Exam 3 Prep U compilation
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?
Administering ordered analgesics and monitoring their effects Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.
A client who has recently attended a talk on healthy tips for preventing cancer identifies which foods/compounds to be carcinogenic in humans? Select all that apply.
Cigarette smoke Nickel compounds Smoked foods Explanation: There are many agents known to be carcinogenic to humans, including soot, tar, cigarette smoke, arsenic compounds, nickel compounds, and smoked foods among many others.
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.
False Explanation: Gold compounds are used for a client with rheumatoid arthritis who does not respond to the usual anti-inflammatory agents and in whom the conditions worsen despite weeks or months of standard pharmacologic treatment.
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?
Gold salts Explanation: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.
A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment data (or diagnostic data) to confirm the diagnosis. Select all that apply.
Low serum bicarbonate Positive urine ketones Explanation: The definitive diagnosis of DKA consists of hyperglycemia (blood glucose levels >250 mg/dL [13.8 mmol/L]), low serum bicarbonate, low arterial pH, and positive urine and serum ketones.
The nurse is preparing to administer octreotide. The nurse expects to administer this drug by which route?
Subcutaneous Explanation: Octreotide must be administered subcutaneously.
When providing health education to a client taking octreotide, the nurse should warn the client about the possibility of what potential adverse effect?
abdominal pain Explanation: Octreotide and lanreotide have commonly been associated with the development of acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis, which would present with abdominal pain, so clients should be taught to report this symptom. The drug is not associated with alteration in consciousness, changes in vision, or tinnitus.
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?
antimetabolite Explanation: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).
The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?
After the client has had a warm paraffin hand bath Explanation: Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.
A client has undergone extensive diagnostic testing and has been diagnosed with breast cancer staged as T3, N0, M0. What conclusion can the nurse draw from the staging of the client's breast cancer?
The client has a sizable tumor but there is no lymphatic involvement. Explanation: This client's staging indicates a tumour of significant size but no evidence of lymph node involvement or metastasis. The "3" in "T3" does not denote a specific size of 3 mm, however. Metastasis is not currently present, but this does not mean that it is not a future possibility if left untreated.
A patient has been diagnosed with rheumatoid arthritis and is experiencing pain and decreased mobility. Etanercept has been proposed as possible treatment option. Which characteristic of this patient would likely preclude the use of etanercept?
The patient has chronic osteomyelitis resulting from a diabetic foot ulcer. Explanation: Infection is a major contraindication for the use of etanercept. Obesity, family history of cancer, and occasional use of topical corticosteroids do not preclude the use of etanercept.
The nurse is educating a client who is undergoing gamma knife radiosurgery for a brain metastasis. What advantage to this procedure should the nurse share when comparing it to other conventional treatments?
less cognitive dysfunction Explanation: Gamma knife radiosurgery allows the application of focused radiation for limited brain metastasis and is associated with fewer long-term complications, such as cognitive dysfunction, compared to whole-brain radiation. Seizure activity, migraine headaches, and vomiting all can be related to the primary tumor in the brain
Which would the nurse identify as an antineoplastic antibiotic?
mitomycin Explanation: Mitomycin is an example of an antineoplastic antibiotic. Teniposide, vinblastine, and docetaxel are examples of mitotic inhibitors
According to the TNM classification system, T0 means there is
no evidence of primary tumor. Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
Which statement best describes the pathogenesis of systemic lupus erythematosus (SLE)?
Formation of autoantibodies and immune complexes (type III hypersensitivity) Explanation: SLE is characterized by the formation of autoantibodies and immune complexes (B-cell-hyperreactivity). SLE may be acute or insidious, and the course of the disease is characterized by exacerbations and remissions. Exposure to UV light, specifically UVB associated with exposure to the sun or unshielded fluorescent bulbs, may trigger exacerbations.
The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care?
increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?
located over bony prominence Explanation: Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.
A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?
"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." Explanation: A major clinical manifestation of hyperglycemia is fasting blood glucose levels exceeding 126 mg/dL (6.99 mmol/L). A person with a fasting blood glucose level between 100 and 125 mg/dL (5.55 to 6.94 mmol/L) is said to have impaired fasting glucose or prediabetes. The normal hemoglobin A1C level is under 7.
A client has been diagnosed with rheumatoid arthritis (RA). What will the nurse tell the client about this disorder's etiology?
"Genetic predisposition is very likely." Explanation: The cause of RA is uncertain but evidence points to genetic predisposition. The disease usually occurs later in life.
A client is diagnosed with diabetes insipidus. The health care provider orders desmopressin, which the nurse knows is the synthetic equivalent of what hormone?
ADH Explanation: Desmopressin (DDAVP, Stimate) and vasopressin (Pitressin) are synthetic equivalents of ADH. A major clinical use is the treatment of neurogenic diabetes insipidus, a disorder characterized by a deficiency of ADH and the excretion of large amounts of dilute urine.
A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?
Autoimmune process Explanation: The cause of SLE is unknown. It is characterized by the formation of autoantibodies and immune complexes.
A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The oncologist sits down with the client/family to explain treatment options. The nurse knows that which treatment option will be discussed for her cancers?
Chemotherapy Explanation: One of the advantages of chemotherapy is that, unlike surgery and radiation, it is able to treat cancer both at the primary site and at sites of metastasis. Hormone therapy is also able to exert therapeutic effects at a more systemic level, but to a lesser degree than chemotherapy.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids Explanation: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
Patients with hyperthyroidism are characteristically:
Sensitive to heat Explanation: Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
Which of the following disorders is characterized by an increased autoantibody production?
Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.
The nurse is teaching a client with rheumatoid arthritis about pannus, which develops in the affected joint area. What does the nurse include to describe pannus?
Vascular granulation tissue that destroys cartilage and bone Explanation: A network of new blood vessels in the synovial membrane that contributes to the advancement of the rheumatoid synovitis, called pannus, develops. This destructive vascular granulation tissue extends from the synovium to involve a region of unprotected bone at the junction between cartilage and the subchondral bone. Inflammatory cells found in the pannus have a destructive effect on adjacent cartilage and bone leading to reduced joint motion and the possibility of eventual ankylosis.
The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?
allopurinol Explanation: The nurse may be asked to administer allopurinol to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Leucovorin provides folic acid to cells after methotrexate administration.
