Unit 5

A patient has a low serum T3 and the physician orders a TSH level. If the TSH levels is elevated, this indicates that: a. The cause of the low T3 is most likely primary hypothyroidism. b. The negative feedback system is failing to stimulate the anterior pituitary gland c. The patient has an underactive thyroid gland that is not receiving TSH stimulation. d. There is most likely a tumor of the anterior pituitary gland that is causing increased production of TSH.

A

A patient is diagnosed with primary hypothyroidism. When evaluating the patient's labs, you would expect to find: a. Elevated TSH, decreased T4 & T3 b. Decreased TSH, decreased T4 & T3 c. Decreased TSH, elevated T4 & T3 d. Normal TSH, elevated T4 & T3

A

Mrs. Kelly is returning to the nursing unit following thyroid surgery. Which medication should the nurse have available in case of emergencies related to this type of surgery? a. Calcium gluconate b. Epinephrine c. Rectal aspirin d. Potassium chloride

A

The client has end-stage liver failure secondary to alcoholic cirrhosis. Which complication indicates the client is at risk for developing hepatic encephalopathy? a. Gastrointestinal bleeding b. Hypoalbuminemia c. Splenomegoly d. Hyperaldosteronism

A

The nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Which statement best explains the rationale for administering this medication? a. It is an exogenous source of protease, amylase, and lipase b. This enzyme increases the number of bowel movements. c. This medication breaks down in the stomach to help with digestion. d. Pancreatic enzymes help break down fat in the small intestine

A

The nurse is caring for a client with Addison's disease. The nurse recognizes that the manifestations of this disease are primarily related to what pathophysiologic problem? a. Adrenal insufficiency b. Increased intracranial pressure c. Renal disease d. Thyroid hyperfunction

A

The nurse writes the client problem "imbalanced nutrition: less than body requirements " for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care? a. Provide a high-calorie intake diet b. Discuss TPN c. Instruct the client to decrease salt intake d. Encourage the client to increase water intake

A

A client is admitted to an ED, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? a. Warm the patient b. Maintain a patent airway c. Administer thyroid hormone d. Administering fluid replacement

B

A client takes high dosages of glucocorticoids to control the symptoms of systemic lupus erythematosus. The nurse teaches the client not to stop the medication abruptly, knowing that a hypocortisolism crisis could occur because: a. High glucocorticoid levels cause cellular damage to the adrenal glands themselves, decreasing the cortisol secretion b. Negative feedback of high glucocorticoid levels inhibits ACTH secretion and CRH release c. High levels of glucocorticoids cause a positive feedback to the anterior pituitary gland, causing decreased release of ACTH d. The positive feedback of high glucocorticoid levels creates a greater demand for cortisol than can be met by the adrenal glands

B

A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: a. Myxedema b. Graves' disease c. Addison's disease d. Cushing's syndrome

B

A patient with a head injury develops SIADH. Symptoms the nurse would expect to find include: a. Edema b. Weight gain c. Urine specific gravity of 1.004 d. Serum sodium of 140 mEq/L

B

A risk factor associated with cancer of the pancreas is: a. Alcohol intake b. Cigarette smoking c. Exposure to asbestos d. Increased dietary intake of milk and milk products

B

Combined with clinical manifestations, the lab finding that is most commonly used to diagnose acute pancreatitis is: a. Increased serum calcium b. Increased serum amylase c. Increased urinary amylase d. Decreased serum glucose

B

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse administering the medication monitors the client for which therapeutic response? a. Decreased blood glucose level b. Decreased urinary output c. Decreased blood pressure d. Decreased peripheral edema

B

Diabetes Insipidus is caused by: a. Increase in antidiuretic hormone (ADH) b. Decrease in ADH c. Increase in insulin d. Decrease in insulin

B

The client in end-stage licer failure has an elevated ammonia level. The HCP prescribes lactulose (Cephulac), a laxative. Which intervention should the nurse implement to determine the effectiveness of the medication? a. monitor the client's intake and output b. assess the client's neurological status c. measure the client's abdominal girth d. document the number of bowel movements

B

The patient in the ED who reports lethargy, muscle weakness, nausea, vomiting, and weight loss over the past weeks is diagnosed with Addisonian crisis. Which drugs does the nurse expect to administer to this patient? a. Beta blocker to control the hypertension and dysrhythmias b. Solu-Cortef IV changing to oral prednisone when stable c. IV fluids of D5NS with KCL added for dehydration d. Spironolactone(Aldactone) to promote diuresis

