Exam 3 HE

*Question:*Which of the following describes the change that takes place as a result of a response to a stressor? 1) Adaptation 2) Stress 3) Defense mechanism 4) Anxiety

Correct answer: *1* p. 1522. Adaptation is a change that takes place as a result of the response to a stressor. Adaptation is an ongoing process as a person strives to maintain balance in his or her internal and external environments. It occurs in families and groups and is necessary for normal growth and development. It is also needed to be able to tolerate changing situations, and have the ability to respond to physical and emotional stressors.

*Question:*In which of the stages of the GAS does the body attempt to adapt to the stressor? 1) Alarm reactions 2) Resistance 3) Exhaustion 4) Homeostasis

Correct answer: *2* p. 1525. After the body perceived a threat and mobilized its resources, the body moves to the stage or resistance and attempts to adapt to the stressor. Vital signs, hormone levels, and energy production return to normal.

*Question:*A client with cancer has a family who is emotionally supportive of the client. Having a supportive family is which of the type of resource? A. External resource B. Financial resource C. Professional resource D. Internal resource

Correct answer: *A* A person's situational support is considered an external resource, whereas a person's coping mechanisms are internal resources. A health care professional is a professional resource. Financial resources are provided by income, benefits, and contributions.

*Question:*A middle-age adult discusses with the nurse the loss of his job due to frequent illness. The nurse recognizes the client's loss of his income as to which of the following? A. A stressor B. Adaptation C. Homeostasis D. A coping mechanism

Correct answer: *A* A stressor is anything that is perceived as challenging, threatening, or demanding. Loss of a job and financial insecurity are external stressors.

*Question:*In contrast to anxiety, fear is characterized by which of the following? A. A cognitive response to a known threat B. The creation of an action plan to deal with a perceived threat C. Short-term resolution D. A real, rather than perceived, threat

Correct answer: *A* Fear is a cognitive response to a known threat, while anxiety is the emotional response to threat. Fear does not necessarily resolve in the short term, and an action plan may or may not be formulated by the individual. The fact that fear involves the identification of a known threat does not necessarily mean that the object of fear is objectively real

*Question:*A nurse working on an oncology floor often sits with her clients in a calm, dimly lit environment and describes a walk along the ocean's shore. The nurse provides details of the walk and verbally defines this form of stress management? A. Guided imagery B. Anticipatory guidance C. Medication D. Biofeedback

Correct answer: *A* Guided imagery often involves creating a mental image based upon a verbal description offered by another individual. Biofeedback is a method of gaining mental control of the autonomic nervous system and regulating body responses. Mediation involves relaxing a major muscle group and repeating a work silently during exhalation. Anticipatory guidance focuses on physiologically preparing a person for an unfamiliar or painful event

*Question:*The parents of an infant who requires cardiac surgery inform the nurse that they are not anxious about the surgery and "will leave the outcome in God's hands." The nurse notes that the parents are likely anxious when she observes what? A. The parents pacing around the child's hospital room B. A calm, serene manner C. Euphoric attitudes and facial expressions D. The parents speaking in a slow, deliberate manner

Correct answer: *A* Objective data related to anxiety may include pacing, tremors, rapid speech, dilated pupils, lack of facial expressions, and restlessness

*Question:*Upon arrival to the emergency room, the mother of a client involved in a motor vehicle accident become upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing? A. A panic attack B. Moderate anxiety C. Mild anxiety D. Severe anxiety

Correct answer: *A* Panic causes the person to lose control and experience dread and terror. Panic is characterized by a disorganized state, increase physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a chocking sensation, and sensations of chest pressure or pain. Severe anxiety creates a narrow focus on specific detail; moderate anxiety leads to a focus on immediate concerns; and mild anxiety is often present in day-to-day living, and it increases alertness and perceptual fields.

*Question:*A nurse hears a client yelling for help from his room. The nurse runs in the client's room, and upon arriving in the room, the nurse's heart rate and oxygen demands have increased. What phase of the general adaptation syndrome is best described by the nurse's physiologic changes? A. Alarm reaction B. Resistance C. Rest and recovery D. Exhaustion

Correct answer: *A* The alarm reaction is initiated when a person perceives a specific stressor and the person experiences an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness. Resistance occurs when the body attempts to adapt to the stressor, and vital signs, hormone levels, and energy production return to normal. Exhaustion results when the adaptive mechanisms are exhausted.

*Question:*The nurse works in the emergency department and feels like she is becoming somewhat jaded about her nursing practice. The nurse talks to her supervisor about this and he suggests making some goals for enhancing her self-concept as a professional nurse. Which of the following would be an important goal to establish that would build up the nursing self-concept? A. Schedule time every day to meet personal needs B. Keep your last error in mind so you don't do it again C. Avoid weakness until they become strengths D. Pursue a doctorate in nursing education

Correct answer: *A* These are goals that will enhance your professional self concept: -Identify basic unmet human needs, exploring positive means to meet these needs -Schedule time every day to meet personal needs -Assess the effect of feedback from significant others on self-esteem -Describe personal strengths accurately -Develop a realistic plan to achieve goals for personal growth and development Don't dwell on errors; remember them so you don't repeat them, but don't make remembering them a goal. Pursuing a higher degree may be a worthy goal, but it will not enhance your self-concept right now. Avoiding weaknesses will not make them become strengths.

*Question:*A female client experienced facial burns in a motor vehicle accident. Recently, the client told her nurse, "I can't stop worrying that my fiance isn't going to want me anymore." Which of the following nursing diagnosis is most clearly suggested by the client's statement? A. Anxiety B. Hopelessness C. Impaired Adjustment D. Ineffective Coping

Correct answer: *A* While issues related to adjustment, coping, and hopelessness may underlie or result from the client's feelings, her expression of worry is primarily indicative or the nursing diagnosis of anxiety.