A client is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurse's best response?
excess TSH Explanation: Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism, which occurs when the thyroid is overstimulated by thyroid stimulating hormone (TSH). This can happen if the thyroid gland does not produce sufficient thyroid hormones to turn off the hypothalamus and anterior pituitary. In the body's attempt to produce the needed amount of thyroid hormone, the thyroid is continually stimulated by increasing levels of TSH. There is a deficiency of thyroxine. It is not related to chloride or iodine deficiencies.
Diabetes insipidus is a relatively rare disease characterized by
the production of large amounts of dilute urine containing no glucose.
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply.
Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray Explanation: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.
A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?
exposure to carcinogens Explanation: When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.
Bone density testing in clients with post-polio syndrome has demonstrated
low bone mass and osteoporosis. Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.
While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse?
"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Explanation: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.
A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make?
"More women than men are affected by lupus." Explanation: There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.
The nurse determines that additional client education is needed when a client with gout makes which statement?
"When I have an exacerbation of my symptoms, a glass of red wine will be helpful." Explanation: The statement about drinking alcohol to decrease the symptoms would need more follow-up, since it is a strong contributor to an exacerbation of gout. The other statements are valid.
Pegvisomant is used to treat which disorder?
Acromegaly Explanation: Pegvisomant is a growth hormone analogue approved for the treatment of acromegaly in patients who do not respond to other therapies.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse Explanation: Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease?
Autologous antibodies Explanation: The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Approximately 70%-80% of people with the disease have a substance called rheumatoid factor, which is an autologous (self-produced) antibody that causes joint destruction.
The nurse identifies the marker for thyroid cancer as which of the following?
Calcitonin Explanation: Calcitonin is the hormonal marker for thyroid cancer. hCG is the marker for germ cell cancer of the testis, CA 125 the marker for ovarian cancer, and CEA the marker for colorectal cancers.
Lack of antidiuretic hormone (ADH) produces which disease process?
Diabetes insipidus Explanation: Lack of ADH produces diabetes insipidus, which is characterized by large amounts of dilute urine and excessive thirst.
Which would a nurse expect to assess in a client experiencing hyperthyroidism?
Flushed, warm skin Explanation: Clients with hyperthyroidism typically exhibit flushed, warm skin; hyperactive deep tendon reflexes; tachycardia; and intolerance to heat.
A nurse is conducting a medication reconciliation for an older adult client who has just relocated to the long-term care facility. The nurse notes that the resident has been taking colchicine on a regular basis. Which medication regimen should signal the nurse to the possibility of what diagnosis?
Gout Explanation: Colchicine, the prototype agent for the treatment and prevention of gout, is the most commonly administered anti-gout medication. This medication is thought to block neutrophil-mediated inflammation. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis since they are not a result of neutrophil-mediated inflammation.
It is well known that cancer is not a single disease. It follows then that cancer does not have a single cause. It seems more likely that the occurrence of cancer is triggered by the interactions of multiple risk factors. What are some identified risk factors for cancer?
Hormonal factors, chemicals, and immunologic mechanisms Explanation: Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic (cancer-producing) agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been interest in obesity and type 2 diabetes mellitus as risk factors for a number of cancers. Body type, age, and color of skin have not been identified as risk factors for cancer.
A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?
Hyperuricemia Explanation: Gout is caused by hyperuricemia (increased serum uric acid).
Release and synthesis of anterior pituitary hormones are mainly regulated by which part of the body?
Hypothalamus Explanation: The hypophysis (pituitary plus hypothalamus) and hypothalamus stimulatory hormones regulate the release and synthesis of anterior pituitary hormones. The adrenal gland and thymus gland hormones are regulated by the hypothalamus. Cell receptors are involved with the target cell response to the hormones
Prostaglandins are chemical substances with what property?
Increase the sensitivity of pain receptors Explanation: Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin
A 55-year-old client has reported joint pain in the feet. Which laboratory result should prompt further testing to rule out primary gout?
Increased serum uric acid Explanation: Although hyperuricemia is not diagnostic of gout, it is suggestive and should prompt further assessment. Increases in CRP, polymorphonuclear leukocytes, and cortisol levels are not as closely associated with the body's response to gout.
Chemotherapeutic agents have which effect associated with the renal system?
Increased uric acid excretion Explanation: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply.
Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Explanation: Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.
A client who has just recently been diagnosed with cancer asks the nurse what tumor markers are. Which answer would be the nurse's best response?
Markers are antigens expressed on the surface of tumor cells. Explanation: Tumor markers are antigens expressed on the surface of tumor cells or substances released from normal cells in response to the presence of a tumor.
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?
Methotrexate (Rheumatrex) Explanation: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Etanercept and Infliximab are TNF-alpha inhibitors that reduce pain and inflammation. Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction.
What is the route of administration for bromocriptine?
Oral Explanation: Bromocriptine is administered orally and effectively absorbed from the gastrointestinal tract.
A client with a history of brain tumors that resulted in partial removal of the pituitary gland years ago expresses concern to the health care provider about whether she will be able to breast-feed her infant. Which physiologic function of the pituitary gland facilitates breast milk production?
Prolactin Explanation: The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin that is involved with breast growth and milk production.
Which laboratory study indicates the rate of bone turnover?
Serum osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.
A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which diagnostic test is being performed?
Stimulation test Explanation: A stimulation test involves the introduction of an element that stimulates the production of another factor or hormone followed by measurement of that hormone. This is not the case in a suppression test, RIA test, or metabolite excretion test.
The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function.
Stimulation tests Explanation: Stimulation tests are used when hypofunction of an endocrine organ is suspected. Suppression tests are used when hyperfunction of an endocrine organ is suspected. Genetic testing is used for DNA analysis, and imaging may be used as a follow-up after the diagnosis.
A nurse is caring for a client admitted with a malar rash on the nose and cheeks. The nurse recognizes that this rash is characteristic of which disease process?
Systemic lupus erythematosus (SLE) Explanation: In SLE, the acute skin lesions include the classic malar or "butterfly" rash on the nose and cheeks.
A 68-year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiologic events involved in her health problem in the correct order that they most likely occurred. Use all the options.
T-cell mediated immune response Interaction between rheumatoid factor (RF) and IgG Inflammatory response Pannus invasion Destruction of articular cartilage
A client's current drug regimen includes intranasal administration of desmopressin acetate. In this client's plan of nursing care, what is the most likely desired outcome of treatment?
The client's urine output will not exceed 80 mL/h. Explanation: Desmopressin acetate is the prototype posterior pituitary hormone medication. It is used to treat diabetes insipidus. Consequently, reduced urine output is the primary goal of treatment. The drug does not influence growth (height) or ovulation.
