EAQ Review

AWhat is an example of third spacing in a burn injury? A. Blister formation B. Edema formation C. Fluid mobilization D. Fluid accumulation

A Blister formation is an example of third spacing in burn injuries. Edema formation and fluid mobilization generally happen in every burn injury. Fluid accumulation is formed in second spacing in a burn injury.

Which feature in the client indicates hypersecretion of adrenocorticotrophic hormone? A. Moon face B. Lower jaw protrusion C. Heat intolerance D. Barrel-shaped chest

A Hypersecretion of adrenocorticotrophic hormone results in Cushing's disease, which is characterized by "moon face" appearance, an abnormal distribution of fat in the face. Protrusion of the lower jaw is a feature of acromegaly, caused by excess secretion of growth hormone. Heat intolerance is seen in clients with excess secretion of thyrotropin. In acromegaly, the client presents with "barrel-shaped" chest appearance.

The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that teaching was effective when the client states, "Instead of asparagus, broccoli, and mushrooms, I will eat which foods?" A. String beans, beets, or carrots." B. Corn, lima beans, or dried peas." C. Baked beans, potatoes, or parsnips." D. Corn muffins, corn chips, or pretzels."

A String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

The nurse is teaching the client about wound healing. Which feature is associated with the "maturation phase" of normal wound healing? A. The scar is firm and inelastic on palpation. B. Fibrin strands form a scaffold or framework. C. White blood cells migrate into the wound. D. Epithelial cells are grown over the granulation tissue bed.

A The maturation phase of normal wound healing involves a mature scar that is firm and inelastic when palpated. In the proliferative phase, the fibrin strands form a scaffold or framework. White blood cells migrate into the wound during the inflammatory phase. In the proliferative phase, the epithelial cells are grown over the granulation tissue bed.

The student nurse is learning about the developmental characteristics of vision. Which major developmental characteristics does an infant start exhibiting around age 6 weeks? Select all that apply. A. Having binocular vision B. Having doll's eye reflex C. Having visual acuity 20/40 to 20/60 D. Having peripheral vision to 180 degree E. Having strabismus if binocular vision is absent

A & D

Which physiologic body functions decrease in response to certain pubertal changes? Select all that apply. A. Pulse rate B. Blood volume C. Strength of the heart D. Basal heat production E. Systolic blood pressure

A & D

The nurse is assessing an elderly male. Which finding is seen with aging? A. Symmetrical testes B. Reduced size of testes C. Presence of pubic hair D. Presence of foreskin on the penis

B A reduction in the size of the testes is a characteristic of aging. The testes are symmetrical in shape and length; any change in their symmetry denotes an abnormality. Presence of pubic hair is normal. The penis is covered with foreskin; however, circumcised men do not have foreskin. An easily retractable foreskin is an age-related finding.

Which statement regarding calcitonin is correct? A. It is secreted by follicular cells. B. Its actions are opposite to that of parathyroid hormone. C. It decreases phosphorous levels by increasing bone resorption. D. It works along with thyroid hormone to maintain normal calcium levels in blood

B Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels. Therefore, the actions of calcitonin are opposite to that of parathyroid hormone. Calcitonin is secreted by parafollicular cells of the thyroid gland. Calcitonin decreases calcium and phosphorus levels by decreasing bone resorption. Calcitonin works along with parathyroid hormone to maintain calcium levels in blood.

Which statement is true regarding the functions of kidney hormones? A. Prostaglandin increases blood flow and vascular permeability. B. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction. C. Renin raises blood pressure because of angiotensin and aldosterone secretion. D. Erythropoietin promotes the absorption of calcium in the gastrointestinal tract (GI) tract.

C Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells.

The partner of a woman in labor is having difficulty timing the frequency of contractions and asks the nurse to review the procedure. How should contractions be timed? A. From the end of one contraction to the end of the next contraction B. From the end of one contraction to the beginning of the next contraction C. From the beginning of one contraction to the end of the next contraction D. From the beginning of one contraction to the beginning of the next contraction

D

The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority? A. Weigh the client daily. B. Restrict the client's oral fluid intake. C. Measure the client's urine specific gravity. D. Observe the client for increasing confusion.

D An increased serum ammonia level impairs the central nervous system, causing an altered level of consciousness. Increasing ammonia levels are not related to weight. An alteration in fluid intake will not affect the serum ammonia level. Measuring the client's urine specific gravity is not the priority; the priority is to monitor the client's neurological status.

A nurse is counseling a woman who had recurrent urinary tract infections. Which factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection? A. Altered urinary pH B. Hormonal secretions C. Juxtaposition of the bladder D. Proximity of the urethra to the anus

D Because a woman's urethra is closer to the anus than a man's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women.

The nurse is aware that the Cowper gland is also often referred to by which other term? A. Skene gland B. Prostate gland C. Bartholin gland D. Bulbourethral gland

D Cowper glands are accessory glands of the male reproductive system; they are also referred to as the bulbourethral glands. Skene glands are a part of the female reproductive system. The prostate gland is also a gland of the male reproductive system. Bartholin glands are part of the female reproductive system.

A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? A. Inhibin B. Estrogen C. Prolactin D. Progesterone

C

Which drug would be effective for the treatment of pituitary Cushing's syndrome? A. Mitotane B. Cabergoline C. Cyproheptadine D. Bromocriptine mesylate

C Cyproheptadine is effective for the treatment of pituitary Cushing's syndrome. Mitotane is prescribed for the treatment of adrenal Cushing's syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.

A nurse is reviewing several charts. Which condition is an autoimmune disorder? A. Addison's disease B. Cushing's syndrome C. Hashimoto's disease D. Sheehan's syndrome

C Hashimoto's disease is an autoimmune disorder, wherein the immune system attacks the thyroid gland. Addison's disease is caused by adrenal insufficiency. Cushing's syndrome is caused by increased body levels of cortisol. Sheehan's syndrome is hemorrhage-associated hypopituitarism after delivery of a child.