*Question:*The need to reach one's potential through full development of one's unique capability is known as which of the following? A. Self-actualization B. Self-concept C. Self-esteem D. Ideal self

Correct answer: *A* p. 1493. The need for self-actualization is the need to reach one's potential through full development of one's unique capability. On the other end of the spectrum are identity diffusion and depersonalization.

*Question:*Which of the following questions would provide the healthcare worker with the information needed first when assessing self-concept? A. How would you describe yourself to others? B. Do you like yourself? C. What do you see yourself doing 5 years from now? D. What are some of your personal strengths?

Correct answer: *A* p. 1501. When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is. "How would you describe yourself to others?". Look for personal characteristics and traits, strengths, and fears.

*Question:*Which of the following nursing diagnoses lacks a self-concept disturbance etiology? A. Self-Care Deficit related to dysfunctional grieving B. Noncompliance related to low self-esteem C. Post trauma response related to disturbance in personal identity D. Altered Health Maintenance related to altered role performance

Correct answer: *A* p. 1505. Because disturbances in self-concept have the potential to affect so many other arenas of human functioning, they may serve as etiologies for numerous problem statements. When assessment data point to an alteration in self-concept the first task is to determine whether the altered self-concept is the problem, the cause of the problem (etiology), or merely a sign that a problem exists. Self-concept date seem to fit well in all three categories. It is important that an accurate determination be made because this directs the outcomes developed for the patient and related nursing interventions.

*Question:*The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

Correct answer: *A* Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

*Question:*The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-year-old woman with a hemoglobin A1C of 8.4% B. A 58-year-old man with a fasting blood glucose of 111 mg/dL C. A 68-year-old woman with a random plasma glucose of 190 mg/dL D. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

Correct answer: *A* Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.

*Question:*A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. What potential problem should the nurse assess the patient for? A. Thyroid disorders B. Diabetes insipidus C. Pituitary dysfunction D. Parathyroid dysfunction

Correct answer: *A* Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.

*Question:*The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level.

Correct answer: *A* In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

*Question:*The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75o F) for up to a month."

Correct answer: *A* Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

*Question:*Which class of diabetic drugs primarily act to stimulate insulin secretion in order to achieve euglycemia? A) Sulfonylureas (Glucotrol, Amaryl). B) Glitazones (TZDs or thiazolidinediones - Actos; Avandia). C) Metformin (class: biguanide; Glucophage). D) a-glucosidase inhibitors.

Correct answer: *A* Lewis, p. 1229, Table 49-7. Metformin decreases rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles; Sulfonylureas stimulate release of insulin from pancreatic islets. Glitazones increase glucose uptake in the muscle and decrease endogenous glucose production. a-glucosidase inhibitors delay absorption of glucose from the GI tract.

*Question:*Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

Correct answer: *A* Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

*Question:*The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

Correct answer: *A* The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

*Question:*When the nurse assesses the patient that has pancreatitis, what function may be altered related to the endocrine function of the pancreas? A. Blood glucose regulation B. Increased response to stress C. Fluid and electrolyte regulation D. Regulates metabolic rate of cells

Correct answer: *A* The endocrine functions of the pancreas are regulated by α cells that produce and secrete glucagon, β cells that produce and secrete insulin and amylin, delta cells that produce and secrete somatostatin, and F cells that secrete pancreatic polypeptide. Glucagon, insulin, and amylin, and somatostatin all affect blood glucose. Pancreatic polypeptide regulates appetite. Increased response to stress occurs from epinephrine secreted by the adrenal medulla. Fluid and electrolyte regulation occurs in response to several hormones (mineralocorticoids, antidiuretic hormone, parathyroid hormone, calcitonin) from several organs (adrenal cortex, posterior pituitary, parathyroid, thyroid). The metabolic rate of cells is regulated by triiodothyronine (T3) from the thyroid.

*Question:*The patient has been feeling tired lately and has gained weight; reports thickened, dry skin and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first? A. Free thyroxine (FT4) B. Serum growth hormone (GH) C. Follicle stimulating hormone (FSH) D. Magnetic resonance imaging (MRI) of the head

Correct answer: *A* The manifestations the patient is experiencing could be related to hypothyroidism. Free thyroxine (FT4) is considered a better indicator of thyroid function than total T4 and could be done to evaluate the patient for hypothyroidism. Growth hormone excess could cause thick, leathery, oily skin but does not demonstrate the other manifestations. FSH is manifest with menstrual irregularity and would be useful in distinguishing primary gonadal problems from pituitary insufficiency. MRI is the examination of choice for radiologic evaluation of the pituitary gland and the hypothalamus but would not be the first diagnostic study to further explore the basis of these manifestations.

*Question:*The surgeon was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which laboratory value? A. Calcium levels B. Potassium levels C. Blood glucose levels D. Sodium and chloride levels

Correct answer: *A* The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not directly influenced by the loss of the parathyroid gland.

*Question:*The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

Correct answer: *A* The patient should select a site on the sides of the fingertips, not on the center of the finger pad as this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

*Question:*A client diagnoses with renal failure has been informed he will need to start dialysis. He is concerned because he has been advised to stop working for a couple months, as his body adjusts to the dialysis. Which nursing diagnosis is most appropriate for this client? A. Ineffective sexuality patterns B. Ineffective role performance C. Disturbed sensory perception D. Posttrauma syndrome

Correct answer: *B* Life roles such as our occupation or profession can constitute a major portion of our identity. The ability to successfully execute societal roles, as well as our own expectations regarding role-specific behaviors (or our role performance), is easily compromised by illness or injury. An appropriate nursing diagnosis for this client is ineffective role performance.

