Med Surg 1 final

The nurse teaches a patient about diagnostic tests for ascertaining the presence of Cushing syndrome. Which advice would the nurse tell the patient to do to confirm the diagnosis? Select all that apply. 1 "Check plasma adrenocorticotropic hormone (ACTH) levels." 2 "Take blood chemistries for sodium, potassium, and calcium." 3 "Opt for a complete blood count (CBC) with RBC differential." 4 "Collect a 24-hour urine sample for testing free cortisol and 17-ketosteroids." 5 "Undergo computed tomography (CT) scan or magnetic resonance imaging (MRI)."

> "Check plasma adrenocorticotropic hormone (ACTH) levels." > "Collect a 24-hour urine sample for testing free cortisol and 17-ketosteroids." > "Undergo computed tomography (CT) scan or magnetic resonance imaging (MRI)." - Checking plasma adrenocorticotropic (ACTH) hormone levels will help assess the underlying cause of Cushing syndrome because a high or normal ACTH level indicates Cushing syndrome. - A urine cortisol level higher than the normal range of 80 to 120 mcg/24 hr is an indicator of Cushing syndrome. - Both a computed tomography (CT) scan and a magnetic resonance imaging (MRI) of the pituitary and adrenal glands are used to detect Cushing syndrome. - Blood chemistries for sodium, potassium, and glucose are also a part of the diagnostic tests for Cushing syndrome. - A complete blood count (CBC) with WBC, not RBC, differential is usually performed as part of the diagnostic tests for Cushing syndrome.

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the blood pressure (BP) is now within the normal range. Which nursing response is appropriate? 1 "You may stop the medication because your BP is normal." 2 "You may stop taking the medication if you maintain a healthy lifestyle." 3 "Begin taking half-doses of the medication because the BP has decreased." 4 "Continue the medication until your health care provider advises to discontinue it."

> "Continue the medication until your health care provider advises to discontinue it." - Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the primary health care provider. - The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. - A reduction of the dosage may reduce the efficacy of the drug. - Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.

The nurse is teaching a patient with Addison's disease about corticosteroid therapy. The nurse should prioritize which of these teaching points? 1 "Plan a high-carbohydrate diet." 2 "Increase your daily intake of sodium." 3 "Decrease your daily intake of calcium." 4 "Do not stop taking the medication abruptly."

> "Do not stop taking the medication abruptly." - The patient should be instructed to not stop the medication abruptly because this can cause adverse side effects. - Patients taking corticosteroids should not consume a high-carbohydrate diet, because corticosteroids increase blood sugar. - Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. - Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.

The nurse obtains a medical history from a patient with a suspected abdominal aortic aneurysm. What question is the priority for the nurse to ask the patient? Correct1 "Do you have back pain?" 2 "Have you noticed blood in your urine?" 3 "Do you have frequent headaches?" 4 "Are your stools black or tarry?"

> "Do you have back pain?" - Although an abdominal aortic aneurysm is often asymptomatic, some patients have abdominal or back pain. Signs of aneurysm rupture include back pain and a pulsating mass in the abdomen. - Headaches, hematuria, and changes in the color of bowel movements are not signs associated with an abdominal aortic aneurysm.

The nurse provides education to a patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement made by the patient indicates understanding of the teaching? 1 "I should drink no more than three glasses of whole milk per day." 2 "I should include four to five servings of fruits and vegetables daily." 3 "I should eat three servings of red meat, such as pork or beef, daily." 4 "I should consume whole grain products no more than once per week."

> "I should include four to five servings of fruits and vegetables daily." - The DASH diet encourages consumption of fruits and vegetables. - Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. - Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. - The DASH diet recommends a few servings of whole grain products daily.

The nurse provides discharge instructions to a patient who underwent an abdominal aortic aneurysm repair. Which statement made by the patient indicates understanding of the teaching? 1 "I will immediately report if there are irregular bowel habits." 2 "I will immediately report if I feel weak and have a poor appetite." 3 "I will immediately report if the pain or drainage from incisions increase." 4 "I will immediately report if my body temperature is 100°F."

> "I will immediately report if the pain or drainage from incisions increase." - The patient or caregiver should immediately tell the primary health care provider about increased redness, increased pain, or drainage after surgery. These symptoms can be an indication of endoleak or aneurysm growth below and above the graft. If not treated immediately, severe tissue damage or even death may occur. - Fatigue, poor appetite, irregular bowel habits, and body temperature of 100°F are common postoperative symptoms and need not be reported.

After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement? 1 "If I lose weight, I will be able to stop taking insulin." 2 "My pancreas will produce more insulin as I recover." 3 "I will need to be medicated with insulin for the rest of my life." 4 "I will be able to take insulin pills once my blood sugar is stabilized.

> "I will need to be medicated with insulin for the rest of my life." - Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. - Weight loss and recovery will not affect insulin production. - Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally.

The nurse provides preoperative instructions to a patient who is scheduled for surgery to repair an abdominal aortic aneurysm. The patient has a history of cardiovascular disease. Which patient statement indicates the need for further teaching? 1 "I will have some type of bowel preparation the day before surgery." 2 "I should not drink anything after midnight the day of surgery." 3 "I will receive an antibiotic just before the surgery begins." 4 "I will not be allowed to take any medications the day of surgery."

> "I will not be allowed to take any medications the day of surgery." - Patients with cardiovascular disease should receive a beta blocker (e.g., metoprolol) preoperatively. - The other statements indicate understanding of the instructions. - Patients may have an enema or laxative for the bowel preparation, should not drink anything after midnight the night before, and will receive an antibiotic immediately before the surgical incision is made.

The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan? 1 "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." 2 "I will go running each day when my blood sugar is too high to bring it back to normal." 3 "I will plan to keep my job as a teacher because I get a lot of exercise every school day." 4 "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."

> "I will take a brisk 30-minute walk five days per week and do resistance training three times a week." - The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. - Brisk walking is moderate activity. - Fishing and teaching are light activity and running is considered vigorous activity.

