Test 3 practice questions

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1.Dry skin 2.Thin, silky hair 3.Bulging eyeballs 4.Fine muscle tremors

1.Dry skin Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism.

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply. 1.Nocturia 2.Incontinence 3.Enlarged prostate 4.Nocturnal emissions 5.Decreased desire for sexual intercourse

1.Nocturia 2.Incontinence 3.Enlarged prostate

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1.Pallor 2.Edema 3.Anorexia 4.Proteinuria 5.Weight loss 6.Decreased serum lipids

1.Pallor 2.Edema 3.Anorexia 4.Proteinuria Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

During physical examination of a client, which finding is characteristic of hypothyroidism? 1.Periorbital edema 2.Flushed, warm skin 3.Hyperactive bowel sounds 4.Heart rate of 120 beats/min

1.Periorbital edema Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Knowing this should direct you to option 1. Flushed, warm skin; hyperactive bowel sounds; and tachycardia (heart rate >100 beats/min) are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state.

The nurse is assessing a client with liver disease for signs and symptoms of low albumin. Which sign or symptom should the nurse expect to note? 1. Weight loss 2. Peripheral edema 3. Capillary refill of 5 seconds 4. Bleeding from previous puncture sites

2. Peripheral edema Albumin is responsible for maintaining the osmolality of the blood. When the albumin level is low, osmotic pressure is decreased, which in turn can lead to peripheral edema. Weight loss is not a sign or symptom for hypoalbuminemia. Capillary refill of 5 seconds is a delayed filling time but is not associated with decreased albumin levels. Clotting factors produced by the liver (not albumin) are responsible for coagulation, and lack of clotting factors can result in bleeding from old puncture sites. The total protein level may decrease if the albumin level is low.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1.Bile-stained fecal emesis 2.The passage of currant jelly-like stools 3.Failure to pass meconium stool in the first 24 hours after birth 4.Sausage-shaped mass palpated in the upper right abdominal quadrant

3.Failure to pass meconium stool in the first 24 hours after birth Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be identified easily on sight. However, a rectal thermometer or tube may be necessary to determine patency if meconium is not passed in the first 24 hours after birth. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. Options 1, 2, and 4 are findings noted in intussusception.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1.Hypernatremia 2.Signs of water deficit 3.High urine osmolality 4.Low serum osmolality 5.Hypotonicity of body fluids 6.Continued release of antidiuretic hormone (ADH)

3.High urine osmolality 4.Low serum osmolality 5.Hypotonicity of body fluids 6.Continued release of antidiuretic hormone (ADH) SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1.Leg exercises 2.Early ambulation 3.Irrigating the nasogastric tube 4.Coughing and deep-breathing exercises

3.Irrigating the nasogastric tube In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? 1.Carrots and ranch dip 2.Whole-grain cereal and milk 3.A cup of popcorn and a cola drink 4.Applesauce and a graham cracker

4.Applesauce and a graham cracker The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. 1. Diarrhea 2.Black, tarry stools 3.Hyperactive bowel sounds 4.Gray-blue color at the flank 5.Abdominal guarding and tenderness 6.Left upper quadrant pain with radiation to the back

4.Gray-blue color at the flank 5.Abdominal guarding and tenderness 6.Left upper quadrant pain with radiation to the back Rationale: Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The client may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epigastric region or left upper quadrant with radiation to the back. The other options are incorrect.

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? 1.Primary nocturnal enuresis does not respond to treatment. 2.Primary nocturnal enuresis is caused by a psychiatric problem. 3.Primary nocturnal enuresis requires surgical intervention to improve the problem. 4.Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

4.Primary nocturnal enuresis is usually outgrown without therapeutic intervention. Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. 1. Administer stool softeners as prescribed. 2.Instruct the client to limit fluid intake to avoid urinary retention. 3.Encourage a high-fiber diet to promote bowel movements without straining. 4.Apply cold packs to the anal-rectal area over the dressing until the packing is removed. 5.Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

1. Administer stool softeners as prescribed. 3.Encourage a high-fiber diet to promote bowel movements without straining. 4.Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1.Polyuria 2.Diarrhea 3.Polyphagia 4.Weight gain

1.Polyuria Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition? 1.Cystic duct 2.Liver canaliculi 3.Common bile duct 4.Right hepatic duct

1.Cystic duct The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the canaliculi, from which bile flows into the right and left hepatic ducts and then into the common hepatic duct. From there, the bile can be transported for storage in the gallbladder through the cystic duct, or it can flow directly into the duodenum by way of the common bile duct.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? 1."I need to limit my intake of dietary fiber." 2."I need to drink plenty, at least 8 to 10 cups daily." 3."I need to eat regular meals and chew my food well." 4."I will take the prescribed medications because they will regulate my bowel patterns."

