Ch. 14-16 - Perioperative Evolve Questions, Ch 49: Endocrine Problems, Iggy Chp 56 Assessment of Endocrine System (in chp Q's), Week 2, Chapter 17: Surgical Care, NURS 309 Quiz 1 Preoperative Patients, Exam 3: Ch 5, IGGY Chapter 63 questions, Endocri...

Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A Creatinine, 1.9 mg/dL B Fasting glucose, 80 mg/dL C Potassium, 3.9 mEq/L D Sodium, 140 mEq/L

A Creatinine, 1.9 mg/dL Correct: This result is outside the normal range. B Fasting glucose, 80 mg/dL: This result is within normal limits. C Potassium, 3.9 mEq/L: This result is within normal limits. D Sodium, 140 mEq/L: This result is within normal limits.

The nurse reviews with the client a routine discharge teaching plan concerning postoperative care. Which statement by the client indicates that teaching was effective? A. "I may need to restrict my activities for several months." B. "The dressing should stay in place unless it gets wet." C. "The incision needs to be cleaned every 4 hours with hydrogen peroxide." D. "The wound will completely heal in about 2 months."

A. "I may need to restrict my activities for several months." Correct: To protect the integrity of the wound, activities may need to be restricted. Incorrect: B. "The dressing should stay in place unless it gets wet.": The wound will need to be open to air for healing. C. "The incision needs to be cleaned every 4 hours with hydrogen peroxide.": Using hydrogen peroxide can cause wound irritation, unless specifically ordered. D. "The wound will completely heal in about 2 months.": The length of time it takes for a wound to heal varies; a wound can take up to 2 years to heal.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? A. "I will not eat any fatty foods when I am collecting urine for this test." B. "To end the collection, I must empty my bladder and add this urine to the collection." C. "I need to keep the urine container cool in a separate refrigerator or cooler." D. "I won't save the first urine sample of the day."

A. "I will not eat any fatty foods when I am collecting urine for this test." Rationale: A need for further teaching is needed when the client says that he/she will not eat any fatty foods while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating fatty foods does not interfere with collection or testing of the urine sample. The other statements indicate correct understanding of the client's actions for collection of an accurate 24-hour urine specimen.

A blind patient is to have a surgical procedure. She asks the nurse whether she will be able to sign her own consent form. What is the nurse's best response? A. "Yes, but your signature will need to have two witnesses." B. "No, but your next of kin can sign the consent form for you." C. "Yes, but you will need to make an X instead of signing your name." D. "No, but you can give instructions to sign for you to any responsible adult."

A. "Yes, but your signature will need to have two witnesses."

The patient is preparing to go home. What important teaching points should the nurse include? (Select all that apply.) A. "Report any difficulty with orientation to time, place, or person." B. "Note how many hours you sleep in a 24-hr period." C. "Be sure that you take your medication every day at the same time." D. "Your diet should be low-fiber, but with plenty of fluids." E. "Call the provider if you develop an unsteady gait or tremors in your hands."

A. "Report any difficulty with orientation to time, place, or person." B. "Note how many hours you sleep in a 24-hr period." C. "Be sure that you take your medication every day at the same time." E. "Call the provider if you develop an unsteady gait or tremors in your hands." Patients should not take OTC drugs because thyroid hormone preparations interact with many drugs. The patient should always consult the provider before taking any OTC preparations. The diet should include fiber to prevent constipation. When the patient becomes constipated, the dose of replacement thyroid hormone may need to be increased. When the patient has difficulty getting to sleep and has more bowel movements than normal, the dose may need to be decreased.

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? Select all that apply. A. 15 lb weight gain B. Decreased libido C. Four sinus infections D. Frequent constipation E. Increased foot callus formation F. Occasional dripping of clear fluid from both breasts G. Severely sprained ankle from a volley ball injury

A. 15 lb weight gain B. Decreased libido F. Occasional dripping of clear fluid from both breasts Rationale: Several hormones secreted in excess can cause weight gain, although so can increased caloric intake and decreased energy output. However in this instance it is occurring along with other indicators of pituitary hyperfunction. Decreased libido is associated with increased prolactin production, as well as decreased gonadotropins. Galactorrhea (leaking of fluid from the breast) in a man is associated with excess prolactin. Increased sinus infections are not associated with changing pituitary hormone levels. Constipation could be associated with decreased thyroid stimulating hormone but not pituitary hyperfunction. Callus formation and a sprained ankle are physical responses not related to endocrine function.

The RN has just received reports about all of these clients on the inpatient surgical unit. Which client would the nurse care for first? A. A 43-year-old client who had a bowel resection 7 days ago and has new serosanguineous drainage on the dressing B. A 46-year-old client who had a thoracotomy 5 days ago and needs discharge teaching before going home C. A 48-year-old client who had bladder surgery earlier in the day and is complaining of pain when coughing D. A 49-year-old client who underwent repair of a dislocated shoulder this morning and has a temperature of 100.4° F (38° C)

A. A 43-year-old client who had a bowel resection 7 days ago and has new serosanguineous drainage on the dressing Correct: New drainage on the fifth postoperative day is unusual and suggests a complication that would require further assessment and possible immediate action. Incorrect: B. A 46-year-old client who had a thoracotomy 5 days ago and needs discharge teaching before going home: This client is not in need of immediate care at this time. C. A 48-year-old client who had bladder surgery earlier in the day and is complaining of pain when coughing: This client is stable and does not require immediate action or care. D. A 49-year-old client who underwent repair of a dislocated shoulder this morning and has a temperature of 100.4° F (38° C): This client is stable and does not require immediate action or care.

After a patient is prepared for surgery and before preoperative drugs are given and the patient is transported to surgery, which essential intervention can the nurse delegate to the unlicensed assistive personnel (UAP) at this time? A. Assist the patient to empty his or her bladder B. Help the patient remove all clothing C. Ask the patient is he or she wants to brush teeth D. Recheck the patient's identity

A. Assist the patient to empty his or her bladder

A nurse in the ambulatory preoperative unit identifies that a client is more anxious than most clients. What is the nurse's best intervention? A. Attempt to identify the client's concerns B. Reassure the client that surgery is routine C. Report the client's anxiety to the health care provider D. Provide privacy by pulling the curtain around the client

A. Attempt to identify the client's concerns

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) A. Bending at the waist B. Talking C. Deep breathing D. Coughing E. Wearing makeup F. Using dental floss

A. Bending at the waist D. Coughing Rationale: Coughing early after surgery both increases intracranial pressure (ICP) and also increases pressure in the incision area and may lead to a leak of cerebrospinal fluid. Bending at the waist also increases ICP.

In conducting a postoperative assessment of the client, what is most important for the nurse to examine first? A. Breathing pattern B. Level of consciousness C. Oxygen saturation D. Surgical site

A. Breathing pattern Correct: Respiratory assessment is the most important. Incorrect: B. Level of consciousness: Assessing the level of consciousness is secondary. C. Oxygen saturation: Assessing oxygen saturation is secondary. D. Surgical site: Assessing the surgical site is secondary.

Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)? A. Checking the client's blood glucose levels every 4 hours B. Monitoring the client's response to the IV insulin given during a stimulation test C. Teaching the client about a hormone suppression test D. Assessing the client for symptoms of hypopituitarism

A. Checking the client's blood glucose levels every 4 hours Rationale: Monitoring blood glucose is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? A. Chest pain B. Constipation C. Headache D. Increased sleepiness

A. Chest pain Rationale: Bromocriptine can cause serious cardiac dysrhythmias and coronary artery spasms.

During surgery, who is most responsible for monitoring for possible breaks in sterile technique? A. Circulating nurse B. Holding nurse C. Anesthesiologist D. Surgeon

A. Circulating nurse Correct: All are responsible, but the circulating nurse moves around the room and can see more of what is happening. Incorrect: B. Holding nurse: The holding nurse is not in the operating room. C. Anesthesiologist: All are responsible, but the anesthesiologist is focused on providing sedation to the client. D. Surgeon: All are responsible, but the surgeon is concentrating on the surgery and usually cannot monitor all staff.

Who is the most likely person to administer blood products in an operating suite? A. Circulating nurse B. Holding area nurse C. Scrub nurse D. Specialty nurse

A. Circulating nurse Correct: Circulating nurses or "circulators" are registered nurses who coordinate, oversee, and are involved in the client's nursing care in the operating room. Incorrect: B. Holding area nurse: Holding area nurses manage the client's care before surgery. Blood would not yet be needed at this point. C. Scrub nurse: Scrub nurses set up the sterile field, drape the client, and hand sterile supplies, sterile equipment, and instruments to the surgeon and the assistant. D. Specialty nurse: Specialty nurses may be in charge of a particular type of surgical specialty. They are responsible for nursing care specific to clients who need that type of surgery, such as assessing, maintaining, and recommending equipment, instruments, and supplies.

Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A. Creatinine, 1.9 mg/dL (168 mcmol/L) B. Fasting glucose, 80 mg/dL (4.4 mmol/L) C. Potassium, 3.9 mEq/L (3.9 mmol/L) D. Sodium, 140 mEq/L (140 mmol/L)

A. Creatinine, 1.9 mg/dL (168 mcmol/L)

An appendectomy is being performed on a patient with appendicitis. What is the correct classification for this surgery? A. Curative B. Diagnostic C. Urgent D. Radical

A. Curative

Which action best exemplifies the expected outcome of appropriate negative feedback control over endocrine gland hormone secretion? A. Decreased secretion of glucagon when blood glucose approaches normal levels B. Increased secretion of parathyroid hormone in response to a calcium-containing intravenous infusion C. Increased secretion of thyroid-stimulating hormone in response to long-term exogenous thyroid hormone replacement therapy D. Decreased secretion of cortisol in response to a pituitary tumor stimulating the increased secretion of adrenocorticotropic hormone

A. Decreased secretion of glucagon when blood glucose approaches normal levels

Which action best exemplifies the expected outcome of appropriate negative feedback control over endocrine gland hormone secretion? A. Decreased secretion of glucagon when blood glucose approaches normal levels B. Increased secretion of parathyroid hormone in response to a calcium-containing intravenous infusion C. Increased secretion of thyroid stimulating hormone in response to long-term exogenous thyroid hormone replacement therapy D. Decreased secretion of cortisol in response to a pituitary tumor stimulating the increased secretion of adrenocorticotropic hormone

A. Decreased secretion of glucagon when blood glucose approaches normal levels. Rationale: A negative feedback mechanism signals an endocrine gland to secrete a hormone in response to a body change to cause a reaction that will result in actions to oppose the action of the initial condition change and restore homeostasis. Serum calcium levels determine when and to what degree parathyroid hormone PTH is released. PTH secretion decreases when serum calcium levels are high, and it increases when serum calcium levels are low. If thyroid hormone levels are high, as would be the case if a client was taking exogenous thyroid hormone replacement therapy, release of both thyrotropin-releasing hormone (TRH) and thyroid stimulating hormone TSH is inhibited. Adrenocorticotropic hormone (ACTH) triggers the release of cortisol from the adrenal cortex, not suppression of its release.

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) A. Decreased urine output B. Hypotension C. Weigh gain of more than 2.2 lb (1 kg) in 24 hours D. Persistent headache E. Hyperglycemia F. Acute confusion

A. Decreased urine output C. Weight gain of more than 2.2lbs (1 kg) in 24 hours D. Persistent headache F. Acute confusion Rationale: Drug therapy for DI can cause a greatly increased kidney reabsorption of water and lead to life-threatening water toxicity. Indications of water toxicity are a relatively rapid onset of acute confusion, rapid weight gain, decreased urine output, persistent headache, and nausea and vomiting.

An unidentified client from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse, who is verifying the informed consent, do? A. Ensure written consultation of two noninvolved physicians. B. Read the surgeon's consult to determine whether the client's condition is life-threatening. C. Sign the operative permit. D. Withhold surgery until the next of kin is notified

A. Ensure written consultation of two noninvolved physicians.

The unidentified client from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse who is verifying the informed consent do? A. Ensure written consultation of two noninvolved physicians. B. Read the surgeon's consult to determine whether the client's condition is life threatening. C. Sign the operative permit. D. Withhold surgery until the next of kin is notified.

A. Ensure written consultation of two noninvolved physicians. Correct: In a life-threatening situation in which every effort has been made to contact the person with medical power of attorney, consent is desired but not essential. In place of written or oral consent, written consultation by at least two physicians who are not associated with the case may be requested by the physician. Incorrect: B. Read the surgeon's consult to determine whether the client's condition is life threatening: It is not within the nurse's role to make a judgment about the client based on the surgeon's consult. C. Sign the operative permit: Signing documents on the client's behalf is not legal. D. Withhold surgery until the next of kin is notified: Withholding surgery is not in this client's best interests.

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? A. Ensuring the phlebotomist wears a facemask while in the client's room B. Asking the phlebotomist to delay the blood draw C. Monitoring the client closely for cold-like symptoms D. Placing a facemask on the client

A. Ensuring the phlebotomist wears a facemask while in the client's room Rationale: The nurse needs to make sure the phlebotomist wears a facemask because the client is immunosuppressed and at higher risk for respiratory infection. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.Asking the phlebotomist to delay the blood draw could lead to harm by not providing sufficient information about the client's condition. The phlebotomist, not the client, is exhibiting cold-like symptoms, so monitoring the client for these symptoms is not appropriate. Having the client wear a mask during the blood draw does not protect him or her from any airborne microorganisms that remain in the atmosphere of the room or droplets that may reside on surfaces.

Which assessment has the highest priority for the nurse to perform for a client with syndrome of inappropriate antidiuretic hormone (SIADH) receiving tolvaptan therapy for 24 hours? A. Evaluating serum sodium levels B. Evaluating serum potassium levels C. Examining the skin and sclera for jaundice D. Examining the IV site for indications of phlebitis

A. Evaluating serum sodium levels Rationale: Tolvaptan carries a black box warning of increased risk for developing hypernatremia within 12 to 24 hours that can lead to CNS demyelination and death. Serum potassium levels are not directly affected by this drug. Although the drug is associated with an increased risk for jaundice, this problem appears after 30 days of use. Tolvaptan is an oral drug, not a parenteral one.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? A. Increased facial hair and absent menses in a 28-year-old nonpregnant woman B. Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago C. Male-pattern baldness in a 32-year-old man D. Dry skin on the shins of a 70-year-old woman

A. Increased facial hair and absent menses in a 28-year-old nonpregnant women. Rationale: Absence of menses when pregnancy is not present is considered abnormal, especially when accompanied by hirsutism. Possible endocrine problems associated with these changes include ovarian, adrenal gland, hypothalamic, or anterior pituitary dysfunction. Male-pattern baldness in a man is usually associated with a genetic predisposition. Dry skin is a normal finding in older women. An increased appetite when physical activity increases is also considered normal.