When a nurse is caring for a client with gout, which diagnostic study supporting the presence of the disease does the nurse monitor?
Uric acid levels Explanation: People diagnosed with a gout disorder have a high uric acid level, greater than 6.8 mg/dL (404.5 μmol/L).
A nurse caring for a patient with diabetes insipidus is reviewing the patient's laboratory results. What is an expected urinalysis finding?
Urine specific gravity of 1.001 to 1.005 Explanation: Patients with diabetes insipidus experience profound polyuria. Consequently, the patient's urine will have a water-like specific gravity (close to 1.000). The urine would not contain abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions?
Weight loss Explanation: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?
Weight loss, glucose monitoring, and oral antihyperglycemic medications Explanation: Persons with type 2 diabetes would be unlikely to require insulin initially and oral medications are likely to be of benefit as an addition to weight loss and glucose monitoring.
A nurse provides nutritional health teaching to an adult client who had two fractures in 1 year. Besides recommending supplemental calcium, the nurse suggests a high-calcium diet. What would the nurse recommend that the client increase intake of?
Yogurt and cheese. Explanation: Yogurt and cheese are excellent sources of calcium. The other choices are low-calcium foods.
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?
colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout
The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout?
colchicine Explanation: Colchicine is prescribed for the treatment of an acute attack of gout.
After administering desmopressin to a client with diabetes insipidus, which would the nurse identify as indicating drug effectiveness?
decreased reports of thirst Explanation: Thirst is associated with diabetes insipidus. A decrease in the symptom would indicate that the drug is working. Diabetes insipidus causes elevated blood glucose levels. Diabetes insipidus causes polyuria. Decreased skin turgor would suggest dehydration, which is a sign of diabetes insipidus.
Which diagnostic finding has been strongly linked to systematic lupus erythematosus (SLE)?
elevated anti-nuclear antibodies (ANA) Explanation: There is no single diagnostic test that is used to diagnose SLE, such as an "SLE assay." However, the most common laboratory test performed is the immunofluorescence test for ANA, because 95% of people eventually diagnosed with the disease have elevated ANA levels. Rheumatoid factor is relevant to the diagnosis of rheumatoid arthritis, but is not among the diagnostic criteria for SLE. SLE can cause anemia, characterized by a low RBC count, but this finding is not specific to SLE to the same degree as elevated ANA.
The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of
gout. Explanation: The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.
Which of the following would a nurse encourage a client with gout to limit?
purine-rich foods Explanation: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.
A client with diabetes insipidus has been administered desmopressin (DDAVP) and is now reporting drowsiness, lightheadedness, and headache. What intervention will best address this client's symptoms?
reduction in the client's dose of desmopressin Explanation: The adverse effects associated with the use of desmopressin include water intoxication (drowsiness, light-headedness, headache, coma, convulsions) related to the shift to water retention and resulting electrolyte imbalance. These symptoms warrant a reduction in dose. The use of diuretics would not resolve the client's symptoms. Epinephrine would resolve anaphylaxis, not water intoxication. Best rest would have no therapeutic effect beyond ensuring physical safety.
A female client with hyperthyroidism reports nervousness and "racing" heart one week after starting antithyroid medication. How should the nurse respond to the client's report?
"It may take three to four weeks for the effects of this medication to be seen." Explanation: Therapeutic effects of the antithyroid drugs may not be observed for three to four weeks. Counting the resting heart rate doesn't address the client's reports. Increasing the dosage is not initially recommended until the client has been taking the medication at least three to four weeks.
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?
"It will get better and worse again." Explanation: The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?
"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Explanation: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.
You are caring for a client who has just been told that they have stage IV colon cancer. The client asks you what "stage IV" means. What would be your best response?
"Stage IV means that the cancer has spread to other organs of the body." Explanation: Stage IV: Cancer has invaded or metastasized to other organs of the body. Options A and B are part of grading tumors not staging them. Option C is incorrect.
Which manifestation indicates a client is at risk for developing diabetes mellitus?
2 hour oral GTT 175 mg/dL (9.7 mmol/L) Explanation: Laboratory values that are considered normal are hemoglobin A1C less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dL or less than 140 mg/dL 2 hours after an oral glucose tolerance test (GTT). A hemoglobin A1C value that is greater than or equal to 6.5 percent; a fasting blood glucose greater than 126 mg/dL, or a blood glucose level greater than 200 mg/dL 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus. Potassium levels do not directly correlate with a diagnosis of diabetes mellitus.
Which client is most likely to develop systemic lupus erythematosus (SLE)?
A 27-year-old Black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more Black women than white women; its incidence is about 1 in every 250 Black women, compared to 1 in every 700 white women.
A client with symptomatic hyperthyroidism is prescribed propranolol. Which clinical manifestation would the nurse identify that indicates the medication is having the desired effect?
A heart rate of 72 beats/min Explanation: Propranolol is recommended for use in all clients with symptomatic hyperthyroidism because it blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. Since tachycardia is associated with hyperthyroidism, a heart rate of 72 beats/min indicates that the drug is having the desired effect. Profuse diaphoresis indicates that the medication is not effective or having the desired effect intended. The blood glucose is not affected by the propranolol use. The blood pressure of this client is not well controlled and still considered hypertensive.
A nurse is managing the care of a client who has gout. Which medication would be prescribed as the drug of choice to prevent tophi formation and promote tophi regression?
Allopurinol Explanation: Allopurinol (Zyloprim), a xanthine oxidase inhibitor, is considered the drug of choice for preventing the precipitation of an attack, preventing tophi formation, and promoting the regression of existing tophi. Uricosuric agents, such as probenecid (Benemid), correct hyperuricemia and dissolve deposited urate.
When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of:
Anterior pituitary gland Explanation: The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH, and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin.
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Below-normal serum potassium level Explanation: A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?
Biopsy of the axillary lymph nodes Explanation: The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.
The nurse knows that which assessment finding suggests hyperthyroidism?
Blood pressure 145/87 Explanation: Moderate hypertension is a sign of hyperthyroidism. Bradycardia, cool and dry skin, and hard, thick nails are suggestive of hypothyroidism.
A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.
Decrease in serum thyroid-stimulating hormone (TSH) Increased T3 Increased T4 Increase in radioactive iodine uptake Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.