The nurse provides dietary instructions to a patient with type 1 diabetes mellitus. Which statement made by the patient indicates a need for further teaching? 1 "If I go over my calories, I can just increase my insulin." 2 "I'll need a bedtime snack, because I take an evening dose of NPH insulin." 3 "I can have an occasional low-calorie dessert as long as I include it in my meal plan." 4 "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."

> "If I go over my calories, I can just increase my insulin." - The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. - A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management.

The nurse provides education to a patient with newly diagnosed type 1 diabetes mellitus. Which statement made by the patient indicates a need for further instruction? 1 "If I skip breakfast, I can hold my insulin until noon." 2 "I'll have some options when it comes to food choices." 3 "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." 4 "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."

> "If I skip breakfast, I can hold my insulin until noon." - A diabetic patient should adhere to an American Diabetes Association diet and insulin regimen. These patients should not self-regulate insulin unless directed to do so by their primary health care provider. The statements in the other answer options are all correct in regard to self-management of diabetes at home.

Which statement by the patient with diabetes mellitus indicates that further education regarding exercise is required? 1 "I should exercise about 30 minutes five days a week." 2 "Because I take insulin daily, I should exercise about one hour after eating a meal." 3 "Exercise will help me to lose weight, which will help my body to better use insulin." 4 "It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones."

> "It is especially important that I exercise if my blood sugar is above 250 mg/dL and my urine is positive for ketones." - Strenuous activity can be perceived by the body as a stress and cause an increase in blood sugar by the release of counterregulatory hormones when the blood sugar is elevated and ketosis is present. The American Diabetes Association recommends that people with diabetes exercise 30 minutes per day, five days per week. To prevent hypoglycemia, it is important to exercise about an hour after consuming a meal or eat small carbohydrate snacks every 30 minutes during exercise. Weight loss decreases insulin resistance, which can lower blood glucose.

The nurse has taught a patient who was admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? 1 "Taking a hot bath every day will help with my circulation." 2 "I should avoid walking barefoot at all times." 3 "I should look at the condition of my feet every day." 4 "I need a podiatrist to treat my ingrown toenails."

> "Taking a hot bath every day will help with my circulation." - Hot water may injure tissue related to decreased sensation and should be avoided. - Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.

A nurse is caring for a patient on an inpatient unit with type I diabetes mellitus. The primary health care provider has ordered regular insulin to be administered. The nurse is preparing the medication for subcutaneous injection. The patient asks the nurse why the abdomen is the chosen site to inject the insulin. Which response by the nurse demonstrates an understanding of the choice of injection site? 1 "The abdomen is the preferred site for injection because it does not hurt as badly." 2 "The abdomen is the preferred site for injection because it is easier to administer there." 3 "The abdomen is the preferred site for injection because the insulin will be absorbed faster there than at other sites." 4 "The abdomen is the preferred site for injection because you've been self-injecting there at home, and I should use the same site."

> "The abdomen is the preferred site for injection because the insulin will be absorbed faster there than at other sites." - The abdomen is the preferred site for subcutaneous injection of insulin because it has the fastest subcutaneous absorption. - The reason that the abdomen is the preferred site for injection is not because it does not hurt; all injections are uncomfortable. - The abdomen may be an easier site to access, but that is not the reason the abdomen is used as an injection site. - The nurse should not use the same injection site for administration that the patient has been using for self-injection; instead, the nurse should rotate the injection within and between sites to allow for better insulin absorption.

A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? 1 "Have you ever skipped a dose of metformin?" 2 "When was the last time you took your metformin?" 3 "How many times a day do you take your metformin?" 4 "How long have you been taking metformin for diabetes?

> "When was the last time you took your metformin?" - During an IVP, contrast dye is injected so that the urinary system can be visualized. To reduce risk of kidney injury, metformin should be discontinued a day or two before the procedure and for 48 hours following the procedure. - Medication administration adherence, dosage, and history are important to assess, but will not affect the interaction.

Which statements are appropriate for the nurse to make to a patient newly diagnosed with Type I diabetes mellitus (DM)? Select all that apply. 1 "You should decrease your dietary sugar intake." 2 "I will teach you how to self-administer your insulin." 3 "It is important to consume a diet that is high in fats." 4 "It is important for you to reduce your physical activity." 5 "You should monitor your blood sugar as prescribed."

> "You should decrease your dietary sugar intake." > "I will teach you how to self-administer your insulin." > "You should monitor your blood sugar as prescribed." - The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. - A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. - Reduction of physical exercise can also lead to increase in blood glucose level.

The patient with diabetes should consume fiber as part of a healthy diet. The current recommendation for persons with diabetes is 1 25 to 30 g/day 2 20 to 25 g/day 3 40 to 50 g/day 4 10 to 20 g/day

> 25 to 30 g/day - The American Diabetes Association (ADA) recommends that diabetics consume 25 to 30 grams of fiber daily. This is the same level recommended for the nondiabetics, because there is no evidence that a higher intake of fiber is essential. - Forty to 45 grams is too much fiber for the patient to consume, and 10 to 25 grams is not enough fiber.

A patient has a 2-month history of taking warfarin as treatment for deep vein thrombosis (DVT). The patient is scheduled for an unrelated surgery. The nurse determines that it is safe and necessary to give vitamin K based on what international normalized ratio (INR) result? 1 - 1.0 2 - 1.2 3 - 2.0 4 - 3.4

> 3.4 - Vitamin K is the antidote to warfarin. Warfarin is an anticoagulant that impairs the ability of the blood to clot; therefore, it is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. - The value of the INR indicates an impairment of clotting ability, making 3.4 the correct selection. - For a patient with a history of VTE, a therapeutic INR is maintained between 2.0 and 3.0.

The nurse performs blood pressure measurements at a wellness clinic. The nurse identifies that which patient has the highest risk for developing primary hypertension? 1 A 65-year-old African American patient; BMI of 35 2 A 45-year-old patient who has chronic pain caused by cancer 3 A 65-year-old retired Caucasian patient; body mass index (BMI) of 15 4 A 45-year-old factory worker who smokes one pack of cigarettes per day

> A 65-year-old African American patient; BMI of 35 - The 65-year-old African American patient has three risk factors for primary hypertension: advanced age, African American race, and morbid obesity with a BMI of 35. - All of the other patients have fewer risk factors for primary hypertension, In the 45-year-old, smoking is the only risk factor. - In the 45-year-old with cancer, pain is the only risk factor. - In the 65-year-old retiree, the only risk factor is advanced age.