Which statement is true regarding the patient who has given consent for a surgical procedure? A. Information necessary to understand the nature of and reason for the surgery has been provided B. The length of stay in the hospital has been preapproved by the managed care provider C. Information about the surgeon's experience has been provided D. The nurse has provided detailed information about the surgical procedure

A. Information necessary to understand the nature of and reason for the surgery has been provided

A patient with type I diabetes mellitus is scheduled for surgery at 0700. Which actions must the nurse perform for this patient before he goes to the operating room? SATA A. Modify the dose of insulin given based on the patient's blood glucose as ordered B. Complete the preoperative checklist before transfer to the surgical suite C. Teach the patient about foot care and properly fitted shoes D. Delegate obtaining the patient's fingerstick blood glucose and vital signs to the unlicensed assistive personnel (UAP) E. Check if the patient is wearing any jewelry and call security to secure valuables if necessary F. Place the patient on NPO status for the period ordered by the physician

A. Modify the dose of insulin given based on the patient's blood glucose as ordered B. Complete the preoperative checklist before transfer to the surgical suite D. Delegate obtaining the patient's fingerstick blood glucose and vital signs to the unlicensed assistive personnel (UAP) E. Check if the patient is wearing any jewelry and call security to secure valuables if necessary F. Place the patient on NPO status for the period ordered by the physician

During preoperative screening,, the nurse discovers that the patient is allergic to shellfish. What is the nurse's best first action? A. Notifies the surgeon B. Develops a plan to keep the patient safe C. Obtains an order for a shellfish-free diet D. Asks the patient if any other family members have the same allergy

A. Notifies the surgeon

A client is admitted for surgery. Although not physically distressed, the client appears apprehensive and withdrawn. What is the nurse's best action? A. Orient the client to the unit environment B. Have a copy of hospital regulations available C. Explain that there is no reason to be concerned D. Reassure the client that the staff is available to answer questions

A. Orient the client to the unit environment

A colostomy is scheduled to be done on a patient with Crohn's disease. What is the correct classification for this surgery? A. Palliative B. Minor C. Restorative D. Curative

A. Palliative

An older adult is scheduled for an elective surgical procedure. On assessment, the nurse notes brittle nails, dry flaky skin, muscle wasting, and dry sparse hair. The patient's BP is 82/48 and heart rate is 112/minute. How does the nurse interpret this assessment data? A. Poor fluid and nutrition status B. Improper care in the home C. Expected physiological changes of aging D. Depression related to aging processes

A. Poor fluid and nutrition status

The 79-year-old patient with type 2 diabetes is scheduled for surgery to remove his left great toe. Which risk factors for complications of surgery does the nurse assess in this patient? SATA A. Presence of chronic illness B. Problems with healing C. Absence of smoking history D. Dehydration E. Electrolyte imbalance F. Daily exercise routine

A. Presence of chronic illness B. Problems with healing D. Dehydration E. Electrolyte imbalance

Which are the focus areas for the Surgical Care Improvement Project (SCIP)? SATA A. Prevention of infection B. Prevention of respiratory complications C. Prevention of serious cardiac events D. Prevention of venous thromboembolism E. Prevention of acute kidney injury F. Maintenance of normothermia

A. Prevention of infection C. Prevention of serious cardiac events D. Prevention of venous thromboembolism F. Maintenance of normothermia

The nurse has given the ordered preoperative medications to the patient. What actions must the nurse take after administering these drugs? SATA A. Raise the side rails B. Place the call light within the patient's reach C. Ask the patient to sign the consent form D. Instruct the patient not to get out of bed E. Place the bed in its lowest position F. Tell the patient that he or she may become drowsy

A. Raise the side rails B. Place the call light within the patient's reach D. Instruct the patient not to get out of bed E. Place the bed in its lowest position F. Tell the patient that he or she may become drowsy

Which postoperative interventions will the nurse typically teach a patient to prevent complications following surgery? SATA A. Range-of-motion exercises B. Massaging of lower extremities C. Taking pain medications only when experiencing severe pain D. Incision splinting E. Deep-breathing exercises F. Use of incentive spirometry

A. Range-of-motion exercises D. Incision splinting E. Deep-breathing exercises F. Use of incentive spirometry

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? A. Serum sodium increases from 122 mEq/L to 140 mEq/L. B. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. C. Serum chloride decreases from 109 mEq/L to 99 mEq/L. D. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.

A. Serum sodium increases from 122 mEq/L to 140 mEq/L. Rationale: The purpose of tolvaptan is to restore a normal sodium concentration to the blood and other extracellular fluid. In the case of syndrome of inappropriate antidiuretic hormone, excessive amounts of antidiuretic hormone have caused more water to be absorbed, causing the serum sodium to be diluted. When tolvaptan therapy brings the serum sodium level to normal levels, it must be discontinued to prevent hypernatremia. A serum sodium of 140 mEq/L is within the normal range.

The client has an acute case of opioid depression and receives a dose of naloxone (Narcan). Which statement is true about this client? A. Supplemental pain reduction is needed. B. One dose is needed. C. This is an acute emergency. D. The client will be hostile.

A. Supplemental pain reduction is needed. Correct: The client has breakthrough pain after the opioid antagonist is given, so other interventions to promote comfort are needed. Incorrect: B. One dose is needed: Several doses may be needed because naloxone has a shorter half-life. C. This is an acute emergency: This is a manageable situation. D. The client will be hostile: The client with opioid depression usually is not fully conscious.

The nurse has received a patient in the holding area who is scheduled for a left femoral-popliteal bypass. What are the priority safety measures for this patient before surgery? SATA A. The operative limb is marked by the surgeon B. The patient is positively identified by checking the name and date of birth C. The patient is asked to confirm the marked operative limb D. The patient is identified by checking the name and room number E. The patient is instructed to verify any family members waiting F. The patient is kept on NPO status

A. The operative limb is marked by the surgeon B. The patient is positively identified by checking the name and date of birth C. The patient is asked to confirm the marked operative limb F. The patient is kept on NPO status

Which are implied with informed consent? SATA A. The patient understands the nature of and the reason for surgery B. The patient is informed of what type of anesthesia drugs will be used C. The patient understands who will do the surgery and who will be present during surgery D. The patient understands the risks associated with the surgical procedure and its potential outcomes E. The patient understands that blood and blood products must be available during surgery F. The patient is informed of all available options and the benefits and risks associated with each option

A. The patient understands the nature of and the reason for surgery C. The patient understands who will do the surgery and who will be present during surgery D. The patient understands the risks associated with the surgical procedure and its potential outcomes F. The patient is informed of all available options and the benefits and risks associated with each option

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? A. Urine output of 30 to 50 mL/hr B. Blood glucose level of 110 mg/dL (6.1 mmol/L) C. Respiratory rate of 20 breaths/min D. Potassium level of 3.9 mEq/L (mmol/L)

A. Urine output of 30 to 50 mL/hr Rationale: With DI, insufficient amounts of vasopressin (antidiuretic hormone [ADH]) prevent reabsorption of water, leading to profound diuresis that can result in dehydration. Desmopressin, a synthetic form of ADH, is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels, as are the respiratory rate and the potassium level.

If a patient has hypothyroidism, what would the thyroid-stimulating hormone level be? a. Increased b. Decreased c. Normal d. Not used to evaluate hypothyroidism

A. increased

A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?

ANS: 1.6 A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL. DIF: Cognitive Level: Apply (application) REF: 1179 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

32. A nurse discovers on the preoperative assessment that a patient has a condition that would require increased amounts of general anesthesia. The condition is _____.

ANS: alcoholism Individuals who use alcohol excessively usually require greater amounts of anesthesia. DIF: Cognitive Level: Comprehension REF: p. 257 OBJ: 6 TOP: Conditions That Affect Anesthesia KEY: Nursing Process Step: Assessment

The nurse screens a preoperative patient for conditions that may increase the risk for complications during the perioperative period. Which conditions are possible risk factors? SATA A. Emotionally stable B. Age 67 C. Obesity D. Marathon runner E. Pulmonary disease F. Hypertension

B. Age 67 C. Obesity E. Pulmonary disease F. Hypertension

8. A nurse is performing a postoperative assessment on a patient who has just returned from a hernia repair. The patient's blood pressure is 90/60 mm Hg, and the apical pulse is 108 beats/min. What should be the nurse's first action? a. Check the dressing for bleeding. b. Notify the registered nurse (RN). c. Document the vital signs. d. Increase the rate of infusion of intravenous fluids.

ANS: A A decrease in blood pressure and tachycardia could indicate postoperative bleeding. The first action of the nurse should be to check the dressing and then report to the RN. DIF: Cognitive Level: Application REF: p. 270 OBJ: 8 TOP: Postoperative Complications KEY: Nursing Process Step: Implementation

26. Why should a nurse assess a patient's limbs and position the limbs frequently after a regional anesthesia? a. Pain is not perceived, although motion is possible. b. Rashes and skin eruptions would indicate an allergy. c. Permanent paralysis is a concern. d. Contracture deformities may occur.

ANS: A After a regional anesthesia, movement is possible, but pain is not perceived immediately after surgery, which leaves the patient susceptible to injury. DIF: Cognitive Level: Comprehension REF: p. 267 OBJ: 6 TOP: Regional Anesthesia KEY: Nursing Process Step: Assessment

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level

ANS: A An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

22. A patient scheduled for a liver biopsy has given a nurse a list of medications routinely taken at home. Which medication should the nurse question? a. Aspirin b. Multivitamin c. Furosemide d. Acetaminophen

ANS: A Aspirin is an anticoagulant, which can increase the risk of postoperative bleeding. Drugs that have been taken for a long time may require dose adjustments because of the effects of surgery or the effect of additional drugs, which may be held or modified. DIF: Cognitive Level: Application REF: p. 257 OBJ: 2 TOP: Preoperative Assessment KEY: Nursing Process Step: Assessment

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patient's T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland

ANS: A Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action DIF: Cognitive Level: Analyze (analysis) REF: 1163 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels

ANS: A Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective DIF: Cognitive Level: Apply (application) REF: 1178 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

15. A nurse is doing an assessment of a patient who has returned from a cardiac catheterization and had conscious sedation. Which finding should the nurse report? a. Difficulty arousing the patient b. Blood pressure of 124/72 mm Hg c. Oxygen saturation of 96% d. Patient complaints of the need to void

ANS: A Conscious sedation uses intravenous drugs to reduce pain intensity or awareness without a loss of reflexes. A complication may be excessive sedation approaching that of general anesthesia. The patient should be easily aroused. DIF: Cognitive Level: Application REF: p. 268 OBJ: 6 TOP: Anesthesia KEY: Nursing Process Step: Assessment

A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism. The nurse providing care should a. monitor the blood pressure every 4 hours. b. elevate the patient's legs to relieve edema. c. monitor blood glucose level every 4 hours. d. order the patient a potassium-restricted diet.

ANS: A Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism DIF: Cognitive Level: Apply (application) REF: 1180 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

5. A nurse is caring for a postoperative patient who has had spinal anesthesia. Which assessment is a priority for this patient? a. Complaints of a headache b. Pulse rate of 78 beats/min c. Voided 300 mL d. Blood pressure of 126/78 mm Hg

ANS: A One complication of spinal anesthesia is postspinal headache, which is caused by the leaking of cerebrospinal fluid at the puncture site. DIF: Cognitive Level: Application REF: p. 267 OBJ: 7 TOP: Regional Anesthesia KEY: Nursing Process Step: Assessment

The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following? a. "I need to shop for foods low in sodium and avoid adding salt to food." b. "I should weigh myself daily and report any sudden weight loss or gain." c. "I need to limit my fluid intake to no more than 1 quart of liquids a day." d. "I will eat foods high in potassium because diuretics cause potassium loss."

ANS: A Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

19. A nurse is assisting in the transfer of a postoperative patient from the postanesthesia care unit to the surgical nursing unit. What action should the nurse implement to ensure the safety of the patient? a. Put the side rails up after moving the patient from the stretcher to the bed. b. Ask the patient to move from the stretcher to the bed. c. Move the patient rapidly from the stretcher to the bed. d. Uncover the patient before transferring from the stretcher to the bed.

ANS: A The patient will probably still be experiencing residual effects of anesthesia; the side rails should be up to prevent the patient from falling out of bed. DIF: Cognitive Level: Application REF: p. 274 OBJ: 9 TOP: Postoperative Care KEY: Nursing Process Step: Implementation

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic. b. The patient reports a recent head injury. c. The patient has a urine output of 400 mL/hr. d. The patient's urine specific gravity is 1.003.

ANS: A The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications DIF: Cognitive Level: Analyze (analysis) REF: 1161 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use? a. Provide written reminders of self-care information. b. Offer multiple options for management of therapies. c. Ensure privacy for teaching by asking visitors to leave. d. Delay teaching until patient discharge date is confirmed.

ANS: A Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid DIF: Cognitive Level: Apply (application) REF: 1170 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm? a. Propranolol (Inderal) b. Propylthiouracil (PTU) c. Methimazole (Tapazole) d. Iodine (Lugol's solution)

ANS: A b-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

29. A patient has an extensive bowel preparation of oral laxatives and enemas for a colon resection. What rationales should the nurse list when asked about the rigorous preparation? (Select all that apply.) a. Reduces possibility of fecal contamination of the operative site b. Flattens the colon c. Decreases postoperative distention d. Avoids postoperative constipation e. Decreases straining at stool

ANS: A, C, D, E Preoperative bowel prep reduces the risk for infection from bowel contents and decreases postoperative distention, constipation, and straining at stool. DIF: Cognitive Level: Comprehension REF: p. 260 OBJ: 4 TOP: Rationale for Bowel Preparation KEY: Nursing Process Step: Implementation

28. Patients with preoperative disorders put them at risk during recovery. What disorders should a nurse be aware may pose this hazard? (Select all that apply.) a. Diabetes b. Warfarin therapy c. Fungal skin infection d. Hepatitis C e. Chronic obstructive pulmonary disease (COPD)

ANS: A, D, E Diabetes, hepatitis C, and COPD all complicate recovery related to blood-clotting deficiencies, respiratory problems, or disturbance in the healing process. Warfarin therapy is not a disorder and should have been discontinued well before surgery, and fungal skin infections do not pose a threat. DIF: Cognitive Level: Comprehension REF: p. 257 OBJ: 2 TOP: Conditions That Complicate Recovery KEY: Nursing Process Step: Assessment

A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Is there a family history of acromegaly?" d. "Are you experiencing tremors or anxiety?"

ANS: B Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly DIF: Cognitive Level: Apply (application) REF: 1157 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours.

ANS: B After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed DIF: Cognitive Level: Apply (application) REF: 1159 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include a. high blood pressure. b. decreased facial hair. c. elevated blood glucose. d. tachycardia and cardiac palpitations.

