Health and Illness Exam 2

The nurse is caring for a client newly diagnosed with Hypothyroidism and teaching about Levothyroxine. The client requires further teaching when they state which of following? A. "I took my thyroid medication 30 minutes ago, so now I am able to eat." B. "I am glad my breakfast is her so I can take my thyroid medication right before I eat." C. "While I love seafood, I need to make other food choices." D. "Kelp is not good for me when taking this medication."

"I am glad my breakfast is here so I can take my thyroid medications right before I eat." • pts taking thyroid meds need to wait at least 30 minutes before eating a meal. avoid foods high in iodine like seafood, kelp, dairy, and iodized salt

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? A. "I need to stop my insulin." B. "I need to monitor my blood glucose every 3 to 4 hours." C. "I need to increase my fluid intake." D. "I need to call the health care provider (HCP) because of these symptoms."

"I need to stop my insulin." Insulin should never be stopped immediately

The nurse has taught a patient admitted with diabetes 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 look at the condition of my feet every day." B. "I like when I go out to eat dinner with my husband because I enjoy wearing my high heels." C. "I should only walk barefoot in nice dry weather." D. "I am lucky my shoes fit so nice and tight because they give me firm support."

"I should look at the condition of my feet every day."

The nurse has completed discharge instructions for a client with application of a halo device. Which statement indicates that the client needs further clarification of the instructions? A. "I will use a straw for drinking." B. "I will be careful because the device alters balance." C. "I will wash the skin daily under the lamb's wool liner of the vest." "I will drive only during the daytime."

"I will drive only during the daytime." pts cannot drive on when using this device

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I will take a brisk 30-minute walk 3-5 days per week three times a week." B. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." C. "I will go running each day when my blood sugar is too high to bring it back to normal." D. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen."

"I will take a brisk 30-minute walk 3-5 days a week three times a week."

A client has fallen and sustained a leg injury. Which question would the nurse ask to help determine if the client sustained a fracture? A. "Does the pain feel like the muscle was stretched?" B. "Is the pain a dull ache?" C. "Is the pain sharp and continuous?" D. "Does the discomfort feel like a cramp?"

"Is the pain sharp and continuous?"

An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? A. "The medication prevents sodium and water retention after surgery." B. "The drug prevent clots from forming in the legs during your recovery from surgery." C. "This drug stimulates your immune system and promotes wound healing." D. "This medicine is given to help your body respond to stress after removal of the adrenal glands."

"This medicine is given to help your body respond to stress after removal of the adrenal glands."

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? A. "You will develop type 2 diabetes within 5 years." B. "The test is normal, and diabetes is not a problem." C. "You are at increased risk for developing diabetes." D. "The laboratory test result is positive for type 2 diabetes."

"You are at an increased risk for developing diabetes."

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply A. persistent lethargy B. loss of body hair and feeling cold C. puffiness of the face D. tremors and weight loss

- persistent lethargy - loss of body hair and feeling cold - puffiness of the face tremors and weight loss are signs of hyperthyroidism

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply. A. bone pain B. headache C. polyuria D. weight gain

- polyuria - bone pain PTH role is to maintain serum calcium levels. When PTH is too high, is causes bone resorption (calcium is pulled out of the bones)

A client has had type 2 diabetes for the past 5 years and is admitted for a myocardial infarction. The client is concerned about having another MI and is asking what caused this one. Which would be high priority when discussing diabetes management practices and the risks of another MI? Choose all that apply. A. checking foot care practices B. determining treatment for hypoglycemia C. reviewing prior BGLs D. reviewing prior blood pressure readings

- reviewing prior BGLs and prior blood pressure readings

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder may be developing. Select all that apply. A. lethargy B. tremors and confusion C. bradycardia D. fever and nausea

- tremors and confusion - fever and nausea THYROID STORM uncontrolled hyperthyroidism