*Question:*An adolescent states, "I want to go to college and learn to be a chef." This is an example of... A. Social self B. Self-expectation C. Self-knowledge D. Self-perception

Correct answer: *B* Self-expectation involves the ideal self, the self a person wants to be.

*Question:*A pediatric nurse is working with a girl 16 years of age who is concerned that her parents will be upset to find out she is pregnant. Based upon Coopersmith's four bases of self-esteem, this adolescent is concerned about which base of self-esteem? A. Power B. Significance C. Competence D. Virtue

Correct answer: *B* Significance is the way a person feels he or she is loved and approved by the people important to that person. Competence is the way tasks that are considered important are performed. Virtue is the attainment of moral-ethical standards. Power is the extent to which a person influences his or her own life and others' lives.

*Question:*Which of the following nurses is most likely to experience the greatest amount of stress related to his or her position as a nurse? A. A nurse with one year of experience working on an oncology unit B. A graduate nurse working on a telemetry unit C. A nurse who is an editor of a nursing journal D. A nurse with 10 years of experience working as a nurse educator

Correct answer: *B* Stress is often greater for new graduate nurses and nurses who work in settings such as intensive care unit and emergency unit

*Question:*A high school student comes to the nurse's office to discuss her anxiety regarding an upcoming test. Her test-taking anxiety is a(an)... A. Threat B. Stressor C. Concern D. Adjustment

Correct answer: *B* Stress, coping, and adaptation are interrelated. Survival depends upon successful coping responses to ordinary and sometimes extraordinary circumstances and challenges

*Question:*A nurse is assessing a client who has recently lost her husband. During an interview the nurse realizes that the client is unable to cope with the loss. The client finds it difficult to organize daily tasks or solve problems effectively. Which suggestion would be most appropriate for the nurse to suggest as a crisis intervention? A. Perform meditation to relax B. Seek assistance from family and friends C. Keep the home environment noise free D. Tense and relax muscle groups systematically

Correct answer: *B* The nurse should suggest that the client seek assistance from family and friends as a crisis intervention. Adequate support during a crisis and its resolution can help clients realistically perceive the problem and reinstitute coping strategies. Performing meditation, tensing and relaxing muscle groups systematically for progressive relaxation, and keeping the home environment noise free and methods to calm and relax the client that may not necessarily help in crisis intervention.

*Question:*A nursing student informs her instructor that she is doing poorly in class because she is not interested in becoming a nurse. She informs the instructor that her mother is a nurse and expected that her daughters would also be nurses. If the student continues to follow the wishes of her mother, what might she develop? A. Self-actualization B. A false self C. The ideal self D. A global self

Correct answer: *B* The nursing student is at risk for developing a false self, which develops in individual who has the emotional need to respond to the needs and ambitions of significant people in their lives. A global self describes the composite of all the basic facts, qualities, traits, images, and feelings one hold about oneself. The ideal self constitutes the self one wants to be. The student will not reach the stage of self-actualization if she does not follow paths of interest and self-fulfillment.

*Question:*The pediatric nurse is caring for a boy 5 years of age, who is being seen in the clinic today. He is very worried that the doctor may harm his body. His mother asks the nurse if this is normal for this age. The nurse shares with the mother that the very young child worries about which of the following related to his body? A. Sexuality and style B. Intactness and mutilation C. Fitness and energy D. Rapid changes

Correct answer: *B* The young child is fearful of bodily mutilation and desires very much to have an intact body. The adolescent worries about the rapid changes occurring to the body. The adult is concerned with fitness, energy, sexuality, and style.

*Question:*Hurricane Katrina in 2005 was a crisis for the residents in New Orleans. What type of crisis was this event? A. Maturational B. Adventitious C. Situational D. Developmental

Correct answer: *B* There are three types of crisis: maturational, situational, and adventitious. Adventitious crises are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, hurricanes, earthquakes, and floods. Maturational crises occur during developmental events that require role change. Situational crises occur when a life event disrupts a person's psychological equilibrium, such as loss of a job or loved one.

*Question:*When children identify sports figures as their heroes, they are experiencing which of the following aspects of self-concept? A. Self-knowledge B. Self-expectations C. Self-evaluation D. Self-actualization

Correct answer: *B* p. 1495. Expectations for the self flow from various sources. The ideal self-constitutes the self one wants to be. These self-expectations develop unconsciously early in childhood and are based on the image of role models such as parents, other caregiving figures, and public figures.

*Question:*A child is able to learn self-recognition in which of the following stages of childhood A. Infancy B. 18 months C. 3 years D. 6 to 7 years

Correct answer: *B* p. 1496. Stages in development of the self include: self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6-7 years).

*Question:*Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test? A. Serum glucose B. Patient weight C. Arterial blood gases D. Patient temperature

Correct answer: *B* A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient's weight drops more than 2 kg at any time. The other assessment parameters do not assess fluid balance.

*Question:*The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

Correct answer: *B* Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.

*Question:*Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? A. A 58-year-old patient with diabetic retinopathy B. A 73-year-old patient who takes propranolol (Inderal) C. A 19-year-old patient who is on the school track team D. A 24-year-old patient with a hemoglobin A1C of 8.9%

Correct answer: *B* Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

*Question:*A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Correct answer: *B* In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.

*Question:*Which of the following statement most appropriately characterizes Type 1 diabetes ? A) Insulin resistance. B) Lack of any insulin production. C) Inadequate insulin production. D) Obesity.

Correct answer: *B* Lewis, p. 1219, Table 49-1. If the students examine this table, they will find that type 2 diabetes is characterized by obesity and lack of exercise, insulin resistance and decreased insulin production over time. Type 1 diabetes is characterized by absent or minimal insulin production.

