EXAM 2 PREP-U's

Dilutional hyponatremia occurs in which disorder? A.) Diabetes insipidus (DI) B.) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C.) Pheochromocytoma D.) Addison disease

Answer: B.) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. - Hyperkalemia - Metabolic alkalosis - Anemia - Hyperalbuminemia - Hypocalcemia

Answer: - Hyperkalemia - Anemia - Hypocalcemia Rationale: Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.

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

Answer: - Hypothermia - Hypotension - Hypoventilation

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? A.) "This medication will relieve your pain." B.) "This medication should be taken at bedtime." C.) "This medication will prevent re-infection." D.) "This will kill the organism causing the infection."

Answer: A.) "This medication will relieve your pain."

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? A.) "Your child will need less blood work as his glucose levels stabilize." B.) "Your child is young and will soon forget this experience." C.) "I'll see if the physician can reduce the number of blood draws." D.) "Our laboratory technicians use tiny needles and they're really good with children."

Answer: A.) "Your child will need less blood work as his glucose levels stabilize." Rationale: Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? A.) Application of an ostomy pouch B.) Intermittent catheterizations C.) Exercises to promote sphincter control D.) Irrigating the urinary diversion

Answer: A.) Application of an ostomy pouch

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following? A.) Bleeding B.) Infection C.) Dehydration D.) Allergic reaction

Answer: A.) Bleeding Rationale: Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? A.) Blood pressure varying between 120/86 and 240/130 mm Hg B.) Heart rate of 56-64 bpm C.) Shivering D.) Complaints of nausea

Answer: A.) Blood pressure varying between 120/86 and 240/130 mm Hg

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? A.) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. B.) BUN of 18 mg/dL. C.) Serum creatinine of 1.2 mg/dL. D.) Glomerular filtration rate (GFR) of 100 mL/min.

Answer: A.) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. Rationale: The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? A.) Costovertebral angle tenderness B.) Suprapubic pain C.) Pain after voiding D.) Perineal pain

Answer: A.) Costovertebral angle tenderness Rationale: Acute pyelonephritis is characterized by costovertebral angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following? A.) Dysfunction of the thyroid gland itself B.) Failure of the pituitary gland C.) Disorder of the hypothalamus D.) Inadequate secretion of TSH

Answer: A.) Dysfunction of the thyroid gland itself Rationale: Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH

A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? A.) Helps the body adjust to stress B.) Maintains blood pressure C.) Slows the body's response to inflammation D.) Regulates metabolism

Answer: A.) Helps the body adjust to stress

When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following? A.) Inadequate secretion of parathormone B.) Increase in serum calcium C.) Lowered blood phosphate D.) Increase in the renal excretion of phosphate

Answer: A.) Inadequate secretion of parathormone Rationale: In hypoparathyroidism, there is an increased blood phosphate. Blood calcium is decreased, and there is a decreased renal excretion of phosphate. The secretion of parathormone is inadequate.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? A.) It carries glucose into body cells. B.) It aids in the process of gluconeogenesis. C.) It stimulates the pancreatic beta cells. D.) It decreases the intestinal absorption of glucose.

Answer: A.) It carries glucose into body cells.

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? A.) Magnetic resonance imaging (MRI) B.) Radioactive iodine uptake test C.) Radioimmunoassay D.) A nuclear scan

Answer: A.) Magnetic resonance imaging (MRI) Rationale: A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? A.) Observe stool color. B.) Monitor bowel patterns. C.) Monitor vital signs every 4 hours. D.) Observe urine output.

Answer: A.) Observe stool color.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A.) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. B.) On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C.) A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. D.) When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.

Answer: A.) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? A.) Physical and environmental conditions B.) History of allergies C.) Occupational history D.) Smoking habits

Answer: A.) Physical and environmental conditions

Vision and visual fields are altered in disorders of which of the following endocrine glands? A.) Pituitary B.) Thyroid C.) Parathyroid D.) Pancreas

Answer: A.) Pituitary Rationale: The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? A.) Presence of islet cell antibodies B.) Obesity C.) Rare ketosis D.) Requirement for oral hypoglycemic agents

Answer: A.) Presence of islet cell antibodies Rationale: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

Which of the following hormones is secreted by the juxtaglomerular apparatus? A.) Renin B.) Aldosterone C.) Antidiuretic hormone (ADH) D.) Calcitonin

Answer: A.) Renin

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? A.) Stimulate more hormones using the negative feedback system B.) Stimulate more hormones using the positive feedback system C.) Produce a new hormone to try and regulate the thyroid function D.) The feedback loop will be unable to perform in response to low levels of thyroid hormone.