The nurse is monitoring a client with a severe head injury for signs and symptoms of increasing intracranial pressure. Which finding is most indicative of increasing intracranial pressure? A. Polyuria B. Tachypnea C. Increased restlessness D. Intermittent tachycardia

C Increased restlessness indicates a lack of oxygen to the brainstem; cerebral hypoxia impairs the reticular activating system. Urine output is not related to increased intracranial pressure. The respiratory rate will decrease. The pulse will be slow and bounding.

Which skin color in a client indicates an increased urochrome level? A. Red B. Blue C. Reddish blue D. Yellow-orange

D

A client is to have a parotidectomy to remove a cancerous lesion. Which postoperative complication that may be permanent should the nurse monitor in this client? A. A tracheostomy B. Frey syndrome C. An increase in salivation D. Facial nerve dysfunction

D The facial nerve may be damaged during surgery. Drooping of the area results from loss of muscle tone. A tracheostomy is not a complication. Frey syndrome is also called auriculotemporal syndrome; it may follow infection and suppuration of the parotid gland and is not a surgical complication. The parotid is a salivary gland; its removal will decrease salivation.

The registered nurse is assigning tasks to a healthcare team to provide care for a group of clients in hospice care. How should the registered nurse help the healthcare team attain an effective outcome in the hospice care? A. Assisting the healthcare team in planning B. Assisting the healthcare team in interpreting C. Assisting the healthcare team to enhance the ability D. Assisting the healthcare team to achieve optimal functioning

A

Which type of behavior by the registered nurse results in a low-to-stable level of commitment? A. Punitive B. Charismatic C. Inspirational D. Intellectual stimulation

A

The nurse is caring for a client 4 days after the client was admitted to the hospital with burns on the trunk and arms. The nurse collaborates with the dietician to develop a dietary plan for the following day. Which plan will the nurse follow? A. High caloric intake, liberal potassium intake, and 3 g protein/kg/day B. High caloric intake, restricted potassium intake, and 1 g protein/kg/day C. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day D. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day

A A high-calorie diet is needed for the increased metabolic rate associated with burns; the administration of potassium prevents hypokalemia, which can occur after the first 48 to 72 hours when potassium moves from the extracellular compartment into the intracellular compartment; protein promotes tissue repair. High caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the protein and potassium are too limited. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day do not meet the body's needs for tissue repair; the calories are too limited. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the calories, potassium, and protein are too limited

Which side effect should the nurse monitor for when administering androgen therapy? A. Baldness B. Headaches C. Gastric irritation D. Orthostatic hypotension

A Androgen therapy may cause baldness, gynecomastia, and acne. Headaches, gastric irritation, and orthostatic hypotension are associated with bromocriptine, which is used to treat hyperpituitarism.

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do? A. Monitor for nonverbal cues of pain B. Check the pressure dressing for bleeding C. Assist the client to ambulate around his room D. Irrigate the client's nasogastric tube with sterile water

A Asian clients tend to be stoic regarding pain and usually do not acknowledge pain; therefore, the nurse should assess these clients further. This type of surgery does not require pressure dressings. First, the client must be assessed further for pain. If there is pain, the client should ambulate after, not before, receiving pain medication. Postoperatively, nasogastric tubes are irrigated when needed, not routinely.

A nurse is caring for a client with Addison disease. Which dietary instruction should the nurse teach the client to follow? A. Add extra salt to food B. Consume high-potassium foods C. Omit protein foods at each meal D. Restrict the daily intake of fluids to 1 L

A Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to developing hyponatremia. Therefore, the addition of salt to the diet is advised. Clients with Addison disease are prone to hyperkalemia. High-potassium foods can be restricted. Protein is not omitted from the diet; ingestion of essential amino acids is necessary for optimum metabolism and healing. Fluids are not restricted for clients with Addison disease.

A client is scheduled for radiation treatments Monday through Friday. The client asks why the treatments will not be given on Saturday and Sunday. Which is the nurse's best response? A. "This type of schedule gives noncancerous cells time to recover." B. "The department only operates from Monday through Friday." C. "Your energy level will be increased greatly by a 5-day schedule." D. "Side effects are eliminated when treatment is administered for 5 rather than 7 days."

A Both malignant and healthy cells are affected by radiation; time between courses of treatment allows normal cells to repair. Staff are available if necessary for a treatment protocol; some facilities operate 7 days a week. Fatigue occurs in either a 5- or 7-day schedule. Some side effects are inevitable, although they vary with each individual; they cannot be eliminated

A nurse is planning to teach facts about hyperglycemia to a client with diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis? A. Breakdown of fat stores for energy B. Ingestion of too many highly acidic foods C. Excessive secretion of endogenous insulin D. Increased amounts of cholesterol in the extracellular compartment

A In the absence of insulin, which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35). The pH of food ingested has no effect on the development of acidosis. The opposite of excessive secretion of endogenous insulin is true. Cholesterol level has no effect on the development of acidosis.

What is the function of limbic system? A. Influence emotional behavior B. Regulate autonomic functions C. Facilitate automatic movements D. Relay sensory and motor inputs for cerebrum

A Located lateral to the hypothalamus, the limbic system influences emotional behavior and basic drives such as feeding and sexual behaviors. The regulation of endocrine and autonomic functions is the function of the hypothalamus. The control and facilitation of learned and automatic movements is the function of the basal ganglia. The thalamus relays sensory and motor input to and from the cerebrum.