*Question:*Which one of the following is not a counter regulatory hormone? A) Glucagon. B) Ephedrine. C) Epinephrine. D) Growth factor.

Correct answer: *B* Lewis, p. 1219. There are hormones that work to oppose the effect of insulin. They are glucagon, epinephrine, growth hormone and cortisol.

*Question:*Humalog and NovoLog should be given _______ and regular insulin should be given _______ before meals. A) 1 hour; 30 minutes. B) 0-15 minutes; 30 minutes. C) 20-30 minutes; 15 minutes. D) 30 minutes; 1 hour.

Correct answer: *B* Lewis, p. 1224. Rapid-acting synthetic insulin analogs, which include Lispro (Humalog), aspart (NovoLog) and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected 0-15 minutes before the meal. These rapid acting analogs most closely mimic natural insulin secretion in response to a meal. Short-acting regular insulin has an onset of action 30-60 minutes and should be injected 30-45 minutes before a meal to ensure that the onset of action coincides with meal absorption.

*Question:*Which medication is the one most likely to contribute to hyperglycemia? A) Atenolol (Tenormin). B) Prednisone (Deltasone). C) Allopurinol (Zyloprim). D) Phenelzine (Nardil).

Correct answer: *B* Lewis, p. 1231, Table 49-8. Atenolol (ß-blocker), Phenelzine (monoamine oxidase inhibitor) and allopurinol (xanthine oxidase inhibitor) are listed as those that lower blood glucose. Prednisone is a corticosteroid and is well-known to raise blood glucose.

*Question:*For a finger stick blood sugar (FSBS) less than 40, the patient should be given which of the following: A) 8 ounces diet pop. B) 4-6 ounces fruit juice. C) 8 ounces milkshake. D) 4 packages of sugar mixed in 4 ounces of fruit juice.

Correct answer: *B* Lewis, p. 1246. "A' is not the answer because there is no fast-acting carbohydrate in a diet drink. "C" is not the answer because it may contain fat and fat may slowdown the absorption of sugar and delay the response to treatment. "D" is not the answer because this intervention may be overtreatment of large quantities of fast-acting carbohydrate. This may cause a rapid fluctuation to hyperglycemia and this should be avoided. "B" is the most appropriate treatment.

*Question:*The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."

Correct answer: *B* Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

*Question:*The nurse interviews a 50-year-old man with a history of type 2 diabetes mellitus, chronic bronchitis, and osteoarthritis who has a fasting blood glucose of 154 mg/dL. Which medications, if taken by the patient, may raise blood glucose levels? A. Glargine (Lantus) B. Prednisone (Deltasone) C. Metformin (Glucophage) D. Acetaminophen (Tylenol)

Correct answer: *B* Prednisone is a corticosteroid that may cause glucose intolerance in susceptible patients by increasing gluconeogenesis and insulin resistance. Insulin (e.g., glargine) and metformin (an oral hypoglycemic agent) decrease blood glucose levels. Acetaminophen has a glucose-lowering effect.

*Question:*The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

Correct answer: *B* The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.

*Question:*A 51-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

Correct answer: *B* Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

*Question:*A pediatric nurse understands the concepts surrounding the formation of self-concept and incorporates these concepts into the delivery of her nursing care. Bases upon these concepts, when does an individual learn that the physical self is different from the environment? A. During the school-age years B. During adolescence C. During infancy D. During the preschool years

Correct answer: *C* An infant learns that the physical self is different from the environment. During this period of time, if the infant's basic needs are met, warmth and affection are experienced. The caregiver's anxiety is minimized, and the child begins life with positive feelings about self.

*Question:*Prior to the client's scheduled bone marrow biopsy, the nurse has devoted time to educating him about the rationale and the specific details of the procedure. The nurse's actions constitute what stress management technique? A. Relaxation B. Normalization C. Anticipatory guidance D. Guided imagery

Correct answer: *C* Anticipatory guidance involving preparing a client psychologically for an event in the knowledge that familiarity reduces anxiety. Guided imagery involves the creation of mental image, not education. Relaxation focuses on the control of the body's responses to stress. Normalization is not specific stress management technique.

*Question:*A man age 80 years with a diagnosis of early-stage Alzheimer's disease has recently moved to a long-term facility, largely as a result of his wife's caregiver burnout. What question can the nurse ask to foster the man's sense of self? A. "How are you feeling about being apart from your wife?" B. "How did you feel when you first got your diagnosis? C. "What line of work were you in?" D. "Do you feel like you're adjusting to the routines around here?"

Correct answer: *C* Asking a client about his life experiences and accomplishments can help individuals maintain a sense of self, especially later in life. Issues such as separation from a spouse, adjustment to a new setting, and feelings around a serious diagnosis are important and should be appropriately addresses, but these do not directly address and enhance the client's sense of self.

*Question:*A nurse involved in coordinating a support group for spinal cord injury clients learns that one of the participants in the support group was a college athlete prior to his diving accident. The client informs the group that he earned a scholarship based upon his athletic abilities and not his academic performance, and after the accident, he focused his energies on his studies and has been on the dean's list for two semesters. What defense mechanism illustrated in this scenario? A. Sublimation B. Reaction formation C. Compensation D. Projection

Correct answer: *C* Compensation is overcoming a perceived weakness by emphasizing a more desirable trait or achieving in a more comfortable area. Sublimation involves a person substituting a socially acceptable goal for one whose normal channel of expression is blocked. Projection is a person's thoughts or impulses attributed to someone else. Reaction formation is the development of conscious attitudes and behavior patterns that are opposite to what he or she would really like to do.

