307 Exam 4 Practice Questions
The human insulin whose onset of action occurs within ____ minutes is Humalog (Lispro). A) 5-15 B) 60-120 C) 30-45 D) 45-60
A) 5-15
A patient has type 1 diabetes, early signs and symptoms of a hypoglycemic reaction include A) perspiration and a trembling sensation B) abdominal pain and nausea. C) dyspnea and pallor. D) flushing of the skin and headache
A) perspiration and a trembling sensation
Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: a. ondansetron (Zofran). b. fluoxetine (Prozac). c. paroxetine (Paxil). d. sertraline (Zoloft).
A. Chemotherapy often induces vomiting centrally by stimulating the chemoreceptor trigger zone (CTZ) and peripherally by stimulating visceral afferent nerves in the GI tract. Ondansetron (Zofran) is a serotonin antagonist that bocks the effects of serotonin and prevents and treats nausea and vomiting. It is especially useful in single-day highly emetogenic cancer chemotherapy (for example, cisplatin). The agents in options 2-4 are selective serotonin reuptake inhibitors. They increase the available levels of serotonin.
A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse determines that the client is experiencing optimal effects of the medication if: A. Heart burn is relieved B. Muscle twitching stops C. Serum calcium levels rise D. Serum phosphrous levels decrease
A. Heart burn is relieved
Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy? a. Tachycardia b. Bradycardia c. Hypotension d. Constipation
A. Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease.
12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A. antidiuretic hormone (ADH). B. thyroid-stimulating hormone (TSH). C. follicle-stimulating hormone (FSH). D. luteinizing hormone (LH).
Answer A. ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.
7. A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression b. Neuropathy c. Hypoglycemia d. Hyperthyroidism
Answer A. Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
22. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? a. Oral anticoagulants b. Anabolic steroids c. Beta-adrenergic blockers d. Thiazide diuretics
Answer A. 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.
8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A. vasopressin (Pitressin Synthetic). B. furosemide (Lasix). C. regular insulin. D. 10% dextrose.
Answer A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
9. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism b. Graves' disease c. Thyrotoxicosis d. Euthyroidism
Answer A. Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
23. Which instruction about insulin administration should nurse Kate give to a client? a. "Always follow the same order when drawing the different insulins into the syringe." b. "Shake the vials before withdrawing the insulin." c. "Store unopened vials of insulin in the freezer at temperatures well below freezing." d. "Discard the intermediate-acting insulin if it appears cloudy."
Answer A. 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.
16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. "Be sure to take glipizide 30 minutes before meals." b. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." c. "You won't need to check your blood glucose level after you start taking glipizide." d. "Take glipizide after a meal to prevent heartburn."
Answer A. The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
21. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? a. "You'll need more insulin when you exercise or increase your food intake." b. "You'll need less insulin when you exercise or reduce your food intake." c. "You'll need less insulin when you increase your food intake." d. "You'll need more insulin when you exercise or decrease your food intake."
Answer B. Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements.
24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? A. Initiate insulin therapy. B. Switch the client to a different oral antidiabetic agent. C. Prescribe an additional oral antidiabetic agent. D. Restrict carbohydrate intake to less than 30% of the total caloric intake.
Answer B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.
22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: A. prefers to take insulin orally. B. has type 2 diabetes. C. has type 1 diabetes. D. is pregnant and has type 2 diabetes.
Answer B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
1. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: a. Hypotension. b. Thick, coarse skin. c. Deposits of adipose tissue in the trunk and dorsocervical area. d. Weight gain in arms and legs.
Answer C. 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.
2. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? a. "Administer desmopressin while the suspension is cold." b. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." c. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." d. "You won't need to monitor your fluid intake and output after you start taking desmopressin."
Answer C. Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.
6. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? A. Dysuria B. Leg cramps C. Tachycardia D. Blurred vision
Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren't associated with levothyroxine.
6. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose's: a. Onset to be at 2 p.m. and its peak to be at 3 p.m. b. Onset to be at 2:15 p.m. and its peak to be at 3 p.m. c. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. d. Onset to be at 4 p.m. and its peak to be at 6 p.m.
Answer C. Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.
24. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: a. I.M. or subcutaneous glucagon. b. I.V. bolus of dextrose 50%. c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. d. 10 U of fast-acting insulin.
