RN- Final Exam 1228
A client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? 1. Decreased serum sodium level 2. Decreased serum creatinine level 3. Increased hematocrit 4. Increased blood urea nitrogen (BUN) level
1. Decreased serum sodium level RATIONALES: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. Typically, the hematocrit and BUN level decrease.
For a client with hyperthyroidism, treatment is most likely to include: 1. a thyroid hormone antagonist. 2. thyroid extract. 3. a synthetic thyroid hormone. 4. emollient lotions.
1. a thyroid hormone antagonist. RATIONALES: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1. 2 to 5 g of a simple carbohydrate. 2. 10 to 15 g of a simple carbohydrate. 3. 18 to 20 g of a simple carbohydrate. 4. 25 to 30 g of a simple carbohydrate.
2. 10 to 15 g of a simple carbohydrate. RATIONALES: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and: 1. folic acid. 2. vitamin D. 3. potassium. 4. iron.
2. vitamin D. RATIONALES: Typically, clients with hypoparathyroidism are prescribed daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
A client is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention would help prevent complications associated with SIADH? 1. Restricting fluids to 800 ml/day 2. Administering vasopressin as ordered 3. Elevating the client's head of bed to 90 degrees 4. Restricting sodium intake to 1 gm/day
1. Restricting fluids to 800 ml/day RATIONALES: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.
Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium reabsorption and phosphate excretion 2. Stimulation of phosphate reabsorption and calcium excretion 3. Increased absorption of vitamin D and excretion of vitamin E 4. Increased absorption of vitamin E and excretion of vitamin D
1. Stimulation of calcium reabsorption and phosphate excretion RATIONALES: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
When administering spironolactone (Aldactone) to a client who has had a unilateral adrenalectomy, the nurse should instruct the client about which possible adverse effect of the drug? 1. Constipation 2. Menstrual irregularities 3. Hypokalemia 4. Hypernatremia
2. Menstrual irregularities RATIONALES: Spironolactone can cause menstrual irregularities and decreased libido. Men may also experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spirolactone.
A client with type 1 diabetes mellitus has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse would be accurate in telling him the regimen includes the use of: 1. intermediate- and long-acting insulins. 2. short- and long-acting insulins. 3. short-acting insulin only. 4. short- and intermediate-acting insulins.
3. short-acting insulin only. RATIONALES: Continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate- or long-acting insulins
When caring for a client with a history of hypoglycemia, the nurse should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? 1. sulfisoxazole (Gantrisin) 2. mexiletine (Mexitil) 3. prednisone (Orasone) 4. lithium carbonate (Lithobid)
1. sulfisoxazole (Gantrisin) RATIONALES: Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
Which instruction about insulin administration should the nurse give to a client? 1. "Always follow the same order when drawing the different insulins into the syringe." 2. "Shake the vials before withdrawing the insulin." 3. "Store unopened vials of insulin in the freezer at temperatures well below freezing." 4. "Discard the intermediate-acting insulin if it appears cloudy."
1. "Always follow the same order when drawing the different insulins into the syringe." RATIONALES: The client should be instructed always to follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin protein molecules may be damaged. Intermediate-acting insulin is normally cloudy.
Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? 1. Confusion and seizures 2. Sunken eyeballs and spasticity 3. Flaccidity and thirst 4. Tetany and increased blood urea nitrogen (BUN) levels.
1. Confusion and seizures RATIONALES: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.
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. a blood pressure of 176/88 mm Hg. RATIONALES: 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.
The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: 1. exophthalmos and conjunctival redness 2. flushed, warm, moist skin 3. systolic murmur at the left sternal border 4. decreased body temperature and cold intolerance
4. decreased body temperature and cold intolerance RATIONALES: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. The other options are typical findings in a client with hyperthyroidism.
A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate that the treatment he's receiving for SIADH is effective? 1. Decrease in body weight 2. Rise in blood pressure and drop in heart rate 3. Absence of wheezes in the lungs 4. Increase in urine output 5. Decrease in urine osmolarity
1. Decrease in body weight 4. Increase in urine output 5. Decrease in urine osmolarity RATIONALES: SIADH is an abnormality involving an abundance of diuretic hormone. The predominant feature is water retention with oliguria, edema, and weight gain. Successful treatment should result in weight reduction, increased urine output, and a decrease in the urine concentration (urine osmolarity).