*Question:*The client is a single mother of two children who attends college and works full time. She is seeing the college nurse due to a crying outburst in class. The first step of crisis intervention that the nurse employs is what? A. Asking the client, "What would happen if you did this solution?" B. Having the client select an acceptable solution to her problem C. Assisting the client to identify the reason for her outburst D. Outlining several solutions to the crisis with the client

Correct answer: *C* Crisis intervention is a five-step problem-solving technique. The first step is to identify the problem. The other options follow problem identification

*Question:*Family conflict around the care of a recently hospitalized woman has escalated to the point of crisis intervention may be required. What should this process begin with? A. Comparison of the family's situation to other similar situations B. Careful and objective analysis of different proposed options C. Clear identification of the relevant problem D. Presentation of clear, achievable, and evidence-based solutions

Correct answer: *C* Crisis intervention is a problem-solving technique that begins with the identification of the problem. This precedes the identification of options and assessment of proposed solutions

*Question:*A client has just been diagnosed with a brain tumor after recurring headaches prompted his physician to order a CT scan. The client may be experiencing the nursing diagnosis of ineffective denial if he states which of the following? A. "I've done some online research, and there are some really promising new treatments out there" B. "I had a coworker whose wife had a brain tumor and she managed to recover" C. "I really need to get back to my job because i'm falling behind in alot of tasks" D. "I'm going to do anything I can to beat this thing"

Correct answer: *C* Fixating on work responsibilities indicates that the client may be making an attempt to disavow the reality of the situation at hand. Expressions of optimism and determination are often effective responses to an anxiety-provoking situation.

*Question:*The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve? A. The use of progressive tensing and relaxing of muscles to release tension in each muscle group B. The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations C. The mindful use of a word, phrase, or visual image which allows one's self to be distracted and temporarily escape from stressful situation D. Using positive self-image to increase and intensify physical workouts in the gym, which decreases stress

Correct answer: *C* Guided imagery is the mindful use of a word, phrase, or visual image for the purpose of distracting one's self from distressing situations or consciously taking time to relax or re-energize.

*Question:*The children of a woman 60 years of age are distraught at her apparent lack of recovery following a stroke several weeks earlier. The client's daughter has frequently directed harsh criticism toward the nurse, accusing them of a substandard effort in rehabilitating her mother despite their best effort. What defense mechanism may the client's daughter be exhibiting? A. Denial B. Regression C. Displacement D. Sublimation

Correct answer: *C* The daughter may be transferring her feelings about her mother's health status to the care providers, an act that involves the displacement of the emotional reaction to another person. Denial about her mother's potential for recovery may underlie her response, but this is not demonstrated as clearly as displacement.

*Question:*A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confirmed to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nursing diagnosis would the nurse most likely identify for this client? A. Ineffective coping B. Compromised family adjustment C. Caregiver role strain D. Anxiety

Correct answer: *C* The most appropriate nursing diagnosis is caregiver role strain, because the client feels tired and fatigues by struggling to care for her mother and fulfilling family needs. Ineffective coping, compromised family adjustment, and anxiety would be inappropriate nursing diagnoses based on the information provided

*Question:*A single mother age 51 years has been recently diagnosed with multiple sclerosis. As a component of assessment, the nurse has asked the client, "How important is it for you to keep up the day-to-day maintenance of your household?" This question addresses the client's perception of which of the following? A. Virtue B. Significance C. Competence D. Power

Correct answer: *C* The nurse's question addresses the importance of tasks, as well as referencing the client's ability to execute these tasks. This relates to the client's perceptions of competence. If the nurse focused on the client's need to stay in control, this would have related primarily to power; however, the focus on tasks is more indicative of focus on competence.

*Question:*The nurse is assessing for information about the client's self-concept. The information needed first is about which of the following? A. Body image B. Gender identity C. Personal identity D. Sexual orientation

Correct answer: *C* When assessing self-concept, the information needed first is the client's description an individual's conscious sense of who he or she is. Sexual orientation may not be how someone identifies themselves, or may only be a small part of their personal identity. Body image and gender identity may also be only part of their self-identity.

*Question:*Which of the following questions would you expect to find on a self-concept assessment related to body image? A. Do you like who you are? B. Who influenced you the most growing up? C. How do you feel about any physical changes you noticed recently? D. Who would you most like to be?

Correct answer: *C* p. 1501. It is important when conducting the assessment to realize the limitations of self-reporting. Body image is the subjective view a person has about his or her physical appearance. Body image disturbances can be expected with any alteration in bodily appearance, structure, or function. Appropriate questions to ask would be: "describe your body to me" or "what do you like most/least about your body?", or IS there anything about your body that you would like to change".

*Question:*Which of the following questions would best relate to self-identity on a focused self-concept assessment? A. Would you like to be? B. What do you like most about your body? C. What are your personal strengths? D. Do you like being a teacher?

Correct answer: *C* p. 1501. When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is. "How would you describe yourself to others?". Look for personal characteristics and traits, strengths, and fears.

*Question:*A student nurse who has not maintained healthy relationships with his/her peers would be at risk for which of the following self-concept disturbances? A. Personal identity disturbance B. Body image disturbance C. Self-esteem disturbance D. Altered role performance

Correct answer: *C* p. 1506. Low self-esteem includes feeling unloved or unapproved of by significant others, feelings of incompetence, failure to live according to personal moral ethical code, and powerlessness.

*Question:*When instructing a patient regarding a urine study for free cortisol, what is most important for the nurse to tell the patient? A. Save the first voided urine in the morning. B. Maintain a high-sodium diet 3 days before collection. C. Try to avoid stressful situations during the collection period. D. Complete at least 30 minutes of exercise before collecting the urine sample.

