange juice. This patient is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse would administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment would be repeated. The patient does not need intravenous dextrose, insulin, or glucagon.

11. At 4:45pm, a nurse assesses a patient with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the patient is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: capillary blood glucose testing (AC/HS), dietary intake at 0630 = 95, at 1130 = 70, at 1630 = 46. Breakfast: 10% eaten - the patient states that she is not hungry. Lunch: 5% eaten - patient is nauseous, vomits once. After reviewing the patient's assessment data, which action is appropriate at this time?

Administer dextrose 50% intravenously and reassess the patient. The patient's symptoms are related to hypoglycemia. Since the patient has not been tolerating food, the nurse would administer dextrose intravenously. The patient's oxygen level could be checked, but based on the information provided, this is not the priority. The patient will not be reoriented until the glucose level rises.

A nurse cares for a patient experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take?

Administration of intravenous insulin The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The patient who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the patient glucose would be contraindicated. The patient does not require seizure precautions.

6. A nurse is caring for a patient who has just experienced a 90-s tonic-clonic seizure. The patient's arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3- 22 mEq/L (22 mmol/L). What action would the nurse take first?

Apply oxygen by mask or nasal cannula. The patient has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange. When the seizures have stopped and the patient can breathe again, the fastest way to return acid-base balance is to administer oxygen. Applying a paper bag over the patient's nose and mouth would worsen the acidosis. Sodium bicarbonate would not be administered because the patient's arterial bicarbonate level is normal. Glucose and insulin are administered together to decrease serum potassium levels. This action is not appropriate based on the information provided.

A nurse assesses a patient who is recovering from a subtotal thyroidectomy. On the second postoperative day the patient states, "I feel numbness and tingling around my mouth." What action does the nurse take?

Asses for Chvostek's sign. 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 patient 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 with a known abdominal aortic aneurysm reports dizziness and severe abdominal pain. The nurse assesses the patient's blood pressure at 82/30 mm Hg. What actions by the nurse are most important? Select all that apply.

Assess distal pulses every 10 minutes. Notify the Rapid Response Team. Take vital signs every 10 minutes. This patient may have a ruptured/rupturing aneurysm. The nurse would notify the Rapid Response team and perform frequent patient assessments. Giving pain medication will lower the patient's blood pressure even further. The nurse cannot have the patient sign a consent until the physician has explained the procedure.

A nurse assesses a patient who is admitted with an acid-base imbalance. The patient's arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3- 16 mEq/L (16 mmol/L). What action does the nurse take next?

Assess patient's rate, rhythm, and depth of respiration. Progressive skeletal muscle weakness is associated with increasing severity of acidosis. Muscle weakness can lead to severe respiratory insufficiency. Acidosis does lead to dysrhythmias (due to hyperkalemia), but these would best be assessed with cardiac monitoring. Findings would be documented, but simply continuing to monitor is not sufficient. Before notifying the physician, the nurse must have more data to report.

A nurse evaluates a patient's arterial blood gas values: pH 7.30, PaO2 86 mm Hg, PaCO2 55 mm Hg, and HCO3- 22 mEq/L (22 mmol/L). Which intervention does the nurse implement first?

Assess the airway All interventions are important for patients with respiratory acidosis; this is indicated by the ABGs. However, the priority is assessing and maintaining an airway. Without a patent airway, other interventions will not be helpful.

6. A nurse assesses a patient 2 hours after a cardiac angiography via the left femoral artery. The nurse notes that the left pedal pulse is weak. What action would the nurse take?

Assess the color and temperature of the leg. Loss of a pulse distal to an angiography entry site is serious, indicating a possible arterial obstruction. The pulse may be faint because of edema. The left pulse would be compared with the right, and pulses would be compared with previous assessments, especially before the procedure. Assessing color (pale, cyanosis) and temperature (cool, cold) will identify a decrease in circulation. Once all peripheral and vascular assessment data are acquired, the primary healthcare provider would be notified. Simply documenting the findings is inappropriate. The leg would be positioned below the level of the heart or dangling to increase blood flow to the distal portion of the leg. Increasing intravenous fluids will not address the patient's problem.

12. A nurse is caring for a patient on IV infusion of heparin. What action does this nurse include in the patient's plan of care? Select all that apply.