ANS: B Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

27. A patient who received Penthrane as an inhaled anesthesia complains of a sore throat and a raspy voice. What should the nurse explain as the probable cause of these discomforts? a. Drying effect of the anesthesia b. Insertion of an endotracheal tube c. Postsurgical dehydration d. Possible upper respiratory infection

ANS: B Inhalant anesthesia is administered via an endotracheal tube that is inserted after the patient is unconscious. DIF: Cognitive Level: Comprehension REF: p. 268 OBJ: 6 TOP: Inhalant Anesthesia KEY: Nursing Process Step: Implementation

The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's a. weight has increased. b. urinary output is increased. c. peripheral edema is decreased. d. urine specific gravity is increased.

ANS: B Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimoto's thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addison's disease who takes hydrocortisone twice daily

ANS: B Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment

21. A patient has just returned to the surgical unit after varicose vein stripping and ligation. What is the best technique for a nurse to evaluate pain relief? a. Check the patient's record for the last dose of pain medication administered. b. Ask the patient to rate the severity of the pain on a scale of 1 to 10. c. Ask the family if they think that the patient is having pain. d. Tell the patient to ask for pain medicine when it is needed.

ANS: B Having the patient rate the pain provides a system for evaluating response to the pain medication. Pain is controlled better if treated before it becomes severe, and the patient may not ask for pain medicine soon enough. DIF: Cognitive Level: Application REF: p. 273 OBJ: 8 TOP: Postoperative Pain Relief KEY: Nursing Process Step: Assessment

9. A postoperative patient who has no previous medical conditions is difficult to arouse when transferred to the surgical unit from the postanesthesia care unit. A nurse monitors the pulse oximeter and gets a reading of 85%. What should be the nurse's next action? a. Assess the pulse oximeter reading again in 1 hour. b. Arouse the patient, have him cough, and encourage deep breathing. c. Administer a dose of pain medication. d. Suction fluid from the oral cavity.

ANS: B If the pulse oximeter reading is less than 90%, the patient should be aroused and encouraged to take deep breaths. The patient's respirations may not be adequate as a result of the effects of anesthesia. DIF: Cognitive Level: Application REF: p. 271 OBJ: 8 TOP: Hypoxia KEY: Nursing Process Step: Assessment

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness

ANS: B In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications DIF: Cognitive Level: Analyze (analysis) REF: 1169 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-year-old male who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

ANS: B Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications DIF: Cognitive Level: Analyze (analysis) REF: 1169 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? a. "How much milk do you drink?" b. "What medications are you taking?" c. "Are your immunizations up to date?" d. "Have you had any recent neck injuries?"

ANS: B Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter DIF: Cognitive Level: Understand (comprehension) REF: 1162 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels. c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation.

ANS: B Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

16. What is the goal of palliative surgery? a. Remove and study tissue to make a diagnosis. b. Relieve symptoms or improve function without correcting the basic problem. c. Remove diseased tissue or correct defects. d. Correct serious defects that only affect appearance.

ANS: B Palliative surgery is performed only to relieve symptoms or to improve function. It is not curative. DIF: Cognitive Level: Comprehension REF: p. 256 OBJ: 1 TOP: Types of Surgery KEY: Nursing Process Step: Planning

Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)? a. The medication will be needed for 3 to 6 months. b. Inject the medication subcutaneously every day. c. Blood glucose levels may decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.

ANS: B Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Monitor for peripheral edema. b. Offer patient hard candies to suck on. c. Encourage fluids to 2 to 3 liters per day. d. Keep head of bed elevated to 30 degrees.

ANS: B Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release DIF: Cognitive Level: Apply (application) REF: 1161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

3. A patient who had a hysterectomy yesterday has not been allowed food or drink by mouth (NPO). The physician has now ordered the patient's diet to be clear liquids. What should the nurse assess prior to providing this patient with clear liquids? a. Feelings of hunger b. Bowel sounds c. Positive Homans sign d. Gag reflex

ANS: B The absence of bowel sounds would contraindicate a diet of clear liquids. DIF: Cognitive Level: Application REF: p. 283 OBJ: 7 | 8 TOP: Postoperative Nursing Implementations KEY: Nursing Process Step: Assessment

4. Which technique should a nurse implement when changing a postoperative dressing? a. Enteric isolation b. Aseptic technique c. Clean technique d. Respiratory isolation

ANS: B The aseptic technique is important to reduce the risk of infection. DIF: Cognitive Level: Comprehension REF: p. 281 OBJ: 9 TOP: Postoperative Risk for Infection KEY: Nursing Process Step: Planning

The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for a. flushing. b. headache. c. bradycardia. d. hypoglycemia.

ANS: B The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected DIF: Cognitive Level: Apply (application) REF: 1181 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

24. What should a nurse suggest to a patient to prevent the effects of postoperative immobility on the gastrointestinal system? a. Avoid taking antibiotics. b. Increase her fluid intake. c. Avoid high-fiber foods. d. Limit her activity for the first 3 to 4 days.

ANS: B The intake of oral fluids and ingestion of a normal diet help stimulate peristalsis. DIF: Cognitive Level: Application REF: p. 283 OBJ: 9 TOP: Postoperative Complications KEY: Nursing Process Step: Implementation

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information is most important to communicate to the surgeon? a. The patient reports 7/10 incisional pain. b. The patient has increasing neck swelling. c. The patient is sleepy and difficult to arouse. d. The patient's cardiac rate is 112 beats/minute.

ANS: B The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected. DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease? a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I had the stomach flu earlier this week, so I couldn't take the hydrocortisone." c. "I always double my dose of hydrocortisone on the days that I go for a long run." d. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."

ANS: B The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease. DIF: Cognitive Level: Apply (application) REF: 1179 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which nursing action will be included in the plan of care for a 55-year-old patient with Graves' disease who has exophthalmos? a. Place cold packs on the eyes to relieve pain and swelling. b. Elevate the head of the patient's bed to reduce periorbital fluid. c. Apply alternating eye patches to protect the corneas from irritation. d. Teach the patient to blink every few seconds to lubricate the corneas.

ANS: B The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful DIF: Cognitive Level: Apply (application) REF: 1167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvostek's sign.

ANS: B The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone DIF: Cognitive Level: Apply (application) REF: 1173 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.

ANS: B The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor DIF: Cognitive Level: Apply (application) REF: 1168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

30. A nurse carefully monitors an obese patient after a hysterectomy for the peculiar postoperative complications. Which postoperative complications are associated with obesity? (Select all that apply.) a. Nausea b. Wound infection c. Hypertension d. Hemorrhage e. Respiratory difficulties

ANS: B, E Obese patients are especially prone to postoperative respiratory complications of pneumonia and atelectasis. Obese patients are at increased risk for infection because of the amount of adipose tissue. DIF: Cognitive Level: Comprehension REF: p. 271 OBJ: 8 TOP: Postoperative Complications in the Obese Patient KEY: Nursing Process Step: Assessment

31. What are the responsibilities of a circulating nurse? (Select all that apply.) a. Assisting the surgeon with the procedure b. Setting up the surgical room c. Scrubbing in to handle instruments d. Maintaining patient safety e. Documenting nursing care

ANS: B, D, E The circulating nurse is in charge of the operating room, monitors asepsis, provides supplies, and documents patient care. The first assistant helps the surgeon with the procedure and the scrub nurse handles the instruments. DIF: Cognitive Level: Knowledge REF: p. 266 OBJ: 5 TOP: Circulating Nurse KEY: Nursing Process Step: N/A

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain caused by increased appetite." b. "A weight-bearing exercise program will help minimize the risk for osteoporosis." c. "The prednisone dose should be decreased gradually rather than stopped suddenly." d. "Call the health care provider if you experience mood alterations with the prednisone."

ANS: C Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods. DIF: Cognitive Level: Analyze (analysis) REF: 1177 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to a. protect the patient's skin. b. monitor for signs of infection. c. balance fluids and electrolytes. d. prevent emotional disturbances.

ANS: C After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances DIF: Cognitive Level: Analyze (analysis) REF: 1177 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows.

ANS: C Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for a. sodium restriction to prevent fluid retention. b. insulin to maintain normal blood glucose levels. c. oral corticosteroids to replace endogenous cortisol. d. chemotherapy to prevent malignant tumor recurrence.

ANS: C Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

17. What information should a nurse ask a patient during the preoperative assessment? a. Current address and telephone number b. Food preferences c. Allergies, medications, and past medical conditions d. Bathing and sleep patterns

ANS: C If an emergency should arise, any allergies can be promptly managed. Knowledge of the patient's medications can enable the nurse to anticipate possible drug interactions. Past medical conditions may increase surgical risks or require special attention during the perioperative period. DIF: Cognitive Level: Comprehension REF: p. 257-258 OBJ: 2 TOP: Preoperative Assessment KEY: Nursing Process Step: Assessment

As the nurse is assessing a patient with Grave's disease, which finding requires immediate attention? a.Elevated temperature b.Elevated blood pressure c.Change in respiratory rate d.Irregular heart rate and rhythm

Answer: A Rationale: Increases in temperature may indicate a rapid worsening of the patient's condition and the onset of "thyroid storm." Further evaluation of cardiovascular status is warranted.

2. A nurse is caring for a postoperative patient. What should the nurse ask when assessing for the complication of malignant hyperthermia? a. "Do you think you might have a fever?" b. "Do you currently have an infection?" c. "Has anyone in your family ever had problems with general anesthesia?" d. "Have you ever had any type of malignancy?"

ANS: C Malignant hyperthermia is a life-threatening complication that occurs in response to certain drugs. Susceptibility to this response is inherited. DIF: Cognitive Level: Application REF: p. 268 OBJ: 7 TOP: General Anesthesia KEY: Nursing Process Step: Assessment

Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.

ANS: C Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease although surgery may be used DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

23. A patient scheduled for a bronchoscopy is placed on an NPO status after midnight before the procedure. The patient is complaining of being thirsty and requests some water on the morning of the procedure. What action should the nurse implement? a. Deny any oral fluid per order. b. Allow 8 oz of tap water. c. Offer limited ice chips. d. Administer only carbonated drinks.

ANS: C Patients are given nothing by mouth from midnight before the scheduled procedure to reduce the risk of vomiting and aspiration during or after the procedure. Recent practice allows small amounts of fluid or ice chips during the day of surgery. DIF: Cognitive Level: Application REF: p. 262 OBJ: 3 TOP: Preparation for Surgery KEY: Nursing Process Step: Implementation

A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

ANS: C Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency DIF: Cognitive Level: Understand (comprehension) REF: 1175 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider? a. Patient's blood pressure is 148/94 mm Hg. b. Patient has bilateral 2+ pitting ankle edema. c. Patient stopped taking the medication 2 days ago. d. Patient has not been taking the prescribed vitamin D.

ANS: C Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment DIF: Cognitive Level: Analyze (analysis) REF: 1176 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a. The blood glucose is 176 mg/dL. b. The lungs have bibasilar crackles. c. The blood pressure (BP) is 88/50 mm Hg. d. The patient reports 5/10 incisional pain.

ANS: C The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy. DIF: Cognitive Level: Analyze (analysis) REF: 1176 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

14. When obtaining a patient's signature on the surgical consent form, the patient seems confused about the procedure to be performed. What is the most appropriate response by the nurse? a. Tell the patient to talk to the physician after he or she gets to the surgical department. b. Ask the patient to go ahead and sign the consent. c. Ask the patient what the physician told him and then call the physician if necessary. d. Encourage the patient to ask his family what the physician told them.

ANS: C The patient may not understand some of the medical terms used by the physician, and the nurse may be able to explain them. If the patient needs further information, notify the physician. The physician is responsible for explaining the procedure and the risks to the patient. DIF: Cognitive Level: Application REF: p. 260 OBJ: 3 TOP: Consent Form KEY: Nursing Process Step: Implementation

12. The suprapubic area of a postoperative patient is distended. The patient states that he has not voided since surgery approximately 9 hours ago. What should be the nurse's first action? a. Notify the head nurse or physician. b. Insert a catheter and document insertion. c. Seat the patient on the side of the bed to try to void. d. Prepare the patient to return to surgery.

ANS: C The patient should be encouraged to try to void in a natural position before other measures are taken. Seated on the bedside or on a bedside commode may make urination easier. DIF: Cognitive Level: Application REF: p. 283 OBJ: 9 TOP: Postoperative Urinary Retention KEY: Nursing Process Step: Implementation

After obtaining the information shown in the accompanying figure regarding a patient with Addison's disease, which prescribed action will the nurse take first? Assessment * Complains of fatigue * Bronze colored skin * Poor skin turgor Vital Signs * BP 76/40 mm Hg * Heart rate 126 b/m * RR 24 * SpO2 94% Lab Data * Sodium 1123 mEq/L * Potassium 5.1 mEq/L * Glucose 62 mg/dL a. Give 4 oz of fruit juice orally. b. Recheck the blood glucose level. c. Infuse 5% dextrose and 0.9% saline. d. Administer O2 therapy as needed.

ANS: C The patient's poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may also be needed but are not the initial action for the patient. DIF: Cognitive Level: Analyze (analysis) REF: 1179 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first? a. Administer the ordered muscle relaxant. b. Give the ordered oral calcium supplement. c. Have the patient rebreathe from a paper bag. d. Start the PRN oxygen at 2 L/min per cannula.

ANS: C The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg

ANS: C The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications DIF: Cognitive Level: Analyze (analysis) REF: 1165 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

25. A postanesthesia care nurse is evaluating a patient for possible transfer to the surgical unit. Which assessment should prevent the patient's transfer? a. Blood pressure of 126/78 mm Hg b. Pulse rate of 82 beats/min c. Pulse oximeter reading of 85% d. Respirations of 22 breaths/min

ANS: C The pulse oximeter reading should be 95% to 100%. The patient should not be transferred from the recovery room until the vital signs are stable, respiratory and circulatory functions are adequate, pain is minimal, the patient is easily awakened, no complications have been experienced, and the gag reflex is present. DIF: Cognitive Level: Analysis REF: p. 281 OBJ: 8 TOP: Postoperative Assessment KEY: Nursing Process Step: Assessment

13. Which modification should the nurse implement when caring for a postoperative patient after cataract surgery? a. Early ambulation is not necessary. b. Remove the dressing immediately. c. Omit instructions relative to coughing. d. Omit use of an incentive spirometer for deep breathing.

ANS: C There are only a few instances in which coughing is contraindicated. They include surgeries for hernias, cataracts, and brain surgery. DIF: Cognitive Level: Application REF: p. 282 OBJ: 7 TOP: Postoperative Complications KEY: Nursing Process Step: Planning

A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.

