hesi evolve questions (endocrine, neuro)

Which intervention would the nurse include in the plan of care for a client with Addison disease? - encourage exercise - protect from exertion - restrict fluid intake - monitor for hypokalemia

protect from exertion (rationale: exertion, either physical or emotional, places additional stress on the adrenal glands) (53% nationwide answered correctly)

The nurse is educating a client with hypothyroidism about the use of levothyroxine. Which information would the nurse provide? Select all that apply. One, some, or all responses may be correct. - take dose same time each day - refrain from switching brands - have regular bloodwork drawn - hold medication for pulse >60 beats per minute - report weight loss more than 3 pounds

- take dose same time each day - refrain from switching brands - have regular bloodwork drawn (25% nationwide answered correctly)

A client manifests right-sided hemianopsia as a result of a cerebrovascular accident (CVA, also known as a "brain attack"). Which goal would the nurse include in the client's plan of care? - correct the client's misuse of equipment - instruct the client to scan surroundings - teach the client to look at the position of the left extremities - provide the client with tactile stimulation to the affected extremities

instruct the client to scan surroundings (rationale: the client has lost vision from the right visual field; scanning compensates for this loss) (67% nationwide answered correctly)

Which assessment findings are associated with Cushing disease? Select all that apply. One, some, or all responses may be correct. - round face - dependent edema in the feet and ankles - increased fatty deposition in the extremities - thin, translucent skin with bruising - increased fatty deposition in the neck and back

- dependent edema in the feet and ankles - thin, translucent skin with bruising - increased fatty deposition in the neck and back (11% nationwide answered correctly)

The nurse is assessing a client with a moon-shaped face and thin arms and legs. The nurse expects which other assessment findings? Select all that apply. One, some, or all responses may be correct. - weight loss - gastric ulcer - pain in bones - poor appetite - muscle weakness

- gastric ulcer - pain in bones - muscle weakness (46% nationwide answered correctly)

Which findings would support a client's diagnosis of Parkinson disease? Select all that apply. One, some, or all responses may be correct. - nonintentional tremors - frequent bouts of diarrhea - masklike facial expression - hyperextension of the neck - rigidity to passive movement

- nonintentional tremors - masklike facial expression - rigidity to passive movement (rationale: nonintentional tremors r/t degeneration of dopaminergic pathways & excess cholinergic activity. mask like facial expression r/t nigral and basal ganglia depletion of dopamine/ cogwheel rigidity is increased resistance to passive motion & is a classic sign) (64% nationwide answered correctly)

The nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan? - increase potassium intake to replace renal losses - increase protein intake to heal the adrenal tissue and thus cure the disease - take supplemental vitamins to supply energy and assist in regaining the weight that was lost - consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium

consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium (rationale: lack of mineralocorticoids (aldosterone) leads to loss of sodium) (74% nationwide answered correctly)

Which symptom would the nurse expect a client diagnosed with Cushing syndrome to exhibit? - lability of mood - postural hypotension - increased skin thickness - ectomorphism with a moon face

lability of mood (rationale: excess adrenocorticoids can cause emotional lability, euphoria, and psychosis) (24% nationwide answered correctly)

The nurse is caring for a client with type 2 diabetes mellitus and renal insufficiency. The client is scheduled for a computerized tomography (CT) scan with contrast. Which medication would the nurse withhold to prevent lactic acidosis? - pioglitazone - insulin - glyburide - metformin

metformin (rationale: would be held in clients with renal impairment as this medication along with contrast dye can cause lactic acidosis) (79% nationwide answered correctly)

Which action would be included in the plan of care for a client with a history of parkinsonism who has recently developed rigidity, tremors, and signs of pneumonia? - gait training in the physical therapy department daily - isometric exercises every 2 hours while awake - active range-of-motion exercises at least every 4 hours - passive range-of-motion exercises at least every 8 hours

passive range-of-motion exercises at least every 8 hours (rationale: to maintain the range of joint movement with a minimum of energy expenditure) (43% nationwide answered correctly)

A client is admitted to the hospital with a tentative diagnosis of Guillain-Barré syndrome. Which question by the nurse will elicit information consistent with this diagnosis? - "Have you experienced an infection recently?" - "Is there a history of this disorder in your family?" - "Did you receive a head injury during the past year?" - "What medications have you taken in the past several months?"