Answer: A.) Stimulate more hormones using the negative feedback system Rationale: Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? A.) Sweating, tremors, and tachycardia B.) Dry skin, bradycardia, and somnolence C.) Bradycardia, thirst, and anxiety D.) Polyuria, polydipsia, and polyphagia

Answer: A.) Sweating, tremors, and tachycardia

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? A.) Sympathetic B.) Parasympathetic C.) Gastrointestinal effects D.) Respiratory effects

Answer: A.) Sympathetic Rationale: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? A.) Tetany B.) Hemorrhage C.) Thyroid storm D.) Laryngeal nerve damage

Answer: A.) Tetany

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? A.) pH 7.20, PaCO2 36, HCO3 14- B.) pH 7.31, PaCO2 48, HCO3 24- C.) pH 7.47, PaCO2 45, HCO3 33- D.) pH 7.50, PaCO2 29, HCO3 22-

Answer: A.) pH 7.20, PaCO2 36, HCO3 14- Rationale: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? A.) pituitary disorder B.) thyroid disorder C.) parathyroid disorder D.) adrenal disorder

Answer: A.) pituitary disorder Rationale: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: A.) removal of the transplanted kidney. B.) high-dose IV cyclosporine (Sandimmune) therapy. C.) bone marrow transplant. D.) intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol).

Answer: A.) removal of the transplanted kidney. Rationale: Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given IV to treat acute organ rejection, but it's ineffective against hyperacute rejection.

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

Answer: A.) vasopressin.

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question? A.) "Do you have a strong desire to void?" B.) "Do you urinate while sleeping?" C.) "Does it burn when you urinate?" D.) "Is it painful when you urinate?"

Answer: B.) "Do you urinate while sleeping?"

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? A.) "The spleen releases ketones when your body can't use glucose." B.) "Ketones will tell us if your body is using other tissues for energy." C.) "Ketones can damage your kidneys and eyes." D.) "Ketones help the physician determine how serious your diabetes is."

Answer: B.) "Ketones will tell us if your body is using other tissues for energy."

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? A.) 1 month B.) 3 months C.) 6 months D.) 9 months

Answer: B.) 3 months

What is the duration of regular insulin? A.) 3 to 5 hours B.) 4 to 6 hours C.) 12 to 16 hours D.) 24 hours

Answer: B.) 4 to 6 hours

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? A.) Duration of the insulin B.) Accuracy of the dosage C.) Area for insulin injection D.) Technique for injecting

Answer: B.) Accuracy of the dosage

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A.) Risk for infection B.) Decreased cardiac output C.) Impaired physical mobility D.) Imbalanced nutrition: Less than body requirements

Answer: B.) Decreased cardiac output Rationale: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? A.) Adventitia (connective tissue) B.) Detrusor muscle C.) Submucosal layer of connective tissue D.) Inner layer of epithelium

Answer: B.) Detrusor muscle

Which is a clinical manifestation of diabetes insipidus? A.) Low urine output B.) Excessive thirst C.) Weight gain D.) Excessive activities

Answer: B.) Excessive thirst Rationale: 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.

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test? A.) Serum immunoassay for TSH B.) Fine-needle biopsy of the thyroid gland C.) Free T4 analysis D.) Ultrasound of the thyroid gland

Answer: B.) Fine-needle biopsy of the thyroid gland

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: A.) thyroiditis. B.) Graves' disease. C.) Hashimoto's thyroiditis. D.) multinodular goiter.

Answer: B.) Graves' disease.

Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor? A.) Administer prescribed corticosteroids carefully. B.) Handle body fluids carefully. C.) Monitor the respiratory status. D.) Administer the prescribed medications at the same time each day.

Answer: B.) Handle body fluids carefully. Rationale: The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? A.) Hypocalcemia B.) Hypercalcemia C.) Hyperphosphatemia D.) Hypophosphaturia

Answer: B.) Hypercalcemia

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? A.) Elevated urea levels B.) Hyperkalemia C.) Hypocalcemia D.) Elevated white blood cells

Answer: B.) Hyperkalemia Rationale: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? A.) Headache B.) Hypotension C.) Diaphoresis D.) Palpitations

Answer: B.) Hypotension Rationale: The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.

