unit 14

A client with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to the treatment regimen. What does the nurse tell the client about the diarrhea and mouth ulcers? A. "A combination of chemotherapeutic agents has caused them." B. "GI problems are symptoms of the advanced stage of your disease." C. "5-FU cannot discriminate between your cancer and your healthy cells." D. "You have these as a result of the radiation treatment."

"5-FU cannot discriminate between your cancer and your healthy cells." 5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the client's GI problems.

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm? "Check your hands and feet weekly for chronic excessive sweating." "Change positions slowly when moving from sitting to standing." "Avoid drinking caffeine or caffeinated beverages." "Be sure to take your blood pressure drug daily."

"Change positions slowly when moving from sitting to standing." Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults.Although taking blood pressure medication daily is important, it does not prevent orthostatic hypotension and in fact, may make orthostatic hypotension worse. Sensation changes are associated with peripheral neuropathy, not cardiovascular autonomic neuropathy. Avoiding caffeine is no longer a recommended action.

The nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? A. "I can drive my car in about 2 weeks." B. "I should avoid drinking carbonated sodas." C. "It may take 6 weeks to see the effects of some foods on my bowel patterns." D. "Stool softeners will help me avoid straining."

"I can drive my car in about 2 weeks." The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The client should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The client should avoid straining at stool.

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? A. "A dark or purplish-looking stoma is normal and should not concern me." B. "If the skin around the stoma is red or scratched, it will heal soon." C. "I need to check for leakage underneath my colostomy." D. "I should strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy." The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? A. "A drink of diet soda with dinner is OK for me." B. "I need to go for a walk every evening." C. "Maintaining a low-fiber diet will manage my constipation." D. "Watching the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening." Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in clients with IBS. Fiber is encouraged in clients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur? "I will eat three graham crackers." "I will drink a glass of water." "I will sit down and rest." "I will give myself a dose of glucagon."

"I will eat three graham crackers." Feeling hungry and shaky are symptoms of mild hypoglycemia. Correct understanding of what the client needs to do when these symptoms occur is to eat three graham crackers. This is the correct management strategy for mild hypoglycemia.Drinking a glass of water or sitting down and resting does not remedy hypoglycemia. Glucagon is generally administered for episodes of severe not mild hypoglycemia.

The Certified Wound, Ostomy, and Continence Nurse is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills? A. "I will have my spouse change the bag for me." B. "If I have any leakage, I'll put a towel over it." C. "I need to call my home health nurse to come out if I have any problems." D. "I will make certain that I always have an extra bag available."

"I will make certain that I always have an extra bag available." The statement that the client will be certain to bring an extra bag is the only statement illustrating that the client is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions? A. "I should take Ex-Lax after the surgery to 'keep things moving'." B. "I will need to eat a diet high in fiber." C. "Limiting my fluids will help me with constipation." D. "To help with the pain, I'll apply ice to the surgical area."

"I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications; cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? A. "I may have trouble urinating immediately after the surgery." B. "I will need to stay in the hospital overnight." C. "I should not eat after midnight the day of the surgery." D. "My chances of having complications after this procedure are slim."

"I will need to stay in the hospital overnight." Usually, the client is discharged 3 to 5 hours after MIIHR surgery. Male clients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Clients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most clients who have MIIHR surgery have an uneventful recovery.

A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about your frustration with your spouse's refusal to participate in AA."

"I'll get you some information on the support group Al-Anon." Putting the client's spouse in contact with an Al-Anon support group assists with the spouse's frustration. Telling the spouse that the client will sign up for AA meetings when the client is ready and telling the spouse to keep mentioning AA do not address the spouse's frustration with the client's refusal to participate in AA. Encouraging the spouse to say more about his or her frustration may allow the spouse to vent frustration, but it does not offer any options or solutions.

A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? A. "During the test, you will drink small amounts of an antacid as directed by the technician." B. "If you have IBS, hydrogen levels may be increased in your breath samples." C. "The test will take between 30 and 45 minutes to complete." D. "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples." Excess hydrogen levels are produced in clients with IBS. This is due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted. The client will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes. The client has breath samples taken every 15 minutes for 1 to 2 hours. The client needs to be NPO (except for water) for 12 hours before the test.

What is the nurse's best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug? "Injected insulin works faster than oral drugs to lower blood glucose levels." "Oral insulin is so weak that it would require very high dosages to be effective." "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

"Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." Because insulin is a small protein that is easily destroyed by stomach acids and intestinal enzymes, it cannot be used as an oral drug. Most commonly, it is injected subcutaneously.

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared that I can't do it all and will get so sick that I will be a burden on my family." What is the nurse's best response? "Let's tackle it piece by piece. What is most scary to you?" "It is overwhelming, isn't it?" "Let's see how much you can learn today, so you are less nervous." "Many people live with diabetes and do it just fine."

"Let's tackle it piece by piece. What is most scary to you?" The nurse's best response is to suggest that the client tackle it piece by piece and ask what is most scary to him or her. This is the best client-centered response, and acknowledges the client's concern, letting the client master survival skills first.Referring to the illness as overwhelming may reflect the client's feelings, but is a closed-ended question and does not encourage the client to express his feelings about the underlying fear. Trying to see how much the client can learn in 1 day may add to his anxiety by overwhelming him with information and the need to "do it all" in 1 day. Suggesting that other people handle the illness just fine criticizes the client and does not recognize his concerns.

What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot? "Make an appointment with your podiatrist as soon as possible." "Make an appointment with a pedicurist and have them cut or file off the callus." "Soak your feet nightly in warm water and peel of a little of the callus every day." "Apply an over-the-counter callus-dissolving pad and follow the package directions."

"Make an appointment with your podiatrist as soon as possible." The client with diabetes is taught to see his or her diabetes health care provider or a podiatrist for calluses, corns, or any other foot lesion and never to self-treat such problems. The risk for development of an ongoing injury with chronic infection is very high could lead to eventual amputation.

Which specific action is a priority for the nurse to teach a client with diabetes who has peripheral neuropathy to prevent harm? "Wear a medical alert bracelet." "Never go barefoot." "Never reuse insulin syringes." "Drink at least 3 L of fluids daily."

"Never go barefoot." All the actions are important for the client with diabetes to perform for safety and to prevent a variety of complications. However, the most important action to prevent harm from peripheral neuropathy is to never go barefoot and wear shoes and slippers with firm soles.

A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? A. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." B. "It is inherited, so it could run in your family." C. "It might be caused by a virus, so you could have gotten it almost anywhere." D. "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."

"Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine." Stating that the disorder is the result of flattening of the mucosa of the large intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

"See your health care provider immediately when experiencing symptoms of a gallbladder attack." In this case, the client's pancreatitis was likely triggered by the development of gallstones. A diagnostic statement must come from the provider. Also, the client may not require removal of the gallbladder. The client must see the provider promptly when experiencing gallbladder disease and should not wait. Because this client's acute pancreatitis is likely related to gallstones, alcohol consumption need not be restricted.

The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? A. "Do you usually binge drink?" B. "Do you tend to drink more on holidays or weekends?" C. "Tell me more about your alcohol intake." D. "Estimate how many episodes of binge drinking you do in a week."

"Tell me more about your alcohol intake." Asking the client about his or her alcohol intake is the only way that will allow the client to provide information in the client's own words and to the extent that the client wishes to provide it. Asking the client if he or she binge drinks or tends to drink more on holidays or weekends may put the client on the defensive rather than provide the desired information. It has not yet been determined whether the client engages in binge drinking.

A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? A. "Are you afraid of what your spouse will think of the colostomy?" B. "Don't worry. You will get used to the colostomy eventually." C. "Tell me what worries you the most about this procedure." D. "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure." Asking the client about what worries him or her is the only question that allows the client to express fears and anxieties about the diagnosis and treatment. Asking the client if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response); it closes the dialogue and is not therapeutic. Telling the client not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place clients on the defense and are not therapeutic because they close the conversation.

Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation? "The abdominal site is best because it is closest to the pancreas." "I can reach my thigh best, so I will use different areas of the same thigh." "If I change my injection site from the thigh to an arm, the inulin absorption may be different." "By rotating sites within one area, my chance of having skin changes is less."

"The abdominal site is best because it is closest to the pancreas." The abdominal site has the fastest and most consistent rate of absorption because of the blood vessels in the area and not because of its proximity to the pancreas. The other statements demonstrate correct understanding about injection site selection and rotation.

A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? A. "Have you asked your health care provider what he or she thinks your chances are?" B. "It is hard to know what can predispose a person to develop a certain disease." C. "No. Just because they both had CRC doesn't mean that you will have it, too." D. "The only way to know whether you are predisposed to CRC is by genetic testing."

"The only way to know whether you are predisposed to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the client has a predisposition to develop CRC. A higher incidence of the disease has been noted in families who have a history; however, it is not the responsibility of the nurse to engage in genetic counseling, and this client might not be predisposed to developing CRC. Asking the client what the health care provider thinks is an evasive response by the nurse and does not address the client's concerns.

What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty? "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost." "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

"The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." The high blood glucose levels that are present, because movement of glucose into cells is impaired, increase the osmolarity of the blood. The increased osmolarity stimulates the osmoreceptors in the hypothalamus, which triggers the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.

A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present, but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

"This type of gallbladder inflammation is associated with hypovolemia." This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed.

The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? A. "The diabetes could be related to your obesity." B. "What has your doctor told you about your disease?" C. "Do you consume alcohol on a frequent basis?" D. "Type 1 diabetes can occur when the pancreas is destroyed by disease."

"Type 1 diabetes can occur when the pancreas is destroyed by disease." Telling the client that type 1 diabetes can occur when the pancreas is destroyed by disease is the only response that accurately describes the relationship of the client's diabetes to pancreatic destruction. Type 2, not type 1, diabetes is usually related to obesity. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's question. Many factors could produce acute pancreatitis other than alcohol consumption.

A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? A. "Maybe you should find a support group to join." B. "Would you like me to contact the hospital chaplain for you?" C. "Do you want me to try to find a therapist for you?" D. "Do you have any friends whom you want me to call?"

