Exam 1 prepU

The admissions department at a local hospital is registering a male older adult for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client? "Advance directives are not legal documents, so you have nothing to worry about." "Advance directives are limited only to health care instructions and directives." "Your finances cannot be managed without an advance directive." "Advance directives are implemented when you become incapacitated, and then you will use a living will to allow the state to manage your money."

"Advance directives are limited only to health care instructions and directives." Explanation: An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to health care, not financial issues. They do not address financial issues. Advance directives are implemented when a client becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances, or financial power of attorney.

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

"Buffalo hump" Thin extremities "Moon face" Truncal obesity Purple striae Explanation: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.

Which statement indicates that a client with diabetes mellitus understands proper foot care? "I'll schedule an appointment with my physician if my feet start to ache." "I'll rotate insulin injection sites from my left foot to my right foot." "I'll go barefoot around the house to avoid pressure areas on my feet." "I'll wear cotton socks with well-fitting shoes."

"I'll wear cotton socks with well-fitting shoes." Explanation: The client demonstrates understanding of proper foot care if he states that he'll wear cotton socks with well-fitting shoes because cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. Aching isn't a common sign of foot problems; however, a tingling sensation in the feet indicates neurovascular changes. Injecting insulin into the foot may lead to infection. The client shouldn't go barefoot. Doing so can cause injury.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? "The head of your bed must remain flat for 24 hours after surgery." "You should avoid deep breathing and coughing after surgery." "You won't be able to swallow for the first day or two." "You must avoid hyperextending your neck after surgery."

"You must avoid hyperextending your neck after surgery." Explanation: To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? "You'll need more insulin when you exercise or increase your food intake." "You'll need less insulin when you exercise or reduce your food intake." "You'll need less insulin when you increase your food intake." "You'll need more insulin when you exercise or decrease your food intake."

"You'll need less insulin when you exercise or reduce your food intake." Explanation: The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin

Once digested, what percentage of carbohydrates is converted to glucose? 70 80 90 100

100 Explanation: Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? 7:45 AM 8:00 AM 8:15 AM 8:30 AM

7:45 AM Explanation: Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? Always carry a form of fast-acting sugar. Perform exercise prior to eating whenever possible. Eat a meal or snack every 8 hours. Check blood sugar at least every 24 hours.

Always carry a form of fast-acting sugar. Explanation: The following teaching points should be included in information provided to the client on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

When administering medications to an older adult patient, which medication does the nurse understand may remain in the body longer due to increased body fat? Anticoagulants Barbiturates Digitalis glycosides Diuretics

Barbiturates Explanation: Proportion of body fat increases with age, resulting in increased ability to store fat-soluble medications, including barbiturates; this causes drug accumulation, prolonged storage, and delayed excretion. The other medications listed are not fat-soluble.

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Sudden weight loss and anorexia Wounds that heal slowly or respond poorly to treatment

Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Wounds that heal slowly or respond poorly to treatment Explanation: All the options are correct except for weight loss and anorexia. Obesity is almost always associated with type 2 diabetes.

Nursing students are reviewing different types of mental health problems in the older adult population. The students demonstrate an understanding of this information when they identify which condition as the most common affective disorder? Anxiety Depression Schizophrenia Phobias

Depression Explanation: Depression is the most common affective or mood disorder of old age. Although anxiety may be common, anxiety disorders including phobias are not as common as depression. Schizophrenia is a thought disorder and is less common than depression.

A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips.

Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. Explanation: When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? With diabetes, drinking more results in more urine production. Increased ketones in the urine promote the manufacturing of more urine. High sugar pulls fluid into the bloodstream, which results in more urine production. The body's requirement for fuel drives the production of urine.

High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

An elderly client is reporting changes in bowel movements from every day to every 3 to 4 days. The client also states that the stools are hard. Nursing interventions include instructing the client to Use laxatives frequently. Increase fluid intake. Exercise after meals. Ingest foods high in fat.

Increase fluid intake. Explanation: Factors that may cause constipation include prolonged use of laxatives and excessive dietary fat. To promote gastrointestinal motility, the client should ensure adequate fluid intake and avoid exercise immediately after eating.

A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does hyperosmolar nonketotic syndrome most often occur? Clients who are obese and who have no known history of diabetes Clients with type 1 diabetes and poor dietary control Adolescents with type 2 diabetes and sporadic use of antihyperglycemics Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Middle-aged or older people with either type 2 diabetes or no known history of diabetes Explanation: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. The incidence is lower among the other listed groups.

The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? Bananas Chicken livers Hamburger Milk

Milk Explanation: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse? Notify the surgical team to remove all latex-based items. Notify the dietary department. Notify the physician regarding postoperative pain medications. Notify the nurse manager to follow up on the procedure.

Notify the surgical team to remove all latex-based items. Explanation: Allergies to avocados and bananas may indicate an allergy to latex. Although it is necessary to notify the dietary department and physician, it is not an immediate threat, as the patient is receiving nothing by mouth and pain medication will be ordered postoperatively. The nurse manager does not need to be notified of the client's allergies.

Why are IV solutions usually given at a slower rate to older adults? Older adults may have poor skin turgor. Veins of older adults tend to be rigid. Older adults often find infusions painful. Older adults may have cardiac or renal disorders.

Older adults may have cardiac or renal disorders. Explanation: IV solutions usually are given at a slower rate to older adults because these clients usually have cardiac or renal disorders. Veins of older adults tend to be rigid and they have poor skin turgor, making venipuncture difficult; however, this factor does not affect infusion. Older adults do not find infusion more painful than other clients.

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.) Hypertension Oliguria Tachycardia Bradycardia Tachypnea

Oliguria Tachycardia Tachypnea Explanation: Hypovolemia, or fluid volume deficit, is indicated by decreased, not increased, blood pressure (hypotension), oliguria, tachycardia (not bradycardia), and tachypnea.

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? Effective coughing and deep breathing Types of postoperative pain medication Post-discharge diet Knowledge of surgical procedure

Post-discharge diet Explanation: The least helpful postoperative teaching that could be omitted due to the need to obtain emergency surgery is explaining the post-discharge diet. This is not essential information to improve client participation in their postoperative recovery. Coughing and deep breathing is essential in the immediate postoperative period. Clients are often concerned about postoperative pain so instruction on pain medication can decrease anxiety. Knowledge of the surgical procedure must be explained by a physician when signing a surgical consent.

he nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? Select all that apply. Rapid-acting Short-acting Intermediate-acting Long-acting

Rapid-acting Short-acting Explanation: Insulins may be grouped into several categories based on the onset, peak, and duration of action. Rapid- and short-acting insulin can be administered by IV. Intermediate- and long-acting insulin cannot.