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient receives a prescription for 30 mg enoxaparin. Which injection site should the nurse use to administer this medication safely? 1 Buttock, upper outer quadrant 2 Abdomen, anterior-lateral aspect 3 Back of the arm, 2 inches away from a mole 4 Anterolateral thigh, with no scar tissue nearby

> Abdomen, anterior-lateral aspect - Enoxaparin is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. Enoxaparin will not be given in the upper quadrant of the buttock. - All subcutaneous injections should be given away from scars, lesions, or moles.

A patient with adrenocortical insufficiency develops Addisonian crisis. What should be the immediate nursing action? 1 Administer fludrocortisone daily. 2 Advise an increased intake of salt. 3 Decrease the glucocorticoid dosage. 4 Administer large volumes of saline and dextrose.

> Administer large volumes of saline and dextrose. - Addisonian crisis is a life-threatening emergency in which the patient has low levels of adrenal hormones, leading to a loss of water and sodium. The first course of action is to reverse hypotension by administering large volumes of saline and dextrose. - Administration of fludrocortisone can be administered once hypotension is corrected. - Increasing the salt in the diet would not have an immediate effect during the Addisonian crisis. - Glucocorticoids are given as a long-term therapy.

Which preoperative nursing interventions are beneficial to a patient who is scheduled for aortic aneurysm surgery the following day? Select all that apply. 1 Administering a bowel preparation 2 Ensuring that the patient has nothing by mouth (NPO) after midnight 3 Cleansing the skin with an antimicrobial agent 4 Providing for a visit to the intensive care unit, if necessary 5 Informing the patient that no medications will be given after midnight

> Administering a bowel preparation > Ensuring that the patient has nothing by mouth (NPO) after midnight > Cleansing the skin with an antimicrobial agent > Providing for a visit to the intensive care unit, if necessary - In general, aortic surgery patients have a bowel preparation (e.g., laxatives, enema) and skin cleansing with an antimicrobial agent the day before surgery, have nothing by mouth (NPO) after midnight the day of surgery, and receive IV antibiotics immediately before the incision is made. If appropriate, a preoperative visit to the intensive care unit (ICU) may be helpful to the patient and caregiver. - On the day of the surgery, the patients may receive medication including essential medications (e.g., antihypertensives), preoperative antibiotic, and a beta blocker if the patient has a history of cardiovascular disease (CVD).

A patient is at risk for developing a deep vein thrombosis after a knee replacement surgery. Which interventions would reduce the risk of this complication? Select all that apply. 1 Applying heat to the operative site 2 Administrating prophylactic anticoagulant drugs 3 Administrating intermittent positive pressure ventilation 4 Restricting the range of motion of the unaffected lower extremity 5 Encouraging the patient to wear a compression gradient stocking

> Administrating prophylactic anticoagulant drugs > Encouraging the patient to wear a compression gradient stocking - To decrease the risk for thromboembolism after knee replacement surgery, a patient is treated with prophylactic anticoagulant drugs. - Encouraging the patient to wear a compression gradient stocking will lead to increased venous blood return from the extremities. - Heat is applied during the initial postoperative period to decrease swelling. - However, heat does not affect the development of a deep vein thrombosis. - Intermittent positive pressure ventilation is administered during fat embolism syndrome. - Restricting the range of motion of the unaffected lower extremity would result in thromboembolism.

A patient with chronic hypertension has a serum potassium level of 6.4 mEq/L. The patient asks the nurse about the relationship between high blood pressure and high serum potassium. If the nurse is unsure about the relationship, how should the nurse respond? 1 Educate the patient about the effects of high blood pressure. 2 Educate the patient about the effects of high serum potassium. 3 Tell the patient to not worry about it for now; the patient needs to focus on wellness. 4 Admit not having knowledge about it; reassure the patient that help will be sought to provide the answer.

> Admit not having knowledge about it; reassure the patient that help will be sought to provide the answer. - A nurse should be aware of knowledge limitations. When the nurse is unsure of a certain question posed by the patient or the caregivers, it should be clarified. If the nurse does not have enough knowledge to answer the question, it should be admitted to the patient. The nurse can then seek help from other members of the health care team or other reliable sources. - It would be inappropriate to give information strictly about blood pressure or high potassium. - It is the nurse's responsibility to keep the patient informed and to respond appropriately to a patient's questions and concerns.

A nurse creating a plan of care for a patient with Addison's disease expects that primary treatment will include: 1 Blood transfusions 2 Ablation of the thyroid 3 Oral calcium supplementation 4 Adrenocorticosteroid replacement therapy

> Adrenocorticosteroid replacement therapy - Because Addison's disease results from a deficiency of adrenocorticosteroid hormones, steroid therapy is the primary treatment. - Blood transfusions, thyroid ablation, and oral calcium supplements are not primary treatments for Addison's disease.

A patient that has been taking an antihypertensive medication for four years reports blurred vision. The nurse notes that the patient's diagnostic reports indicate the blurred vision is due to retinal damage caused by hypertension. What are other manifestations of target organ disease? Select all that apply. 1 Anemia 2 Aneurysm 3 Proteinuria 4 Pneumonia 5 Transient ischemic attack

> Aneurysm > Proteinuria > Transient ischemic attack - Hypertension affects the kidneys; a manifestation of renal disease is proteinuria (>1+). - Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to aneurysms. - Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. - Pneumonia and anemia are not manifestations of target organ disease.

The nurse is caring for a patient with superficial vein thrombosis and expects what assessment findings? 1 Tenderness to pressure over the involved vein 2 Presence of edema with pain 3 Induration of the overlying muscle 4 Appearance of the vein as a palpable cord

> Appearance of the vein as a palpable cord - In superficial vein thrombosis, the vein appears as a palpable cord. - Tenderness to palpation over the involved vein, presence of edema with pain, and induration of overlying muscle are noted in venous thromboembolism. - Edema rarely occurs in superficial vein thrombosis.

