Exam 3 NCLEX Questions
After completion of peritoneal dialysis, the nurse should assess the client for: hypertension. weight loss. increased urine output. hematuria
weight loss
The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test?
• Cortisol levels before and after the system is challenged with a synthetic steroid
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. •Tingling •Muscle twitching and spasms •Aphasia •Numbness
• Numbness • Tingling • Muscle twitching and spasms 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. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.
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.
•Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. •Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). •A medical identification bracelet should be worn. •Family members need to be informed about the warning signals of adrenal crisis. •Dental work or surgery will require adjustment of daily medication.
A nurse is caring for a client with a low calcium level. Place the following options in chronological order to indicate the regulatory feedback mechanism of parathyroid hormone (PTH) release in relation to calcium levels. All options must be used. 1 High serum calcium level inhibits PTH secretion. 2 Parathyroid gland releases PTH. 3 Low serum calcium level stimulates parathyroid gland. 4 Calcium is reabsorbed.
1. Low serum calcium level stimulates parathyroid gland. 2. Parathyroid gland releases PTH. 3. Calcium is reabsorbed. 4. High serum calcium level inhibits PTH secretion.
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes? Assess the client's mental status regularly. Allow the client to grieve for body image changes. Restrict foods that are high in potassium. Restrict fluid intake to 1,000 mL/day.
Assess the client's mental status regularly.
Clients with Addison's disease must ________ sodium intake and fluid intake in times of stress of prevent hypotension.
Increase
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?
Serum potassium level of 5.8 mEq/L (5.8 mmol/L) Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease.
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?
Tetany
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? Weigh the client. Administer oral hydrocortisone. Test urine for ketones. Assess vital signs.
Assess Vital Signs Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.
Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply. Cold intolerance. Heat intolerance. Fatigue. Dry skin. Hair loss. Increased energy.
Cold intolerance. Fatigue. Dry skin. Hair loss.
A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which of the following would be a primary assessment? Presence of thrush and circumoral pallor Presence of edema and fluid volume overload Presence of fatigue and weakness Presence of dyspnea and cyanosis
Presence of fatigue and weakness
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: hematuria. weight loss. increased urine output. increased blood pressure.
Weight loss
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? Hypotonic saline Hydrocortisone Potassium Insulin
Hydrocortisone Explanation: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution.
Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately report: sore throat. increased urine output. constipation. 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 client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. The nurse should tell the client that: The physical changes are permanent, but the mood swings will disappear. The body changes are permanent and the client will not be the same as before this condition. The body and mood will gradually return to normal. The physical changes are temporary, but the mood swings are permanent.
the body and mood will gradually return to normal. Explanation: As the body readjusts to normal cortisol levels, mood and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.
Which laboratory finding is present in nephrotic syndrome?
• decreased total serum protein
What is the most common cause of hyperaldosteronism? A pituitary adenoma Deficient potassium intake Excessive sodium intake An adrenal adenoma
An adrenal adenoma
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes? Allowing the client to express feelings related to body image changes Restricting foods high in potassium Assess the clint's metal status regularly Reduce fluid intake
Assess the client's mental status regularly. Explanation: Central nervous system changes include such symptoms as apathy, lethargy, and decreased concentration. Seizures and coma can also occur. The nurse should assess the client's level of consciousness at regular intervals and maintain client safety.
A client is seen in the clinic with suspected parathormone (PTH) deficiency. Which electrolyte levels would the nurse expect to be abnormal in a client with PTH deficiency? Select all that apply. Calcium Potassium Phosphorous Sodium Chloride Glucose
Calcium, Phosphorous Explanation: A client with PTH deficiency has abnormal serum calcium and phosphorous levels because PTH regulates these two electrolytes. PTH deficiency does not affect sodium, potassium, chloride, or glucose.
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. Bradycardia. Low body temperature. ECG changes. Dry mouth. Nervousness. Tachycardia.
ECG changes. Low body temperature. Bradycardia. In hypothyroidism, the body is in a hypometabolic state. Therefore, ECG changes with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.
The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? Acromegaly Cushing's Syndrome Hypopituitarism Diabetes Mellitus
Hypopituitarism Explanation Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hormone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. In adults, changes in sexual function, impotence, or decreased libido should be reported.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? Myocardial infarction Thyroid storm Congestive heart failure Myxedema coma
Myxedema coma
What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?
Restrict sodium and potassium and restrict fluids as ordered. Explanation: In renal failure, there is retention of sodium and potassium, so these are restricted. Important care measures will also include fluid restrictions. The client will require permanent dialysis, not temporary as with acute renal failure. The diet will be restricted in protein to decrease waste products. Hypertension is associated with chronic renal failure.
hen instructing a client diagnosed with hypoparathyroidism about diet, the nurse should stress the importance of: You Selected: Restricting sodium Restricting potassium Restricting fluids. Encouraging fluids.
Restricting fluids
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate
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? tachycardia Dysuria leg cramps blurred vision
Tachycardia 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. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? Weight gain, decreased appetite, and constipation Weight loss, increased urination, and increased thirst Weight loss, increased appetite, and hyperdefecation Weight gain, increased urination, and purplish-red stria
Weight gain, decreased appetite, and constipation 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. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.
The client's serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate. The mechanism of action for this drug is to: exchange sodium for potassium ions in the colon. release hydrogen ions for sodium ions. increase calcium absorption in the colon. increase potassium excretion from the colon
exchange sodium for potassium ions in the colon. Polystyrene sulfonate, a cation-exchange resin, causes the body to excrete potassium through the gastrointestinal tract. In the intestines, particularly the colon, the sodium of the resin is partially replaced by potassium. The potassium is then eliminated when the resin is eliminated with feces. Although the result is to increase potassium excretion, the specific method of action is the exchange of sodium ions for potassium ions.
