HCC 2- Exam 2 - PrepU

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day."

A client with diabetes mellitus states, "I can eat as many carbohydrates as I want and it will not affect my blood sugar." What is the nurse's best response? •

"Carbohydrates are broken down into monosaccharides before being absorbed."

The pathophysiology student is studying the general adaptation syndrome (GAS). Which statement by the student demonstrates understanding? •

"Epinephrine is released in the alarm stage."

The nurse is caring for a client with diabetes. Which client statement reflects that nursing teaching has been effective? •

"I will eat a meal within a half hour of taking my morning insulin."

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.

"I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I'm so glad I don't have to make any changes in my diet."

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include?

"The drug helps to control the symptoms of the disease."

A female client presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the client had vaginal small cell carcinoma. How can the health care providers explain the Cushing syndrome signs/symptoms to this client? •

"The tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs/symptoms."

Which statement would a nurse tell a client that best describes a lab finding of metaplasia? •

"This is a change in cell form as it adapts to increased work demands or threats to survival."

A 17-year-old female has announced to her family physician a desire to wholly eliminate fats from her diet. Which aspect of the role of fats would underlie the physician's response to the client?

-Apart from providing energy, -fats are necessary as carriers of certain -vitamins are precursors to prostaglandins.

Which is considered an isotonic solution? •

0.9% normal saline

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? •

1,000 mL

A pregnant woman determined to be at high risk for gestational diabetes is undergoing a 1-hour glucose challenge test. The nurse schedules the client for a 3-hour glucose tolerance test based on which result? •

146 mg/dL

Brain cell death may occur in as little as: •

3 minutes

A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? •

3.5-5.0 mEq/L

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? •

6%

What dietary recommendations should a nurse provide a client with a lung abscess? •

A diet rich in protein

Which is the most common cause of symptomatic hypomagnesemia? •

Alcoholism

Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function? •

Beta-adrenergic blocking agent (beta-blocker)

A client is experiencing difficulty speaking and numbness on his right side. His wife calls a neighbor who is a nurse for help. Upon arrival at the scene, the nurse calls 911 immediately. Which of the following displays the nurse's critical clinical judgement? •

Brain cells without oxygen die in approximately 3 to 6 minutes.

A client who has had an intestinal bypass has developed a kidney stone. Which type of kidney stone does the nurse recognize that this client will most likely be treated for? •

Calcium

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? •

Calcium

When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important? •

Checking if the mucous membranes are dry

A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? •

Class I obesity

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? •

Conduct disorder

Which term refers to casts in the urine? •

Cylindruria

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? •

Dark, concentrated urine

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: •

Deficient knowledge (treatment regimen).

A nurse examines the laboratory values of a client in heart failure. Which value indicates a compensatory hormone mechanism?

Elevated atrial natriuretic hormone

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? •

Elevated blood pressure

When discussing the various functions of the cellular parts, the pathophysiology professor asks a group of students, "Where are the primary sites of protein synthesis located in a cell?" Which student response is correct? •

Endoplasmic reticulum

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance? •

Fats

The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for? •

Fluid deprivation test

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? •

Frequent vomiting, leading to loss of fluid volume

Which measures would likely be rejected as part of a first-line weight loss plan for a client with a BMI of 30.2, type 2 diabetes, and hypertension? •

Gastric bypass

Antithyroid medications are not generally recommended for elderly patients because of which side effect? •

Granulocytopenia

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis? •

Hashimoto thyroiditis

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?

Hypercalcemia

The nurse is caring for a patient who has sustained severe burns to 50% of the body. The nurse is aware that fluid shifts during the first week of the acute phase of a burn injury cause massive cell destruction. What should the nurse report immediately when reviewing laboratory studies? •

Hyperkalemia

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse mostlikely expect to address? •

Hypocalcemia

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which part of the brain? •

Hypothalamus

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice? •

Impaired uptake of bilirubin

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? •

Increase hydration

A neonate undergoing phototherapy treatment must be monitored for which adverse effect? •

Increased insensible water loss

A nurse is assessing a patient with posttraumatic stress disorder (PTSD) who is exhibiting physiologic manifestations. The nurse interprets these manifestations as being the result of which of the following? •

Increased sympathetic activity

Which route of administration of medication is preferred in the most acute care situations? •

Intravenous

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis? •

Jaundice and pruritus

The preferred preparation for treating hypothyroidism includes which of the following?

Levothyroxine (Synthroid)

The hormone progesterone is metabolized in which organ? •

Liver

The nurse is caring for a geriatric client and notices polypharmacy. Which diagnostic studies are anticipated? •

Liver function studies

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? •

Location of discomfort

Which of the following statements is true concerning ribonucleic acid (RNA)? •

Messenger RNA is the template for protein synthesis.