A patient with chronic venous insufficiency (CVI) presents to the hospital with a large and infected leg venous ulcer. In which order should the nurse perform interventions to provide the most effective care to the patient? 1. Assess the ulcer for clinical signs of infection. 2. Obtain a wound culture. 3. Provide antibiotic therapy. 4. Evaluate the effectiveness of treatment. 5. Consider other options if unresponsive to standard therapy after 4 to 6 weeks.

> Assess the ulcer for clinical signs of infection. > Obtain a wound culture. > Provide antibiotic therapy. > Evaluate the effectiveness of treatment. > Consider other options if unresponsive to standard therapy after 4 to 6 weeks. - The nurse should assess the patient before determining any treatment plan. - A wound culture should be obtained. - Antibiotic therapy should be guided by wound culture results. - Routine evaluations are desirable to check the efficiency of the therapy. - Other treatments are recommended if the ulcer does not respond to standard therapy after 4 to 6 weeks.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? 1 At least eight hours 2 4 AM on the day of the test 3 After dinner the evening before the test 4 7 AM on the day of the test

> At least eight hours - Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8 AM should not have any food or beverages containing any calories after midnight. - It is not necessary to fast longer than eight hours; 4 AM and 7 AM would not allow for sufficient time to fast for morning laboratory testing.

Which treatment strategy would be most effective for an obese patient who has had type 2 diabetes for more than four years who has a body mass index (BMI) of 40 kg/m 2 and 8% A1C? 1 Insulin therapy 2 Bariatric surgery 3 Nutritional therapy 4 Pancreas transplantation

> Bariatric surgery - Bariatric surgery is a stomach and/or intestinal operation that decreases the BMI level, helps to maintain blood glucose levels, and helps in recovering from type 2 diabetes in obese patients. Insulin therapy helps in maintaining the glucose level in the body; however, it will not be very effective in decreasing the BMI level. - Nutritional therapy only will not be effective in completely curing type 2 diabetes. - Pancreas transplantation is effective for type 1 diabetes only.

A patient is recovering from abdominal aortic aneurysm repair. After taking the patient's vital signs, which result necessitates immediate action by the nurse? 1 Temperature 99.9º F (37.7º C) 2 Apical pulse rate 86 beats/minute 3 Respiratory rate 16 per minute 4 Blood pressure 196/100

> Blood pressure 196/100 - Severe hypertension should be avoided since it may cause undue stress on the arterial anastomoses, resulting in leakage of blood or rupture at the suture lines. - A temperature of 99.9º F is considered to be low-grade temperature and not cause for concern. - A heart rate of 86 is normal and not a priority. - A respiratory rate of 16 is normal.

An African American patient is hospitalized for treatment of hypertension. When comparing medications used to treat high blood pressure, the nurse recalls that which type of medication provides better control for this population? 1 Beta adrenergic blockers 2 Calcium-channel blockers 3 Peripheral adrenergic inhibitors 4 Angiotensin-converting enzyme inhibitors

> Calcium-channel blockers - In African Americans, calcium-channel blockers provide better control than other classes of antihypertensives, including beta adrenergic blockers and peripheral adrenergic inhibitors. - African Americans have a higher risk of angioedema with angiotensin-converting enzyme inhibitors than whites.

A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, what is the nurse's next action? 1 Obtain vital signs. 2 Obtain a crash cart. 3 Check blood glucose. 4 Perform a neurologic assessment

> Check blood glucose - The patient's blood glucose levels in hyperosmolar hyperglycemic syndrome are high; they increase serum osmolality and produce severe neurologic manifestations, such as aphasia and hemiparesis. It is critical to check the patient's blood glucose level for correct diagnosis and treatment, because these signs and symptoms resemble those of a stroke. - Obtaining vital signs is not the next action to take; that can happen later. - Obtaining the crash cart is not necessary in this situation. - Performing a neurologic assessment can be done, but it is not the next action the nurse should take.

A patient hospitalized with diabetes mellitus has become shaky, anxious, and diaphoretic. Which action should the nurse implement first? 1 Administer a 15 g snack. 2 Notify the health care provider. 3 Check the blood glucose level. 4 Administer the prescribed insulin dose.

> Check the blood glucose level. - The blood glucose level should be checked with the first signs of hypoglycemia because it can be reversed easily, but can be life threatening if not treated. In the hospital setting, it is convenient to check the blood glucose. - A 15 g snack should be provided after the blood glucose has been determined to be low. - The health care provider should be notified after the blood glucose level is known. - The patient is exhibiting signs of decreased blood glucose. Administration of insulin will lower further the blood glucose.

A patient diagnosed with type 1 diabetes has had elevated blood sugar readings each morning for the past four days. Which intervention by the nurse should be performed initially? 1 Check the patient's blood sugar at 3 AM. 2 Provide the patient with an evening snack. 3 Rotate insulin injection sites between the abdomen, thigh, and arm. 4 Contact the health care provider to increase the evening insulin dose.

> Check the patient's blood sugar at 3 AM. - Hyperglycemia in the morning may be caused by the Somogyi effect. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect. - Diabetics should be given evening snacks to prevent hypoglycemia during the night, but glucose assessment is a priority to rule out the Somogyi effect. - Injection sites are rotated to prevent lipodystrophy. - An increased dose of evening insulin may cause further decrease in early morning glucose and increased rebound hyperglycemia.

A 30-year-old patient has been diagnosed with hypothyroidism. What should the nurse expect to assess in this patient's integumentary system? 1 Warm, flushed skin, alopecia, and thin nails 2 General hyperpigmentation and loss of body hair 3 Pale skin, pale mucous membranes, hair loss, and nail dystrophy 4 Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails

> Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails - With hypothyroidism the patient will manifest with cold, dry, pale skin; dry, coarse, brittle hair; and brittle, slow growing nails. - With hyperthyroidism the patient will have warm, flushed skin, alopecia with fine soft hair, and thin nails. - With Addison's disease the patient will have loss of body hair and generalized hyperpigmentation, especially in folds. - With anemia, the patient will display pallor, pale mucous membranes, hair loss, and nail dystrophy.

