NCLEX 10000 Endocrine & Metabolic Disorders

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: a) "Your insulin regimen must be altered significantly." b) "The test must be repeated following a 12-hour fast." c) "It looks like you aren't following the ordered diabetic diet." d) "It tells us about your sugar control for the last 3 months."

"It tells us about your sugar control for the last 3 months." Explanation: The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn.

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. Teaching regarding the use of these medications is effective if the client will take: a) all medications before going to bed. b) the levothyroxine before breakfast and the other medications 4 hours later. c) the levothyroxine with breakfast and the other medications after breakfast. d) all medications together 1 hour after eating breakfast.

the levothyroxine before breakfast and the other medications 4 hours later. Correct Explanation: Levothyroxine) must be given at the same time each day on an empty stomach, preferably ½ to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours

A client with diabetes begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." What would be the best response by the nurse? a) "What is it about giving yourself the insulin shots that bothers you?" b) "I can arrange to have a home care nurse give you the shots every day." c) "We can teach a family member to give the shots so you will not have to do it." d) "If you do not give yourself your insulin shots, you will be at greater risk for complications."

"What is it about giving yourself the insulin shots that bothers you?" Correct Explanation: The best response is to allow the client to verbalize fears about performing self-injection.

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? a) Potassium b) Insulin c) Hypotonic saline d) Hydrocortisone

Hydrocortisone Correct Explanation: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a) Providing the client with plenty of P.O. fluids b) Reserving an antecubital site for a peripherally inserted central catheter (PICC) c) Providing generous servings at mealtime d) Limiting I.V. fluid intake according to the physician's order

Reserving an antecubital site for a peripherally inserted central catheter (PICC) Explanation: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The expected outcome of using this drug is that it helps: a) slow progression of exophthalmos. b) reduce the vascularity of the thyroid gland. c) decrease the body's ability to store thyroxine. d) increase the body's ability to excrete thyroxine

reduce the vascularity of the thyroid gland. Correct Explanation: SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity.

The client who has been hospitalized with pancreatitis does not drink alcohol because of religious convictions. The client comes upset when the health care provider (HCP) persists in asking about alcohol intake. The nurse should explain that the reason for these questions is that:

there is a strong link between alcohol use and acute pancreatitis. Explanation: Alcoholism is a major cause of acute pancreatitis in the United States and Canada. Because some clients are reluctant to discuss alcohol use, staff may inquire about it in several ways. Generally, alcohol intake does not interfere with the tests used to diagnose pancreatitis. Recent ingestion of large amounts of alcohol, however, may cause an increased serum amylase level. Large amounts of ethyl and methyl alcohol may produce an elevated urinary amylase concentration. All clients are asked about alcohol and drug use on hospital admission, but this information is especially pertinent for clients with pancreatitis.

An obese client, age 65, is diagnosed with type 2 diabetes. When educating this client about his diagnosis, the nurse knows that the client will need more education when he says which of the following? Select all that apply. a) "If I don't keep my sugar under control, I could go into kidney failure." b) "I guess I will need to stop meeting my friends at the coffee shop." c) "I can never eat a hot fudge sundae again." d) "My doctor says that if I keep my weight down I probably won't have to go on insulin." e) "If I follow my diet and exercise, I won't have diabetes any more."

• "I can never eat a hot fudge sundae again." • "I guess I will need to stop meeting my friends at the coffee shop." • "If I follow my diet and exercise, I won't have diabetes any more." Correct Explanation: Patients with type 2 diabetes who follow a diet and exercise program will likely be able to achieve normal blood sugar levels, but cannot consider themselves "cured" of diabetes. Renal failure is a possible complication of uncontrolled diabetes. A person with well controlled diabetes can modify their diet to include occasional treats like ice cream if they select sugar free versions. Meeting friends for coffee is fine as long as the client does not include high sugar items along with the beverage. Type 2 diabetes can often be controlled with oral hypoglycemics

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client indicate that client teaching has been effective? Select all that apply. a) "I need to call my physician to discuss my steroid needs before I have dental work." b) "I need to obtain and wear a Medic Alert bracelet." c) "If I feel like I have the flu, I'll carry on as usual because this is an expected response." d) "I'll call the physician if I suddenly feel profoundly weak or dizzy." e) "I need to weigh myself daily to be sure I don't eat too many calories." f) "I have to take my steroids for 10 days."

• "I need to call my physician to discuss my steroid needs before I have dental work." • "I'll call the physician if I suddenly feel profoundly weak or dizzy." • "I need to obtain and wear a Medic Alert bracelet." Explanation: Dental work can be a cause of physical stress; therefore, the client's physician needs to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue, weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be notified if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's history of Addison's disease if the client is unable to communicate this information.

When caring for a client who's being treated for hyperthyroidism, the nurse should: a) Encourage the client to report any gastrointestinal upset and diarrhea, which may be related to the medications the client is taking. b) Provide extra blankets and clothing to keep the client warm. c) Monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. d) Balance the client's periods of activity and rest.

Balance the client's periods of activity and rest. Correct Explanation: A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest.

On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first? a) A 55-year-old complaining of chest pressure b) An 80-year-old client with a blood glucose level of 350 mg/dl c) A 60-year-old client experiencing nausea and vomiting d) A 20-year-old client with a blood glucose level of 70 mg/dl

A 55-year-old complaining of chest pressure Explanation: The nurse should assess the client with chest pressure first because he might be experiencing a myocardial infarction

The nurse is caring for a client following a motor vehicle incident with head trauma suspected of diabetes insipidus. Which nursing intervention is appropriate? a) Assess pupils for constriction. b) Measure and record urinary output. c) Monitor capillary glucose twice a day. d) Obtain a daily weight to determine retention.

Measure and record urinary output. Correct 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 physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? a) A decreased TSH level b) Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay c) An increase in the TSH level after 30 minutes during the TSH stimulation test d) No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test

No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test Explanation: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism.

A patient is coming to the clinic for a follow-up appointment after taking metformin for 9 months. After reviewing the patient's HbA1C level of 8.5%, the nurse anticipates what response from the primary care provider? a) Satisfaction with the medication's effectiveness b) Switch the client to a different oral antidiabetic agent. c) Initiate insulin therapy. d) Order an additional oral antidiabetic agent.

Order an additional oral antidiabetic agent. Explanation: The nurse should anticipate that the physician will order an additional oral antidiabetic agent, specifically a sulfonylurea. As many as 40% of patients do not experience blood glucose control on one medication. It would not be appropriate to initiate insulin therapy at this time. However, if a combination of oral antidiabetic agents are unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to metformin. The medication has not satisfactorily reduced the patient's HbA1C, so the care provider will not be satisfied.

When obtaining the nursing history of a client who has diabetes mellitus, the nurse should assess the client for which of the following early symptom of renal insufficiency? a) Oliguria. b) Hematuria. c) Polyuria. d) Dysuria.

Polyuria. Correct Explanation: In early renal insufficiency, the kidneys lose the ability to concentrate urine, resulting in polyuria. Oliguria occurs later. Dysuria and hematuria are not associated with renal insufficiency.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a) Thyroid storm b) Hemorrhage c) Laryngeal nerve damage d) Tetany

Tetany Correct Explanation: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? a) Half-normal saline solution b) 10% dextrose in water c) 5% dextrose and normal saline solution d) Lactated Ringer's solution

Lactated Ringer's solution Explanation: Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Avoid coffee and alcoholic beverages." b) "Lie down after meals to promote digestion." c) "Limit fluid intake with meals." d) "Take antacids with meals."

"Avoid coffee and alcoholic beverages." Correct Explanation: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol.

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. b) Observe for swelling of the neck, tracheal deviation, and severe pain. c) Monitor laboratory values daily for elevated thyroid-stimulating hormone. d) Evaluate the quality of the client's voice postoperatively, noting any drastic changes.

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Correct Explanation: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia.

A client is admitted with severe abdominal pains and the diagnosis of acute pancreatitis. The nurse should develop a plan of care during the acute phase of pancreatitis that will involve interventions to manage which of the following problems? a) Drug and alcohol abuse. b) Ineffective airway clearance. c) Risk for injury. d) Severe pain.

Severe pain. Explanation: Acute pancreatitis is very painful; management involves interventions for pain.

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? a) Tell the client that she looks fine and offer to help her with makeup. b) Tell the client she needs to learn to accept herself as she is and be compliant during treatment. c) Tell the client to ask her physician if she is taking the correct dosage of her medication. d) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Correct Explanation: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently.

Which of the following may be the first sign of respiratory acidosis in an anesthetized client? a) Labile blood pressure b) Seizure c) Sudden hyperthermia d) Ventricular fibrillation

Ventricular fibrillation Correct Explanation: Ventricular fibrillation may be the first sign of respiratory acidosis in anesthetized patients. Respiratory acidosis is not characterized by instabilities in blood pressure, seizure activity or a sudden onset of hyperthermia.

For a client with hyperthyroidism, treatment is most likely to include: a) a thyroid hormone antagonist. b) thyroid extract. c) emollient lotions. d) a synthetic thyroid hormone.

a thyroid hormone antagonist. Explanation: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production.

A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. The nurse should: a) increase protein in the diet. b) monitor serum bilirubin levels. c) assess for gastrointestinal (GI) bleeding. d) withhold the lactulose.

assess for gastrointestinal (GI) bleeding. Correct Explanation: Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increase protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurological symptoms are worsening.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for: a) diaphoresis, vomiting, and diarrhea. b) manifestations of hypoglycemia. c) constipation, dehydration, and hypercapnia. d) manifestations of electrolyte disturbances.

diaphoresis, vomiting, and diarrhea. Correct Explanation: The nurse must monitor for diaphoresis, vomiting, and diarrhea because these signs suggest an intolerance to the ordered enteral feeding solution. Other signs and symptoms of feeding intolerance include abdominal cramps, nausea, aspiration, and glycosuria.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The nurse does this to monitor for signs of: a) laryngeal nerve damage. b) upper airway obstruction. c) internal hemorrhage. d) decreasing level of consciousness.

laryngeal nerve damage. Explanation: Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the health care provider (HCP) immediately.

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery? a) methylprednisolone sodium succinate intravenously b) spironolactone intramuscularly c) fludrocortisone subcutaneously d) prednisone orally

methylprednisolone sodium succinate intravenously Correct Explanation: A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy.