Assess the patient for bleeding. Monitor the daily activated partial thromboplastin time (aPTT) results. Use an IV pump for the infusion. Assessing for bleeding, monitoring aPTT, and using an IV pump for the infusion are all important safety measures for heparin to prevent injury from bleeding. The aPTT needs to be 1.5 to 2 times normal in order to demonstrate that the heparin is therapeutic. Weighing the patient is not related.

10. The nurse is assessing a patient on admission to the hospital. The patient's leg appears as shown below. What action by the nurse is best?

Assess the patient's ankle-brachial index. This patient has dependent rubor, a classic finding in peripheral arterial disease. The nurse would measure the patient's ankle-brachial index. Elevating the leg above the heart will further impede arterial blood flow. Ice will cause vasoconstriction, also impeding circulation and perhaps causing tissue injury. Heparin sodium is not the drug of choice for this condition.

18. A patient with a history of heart failure and hypertension is in the clinic for a follow-up visit. The patient is on lisinopril (Prinivil) and warfarin (Coumadin). The patient reports new-onset cough. What action by the nurse is most appropriate?

Assess the patient's lung sounds and oxygenation. This patient could be having an exacerbation of heart failure or experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse would assess the patient's lung sounds and other signs of oxygenation first. The patient may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse would assess the respiratory system first. If the cough turns out to be a side effect, reminding the patient is appropriate, but then more action needs to be taken.

A nurse assesses a patient who is experiencing an acid-base imbalance. The patient's arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3- 19 mEq/L (19 mmol/L). Which assessment would the nurse perform first?

Cardiac rate and rhythm Early cardiovascular changes for a patient experiencing moderate acidosis include increased heart rate and cardiac output. As the acidosis worsens, the heart rate decreases and electrocardiographic changes will be present. Central nervous system and neuromuscular system changes do not occur with mild acidosis and would be monitored if the acidosis worsens. Skin and mucous membrane assessment is not a priority now, but will change as acidosis worsens.

A nurse is caring for a client admitted with cardiovascular disease. During the assessment of the client's lower extremities, the nurse notes that the client has thin, shiny skin; decreased hair growth; and thickened toenails. What might this indicate?

Clients experiencing arterial insufficiency present with lower extremities that become pale when elevated and dusky red when lowered. Lower extremities may also be cool to touch, pulses may be absent or mild, and skin may be shiny and thin with decreased hair growth and thickened nails. Clients with venous insufficiency ofter have normal-colored extremities, normal temperature, normal pulses, marked edema, and brown pigmentation around the ankles. Phlebitis is an inflammation of a vein that occurs most often after trauma to the vessel wall, infection, and immobilization. Lymphedema is swelling in one or more extremities that is a direct result to impaired flow of the lymphatic system.

2. A nurse assesses a patient with diabetes mellitus 3 hours after a surgical procedure and notes that the patient's breath has a "fruity" odor. What action would the nurse take?

Consult the provider to test for ketoacidosis. The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the patient to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a "fruity" odor to the breath. Documentation would occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this patient's problem.

17. A nurse is caring for a patient with a nonhealing arterial lower leg ulcer. What action by the nurse is best?

Consult with the wound care nurse. A nonhealing wound needs the expertise of the wound care nurse. Premedicating prior to painful procedures and maintaining sterile technique are helpful, but if the wound is not healing, more needs to be done. The patient may need an amputation, but other options need to be tried first.

Which treatment intervention should be provided to a client diagnosed with Cushing's disease?

Decrease blood glucose levels Cushing's disease affects the glucose metabolism and results in reduced glucose uptake by tissues and increased glucose levels; therefore interventions to regulate blood glucose levels should be undertaken. Hypersecretion of cortisol causes Cushing's disease; therefore interventions should be aimed at decreasing the cortisol levels. Sodium levels are elevated in hypercortisolism; therefore interventions to decrease these levels should be initiated. Measures to increase the low serum calcium levels in Cushing's disease will be beneficial to the client.

DIABETES 1. A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which manifestations would the nurse monitor the patient? Select all that apply.

Deep and fast respirations Tachycardia Orthostatic hypotension DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually, patients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

On admission to the intensive care unit, a client is diagnosed with compensated metabolic acidosis. During the assessment, what is the nurse most likely to identify?