1."I need to limit my intake of dietary fiber." IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1."I should limit my fluids to 1 liter per day." 2."I should use my treadmill or go for walks daily." 3."I should follow a moderate-calcium, high-fiber diet." 4."My alendronate helps to keep calcium from coming out of my bones."

1."I should limit my fluids to 1 liter per day." In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to 2 liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps to protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Clients should follow a moderate-calcium, high-fiber diet. Even though serum calcium is already high, clients should follow a moderate-calcium diet because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

A nursing instructor is teaching the class about Addison's disease. The instructor determines that the class understands the disease process if they indicate which are affected in this disease? Select all that apply. 1.Androgens 2.Bicarbonate 3.Electrolytes 4.Glucocorticoids 5.Mineralocorticoids

1.Androgens 4.Glucocorticoids 5.Mineralocorticoids In Addison's disease, all three classes of corticosteroids are affected: glucocorticoids, mineralocorticoids, and androgens. Electrolytes and bicarbonate are not directly affected by Addison's disease.

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1.Assessment of vital signs 2.Completion of abdominal examination 3.Insertion of the prescribed nasogastric tube 4.Thorough investigation of precipitating events

1.Assessment of vital signs The priority nursing action is to assess the vital signs. This would provide information about the amount of blood loss that has occurred and provide a baseline by which to monitor the progress of treatment. The client may be unable to provide subjective data until the immediate physical needs are met. Although an abdominal examination and an assessment of the precipitating events may be necessary, these actions are not the priority. Insertion of a nasogastric tube is not the priority and will require a health care provider's prescription; in addition, the vital signs should be checked before performing this procedure.

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1.Calcium level of 8 mg/dL (2.0 mmol/L) 2.Calcium level of 11.2 mg/dL (2.8 mmol/L) 3.Potassium level of 2.9 mEq/L (2.9 mmol/L) 4.Potassium level of 5.6 mEq/L (5.6 mmol/L)

1.Calcium level of 8 mg/dL (2.0 mmol/L) Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]) this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse should expect the calcium level to be low. Therefore, option 1 is the correct answer.

The nurse is caring for a client with acute pancreatitis. Which finding should the nurse expect to note when reviewing the laboratory results? 1.Elevated serum lipase level 2.Elevated serum bilirubin level 3.Decreased serum trypsin level 4.Decreased serum amylase level

1.Elevated serum lipase level The serum lipase level is elevated in the presence of pancreatic cell injury. Serum trypsin and amylase levels are also elevated in pancreatic injury. Although bilirubin can be elevated in the client with pancreatitis, it is secondary to the hepatobiliary obstructive process.

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia

1.Fever 2.Nausea 4.Tremors 5.Confusion Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1.Hypotension 2.Leukocytosis 3.Hyperkalemia 4.Hypercalcemia 5.Hypernatremia

1.Hypotension 3.Hyperkalemia In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure by holding salt and water and excreting potassium. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with Addisonian crisis.

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1.Hypotension and fever 2.Mental status changes and hypertension 3.Subnormal temperature and hypotension 4.Complaints of weakness and hypertension

1.Hypotension and fever The nurse should be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data should alert the nurse to this occurrence? 1.Inability to pass flatus 2.Loss of anal sphincter control 3.Severe, constant pain with rapid onset 4.Firm, nontender mass palpable at the lower right costal margin

1.Inability to pass flatus An inflammatory reaction such as acute pancreatitis can cause paralytic ileus, the most common form of nonmechanical obstruction. Inability to pass flatus is a clinical manifestation of paralytic ileus. Loss of sphincter control is not a sign of paralytic ileus. Pain is associated with paralytic ileus, but the pain usually manifests as a more constant generalized discomfort. Option 4 is the description of the physical finding of liver enlargement. The liver may be enlarged in cases of cirrhosis or hepatitis. Although this client may have an enlarged liver, an enlarged liver is not a sign of paralytic ileus or intestinal obstruction.