After assessing a patient, the nurse identifies that the patient is in the initial stage of Raynaud's disorder. The determination was made based on what assessment finding? 1 Throbbing, tingling, and swelling of the limbs 2 Chronic ischemic pain and ulcers on both feet 3 Hypertension, hyperglycemia, and inflamed arteries 4 Color changes of fingers and toes from white to blue to red

> Color changes of fingers and toes from white to blue to red - The vasospasm-induced color changes (from white to blue to red) of fingers, toes, ears, and nose are the usual characteristics of Raynaud's disorder. - Decreased perfusion leads to pallor (white), followed by cyanotic (bluish purple) digits that further turn red when blood flow is restored. - In the later phases of the disease, the patient may complain about numbness and coldness along with throbbing, tingling, and swelling. - Chronic ischemic pain and ulceration may indicate peripheral arterial disease, whereas hypertension, hyperglycemia, and inflamed arteries may indicate one or more cardiovascular disorders. - Further diagnostic tests are desirable to confirm the diagnosis.

The nurse provides care to a patient diagnosed with thromboangiitis obliterans (Buerger's disease). What is the primary treatment for the disease? 1 Iloprost 2 Bypass surgery 3 Complete cessation of tobacco and marijuana use 4 Cilostazol

> Complete cessation of tobacco and marijuana use - Buerger's disease occurs most commonly in young adults with a long history of tobacco and/or marijuana use. The primary treatment is complete cessation of tobacco and marijuana use. - The patient can be prescribed IV iloprost to improve rest pain, promote healing of ulcerations, and decrease the need for amputation. - Bypass surgery is typically not an option because of the involvement of smaller, distal vessels. - Cilostazol may be tried to decrease pain; it will not stop disease progression.

A patient with hypertension undergoes testing on his or her serum electrolyte and plasma aldosterone levels. The laboratory findings showed plasma 18-hydroxycorticosterone levels as 60 ng/dL, potassium level as 2.5 mEq/L, and sodium level as 150 mEq/L. What could be the diagnosis? 1 Conn's syndrome 2 Addison's disease 3 Cushing syndrome 4 Pheochromocytoma

> Conn's syndrome - Conn's syndrome, or hyperaldosteronism, is characterized by increased aldosterone secretion, increased serum sodium levels, and decreased serum potassium levels. - The normal level of 18-hydroxycorticosterone in blood is less than 50 ng/dL; 60 ng/dL indicates an increase in aldosterone secretion. - The normal range of serum potassium is 3.5 to 5 mEq/L; a value of 2.5 mEq/L indicates hypokalemia. - The normal range of serum sodium is 135 to 145 mEq/L; a value of 150 mEq/L indicates hypernatremia. - Addison's disease is characterized by abnormal levels of adrenocorticotropic hormone, hyperkalemia, and hyponatremia. - Cushing syndrome is characterized by abnormal adrenocorticotropic hormone levels, hyperglycemia, and eosinopenia. - Pheochromocytoma is characterized by increased levels of catecholamines such as epinephrine and norepinephrine.

What should the nurse include in dietary instructions provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. 1 Eat a high-fiber diet. 2 Consume a high-calorie diet. 3 Eat snacks high in protein. 4 Avoid caffeinated beverages. 5 Decrease the intake of carbohydrates.

> Consume a high-calorie diet. > Eat snacks high in protein. > Avoid caffeinated beverages. - A diet high in calories and protein is encouraged. - Caffeinated beverages should be avoided. - High-fiber foods should be avoided, not encouraged, because they can further stimulate the already hyperactive gastrointestinal tract. - The patient should increase intake of carbohydrate-rich foods to compensate for the increased metabolism. This provides energy and decreases the use of body-stored protein.

A patient with type 2 diabetes mellitus (DM) is prescribed an oral hyperglycemic agent. The nurse provides the patient with a list of food items with a high glycemic index (GI). What should the nurse include on the list? 1 Baked beans, parboiled rice, and regular milk 2 Oatmeal with regular milk, sweet corn, and a cup of green pea soup 3 Apple, oat bran cereal with regular milk, and slices of raw sweet potatoes 4 Cornflake cereal with regular milk and white bread sandwich with potato stuffing

> Cornflake cereal with regular milk and white bread sandwich with potato stuffing - Glycemic index (GI) is the term used to describe the rise in blood glucose levels after a person consumes a food containing carbohydrates. Foods with high GI raise glucose levels higher and more quickly than foods with a low GI. - Cornflake cereal, white bread, and potatoes have a GI above 70. - Baked beans, parboiled rice, oatmeal, sweet corn, and green pea soup have a medium GI ranging from 56 to 69. - Apples, oat bran cereal, regular milk, and raw sweet potatoes have a low GI of about 55 or less.

A patient is prescribed lisinopril for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1 Cough 2 Edema 3 Impotence 4 Hypotension 5 Muscle stiffness

> Cough > Hypotension - Cough and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. - Peripheral edema is a side effect of calcium channel blockers. - Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. - Muscle stiffness is not associated with an ACE inhibitor.

The nurse is assessing a patient diagnosed with Addison's disease. What would the nurse expect to find in this patient? 1 Patchy areas of light skin 2 Warm, smooth, moist skin 3 Purplish red marks on the abdomen 4 Darkened skin on the knuckles, elbows, and palmar creases

> Darkened skin on the knuckles, elbows, and palmar creases - Hyperpigmentation, or "bronzing" of the skin, particularly on the knuckles, elbows, knees, genitalia, and palmar creases, is found in Addison's disease. - Patchy areas of light skin may indicate autoimmune endocrine disorders. - Warm, smooth, moist skin may indicate hyperthyroidism. - Purplish red marks on the abdomen are seen in patients with Cushing syndrome.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse tell the patient to best explain how this medication works? 1 Increases insulin production from the pancreas 2 Slows the absorption of carbohydrate in the small intestine 3 Decreases rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles 4 Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

> Decreases rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles - Metformin is a biguanide that decreases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. - Sulfonylureas and meglitinides increase insulin production from the pancreas. - α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. - Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

A patient with Raynaud's phenomenon is being discharged from the hospital. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply. 1 Do not smoke or use any tobacco products. 2 Wear tight, warm clothing in the wintertime. 3 Identify strategies to reduce emotional stress. 4 Placing hands in cool water often decreases the vasospasm. 5 Do not use drugs that contain pseudoephedrine.