Deep and rapid respirations Deep, rapid respirations are an adaptation to a decreased serum pH. Carbonic acid dissociates in the lungs to hydrogen ions and carbon dioxide, which helps increase the serum pH. Muscle twitching results from low serum calcium (hypocalcemia), not compensated metabolic acidosis. Mental confusion does not occur in compensated acidosis; confusion can occur in uncompensated metabolic acidosis. Tachycardia and cardiac dysrhythmias are associated with hyperthyroidism, not compensated metabolic acidosis.

Interventions DI

Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results is dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore erythromycin would not be described. The primary pharmacologic treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).

7. A patient is being discharged on warfarin (Coumadin) therapy. What discharge instructions is the nurse required to provide? Select all that apply.

Dietary restrictions Follow-up laboratory monitoring Possible drug-drug interactions Reason to take medication The Joint Commission's Core Measures state that patients being discharged on warfarin need instruction on follow-up monitoring, dietary restrictions, drug-drug interactions, and reason for compliance. Driving is typically not restricted.

15. A patient had a percutaneous transluminal coronary angioplasty for peripheral arterial disease. What assessment finding by the nurse indicates that a priority outcome for this patient has been met?

Distal pulse on affected extremity 2+/4+ Assessing circulation distal to the puncture site is a critical nursing action. A pulse of 2+/4+ indicates good perfusion. Pain control, remaining on bedrest as directed after the procedure, and understanding are all important, but do not take priority over perfusion.

5. A nurse prepares to administer insulin to a patient at 1800. The patient's medication administration record contains the following information Insulin glargine: 12 units daily at 1800, Regular insulin: 6 units QID at 0600, 1200, 1800, 2400. Based on the patient's medication administration record, what action would the nurse take?

Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward.

When caring for a client with venous insufficiency, the nurse would implement which nursing measure?

Elevate the client's legs above heart level. Venous insufficiency occurs when vascular damage impedes the body's ability to move blood from the legs toward the heart. This causes blood to pool in the legs, where it can cause swelling, pain, and in some cases, leaking fluid in the skin or ulcers. Elevation of the legs above the level of the heart makes up of gravitational forces to drain blood through the veins toward the heart. Clients should not wear tight restrictive pants and should avoid wearing a girdle or garter, which may impede venous return. Compression stockings prevent blood pooling. Elevating the upper extremities will not decrease edema in lower extremities.

Surgery is performed on a client. The postoperative arterial blood gas values are pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq/L (25 mmol/L). Which action should the nurse take?

Encourage the client to take deep, cleansing breaths. The client is in respiratory acidosis, probably caused by the depressant effects of an anesthetic or a compromised airway; deep breaths blow off CO2 and encourage coughing. Obtaining a prescription for a diuretic will not correct the respiratory acidosis and may aggravate hypokalemia if present. Having the client breathe into a rebreather bag is a treatment for respiratory alkalosis; the client is in respiratory acidosis. Obtaining a medical prescription for the administration of sodium bicarbonate is not necessary if clearing of the airway corrects the problem.

1. A nurse assesses a patient who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention?

Slurred speech and confusion left-sided cardiac catheterization specifically increases the risk for a cerebral vascular accident. A change in neurologic status needs to be acted on immediately. Discomfort and bruising are expected at the site. If intake decreases, a patient can become dehydrated because of dye excretion. The second intervention would be to increase the patient's fluid status. Neurologic changes would take priority.

A nurse is caring for a client with Addison's disease. Which information should the nurse include in a teaching plan to encourage this client to modify dietary intake?

Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium

17. A nurse assesses a patient who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding alerts the nurse that the medication therapy is effective?

Heart rate is 70 beats/min and regular. Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a patient'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 patient 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.

A nurse is caring for a client admitted to the hospital with a diagnosis of Addison's disease. The nurse should assess the client for what signs related to this disorder?

Hypoglycemia and hypotension Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone resulting in fluid excretion that leads to hypotension. Although diarrhea can occur initially with steroid replacement, it should subside; pyrexia will occur only if there is a concomitant infection. Edema and hypertension are not related to Addison disease; they are associated with Cushing disease, because of excessive cortisol and aldosterone, resulting in fluid and sodium retention. Moon face and hirsutism are related to Cushing disease, not Addison disease; moon face is caused by adipose tissue deposition, and hirsutism is caused by excessive androgen secretion.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

Hyperglycemia and urine negative for ketones In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketone, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible, if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dl (8.9 to 10mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes

After reviewing the reports of a client, the nurse suspects hypofunctioning of the adrenal gland. Which findings are consistent with hypofunctioning of the adrenal gland? Select all that apply.