The nurse is teaching a client newly diagnosed with diabetes about the importance of glucose monitoring. Which blood glucose levels should the nurse identify as hypoglycemia? A. 68 mg/dL (3.8 mmol/L) B. 78 mg/dL (4.3 mmol/L) C. 88 mg/dL (4.9 mmol/L) D. 98 mg/dL (5.4 mmol/L)

A Normal blood glucose level for an adult is 72-108 mg/dL (4-6 mmol/L). Clients who have blood glucose levels below 72 mg/dL (4 mmol/L) may experience hypoglycemia; 78 mg/dL (4.3 mmol/L), 88 mg/dL (4.9 mmol/L), and 98 mg/dL (5.4 mmol/L) are normal blood glucose levels.

A nurse is caring for a client with a hiatal hernia. Which risk factor should the nurse assess for in this client? A. Obesity B. Alcoholism C. Chronic bronchitis D. Esophageal varices

A Obesity causes stress on the diaphragmatic musculature, which weakens and allows the stomach to protrude into the thoracic cavity. Alcoholism may cause gastritis, an enlarged liver, or pancreatitis, but not a hiatal hernia. Inflammation of the bronchi will not weaken the diaphragm. Esophageal varices result from increased portal pressure; they do not cause a hiatal hernia.

Which hormone is released from the posterior pituitary gland? A. Oxytocin B. Prolactin C. Growth hormone D. Luteinizing hormone

A Oxytocin is released from the posterior pituitary gland, which acts on the uterus and mammary glands. Prolactin, growth hormone, and luteinizing hormone are produced by the anterior pituitary gland.

The nurse is caring for a client with burns and reviews the client's laboratory results: blood urea nitrogen (BUN), 30 mg/dL (10.2 mmol/L); creatinine, 2.4 mg/dL (184 mcmol/L); serum potassium, 6.3 mEq/L (6.3 mmol/L); pH, 7.1; Po2, 90 mm Hg; and hemoglobin (Hgb), 7.4 g/dL (74 mmol/L). Which condition does the nurse suspect the client has based upon these findings? A. Azotemia B. Hypokalemia C. Metabolic alkalosis D. Respiratory alkalosis

A The BUN is greater than the expected value of 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Urea nitrogen is the major nitrogenous end product of protein and amino acid catabolism; azotemia is the accumulation of excessive nitrogenous compounds, such as BUN and creatinine, in the blood. The client has hyperkalemia; the expected value for potassium is 3.5 to 5.5 mEq/L (3.5 to 5.5 mmol/L). Although the client does have a metabolic acid-base imbalance, it is acidosis, not alkalosis, because the pH is less than the expected range of 7.35 to 7.45. The PO2 is within the expected range of 80 to 100 mm Hg, which indicates that the problem is metabolic, not respiratory.

The nurse is teaching a client about the causes of dandruff. Which client statement demonstrates to the nurse that further instruction is needed? A. "It is a contagious scalp condition." B. "It can be related to scalp tenderness." C. "It can be the rare side effect of a drug." D. "It is the problem of an oily, irritated scalp."

A The client statement: "It is a contagious scalp condition" demonstrates to the nurse that further instruction is needed because dandruff itself is only a symptom and is not contagious. Dandruff is most commonly associated with an oily, irritated scalp. It can also occur as a rare side effect of a drug, such as cancer chemotherapy agents that affect the hair shaft. Dandruff can be related to scalp tenderness if there is seborrheic dermatitis.

A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites? A. Impaired portal venous return B. Impaired thoracic lymph channels C. Excess production of serum albumin D. Enhanced hepatic deactivation of aldosterone secretio

A The congested liver impairs venous return, leading to increased portal vein hydrostatic pressure and an accumulation of fluid in the abdominal cavity. Although lymph channels in the abdomen become congested, facilitating the leakage of plasma into the peritoneal cavity, it is primarily the increased portal vein hydrostatic pressure that causes the accumulation of fluid in the abdominal cavity. Increased serum albumin causes hypervolemia, not ascites. As fluid is trapped in the peritoneal cavity, circulating blood volume drops and aldosterone secretion increases, not decreases; aldosterone secretion is related to the renin-angiotensin system.

Which gland secretes melatonin? A. Pineal gland B. Thyroid gland C. Adrenal gland D. Parathyroid gland

A The pineal gland secretes the hormone melatonin, which regulates the circadian rhythm and reproductive system at the onset of puberty. The thyroid gland secretes thyroid hormones. The adrenal gland secretes androgens, corticosteroids, and catecholamines. The parathyroid gland secretes the hormone calcitonin.

Which key feature does the nurse associate with a stage 2 pressure ulcer? A. Presence of nonintact skin B. Development of sinus tracts C. Damage to the subcutaneous tissues D. Appearance of a reddened area over a bony prominence

A The skin is nonintact in stage 2 of pressure ulcers. Sinus tracts may develop during stage 4 of pressure ulcers. The subcutaneous tissue becomes damaged or necrotic during stage 3 of pressure ulcers. A reddened area over a bony surface occurs in stage 1 of pressure ulcers.

Which is the target tissue for the parathyroid hormone? A. Intestines B. All body cells C. Mammary glands D. Sympathetic effectors

A The target tissue of the parathyroid gland is the intestines. Growth hormone acts on all body cells. The mammary gland is the target tissue of oxytocin. Epinephrine and non-epinephrine acts on the sympathetic effectors.

Which fungal infection in a client is commonly referred to as athlete's foot? A. Tinea pedis B. Tinea cruris C. Tinea corporis D. Tinea unguium

A Tinea pedis is a fungal infection commonly known as athlete's foot. Tinea cruris is jock itch. Tinea corporis is ringworm. Tinea unguium is onychomycosis.