ANS: C There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed DIF: Cognitive Level: Apply (application) REF: 1166 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. avoid brushing teeth for at least 10 days after the surgery. d. be positioned flat with sandbags at the head postoperatively.

ANS: C To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches DIF: Cognitive Level: Apply (application) REF: 1159 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

7. During a nurse's preoperative assessment, the nurse notices that a patient is extremely anxious. The patient's blood pressure is 142/92 mm Hg, the heart rate is 104 beats/min, and respirations are 32 breaths/min. What nursing action should be implemented? a. Give the preoperative medicine early to help calm the patient. b. Call the surgical department and cancel the surgery. c. Notify the anesthesiologist or surgeon. d. Instruct the patient on possible postoperative complications.

ANS: C When significant fear is associated with surgical complications, sometimes surgery is postponed until the anxiety level is reduced. DIF: Cognitive Level: Analysis REF: p. 259 OBJ: 3 TOP: Preoperative Anxiety KEY: Nursing Process Step: Planning

An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).

ANS: C Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)? a. The patient has a recent weight gain of 9 lb. b. The patient complains of dyspnea with activity. c. The patient has a urine specific gravity of 1.025. d. The patient has a serum sodium level of 118 mEq/L.

ANS: D A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action DIF: Cognitive Level: Analyze (analysis) REF: 1160 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Titrate the infusion of 5% dextrose in water. b. Teach the patient how to use desmopressin (DDAVP) nasal spray. c. Assess the patient's hydration status every 8 hours. d. Administer subcutaneous DDAVP.

ANS: D Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN. DIF: Cognitive Level: Apply (application) REF: 1161 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

11. A nurse should include the proper use of an incentive spirometer in teaching a preoperative patient. What postoperative assessment of this patient would reveal that the incentive spirometry teaching has been effective? a. Adventitious breath sounds b. Expiratory wheezing c. Thick, green respiratory secretions d. Clear breath sounds

ANS: D An incentive spirometer is used to promote lung expansion, which opens airways, reduces atelectasis, and stimulates coughing to clear secretions. DIF: Cognitive Level: Comprehension REF: p. 281 OBJ: 8 TOP: Impaired Gas Exchange KEY: Nursing Process Step: Evaluation

6. What should a nurse ensure that a postoperative patient implement to best prevent deep vein thrombosis (DVT)? a. Splint the incision. b. Cough and deep breathe every 2 hours. c. Regularly remove antiembolism stockings. d. Ambulate frequently.

ANS: D DVT is best prevented by early and frequent ambulation of the patient. DIF: Cognitive Level: Application REF: p. 272 OBJ: 7 TOP: Postoperative Complications KEY: Nursing Process Step: Planning

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting

ANS: D Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications DIF: Cognitive Level: Analyze (analysis) REF: 1157 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

1. A postoperative patient is complaining of incisional pain. An order has been given for morphine every 4 to 6 hours as needed (PRN). What should the nurse assess first? a. Assess for the presence of bowel sounds. b. Assess pupillary reaction. c. Ask the patient's family if she is having pain. d. Determine when the patient last received pain medication.

ANS: D Verifying the time of the last dose decreases the risk of a dose of medication being given too soon. DIF: Cognitive Level: Application REF: p. 277 OBJ: 9 TOP: Acute Pain KEY: Nursing Process Step: Assessment

18. Which member of the surgical team administers anesthetics and monitors the patient's status throughout the procedure? a. Surgeon b. Circulating nurse c. Perfusionist d. Anesthesiologist

ANS: D The anesthesiologist and nurse anesthetist have special training and are the members of the surgical team that administer anesthesia and are responsible for closely monitoring the patient during surgery. DIF: Cognitive Level: Knowledge REF: p. 267 OBJ: 5 TOP: Surgical Team KEY: Nursing Process Step: N/A

20. A patient who has just undergone a colon resection complains to a nurse that he felt something pop under his dressing while trying to get out of bed. The nurse removes the dressing and finds that dehiscence of the wound has occurred. What nursing action should be implemented first? a. Replace the dressing; dehiscence is normal. b. Call the physician. c. Pull the wound edges together and replace the dressing. d. Cover the wound with sterile dressings saturated with normal saline.

ANS: D The first action of the nurse should be to cover the wound with saline-saturated dressings to prevent damage of the exposed organs from drying and then to call the physician. DIF: Cognitive Level: Application REF: p. 271 OBJ: 9 TOP: Wound Dehiscence KEY: Nursing Process Step: Implementation

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

ANS: D The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices DIF: Cognitive Level: Apply (application) REF: 1177 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. A nurse has completed giving discharge instructions to a patient after a hernia repair. What verbalization by the patient should lead the nurse to determine that the patient understands the instructions? a. Go back to work tomorrow. b. Do not change the dressing until he sees his physician in 2 weeks. c. Ignore changes in the size of his abdomen. d. Report fever, redness, swelling, or increased pain at the incision site.

ANS: D The patient should report any signs and symptoms of infection (e.g., fever, redness, swelling, pain). DIF: Cognitive Level: Comprehension REF: p. 284 OBJ: 10 TOP: Discharge Planning KEY: Nursing Process Step: Evaluation

Which of the following is the primary hormone for the long-term regulation of sodium balance? a) Aldosterone b) Thyroxin c) Calcitonin d) Antidiuretic hormone (ADH)

Aldosterone

C Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected DIF: Cognitive Level: Apply (application) REF: 1161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is a. excess fluid volume related to intake greater than output. b. impaired gas exchange related to fluid retention in lungs. c. sleep pattern disturbance related to frequent waking to void. d. risk for impaired skin integrity related to generalized edema.

What is the priority nursing intervention for an older female patient with a history of hyperparathyroidism? a.Implement fall precautions. b.Encourage oral fluid hydration. c.Encourage small frequent meals. d.Provide pain medications as prescribed.

Answer: A Rationale: Manifestations of hyperparathyroidism may present as bone lesions, pathologic fractures, bone cysts, and osteoporosis. Preventing falls is a priority nursing intervention. Fluid hydration may be used to treat hypercalcemia. Small frequent meals can assist with nutritional need.

When developing a postoperative plan of care for a patient after a total thyroidectomy, the nurse knows the plan should include which intervention? a.Avoiding extending the patient's neck b.Assessing the patient's voice once per shift c.Encouraging the patient to be out of bed in a chair d.Administering oxygen via nasal cannula as needed

Answer: A Rationale: The nurse should avoid extending the patient's neck to decrease tension on the suture line. The air in the patient's room should be humidified to promote easier respirations and thin respiratory secretions. The patient's voice should be assessed for changes every 2 hours. Sandbags or pillows should be used to support the patient's head or neck, and the patient should be placed in a semi-Fowler's position.

The patient is preparing to go home. What important teaching points should the nurse include in discharge teaching? (Select all that apply.) a. "Your diet should be low-fiber, but with plenty of fluids." b."Note how many hours you sleep in a 24-hr period." c."Report any difficulty with orientation to time, place, or person." d."Be sure that you take your medication every day at the same time." e."Call the provider if you develop an unsteady gait or tremors in your hands."

Answer: B, C, D, E The patient's diet should include fiber to prevent constipation. If the patient is constipated, the dose of replacement thyroid hormone may need to be increased. Sleep should be monitored because when the patient has difficulty getting to sleep, the dose may need to be decreased. Changes in orientation, gait, or development of tremors may require an alteration in dose of replacement thyroid hormone. Medication should be taken at the same time daily.

The provider orders laboratory work that includes thyroid function tests. Which results does the nurse expect to see? a. Normal T3 and T4 levels b. Decreased TSH level c. Increased T3 and T4 levels d. Decreased T3 and T4 levels

Answer: D Laboratory findings for hypothyroidism include decreased T3 and T4 levels and increased thyroid-stimulating hormone (TSH) levels with primary hypothyroidism. With secondary hypothyroidism, the TSH level can be close to normal.

Which patient statement indicates that further nursing teaching is needed about hypothyroidism? a. "When I go home I should check my heart rate and BP every day." b."I will be sure to include fiber in my diet and drink plenty of water." c."I will call my provider if I notice any change in level of consciousness." d."When I am feeling better in a few months, I will no longer need to take the Synthroid pills."

Answer: D The most important educational need for the patient with hypothyroidism is about hormone replacement therapy and its side effects. The need to take these drugs is life-long.

Which of the following are the priority precautions the nurse will teach the client who remains at continuing risk for adrenal hypofunction and is taking hormone replacement therapy to prevent harm related to the disorder? Select all that apply. A. Avoid crowds and people who are ill B. Check your heart rate for irregular or skipped beats twice daily C. Do not choose low sodium versions of prepared foods D. Get up slowly from sitting or lying positions E. Keep a source of glucose, such as candy, with you at all times F. Never skip your hormone replacement drugs

Answers: A, B, C, D, E, F All precautions are a priority. The hormone replacement therapy reduces inflammation and Immunity, increasing the risk for infection. A pathologic problem with adrenal hypofunction and reduced aldosterone is increased serum potassium levels that cause cardiac dysrhythmias. Adrenal hypofunction causes low sodium levels, and the client needs to ensure an adequate intake of this mineral. The disorder is associated with hypotension and postural hypotension. Another common problem is hypoglycemia. The client should always have a concentrated oral glucose source on hand and eat it whenever symptoms of hypoglycemia are present. Skipping hormone replacement therapy increases the likelihood that serious and potentially life-threatening complications can occur quickly. Blood hormone levels need to be relatively constant.

Which client is at greatest risk for slow wound healing? A. 12-year-old healthy girl B. 47-year-old obese man with diabetes C. 48-year-old woman who smokes D. 98-year-old healthy man

B. 47-year-old obese man with diabetes Correct: Diabetes and obesity significantly contribute to slow wound healing. Incorrect: A. 12-year-old healthy girl: This client is not at highest risk. C. 48-year-old woman who smokes: This client is not at highest risk. D. 98-year-old healthy man: This client is not at highest risk.

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? A. "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." B. "I will keep the cat food bowl on my counter so that I do not have to bend over." C. "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." D. "If the dressing gets wet, I will wash the incision line and redress it immediately."

B. "I will keep the cat food bowl on my counter so that I do not have to bend over." Rationale: After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat. Wearing dark glasses while outside is not necessary to prevent complications from the surgery.

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? A. "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." C. "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." D. "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."

B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." Rationale: One of the most frequent 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 ACTH and adrenal production of cortisol. None of the other statements are completely accurate.

A CBC, urinalysis, and x-ray examination of the chest are ordered for a client before surgery. The client asks why these tests are done. Which is the best reply by the nurse? A. "Don't worry; these tests are routine." B. "They are done to identify other health risks." C. "They determine whether surgery will be safe." D. "I don't know; your health care provider ordered them."

B. "They are done to identify other health risks."

The preoperative patient tells the nurse that she is afraid that she may experience a reaction if she must receive blood during or after her surgery. What is the nurse's best response to the patient's concern? A. "The likelihood that you will need a blood transfusion for your surgery is minimal, so do not worry about this." B. "You could donate some of your own blood (autologous donation) a few weeks before your surgery." C. "With today's technology and procedures, it is very unlikely that you would have a reaction to donated blood." D. "The nursing staff follows strict procedures to prevent such an event from ever happening."

B. "You could donate some of your own blood (autologous donation) a few weeks before your surgery."

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? A. "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." C. "I will tell your primary health care provider order a psychiatric consult for you." D. "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"

B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." Rationale: Changes in blood cortisol levels can cause the client to show neurotic or psychotic behaviors. The client's need to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and more steady blood cortisol levels. Drug therapy to reduce these feelings and behaviors may be appropriate.

While receiving a preoperative enema, a client starts to cry and says "I'm sorry you ave to do this messy thing for me." What is the nurse's best response? A. "I don't mind it." B. "You seem upset." C. "This is part of my job." D. "Nurses get used to this."

B. "You seem upset."

For which client will the nurse question the prescription for long-term androgen therapy? A. A 40 year old who also has syndrome of inappropriate antidiuretic hormone (SIADH). B. A 52 year old with a history of prostate cancer treatment. C. A 30 year old who is taking antiviral therapy for HIV disease. D. A 66 year old with impotence that is resistant to standard erectile dysfunction therapy.

B. A 52 year old with a history of prostate cancer treatment. Rationale: Androgen therapy can make any residual prostate cancer cells proliferate and cause a recurrence of the disease.

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? A. Prolactin and prolactin inhibiting hormone (PIH) B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) C. Growth hormone (GH) and melanocyte-stimulating hormone (MSH) D. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) Rationale: Deficiencies of (ACTH) or TSH are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.

Which instruction/precaution does the nurse teach a client to prevent harm during a 24-hour urine specimen collection? A. Be sure to keep the specimen cool for the entire collection period B. Avoid splashing urine in the container when a preservative is present C. Add the preservative to the collection container before adding any urine D. Discard the first specimen that marks the beginning of the 24 hour test period

B. Avoid splashing urine in the container when a preservative is present

Which instruction/precaution does the nurse teach a client to prevent harm during a 24-hour urine specimen collection? A. Be sure to keep the specimen cool for the entire collection period. B. Avoid splashing urine in the container when a preservative is present. C. Add the preservative to the collection container before adding any urine. D. Discard the first specimen that marks the beginning of the 24-hour test period.

B. Avoid splashing urine in the container when a preservative is present. Rationale: All instructions/precautions are needed for correct collection of a 24-hour urine collection. The only precaution that will prevent harm is the one for avoiding the splashing of any urine in the container with the preservative.

During the preoperative period, a patient receives surgery on the wrong extremity. To which agency must this occurrence be reported? A. Association of periOperative Registered Nurses (AORN) B. Centers for Medicare and Medicaid Services (CMS) C. The Joint Commission (TJC) D. American Society of Anesthesiologists (ASA)

B. Centers for Medicare and Medicaid Services (CMS)

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? A. Urine output for the past 24 hours has increased. B. Client reports numbness and tingling around the mouth. C. Temperature is now elevated. D. pH is now 7.43.

B. Client reports numbness and tingling around the mouth. Rationale: Hyperaldosteronism causes potassium to be excreted excessively. As hypokalemia becomes more severe, paresthesias occur with numbness and tingling around the mouth and of the fingers and toes.

As the nurse obtains informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contact the anesthesiologist. B. Contact the surgeon. C. Explain the procedure. D. Have the client sign the form.

B. Contact the surgeon.

As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contacts the anesthesiologist B. Contacts the surgeon C. Explains the procedure D. Has the client sign the form

B. Contacts the surgeon Correct: The nurse is not responsible for providing detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been presented by the physician and to dispel myths that the client or family may have about the surgical experience. Incorrect: A. Contacts the anesthesiologis: The anesthesiologist is responsible for the anesthesia, not the surgical details. C. Explains the procedur: The nurse is not responsible for providing detailed information about the surgical procedure. D. Has the client sign the form: Although the nurse is only witnessing the signature, it is the nurse's role to ensure that the facts are clarified.