Hypofunctioning of the adrenal gland is manifested by increased serum calcium, decreased serum cortisol, and decreased serum sodium levels. Decreased serum potassium and decreased serum bicarbonate levels are associated with hyperfunctioning of the adrenal gland. Normal to increased serum glucose is associated with hyperfunctioning of the adrenal gland.

2. A nurse assesses a patient diagnosed with adrenal hypofunction. Which patient statement would the nurse correlate with this diagnosis?

I have a terrible craving for potato chips." The nurse correlates a patient's salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Patients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus.

nurse teaches a patient with a cortisol deficiency who is prescribed cortisol replacement therapy. Which statement would the nurse include in this patient's instructions?

If you are vomiting you will have to use injectable cortisol." Teaching for self-management of cortisol replacement therapy includes instructing the patient on how to give hydrocortisone injections in case of severe vomiting. The drug is usually given orally in divided doses with one dose in the morning and the other between 4 and 6 PM. A potassium restriction is not necessary.

The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)?

Inactivity A DVT, or thrombus, may form as a result of venous stasis. It may lodge in a vein and can cause venous occlusion. Inactivity is a major cause of venous stasis leading to DVT. Pregnancy and tight clothing are also risk factors for DVT, secondary to inactivity. Aerobic exercise is not a risk factor for DVT.

10. A nurse reviews the chart and new prescriptions for a patient with diabetic ketoacidosis: vital signs and assessment, laboratory results, medications. Blood pressure: 90/62 mm Hg, pulse: 120 bpm, respirations: 28 breaths/min, urine output: 20 mL/hr via catheter, serum potassium: 2.6 mEq/L, potassium chloride 40 mEq/L, IV bolus STAT increase IV fluid to 100 mL/hr. What action would the nurse take?

Increase the intravenous rate and then consult with the provider about the potassium prescription. The patient is acutely ill and is severely dehydrated and hypokalemic. The patient requires more IV fluids and potassium. However, potassium would not be infused unless the urine output is at least 30 mL/hr. The nurse would first increase the IV rate and then consult with the provider about the potassium.

A nurse is caring for a client after a thyroidectomy. Which symptoms indicating thyroid storm should the nurse monitor the client for? Select all that apply.

Increased heart rate Increased temperature Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increases the metabolic rate, thereby causing an increased heart rate (tachycardia). Because of the increased metabolic rate associated with thyroid storm, body temperature will increase. Because of the increased metabolic rate associated with thyroid storm, the respiratory rate increases (tachypnea) to meet the body's oxygen needs. Pulse deficit, the difference between apical and peripheral pulse rates, is not indicative of thyroid storm. The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

A nurse assesses a patient with diabetes mellitus who is admitted with an acid-base imbalance. The patient's arterial blood gas values are pH 7.36, PaO2 98 mm Hg, PaCo2 33 mm Hg, and HCO3- 18 mEq/L (18 mmol/L). Which manifestation does the nurse identify as an example of the patient's compensation mechanism?

Increased rate and depth of respirations This patient has metabolic acidosis. The respiratory system compensates by increasing its activity and blowing off excess carbon dioxide. Increased urinary output, thirst, and hunger are manifestations of hyperglycemia but are not compensatory mechanisms for acid-base imbalances. The kidneys do not release acids.

15. A nurse assesses a patient with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the patient's level of consciousness has decreased. What actions does the nurse perform? Select all that apply

Infuse intravenous fluids. Cover the patient with warm blankets. Maintain a patent airway. A patient 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 patient with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

An adolescent is found to have type 1 diabetes. The nurse plans to teach the adolescent that dietary control and exercise can help regulate the disorder. What additional information should the nurse include in the teaching plan? Select all that apply.

Insulin therapy Correct! Adherence to the treatment regimen Blood glucose monitoring Because clients with type 1 diabetes have little or no endogenous insulin, they must take insulin. Blood glucose monitoring is an important aspect of therapy because it aids evaluation of the effectiveness of diabetic control. Dietary control and exercise reduce the amount of exogenous insulin needed. Although adhering to the diabetic regimen is difficult, especially for adolescents who need to identify with their peers, its importance in promoting euglycemia should be discussed. Although infection increases insulin requirements, prophylactic antibiotics are not needed. Oral hypoglycemics are ineffective in stimulating insulin secretion in clients with type 1 diabetes.