A 76-year-old client had surgery for an abdominal hernia. The PACU nurse observes that the client is confused and is trying to climb out of the bed and pull at the cardiac monitor lines. At this time, what interventions by the nurse are appropriate? Select all that apply. Reorient the client. Assess for hypoxia. Assess urine output. Administer opioid pain medication per orders. Ambulate the client. Apply wrist restraints.

Reorient the client. Assess for hypoxia. Assess urine output. Explanation: The nurse should provide reassurance and reorient the client as needed. Hypoxia and urinary retention may cause acute confusion in the older adults postoperatively, so it would be appropriate for the nurse to assess for hypoxia and urine output. Opioid pain medications may cause further confusion; the physician should be consulted about the type and dosage of the pain medication. Ambulating the client may present safety concerns, especially if the client is bleeding or hypoxic.

The surgical client has been given general anesthesia. The nurse recognizes that the client is in stage II (the excitement stage) of anesthesia. Which intervention would be most appropriate for the nurse to implement during this stage? Rub the client's back. Restrain the client. Encourage the client to express feelings. Stroke the client's hand.

Restrain the client. Explanation: In stage II, the client may struggle, shout, or laugh. The movements of the client may be uncontrolled, so it is essential the nurse help to restrain the client for safety. None of the other listed actions protects the client's safety.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? Serum glucose level of 450 mg/dl Serum glucose level of 52 mg/dl Serum calcium level of 8.9 mg/dl Serum calcium level of 10.2 mg/dl

Serum glucose level of 52 mg/dl Explanation: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? Dysuria Leg cramps Tachycardia Blurred vision

Tachycardia Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.

A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? Persistently cold feet Pain that does not respond to analgesia Acute pain, unrelieved by rest The presence of a tingling sensation

The presence of a tingling sensation Explanation: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. The intermediate-acting insulin is withdrawn before the short-acting insulin. Different types of insulin are not to be mixed in the same syringe. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

Which of the following clinical manifestations increase the risk for evisceration in the postoperative client? Hypovolemia Edema Valsalva maneuver Hypoxia

Valsalva maneuver Explanation: The Valsalva maneuver produces tension on abdominal wounds, which increases the risk for evisceration.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? Protein metabolism Blood glucose level Weight loss Carbohydrate intake

Weight loss Explanation: Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? Weight gain, constipation, and lethargy Weight loss, nervousness, and tachycardia Exophthalmos, diarrhea, and cold intolerance Diaphoresis, fever, and decreased sweating

Weight loss, nervousness, and tachycardia Explanation: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: verapamil (Isoptin) dantrolene sodium (Dantrium) potassium chloride an acetaminophen suppository

dantrolene sodium (Dantrium) Explanation: The client is exhibiting clinical manifestations of malignant hyperthermia. Dantrolene sodium, a skeletal muscle relaxant, is administered.

For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: hypocalcemia. hypercalcemia. hypokalemia. hyperkalemia.

hypocalcemia. Explanation: A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. nutritional status age physical condition gender health status Ethnicity

nutritional status age physical condition health status Rationale; General surgical risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time? 8:00 AM 12:00 PM 5:00 PM 8:00 PM

5:00 PM Explanation: An overnight dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? 6.5% 7.5% 8.0% 8.5%

6.5% Explanation: Normally, the level of glycosylated hemoglobin is less than 7%. Thus, a level of 6.5% would indicate that the client's blood glucose level is well controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dl. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address? A decrease in cognition, judgment, and memory A decrease in muscle mass and bone density The disappearance of sexual desire for both men and women An increase in sebaceous and sweat gland function in both men and women

A decrease in muscle mass and bone density Explanation: Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Cognitive changes are usually attributable to pathologic processes, not healthy aging.

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? A decrease in blood pressure A decrease in blood glucose levels A decrease in urine output A decrease in appetite

A decrease in urine output Explanation: Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which of the following phenomena is currently undergoing the most rapid and profound change? More families are having to provide care for their aging members. Adult children find themselves participating in chronic disease management. A growing number of people live to a very old age. Elderly people are having more accidents, increasing the costs of health care.

A growing number of people live to a very old age. Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 11: Health Care of the Older Adult, Demographics of Aging, p. 193.

A nurse is caring for an older adult client who has become increasingly frail and unsteady on her feet. During the assessment, the client indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this client is at a high risk for what health problem? A hip fracture A femoral fracture Pelvic dysplasia Tearing of a meniscus or bursa

A hip fracture Explanation: The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture.

Which older adult is at highest risk for medication-related toxicity? A 65-year-old with renal insufficiency An 82-year-old with chronic diarrhea A 72-year-old with a body mass index (BMI) of 22.6 An 86-year-old who has had type 2 diabetes mellitus for 2 years

A 65-year-old with renal insufficiency Explanation: Many medications are excreted through the kidneys; therefore, the patient with the highest risk for drug toxicity is the patient with renal insufficiency. An older adult with chronic diarrhea has increased gastric motility, which may decrease the absorption of the medication and not increase the risk of toxicity. A BMI of 22.6 is within the normal range; therefore, the client is not at as high risk as someone who is underweight or overweight. Vascular changes do happen with diabetes mellitus, which may increase the risk for drug toxicity. Because the client has been diagnosed with diabetes for only 2 years, vascular changes are usually not significant enough to put the client at a higher risk than someone with known renal insufficiency.

Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply. Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics. Peristalsis increases. The elasticity of skin increases and decreases the risk of shearing.

Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics. Explanation: Lower doses of anesthetic agents are required in older adults due to decreased tissue elasticity (lung and cardiovascular systems) and reduced lean tissue mass. Older clients often experience an increase in the duration of clinical effects of medications. With decreased plasma proteins, more of the anesthetic agent remains free or unbound, and the result is more potent action. In addition, body tissues of the older adult are made up predominantly of water, and those tissues with a rich blood supply, such as skeletal muscle, liver, and kidneys, shrink as the body ages.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has not consumed sufficient calories. Client has been exercising more than usual. Client has been sleeping excessively. Client is experiencing effects of the aging process.

Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has not consumed sufficient calories. Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: Stimulate the beta cells of the pancreas to secrete insulin. Decrease the body's sensitivity to insulin. Inhibit the production of glucose by the liver. Increase the absorption of carbohydrates in the intestines.

Inhibit the production of glucose by the liver. Explanation: The action of the biguanides can be found in Table 30-6 in the text.

A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? Insulin Parathormone Melatonin Calcitonin

Insulin Explanation: Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.

A nurse is teaching a client about type 2 diabetes. What major client physiological problem should the nurse include in the teaching? Older age (> 60 years). Obesity (>20% of IBW). Insulin resistance. Overactive insulin secretion.