The nurse is reviewing the test results of a client who was given thyrotropin-releasing hormone (TRH) to evaluate the function of the pituitary gland. The nurse would recognize pituitary dysfunction as:
Decreased TSH levels Explanation: Stimulation tests are used when hypofunction of an endocrine organ is suspected. Failure to increase TSH levels after a TRH stimulation test suggests an inadequate capacity to produce TSH by the pituitary (i.e., the pituitary is dysfunctional in some way).
The nurse is caring for a client with rheumatoid arthritis (RA). Which assessment findings correlate with this diagnosis? Select all that apply.
Fatigue Weight loss Anorexia Explanation: RA is characterized by weight loss, generalized aching, anorexia, fatigue, as well as joint changes such as pain and stiffness. Increased appetite and flushed skin are not symptoms of RA.
The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:
Growth factors Explanation: Many tumors secrete growth factors, which trigger and regulate the angiogenesis process. Tumor cells express various cell surface attachment factors, for anchoring. Tumor cells secrete proteolytic enzymes to degrade the basement membrane and migrate into surrounding tissue. Cancer cells may produce procoagulant materials that affect clotting mechanisms.
Which hormones are secreted by the anterior pituitary gland? (Select all that apply.)
Growth hormone Adrenocorticotropic hormone Prolactin Explanation: Prolactin, adrenocorticotropic hormone, growth hormone, luteinizing hormone, follicle stimulation hormone, and thyroid stimulating hormone are secreted by the anterior pituitary gland.
Which hormone is produced by the anterior pituitary gland?
Growth hormone (GH) Explanation: GH is among the hormones produced and released by the anterior pituitary. Oxytocin is a posterior pituitary hormone, whereas CRH is produced by the hypothalamus. Norepinephrine and epinephrine are produced by the adrenal medulla.
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?
Ham and bacon Explanation: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.
An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health?
Immunologically mediated joint inflammation Explanation: The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Paget disease is caused by abnormal bone resorption and remodeling, whereas collagen deposition underlies scleroderma. Osteoarthritis is believed to be initiated by mechanical injury and subsequent cytokine release.
While studying cancer, nursing students learn about the process by which cancer-causing agents cause normal cells to become cancerous. This process is a multi-step mechanism that can be divided into three stages, which include which of the following? Select all that apply.
Initiation Promotion Progression Explanation: The process by which carcinogenic agents cause normal cells to become cancerous is a mechanism that are divided into three stages: initiation, promotion, and progression.
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of:
Intolerance to heat Explanation: With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this?
Iodine Explanation: Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?
It is suggestive of rheumatoid arthritis. Explanation: Rheumatoid factor is present in about 70% to 80% of patients with rheumatoid arthritis, but its presence alone is not diagnostic of rheumatoid arthritis, and its absence does not rule out the diagnosis. The antinuclear antibody (ANA) test is used to diagnose Sjögren's syndrome and systemic lupus erythematosus.
Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?
Joint pain and proteinuria Explanation: Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage.
Which joint is most commonly affected in gout?
Metatarsophalangeal Explanation: The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.
The nurse is caring for a client with newly diagnosed systemic lupus erythematosus (SLE). Which over-the-counter medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis?
Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Treatment with medications may be as simple as a drug to reduce inflammation, such as an NSAID. NSAIDs can control fever, arthritis, and mild pleuritis.
The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.
Safe exercise Medication dosages and side effects Assistive devices Explanation: The client with rheumatoid arthritis who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints, walkers, and canes, may assist the client to perform safe self-care. Narcotics are not commonly used, and there would be no reason for dressings.
Which of the following agents suppress release of thyroid hormones? Select all that apply.
Sodium iodide Potassium iodide Dexamethasone Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.
The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action?
Stop the infusion and inform the health care provider immediately. Explanation: Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit by distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.
While reviewing the following diagnostic findings on a group of clients with joint complaints, which finding would be a priority for further investigation and possible medical intervention?
Synovial fluid aspiration indicates the presence of monosodium urate crystals. Explanation: The presence of crystalline deposits in synovial fluid confirms a diagnosis of gout and would necessitate further investigation and/or treatment. Hyperuricemia is not necessarily indicative of gout, and while diet can contribute to gout, this would not necessarily require modification in the absence of gout. Oral colchicine often takes 48 hours to take effect during an acute attack of gout.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. Explanation: Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.
During the follicular stage of menstruation, increased estradiol production causes an increase in FSH production. This increase in FSH production by the anterior pituitary gland will have what effect on the follicle?
The follicle will die, which results in a fall of FSH. Explanation: In positive feedback control, rising levels of a hormone cause another gland to release a hormone that is stimulating to the first. Increased estradiol production during the follicular stage of the menstrual cycle causes increased FSH production by the anterior pituitary gland. This stimulates further increases in estradiol levels until the demise of the follicle.
When teaching a client recently diagnosed with systemic lupus erythematosus (SLE), what does the nurse teach the client to avoid to prevent exacerbations?
Ultraviolet light (UV) Explanation: Possible environmental triggers for SLE include UV light, chemicals (e.g., drugs, hair dyes), some foods, and infectious agents. Sun exposure may trigger exacerbations.
The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?
Vitamin D Explanation: To support the absorption of calcium from the gastrointestinal tract and increase the amount of calcium in the blood, there needs to be sufficient active vitamin D. Vitamin A is for eye health. Vitamin B12 is for anemia prevention. Vitamin C is used for skin and immune health.
An older adult client has recently been diagnosed with rheumatoid arthritis. The nurse should focus assessment on which aspects?
Weight and nutritional status Explanation: Anorexia is a common extra-articular symptom of rheumatoid arthritis. Consequently, there is a need to monitor the client's nutritional status and intake. Cognition, respiratory status, and electrolytes are not typically affected.
A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?
hydroxychloroquine Explanation: The DMARD hydroxychloroquine is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmologic examinations every 6-12 months. Azathioprine, diclofenac, and cyclophosphamide do not have visual changes as a side effect.
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation?
random blood glucose 195 mg/dl (10.8 mmol/l) Explanation: Laboratory values that are considered normal are hemoglobin A1C less than 6%, fasting plasma glucose (FPG) less than 100 mg/dl (5.5 mmol/l) or less than 140 mg/dl (7.8 mmol/l) 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5%, a fasting blood glucose greater than 126 mg/dl (7.0 mmol/l), or a blood glucose level greater than 200 mg/dl (11.1 mmol/l) 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the 2-hour GTT results and should be below 200 mg/dl (11.1 mmol/l). Although the client does not have a result that meets the threshold to be diagnosed with diabetes, the elevated levels warrant assessment for prediabetes and early intervention.