Answer C. This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A. Diabetes mellitus B. Diabetes insipidus C. Hypoparathyroidism D. Hyperparathyroidism
Answer D. Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
19. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
Answer D. In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
A patient has been diagnosed with diabetes insipidus. In diabetes insipidus, clinical manifestations are caused by a deficiency of A) thyroid-stimulating hormone (TSH). B) antidiuretic hormone (ADH). C) follicle-stimulating hormone (FSH). D) adrenocorticotropic hormone (ACTH).
B) antidiuretic hormone (ADH).
A client has been taking omeprazole (Prilosec) for 4 weeks. The nurse determines that the client is receiving the optimal intended effect of the medication if the client reports absence of which of the following symptoms? A. Diarrhea B. Heartburn C. Flatulence D. Constipation
B. Heartburn
A physician prescribes bisacodyl (Dulcolax) for a client in preparation for a diagnostic test and wants the client to achieve a rapid effect from the medication. The nurse then tells the client to take the medication: A. With a large meal B. On an empty stomach C. At bedtime with a snack D. With two glasses of juice
B. On an empty stomach
A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is: a. Parasite infection. b. Viral infection. c. Bacterial infection. d. Spirochete infection.
B. Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents.
Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence
C. Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness.
A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take: a. aspirin (acetylsalicylic acid, ASA) b. ibuprofen (Motrin) c. acetaminophen (Tylenol) d. naproxen (Naprosyn)
C. The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an already existing GI problem.
A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should: a. draw up and administer the dose b. shake the vial in an attempt to disperse the clumps c. draw the dose from a new vial d. warm the bottle under running water to dissolve the clump
C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: A. constipation B. abdominal pain C. episode of diarrhea D. Hematest-positive nasogastric tube drainage
C. episode of diarrhea
A client has a PRN order for ondansetron (Zofran). The nurse would administer this medication to the postoperative client for relief of: A. paralytic ileus B. incisional pain C. urinary retention D. Nausea and vomiting
D. Nausea and vomiting
A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? A. Abdominal pain B. Reduction in steatorrhea C. Hematest-negative stools D. Regular bowel movements
D. Regular bowel movements
Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? a. "I will take this medication in the morning so as not to interfere with sleep." b. "I will double my dose if I gain more than 1 pound per day." c. "I will stop the medication immediately if I lose more than 2 pounds in a week." d. "I can expect to see relief of my symptoms within 1 week."
a. "I will take this medication in the morning so as not to interfere with sleep." Rationale: Levothyroxine increases basal metabolism and thus wakefulness. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.
With a prolonged episode of vomiting, the patient could be at risk for the development of what problem? a. Acid-base disturbances b. Intractable diarrhea c. Esophageal tears d. Hypoventilation
a. Acid-base disturbances Rationale: After a prolonged episode of vomiting, the patient could be at risk for acid-base disturbances.
A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what? a. Acts on smooth intestinal muscle to gently increase peristalsis b. Absorbs water into the intestines to increase bulk and peristalsis c. Lowers surface tension and increases water accumulation in the intestines d. Pulls hyperosmolar salts into the colon and increases water in the feces to increase bulk
a. Acts on smooth intestinal muscle to gently increase peristalsis
What is a priority nursing intervention when administering ranitidine (Zantac)? a. Administer just before meals. b. Administer right after eating. c. Administer 1 to 2 hours after meals. d. Administer during meals.
a. Administer just before meals.
Peptic ulcer disease is commonly treated with inexpensive therapy medications called _____. a. Aluminum hydroxide (antacid) b. Pirenzepine (Gastrozepin) c. Misoprostol (Cytotec) d. Sucralfate (Carafate)
a. Aluminum hydroxide (antacid) Rationale: Antacids are effective at neutralizing stomach acid, and are inexpensive OTC therapy for PUD or GERD.
What assessment has the highest priority for a client using sodium bicarbonate to treat gastric hyperacidity? a. Assess for metabolic alkalosis. b. Assess for fluid volume deficit. c. Assess for hyperkalemia. d. Assess for hypercalcemia.
a. Assess for metabolic alkalosis.
When assessing for potential toxicity to PTU, the nurse will monitor the patient for changes in which laboratory test? a. CBC b. BNP c. Serum electrolytes d. Renal function tests
a. CBC Rationale: With antithyroid medications, the nurse should monitor for possible toxic reactions such as agranulocytosis, pancytopenia, and life-threatening hepatitis. An abnormal CBC would indicate bone marrow dysfunction.