"Have you experienced an infection recently?" (rationale: symptoms usually appear 1-3 weeks after an acute infection; the syndrome is linked to diseases such as viral hepatitis, Epstein Barr virus, and infectious mono) (75% nationwide answered correctly)

Which signs and symptoms will a client admitted to the hospital with a diagnosis of Cushing syndrome exhibit? - hyperkalemia and edema - hypotension and sodium loss - muscle wasting and hypoglycemia - muscle weakness and frequent urination

muscle weakness and frequent urination (rationale: increased glucose-genesis may lead to hyperglycemia and glycosuria which can produce urinary frequency; protein catabolism will cause muscle weakness) (45% nationwide answered correctly)

Which is a secondary cause of adrenal insufficiency? - hemorrhage - tuberculosis - pituitary tumors - metastatic cancer

pituitary tumors (rationale: secondary causes of adrenal insufficiency - Addison's - include pituitary tumors) (77% nationwide answered correctly)

Which health problem history would increase an older adult's risk for experiencing a cerebrovascular accident (CVA, also known as a "brain attack")? - glaucoma - hypothyroidism - continuous nervousness, stress - transient ischemic attacks (TIAs)

transient ischemic attacks (TIAs) (rationale: TIAs are temporary neurological deficits related to cerebral hypoxia; about one third of the people who have TIAs will have a brain attack (CVA) within 2 to 5 years) (92% nationwide answered correctly)

Which neurological manifestation is associated with hyperthyroidism? - confusion - hearing loss - tremors - slowness of speech

tremors (68% nationwide answered correctly)

When assisting a client with Parkinson disease to ambulate, which instruction would the nurse provide the client? - avoid leaning forward - hesitate between steps - rest when tremors are experienced - keep arms close to the center of gravity

avoid leaning forward (rationale: the shift away from the center of gravity causes instability) (55% nationwide answered correctly)

Which term would the nurse use to document observing the characteristic gait associated with Parkinson disease? - ataxic - shuffling - scissoring - asymmetric

shuffling (rationale: with a shuffling gait, the steps are short and dragging; this is seen with basal ganglia defects) (89% nationwide answered correctly)

Which client statement indicates that the discharge teaching after a cataract extraction and an intraocular lens implant is effective? - "I should call the clinic if my eye begins to hurt." - "I am so glad that I can take a shower today." - "There will be bright flashes of light for a few days." - "My vision should show some improvement by tomorrow."

"I should call the clinic if my eye begins to hurt." (rationale: pain after a cataract extraction and intraocular lens implant may indicate infection, increased intraocular pressure, or hemorrhage) (60% nationwide answered correctly)

A health care provider prescribed a diagnostic workup for a client who may have myasthenia gravis. Which initial objective would the nurse establish with the client? - "The client will adhere to the teaching plan." - "The client will achieve psychologic adjustment." - "The client will maintain present muscle strength." - "The client will prepare for a possible myasthenic crisis."

"The client will maintain present muscle strength." (rationale: until confirming the diagnosis, the primary goal should be to maintain appropriate activity and prevent muscle atrophy) (60% nationwide answered correctly)

Which information would the nurse include in the discharge teaching plan for a client who sustained a cerebrovascular accident (CVA, also known as a "brain attack") with residual hemiparesis and hemianopsia? - necessity for bed rest at home - use of oxygen (O2) therapy at home - significance of a safe environment - need for decreased protein in the diet

significance of a safe environment (89% nationwide answered correctly)

When assessing a client with diabetes insipidus, which signs would the nurse anticipate finding? Select all that apply. One, some, or all responses may be correct. - excessive thirst - increased blood glucose - dry mucous membranes - increased blood pressure - decreased serum osmolarity - decreased urine specific gravity