> Do not smoke or use any tobacco products. > Identify strategies to reduce emotional stress. > Do not use drugs that contain pseudoephedrine. - Smoking or use of any tobacco products, emotional stress, and drugs containing pseudoephedrine often trigger an attack of Raynaud's phenomenon. - Tight clothing should not be worn because it can reduce circulation. - During an attack fingertips should be immersed in warm water to help decrease vasospasm.

The nurse provides teaching to a patient with Raynaud's phenomenon about how to prevent recurrent episodes. The nurse should instruct the patient to avoid what? Select all that apply. 1 Wearing gloves 2 Drinking caffeinated coffee 3 Exposure to heat 4 Emotional upsets 5 Cigarette smoking

> Drinking caffeinated coffee > Emotional upsets > Cigarette smoking - Exposure to cold (not heat), emotional upsets, tobacco use, and caffeine often bring on symptoms of Raynaud's phenomenon. - Wearing gloves often is recommended to protect the hands from exposure to cold.

A patient with a history of deep vein thrombosis is recovering in the postanesthesia care unit (PACU) after an abdominal surgery. Considering that the patient is at risk of developing pulmonary embolism (PE), what signs should the nurse watch out for? Select all that apply. 1 Dyspnea 2 Tachypnea 3 Tachycardia 4 Coarse crackles 5 Noisy respirations

> Dyspnea > Tachypnea > Tachycardia - PE can be recognized by the presence of tachycardia, tachypnea, and dyspnea, especially if the patient is already receiving oxygen therapy. - PE may occur in a postoperative patient who already has a history of deep vein thrombosis and is an older adult. - Other symptoms of PE may include agitation, chest pain, hypotension, hemoptysis, dysrhythmias, and heart failure. - Coarse crackles and noisy respirations may happen if thick secretions are present in the airway.

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient with primary hypoparathyroidism? Select all that apply. 1 Anorexia 2 Easy fatiguability 3 Depressed reflexes 4 Circumoral numbness 5 Positive Trousseau's sign

> Easy fatigability > Circumoral numbness > Positive Trousseau's sign - Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Manifestations of low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek's and Trousseau's signs, and others. Anorexia and depressed reflexes are manifestations of hypercalcemia.

A male patient has a history of hypertension and type 1 diabetes mellitus. Because of these chronic illnesses, the patient exercises and eats the healthy diet that his wife prepares for him. Which factors most likely will have a positive impact on his biologic aging? Select all that apply. 1 Exercise 2 Diabetes 3 Social support 4 Good nutrition 5 Coping resources

> Exercise > Social support > Good nutrition > Coping resources - Biologic aging is the progressive loss of function. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process. - Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging.

The nurse suspects that a patient has hyperthyroidism. Which finding supports the nurse's suspicion? 1 Moon face 2 Striae on skin 3 Exophthalmos 4 Thick, dry skin

> Exophthalmos - Exophthalmos is a condition in which the eyeballs protrude from the orbits. Exophthalmos occurs in hyperthyroidism due to accumulation of fluid in the eye and the retroorbital tissue. - Moon face is periorbital edema and facial fullness, which is associated with Cushing syndrome due to an increase in cortisol secretion. - Striae are purplish-red marks below the skin surface also associated with Cushing syndrome. - Thick, dry skin is not a clinical manifestation of hyperthyroidism; the patient with hyperthyroidism has warm, smooth skin due to increased metabolism.

The nurse is assessing a patient with Cushing syndrome. What might the nurse observe in the patient? Select all that apply. 1 Facial fullness 2 Mask-like effect 3 Periorbital edema 4 Excessive facial hair 5 Eyeball protrusion from orbits

> Facial fullness > Periorbital edema > Excessive facial hair - Cushing syndrome is caused by increased cortisol secretion. Excessive facial hair, periorbital edema, and facial fullness are noted in the patient with Cushing syndrome. - Eyeball protrusion from orbits occurs in hyperthyroidism as a result of fluid accumulation in eye and retroorbital tissue. - A mask-like effect is found in patients with hypothyroidism.

The nurse provides education to a patient with hypertension about symptoms of uncontrolled hypertension. What should the nurse include in the education? Select all that apply. 1 Fatigue 2 Dizziness 3 Palpitations 4 Cluster headaches 5 Shortness of breath

> Fatigue > Dizziness > Palpitations - Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. - Cluster headaches and shortness of breath do not occur with uncontrolled hypertension.

What are the characteristic signs and symptoms of hyperparathyroidism? Select all that apply. 1 Fractures 2 Tachycardia 3 Hypotension 4 Osteoporosis 5 Nephrolithiasis

> Fractures > Osteoporosis > Nephrolithiasis - Fractures may be seen due to increase in parathyroid hormone secretion. It decreases bone density because it has an effect on osteoclastic and osteoblastic activity. - Osteoporosis may occur due to deformation of bones. - Nephrolithiasis can occur due to an increase in calcium levels in the urine. - Tachycardia may be present in some patients but it is not a characteristic symptom. - Hypotension is not associated with hyperparathyroidism.

A patient has developed Cushing syndrome due to the prolonged administration of corticosteroid hormonal therapy. What course of action should be taken to treat the patient? 1 Withholding therapy for few days 2 Conversion to an alternate-day regimen 3 Abrupt discontinuance of corticosteroids 4 Gradual discontinuance of corticosteroids

> Gradual discontinuance of corticosteroids - Corticosteroid hormone doses should be decreased gradually until the discontinuation of therapy if the therapy leads to Cushing syndrome. - The therapy should not be withheld for a few days. - Alternate-day regimen cannot be applied for hormonal therapy. - Discontinuing the therapy suddenly might lead to adrenal insufficiency, which is life threatening.