A nurse is planning care for a patient who is anxious and irritable. The patient's arterial blood gas values are pH 7.30, PaO2 96 mm Hg, PaCO2 43 mm Hg, and HCO3- 19 mEq/L (19 mmol/L). Which questions would the nurse ask the patient and spouse when developing the plan of care? Select all that apply.

Is your spouse's current behavior typical?" "Do you drink any alcoholic beverages?" This patient's symptoms of anxiety and irritability are related to a state of metabolic acidosis. The nurse would ask the patient's spouse or family members if the patient's behavior is typical for him or her, and establish a baseline for comparison with later assessment findings. The nurse would also assess for alcohol intake because alcohol can change a patient's personality and cause metabolic acidosis. The other options are not causes of metabolic acidosis.

A nurse is teaching the parents of an 8-year-old child who is taking a high dose of oral prednisone for asthma. What critical information about prednisone will be included?

It should be stopped gradually. Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The drug usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect

The nurse is assessing a client experiencing diabetic ketoacidosis (DKA). Which unique response associated with DKA that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?

Kussmaul respirations occur in diabetic ketoacidosis (DKA) as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis) HHNS affects people with type 2 diabetes who still have insulin production; the insulin prevents the breakdown of fate into ketones. Fluid loss is common in both because an increased blood sugar ultimately leads to polyuria. Glycosuria is common in both conditions. Hyperglycemia is common in both conditions.

Why extra salt with Addisons

Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and thus cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing; nor will they help the client gain weight.

An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results?

Metabolic acidosis

2. A nurse is assessing patients who are at risk for acid-base imbalance. Which patients are correctly paired with the acid-base imbalance? Select all that apply.

Metabolic acidosis - older adult who is following a carbohydrate-free diet Respiratory alkalosis - patient on mechanical ventilation at a rate of 28 breaths/min Metabolic alkalosis - older patient prescribed antacids for gastroesophageal reflux disease Respiratory acidosis often occurs as the result of underventilation. The patient who is taking opioids, especially IV opioids, is at risk for respiratory depression and respiratory acidosis. One cause of metabolic acidosis is a strict low-calorie diet or one that is low in carbohydrate content. Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids. A ventilator set at a high respiratory rate or tidal volume will cause the patient to lose too much carbon dioxide, leading to an acid deficit and respiratory alkalosis. Citrate is a substance used as a preservative in blood products. It is not only a base, but also a precursor for bicarbonate. Multiple units of packed red blood cells could cause metabolic alkalosis. Sodium bicarbonate antacids may increase the risk of metabolic alkalosis.

5. A nurse assesses a patient who is prescribed furosemide (Lasix) for hypertension. For which acid-base imbalance does the nurse assess to prevent complications of this therapy?

Metabolic alkalosis Many diuretics, especially loop and thiazide diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an acid deficit of metabolic origin.

A nurse assesses a patient with Cushing's disease. Which assessment findings would the nurse correlate with this disorder? Select all that apply.

Moon face Petechiae Muscle atrophy Clinical manifestations of Cushing's disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy

A nurse is planning an evening snack for a child receiving NPH insulin. What is the reason for this nursing action?

Nourishment helps counteract late insulin activity. A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There is no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep.

An emergency nurse cares for a patient who is experiencing an acute adrenal crisis. What action would the nurse take first?

Obtain intravenous access. All actions are appropriate for the patient 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 arrives at the outpatient clinic with a painful leg ulcer, and the nurse performs a physical assessment. Which clinical findings in the lower extremity support a diagnosis of an arterial ulcer? Select all that apply

Pain at ulcer site Diminished pedal pulses Correct Answer Thickened toenails Correct Answer Lack of hair Prolonged lack of oxygen to hair follicles results in hair loss. Prolonged lack of oxygen to the toes results in thickened toenails. Arterial ulcers are painful because of the interruption of blood supply to peripheral tissues. Inadequate arterial perfusion results in diminished volume of blood flow to the lower extremities. Brown skin discoloration is characteristic of venous ulcers

9. A nursing student is caring for a patient with an abdominal aneurysm. What action by the student requires the registered nurse to intervene?

Palpates the abdomen in four quadrants Abdominal aneurysms should never be palpated as this increases the risk of rupture. The registered nurse would intervene when the student attempts to do this. The other actions are appropriate.