A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse should include which measures in the plan of care to minimize the risk of occurrence? Select all that apply. Scroll down to see the 5 answer choices. A. keeping the linens wrinkle-free under the client B. preventing unnecessary pressure on the lower limbs C. Ensuring that the client has a BM at least once a week D. Limiting bladder catheterization to once every 12 hrs E. Turning and repositioning the client at least every 2 hours

A, B, & E

Thyroid storm can be caused by the following: Select all that apply. A. severe infection B. stress C. manipulation of the thyroid gland during surgery and the release of thyroid into the bloodstream D. controlled hyperthyroidism

A, B, C

The nurse is caring for a client who has been placed in Buck's extension traction while awaiting surgical repair of a fractured femur, the nurse would perform a complete neurovascular assessment of the affected extremity that includes which interventions. Select all that apply. Scroll down to view all 5 answer choices. A. Capillary refill of the affected toes B. Pulse in the affected extremity C. Level of pain in the affected leg D. Bilateral lung sounds E. Skin color of the affected extremity

A, B, C, & E

Exophthalmos is a common finding among patient with hyperthyroidism. What can the nurse do to help the patient with this condition? Select all that apply. A. encourage the use of dark glasses B. tape eyelids shut at night if needed C. provide a warm blanket D. administer artificial tears for comfort

A, B, D

The nurse is managing a client with DKA. What management intervention is incorrect in the management of a client with DKA? A. infuse normal saline (0.9%) tp replace fluid loss B. assess potassium levels 2 hours after treatment because potassium shifts affect the heart C. assess vital signs and monitor ketone levels D. administer regular insulin as ordered

Assess K+ levels 2 horus after treatment because K+ shifts affect the heart

Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? A. HR 120, BP 22/102, temp 103.2 B. HR 35, BP 60/43, temp 95.3 C. soft hair. irritable, diarrhea D. constipation, drowsiness, goiter

HR 120, BP 22/102, temp 103.2

Describe how diabetic ketoacidosis could develop in a patient with Type 1 DM, who has undergone surgery.

In a patients with Type I DM who have surgery, they may experience extra stress in the body or could be developing an infection, which would cause ketoacidosis.

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? A. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal. B. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. D. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals.

It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

A client with a C4 spinal cord injury has been placed in traction with cervical tongs. Nursing care should include: A. performing sterile pin care as ordered B. Releasing the traction for five minutes each shift C. Elevating the head of the bed 90º D. Loosening the pins if the client complains of headache

Performing sterile pin care as ordered

The nurse is caring for a client who has been given radioactive iodine for the treatment of their hyperthyroidism. The patient vomits after treatment. The nurse knows which important information regarding the emesis from this patient? A. This is not a common occurrence and the HCP must be notified immediately B. Clean the emesis immediately as it is a danger to the patient C. The patient is fine and there is no immediate danger to the patient or the nurse D. Proceed with caution because the emesis is radioactive

Proceed with caution because the emesis is radioactive

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? a. Increased appetite and weight loss b. Puffiness of the face and hands c. Nervousness and tremors d. Thyroid gland swelling

Puffiness of the face and hands

The nurse is caring for a patient with hypothyroidism. The patient states they have been taking their thyroid medication as prescribed but states they are now experiencing fatigue, brittle nails, dry hair, dry skin and feeling cold. They also share they have 10 pounds of unexplained weight gain. The nurse suspects which of the following? A. The patient is not telling the truth about taking their medication as prescribed B. The patient is exaggerating and needs to be told this is normal C. The patient may need an adjustment in their medication D. The patient may need to stop taking their medication

The patient may need an adjustment in their medication

Thyroid storm is an acute and life-threatening condition that occurs in clients with uncontrollable hyperthyroidism. True or False

True

What are the signs and symptoms of hyperthyroidism?

agitation, confusion, exopthalamos (grape eye), high BP, tachycardia, high RR, diarrhea *THINK HIGH & HOT* *THINK THYROID STORM* *THINK HYPER TIGGER*