What are the roles of an unlicensed assistive personnel in skin care? Select all that apply. A. To assist the client in bathing B. To apply wet dressings to the skin C. To report changes in the skin appearance D. To reinforce teaching as done by the registered nurse E. To determine whether the client is taking a drug that increases photosensitivity

A, B, & C The unlicensed assistive personnel may be responsible for assisting the client in bathing, applying wet dressings to the skin, and reporting changes in the skin appearance. Teaching done by the registered nurse can be reinforced by a licensed practical nurse or a vocational nurse. The registered nurse would be responsible for determining whether the client is taking a drug that increases photosensitivity.

While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? Select all that apply. A. Diaphoresis B. Weight loss C. Constipation D. Protruding eyes E. Cold intolerance

A, B, & D Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia. Weight loss occurs with hyperthyroidism because of increased metabolism. Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retroorbital tissue, which causes the eyeballs to enlarge and push forward. Diarrhea occurs because of increased body processes, specifically increased gastrointestinal peristalsis. Heat intolerance occurs because of the increased metabolism associated with hyperthyroidism.

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply. A. Hirsutism B. Round face C. Pitting edema D. Buffalo hump E. Hypoglycemia

A, B, & D Hirsutism is caused by excess adrenocortical activity associated with Cushing syndrome. A moon face results from an accumulation of adipose tissue associated with hypercortisolism. A buffalo hump results from an accumulation of adipose tissue associated with hypercortisolism. Pitting edema does not occur, except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.

A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply. A. Rye B. Oats C. Rice D. Corn E. Wheat

A, B, & E Rye, oats, and wheat should be avoided because they are irritating to the gastrointestinal mucosa. Gluten is not found in rice or corn; therefore, these items do not have to be avoided.

A nurse who is assessing a full-term newborn elicits the Babinski reflex. How is this reflex elicited? A. Striking the surface of the crib suddenly B. Stroking the outer sole of the foot from the heel to the little toe C. Maintaining the supine position and applying pressure to the soles of the feet D. Holding the infant's body upright and allowing the feet to touch the surface of the crib

B

According to the disaster triage tag system, which color tag would the nurse feel is most suitable for a client who died in an earthquake? A. Red B. Black C. Green D. Yellow

B

The nurse assists a client to the bathroom to void several times during the first stage of labor. Why is this is an important component of nursing? A. A full bladder is often injured during labor. B. A full bladder may inhibit the progress of labor. C.A full bladder jeopardizes the status of the fetus. D. A full bladder predisposes the client to urinary infection.

B

The parent of a 3-month-old infant asks the nurse about selecting toys for the infant. Which toy should the nurse tell the parent is most appropriate at this age? A. Stuffed animal B. Metallic mirror C. Push-pull wagon D. Large plastic ball

B

While entering data for a client in the electronic health record (EHR), the nurse uses North American Nursing Diagnosis Association (NANDA) International terminology to document which part of the nursing process? A. Planning B. Diagnosis C. Outcomes D. Interventions

B

The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder? A. Ham sandwich with cheese, whole milk, and potato chips B. Penne pasta, spinach, banana, and decaffeinated iced tea C. Baked lasagna with sausage, salad, and milkshake D. Hamburger, french fries, and cola

B A client with cirrhosis and ascites will require moderate to low fat and low sodium (penne pasta, spinach, banana, and decaffeinated iced tea). Caffeine can stimulate and cause distention. Ham, cheese, whole milk, potato chips, baked lasagna with sausage, milkshake, hamburger, french fries, and cola all have more fat and sodium than a client with cirrhosis should consume.

Which structure is removed during circumcision of an infant? A. Glans B. Prepuce C. Epididymis D. Vas deferens

B Circumcision involves removal of the prepuce, which is a skin folding over the glans. The glans is the tip of the penis. The epididymis is the internal structure that helps in the transportation and maturation of sperm. The vas deferens carries sperm from the epididymis to the ejaculatory duct.

A client is diagnosed with hyperthyroidism, and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, what instruction should the nurse teach the client? A. Consciously attempt to calm down. B. Eliminate coffee, tea, and cola from the diet. C. Keep the home warm, and use an extra blanket at night. D. Schedule activities during the day to overcome lethargy.

B Coffee, tea, and cola contain caffeine, which may increase thyroid activity. Hyperactivity is a physiological response; it is not under conscious control. The increased metabolic rate associated with hyperthyroidism will make the client feel warm; a cool environment is needed. Hyperactivity is a problem, and the client should be encouraged to rest.

A client was admitted with full-thickness burns 2 weeks ago. Since admission, the client has lost an average of 1 lb (0.5 kg) of weight each day. Which action will the nurse most likely take based upon the adjusted dietary plan? A. Provide low-sodium milk. B. Provide high-protein drinks. C. Provide foods that are low in potassium. D. Provide 10% more calories in the form of fats.

B High-protein drinks have twice the calories per volume of other fluids and provide protein for wound healing. Low-sodium milk does not contain adequate calories to help meet the high metabolic rate associated with burns. Potassium is restricted during the first 48 to 72 hours after a burn injury, not 2 weeks after the injury. Increased calories in the form of protein and carbohydrates, not fats, are needed.

Which predisposing condition may be present in a client with pitting edema? A. Shock B. Kidney disease C. Hypothyroidism D. Severe dehydration

B Kidney disease may be a predisposing condition associated with pitting edema. Shock may be associated with a decreased temperature. Hypothyroidism may be a predisposing condition of non-pitting edema, which occurs due to an endocrine imbalance. Severe dehydration may be associated with decreased elasticity of the dermis.

The nurse is educating student nurses about the anatomy and physiology of the kidneys. What term does the nurse explain is used for the tip of the pyramid of a kidney? A. Calyx B. Papilla C. Renal pelvis D. Renal column

B Pyramids are components of renal medulla, and the tip of each pyramid is called a papilla. A calyx is a structure that collects the urine at the end of each pyramid. The renal calices join together to form the renal pelvis. A renal column is a cortical tissue that separates the pyramids.