B

The patient is diagnosed with syndrome of inappropriate ADH (SIADH). What manifestations should the nurse expect to find? a. Decreased body weight b. Decreased urinary output c. Increased plasma osmolality d. Increased serum sodium level

B

Which client problem has priority for the client diagnosed with acute pancreatitis? a. Risk for fluid volume deficit b. Alteration in comfort c. Imbalanced nutrition: less than body requirements d. Knowledge deficit

B

Which instruction should the nurse discuss with the patient who is in the icteric phase of hepatitis C? a. Decrease alcohol intake b. Encourage rest periods c. Eat a large evening meal d. Drink diet drinks and juices

B

Which of the following manifestations would the nurse expect to see in a client with hyperthyroidism? a. Anorexia, constipation, and cold extremities b. Heat intolerance, weight loss, and diarrhea c. Muscle cramps, paresthesia, and numbness of the fingers and toes d. Blurred vision, night sweats, and palpitations

B

Which patient problem has priority for the patient diagnosed with acute pancreatitis? a. Risk for fluid volume deficit b. Alterations in comfort c. Imbalanced nutrition: less than body requirements d. Knowledge deficit

B

Which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? a. Airborne precautions b. Standard precautions c. Droplet precautions d. Exposure precautions

B

Your patient is having both of the adrenal glands removed due to hyperplasia and adenoma of the adrenal cortex. Patient education would include which of the following statements? a. It will be important for you to exercise 20 minutes, 3 times a week to enhance ACTH production b. Lifelong corticosteroid replacement is required. c. PTH levels will be adversely affected, and the patient should observe for numbness and tingling in the extremities. d. The dose of Synthroid will be high at first, but as you adapt to the absence of your adrenal glands the dosage will decrease until you no longer required its administration.

B

A client is admitted to a hospital with a diagnosis of DKA. The initial blood glucose level was 950 mg/dl. A continuous infusion of regular insulin is initiated, along with IV rehydration with NS. The serum glucose level is now 240 mg/dl. The nurse would next prepare to administer which of the following? a. Ampule of 50% dextrose b. NPH insulin SQ c. IV fluids containing 5% dextrose d. Phenytoin (Dilantin) for the prevention of seizures

C

A client is brought to the ED in an unresponsive state and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHNK) is made. The nurse would immediately prepare to initiate which of the following anticipated physician's orders? a. Endotracheal intubation b. 100 units of NPH insulin c. IV infusion of normal saline d. IV infusion of sodium bicarbonate

C

A patient with Addison's disease comes to the ED with complaints of nausea, vomiting, diarrhea, and fever. The nurse would expect collaborative care to include: a. Parenteral injections of ACTH b. IV administration of vasopressors c. IV administration of hydrocortisone d. IV administration of D5W with 20 mEq of KCL

C

A patient with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy. To detect complications of the bleeding episode, it is most important for the nurse to monitor: a. The prothrombin time b. Serum bilirubin levels c. Serum ammonia levels d. Serum potassium levels

C

A patient with cirrhosis is beginning to show signs of hepatic encephalopathy. A nurse would plan a dietary consult to limit the amount of which of the following ingredients in the patient's diet? a. Fat b. CHO c. Protein d. Minerals

C

During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse: a. Prepare the patient for immediate portal shunting surgery b. Perform guaiac testing on all stools to detect occult blood c. Maintain the patient's airway and prevent aspiration of blood d. Monitor for the cardiac effects of IV vasopressin and NTG

C

Ketoacidosis occurs as a complication of diabetes when: a. Illnesses causing nausea and vomiting lead to bicarbonate loss b. The glucose level becomes so high that osmotic diuresis promotes fluid and electrolyte loss c. An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy d. The patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy

C

Prednisone (Delatsone) is prescribed for a client with type 1 DM who is taking NPH insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? a. An additional dose of prednisone daily b. A decreased amount of daily NPH insulin c. An increased amount of daily NPH insulin d. The addition of an oral hypoglycemic medication

C

Prednisone (Delatsone) is prescribed for a patient with type 1 diabetes who is taking NPH insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with prednisone? a. An additional dose of prednisone daily b. A decreased amount of daily NPH insulin c. An increased amount of daily NPH insulin d. The addition of an oral hypoglycemic medication

C

The client diagnosed with acute pancreatitis is in pain. Which position should the nurse assist the client to assume to help decrease the pain? a. Recommend lying in the prone position with legs extended b. Maintain a tripod position over the bedside table c. Place in side-lying position with knees flexed d. Encourage a supine position with a pillow under the knees