The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care? 1.Infection 2.Poor body image 3.Decreased urinary elimination 4.Cracking oral mucous membranes

1.Infection Gastroschisis occurs when the bowel herniates through a defect in the abdominal wall to the right of the umbilical cord. There is no membrane covering the exposed bowel. Surgical repair will be done as soon as possible because of the risk of infection in the unprotected bowel. Therefore, the greatest risk immediately after delivery is infection. Because the client is a neonate, poor body image is not an immediate problem. Impaired urinary elimination is unlikely because the gastrointestinal tract is affected, not the genitourinary system. Gastroschisis involves the lower gastrointestinal system, so the oral mucous membranes are not affected.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1.Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3.Restrict fluids to 800 mL over 24 hours. 4.Elevate the head of the bed to high Fowler's. 5.Administer a vasopressin antagonist as prescribed.

1.Initiate an infusion of 3% NaCl. 2. 3.Restrict fluids to 800 mL over 24 hours. 5.Administer a vasopressin antagonist as prescribed. Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed. ADH makes you retain water, but not salt??

The nurse is reviewing the health care provider's prescriptions for a child hospitalized with nephrotic syndrome. Which food should the nurse tell the unlicensed assistive personnel to remove from the child's food tray? 1.Pickle 2.Wheat toast 3.Baked chicken 4.Steamed vegetables

1.Pickle A no-added-salt diet is indicated. High-sodium foods such as pickles, chips, and cured meats should be avoided. The items in the remaining options can be consumed.

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1.Irritability 2.Complaints of nausea 3.Sodium level of 128 mEq/L (128 mmol/L) 4.Potassium level of 3.2 mEq/L (3.2 mmol/L) 5.Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1.Irritability 2.Complaints of nausea 3.Sodium level of 128 mEq/L (128 mmol/L) 5.Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomiting, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthostatic hypotension. Irritability and depression may also occur in primary adrenal hypofunction.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1.Lying recumbent following meals 2.Consuming small, frequent, bland meals 3.Taking H2-receptor antagonist medication 4.Raising the head of the bed on 6-inch (15 cm) blocks

1.Lying recumbent following meals Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep.

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. 1.Nuts 2.Corn 3.Liver 4.Apples 5.Lentils 6.Bananas

1.Nuts 3.Liver 5.Lentils

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1.Pale pink urine 2.Dark pink urine 3.Tea-colored urine 4.Bright red blood with small clots in the urine

1.Pale pink urine If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the health care provider.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1.Polyuria 2.Headache 3.Bone pain 4.Nervousness 5.Weight gain

1.Polyuria 3.Bone pain The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1.Sweating and pallor 2.Bradycardia and indigestion 3.Double vision and chest pain 4.Abdominal cramping and pain

1.Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A nurse is assessing the status of jaundice in a child with hepatitis. Which anatomical areas will provide the best data regarding the presence of jaundice? Select all that apply. 1.The sclera 2.The nail beds 3.The mucous membranes 4.The skin in the sacral area 5.The skin in the abdominal area

1.The sclera 2.The nail beds 3.The mucous membranes Jaundice, if present, is best assessed in the sclera, nail beds, and mucous membranes. Generalized jaundice will appear in the skin throughout the body.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1.Thyroid 2.Pituitary 3.Parathyroid 4.Adrenal cortex

1.Thyroid The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding? 1.Waves of loud gurgles auscultated in all 4 quadrants 2.Low-pitched swishing auscultated in 1 or 2 quadrants 3.Relatively high-pitched clicks or gurgles auscultated in all 4 quadrants 4.Very high-pitched, loud rushes auscultated especially in 1 or 2 quadrants

