Nurs 6015 Exam 2 Practice Questions

b. "I must stay at home during therapy to avoid exposing others to radiation"

A 34-year old female is prescribed iodine131 for toxic nodular goiter. Which statement, if made by tis patient, would indicate a need for further teaching? a. "I can develop inadequate thyroid hormone secretion from this therapy" b. "I must stay at home during therapy to avoid exposing others to radiation" c. "I need to use two reliable methods of birth control d. "This drug takes months before it is fully effective"

a, c, and e

A child would be at risk of contracting the disease if which immunization was administered when the child is receiving glucocorticoid therapy? (select all that apply) a. nasal influenza b. injected influenza c. measles, mumps, and rubella d. pneumococcal e. varicella

a. profuse sweating

A nurse administered 30 units of NPH insulin in the same syringe as 8 units of aspart insulin coverage so that the patient would only need one injection. The nurse monitors the patient for which symptom that may result from administration? a. profuse sweating b. itching c. thirst d. vomiting

b. Cortisol

A nurse administers dexamethasone [Decadron], 1 mg, at 11:00 PM to a patient who has suspected adrenal dysfunction. The nurse obtains blood for which of these laboratory tests at 8:00 AM the next morning? a. Potassium b. Cortisol c. Glucose d. Sodium

b. Sweating

A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin. Which finding requires immediate follow-up by the nurse? a. Skin rash b. Sweating c. Itching d. Pedal edema

b, d, and e

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) a. Type 2 diabetes b. Altered fat metabolism leading to ketones c. Arterial blood pH of 7.35 to 7.45 d. Sudden onset, triggered by acute illness e. Plasma osmolality of 300 to 320 mOsm/L

b. Hypothyroidism

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? a. Thyrotoxicosis b. Hypothyroidism c. Hyperthyroidism d. Graves' disease

a. At times of stress, the patient increases the glucocorticoid dose.

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? a. At times of stress, the patient increases the glucocorticoid dose. b. The patient wears a Medic Alert bracelet at all times. c. The patient carries an injectable form and an oral form of glucocorticoid. d. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

c. Beta human chorionic gonadotropin (hCG) test

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? a. White blood cell (WBC) count b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level

d. Serum potassium level of 2.3 mEq/L

A patient being treated for pernicious anemia with cyanocobalamin reports new onset of muscle weakness and states, "My heart is skipping beats." Which laboratory value most likely is contributing to these new symptoms? a. Serum chloride level of 98 mEq/L b. Serum sodium level of 133 mEq/L c. Serum glucose level of 185 mg/dL d. Serum potassium level of 2.3 mEq/L

a. consult with prescriber

A patient complains of intolerable nausea and heartburn from taking an oral iron preparation. What should the nurse instruct the patient to do? a. consult with prescriber b. take a calcium carbonate antacid with the iron c. take the iron with milk d. take the iron with orange juice

a. "I'll take this medication in the morning so as not to interfere with sleep."

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? a. "I'll take this medication in the morning so as not to interfere with sleep." b. "I'll plan to double my dose if I gain more than 1 pound per day." c. "It is best to take the medication with food so I don't have any nausea." d. "I'll be glad when I don't have to take this medication in a few months."

a. draw up the two insulins in different syringes

A patient has been prescribed 5 units of insulin aspart and 25 units of insulin detemir to be administered at 8:00 AM? What should the nurse do? a. draw up the two insulins in different syringes b. draw up 5 units of aspart insulin first, then 25 units of detemir insulin in the same syringe c. draw up the clear insulin, then the cloudy insulin, in the same syringe d. draw up 25 units of detemir insulin first, then 5 units aspart insulin in the same syringe

d. Megaloblastic

A patient has vitamin B12 deficiency following a subtotal gastrectomy. The nurse understands the patient has which type of anemia? a. Microcytic b. Iron deficiency c. Hemolytic d. Megaloblastic

d. consult the prescriber STAT

A patient is admitted in a state of diabetic ketoacidosis. The resident orders insulin detemir 0.1mg/kg per hour to be administered by intravenous drip. What should the nurse do? a. calculate the insulin dose and mix it with 100mL of normal saline b. calculate the insulin dose and mix it with 100mL of D5W c. calculate the insulin dose and infuse the solution prepared by the pharmacy d. consult the prescriber STAT

d. Potassium

A patient is receiving cyanocobalamin for the treatment of pernicious anemia. Which electrolyte should the nurse monitor as a result of this treatment? a. Sodium b. Calcium c. Chloride d. Potassium

b. Acetaminophen [Tylenol]

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? a. Aspirin [Bayer] b. Acetaminophen [Tylenol] c. Ibuprofen [Advil] d. Naproxen sodium [Aleve]

a. Blood glucose control for 24 hours

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? a. Blood glucose control for 24 hours b. Mealtime coverage of blood glucose c. Less frequent blood glucose monitoring d. Peak effect achieved in 2 to 4 hours

a, d, and e

A patient is taking dexamethasone for COPD and digoxin for HF. Because of the increased risk for digoxin toxicity, the nurse should asses for what effects? (select all that apply) a. loss of appetite b. positive Chvostek sign c. flushed skin d. confusion e. visual changes

c. Muscle weakness

A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? a. Syncope b. Weight loss c. Muscle weakness d. Numbness and tingling

c. Tachycardia

A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the presence of which symptom? a. Vomiting b. Muscle cramps c. Tachycardia d. Chills

d. It promotes the passage of glucose into cells for energy.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? a. It stimulates the pancreas to reabsorb glucose. b. It promotes the synthesis of amino acids into glucose. c. It stimulates the liver to convert glycogen to glucose. d. It promotes the passage of glucose into cells for energy.