A male client with ascites is to have a paracentesis and has signed the consent. While the nurse is caring for him, he says that he has changed his mind and no longer wants the procedure. Which initial response by the nurse is best? A. "Why did you sign the consent?" B. "Can you tell me why you decided to refuse the procedure?" C. "You are obviously afraid about something concerning the procedure." D. "Although the procedure is very important, I understand why you changed your mind."

B The response "Can you tell me why you decided to refuse the procedure?" attempts to explore why the client is refusing the procedure; it promotes communication. The response "Why did you sign the consent?" is accusatory; the client has the right to withdraw consent at any time. The response "You are obviously afraid about something concerning the procedure" is a conclusion without appropriate data; it puts the client on the defensive. The response "Although the procedure is very important, I understand why you changed your mind" is a conclusion without appropriate data; it may raise the client's anxiety level.

Which skin changes due to aging are caused by chronic exposure to ultraviolet rays? Select all that apply. A. Reduced circulation B. Actinic keratosis C. Capillary fragility D. Senile lentigines E. Facial hirsutism

B & D The skin changes due to aging caused by chronic exposure to ultraviolet rays are actinic keratosis and senile lentigines (or lentigo). Reduced circulation, capillary fragility, and facial hirsutism are considered normal skin changes related to aging.

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply. A. Impaired memory B. Intolerance to cold C. Difficulty breathing D. Decreased blood pressure E. Decreased body temperature

B & E Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neuromuscular manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in the client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in the client with hypothyroidism.

What makes a crisis access hospital (CAH) different from an intensive care unit (ICU)? A. It offers 24-hour emergency care. B. It offers health care to acutely ill people. C. It provides temporary care for 96 hours or less. D. It provides the most expensive health care delivery.

C

A nurse is assessing the integumentary system of four clients. Which client has the least chance of a false-positive result while undergoing assessment of capillary refill time? A. Client with shock B. Client with anemia C. Client with epilepsy D. Client with peripheral vascular disease

C A client with epilepsy does not have any circulatory inadequacy. Therefore the capillary refill time of this client, as assessed in the nails, is a reliable indicator (i.e., does not reveal a false-positive result). A client with shock has decreased oxygen saturation levels that further prolong the capillary refill time. Capillary refill time is not a reliable indicator of blood circulation for clients with anemia, peripheral vascular disease, or diabetes.

A nurse is caring for a client who just had surgery for a parotid tumor. Which nursing intervention is the priority in the immediate postoperative period? A. Offering psychological support B. Monitoring the client's fluid balance C. Keeping the client's respiratory passages patent D. Providing a pad and pencil for writing messages

C A patent airway is always the priority; therefore, removal of secretions is imperative. Offering psychological support is an important postoperative intervention, but it is not the priority immediately after removal of a parotid tumor. Monitoring the client's fluid balance is an important postoperative intervention, but it is not the priority immediately after removal of a parotid tumor. Providing for a means of communication is an important postoperative intervention, but it is not the priority immediately after removal of a parotid tumor.

While a nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." Which food should the nurse suggest to substitute for broccoli? A. Peas B. Corn C. Green beans D. Mashed potato

C According to exchange lists for meal planning, green beans and broccoli are equivalent vegetable substitutes. Peas are a starch and are not an equivalent vegetable substitute for broccoli. Corn is a starch and is not an equivalent vegetable substitute for broccoli. Mashed potato is a starch and is not an equivalent vegetable substitute for broccoli.

A client is diagnosed as having invasive cancer of the bladder, and brachytherapy is scheduled. What should the nurse expect the client to demonstrate that indicates success of this therapy? A. Decrease in urine output B. Increase in pulse strength C. Shrinkage of the tumor on scanning D. Increase in the quantity of white blood cells (WBCs)

C Brachytherapy, in which isotope seeds are implanted in the tumor, interferes with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary output will increase with successful therapy. With brachytherapy of the bladder, increase in pulse strength is not a sign of success. Bone marrow sites may be affected by radiation, resulting in a reduction of WBCs.

A client tells the nurse about recent recurrent episodes of bleeding hemorrhoids. What should the nurse advise the client to do to help prevent future hemorrhoidal episodes? A. Exercise to improve circulation B. Eat bland foods and avoid spices C. Consume a high-fiber diet and drink adequate water D. Use laxatives to avoid constipation and the Valsalva maneuver

C Consuming a high-fiber diet and drinking adequate water promote regular bowel function, prevents constipation, and prevent straining, which can make hemorrhoids worse; a high-fiber diet provides bulk that stimulates peristalsis, and water promotes a soft stool. Exercise is advisable, but the purpose in this instance is to increase peristalsis, not improve circulation. Bland foods and spices are unrelated to hemorrhoids; bland foods are preferred for clients with gastric or intestinal problems. Laxatives are contraindicated because they are irritating to the bowel, decrease intestinal tone, and promote dependency. The Valsalva maneuver should also be avoided.

What would the nurse state is a cause of systemic altered inflammatory response in impaired wound healing? A. Uremia B. Cirrhosis C. Leukemia D. Hypovolemia

C Leukemia is a cause of systemic altered inflammatory response in impaired wound healing. Uremia, cirrhosis, and hypovolemia are systemic impaired cellular proliferation responses in impaired wound healing.

Which physical changes may cause longitudinal nail ridges? A. Decreased rate of growth B. Decreased cell division C. Decreased blood flow D. Decreased vitamin D production

C Longitudinal ridges may be due to decreased blood flow to the nail beds. Decreased cell division in the skin may cause a delay in wound healing. Increased risk of fungal infections is due to decreased rate of growth. Increased risk of osteomalacia is due to a decrease in vitamin D levels.