A client is scheduled for an adrenalectomy. What does the nurse expect that the plan of care will include?

Parenteral corticosteroids Steroid therapy usually is given intravenously or intramuscularly preoperatively and continues intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24- hour urine specimen in unnecessary. Corticosteroids must be administered preoperatively to prevent adrenal insufficiency during surgery, so withholding all medications for 48 hours before surgery is contraindicated.

Which does the nurse state is a secondary cause of adrenal insufficiency?

Pituitary tumors Adrenal insufficiency is also called Addison's disease. Secondary causes of adrenal insufficiency include pituitary tumors. Primary causes, which are responsible for adrenal insufficiency, include hemorrhage, tuberculosis, and metastatic cancer.

In anticipation of a client returning to their room following a subtotal thyroidectomy, what intervention would be highest priority for the nurse to perform?

Place a tracheostomy set at the bedside Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause an airway obstruction. Although not common, airway obstruction after thyroid surgery is an emergent situation. Oxygen, suction equipment, and a tracheostomy tray should be readily available in the client's room A patent airway takes priority over incision inspection. Speaking is important to determine the status of the laryngeal nerve. The semi-fowler position is indicated to maximize respiratory excursion.

What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury? Select all that apply.

Providing adequate fluids within easy reach. Correct! Monitoring for constipation, weight loss, hypotension and tachycardia Assessing for and reporting changes in neurological status.

2. A nurse assess a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find?

Pulse decreased from 100 to 80 bpm Beta-blockers block the stimulation of beta1-adrenergic receptors. They block the sympathetic (fight-or-flight) response and decrease the heart rate (HR). The beta-blocker will decrease HR and blood pressure, increasing ventricular filling time. It usually does not have effects on beta2-adrenergic receptor sites. Cardiac output will drop because of decreased HR.

3. A patient with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this patient?

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

A nurse assesses a patient who is experiencing an acid-base imbalance. The patient's arterial blood gas values are pH 7.32, PaO2 94 mm Hg, PaCO2 34 mm Hg, and HCO3- 18 mEq/L (18 mmol/L). For which clinical manifestations would the nurse assess? Select all that apply.

Reduced deep tendon reflexes Drowsiness Increased respiratory rate Metabolic acidosis causes neuromuscular changes, including reduced muscle tone and deep tendon reflexes. Patients usually present with lethargy and drowsiness. The respiratory system will attempt to compensate for the metabolic acidosis; therefore, respirations will increase rate and depth. A positive Trousseau's sign is associated with alkalosis. Decreased urine output is not a manifestation of metabolic acidosis.

11. A nurse cares for a patient who is recovering from a hypophysectomy. What action would the nurse take first?

Report clear or light yellow drainage from the nose. light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The nurse would report this finding. The patient 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 client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, what will the nurse include in the teaching?

Report palpations, nervousness, tremors, or loss of weight that may indicate and overdose of thyroid hormone. Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

12. A nurse cares for a patient who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The patient's serum sodium level is 114 mEq/L (114 mmol/L). What action would the nurse take first?

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

The nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which finding in the client is consistent with the diagnosis?

Retention of water SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules. There is hyponatremia and dilution of serum sodium in SIADH. Decreased vasopressin is seen in diabetes insipidus. Generally pedal (dependent) edema is not seen in SIADH despite water retention.

4. A nurse assesses a patient who is recovering after a coronary catheterization. Which assessment findings in the first few hours after the procedure require immediate action by the nurse? Select all that apply.

Serum potassium of 2.9 mEq/L Expanding groin hematoma Rhythm changes on the cardiac monitor In the first few hours postprocedure, the nurse monitors for complications such as bleeding from the insertion site, hypotension, acute closure of the vessel, dye reaction, hypokalemia, and dysrhythmias. The patient's blood pressure is slightly elevated but does not need immediate action. Warmth and redness at the site would indicate an infection, but this would not be present in the first few hours.

A nurse is caring for a patient who is experiencing excessive diarrhea. The patient's arterial blood gas values are pH 6.96, PaO2 98 mm Hg, PaCO2 45 mm Hg, and HCO3- 16 mEq/L (16 mmol/L). Which provider order does the nurse expect to receive?

