missing Chapter 47: Assessment of Endocrine System

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. fresh fruits. 2. dairy products. 3. processed meats. 4. cereals and grains.

1 Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

The nurse is performing discharge teaching for a client diagnosed with Cushing'sdisease. Which statement made by the client demonstrates an understanding of theinstructions? 1. "I will be sure to notify my health-care provider if I start to run a fever." 2. "Before I stop taking the prednisone, I will be taught how to taper it off." 3. "If I get weak and shaky, I need to eat some hard candy or drink some juice." 4. "It is fine if I continue to participate in weekend games of tackle football."

1 Cushing's syndrome/disease predisposes the client to develop infections as a result of the immunosuppressive nature of the disease.

The nurse is performing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstrates an understanding of the instructions? 1. "I will be sure to notify my health-care provider if I start to run a fever." 2. "Before I stop taking the prednisone, I will be taught how to taper it off." 3. "If I get weak and shaky, I need to eat some hard candy or drink some juice." 4. "It is fine if I continue to participate in weekend games of tackle football."

1

The nurse is planning the care of a client diagnosed with Addison's disease. Which intervention should be included? 1. Administer steroid medications. 2. Place the client on fluid restriction. 3. Provide frequent stimulation. 4. Consult physical therapy for gait training.

1

A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? 1. "I can eat foods that contain potassium." 2. "I will need to limit the amount of protein in my diet." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."

1 A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.

Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia

1 Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

For a client in addisonian crisis, it would be very risky for a nurse to administer: 1. potassium chloride. 2. normal saline solution. 3. hydrocortisone. 4. fludrocortisone.

1 Addisonian crisis results in hyperkalemia; therefore, administering potassium chloride is contraindicated. Because the client will be hyponatremic, normal saline solution is indicated. Hydrocortisone and fludrocortisone are both useful in replacing deficient adrenal cortex hormones.

The nurse is planning the care of a client diagnosed with Addison's disease. Whichinterventions should be included? 1. Administer steroid medications. 2. Place the client on fluid restriction. 3. Provide frequent stimulation. 4. Consult physical therapy for gait training.

1 Clients diagnosed with Addison's disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal gland

Before discharge, what should a client with Addison's disease be instructed to do when exposed to periods of stress? 1. Administer hydrocortisone I.M. 2. Drink 8 oz of fluids. 3. Perform capillary blood glucose monitoring four times daily. 4. Continue to take his usual dose of hydrocortisone.

1 Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. It's important to keep well hydrated during stress, but the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.

Which nursing instruction should the nurse discuss with the client who is receiving glucocorticoids for Addison's disease? 1. Discuss the importance of tapering medications when discontinuing medication. 2. Explain the dose may need to be increased during times of stress or infection. 3. Instruct the client to take medication on an empty stomach with a glass of water. 4. Encourage the client to wear clean white socks when wearing tennis shoes.

2

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? 1. Adrenal cortex 2. Pancreas 3. Adrenal medulla 4. Parathyroid

1 Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

A client with Addison's disease asks the nurse how a newly prescribed medication, fludrocortisone acetate (Florinef), will improve the condition. When formulating a response, the nurse should incorporate that a key action of this medication is to: 1. Help restore electrolyte balance. 2. Make the body produce more cortisol. 3. Replace insufficient circulating estrogens. 4. Alter the body's immune system functioning.

1 Fludrocortisone acetate is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity. It is prescribed for the long-term management of Addison's disease. Mineralocorticoids cause renal reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. These actions help restore electrolyte balance in the body. The other options are incorrect.

The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find? 1. Hyperkalemia 2. Reduced blood urea nitrogen (BUN) 3. Hypernatremia 4. Hyperglycemia

1 In adrenal insufficiency, the client has hyperkalemia due to reduced aldosterone secretion. BUN increases as the glomerular filtration rate is reduced. Hyponatremia is caused by reduced aldosterone secretion. Reduced cortisol secretion leads to impaired glyconeogenesis and a reduction of glycogen in the liver and muscle, causing hypoglycemia.

Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia as indicated by: 1. muscle weakness. 2. tremors. 3. diaphoresis. 4. constipation.

1 Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

The adrenal cortex is responsible for producing which substances? 1. Glucocorticoids and androgens 2. Catecholamines and epinephrine 3. Mineralocorticoids and catecholamines 4. Norepinephrine and epinephrine

1 The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.

The client diagnosed with Addison's disease is being discharged. Which statement indicates the client needs more discharge teaching? 1. "I will be sure to keep my dose of steroid constant and not vary." 2. "I may have to take two forms of steroids to remain healthy." 3. "I will get weak and dizzy if I don't take my medication." 4. "I need to notify any new HCP of the medications I take."

1 The dose of corticosteroids may have to be increased during the stress of an infection or surgery. It is imperative that under these circumstances the client receives enough medication to replicate the body's own responses to stress.

Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for which condition? 1. Hypocortisolism 2. Hypoglycemia 3. Hyperglycemia 4. Hypercalcemia

1 The nurse should assess for hypocortisolism. Abrupt withdrawal of endogenous cortisol may lead to severe adrenal insufficiency. Steroids should be given during surgery to prevent hypocortisolism from occurring. Signs of hypocortisolism include vomiting, increased weakness, dehydration and hypotension. After the corticotropin-secreting tumor is removed, the client shouldn't be at risk for hyperglycemia. Calcium imbalance shouldn't occur in this situation.

The client diagnosed with Addison's disease is admitted to the emergency departmentafter a day at the lake. The client is lethargic, forgetful, and weak. Which interventionshould be the emergency department nurse's first action? 1. Start an IV with an 18-gauge needle and infuse NS rapidly. 2. Have the client wait in the waiting room until a bed is available. 3. Perform a complete head-to-toe assessment. 4. Collect urinalysis and blood samples for a CBC and calcium level.

1 This client has been exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an Addisonian crisis. Rapid IV fluid replacement is necessary.

There are about ______________ nephrons per kidney, and each nephron independently performs filtration and makes urine from blood.

1 million

about _________________ is excreted each day as urine

1 to 3 L

Normal daily urine output for adults

1,500 - 2,000 mL

When assessing for potential adverse effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which condition? A. Hypokalemia B. Hypovolemia C. Hyponatremia . Hypercalcemia

A

he client has developed iatrogenic Cushing's disease. Which statement is the scientific rationale for the development of this diagnosis? 1. The client has an autoimmune problem causing the destruction of the adrenal cortex. 2. The client has been taking steroid medications for an extended period for another disease process. 3. The client has a pituitary gland tumor causing the adrenal glands to produce too much cortisol. 4. The client has developed an adrenal gland problem for which the health-care provider does not have an explanation.

2

The nurse is developing a plan of care for the client diagnosed with acquired immunodeficiency syndrome (AIDS) who has developed an infection in the adrenal gland.Which problem would have the highest priority? 1. Altered body image. 2. Activity intolerance. 3. Impaired coping. 4. Fluid volume deficit.

4 Fluid volume deficit (dehydration) can leadto circulatory impairment and hyperkalemia.

A nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? Select all that apply. 1. Monitoring daily weight 2. Monitoring intake and output 3. Maintaining a low-potassium diet 4. Monitoring extremities for edema 5. Maintaining a low-sodium diet

1245 The client with Cushing's syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.

Blood flow to the kidney declines by about ____________ per decade as blood vessels thicken.

10%

A nurse is reviewing a plan of care for a client with Addison's disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing intervention is an appropriate component of the plan of care? Select all that apply. 1. Encouraging fluid intake of at least 3000 mL/day 2. Encouraging an intake of low-protein foods 3. Monitoring for changes in mental status 4. Monitoring intake and output 5. Maintaining a low-sodium diet

134 The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase the intake of sodium, protein, and complex carbohydrates. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required.

The client diagnosed with Cushing's disease is prescribed alendronate to prevent osteoporosis. Which information should the clinic nurse teach? Select all that apply. 1. Take the medication and sit upright for 30 minutes. 2. Take the medication just before going to bed. 3. Take the medication with an antacid to alleviate gastric disturbances. 4. Take the medication at least 30 minutes before breakfast. 5. Take the medication with a full glass of water.

145

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? (SATA) 1. Monitor for changes in mentation. 2. Encourage an intake of low-protein foods. 3. Encourage an intake of low-sodium foods. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

145 The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase intake of sodium, protein, and complex carbohydrates and fluids. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required. Mentation, vital signs, skin turgor and intake and output should be monitored for signs of fluid volume deficit.

The client diagnosed with Cushing's disease is prescribed pantoprazole. Which statement is the scientific rationale for prescribing this medication? 1. Pantoprazole increases the client's ability to digest food. 2. Pantoprazole decreases the excess amounts of gastric acid. 3. Pantoprazole absorbs gastric acid and eliminates it in the bowel. 4. Pantoprazole coats the stomach and prevents ulcer formation.

2

A nurse is providing discharge instructions to a client who had a unilateral adrenalectomy. Which of the following will be a component of the instructions? 1. The reason for maintaining a diabetic diet 2. Instructions about early signs of a wound infection 3. Teaching regarding proper application of an ostomy pouch 4. The need for lifelong replacement of all adrenal hormones

2 A client who is undergoing a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Because of the anti-inflammatory properties of corticosteroids, clients who undergo an adrenalectomy are at increased risk for developing wound infections. Because of this increased risk for infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection is present. Options 1, 3, and 4 are incorrect instructions.

A nurse is caring for a client with Addison's disease. The nurse checks the vital signs and determines that the client has orthostatic hypotension. The nurse determines that this finding relates to which of the following? 1. A decrease in cortisol release 2. A decreased secretion of aldosterone 3. An increase in epinephrine secretion 4. Increased levels of androgens

2 A decreased secretion of aldosterone results in a limited reabsorption of sodium and water; therefore the client experiences fluid volume deficit. A decrease in cortisol, an increase in epinephrine, and an increase in androgen secretion do not result in orthostatic hypotension.