Which test is used to specifically detect intracranial aneurysms in clients? A. Diffusion imaging B. Magnetic resonance imaging C. Magnetic resonance angiography D. Magnetic resonance spectroscopy

C Magnetic resonance angiography is used to evaluate blood flow and blood vessel abnormalities, such as arterial blockage, intracranial aneurysms, and arteriovenous malformations. Magnetic resonance spectroscopy is indicated in epilepsy, Alzheimer disease, and stroke to assess abnormalities in the brain's biochemical processes. Diffusion imaging is indicated for evaluation of ischemia in the brain to determine the location and severity of a stroke. Magnetic resonance imaging is taking multiple sets of images to determine normal and abnormal anatomy.

Which organism infestation is diagnosed with the help of the mineral oil test? A. Lice B. Ticks C. Mites D. Fungus

C Mites are the causative organism of scabies. Examination using mineral oil is a diagnostic measure for the scabies infection. To check for infestations, scrapings are placed on a slide with mineral oil and viewed microscopically. Lice leave excrement and eggs on skin and hair, live in seams of clothing (if body lice), and in hair as nits. A diagnosis of Lyme disease caused by ticks is often based on clinical manifestations, in particular the erythema migrans lesion, and a history of exposure in an endemic area. If the enzyme immunoassays is positive or inconclusive, a Western blot test is done to confirm the infection. The microscopic examination of skin lesions in 10% to 20% potassium hydroxide is a diagnostic measure to determine the presence of a fungus.

A client is diagnosed with psoriasis, and the nurse is providing health teaching concerning skin care at home. Which recommendation does the nurse include in the teaching? A. "Shower twice a day." B. "Soak the affected areas in hot water." C. "Apply moisturizing lotion several times a day." D. "Cover affected areas when in contact with others."

C Moisturizing lotions provide an occlusive film on the skin surface so that usual water loss through the skin is limited, allowing the trapped water to hydrate the stratum corneum. Excessive exposure to water, particularly hot water, increases irritation and scaling. Psoriasis is not a communicable disease, and affected areas do not need to be covered when in contact with others.

Radium inserted in the vagina of a client now is being removed. Which safety precaution should the nurse employ when assisting with the radium removal? A. Clean the radium in ether or alcohol. B. Wear foil-lined rubber gloves while handling the radium. C. Ensure that long forceps are available for removing the radium. D. Document how long the radium was in place and when it was removed.

C Radium must be handled with long forceps because distance helps limit exposure. A nurse does not clean radium implants. Foil-lined rubber gloves do not provide adequate shielding from the gamma rays emitted by radium. The amount and duration of exposure are important in assessing the effect on the client; however, documentation will not affect safety during removal.

A nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome? A. Low-residue, bland diet B. Fluid intake below 500 mL C. Small, frequent feeding schedule D. Low-protein, high-carbohydrate diet

C Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum. Although a diet high in roughage may be avoided, a low-residue, bland diet is not necessary. Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. Concentrated sweets pass rapidly out of the stomach and increase fluid shifts; the diet should be low in carbohydrates. Relatively high protein is needed to promote tissue repair.

An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the healthcare provider will most likely prescribe? A. Increase intake of dietary roughage quickly B. Avoid oral feedings for a prolonged period C. Resume small, easily digested feedings gradually D. Limit intake to self-selection of personally preferred foods

C Small, frequent feedings are tolerated best after a subtotal gastrectomy. Roughage may be irritating to the gastrointestinal (GI) tract after surgery. As soon as edema subsides, the individual generally is given small amounts of fluid, and then the diet is progressed gradually. Allowing only personal food preferences does not ensure inclusion of nutrients necessary for recovery.

A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first? A. Clamp the nasogastric tube. B. Irrigate the tube gently with normal saline. C. Record the observation and continue to monitor the drainage from the tube. D. Reduce the pressure of the suction and record observations of the drainage characteristics.

C Some bright red blood at this point is an expected finding that should be monitored; large amounts of blood or bleeding should be reported immediately. Clamping the nasogastric tube is contraindicated; secretions will accumulate and cause pressure on the suture line. Also, clamping the tube prevents observation of gastric drainage. If the tube is draining, there is no need to irrigate; also, irrigations are traumatic. Reducing suction pressure allows secretions to accumulate and causes pressure on the suture line.

A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The primary healthcare provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the primary healthcare provider to prescribe to confirm this diagnosis? A. Cystoscopy and bilirubin level B. Specific gravity and pH of the urine C. Urinalysis and urine culture and sensitivity D. Creatinine clearance and albumin/globulin (A/G) ratio

C The client's manifestations may indicate a urinary tract infection; a culture of the urine will identify the microorganism, and sensitivity will identify the most appropriate antibiotic. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells (RBCs), white blood cells (WBCs), or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.

A client is taught how to change the dressing and how to care for a recently inserted nephrostomy tube. On the day of discharge the client states, "I hope I can handle all this at home; it's a lot to remember." Which is the best response by the nurse? A. "I'm sure you can do it." B. "Oh, a family member can do it for you." C. "You seem to be nervous about going home." D. "Perhaps you can stay in the hospital another day."

C The response "You seem to be nervous about going home" is the best reply. Reflection conveys acceptance and encourages further communication. The response "I'm sure you can do it" is false reassurance that does not help to reduce anxiety. The response "Oh, a family member can do it for you" provides false reassurance and removes the focus from the client's needs. The response "Perhaps you can stay in the hospital another day" is unrealistic, and it is too late to suggest this.