Which action does the nurse implement for the client with wound evisceration? A. Applies direct pressure to the wound B. Covers the wound with a sterile, warm, moist dressing C. Irrigates the wound with warm, sterile saline D. Replaces tissue protruding into the opening

B. Covers the wound with a sterile, warm, moist dressing Correct: Covering the wound with a sterile, warm, moist dressing protects the organs until the surgeon can repair the wound. Incorrect: A. Applies direct pressure to the wound: Applying direct pressure to a wound traumatizes the organs. C. Irrigates the wound with warm, sterile saline: Irrigating the wound is not necessary. D. Replaces tissue protruding into the opening: Replacing protruding tissue could induce infection.

An RN and an LPN/LVN are working together in caring for a client who needs all of the following actions after orthopedic surgery. Which actions would be best for the RN to accomplish? A. Reinforce the need to cough and deep breathe every 2 to 4 hours. B. Develop the discharge teaching plan in conjunction with the client. C. Administer narcotic pain medications before assisting the client with ambulation. D. Listen for bowel sounds, and monitor the abdomen for distention and pain.

B. Develop the discharge teaching plan in conjunction with the client. Correct: Education and preparation for discharge are within the scope of practice of the RN. Incorrect: A. Reinforce the need to cough and deep breathe every 2 to 4 hours: This is in the scope of the LVN/LPN nurse. C. Administer narcotic pain medications before assisting the client with ambulation: LPN/LVNs can administer pain medications. D. Listen for bowel sounds, and monitor the abdomen for distention and pain: Monitoring of the client is within the scope of the LVN/LPN and can be delegated.

A 75-year-old patient is having an exploratory laparotomy tomorrow. The wife tells the nurse that at night the patient gets up and walks around his room. What priority action does the nurse take after hearing this information? A. Notify the provider B. Develops a plan to keep the patient safe C. Obtains an order for sleep medication D. Tells the patient not to get out of bed at night

B. Develops a plan to keep the patient safe

The client has undergone an 8-hour surgical procedure under general anesthesia. In assessing the client for complications related to positioning, the nurse is most concerned with which finding? A. Decreased sensation in the lower extremities B. Diminished peripheral pulses in the lower extremities C. Pale, cool extremities D. Reddened areas over bony prominences

B. Diminished peripheral pulses in the lower extremities Correct: Diminished peripheral pulses in the lower extremities indicate diminished blood flow. Incorrect: A. Decreased sensation in the lower extremities: Decreased sensation can be a normal occurrence in clients who have undergone a long surgical procedure. C. Pale, cool extremities: Pale, cool extremities can be a normal finding for clients who have undergone a long surgical procedure. D. Reddened areas over bony prominences: Reddened areas over bony prominences can be a normal occurrence for clients who have undergone a long surgical procedure.

A patient with an abdominal aortic aneurysm is having surgical repair. What is the correct classification for this surgery? A. Restorative B. Emergent C. Urgent D. Minor

B. Emergent

The client who is preparing to undergo a vaginal hysterectomy is concerned about being exposed. How does the nurse ensure that this client's privacy will be maintained? A. Tells the client that she will be asleep B. Ensures that drapes will minimize perianal exposure C. Explains postoperative expectations D. Restricts the number of technicians in the procedure

B. Ensures that drapes will minimize perianal exposure Correct: Using drapes is the best action to take. A Tells the client that she will be asleep Incorrect: Telling the client that she will be asleep is not therapeutic. Incorrect: A. Tells the client that she will be asleep: Telling the client that she will be asleep is not therapeutic. C. Explains postoperative expectations: Explaining the procedure will not help with the client's concerns about modesty. D. Restricts the number of technicians in the procedure: The number of people involved in the procedure is not something the nurse can necessarily control.

What information about the postoperative client does the nurse include in the report to the postanesthesia care unit (PACU) nurse? A. Confirmation of informed consent B. Estimated blood loss C. Type of surgical instruments used D. Type of suture material used

B. Estimated blood loss Correct: Estimated blood loss is important to know, so that the client can be properly monitored. Incorrect: A. Confirmation of informed consent: Informed consent is taken care of before surgery. C. Type of surgical instruments used: It is not necessary for the PACU nurse to know what types of surgical instruments were used, unless they were out of the ordinary. D. Type of suture material used: It is not necessary for the PACU nurse to know what types of suture materials were used.

Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months? A. Random blood glucose level B. Glycosylated hemoglobin (HbA1c) C. Fasting blood insulin level D. Fasting blood glucose level

B. Glycosylated Hemoglobin (HbA1c) Rationale: The glycosylated hemoglobin (HbA1c) evaluates the average blood glucose level for 2 to 3 months; this is the best indicator of overall blood glucose control.

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? A. Decreased sodium; decreased glucose B. Increased sodium; increased glucose C. Increased sodium; decreased glucose D. Decreased sodium; increased glucose

B. Increased sodium; increased glucose Rationale: Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.

Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter. B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy.

B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer.

Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter. B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy.

B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. Correct: Insertion of a catheter is within the scope of skills approved for the LPN/LVN. Incorrect: A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter: Preoperative teaching is under the scope of the RN. C. Obtain the medical history from a client who is scheduled for a total hip replacement: History information would be completed by the RN on the unit. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy: Physical assessment of a preoperative client is within the scope of the RN.

Which statement best describes the preoperative period? SATA A. It begins when the patient makes the appointment with the surgeon to discuss the need for surgery B. It ends at the time of transfer to the surgical suite C. It is a time during which the patient's need for surgery is established D. It begins when the patient is scheduled for surgery E. It is a time during which the patient receives testing and education related to impending surgery F. It is a time when patients families receive discharge instructions

B. It ends at the time of transfer to the surgical suite D. It begins when the patient is scheduled for surgery E. It is a time during which the patient receives testing and education related to impending surgery

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? A. High carbohydrate, low potassium, and fluid restriction B. Low carbohydrate, high calorie, and low sodium C. Low protein, high carbohydrate, and low calcium D. High protein, high carbohydrate, and low potassium

B. Low carbohydrate, high calorie, and low sodium Rationale: The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to moderately restrict sodium intake.

The patient is scheduled for same-day surgery for an uncomplicated cholecystectomy. Which surgical approach will most likely be used? A. Simple B. Minimally invasive C. Open D. Radical

B. Minimally invasive

Facial edema that is associated with long-term untreated hypothyroidism is called __________. a. cretinism b. myxedema c. tetany d. thyroiditis

B. myxedema

The nurse assesses the client's wound 24 hours postoperatively. Which finding causes the nurse the greatest concern? A. Crusting along the incision line B. Redness and swelling around the incision C. Sanguineous drainage at the suture site D. Serosanguineous drainage on the dressing

B. Redness and swelling around the incision Correct: Redness and swelling around the incision indicate an infection. Incorrect: A. Crusting along the incision line: Crusting along the incision line is normal. C. Sanguineous drainage at the suture site: Sanguineous drainage at the suture site is normal. D. Serosanguineous drainage on the dressing: Serosanguineous drainage on the dressing is normal.

A patient who can barely ambulate with a walker at home is having a left total knee replacement. What is the most appropriate category for this surgery? A. Urgent B. Restorative C. Simple D. Palliative

B. Restorative

Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocotisone that the client is responding positively to this drug therapy? A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L) B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L) C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L) D. Serum sodium 119 mEq/L ((mmol/L); serum potassium 6.2 mEq/L (mmol/L)

B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L) Rationale: With adrenal hypofunction reduced levels of cortisol and aldosterone decrease serum sodium levels below normal (hyponatremia) and increase serum potassium levels above normal (hyperkalemia). Adequate drug therapy with hormone replacement is expected to return these electrolytes back to their normal ranges (sodium = 135-145 mEq/L [mmol/L]; potassium = 3.5-5.0 mEq/L [mmol/L]). Response A indicates hypernatremia and hyperkalemia. Response C indicates hyponatremia and hypokalemia. Response D indicates severe hyponatremia and hyperkalemia.

Which assessment finding in a 40 year old client is most relevant for the nurse to assess further for a possible endocrine problem? A. He has lost 10 lb in the past month following a low-carbohydrate eating plan B. The client reports now needing to shave only once weekly instead of daily C. His new prescription for eyeglasses is for a higher strength D. The client's father died of a stroke at age 70

B. The client reports now needing to shave only once weekly instead of daily

Which assessment finding in a 40-year-old client is most relevant for the nurse to assess further for a possible endocrine problem? A. He has lost 10 lbs in the past month following a low carbohydrate eating plan. B. The client reports now only needed to shave once weekly instead of daily. C. His new prescription for eye glasses is for a higher strength. D. The client's father died of a stroke at age 70 years.

B. The client reports now only needing to shave once weekly instead of daily. Rationale: A change in degree of facial hair is could indicate an endocrine problem, particularly of the pathway for testicular function. An intentional weight loss of 10 lb over a month's time is within the normal range for gender and age. Although the need for a stronger prescription for eye glasses at this age could potentially be related to an endocrine problem, many other factors are more likely to be related to this problem. The same is true of his father's stroke.

Which assessment data finding for a client scheduled for total knee replacement surgery is most important for the nurse to communicate to the surgeon and the anesthesia provider before the procedure? SATA A. The oxygen saturation is 97%. B. The serum potassium level is 3.0 mEq/L (3.0 mmol/L) C. The client took a total of 1300 mg of aspirin yesterday. D. The client requests to talk with a registered dietitian about weight loss. E. The client took a regularly scheduled antihypertensive drug with a sip of water 2 hours ago. F. After receiving the preoperative medications, the client tells the nurses that he lied on the assessment form and that he really is a current smoker.

B. The serum potassium level is 3.0 mEq/L (3.0 mmol/L) C. The client took a total of 1300 mg of aspirin yesterday. F. After receiving the preoperative medications, the client tells the nurses that he lied on the assessment form and that he really is a current smoker.

The nurse is preparing the patient for surgery. Which common laboratory tests does the nurse anticipate being ordered? SATA A. Total cholesterol B. Urinalysis C. Electrolyte levels D. Uric acid E. Clotting studies F. Serum creatinine

B. Urinalysis C. Electrolyte levels E. Clotting studies F. Serum creatinine

A male patient is having revision of a scar on his forehead from a third-degree burn. What is the correct classification for this surgery? A. Major B. Restorative C. Cosmetic D. Curative

C. Cosmetic

What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."? A. "Don't worry. It happens to everyone occasionally." B. "Do you use any over the counter or recreational drugs?" C. "Can you please tell me more?" D. "Would you like to speak with a counselor?"

C. "Can you please tell me more?" Rationale: An open-ended question such as, "Can you please tell me more?," is a best first response because it allows the nurse to explore the client's feelings more thoroughly. Clients with endocrine disorders may report issues with infertility, impotence, and changes in sexual function.

Which precaution is most important for the nurse to teach a female client to prevent harm while undergoing drug therapy with estrogen and progesterone for hypopituitarism? A. "Use a barrier method of contraception to prevent an unplanned pregnancy." B. "Wear a hat with a brim and use sunscreen when outdoors." C. "Do not smoke or use nicotine in any form." D. "Avoid drinking caffeinated beverages."

C. "Do not smoke or use nicotine in any form." Both estrogen therapy and progesterone therapy increase the risk for thromboembolism formation. This condition greatly increases the chance for strokes, heart attacks, and pulmonary embolism. Cigarette smoking and other forms of nicotine increase this risk. Pregnancy is unlikely to occur without further medical intervention. These hormones do not increase photosensitivity or the general risk for harm from ultraviolet radiation exposure. There are no recommendations for avoiding caffeine while taking these drugs.

During a preoperative assessment, which statement by a client requires further investigation by the nurse to assess surgical risks? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I quit smoking 10 years ago."

C. "I had a heart attack 4 months ago."

During a preoperative assessment, which statement by the client requires further investigation by the nurse to assess risk? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I don't like latex balloons."

C. "I had a heart attack 4 months ago." Correct: Cardiac problems increase surgical risks. The risk for a myocardial infarction (MI) during surgery is higher in clients who have heart problems. Incorrect: A. "I am taking vitamins.": The type of vitamins should be assessed, but this is not the highest risk. B. "I drink a glass of wine a night." Incorrect: Moderate alcohol consumption is not considered high-risk behavior. D. "I don't like latex balloons.": A dislike for latex is not the same as a latex allergy. However, it might be a good idea to ask why the client doesn't like latex balloons.

The nurse is instructing a client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "It's better if they are too tight rather than too loose." D. "These stockings help promote blood flow."

C. "It's better if they are too tight rather than too loose."

The nurse is instructing the client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "These stockings will prevent blood clots." D. "These stockings help promote blood flow."

C. "These stockings will prevent blood clots." Correct: Antiembolism stockings alone will not prevent deep venous thrombosis (DVT). However, along with exercise, they will help promote venous return, which aids in preventing DVT. Incorrect: A. "I will take off my stockings one to three times a day for 30 minutes.": Frequent removal of the stockings is appropriate to allow for hygiene and a break from their wear. B. "My stockings are too loose.": Stockings should be neither too loose (ineffective) nor too tight (inhibit blood flow). D. "These stockings help promote blood flow.": Antiembolism stockings may be used during and after surgery to promote venous return.

The client is having an arthroscopy of the left knee and has just been moved to the surgical holding area. Which statement by the nurse properly identifies the client while the nurse checks the identification label? A. "Are you Mr. Smith?" B. "Good morning, Mr. Smith." C. "What is your name, and where were you born?" D. "What surgery are you having today?"

C. "What is your name, and where were you born?" Correct: The nurse must verify the client's identity with two types of identifiers. This practice prevents errors by drowsy or confused clients. Incorrect: A. "Are you Mr. Smith?": The client may respond inappropriately if he is anxious or sedated. B. "Good morning, Mr. Smith." Incorrect: The client may respond inappropriately if he is anxious or sedated. D. "What surgery are you having today?": Asking the client about his or her surgery does help with identification. However, it is really done to ascertain that the client's perception of the procedure, the operative permit, and the operative schedule are the same.

A client was originally scheduled for surgery at noon. The surgeon is delayed, and the surgery has been rescheduled for 3:00 p.m. How will the nurse plan to administer the preoperative prophylactic antibiotic? A. Give at noon as originally prescribed. B. Cancel orders, preoperative prophylactic antibiotics are given optionally. C. Adjust the administration time to be given within 1 hour before surgery. D. Hold the preoperative antibiotic so it can be administered immediately following surgery.