Paralysis from the damaged cellular structures (neurons) in a client with a spinal cord injury may affect: (choose all that apply) A. mobility B. sexual function C. sensation D. bladder and bowel function

all answers are correct

Myxedema coma can be precipitated by which of the following? Select all that apply. A. hyperthermia B. use of sedatives and opioid analgesics C. acute illness D. rapid withdrawal of thyroid med E. anesthesia and surgery

all except hyperthermia

A client is admitted to the hospital with a suspected diagnosis of Graves' disease. On assessment, which manifestation related to the client's menstrual cycle would the nurse expect the client to report? A. dysmenorrhea B. amenorrhea C. menorrhagia D. menorrhagia

amenorrhea

The nurse is checking the laboratory results of an adult client with type 1 diabetes (see below). What laboratory result indicates a problem that should be managed? Blood glucose: 192mg/dL Total cholesterol: 201 mg/dL Hemoglobin: 12.3 mg/dL Low-density lipoprotein (LDL) cholesterol: 125 mg/dL A. blood glucose B. hemoglobin C. LDL cholesterol D. total cholesterol

blood glucose

The nurse performs a neurovascular assessment on a client with a newly applied cast. The nurse would determine that there is a need for close observation and a need for follow-up if which is noted? A. Palpable pulses distal to the cast B. cap refill greater than 6 seconds C. Sensation when the area distal to the cast is pinched D. Blanching of the nail bed when it is depressed

cap refill greater than 6 seconds

A patient with type 1 diabetes calls the clinic reporting nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to: A. check the blood glucose level every 2-4 hours B. withhold the regular dose of insulin C. use a less strenuous form of exercise than usual until the illness resolves D. drink cool fluids with high glucose content

check the blood glucose levels every 2-4 hours

During the postoperative period, the client who underwent a hip replacement reports pain the calf area. What action would the nurse take? A. ask the client to walk and observe the gait B. check the calf area for temp , color, and size C. lightly massage the calf area to relieve the pain D. Administer as needed (PRN) morphine sulfate as prescribed for postoperative pain

check the calf area for temp, color, and size

The nurse is performing pin-site care on a client in skeletal traction. Which normal finding would the nurse expect to note when assessing the in sites? A. redness and swelling around the pin sites B. numbness at the pin sites C. warm skin around the pin sites D. clear drainage from the pin sites

clear drainage from the pin sites

The fracture when bone is broken into many fragments: A. Open fracture B. greenstick C. oblique D. comminuted

comminuted

fracture that breaks through the skin: A. compound B. oblique C. comminuted D. none

compound (open)

A client with DM demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the most appropriate intervention to decrease the client's anxiety? A. Convey empathy, trust, and respect towards the client B. Ignore the signs and symptoms of anxiety, anticipating that they will son disappear. C. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening. D. Administer a sedative.

convey empathy, trust, and respect toward the client

A nurse is assessing a child suspected of having type 1 diabetes mellitus (DM). Which question should the nurse ask the parents to validate the diagnosis? A. "how much exercise does the child get?" B. "does the child complain of headaches?" C. "Does the child have urinary frequency?" D. "Has the child gained a lot of weight?"

does the child have urinary frequency

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in visions, and being anxious but does not have a portable blood glucose monitor present. Which priority action should the nurse advise her to take? A. drink some diet soup B. eat 15g of carbs C. eat a piece of cheese pizza D. take an extra dose of rapid-acting insulin

eat 15g of carbs

The nurse plans a class for patients who have newly diagnosed type 2 diabetes. Which goal is most appropriate? A. Enable the patients to become active participants in the management of their disease B. Make all patients responsible for the management of their disease C. Provide the patients with as much information as soon as possible to prevent complications D. Involve the family and significant others in the care of these patients

enable the patients to become active participants in the management of their disease