d. Potassium

A patient takes glucocorticoids and digoxin [Lanoxin]. It is most important for the nurse to monitor which electrolyte? a. Calcium b. Magnesium c. Sodium d. Potassium

b. Enhanced radiation effect to the brain

A patient who has Cushing's syndrome is taking ketoconazole [Nizoral] as an adjunct treatment to brain radiation. A nurse should expect the patient to have which of these therapeutic responses? a. Increased resistance to infection b. Enhanced radiation effect to the brain c. Suppressed cortisol synthesis d. Increased ACTH production

a. BP 84/47 mm Hg

A patient who has been receiving glucocorticoid therapy for 2 months is being tapered off the glucocorticoids. Which symptom suggests withdrawal syndrome? a. BP 84/47 mm Hg b. fasting glucose 255 mg/dL c. potassium 3.5 mEq/L d. pulse 55 beats/min

b. A1c

A patient who has type 2 DM has been unable to follow the recommended diet and exercise regimen. He tries to alter his laboratory results by eating less than usual before having blood testing performed. Which test would be most accurate for this patient because it evaluates his glucose control over the past 3 months? a. fasting glucose b. A1c c. postprandial glucose d. two-hour glucose tolerance

a. Refer the patient to a diabetes educator because the result reflects poor glycemic control.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? a. Refer the patient to a diabetes educator because the result reflects poor glycemic control. b. Glycemic control is adequate; no changes are needed. c. Hypoglycemia is a risk; teach the patient the symptoms. d. Instruct the patient to limit activity and weekly exercise.

b. Promotion of insulin secretion

A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? a. Inhibition of carbohydrate digestion b. Promotion of insulin secretion c. Decreased insulin resistance d. Inhibition of ketone formation

c. Check the patient's capillary blood sugar.

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? a. Take the patient's blood pressure. b. Give the patient's PRN dose of insulin. c. Check the patient's capillary blood sugar. d. Advise the patient to lie down with the legs elevated.

c. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance."

A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? a. "I'll have to isolate myself from my family so I don't expose them to radiation." b. "I'm looking forward to feeling better immediately after this treatment." c. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." d. "I'll need to take this drug on a daily basis for at least 1 year."

d. The patient will need higher doses of glucocorticoids following a trauma.

A patient with a chronic illness is on daily glucocorticoids. He is brought to the hospital following a severe motor vehicle accident. He is wearing a medical alert bracelet stating his home medications. Noting that the patient takes glucocorticoids daily, the nurse knows which of the following to be true? a. The patient will need lower doses of glucocorticoids following the trauma. b. The patient will have to stop all glucocorticoids immediately. c. The patient will need the same dose of glucocorticoids he used at home. d. The patient will need higher doses of glucocorticoids following a trauma.

b. MRI

A patient with chronic kidney disease is prescribed ferumoxytol. It would be a priority to inform the consulting physician of this drug if he or she orders which diagnostic test? a. CT b. MRI c. PET d. ultrasound

a. edema of the face and throat

A patient with peptic ulcer disease has developed severe anemia. Iron dextran has just been prescribed. The nurse has administered a test dose. It is a priority for the nurse to observe the patient for what adverse effect? a. edema of the face and throat b. hives c. phlebitis at the site of injection d. tissue damage from extravasation

b. intensive insulin therapy usually requires four injections if a rapid-acting insulin each day in addition to an injection of basal insulin

A patient with type 1 diabetes who has been using traditional insulin therapy has been prescribed intensive insulin therapy to achieve tighter glucose control. Which information should be included in the teaching? a. an insulin pump is used to provide the best glucose control and requires about the same amount of of attention as intensive insulin therapy b. intensive insulin therapy usually requires four injections if a rapid-acting insulin each day in addition to an injection of basal insulin c. intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who have never experienced ketoacidosis d. studies have shown that intensive insulin therapy is most effective in preventing the macrovascular complications characteristic of type 2 DM

d. prescription of insulin will be adjusted to meet needs while on prednisone

A patient with type 2 DM that is controlled with diet and metformin also has severe rheumatoid arthritis and has been prescribed prednisone to control inflammation. What is most likely to occur? a. development of acute hypoglycemia because of the RA exacerbation b. development of a rash caused by metformin-prednisone interactions c. needing a diet higher in calories while receiving prednisone d. prescription of insulin will be adjusted to meet needs while on prednisone

a. "Inject this insulin with your first bite of food, because it is very fast acting."

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? a. "Inject this insulin with your first bite of food, because it is very fast acting." b. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." c. "This insulin needs to be mixed with regular insulin to enhance the effects." d. "To achieve tight glycemic control, this is the only type of insulin you'll need."

c. "You may need a lower dose, I will contact your primary healthcare provider and call you back."