- excessive thirst - dry mucous membranes - decreased urine specific gravity (33% nationwide answered correctly)

Which parameter monitoring would be the nurse's priority while caring for a client with hypothyroidism? - pulse rate - blood pressure - respiratory rate - body temperature

respiratory rate (55% nationwide answered correctly)

Which client is at risk for developing type 2 diabetes mellitus (DM)? Select all that apply. One, some, or all responses may be correct. - 15-year-old male who plays video games 6 hours per day - 36-year-old female with a history of gestational diabetes - 47-year-old male who weighs 250 pounds and is 5' 9" tall - 28-year-old female with polycystic ovarian syndrome (POS) - 60-year-old male of Native American descent who abuses alcohol

- 36-year-old female with a history of gestational diabetes - 47-year-old male who weighs 250 pounds and is 5' 9" tall - 28-year-old female with polycystic ovarian syndrome (POS) (27% nationwide answered correctly)

Which finding would be expected in a client with a history of hypothyroidism? Select all that apply. One, some, or all responses may be correct. - cold intolerance - lethargy and fatigue - hemoglobin 11.2 g/dL - 15-pound weight gain - heart rate 59 beats/min

- cold intolerance - lethargy and fatigue - heart rate 59 beats/min (18% nationwide answered correctly)

Which symptoms would the nurse include when teaching a client to recognize symptoms of hypoglycemia? Select all that apply. One, some, or all responses may be correct. - rapid heartbeat - emotional changes - abdominal cramping - nausea and vomiting - weakness and fatigue - numbness of fingers, toes, or mouth

- rapid heartbeat - emotional changes - numbness of fingers, toes, or mouth (rationale: abdominal cramping, nausea and vomiting, and weakness and fatigue are indicative of hyperglycemia) (2% nationwide answered correctly)

The nurse assists a client on a rehabilitation unit after a cerebrovascular accident (CVA, also known as a "brain attack") with residual hemiparesis to walk with the use of a cane. To help achieve the goal of safe walking with a cane, which method would the nurse teach the client? - shorten the stride of the unaffected extremity - advance the cane and the affected extremity simultaneously - lean the body toward the side with the cane when ambulating - hold the cane on the same side as the affected extremity and increase the base of support

advance the cane and the affected extremity simultaneously (54% nationwide answered correctly)

Which explanation would the nurse provide a client who asks what a cataract is? - an opacity of the lens - a thin film over the cornea - a crystallization of the pupil - an increase in the density of the conjunctiva

an opacity of the lens (76% nationwide answered correctly)

An older client experiences a cerebrovascular accident (CVA) with right-sided hemiplegia and expressive aphasia. The client's children ask the nurse which functions will be impaired. Which abilities would the nurse explain will be affected? - speaking preferences aloud - recognizing familiar objects - comprehending written words - understanding verbal communication

speaking preferences aloud (rationale: impaired ability to speak and state wishes verbally is a characteristic of expressive aphasia from damage to Broca's area in the dominant hemisphere of the brain) (74% nationwide answered correctly)

A client who had a cerebrovascular accident (CVA, also known as a "brain attack") begins to eat lunch. Which client behavior indicates the client may be experiencing left hemianopsia? - the client asks to have food moved to the left side of the tray - the client drops the coffee cup when trying to use the right hand - the client ignores the food on the left side of the tray when eating - the client reports not being able to use the right arm to help eat meals

the client ignores the food on the left side of the tray when eating (73% nationwide answered correctly)

A client with myasthenia gravis asks the nurse, "What is going to happen to me and to my family?" Which information about the anticipated disease process would the nurse incorporate when responding to the client's question? - there is a high cure rate with proper treatment for this disease - this disease has a slow, progressive course, without remissions - the disease is a chronic illness with exacerbations and remissions - myasthenia gravis has a poor prognosis, with death occurring in a few months

the disease is a chronic illness with exacerbations and remissions (80% nationwide answered correctly)