Insulin resistance. Explanation: A major physiological concern with type 2 diabetes is insulin resistance, which refers to decreased tissue sensitivity to insulin. Age and body weight contribute to the diagnosis. Overactive insulin secretion is not associated with type 2 diabetes.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. Ketosis-prone Little endogenous insulin Obesity at diagnoses Younger than 30 years of age Older than 65 years of age

Ketosis-prone Little endogenous insulin Younger than 30 years of age Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: an ectopic corticotropin-secreting tumor. adrenal carcinoma. a corticotropin-secreting pituitary adenoma. an inborn error of metabolism.

a corticotropin-secreting pituitary adenoma. Explanation: A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.

A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. Urine specific gravity of 1.001 Serum ADH level of 2.3 pg/mL Serum osmolality of 310 mOsm/kg Urine osmolality of 800 mOsm/kg Serum sodium level of 149 mEq/L

Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L Explanation: All are indicative of diabetes insipidus, except for B and D, which are normal results. Refer to Table 31-1.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Impaired adjustment. Defensive coping. Deficient knowledge (treatment regimen). Health-seeking behaviors (diabetes control).

he client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder? body temperature increase of 1 °C to 2 °C (2 °F to 4 °F) tentanus-like jaw movements generalized muscle rigidity heart rate over 150 beats per minute

heart rate over 150 beats per minute Explanation: With malignant hyperthermia, tachycardia with a heart rate greater than 150 beats per minute is often the earliest sign because of an increase in end-tidal carbon dioxide. Generalized muscle rigidity and tetanus-like movement occurs often in the jaw are not the first signs for health care providers to note with malignant hyperthermia. The rise in body temperature is a late sign that develops rapidly.

A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should: incorporate the client's toileting schedule into the pattern of his wandering. ask the physician to order sedation to allow the client to rest. ask the physician to order restraints to prevent wandering. have the client wear two briefs at a time to ensure absorption of incontinent urine.

incorporate the client's toileting schedule into the pattern of his wandering. Explanation: Incorporating the client's toileting schedule into his wandering assists with elimination and increases the chance of continent episodes. Sedation and restraints will decrease the client's mobility but won't decrease the number of incontinent episodes. Wearing two briefs at a time won't ensure urine absorption and won't address the incontinence issue.

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 periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: thyroid storm. cretinism. myxedema coma. Hashimoto's thyroiditis.

myxedema coma. Explanation: 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.

When caring for a client with diabetes insipidus, the nurse expects to administer: vasopressin. furosemide. regular insulin. 10% dextrose

vasopressin. Explanation: 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.

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection? "All of a sudden my dad seemed to become confused." "My dad said he felt dizzy when he stood up from his chair." "My dad's temperature was 97.6 degrees F this afternoon." "My dad told me that he felt a little more tired today."

"All of a sudden my dad seemed to become confused." Explanation: Due to age-related changes in the nervous system, a sudden onset of confusion may be the first symptom of an infection. Feeling dizzy on arising suggests orthostatic hypotension. A temperature of 97.6 degrees F may or may not suggest an infection. Typically older adults do not experience a traditional fever. Complaints of being tired could indicate numerous conditions.

A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications? "Do you feel any muscle twitches or spasms?" "Do you feel flushed or sweaty?" "Are you experiencing any dizziness or lightheadedness?" "Are you having any pain that seems to be radiating from your bones?"

"Do you feel any muscle twitches or spasms?" Explanation: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. "Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue." "Insulin interferes with glucagon from the pancreas." "Insulin interferes with the release of growth hormone from the pituitary."

"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue." Explanation: Insulin is a hormone secreted by the endocrine part of the pancreas. In addition to lowering blood glucose by permitting entry of glucose into the cells, insulin also promotes protein synthesis and the storage of fat in adipose tissue. Somatostatin exerts a hypoglycemic effect by interfering with glucagon from the pancreas and the release of growth hormone from the pituitary.

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? "The spleen releases ketones when your body can't use glucose." "Ketones will tell us if your body is using other tissues for energy." "Ketones can damage your kidneys and eyes." "Ketones help the physician determine how serious your diabetes is."

"Ketones will tell us if your body is using other tissues for energy." Explanation: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

An intraoperative nurse is applying interventions that will address surgical clients' risks for perioperative positioning injury. What factors contribute to this increased risk for injury in the intraoperative phase of the surgical experience? Select all that apply. Absence of reflexes Diminished ability to communicate Loss of pain sensation Nausea resulting from anesthetic Reduced blood pressure

Absence of reflexes Diminished ability to communicate Loss of pain sensation Explanation: Loss of pain sense, reflexes, and ability to communicate subjects the intraoperative client to possible injury. Nausea and low blood pressure are not central factors that contribute to this risk, though they are adverse outcomes. Reference:

Which disorder results from excessive secretion of somatotropin (growth hormone)? Cretinism Dwarfism Acromegaly Adrenogenital syndrome

Acromegaly Explanation: The client with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? Administer a sedative as ordered. Administer IV calcium gluconate as ordered. Start administering oxygen at 2 L/min via a cannula. Administer an oral calcium supplement as ordered.

Administer IV calcium gluconate as ordered. Explanation: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply. Administering diuretics to prevent fluid overload Administering beta blockers to reduce heart rate Administering insulin to reduce blood glucose levels Applying interventions to reduce the client's temperature Administering corticosteroids

Administering beta blockers to reduce heart rate Applying interventions to reduce the client's temperature Explanation: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply. Administration of calcitonin Administration of calcium carbonate Intravenous isotonic saline solution in large quantities Monitoring the patient for fluid overload Administration of a bronchodilator

Administration of calcitonin Intravenous isotonic saline solution in large quantities Monitoring the patient for fluid overload Explanation: Acute hypercalcemic crisis can occur in patients with hyperparathyroidism with extreme elevation of serum calcium levels. Serum calcium levels greater than 13 mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening (Fischbach & Dunning, 2009). Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin (Shane & Berenson, 2012). Calcitonin promotes renal excretion of excess calcium and reduces bone resorption. The saline infusion should be stopped and a loop diuretic may be needed if the patient develops edema. Dosage and rates of infusion depend on the patient profile. The patient should be monitored carefully for fluid overload.

To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes: Assisting with incentive spirometry every 6 hours Ambulating the client as soon as possible Positioning the client in a supine position Assessing breath sounds at least every 2 hours

Ambulating the client as soon as possible Explanation: The nurse should assist the client to ambulate as soon as the client is able. Incentive spirometry should be performed every 1 to 2 hours. The client should be positioned from side to side and in semi-Fowler's position. While assessing breath sounds is essential, it does not help to prevent pneumonia.

What is the most common cause of hyperaldosteronism? Excessive sodium intake A pituitary adenoma Deficient potassium intake An adrenal adenoma

An adrenal adenoma Explanation: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.