After 3 weeks of therapy with oral ferrous sulfate, a patient calls the clinic nurse, complaining of continuous nausea and vomiting with this drug. Which is the most appropriate response to this patient? a. "This may indicate a serious adverse effect of this drug. You need to come into the clinic." b. "Try to take your medication with meals. This should reduce your nausea and vomiting." c. "You may need a lower dose, I will contact your primary healthcare provider and call you back." d. "Try taking an antacid just before taking your medication. This can help reduce stomach acid, which causes nausea."

a. "I need to notify my doctor if I have episodes of sweating and shakiness"

After receiving teaching about the drug glipizide, which statement, if made by the patient, would suggest that the parent understood the teaching? a. "I need to notify my doctor if I have episodes of sweating and shakiness" b. "I should not have low blood sugar with this drug because it does not stimulate the release of insulin" c. "it is all right to eat what I want as long as I take enough of the drug" d. "this drug is less potent than the newer drugs"

a. 9 years old

Alternate-day glucocorticoid therapy is most appropriate for a patient who is a. 9 years old b. 29 years old c. 45 years old d. 65 years old

Mean Corpuscular Hemoglobin Concentration (MCHC)

Average volume of red cells in a specimen

a. bleeding

Because of drug interactions, the nurse should monitor a patient who is taking warfarin and levothyroxine for which condition? a. bleeding b. dysrhythmias c. insomnia d. tachycardia

d. sore throat

Because of the risk of agranulocytosis, the nurse should teach the patient who is prescribed methimazole to report which symptom? a. anorexia b. bleeding gums c. pale conjunctiva d. sore throat

a. Creatinine (Cr) level of 2.1 mg/dL

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? a. Creatinine (Cr) level of 2.1 mg/dL b. Hemoglobin (Hgb) level of 9.5 gm/dL c. Sodium (Na) level of 131 mEq/dL d. Platelet count of 120,000/mm3

false

Cushing syndrome is usually treated by administration of drugs that suppress adrenal secretion of hormones

c. influence the normalization of potassium levels

Eplerenone and spironolactone are prescribed for patients with adrenal hyperplasia because these drugs a. cause greater excretion of water than other diuretics b. increase renal reabsorption of hydrogen c. influence the normalization of potassium levels d. protect the heart

a. Cyanocobalamin 100 mcg intravenously (IV) every month

For which medication order should the nurse notify the healthcare provider? a. Cyanocobalamin 100 mcg intravenously (IV) every month b. Folic acid 1 mg orally daily × 2 weeks; then folic acid 400 mcg orally daily c. Iron dextran [INFeD] test dose 25 mg (IV) over 5 minutes d. Sodium-ferric gluconate complex [Ferrlecit] 125 mg in 100 mL NSS to run intravenously over 15 minutes

b. just after the patient wakes

Ideally, to follow the normal circadian pattern of glucocorticoid release, glucocorticoid replacement therapy would be administered at what time? a. midmorning b. just after the patient wakes c. midafternoon d. just before the patient falls asleep

c. total IBC

In iron-deficiency anemia, the nurse would expect which test to be elevated from normal levels? a. Hematocrit b. hemoglobin c. total IBC d. MCV

b. chronic kidney disease

It is a priority for the nurse to assess for symptoms of anemia in a patient who has a history of what condition? a. chronic obstructive pulmonary disease b. chronic kidney disease c. diabetes insipidus d. hypertension

a. 1st trimester

It is a priority for the nurse to teach hypothyroid pregnant women that adequate thyroid hormone replacement therapy is critical during which stage of pregnancy? a. 1st trimester b. 2nd trimester c. 3rd trimester d. postpartum period

c. paresthesias

It is a priority to teach the patient with pernicious anemia to report which issue? a. fatigue b. joint pain c. paresthesias d. temperature >100.4

c. profuse sweating and difficult to arouse

It would be a priority for the nurse to respond to which symptoms if exhibited by a patient who is receiving insulin therapy for diabetes? a. fatigue and blurred vision b. perineal itching and copious urine c. profuse sweating and difficult to arouse d. thirst and constant hunger

a. fasting blood sugar 235mg/dL

It would be a priority to report which finding when caring for a patient with Cushing Syndrome? a. fasting blood sugar 235mg/dL b. pH 7.44, HCO3 28mEq/L, pco2 45mm Hg c. peaked T waves on ECG d. sinus rhythm on ECG

d. WBC 2000/mm3

It would be a priority to report which laboratory result to the prescriber if a patient is receiving therapeutic doses of glucocorticoids? a. ALT 30 international units/L b. BUN 20 mg/dL c. Alc 5.9 d. WBC 2000/mm3

a. decreasing intestinal absorption of iron

Normally the body prevents excessive buildup of iron in the body by a. decreasing intestinal absorption of iron b. increasing metabolism of RBCs c. increasing excretion of RBCs in bile d. increasing excretion of RBCs in urine

b. citrus fruits

Patients on long-term glucocorticoid therapy may minimize a common complication of therapy by having adequate servings of which food in their diet? a. broccoli and cauliflower b. citrus fruits c. legumes d. whole grains

b and d

Research suggests that tight glucose control decreases the risk of (select all that apply) a. cerebrovascular options b. peripheral neuropathy c. peripheral vascular disease requiring amputation d. nephropathy

true

T or F: Addison disease involves insufficient secretion of adrenocorticoids and Cushing syndrome is excessive production of adrenocorticoids

true

T or F: Free T4 is the count of T4 hormone not bound by protein

true

T or F: Levothyroxine and other thyroid hormones should not be taken to treat obesity

false

T or F: Propylthiouracil is the first-line drug for hyperthyroidism

true

T or F: There is no ideal percentage of calories that should be ingested from carbohydrates, proteins, and fats

true

T or F: administering insulin or sulfonylurea drugs and not eating can cause serious effects from the blood sugar going too low