A nurse is teaching a client about insulin therapy. The nurse knows the client needs additional teaching when she states that insulin may interact with: a) hormonal contraceptives. b) aspirin. c) hydrochlorothiazide (Hydro DIURIL). d) metoprolol.

metoprolol. Explanation: Although metoprolol may mask the signs of hypoglycemia, it doesn't interact with insulin. Therefore, the client requires additional teaching. Thiazide diuretics such as hydrochlorothiazide, aspirin, and hormonal contraceptives all interact with insulin.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report: a) constipation. b) sore throat. c) increased urine output. d) painful, excessive menstruation.

sore throat. Explanation: The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider (HCP) signs and symptoms of infection, such as a sore throat and fever.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for: a) cold skin. b) weight gain. c) anorexia. d) tachycardia.

tachycardia. Correct Explanation: Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the: a) back of the mouth. b) sinus channel below the right eye. c) upper gingival mucosa in the space between the upper gums and lip. d) nose.

upper gingival mucosa in the space between the upper gums and lip. Correct Explanation: With transsphenoidal hypophysectomy, the sella turcica is entered from below, through the sphenoid sinus. There is no external incision; the incision is made between the upper lip and gums.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level? a) Arm and leg trembling b) Slow, shallow respirations c) Rapid, thready pulse d) Cool, moist skin

Rapid, thready pulse Correct Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations.

A male client expresses concern about how a hypophysectomy will affect his sexual function. Which statement provides the most accurate information about the physiologic effects of hypophysectomy in a male? a) Fertility will be restored, but impotence and decreased libido will persist. b) Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. c) Exogenous hormones will be needed to restore erectile function after the adenoma is removed. d) Potency will be restored, but the client will remain infertile.

Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. Explanation: The client's sexual problems are directly related to the excessive prolactin level. Removing the source of excessive hormone secretion should allow the client to return gradually to a normal physiologic pattern. Fertility will return, and erectile function and sexual desire will return to baseline as hormone levels return to normal

When teaching the diabetic client about foot care, the nurse should instruct the client to: a) avoid going barefoot. b) cut toenails at angles. c) buy shoes a half size larger. d) use heating pads for sore feet.

avoid going barefoot. Correct Explanation: The client with diabetes is prone to serious foot injuries secondary to peripheral neuropathy and decreased circulation. The client should be taught to avoid going barefoot to prevent injury

A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for: a) bruised areas on the skin. b) orthostatic hypotension. c) muscle hypertrophy in the extremities. d) decreased body hair.

bruised areas on the skin. Correct Explanation: Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease.

When obtaining the nursing history of a client who has diabetes mellitus, the nurse should assess the client for which of the following early symptom of renal insufficiency? a) Polyuria. b) Oliguria. c) Hematuria. d) Dysuria.

Polyuria. Correct Explanation: In early renal insufficiency, the kidneys lose the ability to concentrate urine, resulting in polyuria. Oliguria occurs later. Dysuria and hematuria are not associated with renal insufficiency

A client has been diagnosed with hyperthyroidism and presents with heat intolerance and a blood pressure of 174/70 mm Hg; she is 3 months pregnant. The nurse anticipates that the physician will order which medication for this client? a) Methimazole b) Radioactive iodine c) Levothyroxine sodium d) Lisinopril

Methimazole Correct Explanation: Methimazole is the drug of choice for this client.

A nurse administers glucagon to a client with diabetes mellitus, then monitors the client for adverse drug reactions and interactions. Which drug type interacts adversely with glucagon? a) Beta-adrenergic blockers b) Anabolic steroids c) Thiazide diuretics d) Oral anticoagulants

Oral anticoagulants Correct Explanation: As a normal body protein, glucagon interacts adversely only with oral anticoagulants, increasing their anticoagulant effects.

Despite continuous health teaching, a client will use only the left thigh for insulin administration. The nurse is aware this is happening because: a) Repeatedly using the same site is less painful. b) This is attention-seeking behavior. c) The client is exerting control over the situation. d) The client is afraid of scarring.

Repeatedly using the same site is less painful. Correct Explanation: Repeatedly injecting in the same site causes scar tissue (lipohypertrophy) to form, and little or no pain is felt with subsequent injections. It also decreases insulin absorption.

When a client demonstrates the technique for self-administering NPH insulin, which of the following would indicate that the client needs additional teaching? a) Pulling back on the syringe plunger as soon as the needle is in subcutaneous tissue. b) Introducing the needle into subcutaneous tissue using a quick, dartlike action. c) Holding an antiseptic sponge against the needle when removing it from subcutaneous tissue. d) Shaking the insulin vial before withdrawing the insulin into the syringe.

Shaking the insulin vial before withdrawing the insulin into the syringe. Correct Explanation: The client should be instructed to mix the sediment that accumulates in a vial of NPH insulin by rolling the vial gently between the palms or by turning the vial upside down several times. Shaking the vial is not recommended because it produces bubbles that make it difficult to withdraw accurate doses of insulin.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? a) Weight gain, constipation, and lethargy b) Exophthalmos, diarrhea, and cold intolerance c) Diaphoresis, fever, and decreased sweating d) Weight loss, nervousness, and tachycardia

Weight loss, nervousness, and tachycardia Correct Explanation: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: a) weight gain in arms and legs. b) deposits of adipose tissue in the trunk and dorsocervical area. c) hypotension. d) thick, coarse skin.

deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump).

When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should: a) use a high-dose insulin syringe. b) draw up the long-acting insulin first. c) draw up either insulin first. d) inject air in the vial with the long-acting insulin first.

inject air in the vial with the long-acting insulin first. Correct Explanation: The air is injected into the long-acting insulin first. Air is then injected into the short-acting insulin and the short-acting insulin is withdrawn. Then the long-acting insulin is withdrawn. It does matter which insulin is drawn up first because the nurse does not want to contaminate the short-acting insulin with the long-acting insulin.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The nurse does this to monitor for signs of: a) upper airway obstruction. b) internal hemorrhage. c) laryngeal nerve damage. d) decreasing level of consciousness.

laryngeal nerve damage. Correct Explanation: Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the health care provider (HCP) immediately.

One day following a subtotal thyroidectomy a client begins to have tingling in the fingers and toes. The nurse should first: a) encourage the client to flex and extend the fingers and toes. b) ask the client to speak. c) notify the health care provider (HCP). d) assess the client for thrombophlebitis.

notify the health care provider (HCP). Correct Explanation: Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively.

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. The nurse should tell the client: a) "You can take the ginseng to help improve your memory." b) "You can take ginseng if you take it with a carbohydrate" c) "Taking ginseng will increase the risk of hypoglycemia." d) "No, there are no therapeutic benefits of ginseng."

"Taking ginseng will increase the risk of hypoglycemia." Explanation: Taking ginseng when on insulin is not encouraged because ginseng increases the risk of hypoglycemia. Ginseng can be therapeutic in certain situations but is potentially harmful for clients taking insulin

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? a) with meals or with an antacid b) at bedtime to increase absorption c) with a full glass of water d) on an empty stomach

with meals or with an antacid Explanation: Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid.

The nurse should assess the client with hypothyroidism for: a) decreased activity due to fatigue. b) corneal abrasion due to inability to close the eyelid. c) weight loss due to hypermetabolism. d) fluid loss due to diarrhea.

decreased activity due to fatigue. Explanation: A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms include lethargy, personality changes, generalized edema, impaired memory, slowed speech, cold intolerance, dry skin, muscle weakness, constipation, weight gain, and hair loss.

When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: a) restricting potassium. b) encouraging fluids. c) restricting sodium. d) restricting fluids.

encouraging fluids. Correct Explanation: The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine.

Which finding should the nurse report to the client's health care provider (HCP) for a client with unstable type 1 diabetes mellitus? Select all that apply. a) urine ketones, negative b) high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) c) systolic blood pressure, 145 mm Hg d) diastolic blood pressure, 87 mm Hg e) triglycerides, 425 mg/dL (23.6 mmol/L) f) glycosylated hemoglobin (HbA1c), 10.2% (0.1)

• high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) • glycosylated hemoglobin (HbA1c), 10.2% (0.1) • triglycerides, 425 mg/dL (23.6 mmol/L) • systolic blood pressure, 145 mm Hg • diastolic blood pressure, 87 mm Hg Correct Explanation: The client with unstable diabetes mellitus is at risk for many complications. Heart disease is the leading cause of mortality in clients with diabetes. The goal blood pressure for diabetics is less than 130/80 mm Hg. Therefore, the nurse would need to report any findings greater than 130/80 mm Hg. The goal of HbA1c is less than 7% (0.07); thus, a level of 10.2% (0.1) must be reported. HDL less than 40 mg/dL (2.2 mmol/L) and triglycerides greater than 150 mg/dL (8.3 mmol/L) are risk factors for heart disease. The nurse would need to report the client's HDL and triglyceride levels. The urine ketones are negative, but this is a late sign of complications when there is a profound insulin deficiency.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? a) "I may stop taking this medication when I feel better." b) "I will avoid friends and family members who are sick." c) "I will eat lots of chicken and dairy products." d) "I will see my ophthalmologist regularly for a check-up."

"I may stop taking this medication when I feel better." Explanation: The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning.

When educating the client with type 1 diabetes, the nurse knows that the client needs more education when he or she says: a) "I will need to go to the podiatrist to get my toenails cut so I don't get an infection." b) "I will need to give myself insulin every day." c) "I will be able to switch to insulin pills when my sugar is under control." d) "I will need to eliminate sugar from my diet."

"I will be able to switch to insulin pills when my sugar is under control." Correct Explanation: Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. The need to eliminate sugar, give insulin, and receive proper foot care are all items that indicate the client understands the teaching.

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? a) "When your thyroid levels are stable, we won't have to draw your blood as often." b) "I'll stay here with you while the technician draws your blood." c) "It's only a little stick. It'll be over before you know it." d) "The physician has ordered this test so you can get better sooner."

"I'll stay here with you while the technician draws your blood." Explanation: The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client.

The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings? a) Edema and coolness in the ankles and feet b) Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet c) Capillary refill in the toes within 3 seconds d) Redness, inflammation, and sharp pain with calf muscle contraction

Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet Explanation: This choice is the most accurate description of an interference with arterial circulation. The dorsalis pedis is one of the most peripheral pulses, its absence along with coolness indicates compromised arterial flow. Impaired blood flow will also affect the nervous status in the foot, resulting in decreased sensation.

A nurse is caring for a client immediately following an appendectomy. The nurse should assign which nursing diagnosis the highest priority? a) Risk for constipation b) Acute pain c) Deficient knowledge (postoperative care) d) Excess fluid volume

Acute pain Correct Explanation: This client is most likely experiencing postoperative pain, so Acute pain should be the priority nursing diagnosis.