What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply. A pulse rate slower than 90 bpm An elevated systolic blood pressure Muscular fatigability Weight loss. Intolerance to cold

An elevated systolic blood pressure Muscular fatigability Weight loss. Explanation: Manifestations of hyperthyroidism include an increased appetite and dietary intake, weight loss, fatigability and weakness (difficulty in climbing stairs and rising from a chair), amenorrhea, and changes in bowel function. Atrial fibrillation occurs in 15% of in older adult patients with new-onset hyperthyroidism (Porth & Matfin, 2009). Cardiac effects may include sinus tachycardia or dysrhythmias, increased pulse pressure, and palpitations. These patients are often emotionally hyperexcitable, irritable, and apprehensive; they cannot sit quietly; they suffer from palpitations; and their pulse is abnormally rapid at rest as well as on exertion. They tolerate heat poorly and perspire unusually freely.

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug? An older client has less subcutaneous tissue and less muscle mass than a younger client. An older client has more subcutaneous tissue and less durable skin than a younger client. An older client has more superficial and tortuous nerve distribution than a younger client. An older client has a higher risk of bleeding after an IM injection than a younger client.

An older client has less subcutaneous tissue and less muscle mass than a younger client. Explanation: When administering IM injections, the nurse should remember that in an older client, subcutaneous fat diminishes, particularly in the extremities. Muscle mass also decreases. There are no significant differences in nerve distribution or bleeding risk.

The nurse is caring for a client in the postanesthesia care unit (PACU). The client has the following vital signs: pulse 115, respirations 20, oral temperature 97.2°F, blood pressure 84/50. What should the nurse do first? Notify the physician. Assess for bleeding. Increase rate of IV fluids. Review the client's preoperative vital signs.

Assess for bleeding. Explanation: The client is tachycardic with low blood pressure; thus assessing for hemorrhage is the priority action. While the physician may need to be notified, the nurse needs to be able to communicate a complete picture of the client, which would include bleeding, when calling the physician. The rate of IV fluid administration should be adjusted according to a physician order. The nurse should review prior vital signs but only after the immediate threat of hemorrhage is assessed.

A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. Encourage deep breathing and coughing. Offer the client a straw when drinking liquids.

Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. Explanation: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.

A client is at postoperative day 1 after abdominal surgery. The client is receiving 0.9% normal saline at 75 mL/h, has a nasogastric tube to low wall suction with 200 mL every 8 hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every 8 hours. The 24-hour urine output total is 2430 mL. What action by the nurse is mostappropriate? Document the findings and reassess in 24 hours. Assess for signs and symptoms of fluid volume deficit. Assess for edema. Discontinue the nasogastric tube suctioning.

Assess for signs and symptoms of fluid volume deficit. Explanation: The client's 24-hour intake is 1800 mL (75 x 24). The client's 24-hour output is 3180 mL [(200 × 3) + (50 × 3) + 2430]. Because the output is significantly higher than the intake, the client is at risk for fluid volume deficit. The nurse should not discontinue the nasogastric suctioning without a physician's order. The findings should be documented and reassessed, but the nurse needs to take more action to prevent complication. Edema is usually associated with fluid volume excess.

An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first? Assess for the potential for self-harm. Notify the physician. Encourage the client to participate in exercise activities. Encourage the client to discuss feelings.

Assess for the potential for self-harm. Explanation: A score of 12 on the GDS indicates that the client may be mildly depressed, and even mildly depressed clients can have thoughts of suicide. The nurse must first assess the potential for self-harm; safety is the top concern. The other actions by the nurse would be appropriate only after the potential for self-harm is addressed.

When the nurse observes that a postoperative client demonstrates a constant low level of oxygen saturation via the O₂ saturation monitor despite the client's breathing appearing normal, what action should the nurse take first? Assess the client's heart rhythm and nail beds. Apply oxygen. Notify the physician. Document the findings.

Assess the client's heart rhythm and nail beds. Explanation: A clent may demonstrate low oxygenation readings because of certain colors of nail polish or may show an irregular heart rate such as atrial fibrillation. These factors should be assessed to ensure the accuracy of the oxygen reading. Once the reading is confirmed as accurate, then the nurse may need to apply oxygen, notify the physician, and document the findings.

Family members report to the nurse that their elderly grandmother has had a sudden onset of confusion and that they are having difficulty providing care for her. What is the nurse's best response? Assess the grandmother for adventitious lung sounds Inform the family that this is a result of aging Administer donepezil every day Recommends placement of the grandmother in a nursing home

Assess the grandmother for adventitious lung sounds Explanation: Sudden onset of confusion may be the first symptom of an infection, such as pneumonia or urinary tract infection. The nurse needs to fully assess the situation before acting (such as telling the family this is a result of aging). Donepezil is used for Alzheimer's disease, which does not have acute onset. A recommendation for placement in a nursing home is premature without a full assessment at this time.

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient? (Select all that apply.) Assessing for symptoms of nausea and malaise Encouraging the intake of low-sodium liquids Monitoring neurologic status Restricting tap water intake Encouraging the use of salt substitute instead of salt

Assessing for symptoms of nausea and malaise Monitoring neurologic status Restricting tap water intake Explanation: For patients at risk, the nurse closely laboratory values (i.e., sodium) and be alert for GI manifestations such as anorexia, nausea, vomiting, and abdominal cramping. The nurse must be alert for central nervous system changes, such as lethargy, confusion, muscle twitching, and seizures. Neurologic signs are associated with very low sodium levels that have fallen rapidly because of fluid overloading. For a patient with abnormal losses of sodium who can consume a general diet, the nurse encourages foods and fluids with high sodium content to control hyponatremia. For example, broth made with one beef cube contains approximately 900 mg of sodium; 8 oz of tomato juice contains approximately 700 mg of sodium. If the primary problem is water retention, it is safer to restrict fluid intake than to administer sodium.

An elderly client with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to Ingest meals with a slightly higher fat content. Take a laxative, such as milk of magnesia, every day. Avoid straining when having a bowel movement. Increase fluid intake to 3000 mL per day.

Avoid straining when having a bowel movement. Explanation: An elderly client may experience hypotension and needs to avoid straining when having a bowel movement. The client should ingest meals with a higher fiber intake, not fat content. Clients are not to take laxatives every day because they can increase their risk for dependence on laxatives to have a bowel movement. It may be good for clients to increase fluids; however, this client has heart failure and may not be able to increase fluid intake.

The nurse is aware that infection is a potential complication of surgery. Which intervention should the nurse implement to prevent infection? Select all that apply. Avoid touching sterile items unless necessary. Keep artificial nails clean and in good repair. Alert the surgical team of any breaches of sterile technique. Wear a long-sleeved, sterile gown and gloves. Remove hair from the surgical site using a razor.