What is a characteristic of the intrarenal category of acute renal failure? A.) Decreased creatinine B.) Increased BUN C.) High specific gravity D.) Decreased urine sodium

Answer: B.) Increased BUN Rationale: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? A.) Bleeding B.) Intake of medication such as phenazopyridine hydrochloride C.) Intake of multiple vitamin preparations D.) Infection

Answer: B.) Intake of medication such as phenazopyridine hydrochloride

Which is an effect of aging on upper and lower urinary tract function? A.) Increased glomerular filtration rate B.) More prone to develop hypernatremia C.) Increased blood flow to the kidneys D.) Acid-base balance

Answer: B.) More prone to develop hypernatremia Rationale: The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? A.) Initiation B.) Oliguria C.) Diuresis D.) Recovery

Answer: B.) Oliguria Rationale: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? A.) Stress B.) Urge C.) Overflow D.) Functional

Answer: B.) Urge

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? A.) Low blood pressure B.) Urinary tract infections C.) Lifelong obesity D.) Elevated triglycerides

Answer: B.) Urinary tract infections Rationale: Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? A.) Blood glucose level of 200 mg/dl B.) White blood cell (WBC) count of 20,000/mm3 C.) Potassium level of 3.5 mEq/L D.) Hematocrit (HCT) of 35%

Answer: B.) White blood cell (WBC) count of 20,000/mm3 Rationale: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A.) "I inherited this disorder from one of my parents." B.) "The cysts can get quite large in size." C.) "As long as I have one normal kidney, I should be fine." D.) "If renal failure develops, I may need to consider dialysis."

Answer: C.) "As long as I have one normal kidney, I should be fine." Rationale: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? A.) "Have you noticed any vaginal bleeding?" B.) "Do you take phenytoin daily?" C.) "Do you take multiple vitamin preparations?" D.) "Have you had a recent urinary tract infection?"

Answer: C.) "Do you take multiple vitamin preparations?"

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? A.) Weigh the client. B.) Test urine for ketones. C.) Assess vital signs. D.) Administer oral hydrocortisone.

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

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? A.) Hyperalbuminemia B.) Peripheral neuropathy C.) Cola-colored urine D.) Hypotension

Answer: C.) Cola-colored urine Rationale: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

Which value does the nurse recognize as the best clinical measure of renal function? A.) Circulating ADH concentration B.) Volume of urine output C.) Creatinine clearance D.) Urine-specific gravity

Answer: C.) Creatinine clearance Rationale: Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

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: A.) Impaired adjustment. B.) Defensive coping. C.) Deficient knowledge (treatment regimen). D.) Health-seeking behaviors (diabetes control).

Answer: C.) Deficient knowledge (treatment regimen).

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? A.) Thiazide diuretics B.) Ibuprofen C.) Desmopressin (DDAVP) D.) Diabinese

Answer: C.) Desmopressin (DDAVP)

A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? A.) Hyperuricemia B.) Pancreatitis C.) Diabetes mellitus D.) Hyperparathyroidism

Answer: C.) Diabetes mellitus

A nurse should perform which intervention for a client with Cushing's syndrome? A.) Offer clothing or bedding that's cool and comfortable. B.) Suggest a high-carbohydrate, low-protein diet. C.) Explain that the client's physical changes are a result of excessive corticosteroids. D.) Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

Answer: C.) Explain that the client's physical changes are a result of excessive corticosteroids.

NPH is an example of which type of insulin? A.) Rapid-acting B.) Short-acting C.) Intermediate-acting D.) Long-acting

Answer: C.) Intermediate-acting

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? A.) Wear a mask while handling any dialysate solutions B.) Keep the catheter stabilized to the abdomen, below the belt line C.) Keep the dialysis supplies in a clean area, away from children and pets D.) Clean the catheter insertion site daily with soap

Answer: C.) Keep the dialysis supplies in a clean area, away from children and pets Rationale: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? A.) Bactrim B.) Levaquin C.) Pyridium D.) Septra

Answer: C.) Pyridium

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? A.) Determine the stone type. B.) Relieve any obstruction. C.) Relieve the pain. D.) Prevent nephron destruction.