A nurse is caring for a patient who has Addison's disease. The nurse should assess the patient for which symptoms? Select all that apply. 1 Weight gain 2 Hyperpigmentation 3 Weakness and fatigue 4 Orthostatic hypotension 5 Thin skin with ecchymosis

> Hyperpigmentation > Weakness and fatigue > Orthostatic hypotension - Hyperpigmentation, orthostatic hypotension, and weakness coupled with fatigue are all manifestations of Addison's disease. - A patient with Addison's disease will have weight loss, not weight gain. - Thin skin with ecchymosis is a manifestation of Cushing syndrome, not Addison's disease.

The nurse is assessing a patient with Raynaud's phenomenon. What should the nurse teach the patient to prevent recurrent episodes? 1 Wear thin, light clothing to allow better circulation. 2 Drink small amounts of caffeine throughout the day to stimulate heartbeat and increase circulation. 3 Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. 4 Use a cold compress or heating pad as needed for comfort.

> Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. - Raynaud's phenomenon is triggered by stress and cold, and immersing hands in warm water often may decrease vasospasm. - The patient should wear loose, warm clothing to protect from the cold, including gloves when handling cold objects. - The patient should stop using all tobacco products and avoid caffeine and any drugs, such as cocaine, amphetamines, ergotamine, and pseudoephedrine, that have vasoconstrictive effects. - The patient should avoid extreme temperatures at all times, so the use of a cold compress or heating pad would not be recommended.

The patient is brought to the emergency department following a car accident and is wearing medical identification that says the patient has Addison's disease. What should the nurse expect to be included in the collaborative care of this patient? 1 Low-sodium diet 2 Increased glucocorticoid replacement 3 Suppression of pituitary adrenocorticotropic hormone (ACTH) synthesis 4 Elimination of mineralocorticoid replacement

> Increased glucocorticoid replacement - The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. - The patient with Addison's also may need a high-sodium diet. - Suppression of pituitary ACTH synthesis is done for Cushing's syndrome. - Elimination of mineralocorticoid replacement cannot be done for Addison's disease.

Which statements are true regarding Raynaud's phenomenon? Select all that apply. 1 It can precede the onset of a systemic disease. 2 Cyanosis occurs as hemoglobin releases oxygen. 3 It occurs more often in diffuse scleroderma than in limited scleroderma. 4 It can lead to diminished blood flow to fingers and toes with exposure to cold. 5 Numbness and tingling sensations differentiate the white phase from the other two phases.

> It can precede the onset of a systemic disease. > Cyanosis occurs as hemoglobin releases oxygen. > It can lead to diminished blood flow to fingers and toes with exposure to cold. - Raynaud's phenomenon can precede the onset of systemic disease for months or years. - Cyanosis occurs as hemoglobin releases oxygen to the tissues, which is also called the blue phase. - There is diminished flow of blood to the fingers and toes. - All phases are accompanied by numbness and tingling sensation. - People with limited scleroderma report symptoms of Raynaud's phenomenon more than those with the diffuse form.

A patient with type 2 diabetes mellitus (DM) receives a prescription for metformin. The nurse identifies that which statement is characteristic of this medication? 1 It causes weight gain. Correct2 It decreases hepatic glucose production. 3 It should not be given with sulfonylureas. 4 It is inappropriate for initial management of type 2 DM.

> It decreases hepatic glucose production. - The primary action of metformin is to reduce glucose production by the liver. - Metformin often causes weight loss instead of weight gain. - Metformin can be administered in conjunction with sulfonylureas. - Metformin is preferred for the initial management of type 2 diabetes.

The nurse is caring for a patient with Buerger's disease and expects which clinical manifestation? 1 Back pain when lying flat 2 Chest pain when walking up stairs 3 Leg pain with exercise and relief with rest 4 Reddening of lower legs and feet when elevated

> Leg pain with exercise and relief with rest - Buerger's disease is characterized by inflammation of the arteries and veins of the upper and lower extremities. This causes pain in the legs and feet with exercise. Sensitivity to cold and paresthesias is also often seen with this condition. - Buerger's disease is not associated with back pain when lying flat or vasodilation resulting in reddening of the lower legs or feet when elevated. - Buerger's disease is not directly associated with chest pain.

In developing a teaching plan for the patient with Addison's disease, what is the nurse's highest priority? 1 Avoiding infection 2 Following a low-salt diet 3 Practicing stress management techniques 4 Managing lifelong corticosteroid replacement

> Managing lifelong corticosteroid replacement - The patient with Addison's disease experiences hypofunctioning of the adrenal cortex, resulting in decreased production of glucocorticoids, mineral corticoids, and androgens. Patients with Addison's disease require lifelong glucocorticoid and mineral corticoid replacement therapy to avoid Addisonian crisis. - Addisonian crisis is characterized by profound hypotension, dehydration, fever, tachycardia, hyponatremia, and hyperkalemia. Circulatory collapse may occur if the patient is treated inadequately. - Although Addisonian crisis often is triggered by illness-related physiologic stress, and although avoiding infection is important, avoiding infection is of lower priority than managing lifelong corticosteroid replacement. Corticosteroid replacement must be increased during times of stress to prevent Addisonian crisis. - Patients taking a mineralocorticoid should increase their salt intake. Emotional stress may contribute to the need for increased corticosteroid replacement. - Stress management techniques are important. Practicing stress management techniques, however, is of lower priority than managing lifelong corticosteroid replacement.

Which syndrome does the nurse suspect in a patient who has symptoms of hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein (HDL), and abdominal obesity? 1 Barret's esophagus 2 Cushing's syndrome 3 Metabolic syndrome 4 Irritable bowel syndrome

> Metabolic syndrome - Metabolic syndrome is a cluster of conditions such as increased blood pressure, body fat around the waist, and abnormal cholesterol levels, which increase the risk of diabetes. - Barrett's esophagus is a condition where the inner lining of the esophagus changes to resemble the intestinal lining, and it predisposes one to adenocarcinoma. - Cushing's syndrome is a hormonal disorder that occurs due to abnormally high levels of cortisol in the body. - Irritable bowel syndrome is characterized by chronic discomfort associated with defecation.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? 1 6:00 PM on the evening before the test 2 Midnight before the test 3 4:00 AM on the day of the test 4 7:00 AM on the day of the test

> Midnight before the test - Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

Which nursing intervention is most important for a patient with diabetes insipidus? 1 Providing dietary education 2 Monitoring fluid intake and output 3 Assessing for constipation every day 4 Obtaining a finger-stick blood glucose leve

> Monitoring fluid intake and output - Polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore, strict monitoring of fluid intake and output is a priority nursing intervention. - Diet education and finger-stick blood glucose measurements are not high-priority interventions for diabetes insipidus. - Constipation can be a secondary problem, as a result of dehydration.