Avoid touching sterile items unless necessary. Alert the surgical team of any breaches of sterile technique. Wear a long-sleeved, sterile gown and gloves. Explanation: Nursing interventions to prevent infection during the intraoperative phase include wearing appropriate attire; avoiding touching sterile items; and alerting the surgical team of breaches of sterile technique. Artificial nails are banned for OR personnel, because they can harbor microorganisms. Excess hair is removed with clippers, not a razor.

An elderly client with diabetes comes to the clinic with her daughter. The nurse reviews foot care with the client and her daughter. Why would the nurse feel that foot care is so important to this client? An elderly client with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. Explanation: The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs given for diabetes.

A health care team is involved in caring for a client with advanced Alzheimer's disease. During a team conference, a newly hired nurse indicates that she has never cared for a client with advanced Alzheimer's disease. Which key point about the disease should the charge nurse include when teaching this nurse? The nursing staff should rely on the family to assist with care because family members know the client best. Alzheimer's disease affects memory so the client doesn't need an explanation before procedures are performed. As long as the client receives the ordered medication, special care measures aren't necessary. Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment.

Clients with Alzheimer's disease are at high risk for injury because of their impaired memory and poor judgment. Explanation: The charge nurse should inform the new nurse that clients with Alzheimer's disease are at high risk for injury because they have impaired memory and poor judgment. Maintaining a safe environment takes top priority. Families are an important part of the client care team; however, they shouldn't be relied upon to deliver care. Family members may take turns sitting with the hospitalized client to help maintain client safety. All procedures should be explained in simple terms that the client can understand. Medications should be administered as ordered; however, they don't typically improve symptoms. Instead, they slow disease progression.

The surgical nurse is preparing to send a client from the presurgical area to the OR and is reviewing the client's informed consent form. What are the criteria for legally valid informed consent? Select all that apply. Consent must be freely given. Consent must be notarized. Consent must be signed on the day of surgery. Consent must normally be obtained by a physician. Signature must be witnessed by a professional staff member.

Consent must be freely given. Consent must normally be obtained by a physician. Signature must be witnessed by a professional staff member. Rationale; Valid consent must be freely given, without coercion. Consent must be obtained by a physician and the client's signature must be witnessed by a professional staff member. It does not need to be signed on the same day as the surgery and it does not need to be notarized.

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. Decreased kidney mass Increased conservation of sodium Increased total body water Decreased renal blood flow Decreased excretion of potassium

Decreased kidney mass Decreased renal blood flow Decreased excretion of potassium Explanation: Dehydration in the elderly is common as a result of decreased kidney mass, decreased glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine, inability to conserve sodium, decreased excretion of potassium, and a decrease of total body water.

An 84-year-old client has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The client is oriented to name only. The client's family is very upset because, before having surgery, the client had no cognitive deficits. The client is subsequently diagnosed with postoperative delirium. What should the nurse explain to the client's family? This problem is self-limiting and there is nothing to worry about. Delirium involves a progressive decline in memory loss and overall cognitive function. Delirium of this type is treatable and her cognition will return to previous levels. This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.

Delirium of this type is treatable and her cognition will return to previous levels. Explanation: Surgery is a common cause of delirium in older adults. Delirium differs from other types of dementia in that delirium begins with confusion and progresses to disorientation. It has symptoms that are reversible with treatment, and, with treatment, is short term in nature. It is patronizing and inaccurate to reassure the family that there is "nothing to worry about." The problem is not treated by the administration of antidotes to anesthetic.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? Nearly two-thirds of clients with diabetes mellitus are older than age 60. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Explanation: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.

A postoperative client is being discharged home after minor surgery. The PACU nurse is reviewing discharge instructions with the client and the client's spouse. What actions by the nurse are appropriate? Select all that apply. Educate on activity limitations. Discuss wound care. Have the spouse review when to notify the physician. Have the client sign his or her advance directive form. Provide information on health promotion topics.

Educate on activity limitations. Discuss wound care. Have the spouse review when to notify the physician. Provide information on health promotion topics. Explanation: The nurse should provide education on activity limitations and wound care, and should review complications that require notification to the physician. The nurse should also provide information regarding health promotion topics, such as weight management and smoking cessation. The client should not make any major decisions or sign any legal forms because of the effects of anesthesia.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Absent ketones Normal arterial pH level

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.

Which is a clinical manifestation of diabetes insipidus? Low urine output Excessive thirst Weight gain Excessive activities

Excessive thirst Explanation: Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.

The nurse is caring for a client who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the client's ribs and xiphoid process are prominent. The client states she exercises two to three times daily and her mother indicates that she is being treated for anorexia nervosa. How should the nurse best follow up these assessment data? Inform the postoperative team about the client's risk for wound dehiscence. Evaluate the client's ability to manage her pain level. Facilitate a detailed analysis of the client's electrolyte levels. Instruct the client on the need for a high-sodium diet to promote healing.

Facilitate a detailed analysis of the client's electrolyte levels. Raitonale; The surgical team should be informed about the client's medical history regarding anorexia nervosa. Any nutritional deficiency, such as malnutrition, should be corrected before surgery to provide adequate protein for tissue repair. The electrolyte levels should be evaluated and corrected to prevent metabolic abnormalities in the operative and postoperative phase. The risk of wound dehiscence is more likely associated with obesity. Instruction on proper nutrition should take place in the postoperative period, and a consultation should be made with her psychiatric specialist. Evaluation of pain management is always important, but not particularly significant in this scenario.

A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply. Foods high in vitamin D Foods high in calories Foods high in protein Foods high in calcium Foods high in sodium

Foods high in vitamin D Foods high in protein Foods high in calcium Explanation: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.

A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor? Tremors and palpitations Headaches and visual disturbances Galactorrhea Inappropriate responses to stimuli

Galactorrhea Explanation: All choices are indicators of a pituitary tumor, but the most common form is indicated by the spontaneous and inappropriate flow of milk from the male or female breast in the absence of pregnancy or breastfeeding. A normal prolactin level is less than 20 ng/mL

The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? Gigantism Dwarfism Acromegaly Simmonds' disease

Gigantism Explanation: When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? Epinephrine Glucagon 50% dextrose Hydrocortisone

Glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? Somatostatin Insulin Glucagon Cholecystokinin

Glucagon Explanation: Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.

A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? A serum glucose level Glucose tolerance test in combination with a GH measurement Growth hormone levels Bone radiographs

Glucose tolerance test in combination with a GH measurement Explanation: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.