Answer: C.) Relieve the pain.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A.) Infusing IV fluids rapidly as ordered B.) Encouraging increased oral intake C.) Restricting fluids D.) Administering glucose-containing I.V. fluids as ordered

Answer: C.) Restricting fluids

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? A.) Fasting blood glucose test B.) 6-hour glucose tolerance test C.) Serum glycosylated hemoglobin (Hb A1c) D.) Urine ketones

Answer: C.) Serum glycosylated hemoglobin (Hb A1c)

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: A.) Creatinine 0.7 mg/dL B.) Protein 15 mg/dL C.) Specific gravity 1.035 D.) Bright yellow urine

Answer: C.) Specific gravity 1.035

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? A.) Increased risk for urologic complications B.) Need for exocrine enzymatic drainage C.) Underlying problem of insulin resistance D.) Need for lifelong immunosuppressive therapy

Answer: C.) Underlying problem of insulin resistance

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? A.) increase in hormonal levels B.) hormonal overproduction C.) decrease in hormonal levels D.) hormonal underproduction

Answer: C.) decrease in hormonal levels

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: A.) nausea and vomiting. B.) dyspnea and cyanosis. C.) fatigue and weakness. D.) thrush and circumoral pallor.

Answer: C.) fatigue and weakness. Rationale: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A.) 90 mg/dL before meals. B.) 120 mg/dL, 1 hour postprandial. C.) 80 mg/dL, 1 hour postprandial. D.) 138 mg/dL, 2 hours postprandial.

Answer: D.) 138 mg/dL, 2 hours postprandial.

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? A.) 50 pg/mL B.) 100 pg/mL C.) 100 to 300 pg/mL D.) 450 pg/mL

Answer: D.) 450 pg/mL Rationale: Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? A.) Administration of an insulin drip B.) Administration of a loop diuretic C.) Administration of sodium bicarbonate D.) Administration of sodium polystyrene sulfonate [Kayexalate])

Answer: D.) Administration of sodium polystyrene sulfonate [Kayexalate])

What is the most common cause of hyperaldosteronism? A.) Excessive sodium intake B.) A pituitary adenoma C.) Deficient potassium intake D.) An adrenal adenoma

Answer: D.) An adrenal adenoma Rationale: 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.

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? A.) Antispasmodic agents B.) Urinary analgesics C.) Antibiotics D.) Anticholinergic agents

Answer: D.) Anticholinergic agents Rationale: Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence.

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? A.) Voiding at given intervals B.) Prompted voiding C.) Interval voiding D.) Bladder retraining

Answer: D.) Bladder retraining

A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? A.) Glucocorticoids B.) Mineralocorticoids C.) Glucagon D.) Epinephrine

Answer: D.) Epinephrine Rationale: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.

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

Answer: D.) Maintaining room temperature in the low-normal range

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? A.) Bananas B.) Chicken livers C.) Hamburger D.) Milk

Answer: D.) Milk

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? A.) Use clean technique during insertion B.) Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens C.) Place the catheter bag on the client's abdomen when moving the client D.) Perform meticulous perineal care daily with soap and water

Answer: D.) Perform meticulous perineal care daily with soap and water

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? A.) Risk for altered urinary elimination B.) Risk for deficient knowledge: self-catherization C.) Risk for fluid volume excess D.) Risk for infection

Answer: D.) Risk for infection Rationale: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

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? A.) Blood urea nitrogen (BUN) level of 12 mg/dl B.) Blood glucose level of 90 mg/dl C.) Serum sodium level of 134 mEq/L D.) Serum potassium level of 5.8 mEq/L

Answer: D.) Serum potassium level of 5.8 mEq/L Rationale: 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 nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A.) encourage the client to ask questions about personal sexuality. B.) provide time for privacy. C.) provide support for the spouse or significant other. D.) suggest referral to a sex counselor or other appropriate professional.

Answer: D.) suggest referral to a sex counselor or other appropriate professional.

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: A.) insulin. B.) furosemide. C.) potassium chloride. D.) vasopressin.

Answer: D.) vasopressin.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? A.) Pitting edema of the legs B.) An irregular apical pulse C.) Dry mucous membranes D.) Frequent urination

Answer: B.) An irregular apical pulse

A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection? A.) Blood urea nitrogen B.) Creatinine C.) Osmolality D.) Hemoglobin

Answer: B.) Creatinine

Lispro (Humalog) is an example of which type of insulin? A.) Rapid-acting B.) Intermediate-acting C.) Short-acting D.) Long-acting

Answer: A.) Rapid-acting

Which diagnostic test is done to determine suspected pituitary tumor? A.) computed tomography scan B.) measurement of blood hormone levels C.) radioimmunoassay D.) radiographs of the abdomen

Answer: A.) computed tomography scan

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

Answer: A.) 7:45 AM

When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: A.) Thyroxine B.) Phosphorus C.) Parathyroid D.) Calcitonin

Answer: D.) Calcitonin