MedSurg: Prioritization Ch 8 Endocrine Mgmt

The hospice nurse caring for a client diagnosed with diabetes mellitus type 2 observes the client eating a bowl of ice cream. Which intervention should the nurse implement first? 1. Allow the client to enjoy the ice cream. 2. Check the client's blood glucose. 3. Remind the client not to eat ice cream. 4. Suggest the client eat low-fat sweets.

Correct answer: 1 1. A terminally ill client should be allowed comfort measures even when the activity would normally not be encouraged or allowed. The client can receive sliding- scale insulin, if needed, to cover the ice cream. 2. The nurse could do this after the ice cream has been metabolized to determine whether an insulin injection is needed. 3. The nurse should tell the client that food such as ice cream may be consumed in moderation and with the appropriate coverage. 4. Low-fat sweets may be a good substitute for some of the foods the client may want to eat.

The clinic nurse is caring for a 10-year-old client diagnosed with diabetes mellitus type 2. Which client problem is priority? 1. Altered nutrition, excessive intake. 2. Risk for low self-esteem. 3. Hypoglycemia. 4. Risk for loss of body part.

Correct answer: 1 1. Children are being diagnosed with type 2 diabetes mellitus because of excessive intake of calories and lack of exercise. This is the priority problem. Many states are performing screening activities to identify children at risk for developing type 2 DM so that interventions can be made to delay or prevent the child being diagnosed with type 2 DM. Acanthosis nigricans (hyperinsulinemia) can be identified with simple, non-invasive screening. 2. The client has a risk of low self-esteem because of the excess weight, but if the client and parents adhere to the recommended treatment regimen for weight control, diet, and exercise, the client's self-esteem should improve. 3. The client's problem is hyperglycemia, not hypoglycemia. 4. Amputation is a chronic problem associated with diabetes and occurs after years of uncontrolled blood glucose levels. This is not the priority problem at this time.

Which task is most appropriate for the charge nurse to assign to the licensed practical nurse (LPN)? 1. Tell the LPN to change the client's subclavian dressing. 2. Request the LPN to obtain the client's daily weight. 3. Assign the LPN to care for the client in myxedema coma. 4. Ask the LPN to complete discharge teaching to the client.

Correct answer: 1 1. The LPN can change sterile dressings according to his or her scope of practice. 2. The UAP can obtain the client's weight; therefore, it should not be assigned to the LPN 3. The client in myxedema coma is not a stable client and should be assigned to the nurse, not the LPN. {Myxedema coma is a complication of severe hypothyroidism} 4. Teaching should not be assigned to the LPN, only to the nurse.

Which task is most appropriate for the medical nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Request the UAP to take the diabetic client's HS snack to the client. 2. Ask the UAP to escort the client on the PCA pump to the bathroom. 3. Tell the UAP to witness the client's advance directive. 4. Ask the UAP to show the client how to take the client's radial pulse.

Correct answer: 1 1. The UAP can take food to the client since this is not a medication and the client is stable. 2. The client on a PCA pump is under the influence of narcotic analgesics and should be on bed rest, not ambulated to the bathroom. 3. None of the hospital employees should witness the client's advance directive. 4. The nurse cannot delegate teaching to the UAP.

At 1000, the client diagnosed with type 1 diabetes is complaining of being jittery, having a headache, and being dizzy. Which intervention should the nurse implement first? 1. Give the client glucose tablets. 2. Provide the client with the lunch meal. 3. Request the laboratory to draw a serum glucose level. 4. Determine the last time the client received insulin.

Correct answer: 1 1. The client is exhibiting signs of hypoglycemia; therefore, the nurse should treat the client's symptoms with a simple carbohydrate, such as glucose tablets. This is the first intervention. 2. The nurse should provide the client with complex carbohydrates so another episode of hypoglycemia will not occur. 3. The nurse could obtain a glucometer reading at the bedside, but having the laboratory draw a serum blood glucose level should not be the nurse's first intervention. 4. The nurse should determine the last time the client received insulin but it is not the first intervention. Remember: The nurse should not assess if the client is in distress.

The unit manager of an endocrinology unit is over-budget for the year and must transfer one staff member to another unit. Which option is the best action for the unit manager to take before deciding which staff member to transfer? 1. Assess each staff member's abilities. 2. Choose the last staff member hired. 3. Ask for input from the staff members. 4. Request the transfer documentation form.

Correct answer: 1 1. The manager should assess the abilities of each staff member for the needs of the unit before deciding which staff member to transfer. 2. This may be the method used by many managers, but the best action is to evaluate the needs of the unit and the abilities of the staff. 3. In many instances, the unit manager must make hard decisions without consulting the staff members. Asking for the staff members' input could cause tension among the staff; therefore, this is not an appropriate intervention. 4. This will be completed after the decision has been made and the staff member notified.

Which client should the charge nurse on a medical unit assign to a nurse who is 3 months pregnant? 1. The client who is receiving chemotherapy who is immunosuppressed. 2. The client with postoperative hyperparathyroidism who has shingles (herpes zoster). 3. The client with hyperthyroidism who is receiving radioactive iodine I-131. 4. The client diagnosed with AIDS who has a cytomegalovirus infection.

Correct answer: 1 1. The pregnant nurse can administer antineoplastic medications to clients. The nurse should not be exposed to antineoplastic agents outside of the administration bags and tubing. The pregnant nurse can care for a client who is immunosuppressed. 2. Shingles (herpes zoster) is a painful, blistering skin rash due to the varicellazoster virus, the virus that causes chickenpox. The pregnant nurse should not be assigned this client. 3. The client receiving radioactive iodine should not be around pregnant women or young children; therefore, the nurse who is pregnant should not care for this client. 4. The client has the cytomegalovirus, which crosses the placental barrier. Therefore, a pregnant nurse should not be assigned this client. Any client with a communicable disease that crosses the placental barrier should not be assigned to a nurse who is pregnant.