1.Waves of loud gurgles auscultated in all 4 quadrants Although frequency and intensity of bowel sounds vary depending on the phase of digestion, normal bowel sounds are relatively high-pitched clicks or gurgles. Loud gurgles (borborygmi) indicate hyperperistalsis and are commonly associated with nausea and vomiting. A swishing or buzzing sound represents turbulent blood flow associated with a bruit. Bruits are not normal sounds. Bowel sounds are very high-pitched and loud (hyperresonance) when the intestines are under tension, such as in intestinal obstruction. Therefore, options 2, 3, and 4 are incorrect.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the health care provider for which type of diet for this client? 1A low-fat diet 2.A low-fiber diet 3.A high-protein diet 4.A high-carbohydrate diet

2.A low-fiber diet A low-fiber diet places less strain on the intestines because this type of diet is easier to digest. Clients should avoid high-fiber foods when experiencing acute diverticulitis. As the attack resolves, fiber can be added gradually to the diet.

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 1."Do you have tremors in your hands?" 2."Are you experiencing pain in your joints?" 3."Do you notice swelling in your legs at night?" 4."Have you had problems with diarrhea lately?"

2."Are you experiencing pain in your joints?" Hyperparathyroidism is associated with oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures. Tremors and diarrhea relate to assessment findings of hypoparathyroidism. Swelling in the legs at night is unrelated to hyperparathyroidism.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1."I'm so glad they didn't find any protein in his urine." 2."I noticed his urine was the color of coca-cola lately." 3."His health care provider said his kidneys are working well." 4."The nurse who admitted my child said his blood pressure was low."

2."I noticed his urine was the color of coca-cola lately." Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? 1."I will need to limit the amount of protein in my diet." 2."I should eat foods that have a lot of potassium in them." 3."I am fortunate that I can eat all of the salty foods I enjoy." 4."I am fortunate that I do not need to follow any special diet."

2."I should eat foods that have a lot of potassium in them." A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue

The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? 1."You should use a plastic spoon to feed the child." 2."You need to use an orthodontic nipple on the child's bottle." 3."You can allow the child to use a pacifier but only for 30 minutes at a time." 4."You need to monitor the child's temperature for signs of infection using an oral thermometer."

2."You need to use an orthodontic nipple on the child's bottle." An orthodontic nipple should be placed on the child's bottle, and the mother should be instructed to give the child baby food or baby food mixed with water. The mother should be instructed that straws, pacifiers, spoons, or fingers must be kept away from the child's mouth for 7 to 10 days after surgery. A pacifier should not be used for at least 2 weeks following the surgical repair. Additionally, the mother should be advised to avoid taking oral temperatures.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record? 1.Apply a cold pack to the abdomen. 2.Administer 30 mL of milk of magnesia (MOM). 3.Maintain nothing by mouth (nil per os [NPO]) status. 4.Initiate an intravenous (IV) line for the administration of IV fluids.

2.Administer 30 mL of milk of magnesia (MOM). Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1.Dry skin 2.Bulging eyeballs 3.Periorbital edema 4.Coarse facial features

2.Bulging eyeballs Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality? 1.Sodium 2.Calcium 3.Potassium 4.Magnesium

2.Calcium The C cells of the thyroid gland are helpful in maintaining normal plasma calcium levels. They do not affect the levels of sodium, potassium, or magnesium.

A client who visits the health care provider's office for a routine physical examination reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations? 1.Weight loss and thinning skin 2.Complaints of weakness and lethargy 3.Diaphoresis and increased hair growth 4.Increased heart rate and respiratory rate

2.Complaints of weakness and lethargy Weakness and lethargy are common complaints associated with hypothyroidism. Other common symptoms include weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food? 1.Rice 2.Corn 3.Broiled chicken 4.Cream of wheat

2.Corn The client with irritable bowel should take in a diet that consists of 30 to 40 g of fiber daily because dietary fiber will help produce bulky, soft stools and establish regular bowel habits. The client should also drink 8 to 10 glasses of fluid daily and chew food slowly to promote normal bowel function. Foods that are irritating to the intestines need to be avoided. Corn is high in fiber but can be very irritating to the intestines and should be avoided. The food items in the other options are acceptable to eat.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1.Hypertension 2.Generalized edema 3.Increased urinary output 4.Frank, bright red blood in the urine

2.Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2.Hypertension AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client? 1.Avoid driving a car for at least 1 week. 2.Increase fluid intake to at least 2.5 L/day. 3.Avoid lifting any objects greater than 30 pounds (13.6 kg). 4.Contact the health care provider (HCP) if small clots are noticed in the urine.