The elderly population is known to use laxatives with regularity. In advising an older adult practicing this habit, the nurse would identify all of the following except: (Select all that apply.) a. Consistent use of laxatives inhibits natural defecation reflexes, and is thought to cause rather that cure constipation. b. Habitual use of laxatives eventually requires larger or stronger doses because the effect is progressively reduced. c. Laxatives may interfere with fluid and electrolyte balance. d. Laxatives increase the absorption of certain vitamins.
a. Consistent use of laxatives inhibits natural defecation reflexes, and is thought to cause rather that cure constipation. b. Habitual use of laxatives eventually requires larger or stronger doses because the effect is progressively reduced. c. Laxatives may interfere with fluid and electrolyte balance.
When administering intravenous magnesium sulfate, the nurse will monitor for which signs and symptoms of hypermagnesemia? a. Depressed deep tendon reflexes b. Hyperthermia c. Diaphoresis d. Tachycardia
a. Depressed deep tendon reflexes Rationale: Signs and symptoms of excess magnesium include tendon reflex loss, difficult bowel movements, central nervous system depression, respiratory distress, heart block, and hypothermia.
Mr. Howard has been diagnosed with constipation after surgery. What drug should the nurse have prepared to administer? a. Docusate sodium (Colace) b. Prochlorperazine (Compazine) c. Loperamide (Imodium) d. Promethazine (Phenergan)
a. Docusate sodium (Colace) Rationale: A stool softener such as docusate sodium (Colace) should be administered.
What would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin? a. Fluid balance b. Patient's pain scale c. Serum albumin levels d. Adrenocorticotropic hormone (ACTH) levels
a. Fluid balance Rationale: Vasopressin causes decreased water excretion in the renal tubule, thus decreasing urine output. It is used to treat diabetes insipidus, which presents with polyuria and dehydration.
Mrs. Johnson is an epileptic, taking phenytoin (Dilantin). Patient teaching should warn Mrs. Johnson that interaction with Dilantin might cause a reduction in what vitamin? a. Folic acid b. Thiamine c. Vitamin D d. Vitamin A
a. Folic acid Rationale: The client will have a reduction of folic acid with the use of Dilantin.
When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? (Select all that apply.) a. Headache b. Weight gain c. Nasal irritation d. Hyperglycemia e. Hypotension
a. Headache b. Weight gain c. Nasal irritation Rationale: Desmopressin works to decrease urine output; thus the patient would retain fluid and gain weight. Headache may also occur as a sequela of fluid retention. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin does not affect serum glucose levels.
A client is diagnosed with peptic ulcer disease. The nurse realizes that which factor is a predisposing factor for this condition? a. Helicobacter pylori b. hyposecretion of pepsin c. decreased hydrochloric acid d. decreased number of parietal cells
a. Helicobacter pylori
The nurse is reviewing adverse effects of antithyroid medications with a patient who has been taking PTU. What adverse effects does the nurse include in the teaching? (Select all that apply.) a. Liver toxicity b. Polyuria c. Kidney damage d. Bone marrow toxicity e. Joint pain
a. Liver toxicity d. Bone marrow toxicity e. Joint pain Rationale: The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.
Mrs. Smith has had intractable diarrhea for two weeks. The nurse would expect to administer what type of drug for the treatment of this condition? a. Opioids b. Laxatives c. Cathartics d. Bulk-forming agents
a. Opioids Rationale: The nurse would expect to administer opioids, such as atropine (Lomotil), for intractable diarrhea.
When treating a nauseated patient with antiemetics, it is essential that the nurse understand what principle? a. Patient safety is a concern, as drowsiness is a frequent side effect. b. Sports drinks are an excellent substitute for antiemetics. c. Sports drinks replace the essential ingredients lost by dehydration. d. There are no known side effects of antiemetics.
a. Patient safety is a concern, as drowsiness is a frequent side effect. Rationale: The medication could cause drowsiness, and the patient should avoid driving or performing hazardous tasks. Vomiting could be a serious disorder, and should not be treated with OTC medications for a long period of time.