Which client should the nurse on the endocrinology unit assess first? 1. The client with hypothyroidism whose vital signs are T 94.2, AP 48, RR 14, B/P 90/68. 2. The client with hypoparathyroidism who has a positive Chvostek's sign. 3. The client who is 1 day postoperative thyroidectomy who is hoarse. 4. The client with diabetes insipidus who is drinking large amounts of water.

Correct answer: 1 1. These are signs of myxedema coma, which is characterized by subnormal temperature, hypotension, and hypoventilation. This client should be seen first by the nurse. 2. The client with hypoparathyroidism is expected to have a positive Chvostek's sign; therefore, the nurse should not assess this client first. 3. Hoarseness is expected for 3 to 4 days after surgery because of edema; therefore, the nurse should not assess this client first. 4. The client with diabetes insipidus has polyuria and compensates for the fluid loss by drinking great amounts of water; therefore, the nurse should not assess this client first.

The nurse in the outpatient clinic is working with an unlicensed assistive personnel (UAP). Which tasks are most appropriate for the nurse to delegate to the UAP? Select all that apply. 1. Take the client to the examination room and take the vital signs. 2. Weigh the client and document the weight in the client's chart. 3. Clean the room and set it up for the next client. 4. Discuss the prescriptions prescribed by the healthcare provider. 5. Call the pharmacy to authorize a refill on a client's prescription.

Correct answer: 1, 2, and 3 1. The UAP can escort the patient to the examination room and take the initial vital signs. 2. The UAP can weigh the patient and document the weight. 3. The UAP can clean the room and prepare it for the next patient. 4. Discussing prescriptions is teaching and the nurse cannot delegate teaching. 5. Calling the pharmacy requires knowledge of medications and medication administration. This task cannot be delegated to a UAP.

The nurse in an outpatient clinic is returning telephone calls. Rank the calls in the order they should be returned, with the highest priority call first. 1. The call from a husband who states his wife started on an antidepressant and now will not wake up. 2. The call from a client who states the medication that was prescribed for her diabetes mellitus type 2 is too expensive. 3. The client with hypothyroidism who is reporting feeling hot, having hand tremors, and having diarrhea. 4. The call from the pharmacist wanting an authorization to change a medication from a trade name to a generic name drug. 5. The call from the client who had a magnetic resonance imaging (MRI) scan 2 days ago and has not received the results.

Correct answer: 1, 3, 4, 2, 5 1. This client may have overdosed accidently or on purpose. This is a physiological problem and the nurse must determine which intervention is required next. This is a potentially life-threatening situation, so the nurse should return this phone call first. 3. The client with hypothyroidism is reporting signs of hyperthyroidism, indicating the client is overdosing on the thyroid hormone replacement and needs to be seen in the clinic. This is a physiological problem; therefore, the nurse should call this client second. 4. The pharmacist needs to know if the substitution can be made in order to fill this prescription. This call should be returned third. 2. The nurse needs to discuss the prescribed medication with the HCP to see if a different, less expensive medication would work as well for the client, or if there is an alternative medication program that could be discussed with the client. This phone call should be returned fourth. 5. The nurse must first determine where the breakdown in the communication of the results of the MRI occurred, then obtain the results and provide them to the HCP prior to returning the call. This phone call can be returned last.

Which activities are examples of home healthcare nurse responsibilities when caring for clients with endocrine disorders? Select all that apply. 1. Complete nutritional counseling and teaching for a client on a high-fiber diet. 2. Discuss preoperative teaching for the client having a total right hip replacement. 3. Manage oxygen therapy for a client with chronic obstructive pulmonary disease (COPD). 4. Teach the client and family about administration and side effects of medications. 5. Draw blood for studies related to monitoring disease processes and therapy.

Correct answer: 1, 3, 4, and 5 1. This is an example of an activity the home health nurse would implement in the home. 2. Preoperative teaching is not an activity the home health nurse performs in the home. This is usually completed by the preoperative nurse. 3. This is an example of an activity the home health nurse would implement in the home. 4. This is an example of an activity the home health nurse would implement in the home. 5. This is an example of an activity the home health nurse would implement in the home.

The nurse is hanging 1,000 mL of IV fluids to run for 8 hours. The intravenous tubing is a microdrip. At how many gtt/min should the IV rate be set? _______ gtt/min

Correct answer: 125 gtt/min A microdrip delivers 60 gtt/mL. The formula for this dosage problem is as follows: 1,000 mL divided by 8 = 125 mL per hour 125 times 60 = 7,500 gtt per hour 7,500 divided by 60 minutes = 125 gtts per minute.

Which client is priority to be assigned to a case manager in the outpatient clinic so that care can be achieved? 1. The client with renal calculi who is 2 weeks post-lithotripsy procedure. 2. The client who has type 2 diabetes and coronary artery disease (CAD). 3. The client who is diagnosed with hypothyroidism receiving radiation treatment. 4. The client with Addison's disease who is on corticosteroid therapy.

Correct answer: 2 1. A case manager is assigned to a client with a chronic illness; therefore, a client with a renal calculi who had lithotripsy would not be appropriate for a case manager. 2. It would be appropriate to assign this client to a case manager since this client has two chronic illnesses, often having multiple hospitalizations and chronic complications and requires long-term healthcare. 3. Hypothyroidism is not a disease process resulting in multiple hospitalizations or chronic complications. 4. A client with Addison's disease on corticosteroid therapy would not be a client referred to a case manager.

