NSG 210 Test 3

Magnesium (Mg)

1.8-2.6 mEq/L

Sodium (Na)

135-145 mEq/L

Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter

A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F

Which of the following is not a typical sign and symptom of Cushing's syndrome? A. Hyperpigmentation of the skin B. Hirsutism C. Purplish striae D. Moon Face

A. Hyperpigmentation of the skin

A client is admitted to the ER. The client is unconscious on arrival. However, the client's family is with the client and reports that before the client became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the client has not been taking any medications. The client was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the client's blood pressure is 70/45. In the scenario above, what medication do you expect the client to be started on? A. IV Solu-Cortef B. PO Prednisone C. PO Declomycin D. IV Insulin

A. IV Solu-Cortef

In Cushing's Disease and Syndrome there are: A. Increased cortisol production B. Low potassium and glucose levels C. Increased production of aldosterone and cortisol D. Decreased production of cortisol and aldosterone

A. Increased cortisol production

Which statement is true of the eating disorder referred to as bulimia? A. Patients with bulimia often appear at a normal weight. B. Patients with bulimia binge eat but do not engage in compensatory measures. C. Patients with bulimia severely restrict their food intake. D. One sign of bulimia is lanugo.

A. Patients with bulimia often appear at a normal weight.

A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on? A. Propylthiouracil (PTU) B. Radioactive Iodine C. Tapazole D. Synthroid

A. Propylthiouracil (PTU)

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with? A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient

A. SIADH

A patient with a mild case of diabetes insipidus is started on Diabinese. What would you include in your patient teaching with this patient? A. Signs and symptoms of hypoglycemia B. Restricting foods containing caffeine C. Taking the medication on an empty stomach D. Drinking 16 oz of water when taking the medication

A. Signs and symptoms of hypoglycemia

A patient is receiving radioactive iodine treatment for hyperthyroidism. What will you include in your patient education to this patient about this type of treatment? A. Taste changes and swollen salivary glands B. Constipation C. Excessive thirst D. Sun protection

A. Taste changes and swollen salivary glands

Which of the following are treatment options for hyperthyroidism? Please select all that apply: A. Thyroidectomy B. Methimazole C. Liothyronine Sodium "Cytomel" D. Radioactive Iodine

A. Thyroidectomy D. Radioactive Iodine

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? A. Weight restoration B. Improving interpersonal skills C. Learning effective coping methods D. Changing family interaction patterns

A. Weight restoration

Decreased aldosterone and cortisol hyponatremia hypoglycemia tired & weak muscles hyperkalemia reproductive changes hotn anemia hypovolemia increased pigmentation of skin diarrhea or constipation nausea anorexia depression

Addison's

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. In the scenario above what drug do you anticipate the patient will be started on per doctor's order? A. Desmopressin (DDAVP) IV B. Declomycin C. Diabinese D. Stimate

B. Declomycin

Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______. A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH

B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? A. It will reduce the need for cognitive therapy. B. It will be prescribed at a higher than typical dose. C. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. D. Long-term management of symptoms is best achieved with tricyclic antidepressants.

B. It will be prescribed at a higher than typical dose.

Which of the following is considered a secondary prevention measure for malnutrition? A. Exercise B. Lipid profile C. Healthy diet D. Cognitive Behavioral Therapy

B. Lipid profile

A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing? A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter

B. Myxedema Coma

In Cushing's disease, the _______ is secreting too much ACTH (Adrenocorticotropic hormone) which is causing an increase in cortisol production. A. Adrenal cortex B. Pituitary gland C. Thyroid gland D. Hypothalamus

B. Pituitary gland

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? A. Weigh 2 times daily first week, then three times weekly. B. Weigh fully clothed before breakfast. C. Do not reweigh client when client requests. D. Permit no oral intake before weighing.