What vitamins are most likely to lead to toxic levels, hypervitaminosis, when administered in megadoses? (Select all that apply.) a. Vitamin A b. Vitamin B complex c. Vitamin C d. Vitamin D e. Vitamin K
a. Vitamin A d. Vitamin D e. Vitamin K Rationale: Vitamin megadosing can lead to toxic accumulations known as hypervitaminosis, especially with the fat-soluble vitamins A, D, and K. Vitamin E appears safer, however, even at doses 10 to 20 times the recommended Dietary Reference Intake (DRI). Hypervitaminosis is less likely to occur with the water-soluble vitamins (B complex and C) because they are readily excreted through the urinary system. Nevertheless, it is known that megadosing with vitamin B 6 (pyridoxine) at 50 to 100 times the DRI can cause nerve damage.
The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? a. desmopressin (DDAVP) b. corticotrophin (Acthar) c. octreotide (Sandostatin) d. somatropin (Humatrope)
a. desmopressin (DDAVP) Rationale: Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response? a. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." b. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." c. "Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better." d. "Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland."
b. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Rationale: Propylthiouracil is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.
Which statement demonstrates to the nurse that the client understands instructions regarding the use of histamine2-receptor antagonists? a. "Since I am taking this medication, it is all right for me to eat spicy foods." b. "Smoking decreases the effects of this medication, so I should look into cessation programs." c. "I should take this medication 1 hour after each meal in order to decrease gastric acidity." d. "I should decrease bulk and fluids in my diet to prevent diarrhea."
b. "Smoking decreases the effects of this medication, so I should look into cessation programs."
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? a. "I will have to isolate myself from my family for 1 week so as not to expose them to radiation." b. "This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." c. "This drug will help decrease my cold intolerance and weight gain." d "I will need to take this drug on a daily basis for at least 1 year."
b. "This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." Rationale: Radioactive iodine is an antithyroid medication that is administered orally for one or two doses only. It concentrates in the thyroid gland, enabling the radiation to destroy the hyperplastic cells.
A client has nausea and is taking ondansetron (Zofran). The nurse explains that the action of this drug is what? a. Stimulate the CTZ b. Block serotonin receptors in the CTZ c. Block dopamine receptors in the CTZ d. Coat the wall of the GI tract and absorb bacteria
b. Block serotonin receptors in the CTZ
A client is taking famotidine (Pepcid) to inhibit gastric secretions. What are the side effects of famotidine? (Select all that apply.) a. Diarrhea b. Dizziness c. Dry mouth d. Headaches e. Blurred vision f. Decreased libido
b. Dizziness d. Headaches f. Decreased libido
The nurse is administering loperamide (Imodium) to a client with diarrhea. What assessment is essential for this client? a. Vascular assessment b. Gastric assessment c. Hourly blood pressure measurements d. White blood count
b. Gastric assessment
Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect? a. Cardiac arrhythmias b. Increased risk of bleeding c. Excessive weight loss d. Increased risk of deep vein thrombosis
b. Increased risk of bleeding Rationale: Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding.
A client complains of constipation and requires a laxative. In providing teaching to the client, the nurse reviews the common causes of constipation, including which cause? a. Motion sickness b. Lack of exercise c. Food intolerance d. Bacteria (Escherichia coli)
b. Lack of exercise
Which mineral is essential for energy metabolism but may also be used in higher doses to treat certain seizures and preeclampsia? a. Calcium b. Magnesium c. Phosphorus d. Zinc
b. Magnesium Rationale: Magnesium is an essential mineral for body functioning but at higher doses is used in treatment of preeclampsia and seizures related to hypomagnesium levels.
What dietary information is it helpful to record when treating diarrhea in children? (Select all that apply.) a. Measure the percentage of additional high fiber in the diet. b. Measure the fluid intake, including popsicles and ice chips. c. Weigh the client daily. d. Record hours of sleep.
b. Measure the fluid intake, including popsicles and ice chips. c. Weigh the client daily. Rationale: Recording the frequency of stools, noting blood, and reporting any abdominal pain would be helpful in treating diarrhea in children. Measure weight to determine dehydration, and record fluid intake.
Mrs. Smith will be receiving nutritional supplements via an IV line. What type of nutrition would this be considered? a. Enteral infusion b. Parental infusion c. Hyperalimentation infusion d. Superior vena cava infusion
b. Parental infusion Rationale: This type of nutrition would be considered parental infusion.