A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a) Functioning thyroid gland b) Decreased phosphate level c) Adequate vitamin D level d) Increased calcium level

Adequate vitamin D level Correct Explanation: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? a) Drink 8 oz (240 mL) of fluids. b) Perform capillary blood glucose monitoring four times daily. c) Administer hydrocortisone I.M. d) Continue to take his usual dose of hydrocortisone.

Administer hydrocortisone I.M. Explanation: Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone.

After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days to stabilize the body's need for steroids postoperatively. Which of the following exercises will be most effective for preparing a client for ambulation after a period of bed rest? a) Alternately abducting and adducting the legs. b) Alternately stretching the Achilles tendons. c) Alternately flexing and extending the knees. d) Alternately flexing and relaxing the quadriceps femoris muscles.

Alternately flexing and relaxing the quadriceps femoris muscles. Explanation: Alternately flexing and relaxing the quadriceps femoris muscles helps prepare the client for ambulation. This exercise helps maintain the strength in the quadriceps, which is the major muscle group used when walking. The other exercises listed do not increase a client's readiness for walking.

Which nursing intervention would most likely promote self-care behaviors in the client with a hiatal hernia? a) Include the client's daughter in the teaching so that she can help implement the plan. b) Provide reassurance that the client will be able to implement all aspects of the plan successfully. c) Introduce the client to other people who are successfully managing their care. d) Ask the client to identify other situations in which the client changed health care habits.

Ask the client to identify other situations in which the client changed health care habits. Correct Explanation: Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits

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? a) Below-normal serum potassium level b) Serum ketone bodies c) Serum alkalosis d) Elevated serum acetone level

Below-normal serum potassium level Correct 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.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?

Bicarbonate Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance.

A nurse is caring for a client with advanced cirrhosis who describes feelings of nausea and dizziness. Upon assessment, the nurse notes pallor with a distended and firm abdomen. What is the most likely cause? a) Portal hypertension resulting in a sudden fluid shift and signs of hypovolemia b) Ascites increasing significantly due to hypoalbuminemia c) Bleeding esophageal varices causing gastric distension d) Development of a paralytic ileus associated with cirrhosis

Bleeding esophageal varices causing gastric distension Correct Explanation: A complication of cirrhosis is esophageal varices. The nurse needs to be alert for signs of internal bleeding. The nausea, dizziness, pallor, and increased pulse rate are all signs or symptoms of hemorrhage.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? a) Plasma bicarbonate 12 mEq/L (12 mmol/L) b) Blood urea nitrogen (BUN) 15 mg/dl (0.82 mmol/L) c) Blood glucose level 1,100 mg/dl (61.05 mmol/L) d) Arterial pH 7.25

Blood glucose level 1,100 mg/dl (61.05 mmol/L) 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 (33.33 mmol/L) in response to illness or infection.

A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? a) Smearing the drop of blood onto the reagent pad b) Starting the timer on the machine while gathering supplies c) Calibrating the machine after installing a new battery d) Ungloving the hands when removing the test strip

Calibrating the machine after installing a new battery Explanation: To obtain accurate readings, the nurse should calibrate the machine whenever a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing.

A physician writes a stat order for insulin and leaves the hospital. The nurse's client assessment includes fruity swelling breath, weakness, nausea, vomiting, and shortness of breath. The nurse cannot determine the dosage, but is familiar with this physician's routine and habit of writing insulin sliding scales orders. What should the nurse do? a) Ask a coworker to attempt to read the order. b) Make every attempt to contact the physician that ordered the insulin for clarification. c) Consult the physician's partner since he is readily available. d) Quickly administer what the physician would usually order.

Consult the physician's partner since he is readily available. Explanation: A nurse should never make assumptions or second-guess a physician order. Based on this client's symptoms, asking the attending physician's partner would not be out of line. It would take care of the problem and the original order can be clarified later.

A nurse observes a second nurse documenting a peripheral blood glucose level that the second nurse did not actually collect from a client with diabetes. What is the priority action by the nurse observing this situation? a) Do the blood glucose level on the client for the other nurse. b) Discuss the observation with the other nurse. c) Strike through the entry that the nurse documented. d) Document the nurse's behavior on the client's chart.

Discuss the observation with the other nurse. Correct Explanation: The first action the nurse should take is to discuss what was witnessed with the other nurse and express concern that this behavior is unethical, unprofessional, and illegal.

The nurse is teaching a client who is taking dexamethasone for cerebral edema about early symptoms of Cushing's disease. The nurse should advise the client to report which of the following is a symptom of hyperadrenocorticism? a) Increased urinary frequency. b) Easy bruising. c) Increased muscle mass. d) Hypotension.

Easy bruising. Correct Explanation: The client taking dexamethasone needs to know the early signs of Cushing's disease, which include easy bruising, moonface, buffalo hump, and osteoporosis. Loss of collagen makes the skin weaker and thinner; therefore, the client bruises more easily. The nurse should instruct the client to report any of these signs to the physician. Hypertension is a symptom of Cushing's disease, and muscle mass is decreased.

The adrenal cortex is responsible for producing which substances? a) Norepinephrine and epinephrine b) Mineralocorticoids and catecholamines c) Catecholamines and epinephrine d) Glucocorticoids and androgens

Glucocorticoids and androgens Correct Explanation: The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client? a) Nitroprusside b) Dopamine c) Lidocaine d) Insulin

Nitroprusside Correct Explanation: Excess catecholamine release occurs with pheochromocytoma and causes hypertension. The nurse should prepare to administer nitroprusside to control the hypertension until the client undergoes adrenalectomy to remove the tumor.

A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. When doing the medication reconciliation, the nurse notes that the client is also taking celecoxib for osteoarthritis. Which medication might the nurse suggest the physician add for this client? a) Omeprazole b) Diphenhydramine c) Misoprostol d) Over-the-counter antacids

Over-the-counter antacids Explanation: Misoprostol is a synthetic prostaglandin E1 analogue that will replace gastric prostaglandins depleted by steroid therapy and thereby prevent the development of gastritis or peptic ulcer disease. Omeprazole is a proton pump inhibitor that will decrease gastric acidity; over-the-counter antacids may help to decrease acidity.

Clients with diabetes mellitus require frequent vision assessment. The nurse should instruct the client about which of the following eye problems most likely to be associated with diabetes mellitus? a) Cataracts. b) Retinopathy. c) Glaucoma. d) Astigmatism.

Retinopathy. Correct Explanation: The major cause of blindness in people with diabetes mellitus is diabetic retinopathy. Corneal problems, cataracts, refractive changes, glaucoma, and extraocular muscle changes are also noted, but retinopathy is the most common problem.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? a) Urine ketones b) Serum glycosylated hemoglobin (Hb A1c) c) 6-hour glucose tolerance test d) Fasting blood glucose te

Serum glycosylated hemoglobin (Hb A1c) Correct Explanation: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months

When caring for a client with a history of hypoglycemia, the nurse should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? a) Sulfisoxazole b) Prednisone c) Mexiletine d) Lithium carbonate

Sulfisoxazole Correct Explanation: Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia.

The nurse might expect to see which of these manifestations in the client who is hypocalcemic? Select all that apply. a) Fatigue b) Prolonged Q-T interval c) Tetany d) Syncope e) Irritability

• Prolonged Q-T interval • Irritability • Tetany Explanation: Hypocalcemia will cause a prolonged Q-T interval, irritability, and tetany

Which skin preparation would be best to apply around the client's colostomy? a) antiseptic cream b) cornstarch c) adhesive skin barrier d) petroleum jelly

adhesive skin barrier Correct Explanation: An adhesive skin barrier is effective for protecting the skin around a colostomy to keep the skin healthy and prevent skin irritation from stoma drainage.

A client with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: a) collect a 24-hour urine specimen to measure serum cortisol levels. b) administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. c) draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. d) administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.

administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. Correct Explanation: When Cushing's syndrome is suspected, a 24-hour urine collection for free cortisol is performed. Levels of 50 to 100 mcg/day (1,379 to 2,756 nmol/L) in adults indicate Cushing's syndrome. If these results are borderline a high-dose dexamethasone suppression test is done. The dexamethasone is given at 2300 to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 0800. Normal cortisol level less than 5 mcg/dL (140 nmol/L) indicates normal adrenal response.

Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease?

an abnormality in the body's mucus-secreting glands Explanation: CF is characterized by a dysfunction in the body's mucus-producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients.

A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise the client to: a) apply a high-quality corn plaster to the area. b) apply iodine to the corns before peeling them off. c) consult a health care provider (HCP) about removing the corns. d) soak the feet in borax solution to peel off the corns.

consult a health care provider (HCP) about removing the corns. Correct Explanation: A client with diabetes should be advised to consult a HCP or podiatrist for corn removal because of the danger of traumatizing the foot tissue and potential development of ulcers. The diabetic client should never self-treat foot problems but should consult a HCP or podiatrist.

A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. a) Prolonged QT interval on ECG. b) Bradycardia. c) Nervousness. d) Dry mouth. e) Low body temperature. f) Tachycardia.

• Prolonged QT interval on ECG. • Low body temperature. • Bradycardia. Explanation: In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate.

A client who had a splenectomy yesterday has a nasogastric (NG) tube. The expected outcome of using the NG tube is to: a) irrigate the operative site. b) decrease abdominal distention. c) move the stomach away from where the spleen was removed. d) assess for the gastric pH as peristalsis returns.

decrease abdominal distention. Correct Explanation: A splenectomy may involve manipulation of the upper abdominal organs, such as diaphragm, stomach, liver, spleen, and small intestines. Manipulation of these organs and resulting inflammation lead to a slowed peristalsis. An NG tube is placed to decrease abdominal distention in the immediate postoperative phase.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a) flushed, warm, moist skin. b) decreased body temperature and cold intolerance. c) exophthalmos and conjunctival redness. d) systolic murmur at the left sternal border.

decreased body temperature and cold intolerance. Correct Explanation: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression.

The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is: a) decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. b) decreased TSH and increased T4 levels. c) absence of antithyroid antibodies. d) decreased creatine phosphokinase levels.

decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. Correct Explanation: The nurse should expect to find decreased levels of thyroxine and triiodothyronine and increased TSH. Other indicators of hypothyroidism are the presence of antithyroid antibodies and elevation of the creatine phosphokinase (CPK-MM) level.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: a) suggest referral to a sex counselor or other appropriate professional. b) encourage the client to ask questions about personal sexuality. c) provide time for privacy. d) provide support for the spouse or significant other.

suggest referral to a sex counselor or other appropriate professional. Correct Explanation: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care.