The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply.
susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.
The control mechanisms for most metabolic functions of the body, as well as the maintenance of homeostasis, is the function of:
the hypothalamus and the pituitary gland. Explanation: The hypothalamus of the brain and the pituitary gland interact to control most metabolic functions of the body and to maintain homeostasis. The hypothalamus controls secretions of the pituitary gland. The pituitary gland, in turn, regulates secretions or functions of other body tissues, called target tissues.
A cancer client has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S phase of the cell cycle. When teaching this client, the nurse explains that during the S phase of the cell cycle:
the synthesis of DNA occurs, causing two separate sets of chromosomes to develop. Explanation: During the S phase, DNA synthesis occurs, causing two separate sets of chromosomes to develop. Antimetabolites can cause abnormal timing of DNA synthesis. Because of their S-phase specificity, the antimetabolites are more effective when given as a prolonged infusion.
The nurse is caring for a client receiving octreotide for the treatment of acromegaly. The nurse should emphasize the need for what form of baseline and periodic testing?
ultrasound evaluation of the gallbladder Explanation: Arrange for baseline and periodic ultrasound evaluation of the gallbladder for clients receiving octreotide because common adverse effects of the drug are acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis. A client taking octreotide does not need baseline and periodic MRIs of the brain, serum glucose levels, or complete blood counts.
A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply.
"I'm having a hard time opening doors since it hurts so bad." "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands." "Look how my hand is deformed. My doctor calls it hyperextension." Explanation: Rheumatoid arthritis (RA) joint involvement usually is symmetric and polyarticular. Pain with turning door knobs, opening jars, and buttoning shirts is commonly reported due to swelling of the wrists and small joints of the hand. Hyperextension of the PIP joint and partial flexion of the distal interphalangeal (DIP) joint is called a swan neck deformity. As the RA inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia. With osteoarthritis (OA), joint changes result from the inflammation caused when the cartilage attempts to repair itself, creating osteophytes or spurs. Raynaud phenomenon (a vascular disorder characterized by reversible vasospasm of the arteries supplying the fingers) and telangiectasia (dilated skin capillaries) are characteristic of scleroderma.
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?
"Ketones will tell us if your body is using other tissues for energy." Explanation: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.
A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client?
"Losing some weight and reducing your alcohol intake will likely be beneficial." Explanation: For many clients with gout, changes in lifestyle may be needed, such as maintenance of ideal weight, moderation in alcohol consumption, and avoidance of purine-rich foods. Weekly blood work is not necessary and NSAIDs are preferred to opioids for pain management. Physiotherapy is not a major treatment modality for gout.
Spinal cord injury is an example of which type of disability?
Acquired Explanation: Spinal cord injury is an example of an acquired disability. An acute nontraumatic injury is a stroke or myocardial infarction. Age-related disabilities include hearing loss, osteoporosis, and osteoarthritis. Cerebral palsy and muscular dystrophy are examples of developmental disabilities.
A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect?
Dawn phenomenon Explanation: The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement during the early morning hours. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors. The other answer selections are not characterized by increased early morning levels of blood glucose.
A client experiences an increase in cortisol as a result of Cushing disease. Which hormonal responses demonstrate the negative feedback mechanism?
Decreased adrenocorticotropic hormone (ACTH) Explanation: Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, ACTH manufactured by the anterior pituitary gland would normally stimulate the release of cortisol, but with the increase of cortisol produced by the secreting tumor, enough cortisol already floods the system that there should be a reduction in the ACTH level.
A head injury has resulted in the hospitalization of a client. Nursing assessments confirm that the client is producing substantial amounts of dilute urine and is consuming large amounts of liquids. Considering the history and assessment findings support the possibility of what metabolic disorder?
Diabetes insipidus (DI) Explanation: Diabetes insipidus is caused by a deficiency in the amount of posterior pituitary ADH and may result from pituitary disease or injury (e.g., head trauma, surgery, tumor). With this rare metabolic disorder, patients produce large quantities of dilute urine and are constantly thirsty. None of the other options present with this clinical picture of history and assessment findings.
The nurse is caring for a client who is receiving desmopressin for treatment of neurogenic diabetes insipidus. The nurse will be alert for which symptom that will alert the client to a serious adverse effect?
Diminished mental status Explanation: The nurse needs to be alert for signs of hyponatremia, which include diminished mental status. Decrease in urine output, decrease in thirst, and increase in urine specific gravity are all therapeutic effects.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?
Elevated erythrocyte sedimentation rate Explanation: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.
A patient has been admitted to an acute medical unit with a diagnosis of diabetes insipidus with a neurogenic etiology. When planning this patient's care, what diagnosis should be the nurse's most likely priority?
Fluid volume deficit related to increased urine output Explanation: The hallmark of diabetes insipidus, and the primary focus of interventions, is the copious urine output that accompanies the condition. Confusion, injury, and impaired nutrition are less likely to result from diabetes insipidus.
Octreotide (Sandostatin) would be the drug of choice in the treatment of acromegaly in a client with which of the following conditions?
Hypothalamic lesions Intolerance to other therapies Acromegaly in a client older than the age of 18 years
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Explanation: Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.
The ICU nurse is assessing a client who has been given desmopressin for treatment of diabetes insipidus. What lab values should the nurse prioritize during assessment?
Sodium Explanation: The FDA has issued a black box warning stating that clients taking desmopressin can develop hyponatremia, leading to seizures. Consequently, assessment of sodium levels takes precedence over hematocrit, calcium, and platelet levels.
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?
dyspnea and hypertension Explanation: Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.
When caring for a client with diabetes insipidus, the nurse expects to administer:
vasopressin. Explanation: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life?
weight loss and inadequate food intake Explanation: The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
"Monitor your body temperature." Explanation: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.
Following a progressive onset of fatigue, aching, and joint stiffness over the last two years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which teaching point should his primary care physician include during the office visit in which this diagnosis is communicated to the client?
"Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms." Explanation: Current treatment guidelines for RA involve early and aggressive pharmacologic treatment, including NSAIDs and corticosteroids. Damage cannot be reversed, and while therapeutic exercise plays a role in treatment, rest is also important.
An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as
Acquired Explanation: An acquired disability results from an acute and sudden injury, such as trauma to the spinal cord. The paralysis may be temporary. It may not be known to be permanent until swelling in the spinal cord has decreased. This may take weeks to months. A developmental disability is one that occurs prior to age 22 years. An age-related disability occurs in the elderly population as a result of the aging process.