B. Weigh fully clothed before breakfast.

___________ is an autoimmune disorder where the body attacks the thyroid gland that causes it to stop releasing T3 and T4. The patient is likely to have the typical signs/symptoms of hypothyroidism, however, they may present with what other sign as well? A. Myxedema coma; joint pain B. Thyroid storm; memory loss C. Hashimoto's Thyroiditis; goiter D. Toxic nodular goiter (TNG); goiter

C. Hashimoto's Thyroiditis; goiter

The three essential macronutrients that provide energy to the body and support body functions are: A. Vitamins, Minerals, Water B. Vitamins, Minerals, Carbohydrates C. Carbohydrates, Fats, Minerals D. Proteins, Fats, Vitamins E. Proteins, Fats, Carbohydrates

E. Proteins, Fats, Carbohydrates

T/F: Any item with kilocalories can support bodily functions as well as provide energy.

F

T/F: The primary macronutrient involved in neurotransmitter production in the brain is protein.

F

increased T3&T4, decreased TSH wt loss heat intolerance htn, tachycardia, cardiac dysrhythmias hyperglycemia diarrhea smooth skin irritability, moody, anxiety insomnia irregular menses increased libido amenorrhea & decreased fertility goiter (some, not all)

Hyperthyroid

decreased T3&T4, increased TSH wt gain cold intolerance hotn, bradycardia extreme fatigue, lethargy constipation dry skin thin, brittle hair depression, memory loss joint, muscle pain decreased libido & fertility goiter (some, not all)

Hypothyroid

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina: a. "I need to go through the belongings you have brought with you." b. "You can use the scale in the back room when you need to." c. "You will be eating five times a day here." d. "The daily structure is based around your desire to eat."

a. "I need to go through the belongings you have brought with you."

Which patient statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to." c. "I've been told I drink way too much alcohol." d. "I don't get much pleasure out of life anymore."

a. "I'm terrified of gaining weight."

Safety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor: Select all that apply. a. Foods that are eaten b. Attempts at self-induced vomiting c. Relationships with other patients d. Weight

a. Foods that are eaten b. Attempts at self-induced vomiting d. Weight

Which intervention will promote independence in a patient being treated for bulimia nervosa? a. Have the patient monitor daily caloric intake and intake and output of fluids. b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors. c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge. d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.

d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.

low ADH = dehydration dehydrated high UOP hypernatremia lose too much fluid polyuria polydipsia confusion dry mucous membranes fatigue, weakness/muscle pain anorexia

diabetes insipidus (DI)

increased ADH = water retention overhydrated fluid overload hyponatremia htn, tachycardia confusion seizures anorexia decreased UOP

syndrome of inappropriate antidiuretic hormone (SIADH)

Micronutrients

vitamins and minerals

The nurse is reviewing the medical records of several clients. Which client has a condition that is an autoimmune disorder? A. Addison disease B. Cushing syndrome C. Hashimoto disease D. Sheehan syndrome

C. Hashimoto disease

A client with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the client's discharge teaching after the procedure? A. Glucocorticoid replacement therapy B. Avoiding avocadoes and pears C. Declomycin therapy D. Signs and symptoms of Grave's Disease

A. Glucocorticoid replacement therapy

Phosphorus (P)

3.0-4.5 mg/dL

Albumin

3.4-5.4

Potassium (K)

3.5-5.0 mEq/L

increased cortisol skin fragile truncal obesity with small arms moon face buffalo hump htn hypokalemia striae on extremities and ABD hyperglycemia hypernatremia hirsutism depression osteoporosis

Cushing's

Calcium (Ca)

9-10.5 mg/dL

Chloride (Cl-)

98-106 mEq/L

Choose the three items discussed in class that are typical for a patient with anorexia but not a patient with bulimia. A. Understands that behavior is abnormal B. A recurrent cycle of guilt and anxiety followed by eating and using laxatives C. Denies behavior as abnormal D. Binging and Purging E. Weight is below normal for age and height F. Introverted G. Extroverted

C. Denies behavior as abnormal E. Weight is below normal for age and height F. Introverted

A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT? A. "I will continue taking aspirin daily." B. "I will take this medication at the same time every day." C. "It may take a while before I notice that the medication is helping my condition." D. "I will avoid foods containing high levels of iodine."

A. "I will continue taking aspirin daily."

You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."

A. "I will take this medication at bedtime with a snack."

Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)? A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.