A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. a) Tachycardia. b) Bradycardia. c) Nervousness. d) Dry mouth. e) Prolonged QT interval on ECG. f) Low body temperature.

• Prolonged QT interval on ECG. • Low body temperature. • Bradycardia. Explanation: In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate.

A client recently diagnosed with hyperparathyroidism demands to see what the physician has written about him in the chart. What is the nurse's best response?

"I'll get the chart and set up a time for you to review it with your physician." Explanation: Every client has a right to access information the hospital has collected about him. However, it's in the client's best interests to have a knowledgeable professional present to explain complicated information and unfamiliar terminology the chart might include

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client? a) Nitroprusside b) Insulin c) Lidocaine d) Dopamine

Nitroprusside Correct Explanation: Excess catecholamine release occurs with pheochromocytoma and causes hypertension. The nurse should prepare to administer nitroprusside to control the hypertension until the client undergoes adrenalectomy to remove the tumor.

A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus? a) Treating hypoglycemia b) Teaching the client dietary changes necessary with diabetes mellitus c) Assessing the client experiencing a hypoglycemic reaction d) Obtaining, reporting, and documenting fingerstick glucose levels

Obtaining, reporting, and documenting fingerstick glucose levels Explanation: The educator should teach the nursing assistants how to obtain and document a fingerstick glucose level. She should also teach them normal and abnormal results and the importance of reporting them to the registered nurse caring for the client. Treating hypoglycemia, teaching clients about dietary changes, and assessing clients experiencing hypoglycemic reactions are outside the scope of practice for a nursing assistant

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? a) Blurred vision b) Tachycardia c) Dysuria d) Leg cramps

Tachycardia Correct Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: a) a blood pressure of 176/88 mm Hg. b) a blood glucose level of 130 mg/dl (7.2 mmol/L). c) a blood pressure of 130/70 mm Hg. d) bradycardia

a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss.

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as: a) a canker sore of the oral soft tissues. b) an acute stomach infection. c) acid indigestion. d) an early sign of peptic ulcer disease

a canker sore of the oral soft tissues. Correct Explanation: Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? a) on an empty stomach b) with a full glass of water c) with meals or with an antacid d) at bedtime to increase absorption

with meals or with an antacid Explanation: Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Only instructing the client to take the medication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach.

A nurse is caring for clients with diabetes insipidus and must be aware of the disorder's pathophysiology. Place the following events in chronological sequence to show the pathophysiologic process. Use all of the options. 1 2 3 4 5 Distal renal tubules are unable to absorb water. Polyuria occurs. Thirst occurs. Body has insufficient level of ADH. Dehydration occurs.

Body has insufficient level of ADH. Distal renal tubules are unable to absorb water. Polyuria occurs. Dehydration occurs. Thirst occurs. Explanation: The pathophysiology of diabetes insipidus begins with a decrease in ADH or with the kidneys' inability to respond to ADH. Without ADH, the distal kidney tubules and collecting ducts cannot absorb water and polyuria occurs. This leads to dehydration and then thirst.

A client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. He's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl (6.9 mmol/L), and potassium level 3.8 mEq/L (3.8 mmol/L). Which nursing diagnosis is most appropriate for this client? a) Deficient fluid volume related to osmotic diuresis induced by hypernatremia b) Deficient fluid volume related to inability to conserve water c) Imbalanced nutrition: Less than body requirements related to hypermetabolic state d) Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency

Deficient fluid volume related to inability to conserve water Explanation: The client has signs and symptoms of diabetes insipidus, probably caused by the failure of his renal tubules to respond to antidiuretic hormone as a consequence of pyelonephritis. Therefore, Deficient fluid volume related to inability to conserve water is the most appropriate nursing diagnosis. The client's hypernatremia is secondary to his water loss.

A client with a serum glucose level of 618 mg/dl (34.33 mmol/L) is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? a) Deficient fluid volume related to osmotic diuresis b) Decreased cardiac output related to elevated heart rate c) Ineffective thermoregulation related to dehydration d) Imbalanced nutrition: Less than body requirements related to insulin deficiency

Deficient fluid volume related to osmotic diuresis Explanation: A serum glucose level of 618 mg/dl (34.33 mmol/L) indicates hyperglycemia, which causes polyuria and fluid volume deficit, making Deficient fluid volume related to osmotic diuresis the highest priority. In this client, tachycardia is more likely to result from fluid volume deficit than from decreased cardiac output because his blood pressure is normal.

he nurse is caring for a client who is administering insulin for diabetes mellitus for the first time. The nurse is instructing the client on mixing Humulin N insulin and Humulin R insulin in one syringe. Arrange the instructions in order. All options must be used. 1 2 3 4 5 6 Gently roll both insulins between your hands Wipe with alcohol and inject air (equal to units ordered) into the Humulin R insulin Withdraw Humulin N insulin Withdraw the Humulin R Wipe with alcohol and inject air (equal to units ordered) into the Humulin N insulin Double check the total number of units in syringe

Gently roll both insulins between your hands Wipe with alcohol and inject air (equal to units ordered) into the Humulin N insulin Wipe with alcohol and inject air (equal to units ordered) into the Humulin R insulin Withdraw the Humulin R Withdraw Humulin N insulin Double check the total number of units in syringe Correct Explanation: Mixing insulin requires careful consideration. Both insulins are gently rolled to warm. Do not shake. Wipe the caps and inject air, first into the Humulin N and then Humulin R. Turn the Humulin R vial upside down and withdraw the number of units prescribed. Next, withdraw Humulin N. Double check syringe total against order

Which of the following is most effective in assessing the client suspected of developing diabetes insipidus?

Measuring urine output hourly. Explanation: Diabetes insipidus results from deficiency of antidiuretic hormone (ADH). The condition may occur in conjunction with head injuries as well as with other disorders. In ADH deficiency, the client is extremely thirsty and excretes large amounts of highly diluted urine. Measuring the urine output to detect excess amount and checking the specific gravity of urine samples to determine urine concentration are appropriate measures to determine the onset of diabetes insipidus.

A client has been diagnosed with hyperthyroidism and presents with heat intolerance and a blood pressure of 174/70 mm Hg; she is 3 months pregnant. The nurse anticipates that the physician will order which medication for this client? a) Methimazole b) Radioactive iodine c) Levothyroxine sodium d) Lisinopril

Methimazole Correct Explanation: Methimazole is the drug of choice for this client. Radioactive iodine is usually used for hyperthyroidism but is contraindicated in pregnancy. Levothyroxine sodium is for hypothyroidism. Lisinopril is an ACE inhibitor (ACEI) — all ACEIs are contraindicated in pregnancy.

A nurse should expect a client with hypothyroidism to report: a) increased appetite and weight loss. b) nervousness and tremors. c) puffiness of the face and hands. d) thyroid gland swelling.

puffiness of the face and hands. Correct Explanation: Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a) Monitor laboratory values daily for elevated thyroid-stimulating hormone. b) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. c) Observe for swelling of the neck, tracheal deviation, and severe pain. d) Evaluate the quality of the client's voice postoperatively, noting any drastic changes.

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Correct Explanation: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia

Which laboratory test results should a nurse expect to find in a client diagnosed with Hashimoto's thyroiditis? a) Thyroxine (T4), 22 ?g/dl; triiodothyronine (T3), 320 ng/dl; thyroid-stimulating hormone (TSH) undetectable b) T4, 2 ?g/dl; T3, 35 ng/dl; TSH 45 ?IU/ml c) T4, 2 ?g/dl; T3, 200 ng/dl; TSH 5.9 ?IU/ml d) T4, 22 ?g/dl; T3, 200 ng/dl; TSH 0.1 ?IU/ml

T4, 2 ?g/dl; T3, 35 ng/dl; TSH 45 ?IU/ml Explanation: Normal thyroid function tests are as follows: T4, 5 to 12 ?g/dl; T3, 65 to 195 ng/dl; TSH 0.3 to 5.4 ?IU/ml. With Hashimoto's thyroiditis, T4 and T3 levels are typically subnormal and TSH is elevated. With primary hyperthyroidism, T4 and T3 levels are elevated and TSH is subnormal. With hypothyroidism, T4 is subnormal and T3 and TSH levels are elevated.

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? a) The kidneys regulate the bicarbonate level in the intracellular fluid. b) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. c) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. d) The kidneys react rapidly to compensate for imbalances in the body.

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. Correct Explanation: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a) They cause wide fluctuations in the need for insulin. b) They decrease the need for insulin. c) They have no effect. d) They increase the need for insulin.

They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications.

A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: a) neuropathy. b) hyperthyroidism. c) hypoglycemia. d) depression.

depression. Explanation: Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome.

Which is an expected outcome for a client with peptic ulcer disease? The client will: a) eliminate engaging in contact sports. b) explain the rationale for eliminating alcohol from the diet. c) demonstrate appropriate use of analgesics to control pain. d) verbalize the importance of monitoring hemoglobin and hematocrit every 3 months.

explain the rationale for eliminating alcohol from the diet. Correct Explanation: Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. a) Aphasia b) Polyuria c) Numbness d) Polydipsia e) Tingling f) Muscle twitching and spasms

• Numbness • Tingling • Muscle twitching and spasms Correct Explanation: When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms.

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? a) "It's only a little stick. It'll be over before you know it." b) "I'll stay here with you while the technician draws your blood." c) "The physician has ordered this test so you can get better sooner." d) "When your thyroid levels are stable, we won't have to draw your blood as often."

"I'll stay here with you while the technician draws your blood." Correct Explanation: The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client.

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? a) "Administer insulin into areas of scar tissue or hypertrophy whenever possible." b) "Rotate injection sites within the same anatomic region, not among different regions." c) "Administer insulin into sites above muscles that you plan to exercise heavily later that day." d) "Inject insulin into healthy tissue with large blood vessels and nerves."

"Rotate injection sites within the same anatomic region, not among different regions." Explanation: The nurse should instruct the client to rotate injection sites within the same anatomic region.

Which instruction about levothyroxine administration should a nurse teach a client? a) "Take the drug whenever convenient." b) "Take the drug in the evening." c) "Take the drug on an empty stomach." d) "Take the drug with meals."