The nurse must be aware of what natural therapy that many people use to induce a sense of calm, but which in reality could make esophageal reflux more pronounced? a. Ginger b. Peppermint c. Basil d. Chocolate
b. Peppermint Rationale: Peppermint may be used to induce a sense of calm, but in reality, it could make esophageal reflux more pronounced.
Caffeinated beverages and smoking are risk factors to assess for in the development of what condition? a. Duodenal ulcers b. Peptic ulcers c. Helicobacter pylori d. Esophageal Reflux
b. Peptic ulcers Rationale: PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine.
The gram-negative bacterium Helicobacter pylori is the primary cause of what type of ulcer development? a. Duodenal ulcers b. Peptic ulcers c. Gastric ulcers d. Esophageal ulcers
b. Peptic ulcers Rationale: The gram-negative bacterium Helicobacter pylori is the primary cause development of peptic ulcers.
Cyanocobalamin (vitamin B12) is indicated for the treatment of which condition? a. Acute lymphocytic leukemia b. Pernicious anemia c. Bone marrow suppression d. Optic nerve atrophy
b. Pernicious anemia Rationale: Cyanocobalamin is used to treat deficiency states of vitamin B12. The most common manifestation of untreated cyanocobalamin deficiency is pernicious anemia.
Which nursing diagnoses is appropriate for a client receiving famotidine (Pepcid)? a. Increased risk for infection related to immunosuppression b. Potential risk for bleeding related to thrombocytopenia c. Alteration in urinary elimination related to retention d. Alteration in tissue perfusion related to hypertension
b. Potential risk for bleeding related to thrombocytopenia
A patient receiving vitamin K most likely has demonstrated a. diarrhea. b. altered coagulation studies. c. seizure activity. d. confusion.
b. altered coagulation studies. Rationale: Vitamin K is an essential nutrient for the synthesis of clotting factors. It is also the antidote for warfarin, an oral anticoagulant. The administration of vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding.
A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse a. explains that caloric intake must be reduced when drug therapy is started b. provides written instruction for all information related to the medication therapy c. assures the patient that a return to normal function will occur with replacement therapy d. informs the patient that medications must be taken until hormone balance is reestablished
b. provides written instruction for all information related to the medication therapy (rationale- because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)
When caring for a patient with nephrogenic DI, the nurse would expect treatment to include a. fluid restriction b. thiazide diuretics c. a high-sodium diet d. chlorpropamide (DIabinese)
b. thiazide diuretics (Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate in the kidney and produce a decrease in urine output. Low-sodium diets are also thought to decrease urine output. Fluids are not restricted, because the patient could become easily dehydrated.)
The nurse is educating an elderly patient on vitamin supplementation. The patient states that she takes "lots of vitamins every day" to stay healthy. Based on this information and knowledge of vitamins, what is the nurse's best response? a. "That's great. You should be very healthy." b. "You need to make certain that is okay with your health care provider." c. "Can you tell me what vitamins you take and how many and how often?" d. "You don't need vitamins if you eat well."
c. "Can you tell me what vitamins you take and how many and how often?" Rationale: The nurse needs further information on the amount and type of vitamins the patient is taking. A patient may develop hypervitaminosis if not cautious with certain vitamins.
The nurse encounters a 75-year-old in the emergency department, with complaints of nausea, diarrhea, and anorexia. He has been evaluated, and it is determined that he can be treated at home. In discussing the guidelines of managing diarrhea, the nurse knows the client understands his care measures when he says: a. "I will drink two glasses of water a day to prevent dehydration." b. "I will drink tea when I get home." c. "I will increase foods with fiber, like oatmeal." d. "I will eat fried chicken for supper."
c. "I will increase foods with fiber, like oatmeal."
Mr. Jones is recovering from major surgery. He is unable to be fed. Because he will require hyperalimentation, what type of access is most preferable? a. Peripheral vein access b. Arterial access c. Central venous access d. Jejunostomy access
c. Central venous access Rationale: Central venous access is most preferable, because he will require hyperalimentation.
Which client needs immediate intervention? a. Client taking aluminum-containing antacids with complaints of reflux. b. Client taking calcium-containing antacids who is hypocalcemic. c. Client taking magnesium-containing antacids who has renal failure. d. Client taking antacids who is older than 70 years.
c. Client taking magnesium-containing antacids who has renal failure.