A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?
Acquired disability Explanation: Disabilities can be categorized as developmental disabilities, acquired disabilities, and age-associated disabilities. Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury (e.g., traumatic brain injury, spinal cord injury, traumatic amputation), acute nontraumatic disorders (e.g., stroke, myocardial infarction), or progression of a chronic disorder (e.g., arthritis, multiple sclerosis, chronic obstructive pulmonary disease, blindness due to diabetic retinopathy). A chronic disability is one that has a long disease course and is likely incurable. An impairment is a loss or abnormality of psychological physiologic, or anatomic structure or function at the organ level.
A new client arrives at the clinic. The physician is suspecting the client may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and history of pleural effusions. The nurse should anticipate which diagnostic test will be a priority to facilitate with the diagnosis?
Anti-DNA antibody test. Explanation: 95% of people with untreated SLE have high ANA levels. However, ANA is not specific for SLE. The anti-DNA antibody test is more specific for the diagnosis of SLE. Hemoglobin may be low if the client has severe anemia but it is not specific for SLE. C-reactive protein will show an inflammatory response but again not specific for SLE.
The client takes naproxen for arthritic pain and is now prescribed warfarin for persistent atrial fibrillation. Due to the interactions of the medications, what is the nurse's best response?
Assess the client's stool for color Explanation: Clients who take NSAIDs, such as naproxen (Aleve), with warfarin (Coumadin) may experience gastrointestinal bleeding. The nurse will need to monitor for this. Clients are to ingest a consistent level of vitamin K. Administering the medications with food does not increase absorption. Ingesting food with the medications may decrease gastrointestinal upset. Clients are instructed to not ingest alcohol.
An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of what?
BUN and creatinine Explanation: The antimetabolites may also be nephrotoxic. MTX use in clients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the client's renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.
A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given:
Before pain is experienced. Explanation: NSAIDs are most effective for preventive pain management when administered on a fixed-schedule (i.e., every 3-4 hours) to prevent the pain experience. When combined with an opioid, the medication regimen is highly effective in managing moderate to severe pain.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl Explanation: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery?
Cerebrospinal fluid leakage Explanation: Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF.
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?
Consume adequate amounts of fluid. Explanation: The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.
A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:
Dawn phenomenon Explanation: A change in the normal circadian rhythm for glucose tolerance, which usually is higher during the later part of the morning, is altered in people with diabetes, with abnormal nighttime growth hormone secretion as a possible factor. The dawn phenomenon is characterized by increased levels of fasting blood glucose or insulin requirements, or both, between 5 AM and 9 AM without preceding hypoglycemia. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. The cycle begins when the increase in blood glucose and insulin resistance is treated with larger insulin doses. The insulin-induced hypoglycemia produces a compensatory increase in blood levels of catecholamines, glucagon, cortisol, and growth hormone, leading to increased blood glucose with some insulin resistance.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP) Explanation: DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.
Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?
Developmental Explanation: Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.
A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the client for which clinical manifestations?
Dry lips, excess urine output, and seizures. Explanation: Hyperosmolar hyperglycemic state is characterized by high blood glucose (>600 mg/dL [33.3 mmol/L]), dehydration (dry lips), depression of sensorium, hemiparesis, seizures, and coma. The client may also experience weakness, polyuria, and excessive thirst. HHS may occur in various conditions, including type 2 diabetes, acute pancreatitis, severe infection, MI, and treatment with oral or parenteral nutrition solutions.
Which nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms?
Elevating the head of the bed. Explanation: The nurse should monitor the respiratory status and elevate the head of the bed to relieve respiratory symptoms. A high-iodine diet does not relieve respiratory distress. Although proper air circulation in the room and avoiding physical exertion may be important, these actions do not address the respiratory symptoms.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Extravasation Explanation: The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?
Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.
The nurse is planning care for a client who is receiving antimetabolite chemotherapy. What should the nurse include in the plan of care? Select all that apply.
Falls prevention protocol Daily weights Monitor bowel movements closely. Explanation: Common side effects when taking an antimetabolite include stomatitis, diarrhea, and myelosuppression. The nurse should monitor bowel movements due to the risk for diarrhea and for possible gastrointestinal blood loss related to thrombocytopenia and mucosal injury, which affect the S phase of the cell cycle. Due to this increased risk for bleeding, falls prevention is also important. While stomatitis would make a soft diet appropriate, fresh fruits and vegetables can introduce microbes that could be harmful for the immunocompromised client. Due to this increased risk for infection, an indwelling catheter is not recommended. Daily weight can help determine total body water and is recommended due to the risk for decreased intake and increased losses for these clients, placing them at risk for fluid volume deficit.
A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis?
Fluid deprivation test Explanation: Diabetes insipidus (DI) is the most common disorder of the posterior lobe of the pituitary gland and is characterized by a deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day. Explanation: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply.
Foods high in vitamin D Foods high in protein Foods high in calcium Explanation: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?
Fruity breath Explanation: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.
A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?
Helping the client make meaningful changes to his diet and activity level. Explanation: Weight loss and dietary management are the initial focus of treatment for type 2 diabetes. For many people with type 2 diabetes, the benefits of exercise include a decrease in body fat, better weight control, and improvement in insulin sensitivity. If good glycemic control cannot be achieved with exercise and diet, then antidiabetic agents and even insulin can be added to the treatment plan. Education is imperative, but there is no need to emphasize hypoglycemia, since there is no evidence the client is on a medication that would cause hypoglycemia.
Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.
Hemoglobin A1C 9.1% (.09) 2 hour oral GTT 245 mg/dL (13.6 mmol/L) Explanation: Laboratory values that are considered normal are hemoglobin A1C less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dL or less than 140 mg/dL 2 hours after an oral glucose tolerance test (GTT). A hemoglobin A1C value that is greater than or equal to 6.5 percent; a fasting blood glucose greater than 126 mg/dL; or a blood glucose level greater than 200 mg/dL 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus. Potassium levels do not directly correlate with a diagnosis of diabetes mellitus.
Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.
Hydrocortisone Acetaminophen Methimazole Iodine Explanation: Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing?
Hyperglycemic hyperosmolar syndrome Explanation: Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes (Reynolds, 2012). The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis).
The hypophysis is a unit formed by the pituitary and the hypothalamus. These two glands are connected by the blood flow in what system?