Correct answer: *C* A urine study for free cortisol requires a 24-hour urine collection. The patient should be instructed to avoid stressful situations and excessive physical exercise that could unduly increase cortisol levels. The patient should also maintain a low-sodium diet before and during the urine collection period.

*Question:*The nurse is caring for a group of older patients in a long-term care setting. Which physical changes in the patients should the nurse investigate as signs of possible endocrine dysfunction? A. Absent reflexes, diarrhea, and hearing loss B. Hypoglycemia, delirium, and incontinence C. Fatigue, constipation, and mental impairment D. Hypotension, heat intolerance, and bradycardia

Correct answer: *C* Changes of aging often mimic clinical manifestations of endocrine disorders. Clinical manifestations of endocrine dysfunction such as fatigue, constipation, or mental impairment in the older adult are often missed because they are attributed solely to aging.

*Question:*The nurse is caring for a 36-year-old woman with possible hypoparathyroidism after a thyroidectomy. It is most appropriate for the nurse to assess for which clinical manifestations? A. Polyuria, polydipsia, and weight loss B. Cardiac dysrhythmias and hypertension C. Muscle spasms and hyperactive deep tendon reflexes D. Hyperpigmentation, skin ulcers, and peripheral edema

Correct answer: *C* Common assessment abnormalities associated with hypoparathyroidism include tetany (muscle spasms) and increased deep tendon reflexes. Hyperpigmentation is associated with Addison's disease. Skin ulcers occur in patient with diabetes. Edema is associated with hypothyroidism. Polyuria and polydipsia occur in patients with diabetes mellitus or diabetes insipidus. Weight loss occurs in hyperthyroidism or diabetic ketoacidosis. Hypertension and cardiac dysrhythmias may be caused by hyperthyroidism, hyperparathyroidism, or pheochromocytoma.

*Question:*Which of the following are symptoms of mild hypoglycemia? A) Coma, seizures. B) Fatigue, headache, slurred speech. C) Tremors, hunger, weakness. D) Blurred vision, bradycardia, dizziness.

Correct answer: *C* Lewis, p. 1242, Table 49-17 has the comparison of hyperglycemia and hypoglycemia. The student should know the major differences between hypoglycemic and hyperglycemia symptoms. Common manifestations of hypoglycemia can mimic alcohol intoxication. Symptoms include: confusion, irritability, diaphoresis, tremors, hunger, weakness and visual disturbances. Hyperglycemia, especially from type 1 diabetes is primarily manifested by polyuria, polyphasia, and polydipsia. Weakness and fatigue can also be exhibited. Those symptoms commonly found with hyperglycemia episode from type 2 diabetes included recurrent infections, prolonged wound healing and visual changes.

*Question:*A client with type II diabetes mellitus demonstrates a finger stick blood sugar (FSBS) of 120 mg/dL, a temperature of 101 degrees Fahrenheit , pulse of 88, respirations (RR) of 22, and blood pressure (BP) of 140/84 mm Hg. Which finding would be of most concern to the nurse? A) BP. B) RR. C) Temperature. D) Pulse.

Correct answer: *C* Lewis, p. 1251. The temperature of this client is a clue that he/she may be experiencing an infection. This situation will require more intense management, such as extra insulin to maintain glycemic goals and avoid hyperglycemia.

*Question:*The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.

Correct answer: *C* Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

*Question:*A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration.

Correct answer: *C* This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

*Question:*Upon assessment of a client being evaluated at the headache clinic, the client informs the nurse that her headaches started when she started experiencing marital problems. The client reports that each time she and her husband have a fight, she develops a headache and loses her appetite for several days. Which of the following best defines the physiologic symptoms? A. Anxiety B. Fear C. A coping mechanism D. A psychosomatic disorder

Correct answer: *D* A psychosomatic disorder is a real illness cause by psychological influences. The client's fight with her husband causes emotions that lead to physical symptoms. Anxiety is vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fear is a cognitive response to a known threat. Anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety.

*Question:*A client 57 years of age with breast cancer needs a bilateral mastectomy. Having already established a strong therapeutic partnership with the client, how can the nurse best assess the client's self-concept in light of this bodily change? A. "Do you have any friends or family members who have had breast cancer?" B. "How do you think that you'll accommodate this change in your daily routines?" C. "Has anyone talked to you yet about your options for breast reconstruction?" D. "Now that it's completed, how are you feeling about the surgery that you had?"

Correct answer: *D* Assessment of a client's self-concept is challenging for the nurse; an open-ended question to the client may elicit the client's feelings on this matter. Discussing reconstruction, peers in similar circumstances, or the influence of the surgery on the client's lifestyle are probably less likely to facilitate assessment of the client's self-concept.

*Question:*A nurse has been forced to accept numerous overtime shifts over the past several months in an effort to meet her personal financial obligations. The nurse now describes herself as "burned out", a condition that is comparable to what stage of anxiety? A. Resistance B. Recovery C. Alarm D. Exhaustion

Correct answer: *D* Burnout is comparable to the exhaustion stage of anxiety; both occur following prolonged alarm and resistance, but the positive outcome of rest and recovery is not attained

*Question:*Which of the following factors is most likely to present a challenge to the self-concept of a man 79 years of age? A. Assisting his grandchildren with their college tuition costs B. The realization that his children are themselves undergoing age-related changes C. The man's increasing level of dependence on his children D. Financial pressures associated with the depletion of his savings

Correct answer: *D* Dependency near the end of life can present a significant challenge to an individual's self-concept. Helping his grandchildren with the costs of education and facing financial challenges may be difficult, but these are likely less of a threat to self-concept that the realization of decreasing independence. The aging of the man's children is less likely to affect his own self-concept.