A. A patient diagnosed with small cell lung cancer.

A client is admitted to the ER. The client is unconscious on arrival. However, the client's family is with the client and reports that before the client became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the client has not been taking any medications. The client was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the client's blood pressure is 70/45. What disorder is this client most likely experiencing? A. Addisonian Crisis B. Cushing Syndrome C. Thyroid crisis D. Hashimoto thyroiditis

A. Addisonian Crisis

Which of the following side effects are possible for a patient taking an anti-thyroid medication? A. Agranulocytosis and aplastic anemia B. Tachycardia C. Skin discoloration D. Joint pain and eczema

A. Agranulocytosis and aplastic anemia

Which action would the nurse include in the plan of care for a client undergoing a transsphenoidal hypophysectomy? Select all that apply. One, some, or all responses may be correct. A. Assessing for clear nasal drainage B. Maintaining strict intake and output C. Increasing daily dietary fiber intake D. Elevating the head of the bed 30 degrees E. Instructing on the use of an incentive spirometer

A. Assessing for clear nasal drainage B. Maintaining strict intake and output C. Increasing daily dietary fiber intake D. Elevating the head of the bed 30 degrees E. Instructing on the use of an incentive spirometer

A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply: A. Fentanyl B. Tylenol C. Morphine D. Dilaudid

A. Fentanyl C. Morphine D. Dilaudid

You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient? A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity

A. Fluid volume overload

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight? A. Gain a maximum of 3 lb. B. Develop a pattern of normal eating behavior. C. Discuss fears and feelings about gaining weight. D. Verbalize awareness of the sensation of hunger.

A. Gain a maximum of 3 lb.

Which symptom would the nurse identify when assessing a client with Graves disease? A. Constipation B. Lethargy C. Exophthalmos D. Weight gain

C. Exophthalmos

A client with Addison's Disease is being discharged home on Prednisone. Which of the following statements by the client warrants you to re-educate the client? A. "I will notify the doctor if I become sick or experience extra stress." B. "I will take this medication as needed when symptoms present." C. "I will take this medication at the same time every day." D. "My daughter has bought me a Medic-Alert bracelet."

B. "I will take this medication as needed when symptoms present."

Which of the following clients are at risk for developing Cushing's Syndrome? A. A client with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. B. A client taking glucocorticoids for several weeks. C. A client with a tuberculosis infection. D. A client who is post-opt from an adrenalectomy.

B. A client taking glucocorticoids for several weeks.

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? A. Mood stabilizers B. Antidepressants C. Anxiolytics D. Atypical antipsychotics

B. Antidepressants

A client presents with chief complaints of unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, there is truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. The symptoms described are suggestive of which disease? A. Addison disease B. Cushing disease C. Multiple sclerosis D. Kaposi sarcoma

B. Cushing disease

A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? A. Thyroiditis B. Deficiency of iodine consumption C. Grave's Disease D. Hypothyroidism

C. Grave's Disease

Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? A. "I purge only once a day now instead of twice." B. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." C. "I am a hard worker and I am very compassionate toward others." D. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

C. "I am a hard worker and I am very compassionate toward others."

What hormone is secreted by the posterior pituitary gland? A. Prolactin B. Corticotropin C. ADH D. Cortisol

C. ADH

Which complication is the nurse's main priority during the early postoperative period after a subtotal thyroidectomy? A. Hemorrhage B. Thyrotoxic crisis C. Airway obstruction D. Hypocalcemic tetany

C. Airway obstruction

The nurse administers vasopressin to a client and recalls that the medication is which type of hormone? A. Growth hormone B. Luteinizing hormone C. Antidiuretic hormone D. Thyroid-stimulating hormone

C. Antidiuretic hormone

A client with Addison's Disease should consume which of the following diets? A. High fat and fiber B. Low potassium and high protein C. High protein, carbs, and adequate sodium D. Low carbs, high protein, and increased sodium

C. High protein, carbs, and adequate sodium

Which physical symptoms would a client diagnosed with Cushing syndrome exhibit? A. Fever and tachycardia B. Lethargy and constipation C. Hypertension and moon face D. Hyperactivity and exophthalmos

C. Hypertension and moon face

Where is the anti-diuretic hormone PRODUCED in the body? A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Medulla