A client is brought to the emergency department by the paramedics. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. Leukocytosis Glycosuria Dehydration Hypernatremia Hyperglycemia

Glycosuria Dehydration Hypernatremia Hyperglycemia Explanation: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? Diabetes mellitus Goiter Diabetes insipidus Cushing's syndrome

Goiter Explanation: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? Keep an accurate record of intake and output. Use nasal desmopressin acetate (DDAVP). Have regular follow-up care. Exercise to improve cardiovascular fitness

Have regular follow-up care. Explanation: The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? A decline in sexual activity is a normal occurrence as you age. Most older adults reside in a long-term care facility. As an older adult, you will not be able to learn new skills or knowledge. How old you feel will be determined by your physical and cognitive abilities.

How old you feel will be determined by your physical and cognitive abilities. Explanation: The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hypocalcemia Hypercalcemia Hyperphosphatemia Hypophosphaturia

Hypercalcemia Explanation: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. Hypertension Alterations in glucose metabolism Poor wound healing Hypotension Weight loss

Hypertension Alterations in glucose metabolism Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases the levels of high-density lipoproteins Decreases total cholesterol Increases glucose uptake by body muscles

Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles Explanation: All of the options are benefits of exercise except the effect of decreasing the levels of HDL. Exercise increases the levels of HDL.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? Hypocalcemia Hyponatremia Hyperkalemia Hypermagnesemia

Hypocalcemia Explanation: Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Hypoglycemia Hyponatremia Ketonuria Polyphagia

Hypoglycemia Explanation: The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.

The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of: Laryngospasm Hyperventilation Hypoxemia and hypercapnia. Pulmonary edema and embolism.

Hypoxemia and hypercapnia. Explanation: The primary objective in the immediate postoperative period is to maintain pulmonary ventilation and thus prevent hypoxemia and hypercapnia. Both can occur if the airway is obstructed and ventilation is reduced. Besides checking the health care provider's orders for and administering supplemental oxygen, the nurse assesses respiratory rate and depth, ease of respirations, oxygen saturation, and breath sounds.

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine."

I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." Explanation: The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test one's blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the physician. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

A client has been brought to the emergency department by paramedics after being found unconscious. The client's Medic Alert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? IV administration of 50% dextrose in water Subcutaneous administration of 10 units of Humalog Subcutaneous administration of 12 to 15 units of regular insulin IV bolus of 5% dextrose in 0.45% NaCl

IV administration of 50% dextrose in water Explanation: In hospitals and emergency departments, for clients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the client's condition.

A nurse is planning preopertive teaching for an older client. Which structural or functional changes in the older adult impact the surgical experience? Select all that apply. Increased plasma proteins decrease the effects of anesthesia. Increased fatty tissue prolongs elimination of anesthesia. Decreased ability to compensate for hypoxia increases the risk of an embolism. Enlarged liver, due to fatty deposits, alters the breakdown of anesthetic agents. Loss of collagen increases the risk of skin complications. Reduced tactile sensitivity can lead to assessment and communication problems.

Increased fatty tissue prolongs elimination of anesthesia. Decreased ability to compensate for hypoxia increases the risk of an embolism. Loss of collagen increases the risk of skin complications. Reduced tactile sensitivity can lead to assessment and communication problems. Explanation: The older adult has increased fatty tissue which prolongs elimination of anesthesia, decreased ability to compensate for hypoxia increases the risk of an embolism, loss of collagen increases the risk of skin complications, and reduced tactile sensitivity can lead to assessment and communication problems. The older adult has decreased plasma proteins, and no enlarged liver unless there is an underlying disease.

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? (Select all that apply.) The patient lying in the supine position Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration An allergic reaction to the medication used

Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration Explanation: Headache may be an aftereffect of spinal anesthesia. Several factors are related to the incidence of headache: the size of the spinal needle used, the leakage of fluid from the subarachnoid space through the puncture site, and the patient's hydration status. Measures that increase cerebrospinal pressure are helpful in relieving headache. These include maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated. A headache is not likely to occur as the result of the patient lying in the supine position or of an allergic reaction to the medication.

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? Methimazole (Tapazole) Thyroid USP desiccated (Thyroid USP Enseals) Liothyronine (Cytomel) Levothyroxine (Synthroid)

Levothyroxine (Synthroid) Explanation: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

A nurse is working with the family of a patient with Alzheimer's disease to develop an appropriate plan of care. Which of the following would the nurse suggest to foster socialization? Promoting frequent lengthy visits from friends Encouraging participation in multiple-stepped activities Limiting visitors to one or two at a time Promoting hobbies involving fine motor skills

Limiting visitors to one or two at a time Explanation: When promoting socialization, visits, letters, and phone calls are encouraged. Visits should be brief and nonstressful, limiting visitors to one or two at a time to reduce overstimulation. The patient also is encouraged to participate in simple activities. Activities with multiple steps and hobbies requiring fine motor activity increase the risk of frustration, leading to the patient becoming overwhelmed.

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of Degeneration in the efficiency of bone joints The client's failure to exercise Loss of bone density Decreased muscle mass and joint cartilage

Loss of bone density Explanation: Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.

For a client with Graves' disease, which nursing intervention promotes comfort? Restricting intake of oral fluids Placing extra blankets on the client's bed Limiting intake of high-carbohydrate foods Maintaining room temperature in the low-normal range

Maintaining room temperature in the low-normal range Explanation: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply. May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels May reduce postprandial glucose levels Increase potassium levels

May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels Explanation: Increased fiber in the diet may improve blood glucose levels, decrease the need for exogenous insulin, and lower total cholesterol and low-density lipoprotein levels in the blood (ADA, 2008b; Geil, 2008).

When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include? The gland becomes enlarged leading to a deficiency of the hormone. Most disorders result from over- or underproduction of the hormone. The gland slows hormone secretion when the hormone level decreases. Hormone secretion occurs as a straight-line continuous process.

Most disorders result from over- or underproduction of the hormone. Explanation: Most endocrine disorders result from an overproduction or underproduction of specific hormones. A negative feedback loop controls hormone levels, such that a decrease in levels stimulates the releasing gland. Glandular enlargement is not involved with hormonal regulation.

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? Weight gain Muscle wasting and tissue loss Dehydration Altered mental state

Muscle wasting and tissue loss Explanation: Polyphagia results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats. Although clients with type 1 diabetes may experience polyphagia (increased hunger), they may also exhibit muscle wasting, subcutaneous tissue loss, and weight loss due to impaired glucose and protein metabolism and impaired fatty acid storage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, p. 1460.

A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test A decreased TSH level An increase in the TSH level after 30 minutes during the TSH stimulation test Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay

No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test Explanation: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.

hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. Normal bedtime blood glucose Rise in blood glucose about 3:00 AM Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Elevated blood glucose at bedtime

Normal bedtime blood glucose Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Explanation: The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.

An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? Aging processes reduce the chances that surgery will be successful for these clients. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries.

Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Explanation: The underlying principle that guides preoperative assessment, surgical care, and postoperative care is that elderly clients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than younger clients. The hazards of surgery for the elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. Respiratory and cardiac complications are the leading causes of postoperative morbidity and mortality in older adults.

When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal? Within the first 12 hours About 24 hours postoperatively On the second or third day 4 days after a surgical procedure

On the second or third day Explanation: The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk. In patients who are alcohol dependent, alcohol withdrawal syndrome may be anticipated 2 to 4 days after the last drink and is associated with a significant mortality rate when it occurs postoperatively.

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next? Make the client NPO and order a stat hemoglobin and hematocrit. Remove the dressing, assess the wound, and apply a new sterile dressing. Outline the drainage with a pen and record the date and time next to the drainage. Take the client's vital signs and call the surgeon.

Outline the drainage with a pen and record the date and time next to the drainage. Explanation: Areas of drainage on the dressing should be outlined with a pen, and the date and time should be recorded next to the drainage. Blood drainage from the incision is a normal expected finding in the immediate postoperative period; however, excessive amounts should be reported to the surgeon.

A client who is receiving the maximum levels of pain medication for postoperative recovery asks the nurse if there are other measures that the nurse can employ to ease pain. Which of the following strategies might the nurse employ? Select all that apply. Performing guided imagery Putting on soothing music Changing the client's position Applying hot cloths to the client's face Massaging the client's legs

Performing guided imagery Putting on soothing music Changing the client's position Explanation: Guided imagery, music, and application of heat or cold (if prescribed) have been successful in decreasing pain. Changing the client's position, using distraction, applying cool washcloths to the face, and providing back massage may be useful in relieving general discomfort temporarily.

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury? Absence of itching Pulse oximetry 98% Peripheral pulses palpable Vital signs within normal limits for client

Peripheral pulses palpable Explanation: Surgical clients are at risk for pressure ulcers and damage to nerves and blood vessels as a result of awkward positioning required for surgical procedures. Palpable peripheral pulses indicate integrity of the blood vessels.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? Thymus gland, thymosin Parathyroid glands, parathormone Pineal gland, melatonin Adrenal cortex, corticosteroids

Pineal gland, melatonin Explanation: The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.

The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? Levothyroxine Spironolactone Propylthiouracil Propranolol

Propylthiouracil Explanation: Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.

A postoperative client rapidly presents with hypotension; rapid, thready pulse; oliguria; and cold, pale skin. The nurse suspects that the client is experiencing a hemorrhage. What should be the nurse's first action? Leave and promptly notify the physician. Quickly attempt to determine the cause of hemorrhage. Begin resuscitation. Put the client in the Trendelenberg position.

Quickly attempt to determine the cause of hemorrhage. Explanation: Transfusing blood or blood products and determining the cause of hemorrhage are the initial therapeutic measures. Resuscitation is not necessarily required and the nurse must not leave the client. The Trendelenberg position would be contraindicated.

Based on a client's vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurse's primary responsibility? Report the findings to adult protective services. Confront the suspected perpetrator. Gather evidence to corroborate the abuse. Work with the family to promote healthy conflict resolution.

Report the findings to adult protective services. Explanation: If neglect or abuse of any kind—including physical, emotional, sexual, or financial abuse—is suspected, the local adult protective services agency must be notified. The responsibility of the nurse is to report the suspected abuse, not to prove it, confront the suspected perpetrator, or work with the family to promote resolution.

After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this man's risk of future infarcts, what action should the nurse most strongly encourage? Activity limitation and falls reduction efforts Adequate nutrition and fluid intake Rigorous control of the client's blood pressure and serum lipid levels Use of mobility aids to promote independence

Rigorous control of the client's blood pressure and serum lipid levels Explanation: Because vascular dementia is associated with hypertension and cardiovascular disease, risk factors (e.g., hypercholesterolemia, history of smoking, diabetes) are similar. Prevention and management are also similar. Therefore, measures to decrease blood pressure and lower cholesterol levels may prevent future infarcts. Activity limitation is unnecessary and infarcts are not prevented by nutrition or the use of mobility aids.

A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse? Relocation stress syndrome related to hospitalization Defensive coping related to diagnosis of Alzheimer's disease Risk for caregiver role strain related to increased client care needs Decisional conflict related to lack of relevant treatment information

Risk for caregiver role strain related to increased client care needs Explanation: The client's spouse is at risk for caregiver role strain because the client has started to exhibit care needs beyond the spouse's capacity to provide. A diagnosis of Relocation stress syndrome may be appropriate for a client with inadequate preparation for hospital admission, transfer, or discharge; however, this client is confused and may be unable to grasp the meaning of such preparation. The spouse, on the other hand, is more likely to be relieved, at least physically, and able to rest because of the client's admission. Defensive coping and Decisional conflict aren't pertinent nursing diagnoses in this situation because the client's spouse is aware of and has accepted the client's disease.

An older adult client has returned to the community following knee replacement surgery. The community health nurse recognizes that the client has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses? Risk for infection related to polypharmacy and hypotension Risk for falls related to polypharmacy and impaired balance Adult failure to thrive related to chronic disease and circulatory disturbance Disturbed thought processes related to adverse drug effects and hypotension

Risk for falls related to polypharmacy and impaired balance Explanation: Polypharmacy and loss of balance are major contributors to falls in the elderly. This client does not exhibit failure to thrive or disturbed thought processes. There is no evidence of a heightened risk of infection.

Which nursing diagnosis is most important for the client who is undergoing a surgical procedure expected to last several hours? Risk for perioperative positioning injury related to positioning in the OR Risk of latex allergy response related to possible exposure in the OR environment Disturbed sensory perception related to the effects of general anesthesia Anxiety related to ineffective coping with surgical concerns

Risk for perioperative positioning injury related to positioning in the OR Explanation: Pressure ulcers, nerve and blood vessel damage, and discomfort are risks associated with prolonged, awkward positioning required for surgical procedures.

A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? Side-lying with one pillow under the head Head of the bed elevated 30 degrees and no pillows placed under the head Semi-Fowler with the head supported on two pillows Supine, with a small roll supporting the neck

Semi-Fowler with the head supported on two pillows Explanation: When moving and turning the client, the nurse carefully supports the client's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows.

The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action? Send the client for a chest x-ray. Administer the prescribed IV fluids. Obtain written consent for the procedure. Assess the client's blood pressure (BP) on the right arm.