The client diagnosed with Addison's disease asks the nurse, "Why do I have to take fludrocortisone?" Which statement is the nurse's best response? 1. "It will keep you from getting high blood sugars." 2. "Fludrocortisone helps the body retain sodium." 3. "Fludrocortisone prevents muscle cramping." 4. "It stimulates the pituitary gland to secrete adrenocorticotropic hormone."

2 Fludrocortisone (Florinef) is a mineral corticosteroid. Mineral corticosteroids help the body to maintain the correct serum sodium levels. Florinef is the preferred medication for Addison's disease, primary hypoaldosteronism, and congenital adrenal hyperplasia when sodium wasting occurs.

The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? 1. Pitting edema of the legs 2. An irregular apical pulse 3. Dry mucous membranes 4. Frequent urination

2 Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: 1. Risk for imbalanced fluid volume related to excessive sodium loss. 2. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. 3. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. 4. Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

2 Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse should expect an excess of which substance? 1. Calcium 2. Cortisol 3. Epinephrine 4. Norepinephrine

2 Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "Cushing's disease is characterized by an oversecretion of insulin." 2. "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones." 3. "Cushing's disease is characterized by an undersecretion of corticotropic hormones." 4. "Cushing's disease is characterized by an undersecretion of glucocorticoid hormones."

2 Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones. Addison's disease is characterized by the failure of the adrenal cortex to produce and secrete adrenocortical hormones. Options 1 and 4 are inaccurate regarding Cushing's syndrome.

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. When he awoke this morning, his wife noticed that he acted confused and was extremely weak. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What would the nurse expect to administer by I.V. infusion? 1. Insulin 2. Hydrocortisone 3. Potassium 4. Hypotonic saline

2 Emergency treatment for acute adrenal insufficiency (Addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until the client's blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

The client has developed iatrogenic Cushing's disease. Which is a scientific rationalefor the development of this problem? 1. The client has an autoimmune problem that causes the destruction of the adrenalcortex. 2. The client has been taking steroid medications for an extended period for anotherdisease process. 3. The client has a pituitary gland tumor that causes the adrenal glands to produce toomuch cortisol. 4. The client has developed an adrenal gland problem for which the health-careprovider does not have an explanation.

2 Iatrogenic means that a problem has been caused by a medical treatment or procedure—in this case, treatment with steroids for another problem. Clients taking steroids over a period of time develop the clinical manifestations of Cushing's disease.Disease processes for which long-term steroids are prescribed include chronic obstructive pulmonary disease, cancer, and arthritis.

A nurse is performing an admission assessment on a client with a diagnosis of pheochromocytoma. The nurse should assess for the major sign associated with pheochromocytoma by performing which action? 1. Obtaining the client's weight 2. Taking the client's blood pressure 3. Testing the client's urine for glucose 4. Palpating the skin for its temperature

2 Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the major sign associated with pheochromocytoma. Taking the client's blood pressure would assess the blood pressure status. Weight loss, glycosuria, and diaphoresis are also clinical manifestations of pheochromocytoma, yet hypertension is the major sign.

The client is admitted to rule out Cushing's syndrome. Which laboratory tests wouldthe nurse anticipate being ordered? 1. Plasma drug levels of quinidine, digoxin, and hydralazine. 2. Plasma levels of ACTH and cortisol. 3. 24-hour urine for metanephrine and catecholamine. 4. Spot urine for creatinine and white blood cells.

2 The adrenal gland secretes cortisol and the pituitary gland secretes adrenocorticotropic hormone (ACTH), a hormone used by the body to stimulate the production of cortisol.

A nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which statement reflects a need for further client education? 1. "Taking my medications exactly as prescribed is essential." 2. "I need to read the labels on any over-the-counter medications I purchase." 3. "My family needs to be familiar with the signs and symptoms of hypoadrenalism." 4. "I could experience the signs and symptoms of hyperadrenalism because of Cushing's."

2 The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the health care provider before purchasing any over-the-counter medications, and maintaining regular follow-up care. The nurse should also instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse plans care and places highest priority on which potential problem? 1. Nervousness 2. Infection 3. Concern about appearance 4. Inability to care for self

2 The client with a stab wound has a break in the body's first line of defense against infection. The client with Cushing's disease is at great risk for infection because of excess cortisol secretion and subsequent impaired antibody function and decreased proliferation of lymphocytes. The client may also have a potential for the problems listed in the other options but these are not the highest priority at this time.

The client is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered? 1. Plasma drug levels of quinidine, digoxin, and hydralazine. 2. Plasma levels of ACTH and cortisol. 3. A 24-hour urine for metanephrine and catecholamine. 4. Spot urine for creatinine and white blood cells (WBCs).

2 adrenal gland secretes cortisol & pituitary gland scrte adrenocorticotropic hormone (ACTH), used by the body to stimulate the production of cortisol.

The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency(Addison's disease). When assessing the client, which clinical manifestations would thenurse expect to find? 1. Moon face, buffalo hump, and hyperglycemia. 2. Hirsutism, fever, and irritability. 3. Bronze pigmentation, hypotension, and anorexia. 4. Tachycardia, bulging eyes, and goiter.

3 Bronze pigmentation of the skin, particularly of the knuckles and other areas of skincreases, occurs in Addison's disease.Hypotension and anorexia also occur withAddison's.

The emergency department nurse is caring for a client in an Addisonian crisis. Which intervention should the nurse implement first? 1. Draw serum electrolyte levels. 2. Administer methylprednisolone IV. 3. Start an 18-gauge catheter with normal saline. 4. Ask the client what medications he or she is taking

3 The nurse must treat an Addisonian crisis as all other shock situations. An IV and fluid replacement are imperative to prevent or treat shock. This is the first action

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which of the following items in the preoperative period? 1. Intake and output 2. Blood urea nitrogen (BUN) 3. Vital signs 4. Urine glucose and ketones

3 Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

A nurse is caring for a postoperative adrenalectomy client. Which of the following does the nurse specifically monitor for in this client? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypocalcemia 4. Signs and symptoms of hypovolemia

4 Following adrenalectomy, the client is at risk for hypovolemia. Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. A deficiency of adrenocortical hormones does not cause the clinical manifestations noted in options 1, 2, and 3.

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1. "I should avoid contact sports." 2. "I should check my ankles for swelling." 3. "I need to avoid foods high in potassium." 4. "I need to check my blood glucose regularly."

3 Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

Which of the following laboratory test results would suggest to the nurse that a client has a corticotropin-secreting pituitary adenoma? 1. High corticotropin and low cortisol levels 2. Low corticotropin and high cortisol levels 3. High corticotropin and high cortisol levels 4. Low corticotropin and low cortisol levels

3 A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels. A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level would be associated with hypocortisolism. Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.

A nurse is preparing to provide instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which of the following diets would likely be prescribed for this client? 1. Low-protein diet 2. Low-sodium diet 3. High-sodium diet 4. Low-carbohydrate diet

3 A high-sodium, high-complex carbohydrate, and high-protein diet will be prescribed for the client with Addison's disease. To prevent excess fluid and sodium loss, the client is instructed to maintain an adequate salt intake of up to 8 g of sodium daily and to increase salt intake during hot weather, before strenuous exercise, and in response to fever, vomiting, or diarrhea.

The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: 1. hypotension. 2. thick, coarse skin. 3. deposits of adipose tissue in the trunk and dorsocervical area. 4. weight gain in arms and legs.

3 Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

During the first 24 hours after a client is diagnosed with Addisonian crisis, which intervention should the nurse perform frequently? 1. Weigh the client. 2. Test urine for ketones. 3. Assess vital signs. 4. Administer oral hydrocortisone.

3 Because the client in Addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

The usual renal threshold for glucose is about

220 mg/dL

A nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which of the following, if noted in the client, indicates signs and symptoms related to adrenal insufficiency? Select all that apply. 1. Double vision 2. Hypotension 3. Mental status changes 4. Weakness 5. Fever

2345 The nurse should be alert to signs and symptoms of adrenal insufficiency in a client following adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. Double vision is generally not associated with this condition.

The client is scheduled for a bilateral adrenalectomy for Cushing's disease. Which information regarding the prescribed prednisone should the nurse teach? Select all that apply. 1. When discontinuing this medication, it must be tapered. 2. Take the medication regularly; do not skip doses. 3. Stop taking the medication if you develop a round face. 4. Notify the HCP if you start feeling thirsty all the time. 5. Wear a MedicAlert bracelet in case of an emergency.

245

The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client? 1. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed. 2. Teach the client regarding sexual functioning and androgen replacement therapy. 3. Explain the signs and symptoms of infection and when to call the health-care provider. 4. Demonstrate turn, cough, and deep-breathing exercises the client should perform every two (2) hours.

3

The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess? 1. Moon face, buffalo hump, and hyperglycemia. 2. Hirsutism, fever, and irritability. 3. Bronze pigmentation, hypotension, and anorexia. 4. Tachycardia, bulging eyes, and goiter.

3

The nurse is assessing a client in an outpatient clinic. Which assessment data are a risk factor for developing pheochromocytoma? 1. A history of skin cancer. 2. A history of high blood pressure. 3. A family history of adrenal tumors. 4. A family history of migraine headaches.

3

The nurse is discussing the endocrine system with the client. Which endocrine gland secretes epinephrine and norepinephrine? 1. The pancreas. 2. The adrenal cortex. 3. The adrenal medulla. 4. The anterior pituitary gland

3

The nurse writes a problem of "altered body image" for a 34-year-old client diagnosed with Cushing's disease. Which intervention should be implemented? 1. Monitor blood glucose levels prior to meals and at bedtime. 2. Perform a head-to-toe assessment on the client every shift. 3. Use therapeutic communication to allow the client to discuss feelings. 4. Assess bowel sounds and temperature every four (4) hours.