C. Adjust the administration time to be given within 1 hour before surgery.

Which of these RNs who have been floated to the postanesthesia care unit (PACU) for the day should the charge nurse assign to care for an 18-year-old diabetic client who has just arrived from the operating room (OR) after having laparoscopic abdominal surgery? A. An RN who usually works on the inpatient pediatric unit B. An RN who provides education to diabetic clients in a clinic C. An RN who has 5 years of experience in the delivery room D. An RN who ordinarily works as a scrub nurse in the OR

C. An RN who has 5 years of experience in the delivery room Correct: This RN would have experience with abdominal surgery and with postoperative care of clients with diabetes and would be aware of possible postoperative complications for this client. Incorrect: A. An RN who usually works on the inpatient pediatric unit: This RN would not be aware of potential complications and routine assessments for this client. B. An RN who provides education to diabetic clients in a clinic: This RN would be able to provide required care for the client's diabetes but not the postoperative aspect of care. D. An RN who ordinarily works as a scrub nurse in the OR: This RN would not have knowledge and understanding of routine postoperative care for this client.

Which drug may the surgeon allow the patient to take prior to surgery? A. Daily vitamin B. Stool softener C. Anti-seizure drug D. Daily baby aspirin

C. Anti-seizure drug

A preoperative patient is scheduled for surgery at 7:30 a.m. At 0600, the patient's vitals are BP 90/60, HR 110 and irregular, respirations 22/minute, and oral temperature 100.9F. The patient's oxygen saturation is 92% and he has a productive cough. What is the nurse's priority action at this time? A. Administer acetaminophen (Tylenol) with just a sip of water B. recheck the vital signs at 0700 C. Call and notify the surgeon immediately D. Have the patient cough and take some deep breaths

C. Call and notify the surgeon immediately

The preoperative client wears a hearing aid and is extremely hard of hearing without it. What does the nurse do to help reduce this client's anxiety? A. Actively listens to this client's concerns B. Allows the client to wear the hearing aid to surgery C. Checks to see whether the operating room (OR) staff minds if the client wears the hearing aid until anesthesia is given D. Apologizes to the client and explains that it is hospital policy to remove a hearing aid before surgery

C. Checks to see whether the operating room (OR) staff minds if the client wears the hearing aid until anesthesia is given Correct: In some facilities, clients may wear eyeglasses and hearing aids until after anesthesia induction. Incorrect: A. Actively listens to this client's concerns: Listening isn't always enough. More intervention is needed. B. Allows the client to wear the hearing aid to surgery: The OR staff may have a different policy, or the hearing aid may get lost. D. Apologizes to the client and explains that it is hospital policy to remove a hearing aid before surgery: Telling the client that a policy precludes the client's needs is not therapeutic.

The provider orders laboratory work that includes thyroid function tests. Which results does the nurse expect to see? A. Increased T3 and T4 levels B. Decreased TSH level C. Decreased T3 and T4 levels D. Normal T3 and T4 levels

C. Decreased T3 and T4 levels Laboratory findings for hypothyroidism include decreased T3 and T4 levels, and increased TSH levels with primary hypothyroidism. With secondary hypothyroidism, the TSH level can be close to normal.

The nurse completes the preoperative checklist on a client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A. Age 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds (4.5 kg) over the client's ideal body weight

C. Diet-controlled diabetes mellitus

The nurse completes the preoperative checklist on the client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A. Age of 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds over the client's ideal body weight

C. Diet-controlled diabetes mellitus Correct: Diabetes contributes an increased risk for surgery. Incorrect: A. Age of 59 years: Older adults are at greater risk for surgical procedures. This client is not classified as an older adult. B. General anesthesia complications experienced by the client's brother: Family medical history and problems with anesthetics may indicate possible reactions to anesthesia, but this is not the best answer. D. Ten pounds over the client's ideal body weight: Obesity increases the risk for poor wound healing, but being 10 pounds overweight does not categorize this client as obese.

A 76-year-old patient is having bilateral cataract removal. What is the correct classification for this surgery? A. Major B. Cosmetic C. Elective D. Emergent

C. Elective

At 8:00 a.m., the registered nurse is admitting a client scheduled for sinus surgery to the outpatient surgery department. Which information given by the client is of most immediate concern to the nurse? A. An allergy to iodine and shellfish B. Being nauseated after a previous surgery C. Having a small glass of juice at 7:00 a.m. D. Expressing anxiety about the surgery

C. Having a small glass of juice at 7:00 a.m.

The surgical client has signed do-not-resuscitate (DNR) orders before going to the operating room (OR). A complication requiring resuscitation happens during surgery. What is the nurse's proper action? A. Call the legal department. B. Call the client's medical physician. C. Honor the DNR order. D. Resuscitate per OR procedure.

C. Honor the DNR order. Correct: According to the Association of Perioperative Registered Nurses, suspending a DNR order during surgery violates a client's right to self-determination. A. Call the legal department: Calling the legal department is not an appropriate response. B. Call the client's medical physician: Calling the client's physician is not an appropriate response. D. Resuscitate per OR procedure: Resuscitating this client is illegal.

Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone? (Select all that apply.) A. Hypoglycemia B. Hyponatremia C. Hypokalemia D. Hypernatremia E. Hyperglycemia F. Hyperkalemia

C. Hypokalemia D. Hypernatremia Rationale: Aldosterone is the mineralocorticoid that maintains extracellular fluid volume and electrolyte composition. It promotes sodium and water reabsorption and potassium excretion in the kidney. Excessive amounts of this hormone result in hypernatremia and hypokalemia.

The nurse anesthetist notices that the surgical client has an unexpected rise in the end-tidal carbon dioxide level, with a decrease in oxygen saturation and sinus tachycardia. What is the nurse's first action? A. Administer cardiopulmonary resuscitation (CPR). B. Continue as normal. C. Immediately stop all inhalation anesthetic agents and succinylcholine. D. Inform the surgeon.

C. Immediately stop all inhalation anesthetic agents and succinylcholine. Correct: The most sensitive indication of malignant hypothermia (MH) is an unexpected rise in the end-tidal carbon dioxide level, along with a decrease in oxygen saturation. Another early indication is sinus tachycardia. Survival depends on early diagnosis and the actions of the entire surgical team. Time is crucial when MH is diagnosed. Incorrect: A. Administer cardiopulmonary resuscitation (CPR): This client does not require resuscitation. B. Continue as normal: This client is exhibiting early symptoms of malignant hypothermia (MH), and immediate intervention is required. D. Inform the surgeon: This client is exhibiting early symptoms of malignant hypothermia; immediate intervention is required, so informing the surgeon is not the priority.

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? A. New-onset hypertension. B. The client reports extreme salt craving. C. No change in urine output with minimal fluid intake. D. The client's headache is gradually increasing in intensity.

C. No change in urine output with minimal fluid intake. Rationale: DI results from absent or insufficient secretion of antidiuretic hormone (ADH, vasopressin) from the posterior pituitary and can result from a head injury that damages this endocrine gland. With less or absent ADH, the client is unable to reabsorb water even when fluid intake is low. Although headache is usually present with a head injury, it is not associated with DI. The dehydration associated with DI would cause hypotension and an increased serum sodium concentration.

Which intervention does the nurse implement for the older adult client to minimize skin breakdown related to surgical positioning? A. Applies elastic stocking to lower extremities B. Monitors for excessive blood loss C. Pads bony prominences D. Secures joints on a board in anatomic positions

C. Pads bony prominences Correct: Padding bony prominences best minimizes skin breakdown. Incorrect: A. Applies elastic stocking to lower extremities: Elastic stockings assist in increased venous return. B. Monitors for excessive blood loss: Monitoring for blood loss does not protect the skin. D. Secures joints on a board in anatomic positions: Securing joints does not protect the skin.

Which is the top priority for nurses during the preoperative period? A. Patient teaching B. Patient diagnostic testing C. Patient safety D. Patient care documentation

C. Patient safety

If a sterile gauze falls to the ground and hits the front of the surgeon's gown on the way down, what does the nurse do for proper infection control? A. Helps the surgeon change the gown B. Picks the gauze up with a pair of sterile gloves C. Picks the gauze up without touching the surgeon D. Sprays an antimicrobial on the surgeon's gown

C. Picks the gauze up without touching the surgeon Correct: The surgeon is sterile, but the gauze is now nonsterile and must be removed and counted. Incorrect: A. Helps the surgeon change the gown: A sterile gauze touching a sterile gown does not require a gown change. B. Picks the gauze up with a pair of sterile gloves: Once the gauze falls, it is no longer sterile. Sterile gloves are not needed to pick it up. D. Sprays an antimicrobial on the surgeon's gown: A sterile gauze touching a sterile gown requires no action. An antimicrobial spray is inappropriate.

What client teaching will the nurse provide regarding postoperative leg exercises to minimize the risk for development of deep vein thrombosis after surgery? A. Only perform each exercise one time to prevent overuse. B. Begin exercises by sitting at a 90-degree angle on the side of the bed. C. Point toes of one foot toward bottom of bed; then point toes of same leg toward his or her face. Repeat several times; then switch legs. D. Bend knee and push heel of foot into the bed until the calf and thigh muscles contract. Repeat several times; then switch legs.

C. Point toes of one foot toward bottom of bed; then point toes of same leg toward his or her face. Repeat several times; then switch legs.

After gastric surgery, a client arrives in the postanesthesia care unit (PACU). Which of these nursing actions is most appropriate for the RN to delegate to an experienced nursing assistant? A. Monitor respiratory rate and airway patency. B. Irrigate the nasogastric tube with saline. C. Position the client on the left side. D. Assess the client's pain level.

C. Position the client on the left side. Correct: This action can be delegated to a unlicensed care provider. Incorrect: A. Monitor respiratory rate and airway patency: Airway patency requires the care of a nurse in case of emergency management requirements. B. Irrigate the nasogastric tube with saline: This is a nursing skill and care by a nurse would be required. D. Assess the client's pain level: Pain assessment is within the scope of a nurse.

Which assessment finding in the postoperative client after general anesthesia requires immediate intervention? A. Heart rate of 58 B. Pale, cool extremities C. Respiratory rate of 6 D. Suppressed gag reflex

C. Respiratory rate of 6 Correct: The most important postoperative assessment is respiratory assessment, and a rate of 6 is too low. Incorrect: A. Heart rate of 58: A heart rate of 58 is a normal postoperative finding B. Pale, cool extremities: Pale, cool extremities are a normal postoperative finding. D. Suppressed gag reflex: A suppressed gag reflex is a normal postoperative finding.

Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately? A. Blood glucose 148 mg/dL (7.4 mmol/L) B. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) C. Serum sodium 110 mEq/L (110 mmol/L) D. Serum potassium 3.2 mEq/L (3.2 mmol/L)

C. Serum sodium 110 mEq/L (110 mmol/L) Rationale: The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia, requiring immediate action to prevent increased intracranial pressure, seizures, and death as the intravascular fluid shifts into brain tissue. The most likely cause of the problem is an increased vasopressin level that is increasing water reabsorption and diluting the serum sodium level.

How does the nurse position the client with postoperative respiratory depression? A. Flat in bed, with the head in alignment with the body B. Prone, with the head of the bed flat C. Side-lying, with the head in a neutral position D. Supine in bed, with the neck flexed

C. Side-lying, with the head in a neutral position Correct: The side-lying position is the most natural and effective. A. Flat in bed, with the head in alignment with the body: This position is not a neutral position. B. Prone, with the head of the bed flat: This position is unnatural. D. Supine in bed, with the neck flexed: This position is unnatural.

The client has just undergone a surgical procedure with general anesthesia. Which finding indicates that the client needs further assessment in the postanesthesia care unit? A. Pain at the surgical site B. Requirement for verbal stimuli to awaken C. Snoring sounds when inhaling D. Sore throat on swallowing

C. Snoring sounds when inhaling Correct: Snoring sounds when inhaling may indicate respiratory depression. Incorrect: A. Pain at the surgical site: Postsurgical pain at the surgical site is normal. B. Requirement for verbal stimuli to awaken: Requiring verbal stimuli to awaken is normal post sedation. D. Sore throat on swallowing: A sore throat on swallowing is normal post intubation.

A preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instruct the client to quit smoking. B. Teach about the dangers of tobacco. C. Teach the importance of incentive spirometry. D. Tell the client that smoking increases postoperative complications.

C. Teach the importance of incentive spirometry.

The preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instructs the client to quit smoking B. Teaches about the dangers of tobacco C. Teaches the importance of incentive spirometry D. Tells the client where the smoking lounge

C. Teaches the importance of incentive spirometry Correct: Incentive spirometry is good for lung hygiene. It encourages deep breathing. Incorrect: A. Instructs the client to quit smoking: The nurse can suggest quitting, but it is not therapeutic to instruct it at this time. B. Teaches about the dangers of tobacco: The nurse can educate the client about the dangers of tobacco, but teaching on this topic would not be therapeutic at this time. D. Tells the client where the smoking lounge is: Directing the client to the smoking lounge is not helpful.

At 8 AM, the registered nurse is admitting to the outpatient surgery department a client who is scheduled for sinus surgery. Which information given by the client would be of most immediate concern to the nurse? A. The client has an allergy to iodine and shellfish. B. The client was nauseated after a previous surgery. C. The client had a small glass of juice at 7 AM. D. The client expresses anxiety about the surgery.

C. The client had a small glass of juice at 7 AM. Correct: Clients need to be NPO for a sufficient length of time before surgery. Intake of food or fluids may delay the start time of the surgery; the nurse needs to notify the surgeon and anesthesia for possible rescheduling. Incorrect: A. The client has an allergy to iodine and shellfish: The nurse should confirm that the information is charted, and that the client has the correct allergy band identification. B. The client was nauseated after a previous surgery: Many clients experience nausea after surgery. The nurse should document this in the client's information. D. The client expresses anxiety about the surgery: The nurse should talk with the client and explore the anxiety; this is a normal feeling before surgery.

Which statement best describes the collaborative roles of the nurse and surgeon when obtaining the informed consent? A. The nurse is responsible for having the informed consent form on the chart for the healthcare provider (HCP) to witness B. The nurse may serve as a witness that the patient has been informed by the HCP before surgery is performed C. The nurse may serve as a witness to the patient's signature after the HCP has the consent form signed before preoperative sedation is given and before surgery is performed D. The nurse has no duties regarding the consent form if the patient has signed the informed consent form for the HCP, even if the patient then asks additional questions about the surgery

C. The nurse may serve as a witness to the patient's signature after the HCP has the consent form signed before preoperative sedation is given and before surgery is performed

Which statement regarding trophic hormones is true? A. All are categorized as catecholamines B. Responses are independent of target tissue receptors C. Their target tissues are always another endocrine gland D. They represent the final hormone secreted in a complex negative feedback pathway

C. Their target tissues are always another endocrine gland

Which statement regarding trophic (tropic) hormones is true? A. All are categorized as catecholamines. B. Responses are independent of target tissue receptors. C. Their target tissues are always another endocrine gland. D. They represent the final hormone secreted in a complex negative feedback pathway.