C. Hypothalamus

Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst

C. Polyphagia

Where is the anti-diuretic hormone SECRETED in the body? A. Hypothalamus B. Thyroid C. Posterior Pituitary gland D. Anterior pituitary gland

C. Posterior Pituitary gland

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa? A. Disturbed body image B. Chronic low self-esteem C. Risk for injury: electrolyte imbalance D. Ineffective coping: impulsive responses to problems

C. Risk for injury: electrolyte imbalance

The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Select all that apply A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland

C. Stimulating the Sympathetic Nervous System E. Regulating TSH produced by the anterior pituitary gland

A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? A. Tapazole B. PTU (Propylthiouracil) C. Synthroid D. Inderal

C. Synthroid

Assessment of a client suspected of experiencing bulimia nervosa calls for the nurse to perform A. a range of motion assessment. B. inspection of body cavities. C. inspection of the oral cavity. D. body fat analysis.

C. inspection of the oral cavity.

The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH. A. high, low B. absent, absent C. low, high D. low, low

C. low, high

The Newborn Screening Test can provide results for up to this many diseases: A. 78 B. 32 C. 35 D. 50

D. 50

Which hormonal deficiency causes diabetes insipidus in a client? A. Prolactin B. Thyrotropin C. Luteinizing hormone D. Antidiuretic hormone (ADH)

D. Antidiuretic hormone (ADH)

A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention? A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.

D. Assessment finding of crackles throughout the lung fields.

Which of the following labs is NOT one that was discussed in class as a common diagnostic test for malnutrition? A. Lipid Panel - LDL, HDL, Cholesterol B. Hemoglobin A1c C. Albumin and pre-albumin D. CBC with differential E. Blood glucose

D. CBC with differential

Which nursing intervention is appropriate during the first 24 hours after a thyroidectomy when the nurse is concerned about thyroid storm? A. Perform range-of-motion exercises. B. Humidify the room air continuously. C. Assess for hoarseness every 2 hours. D. Check vital signs every 2 hours after they stabilize.

D. Check vital signs every 2 hours after they stabilize.

Addison's Disease is: A. Increased secretion of cortisol B. Increased secretion of aldosterone and cortisol C. Decreased secretion of cortisol D. Decreased secretion of aldosterone and cortisol

D. Decreased secretion of aldosterone and cortisol

A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss

D. Hair loss

A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism

D. Hypothyroidism

A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in? A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's

D. Semi-Fowler's

Which client response is most important for the nurse in the postanesthesia care unit to monitor when caring for a client who had a thyroidectomy? A. Urinary retention B. Signs of restlessness C. Decreased blood pressure D. Signs of respiratory obstruction

D. Signs of respiratory obstruction

During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Which additional assessment would the nurse report immediately to the health care provider? A. Increased appetite B. recent weight loss C. feelings of warmth D. fluttering in the chest

D. fluttering in the chest

When considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. a. Provide scheduled portion-controlled meals and snacks. b. Congratulate patients for weight gain and behaviors that promote weight gain. c. Limit time spent in bathroom during periods when not under direct supervision. d. Promote exercise as a method to increase appetite. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

a. Provide scheduled portion-controlled meals and snacks. c. Limit time spent in bathroom during periods when not under direct supervision. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

• Intense fear of gaining weight• Distorted body image• Underweight (BMI <18.5)• Compensatory behaviors• Restricting Type restricts calories, overexercises• Binging - Purging Type: Eats a LOT then purges (vomit, laxatives, diuretics)• Recurrent behavior over at least three months

anorexia nervosa

When considering an eating disorder, what is a physical criterion for hospital admission? a. A daytime heart rate of less than 50 beats per minute b. An oral temperature of 100°F or more c. 90% of ideal body weight d. Systolic blood pressure greater than 130 mm Hg

b. An oral temperature of 100°F or more

• Intense fear of gaining weight• Distorted body image• Binge eating• Compensatory behaviors • Vomits, overexercises uses laxatives or diuretics• Recurrent behavior at least one per week for three months• BMI normal or high

bulimia

Macronutrients

carbohydrates, proteins, and fats