3

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which response by the nurse is appropriate? 1. "Don't be concerned, this problem can be covered with clothing." 2. "This is permanent, but looks are deceiving and not that important." 3. "Usually, these physical changes slowly improve following treatment." 4. "Try not to worry about it. There are other things to be concerned about."

3 The client with Cushing's syndrome should be reassured that most physical changes resolve with treatment. Options 1, 2, and 4 are not therapeutic responses.

A client has been diagnosed with pheochromocytoma. Which clinical manifestation is most indicative of this condition? 1. Water loss 2. Bradycardia 3. Hypertension 4. Decreased cardiac output

3 The client with pheochromocytoma has a benign or malignant tumor in the adrenal medulla. Because the medulla secretes epinephrine and norepinephrine, the client will exhibit signs related to excesses of these catecholamines, including tachycardia, increased cardiac output, and increased blood pressure. Vasoconstriction of the renal arteries triggers the renin-angiotensin system, resulting in water reabsorption and retention.

A client with suspected Cushing's syndrome is scheduled for adrenal venography. A nurse has provided instructions to the client regarding the test. Which statement by the client indicates a need for further instruction? 1. "I need to sign an informed consent." 2. "The insertion site will be locally anesthetized." 3. "I will be placed in a high-sitting position for the test." 4. "I may feel a burning sensation after the dye is injected."

3 The test aids in determining whether signs and symptoms are caused by abnormalities in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is informed that the supine position is necessary to access the femoral vein. An informed consent form is required, the insertion site will be locally anesthetized, and the client will experience a transient burning sensation after the dye is injected.

The charge nurse of an intensive care unit is making assignments for the night shift.Which client should be assigned to the most experienced intensive care nurse? 1. The client diagnosed with respiratory failure who is on a ventilator and requiresfrequent sedation. 2. The client diagnosed with lung cancer and iatrogenic Cushing's disease with ABGsof pH 7.35, PaO2 88, PaCO2 44, and HCO3 22. 3. The client diagnosed with Addison's disease who is lethargic and has a BP of 80/45,P 124, and R 28. 4. The client diagnosed with hyperthyroidism who has undergone a thyroidectomytwo (2) days ago and has a negative Trousseau's sign.

3 This client has a low blood pressure and tachycardia. This client could be about to go into an Addisonian crisis, a potentially life-threatening condition. The most experienced nurse should care for this client.

The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse teach? 1. Instruct the client to take the glucocorticosteroid and mineralcorticosteroid medications as prescribed. 2. Teach the client regarding sexual functioning and androgen replacement therapy. 3. Explain the signs and symptoms of infection and when to call the health-care provider. 4. Demonstrate turn, cough, and deep-breathing exercises that the client should perform every (2) hours.

3 This is information given to all surgical clients on discharge.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: 1. calcium and phosphorus abnormalities. 2. chloride and magnesium abnormalities. 3. sodium and chloride abnormalities. 4. sodium and potassium abnormalities.

4 In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: 1. a blood pressure of 130/70 mm Hg. 2. a blood glucose level of 130 mg/dl. 3. bradycardia. 4. a blood pressure of 176/88 mm Hg.

4 Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options.

A nursing student notes in the medical record that a client with Cushing's syndrome is experiencing body image disturbances. The need for additional education regarding this problem is identified when the nursing student suggests which nursing intervention? 1. Encouraging the client's expression of feelings 2. Evaluating the client's understanding of the disease process 3. Encouraging family members to share their feelings about the disease process 4. Evaluating the client's understanding that the body changes need to be dealt with

4 Evaluating the client's understanding that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. Options 1, 2, and 3 are appropriate because they address the client and family feelings regarding the disorder.

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client would indicate that client teaching has been effective? (SATA) 1. "I have to take my steroids for 10 days." 2. "I need to weigh myself daily to be sure I don't eat too many calories." 3. "I need to call my doctor to discuss my steroid needs before I have dental work." 4. "I will call the doctor if I suddenly feel profoundly weak or dizzy." 5. "If I feel like I have the flu, I'll carry on as usual because this is an expected response." 6. "I need to obtain and wear a Medic Alert bracelet."

346 Dental work can be a cause of physical stress; therefore, the client's physician needs to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue, weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be notified if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's history of Addison's disease if the client is unable to communicate this information. A client with Addison's disease doesn't produce enough steroids, so routine administration of steroids is a lifetime treatment. Daily weights should be monitored to monitor changes in fluid balance, not calorie intake. Influenza is an added physical stressor and the client may require an increased dosage of steroids. The client shouldn't "carry on as usual."

The client is three (3) days postoperative unilateral adrenalectomy. Which discharge instructions should the nurse teach? 1. Discuss the need for lifelong steroid replacement. 2. Instruct the client on administration of vasopressin. 3. Teach the client to care for the suprapubic Foley catheter. 4. Tell the client to notify the HCP if the incision is inflamed.

4

The nurse is admitting a client to rule out aldosteronism. Which assessment data support the client's diagnosis? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

4

The nurse is caring for a client with Addison's disease. The client asks the nurse about the risks associated with this disease, specifically about addisonian crisis. Regarding prevention of this complication, how should the nurse inform the client? 1. "You can take either hydrocortisone or fludrocortisone for replacement." 2. "You need to take your fludrocortisone 3 times a day to prevent a crisis." 3. "You need to increase salt in your diet, particularly during stressful situations." 4. "You need to decrease your dosages of glucocorticoids and mineralocorticoids during stressful situations."

4 Addison's disease is a result of adrenocortical insufficiency, and management is focused on treating the underlying cause. Hormone therapy is used for replacement. Hydrocortisone has both glucocorticoid and mineralocorticoid properties and needs to be taken 3 times daily, with two thirds of the daily dose taken on awakening. Fludrocortisone is taken once daily in the morning. Salt additives are necessary, particularly during times of stress, to compensate for excess heat or humidity as a result of the condition. There needs to be an increased dose of cortisol given for stressful situations such as surgery or hospitalization.

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

4 Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. The remaining options do not identify clinical manifestations associated with addisonian crisis.

Which clinical manifestation should the nurse expect to note when assessing a client with Addison's disease? 1. Edema 2. Obesity 3. Hirsutism 4. Hypotension

4 Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in options 1, 2, and 3 are not associated with Addison's disease.

The nursing care for the client in addisonian crisis should include which intervention? 1. Encouraging independence with activities of daily living (ADLs) 2. Allowing ambulation as tolerated 3. Offering extra blankets and raising the heat in the room to keep the client warm 4. Placing the client in a private room

4 The client in addisonian crisis has a reduced ability to cope with stress due to an inability to produce corticosteroids. Compared to a multibed room, a private room is easier to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.

A client has been diagnosed with Cushing's syndrome. The nurse should assess the client for which expected manifestations of this disorder? 1. Dizziness 2. Weight loss 3. Hypoglycemia 4. Truncal obesity

4 The client with Cushing's syndrome may exhibit a number of different manifestations. These may include moon face, truncal obesity, and a "buffalo hump" fat pad. Other signs include hyperglycemia, hypernatremia, hypocalcemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

Which nursing measure would be effective in preventing complications in a client with Addison's disease? 1. Restricting fluid intake 2. Offering foods high in potassium 3. Checking family support systems 4. Monitoring the blood glucose

4 The decrease in cortisol secretion that characterizes Addison's disease can result in hypoglycemia. Therefore monitoring the blood glucose would detect the presence of hypoglycemia so that it can be treated early to prevent complications. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of hyperkalemia. Option 3 is not a priority for this client.

The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 1. Skin atrophy 2. The presence of sunken eyes 3. Drooping on 1 side of the face 4. A rounded "moonlike" appearance to the face

4 With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. The remaining options are not associated with the assessment findings in Cushing's syndrome.

A 50-year-old man has been taking prednisone (Deltasone) as part of treatment for bronchitis. He notices that the dosage of the medication decreases. During a follow-up office visit, he asks the nurse why he must continue the medication and why he cannot just stop taking it now that the feels better. What is the rationale behind tapering the doses? A. Sudden discontinuation of the medication may result in adrenal insufficiency. B. The patient would experience withdrawal symptoms if the drug were discontinued abruptly. C. Cushing's syndrome may develop as a reaction to a sudden drop in serum cortisone levels. D. When the symptoms have started to disappear, lower dosages are needed.

A

The tubules return about ______________ of filtered water back into the body

99 %

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms should the nurse monitor for? Select all that apply. 1. Anorexia 2. Dizziness 3. Weight loss 4. Moon face 5. Hypertension6. Truncal obesity

456 A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon face, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

The kidneys have a rich blood supply and receive a blood flow from

600 to 1300 mL/min.

When systolic pressure drops below __________________ , these self-regulation processes do not maintain GFR.

65 to 70 mmHg

Over secretion of the adrenocortical hormones leads to: A. Cushing's syndrome B. Addison's disease

A

The nurse should question a prescription for aminoglutethimide (Cytadren) in a patient with which condition? A. Addison's disease B. Adrenal malignancy C. Cushing's syndrome D. Metastatic breast cancer

A

A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/L

A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.

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

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

The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? A. Client with Cushing's syndrome who requires orthostatic vital signs assessments B. Client with diabetes mellitus who was admitted with a blood glucose of 45 mg/dL C. Client with exophthalmos who has many questions about endocrine function D. Client with possible pituitary adenoma who has just arrived on the nursing unit

A An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs. The client with a blood glucose of 45 mg/dL, the client with questions about endocrine function, and the client with a possible pituitary adenoma all have complex needs that require the experience and scope of practice of an RN.