Sodium bicarbonate 100 mEq diluted in 1 L of D5W This patient's arterial blood gas values represent metabolic acidosis related to a loss of bicarbonate ions from diarrhea. The bicarbonate would be replaced to help restore this patient's acid-base balance as the pH is below 7.0 and the bicarbonate level is abnormal. Furosemide would cause an increase in acid fluid and acid elimination via the urinary tract; although this may improve the patient's pH, the patient has excessive diarrhea and cannot afford to lose more fluid. Mechanical ventilation is used to treat respiratory acidosis for patients who cannot keep their oxygen saturation at 90%, or who have respirator muscle fatigue. Mechanical ventilation and an indwelling urinary catheter would not be prescribed for this patient.

7. A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? Select all that apply.

Stroke Kidney failure Blindness Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

To prepare a client for surgery, which explanation by a nurse would be accurate related to pneumatic compression devices?

They help with venous blood return to the heart. Deep vein thrombosis (DVT) is a potential complication of any surgery lasting longer than 30 minutes. The purpose of the pneumatic compression devices is to increase venous return. Clients often complain about pneumatic compression devices being hot and itchy. In additional to the pneumatic compression devices, a mechanical form of DVT prophylaxis, pharmaceutical prophylaxis is often required. Pneumatic compression devices are continued until the client is up ambulating frequently throughout the day.

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing?

The Somogyi effect is a response to hypoglycemia induced by too much insulin; the body responds to the hypoglycemia by counterregulatory hormones stimulating lipolysis, gluconeogenesis, and glycogenolysis, resulting in rebound hyperglycemia. The Dawn phenomenon is hyperglycemia that is present on awakening in the morning because the release of counterregulatory hormones in the predawn hours; it is thought that growth hormone or cortisol is related to this phenomenon. Diabetic ketoacidosis (diabetic coma) is a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Hyperosmolar nonketotic syndrome occurs in clients with type 2 diabetes. It is a condition in which the client produces enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

5. A nurse assesses a patient who has aortic regurgitation. In which location in the illustration shown below would the nurse auscultate to best hear a cardiac murmur related to aortic regurgitation?

The aortic valve is auscultated in the second intercostal space just to the right of the sternum. The pulmonic valve would be heard in location B located in the second intercostal space just left of the sternum. The mitral valve would be heard in location D located in the fifth intercostal space at the apex of the heart. The tricuspid valve would be heard in location C located in the fifth intercostal space at the lower left of the sternal border.

The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan? Select all that apply.

The teaching plan should include signs and symptoms of hypoglycemia. Correct! The client should obtain a finger stick glucose reading before each meal. Correct! The teaching plan should include sick day rules. All diabetic clients, regardless of type, should check finger stick blood sugars before each meal and snack. Antidiabetic medications can cause hypoglycemia; therefore, the client needs to be instructed on the symptoms of hypoglycemia. All diabetic clients need to be educated on sick day ruled. All diabetic clients should follow the American Diabetes Association diet.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client?

Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3) A decreased TSH array together with an elevated T3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T4 level might indicate hyperthyroidism. However, this may be a false reading because of the prescence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. PO2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test in not definitive because it is influenced by the intake of exogenous iodine.

A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply.

Truncal obesity Thin arms and legs Correct! Sleep distrubance

Signs of Cushings

Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arm and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of the sodium and water retention.

While assessing a patient with Grave's disease, the nurse notes that the patient's temperature has risen 1 degree F. What does the nurse do first?

Turn the lights down and shut the patient's door. temperature increase of 1° F (1° C) 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.

A nurse cares for a patient who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? Select all that apply.

Urine output is decreased. Specific gravity is increased. Urine osmolality is increased. 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 and increased osmolality.

5. A nurse plans care for a patient with Cushing's disease. Which action would the nurse include in thi patient's plan of care to prevent injury?

Use a lift sheet to change the patient's position. 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 side rails and assisting the patient to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The patient would not require suctioning.

A nurse is planning care for a patient who is hyperventilating. The patient's arterial blood gas values are pH 7.52, PaO2 94 mm Hg, PaCO2 31 mm Hg, and HCO3- 26 mEq/L (26 mmol/L). Which question would the nurse ask when developing this patient's plan of care?

You appear anxious. What is causing your distress?" The nurse should assist the patient who is experiencing anxiety-induced respiratory alkalosis to identify causes of the anxiety. The other questions will not identify the cause of the acid-base imbalance.