C. Their target tissues are always another endocrine gland. Rationale: Trophic (tropic) hormones stimulate the secretion of other hormones from another endocrine gland. Just like any other hormone, a receptor is required for action (receptor can be on the receptor or somewhere else inside the responsive target tissue. Only epinephrine, norepinephrine, and dopamine are catecholamines. None of them are trophic hormones. Trophic hormones represent the initiating hormone or an intermediate hormone in a more complex negative feedback pathway, not the final hormone.

Why is it important to wear sterile gloves during a dressing change? A. They protect the client from infection. B. They protect the nurse from infection. C. They protect both the client and the nurse from infection. D. Their use prevents lawsuits.

C. They protect both the client and the nurse from infection. Correct: Standard Precautions and infection control protect both the nurse and the client from infection. Incorrect: A. They protect the client from infection. Incorrec: This response is only partially correct. B. They protect the nurse from infection: This response is only partially correct. D. Their use prevents lawsuits: Preventing lawsuits is not the purpose of wearing sterile gloves.

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

C. Urine output volume decreased; urine specific gravity increased Rationale: Diabetes insipidus (DI) occurs with reduced or absent secretion of vasopressin (ADH). As a result, water is excessively excreted, causing a decrease in blood volume and an increase in urine volume. Blood is concentration indicating dehydration and urine is very dilute, as measured by specific gravity, is very low. When interventions to counter act DI are effective, the adult increases water reabsorption so that urine output volume decreases at the same time that urine concentration increases, seen as an increased urine specific gravity.

A nurse caring for a client with Cushing's syndrome who must remain on continued corticosteroid therapy for another health problem will use which of the following actions to prevent harm? A. Urging the client to salt his or her food. B. Testing voided urine for the present of glucose. C. Using non-adhesive methods to secure an IV access. D. Ensuring that the prescribed corticosteroid drug is given on an empty stomach.

C. Using non-adhesive methods to secure an IV access. Rationale: The skin of a client on chronic corticosteroid therapy is thin, very fragile, and easily injured. The client also is a increased risk for infection and an open skin site increases that risk. Using nonadhesive methods to secure an IV access protects the skin from injury. Usually the client on a corticosteroid has problems with sodium retention and is on a salt-restricted diet. Urine testing for glucose not accurate and is no longer performed. Corticosteroids irritate the stomach lining and can cause GI bleeding for many reasons. They are recommended to be taken with food to prevent GI irritation.

The most visible sign of Graves' disease is __________. a. swelling of the neck b. exophthalmus c. weight loss d. irritability

C. weight loss

The nurse is educating a preoperative client about colostomy surgery. The colostomy surgery is categorized as what type of surgery? A Cosmetic B Curative C Diagnostic D Palliative

D Palliative Palliative surgery is performed to relieve symptoms of a disease process but does not cure the disease. Incorrect: A Cosmetic: Cosmetic surgery is performed primarily to alter or enhance personal appearance. B Curative: Curative surgery is performed to resolve a health problem by repairing or removing the cause. C Diagnostic: Diagnostic surgery is performed to determine the origin and cause of a disorder or the cell type for cancer.

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which order does the nurse accomplish first? A. Use electric clippers to cut hair at the surgical site. B. Start an infusion of lactated Ringer's solution at 75 mL/hr. C. Administer one-half of the client's usual lispro insulin dose. D. Draw blood for glucose, electrolyte, and complete blood count values.

D. Draw blood for glucose, electrolyte, and complete blood count values.

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? A. "Do you think if I lost weight my sleep apnea would improve?" B. "Why do I feel thirsty all the time?" C. "How can I make my skin less itchy?" D. "Does everyone's feet get bigger during menopause?"

D. "Does everyone's feet get bigger during menopause?" Rationale: Growth hormone is secreted and is needed throughout the life span. When it is secreted in excess in adults, organs can enlarge and bones containing desmoid bone type increase in size, including the facial bones, hands, and feet.The other client questions are reasonable for a client with sleep apnea, hyperglycemia, and menopause to ask.

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? A. "Are you experiencing any pain during sexual intercourse?" B. Do you work with or have hobbies that involve exposure to chemicals?" C. "Have you gained or lost any weight recently?" D. "How often do you need to shave your face?"

D. "How often do you need to shave your face?" Rationale: A gonadotropin deficiency reduces the expression of secondary sexual characteristics and leads to decreased libido and fertility in both male and female clients. Male clients lose facial fair and need to shave less frequently. This change may be the first problem noticed by the client. A deficiency does not result in painful intercourse for men although it can in women from vaginal dryness.

Which statement by a student nurse indicates a need for further teaching about operating room (OR) surgical attire? A. "I must cover my facial hair." B. "I don't need a sterile gown to be in the OR." C. "If I go into the OR, I must wear a protective mask." D. "My scrubs are sterile."

D. "My scrubs are sterile." Correct: Scrub attire is provided by the hospital and is clean, not sterile. Incorrect: A. "I must cover my facial hair.": All members of the surgical team must cover their hair, including any facial hair. B. "I don't need a sterile gown to be in the OR.": Team members who are not scrubbed (e.g., anesthesia provider, student nurse) are not required to be sterile. They may wear cover scrub jackets that are snapped or buttoned closed to prevent shedding of organisms from bare arms. C. "If I go into the OR, I must wear a protective mask.": Everyone who enters an OR in which a sterile field is present must wear a mask.

The nurse is educating a client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A. "I will wake up with a tube in my throat." B. "I will have a bandage on my chest." C. "My family will not be able to see me right away." D. "Pain medication will take away my pain."

D. "Pain medication will take away my pain."

The nurse is educating the client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A. "I will wake up with a tube in my throat." B. "I will have a bandage on my chest." C. "My family will not be able to see me right away." D. "Pain medication will take away my pain."

D. "Pain medication will take away my pain." Correct: Pain medication will minimize pain but will not take it away completely. Incorrect: A. "I will wake up with a tube in my throat.": This is an accurate statement. B. "I will have a bandage on my chest.": This is an accurate statement. C. "My family will not be able to see me right away.": This is an accurate statement.

A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland asks the nurse whether the physical changes from the excessive cortisol will go away as a result of the surgery so she can look like herself again. What is the nurse's best response? A. "The surgery is to remove the tumor, not reconstructive surgery." B. "You will notice a great difference in your appearance starting within a week after surgery." C. "All the changes will resolve but may take a year or longer to completely disappear." D. "The fatty changes and and acne will resolve with time but the stretch marks only fade."

D. "The fatty changes and acne will resolve with time but the stretch marks only fade." Rationale: The good news is that the changes that are not related to tissue structure, such as the moon face, buffalo hump, weight gain, truncal obesity, and acne will resolve and go away but may take a year or longer to do so. Her muscles can become stronger and larger again as well. However, the stretch marks will only fade and become less noticeable. Although she did not ask about bone changes and osteoporosis, this may never completely resolve.

Which statement by the patient indicates the need for additional teaching about her condition? A. "When I go home I should check my heart rate and BP every day." B. "I will call my provider if I notice any change in level of consciousness." C. "I will be sure to include fiber in my diet and drink plenty of water." D. "When I am feeling better in a few months I will no longer need to take the Synthroid pills."

D. "When I am feeling better in a few months I will no longer need to take the Synthroid pills." The most important educational need for the patient with hypothyroidism is about hormone replacement therapy and its side effects. The need to take these drugs is life-long.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 42 year old with diabetes insipidus who has a dose of desmopressin due. B. A 35 year old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). C. A 50 year old with pituitary adenoma who is reporting a severe headache. D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L). Rationale: The nurse first attends to the client with adrenal insufficiency who has a blood glucose level of 36 mg/dL (2.0 mmol/L). The client's condition is considered a medical emergency and must be assessed and treated immediately.

The charge nurse for a hospital operating room is making client assignments for the day. Which client is most appropriate to assign to the least-experienced circulating nurse? A. A 20-year-old client who has a ruptured appendix and is having an emergency appendectomy B. A 28-year-old client with a fractured femur who is having an open reduction and internal fixation C. A 45-year-old client with coronary artery disease who is having coronary artery bypass grafting D. A 52-year-old client with stage I breast cancer who is having a tunneled central venous catheter placed

D. A 52-year-old client with stage I breast cancer who is having a tunneled central venous catheter placed Correct: This is the most stable client among all scheduled procedures. This assignment would be appropriate for the beginning nurse or one with less experience. Incorrect: A. A 20-year-old client who has a ruptured appendix and is having an emergency appendectomy: This is a less stable client who is at high risk for infection/sepsis. A more experienced nurse is required. B. A 28-year-old client with a fractured femur who is having an open reduction and internal fixation: This client is at high risk for clotting, infection, and aspiration owing to the surgery. A more experienced nurse would be better. C. A 45-year-old client with coronary artery disease who is having coronary artery bypass grafting: This client is having high-risk surgery with risk for multiple complications and requires an experienced operating room (OR) nurse.

Which of these staff members will be best for the nurse manager to assign to update standard nursing care plans and policies for care of the client in the operating room (OR)? A. A surgical technologist with 10 years of experience in the OR at this hospital B. A certified registered nurse first assistant (CRNFA) who has worked for 5 years in the ORs of multiple hospitals C. A holding room RN who has worked in the hospital holding room for longer than 15 years D. A circulating RN who has been employed in the hospital OR for 7 years

D. A circulating RN who has been employed in the hospital OR for 7 years Correct: This nurse has the experience and background to write OR policy and has been employed in this hospital and is aware of hospital policy and procedures. Incorrect: A. A surgical technologist with 10 years of experience in the OR at this hospital: A surgical technologist does not have the background to write policy for nurses. B. A certified registered nurse first assistant (CRNFA) who has worked for 5 years in the ORs of multiple hospitals: This nurse has worked in multiple hospitals but does not have a work history with this specific hospital to be aware of the unit policy. C. A holding room RN who has worked in the hospital holding room for longer than 15 years: A holding room or preoperative or postoperative care nurse would not be the choice to write OR policy.

A patient scheduled for surgery has a history of myocardial infarction 6 weeks ago. Which classification will this patient meet preoperatively based on the ASA Physical Status Classification system? A. ASA class I B. ASA class II C. ASA class III D. ASA class IV

D. ASA class IV

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? A. Dry lips and oral mucosa on examination B. Nasal drainage that tests negative for glucose C. Urine specific gravity of 1.016 D. Client report of a headache and stiff neck

D. Client report of a headache and stiff neck Rationale: Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provider.Dry lips and mouth are not unusual after surgery. Nasal drainage that tests negative for glucose is normal, expected, and not significant. A urine specific gravity of 1.016 is within normal limits.

Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)? A. Getting 8 hours of sleep nightly B. Chronic constipation C. Protein-calorie malnutrition D. Cold environmental temperatures

D. Cold environmental temperatures Rationale: Cold and stress are two factors that cause the hypothalamus to secrete thyrotropin-releasing hormone (TRH), which then stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH) to increase production of the two major thyroid hormones.

What should the nurse do initially when obtaining consent for surgery? A. Describe the risks involved in the surgery B. Explain that obtaining the signature is routine for any surgery C. Witness the client's signature which the nurse's signature will document D. Determine whether the client's knowledge level is sufficient to give consent

D. Determine whether the client's knowledge level is sufficient to give consent

A female patient is having a biopsy of a nodule found in the right breast. Which classification identifies this surgery? A. Urgent B. Minor C. Cosmetic D. Diagnostic

D. Diagnostic

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which orders should the registered nurse accomplish first? A. Use electrical clippers to cut hair at the surgical site. B. Start an infusion of lactated Ringer's solution at 75 mL/hr. C. Administer one half of the client's usual lispro insulin dose. D. Draw blood for glucose, electrolyte, and complete blood count values.

D. Draw blood for glucose, electrolyte, and complete blood count values. Correct: If blood work is abnormal, the surgery may be rescheduled. The blood work needs to be drawn and sent to the laboratory first to confirm that results are within normal limits. This is not of immediate concern. Incorrect: A. Use electrical clippers to cut hair at the surgical site: Removal of hair can be accomplished in the operating room directly before the start of surgery. While important, it is not of immediate concern. B. Start an infusion of lactated Ringer's solution at 75 mL/hr: The IV infusion is not the first task to accomplish for preoperative clients. This can be accomplished after the laboratory orders have been completed. This is not of immediate concern. C. Administer one half of the client's usual lispro insulin dose: The nurse should check blood glucose with the laboratory orders before administration of lispro.

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? A. Inspecting feet and legs for ulcers B. Planning for weight-bearing activities C. Stressing the important of fiber in the diet D. Encouraging fluids every 2 hours

D. Encouraging fluids every 2 hours Rationale: A decrease in ADH production in the older adult causes urine to be more dilute. In this instance, urine might not concentrate when fluid intake is low, allowing for excess water loss. Encouraging fluid intake every 2 hours, even during the night, is important to prevent dehydration.

What principle must a nurse consider when caring for a client with a closed wound drainage system? A. Gravity causes fluid to flow down a pressure gradient B. Fluid flow rate is determined by the diameter of the lumen C. Siphoning causes fluids to flow from one level to a lower level D. Fluids flow from an area of higher pressure to one of lower pressure

D. Fluids flow from an area of higher pressure to one of lower pressure

As the nurse is about to give the preoperative medication to the client going into surgery, it is discovered that the preoperative permit is not signed. What does the nurse do? A. Calls the surgeon B. Calls the anesthesiologist C. Gives the medication as ordered D. Has the client sign the permit

D. Has the client sign the permit Correct: The nurse may ask the client to sign the permit, after which the medication can be administered. Incorrect: A. Calls the surgeon Incorrect: Calling the surgeon is not necessary. B. Calls the anesthesiologist: Calling the anesthesiologist is not necessary. C. Gives the medication as ordered: It is illegal for the client to sign the permit after being sedated.

A client had extensive, prolonged surgery. Which electrolyte level should the nurse monitor most closely? A. Sodium B. Calcium C. Chloride D. Potassium

D. Potassium

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? A. Administering an infusion of 150 mL hypertonic saline over the next 3 hours B. Drawing blood for hemoglobin and hematocrit levels C. Measuring serial weights at the same daily with the client wearing the same amount of clothing D. Inserting an indwelling catheter and monitoring urine output

D. Inserting an indwelling catheter and monitoring urine output Rationale: The first intervention the nurse performs is to administer an infusion of 150 mL hypertonic saline over 3 hours. When the serum sodium level is below 115 mEq/L (115 mmol/L), the client is at increased risk for seizures and coma.