A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which nursing diagnosis is most appropriate for this client? 1. Deficient fluid volume related to inability to conserve water 2. Imbalanced nutrition: Less than body requirements related to hypermetabolic state 3. Deficient fluid volume related to osmotic diuresis induced by hypernatremia 4. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency
1. Deficient fluid volume related to inability to conserve water RATIONALES: The client has signs and symptoms of diabetes insipidus, probably caused by the failure of her renal tubules to respond to antidiuretic hormone as a consequence of pyelonephritis. The hypernatremia is secondary to her water loss. Imbalanced nutrition related to hypermetabolic state or catabolic effect of insulin deficiency is an inappropriate nursing diagnosis for the client.
A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which nursing diagnosis is most appropriate for this client? 1. Deficient fluid volume related to inability to conserve water 2. Imbalanced nutrition: Less than body requirements related to hypermetabolic state 3. Deficient fluid volume related to osmotic diuresis induced by hypernatremia 4. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency
1. Deficient fluid volume related to inability to conserve water RATIONALES: The client has signs and symptoms of diabetes insipidus, probably caused by the failure of her renal tubules to respond to antidiuretic hormone as a consequence of pyelonephritis. The hypernatremia is secondary to her water loss. Imbalanced nutrition related to hypermetabolic state or catabolic effect of insulin deficiency is an inappropriate nursing diagnosis for the client.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1. Fluid intake is less than 2,500 ml/day. 2. Urine output measures more than 200 ml/hr. 3. Blood pressure is 90/50 mm Hg. 4. Heart rate is 126 beats/min.
1. Fluid intake is less than 2,500 ml/day. RATIONALES: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hr indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/min indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
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. Hyperkalemia RATIONALES: 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.
A nurse administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? 1. Oral anticoagulants 2. Anabolic steroids 3. Beta-adrenergic blockers 4. Thiazide diuretics
1. Oral anticoagulants RATIONALES: As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn't interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? 1. Related to bone demineralization resulting in pathologic fractures 2. Related to exhaustion secondary to an accelerated metabolic rate 3. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces 4. Related to tetany secondary to a decreased serum calcium level
1. Related to bone demineralization resulting in pathologic fractures RATIONALES: Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.
A client is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention would help prevent complications associated with SIADH? 1. Restricting fluids to 800 ml/day 2. Administering vasopressin as ordered 3. Elevating the client's head of bed to 90 degrees 4. Restricting sodium intake to 1 gm/day
1. Restricting fluids to 800 ml/day RATIONALES: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.
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. potassium chloride. RATIONALES: 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.
A client diagnosed with thyroid cancer signed a living will that states she doesn't want ventilatory support if her condition deteriorates. As her condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best? 1. "I'll ask your doctor to revoke your do not resuscitate order." 2. "Do you understand that you'll be placed on a ventilator?" 3. "What exactly do you mean by wanting 'everything' done for you?" 4. "Maybe you should talk to your family."
3. "What exactly do you mean by wanting 'everything' done for you?" RATIONALES: Option 3 is the best response. The nurse should clarify the client's request and get as much information as she can before notifying the physician of the client's wishes. Option 1 assumes that the client wants her do-not-resuscitate (DNR) order without obtaining clarification of her statement. The client might want aggressive treatment without reversing the DNR order. Option 2 places the client on the defensive. Option 4 is an inappropriate response; the client has the right to change her treatment plan without input from her family.
Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 1. 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin 2. 70 units of regular insulin and 30 units of NPH insulin 3. 70% NPH insulin and 30% regular insulin 4. 70% regular insulin and 30% NPH insulin
3. 70% NPH insulin and 30% regular insulin RATIONALES: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.