A pt sustained a fracture to the femur. The pt has suddenly become confused, restless, and has a RR of 40 bpm. Based on the location of a fracture and the presenting symptoms, the pt may be experiencing what kind of complications? A. Compartment syndrome B. osteomyelitis C. fat embolism D. hypovolemia

fat embolism

An adult client who experienced a fractured left tibia has a long leg cast and is using crutches to ambulate. In caring for the client, the nurse assesses for which sign/symptom that indicates a complication associated with crutch walking? A. weak biceps brachii B. forearm muscle weakness C. left leg discomfort D. triceps muscle weakness

forearm muscle weakness

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 within the last 3 months? - prealbumin level - urine ketone level - fasting glucose level - glycosylated hemoglobin level (HgA1c)

glycosylated hemoglobin level (HgA1c)

In a client with Graves Disease, which clinical manifestation would the nurse expect a client to report? A. bradycardia B. heat intolerance C. lethargy D. cold, clammy skin

heat intolerance Common signs and symptoms of Graves' disease include: - Anxiety and irritability - A fine tremor of the hands or fingers - Heat sensitivity/intolerance and an increase in perspiration or warm, moist skin - Weight loss, despite normal eating habits - Enlargement of the thyroid gland (goiter) - Change in menstrual cyclesErectile dysfunction or reduced libido - Frequent bowel movementsBulging eyes (Graves' ophthalmopathy) - FatigueThick, red skin usually on the shins or tops of the feet (Graves' dermopathy) - Rapid or irregular heartbeat (palpitations) - Sleep disturbance

What are the labs for hyperthyroidism?

high T3 & T4, low TSH *note: always look at T3 and T4 first!!!*

The nurse is caring for a patient with type 1 diabetes who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? A. fluid overload B. hypoglycemia C. hypokalemia D. hyperphosphatemia

hypokalemia Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate levels. A patient with diabetic ketoacidosis will be dehydrated (fluid volume deficit), and blood glucose levels would be elevated (hyperglycemia).

A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. pheochromocytoma B. hyperthyroidism C. thyroid storm D. hypothyroidism

hypothyroidism

What are some factors that effect fracture healing?

infection, age, nutrition, activity level, blood supply

A client who experienced a fractured right ankle has a short leg cast applied in the emergency department. During discharge teaching, which information would the nurse provide to the client to prevent complications? A. trim the rough edges of the cast after it is dry B. weight bearing on the right leg is allowed once the cast feels dry C. keep the right ankle elevated above the heart level with pillows for 24hrs D. expect burning and tingling sensations under the cast for 3-4 days

keep the right ankle elevated above the heart level with pillows for 24hrs

The nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the health care provider immediately? A. abdominal cramps B. laryngeal stridor C. difficulty swallowing D. mild to moderate incisional pain

laryngeal stridor Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration; stridor is caused by compression of the trachea, leading to respiratory distress

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120mg/dL. The nurse will first plan to teach the patient about _____. A. lifestyle changes to lower blood glucose B. self-monitoring of blood glucose C. using low doses of regular insulin D. effects of oral hypoglycemic medications

lifestyle changes to lower blood glucose

What are the labs of hypothyroidism?

low T3 & T4, high TSH *note: always look at T3 and T4 first!!!*

What are the signs and symptoms of hypothyroidism?

low T3 & T4, high TSH, low BP, low HR, low RR, hair loss, low metabolism (weight gain), amenorrhea, apathy/confusion *think lOw and slOw* *PRIORITY: keep trach kit by bedside*

A client is admitted to an emergency department and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? A. administer fluid replacement B. warm the client C. maintain a patent airway D. administer IV thyroid hormone replacement

maintain a patent airway

The nurse is caring for a client who had an orthopedic injury of the leg that required surgery and the application of cast. Postoperatively, which nursing assessment is of highest priority to assure client safety? A. monitoring for blanching ability of toe nail beds B. monitoring for heel breakdown C. monitoring for extremity D. monitoring for bladder distention

monitoring for blanching ability of toe nail beds

What is a fracture that is slanted across the bone shaft? A. transverse B. spiral C. oblique D. compound

oblique

What are the 6 P's of a neurovascular assessment?