C

The client exposed to hepatitis A calls the clinic and wants to know if anything can be done to prevent getting hepatitis A. Which information should the nurse tell the client? a. explain that there is a hepatitis A vaccine available that the client can receive b. inform the client that there is nothing available to help prevent hepatitis A instruct the client to get an immune globulin injection within two weeks tell the client to fo to the nearest ED as soon as possible

C

The client is in end-stage liver failure. Which gastrointestinal assessment data would the nurse expect to find when assessing the client? a. Hypoalbuminemia and muscle wasting b. Oligomenorrhea and decreased body hair c. Clay-colored stools and hemorrhoids d. Dyspnea and caput medusa

C

The nurse administers spironolactone 100 mg orally to a patient with portal HTN. which of the following is most important for the nurse to monitor during the administration of the drug? a. Intake and output b. Abdominal girth c. Serum potassium levels d. Specific gravity of urine

C

The patient has had a liver biopsy. Which post-procedure intervention should the nurse implement? a. Instruct the patient to void immediately b. Keep the patient NPO for eight hours c. Place the patient on the right side d. Monitor the BUN and creatinine level

C

A client is diagnosed with pheochromocytoma. A nurse prepares a plan of care for the client, while planning , the nurse understands the pheochromocytoma is a condition that: a. Causes profound hypotension b. Is manifested by severe hypoglycemia c. Is not curable and is treated symptomatically d. Causes the release of excessive amounts of catecholamines

D

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an ED. Which finding would a nurse expect to note as confirming this diagnosis? a. Comatose state b. Decreased urine output c. Increased respirations and an increase in pH d. Elevated blood glucose level and low plasma bicarbonate level

D

A client with type 2 DM has a blood glucose level higher than 600 mg/dl and is complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physician's documentation and would expect to note which of the following diagnoses? a. Hypoglycemia b. Pheochromocytoma c. DKA d. HHNS (or HHNK)

D

A patient who recently had a calcium phosphate renal stone had a bone density study, which showed a decrease in her bone density. Which endocrine problem could this patient have? a. SIADH b. Hypothyroidism c. Cushing Syndrome d. Hyperparathyroidism

D

Acromegaly is caused by: a. Increased TSH b. Increased ADH c. Increased ACTH d. Increased GH

D

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. The initial nursing action is to: a. Increase fluid intake b. Document the complaints c. Assess for urinary glucose d. Assess urine specific gravity

D

Of the laboratory values below, which is the most significant indication of acute pancreatitis? a. Metabolic acidosis. b. Increased WBC=s. c. Decreased fat content in the stool. d. Increased serum amylase.

D

The client is diagnosed with acute pancreatitis. Which HCP's admitting order should the nurse question? a. Bed rest with BRP b. Initiate IV therapy with D5W 125 ml/ hr c. Weigh client daily d. Low-fat, low CHO diet

D

The client is in the preicteric phase of hepatitis. Which S&S would the nurse expect the client to exhibit during this phase? a. Clay-colored stools b. Normal appetite and pruritus c. Being afebrile and left upper quadrant pain d. Complaints of fatigue and diarrhea

D

The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease? The best response by the nurse is: a. "No immunization is available for hepatitis A, nor are you likely to get the disease." b. "Only individuals who have had sexual contact with the patient should receive immunization." c. "All family members should receive the hepatitis A vaccine to prevent or modify the infection." d. "Those who have had household or close contact with the patient should receive immune globulin."

D

The nurse is reviewing laboratory data for a client with Cushing's syndrome. Which of the following laboratory abnormalities might the nurse expect to see? a. Hyperproteinemia and hyponatremia b. Hypercalcemia and hypoglycemia c. Leukeopenia and anemia d. Hyperglycemia and hypokalemia

D

When assessing Mr. Bill, who has acute pancreatitis, you find the following clinical manifestations: muscle twitching, spasms, tetany, and dysrhythmias. You would notify the physician immediately because you suspect the manifestations are due to: a. Hyperkalemia b. Hypomagnesemia c. Hyperglycemia d. Hypocalcemia

D

Which ABG would the nurse expect in the client diagnosed with DKA? a. pH 7.34, PaO2 99, PaCO2 48, HCO3 24 b. pH 7.38, PaO2 95, PaC02 40, HCO3 22 c. pH 7.46, PaO2 85, PaCO2 30, HCO3 26 d. pH 7.30, PaO2 90, Pa CO2 30, HCO3 18

D

Which clinical manifestation is only seen in Graves' disease? a. Increased heart rate b. Weight loss c. Goiter d. Exophthalmos

D