"Would you like me to contact the hospital chaplain for you?" It is appropriate for the nurse to suggest contacting the hospital chaplain as a counseling option for the client and family. Suggesting that the client find a support group does not assist the client and the family with the problem. It is inappropriate for the nurse to suggest that the client and the family need a therapist. The spouse has already told the nurse that they have recently moved to the area, so it is unlikely that they have already made close friends.

How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible? "You can have a beer with a meal if you test yourself for hypoglycemia an hour later." "You can have a beer with a meal if you test yourself for hyperglycemia an hour later." "There are nonalcoholic beers available that you can substitute for a regular beer." "If you gave up dessert, you can still have one beer."

"You can have a beer with a meal if you test yourself for hypoglycemia an hour later." Alcohol consumption contributes to hypoglycemia. This risk is reduced if the alcohol is consumed with or shortly after a meal. The client is instructed to check blood glucose levels about an hour after alcohol is consumed to determine if either more food is needed or if insulin dosage needs to be adjusted.

What is the nurse's best response to a client with type 2 diabetes controlled with metformin who asks why now that he is recovering from surgery, is he prescribed to receive insulin therapy for a few days? "Your insurance doesn't permit metformin to be used during hospitalization." "Your presurgical testing indicates that you now have type 1 diabetes and require daily insulin." "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." "You must take insulin from now on because the surgery has aggravated the intensity of your diabetes."

"You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." The nurse's best response is that due to the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for clients with diabetes who use oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides.No evidence suggests that the client's diabetes has worsened. However, surgery is stressful and may increase insulin requirements. Metformin may be taken in the hospital, but not on days when the client is NPO for surgery. When the client returns to his or her previous health state, oral agents will be resumed.

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a.Deep and fast respirations b.Decreased urine output c.Tachycardia d.Dependent pulmonary crackles e.Orthostatic hypotension

Answer: A, C, E

Which precaution is a priority for the nurse to teach a client prescribed semaglutide to prevent harm? A. Only take this drug once weekly B. Report any vision changes immediately C. Do not mix in the same syringe with insulin D. This drug can only be given by a health care professional

A. Only take this drug once weekly

When (at which time) will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes received regular insulin at 7:00 a.m.? 7:30 a.m. 7:30 p.m. 11:00 a.m. 2:00 p.m.

11:00 a.m. Regular insulin is a short-acting type of insulin. Onset of action to regular insulin is ½ to 1 hour. The peak effect time is when hypoglycemia may start to occur. Peak time for regular insulin is 2 to 4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m. The other options for peak times for regular insulin are incorrect.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." A 30 year old with type 1 diabetes who is reporting thirst. A 40 year old with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L). A 50 year old with type 2 diabetes with a blood pressure of 150/90 mm Hg.

A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." The client the nurse sees first is the client with type 1 diabetes whose insulin pump is beeping "occlusion." Because glucose levels will increase quickly in clients whose continuous insulin pumps malfunction, the nurse must assess this client and the insulin pump first to avoid hyperglycemia or diabetic ketoacidosis.Thirst is an expected symptom of hyperglycemia and, although important, is not a priority. The nurse could delegate fingerstick blood glucose to unlicensed assistive personnel while assessing the client whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL (8.3 mmol/L) is mildly elevated, this does not require immediate action. Mild hypertension does not require immediate action. The nurse can later assess if this is within the client's usual range or represents a change before taking action.

The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first? A. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink B. A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern C. A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants D. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern Ecchymoses in the abdominal area may indicate intraperitoneal or intra-abdominal bleeding; this client requires rapid assessment and interventions. The client who is post colon resection, the client with pneumonia, and the client with FAP do not have an urgent need for further assessment or intervention.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A 50 year old taking repaglinide who has nausea and back pain. A 55 year old taking pioglitazone who has bilateral ankle swelling. A 45 year old taking metformin who has abdominal cramps. A 40 year old taking glyburide who is dizzy and sweaty.

A 45 year old taking metformin who has abdominal cramps. The nurse needs to first assess the client taking glyburide who is dizzy and sweaty and has symptoms consistent with hypoglycemia. Because hypoglycemia is the most serious adverse effect of antidiabetic medications, this client must be assessed as soon as possible.Nausea is a documented side effect of repaglinide. Checking the client's back pain requires assessment, which can be performed after the nurse assesses the client displaying signs and symptoms of hypoglycemia. Metformin may cause abdominal cramping and diarrhea, but the client taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.

Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A. A 41-year-old who needs assistance with choosing a site for a colostomy stoma B. A 47-year-old who needs to receive "whole gut" lavage before a colon resection C. A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy D. A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid

A 47-year-old who needs to receive "whole gut" lavage before a colon resection Because administration of medications is within the LPN/LVN scope of practice, this preoperative client can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative client and the critically ill client will need assessments and interventions that can only be done by an RN.

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? A 55-year-old client who has hypoglycemic unawareness An 80-year-old client with type 2 diabetes mellitus A 45-year-old client with type 1 diabetes mellitus A 75-year-old client whose blood glucose levels show little variation

A 75-year-old client whose blood glucose levels show little variation Comparison studies have shown wide variation between fingertip and alternate sites, and variation is most evident during times when blood glucose levels are rapidly changing. Clients are taught that there is a lag time for blood glucose levels between the fingertip and other sites when blood glucose levels are changing rapidly and that the fingertip reading is the only safe choice at those times. Because of this lag time, clients who have hypoglycemic unawareness are warned to not ever use alternate sites for SMBG.

The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) A. Acupuncture B. Decreasing physical activities C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga

A. Acupuncture C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga Acupuncture is recommended as a complementary therapy for IBS. Moxibustion is helpful for some clients with IBS. Meditation, yoga, and other relaxation techniques help many clients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) A. Broccoli B. Buttermilk C. Mushrooms D. Onions E. Peas F. Yogurt

A. Broccoli C. Mushrooms D. Onions E. Peas Broccoli, mushrooms, onions, and peas often cause flatus. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? (Select all that apply.) A. Check blood glucose often. B. Check bowel sounds and stools. C. Ensure that drainage color is clear. D. Monitor mental status. E. Place the client in the supine position.

A. Check blood glucose often. B. Check bowel sounds and stools. D. Monitor mental status. Glucose should be checked often to monitor for diabetes mellitus. Bowels sounds and stools should be checked to monitor for bowel obstruction. A change in mental status or level of consciousness could be indicative of hemorrhage. Clear, colorless, bile-tinged drainage or frank blood with increased output may indicate disruption or leakage of a site of anastomosis. The client should be placed in semi-Fowler's position to reduce tension on the suture line and the anastomosis site and to optimize lung expansion.

Which action best exemplifies the expected outcome of appropriate negative feedback control over endocrine gland hormone secretion? A. Decreased secretion of glucagon when blood glucose approaches normal levels B. Increased secretion of parathyroid hormone in response to a calcium-containing intravenous infusion C. Increased secretion of thyroid-stimulating hormone in response to long-term exogenous thyroid hormone replacement therapy D. Decreased secretion of cortisol in response to a pituitary tumor stimulating the increased secretion of adrenocorticotropic hormone

A. Decreased secretion of glucagon when blood glucose approaches normal levels

Which physiological processes directly prevent sever hypoglycemia in a healthy adult without diabetes who is NPO for 12 hours? (SATA) A. Gluconeogenesis B. Glycogenesis C. Glycogenolysis D. Ketogenesis E. Lipogenesis F. Lipolysis

A. Gluconeogenesis C. Glycogenolysis

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? A. Increased rate and depth of respiration B. Extremity tremors followed by seizure activity C. Oral temperature of 102F (38.9C) D. Severe orthostatic hypotension

Answer: A

A nurse assesses a client who is being treated for hyperglycemic - hyperosmolar state. Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? A. Serum potassium level has increased B. Blood osmolarity has decreased C. Glasgow Coma Scale score is unchanged D. Urine remains negative for ketone bodies

Answer: C

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. "Have you been experiencing any constipation?" b. "Are you eating a diet high in fiber and fluids?" c. "Do you have a history of high blood pressure?" d. "What vitamins and supplements are you taking?"

ANS: A Ischemic colitis is a life-threatening complication of alosetron. The nurse should assess the client for constipation. The other questions do not identify complications related to alosetron.

A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

ANS: A The nurse should empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy wafers with paste should be used to secure and seal the ostomy appliance; surgical tape should not be used.

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How should the nurse respond? a. "The stool will always be liquid with this type of colostomy." b. "Eating additional fiber will bulk up your stool and decrease diarrhea." c. "Your stool will become firmer over the next couple of weeks." d. "This is abnormal. I will contact your health care provider."

ANS: A The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool. This finding is not abnormal. Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this client's assessment? (Select all that apply.) a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain and what does it feel like?" c. "Have you lost a significant amount of weight lately?" d. "Are your stools soft, watery, and black in color?" e. "Do you experience nausea associated with defecation?"

ANS: A, B, E The nurse should ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse should also assess the location, intensity, and quality of the client's pain, and nausea associated with defecation or meals. Clients who have IBS do not usually lose weight and stools are not black in color.

A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.) a. Performs hand hygiene and positions the client in high-Fowler's position, with pillows behind the head and shoulders b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx c. Checks for correct placement by checking the pH of the fluid aspirated from the tube d. Secures the NG tube by taping it to the client's nose and pinning the end to the pillowcase e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

ANS: A, C, E The client's head should be flexed forward once the NG tube has reached the oropharynx. The NG tube should be secured to the client's gown, not to the pillowcase, because it could become dislodged easily. All the other actions are appropriate.

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? A. Encourage the client to use an incentive spirometer B. Increase the client's intravenous fluid flow rate C. Consult the provider to test for ketoacidosis D. Perform meticulous pulmonary hygiene care

Answer: C

A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take? a. Assess the client's heart rate and blood pressure. b. Determine when the client last voided. c. Ask if the client is experiencing flatus. d. Auscultate all quadrants of the client's abdomen

ANS: B Assessment findings indicate that the client may have an over-full bladder. In the immediate postoperative period, the client may experience difficulty voiding due to urinary retention. The nurse should assess when the client last voided. The client's vital signs may be checked after the nurse determines the client's last void. Asking about flatus and auscultating bowel sounds are not related to a hemorrhoidectomy.

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

ANS: B Clients with IBS are advised to eat a high-fiber diet (30 to 40 g/day), with 8 to 10 cups of liquid daily. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. They should avoid alcohol, caffeine, and other gastric irritants.

An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client's lower abdomen. Which action should the nurse take first? a. Measure the client's abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the client's hemoglobin and hematocrit. d. Obtain the client's complete health history.

ANS: B On noticing the ecchymotic areas, the nurse should check to see if abdominal guarding or rigidity is present, because this could indicate major organ injury. The nurse should then notify the provider. Measuring abdominal girth or obtaining a complete health history is not appropriate at this time. Laboratory test results can be checked after assessment for abdominal guarding or rigidity.

A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, "I need to have a bowel movement." Which action should the nurse take? a. Obtain a bedside commode for the client to use. b. Stay with the client while providing privacy. c. Make sure the call light is in reach to signal completion. d. Gather supplies to collect a stool sample for the laboratory.

ANS: B The first bowel movement after hemorrhoidectomy can be painful enough to induce syncope. The nurse should stay with the client. The nurse should instruct clients who are discharged the same day to have someone nearby when they have their first postoperative bowel movement. Making sure the call light is within reach is an important nursing action too, but it does not take priority over client safety. Obtaining a bedside commode and taking a stool sample are not needed in this situation.

A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, "My doctor told me that the fecal occult blood test was negative for colon cancer. I don't think I need the colonoscopy and would like to cancel it." How should the nurse respond? a. "Your doctor should not have given you that information prior to the colonoscopy." b. "The colonoscopy is required due to the high percentage of false negatives with the blood test." c. "A negative fecal occult blood test does not rule out the possibility of colon cancer." d. "I will contact your doctor so that you can discuss your concerns about the procedure."

ANS: C A negative result from a fecal occult blood test does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed so the entire colon can be visualized and a tissue sample taken for biopsy. The client may want to speak with the provider, but the nurse should address the client's concerns prior to contacting the provider.

A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this client's plan of care? a. "You may experience nausea and vomiting for the first few weeks." b. "Carbonated beverages can help decrease acid reflux from anastomosis sites." c. "Take a stool softener to promote softer stools for ease of defecation." d. "You may return to your normal workout schedule, including weight lifting."

ANS: C Clients recovering from a colon resection should take a stool softener as prescribed to keep stools a soft consistency for ease of passage. Nausea and vomiting are symptoms of intestinal obstruction and perforation and should be reported to the provider immediately. The client should be advised to avoid gas-producing foods and carbonated beverages, and avoid lifting heavy objects or straining on defecation.

A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. "Eat low-fiber and low-residual foods." b. "White rice and bread are easier to digest." c. "Add vegetables such as broccoli and cauliflower to your new diet." d. "Foods high in animal fat help to protect the intestinal mucosa."

ANS: C The client should be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

ANS: C The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. The nurse should contact the provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The registered nurse is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the client's bowel sounds.

ANS: D A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee-chest position for comfort, but this is not the priority action. The nurse need not insert a nasogastric tube for decompression.

A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

ANS: D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Measure intake and output every shift. B. Do not administer food or fluids by mouth. C. Administer opioid analgesic medication. D. Assist the client to assume a position of comfort.

Administer opioid analgesic medication. For the client with acute pancreatitis, pain relief is the highest priority. Although measuring intake and output, NPO status, and positioning for comfort are all important, they are not the highest priority.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? A. Analgesics and antiemetics B. Analgesics and benzodiazepines C. Steroids and analgesics D. Steroids and anti-inflammatory medications

Analgesics and antiemetics Clients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these clients.

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? A. Administer another half-cup of orange juice B. Administer a half-ampule of dextrose 50% intravenously C. Administer 10 units of regular insulin subcutaneously D. Administer 1 mg of glucagon intramuscularly

Answer: A

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? A. Administer 1 mg of intramuscular glucagon B. Encourage the client to drink orange juice C. Insert a new intravenous access line D. Administer 25 mL dextrose 50% (D50) IV push

Answer: A

A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? A. "Your risk of diabetes is higher than the general population, but it may not occur." B. "No genetic risk is associated with the development of type 1 diabetes mellitus." C. "The risk for becoming a diabetic is 50% because of how it is inherited." D. "Female children do not inherit diabetes mellitus, but male children will."

Answer: A

A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How should the nurse respond? A. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up." B. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light." C. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes." D. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container."

Answer: A

A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: -Insulin glargine: 12 units daily at 1800 -Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the client's medication administration record, which action should the nurse take? A. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin B. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin C. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together D. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix and inject the two insulins together

Answer: A

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? A. "Maintain tight glycemic control and prevent hyperglycemia." B. "Restrict your fluid intake to no more than 2 liters a day." C. "Prevent hypoglycemia by eating a bedtime snack." D. "Limit your intake of protein to prevent ketoacidosis."

Answer: A

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? A. Document the finding in the client's chart B. Administer a bolus of regular insulin IV C. Call the surgeon to cancel the procedure D. Draw blood gases to assess the metabolic state

Answer: A

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education? A. "If I develop an infection, I should stop taking my corticosteroid." B. "If I have pain over the transplant site, I will call the surgeon immediately." C. "I should avoid people who are ill or who have an infection." D. "I should take my cyclosporine exactly the way I was taught."

Answer: A

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? A. "The lower abdomen is the best location because it is closest to the pancreas." B. "I can reach my thigh the best, so I will use the different areas of my thighs." C. "By rotating the sites in one area, my chance of having a reaction is decreased." D. "Changing injection sites from the thigh to the arm will change absorption rates."

Answer: A

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a.Stroke b.Kidney failure c.Blindness d.Respiratory failure e.Cirrhosis

Answer: A, B, C

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a.Registered dietitian b.Clinical pharmacist c.Occupational therapist d.Health care provider e.Speech-language pathologist

Answer: A, B, D

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a."Do not walk around barefoot." b."Soak your feet in a tub each evening." c."Trim toenails straight across with a nail clipper." d."Treat any blisters or sores with Epsom salts." e."Wash your feet every other day."

Answer: A, C

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a.56-year-old African-American male b.Female with a 30-pound weight gain during pregnancy c.Male with a history of pancreatic trauma d.48-year-old woman with a sedentary lifestyle e.Male with a body mass index greater than 25 kg/m2 f.28-year-old female who gave birth to a baby weighing 9.2 pounds

Answer: A, D, E, F

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

Answer: B

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? A. Urine specific gravity of 1.033 B. Presence of protein in the urine C. Elevated capillary blood glucose level D. Presence of ketone bodies in the urine

Answer: B

A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? A. 0800 B. 1600 C. 2000 D. 2300

Answer: B

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? A. "Following the drug regimen more closely would have prevented this." B. "One acute rejection episode does not mean that you will lose the new organs." C. "Dialysis is a viable treatment option for you and may save your life." D. "Since you are on the national registry, you can receive a second transplantation."

Answer: B

A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? A. Assess for pain or burning with urination B. Review the client's liver function study results C. Instruct the client to increase water intake D. Test a sample of urine for occult blood

Answer: B

A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond? A. "You need to start with multiple injections until you become more proficient at self-injection." B. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." C. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." D. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."

Answer: B

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? A. Carbohydrates B. Proteins C. Fats D. Total Calories

Answer: B

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? A. "Glucose is the only fuel used by the body to produce the energy that it needs." B. "Your brain needs a constant supply of glucose because it cannot store it." C. "Without a minimum level of glucose, your body does not make red blood cells." D. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

Answer: B

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications 1. Inspect the bottle for expiration dates 2. Gently roll the bottle of NPH between the hands 3. Wash your hands 4. Inject air into the regular insulin 5. Withdraw the NPH insulin 6. Withdraw the regular insulin 7. Inject air into the NPH bottle 8. Clean rubber stoppers with an alcohol swab A. 1, 3, 8, 2, 4, 6, 7, 5 B. 3, 1, 2, 8, 7, 4, 6, 5 C. 8, 1, 3, 2, 4, 6, 7, 5 D. 2, 3, 1, 8, 7, 5, 4, 6

Answer: B

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL Postprandial blood glucose: 200 mg/dL Hemoglobin A1C level: 5.5% How should the nurse interpret these laboratory findings? A. Increased risk for developing ketoacidosis B. Good control of blood glucose C. Increased risk for developing hyperglycemia D. Signs of insulin resistance

Answer: B

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and Assessment: Blood pressure: 90/62 mm Hg Pulse: 120 beats/min Respiratory rate: 28 breaths/min Urine output: 20 mL/hr via catheter Laboratory Results: Serum potassium: 2.6 mEq/L Medications: Potassium chloride 40 mEq IV bolus STAT Increase IV fluid to 100 mL/hr Which action should the nurse take? a.Administer the potassium and then consult with the provider about the fluid order. b.Increase the intravenous rate and then consult with the provider about the potassium prescription. c.Administer the potassium first before increasing the infusion flow rate. d.Increase the intravenous flow rate before administering the potassium.

Answer: B

A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depressed and is taking this drug. Do you think I'm depressed?" How should the nurse respond? A. "Many people with long-term diabetes become depressed after a while." B. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" C. "This antidepressant also has anti-inflammatory properties for diabetic pain." D. "No. Many medications can be used for several different disorders."

Answer: B

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? A. "Wash your hands after completing each test." B. "Do not share your monitoring equipment." C. "Blot excess blood from the strip with a cotton ball." D. "Use gloves when monitoring your blood glucose."

Answer: B

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? A. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." B. "Monitor your blood glucose levels at least every 4 hours while sick." C. "If vomiting, do not use insulin or take your oral antidiabetic agent." D. "Try to continue your prescribed exercise regimen even if you are sick."

Answer: B

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? A. "Change positions slowly when you get out of bed." B. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." C. "If you miss a dose of this drug, you can double the next dose." D. "Discontinue the medication if you develop a urinary infection."

Answer: B

After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? A. "I need to have an annual appointment even if my glucose levels are in good control." B. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." C. "I can still develop complications even though I do not have to take insulin at this time." D. "If I have surgery or get very ill, I may have to receive insulin injections for a short time."

Answer: B

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? A. Document the finding in the client's chart B. Assess tactile sensation in the client's hands C. Examine the client's feet for signs of injury D. Notify the health care provider

Answer: C

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? A. "I should increase my intake of vegetables with higher amounts of dietary fiber." B. "My intake of saturated fats should be no more than 10% of my total calorie intake." C. "I should decrease my intake of protein and eliminate carbohydrates from my diet." D. "My intake of water is not restricted by my treatment plan or medication regimen."

Answer: C

At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (ACHS) At 0630: 95 At 1130: 70 At 1630: 47 Dietary Intake Breakfast: 10% eaten - client states she is not hungry Lunch: 5% eaten - client is nauseous; vomits once After reviewing the client's assessment data, which action is appropriate at this time? A. Assess the client's oxygen saturation level and administer oxygen B. Reorient the client and apply a cool washcloth to the client's forehead C. Administer dextrose 50% intravenously and reassess the client D. Provide a glass of orange juice and encourage the client to eat dinner

Answer: C

A nurse assesses a client with diabetes melltius who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? A. Apply ice to the site to reduce inflammation B. Consult the provider for a new administration route C. Assess the client for other signs of cellulitis D. Instruct the client to rotate sites for insulin injection

Answer: D

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? A. A 29-year-old Caucasian B. A 32-year-old African American C. A 44-year-old Asian D. A 48-year-old American Indian

Answer: D

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? A. Administration of oxygen via face mask B. Intravenous administration of 10% glucose C. Implementation of seizure precautions D. Administration of intravenous insulin

Answer: D

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond? A. "Drinking any wine or alcohol will increase your insulin requirements." B. "Because of poor kidney function, people with diabetes should avoid alcohol." C. "You should not drink alcohol because it will make you hungry and overeat." D. "One glass of wine is okay with a meal and is counted as two fat exchanges."

Answer: D

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? A. Serum sodium: 163 mEq/L B. Serum creatinine: 1.6 mg/dL C. Presence of urine ketone bodies D. Serum osmolarity: 375 mOsm/kg

Answer: D

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? A. Serum chloride level of 98 mmol/L B. Serum calcium level of 8.8 mg/dL C. Serum sodium level of 132 mmol/L D. Serum potassium level of 2.5 mmol/L

Answer: D

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? A. Pioglitazone (Actos) B. Glimepiride (Amaryl) C. Glipizide (Glucotrol) D. Metformin (Glucophage)

Answer: D

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education? A. "Test your urine daily for ketones." B. "Use only buffered insulin in your pump." C. "Store the insulin in the freezer until you need it." D. "Change the needle every 3 days."

Answer: D

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury? A. "Examine your feet using a mirror every day." B. "Rotate your insulin injection sites every week." C. "Check your blood glucose level before each meal." D. "Use a bath thermometer to test the water temperature."

Answer: D

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? A. "Limit your fluid intake to 2 liters a day." B. "Animal organ meat is high in insulin." C. "Limit your carbohydrate intake to 80 grams a day." D. "Walk at a moderate pace for 1 mile daily."

Answer: D

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? A. "I have so many complications; exercising is not recommended." B. "I will exercise more frequently because I have so many complications." C. "I used to run for exercise; I will start training for a marathon." D. "I should look into swimming or water aerobics to get my exercise."

Answer: D

After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? A. "I'll take this medicine during each of my meals." B. "I must take this medicine in the morning when I wake." C. "I will take this medicine before I go to bed." D. "I will take this medicine before I eat."

Answer: D

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? A. "At my age, I should continue seeing the ophthalmologist as I usually do." B. "I will see the eye doctor when I have a vision problem and yearly after age 40." C. "My vision will change quickly. I should see the ophthalmologist twice a year." D. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

Answer: D

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond? A. "I can give your injections to your while you are here in the hospital." B. "Everyone gets used to giving themselves injections. It really does not hurt." C. "Your disease will not be managed properly if you refuse to administer the shots." D. "Tell me what it is about the injections that are concerning you."

Answer: D

Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air? Administering oxygen Connecting a cardiac monitor Assessing arterial blood gas (ABG) values Assessing blood glucose level

Assessing blood glucose level The nurse would first obtain the client's glucose level. Breathing deeply and stating, "I can't catch my breath" is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis (DKA).Based on the oxygen saturation, oxygen administration is not indicated. The diagnosis of DKA does not require ABGs. Cardiac monitoring may be implemented, but the first action would be to obtain the glucose level.

A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing the client's incision for signs of infection B. Assisting the client to stand to void C. Instructing the client in how to deep-breathe D. Monitoring the client's pain level

Assisting the client to stand to void Assisting the client with activities is part of the UAP role. Assessment of the client's incision and pain level requires broader education and scope of practice and should be done by licensed nursing personnel. Client teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and should be done by licensed nursing personnel.

Which health promotion activity(ies) will the nurse recommend to prevent harm in a client with type 2 diabetes? (SATA) A. "Avoid all dietary carbohydrate and fat." B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols." D. "Be sure to take your anti diabetes drug right before your engage in any type of exercise." E. "Keep your feet warm in cold weather by using either a hot water bottle or a heating pad." F. "Avoid foot damage from shoe-rubbing by going barefoot or wearing flip-flops when you are at home."

B. "Have your eyes and vision assessed by an ophthalmologist every year." C. "Reduce your intake of animal fat and increase your intake of plant sterols."

A client with diabetes who now has chronic albuminuria asks the nurse how this change will affect his health. How will the nurse answer this question? A. "You will ned to limit your intake of dietary albumin and other proteins to reduce the albuminuria." B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage." C. "Your risk for developing urinary tract infections is greatly increased, requiring the need to take daily antibiotics for prevention." D. "From now on you will need to limit your fluid intake to just 1 L daily and completely avoid caffeine to protect your kidneys."

B. "This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage."

Which instruction/precaution does the nurse teach a client to prevent harm during a 24-hour urine specimen collection? A. Be sure to keep the specimen cool for the entire collection period B. Avoid splashing urine in the container when a preservative is present C. Add the preservative to the collection container before adding any urine D. Discard the first specimen that marks the beginning of the 24 hour test period

B. Avoid splashing urine in the container when a preservative is present

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) A. Antihistamines B. Caffeinated drinks C. Stress D. Sleeping pills E. Anxiety

B. Caffeinated drinks C. Stress E. Anxiety Factors such as ingestion of coffee or other gastric stimulants, stress, anxiety, and milk allergy are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected as causing IBS.

Which hormones help prevent hypoglycemia? (SATA) A. Aldosterone B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon F. Insulin G. Norepinephrine H. Proinsulin

B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon G. Norepinephrine

While making rounds the nurse finds a client with type 1 diabetes mellitus pale, sweaty, and slightly confused; the client can swallow. The client's blood glucose level check is 48 mg/dL. What is the nurse's best first action to prevent harm? A. Call the pharmacy and order a STAT dose of glucagon B. Immediately give the client 30 g of glucose orally C. Start an IV and administer a small amount of a concentrated dextrose solution D. Recheck the blood glucose level and call the Rapid Response team

B. Immediately give the client 30 g of glucose orally

Which assessment finding in a 40 year old client is most relevant for the nurse to assess further for a possible endocrine problem? A. He has lost 10 lb in the past month following a low-carbohydrate eating plan B. The client reports now needing to shave only once weekly instead of daily C. His new prescription for eyeglasses is for a higher strength D. The client's father died of a stroke at age 70

B. The client reports now needing to shave only once weekly instead of daily

How will the nurse modify insulin injection technique for a client who is 5 feet 10 inches tall and weighs 106 lb? A. Use a 6 mm needle and inject at a 90 degree angle B. Use a 6 mm needle and inject at a 45 degree angle C. Use a 12 mm needle and inject at a 90 degree angle D. Use a 12 mm needle and inject at a 45 degree angle

B. Use a 6 mm needle and inject at a 45 degree angle

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? A. Bulk-forming laxatives B. Saline laxatives C. Stimulant laxatives D. Stool-softening agents

Bulk-forming laxatives For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water. Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

Which precaution is a priority for the nurse to teach a client prescribed pramlintide to prevent harm? A. Only take this drug once weekly B. Do not drink alcohol when taking this drug C. Do not mix in the sam syringe with insulin D. Report any genital itching to your primary health care provider

C. Do not mix in the sam syringe with insulin

Which statement regarding trophic hormones is true? A. All are categorized as catecholamines B. Responses are independent of target tissue receptors C. Their target tissues are always another endocrine gland D. They represent the final hormone secreted in a complex negative feedback pathway

C. Their target tissues are always another endocrine gland

The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially? A. Certified Wound, Ostomy, and Continence Nurse (CWOCN) B. Home health nursing agency C. Hospice D. Hospital chaplain

Certified Wound, Ostomy, and Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the client because the client is scheduled to receive a colostomy. The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? A. Attaching the tube to high continuous suction B. Auscultating for bowel sounds and peristalsis while the suction runs C. Connecting the tube to low intermittent suction D. Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low intermittent suction The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the client's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

When preparing to administer a prescribed subcutaneous dose of NPH insulin from an open vial taken from a medication drawer to a client with diabetes, the nurse notes the solution is cloudy. What action will the nurse perform to ensure client safety? A. Warm the vial in a bowl of warm water until it reaches normal body temperature B. Return the vial to the pharmacy and open a fresh vial of NPH insulin C. Roll the vial between the hands until the insulin is clear D. Check the expiration date and draw up the insulin dose

D. Check the expiration date and draw up the insulin dose

The nurse reviewing the preadmission testing lab values for a 62 year old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding? A. The clients A1C is completely normal B. The client has type 1 diabetes C. The client has type 2 diabetes D. The client has prediabetes mellitus

D. The client has prediabetes mellitus

Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management? Current energy level and rest patterns Sexual orientation Current lifestyle for diet and exercise Education and literacy levels

Education and literacy levels The most important factor for the nurse to determine before providing instruction to the newly diagnosed client with diabetes is the client's educational level and literacy level. A large amount of information must be synthesized. Written instructions are typically given. The client's ability to learn and read is essential to provide the client with instructions and information about diabetes.Although lifestyle would be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.

A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? A. Decrease in liver function test results B. Elevated carcinoembryonic antigen C. Elevated hemoglobin levels D. Negative test for occult blood

Elevated carcinoembryonic antigen Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

Elevated lipase, elevated white blood cell count, elevated glucose Elevated lipase is more specific to a diagnosis of acute pancreatitis. Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis.

A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? A. Encourages the client to look at and touch the colostomy stoma B. Instructs the client about complete care of the colostomy C. Schedules a visit from a client who has a colostomy and is successfully caring for it D. Suggests that the client involve family members in the care of the colostomy

Encourages the client to look at and touch the colostomy stoma The initial intervention is to get the client comfortable looking at and touching the stoma before providing instructions on its care. Instructing the client about colostomy care will be much more effective after the client's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the client only after his or her anxiety level has stabilized. The client has begun to express feelings regarding the colostomy and its care; it is too soon to involve others. The client must get comfortable with this body image change first.

What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet? Testing the sensory perception of the client's hands Examining both feet for indications of injury Explaining to the client that peripheral neuropathy is now present Documenting the finding as the only action

Examining both feet for indications of injury When reduced peripheral sensory perception is present, the likelihood of injury is high. Any open area or other problem on the foot of a person with diabetes is at great risk for infection and must be managed carefully and quickly. Checking for sensory perception on the hands and other areas is important but can come after a thorough foot examination.

What is the nurse's best response when a client with diabetes who is being treated for hypoglycemic asks why people without diabetes don't become severely hypoglycemic even after fasting for 8 hours? In a person without diabetes, fasting for 8 hours converts proteins into glycose (gluconeogenesis) so that hypergycemia develops rather than hypoglycemia. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). Normal metabolism is so slow when a person without diabetes fasts that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur. Lipolysis (fat breakdown) in fat stores occurs faster in the nondiabetic person, which converts fatty acids into glucose to maintain blood glucose levels.

In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). Glucagon is a counter-regulatory hormone secreted by pancreatic alpha cells when blood glucose levels are low, as they would be during an 8 hour fast. The body's metabolic rate does decrease during sleep (which is not stated in this question) but not sufficiently to prevent hypoglycemia. Glucagon works on the glycogen stored in the liver, breaking it down to glucose (glycogenolysis) molecules that are then released into the blood to maintain blood glucose levels and prevent hypoglycemia. Although proteins can be broken down and converted to glucose, they are not converted to glycogen. Fat break down through lipolysis can provide fatty acids for fuel but this is not glucose and lipolysis does not occur until all stored glycogen is used.

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall An increased WBC count is evidence of inflammation. Only calcified gallstones will be visualized on abdominal x-ray. Ultrasonography of the right upper quadrant is the best diagnostic test for cholecystitis. Acute cholecystitis is seen as edema of the gallbladder wall and pericholecystic fluid. Alkaline phosphatase will be elevated if liver function is abnormal; this is not common in gallbladder disease.

Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy? Loss of sensation in both feet Hyperglycemia Intermittent constipation Increased thirst

Intermittent constipation Autonomic neuropathy can affect the entire GI system. The most common GI problem from diabetic automonic neuropathy is sluggish intestinal movement and chronic intermittent constipation.Loss of sensation in the feet is peripheral neuropathy, not autonomic neuropathy. Hyperglycemia is not related to any type of neuropathy. Increased thirst is related to hyperglycemia and increased blood osmolarity, not neuropathy.

.What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? A. It destroys the cancer's cell wall, which will kill the cell. B. It decreases blood flow to rapidly dividing cancer cells. C. It stimulates the body's immune system and stunts cancer growth. D. It blocks factors that promote cancer cell growth.

It blocks factors that promote cancer cell growth. Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? A. Limiting the client's activities to one floor of the home B. Instructing the client to take an as-needed (PRN) sleeping medication at night C. Arranging for the client to have a nutritional consult to assess the client's diet D. Asking the health care provider for a request for PRN nasal oxygen

Limiting the client's activities to one floor of the home Limiting the client's activities to one floor of the home will prevent tiring the client with stair climbing. Taking a PRN sleeping medication may not necessarily increase the client's strength level or conserve strength; also, the client may not be experiencing difficulty sleeping. Arranging for a nutritional consult or placing the client on PRN nasal oxygen will not necessarily result in an increase in the client's strength level or conserve strength; no information suggests that the client has any history of breathing difficulties.

The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

Middle-aged thin adult who has had a laparoscopic cholecystectomy The combination of client age, a thin frame, and the type of procedure performed will determine that the middle-aged thin client who had a laparoscopic cholecystectomy will be discharged first. Although the older obese client who had a laparoscopic cholecystectomy will have a faster discharge time than one with a traditional cholecystectomy, the client's obesity and age probably will require a longer stay. A traditional cholecystectomy will always require a longer recovery time. The older obese client with a history of COPD will likely have a more lengthy recovery because of associated breathing problems.

A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client? A. Antidiarrheal agent B. Muscarinic receptor antagonist C. Serotonin antagonist D. Tricyclic antidepressant

Muscarinic receptor antagonist A muscarinic (M3) receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this client. A tricyclic antidepressant is not going to be effective for this client's diarrhea.

Which new-onset symptoms will the nurse instruct a client with diabetes who is prescribed to take the sodium-glucose cotransport inhibitor, empagliflozin, to report to the diabetes health care provider to prevent harm? (Select all that apply.) Select all that apply. Muscle weakness and dizziness on standing Redness and tenderness at the injection site Rapid weight gain and shortness of breath Redness and tenderness of the perineum Sensations of hunger, tremors, sweating, and confusion Pain and burning on urination

Muscle weakness and dizziness on standing Redness and tenderness of the perineum Sensations of hunger, tremors, sweating, and confusion Pain and burning on urination Drugs from the lower blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine. This filtered glucose is excreted in the urine rather than moved back into the blood. Hypoglycemia (symptoms of hunger, tremors, sweating, confusion) is possible as is dehydration with excessive sodium loss (muscle weakness and orthostatic hypotension with dizziness on standing). The excess glucose in the urine increases the risk for urinary tract infections with pain and burning on urination. These drugs increase the risk for Fournier gangrene with perineal fasciitis, which has early symptoms of redness and tenderness of the perineal skin.The drug is taken orally and not by injection. It is not associated with heart failure that may manifest with symptoms of rapid weight gain and shortness of breath.

The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk.

A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

Obtaining the admission weight, height, and vital signs Obtaining height, weight, and vital signs is included in the education for UAP and usually is included in the job description for these staff members. Assessment, checking bowel sounds, and determining precipitating factors for abdominal pain require broader education and are within the scope of practice of licensed nursing staff.

Which action is appropriate for the nurse to delegate to the assistive personnel (AP) when caring for clients with diabetes? Monitoring a client who reports palpitations and anxiety Verifying the infusion rate on a continuous infusion insulin pump Performing a blood glucose check on a client who requires insulin Assessing a client who reports tremors and irritability

Performing a blood glucose check on a client who requires insulin Performing bedside glucose monitoring is a task that may be delegated to an AP who has been educated in this technique because it does not require extensive clinical judgment to perform. There is no evidence the client is unstable at this time. The nurse will follow up with the results and insulin administration after assessing the less stable clients.Intravenous therapy and medication administration are not within the scope of practice for AP. The client with tremors and irritability is displaying symptoms of hypoglycemia requiring further assessment and intervention that are not within the scope of practice for AP. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention. This client must be assessed by licensed nursing staff.

Which assessment is a priority for the nurse to make when a client with diabetic ketoacidosis (DKA) who is being monitored while receiving an insulin infusion begins to show an irregular heart beat with inverted T-waves? Rate of IV infusion Urine output Potassium level Breath sounds

Potassium level After DKA therapy starts, serum potassium levels drop quickly. An ECG showing an irregular pattern and inverted T-waves is most likely related to low potassium levels (hyperkalemia). Hypokalemia is a common cause of death in the treatment of DKA. Detecting and treating the underlying cause of the cardiac irregularities is essential. The cardiac issues are not associated with changes in urine output even though hyperglycemia will cause osmotic diuresis. The client with DKA is not at risk for hypoventilation or poor gas exchange. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the hypokalemia.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? A. Administers medication for pain B. Changes the nasogastric suction level from "intermittent" to "constant" C. Positions the client in high-Fowler's position D. Prepares the client for emergency surgery

Prepares the client for emergency surgery The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this client is likely experiencing.

Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

Presence of jaundice, pain worsening when lying supine Pain that worsens when lying supine and the presence of jaundice are the only assessment findings indicative of acute pancreatitis. Pain associated with acute pancreatitis usually has an abrupt onset, is located in the mid-epigastric or upper left quadrant, and lessens with sitting up; also, jaundice is present.

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. Carbohydrates B. High fat C. High fiber D. Protein

Protein Enzyme preparations should not be mixed with foods containing protein because the enzymes will dissolve the food into a watery substance. No evidence suggests that enzyme preparations should not be mixed with carbohydrates, food with high fat content, and food with high fiber content.

Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys? White blood cells (WBCs) in the urine during a random urinalysis Ketone bodies in the urine during acidosis Glucose in the urine during hyperglycemia Protein in the urine during a random urinalysis

Protein in the urine during a random urinalysis Urine should not contain protein and the presence of proteinuria in a client with marks the beginning of renal problems known as diabetic nephropathy, that progresses eventually to end-stage renal disease. Chronically elevated blood glucose levels cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. The excess leakiness allows larger substances, such as proteins, to be filtered into the urine.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? A. LPN/LVN who has worked with many home health clients after colostomy surgeries B. LPN/LVN with 20 years of experience in the home health agency C. RN who is new to the agency with 5 years experience in the emergency department D. Social worker who is experienced with case management of older clients

RN who is new to the agency with 5 years experience in the emergency department Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? A. Femoral B. Reducible C. Strangulated D. Ventral

Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? A. Supine, with a pillow supporting the abdomen B. Up in a chair between frequent periods of ambulation C. High-Fowler's position, with pillows used as needed D. Side-lying position, with knees drawn up to the chest

Side-lying position, with knees drawn up to the chest The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis. No evidence suggests that supine position, sitting up in a chair, or high-Fowler's position have any effect on abdominal discomfort related to acute pancreatitis.

After an automobile crash, a client is admitted to the emergency department with possible abdominal trauma. Which health care provider request does the nurse implement first? A. Insert a nasogastric tube and connect it to intermittent suction. B. Obtain a complete blood count and coagulation panel. C. Start an IV line and infuse normal saline at 200 mL/hr. D. Arrange for a computed tomography (CT) scan of the abdomen.

Start an IV line and infuse normal saline at 200 mL/hr. After the initial airway, breathing, and circulation assessment is completed, the most immediate concerns are the high risks for hemorrhage and shock. To rapidly treat for these possible complications, IV access and infusion of fluids are necessary as the priority intervention. Inserting a nasogastric tube, laboratory studies, and arranging a CT scan are secondary to establishing IV access and instilling fluids.

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? A. Steak with pasta B. Spaghetti with tomato sauce C. Steamed broccoli with turkey D. Tuna salad with wheat crackers

Steamed broccoli with turkey Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates. Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

A 21-year-old with a stab wound to the abdomen has come to the emergency department. Once stabilized, the client is admitted to the medical-surgical unit. What does the admitting nurse do first for this client? A. Administer pain medication. B. Assess skin temperature and color. C. Check on the amount of urine output. D. Take vital signs.

Take vital signs. Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition. The client should not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the client's overall condition. If the client is in shock, urine output will be scant and will not be an accurate assessment variable.

Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "dawn phenomenon" to achieve better control? Eat a bedtime snack containing equal amounts of protein and carbohydrates." Avoid eating any carbohydrate with your evening meal." Take your evening insulin dose right before going to bed instead of at supper time." Inject the insulin into your arm rather than into the abdomen around the navel."

Take your evening insulin dose right before going to bed instead of at supper time." A client with "dawn phenomenon," diagnosed by checking blood glucose levels during the night, has morning hyperglycemia that results from a nighttime release of adrenal hormones causing blood glucose elevations at about 5 to 6 a.m. It is managed by providing more insulin for the overnight period (e.g., giving the evening dose of intermediate-acting insulin at 10 p.m. instead of with the evening meal).Bedtime snacks are needed for "Somogyi phenomenon" that is morning hyperglycemia caused by the counterregulatory response to nighttime hypoglycemia. Changing the injection site would not prevent morning hyperglycemia. Not eating any carbohydrate with a meal is more likely to cause severe hypoglycemia during the night and is dangerous.

How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%? The values indicate that the client has poorly managed his or her disease. The values indicate that the client has managed his or her disease well. The client's glucose control for the past 24 hours has been good but the overall control is poor. The client's glucose control for the past 24 hours has been poor but the overall control is good.

The values indicate that the client has managed his or her disease well. Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client's FBG is well within the normal range.A1c provides an indication of general blood glucose control for the past several months because when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client's A1c level is within the desirable range, indicating good long-term glucose control as well as short-term control.

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this client. Steak, French fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a client with gallbladder disease.

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? A. Cramping intermittently, metabolic acidosis, and minimal vomiting B. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis C. Metabolic acidosis, upper abdominal distention, and intermittent cramping D. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and great amount of vomiting A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, metabolic acidosis, and minimal vomiting are all symptoms of a large bowel obstruction.

A client newly diagnosed with type 1 diabetes says she is not ready to learn everything about diabetes control right now. Which information has the greatest priority for the nurse to teach this client and her family for now to prevent harm? (Select all that apply.) Select all that apply. Causes of type 1 diabetes What to do when ill? Symptoms and treatment of hypoglycemia Insulin administration Dietary control of blood glucose Importance of regular exercise

What to do when ill? Symptoms and treatment of hypoglycemia Insulin administration The priority information for safety and preventing harm that the nurse needs to teach the client and family about diabetes are:Symptoms and management of hypoglycemia because it is a life-threatening condition.Proper insulin administration is essential for the management of type 1 diabetes and to prevent death.Knowing what to do when ill is critical information because illness will require changes in the client's day-to-day use of insulin and may need contact with the client's diabetes health care provider to prevent harm.The causes of diabetes, dietary control, and exercise are less important for immediate safety and can be taught at another time.

The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? A. Administer pancrelipase before taking an antacid. B. Chew tablets before swallowing. C. Take pancrelipase before meals. D. Wipe your lips after taking pancrelipase.

Wipe your lips after taking pancrelipase. Pancrelipase is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped. Pancrelipase should be administered after antacids or histamine2 blockers are taken. It should not be chewed to minimize oral irritation and allow the drug to be released more slowly. It should be taken with meals and snacks and followed with a glass of water.

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The client with cholecystitis and the client with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult client's glucose level will require intervention but, again, is not a medical emergency.

9. The binding of a hormone to a specific receptor site is an example of which endocrine process? a. "Lock and key" manner b. Negative feedback mechanism c. Neuroendocrine regulation d. "Fight-or-flight" response

a "Lock and key" manner

11. Which hormone is directly suppressed when circulating levels of cortisol are above normal? a. Corticotropin-releasing hormone (CRH) b. ADH c. Adrenocorticotropic hormone (ACTH) d. Growth hormone-releasing hormone (GH-RH)

a Corticotropin-releasing hormone (CRH)

34. In the older adult female, which physiologic changes occur as a result of decreased function of the ovaries? a. Decreased bone density, decreased production of estrogen. b. Decreased sensitivity of peripheral tissues to the effects of insulin c. Decreased urine-concentrating ability of the kidneys d. Decreased metabolic rate

a Decreased bone density, decreased production of estrogen.

35. An older adult reports a lack of energy and not being able to do the usual daily activities without several naps during the day. Which problem may these symptoms indicate that is often seen in the older adult? a. Hypothyroidism b. Hyperparathyroidism c. Overproduction of cortisol d. Underproduction of glucagon

a Hypothyroidism

22. Which hormone responds to a low serum calcium blood level by increasing bone resorption? a. Parathyroid hormone (PTH) b. T4 c. T3 d. Calcitonin

a Parathyroid hormone (PTH)

14. The anterior pituitary gland secretes tropic hormones in response to which hormones from the hypothalamus? a. Releasing hormones b. Target tissue hormones c. Growth hormones d. Demand hormones

a Releasing hormones

38. Which are diagnostic methods to measure patient hormone levels? (Select all that apply.) a. Stimulation testing b. Suppression testing c. 24-hour urine testing d. Chromatographic assay e. Needle biopsy

a, b, c, d Stimulation testing, Suppression testing, 24-hour urine testing, Chromatographic assay

20. Which assessment findings does the nurse monitor in response to catecholamines released by the adrenal medulla? (Select all that apply.) a. Increased heart rate related to vasoconstriction b. Increased blood pressure related to vasoconstriction c. Increased perspiration d. Constriction of pupils e. Increased blood glucose in response to glycogenolysis

a, b, c, e Increased heart rate related to vasoconstriction. Increased blood pressure related to vasoconstriction. Increased perspiration. Increased blood glucose in response to glycogenolysis.

24. Which statements about T3 and T4 hormones are correct? (Select all that apply.) a. The basal metabolic rate is affected. b. Hypothalamus is stimulated by cold and stress to secret thyrotropin-releasing hormone (TRH). c. These hormones need intake of protein and iodine for production. d. Circulating hormone in the blood directly affects the production of TSH. e. T3 and T4 increase oxygen use in tissue.

a, b, c, e The basal metabolic rate is affected. Hypothalamus is stimulated by cold and stress to secret thyrotropin-releasing hormone (TRH). These hormones need intake of protein and iodine for production. T3 and T4 increase oxygen use in tissue.

41. Which are the types of radiographic tests that may be used for an endocrine assessment? (Select all that apply.) a. Ultrasonography b. Skull x-ray c. Chest x-ray d. Magnetic resonance imaging (MRI) e. Computed tomography (CT)

a, b, d, e Ultrasonography, Skull x-ray, Magnetic resonance imaging (MRI), Computed tomography (CT)

13. Which statements about the pituitary glands are correct? (Select all that apply.) a. The main role of the anterior pituitary is to secrete tropic hormones. b. The posterior pituitary gland stores hormones produced by the hypothalamus. c. The anterior pituitary is connected to the thalamus gland. d. The anterior pituitary releases stored hormones produced by the hypothalamus. e. The anterior pituitary gland secretes gonadotropins.

a, b, e The main role of the anterior pituitary is to secrete tropic hormones. The posterior pituitary gland stores hormones produced by the hypothalamus. The anterior pituitary gland secretes gonadotropins.

8. Which statements about hormones and the endocrine system are accurate? (Select all that apply.) a. There are specific normal blood levels of each hormone. b. Hormones exert their effects on specific target tissues. c. Each hormone can bind with multiple receptor sites. d. The endocrine system works independently to regulate homeostasis. e. More than one hormone can be stimulated before the target tissue is affected.

a, b, e There are specific normal blood levels of each hormone. Hormones exert their effects on specific target tissues. More than one hormone can be stimulated before the target tissue is affected.

1. Which glands are parts of the endocrine system? (Select all that apply.) a. Thyroid b. Occipital c. Parathyroid d. Adrenal e. Pituitary

a, c, d, e Thyroid, Parathyroid, Adrenal, Pituitary

28. Which statements about insulin secretion are correct? (Select all that apply.) a. Insulin levels increase following the ingestion of a meal. b. Insulin is stimulated primarily by fat ingestion. c. Basal levels are secreted continuously. d. Insulin promotes glycogenolysis and gluconeogenesis. e. Carbohydrate intake is the main trigger for insulin secretion.

a, c, e Insulin levels increase following the ingestion of a meal. Basal levels are secreted continuously. Carbohydrate intake is the main trigger for insulin secretion.

5. Which hormones are secreted by the thyroid gland? (Select all that apply.) a. Calcitonin b. Somatostatin c. Glucagon d. Thyroxine (T4) e. Aldosterone f. Triiodothyronine (T3)

a, d, f Calcitonin, Thyroxine (T4), Triiodothyronine (T3)

17. Which statements about the adrenal glands are correct? (Select all that apply.) a. The cortex secretes androgens in men and women. b. Catecholamines are secreted from the cortex. c. Glucocorticoids are secreted by the medulla. d. The medulla secretes hormones essential for life. e. The cortex secrets aldosterone that maintains extracellular fluid volume.

a, e The cortex secretes androgens in men and women. The cortex secrets aldosterone that maintains extracellular fluid volume.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? a. "I will not eat any fatty foods when I am collecting urine for this test." b. "To end the collection, I must empty my bladder and add this urine to the collection." c. "I need to keep the urine container cool in a separate refrigerator or cooler." d. "I won't save the first urine sample of the day."

a. "I will not eat any fatty foods when I am collecting urine for this test."

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) a. Bending at the waist b. Talking c. Deep breathing d. Coughing e. Wearing makeup f. Using dental floss

a. Bending at the waist d. Coughing

Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)? a. Checking the client's blood glucose levels every 4 hours b. Monitoring the client's response to the IV insulin given during a stimulation test c. Teaching the client about a hormone suppression test d. Assessing the client for symptoms of hypopituitarism

a. Checking the client's blood glucose levels every 4 hours

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? a. Chest pain b. Constipation c. Headache d. Increased sleepiness

a. Chest pain

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) a. Decreased urine output b. Hypotension c. Weigh gain of more than 2.2 lb (1 kg) in 24 hours d. Persistent headache e. Hyperglycemia f. Acute confusion

a. Decreased urine output c. Weigh gain of more than 2.2 lb (1 kg) in 24 hours d. Persistent headache f. Acute confusion

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? a. Ensuring the phlebotomist wears a facemask while in the client's room b. Asking the phlebotomist to delay the blood draw c. Monitoring the client closely for cold-like symptoms d. Placing a facemask on the client

a. Ensuring the phlebotomist wears a facemask while in the client's room

21. The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test? a. History of renal insufficiency b. Complains of chronic headache c. Recent bilateral visual field loss d. Blood glucose level of 134 mg/dL

a. History of renal insufficiency Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patients diagnosis of a pituitary tumor.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? a. Increased facial hair and absent menses in a 28-year-old nonpregnant woman b. Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago c. Male-pattern baldness in a 32-year-old man d. Dry skin on the shins of a 70-year-old woman

a. Increased facial hair and absent menses in a 28-year-old nonpregnant woman

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? a. Serum sodium increases from 122 mEq/L to 140 mEq/L. b. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. c. Serum chloride decreases from 109 mEq/L to 99 mEq/L. d. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.

a. Serum sodium increases from 122 mEq/L to 140 mEq/L.

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? a. Urine output of 30 to 50 mL/hr b. Blood glucose level of 110 mg/dL (6.1 mmol/L) c. Respiratory rate of 20 breaths/min d. Potassium level of 3.9 mEq/L (mmol/L)

a. Urine output of 30 to 50 mL/hr

1. Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)? a. You will need to avoid smoking before the test. b. Exercise should be avoided until the testing is complete. c. Several blood samples will be obtained during the testing. d. You should follow a low-calorie diet the day before the test. e. The test requires that you fast for at least 8 hours before testing.

a. You will need to avoid smoking before the test. c. Several blood samples will be obtained during the testing. e. The test requires that you fast for at least 8 hours before testing. Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.

1. A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show a. increased urinary cortisol. b. decreased serum thyroxine. c. elevated serum aldosterone levels. d. low urinary catecholamines excretion.

a. increased urinary cortisol. Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary

6. A patient has a low serum cortisol level. Which hormone would the nurse expect to be secreted to correct this? a. Thyroid-stimulating hormone (TSH) b. Adrenocorticotropic hormone c. Parathyroid hormone d. Antidiuretic hormone

b Adrenocorticotropic hormone

3. Which mechanism is used to transport the substance produced by the endocrine glands to their target tissue? a. Lymph system b. Bloodstream c. Direct seeding d. Gastrointestinal system

b Bloodstream

39. What is the correct nursing action before beginning a 24-hour urine collection for endocrine studies? a. Place each voided specimen in a separate collection container. b. Check whether any preservatives are needed in the collection container. c. Start the collection with the first voided urine. d. Weigh the patient before beginning the collection.

b Check whether any preservatives are needed in the collection container.

18. Which is the major function of the hormones produced by the adrenal cortex? a. "Fight-or-flight" response b. Control of potassium, sodium, and water c. Regulation of cell growth d. Calcium and stress regulation

b Control of potassium, sodium, and water

31. Which disease involves a disorder of the islets of Langerhans? a. Diabetes insipidus b. Diabetes mellitus c. Addison's disease d. Cushing's disease

b Diabetes mellitus

15. Which statement about pituitary hormones is correct? a. ACTH acts on the adrenal medulla. b. Follicle-stimulating hormone (FSH) stimulates sperm production in men. c. Growth hormone promotes protein catabolism. d. Vasopressin decreases systolic blood pressure.

b Follicle-stimulating hormone (FSH) stimulates sperm production in men.

42. A patient is suspected of having a pituitary tumor. Which radiographic test aids in determining this diagnosis? a. Skull x-rays b. MRI/CT c. Angiography d. Ultrasound

b MRI/CT

12. The maintenance of internal body temperature at approximately 98.6F (37C) is an example of which endocrine process? a. "Lock and key" manner b. Neuroendocrine regulation c. Positive feedback mechanism d. Stimulus-response theory

b Nueroendocrine regulation

37. Which statement about performing a physical assessment of the thyroid gland is correct? a. The thyroid gland is easily palpated in all patients. b. The patient is instructed to swallow sips of water to aid palpation. c. The anterior approach is preferred for thyroid palpation. d. The thumbs are used to palpate the thyroid lobes.

b The patient is instructed to swallow sips of water to aid palpation.

29. In addition to the pancreas that secretes insulin, which gland secretes hormones that affect protein, carbohydrate, and fat metabolism? a. Posterior pituitary b. Thyroid c. Ovaries d. Parathyroid

b Thyroid

36. The nurse is performing a physical assessment of a patient's endocrine system. Which gland can be palpated? a. Pancreas b. Thyroid c. Adrenal glands d. Parathyroids

b Thyroid

33. Which statement about age-related changes in older adults and the endocrine system is true? a. All hormone levels are elevated. b. Thyroid hormone levels decrease. c. Adrenal glands enlarge. d. The thyroid gland enlarges.

b Thyroid hormone levels decrease.

44. A patient is at risk for falling related to the effect of pathologic fractures as a result of bone demineralization. Which endocrine problem is this pertinent to? a. Underproduction of PTH b. Overproductive of PTH c. Underproduction of thyroid hormone d. Overproduction of thyroid hormone

b Overproductive of PTH

25. Which are the target organs of PTH in the regulation of calcium and phosphorus? (Select all that apply.) a. Stomach b. Kidney c. Bone d. Gastrointestinal tract e. Thyroid gland

b, c, d Kidney, Bone, Gastrointestinal tract

21. Which statements about the thyroid gland and its hormones are correct? (Select all that apply.) a. The gland is located in the posterior neck below the cricoid cartilage. b. The gland has two lobes joined by a thin tissue called the isthmus. c. T4 and T3 are two thyroid hormones. d. Thyroid hormones increase red blood cell production. e. Thyroid hormone production depends on dietary intake of iodine and potassium.

b, c, d The gland has two lobes joined by a thin tissue called the isthmus. T4 and T3 are two thyroid hormones. Thyroid hormones increase red blood cell production.

32. Which endocrine tissues are most commonly found to have reduced function as a result of aging? (Select all that apply.) a. Hypothalamus b. Ovaries c. Testes d. Pancreas e. Thyroid gland

b, c, d, e Ovaries, Testes, Pancreas, Thyroid gland

19. Which statements about the hormone cortisol being secreted by the adrenal cortex are accurate? (Select all that apply.) a. Cortisol peaks occur late in the day, with lowest points 12 hours after each peak. b. Cortisol has an effect on the body's immune function. c. Stress causes an increase in the production of cortisol. d. Blood levels of cortisol have no effect on its secretion. e. Cortisol affects carbohydrate, protein, and fat metabolism.

b, c, e Cortisol has an effect on body's immune function. Stress causes an increase in the production of cortisol. Cortisol affects carbohydrate, protein, and fat metabolism.

4. Which hormones are secreted by the posterior pituitary gland? (Select all that apply.) a. Testosterone b. Oxytocin c. Growth hormone (GH) d. Antidiuretic hormone (ADH) e. Cortisol

b, d Oxytocin, Antidiuretic hormone (ADH)

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? a. "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." b. "I will keep the cat food bowl on my counter so that I do not have to bend over." c. "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." d. "If the dressing gets wet, I will wash the incision line and redress it immediately."

b. "I will keep the cat food bowl on my counter so that I do not have to bend over."

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? a. "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." b. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." c. "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." d. "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."

b. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again."

2. What is the name of the substance secreted by the endocrine glands? a. Vasoactive amines b. Chemotaxins c. Hormones d. Cytotoxins

c Hormones

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? a. "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." b. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." c. "I will tell your primary health care provider order a psychiatric consult for you." d. "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"

b. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you."

For which client will the nurse question the prescription for long-term androgen therapy? a. A 40-year-old who also has syndrome of inappropriate antidiuretic hormone (SIADH). b. A 52-year-old with a history of prostate cancer treatment. c. A 30-year-old who is taking antiviral therapy for HIV disease. d. A 66-year-old with impotence that is resistant to standard erectile dysfunction therapy.

b. A 52-year-old with a history of prostate cancer treatment.

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? a. Prolactin and prolactin inhibiting hormone (PIH) b. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) c. Growth hormone (GH) and melanocyte-stimulating hormone (MSH) d. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

b. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH)

20. A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test? a. Bilateral poor peripheral vision b. Allergies to iodine and shellfish c. Recent weight loss of 20 pounds d. Complaint of ongoing headaches

b. Allergies to iodine and shellfish Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

3. A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test? a. Urinary 17-ketosteroids b. Antidiuretic hormone level c. Growth hormone stimulation test d. Adrenocorticotropic hormone level

b. Antidiuretic hormone level Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patients hyponatremia.

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? a. Urine output for the past 24 hours has increased. b. Client reports numbness and tingling around the mouth. c. Temperature is now elevated. d. pH is now 7.43.

b. Client reports numbness and tingling around the mouth.

Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months? a. Random blood glucose level b. Glycosylated hemoglobin (HbA1c) c. Fasting blood insulin level d. Fasting blood glucose level

b. Glycosylated hemoglobin (HbA1c)

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? a. Decreased sodium; decreased glucose b. Increased sodium; increased glucose c. Increased sodium; decreased glucose d. Decreased sodium; increased glucose

b. Increased sodium; increased glucose

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? a. High carbohydrate, low potassium, and fluid restriction b. Low carbohydrate, high calorie, and low sodium c. Low protein, high carbohydrate, and low calcium d. High protein, high carbohydrate, and low potassium

b. Low carbohydrate, high calorie, and low sodium

18. Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? a. The RN checks the blood pressure on both arms. b. The RN palpates the neck thoroughly to check thyroid size. c. The RN lowers the thermostat to decrease the temperature in the room. d. The RN orders nonmedicated eye drops to lubricate the patients bulging eyes.

b. The RN palpates the neck thoroughly to check thyroid size. Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

19. The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider? a. The patient complains of intense thirst. b. The patient has a 5-lb (2.3 kg) weight loss. c. The patients urine osmolality does not increase. d. The patient feels dizzy when sitting on the edge of the bed.

b. The patient has a 5-lb (2.3 kg) weight loss. A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

17. Which information about a 30-year-old patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test? a. The patient reports having occasional orthostatic dizziness. b. The patient takes oral corticosteroids for rheumatoid arthritis. c. The patient has had a 10-pound weight gain in the last month. d. The patient drank several glasses of water an hour previously.

b. The patient takes oral corticosteroids for rheumatoid arthritis. Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

11. A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease? a. Ideal weight b. Value system c. Activity level d. Visual changes

b. Value system When dealing with a patient with a chronic condition such as diabetes, identification of the patients values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.

7. During the physical examination of a 36-year-old female, the nurse finds that the patients thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patients neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

b. document that the thyroid was nonpalpable. The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid- stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

14. A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to a. insert and maintain a retention catheter. b. keep the specimen refrigerated or on ice. c. drink at least 3 L of fluid during the 24 hours. d. void and save that specimen to start the collection.

b. keep the specimen refrigerated or on ice. The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

10. What are tropic hormones? a. Hormones that rigger female and male sex characteristics. b. Hormones that have a direct effect on final target tissues. c. Hormones produced by the anterior pituitary gland that stimulate other endocrine glands. d. Hormones that are synthesized in the hypothalamus and stored in the posterior pituitary gland

c Hormones produced by the anterior pituitary gland that stimulate other endocrine glands.

40. Which instructions are included when teaching a patient about urine collection for endocrine studies? (Select all that apply.) a. Fast before starting the urine collection. b. Measure the urine in mL rather than ounces. c. Empty the bladder completely, and then start timing. d. Time the test for exactly the instructed number of hours. e. Avoid taking any unnecessary drugs during endocrine testing. f. Empty the bladder at the end of the time period and keep that specimen.

c, d, e, f Empty the bladder completely, and then start timing. Time the test for exactly the instructed number of hours. Avoid taking any unnecessary drugs during endocrine testing. Empty the bladder at the end of the time period and keep that specimen.

What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."? a. "Don't worry. It happens to everyone occasionally." b. "Do you use any over the counter or recreational drugs?" c. "Can you please tell me more?" d. "Would you like to speak with a counselor?"

c. "Can you please tell me more?"

5. A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide? a. Avoid adding any salt to your foods for 24 hours before the test. b. You will need to lie down for 30 minutes before the blood is drawn. c. Come to the laboratory to have the blood drawn early in the morning. d. Do not have anything to eat or drink before the blood test is obtained.

c. Come to the laboratory to have the blood drawn early in the morning. Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

4. Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder? a. What methods do you use to help cope with stress? b. Have you experienced any blurring or double vision? c. Have you had a recent unplanned weight gain or loss? d. Do you have to get up at night to empty your bladder?

c. Have you had a recent unplanned weight gain or loss? Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone? (Select all that apply.) a. Hypoglycemia b. Hyponatremia c. Hypokalemia d. Hypernatremia e. Hyperglycemia f. Hyperkalemia

c. Hypokalemia d. Hypernatremia

16. A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate

c. Ionized calcium Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? a. New-onset hypertension. b. The client reports extreme salt craving. c. No change in urine output with minimal fluid intake. d. The client's headache is gradually increasing in intensity.

c. No change in urine output with minimal fluid intake.

Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately? a. Blood glucose 148 mg/dL (7.4 mmol/L) b. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) c. Serum sodium 110 mEq/L (110 mmol/L) d. Serum potassium 3.2 mEq/L (3.2 mmol/L)

c. Serum sodium 110 mEq/L (110 mmol/L)

15. Which additional information will the nurse need to consider when reviewing the laboratory results for a patients total calcium level? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.

c. The serum albumin level is low. Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

8. Which laboratory value should the nurse review to determine whether a patients hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4 ) level b. Triiodothyronine (T3 ) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level

c. Thyroid-stimulating hormone (TSH) level A low TSH level indicates that the patients hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

13. The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing a. a water deprivation test. b. testing for serum T3 and T4 levels. c. a 24-hour urine test for free cortisol. d. a radioactive iodine (I-131) uptake test.

c. a 24-hour urine test for free cortisol. Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

10. A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for a. increased serum sodium. b. decreased urinary output. c. elevated serum potassium. d. evidence of fluid overload.

c. elevated serum potassium. Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

9. The nurse reviews a patients glycosylated hemoglobin (Hb A1C) results to evaluate a. fasting preprandial glucose levels. b. glucose levels 2 hours after a meal. c. glucose control over the past 90 days. d. hypoglycemic episodes in the past 3 months.

c. glucose control over the past 90 days. Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

23. Which hormone responds to elevated serum calcium blood level by decreasing bone resorption? a. PTH b. T4 c. T3 d. Calcitonin

d Calcitonin

16. Which statement about the gonads is correct? a. Gonads are reproductive glands found in males only. b. The function of the hormones begins at birth in low, undetectable levels. c. The placenta secretes testosterone for the development of male external genitalia. d. External genitalia maturation is stimulated by gonadotropins during puberty.

d External genitalia maturation is stimulated by gonadotropins during puberty.

30. The bloodstream delivers glucose to the cells for energy production. Which hormone controls the cells' use of glucose? a. T4 b. Growth hormone c. Adrenal steroids d. Insulin

d Insulin

27. Which statement about glucagon secretion is correct? a. It is stimulated by an increase in blood glucose levels. b. It is stimulated by a decrease in amino acid levels. c. It exerts its primary effect on the pancreas. d. It acts to increase blood glucose levels.

d It acts to increase blood glucose levels.

7. The target tissue for ADH is which organ? a. Hypothalamus b. Thyroid c. Ovary d. Kidney

d Kidney

43. After an ultrasound of the thyroid gland, which diagnostic test determines the need for surgical intervention for thyroid nodules? a. CT scan b. MRI c. Angiography d. Needle biopsy

d Needle biopsy

26. Which statement about the pancreas is correct? a. Endocrine functions of the pancreas include secretion of digestive enzymes. b. Exocrine functions of the pancreas include secretion of glucagon and insulin. c. The islets of Langerhans are the only source of somatostatin secretion. d. Somatostatin inhibits pancreatic secretion of glucagon and insulin.

d Somatostatin inhibits pancreatic secretion of glucagon and insulin.

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? a. "Do you think if I lost weight my sleep apnea would improve?" b. "Why do I feel thirsty all the time?" c. "How can I make my skin less itchy?" d. "Does everyone's feet get bigger during menopause?"

d. "Does everyone's feet get bigger during menopause?"

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? a. "Are you experiencing any pain during sexual intercourse?" b. "Do you work with or have hobbies that involve exposure to chemicals?" c. "Have you gained or lost any weight recently?" d. "How often do you need to shave your face?"

d. "How often do you need to shave your face?"

12. An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a. ice in a basin. b. glargine insulin. c. a cardiac monitor. d. 50% dextrose solution.

d. 50% dextrose solution. Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? a. A 42-year-old with diabetes insipidus who has a dose of desmopressin due. b. A 35-year-old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). c. A 50-year-old with pituitary adenoma who is reporting a severe headache. d. A 28-year-old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

d. A 28-year-old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? a. Dry lips and oral mucosa on examination b. Nasal drainage that tests negative for glucose c. Urine specific gravity of 1.016 d. Client report of a headache and stiff neck

d. Client report of a headache and stiff neck

Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)? a. Getting 8 hours of sleep nightly b. Chronic constipation c. Protein-calorie malnutrition d. Cold environmental temperatures

d. Cold environmental temperatures

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? a. Inspecting feet and legs for ulcers b. Planning for weight-bearing activities c. Stressing the important of fiber in the diet d. Encouraging fluids every 2 hours

d. Encouraging fluids every 2 hours

2. Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? a. I notice my breasts are tender lately. b. I am so thirsty that I drink all day long. c. I get up several times at night to urinate. d. I feel a lump in my throat when I swallow.

d. I feel a lump in my throat when I swallow. Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? a. Administering an infusion of 150 mL hypertonic saline over the next 3 hours b. Drawing blood for hemoglobin and hematocrit levels c. Measuring serial weights at the same daily with the client wearing the same amount of clothing d. Inserting an indwelling catheter and monitoring urine output

d. Inserting an indwelling catheter and monitoring urine output

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? a. 5-lb weight loss b. Dry, cracked lips c. Thinning pubic hair d. Skin darkening

d. Skin darkening

6. A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels. a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone

d. parathyroid hormone Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.