The Home Health Director of Nurses hears a nurse and the occupational therapist loudly disagreeing about the care of a newly admitted client while they are sitting in an area that is accessible to anyone coming into the office. Which action should the Director of Nurses implement first? 1. Ask the staff members to move the argument to another room. 2. Request both individuals to come into the director's office. 3. Call the secretary with instructions for the staff to quit arguing. 4. Tell the staff members that arguing is not allowed in the office.

Correct answer: 2 1. Moving the staff members to another room will just allow the argument to continue. This is not the director's first intervention. 2. The nursing supervisor should intervene and listen to both staff members' concerns and attempt to help resolve the disagreement. This is the director's first intervention. 3. The director should not ask another staff member to intervene in the argument. The director should address the professional staff about unprofessional behavior. 4. The director should not act unprofessionally and correct the staff in front of everyone in the office. This should be done in private.

The nurse is preparing to administer morning medications. Which medication should the nurse administer first? 1. The levothyroxine (Synthroid), a thyroid hormone, to a client diagnosed with hypothyroidism. 2. The Humulin N insulin, a pancreatic hormone, to a client diagnosed with type 2 diabetes. 3. The prednisone, a glucocorticoid, to a client diagnosed with Addison's disease. 4. The tiotropium (Spiriva) inhaler, a bronchodilator, to a client diagnosed with chronic asthma.

Correct answer: 2 1. Synthroid is a daily medication and can be administered within the 1-hour time frame (30 minutes before and 30 minutes after the dosing time). 2. Insulin should be administered before a meal for best effects. This medication should be administered first. 3. Prednisone is a routine medication and can be administered within the 1-hour time frame (30 minutes before and 30 minutes after the dosing time). 4. Spiriva is a routine daily medication and can be administered within the 1-hour time frame (30 minutes before and 30 minutes after the dosing time).

The unlicensed assistive personnel (UAP) has just taken the blood pressure of a client who had a thyroidectomy. The UAP tells the nurse that the client's hand turned into a claw when the blood pressure was taken. Which intervention should the nurse implement first? 1. Prepare to administer intravenous calcium gluconate. 2. Assess the client for signs/symptoms of hypoparathyroidism. 3. Request the UAP to elevate the client's head of the bed. 4. Notify the client's healthcare provider immediately.

Correct answer: 2 1. The client is exhibiting Trousseau's sign indicating hypoparathyroidism and is treated with IV calcium gluconate, but it is not the nurse's first intervention. The nurse must first assess the client prior to taking any action. 2. When the UAP gives information to the nurse about a client, the nurse must first assess the client prior to taking any action. 3. The client is exhibiting signs/symptoms of hypoparathyroidism, which makes this client unstable, and the nurse should not delegate any task to the UAP for the client who is unstable. 4. The nurse will need to notify the HCP, but not prior to assessing the client first.

The charge nurse of a surgical unit has been notified of an external disaster with multiple casualties. Which client should the charge nurse request to be discharged from the hospital to make room for clients from the disaster? 1. The client scheduled for a bilateral adrenalectomy in the morning whose preoperative teaching has not been started. 2. The client who had a total abdominal hysterectomy 2 days ago and PCA machine has been discontinued. 3. The client who is postoperative bilateral thyroidectomy who has a hemoglobin of 7 mg/dL and a hematocrit of 22.1%. 4. The client with type 2 diabetes who has just had a kidney transplant and is experiencing fever and pain at the surgical site.

Correct answer: 2 1. The client needs preoperative teaching and the charge nurse should not request a discharge for a client having surgery in the morning. 2. This client is stable and could be prescribed oral pain medication. She could be discharged home and followed by home health nursing if needed. This client is the most appropriate client for the charge nurse to request to be discharged. 3. This client is experiencing a complication of surgery and is hemorrhaging; the Hgb/Hct is very low. Therefore, this client cannot be discharged home. 4. This client may be showing signs of acute rejection; therefore, this client cannot be discharged home.

The nurse is working on an endocrinology unit. Which client should the nurse assess first? 1. The client diagnosed with diabetes insipidus who has polyuria and polydipsia. 2. The client who is 1 day postoperative thyroidectomy who has neck edema. 3. The client who has hypoparathyroidism who has painful muscle cramps and irritability. 4. The client diagnosed with Addison's who has weakness, fatigue, and anorexia.

Correct answer: 2 1. The client with diabetes insipidus, a deficiency in the production of the antidiuretic hormone, will have an increase in thirst and urination. The nurse should not assess this client first. 2. The nurse should assess the client with a thyroidectomy for hemorrhaging every 2 hours. Neck edema, irregular breathing, and frequent swelling {frequent swallowing} are signs of hemorrhaging; therefore, the nurse should assess this client first. 3. The client with hypofunction of the parathyroid gland is expected to have muscle cramps and irritability; therefore, the nurse should not assess this client first. Bleeding and loss of airway are priority over an expected symptom of the disease process, which is not as immediately life threatening. 4. Addison's disease, hypofunction of the adrenal gland, causes the client weakness, fatigue, and anorexia. These signs/symptoms are expected; therefore, the nurse should not assess this client first.

The new graduate nurse on the endocrine unit is having difficulty completing the workload in a timely manner. Which suggestion could the preceptor make to help the new graduate become more organized? 1. Suggest the new nurse take a break whenever the nurse feels overwhelmed with tasks. 2. Tell the new nurse to start the shift with a work organization sheet for the assigned clients. 3. Instruct the new nurse to take five deep breaths at the beginning of the shift, and then begin. 4. Review each day's assignments for the new nurse and organize the work for the new nurse.

Correct answer: 2 1. The new graduate cannot take a break whenever he or she becomes overwhelmed because the work may never get done. The new graduate should schedule breaks throughout the shift, not when he or she wants to take them. 2. The preceptor should recommend that the new graduate use some tool to organize the work so important tasks, such as medication administration and taking vital signs, are not missed. 3. Encouraging the new graduate to calm him or herself down (five deep breaths) before beginning work is good, but it will not help the new graduate with time management. 4. The new graduate must find the best way to organize him- or herself. Doing the organizing for the new graduate will not help him or her.