Hypophyseal portal system Explanation: The hypothalamus and pituitary (i.e., hypophysis) form a unit that exerts control over many functions of several endocrine glands as well as a wide range of other physiologic functions. These two structures are connected by blood flow in the hypophyseal portal system, which begins in the hypothalamus and drains into the anterior pituitary gland, and by the nerve axons that connect the supraoptic and paraventricular nuclei of the hypothalamus with the posterior pituitary gland.
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland?
Hypothalamus Explanation: The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?
If you have problems with a medication, you may stop it until your next physician visit. Explanation: Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
The most common type of goiter is caused by lack of which of the following?
Iodine Explanation: The most common type of goiter is often encountered in geographic regions where there is lack of iodine. If too little iodine exists, the level of thyroxine will decrease, causing the stimulation of thyroid-stimulating hormone (TSH) from the anterior pituitary.
Joint destruction in rheumatoid arthritis occurs by an obscure process. The cellular changes, however, have been documented. Place the process in the correct order.
Neutrophils, macrophages, and lymphocytes arrive Immune complexes phagocytized, releasing lysosomal enzymes Destructive changes in joint cartilage Inflammatory response Reactive hyperplasia of synovial cells and subsynovial tissues Vasodilation and joint swelling Explanation: The role of the autoimmune process in the joint destruction of RA remains obscure. At the cellular level, neutrophils, macrophages, and lymphocytes are attracted to the area. The neutrophils and macrophages phagocytize the immune complexes and, in the process, release lysosomal enzymes capable of causing destructive changes in the joint cartilage. The inflammatory response that follows attracts additional inflammatory cells, setting into motion a chain of events that perpetuates the condition. As the inflammatory process progresses, the synovial cells and subsynovial tissues undergo reactive hyperplasia. Vasodilation and increased blood flow cause warmth and redness. The joint swelling that occurs is the result of the increased capillary permeability that accompanies the inflammatory process.
An adult client with suspected hypothyroidism is scheduled for a thyrotropin-releasing hormone (TRH) stimulation test to evaluate pituitary response. Which test results would confirm secondary hypothyroidism?
No increase in TSH Explanation: A stimulation test is intended to determine if an organ that is undersecreting will produce an increased response. A normal response to the TRH stimulation test would be for the pituitary to produce an increased amount of TSH. If the pituitary gland responds with increased production, then hypothalamic undersecretion may be the cause of the condition. If the pituitary does not increase secretion, it can indicate secondary hypothyroidism. Calcitonin is not secreted by the pituitary.
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?
Observe the color of stool. Explanation: The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.
The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply.
Pallor Rapid respiratory rate Hypotension Explanation: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.
A client with rheumatoid arthritis has been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory result(s) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply.
Platelet count 10,000/µL (100 ×109/L) Red blood cell count of 8.0 ×106/µL (8.0 ×1012/L) Absolute neutrophil count of 500/µL (0.50 ×109/L) Explanation: Bone marrow suppression, also known as myelosuppression, is the decrease in production of cells responsible for providing immunity (leukocytes), carrying oxygen (erythrocytes), and/or those responsible for normal blood clotting (thrombocytes). Anemia occurs when red blood cells are low. Leukopenia/neutropenia happens when the white blood cells are low. White blood cells help your body fight off diseases. Leukopenia does not cause many noticeable side effects, but it means the person will be at higher risk of developing an infection. Thrombocytopenia is when your platelet count is low. A normal platelet count ranges from 150,000/μL to 400,000/μL (1500 to 4000 ×109/L) ; below 10,000/μL (100 ×109/L) is a severely low count. With this disorder, one will likely notice bruising easier, bleeding easier, having tiny red spots on the skin, or having blood in the urine. Normal adult red blood cell count is between 12 to 14 g/dL . Below that is low and called anemia. Neutropenia is an abnormally low concentration of neutrophils (a type of white blood cell) in the blood. Normal serum potassium levels are between 3.5 and 5.0 mEq/L (3.5 and 5.0 mmol/L). Normal adult creatinine levels (which indicates renal function) is 0.6 to 1.2 mg/dL (53-106 µmol/L).
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder?
Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.
After teaching a group of students about growth hormone agonists and antagonists, the instructor determines that additional teaching is needed when the students identify which agent as a growth hormone antagonist?
Somatropin Explanation: Somatropin is a growth hormone agonist.
Research has identified a cycle of insulin-induced post hypoglycemic episodes. What is this phenomenon called?
Somogyi effect Explanation: The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. In 1924, Joslin and associates noticed that hypoglycemia was associated with alternate episodes of hyperglycemia.
A client undergoing an evaluation of hormone levels asks, "What regulates the hormone levels?" Which response by the nurse would be considered most accurate?
The hypothalamic-pituitary-target cell system Explanation: The levels of many of the hormones are regulated by feedback mechanisms that involve the hypothalamic-pituitary-target cell system. Positive feedback control refers to rising levels of a hormone that causes another gland to release a hormone that is stimulating to the first. The hypophyseal portal system connects the supraoptic and paraventricular nuclei of the hypothalamus with the posterior pituitary gland. Exogenous forms of hormones (given as drug preparations) can influence the normal feedback control of hormone production and release.
When describing to a client newly diagnosed with diabetes how insulin is regulated, the nurse will draw upon her knowledge of which hormonal regulation mechanism?
The hypothalamic-pituitary-target cell system Explanation: The hypophysis (pituitary plus hypothalamus) and hypothalamus stimulatory hormones regulate the release and synthesis of anterior pituitary hormones. The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body. The levels of many of the hormones are regulated by feedback mechanisms that involve the hypothalamic-pituitary-target cell system.
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms?
The moon face and acne will resolve when the medication is tapered off. Explanation: Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding?
The patient may have hyperthyroidism. Explanation: If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
Which factor is the focus of nutrition intervention for clients with type 2 diabetes?
Weight loss Explanation: Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.
The nurse is caring for a client whose current chemotherapy regimen includes mitomycin. What is the client's most likely diagnosis?
adenocarcinoma of the pancreas Explanation: Mitomycin is used before the treatment of disseminated adenocarcinoma of the stomach and pancreas. It is not indicated in the treatment of non-Hodgkin lymphoma, lung cancer, or neuroblastoma.
A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects?
aspirin Explanation: Salicylates like aspirin may have side effects such as tinnitus, gastric intolerance and bleeding. While celecoxib, methotrexate, and hydroxychloroquine have GI upset effects, the tinnitus is unique to aspirin.