A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to unlicensed assistive personnel (UAP)? a) Assist with personal hygiene and skin care. b) Develop a plan of care to minimize risk for infection. c) Instruct the client on the reasons to avoid overeating. d) Monitor for signs and symptoms of fluid retention.

A Assisting a client with bathing and skin care is included in UAP scope of practice. It is not within their scope of practice to develop a plan of care, although they will play a very important role in following the plan of care. Client teaching requires a broad education and should not be delegated to UAP. Monitoring for signs and symptoms of fluid retention is part of client assessment, which requires a higher level of education and clinical judgment.

The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs? a. Bruising b. Constipation c. Myalgia d. Nausea

A Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are known side effects but are not serious. Myalgia is not common.

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

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

A female patient who is on drug therapy for hyperaldosteronism develops menstrual disorders. Which prescribed drug may be the cause of this condition? a. Spironolactone b. Amlodipine c. Dexamethasone d. Aminoglutethimide

A Spironolactone is a potassium-sparing diuretic given to patients with hyperaldosteronism to treat hyperkalemia. This drug can cause menstrual disorders in women. Amlodipine and dexamethasone both control high blood pressure. Aminoglutethimide is given to decrease aldosterone synthesis.

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

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

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? a) Avoids palpating the abdomen b) Monitors for pulmonary edema with a chest x-ray c) Obtains a 24-hour urine specimen on admission d) Places the client in a room with a roommate for distraction

A The abdomen must not be palpated in a client with pheochromocytoma because this action could cause a sudden release of catecholamines and severe hypertension. The tumor on the adrenal gland causes sympathetic hyperactivity, increasing blood pressure and heart rate, not pulmonary edema. A 24-hour urine collection will already have been completed to determine the diagnosis of pheochromocytoma. A client diagnosed with a pheochromocytoma may feel anxious as part of the disease process; providing a roommate for distraction will not reduce the client's anxiety.

A nurse is caring for a client who has pheochromocytoma. Which of the following actions should the nurse take? a. Elevated the head of the client's bed. b. Palpate the client's abdomen. c. Monitor the client for hypotension. d. Check the client's urine specific gravity.

A The nurse should elevate the head of the client's bed to reduce BP and abdominal pressure. Palpating the abdomen can cause release of catecholamines and increase BP. Hypertension is associated with pheochromocytoma, not hypotension. Urine specific gravity is monitored for client's who have DI or SIADH.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? a) Administer insulin and dextrose in normal saline to shift potassium into cells. b) Give spironolactone (Aldactone) 100 mg orally. c) Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. d) Obtain arterial blood gases to assess for peaked T waves.

A This client is hyperkalemic. The nurse should anticipate a request to administer 20 to 50 units of insulin with 20 to 50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the client does not need. Although H2 blocker therapy would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess for peaked T waves associated with hyperkalemia; an electrocardiogram needs to be obtained instead.

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

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

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

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

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

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

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

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

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

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

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

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

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyper function? Select all that apply.

A. 15 pound weight gain B. Decreased libido F. Occasional dripping of clear fluid from both breasts

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

A. Attempt to identify the client's concerns

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

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

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

A. Assist the patient to empty his or her bladder

Which of the following are the priority precautions and nurse will teach the client who remains at continuing risk for adrenal hypo function and is taking hormone replacement therapy to prevent harm related to the disorder? Select all that apply.

A. Avoid crowds and people who are ill. B. Check your heart rate for irregular or skipped beats twice daily. C. Do not choose low sodium versions of prepared foods. D. Get up slowly from sitting or lying positions. E. Keep a source of glucose, such as candy, with you at all times. F. Never skip your hormone replacement drugs.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A. Curative

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

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

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

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

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

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

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

A. Ensure written consultation of two noninvolved physicians.

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

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

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

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

Which assessment has the highest priority for the nurse to perform for a client with syndrome is inappropriate anti-diuretic hormone receiving tolvaptan therapy for 24 hours?

A. Evaluating serum sodium levels

Which physiological processes directly prevent sever hypoglycemia in a healthy adult without diabetes who is NPO for 12 hours? (SATA) A. Gluconeogenesis B. Glycogenesis C. Glycogenolysis D. Ketogenesis E. Lipogenesis F. Lipolysis

A. Gluconeogenesis C. Glycogenolysis

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

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

Which psychological process directly prevent severe hypoglycemia and a healthy adult without diabetes who is NPO for 12 hours? Select all that apply.

A. Gluconeogenesis C. Glycogenolysis

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

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

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

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

Performance of which assessment is a priority for the nurse before giving a client the first oral dose of hormone replacement for hypothyroidism?

A. Measuring heart rate and rhythm

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

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

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

A. Notifies the surgeon

Which precaution is a priority for the nurse to teach a client prescribed semaglutide to prevent harm?

A. Only take this drug once weekly

Which precaution is a priority for the nurse to teach a client prescribed semaglutide to prevent harm? A. Only take this drug once weekly B. Report any vision changes immediately C. Do not mix in the same syringe with insulin D. This drug can only be given by a health care professional

A. Only take this drug once weekly

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

A. Orient the client to the unit environment

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

A. Palliative

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

A. Poor fluid and nutrition status

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

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

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

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

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

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

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

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

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

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

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

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

Which assessment finding of a client eight hours after a sub total thyroidectomy does a nurse consider most relevant as an indication of a possible complication?

A. The clients hand spasms during blood pressure measurement

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

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

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

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

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

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

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

A. increased

When monitoring a patient who is taking corticosteroids, the nurse observes for which adverse effects? (Select all that apply) A. Fragile skin B. Hyperglycemia C. Nervousness D. Hypotension E. Weight loss F. Drowsiness

ABC

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

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

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

ACF Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

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

ADE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which health promotion activities for the nurse recommend to prevent harm in a client with type two diabetes? Select all that apply

B. Have your eyes and vision assessed by an ophthalmologist every year C. Reduce your intake of animal fat and increase your intake of plant sterols

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aldosterone

____________________ promotes the reabsorption of sodium in the DCT. Water reabsorption occurs as a result of the movement of sodium (where sodium goes, water follows).

Aldosterone

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Discharge teaching for a patient receiving glucocorticoids would include the use of which medication for pain management? A. Aspirin (Acetylsalicylic acid) B. Acetaminophen (Tylenol) C. Ibuprofen D. Naprosyn (Naproxen)

B

The nurse would recognize which of the following as a potential side effect of the glucocorticoid therapy in young children? A. Arthritis B. Growth suppression C. Constipation D. Iron-deficiency anemia

B

Under secretion of the adrenocortical hormones leads to: A. Cushing's syndrome B. Addison's disease

B

When discussing glucocorticoids to a patient, what statement by the nurse is accurate regarding the action of these medications? A. They decrease serum sodium and glucose levels. B. They regulate carbohydrate, fat, and protein metabolism. C. They stimulate defense mechanisms to produce immunity. D. They are produced in lower amounts during times of stress.

B

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? a) Anxiety b) Headache c) Nausea d) Weight loss

B A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the client's blood pressure should be monitored. Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction; it is not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

A patient with adrenocortical insufficiency is prescribed hydrocortisone. Which drugs should be avoided in the patient's prescription? a. Oral contraceptives, antiepileptics, and nonsteroidal antiinflammatory drugs (NSAIDs) b. Oral hypoglycemics, anticoagulants, and nonsteroidal antiinflammatory drugs (NSAIDs) c. Antihypertensives, oral hypoglycemics, and nonsteroidal antiinflammatory drugs (NSAIDs) d. Antiepileptics, antihypertensives, and oral hypoglycemics

B Hydrocortisone is a corticosteroid. Oral hypoglycemics, anticoagulants, and nonsteroidal antiinflammatory drugs (NSAIDs) have potential interactions with corticosteroids and should be avoided by a patient taking hydrocortisone. Note that antiepileptics and antihypertensives may or may not interact with corticosteroids.

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

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

Which finding is consistent with a diagnosis of hyperaldosteronism?Multiple choice question a. Edema b. Hypernatremia c. Low blood pressure d. Potassium retention

B In hyperaldosteronism, elevated levels of aldosterone are associated with sodium retention, which leads to hypernatremia. Edema and low blood pressure are not caused by an increase in sodium excretion. Elevated levels of aldosterone lead to potassium excretion.

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

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

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

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

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this client? a) Administering furosemide (Lasix) b) Providing isotonic fluids c) Replacing potassium losses d) Restricting sodium

B Providing isotonic fluid is the priority intervention because this client's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone. Furosemide is a loop diuretic, which this client does not need. Potassium is normally increased in acute adrenal insufficiency, but potassium may have been lost if the client has had diarrhea; laboratory work will have to be obtained. Any restrictions, including sodium, should not be started without obtaining laboratory values to establish the client's baseline.

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

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

Which health promotion activity(ies) will the nurse recommend to prevent harm in a client with type 2 diabetes? (SATA) A. "Avoid all dietary carbohydrate and fat." B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols." D. "Be sure to take your anti diabetes drug right before your engage in any type of exercise." E. "Keep your feet warm in cold weather by using either a hot water bottle or a heating pad." F. "Avoid foot damage from shoe-rubbing by going barefoot or wearing flip-flops when you are at home."

B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols."

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

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

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

B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." Rationale: One of the most frequent causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol. None of the other statements are completely accurate.

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

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

A client with diabetes who now has chronic albuminuria asks the nurse how this change will affect his health. How will the nurse answer this question? A. "You will ned to limit your intake of dietary albumin and other proteins to reduce the albuminuria." B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage." C. "Your risk for developing urinary tract infections is greatly increased, requiring the need to take daily antibiotics for prevention." D. "From now on you will need to limit your fluid intake to just 1 L daily and completely avoid caffeine to protect your kidneys."