The nurse administering medications to clients on a medical unit discovers the wrong medication was administered to a client, Mrs. Jones. Mrs. Jones had replied she was Mrs. Smith when the nurse asked her name from the MAR. Which step in medication administration did the nurse violate when administering the medication? 1. Asking the client to repeat her name. 2. Verifying the client's armband with the MAR. 3. Checking the medication against the MAR. 4. Documenting the medication on the MAR.

Correct answer: 2 1. The nurse asked the client her name, and the client replied that she was a different person. 2. The step the nurse did not take was to verify the client's armband against the MAR. Checking the identification band against the MAR would have prevented the error. 3. This is not the step that was overlooked. 4. This is not the step that was missed.

The nurse on the medical unit is preparing to administer 0900 medications. Which medication should the nurse question administering? 1. The hormone levothyroxine (Synthroid) to the client diagnosed with hypothyroidism. 2. The metformin (Glucophage) to the type 2 diabetic who just had a CT scan with dye. 3. The Humulin N insulin to the client with type 1 diabetes who is no longer NPO. 4. The steroid prednisone to a client diagnosed with Addison's disease.

Correct answer: 2 1. The nurse would expect to administer a thyroid hormone to the client diagnosed with hypothyroidism. 2. Metformin must be held 24 hours after a client has received any type of contrast dye, since it can cause renal failure. This medication should be questioned by the nurse. 3. The client with DM should receive their prescribed insulin as soon as they are no longer NPO. 4. The client with Addison's would be receiving prednisone; therefore, the nurse would not question administering this medication.

Which client is most appropriate for the parish nurse to care for? 1. The post-gestational diabetic client who had triplets and is a single parent. 2. The Presbyterian client who is confined to the home due to severe arthritis. 3. The obese client with Cushing's syndrome who is requesting help with losing weight. 4. The client with chronic renal disease who is being cared for in the home by the wife.

Correct answer: 2 1. This client would benefit from a home health nurse but not a parish nurse. 2. A parish nurse (PN) is a registered nurse with a minimum of 2 years of experience who works in a faith community, addressing health issues of its members as well as those in the broader community or neighborhood. The client is a Presbyterian so that is the reason the parish nurse should care for this client. 3. This option has no faith base; therefore, the parish nurse should not be assigned this client. 4. The client with chronic renal disease and the caregiver need assistance in the home, but the parish nurse does not need to offer it.

Which statement is an example of community-oriented, population-focused nursing? 1. The nurse cares for an elderly client living in the community who has had a kidney transplant. 2. The nurse develops an educational program for the type 2 diabetics in the community. 3. The nurse refers a client with Cushing's syndrome to the registered dietician. 4. The nurse provides pamphlets to the client with chronic renal disease.

Correct answer: 2 1. This is an example of community-based nursing wherein nurses care for an individual client living in the community. 2. Community-oriented, population-focused nursing practice involves the engagement of nursing in promoting and protecting the health of populations, not individuals in the community. Therefore, this is an example of community-oriented, population-focused nursing. 3. This is an example of community-based nursing wherein nurses care for an individual client living in the community. 4. This is an example of community-based nursing wherein nurses care for an individual client living in the community.

Which task is most appropriate for the nurse to delegate/assign when caring for clients on a surgical unit? 1. Instruct the licensed practical nurse (LPN) to feed the client who is 1 day postoperative unilateral thyroidectomy. 2. Ask another nurse to administer an IVP pain medication to a postoperative client in severe pain. 3. Request the unlicensed assistive personnel (UAP) to check the client whose vital signs are AP 112, RR 26, BP 92/58. 4. Instruct the licensed practical nurse (LPN) to obtain the pre-transfusion assessment on a postoperative client.

Correct answer: 2 1. This would be an inappropriate assignment because the UAP, not the LPN, could feed this stable client. 2. The nurse could request that another nurse administer pain medication so that the client obtains immediate pain relief. 3. This client's vital signs indicate that the client is unstable; therefore, the nurse should check on this client and not delegate the assessment to a UAP. 4. The client who requires a blood transfusion is unstable. The nurse should complete the pre-transfusion assessment. The RN, not the LPN, assesses.

The unlicensed assistive personnel (UAP) tells the nurse the client who had a thyroidectomy has a T 104°F, P 128, RR 26, B/P 164/88. Which intervention should the nurse implement first? 1. Prepare to administer the beta-adrenergic blocker propranolol (Inderal). 2. Notify the healthcare provider immediately. 3. Assess the client's vital signs and surgical dressing. 4. Administer acetaminophen (Tylenol) PO STAT.

Correct answer: 3 1. Beta-adrenergic blockers are used to treat relief of thyrotoxicosis, a thyroid storm, but it is not the nurse's first intervention. 2. The nurse should notify the healthcare provider of this rare condition, thyrotoxic crisis, but the nurse should first assess the client prior to calling HCP. 3. Since the UAP gave the nurse this information, the nurse must assess the client prior to taking any further action. 4. The nurse should administer acetaminophen (Tylenol) PO STAT to help decrease the fever, but the nurse should first assess the client since the UAP gave the nurse the information.

Which action by the unlicensed assistive personnel (UAP) warrants intervention by the nurse caring for the client with type 2 diabetes with chronic renal disease who is on hemodialysis? 1. The UAP times the client's activities to help conserve energy. 2. The UAP applies a lubricant to the lips and oral mucous membranes. 3. The UAP ties a sheet around the client sitting in the chair. 4. The UAP uses a fan to facilitate movement of cool air.