A nurse is caring for a client on the second day after an abdominoperineal resection. Which finding does the nurse document as normal in the stoma? A. Dry, pale pink, and even with the skin B. Moist, skin-colored, and flush with the skin C. Moist, red, and raised above the skin surface D. Dry, purple, and depressed below the skin surface

C The surface of a stoma is mucous membrane and should be dark pink to red, moist, and shiny; the stoma usually is raised beyond the skin surface to allow drainage to go into the appliance rather than onto the skin. The stoma should be moist, not dry. Pale pink may indicate limited circulation to the stoma. Although some stomas can be flush with the skin, a raised stoma is more common. Although the stoma should be moist, a skin-colored stoma indicates limited circulation to the stoma. A purple color indicates compromised circulation.

The nurse teaches a client about self-care measures for preventing dry skin. Which statement made by the client indicates that the nurse needs to follow up? A. "I will reduce my daily intake of caffeine and alcohol." B. "I will avoid wearing tight outfits and snug-fitting belts." C. "I will use deodorant soap instead of alkaline soap." D. "I will not use alcohol-based skin and face cleansers."

C Using deodorant soap will worsen dry skin so the nurse needs to follow up to correct this misconception. Deodorant soap should be avoided in clients with dry skin. All of the other statements are correct and need no follow up. Avoiding caffeine and alcohol consumption and not using alcohol-based skin and face cleansers will help to prevent dry skin. Avoiding tight outfits will also prevent dry, irritated skin.

A client has a hiatal hernia. The client is 5 feet 3 inches tall (163 cm) and weighs 160 pounds (72.6 kg). Which information should the nurse include when discussing prevention of esophageal reflux? A. Increase your intake of fat with each meal. B. Lie down after eating to help your digestion. C. Reduce your caloric intake to foster weight reduction. D. Drink several glasses of fluid during each of your meals

C Weight reduction decreases intraabdominal pressure, thereby decreasing the tendency to reflux into the esophagus. Fats decrease emptying of the stomach, extending the period that reflux can occur; fats should be decreased. Lying down after eating increases the pressure against the diaphragmatic hernia, increasing symptoms. Drinking several glasses of fluid during each meal will increase pressure; fluid should be discouraged with meals.

What are the neurologic manifestations of hyperthyroidism? Select all that apply. A. Fatigue B. Diaphoresis C. Blurred vision D. Exophthalmos E. Shallow respirations

C & D Blurred vision and exophthalmos are the neurological manifestations of hyerthyroidism. Fatigue is the metabolic manifestation of hyperthyroidism. Diaphoresis, or excessive sweating, is the skin manifestation of hyperthyroidism. Shallow respirations are the cardiopulmonary manifestation of hyperthyroidism.

A nurse is assessing a client with the diagnosis of scleroderma for signs of calcium deposits in organs, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia (CREST syndrome). Which clinical indicators should the nurse expect to identify upon assessment? Select all that apply. A. Joint pain B. Masklike facies C. Esophageal dysmotility D. Spiderlike hemangiomas E. Episodic blanching of the fingers

C, D, & E Esophageal dysmotility is associated with CREST syndrome; it results in dysphagia and esophageal reflux. Spiderlike hemangiomas (telangiectasia) is associated with CREST syndrome. Episodic blanching of the fingers (Raynaud phenomenon), caused by vasospasms of the arterioles, is a sign associated with CREST syndrome. Joint pain, caused by inflammation, is a symptom associated with scleroderma, not CREST syndrome. Masklike facies is a sign associated with scleroderma, not CREST syndrome; it is caused by fibrotic tissue changes.

A nurse leader honors the team members who use new equipment effectively and ensure clients' safety. Which step of Kotter's eight-step change model does a nurse implement in this situation? A. "Build on the change" B. "Create a vision for change" C. "Communicate the change vision" D. "Anchor the changes in the culture"

D

The registered nurse (RN) delegated a task to a licensed practical nurse (LPN). The LPN completed the task effectively. Which statement made by the RN is appropriate feedback? A. "Nice job." B. "Well done." C. "Your performance was good." D. "You performed that procedure safely and professionally."

D

A nurse is caring for a client who sustained a transection of the spinal cord with no other injuries. The nurse continually monitors this client for which medical emergency? A. Hemorrhage B. Hypovolemic shock C. Gastrointestinal atony D. Autonomic hyperreflexia

D Autonomic hyperreflexia, an uninhibited and exaggerated response of the autonomic nervous system to stimulation, results in a blood pressure greater than 200 mm Hg systolic; it is a medical emergency. While hemorrhage and hypovolemic shock could occur from the trauma, the scenario stated that no other injuries occurred. Although gastrointestinal atony can result from immobility, it is not a medical emergency.

The client's pituitary gland must be removed. Which surgery will the client undergo? A. Mastectomy B. Prostatectomy C. Thyroidectomy D. Hypophysectomy

D A hypophysectomy is the surgical removal of the pituitary gland or its tumor. A mastectomy is the surgical removal of breast tissue. A prostatectomy is the surgical removal of the prostate gland. A thyroidectomy is the surgical removal of the thyroid gland.

The nurse assesses for which major complication in a client who has had a gastroscopy? A. Difficulty swallowing B. Increased gastrointestinal (GI) motility C. Nausea with vomiting D. Abdominal distention with pain

D Abdominal distention, which may be associated with pain, can indicate perforation, a complication that can lead to peritonitis. A local inflammatory response to insertion of the fiberoptic tube may result in a sore throat and dysphagia once the anesthesia wears off; difficulty swallowing is expected. Increased GI motility, together with cramping, is an expected response. Nausea with vomiting is not indicative of any particular problem in this situation.