What will the nurse teach the client about the reason for administering multiple medications for relief of nausea and vomiting? a. Combination therapy decreases the risk of constipation. b. Combination therapy is more cost-effective. c. Combination therapy blocks different vomiting pathways. d. Combination therapy decreases side effects due to lower doses of each drug.
c. Combination therapy blocks different vomiting pathways.
Before administering a stimulant laxative to a client, which nursing intervention is the priority? a. Obtain a history of constipation and causes. b. Record baseline vital signs. c. Evaluate renal function. d. Assess fluid and electrolyte balance.
c. Evaluate renal function.
Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? a. Risk for injury b. Acute pain c. Excess fluid volume d Deficient knowledge regarding medication
c. Excess fluid volume Rationale: Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.
The nurse would question a physician's prescription for vitamin D in a patient with which diagnosis? a. Chronic renal failure b. Hypothyroidism c. Hyperparathyroidism d. Graves' disease
c. Hyperparathyroidism Rationale: Vitamin D is contraindicated with hypercalcemia, a clinical manifestation of hyperparathyroidism.
The nurse is assessing Mr. Howell, and recognizes that he is exhibiting generalized weakness, cardiac arrhythmias, hypertension, loss of deep tendon reflexes, and respiratory distress. What could be the possible cause of these symptoms? a. Hypocalcemia b. Hypercalcemia c. Hypomagnesemia d. Hypermagnesemia
c. Hypomagnesemia
Which assessment is most important for the client who is taking stimulant laxatives? a. Monitor bowel elimination daily. b. Monitor intake and output. c. Monitor signs and symptoms of fluid and electrolyte imbalance. d. Monitor heart rate and blood pressure every 4 hours.
c. Monitor signs and symptoms of fluid and electrolyte imbalance.
Mrs. Johnson has been using over the proton pump inhibitors for relief of gastric upset. The nurse should teach Mrs. Johnson that appropriate administration is to: a. Crush the medication. b. Take with antacids. c. Never crush or chew medication. d. Take medication 30 minutes after eating.
c. Never crush or chew medication. Rationale: Stress the importance of taking medication before meals, and not crushing, breaking, or chewing medication.
The development of GERD (gastroesophageal reflux disease) is often associated with what medical condition? a. Cigarette smoking b. Type II diabetes mellitus c. Obesity d. Alcohol use
c. Obesity Rationale: Development of GERD (gastroesophageal reflux disease) is often associated with obesity.
The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against? a. Milk b. Eggs c. Seafood d. Chicken
c. Seafood Rationale: Seafood contains high amounts of iodine. The other choices do not.
The health care provider prescribes lansoprazole (Prevacid) to a client. Which assessment indicates to the nurse that the medication has had a therapeutic effect? a. The client has no diarrhea. b. The client has no gastric pain. c. The client has no throat pain. d. The client is able to eat.
c. The client has no throat pain.
A client is taking ranitidine (Zantac). The nurse who is teaching the client about this drug should include which information? (Select all that apply.) a. Drug-induced impotence is irreversible b. The drug must be administered 30 minutes before meals c. The drug must be administered separate from an antacid by at least 1 hour d. The drug must always be administered with magnesium hydroxide e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet
c. The drug must be administered separate from an antacid by at least 1 hour e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet
What vitamin can be synthesized by the skin when exposed to sunlight but can also be supplemented as needed? a. Vitamin C b. Vitamin K c. Vitamin D d. Vitamin B complex
c. Vitamin D Rationale: The human body requires vitamins in specific minimum amounts on a daily basis, and these can be obtained from both plant and animal food sources. In some cases, the body synthesizes some of its own vitamin supply. Supplemental amounts of vitamin B complex and vitamin K are synthesized by normal bacterial flora in the gastrointestinal tract. Vitamin D can be synthesized by the skin when the skin is exposed to sunlight.
What is the treatment of choice for overdoses of the drug warfarin (Coumadin?) a. Vitamin A b. Thiamine c. Vitamin K d. Folic acid
c. Vitamin K Rationale: Vitamin K should be given for overdoses of the drug warfarin.
Jack is a 12-year-old hemophiliac. The nurse is aware that Jack will require administration of what vitamin to improve his clotting factors? a. Folic acid b. Riboflavin c. Vitamin K d. Vitamin A
c. Vitamin K Rationale: Vitamin K should be given to the client to improve clotting.