The nurse administers desmopressin (DDAVP) to the client to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?
decreased urine output Explanation: Desmopressin produces its antidiuretic activity in the kidneys, causing the cortical and medullary parts of the collecting duct to become permeable to water, thereby increasing water reabsorption and decreasing urine formation. These activities reduce plasma osmolarity and increase blood volume.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.
dietary substances environmental factors viruses Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.
The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply.
dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.
Goiter, or enlargement of the thyroid gland, is usually associated with
hyperthyroidism.
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?
"My finger joints are oddly shaped." Explanation: Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.
The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?
Follow a low purine diet Explanation: The nurse should encourage the client to follow a low-purine diet which would exclude items such as any alcohol products, organ and game meat, sardines, anchovies, scallops, asparagus, spinach, and peas. Alcohol should not be used at all even in moderation to avoid future attacks of gout. For acute gouty flare-ups, take one dose and the second dose 1 hour later. The dose should not be doubled. Although severe diarrhea may occur, it is not an expected or therapeutic response and should be immediately reported to the health care provider.
A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client?
Magnetic resonance imaging Explanation: Magnetic resonance imaging is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.
A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply.
Positive C-reactive protein (CRP) Positive antinuclear antibody (ANA) Red blood cell (RBC) count of <4.0 million/mcL Explanation: Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive.
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?
Shorten the period of neutropenia Explanation: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?
Calcitonin Explanation: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.
The family member of a client with terminal metastatic cancer who is experiencing cachexia-related weight loss asks the nurse why the client is losing weight despite taking in a large amount of calories per day. What is the nurse's best response?
"This weight loss is related to the cancer itself and occurs despite an intake of adequate calories." Explanation: The nurse should take the opportunity to educate the family member about the condition of cachexia-associated weight loss. This type of weight loss and protein wasting is not directly related to nutritional intake and is not simply lack of digestion of nutrients. Oral or parenteral nutritional supplementation does not reverse cachexia, so the nurse should not imply this by encouraging the family member to bring in food from home or starting tube feeding.
When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider would include which statement?
Blocks the production of uric acid by the body Explanation: Xanthine oxidase inhibitors block the synthesis of uric acid. In this classification, the most commonly prescribed to lower urate levels is allopurinol. The uricosuric agents prevent the tubular reabsorption of urate and increase its excretion in the urine. Uricase agents convert insoluble uric acid to a soluble product than can be excreted easily. Pegloticase is an infusible uricase agent that works rapidly to reduce serum uric acid.
Which type of surgery is used in an attempt to relieve complications of cancer?
Palliative Explanation: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?
minimizing damage Explanation: Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results.
A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of?
organ meats Explanation: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, chocolate, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with gouty arthritis.
The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond?
"I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back." Explanation: Personality changes, mood swings and irritability can be common manifestations of both growth of the brain tumor and also the process of grief and loss, such as in the case of the client who is receiving end-of-life care. The client's anger and yelling at the nurse is indicative of ineffective coping and warrants the nurse to take a therapeutic approach when responding to the anger. Acknowledging that the client is not ready to receive care at the moment and asking the client to contact the nurse when he or she is ready enables to client to maintain control and promotes self-esteem. Telling the client to speak to the nurse's supervisor does not promote a strong nurse-patient relationship and is not a supportive way to manage end-of-life care. Telling the client that he or she is not permitted to speak to the nurse "that way" may increase the client's anger and puts limits on the client's sense of control. This response does not promote an effective nurse-patient relationship. The nurse must use extra caution when responding to a client who is experiencing emotional swings when faced with death and dying. By stating, "I can see you no longer want me as your nurse," the nurse is making an assumption that the client does not want him or her as the nurse any longer. By making this statement, the nurse is limiting opportunities for the client to verbalize feelings and emotions related to stress, grief and loss.
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?
"The belief is that it is an autoimmune disorder with an unknown trigger." Explanation: Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.
The nurse is teaching a client with systemic lupus erythematosus (SLE) about the typical treatment course with this condition. Place in order the typical classes of medication used from earliest stages to the latest stages of the disease. Use all options.
-nonsteroidal anti-inflammatory drugs (NSAIDs) -antimalarial drug (hydroxychloroquine) -systemic corticosteroid drugs -immunosuppressive medications Explanation: Treatment of SLE begins with the anti-inflammatory medications that pose the least side effects while symptoms are mild, such as an NSAID to control fever and arthritis. If this class fails to control symptoms, the antimalarial drug hydroxychloroquine is generally the next medication used. Once this medication fails to control symptoms, corticosteroids may be added to control the more significant symptoms. Sometimes high-dose corticosteroids may need to be used to control symptoms. Finally, immunosuppressive drugs such as cyclophosphamide are used in cases of severe disease.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?
Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply.
Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.
A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that:
Growth is slow and symptoms are caused by compression rather than tissue invasion. Explanation: A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor.
An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?
prophylactic Explanation: Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryoablation uses cold to destroy cancerous cells.
A client and family are dealing with the client's recent terminal diagnosis. A nurse identifies a nursing diagnosis of hopelessness. Which of the following would be most helpful in supporting hope for this family? Select all that apply.
-Arranging for appropriate psychosocial counseling -Encouraging the client to participate in care to foster control -Helping to obtain support from the community Explanation: To enable, support, and foster hope in terminally ill clients and their families, nurses should encourage and support the client's control over circumstances, choices, and environment whenever possible, make referrals for psychosocial and spiritual counseling, and assist with developing supports in the home and community when none exist. Goals set should be realistic, rather than long-term. Information and feelings should be shared. The information provided also should be accurate.
The nurse in the oncology outpatient clinic receives a phone call from a family member of a client who was diagnosed with a metastatic spinal cord tumor. The family member informs the nurse that the client has been reporting increased back pain in the region of the tumor and dizziness. How should the nurse respond?
Tell the family member to get the client to hospital for emergency assessment Explanation: The client's reported symptoms are indicative of spinal cord compression, a complication of spinal cord tumors that can lead to permanent paralysis and several other irreversible sensory impairments. Signs and symptoms of spinal cord compression warrant an urgent assessment, because it is an emergency. Providing education regarding pain management, sharing information about expected symptoms and encouraging the client to lie in the prone position are all ineffective and unsafe nursing actions, because the presenting complaints warrant emergency assessment and intervention.
The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?
The patient has rheumatoid arthritis. Explanation: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.