B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage."

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

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

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

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

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

B. "You seem upset."

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

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

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

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

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

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

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

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

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

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

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

B. Centers for Medicare and Medicaid Services (CMS)

Which assessment findings and a client with hyperthyroidism indicate to the nurse that the client is in danger of thyroid storm? Select all that apply.

B. Client report of increased Palmer sweating E. An increase in temperature from 99.5°F to 101.3°F G. Increase in premature ventricular heart contractions from four per minute to 28 per minute

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

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

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

B. Contact the surgeon.

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

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

Which hormone helps prevent hypoglycemia? Select all that apply.

B. Cortisol C. Epi D. Growth hormone E. Glucagon G. Norepinephrine

Which hormones help prevent hypoglycemia? (SATA) A. Aldosterone B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon F. Insulin G. Norepinephrine H. Proinsulin

B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon G. Norepinephrine

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

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

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

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

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

B. Develops a plan to keep the patient safe

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

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

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

B. Emergent

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

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

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

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

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

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

Changes in the Renal System Related to Aging

Decreased bladder capacity Decreased glomerular filtration rate Nocturia Weakened urinary sphincters and shortened urethra in women Tendency to retain urine

While making rounds the nurse finds a client with type 1 diabetes mellitus pale, sweaty, and slightly confused; the client can swallow. The client's blood glucose level check is 48 mg/dL. What is the nurse's best first action to prevent harm? A. Call the pharmacy and order a STAT dose of glucagon B. Immediately give the client 30 g of glucose orally C. Start an IV and administer a small amount of a concentrated dextrose solution D. Recheck the blood glucose level and call the Rapid Response team

B. Immediately give the client 30 g of glucose orally

While making rounds the nurse finds a client with type one diabetes mellitus pale, sweaty, and slightly confused: the client can swallow. The clients blood glucose level check is 48. What's the nurses best first action to prevent harm?

B. Immediately give the client 30 g of glucose orally

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

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

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

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

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

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

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

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

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

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

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

B. Minimally invasive

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

B. myxedema

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

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

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

B. Restorative

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

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

Which electrolyte laboratory values indicate to the nurse monitoring account client with adrenal insufficiency he undergoing IV therapy with Hydro Cortizone that the client is responding positively to this drug therapy?

B. Serum sodium 137: serum potassium 4.9

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

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

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

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

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

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

A client with diabetes who now has chronic albuminuria asks the nurse how this change will affect his health. How will the nurse answer this?

B. This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage

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

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

How are the nurse modify insulin injection technique for a client who is 5'10" tall and weighs 106 pounds?

B. Use a 6 mm needle and inject a a 45° angle

How will the nurse modify insulin injection technique for a client who is 5 feet 10 inches tall and weighs 106 lb? A. Use a 6 mm needle and inject at a 90 degree angle B. Use a 6 mm needle and inject at a 45 degree angle C. Use a 12 mm needle and inject at a 90 degree angle D. Use a 12 mm needle and inject at a 45 degree angle

B. Use a 6 mm needle and inject at a 45 degree angle

The nurse is administering aminoglutethimide to a patient and will monitor for which adverse effects? (Select all that apply) A. Constipation B. Dizziness C. Anorexia D. Hypotension E. Lethargy

BCE

Which conditions is aminoglutethimide (Cytadren) used to treat? (Select all that apply.) A. Thyroid cancer B. Adrenal cancer C. Testicular cancer D. Cushing's syndrome E. Metastatic breast cancer

BCE

A patient is diagnosed with adrenocortical insufficiency. Which laboratory findings would be consistent with this diagnosis? Select all that apply. (SATA) a. Serum sodium: 140 mEq/L b. Serum potassium: 6.5 mEq/L c. Blood glucose levels: 80 mg/dL d. Blood urea nitrogen (BUN): 30 mg/dL e. Electrocardiogram (ECG): Peaked T waves

BCE Adrenocortical insufficiency leads to hyperkalemia, hypoglycemia, peaked T waves in ECG, hyponatremia, and increased blood urea nitrogen levels. Normal serum electrolyte ranges include sodium from 135 to 145 mEq/L, potassium from 3.5 to 5 mEq/L, glucose from 70 to 99 mg/dL, and blood urea nitrogen from 6 to 20 mg/dL. A serum potassium level of 6.5 mEq/L shows increased serum potassium levels (hyperkalemia). A blood urea nitrogen level of 30 mg/dL shows increased levels. Peaked T waves are observed in electrocardiogram due to hyperkalemia.

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

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

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

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

Collects glomerular filtrate (GF) and funnels it into the tubule

Bowman's capsule

Increase blood flow (vasodilation) and vascular permeability

Bradykinins

A patient has Cushing's syndrome. The nurse expects which drug to be used to inhibit the function of the adrenal cortex in the treatment of this syndrome? A. Fludrocortisone (Florinef) B. Dexamethasone (generic) C. Aminoglutethimide (Cytadren) D. Hydrocortisone (Solu-Cortef)

C

Because corticosteroids may cause sodium retention, the nurse will closely monitor patients with which condition when administering corticosteroids? A. Diabetes mellitus B. Seizure disorders C. Heart failure D. Hyperthyroidism

C

The nurse has a prescription for a patient to receive prednisone (Deltasone) to treat contact dermatitis. The nurse would question this prescription for this patient with what condition? A. Asthma B. Multiple sclerosis C. Acquired immune deficiency syndrome (AIDS) D. Chronic obstructive pulmonary disease

C

The nurse would question a prescription for steroids in a patient with which condition? A. Asthma B. Spinal cord injury C. Diabetes mellitus D. Rheumatoid arthritis

C

A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? A. Ask about risk factors for adrenocortical problems. B. Assess the client's response to physiologic stressors. C. Check the client's blood glucose levels every 4 hours. D. Teach the client how to do a 24-hour urine collection.

C Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill. Assessing risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multi-step process; this task should not be delegated.

Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use? a) Client with hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena b) Client with right upper quadrant pain unrelieved for the past 2 days, dark-brown urine, and clay-colored stools c) Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week d) Client with three emergency department visits in the past month for edema, shortness of breath, weight gain, and jugular venous distention

C Corticosteroids may be used to treat signs and symptoms of asthma, such as shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85%. This places the client at risk for adrenal insufficiency. Corticosteroids are not used to treat signs and symptoms of GI bleeding or peptic ulcer disease (hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena), gallbladder disease (right upper quadrant pain unrelieved for the past 2 days, dark brown urine, and clay-colored stools), or congestive heart failure (edema, shortness of breath, weight gain, and jugular venous distention).

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

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

A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet a. high in carbohydrates. b. high in fat. c. high in protein. d. low in potassium

C Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet.

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? a) "Don't mind this. The disease is causing this." b) "I need to check the client's cortisol level." c) "The disease can sometimes affect emotional responses." d) "Medication is available to help with this."

C The client may have neurotic or psychotic behavior as a result of high blood cortisol levels. Being honest with the family helps them to understand what is happening. Telling the family not to mind the laughter and that the disease is causing it is vague and minimizes the family's concern. This is the perfect opportunity for the nurse to educate the family about the disease. Cushing's disease is the hypersecretion of cortisol, which is abnormally elevated in this disease and, because the diagnosis has already been made, blood levels do not need to be redrawn. Telling the family that medication is available to help with inappropriate laughing does not assist them in understanding the cause of or the reason for the client's behavior.

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

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

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

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

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

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

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

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

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

C. Cosmetic

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

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

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

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

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

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

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

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

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

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

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

C. Anti-seizure drug

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

C. Call and notify the surgeon immediately

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

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

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

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

The nurse reviewing the laboratory values of a client with hypo parathyroidism find a serum calcium level of 7.9. Which perimeter is most important for the nurse to assess to prevent harm?

C. Deep tendon reflexes

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

C. Diet-controlled diabetes mellitus

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

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

Which precaution is a priority for the nurse to teach a client prescribed pramlintide to prevent harm? A. Only take this drug once weekly B. Do not drink alcohol when taking this drug C. Do not mix in the sam syringe with insulin D. Report any genital itching to your primary health care provider

C. Do not mix in the sam syringe with insulin

Which precaution is a priority for the nurse to teach a client prescribed pramlintide to prevent harm?

C. Do not mix in the same syringe with insulin

Which precaution is most important for the nurse to teach a female client to prevent harm while undergoing drug therapy with estrogen and progesterone for hypopituitarism?

C. Do not smoke or use nicotine in any form

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

C. Elective

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

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

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

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

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

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

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

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

In assistive personnel reports that a nursing home client who has hypothyroidism as a pulse of 48 this morning. Which assessments have the highest priority for the nurse to perform immediately? Select all that apply.

C. Measuring oxygen saturation by pulse oximetry. D. Checking blood pressure, heart rate, and rhythm.

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

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

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

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

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

C. Patient safety

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

C. Teach the importance of incentive spirometry.

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

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

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

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

A client at continuing risk for hyper parathyroidism as prescribed to take for furosimide 40 mg and to drink at least 3 to 4 L of fluid daily. He tells the nurse he believes taking a water pill and then drinking so much seems wrong. How will the nurse respond?

C. The drug helps you to get rid of calcium and drinking more helps dilute your blood calcium so the level doesn't get too high

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

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

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

C. Their target tissues are always another endocrine gland

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

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

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

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

Which urine characteristics indicate to the nurse that the client being manage for diabetes insipidus is responding appropriately to interventions?

C. Urine output volume decreased: urine specific gravity increased

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

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

A nurse is caring for a client with Cushing syndrome who must remain on continued glucocorticoid therapy for another health problem will use which of the following actions to prevent harm?