A patient with DI is treated with nasal desmopression. The nurse recognize that the drug is not having an adequate therapeutic effect the the patient experiences a. headache and weight gain b. nasal irritation and nausea c. a urine specific gravity of 1.002 d. an oral intake greater than urinary output
c. a urine specific gravity of 1.002 (rationale- normal urine specific gravity is 1.003 to 1.030, and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of DI is inadequate. H/A, weight gain, and oral intake greater the urinary output are signs of volume excess that occur with overmedication. Nasal irritation & nausea may also indicate overmedication.)
A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find a. hoarseness and laryngeal stridor b. bulging eyeballs and arrhythmias c. elevated temperature and signs of heart failure d. lethargy progressing suddenly to impairment of consciousness
c. elevated temperature and signs of heart failure (rationale- a hyperthyroid crisis results in marked manifestations of hyperthyroidism, with fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in the patient with Gravs' dz, it is not a significant factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
A patient with Grave's dz asks the nurse what caused the disorder. The best response by the nurse is a. "The cause of Grave's disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones" d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."
d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones." (rationale- The antibodies present in Graves' disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)
When a client complains of pain accompanying a peptic ulcer, why should an antacid be given? a. Antacids decrease GI motility. b. Antacids decrease gastric acid secretion. c. Aluminum hydroxide is a systemic antacid. d. Antacids neutralize HCl and reduce pepsin activity.
d. Antacids neutralize HCl and reduce pepsin activity.
The nurse would suspect excessive thyroid replacement in a patient taking levothyroxine (Synthroid) when the patient is exhibiting which adverse effect? a. Depression b. Intolerance to cold c. Weight gain d. Irritability
d. Irritability Rationale: Irritability is a symptom of hyperthyroidism. The other choices are signs of hypothyroidism.
Patient teaching regarding the administration of vitamin C would include which indication(s) of toxicity? a. Excessive bleeding tendencies b. Constipation c. Seizure activity d. Nausea and vomiting and abdominal cramping
d. Nausea and vomiting and abdominal cramping Rationale: Megadoses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones.
Mr. Jameson is a longtime alcoholic. The nurse should be aware that alcoholism is the most common cause of what vitamin deficiency? a. Vitamin E b. Folic acid c. Vitamin D d. Thiamine
d. Thiamine Rationale: Thiamine deficiency occurs when the client is an alcoholic.
_________ is a vitamin that can be used for the effective treatment of night blindness, skin disorders, and decreased wound healing. a. Folic acid b. Vitamin K c. Thiamine d. Vitamin A
d. Vitamin A Rationale: Vitamin A should be given to improve night blindness, skin disorders, and decreased wound healing.
The drug of choice in the H2-receptor antagonists, ranitidine (Zantac), is preferable to the use of cimetidine (Tagamet) for what reason? a. Zantac has a lower cost. b. Zantac (ranitidine) crosses the blood-brain barrier. c. Cimetidine causes less confusion and CNS depression. d. Zantac (ranitidine) has a higher potency than cimetidine, and can be administered once daily.
d. Zantac (ranitidine) has a higher potency than cimetidine, and can be administered once daily. Rationale: Zantac (ranitidine) has higher potency than cimetidine, and can be administered once daily.
Physical changes of hypothyroidism that must be monitored when replacement therapy is started include a. achlorhydria and constipation b. slowed mental processes and lethargy c. anemia and increased capillary fragility d. decreased cardiac contractility and coronary atherosclerosis
d. decreased cardiac contractility and coronary atherosclerosis (rationale- hypothyroidism affects the heart in many ways, causing cardiomyopathy, coronary atherosclerosis, bradycardia, pericardial effusions, and weakened cardiac contractility. when thyroid replacement therapy is started, myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac arrhythmias, and heart failures. It is important to monitor patients with compromised cardiac status when starting replacement therapy.)
In a patient with central diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a a. decrease in body weight b. increase in urinary output c. decrease in blood pressure d. increase in urine osmolality
d. increase in urine osmolality (rationale- a patient with DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in blood pressure.)
A nurse is caring for a client who is unable to tolerate oral medications. The nurse anticipates that the client may be prescribed which proton pump inhibitor to be administered intravenously? a. esomeprazole (Nexium) b. lansoprazole (Prevacid) c. omeprazole (Prilosec) d. pantoprazole (Protonix)
d. pantoprazole (Protonix)