false

T or F: adverse effects of water retention and muscle wasting are expected when a patient take glucocorticoid therapy because of insufficient secretion by the adrenals

false

T or F: assessment for congenital hypothyroidism should be done at the infant's 2-month checkup

false

T or F: blood sugar control will be best achieved if the patient follows a plan created by the health care providers

false

T or F: clear solutions are always short-acting

false

T or F: excess glucocorticoid secretion is associated with depression

true

T or F: exercise improves cellular response to insulin

true

T or F: exophthalmos is not seen in all cases of hyperthyroidism

false

T or F: fludrocortisone is a potent mineralocorticoid that also possesses significant androgenic properties

false

T or F: glucocorticoid excess prevents the breakdown of fat for energy

true

T or F: glucocorticoids raise blood pressure by allowing blood vessels to constrict and limiting capillary permeability and loss of fluid into tissues

true

T or F: hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency

true

T or F: insulin therapy with one-long acting agent that mimics the body's basal insulin secretion and another short-acting agent to cover eating most closely mimics normal functioning

false

T or F: it is more important to take thyroid hormone replacement at the same time each day than with or without food

false

T or F: maternal hypothyroidism has the most significant effects on the fetus in the 3rd trimester when most fetal weight is gained

true

T or F: most long-term complications of diabetes occur secondary to disruption of blood flow

true

T or F: normal secretion of glucocorticoids should not cause hyperglycemia unless the patient is a diabetic

false

T or F: once a patient's blood sugar is stabilized, the patient will be able to maintain control with oral drugs

true

T or F: patients who take glucocorticoid therapy because of insufficient secretion by the adrenals are at risk for hypotension and hypoglycemia any time they experience elevated levels of physical or emotional stress

false

T or F: saturated fats should be limited to less than 10% of the total calories

true

T or F: the 3 and 4 in T3 and T4 indicate the number of atoms of iodine in the molecule

true

T or F: the primary goal of treating diabetes is to prevent long-term complications and manage symptoms of hyperglycemia

true

T or F: thin extremities from muscle wasting is a symptom of glucocorticoid excess

true

T or F: thyroid standardization is based on content of iodine, levothyroxine, and liothyronine

true

T or F: tight glucose control decreases the incidence of kidney failure

false

T or F: treatment can be monitored by blood or urine

false

T or F: weight loss is always needed to decrease the patient's insulin requirements

b. respirations 32 breaths per minute and deep

The college health nurse is caring for a college student with type 2 DM who was brought to the health clinic after getting intoxicated at a party. The student is prescribed metformin 850mg once a day. The nurse assesses the student. What assessment would be of most concern to the nurse? a. dorsalis pedis difficult to palpitate b. respirations 32 breaths per minute and deep c. pulse 100 beats/min d. severe frontal headache

c. tissue perfusion

The dialysis nurse has administered iron dextran and erythropoietin. What is a priority nursing concern relating to adverse effects? a. GI cramping b. infusion site discomfort c. tissue perfusion d. taste alterations

c. 2

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75-mcg tablets. How many tablets will the nurse administer? a. 0.5 b. 1 c. 2 d. 4

b. 0.5 mL

The healthcare provider orders hydrocortisone sodium succinate [Solu-Cortef] 500 mg IV now. The available medication is hydrocortisone sodium succinate [Solu-Cortef] 1000 mg/mL. How many mL will the nurse administer? a. 0.25 mL b. 0.5 mL c. 0.75 mL d. 2 mL

c. 5

The healthcare provider orders the following:Prednisone 5 mg PO q6h × 4 days5 mg PO q12h × 3 days5 mg PO qDay × 3 daysDispense 5-mg tabletsAfter completing 6 days of treatment the patient calls and asks how many pills should be left in the bottle because some may have been lost. How many pills should be left? a. 10 b. 6 c. 5 d. 4

c. 8:00 AM 80mg/dL; prescribed NPH insulin 34 units

The nurse has done an initial assessment on assigned patients and is preparing to administer prescribed insulin. All patients are alert and oriented. It is 8:07 AM, and breakfast trays are scheduled to arrive at 8:45 AM. The nurse should administer insulin first to the patient who has a. 8:00 AM FSBG 100mg/dL; prescribed insulin aspart 5 units b. 8:00 AM FSBG 110mg/dL; prescribed insulin glulisine 7 units c. 8:00 AM 80mg/dL; prescribed NPH insulin 34 units d. 8:00 AM FSBG 90mg/dL; prescribed regular insulin 5 units

a. Ensure that epinephrine is available as needed.

The nurse is administering iron dextran (INFeD) by intravenous (IV) infusion to a patient with iron deficiency. Which is the priority nursing action during the administration of this drug? a. Ensure that epinephrine is available as needed. b. Assess the lung sounds and respiratory rate. c. Monitor the blood urea nitrogen and creatinine levels. d. Use Y-connector tubing to connect to the primary line.