Correct answer: 3 1. Conserving the energy of the client who is dying is an appropriate intervention and does not warrant intervention by the hospice nurse. 2. Applying lubricant to the client's dry lips and mouth is an appropriate intervention and does not warrant intervention by the hospice nurse. 3. This is a form of restraint, and the UAP cannot restrain the client in the home or in the acute care setting. This behavior warrants intervention by the nurse. 4. This is an appropriate action to help with shortness of breath or dyspnea. This action would not warrant intervention by the nurse.

The overhead page has just announced a Code Red, actual fire, on a unit two floors below the unit where the nurse is working. Which action should the nurse implement first? 1. Turn off the oxygen supply to the rooms. 2. Evacuate the clients to a lower floor. 3. Close all of the doors to the clients' rooms. 4. Make a list of clients to discharge.

Correct answer: 3 1. On a floor not directly affected by the fire, the oxygen is turned off only at the instruction of the administrative supervisor or plant operations director. 2. The clients are safer on the floor where they are, not in an area closer to the fire. 3. The first action in a Code Red (actual fire) is to Rescue (R) the clients in immediate danger, followed by confine (C), closing the doors. Doors in a hospital must be fire rated to confine a blaze for an hour and a half. 4. This could be done, but it is a charge nurse's responsibility that is not called for at this time.

The clinic nurse is caring for clients using complementary alternative medicine (CAM). Which is not an example of CAM? 1. The client with hypothyroidism who takes Centella asiatica. 2. The type 2 diabetic client who takes cinnamon daily. 3. The client with coronary artery disease (CAD) who takes a daily baby aspirin. 4. The client who uses acupuncture to help quit smoking cigarettes.

Correct answer: 3 1. Some herbal remedies commonly recommended for hypothyroid conditions include: Equisetum arvense, Avena sativa, Centella asiatica, Coleus forskohlii, and Fucus vesiculosus. This is an example of an herbal CAM, a healing practice that does not fall within the realm of conventional medicine. 2. Cinnamon is a popular spice and flavoring that has shown considerable evidence of lowering blood sugar. This is an example of a CAM, a healing practice that does not fall within the realm of conventional medicine. 3. Daily baby aspirin is a medically accepted practice and prescribed by medical doctors. This is not an example of a CAM. 4. This is an example of a CAM, a healing practice that does not fall within the realm of conventional medicine. Acupuncture is a type of traditional Chinese medicine.

An elderly client diagnosed with thyroid cancer frequently makes statements that are inappropriate for the situation, and is not oriented to place, time, or date. The HCP has ordered a magnetic resonance imaging (MRI) scan of the client's brain. Which intervention should the nurse implement? 1. Administer a mild sedative to prevent claustrophobia. 2. Order a vest restraint for use by the client during the MRI. 3. Make sure the client does not have a pacemaker. 4. Ask a family member to stay with the client while the test is performed.

Correct answer: 3 1. The client has not complained of claustrophobia. The client has some type of neurological abnormality. 2. A vest restraint will not keep the client's head still during the MRI. 3. The nurse should make sure that the client does not have any medical device implanted that could react with the magnetic field created by the MRI scanner. An implanted ECG device could prevent the client from having an MRI, depending on the age of the pacemaker and the material with which it was made. 4. Family members are requested to stay outside of the area where the MRI is performed.

The client diagnosed with type 2 diabetes who has chronic renal disease asks the nurse, "How can I qualify for home healthcare when I go home?" Which statement is the nurse's best response? 1. "You must need constant skilled care by the nurse." 2. "You must have a family member living with you." 3. "You must be homebound to receive home healthcare." 4. "You must be referred by the hospital social worker."

Correct answer: 3 1. The client must need intermittent professional skilled care (such as nursing) not constant care. 2. The client does not have to have a family member living in the home to be eligible for home healthcare. 3. The client must be confined to the home or require a considerable and taxing amount of effort to leave the home for brief periods to be eligible for home healthcare. 4. The client can be referred directly from a healthcare provider's office or a long-term care facility, and clients may also request home healthcare for themselves.

Which priority intervention should the nurse implement when teaching the client with type 2 diabetes about glucometer checks? 1. Instruct the client to keep a written record of the glucometer readings. 2. Recommend the client check the glucometer reading in the morning. 3. Have the client demonstrate how to correctly perform the glucometer reading. 4. Tell the client to dispose of the lancets and strips appropriately.

Correct answer: 3 1. The client should keep a written record of the results but it is not priority. 2. The glucometer readings should be done in the morning when the client has not had anything to eat, but it can be done several times a day. This is not a priority. 3. Have the client demonstrate the skill to ensure the client can correctly perform the glucometer reading. This is the priority when teaching about glucometer checks. 4. Proper disposal of lancets and strips with blood on them is important, but not priority over the client demonstrating the skill.

The client diagnosed with diabetes mellitus type 2 has a hemoglobin A1C of 11 mg/dL. Which intervention should the nurse implement first? 1. Check the client's current blood glucose level. 2. Assess the client for neuropathy and retinopathy. 3. Teach the client about the effects of uncontrolled hyperglycemia. 4. Monitor the client's BUN and creatinine levels.

Correct answer: 3 1. The client's hemoglobin A1C is a test that reveals the average blood glucose for the previous 2 to 3 months. The current blood glucose level may or may not be in the desired range, but the client's diabetes with this level of hemoglobin A1C is not controlled. 2. The nurse should assess for complications of diabetes, but this is not the first intervention. Getting the client to realize the meaning of a high hemoglobin A1C is the priority at this time. 3. The client must be taught the long-term effects of hyperglycemia. A hemoglobin A1C of 11 indicates an average blood glucose of 310 mg/dL. Over time, a level higher than 120 to 140 mg/dL can lead to damage to many body systems. 4. Monitoring blood work is not priority over teaching the client about complications of diabetes when having such a high A1C.