pain pallor paresthesia paralysis poikilothemia pulse

The nurse is assessing the casted extremity of a client for signs of infection. Which finding is indicative of the presence of an infection? A. presence of warm areas on the cast B. diminished distal pulse C. coolness and pallor of the skin D. dependent edema

presence of warm areas on the cast

What is a late sign of compartment syndrome? A. Paralysis B. pain C. parethesia D. Pulselessness

pulselessness

A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? A. ask the patient about home insulin dose B. start an insulin infusion at 0.1 units/kg/hr C. adminiser IV K+ supplements D. put the patient on a heart monitor

put the patient on a heart monitor the cardiac rhythym must be assessed first before any treatment

The nurse is caring for a patient with DKA and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? A. Respiration that are abnormally slow B. Respiration that cease for several seconds C. Respirations that are shallow D. Respirations that are abnormally deep and increased in rate

respirations that are abnormally deep and increased in rate Kussmaul's respirations has the pattern of rapid, deep breathing associated with dyspnea. This is the body's attempt to reverse metabolic acidosis through the exhalation of excess CO2, occurring in DKA patients.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? A. edema at the surgical site B. hypoglycemia C. level of hoarseness D. respiratory distress

respiratory distress • swelling at the surgical site

Which of the following methods would be the preferred method to use when performing physical assessment (palpation) of the thyroid gland? A. Stand in front of the client, place fingers above the trachea, have the client flex the head, and ask the client to swallow B. Stand behind the client, place the fingers on either side of the trachea below the thyroid cartilage, have the client tilt the head to the right and swallow C. Stand behind the client, place the fingers above the jugular notch, have the client extend the head and swallow D. Stand in front of the client, place fingers slightly above the thyroid cartilage, have the client extend the head and swallow

stand behind the client, place the fingers on either side of the trachea below the thyroid cartilage, have the client tilt the head to the right and swallow

A patient being discharged home for treatment of hypothyroidism. Which med is most commonly prescribed for this condition? A. tapazole B. PTU C. synthroid D. inderal

synthroid

A female client with hypothyroidism is receiving levothyroxine, 25mcg P.O. daily. Which finding should the nurse recognize as an adverse effect?

tachycardia

The nurse gives corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? A. the patient is alert and oriented B. the patient's lung sounds are clear C. the patient's urinary output decreases D. the patient's potassium level is 5.7 mEq/L

the patient is alert and oriented

The nurse is caring for a patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? A. The patient makes harsh, vibratory sounds when breathing B. The patient reports a sore throat when swallowing C. The patient supports her head when moving in bed D. The patient reports of increased thirst

the patient makes harsh, vibratory sounds when breathing

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? A. clear, watery drainage from the pin sites B. pain on palpation at the pin sites C. redness around the pin sites D. thick, yellow drainage from the pin sites

thick, yellow drainage from the pin sites

The nurse prepares to transfer the client with a newly applied leg cast into the bed using which method? A. placing ice on top of the cast B. supporting the cast with the fingertips only C. asking the client to support the cast during transfer D. Using the palms of the hands and soft pillows to support the cast

using the palms of the hands and soft pillows to support the cast

The nurse, caring for a client with Buck's traction, is monitoring the client for complications of the traction. Which assessment finding indicates a complication of this form of traction? A. weak pedal pulses B. complaints of leg discomfort C. toes are warm and demonstrate a brisk cap refill D. drainage at the pin sites

weak pedal pulses

Which of the following is not a symptom of hyperglycemia? A. Polydipsia B. weight gain C. Polyuria D. Polyphagia

weight gain

What are the characteristics of HHNS?

• older and slower • BGL 600+ • higher fluid loss / more dehydration • patients die from hypovolemia

What are the characteristics of DKA?

• patients usually die from hypokalemia • BGL of 250-500 • faster & younger (D comes first in alphabet) • ketones & Kussmaul resp. • acidic!!!! <7.35