a, b, d, and e

The nurse is caring for a patient receiving vitamin B12 because of a deficiency. What are common causes of this deficiency? (Select all that apply.) a. Regional enteritis and malabsorption b. Celiac disease c. Decreased intake of foods with vitamin B12 d. Advancing age e. Use of drugs that lower stomach acid

a. BP that is difficult to control

The nurse is caring for a patient who is scheduled for an adrenalectomy for adrenal adenoma. During the night, the nurse should assess the patient for which symptom of the hyperaldosteronism? a. BP that is difficult to control b. postural hypotension when getting up to the bathroom c. tremor and cool, clammy skin from hypoglycemia d. vomiting, diarrhea, and subsequent electrolyte imbalances

a, b, c, d, and e

The nurse is caring for a patient who receives levothyroxine. Which OTC drugs should not be administered within hours of the administration of levothyroxine? (select all that apply) a. aluminum hydroxide b. calcium carbonate c. cimetidine d. ferrous sulfate e. milk of magnesia

b. Chronic blood loss through the GI tract

The nurse is caring for a patient with anemia. What is a common cause of iron deficiency in the United States? a. Decreased intestinal uptake of iron b. Chronic blood loss through the GI tract c. Vegetarian eating patterns d. Rapid growth during adolescence

d. Reticulocyte count 0.002%

The nurse is caring for an anemic cancer patient who is receiving chemotherapy that prevents the reproduction of rapidly dividing cells, including the cancer cells, hair, RBCs, and epithelium of the GI tract. Which laboratory result suggests that the anemia is getting worse? a. Hemoglobin 10mg/dL b. Hematocrit 26% c. RBC 3.8x1012L d. Reticulocyte count 0.002%

d. Increases or supplements dosage of glucocorticoid at times of stress

The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included? a. Increases daily intake of sodium for vascular expansion b. Tapers blood pressure medications to avoid hypotension c. Obtains periodic ultrasound scans of adrenal glands d. Increases or supplements dosage of glucocorticoid at times of stress

c. Fluid volume deficit

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis? a. Altered comfort b. Altered nutrition c. Fluid volume deficit d. Activity intolerance

c. TSH

The nurse is preparing to administer levothyroxine. Which laboratory value, if significantly low, would be a reason for the nurse to withhold the medication and consult the prescriber? a. free T3 b. free T4 c. TSH d. T3

d. NPH 35 units every morning

The nurse is preparing to perform the last assessment of the 7:00 PM to 7:00 AM shift at 6:00 AM. Several assigned patients have diabetes. The patient receiving which drug should be assessed for hypoglycemia first? a. acarbose 50mg 3 time a day with meals b. glargine insulin units every evening plus insulin aspart according to dietary intake an FSBG c. metformin 500mg before breakfast and supper d. NPH 35 units every morning

c. determine if this stool is usual or a change for this patient

The nurse is providing care to a patient who is receiving an oral preparation. The patient's stool is greenish-black. What should the nurse do? a. administer a dose of the iron preparation b. consult the prescriber c. determine if this stool is usual or a change for this patient d. hold the iron preparation

c. Note the contraindication and clarify the order with the healthcare provider.

The nurse is screening a patient before administering a live virus vaccine. The patient is currently taking a glucocorticoid medication. Which action should the nurse take? a. Continue screening and give the vaccine if appropriate. b. Note the contraindication but give the vaccine anyway. c. Note the contraindication and clarify the order with the healthcare provider. d. Hold the vaccine and notify the department of health.

c. "You may be prescribed a high dose of oral vitamin B12."

The nurse is teaching a patient with vitamin B12 deficiency caused by a previous gastrectomy and lack of intrinsic factor. Which statement by the nurse is the most appropriate to include in the teaching plan? a. "Because your body does not have intrinsic factor, vitamin B12 injections will be required." b. "If you increase your intake of animal protein foods, you may be able to avoid injections." c. "You may be prescribed a high dose of oral vitamin B12." d. "You will need to return to the clinic each month for your vitamin B12 injections."

b. "Store the ferrous sulfate in a childproof container and keep it out of the child's reach."

The nurse is teaching the parent of a young child about administering ferrous sulfate to the child at home. Which teaching point should receive the highest priority? a. "Give the liquid iron with a straw to reduce tooth staining." b. "Store the ferrous sulfate in a childproof container and keep it out of the child's reach." c. "This medicine may cause the child's stool to look dark green or black." d. "Do not give iron with any other medications or vitamins."

d. "When I am traveling for work I will take lower doses."

The nurse is teaching the patient about oral steroid therapy. Which statement by the patient indicates a need for further teaching? a. "I can take my full dose in the morning." b. "I can break up my dose and take some in the afternoon if I get tired." c. "I understand that I shouldn't experience many adverse effects." d. "When I am traveling for work I will take lower doses."

a, b, c, d, and e

The nurse should be especially vigilant in assessing for adverse systemic effects of a topical glucocorticoid therapy when administering the preparation? (select all that apply) a. to intertriginous areas b. to mucous membranes c. to well-hydrated skin d. to infants e. under an occlusive barrier

a. Systemic fungal infection

The nurse should question an order for glucocorticoids in the treatment of a patient with what? a. Systemic fungal infection b. Diabetes mellitus c. Myasthenia gravis d. Glaucoma

a. Thyroid stimulating hormone (TSH)

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? a. Thyroid stimulating hormone (TSH) b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level

c. "You can take 16 mg in the morning and 8 mg in the afternoon."