An elderly female client is admitted from the long-term care facility with hyperglycemic hyperosmolar nonketotic coma. The client does not have any family or friends present. Which resource(s) should the admission nurse utilize to obtain information about the client? 1. The nurse should wait until a significant other can be contacted. 2. The verbal report from the ambulance workers and STAT lab work. 3. The transfer form from the nursing home and old hospital records. 4. The healthcare provider's telephone orders about care needed.

Correct answer: 3 1. The nurse needs as much information as possible in order to provide care for the client. The client may or may not have a significant other to be contacted. This is not the best way to try to get information on the client. 2. The ambulance workers will only be able to give a cursory report based on the limited information that was provided to them. This is not the best place to try to get information on the client. 3. The nursing home should send a transfer form with the client that details current medications and diagnoses as well as hygiene needs. Previous hospital records will include a history and physical examination and a discharge summary. This is the best place to start to glean information regarding the client. 4. The HCP orders may contain a current diagnosis but will not contain any information about the client's medical history. This is not the best place to try to get information on the client.

The charge nurse on a busy 20-bed endocrinology unit must send one staff member to the nursery. Which staff member is most appropriate to send to the nursery? 1. The nurse who has worked on the endocrinology unit for 4 years. 2. The graduate nurse who has been on the endocrinology unit for 6 months. 3. The licensed practical nurse (LPN) who has worked in a newborn nursery at another facility. 4. The unlicensed assistive personnel (UAP) who has six small children of her own.

Correct answer: 3 1. The nurse who has worked on the unit for 4 years should not be sent because the nurse's expertise is needed on the unit. 2. The graduate nurse, while knowledgeable of the endocrinology unit with 6 months of experience, would not be sent because he or she does not have experience in the maternal child area. 3. The LPN with maternal child area experience would be most helpful to the nursery. 4. The charge nurse should not make assignments based on a staff member's personal life.

The client with hypothyroidism and a diagnosis of myxedema coma is admitted to the critical care unit. Which assessment data warrants immediate intervention by the nurse? 1. The client's blood glucose level is 74 mg/dL. 2. The client's temperature is 96.2°F; AP, 54; R, 12; and BP, 90/58. 3. The client's ABG values are pH, 7.33; PaO2, 78; PaCO2, 48; HCO3, 25. 4. The client is lethargic and sleeps all the time.

Correct answer: 3 1. This is within the normal range of 70 to 120 mg/dL. Hypoglycemia is expected in a client with myxedema; therefore, a 74 mg/dL blood glucose level would be expected. 2. The client's metabolism is slowed in myxedema coma, which would result in these vital signs. 3. These ABGs indicate respiratory acidosis (ph <7.35, PaCO2 >45) and hypoxemia (O2 <80); therefore, this client would warrant immediate intervention by the nurse. Untreated respiratory acidosis can result in death if not treated immediately. 4. Lethargy is an expected symptom in a client diagnosed with myxedema; therefore, this would not warrant immediate intervention.

Which statement by the client experiencing exophthalmos indicates the client needs more teaching by the endocrinology nurse? 1. "I will use artificial tears to moisten my eyes." 2. "I need to wear dark glasses to prevent irritation." 3. "I should not move my eyes unless absolutely necessary." 4. "I should lightly tape my eyes shut when I sleep"

Correct answer: 3 1. This statement indicates the client understands the teaching and the client does not need more teaching. The exophthalmos that occurs with the disease allows the eyes to dry out, making them uncomfortable, and exposes the client to a risk of sclera damage. 2. The client should wear dark glasses; therefore, the client understands the teaching. 3. To maintain flexibility, the client should exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion. This statement indicates the client needs more teaching. 4. The client should tape the eyes shut; therefore, this client understands the client teaching.

The unlicensed assistive personnel (UAP) tells the nurse the client with thyroid cancer who is terminally ill is having deep-rapid breathing, but then doesn't breathe for about a minute. Which intervention should the nurse implement first? 1. Explain the client is having Cheyne-Stokes respirations. 2. Notify the hospital chaplain to come to the client's room. 3. Go to the client's room immediately and assess the client. 4. Contact the client's family that the client's death is near.

Correct answer: 3 1. This type of breathing is called Cheyne- Stokes respirations, a pattern of breathing characterized by alternating periods of apnea and deep-rapid breathing. This is not the nurse's first intervention. 2. The nurse should notify the chaplain but it is not the nurse's first intervention. 3. The nurse must first assess the client since the UAP gave the nurse the information. 4. The family should be contacted but not prior to assessing the client.

The home health (HH) agency Chief Nursing Officer (CNO) is making assignments for the nurses. Which client should be assigned to the new graduate nurse who just completed orientation? 1. The client diagnosed with Cushing's syndrome who is dyspneic and confused. 2. The client who does not have the money to get prescriptions filled. 3. The client with full-thickness burns on the arm who needs a dressing change. 4. The client complaining of pain who is diagnosed with diabetic neuropathy.

Correct answer: 4 1. Dyspnea and confusion are not expected in a client diagnosed with Cushing's syndrome; therefore, this client would warrant a more experienced nurse to assess the reason for the complications. 2. The client with financial problems should be assigned to a social worker, not to a nurse. 3. A full-thickness (third-degree) burn is the most serious burn and requires excel- lent assessment skills to determine whether complications are occurring. This client should be assigned to a more experienced nurse. 4. The client diagnosed with diabetic neuropathy would be expected to have pain; therefore, this client could be assigned to a nurse new to home health nursing. The client is not exhibiting a complication or an unexpected sign/symptom.