"Take the drug on an empty stomach." Correct Explanation: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? a) To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications" b) To maintain or have moderately high serum lipid levels to reduce the risk for macrovascular complications c) To meet energy needs by eating all foods that keep blood glucose within a relatively normal range d) To monitor weight gain and recognize that 11-22 pounds (5-10 kg) is acceptable and treatable with all diabetic clients

To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications" Explanation: Nutrition and normal blood glucose will help reduce chronic disease processes associated with diabetes

The nurse is reviewing the postoperative prescriptions (see chart) just written by a health care provider (HCP) for a client with type 1 diabetes who has returned to the surgery floor from the recovery room following surgery for a left hip replacement. The client has pain of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client's glucose level, the nurse should first: a) take the vital signs. b) administer oxygen per nasal canula at 2 L/min. c) contact the health care provider (HCP) to rewrite the insulin prescription. d) administer the morphine.

contact the health care provider (HCP) to rewrite the insulin prescription. Explanation: Insulin is on the list of error-prone medications, and the nurse should ask the HCP to rewrite the prescription to spell out the word "units" and to indicate the route by which the drug is to be administered. The nurse should contact the HCP immediately as the nurse is to administer the insulin now. The nurse can then also report the most current glucose level. While waiting for the insulin prescription to be rewritten, the nurse can administer the pain medication if needed, start the oxygen, and check the client's vital signs.

The nurse should assess a client with Addison's disease for: a) lethargy. b) weight gain. c) muscle spasms. d) hunger.

lethargy. Correct Explanation: Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symptoms. Other early signs and symptoms include mood changes, emotional lability, irritability, weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency

Which outcome is a priority for the client with Addison's disease? a) prevention of hypertensive episodes b) adherence to a 2-g sodium diet c) avoidance of normal activities with stress d) maintenance of medication compliance

maintenance of medication compliance Correct Explanation: Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider (HCP) to avoid an Addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress.

A client with diabetes is asking the nurse about drinking alcohol. The nurse's best response would be which of the following? a) "If you drink too much alcohol, you need to set your alarm clock to wake you up to take your blood glucose." b) "Alcohol may decrease the normal physiologic reactions in the body that produce glucose. Therefore, there is a risk for hypoglycemia." c) "Clients with diabetes should give up alcohol, so an alternate source of beverage should be consumed." d) "There is a potential interaction with alcohol and insulin; the alcohol causes an increase in blood glucose. Therefore, more frequent monitoring is needed when drinking alcohol."

"Alcohol may decrease the normal physiologic reactions in the body that produce glucose. Therefore, there is a risk for hypoglycemia." Explanation: This is the systemic physiologic response to alcohol in the body of a diabetic client.

Which statement best indicates that a client understands how to self-administer insulin injections? a) "I need to wash my hands before I give myself my injection." b) "I need to be sure I am drawing up the correct dose of insulin." c) "I wrote down the steps in case I forget what to do." d) "I need to be sure no air bubbles remain."

"I wrote down the steps in case I forget what to do." Correct Explanation: The fact that the client has written down each step of insulin administration provides the best assurance that the client follow through with all the proper steps.

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse shuld tell the client: a) "Long-term use of steroids will prolong periods of remission." b) "The side effects of steroids outweigh their benefits to clients with ulcerative colitis." c) "Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." d) "Ulcerative colitis can be cured by the use of steroids."

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." Correct Explanation: Steroids are effective in management of the acute symptoms of ulcerative colitis.

The laboratory comes to draw an Hgb AIc. The client asks the nurse what this test represents. Which statement would be correct? a) "This blood test is done to measure hyperglycemia in your system for 3 to 4 days after you were diagnosed with diabetic ketoacidosis (DKA)." b) "This test is needed to determine which insulin will be needed to prevent another diabetic ketoacidosis (DKA) episode." c) "This test reflects the average blood glucose over a period of approximately 2-3 months." d) "This test is done to determine length of time that will be needed to correct the diabetic ketoacidosis (DKA) state."

"This test reflects the average blood glucose over a period of approximately 2-3 months." Correct Explanation: HbG AIc is a measurement of blood glucose over the life of a red blood cell. It measures the percentage of glycated hemoglobin in the blood All the other choices do not accurately represent the purpose of the test.

A client with type 2 diabetes who requires insulin asks the nurse about having alcoholic beverages. Which is the best response by the nurse? a) "If you have a drink, the blood glucose value may be elevated at bedtime, and you should skip having a snack." b) "You can have one or two drinks a day as long as you have something to eat with them." c) "if you are going to drink, it is best to consume alcohol on an empty stomach." d) "Alcohol is detoxified in the liver, so it is not a good idea for you to drink anything with alcohol."

"You can have one or two drinks a day as long as you have something to eat with them." Correct Explanation: A modest alcohol intake (1 to 2 drinks/day) may be incorporated into the nutrition plan for individuals who choose to drink. Alcohol is detoxified in the liver where glycogen reserves are stored and normally released in case of hypoglycemia. At the time alcohol is consumed, glucose values will likely rise because of the carbohydrate in the beer, wine or mixed drinks; however, the later and more dangerous effect of alcohol is a hypoglycemic effect. Alcohol should be consumed with food;

A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus at 7 a.m. (0700). At what time should the nurse expect the client to be most at risk for hypoglycemia? a) Noon (1200) b) 4 p.m. (1600) c) 10 p.m. (2200) d) 10 a.m.(1000)

4 p.m. (1600) Explanation: NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m. (0700), the client is at greatest risk for hypoglycemia from 3 (1500) to 7 p.m. (1900).

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? a) 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin b) 70% regular insulin and 30% NPH insulin c) 70% NPH insulin and 30% regular insulin d) 70 units of regular insulin and 30 units of NPH insulin

70% NPH insulin and 30% regular insulin Correct Explanation: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which of the following actions should the nurse take? a) Start oxygen at 2 L/min as needed b) Contact the healthcare provider c) Administer IV glucagon bolus as needed d) Administer a saline bolus as needed

Administer a saline bolus as needed Explanation: The rapid, deep (Kussmaul) respirations are compensatory and indicate metabolic acidosis. There is an immediate need for correction of the acidosis with a saline bolus to prevent hypovolemia. This will be followed by assessment of glucose level and insulin administration to allow the glucose to reenter the cells.

A client with type 1 diabetes must undergo bowel resection in the morning and is therefore NPO. The client's capillary blood glucose (CBG) reading at 0630 is 315, and the insulin orders include insulin glargine 35 units daily in AM and regular insulin 8 units for this CBG reading. How should the nurse proceed while caring for the client on the morning of surgery? a) Administer the insulin glargine only. b) Administer the regular insulin only. c) Withhold all insulin since he is NPO. d) Administer both the insulin glargine and the regular insulin doses.

Administer both the insulin glargine and the regular insulin doses. Correct Explanation: Both the basal and the correctional doses of insulin should be administered; the regular insulin will cover the high blood glucose level that the client is experiencing now, and the insulin glargine will cover the glucose that the liver will continue to produce throughout the day, even if the client is not eating anything. In addition, the client's blood glucose levels will need to be closely monitored during and following surgery because anesthetic agents may interfere with insulin metabolism.

The nurse is caring for a client with type 2 diabetes who has been admitted with hyperglycemia. What is the most important consideration when developing a teaching plan for this client? a) Help the client differentiate between hypoglycemia and hyperglycemia. b) Identify the level of motivation for learning and what information is needed. c) Inform the client about proper dietary planning and regular activity. d) Assess what the client already knows, then identify learning needs.

Assess what the client already knows, then identify learning needs. Explanation: It is most important to assess the client's teaching learning needs. The client needs to share what is already known about diabetes and how it has been managed.

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms? a) Polyuria, polydipsia, hypotension, and hypernatremia b) Coma, anxiety, confusion, headache, and cool, moist skin c) Polyuria, polydipsia, polyphagia, and weight loss d) Kussmaul's respirations, dry skin, hypotension, and bradycardia

Coma, anxiety, confusion, headache, and cool, moist skin Correct Explanation: Signs and symptoms of hypoglycemia [indicated by a blood glucose level of 45 mg/dl (2.5 mmol/L)] include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures.

Upon shift report, the nurse learns the following laboratory values: pH, 7.44; PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance is the client most likely experiencing? a) Compensated respiratory alkalosis b) Compensated metabolic acidosis c) Compensated metabolic alkalosis d) Uncompensated respiratory alkalosis

Compensated respiratory alkalosis Explanation: The question states that the client has a history of acid-base disturbance. The nurse would first note that the pH has returned to close to normal indicating compensation. The nurse then assess the PCO2 (normal: 35 to 45 mm Hg) and HCO3 (normal: 22 to 27mEq/L) levels. In a respiratory condition, the pH and the PCO2 move in opposite direction; thus, the pH rises and the PCO2 drops (alkalosis) or vice versa (acidosis). In a metabolic condition, the pH and the bicarbonate move in the same direction; if the pH is low, the bicarbonate level will be low, also. In this client, the pH is at the high end of normal, indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition (opposite direction of the pH).

A client has been hospitalized with pancreatitis for 3 days. The nurse assesses the client and documents the accompanying results. The nurse realizes these findings are a manifestation of what sign? a) Cullen's sign b) Broca's sign c) Trousseau's sign d) Chvostek's sign

Cullen's sign Correct Explanation: Cullen's sign is evidenced by discoloration at the periumbilical area. This sign may indicate an underlying subcutaneous intraperitoneal hemorrhage.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? a) Hyperphosphatemia b) Hypophosphaturia c) Hypocalcemia d) Hypercalcemia

Hypercalcemia Correct Explanation: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

The client, a 56 year old woman, has just undergone a left adrenalectomy for pheochromocytoma. Which postoperative complication should be the nurse's priority concern? a) Hyperkalemia b) Hypernatremia c) Hypercalcemia d) Hypertension

Hypertension Explanation: Following adrenalectomy for pheochromocytoma, the client must be closely monitored for hypertension. Clients with aldosterone producing tumors may have problems with hyperkalemia.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium.

A client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap? a) Metabolic alkalosis b) Respiratory alkalosis c) Metabolic acidosis d) Respiratory acidosis

Metabolic acidosis Explanation: The anion gap is the difference between sodium and potassium cations and the sum of chloride and bicarbonate anions. An anion gap that exceeds 16 mEq/L indicates metabolic acidosis. In this case, the anion gap is (166 + 5) − (115 + 35), yielding 21 mEq/L, which suggests metabolic acidosis. Anion gap is not used to check for respiratory alkalosis, metabolic alkalosis, or respiratory acidosis

A male client expresses concern about how a hypophysectomy will affect his sexual function. Which statement provides the most accurate information about the physiologic effects of hypophysectomy in a male? a) Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. b) Exogenous hormones will be needed to restore erectile function after the adenoma is removed. c) Fertility will be restored, but impotence and decreased libido will persist. d) Potency will be restored, but the client will remain infertile.

Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. Explanation: The client's sexual problems are directly related to the excessive prolactin level. Removing the source of excessive hormone secretion should allow the client to return gradually to a normal physiologic pattern. Fertility will return, and erectile function and sexual desire will return to baseline as hormone levels return to normal

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a) Providing the client with plenty of P.O. fluids b) Providing generous servings at mealtime c) Reserving an antecubital site for a peripherally inserted central catheter (PICC) d) Limiting I.V. fluid intake according to the physician's order

Reserving an antecubital site for a peripherally inserted central catheter (PICC) Explanation: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome? a) The client is severely dehydrated and needs 2 to 3 L of I.V. fluid rapidly. b) The client is fluid overloaded and needs I.V. fluid slowly to prevent circulatory overload and collapse. c) The client is in need of a dextrose solution containing normal saline solution for gradual rehydration. d) The client is severely dehydrated and needs 10 L of I.V. fluid over the first 24 hours.

The client is severely dehydrated and needs 2 to 3 L of I.V. fluid rapidly. Correct Explanation: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia

Which indicates that the client with diabetes insipidus understands how to manage care? a) The client will select a diabetic diet correctly. b) The client will maintain normal fluid and electrolyte balance. c) The client will exhibit serum glucose level within normal range. d) The client will state dietary restrictions.

The client will maintain normal fluid and electrolyte balance. Correct Explanation: Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client.

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? a) The client will need steroid replacement for the rest of her life. b) The client will need to take steroids whenever her life involves physical or emotional stress. c) The client must decrease the dose of steroid medication carefully to prevent crisis. d) The client will require steroids only until her body can manufacture sufficient quantities.

The client will need steroid replacement for the rest of her life. Correct Explanation: Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually reestablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan.

A client with Cushing's disease tells the nurse that the health care provider (HCP) said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I am not imagining all these symptoms!" The nurse's response will be based on the fact that? a) A single random blood test cannot provide reliable information about endocrine levels. b) Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels. c) The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. d) Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.

The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Explanation: Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? a) To notify the health care provider (HCP) when the blood pressure is suddenly high. b) How to decrease the dose of the corticosteroids when the client experiences stress. c) The need to adjust the steroid dose based on dietary intake and exercise. d) The importance of watching for signs of hyperglycemia.

The importance of watching for signs of hyperglycemia. Explanation: Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia.

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? a) The kidneys regulate the bicarbonate level in the intracellular fluid. b) The kidneys react rapidly to compensate for imbalances in the body. c) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. d) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. Correct Explanation: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance

An elderly client with type 2 diabetes had hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent: a) cerebral edema. b) ketone body formation. c) a major vascular accident. d) fluid volume depletion.

cerebral edema. Correct Explanation: HHS can be caused by acute illness, such as an infection like pneumonia or sepsis. In HHS, there is a residual amount of insulin that suppresses ketosis but cannot control hyperglycemia. This leads to severe dehydration and impaired renal function. Ketone bodies are usually absent in HHS, and they do not form as a result of too rapid correction of blood glucose. The nurse should assess the client for a major vascular accident in the elderly as an etiology for a hyperglycemic crisis. Volume depletion must be treated first in HHS. Cerebral edema is a risk with too rapid correction of blood glucose.

The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for 20 years. Currently the client reports having periods of hypoglycemia followed by periods of hyperglycemia. The nurse should specifically ask if the client is: a) injecting insulin at a site of lipodystrophy. b) adjusting insulin according to blood glucose levels. c) initiating the use of the insulin pump. d) eating snacks between meals.

injecting insulin at a site of lipodystrophy. Explanation: Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections, which can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been receiving insulin for many years, this is the most likely cause of poor control.

A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, "I cannot be expected to remember all this stuff." The nurse should recognize this response as most likely related to which factor? a) early-onset dementia b) normal reaction to learning a new skill c) disinterest in the illness d) moderate to severe anxiety

moderate to severe anxiety Explanation: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for him to learn the steps of the blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes his lifestyle, it is unlikely that he is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate lessening anxiety would be questions to the nurse or requests to repeat part of the instruction

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which change in the menstrual cycle? a) metrorrhagia b) dysmenorrhea c) oligomenorrhea d) menorrhagia

oligomenorrhea Correct Explanation: A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the absence of menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis. Oligomenorrhea in women and decreased libido and impotence in men are common features of thyrotoxicosis.

Which is an expected finding in a client with adrenal crisis (Addisonian crisis)? a) fluid retention b) pain c) peripheral edema d) hunger

pain Explanation: Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities).

A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by: a) performing capillary glucose testing every 4 hours. b) testing for ketones in the urine. c) checking temperature every 4 hours. d) testing urine specific gravity.

performing capillary glucose testing every 4 hours. Correct Explanation: The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia

A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: a) mannitol. b) methyldopa. c) felodipine. d) phentolamine.

phentolamine. Correct Explanation: Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively

A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: a) felodipine. b) mannitol. c) phentolamine. d) methyldopa.

phentolamine. Correct Explanation: Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively.

In the early postoperative period after a bilateral adrenalectomy, the client has an increased temperature. The nurse should assess the client specifically for signs of: a) urinary tract infection. b) wound infection. c) dehydration. d) poor lung expansion.

poor lung expansion. Explanation: Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of slight postoperative temperature elevation. Nursing care includes turning the client and having the client cough and deep-breathe every 1 to 2 hours, or more frequently as prescribed. The client will have postoperative IV fluid replacement prescribed to prevent dehydration. Wound infections typically appear 4 to 7 days after surgery.

The client with cirrhosis who has ascites receives 100 mL of 25% serum albumin I.V. Which finding would best indicate that the albumin is having its desired effect? a) increased ease of breathing b) increased serum albumin level c) reduced ascites d) decreased anorexia

reduced ascites Explanation: Normal serum albumin is administered to reduce ascites. Hypoalbuminemia, a mechanism underlying ascites formation, results in decreased colloid osmotic pressure. Administering serum albumin increases the plasma colloid osmotic pressure, which causes fluid to flow from the tissue space into the plasma.

Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of: a) renal failure. b) chronic obstructive pulmonary disease (COPD). c) cerebrovascular accident. d) pancreatic cancer.

renal failure. Correct Explanation: Renal failure frequently results from the vascular changes associated with diabetes mellitus. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy.

The nurse should teach the client to prevent corneal irritation from mild exophthalmos by: a) wearing dark-colored glasses. b) instilling an ophthalmic anesthetic as prescribed. c) massaging the eyes at regular intervals. d) covering both eyes with moistened gauze pads.

wearing dark-colored glasses. Explanation: Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures such as wearing sunglasses to protect the eyes from corneal irritation.

A 45-year-old female client is admitted to the hospital with Cushing's syndrome. Which nursing interventions are appropriate for this client? Select all that apply. a) Encourage oral fluid intake. b) Weigh the client daily. c) Instruct the client to avoid foods high in potassium. d) Stress the need for a high-calorie, high-carbohydrate diet. e) Assess for peripheral edema. f) Measure intake and output.

• Assess for peripheral edema. • Measure intake and output. • Weigh the client daily. Correct Explanation: Because weight gain and edema are common symptoms of Cushing's syndrome, appropriate interventions include assessing for peripheral edema, measuring intake and output, and weighing the client daily. A low-calorie, low-carbohydrate, high-protein diet is ordered for a client with this disorder. Fluid restriction is often prescribed as well. Treatment of Cushing's syndrome includes the administration of potassium replacements;

The nurse is teaching an adolescent with type 1 diabetes about signs and symptoms of hypoglycemia. Which of the following statements by the client help the nurse determine that the teaching has been effective? Select all that apply. a) "If my blood sugar is low, my blood pressure will increase." b) "If my blood sugar is low, I may feel sweaty and anxious." c) "If my blood sugar is low, I will be very thirsty." d) "If my blood sugar is low, my heart rate will speed up." e) "If my blood sugar is low, my breath will smell fruity."

• "If my blood sugar is low, I may feel sweaty and anxious." • "If my blood sugar is low, my heart rate will speed up." • "If my blood sugar is low, my blood pressure will increase." Explanation: Sweating, anxiety, tachycardia, and increased blood pressure are signs of hypoglycemia. Thirst and a fruity breath odor are signs of hyperglycemia.

The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. a) Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). b) Family members need to be informed about the warning signals of adrenal crisis. c) Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. d) Dental work or surgery will require adjustment of daily medication. e) A medical identification bracelet should be worn. f) Addison's disease will resolve over a few weeks, requiring no further treatment.

• A medical identification bracelet should be worn. • Dental work or surgery will require adjustment of daily medication. • Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). • Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. • Family members need to be informed about the warning signals of adrenal crisis. Correct Explanation: Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn, and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes

Priority nursing care for a client in addisonian crisis should include which intervention(s)? Select all that apply. a) Administer IV hydrocortisone sodium succinate as ordered b) Administer IV dextrose and insulin as ordered to decrease serum potassium level c) Placing the client in a private room d) Encouraging independence with activities of daily living (ADLs) e) Administer IV glucose and glucagon as proscribed, and monitor blood glucose levels

• Administer IV dextrose and insulin as ordered to decrease serum potassium level • Administer IV glucose and glucagon as proscribed, and monitor blood glucose levels • Administer IV hydrocortisone sodium succinate as ordered Correct Explanation: Addisonian crisis is a life-threatening event. The client requires rapid intervention with multiple therapies, including hormone replacement, management of hyperkalemia, and management of hypoglycemia

Priority nursing care for a client in addisonian crisis should include which intervention(s)? Select all that apply. a) Placing the client in a private room b) Administer IV dextrose and insulin as ordered to decrease serum potassium level c) Encouraging independence with activities of daily living (ADLs) d) Administer IV glucose and glucagon as proscribed, and monitor blood glucose levels e) Administer IV hydrocortisone sodium succinate as ordered

• Administer IV hydrocortisone sodium succinate as ordered • Administer IV dextrose and insulin as ordered to decrease serum potassium level • Administer IV glucose and glucagon as proscribed, and monitor blood glucose levels Explanation: Addisonian crisis is a life-threatening event. The client requires rapid intervention with multiple therapies, including hormone replacement, management of hyperkalemia, and management of hypoglycemia.

When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply. a) Amount b) Glucose level c) Ketone bodies d) Specific gravity e) Odor f) pH

• Amount • Odor • Glucose level • Ketone bodies Explanation: Diabetes mellitus is associated with increased amounts of urine, a sweet or fruity odor, and glucose and ketone bodies in the urine. It does not affect the urine's pH or specific gravity.