The patient states that when he takes hydrocortisone 24 mg in the morning, he is very tired by mid-afternoon. Which statement by the nurse is correct? a. "You can take 12 mg in the morning and 12 mg at night." b. "You can take 24 mg at night instead." c. "You can take 16 mg in the morning and 8 mg in the afternoon." d. "This is an adverse effect and you should stop taking the medication."

c. make an appointment, along with the teacher, to speak with their parents about noted concerns

The school nurse has been consulted by a 5th grade teacher regarding a student who is pale and tires excessively as the day progresses, and whose academic performance has been declining. What action would be appropriate at this time? a. contact the child's parents and inform them that their child is anemic b. contact the child's parents and tell them their child needs to be seen by by their pediatrician c. make an appointment, along with the teacher, to speak with their parents about noted concerns d. tell the child that you think he/she is anemic and should tell his/her parents

b. change from 75th to 35th percentile in height

The school nurse would notify the parents of a fourth-grade child who is receiving oral glucocorticoids to control asthma symptoms if height and weight screening findings included a a. change from 35th to 75th percentile in height b. change from 75th to 35th percentile in height c. gain of 2lb in the last year d. gain of 5lb in the last year

a, c, and d

To prevent damage to the developing neural tube of a fetus, it is important for women of child-bearing age to have adequate daily intake of folate, which can be found in which foods? (select all that apply) a. asparagus and spinach b. egg yolks and red meat c. enriched cereals and whole-wheat breads d. lentils and okra e. liver and chicken

c and d

What are the only drugs currently used to treat type 2 DM during pregnancy and lactation? (select all that apply) a. acarbose b. glipizide c. insulin d. metformin e. piogliitazone

a, b, and e

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) a. Adrenal insufficiency b. Osteoporosis c. Hypoglycemia d. Hyperkalemia e. Cataracts

a and c

What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.) a. Impaired carbohydrate and glucose tolerance b. Increased production of glucocorticoids from the adrenals c. Predisposition to gastrointestinal ulceration d. Decrease in serum sodium and glucose levels e. Increase in plaque development in coronary arteries

d. fatigue

What is a common nursing diagnosis for patients with iron-deficiency anemia? a. body image disturbance b. breathing pattern, ineffective c. cardiac output, decreased d. fatigue

d. soft, nondistended abdomen

What is an appropriate outcome for drug therapy with metoclopramide for a patient with DM? a. alert and oriented x3 b. no adventitious lung sounds c. palpable peripheral pulse d. soft, nondistended abdomen

b. dyspepsia

What is the most common adverse effect of administration of ferrous sulfate? a. discoloration of teeth b. dyspepsia c. hypotension d. weak, rapid pulse

b. importance of taking extra doses of corticoids when ill

What is the priority teaching for a patient who has been prescribed hydrocortisone for adrenal insufficiency? a. importance of adequate sodium in the diet b. importance of taking extra doses of corticoids when ill c. importance of including fresh vegetables and fruits in the diet d. importance of orthostatic BP precautions

c. roll the vial gently to mix particles in solution

What special administration techniques must the nurse use when administering NPH insulin? a. never mix with another insulin b. administer this insulin only at bedtime c. roll the vial gently to mix particles in solution d. when mixing with another insulin, draw the NPH insulin first

a, b, and c

What would be the most appropriate nursing intervention for a 23-year old patient, who for the first time, has a fasting plasma glucose level of 145mg/dL? (select all that apply) a. advise the patient to include 150 minutes of moderate to vigorous exercise spread over 3 days per week b. discuss diet changes with the patient c. explain the need for oral antidiabetic medication to the patient d. teach the patient how to do a urine dip for glucose and ketones

c. patient is NPO for a colonoscopy

What would warrant the nurse not administering repaglinide and consulting the prescriber? a. fasting blood glucose 95mg/dL b. glycosylated hemoglobin (A1c) 5.5% c. patient is NPO for a colonoscopy d. patient is scheduled for hemodialysis at 10:00 AM

a. cardiovascular system

When a patient is prescribed drugs that increase the production of RBCs, it is a priority to monitor the effect of changes in serum potassium on which system? a. cardiovascular system b. endocrine system c. GI system d. pulmonary system

c. Ensure that meals are at bedside so that administration with food reduces gastric irritation.

When administering prednisone to a patient, the nurse will do what? a. Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. b. Instruct the patient to stop taking the prednisone immediately if diarrhea develops. c. Ensure that meals are at bedside so that administration with food reduces gastric irritation. d. Avoid intravenous delivery to prevent adverse effects.

a, b, c, and e

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.) a. Osteoporosis b. Moon face c. Glycosuria d. Ketonuria e. Mood swings

d. z-track intramuscular

When iron must be administered by injection, which method of administration should be used? a. intradermal b. intrathecal c. subcutaneous d. z-track intramuscular

a. discard the vial and obtain a new one from the pharmacy

When obtaining a new vial of NPH insulin from the refrigerator, the nurse notes that the suspension is partially frozen. What should the nurse do? a. discard the vial and obtain a new one from the pharmacy b. shake the vial vigorously to produce heat c. warm the suspension in warm water d. withdraw the unfrozen portion and discard the rest

c. swallowing reflex

When performing the initial morning assessment on a patient with diabetes, the nurse notes that the patient is diaphoretic and confused. The nurse checks the FSBG, which is 37mg/dL. What is the priority assessment before administering orange juice? a. blood pressure b. deep tendon reflexes c. swallowing reflex d. temperature

a. benazepril

Which antihypertensive drug might be prescribed for a patient with diabetes mellitus who does not have albuminuria? a. benazepril b. carvedilol c. diltiazem d. furosemide

c. muscle weakness and fatigue

Which are common symptoms of hypokalemia caused by glucocorticoids with high mineralocorticoid activity? a. anxiety and flushed skin b. hypotension and cool, clammy skin c. muscle weakness and fatigue d. tingling around mouth and fingers