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? •

Metabolic alkalosis

The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result? •

Mineralocorticoids

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? •

Monitor the client for an allergy to iodine contrast material.

What is the most common mechanism of hormone control? •

Negative feedback

The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions? •

Neurological system

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle? •

Nocturnal intermittent peritoneal dialysis (NIPD)

The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults? •

Offer a variety of fluids to the client every hour.

The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

Serous fluid is contained in the:

Peritoneal cavity

Which of the following glands is considered the master gland? •

Pituitary

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? •

Positive Chvostek's sign

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? •

Preload

A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced? •

Renal impairment

A nurse is assessing a 4-year-old child's peripheral IV line, observing that it is not infusing. What is the first action the nurse should take to correct this situation? •

Reposition the child's extremity.

A primigravid with severe gestational hypertension has been receiving magnesium sulfate IV for 3 hours. The latest assessment reveals deep tendon reflexes (DTR) of +1, blood pressure of 150/100 mm Hg, a pulse of 92 beats/minute, a respiratory rate of 10 breaths/minute, and a urine output of 20 ml/hour. Which action should the nurse perform next? •

Stop the magnesium sulfate infusion.

Which is a manifestation of right-sided heart failure? •

Systemic venous congestion

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? •

Tachycardia

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?

Tenting of skin

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function? •

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other co-morbidity? •

Type 2 diabetes

The nurse is assessing a client with diabetes and notes an area on the client's right foot as inflamed, necrotic, and eroded. The client states he accidentally slammed his foot in a door 2 weeks ago. The nurse would document this finding as a(n): •

Ulceration

A client with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which process would the client's care team most likely rule out first as a contributing factor? •

Up-regulation has increased the sensitivity of the body to particular hormone levels.

Which statement correctly identifies a difference between duodenal and gastric ulcers? •

Vomiting is uncommon in clients with duodenal ulcers.

Which statement most accurately describes the process of osmosis? •

Water moves from an area of lower solute concentration to an area of higher solute concentration.

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics? •

Weight loss, glucose monitoring, and oral antihyperglycemic medications

How is control over the extracellular concentration of potassium within the human body is exerted? •

aldosterone.

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? •

allopurinol

The nurse is assessing a client with chronic bronchitis. For which finding should the nurse suspect that the client is developing right-sided heart failure? •

bilateral edema of the feet and ankles

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? •

blood glucose level 1,100 mg/dl (61.05 mmol/L)

A client with renal insufficiency is admitted to the hospital with pneumonia. The client is being treated with gentamicin. Which laboratory value should be closely monitored? •

blood urea nitrogen (BUN)

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 diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention?

crackles in both lung bases

An osmotic diuretic such as mannitol is given to the client with increased intracranial pressure (ICP) to •

dehydrate the brain and reduce cerebral edema.

The nurse is caring for a client with polydipsia and large amounts of urine with a specific gravity of 1.003. Which disorder is anticipated? •

diabetes insipidus

While making a follow-up home visit to a client in her first week postpartum, the nurse notes that she has lost 5 pounds. Which reason for this loss would be the most likely? •

diuresis

A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms? •

hyperpituitarism

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream? •

hypertonic

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? •

lack of free water intake

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? •

limiting intake of heavy, greasy foods

A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? •

monoamine oxidase (MAO) inhibitors

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving? •

pH has increased

A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which effect is the most important to report to the physician? •

palpitations and chest pain on exertion

The nurse is administering a rectal suppository. How far will the nurse insert the suppository? •

past the internal sphincter

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? •

phenazopyridine hydrochloride

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: •

removal of the transplanted kidney.

A decrease in arterial blood pressure will result in the release of: •

renin.

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: •

restricting sources of potassium usually found in fresh fruits and vegetables.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with •

seizure.

Penicillin causes bacterial cell death without disrupting normal human cell functioning. This is an example of: •

selective toxicity.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of •

sodium and potassium abnormalities.

The primary extracellular electrolytes are: •

sodium, chloride, and bicarbonate.

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

solid.

Which diagnostic study is usually performed to confirm the diagnosis of heart failure?

• Echocardiogram

The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated?

• The specific gravity will be high.

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

• mEq/L

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply.

•Teach the client meticulous handwashing. •Assess hydration status of the client at each visit. •Urge the client to drink 8 to 10 glasses of fluid daily.

When counseling a group of overweight individuals, the nurse should stress that during parties, the oxidation of alcohol provides how many kilocalorie/gram to one's diet? •

7 kcal/g

Which clinical finding among older adults is most likely to be viewed as a normal part of age-related changes?