A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching? Select all that apply. a) See a podiatrist regularly to have your feet checked. b) Go barefoot only when you know your home environment. c) Wear cotton socks. d) Wear loose-fitting shoes. e) Apply foot powder after bathing. f) Use scissors to trim toenails.

• Apply foot powder after bathing. • Wear cotton socks. • See a podiatrist regularly to have your feet checked. Correct Explanation: Foot care for a client with diabetes mellitus includes keeping the feet dry with the application of foot powder and wearing cotton socks to absorb moisture. The client should have a podiatrist check the feet regularly to detect problems early. To prevent injury to the feet, the client should be instructed not to cut the toenails with scissors, walk barefoot, or wear loose-fitting shoes.

A client with a possible parathormone deficiency is seen in the clinic. Diagnosis of this condition includes the analysis of serum electrolytes. Which electrolytes does the nurse expect to be abnormal? Select all that apply. a) Chloride b) Glucose c) Sodium d) Potassium e) Phosphorous f) Calcium

• Calcium • Phosphorous Correct Explanation: A client with a parathormone deficiency has abnormal calcium and phosphorous values because parathormone regulates these two electrolytes.

A nurse is teaching a client about insulin infusion pump use. What intervention(s) should the nurse include to prevent infection at the injection site? Select all that apply. a) Cleanse the skin at the insertion site for 15 seconds using alcohol. b) Use sterile techniques when changing the needle. c) Wear sterile gloves when inserting the needle. d) Change the needle every 3 days. e) Take the ordered antibiotics before initiating treatment.

• Change the needle every 3 days. • Use sterile techniques when changing the needle. • Cleanse the skin at the insertion site for 15 seconds using alcohol. Explanation: The nurse should teach the client to change the needle every 3 days to prevent infection, use sterile techniques, and properly cleanse the skin. The client does not need to wear gloves when inserting the needle.

A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate that the treatment he's receiving for SIADH is effective? Select all that apply. a) Increase in urine output b) Absence of wheezes in the lungs c) Decrease in urine osmolarity d) Decrease in body weight e) Rise in blood pressure

• Decrease in body weight • Increase in urine output • Decrease in urine osmolarity Explanation: SIADH is an abnormality involving an abundance of diuretic hormone. The predominant feature is water retention with oliguria, edema, and weight gain. Successful treatment should result in weight reduction, increased urine output, and a decrease in the urine concentration (urine osmolarity). As edema decreases, the blood pressure should decrease, not increase. Also, as the client loses fluid, his lungs should be clear of crackles, not wheezes.

A client is diagnosed with a goiter after traveling in a foreign country for 3 months. During the trip, the client could not tolerate food. Which signs and symptoms would the nurse expect to see in this client? Select all that apply. a) Nonpalpable thyroid gland b) Cardiomegaly c) Dysphagia d) Oliguria e) Respiratory distress f) Dizziness when raising the arms above the head

• Dizziness when raising the arms above the head • Dysphagia • Respiratory distress Explanation: A goiter can result from inadequate dietary intake associated with changes in diet or malnutrition. It is caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of a goiter include enlargement of the thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress.

A nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings should the nurse expect to note during the assessment? Select all that apply. a) Excessive thirst b) Elevated serum potassium level c) Low urine specific gravity d) Extreme polyuria e) Bradycardia f) Elevated systolic blood pressur

• Extreme polyuria • Low urine specific gravity • Excessive thirst Signs and symptoms of diabetes insipidus include an abrupt onset of extreme polyuria, excessive thirst, dry skin and mucous membranes, tachycardia, and hypotension. Diagnostic studies reveal low urine specific gravity and osmolarity and elevated serum sodium. Serum potassium levels are likely to be decreased, not increased.

The client has been recently diagnosed with type 2 diabetes and is taking metformin two times per day, 1,000 mg before breakfast and 1,000 mg before supper. The client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission to the hospital. The admission prescriptions include metformin. What should the nurse do? Select all that apply. a) Assess the client's renal function. b) Inform the client that adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. c) Monitor the client's glucose value prior to each meal. d) Administer glargine insulin rather than the metformin. e) Discontinue the metformin.

• Inform the client that adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. • Assess the client's renal function. • Monitor the client's glucose value prior to each meal. Correct Explanation: The nurse may not discontinue a medication without a health care provider's (HCP's) prescription, and the nurse may not substitute one medication for another. Maximum doses may be better tolerated if given with meals. Before therapy begins, and at least annually thereafter, assess the client's renal function; if renal impairment is detected, a different antidiabetic agent may be indicated. To evaluate the effectiveness of therapy, the client's glucose value must be monitored regularly.

A client with a possible parathormone deficiency is seen in the clinic. Diagnosis of this condition includes the analysis of serum electrolytes. Which electrolytes does the nurse expect to be abnormal? Select all that apply. a) Chloride b) Glucose c) Phosphorous d) Calcium e) Sodium f) Potassium

• Phosphorous • Calcium Correct Explanation: A client with a parathormone deficiency has abnormal calcium and phosphorous values because parathormone regulates these two electrolytes

A nurse is developing a care plan for a client with hepatic encephalopathy. Which are goals for the care for this client? Select all that apply. a) Encourage physical activity. b) Provide food and fluids high in carbohydrate. c) Monitor coordination while walking. d) Check the pupil reaction. e) Prevent constipation. f) Administer lactulose to reduce blood ammonia levels.

• Prevent constipation. • Administer lactulose to reduce blood ammonia levels. • Monitor coordination while walking. • Check the pupil reaction. • Provide food and fluids high in carbohydrate. Explanation: Constipation leads to increased ammonia production. Lactulose is a hyperosmotic laxative that reduces blood ammonia by acidifying the colon contents, which retards diffusion of nonionic ammonia from the colon to the blood while promoting its migration from the blood to the colon. Hepatic encephalopathy is considered a toxic or metabolic condition that causes cerebral edema; it affects a person's coordination and pupil reaction to light and accommodation. Food and fluids high in carbohydrates should be given because the liver is not synthesizing and storing glucose. Because exercise produces ammonia as a byproduct of metabolism, physical activity should be limited, not encouraged.

A client is prescribed exenatide. What should the nurse instruct the client to do? Select all that apply. a) Understand that there is a low incidence of hypoglycemia when exenatide is taken with insulin. b) Take the dose of exenatide as soon as the client remembers a dose has been missed. c) Inject in the thigh, abdomen, or upper arm. d) Administer the drug within 60 minutes before morning and evening meals. e) Review the one-time set-up for each new pen.

• Review the one-time set-up for each new pen. • Inject in the thigh, abdomen, or upper arm. • Administer the drug within 60 minutes before morning and evening meals. Explanation: Client teaching includes reviewing proper use and storage of the exenatide dosage pen, particularly the one-time set-up for each new pen. The nurse should instruct the client to inject the drug in the thigh, abdomen, or upper arm. The drug should be administered within 60 minutes of the morning and evening meals; the client should not inject the drug after a meal.

A nurse is participating in a diabetes screening program. Who is (are) at risk for developing type 2 diabetes? Select all that apply. a) a 12-year-old who is overweight b) a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes c) a 44-year-old Native American (First Nations) person who has a body mass index (BMI) of 32 d) a 32-year-old female who delivered a 9½-lb (4,309-g) infant e) an 18-year-old immigrant from Mexico who jogs four times a week

• a 32-year-old female who delivered a 9½-lb (4,309-g) infant • a 44-year-old Native American (First Nations) person who has a body mass index (BMI) of 32 • a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes • a 12-year-old who is overweight Explanation: The risk factors for developing type 2 diabetes include giving birth to an infant weighing more than 9 lb (4,100 g); obesity (BMI over 30); ethnicity of Asian, African, Native American, or First Nations; age greater than 45 years; hypertension; and family history in parents or siblings. Childhood obesity is also a risk factor for type 2 diabetes. Maintaining an ideal weight, eating a low-fat diet, and exercising regularly decrease the risk of type 2 diabetes.

The nurse is performing the initial assessment on a middle age woman recently diagnosed with Cushing's syndrome. The nurse reviews the history and physical (see chart). The nurse should develop a plan with the client to manage which effects? Select all that apply. a) slow healing b) risk for injury c) low blood volume d) risk for infection e) changes in physical appearance

• risk for injury • slow healing • changes in physical appearance • risk for infection Explanation: Cushing's syndrome results from excessive levels of cortisol. Some effects of excessive adrenocortical activity include musculoskeletal changes, and the client may be at risk for injury and falls. There is excessive protein catabolism causing muscle wasting, decreased inflammatory response, and potential for delayed healing and infection. The increased cortisol levels cause a moon-faced appearance to which clients must adjust. The skin becomes thin and fragile, and the client is also at risk for infection. Increased cortisol levels do not cause deficient fluid volume.

When obtaining a health history, the nurse understands that which client statement indicates the need for further follow-up?

"No matter how much I drink, I am still thirsty all the time." Explanation: Polydipsia, or increased thirst, is a classic clinical manifestation of diabetes. The excessive loss of fluids is the result of the osmotic diuresis that occurs with glycosuria.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? a) Tetany b) Severe hyperkalemia c) Hypovolemic shock d) Cerebral edema

Cerebral edema Correct Explanation: Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? a) Flaccidity and thirst b) Tetany and increased blood urea nitrogen (BUN) levels c) Sunken eyeballs and spasticity d) Confusion and seizures

Confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur.

A client's fasting blood sugar (FBS) is 63 mg/dL (3.5 mmol/L) at 0700. The client is alert and oriented. What should the nurse do first? a) Give the prescribed dose of insulin. b) Give one ampule of 50% dextrose via rapid IV infusion. c) Give the client a large glass of orange juice with two packages of sugar. d) Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes.

Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes. Explanation: According to American Diabetes Association (Canadian Diabetes Association) guidelines for treating hypoglycemia, the conscious adult client should be given 15 g of carbohydrate with a follow-up blood glucose level in 15 minutes.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? a) Hypermagnesemia b) Hyponatremia c) Hypocalcemia d) Hyperkalemia

Hypocalcemia Explanation: Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery

When administering spironolactone to a client who has had a unilateral adrenalectomy, a nurse should instruct the client about which possible adverse effect of the drug? a) Constipation b) Hypernatremia c) Hypokalemia d) Menstrual irregularities

Menstrual irregularities Explanation: Spironolactone can cause menstrual irregularities and decreased libido. Men may experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spirolactone.