C. Using non-adhesive methods to secure an IV access

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

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

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

C. weight loss

The nurse should monitor for increases in which laboratory value in a patient being treated with dexamethasone? a. Sodium b. Calcium c. Potassium d. Blood glucose

D Hyperglycemia, or increased blood glucose level, is an adverse effect of corticosteroid therapy. Sodium, calcium, and potassium levels are not affected directly by dexamethasone.

A patient who has been taking corticosteroids has developed a "moon face" and facial redness, and has many bruises on her arms. Which of these is the most appropriate nursing diagnosis? A. Risk for infection B. Imbalanced nutrition: Less than body requirements C. Deficient fluid volume D. Disturbed body image

D

Based on the nurse's knowledge of glucocorticoids, what instructions should be given for this drug? A. Take the medication every evening. B. Inform the patient that the drug can be taken with coffee. C. Advise that the drug does not have to be tapered before stopped. D. Advise to take drug with milk, other dairy products, or food.

D

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? a) Asks another nurse to care for the client b) Monitors the client for cold-like symptoms c) Refuses to care for the client d) Wears a facemask when caring for the client

D A client with hypercortisolism will be immune-suppressed. Anyone with a suspected upper respiratory infection who must enter the client's room must wear a mask to prevent the spread of infection. Although asking another nurse to care for the client might be an option in some facilities, it is not generally realistic or practical. The nurse, not the client, feels the onset of the cold, so monitoring the client for cold-like symptoms is part of good client care for a client with hypercortisolism. Refusing to care for the client after starting care would be considered abandonment.

In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion. What is the nurse's best action? a. Request a "time-out" to determine whether this is a valid prescription. b. Ask the client whether he or she usually takes prednisone. c. Hold the dose because the client has a high cortisol level. d. Administer the drug as prescribed.

D Although the client has hypercortisolism, removal of the adrenal gland will stop the secretion of this important hormone that is essential for life. Further, the stress of surgery also increases the client's need for this hormone. Supplying the hormone throughout surgery prevents the complication (or at least reduces the risk for) acute adrenal crisis.

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? a) Assess skin turgor and mucous membranes for hydration status. b) Discuss the dietary restrictions needed for 24-hour urine testing. c) Plan ways to control the environment that will avoid stimulating the client. d) Remind the client to avoid drinking coffee and changing position suddenly.

D Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because of the effects of catecholamines. Reminding the client about previous instructions is an appropriate role for a nursing assistant who may observe the client doing potentially risky activities. Client assessment, client teaching, and environment planning are higher-level skills that require the experience and responsibility of the RN, and are not within the scope of practice of the nursing assistant.

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

D. Diagnostic

A client with Cushing's disease says that she has lost 1 pound. What does the nurse do next? a) Auscultates the lungs for crackles b) Checks urine for specific gravity c) Forces fluids d) Weighs the client

D Fluid retention with weight gain is more of a problem than weight loss in clients with Cushing's disease. Weighing the client with Cushing's disease is part of the nurse's assessment. Crackles in the lungs indicate possible fluid retention, which would cause weight gain, not weight loss. Urine specific gravity will help assess hydration status, but this would not be the next step in the client's assessment. Forcing fluids is not appropriate because usually excess water and sodium reabsorption cause fluid retention in the client with Cushing's disease.

A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform? a. Observe the patient for hypoglycemia. b. Monitor closely for increased urine output. c. Observe the patient for hypotension. d. Request an order for enteric-coated aspirin.

D Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hypoglycemia, fluid retention, and hypertension.

A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland ask the nurse whether the physical changes from the excessive cortisol will go away as a result of the surgery so she can look like yourself again. What is the nurses best response?

D. The fatty changes and acne will resolve with time but the stretch marks only fade

The nurse is teaching a patient with Addison's disease about corticosteroid therapy. The nurse should prioritize which of these teaching points?Multiple choice question a. "Plan a high-carbohydrate diet." b. "Increase your daily intake of sodium." c. "Decrease your daily intake of calcium." d. "Do not stop taking the medication abruptly."

D The patient should be instructed to not stop the medication abruptly because this can cause adverse side effects. Patients taking corticosteroids should not consume a high-carbohydrate diet, because corticosteroids increase blood sugar. Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

D. ASA class IV

When preparing to administer a prescribed subcutaneous dose of NPH insulin from an open vial taken from a medication drawer to a client with diabetes, the nurse notes the solution is cloudy. What action will the nurse perform to ensure client safety? A. Warm the vial in a bowl of warm water until it reaches normal body temperature B. Return the vial to the pharmacy and open a fresh vial of NPH insulin C. Roll the vial between the hands until the insulin is clear D. Check the expiration date and draw up the insulin dose

D. Check the expiration date and draw up the insulin dose

When preparing to administer a prescribed subcutaneous dose of NPH insulin from an open vile taken from medication drawer to a client with diabetes, the nurse knows the solution is cloudy. What action or the nurse performed to ensure client safety?

D. Check the expiration date and draw up the insulin dose

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

D. Potassium

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

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

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

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

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

D. Palliative

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

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

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

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

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

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

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

D. Talk to the client.

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

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

The nurse reviewing the preadmission testing laboratory values for a 62-year-old client scheduled for a total knee replacement find an A1 C value of 6.2%. How are the nurse interpret this finding?

D. The client has pre-diabetes mellitus

The nurse reviewing the preadmission testing lab values for a 62 year old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding? A. The clients A1C is completely normal B. The client has type 1 diabetes C. The client has type 2 diabetes D. The client has prediabetes mellitus

D. The client has prediabetes mellitus

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

D. Urgent

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

D. reduce the number of intestinal bacteria.

Site of additional water and electrolyte reabsorption, including bicarbonate Potassium and hydrogen secretion

DCT

Delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta

Efferent arteriole

Stimulates bone marrow to make red blood cells

Erythropoietin

Site for reabsorption of sodium, chloride, water, glucose, amino acids, potassium, calcium, bicarbonate, phosphate, and urea

PCT

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

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

Regulate intrarenal blood flow by vasodilation or vasoconstriction

Prostaglandins

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

Reports acute pain at the surgical site

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

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

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

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

glomerular filtrate

Substances that filter out of the blood through the thin walls of the glomeruli

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

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

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

Tolerance to the opioid is developing

Tamponade Effect

a small amount of bleeding creates enough pressure to copress blleding sites

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

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

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

a) Administer hydrocortisone I.M.

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

a) Glucocorticoids and androgens

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

a) Muscle twitching

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

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

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

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

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider (HCP)? Select all that apply. a. Client with an allergy to shrimp b. Client with a history of asthma c. Client who requests morphine sulfate every 3 hours d. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) e. Client who took metformin (Glucophage) 4 hours ago

a, b, d, and e

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns to the unit? a. "Arise slowly and call for assistance when ambulating." b. "I must measure your intake and output." c. "We must save your urine because it is radioactive." d. "I must attach you to this cardiac monitor."

a. "Arise slowly and call for assistance when ambulating."

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? a. "Have you tried using the toilet at least every couple of hours?" b. "How does that make you feel?" c. "We can fix that." d. "That happens when we get older."

a. "Have you tried using the toilet at least every couple of hours?"

The nurse is caring for a 38-year old male with hypertension and stage 1 CKD. The client reports lifestyle changes and feeling "better" and has stopped taking a prescribed diuretic. What is the appropriate nursing response? a. "The diuretic will reduce your blood pressure, which may slow or prevent progression of your chronic kidney disease" b. "Your primary health care provider prescribed the diuretic because it will reverse the damage caused by kidney disease" c. "Taking medications is a personal decision and you have the right to decline this prescription" d. "Since you have implemented lifestyle changes, the diuretic is likely not needed"

a. "The diuretic will reduce your blood pressure, which may slow or prevent progression of your chronic kidney disease"

For which client would the nurse expect to teach intermittent catheterization? a. 35 year old woman who has multiple sclerosis and incontinence b. 48 year old man who is admitted for pneumonia and is on complete bed-rest c. 61 year old woman who is admitted following a fall at home and has new onset dysrhythmia d. 74 year old man who has lung cancer with brain metastasis and has advanced dementia

a. 35 year old woman who has multiple sclerosis and incontinence

The nurse is caring for a male client 8 hours after a nephrectomy. Which assessment data point requires immediate nursing intervention? a. Abdominal distention b. Urine output 38 mL in the last hour c. Blood pressure 108/64 mm Hg d. Hemoglobin 14 g/dL

a. Abdominal distention

A client with these assessment data is preparing to undergo a computed tomography (CT) scan with contrast Assessment Data: BUN 54 mg/dL Creatinine 2.4 mg/dL Ca 8.5 mg/dL Which medication does the nurse plan to administer before the procedure? a. Acetylcysteine (Mucomyst) b. Metformin (Glucophage) c. Captopril (Capoten) d. Acetaminophen (Tylenol)

a. Acetylcysteine (Mucomyst)

Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? a. An 80-year-old man who has benign prostatic hyperplasia b. A 62-year-old woman with a known allergy to contrast media c. A 48-year-old woman with established urinary incontinence d. A 45-year-old man receiving oral and intravenous fluid therapy

a. An 80-year-old man who has benign prostatic hyperplasia

Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? a. An 80-year-old man who has benign prostatic hyperplasia b. A 62-year-old woman with a known allergy to contrast media c. A 48-year-old woman with established urinary incontinence d. A 45-year old man receiving oral and intravenous fluid therapy

a. An 80-year-old man who has benign prostatic hyperplasia

Which age-related change can cause nocturia? a. Decreased ability to concentrate urine b. Decreased production of antidiuretic hormone c. Increased production of erythropoietin d. Increased secretion of aldosterone

a. Decreased ability to concentrate urine

A client with diabetes has the following assessment changes after a percutaneous nephrolithotomy procedure. Which change requires immediate nursing intervention? a. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula b. A point-of-care blood glucose of 150 mg/dL and client report of thirst c. A decreased hematocrit by 1% (compared with preoperative values and hematuria) d. An oral temperature of 38 degrees C (101 F) and cloudiness of urine draining from the nephrostomy tube after IV administration of broad-spectrum antibiotic.

a. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula

When obtaining a health history and physical assessment from a 68-year-old male client who has a history of an enlarged prostate, which finding does the nurse consider significant? Select all that apply. a. Distended bladder b. Absence of a bruit c. Frequency of urination d. Dribbling urine after voiding e. Chemical exposure in the workplace

a. Distended bladder c. Frequency of urination d. Dribbling urine after voiding

A client with a recently created vascular access for hemodialysis is being discharged. Which discharge teaching will the nurse include? a. Do not allow blood pressure measurements in the affected arm b. Elevate the affected arm, allowing for total rest of the extremity c. Assess for a bruit in the affected arm on a daily basis d. Sleep on the affected side to protect the access device

a. Do not allow blood pressure measurements in the affected arm

Which urinary assessment information for a client indicates the potential need for increased fluids? a. Increased blood urea nitrogen b. Increased creatinine c. Pale-colored urine d. Decreased sodium

a. Increased blood urea nitrogen

Which assessment data would the nurse anticipate in a client with acute pyelonephritis? Select all that apply. a. Urinary frequency b. Dysuria c. Oliguria d. Heart rate 120 beats/min e. Uremia f. Costovertebral angle tenderness

a. Urinary frequency b. Dysuria d. Heart rate 120 beats/min f. Costovertebral angle tenderness

When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? Select all that apply. a. Urine output of 15 mL for the first hour and then diminishing b. Tenderness at the surgical site c. Pink-tinged urine draining from the nephrostomy d. A hematocrit value 3% lower than the preoperative value e. Sudden onset of abdominal pain that worsens after abdominal palpation f. Blood pressure of 180/90 mm Hg that persists despite administration of pain medication

a. Urine output of 15 mL for the first hour and then diminishing d. A hematocrit value 3% lower than the preoperative value e. Sudden onset of abdominal pain that worsens after abdominal palpation f. Blood pressure of 180/90 mm Hg that persists despite administration of pain medication

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

a. hyponatremia

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

a. an adenoma

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

a. antidiuretic hormone (ADH) and oxytocin.

Which assessment finding would require the nurse to take immediate action in a client who is 1 hour post kidney biopsy? Select all that apply. a. Pink-tinged urine b. Nausea and vomiting c. Increased bowel sounds d. Reports of flank pain e. The patient is ambulating to the bathroom

a. pink-tinged urine

Promotes absorption of calcium in the GI tract

activated Vitamin D

bladder inflammation, most often with infection

cystitis

Blood supply to the nephron is delivered through the

afferent arteriole

rennin activates Angiotensin to convert to Angiotensin II which results in the secretion of

aldosterone

Potassium and magnesium reabsorption in the thick segment Thin segment is impermeable to water

ascending limb

The serum creatinine level does not increase until

at least 50% of the kidney function is lost

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

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

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

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

When obtaining a health history from a 22-year-old female client who has new onset urinary incontinence, which findings or factors does the nurse consider significant? (Select all that apply.) a. Chemical exposure in the workplace b. A burning sensation occurring on urination c. Urinating 10 times daily although fluid intake remains unchanged d. A recent change in the client's oral contraceptive prescription e. A new inability to hold urine (urgency) f. A "stinky" odor from the urine

b, c, e, and f

The nurse is admitting a client who has type 2 diabetes (T2D) and is scheduled for surgery. Which laboratory findings from this client's admission panel does the nurse report as indicating possible abnormal kidney function? (Select all that apply.) a. Presence of ammonia in the urine b. Urine microalbumin 240 mcg/24 hour (0.240 g/24 hour) c. Urine specific gravity of 1.028 d. Blood urea nitrogen of 38 mg/dL (13.5 mmol/L) f. Serum creatinine 2.2 mg/dL (294.3 mcmol/L) g. Blood osmolarity 290 mOsm/kg (290 mmol/kg)

b, d, and e

When assessing a client with acute glomerulonephritis, which question will the nurse ask to determine if the client is following best practices to slow progression of kidney damage? a. "Do you avoid contact sports while you are taking cyclosporine?" b. "How are you evaluating the amount of daily fluid you drink?" c. "Have you contacted anyone from our dialysis support services?" d. "Have you increased your protein intake to promote healing of the damaged nephrons?"

b. "How are you evaluating the amount of daily fluid you drink?"

Which question will the nurse ask the client who has a urinary tract infection to assess the risk for pyelonephritis? a. "What drugs do you take for asthma?" b. "How long have you has diabetes?" c. "How much fluid do you drink daily?" d. "Do you take your antihypertensive drugs at night or in the morning?"

b. "How long have you had diabetes?"

The nurse is preparing a client with stage 3 CKD for discharge. Which client statement indicates the need for further teaching? a. "I will be sure to attend my follow-up appointment with my nephrologist." b. "I will increase my protein intake so my body can heal" c. "I will weigh myself daily and call the doctor if my weight increases by 2 lb or more" d. "I will take my blood pressure each day and keep a daily log"

b. "I will increase my protein intake so my body can heal"

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

b. 15 minutes

Which client will the nurse identify as at risk for acute kidney injury? Select all that apply. a. 68 year old male with diabetes mellitus b. 16 year old male football player in preseason practice c. 27 year old female recovering from shock following a car accident d. 52 year old male with newly diagnosed hypertension e. 30 year old female in intensive care receiving multiple intravenous antibiotics

b. 16 year old male football player in preseason practice c. 27 year old female recovering from shock following a car accident e. 30 year old female in intensive care receiving multiple intravenous antibiotics

The nurse is caring for a 74 year old client scheduled for a cardiac catherization with contrast dye. What nursing action is appropriate? Select all that apply. a. Assess creatinine clearance using a 24-hour urine collection test b. Assess for coexisting conditions of diabetes, heart failure, and kidney disease c. Collaborate with the provider about whether IV fluids should be infused before the test d. Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 mg/dL in 24 hours e. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m

b. Assess for coexisting conditions of diabetes, heart failure, and kidney disease c. Collaborate with the provider about whether IV fluids should be infused before the test e. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m

Which adverse drug effects will the nurse assess for in a hospitalized client who is prescribed an anticholinergic drug to manage incontinence? (select all that apply) a. Insomnia b. Blurred vision c. Constipation d. Dry mouth e. Loss of sphincter control f. Increased sweating g. Worsening mental function

b. Blurred vision c. Constipation d. Dry mouth g. Worsening mental function

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? a. Client who has just returned from having a kidney artery angioplasty b. Client with polycystic kidney disease who is having a kidney ultrasound c. Client who is going for a cystoscopy and cystourethroscopy d. Client with glomerulonephritis who is having a kidney biopsy

b. Client with polycystic kidney disease who is having a kidney ultrasound

The nurse is reviewing the client's laboratory data prior to a nephrostomy tube insertion. Which data requires the nurse to take action? a. White blood cells in the urine b. INR of 2.1 c. Hematocrit 44% d. Creatinine 0.8 mg/dL

b. INR of 2.1

Which laboratory test is the best indicator of kidney function? a. Blood urea nitrogen (BUN) b. Creatinine c. Aspartate aminotransferase (AST) d. Alkaline phosphatase

b. Creatinine

Which lab finding is indicative of renal function alterations and not dehydration? Select all that apply. a. BUN 20 mL/dL b. Creatinine 2.3 mL/dL c. Hemoglobin 14 g/dL d. Cystatin-c 105 mg/mL e. BUN/creatinine ratio 10 f. Creatinine clearance 175 mL/min

b. Creatinine 2.3 mL/dL d. Cystatin-c 105 mg/mL f. Creatinine clearance 175 mL/min

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

b. Cushing's syndrome.

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

b. Has gained 15 pounds in the past 3 months

Which percussion technique does the nurse use to assess a client who reports flank pain? a. Place outstretched fingers over the flank area and percuss with the fingertips. b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. c. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. d. Quickly tap the flank area with cupped hands.

b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? a. Obtain blood urea nitrogen (BUN) and creatinine. b. Position the client supine. c. Administer pain medications. d. Check urine for hematuria.

b. Position the client supine.

The nurse is admitting a client undergoing a CT scan with contrast. Which finding does the nurse report as a possible immediate hypersensitivity reaction? Select all that apply. a. Nausea b. Pruritus c. Urticaria d. Laryngeal stridor e. Flushing of the skin

b. Pruritus c. Urticaria d. Laryngeal stridor e. Flushing of the skin

A client is on a 24-hour urine collection. At midpoint during the collection, the client tells the nurse that some of the urine was discarded. What action will the nurse take? Select all that apply. a. No action is required b. Reinforce client education c. Notify the laboratory staff d. Restart the urine collection e. Document the discarded urine f. Notify the health care provider

b. Reinforce client education c. Notify the laboratory staff e. Document the discarded urine f. Notify the health care provider

Which client assessment data is essential for the nurse to report to the health care provider before a renal scan is performed? a. Pink-tinged urine b. Reports pregnancy c. Reports claustrophobia d. History of an aneurysm clip

b. Reports pregnancy

A 62 year old client was admitted 2 days ago with traumatic injuries and hypovolemic shock. Which lab result is most important for the nurse to report to the health care provider immediately? a. Serum sodium 132 mEq/L (mmol/L) b. Serum potassium 6.9 mEq/L (mmol/L) c. Blood urea nitrogen 24 mg/dL (mmol/L) d. Hematocrit 32% ().32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)

b. Serum potassium 6.9 mEq/L (mmol/L)

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

b. diabetes insipidus.

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

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

GFR is controlled by

blood pressure and blood flow

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

c) Adequate vitamin D level

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

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

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

c) Cretinism

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

c) Dizziness

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

c) Posterior pituitary

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

c) RAI does not seriously affect other tissues.

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

c) Risk for injury related to weakness

Which instruction does the nurse give a client who needs a clean-catch urine specimen? a. "Save all urine for 24 hours." b. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." c. "Do not touch the inside of the container." d. "You will receive an isotope injection, then I will collect your urine."

c. "Do not touch the inside of the container."

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? a. "I must clean with the wipes and then urinate directly into the cup." b. "I will have to drink 2 liters of fluid before providing the sample." c. "I'll start to urinate in the toilet, stop, and then urinate into the cup." d. "It is best to provide the sample while I am bathing."

c. "I'll start to urinate in the toilet, stop, and then urinate into the cup."

The nurse is providing discharge teaching to a client recovering from kidney transplantation. Which client statement indicates understanding? a. "I can stop my medications when my kidney function returns to normal" b. "If my urine output decreases, I will increase my fluids" c. "The antirejection medications will be taken for life" d. "I will drink 8 ounces (236 mL) of water with my medications"

c. "The antirejection medications will be taken for life"

A 68-year old male client is seeing the primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? a. A 5 pack year history of smoking 45 years ago b. Difficulty starting and stopping the urine stream c. A 30-year occupation as long-distance truck driver d. A recent colon cancer diagnosis in his 72-year-old brother

c. A 30-year occupation as long-distance truck driver

The nurse is caring for an 80 year old female client with recurrent cystitis. Which teaching will the nurse include in the plan of care? Select all that apply. a. Drink citrus juices daily b. Douche regularly; a minimum of two times weekly. c. Encourage fluid intake of 2-3 L of fluid throughout the day d. Instruct her to always wipe the perineum from front to back after each toilet use e. Reinforce that she should complete the entire course of antibiotics as prescribed f. Instruct her to empty her bladder immediately before and after having intercourse

c. Encourage fluid intake of 2-3 L of fluid throughout the day d. Instruct her to always wipe the perineum from front to back after each toilet use e. Reinforce that she should complete the entire course of antibiotics as prescribed f. Instruct her to empty her bladder immediately before and after having intercourse

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? a. Abdominal girth b. Presence of urinary infection c. History of hysterectomy d. Hematuria

c. History of hysterectomy

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

d) Risk for infection

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: Assessment Data: BUN 26 mg/dL Creatinine 1.0 mg/dL) HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? a. Obtain a thyroid-stimulating hormone (TSH) level. b. Report the blood urea nitrogen (BUN) and creatinine. c. Hold the metformin 24 hours before and on the day of the procedure. d. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

c. Hold the metformin 24 hours before and on the day of the procedure.

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? a. Give lispro (Humalog) insulin, 12 units subcutaneously. b. Request a breakfast tray for the client. c. Infuse 0.45% normal saline at 125 mL/hr. d. Administer captopril (Capoten).

c. Infuse 0.45% normal saline at 125 mL/hr.

When caring for a client with uremia, the nurse assesses for which symptom? a. Tenderness at the costovertebral angle (CVA) b. Cyanosis of the skin c. Nausea and vomiting d. Insomnia

c. Nausea and vomiting

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? a. Administer heparin intravenously. b. Remove the urinary catheter. c. Notify the health care provider (HCP). d. Irrigate the catheter with sterile saline.

c. Notify the health care provider (HCP).

A client who performs continuous ambulatory peritoneal dialysis at home reports that the drainage (effluent) has become cloudy in the past 24 hours. What is the priority nursing action? a. Remove the peritoneal catheter b. Notify the nephrology health care provider c. Obtain a sample of effluent for culture and sensitivity d. Teach the client that effluent should be clear or slightly yellow

c. Obtain a sample of effluent for culture and sensitivity

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? a. Increased oral fluids b. IV fluids c. Privacy d. Health history forms

c. Privacy

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

c. Regulate serum calcium levels

A 28-year-old female client states, "I dont know why I get cystitis every year. I don't drink much at work so that I can avoid using the public toilet." Which teaching by the nurse is most likely to reduce her risk for cystitis? Select all that apply. a. Reinforce her choice to avoid using a public toilet b. Teach her to shower immediately after having sexual intercourse c. Suggest that she drink at least 2 to 3 L of fluid throughout the day d. Urge her to change her method of birth control from oral contraceptives to a barrier method e. Instruct her to always wipe her perineum from front to back after each toilet use f. Reinforce that she should complete the entire course of antibiotics as prescribed g. Instruct her to empty her bladder immediately before intercourse

c. Suggest that she drink at least 2 to 3 L of fluid throughout the day e. Instruct her to always wipe her perineum from front to back after each toilet use f. Reinforce that she should complete the entire course of antibiotics as prescribed g. Instruct her to empty her bladder immediately before intercourse

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? a. Pink-tinged urine b. Urinary frequency c. Temperature of 100.8°F (38.2°C) d. Lethargy

c. Temperature of 100.8°F (38.2°C)

functional unit of the kidney and forms urine by filtering waste products and water from the blood.

nephron

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

c. anterior neck

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

c. goiter

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

c. hyperpituitarism.

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

c. mineralocorticoids.

Collect formed urine from several tubules and deliver it into the renal pelvis Receptor sites for antidiuretic hormone regulation of water balance

collecting ducts

GFR is controlled by selectively _________________ the afferent and efferent arterioles.

constricting and dilating

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

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

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

d) Bone density testing

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

d) Placing the client in a private room

A client is diagnosed with renal colic. What would the nurse do first? a. Prepare the client for lithotripsy b. Encourage oral intake of fluids c. Strain the urine and send for urinalysis d. Administer opioids as prescribed

d. Administer opioids as prescribed

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

d. Antithyroid drugs

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? a. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. b. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. c. Use a sterile syringe to withdraw urine from the urine collection bag. d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? a. Client with chronic kidney disease b. Client with heart failure c. Client with complete bowel obstruction d. Client with hyperparathyroidism

d. Client with hyperparathyroidism

When planning an assessment of the urethra, what does the nurse do first? a. Examine the meatus. b. Note any unusual discharge. c. Record the presence of abnormalities. d. Don gloves.

d. Don gloves.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action does the nurse take? a. Asks the client to sign the informed consent b. Cancels the procedure c. Asks the client's spouse to sign the form d. Notifies the department and the HCP

d. Notifies the department and the HCP

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? a. Maintaining bedrest b. Medicating for pain c. Monitoring for hematuria d. Promoting fluid intake

d. Promoting fluid intake

Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? a. The client experiences nausea and vomiting after drinking juice b. The biopsy site is tender to light palpation c. The abdomen is distended, and the client reports abdominal discomfort d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready

d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready

Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? a. The client experiences nausea and vomiting after drinking juice. b. The biopsy site is tender to light palpation. c. The abdomen is distended and the client reports abdominal discomfort. d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

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

d. Vital signs reflect the metabolic rate.

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body areas? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses

d. Words that the client uses

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? a. A 35 year old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash b. A 48 year old man who has established paraplegia and is admitted for pneumonia c. a 61 year old woman who is admitted following a fall at home and has new-onset dysrhythmia d. a 74 year old man who has lung cancer with brain metastasis and is being transitioned to hospice

d. a 74 year old man who has lung cancer with brain metastasis and is being transitioned to hospice

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

d. glucose tolerance test.

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

d. pheochromocytoma.

hormonal GU changes related to aging

decrease in renin secretion, aldosterone levels, and activation of vitamin D.

rapid cell destruction from infection, dehydration, cancer treatment, or steroid therapy may

elevate BUN

From the afferent arteriole, blood flows into the

glomerulus

a series of specialized capillary loops

glomerulus

reterograde

going against the normal flow of urine

When blood glucose levels are ________________ than 220 mg/dL (12 mmol/L), some glucose stays in the filtrate and is present in the urine

greater

Aldosterone increases kidney reabsorption of sodium and water which _______________ BP

increases

Regulation of water balance Permeable to water, urea, and sodium chloride

loop of henle

Kidney functions

maintain body fluid volume create urine for waste ellimination adjust blood pressure regulate ACID-BASE BALANCE produce erythropoietin for RBC synthesis convert vitamin D to an active form.

a low BUN may indicate

malnutrition, fluid volume excess, or severe hepatic damage.

_______________________ is mostly reabsorbed in the PCT and in the thick segment of the loop of Henle.

potassium

Bicarbonate, calcium, and phosphate are mostly reabsorbed in the

proximal convoluted tubule

Most sodium, chloride, and water reabsorption occurs in the

proximal convoluted tubule

The blood supply to each kidney comes from the

renal artery

how much glucose the kidney can reabsorb

renal threshold

Raises blood pressure as result of angiotensin (local vasoconstriction) and aldosterone (volume expansion) secretion

renin

a hormone that is produced when the macula densa cells sense that blood volume, blood pressure, or blood sodium level is low.

renin

____________________ in the kidney pelvis regulate this movement.

stretch receptors

Contractions of the smooth muscle in the ureter move urine from

the kidney pelvis to the bladder

blood cells, albumin, and other proteins, are ______________ to filter through the glomerular capillary walls. Therefore these substances are not normally present in the excreted final urine.

too large

is the buildup of nitrogenous waste products in the blood from inadequate ellimination as a result of kidney failure. Symptoms include anorexia, nausea and vomiting, muscle cramps, pruritus (itching), fatigue, and lethargy.

uremia

he smallest arteries (afferent arterioles) feed the nephrons directly to form

urine

As blood passes from the afferent arteriole into the glomerulus ___________________________ are filtered across the glomerular membrane into the Bowman's capsule to form glomerular filtrate.

water electrolytes creatinine urea nitrogen glucose