The nurse is educating a couple concerning the process of fertilization. The nurse explains to the couple that which component stimulates the release of estrogen and progesterone after fertilization? A. Inhibin B. Testosterone C. Follicle-stimulating hormone (FSH) D. Human chorionic gonadotropin (hCG)

D After fertilization, human chorionic gonadotropin (hCG) stimulates the corpus luteum to produce estrogen and progesterone. Inhibin is a hormone produced by the ovarian follicles; it inhibits the secretion of follicle-stimulating hormone (FSH) and gonadotropin-releasing hormone (GnRH). Testosterone does not affect the release of estrogen and progesterone. Follicle-stimulating hormone (FSH) stimulates the growth and maturity of the ovarian follicle necessary for ovulation.

Which type of biopsy would the nurse identify as required for removal of entire lesions on the skin? A. Punch biopsy B. Shave biopsy C. Incisional biopsy D. Excisional biopsy

D An excisional biopsy is required to remove entire lesions on the skin. A punch biopsy provides full thickness skin for diagnostic purposes. A shave biopsy provides a thin specimen for diagnostic purposes. An incisional biopsy is used along with shave and punch biopsies.

A client is admitted to the hospital with gastrointestinal bleeding, and a nasogastric tube is inserted. The healthcare provider prescribes the nasogastric tube to be irrigated with normal saline whenever necessary to maintain patency. What should the nurse do first when it is determined that the nasogastric tube is not patent? A. Instill normal saline. B. Assess breath sounds. C. Auscultate for bowel sounds. Check the tube for placement

D Checking the tube for placement reduces the risk of introducing the irrigant into the lungs. Instilling normal saline increases the risk of introducing irrigant into the lungs if the tube is not in the stomach. Assessing for breath sounds is not related to the steps associated with instilling a nasogastric tube with an irrigant. Auscultating for bowel sounds is not related to the steps associated with instilling a nasogastric tube with an irrigant.

The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client? A. Cystitis B. Thin and dry skin C. Decreased bone density D. Frequent yeast infections

D Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density. The risk of cystitis, thin and dry skin, and decreased bone density are due to decreased ovarian production of estrogen.

A client is diagnosed with cancer of the rectum and has surgery for an abdominoperineal resection and colostomy. Which nursing care should be implemented during the postoperative period? A. Limiting fluid intake for several days B. Withholding fluids for 72 hours C. Having the client change the colostomy bag D. Keeping the client's skin around the stoma clean

D If the area is not kept both clean and dry, drainage from the colostomy can quickly cause a breakdown of the skin around the stoma. This, in combination with a warm, moist surface, predisposes the individual to infection. Although oral fluids are withheld until peristalsis returns, it is essential that parenteral fluids be administered to replace the losses incurred by surgery. The client is often unable to accept the altered body image and must be given time to adjust before participating actively in self-care.

Which statement does the nurse know is true regarding the effects of parathyroid hormone on bones for the maintenance of calcium balance? A. Increases bicarbonate and sodium excretion B. Enhances absorption of calcium and phosphorous C. Increases reabsorption of calcium and magnesium D. Increases net release of calcium into extracellular fluid

D Parathyroid hormone affects target tissues such as bone, kidney, and the gastrointestinal tract. The effects of parathyroid hormone on bones will be associated with the increase in the net release of calcium into extracellular fluid. Kidneys are responsible for increasing the bicarbonate and sodium excretion from the body. Action of parathyroid hormone on the gastrointestinal tract would show effects such as enhanced absorption of calcium and phosphorous. Kidneys are responsible for increased reabsorption of calcium and magnesium.

Discharge planning for a client with chronic pancreatitis includes dietary teaching. Which statement indicates to the nurse that the client needs more teaching? A. "I must eat foods high in calories." B. "I should avoid alcoholic beverages." C. "I will eat more often but in smaller amounts." D. "I can eat foods high in fat now that the acute stage is over."

D The nurse needs to follow up on the client statement that indicates eating foods high in fat can be allowed. A low-fat diet should be followed to avoid diarrhea. All the rest of the client responses are correct and do not require additional teaching. The response to eating foods high in calories is appropriate because additional calories are needed to maintain weight. The response to avoiding alcoholic beverages is appropriate to prevent overstimulation of the pancreas. Small, frequent meals limit stimulation of the pancreas and is appropriate.

A 50-year-old male client has difficulty communicating because of expressive aphasia after a cerebrovascular accident (CVA, also known as a "brain attack"). When the nurse asks the client how he is feeling, his wife answers for him. How should the nurse address this behavior? A. Ask the wife how she knows how the client feels. B. Instruct the wife to let the client answer for himself. C. When the wife leaves return to speak with the client. D. Acknowledge the wife but look at the client for a response.

D The opportunity must be provided for the client to practice language skills; family participation must be accepted and recognized. The spouse should be included and involved in the client's care. Asking the wife how she knows how the client feels, instructing the wife to let the client answer for himself, and returning to speak with the client when the wife leaves demean the spouse and cut off communication.

A burn victim has waxy white areas interspersed with pink and red areas on the anterior trunk and all of both arms. The nurse calculates the percentage of total body surface area (TBSA). Which percentage will the nurse report? A. 20 B. 25 C. 30 D. 36

D Using the rule of nines, the percentage of total body surface area burned is 9% for each arm (18% total for both arms) and 18% for the anterior trunk; thus the total body surface area burned is 36%. The choices 20%, 25%, and 30% are too low.

Which auditory test is appropriate for infants? A. Play audiometry B. Pure tone audiometry C. Behavioral audiometry D. Auditory brainstem response (ABR)

C

A nurse is caring for a client with Addison's disease. Upon assessment, which classic sign will the nurse find? A. Ecchymosis B. Hyperreflexia C. Exophthalmos D. Hyperpigmentation

D Hyperpigmentation, or "bronzing," is a classic sign of Addison's disease. Ecchymosis (bruise) is the discoloration of the skin due to rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.