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? a) Normal saline solution b) Hydrocortisone c) Fludrocortisone d) Potassium chloride

Potassium chloride Correct Explanation: The nurse should question an order for potassium chloride because addisonian crisis results in hyperkalemia. Administering potassium chloride is contraindicated.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? a) Restricting sodium intake to 1 gm/day b) Elevating the head of the client's bed to 90 degrees c) Administering vasopressin as ordered d) Restricting fluids to 800 ml/day

Restricting fluids to 800 ml/day Correct Explanation: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day.

A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: a) hyperthyroidism. b) neuropathy. c) depression. d) hypoglycemia.

depression. Explanation: Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome.

Which outcome is a priority for the client with Addison's disease? a) avoidance of normal activities with stress b) prevention of hypertensive episodes c) maintenance of medication compliance d) adherence to a 2-g sodium die

maintenance of medication compliance Explanation: Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider (HCP) to avoid an Addisonian crisis.

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema.

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? a) sulfonylureas b) aspirin c) angiotensin-converting enzyme (ACE) inhibitors d) steroids

steroids Explanation: Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for: a) weight gain. b) cold skin. c) tachycardia. d) anorexia.

tachycardia. Correct Explanation: Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a) potassium. b) magnesium. c) phosphorus. d) sodium.

phosphorus. Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. a) Administer IV bicarbonate. b) Maintain intake and output records. c) Document presenting signs and symptoms. d) Compare ABG findings with previous results. e) Suction the client's airway.

• Document presenting signs and symptoms. • Compare ABG findings with previous results. • Maintain intake and output records. Correct Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. Nursing management includes documenting all presenting signs and symptoms to provide accurate baseline data, monitoring laboratory values, comparing ABG findings with previous results (if any), maintaining accurate intake and output records to monitor fluid status, and implementing prescribed medical therapy

A 24-year-old client with diabetes mellitus sustains a large laceration that requires suturing. Which of the following statements indicates that the client understands wound healing? a) "My scar will fade within 4 months." b) "This procedure won't leave a scar." c) "It's so hard to predict when this scar will disappear." d) "If I don't get an infection, the scar may fade in 1 to 3 years."

"It's so hard to predict when this scar will disappear." Explanation: In a client with diabetes, wound healing is delayed and unable to be predicted. A specific time frame for healing is unrealistic as is the statement that suturing does not produce a scar.

An adolescent is to receive radioactive iodine for Graves' disease. Which statement by the client reflects the need for more teaching? a) "Taking radioactive iodine will not affect my ability to have children in the future." b) "I plan to talk on Facebook since I have to keep several feet (meters) from my friends for 3 days." c) "I should try to use a separate bathroom from the rest of my family for several days." d) "The advantage of radioactive iodine is that I will not need future medication for my disease."

"The advantage of radioactive iodine is that I will not need future medication for my disease." Correct Explanation: Most clients will need lifelong thyroid replacement after treatments with radioactive iodine. Most clients are treated as outpatients

A client's glucose level is 365 mg/dl. The physician orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/ml. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place.

0.1 Explanation: To find the correct administration amount, use the cross-product principle to set up the following equation: X/10 units = 1 ml/100 units Next, cross-multiply: 100 x X units = 10 units x 1 ml. Then divide both sides of the equation by 100 units: X = 0.1 ml.

A nurse is about to administer a client's morning dose of insulin. The client's order is for 5 units of regular insulin and 10 units of NPH (neutral protamine Hagedorn) insulin given as a basal dose. The client also is to receive an amount prescribed from the medium-dose sliding scale (shown image) based on morning blood glucose levels. The nurse performs a bedside blood glucose measurement and the result is 264 mg/dl. How many total units of insulin should the nurse administer to the client? Record your answer using a whole number.

21 Correct Explanation: The basal dose for this client is 5 units of regular insulin and 10 units of NPH insulin. The medium-dose sliding scale indicates that, based on the glucose reading of 264 mg/dl, the client should receive an additional 6 units of regular insulin, totaling 21 units (5 units + 10 units + 6 units = 21 units)

A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when she discovers the client takes which over-the-counter preparations? a) Acetaminophen-containing preparations b) Vitamins with iron c) Salicylate-containing preparations d) Antacids

Salicylate-containing preparations Correct Explanation: The client requires additional teaching if he takes salicylates with insulin. Salicylates may interact with insulin, causing hypoglycemia.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? a) Weight gain, increased urination, and purplish-red striae b) Weight loss, increased urination, and increased thirst c) Weight loss, increased appetite, and hyperdefecation d) Weight gain, decreased appetite, and constipation

Weight gain, decreased appetite, and constipation Correct Explanation: Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism.

A client with diabetes has been diagnosed with hypertension, and the health care provider (HCP) has prescribed atenolol, a beta-blocker. When performing discharge teaching, it is important for the nurse to emphasize that the addition of atenolol can cause: a) an increase in the incidence of ketoacidosis. b) a decrease in the incidence of ketoacidosis. c) a decrease in the hypoglycemic effects of insulin. d) an increase in the hypoglycemic effects of insulin.

an increase in the hypoglycemic effects of insulin. Explanation: There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored.

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? a) sodium bicarbonate b) calcium gluconate c) sodium phosphate d) echothiophate iodide

calcium gluconate Correct Explanation: The client with tetany is suffering from hypocalcemia, which is treated by administering an IV preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until normal parathyroid function returns.

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: a) in 1 to 2 weeks. b) in 3 to 4 months. c) immediately. d) in a few days.

in 1 to 2 weeks. Explanation: Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks.

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a) Hashimoto's thyroiditis. b) myxedema coma. c) cretinism. d) thyroid storm.

myxedema coma. Correct Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema.

One day following a subtotal thyroidectomy a client begins to have tingling in the fingers and toes. The nurse should first: a) ask the client to speak. b) assess the client for thrombophlebitis. c) notify the health care provider (HCP). d) encourage the client to flex and extend the fingers and toes.

notify the health care provider (HCP). Correct Explanation: Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of the glottis, and respiratory obstruction. The nurse should notify the HCP.

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During prepoperative teaching, the nurse teaches the client how to do deep breathing exercises after surgery by telling the client to: a) "Sit in an upright position, and take a deep breath." b) "Hold your abdomen firmly with a pillow, and take several deep breaths." c) "Tighten your stomach muscles as you inhale, and breathe normally." d) "Raise your shoulders to expand your chest."

"Hold your abdomen firmly with a pillow, and take several deep breaths." Correct Explanation: Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep-breathe effectively. Deep breathing should be done hourly by the client after surger

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:

Check with the physician for his complete order. Explanation: The nurse should first check with the physician for the complete order of calcium because calcium chloride has a concentration of 13.6 mEq (3.4 mmol/l) of calcium per gram and calcium gluconate has 4.65 mEq (1.2 mmol/l) of calcium per gram. The nurse can always offer the doctor the type of calcium available after the conversion in calcium has been made; otherwise, the error could be fatal.

A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when she discovers the client takes which over-the-counter preparations? a) Antacids b) Acetaminophen-containing preparations c) Salicylate-containing preparations d) Vitamins with iron

Salicylate-containing preparations Correct Explanation: The client requires additional teaching if he takes salicylates with insulin. Salicylates may interact with insulin, causing hypoglycemia.

A staff member says she's really busy and asks the charge nurse to double-check a dose of insulin she has drawn up. The nurse holds up a bottle of Lente insulin, but the charge nurse notices a bottle of Lantus insulin on the medication cart. This nurse has made multiple medication errors and the charge nurse is concerned that she isn't safe. What should the charge nurse do?

Tell the nurse that she'd like to start at the beginning to be on the safe side. Explanation: The charge nurse should observe the process from the beginning and determine whether the nurse is following the five rights of drug administration. Only then should she cosign that the dose is correct

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the: a) upper gingival mucosa in the space between the upper gums and lip. b) sinus channel below the right eye. c) back of the mouth. d) nose.

upper gingival mucosa in the space between the upper gums and lip. Explanation: With transsphenoidal hypophysectomy, the sella turcica is entered from below, through the sphenoid sinus.

One day following a subtotal thyroidectomy a client begins to have tingling in the fingers and toes. The nurse should first: a) ask the client to speak. b) notify the health care provider (HCP). c) assess the client for thrombophlebitis. d) encourage the client to flex and extend the fingers and toes.

notify the health care provider (HCP). Correct Explanation: Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of the glottis, and respiratory obstruction. The nurse should notify the HCP.

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: a) more than 10 beats/minute difference between the apical and radial pulse rates. b) a wide, staggering gait. c) dry, waxy swelling and abnormal mucin deposits in the skin. d) protruding eyes and a fixed stare.

protruding eyes and a fixed stare. Correct Explanation: Exophthalmos is characterized by protruding eyes and a fixed stare.

A client with diabetes who takes insulin has a blood glucose level of 40. What should the nurse offer the client to begin to raise the blood glucose level? Select all that apply. a) one cup (240 mL) of milk b) one tablespoon (15 mL) of peanut butter c) one-half cup (120 mL) of orange juice d) one-quarter cup (60 mL) of tuna e) one slice of bread f) one-half cup (120 mL) of regular soda

• one-half cup (120 mL) of orange juice • one cup (240 mL) of milk • one slice of bread • one-half cup (120 mL) of regular soda Explanation: To treat a low blood glucose level, the nurse should provide the client with approximately 15 g of carbohydrate and monitor the blood glucose level within 15 minutes. The orange juice, milk, bread, or soda would provide approximately 15 g of carbohydrate.

A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I am so clumsy. I am always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate? a) "Wash all wounds in isopropyl alcohol." b) "You really should be fine as long as you take your daily medication." c) "Could you have your children do the cooking and ironing?" d) "Keep all cuts clean and covered."

"Keep all cuts clean and covered." Correct Explanation: Proper and careful first-aid treatment is important when a client with diabetes has a skin cut or laceration. The skin should be kept supple and as free of organisms as possible. Washing and bandaging the cut will accomplish this.

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL (16.7 mmol/L). What should the nurse do? a) Administer the insulin dose dictated by the sliding scale. b) Withhold all medications. c) Notify the surgery department. d) Call the health care provider (HCP) for specific prescriptions based on the glucose level.

Call the health care provider (HCP) for specific prescriptions based on the glucose level. Correct Explanation: The nurse should notify the HCP directly for specific prescriptions based on the client's glucose level. The nurse cannot ignore the elevated glucose level. The surgical experience is stressful, and the client needs specific insulin coverage during the perioperative period.

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? a) Diabetes insipidus b) Cushing's syndrome c) Goiter d) Diabetes mellitus

Goiter Explanation: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress.