Critical Care Exam 3 ONLY ADULT
496. The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call my primary health care provider (PHCP) because of these symptoms."
1. "I need to stop my insulin."
511. A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia
1. Fever 2. Nausea 4. Tremors 5. Confusion
504. A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia
1. Hypotension 3. Hyperkalemia
498. The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high-Fowler's. 5. Administer a vasopressin antagonist as prescribed.
1. Initiate an infusion of 3% NaCl. 3. Restrict fluids to 800 mL over 24 hours. 5. Administer a vasopressin antagonist as prescribed.
494. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate
1. Polyuria
63. Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 2. Serum calcium 3. Urine glucose. 4. Urine white blood cells.
1. The client will have an elevated sodium level as a result of low circulating blood volume. The fluid is being lost through the urine. Diabetes means "to pass through" in Greek, indicating polyuria, a symptom shared with diabetes mellitus. Diabetes in- sipidus is a totally separate disease process.
505. The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps
1. Tremors 3. Irritability 4. Nervousness
525. The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1. "This medication will turn my urine orange." 2. "I should decrease my oral fluids when I start this medication." 3. "The amount of urine I make should increase if this medicine is working." 4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin."
2 & 5 2. "I should decrease my oral fluids when I start this medication." 5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin." (on saunders pg 1466)
489. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level
2. Comatose state 3. Deep, rapid breathing 5. Elevated blood glucose level
23. Which endocrine disorder should the nurse assess for in the client who has a closed head injury with increased intracranial pressure? 1. Pheochromocytoma. 2. Diabetes insipidus. 3. Hashimoto's thyroiditis. 4. Gynecomastia.
2. Diabetes insipidus can be caused by brain tumors or infections, pituitary surgery, cerebrovascular accidents, or renal and organ failure, or it may be a complication of a closed head injury with increased in- tracranial pressure. Diabetes insipidus is a result of antidiuretic hormone (ADH) insufficiency.
61. The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? 1. Assess for dehydration and monitor blood glucose levels. 2. Assess for nausea and vomiting and weigh daily. 3. Monitor potassium levels and encourage fluid intake. 4. Administer vasopressin IV and conduct a fluid deprivation test.
2. Early signs and symptoms are nausea and vomiting. The client has the syndrome of inappropriate secretion of antidiuretic (against allowing the body to urinate) hor- mone. In other words, the client is pro- ducing a hormone that will not allow the client to urinate.
84. Which signs/symptoms should make the nurse suspect the client is experiencing a thyroid storm? 1. Obstipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.
2. Hyperpyrexia and extreme tachycardia. Hyperpyrexia (high fever) and heart rate above 130 beats per minute are signs of thyroid storm, a severely exaggerated hyperthyroidism.
499. A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.
2. Maintain a patent airway.
64. The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made by the client warrants further intervention? 1. "I will keep a list of my medications in my wallet and wear a Medic Alert bracelet." 2. "I should take my medication in the morning and leave it refrigerated at home." 3. "I should weigh myself every morning and record any weight gain." 4. "If I develop a tightness in my chest, I will call my health-care provider."
2. Medication for DI is usually taken every eight (8) to 12 hours, depending on the client. The client should keep the medication close at hand.
77. The client is admitted to the intensive care department diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.
2. Pulse oximeter reading of 90%.
490. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor
2. Shakiness 3. Palpitations 5. Lightheadedness
62. The nurse is admitting a client to the neurological intensive care unit who is postoperative transsphenoidal hypophysectomy. Which data warrant immediate intervention? 1. The client is alert to name but is unable to tell the nurse the location. 2. The client has an output of 2,500 mL since surgery and an intake of 1,000 mL. 3. The client's vital signs are T 97.6oF, P 88, R 20, and BP 130/80. 4. The client has a 3-cm amount of dark-red drainage on the turban dressing.
2. The output is more than double the intake in a short time. This client could be developing diabetes insipidus, a complica- tion of trauma to the head.
523. The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin
2. Tremors excessive doses of levothyroxine can produce S&S of hyperthyroidism.
506. The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hr 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats per minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)
3. A heart rate that is 90 beats per minute and irregular
510. A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hoarseness 2. Hypocalcemia 3. Audible stridor 4. Edema at the surgical site
3. Audible stridor
509. The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face
3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face
493. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures
3. IV fluids containing dextrose
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated primary health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate
3. Intravenous infusion of normal saline
78. Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.
3. Sedatives.
508. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70 mg/dL (3.9 mmol/L), temperature of 101° F (38.3° C), pulse of 82 beats per minute, respirations of 20 breaths per minute, and blood pressure of 118/68 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure
3. Temperature
7. The nurse is assessing a client in an outpatient clinic. Which assessment data are a risk factor for developing pheochromocytoma? 1. A history of skin cancer. 2. A history of high blood pressure. 3. A family history of adrenal tumors. 4. A family history of migraine headaches.
3. There is a high incidence of pheochromo- cytomas in family members with adrenal tumors, and the von Hippel-Lindau gene is thought to be a primary cause.
492. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L)."
4. "I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L)."
500. The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously.
4. Administer short-duration insulin intravenously.
65. The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test? 1. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours. 2. The client will be administered an injection of antidiuretic hormone (ADH), and urine output will be measured for four (4) to six (6) hours. 3. The client will have nothing by mouth (NPO), and vital signs and weights will be done hourly until the end of the test. 4. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.
65 = 3. The client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated.
66. The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday. 2. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours. 3. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching. 4. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night.
66 = 3. Muscle twitching is a sign of early sodium imbalance. If an immediate intervention is not made, the client could begin to seize.
68. The nurse is planning the care of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should be implemented? Select all that apply. 1. Restrict fluids per health-care provider order. 2. Assess level of consciousness every two (2) hours. 3. Provide an atmosphere of stimulation. 4. Monitor urine and serum osmolality. 5. Weigh the client every three (3) days.
68 = 1, 2, & 4 1. Fluids are restricted to 500 to 600 mL per 24 hours. 2. Orientation to person, place, and time should be assessed every two (2) hours or more often. 4. Urine and serum osmolality are monitored to determine fluid volume status.
69. The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? 1. Administer sliding-scale insulin as ordered. 2. Restrict caffeinated beverages. 3. Check urine ketones if blood glucose is >250. 4. Assess tissue turgor every four (4) hours.
69 = 4. The client is excreting large amounts of dilute urine. If the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently.
70. The unlicensed assistive personnel (UAP) complains to the nurse she has filled the water pitcher four (4) times during the shift for a client diagnosed with a closed head injury and the client has asked for the pitcher to be filled again. Which intervention should the nurse implement first? 1. Tell the UAP to fill the pitcher with ice cold water. 2. Instruct the UAP to start measuring the client's I&O. 3. Assess the client for polyuria and polydipsia. 4. Check the client's BUN and creatinine levels.
70 = 3. The first action should be to determine if the client is experiencing polyuria and polydipsia as a result of developing diabe- tes insipidus, a complication of the head trauma. (not right answer: 4. This could be done, but it will not give the nurse information about DI.)
71. The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider? 1. Serum sodium of 112 mEq/L and a headache. 2. Serum potassium of 5.0 mEq/L and a heightened awareness. 3. Serum calcium of 10 mg/dL and tented tissue turgor. 4. Serum magnesium of 1.2 mg/dL and large urinary output.
71 = 1. A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures. A headache is a symptom of a low-sodium level. (not 2 bc that is normal K)
A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?* A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient
A
A nurse is beginning a physical assessment of a client who was recently diagnosed with multiple sclerosis (MS). Which of the following findings should the nurse expect? (Select all that apply) A. Areas of paresthesia B. Involuntary eye movement C. Alopecia D. Increased salivation E. Ataxia
A, B, E Areas of loss of skin sensation, nystagmus, and ataxia can occur in a client who has MS
A nurse is caring for a client who has myasthenia gravis (MG) and has developed drooping eyelids. Which of the following actions should the nurse take? (Select all that apply) A. Apply lubricating eye drops B. Encourage use of sunglasses C. port the head with pillows D. Tape eyes closed at night E. Provide for periods of rest during the day
A, D Lubricating eye drops reduce corneal dryness and irritation caused by weakness of the eyelids Taping the eyes closed prevents corneal dryness
What health history question will give the nurse the most information when evaluating Ms. Wilson for Guillain-Barré syndrome (GBS)? A. "Have you had a respiratory or gastrointestinal virus in the past 2 weeks?" B. "Have you ever been exposed to Epstein-Barr virus?" C. "Has anyone else in your family ever had GBS?" D. "Did you get a flu vaccine in the past year?"
A. "Have you had a respiratory or gastrointestinal virus in the past 2 weeks?"
Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)?* A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.
A. A patient diagnosed with small cell lung cancer.
A nurse is caring for a client who is boss operative following a thyroidectomy which of the following is a priority for the nurse to monitor during the first 24 hours after care for this client? A. Airways patency B. Visual deficits C. Pain Control D. Hoarseness
A. Airways patency
You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient?* A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity
A. Fluid volume overload
The nurse is caring for one day post operative Thyroidectomy which of the following precipitates myxedema coma? (select all apply) A. Rapid withdrawals of thyroid meds B. Opioids meds C. Anesthesia D. Post-op ambulation E. Hyperthermia
A. Rapid withdrawals of thyroid meds B. Opioids meds C. Anesthesia
A nurse in the critical care unit is completing an admission assessment of a client who has a gunshot wound to the head. Which of the following assessment findings are indicative of increased ICP? (Select all that apply) A. headache B. dilated pupils C. tachycardia D. decorticate posturing E. hypotension
A. headache B. dilated pupils D. decorticate posturing
A nurse is caring for a client who was recently admitted to the emergency department following a head-on motor vehicle crash. The client is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. Which of the following is the priority nursing action at this time? A. keep neck stabilized B. insert nasogastric tube C. monitor pulse and blood pressure frequently D. establish IV access and start fluid replacement
A. keep neck stabilized
In a pt w SIADH, what drug do you anticipate the patient will be started on per doctor's order? A. Desmopressin (DDAVP) IV B. Declomycin C. Diabinese D. Stimate
B. Declomycin
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings should indicate to the nurse that the client has hyperglycemia? a. Hunger b. Increased urination c. Cold, clammy skin d. Tremors
B. Increased urination Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.
A nurse is caring for a client who has a closed-head injury with ICP readings ranging from 16 to 22 mm Hg. Which of the following actions should the nurse take to decrease the potential for raising the client's ICP? (Select all that apply) A. suction the endotracheal tube frequently B. decrease the noise level in the client's room C. elevate the client's head on two pillows D. administer a stool softener E. keep the client well hydrated
B. decrease the noise level in the client's room D. administer a stool softener
A nurse is caring for a client who has increased ICP and a new prescription for mannitol. For which of the following adverse effects should the nurse monitor? A. hyperglycemia B. hyponatremia C. hypervolemia D. oliguria
B. hyponatremia
A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. fluctuations in blood pressure B. loss of cognitive function C. ineffective cough D. drooping eyelids
B. loss of cognitive function
A nurse is assisting with the plan of care for a client who has hypothyroidism with myxedema which of the following interventions should the nurse include in the plan of care? A. Check the client for weight loss B. Limit high -fiber foods C. Apply warm blankets D. Place the client on bed test
C. Apply warm blankets
A nurse instructs a client who has myasthenia gravis (MG) about home care and the risk factors that can exacerbate the disease. Which of the following client statements indicates a need for further teaching? A. I should take my medication 45 minutes before meals B. I have suction equipment at home in case I start to choke C. I will soak in a warm bath every day D. I ordered a medical identification bracelet to wear
C. Hot temperatures and hot water can cause a client who has MG to have an exacerbation
Which of the following signs and symptoms is NOT expected with Diabetes Insipidus?* A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst
C. Polyphagia
The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH.* A. high, low B. absent, absent C. low, high D. low, low
C. low, high
A nurse is caring for a client who has just been admitted following surgical evacuation of a subdural hematoma. Which of following is the priority assessment? A. glasgow coma scale B. cranial nerve function C. oxygen saturation D. pupillary response
C. oxygen saturation
A nurse is in emergency department is assisting with the care of client who is comatose The provider is suspect ketoacidosis which of the following findings should the nurse expect? A. Blood glucose level below 40 MG/DL B. Malignant hypertension C. Cheyne-stokes breathing D. Acetone odor to breath
D. Acetone odor to breath
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?* A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.
D. Assessment finding of crackles throughout the lung fields.
The patient stated that he is confused because of the doctor told him that his diabetic insipidus is nephrogenic , The nurse explain that nephrogenic DI differs from neurogenic DI in that nephrogenic DI...? A. Will require dialysis B. Will eventually resolve without medication C. Require the nasal spray lypressin D. Does not respond to Antidiuretic hormone (ADH) when administered
D. Does not respond to Antidiuretic hormone (ADH) when administered
Nurse is caring for the client who is a postoperative and has a history Addison disease for which of the following manifestations should the nurse monitor? A. Hypernatremia B. Bradycardia C. Hypokalemia D. Hypotension
D. Hypotension
A nurse is collecting data from a client who has diabetes mellitus ,the client is confused ,flushed and has an acetone odor on his breath , the nurse should anticipate a prescription for which of the following types of insulin to treat the client? A. NPH B. Detemir C. Glargine D. Regular
D. Regular
True or False: you should encourage PO fluids to a pt w SIADH.
False bc they are on a FLUID RESTRICTION -however, in diabetes insipidus, you should encourage PO fluids!
Nurse is reinforcing teaching with a client who has diabetes Mellitus type 1 about sick day management Which of the following is the priority action for the nurse to recommend to the client? a. Drink 8 ounces of fluid every hour while awake b. Monitoring blood glucose level every four hours c. Take the usual dose of insulin d. Consume 15 g of carbohydrate every 1 to 2 hours
PRETTY SURE IT'S C BUT NEED TO CHECK CUS QUIZLET I GOT IT FROM DIDN'T HAVE THE ANSWER
A nurse is reviewing the laboratory values for a client who has hyperglycemic hyperosmolar nonketotic syndrome. The nurse should expect that which of the following laboratory values is consistent with hyperglycemic hyperosmolar nonketotic syndrome? a. Blood glucose 320 mg/dL b. Positive urine ketones c. Blood pH 7.34 d. Blood osmolality greater than 350 mOsm/kg
a. Blood glucose 320 mg/dL The client who has hyperglycemic hyperosmolar nonketotic syndrome should have a blood glucose level greater than 250 mg/dL which will cause spilling of ketones in the urine and development of metabolic acidosis
A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? a. Compensate for decrease in cortisol levels b. Inhibit glucose metabolism c. Act as a diuretic to maintain urine output d. Decrease susceptibility to infection
a. Compensate for decrease in cortisol levels The client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. On of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loos of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which if untreated, is fatal.
A nurse is caring for a client who has diabetic A nurse is caring for a client who has diabetic insipidus all of the following findings should expect? a. Decreased urine specific gravity b. Moist mucous membranes c. Bradycardia d. Bounding peripheral pulses
a. Decreased urine specific gravity
A nurse suspects a client who has myasthenia gravis is experiencing a myasthenic crisis. Which of the following interventions should the nurse take? a. Prepare the client for mechanical ventilation b. Administer an anticholinesterase medication. c. Instruct the client to perform the pursed lip breathing. d. Prepare to administer a vasoconstrictor.
a. Prepare the client for mechanical ventilation
A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? a. Provide client supervision. b. Limit client physical activity. c. Speak loudly to the client. d. Leave the television on continuously.
a. Provide client supervision.
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply) a. Tachycardia and hypertension b. Respiratory rate 16/min c. Negative Chvostek's sign d. Laryngeal stridor and hoarseness e. Positive Trousseau's sign
a. Tachycardia and hypertension d. Laryngeal stridor and hoarseness e. Positive Trousseau's sign
When caring for a pt in Addisonian Crisis due to a secondary adrenal insufficiency, you expect ACTH to be __________? a. decreased b. increased c. normal
a. decreased
What diet is needed for a pt experiencing a thyroid storm? a. high calorie, high protein b. sodium restriction c. liberal salt & protein intake d. low calorie, low fat, low protein
a. high calorie, high protein
When treating a pt w diabetes insipidus, you would expect their serum sodium to be ___________? a. increased b. decreased c. normal
a. increased
When treating a pt w diabetes insipidus, you would expect their urine output to be ___________? a. increased b. decreased c. normal
a. increased
When caring for a pt in Addisonian Crisis, what you expect their pH to be? SATA!!! a. less than 7.25 b. higher than 7.45 c. metabolic acidosis d. metabolic alkalosis
a. less than 7.25 c. metabolic acidosis
When treating a pt w SIADH, you would expect their serum osmolality to be ___________? a. low b. high c. normal
a. low
When treating a pt w SIADH, you would expect their serum sodium to be ___________? a. low b. high c. normal
a. low
When treating a pt w SIADH, you would expect their urine output to be ___________? a. low b. high c. normal
a. low
When treating a pt w diabetes insipidus, you would expect their urine osmolality to be ___________? a. low b. high c. normal
a. low CLASSIC SIGN OF DI = LOW URINE OSMOLALITY!!! (bc they are dehydrated)
When treating a pt w diabetes insipidus, you would expect their urine specific gravity to be ___________? a. low b. high c. normal
a. low CLASSIC SIGN OF DI = LOW URINE SPECIFIC GRAVITY!!! (bc they are dehydrated & THEIR URINE OSMOLALITY IS LOW TOO)
A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. Which of the following nursing statements are appropriate? a. "Engage in a vigorous exercise program." b. "Implement a schedule to include periods of rest." c. "Wear an eye patch on the right eye at all times." d. "Plan to relax in a hot tub spa each day."
b. "Implement a schedule to include periods of rest." The nurse should assist the client in developing a schedule that includes periods of exercise followed by periods of rest to maintain muscle strength and coordination.
A nurse is preparing a 24-hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hour urine specimen should the nurse use to determine the client's condition? a. Creatinine clearance b. Catecholamine metablolites c. 17-hydroxycorticosteroids (17-OHCS) d. Protein
b. Catecholamine metablolites
What medication is given to a pt in Addisonian Crisis who has no previous dx of adrenal insufficiency? a. Hydrocortisone sodium succinate (Solu-Cortef) b. Dexamethasone (Decadron) c. Methimazole (Tapizole) d. Demeclocycline
b. Dexamethasone (Decadron) (bc it will not interfere w the Cosyntropin Simulation Test)
Desmopressin (DDAVP) is used to treat which disorder? a. Diabetic Ketoacidosis b. Diabetes Insipidus c. SIADH d. Acute Adrenal Insufficiency (Adrenal Crisis)
b. Diabetes Insipidus
A nurse is caring for a client who has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor? a. Confusion b. Weakness c. Increased intracranial pressure d. Increased urinary output
b. Weakness
When treating a pt w SIADH, you would expect their urine osmolality to be ___________? a. low b. high c. normal
b. high
When treating a pt w SIADH, you would expect their urine specific gravity to be ___________? a. low b. high c. normal
b. high
When caring for a pt in Addisonian Crisis, you expect BUN to be _____________? a. low b. high c. normal
b. high (dt dehydration)
When treating a pt w diabetes insipidus, you would expect their serum osmolality to be ___________? a. low b. high c. normal
b. high CLASSIC SIGN OF DI = HIGH SERUM OSMOLALITY!!! (bc they are dehydrated)
Until we fix cortisol levels, what is a key finding in a pt in Addisonian Crisis? a. hypokalemia b. hypotension c. hypertension d. fluid volume overload
b. hypotension pts in Addisonian Crisis are hypovolemic, which causes them to be hypotensive; their hypotension is refractory to fluids until we fix their cortisol levels, and that is a key finding :)
When caring for a pt in Addisonian Crisis due to a primary adrenal insufficiency, you expect ACTH to be __________? a. decreased b. increased c. normal
b. increased
When caring for a pt in Addisonian Crisis, you expect Na to be _______(1)______ & K to be _______(2)______? a. (1) high (2) low b. (1) low (2) low c. (1) low (2) high d. (1) high (2) high
c. (1) low (2) high
A nurse is preparing to administer PO medication to a client who has myasthenia gravis. Which of the following actions should the nurse take prior to administering the client medication? a. Have the client empty his bladder. b. Put up the side rails on the client's bed. c. Ask the client to take a few sips of water. d. Place the client in low Fowler's position.
c. Ask the client to take a few sips of water.
Water deprivation test is used to dx which of the following disorders? a. Diabetic Ketoacidosis b. Hyperosmotic Hyperglycemic Syndrome c. Diabetes Insipidus d. SIADH
c. Diabetes Insipidus
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? a. Polyuria b. Dehydration c. Hyponatremia d. Hyperthermia
c. Hyponatremia The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia
A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? a. Piperacillin/tazobactam b. Levothyroxine c. Levodopa/carbidopa d. Carbamazepine
c. Levodopa/carbidopa
What is the initial treatment (first med you are going to give) for a pt with Diabetic Ketoacidosis? a. 3% Saline b. Dexamethasone c. Normal Saline (0.9% NS) d. Regular Insulin
c. Normal Saline (0.9% NS)
A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? a. Proteinuria b. Oliguria c. Polyuria d. Glycosuria
c. Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity
Which disorder is treated with 3% Saline? a. Diabetic Ketoacidosis b. Diabetes Insipidus c. SIADH d. Acute Adrenal Insufficiency (Adrenal Crisis)
c. SIADH
The cosyntropin stimulation test is used to diagnose what disease? a. Diabetes Insipidus b. Thyroid Storm c. Myxedema Coma d. Acute Adrenal Insufficiency (Adrenal Crisis)
d. Acute Adrenal Insufficiency (Adrenal Crisis)
A nurse is checking a client who has Graves' disease for a development of thyroid storm. The nurse should report which of the following findings to the provider? a. Constipation b. Headache c. Bradycardia d. Fever
d. Fever The client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a sudden extreme elevation in body temperature, hypertension, abdominal pain, and tachycardia
Propylthiouracil or Methimazole (Tapazole) are used to treat which disorder? a. Acute Adrenal Insufficiency (Adrenal Crisis) b. Diabetes Insipidus c. Myxedema Coma d. Thyroid Storm
d. Thyroid Storm
After the admin of Desmopressin (DDAVP), what should the nurse monitor for? a. infection, as signs of infection are often masked by this medication b. peptic ulcers c. hypotension d. fluid overload
d. fluid overload