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? pH 7.47, PaCO2 45, HCO3 33- pH 7.31, PaCO2 48, HCO3 24- pH 7.20, PaCO2 36, HCO3 14- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Metabolic Acidosis
The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. The nurse should assess this client for:
tachycardia. 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 nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
• An irregular apical pulse Explanation: Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia.
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?
• 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. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.
A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment being received for SIADH is effective? Select all that apply.
• Decrease in body weight • Increase in urine output • Decrease in urine osmolarity Explanation: SIADH is an abnormality involving an excessive release of ADH. The predominant feature is water retention with oliguria, edema, and weight gain. Successful treatment would result in a reduction in weight, increased urine output, and a decrease in urine osmolarity (concentration).
The nurse is caring for a client following a motor vehicle incident with head trauma suspected of diabetes insipidus. Which nursing intervention is appropriate?
• Measure and record urinary output.
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?
• The importance of watching for signs of hyperglycemia. 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.
Which clinical finding should a nurse look for in a client with chronic renal failure?
• Uremia Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection?
• cloudy dialysate fluid Cloudy drainage indicates bacterial activity in the peritoneum.
A client with chronic renal failure is undergoing hemodialysis. Postdialysis, the client weighs 59 kg. The nurse should teach the client to:
• control the amount of protein intake to 59 to 70 g/day. Hemodialysis clients have their protein requirements individually tailored according to their postdialysis weight. The protein requirement is 1.0 to 1.2 g/kg body weight per day. Hence, for a 59-kg weight, the amount of protein will be 59 to 70 g/day. Sodium should be restricted to 3 g/day. The client should obtain sufficient calories; if calories are not supplied in adequate amount, the body will use tissue protein for energy, which will lead to a negative nitrogen balance and malnutrition. Fluid intake needs to be restricted. The fluid amount is restricted to 500 to 700 mL plus the urine output.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of:
• profound neuromuscular irritability. Explanation: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany).
A nurse should expect a client with hypothyroidism to report:
• puffiness of the face and hands. Explanation: Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
"I will take it with meals and bedtime snacks." Explanation: Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.
A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply. High-fiber, low-calorie diet High-protein, high-calorie diet Review of the procedure for thyroid radiation therapy Use of stool softeners Thyroid hormone replacements Plan for a thyroidectomy
High-fiber, low-calorie diet Use of stool softeners Thyroid hormone replacements
A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? The client has a history of diverticulitis. The client has a history of severe anemia during hemodialysis. The client is blind in his right eye. The client is on the kidney transplant waiting list.
The client has a history of diverticulitis. Explanation: A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum.
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes: confusion, headache, and seizures. hypotension, tachycardia, and tachypnea. weakness, tingling, and cardiac arrhythmias. acute bone pain and confusion.
hypotension, tachycardia, and tachypnea.
The nurse judges that the mother understands the diet restrictions for her child with chronic renal failure who is receiving peritoneal dialysis when she reports providing a diet involving which components? high potassium and iron protein and phosphorus restrictions sodium and water restrictions high protein and carbohydrates
protein and phosphorus restrictions Explanation: Regulation of the diet is the most effective means, besides dialysis, for reducing renal excretion. Dietary phosphorus is restricted, which reduces the protein load on the kidneys. Clients are also given substances to bind phosphorus in the intestines to prevent absorption. Limited protein in the diet should include foods high in essential amino acids. Foods high in fat and carbohydrate are used to increase caloric intake.
A client comes to the clinic verbalizing a weight loss of 20 pound (9.1 kilogram).over the last month, even with a "ravenous" appetite and no change in activity level. The client is diagnosed with Graves' disease. Which other signs and symptoms of Graves' disease would the nurse assess? Select all that apply. Rapid, bounding pulse Bradycardia Heat intolerance Constipation Mild tremors Nervousness
Rapid, bounding pulse Heat intolerance Mild tremors Nervousness Graves' disease, or hyperthyroidism, is a hypermetabolic state that is associated with a rapid, bounding pulse; heat intolerance; tremors; and nervousness. Bradycardia and constipation are signs and symptoms of hypothyroidism.
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? Restricting sodium intake to 1 gm/day Elevating the head of the client's bed to 90 degrees Restricting fluids to 800 ml/day Administering vasopressin as ordered
Restricting fluids to 800 ml/day 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. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.
Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? The client must decrease the dose of steroid medication carefully to prevent crisis. The client will need to take steroids whenever her life involves physical or emotional stress. 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.
The client will need steroid replacement for the rest of her life.
A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? The client with diabetic ketoacidosis. The client with diabetes mellitus. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The client with diabetes insipidus.
The client with diabetes insipidus.
A client requires hemodialysis. Which type of drug should be withheld before this procedure? Phosphate binders Antibiotics Insulin Cardiac glycosides
Cardiac glycosides Explanation: Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis.
Which of the following results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? Increased energy, weight loss, and a higher temperature and pulse rate Elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels Improved appetite, weight gain, and sleeping fewer hours Decreased edema, stable temperature, and decreased respiratory rate
Increased energy, weight loss, and a higher temperature and pulse rate Explanation: The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
Increased urine osmolarity Explanation: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.
The nurse is caring for a client with chronic renal failure. The nurse should monitor the client for which adverse effects of hypermagnesemia?
lethargy Explanation: Early signs and symptoms of hypermagnesemia include drowsiness, lethargy, nausea, and vomiting. Flushed skin is a sign of hypernatremia. Severe thirst is associated with hyperglycemia. Tremors are associated with hypomagnesemia.