*Question:*A group of nursing students is learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress? A. Parasympathetic nervous system B. Respiratory system C. Endocrine system D. Sympathetic nervous system

Correct answer: *D* Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response

*Question:*A client with uncontrolled hypertension experienced a stroke one week ago, leading to significant motor losses. A successful and normal adaptive response to these new limitations is evident if the client... A. changes the subject when the nurse addresses activities of daily living (ADLs). B. repeatedly states, "It is what it is" C. refuses to participate in physiotherapy D. exhibits signs of grief

Correct answer: *D* Grief is a normal response to a recent deformity or limitation. Changing the subject and refusing treatment would be considered maladaptive responses. Stating that "it is what it is" may possibly signal resignation and defeat, neither of which associated with an adaptive response.

*Question:*The nurse is working with a client to assist him in "reframing" his thoughts regarding his new diagnosis of diabetes. Which of the following best defines reframing? A. Altering a perception of a situation from a positive view to a negative view B. Ignoring the negative aspects of a situation C. Ignoring the positive aspects of a situation D. Altering a perception of a situation from a negative view to a positive view

Correct answer: *D* Helping a client to alter his perspective of a situation from a more negative view to a more positive view is known as "reframing." Reframing does not involve ignoring positive or negative aspects of a situation but seeking the positive aspects to enhance coping skills, behavioral options, or internal and external supports.

*Question:*Which of the following is an appropriate intervention for body image disturbance? A. Assuming self-care behaviors for the client B. Focusing on assisting the client through the sequential stages of loss and grief without returning to prior stages C. Discouraging crying or feelings of depression D. Assisting the client in exploring thoughts and feelings related to body image changes

Correct answer: *D* Interventions for body image disturbances include assisting the client in exploring thoughts and feelings related to body image changes; encouraging the client to participate in self-care behaviors as able; understanding there is no correct way to progress through the various stages of loss and grief; and allowing the client to feel depressed, to cry, and be angry.

*Question:*How can nurses who provide care in long-term care settings best enhance the self-esteem of older adults who reside in these facilities? A. Provide opportunities for the residents to engage with children and teenagers. B. Encourage residents to talk openly about their opinions. C. Ensure that residents are not presented with tasks that carry a risk of failure. D. Maximize the autonomy of residents in organizing their routines.

Correct answer: *D* Maximizing autonomy and control is likely to enhance the self-esteem of older adults who may be very aware of their increasing dependence and loss of control. Encouraging frank discussion and interaction with other generations are also positive interventions, but these are less direct methods of fostering self-esteem. It is inappropriate to completely remove all risk of failure from adults' activities.

*Question:*A nurse is assisting a neurologist, who is assessing the norepinephrine level of a client with complaints of stress. Which of the following functions does norepinephrine preform? A. Transmit sensations of pain B. Promote coordinated movement C. Stabilize mood and regulate temperature D. Heighten arousal and increase energy

Correct answer: *D* Norepinephrine heightens arousal and increases energy. Acetylcholine and dopamine promote coordinated movement. Serotonin stabilizes mood, induces sleep, and regulates the temperature of a person. Substance P transmits the sensation of pain, whereas endorphins are enkephalins interrupt the transmission of substance P and promote a sense of well-being

*Question:*An infant who was born with Down syndrome, gastrointestinal anomalies, and cardiac defects has required nearly continuous hospitalization in the neonatal intensive care and pediatric care units of the hospital during her first year of life. This infant's prolonged hospitalization may have a negative influence on her development of which of the following? A. Self-concept B. Pride C. Power D. Attachement

Correct answer: *D* Prolonged hospitalization has a strong potential to interfere with the formation of the interpersonal bond between the child and his or her parents. This long course of treatment in the hospital is less likely to have a direct effect on the child's pride, power, and self-concept, though these are also reasonable possibilities.

*Question:*The nurse is assisting an adolescent female with the identification and recognition of personal strengths. Which of the following is a technique the nurse will employ? A. Encourage the client to reflect upon her life and reminisce B. Define the client's strengths and convince the patient of these strengths C. Encourage the client to learn from the negative events in her life D. Encourage the client to identify strengths and ways to gain strengths she desires

Correct answer: *D* Specific strategies that can be used to help clients identify and use personal strengths include encouraging the client to identify strengths, and ways to gain strengths they desire. Reflection and reminiscence work well for the older adult but are not particularly helpful for the adolescent. Encouraging the client to replace negative thoughts with positive thinking.

*Question:*A middle-aged woman's father has passed away, and her mother requires physical and emotional help due to disabilities. The woman is married and raising two children, along with working full time. All of the factors described are what? A. Illnesses B. Demands C. Stimuli D. Stressor

Correct answer: *D* Stress is defined as any event or set of events (a stressor) that causes a response. Everyday triggers associated with work or social relationships, and uncommon events such as natural disasters, physical trauma, injuries, illnesses, divorce, death of the loved one, or loss of a job commonly recognized stressor

*Question:*A construction worker age 33 years experienced a fall on a job site that resulted in a spinal cord injury. In recent days, the client has alluded to the fact that he feels "useless" because he now sees himself as "a burden instead of a provider." The nurse would be justified in choosing interventions to... A. promote the client's independence in activities of daily living B. help the client develop a positive body image C. enhance the client's mobility D. modify the client's negative self-concept

Correct answer: *D* The client's statements reveal a strongly negative self-concept, a fact that the care team should address in an appropriate way. The client's statements relate more to his role that his body image. Enhancing his mobility and ADLs may be beneficial, but these will not necessarily change the fundamental way in which the client sees himself.