Send the client for a chest x-ray. Explanation: A chest x-ray is needed to confirm the placement of catheter tip before initiating ordered infusions. Consent should be obtained before, not after, the procedure. No BPs should be taken on the extremity where the catheter is placed.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? Fasting blood glucose test 6-hour glucose tolerance test Serum glycosylated hemoglobin (Hb A1c) Urine ketones

Serum glycosylated hemoglobin (Hb A1c) Explanation: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? Blood urea nitrogen (BUN) level of 12 mg/dl Blood glucose level of 90 mg/dl Serum sodium level of 134 mEq/L Serum potassium level of 5.8 mEq/L

Serum potassium level of 5.8 mEq/L Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. Hypothermia Hypertension Hypotension Hypoventilation Hyperventilation

Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 52: Assessment and Management of Patients With Endocrine Disorders, Clinical Manifestations, p. 1514.

A client asks the nurse about possible ill effects from general anesthesia. What is the bestresponse by the nurse? "Some possible negative effects include difficulty waking up and slow heart rate." "Few negative effects occur with general anesthesia." "Amnesia and analgesia are some of the negative effects of anesthesia." "Clients can experience pain and loss of consciousness."

Some possible negative effects include difficulty waking up and slow heart rate." Explanation: Diffculty waking up (oversedation), allergic reaction, and slow heart rate (bradycardia) are potential adverse effects of surgery and anesthesia. There are a number of effects from general anesthesia. Analgesia is not an adverse effect of general anesthesia. Clients should not experience pain.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? BMI 24; "My family never gives me my favorite foods." Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." Obvious deformity to right arm; "I tripped on the rug and fell on my arm."

Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." Explanation: Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Don't take your insulin or oral antidiabetic agent if you don't eat." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Test your blood glucose every 4 hours." "Follow your regular meal plan, even if you're nauseous."

Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

The nurse is caring for a postoperative client who needs daily dressing changes. The client is 3 days postoperative and is scheduled for discharge the next day. Until now, the client has refused to learn how to change her dressing. What would indicate to the nurse the client's possible readiness to learn how to change her dressing? Select all that apply. The client wants you to teach a family member to do dressing changes. The client expresses interest in the dressing change. The client is willing to look at the incision during a dressing change. The client expresses dislike of the surgical wound. The client assists in opening the packages of dressing material for the nurse.

The client expresses interest in the dressing change. The client is willing to look at the incision during a dressing change. The client assists in opening the packages of dressing material for the nurse. Explanation: While changing the dressing, the nurse has an opportunity to teach the client how to care for the incision and change the dressings at home. The nurse observes for indicators of the client's readiness to learn, such as looking at the incision, expressing interest, or assisting in the dressing change. Expressing dislike and wanting to delegate to a family member do not suggest readiness to learn.

A nurse is assessing the postoperative client on the second postoperative day. What assessment finding requires the nurse to immediately notify the health care provider? The client has an absence of bowel sounds. The client's lungs reveal rales in the bases. The client states a moderate amount of pain at the incisional site. A moderate amount of serous drainage is noted on the operative dressing.

The client has an absence of bowel sounds. Explanation: A nursing assessment finding of concern on the second postoperative day is the absence of bowel sounds, which may indicate a paralytic ileus. Other assessment findings may include abdominal pain and distention as fluids, solids, and gas do not move through the intestinal tract. Rales in the bases are a frequent finding postoperatively, especially if general anesthesia was administered. Encourage the client to cough and breathe deep. Pain is a common symptom following a surgical procedure. Serous drainage on the postoperative dressing needs to monitored and brought to the physician's attention when assessing the client.

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? The client's consumption of carbohydrates History of radiographic contrast studies that used iodine The client's mental and emotional status The client's exercise routine

The client's consumption of carbohydrates Explanation: While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not as important to information related to the client's to be noted in a client with high blood sugar.

A client with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? The client should withhold his next scheduled dose of insulin. The client should promptly eat some protein and carbohydrates. The client's insulin levels are inadequate. The client would benefit from a dose of metformin.

The client's insulin levels are inadequate. Explanation: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? The lungs are unable to breathe in sufficient oxygen. The lungs are unable to exchange oxygen and carbon dioxide. The lungs have ineffective cilia from years of smoking. The lungs are not able to blow off carbon dioxide.

The lungs are not able to blow off carbon dioxide. Explanation: In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to remove the carbon dioxide from the system. Although individuals with COPD frequently have a history of smoking, cilia is not the cause of the acidosis.

A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? The symptoms are permanent side effects of the corticosteroid therapy. The moon face and acne will resolve when the medication is tapered off. Those symptoms are not related to the corticosteroid therapy. The dose of the medication must be too high and should be lowered.

The moon face and acne will resolve when the medication is tapered off. Explanation: Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? They have no effect. They decrease the need for insulin. They increase the need for insulin. They cause wide fluctuations in the need for insulin.

They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? Applying a heating pad Debriding the wound three times per day Using sterile technique during the dressing change Cleaning the wound with a povidone-iodine solution

Using sterile technique during the dressing change Explanation: The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? adrenal function thyroid function thymus function parathyroid function

adrenal function Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.

A client with type 1 diabetes 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 should tell him that the regimen includes the use of: intermediate- and long-acting insulins. short- and long-acting insulins. rapid-acting insulin only. short- and intermediate-acting insulins.

apid-acting insulin only. Explanation: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.

Trousseau sign is elicited by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. by tapping sharply over the facial nerve just in front of the parotid gland and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye. after making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery. when the foot is dorsiflexed and there is pain in the calf.

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

A nurse is caring for a bariatric client prior to a surgical procedure. What surgical complications would the nurse monitor the bariatric client for postoperatively? Select all that apply. cardiovascular complications gastrointestinal complications pulmonary complications renal complications nervous system complications

cardiovascular complications pulmonary complications Rationale; Like age, obesity increases the risk and severity of complications associated with surgery. The cardiovacular system is at risk for complications with obese surgical clients becasue of hyprtension and diabetes complications. The client tends to have shallow respirations when supine, increasing the risk of hypoventilation and postoperative pulmonary complications. The acquired physical characteristics—a short, thick neck; large tongue; recessed chin; and redundant pharyngeal tissue, associated with increased oxygen demand and decreased pulmonary reserves—impede intubation. Obesity should not cause postoperative complications with the gastrointestinal system, renal system, or nervous system.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: hypotension. thick, coarse skin. deposits of adipose tissue in the trunk and dorsocervical area. weight gain in arms and legs

deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), 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.

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. postoperative pain control cough and deep-breathing exercises the client's spouse's thoughts about the upcoming surgery the surgeon's fee and other hospital charges intravenous fluids and other lines and tubes

postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes Rationale ; Preoperative teaching involves teaching clients about their upcoming surgical procedure and expectations. Topics include preoperative medications (when they are given and their effects); postoperative pain control; explanation and description of the post anesthesia recovery room or postsurgical area; and deep-breathing and coughing exercises.

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: severe hypotension. excessive thirst. profound neuromuscular irritability. acute gastritis.

profound neuromuscular irritability. Explanation: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.