b. crackles throughout lung fields and 2.5-lb weight gain

Which assessment change from yesterday morning in a patient who is prescribed pioglitazone would be of most concern to the nurse? a. abdominal pain and two loose stools this morning b. crackles throughout lung fields and 2.5-lb weight gain c. decrease in BP from 130/82 to 118/78mm Hg and pulse drop from 82 to 74 beats/min d. temperature 102.4 and cough

d. temperature 104

Which assessment finding would be most critical for the nurse to report to the prescriber immediately if noted in a patient admitted with urosepsis who has a history of Graves disease treated by an antithyroid drug? a. blood in urine on urinalysis b. burning while urinating c. flank pain d. temperature 104

a. cardiovascular effects

Which complication of diabetes causes the most deaths? a. cardiovascular effects b. hypoglycemia c. ketoacidosis d. kidney damage

b. excessive bruising

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? a. Cardiac dysrhythmias b. excessive bruising c. Weight loss of 5 kg d. Shortness of breath

c and d

Which food(s) should the nurse include in dietary teaching for pregnant women regarding prevention of iron-deficiency anemia? (select all that apply) a. carrots, red peppers, squash b. cheese, milk, yogurt c. chicken, fish, red meat d. egg yolk, legumes e. oranges, apples, pears

a. organ meats

Which foods are good sources of vitamin B12? a. organ meats b. fruits c. grains d. vegetables

a. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin."

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? a. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." b. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." c. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." d. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

b. An intravenous test dose of 25 mg over 5 minutes must be administered.

Which is the priority nursing intervention for a patient receiving parenteral iron dextran (INFeD) infusion? a. The medication must be administered by deep subcutaneous injection. b. An intravenous test dose of 25 mg over 5 minutes must be administered. c. Erythropoietin must also be given when a patient is receiving parenteral iron dextran. d. After administration of a test dose of intramuscular (IM) iron dextran, the patient must be observed for 15 minutes before the full therapeutic dose is given.

c. eGFR 42mL/min

Which laboratory test result increases the risk that a patient who is prescribed glyburide might experience hypoglycemia? a. Alk Phos 142 international units/L b. BUN 24mg/dL c. eGFR 42mL/min d. G6PD 2.4 U/g of hemoglobin

a. Tachycardia

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? a. Tachycardia b. Tremors c. Insomnia d. Irritability

a. change positions slowly

Which nursing action is appropriate when a patient is prescribed bromocriptine for type 2 DM? a. change positions slowly b. elevate the head of the body for 30 minutes after eating c. monitor fluid intake and output d. weigh daily

a. Administer the iron preparation through a dropper.

Which nursing action should prevent an adverse effect of a liquid iron preparation? a. Administer the iron preparation through a dropper. b. Administer the liquid iron preparation along with vitamin C. c. Administer the liquid buccally to delay absorption and lessen adverse effects. d. Mix the liquid iron preparation with an antacid for patients with underlying peptic ulcer disease.

d. two-hour postprandial blood sugar less than 150mg/dL

Which nursing outcome would be most appropriate for a patient who is prescribed acarbose or nateglinide? a. bedtime FSBG 160mg/dL b. fasting blood glucose less than 90mg/dL c. glycosylated hemoglobin (A1c) 7% d. two-hour postprandial blood sugar less than 150mg/dL

c. beverages having a brassy taste

Which of these factors, if identified in a patient receiving Lugol solution, would be a concern to the nurse? a. decrease in free T3 b. weight gain of 2lb in 2 weeks c. beverages having a brassy taste d. drug taken with grapefruit juice

d. weight gain of 2lb in 24 hours

Which of these findings would be a priority to report to the prescriber if a patient was prescribed fludrocortisone? a. BP 135/88mm Hg b. flushed, dry skin c. nausea and vomiting d. weight gain of 2lb in 24 hours

a. ALT 150 international units/L

Which of these laboratory results, if identified in a patient with Cushing's Syndrome who is receiving 800mg of ketoconazole to inhibit corticosteroid synthesis, should the nurse report to the prescriber? a. ALT 150 international units/L b. BUN 15mg/dL c. Creatinine 1.5mg/dL d. Glucose 150mg/dL

a. Intestines

Which organ regulates the body's iron stores? a. Intestines b. Kidneys c. Liver d. Bloodstream

c. potassium 3.1mg/dL

Which possible effect of glucocorticoid therapy in the doses used for nonendocrine disorders would be a priority to report to the prescriber? a. calcium 9mg/dL b. chloride 95mg/dL c. potassium 3.1mg/dL d. sodium 145mg/dL

a. "You need to notify your doctor if you have a sore throat and fever."