2.Increase fluid intake to at least 2.5 L/day. A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds (9 kg) for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1.Anxiety 2.Leukocyosis 3.Chvostek's sign 4.Urinary output of 800 mL/hour 5.Clear drainage on nasal dripper pad

2.Leukocyosis 4.Urinary output of 800 mL/hour 5.Clear drainage on nasal dripper pad Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? 1.Leukopenia with a shift to the left 2.Leukocytosis with a shift to the left 3.Leukopenia with a shift to the right 4.Leukocytosis with a shift to the right

2.Leukocytosis with a shift to the left Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells). Options 1, 3, and 4 are incorrect because they are not associated findings in acute appenditis.

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a health care provider prescription for which type of suction? 1.High and intermittent 2.Low and intermittent 3.High and continuous 4.Low and continuous

2.Low and intermittent Gastric mucosa can be traumatized and pulled into the tube if the suction pressure is placed on high or if the suction is continuous. The suction should be set on low pressure and intermittent suction control.

A client has overactivity of the thyroid gland. The nurse should expect which finding? 1.Weight gain 2.Nutritional deficiencies 3.Low blood glucose levels 4.Increased body fat stores

2.Nutritional deficiencies Although the client may experience an increased appetite with overactivity of the thyroid gland, food intake does not meet energy demands, and nutritional deficiencies can develop. Weight loss occurs as a result of the increased metabolic activity. Glucose tolerance is decreased, and the client experiences hyperglycemia. Overactivity of the thyroid gland also causes increased metabolism, including fat metabolism. This leads to decreased levels of fat in the bloodstream, including cholesterol, and decreased body fat stores.

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? Select all that apply. 1.Irritability 2.Periorbital edema 3.Coarse, brittle hair 4.Slow or slurred speech 5.Abdominal distention 6.Soft, silky, thinning hair

2.Periorbital edema 3.Coarse, brittle hair 4.Slow or slurred speech 5.Abdominal distention The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifestations, such as coarse, brittle hair; thick, brittle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifestations include lethargy, slow or slurred speech, and impaired memory. Gastrointestinal manifestations include complaints of constipation, weight gain, and abdominal distention. Irritability and soft, silky, thinning hair on the scalp are manifestations of hyperthyroidism.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1.Unresponsive pupils 2.Positive Trousseau's sign 3.Negative Chvostek's sign 4.Hypoactive bowel sounds

2.Positive Trousseau's sign Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1.Prevent fluid overload. 2.Prevent loss of electrolytes. 3.Promote the excretion of wastes. 4.Reduce the urine specific gravity.

2.Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition? 1."Are the stools ribbon-like, and is the infant eating poorly?" 2."Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?" 3."Does the vomit contain sour, undigested food without bile, and is the infant constipated?" 4."Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?"

3."Does the vomit contain sour, undigested food without bile, and is the infant constipated?" Vomiting undigested food that is not bile stained and constipation are classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1."I should avoid contact sports." 2."I should check my ankles for swelling." 3."I need to avoid foods high in potassium." 4."I need to check my blood glucose regularly."

3."I need to avoid foods high in potassium." Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1.A platelet count of 200,000 mm3 (200 × 109/L) 2.A blood glucose level of 110 mg/dL (6.28 mmol/L) 3.A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4.A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3.A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1.Provide a warm environment for the client. 2.Instruct the client to consume a low-fat diet. 3.A thyroid-releasing inhibitor will be prescribed. 4.Encourage the client to consume a well-balanced diet. 5.Instruct the client that thyroid replacement therapy will be needed. 6.Instruct the client that episodes of chest pain are expected to occur.

3.A thyroid-releasing inhibitor will be prescribed. 4.Encourage the client to consume a well-balanced diet. The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1.Increase intake of dairy products. 2.Avoid citrus fruits and citrus juices. 3.Avoid green, leafy vegetables such as spinach. 4.Increase intake of meat, fish, plums, and cranberries.