The nurse assisted a client with myasthenia gravis to bathe. The nurse identified the client's arms had progressively become weaker with sustained movement. Which intervention would the nurse implement with this client? - encourage the client to rest for short periods - continue the bath while supporting the client's arms - gradually increase the client's activity level each day - administer a dose of pyridostigmine bromide

encourage the client to rest for short periods (76% nationwide answered correctly)

Which symptom might the nurse identify when assessing a client with hyperthyroidism? - fatigue - dry skin - anorexia - bradycardia

fatigue (rationale: excessive metabolic activity associated with hyperthyroidism causes fatigue) (34% nationwide answered correctly)

The nurse is interviewing a client with a tentative diagnosis of Parkinson disease. Which description would the nurse give to the client about the onset of symptoms? - suddenly - gradually - overnight - irregularly

gradually (rationale: it is insidious with a prolonged course and gradual progression) (94% nationwide answered correctly)

Which classic sign will a nurse find in a client with Addison disease? - ecchymosis - hyperreflexia - exophthalmos - hyperpigmentation

hyperpigmentation (69% nationwide answered correctly)

The nurse assesses a client admitted with suspected Guillain-Barré syndrome who reports numbness, which began in the hands and feet and now involves the arms, legs, and lower trunk. For which related clinical manifestations would the nurse assess in this client? - ptosis and dysphagia - paresthesias and paralysis - atrophy and fasciculations - muscle weakness and drooling

paresthesias and paralysis (rationale: Guillain-Barré syndrome includes the clinical manifestations of paresthesia and paralysis result from patchy demyelination of the peripheral nerves, nerve roots, root ganglia, and the spinal cord. Ptosis & dysphasia are r/t myasthenia gravis. atrophy & fasciculations r/t amyotrophic lateral sclerosis. muscle weakness & drooling r/t Parkinson's) (79% nationwide answered correctly)

Which type of rehabilitation is an essential component to a client's recovery from Guillain-Barré syndrome? - physical therapy - speech exercises - fitting with a vertebral brace - follow-up on cataract progression

physical therapy (rationale: rehabilitation needs for a client with Guillain-Barré syndromefocuses on physical therapy and exercise for the lower extremities because of muscle weakness and discomfort) (85% nationwide answered correctly)

Which clinical manifestations would the nurse expect a client with hypothyroidism to exhibit? Select all that apply. One, some, or all responses may be correct. - cool skin - photophobia - constipation - periorbital edema - decreased appetite

- cool skin - constipation - periorbital edema - decreased appetite (rationale: cool skin r/t decr metabolic rate. constipation r/t decrease in peristalsis r/t lower metabolic rate. periorbial edema by changes causing myxedema & 3rd space fluid effusion. lower appetite r/t metabolic & GI manifestations.) (29% nationwide answered correctly)

A client with myasthenia gravis experiences generalized weakness. Which nursing intervention would the nurse integrate into the client's plan of care? - maintain strict bed rest for this client - provide the client frequent rest periods - reassure the client there are many other tasks awaiting him or her - arrange for a relative to be present with the client

provide the client frequent rest periods (92% nationwide answered correctly)

The nurse is reviewing laboratory results from several clients. Based on the given data, which client is most likely to have a diagnosis of hyperthyroidism documented in the medical record? - client A: 25 yrs old, T4 is 3 mcg/dL, FT4 is 1 ng/dL, T3 total is 60 ng/dL - client B: 35 yrs old, T4 is 13 mcg/dL, FT4 is 2.8 ng/dL, T3 total is 250 ng/dL - client C: 45 yrs old, T4 is 3 mcg/dL, FT4 is 0.6 ng/dL, T3 total is 40 ng/dL - client D: 55 yrs old, T4 is 10 mcg/dL, FT4 is 2 ng/dL, T3 total is 180 ng/dL

client B: 35 yrs old, T4 is 13 mcg/dL, FT4 is 2.8 ng/dL, T3 total is 250 ng/dL (rationale: all levels are elevated indicating hyperthyroidism) (85% nationwide answered correctly)

A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication? - chest pain - tachycardia - hypertension - atrial fibrillation

hypertension (rationale: HTN is a CV complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines) (69% nationwide answered correctly)