78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years

A client is diagnosed with diabetes insipidus. The health care provider orders desmopressin, which the nurse knows is the synthetic equivalent of what hormone? •

ADH

The nurse is correct to state that a client's body needs to have adequate nutrition to maintain energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)? •

Active transport

The nurse is reading the nurse's note from the previous shift to evaluate the client with a risk for impaired skin integrity due to fluid volume excess. Which aspects would demonstrate this improvement? •

Ambulation to the bathroom without noted dyspnea.

Which of the following is a term used to describe the process by which a new blood supply is formed? •

Angiogenesis

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? •

Creatinine clearance level

A 45-year-old client reports "needing to bear down with urination," frequency, and occasional loss of urine when coughing. Based on symptoms, which diagnosis is most appropriate for this client?

Cystocele

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status? •

Delirium related to underlying medical problem

A client arrives in the emergency department with hypovolemia related to excretion of "at least 3 gallon jugs of dilute, water-like urine in the past 24 hours." In collaboration with the physician, the nurse prepares to administer which medication? •

Desmopressin acetate

A head injury has resulted in the hospitalization of a client. Nursing assessments confirm that the client is producing substantial amounts of dilute urine and is consuming large amounts of liquids. Considering the history and assessment findings support the possibility of what metabolic disorder? •

Diabetes insipidus (DI)

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? •

Diarrhea

A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence?

Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.

A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue? •

Follicle stimulating hormone (FSH)

A client is experiencing reflux of stomach contents into the esophagus. The nurse determines that the problem may result from:

Gastroesophageal sphincter

Which factor increases blood urea nitrogen (BUN)? •

Gastrointestinal bleeding

Which substance is required for brain cell metabolism? •

Glucose

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? •

Hypokalemia

Which of the following clinical signs are associated with diabetes insipidus? •

Hypotension

A health care provider is assessing a client for a potential endocrine disorder. Assessment findings identify abnormalities with emotion, pain, and body temperature. Which mechanism of endocrine control will require further laboratory/diagnostic assessment? •

Hypothalamus

Production of melanin is controlled by a hormone secreted by which of the following? •

Hypothalamus

A client is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which aspect of this abnormality? •

Hypoxia

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? •

Observe the color of stool.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? •

Oliguria

The nurse is caring for an infant wih DiGeorge syndrome. Which organ does the nurse know will be underdeveloped or absent? •

Parathyroid and thymus glands

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? •

Phenazopyridine

Which condition is characterized by a deficiency of the liver enzyme phenylalanine hydroxylase? •

Phenylketonuria

Select the most common symptoms of diabetes. Select all that apply.

Polydipsi Polyuria Polyphagia

A physician has ordered the measurement of a cardiac client's electrolyte levels as part of the client's morning blood work. Which statement best captures the importance of potassium in the normal electrical function of the client's heart? •

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a client experiencing hypercalcemia. Which ECG change is typically associated with this electrolyte imbalance? •

Prolonged PR intervals

What is a hallmark of the diagnosis of nephrotic syndrome? •

Proteinuria

A patient has been identified as a poor metabolizer for a drug that undergoes CYP 450 metabolism. The nurse interprets this information as indicating which of the following? •

The patient is at increased risk for toxicity.

A 44-year-old client is being treated for dehydration in an acute care hospital. The nurse determines that the rehydration treatment is working by assessing which values? •

Urine output of 1500 mL in 24 hours

A nurse is assessing a client admitted with deep partial-thickness and full-thickness burns on the face, arms, and chest. Which finding indicates a potential problem? •

Urine output of 20 ml/hour

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? •

Use an aseptic technique during the procedure.

The nurse is caring for an obese client. It would be most important for the nurse to assess the client for which possible psychological factor that contributes to obesity?

Using food as a coping strategy

The client is six hours post-open hysterectomy. Intravenous fluids are infusing at 125 mL/hr, urinary catheter has drained 170 mL since surgery, and the client reports pain as a 3 out of 10. What is the nurse's priority concern? •

fluid balance

A nurse is assisting a neurologist, who is assessing the norepinephrine (noradrenaline) level of a client who is reporting stress. Which function does norepinephrine (noradrenaline) perform? •

heightens arousal and increases energy

Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. This electrolyte imbalance is known as: •

hyponatremia.

While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.

•Gurgling as the client breathes through the mouth •Decrease in amount of urine produced •Refusal to ingest food or fluids

A client with heart failure is admitted to the hospital. What should the nurse assess in the client to determine a risk for impaired skin integrity? Select all that apply.

•crackling breath sounds auscultated over lung fields •increase in blood pressure from 122/76 to 144/90 -neck vein distention with head of bed at 90 degrees

A client is admitted with a risk for skin breakdown and states to the nurse, "I haven't been eating healthy for the last few months." What would the nurse look for to confirm this risk factor? Select all that apply.

•muscle wasting •obesity loss of subcutaneous tissue