The female client diagnosed with type 2 diabetes has frequent urinary tract infections (UTIs). Which priority intervention should the nurse implement? 1. Encourage the client to empty her bladder regularly and completely. 2. Instruct the client to drink 8 ounces of cranberry or lingonberry juice a day. 3. Explain the importance of taking oral hypoglycemic medications. 4. Discuss the importance of taking all the antibiotics.

Correct answer: 4 1. Health promotion activities that help prevent UTIs include emptying the bladder. Bacteria can grow in stagnated urine in the bladder and emptying the bladder will help prevent this. The client is diagnosed with a UTI and antibiotic therapy is the priority nursing intervention. 2. Enzymes found in cranberries inhibit attachment of urinary pathogens (especially E. coli) to the bladder epithelium. Daily cranberry juice helps prevent UTIs but the priority nursing intervention is taking antibiotic therapy. 3. Women with diabetes are two to three times more likely to have bacteria in their bladders than women without diabetes. Taking hypoglycemic medication is important, but when the UTI is diagnosed, antibiotic therapy is priority. 4. Antibiotic therapy is the priority intervention for the client with a diagnosed UTI. None of the health promotion activities will treat the UTI, though they will help prevent further UTIs.

The nurse is administering medications on an endocrinology unit. Which medication should the nurse question administering? 1. The propylthiouracil (PTU) to the client diagnosed with hyperthyroidism. 2. The desmopressin acetate (DDAVP) to the client diagnosed with diabetes insipidus. 3. The somatropin (Genotropin) to the client diagnosed with hypopituitarism. 4. The propranolol (Inderal) to the client diagnosed with hypothyroidism.

Correct answer: 4 1. PTU blocks peripheral conversion of T4 to T3 and is prescribed for the client diagnosed with hyperthyroidism. The nurse would not question administering this medication. 2. DDAVP is the treatment of choice for the client diagnosed with central diabetes insipidus. 3. Genotropin, a growth hormone, is the treatment of choice for clients with hypofunction of the pituitary gland. 4. The client with hypothyroidism has a decreased pulse rate; therefore, the nurse should not administer a beta blocker, which could further decrease pulse rate. The client with thyrotoxicosis (hyperthyroidism) would receive Inderal. The nurse should question administering this medication.

Which laboratory data should the nurse monitor for the client receiving the intravenous Solu-Medrol? 1. Potassium level. 2. Sodium level. 3. Liver enzymes. 4. Glucose level.

Correct answer: 4 1. Steroids do not affect the client's potassium level. 2. Glucocorticoids do not affect the client's sodium level. 3. Steroids do not affect the client's liver enzymes. 4. Steroids are excreted as glucocorticoids from the adrenal gland and are responsible for insulin resistance by the cells, which may cause hyperglycemia; therefore, the nurse should monitor the glucose level. {Solumedrol = Methylprednisolone, a steroid}

The nurse supervisor in the home health (HH) office is assigning tasks for the day. Which task is most appropriate for the nurse supervisor to assign the licensed practical nurse (LPN)? 1. Tell the LPN to complete the admission assessment for the client with Cushing's disease. 2. Request the LPN to evaluate the client's response to the new pain medication regime. 3. Request the LPN perform the wound care for the client with a Stage 4 pressure ulcer. 4. Instruct to the LPN to visit the client with type 2 diabetes who is stable and needs a hospital bed.

Correct answer: 4 1. The LPN cannot perform assessments on new admissions. 2. The nurse cannot assign evaluation of the client's medical regime to the LPN. 3. The wound care nurse should perform care for a Stage 4 pressure ulcer, not the LPN. 4. The LPN can contact medial supply companies and request durable medical equipment (DME); therefore, this is the most appropriate task to assign the LPN.

The charge nurse on the endocrine surgical unit is making assignments. Which task should be delegated/assigned to the team members? 1. Request the licensed practical nurse (LPN) assess the client who is hypoglycemic. 2. Ask the unlicensed assistive personnel (UAP) to assist feeding the client with an adrenalectomy who has a paralytic ileus. 3. Instruct the UAP to insert a nasogastric (N/G) tube into the client who has had a thyroidectomy. 4. Tell the LPN to perform an in and out catheterization for the client diagnosed with acromegaly.

Correct answer: 4 1. The LPN is not licensed to assess the client who is hypoglycemic, nor should the nurse assign or delegate an unstable client. This client is unstable and requires the nurse's assessment skills. 2. The client with a paralytic ileus is NPO and should not have any food. 3. The UAP does not have the skill or training to insert a nasogastric tube. 4. The LPN can perform a sterile procedure such as completing an in and out catheterization.

Which task should the ambulatory care nurse delegate to the unlicensed assistive personnel (UAP)? 1. Ask the UAP to remove the trash from the room of the client who received radioactive iodine with hyperthyroidism. 2. Instruct the UAP to escort the client outside who is asking to smoke a cigar. 3. Request the UAP check the surgical dressing on the client with an ileal conduit. 4. Tell the UAP to take the glucometer reading on the client about to go to surgery.

Correct answer: 4 1. The UAP should not remove anything from the room. The nuclear medicine personnel will check the waste from the room for radioactivity prior to the removal and if radioactive will arrange for disposal in a way that protects the environment. 2. The UAP is hired to care for clients in the ambulatory care unit, not to take a client out to smoke. Clients in ambulatory care should not be smoking prior to or after surgery or procedure. 3. The UAP cannot assess the client's surgical dressing. 4. The UAP can obtain a glucometer reading on a client who is stable, and clients in the ambulatory care unit are stable.

Which nursing intervention is priority for the intensive care nurse to implement when caring for a client diagnosed with diabetic ketoacidosis (DKA)? 1. Assess for a fruity breath odor. 2. Check blood glucose levels ac and hs. 3. Monitor the client's pulse oximeter readings. 4. Maintain the regular insulin IV rate on an infusion pump.