What pain management does the client who has been admitted to the postanesthesia care unit typically receive? A. Intramuscular non-opioid analgesics B. Intramuscular opioid analgesics C. Intravenous non-opioid analgesics D. Intravenous opioid analgesics

D. Intravenous opioid analgesics Correct: IV opioids are given in small doses to provide pain relief but not to mask an anesthetic reaction. Incorrect: A. Intramuscular non-opioid analgesics: IM non-opioid analgesics are too long-acting. B. Intramuscular opioid analgesics: IM opioid analgesics are too long-acting. C. Intravenous non-opioid analgesics: IV non-opioid analgesics usually are not given within the first 48 hours after surgery.

The nurse is providing preoperative care for a client who will have an arthroscopy of the left knee. As part of the Joint Commission National Patient Safety Goals (NPSG), what will the nurse be required to do? A. Ensure that the correct procedure is noted in the client's history. B. Remind the surgeon that the client will have a left knee arthroscopy. C. Verify with the client that a left knee arthroscopy will be performed. D. Mark the left knee site with the client awake and the surgeon present.

D. Mark the left knee site with the client awake and the surgeon present.

Colostomy surgery is categorized as what type of surgery? A. Cosmetic B. Curative C. Diagnostic D. Palliative

D. Palliative

The client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done? A. Decreases expected blood loss during surgery B. Eliminates any risk of infection C. Ensures that the bowel is sterile D. Reduces the number of intestinal bacteria

D. Reduces the number of intestinal bacteria Correct: Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria. Incorrect A. Decreases expected blood loss during surgery: Decreasing expected blood loss is not the goal of a bowel preparation. B. Eliminates any risk of infection: Eliminating infection risk is not the goal of a bowel preparation. While the bowel prep may reduce the number of intestinal bacteria, it will not completely eliminate the risk of infection. C. Ensures that the bowel is sterile: Sterilizing the bowel is not the goal of a bowel preparation.

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? A. 5-lb weight loss B. Dry, cracked lips C. Thinning pubic hair D. Skin darkening

D. Skin darkening Rationale: Clients whose adrenal insufficiency is caused by adrenal glands that cannot produce appropriate levels of adrenal hormones have overall skin darkening. When the problem is in the adrenal gland and not either the hypothalamus or pituitary, plasma ACTH and melanocyte-stimulating hormone (MSH) levels are elevated in response to the adrenal-hypothalamic-pituitary feedback system. (Both ACTH and MSH are made from the same prehormone molecule.) Anything that stimulates increased production of ACTH also leads to increased production of MSH. Elevated MSH levels result in areas of increased pigmentation. Skin darkening does not occur when adrenal insufficiency is caused by hypofunction of the hypothalamus or pituitary gland.

In going through the preoperative checklist, the nurse notices that the client's armband does not match the handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first? A. Calls admissions B. Cancels the surgery C. Contacts the surgeon D. Talks to the operating team

D. T alks to the operating team Correct: The operating team should be called to see if any clients with similar names are having surgery done. The client should confirm the spelling of his or her last name. Also, confirm the procedure that is expected to be done and compare it with the informed consent form. Incorrect: A. Calls admissions: Calling admissions is not the first step. The stamp is correct. B. Cancels the surgery: Canceling surgery is not done by the floor nurse. C. Contacts the surgeon: This is an administrative issue, not one for the surgeon.

An older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Call the legal department to draft the paperwork. B. Document this in the chart. C. Thank the person and do nothing else. D. Talk to the client.

D. Talk to the client.

The older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Calls the legal department to draft the paperwork B. Documents this in the chart C. Thanks the person and does nothing D. Talks to the client

D. Talks to the client Correct: The nurse should determine the client's wishes and state of mind. Incorrect: A. Calls the legal department to draft the paperwork: Calling the legal department is not what the nurse should do first. B. Documents this in the chart: Documenting this in the chart is not what the nurse should do first. C. Thanks the person and does nothing: Doing nothing is not appropriate.

A 47-year-old patient is having surgery to remove kidney stones. What is the correct classification for this surgery? A. Restorative B. Emergent C. Palliative D. Urgent

D. Urgent

A client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. This preoperative procedure is done to A. decrease expected blood loss during surgery. B. eliminate any risk of infection. C. ensure that the bowel is sterile. D. reduce the number of intestinal bacteria.

D. reduce the number of intestinal bacteria.

5 - The nurse is teaching a class on pain management strategies. Which client statement requires additional teaching? A. Persistent pain is a warning in my body that alerts the sympathetic nervous system B. Acute pain has a quick onset and is usually isolated to one area of my body C. My frozen shoulder causes musculoskeletal or somatic pain D. Nociceptive pain follows a normal and predictable pattern

Persistent pain is a warning in my body that alerts the sympathetic nervous system

5 - Which documentation will the nurse record for a client who had a total knee replacement 2 days ago and reports sharp pain at the surgical site? A. Reports acute pain at the surgical site B. Persistent pain reported around the surgical site C. Experiences neuropathic pain near the surgical site D. Discomfort has progressed to chronification of pain

Reports acute pain at the surgical site

A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

Rule out hypothyroidism - most cases of hypothyroidism in the U.S. occur as a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism.

A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

Rule out hypothyroidism - most cases of hypothyroidism in the U.S. occur as a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism. Supporting data: hr, non pitting edema, BP, tx for hyperthyroidism

5 - A client taking newly prescribed gabapentin for persistent neuropathic pain reports dizziness. What is the best nursing response? A. This is a common side effect of gabapentin and will decrease with use B. Stop taking the medication and contact the health care provider C. The dizziness is caused by the neuropathic pain, not the medication D. The dizziness is likely from another medication, not the gabapentin

This is a common side effect of gabapentin and will decrease with use

5 - A client has been receiving the same dose of an IV opioid for 2 days to manage postsurgical pain. The client reports that the drug is no longer controlling the pain. What does the nurse suspect? A. There is likely a history of addiction B. Tolerance to the opioid is developing C. Physical dependence is developing D. The client is opioid naive

Tolerance to the opioid is developing

A group of students are reviewing information about the relationship of the hypothalamus and the pituitary gland. The students demonstrate the need for additional study when they state which of the following? a) "The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus." b) "The hypothalamus, a portion of the brain between the cerebrum and brain stem, creates a pathway for neurohormones." c) "The hypothalamus secretes releasing hormones that stimulate or inhibit pituitary gland secretions." d) "Corticotropin-releasing hormone from the hypothalamus triggers ACTH secretion by the pituitary gland."

a) "The pituitary gland, as the master gland, controls the secretion of hormones by the hypothalamus."

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

a) Administer hydrocortisone I.M.

The adrenal cortex is responsible for producing which substances? a) Glucocorticoids and androgens b) Mineralocorticoids and catecholamines c) Norepinephrine and epinephrine d) Catecholamines and epinephrine

a) Glucocorticoids and androgens

A patient who has had a total parathyroidectomy has returned to the unit from PACU. The nurse caring for the patient knows to assess for what complication following this surgery? a) Muscle twitching b) Hypercalcemia c) Fatigue d) Hemorrhage

a) Muscle twitching

A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? a) Purple striae b) Truncal obesity c) "Moon face" d) "Buffalo hump" e) Thin extremities

a) Purple striae b) Truncal obesity c) "Moon face" d) "Buffalo hump" e) Thin extremities

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

a) balance the client's periods of activity and rest.

A common electrolyte imbalance found in patients with syndrome of inappropriate antidiuretic hormone is __________. a. hyponatremia. c. hyperglycemia. b. hyperkalemia. d. hypochloremia.

a. hyponatremia

The most common cause of hyperparathyroidism is __________. a. an adenoma. b. Wilson's disease c. accidental removal or damage of the parathyroid glands d. hypothyroidism

a. an adenoma

Two hormones produced by the posterior pituitary gland (neurohypophysis) are __________. a. antidiuretic hormone (ADH) and oxytocin. b. growth hormone (GH) and adrenocorticotropic hormone (ACTH). c. thyroid-stimulating hormone (TSH) and growth hormone (GH). d. follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

a. antidiuretic hormone (ADH) and oxytocin.

Which nursing diagnosis is most appropriate for a client with Addison's disease? a) Hypothermia b) Excessive fluid volume c) Urinary retention d) Risk for infection

d) Risk for infection

Which of the following agents suppress release of thyroid hormones? Select all that apply. a) Methimazole b) Dexamethasone c) Potassium iodide d) Sodium iodide e) Saturated solution of potassium iodide (SSKI)

b) Dexamethasone c) Potassium iodide d) Sodium iodide e) Saturated solution of potassium iodide (SSKI)

A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a history of adrenal insufficiency. Considering the patient's history and current symptoms, what would the nurse instruct the patient? a) Increase his intake of potassium until the gastrointestinal symptoms improve b) Increase his intake of sodium until the gastrointestinal symptoms improve c) Increase his intake of calcium until the gastrointestinal symptoms improve d) Increase his intake of glucose until the gastrointestinal symptoms improve

b) Increase his intake of sodium until the gastrointestinal symptoms improve

A patient has undergone a cerebral angiogram and the arterial access catheter has been removed. The nurse should apply pressure to the arterial puncture site for __________. a. 5 minutes. c. 25 minutes. b. 15 minutes. d. 30 minutes.

b. 15 minutes

A 42-year-old woman reports excessive weight gain in the abdomen and shoulders, excessive hair growth on her face, and an intermittent menses. The reported signs are associated with __________. a. Addison's disease. b. Cushing's syndrome. c. gigantism. d. diabetes insipidus.

b. Cushing's syndrome.

Of the following information obtained during a health history, what would indicate a possible thyroid problem? a. Eats three well-balanced meals a day b. Has gained 15 pounds in the past 3 months c. Sleeps 8 hours a night d. Reports a regular menstrual cycle

b. Has gained 15 pounds in the past 3 months

Excessive output of dilute urine from an antidiuretic hormone (ADH) abnormality is characteristic of __________. a. hyperthyroidism. b. diabetes insipidus. c. diabetes mellitus. d. adrenal insufficiency.

b. diabetes insipidus.

Bromocriptine (Parlodel) is a pituitary hormone suppressant that acts to __________. a. inhibit the production of clotting factor VIII from the posterior pituitary gland. b. inhibit the release of prolactin from the anterior pituitary gland. c. suppress the release of growth hormone from the anterior pituitary gland. d. suppress the release of antidiuretic hormone from the anterior pituitary gland.

b. inhibit the release of prolactin from the anterior pituitary gland.

A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a) Decreased phosphate level b) Functioning thyroid gland c) Adequate vitamin D level d) Increased calcium level

c) Adequate vitamin D level

The nurse caring for a patient with Cushing's syndrome is teaching the patient about the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? a) Administration of dexamethasone intravenously, followed by an X-ray of the adrenal glands b) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered c) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning d) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours

c) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning

Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following? a) Myxedema b) Hypothyroidism c) Cretinism d) Diabetes insipidus

c) Cretinism

The nurse is caring for a patient with Addison's disease. The patient is scheduled for discharge in the morning. When teaching the patient about hormone replacement, the nurse instructs that too low a dose may be indicated by what? a) Headache b) Weight gain c) Dizziness d) Increase in systolic blood pressure

c) Dizziness

Urinalysis has been ordered as part of a patient's diagnostic workup, and the nurse has obtained and submitted a sample. Assessment of this patient's urine osmolality may be undertaken to diagnose dysfunction of the patient's: a) Thyroid gland b) Adrenal medulla c) Posterior pituitary d) Adrenal cortex

c) Posterior pituitary

When providing teaching to a client with hyperthyroidism that is prescribed radioactive iodine (RAI) to destroy thyroid tissue, which of the following would the nurse include? a) The process may take several weeks or more. b) Its effect is not apparent until the gland has secreted excess thyroid hormone. c) RAI does not seriously affect other tissues. d) Radioactive iodine (RAI) has no adverse effects.

c) RAI does not seriously affect other tissues.

The nurse is developing a care plan for a patient with hypersecretion of the adrenal cortex (Cushing's syndrome). What nursing diagnosis would have the highest priority in this care plan? a) Risk for loneliness related to disturbed body image b) Disturbed body image related to changes in physical appearance c) Risk for injury related to weakness d) Fatigue related to sleep disturbances

c) Risk for injury related to weakness

What is the function of the parathyroid glands? a. Regulate potassium levels b. Regulate sodium levels c. Regulate serum calcium levels d. Regulate the thyroid gland

c. Regulate serum calcium levels

1. The thyroid gland is located in the __________. a. apex of the lung b. brain c. anterior neck d. abdomen

c. anterior neck

Enlargement of the thyroid gland is called __________. a. hypothyroidism b. Graves' disease c. goiter d. myxedema

c. goiter

A pituitary adenoma is most commonly found in patients with __________. a. Addison's disease. b. hypopituitarism. c. hyperpituitarism. d. Cushing's disease.

c. hyperpituitarism.

Maintenance of extracellular fluid volume is controlled by __________. a. prolactin. b. glucocorticoids. c. mineralocorticoids. d. thyroid-stimulating hormone.

c. mineralocorticoids.

Which of the following statements by patients should prompt the nurse to assess for potential failure of the adrenal cortex? a) "Lately, I find that I'm more irritable and impatient than normal." b) "My thirst is almost insatiable these days, and my mouth always feels dry." c) "The last little while I get numbness and tingling in my lips and fingers a lot." d) "I'm always exhausted these days, and I never really feel like eating."

d) "I'm always exhausted these days, and I never really feel like eating."

A 59-year-old patient is being assessed for hypoparathyroidism. The nurse should anticipate that this patient is likely to require what diagnostic test? a) Cardiac stress testing b) 24-hour urine c) CT of the abdomen d) Bone density testing

d) Bone density testing

Nursing care for a client in addisonian crisis should include which intervention? a) Offering extra blankets and raising the heat in the room to keep the client warm b) Encouraging independence with activities of daily living (ADLs) c) Allowing ambulation as tolerated d) Placing the client in a private room

d) Placing the client in a private room

Thyroid storm is prevented by administering what medications before a thyroidectomy? a. Thyroid replacement hormones c. Can't be prevented b. Thyroid-stimulating drugs d. Antithyroid drugs

d. Antithyroid drugs

Why are vital signs important in assessing thyroid function? a. It's good practice. b. Vital signs are part of the assessment. c. The patient expects it. d. Vital signs reflect the metabolic rate.

d. Vital signs reflect the metabolic rate.

The most reliable test for acromegaly is the __________. a. parathyroid hormone. b. cortisol level. c. thyroid-stimulating hormone level. d. glucose tolerance test.

d. glucose tolerance test.

A tumor of the adrenal medulla causing excessive secretion of catecholamines and resulting in hypertension is a __________. a. leiomyoma. c. pituitary tumor. b. sarcoma. d. pheochromocytoma.

d. pheochromocytoma.