3.Avoid green, leafy vegetables such as spinach. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially? 1.Call the surgeon to report the problem. 2.Reposition the NG tube to the proper location. 3.Check the suction device to make sure it is working. 4.Irrigate the NG tube with saline to remove the obstruction.

3.Check the suction device to make sure it is working. After gastric surgery, the client will have an NG tube in place until bowel function returns. It is important for the NG tube to drain properly to prevent abdominal distention and vomiting. The nurse must ensure that the NG tube is attached to suction at the level prescribed and that the suction device is working correctly. The tip of the NG tube may be placed near the suture line. Because of this possibility, the nurse should never reposition the NG tube or irrigate it. If the NG tube needs to be repositioned, the nurse should call the surgeon, who would do this repositioning under fluoroscopy.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1.Breads 2.Poultry 3.Chocolate 4.Prune juice

3.Chocolate Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible complication of thyroid surgery? 1.Increased serum sodium level 2.Increased serum glucose level 3.Decreased serum calcium level 4.Decreased serum albumin level

3.Decreased serum calcium level Hypocalcemia may occur if the parathyroid glands are removed or damaged or if their blood supply is impaired during thyroid surgery, resulting in decreased parathyroid hormone (PTH) levels and leading to decreased serum calcium levels. Serum sodium, albumin, and glucose levels are not affected by thyroid surgery.

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results? 1.Elevated level of pepsin 2.Decreased level of lactase 3.Elevated level of amylase 4.Decreased level of enterokinase

3.Elevated level of amylase The serum level of amylase, an enzyme produced by the pancreas, increases with pancreatitis. Amylase normally is responsible for carbohydrate digestion. Pepsin is produced by the stomach and is used in protein digestion. Lactase and enterokinase are enzymes produced by the small intestine; lactase splits lactose into galactose and fructose, and enterokinase activates trypsin.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1.Provide a cool environment for the client. 2.Instruct the client to consume a high-fat diet. 3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 5.Inform the client that iodine preparations will be prescribed to treat the disorder. 6.Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 6.Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1.Prone position 2.On the stomach 3.Left lateral position 4.Right lateral position

3.Left lateral position A cleft lip is a congenital anomaly that occurs as a result of failure of soft tissue or bony structure to fuse during embryonic development. After cleft lip repair, the nurse avoids positioning an infant on the side of the repair or in the prone position because these positions can cause rubbing of the surgical site on the mattress. The nurse positions the infant on the side lateral to the repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood, or the tongue. From the options provided, placing the infant on the left side immediately after surgery is best to prevent the risk of aspiration if the infant vomits.

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client? 1.Maintain a high-carbohydrate diet. 2.Increase fluid intake, particularly at mealtime. 3.Maintain a low Fowler's position while eating. 4.Ambulate for at least 30 minutes following each meal.

3.Maintain a low Fowler's position while eating. The client at risk for dumping syndrome should be instructed to maintain a low Fowler's position while eating and lie down for at least 30 minutes after eating. The client also should be told that small, frequent meals are best and to avoid liquids with meals. Avoiding high-carbohydrate food sources also will assist in minimizing dumping syndrome.

A nurse is reviewing the health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 1.Acetaminophen 2.Docusate sodium 3.Morphine sulfate 4.Levothyroxine sodium

3.Morphine sulfate Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

The nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels? 1.Evaluating for asterixis 2.Inspecting for petechiae 3.Palpating for peripheral edema 4.Evaluating for decreased level of consciousness

3.Palpating for peripheral edema Albumin is responsible for maintaining the osmolality of the blood. When there is a low albumin level, there is decreased osmotic pressure, which in turn can lead to peripheral edema. The remaining options are incorrect and are not associated with a low albumin level.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1.To treat thyroid storm 2.To prevent cardiac irritability 3.To treat hypocalcemic tetany 4.To stimulate release of parathyroid hormone

3.To treat hypocalcemic tetany Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure? 1.Portal vein 2.Celiac artery 3.Vagus nerve 4.Pyloric valve

3.Vagus nerve Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the production of gastric acid. The portal vein drains venous blood from the stomach. The celiac artery brings arterial blood to the stomach. The pyloric valve separates the stomach from the duodenum. The pyloric valve may undergo surgical repair if it becomes stenosed; this procedure is known as pyloroplasty.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1.Folate deficiency 2.Malabsorption of fat 3.Intestinal obstruction 4.Fluid and electrolyte imbalance

4.Fluid and electrolyte imbalance A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1."Caution should be used when straddling the infant on a hip." 2."Vital signs should be taken daily to check for bladder infection." 3."Catheterization will be necessary when the infant does not void." 4."Circumcision has been delayed to save tissue for surgical repair."