*Question:*The nurse is preparing to asses a client newly admitted to the behavioral health unit. Assessing the client's self-concept will focus on questions related to which of the following? A. History of hypertension B. Level of pain C. Signs of infection D. Body image

Correct answer: *D* The nurse assessing self-concept focuses on the client's personal identity, body image, self-esteem, and role performance.

*Question:*A nurse is caring for a pregnant client in labor. Which of the following techniques should the nurse instruct the client to do to manage stress? A. Thought stopping B. Biofeedback C. Low-intensity exercise D. Deep breathing

Correct answer: *D* The nurse should suggest that the client take deep breaths to manage stress related to childbirth. Low-intensity exercise, thought stopping, and biofeedback are inappropriate relaxation techniques when the client is in labor.

*Question:*Which of the following responses to stressors results from the activation of the local adaptation syndrome? A. A man is experiencing moderate anxiety before meeting with an important client B. A woman's impeding job interview has prompted the activation of her flight-or-flight response C. A man has a sudden urge for a bowel movement before undergoing thoracentesis D. A girl quickly withdraws her hand from a steam of hot tap water

Correct answer: *D* The reflex pain response is a response to a physiological stress that is a component of the local adaptation syndrome. Psychological anxiety and the activation of the fight-or-flight response are not considered to be manifestations of the local adaptation syndrome

*Question:*A child age 5 years wakes up at night and finds he has wet the bed. He feels embarrassed that he had this accident and sleeps in the wet bed all night, afraid to tell his parents. In the morning, he wakes up early, gets dressed, and hides his pajamas because he still feels shame for this accident. This child is experiencing which feeling of self-evaluation? A. Pride B. Guilt C. Anxiety D. Shame

Correct answer: *D* Three major self-evaluation feelings or affects found in individuals are: (1) pride, based on positive self-evaluation; (2) guilt. based on behaviors incongruent with ideal self; and (3) shame, associated with low global self-worth. These affects are learned in early childhood within relationships with significant others and maintained through practice. Anxiety is discussed in the theories on self-concept, according to Sullivan.

*Question:*A client with a diagnosis of colon cancer has required the creation of an ostomy following bowel surgery. What factor is most likely to influence the client's adjustment to this change? A. The client's knowledge of a peer who also as an ostomy B. The specific location of the ostomy C. The prognosis of the client's cancer after surgery D. The coping mechanisms that the client possesses

Correct answer: *D* While having a peer with a similar challenge is likely to facilitate adjustment to a change such as this, the most significant consideration is likely the client's own coping mechanisms. This factor supersedes the client's prognosis or the location of the ostomy.

*Question:*When a nurse asks a patient to describe her personal characteristics and traits, the nurse is most likely assessing the patient for which of the following self-concept factors? A. Body image B. Role performance C. Self-esteem D. Personal identity

Correct answer: *D* p. 1501 When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is

*Question:*The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

Correct answer: *D* A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

*Question:*A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient teaching related to which diagnostic test? A. Thyroid scan B. Fasting glucose test C. Oral glucose tolerance D. Water deprivation test

Correct answer: *D* A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not directly related to the diagnosis of diabetes insipidus.

*Question:*An 18-year-old male patient is undergoing a growth hormone stimulation test. The nurse should monitor the patient for A. hypothermia. B. hypertension. C. hyperreflexia. D. hypoglycemia.

Correct answer: *D* Insulin or arginine (agent that stimulates insulin secretion) is administered for a growth hormone stimulation test. The nurse should monitor the patient closely for hypoglycemia. Hypothermia and hypertension are not expected in response to insulin or arginine. Hyperreflexia is an autonomic complication of spinal cord injury.

*Question:*A patient is exhibiting hyperglycemia. A priority nursing diagnosis would be: A) Knowledge deficient: disease process and treatment. B) Imbalanced nutrition: less than body requirements. C) Disabled family coping: compromised. D) High risk for fluid volume deficient.

Correct answer: *D* Lewis, p. 1242, Table 49-17. By examining the table, one compares manifestations of hypoglycemia with hyperglycemia. With hyperglycemia, there is increases urination, which places the patient at high risk for fluid volume deficit, which is a priority over knowledge deficit, imbalanced nutrition and disabled family coping (losing fluid is always a priority over less than nutritional requirements). Hyperglycemia produces an osmotic effect which produces polyuria, polydipsia and polyphagia.

*Question:*For a person with diabetes, which hemoglobin A1c test result is the most desirable? A) 11.5. B) 2. C) 9. D) 6.5.

Correct answer:*D* Lewis, p. 1222. For people with diabetes, the ideal A1C goal is 7.0% or less, according to the American Diabetes Association. The American College of Endocrinology recommends an A1C of less than 6.5%.

*Question:*A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. E. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

Correct answers: *A C D* The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.

*Question:*The ICU nurse is caring for a man 63 years of age who has has a stroke. He is on a ventilator and is not expected to live. The physician has recommended to the client's wife that her husband be made a DNR patient. As the nurse talks with the client's wife and tries to comfort her, she recalls from prior reading that Aguilera described three factors that determine's a person's response to crisis. Those factors are the person's... Choose all that apply. A. Perception of the event B. Family and friends C. Church and support group D. External resources E. Internal resources

Correct answers: *A D E* Aguilera (1998) described three factors that determine a person's response to crisis: (1) the person's perception of the event or situation, (2) the person's situational supports (external resources), and (3) the coping mechanism the person possesses (internal resources)

*Question:*Which of the following are bases of self-esteem as identified by Coppersmith (1967)? Select all that apply. A. Consequence B. Significance C. Competence D. Importance E. Capacity F. Power

Correct answers: *B C F* p. 1495. Coppersmith (1967) identified the four bases of self-esteem as: 1. Significance, 2.Competence, 3. Virtue, and 4. Power.