Which statement is the most important for a nurse to make to a patient who is taking methimazole? a. "You need to notify your doctor if you have a sore throat and fever." b. "Another medication can be given if you experience any nausea." c. "You may experience some muscle soreness with this medicine." d. "Headache and dizziness may occur but not very frequently."

a. lowering the heart rate

Which statement would be of greatest priority when a patient is admitted in thyrotoxic crisis? a. lowering the heart rate b. providing adequate nutrition c. raising the secretion of TSH d. suppressing thyroid hormone secretion

c. "this drug should help decrease the bulging appearance of my eyes"

Which statement, if made by a patient receiving the antithyroid drug propylthiouracil, would indicate a need for further teaching? a. "after this drug gets to a therapeutic level, it should help my heart to stop feeling like it is racing b. "I should gain weight while eating less when I am on this drug" c. "this drug should help decrease the bulging appearance of my eyes" d. "this drug should stop the feeling that I am always too hot"

b. "I will not need as much insulin when I am taking levothyroxine"

Which statement, if made by a patient who has type 1 diabetes mellitus and was recently diagnosed with hypothyroidism and prescribed levothyroxine, would indicate a need for further teaching? a. "I should check my blood sugar if I get really thirsty and hot and feel flushed" b. "I will not need as much insulin when I am taking levothyroxine" c. "it is very important to check my blood sugar before meals and at bedtime d. "it will b e weeks before the Synthroid levels off in my blood and my basil insulin dose can be adjusted accordingly"

a, b, and c

Which statements about hydrocortisone are correct? (Select all that apply.) a. It is a synthetic steroid identical to cortisol. b. It is a preferred drug for adrenocortical insufficiency. c. It has glucocorticoid and mineralocorticoid actions. d. It is given IV for chronic replacement therapy. e. It should not be given during times of stress.

b, c, and e

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) a. Levothyroxine should be taken with food. b. Levothyroxine can be given by IV but is usually taken orally. c. Levothyroxine brands should not be changed if possible. d. Levothyroxine should be taken at night to avoid adverse effects. e. Levothyroxine can affect the metabolism of other medications.

d. type 2 diabetes

Which type of diabetes often exists for years before diagnosis, but fasting blood glucose is not elevated because of hyperinsulinemia? a. gestational diabetes b. juvenile diabetes c. type 1 diabetes d. type 2 diabetes

c. "taking the drug on an empty stomach 30-60 minutes before breakfast increases drug absorption"

a patient has received instructions regarding administration of levothyroxine. Which of these statements made by the patient would indicate that the patient understood the directions? a. "I should take the drug in the morning with breakfast" b. "stomach upset occurs if the drug is taken with an antacid" c. "taking the drug on an empty stomach 30-60 minutes before breakfast increases drug absorption" d. "taking the drug with orange juice increases drug absorption"

b. discuss the change with her prescriber

a patient who has hypothyroidism tells the nurse that her insurance company now requires that she use a generic drug if one is available. Up to now, she has been taking brand name Synthroid. The nurse should advise the patient to a. ask the pharmacist what is best b. discuss the change with her prescriber c. pay for the brand name d. use the generic brand; there is no difference

b. deep tendon reflex

a patient with pernicious anemia complains of numbness and tingling of the hands and feet. What data related relating to possible neurologic damage should the nurse collect before notifying the prescriber of the patient's complaint? a. blood pressure b. deep tendon reflex c. capillary glucose d. skin color

Mean Corpuscular Volume (MCV)

average volume of red cells in a specimen

vaccines

can decrease antibody response

bisphonates

can help prevent osteoporosis

Ferritin

complex used to store iron within mucosal cells

androgens

contribute to expression of sexual characteristics

proerythroblast

developing RBC in bone marrow before incorporating hemoglobin

erythroblast

developing RBC in marrow after incorporating hemoglobin

hyperchromic

excessive color

Reticulocyte

immature erythrocytes

loop diuretics

increased risk of hypokalemia

NSAIDs

increased risk of ulceration

glucocorticoids

influence carbohydrate metabolism and other processes

hemosiderin

insoluble form of storage iron found in body tissue

transferrin

iron transport proteins

d. hCG 425 mIU/mL

it would be a priority to report which laboratory test result to the prescriber of methimazole? a. ALT 50 IU/L b. BUN 24mg/dL c. FBG 138mg/dL d. hCG 425 mIU/mL

megaloblast

large erythroblast

macrocyte

large erythrocyte

insulin

may require increased dose

mineralocorticoids

modulate salt and water balance

hemoglobin

oxygen-carrying protein molecule in RBCs

myoglobin

oxygen-storing molecule of muscle

hypochromic

pale

hematocrit

proportion of blood that consists of RBCs

c. pulse 60-80 beats/min

propranolol has been prescribed for a patient in thyrotoxic crisis. Which outcome is appropriate for this therapy? a. BP 110/80-90/60m Hg b. Free T4 0.8-2.3 ng/dL c. pulse 60-80 beats/min d. TSH 0.4-4mU/L

Iron binding capacity

saturation capacity of transferrin with iron

microcytic

small-size cell

a. accelerate maturation of fetal lungs

the adrenals of the full-term fetus release a burst of glucocorticoids during labor and delivery. These steroids act to: a. accelerate maturation of fetal lungs b. lower maternal blood pressure c. prevent uterine contractions d. stimulate fetal weight gain

b. 8:00 AM FSBG 190mg/dL; prescribed regular insulin 4 units per sliding scale coverage

the nurse is caring for a patient who is NPO for a diagnostic test. Which dose of insulin should be administered, if ordered, even if the patient is not eating? a. 8:00 AM FSBG 100mg/dL; prescribed insulin aspart 5 units and NPH 34 units b. 8:00 AM FSBG 190mg/dL; prescribed regular insulin 4 units per sliding scale coverage c. 8:00 AM FSBG 110mg/dL; prescribed insulin detemir 26 units d. 8:00 AM FSBG 80mg/dL; prescribed NPH insulin 34 units

d. heart failure

untreated primary hyperaldosteronism would be most dangerous if a patient had a history of what condition? a. aspiration pneumonia b. bowel obstruction c. cerebral palsy d. heart failure

Red blood cell distribution width

variation in size of RBC