A client is seen in the clinic with a possible parathormone deficiency. Diagnosis of this condition includes the analysis of serum electrolytes. Which electrolytes would the nurse expect to be abnormal? 1. Sodium 2. Potassium 3. Calcium 4. Chloride 5. Glucose 6. Phosphorous
3. Calcium 6. Phosphorous RATIONALES: A client with a parathormone deficiency has abnormal calcium and phosphorous values because parathormone regulates these two electrolytes. Potassium, chloride, sodium, and glucose aren't affected by a parathormone deficiency.
Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis? 1. Weight loss, increased appetite, and hyperdefecation 2. Weight loss, increased urination, and increased thirst 3. Weight gain, decreased appetite, and constipation 4. Weight gain, increased urination, and purplish-red striae
3. Weight gain, decreased appetite, and constipation RATIONALES: Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women over age 40. Weight gain, decreased appetite, constipation, lethargy, dry cool skin, brittle nails, coarse hair, muscle cramps, weakness, and sleep apnea are symptoms of Hashimoto's thyroiditis. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.
When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: 1. restricting fluids. 2. restricting sodium. 3. forcing fluids. 4. restricting potassium.
3. forcing fluids. RATIONALES: The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: 1. thyroid storm. 2. cretinism. 3. myxedema coma. 4. Hashimoto's thyroiditis.
3. myxedema coma. RATIONALES: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes mellitus. Which statement indicates the need for further client teaching about management of this disease? 1. "I always carry hard candy to eat in case my blood sugar level drops." 2. "I avoid exposure to the sun as much as possible." 3. "I always wear my medical identification bracelet." 4. "I often skip lunch because I don't feel hungry."
4. "I often skip lunch because I don't feel hungry." RATIONALES: A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1. Above-normal urine and serum osmolality levels 2. Below-normal urine and serum osmolality levels 3. Above-normal urine osmolality level, below-normal serum osmolality level 4. Below-normal urine osmolality level, above-normal serum osmolality level
4. Below-normal urine osmolality level, above-normal serum osmolality level RATIONALES: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
The nurse explains to a client with thyroid disease that the thyroid gland normally produces: 1. iodine and thyroid-stimulating hormone (TSH). 2. thyrotropin-releasing hormone (TRH) and TSH. 3. TSH, T3, and calcitonin. 4. T3, T4, and calcitonin.
4. T3, T4, and calcitonin. RATIONALES: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. TSH is produced by the pituitary gland to regulate the thyroid gland. TRH is produced by the hypothalamus gland to regulate the pituitary gland.
The nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings should the nurse expect to note during the assessment? 1. Extreme polyuria 2. Excessive thirst 3. Elevated systolic blood pressure 4. Low urine specific gravity 5. Bradycardia 6. Elevated serum potassium level
Correct Answer: 1,2,4 Your Answer: 1,2,4 RATIONALES: Signs and symptoms of diabetes insipidus include an abrupt onset of extreme polyuria, excessive thirst, dry skin and mucous membranes, tachycardia, and hypotension. Diagnostic studies reveal low urine specific gravity and osmolarity and elevated serum sodium. Serum potassium levels are likely to be decreased, not increased.
A nurse is about to administer a client's morning dosage of insulin. The client's order is for 5 U of regular and 10 U of NPH given as a basal dose. He also is to receive an amount prescribed from his medium-dose sliding scale (shown below), based on his morning blood glucose level. The nurse performs a bedside blood glucose measurement and the result is 264 mg/dl. How many total units of insulin should the nurse administer to the client? Plasma glucose (mg/dl) Low dose (Regular insulin) Medium dose (Regular insulin) High dose (Regular insulin) Very high dose (Regular insulin) < 70 Call physician Call physician Call physician Call physician 71-140 0 U 0 U 0 U 0 U 141-180 1 U 2 U 4 U 10 U 181-240 2 U 4 U 8 U 15 U 241-300 4 U 6 U 12 U 20 U 301-400 6 U 9 U 16 U 25 U > 400 8 U and call physician 12 U and call physician 20 U and call physician 30 U and call physician
Correct Answer: 21 RATIONALES: The basal dosage for this client is 5 U of regular insulin and 10 U of NPH insulin. Using the medium-dose sliding scale and the client's blood glucose reading of 264 mg/dl, the nurse should determine that an additional 6 U of regular insulin are required, totalling 21 U (5 U + 10 U + 6 U = 21 U).