Correct answer: 4 1. The client with DKA would have fruity breath; therefore, this nursing intervention does not have priority. 2. Glucose levels are monitored at least every hour. 3. The pulse oximeter reading is not priority for a client in DKA. 4. The client will be on a regular insulin drip, which must be maintained at the prescribed rate on an intravenous pump device. Decreasing the client's blood glucose level is the priority nursing intervention.

The nurse and unlicensed assistive personnel (UAP) are caring for clients on an endocrinology unit. Which task should not be delegated to the UAP? 1. Ambulate the client who had a unilateral adrenalectomy. 2. Change the linens on the client with acute thyrotoxicosis who is diaphoretic. 3. Bring ice-cold water to the client diagnosed with diabetes insipidus. 4. Take the vital signs of a client who has just returned from the post-anesthesia care unit (PACU).

Correct answer: 4 1. The client with a unilateral adrenalectomy should be ambulated to prevent postoperative complications. This task could be delegated to the UAP. 2. The UAP can change linens for a client. Acute thyrotoxicosis is not a life-threatening condition. 3. The client with DI is very thirsty and craves ice water; therefore, this task can be delegated to the UAP. 4. The client just returning from surgery and the PACU should be assessed immediately by the nurse. The UAP is not qualified to identify an unstable situation.

The charge nurse is checking the morning laboratory results for the clients. Which laboratory results require notifying the client's healthcare provider? 1. The client with hypoparathyroidism who has a decreased serum calcium level. 2. The client with Cushing's disease who has a decreased urine cortisol level. 3. The client with diabetes insipidus who has a low urine specific gravity. 4. The client with hyperthyroidism who has an increased TSH level.

Correct answer: 4 1. The client with hypoparathyroidism is expected to have decreased serum calcium level; therefore, the nurse would not contact the client's HCP. 2. The client with Cushing's syndrome is expected to have a urine cortisol level of 50 to 100 mcg/day; therefore, the nurse would not notify the client's HCP. 3. The client with diabetes insipidus is expected to have a low urine specific gravity (<1.005); therefore, the nurse would not notify the client's HCP. 4. The client diagnosed with hyperthyroidism should have a decreased TSH level; therefore, the nurse should notify the client's HCP.

The nurse is preparing to administer medications for clients on a medical unit. The client diagnosed with hypothyroidism is complaining of being hot all the time, feeling palpations, and being jittery. Which intervention should the nurse implement first? 1. Check the client's serum thyroid levels. 2. Assess the client for diarrhea. 3. Document the finding in the chart. 4. Hold the client's thyroid medication.

Correct answer: 4 1. The nurse should check the laboratory tests to determine the thyroid levels, but this is not the first intervention. 2. Assessing the client for diarrhea could be done, but it is more important not to worsen the problem, and, therefore, the nurse should hold the thyroid medication first. 3. Documentation of client complaints is always important, but it is not the first intervention. 4. The client is describing symptoms of hyperthyroidism. Because the client is diagnosed with hypothyroidism, has been prescribed thyroid hormone replacement, and now has symptoms of hyperthyroidism, it can be assumed that the client now has an excess of thyroid hormone. Therefore, the nurse should hold the thyroid medication and check the client's thyroid profile.

For which client's laboratory data should the charge nurse notify the HCP? 1. The potassium level of 3.6 mEq/L in a client diagnosed with heart failure who is taking the loop diuretic furosemide (Lasix). 2. The PTT level of 78 in the client diagnosed with pulmonary embolism who is receiving IV heparin. 3. The blood urea nitrogen (BUN) of 84 mg/dL in a client diagnosed with end-stage renal disease (ESRD) and peripheral edema. 4. The blood glucose level of 543 mg/dL in a client diagnosed with uncontrolled diabetes mellitus type 1.

Correct answer: 4 1. This is a normal potassium level, and the HCP does not need to be notified. 2. This level is within therapeutic range, and the HCP does not need to be notified. 3. A BUN of 84 mg/dL is an abnormal lab value, but it would be expected in a client diagnosed with ESRD. The HCP does not need to be notified. 4. This is a very high blood glucose level, and the client diagnosed with type 1 diabetes will be catabolizing fats at this level and is at risk for diabetic ketoacidosis (DKA) coma.

The clinical nurse manager on the endocrine unit overhears the staff nurses upset and arguing over how the clients are being assigned by the charge nurse. Which statement indicates a democratic leadership style by the clinical nurse manager? 1. "My charge nurse makes the assignments and I support how she does it." 2. "As long as there are no complaints from the clients I will not interfere." 3. "I appreciate you telling me about the situation and I will handle it." 4. "I will schedule a meeting and we will all sit down and discuss the situation."

Correct answer: 4 1. This statement does not allow the nurses to have any input into the assignments; therefore, this is the statement of an autocratic manager. These managers use an authoritarian approach to direct the activities of others. 2. Laissez-faire managers maintain a permissive climate with little direction or control. Allowing the assistants to have total control is laissez-faire management. Supporting the assistants in front of the charge nurse is an appropriate action, but it does not address the needs of the field nurses. 3. This statement does not support a democratic leadership style. It is more autocratic: The director is going to take care of the problem. 4. Democratic managers are people oriented and emphasize efficient group functioning. The environment is open, and communication flows both ways. Meetings to discuss concerns illustrate a democratic leadership style.

The client diagnosed with type 1 diabetes is receiving regular insulin, a pancreatic hormone, by sliding scale. The client's glucometer reading is 249. The order reads blood glucose level: <150 0 units 151-200 5 units 201-250 8 units 251-300 12 units >301 Contact healthcare provider How much insulin should the nurse administer to the client? _______ units

Correct answer: 8 Units The nurse should administer 8 units of regular insulin, since 249 is between 201 and 250.