4."Circumcision has been delayed to save tissue for surgical repair." Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicates the need for further instruction? 1."I'll check his temperature." 2."I'll give him medication so he'll be comfortable." 3."I'll check his voiding to be sure there's no problem." 4."I'll let him decide when to return to his play activities."

4."I'll let him decide when to return to his play activities." Cryptorchidism is a condition in which 1 or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year-olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present? 1.A sunken and hidden stoma 2.A narrow and flattened stoma 3.A stoma that is dusky or bluish 4.A stoma that is elongated with a swollen appearance

4.A stoma that is elongated with a swollen appearance A prolapsed stoma is one in which the bowel protrudes, causing an elongated and swollen appearance of the stoma. A retracted stoma is characterized by sinking of the stoma. A stoma with a narrow opening is described as being stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight, and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? 1.Administer omeprazole before feeding. 2.Place in prone position after each feeding. 3.Instruct parents to keep a log of feedings and any reflux present. 4.Administer predigested formula and feed small, frequent feedings.

4.Administer predigested formula and feed small, frequent feedings. For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula to a predigested formula and feed small, frequent feedings.After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed. A prone position increases the risk of reflux and thus aspiration.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools

4.Bright red blood and mucus in the stools Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

The nurse is preparing an infant for surgery to treat Hirschsprung's disease. Which assessment finding is priority to identify and treat? 1.Vomiting and irritability 2.Malnourishment and lethargy 3.Abdominal distension and tenderness 4.Decreased blood pressure and tachycardia

4.Decreased blood pressure and tachycardia Hirschsprung's disease is also known as congenital aganglionosis or megacolon. It is the result of an absence of ganglion cells in the rectum and, to varying degrees, upward in the colon. Nursing care management includes assessing for signs of enterocolitis, shock, fluid and electrolyte problems, and signs of bowel perforation. While all of the answer options are concerning, low blood pressure and tachycardia are signs of shock. Shock results in decreased perfusion and oxygenation to major organs and is the priority of care.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? 1.Hypercalcemia 2.Hypernatremia 3.Frothy, fatty stools 4.Decreased hemoglobin

4.Decreased hemoglobin Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1.Hematuria and pyuria 2.Dysuria and proteinuria 3.Hematuria and urgency 4.Dysuria and penile discharge

4.Dysuria and penile discharge Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations? 1.Cortisol 2.Androgens 3.Aldosterone 4.Epinephrine

4.Epinephrine Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1.Diarrhea 2.Projectile vomiting 3.Regurgitation of feedings 4.Foul-smelling ribbon-like stools

4.Foul-smelling ribbon-like stools Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distention; and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1.Glycosuria 2.Diaphoresis 3.Weight loss 4.Hypertension

4.Hypertension Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms.

The nurse recognizes that clinical manifestations of nephrotic syndrome include which findings? 1.Hematuria, bacteriuria, weight gain 2.Gross hematuria, albuminuria, fever 3.Hypertension, weight loss, proteinuria 4.Massive proteinuria, hypoalbuminemia, edema

4.Massive proteinuria, hypoalbuminemia, edema

An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems never to get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1.Monitor intake and output. 2.Administer predigested formula. 3.Administer omeprazole before feeding. 4.Prepare the family for surgery for the child.

4.Prepare the family for surgery for the child. Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1.Agitation 2.Diaphoresis 3.Restlessness 4.Severe abdominal pain

4.Severe abdominal pain Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. The remaining options do not identify clinical manifestations associated with addisonian crisis.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1.Soft and swollen prostate gland 2.Swollen, and boggy prostate gland 3.Tender and edematous prostate gland 4.Tender, indurated prostate gland that is warm to the touch

4.Tender, indurated prostate gland that is warm to the touch The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.