One of the unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. What is the nurse's priority intervention? 1 Obtain a bedside glucose reading. 2 Ask patient to drink 4 ounces of orange juice. 3 Ask the unlicensed assistive personnel (UAP) to obtain a set of vital signs. 4 Administer 50 mL of 50% dextrose intravenously.

> Obtain a bedside glucose reading. - The patient with diabetes is exhibiting signs and symptoms of hypoglycemia. The priority intervention at this time is to validate assessment findings with a bedside glucose reading. - Although vital signs may add to assessment data findings, they are not as much a priority as validating hypoglycemia and initiating treatment. - Because the patient is experiencing a change in level of consciousness, management of the hypoglycemia via oral nourishment is contraindicated. - If the patient has an existing intravenous (IV) line, then treatment of documented hypoglycemia with intravenous dextrose may be indicated.

The nurse is preparing to administer levothyroxine to a patient newly diagnosed with hypothyroidism. The patient's resting heart rate is 110. Which initial action should the nurse take? 1 Administer the medication 2 Notify the health care provider 3 Obtain a blood pressure measurement 4 Administer all other scheduled medications except levothyroxine

> Obtain a blood pressure measurement - When thyroid hormone therapy is initiated, patients must be monitored carefully for increased pulse and blood pressure, because increased pulse and blood pressure may lead to angina and cardiac dysrhythmias. The nurse should first obtain a blood pressure measurement and assess for other signs of increased thyroid levels, such as chest pain, nervousness, and tremors. - Thyroid hormone medication should not be administered until the health care provider is notified. - The health care provider should be notified after the nurse collects the appropriate assessment data. - Other scheduled medications can be given, but blood pressure assessment is the initial action.

Which description is characteristic of pain experienced by a patient diagnosed with Raynaud's phenomenon? 1 Ripping type chest pain 2 Leg pain with exercise that resolves with rest 3 Leg pain that resolves when the leg is lowered 4 Pain in fingers or toes with color changes in the skin

> Pain in fingers or toes with color changes in the skin - Pain associated with Raynaud's phenomenon is caused by vasospasm in small arteries, often in the fingers or toes. - The vasospasm decreases circulation, starting with pallor (white), worsening to cyanosis (bluish) and then moving to redness as the blood flow returns to the digit. - The pain occurs with the vasospasm and is throbbing in nature. - Chest pain that is ripping in nature occurs with aortic dissection. - Pain of intermittent claudication occurs with peripheral vascular disease in the lower extremities. - This severe leg pain occurs with exercise and is relieved by rest. - Rest pain occurs in patients with critical limb ischemia (advanced peripheral vascular disease) and is relieved by lowering the limb because gravity improves circulation.

The nurse understands that venous ulcers are characterized by which assessment findings? Select all that apply. 1 Bluish tinge of the extremities 2 Capillary refill greater than 3 seconds 3 Pain worse with leg in a dependent position 4 Well-defined edges along the ulcer 5 Located above the medial malleolus Venous ulcers are often quite painful. Pain may be worse when the leg is in a dependent position. Venous ulcers classically are located above the medial malleolus. A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. Venous ulcers have a bronze-brown pigmentation, and the capillary refill of the extremity is less than three seconds with venous disease. Well-defined edges are seen with arterial ulcers.

> Pain worse with leg in a dependent position > Located above the medial malleolus - Venous ulcers are often quite painful. Pain may be worse when the leg is in a dependent position. - Venous ulcers classically are located above the medial malleolus. - A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. - Venous ulcers have a bronze-brown pigmentation, and the capillary refill of the extremity is less than three seconds with venous disease. - Well-defined edges are seen with arterial ulcers.

The nurse reviews the medication records of several patients with hypertension. Which patient is likely to have a severe cough? - Patient A - Enalapril - Patient B - Furosemide - Patient C - Atenolol - Patient D - Metoprolol 1 Patient A 2 Patient B 3 Patient C 4 Patient D

> Patient A - When monitoring patients, the nurse should be aware of the side effects associated with each patient's prescribed medications. Patient A is taking angiotensin-converting enzyme inhibitors, such as enalapril, to treat hypertension, but they may cause coughing in the patient. The medication may have to be changed if the cough is severe. - Patient B is taking furosemide, which is a diuretic that can lower blood pressure, but is not known to cause coughing. - Patient C is taking atenolol and Patient D is taking metoprolol, which are both beta-blockers that are not known to cause coughing.

The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? - Patient A - Urine volume decreases to 50 mL/hr - Patient B - Urine osmolality of 260 mOsm/kg - Patient C - Urine osmolality of 600 mOsm/kg - Patient D - Kidneys responded to ADH analog by concentrating urine 1 Patient A 2 Patient B 3 Patient C 4 Patient D

> Patient B - Patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg. - Patients with central diabetes insipidus show a significant increase in urine volume above 200 mL/hr and a dramatic increase in the urine osmolality from 100 to 600 mOsm/kg. - When an antidiuretic hormone analog such as desmopressin is administered, if the patient has central diabetes, the kidneys respond by forming concentrated urine.

What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? 1 Providing a dark, low-stimulation environment 2 Closely monitoring the patient's intake and output 3 Patient teaching related to levothyroxine 4 Patient teaching related to radioactive iodine therapy

> Patient teaching related to levothyroxine - A euthyroid state most often is achieved in patients with hypothyroidism by the administration of levothyroxine. - It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.

The nurse is educating a patient about decreasing the risk of developing deep vein thrombosis (DVT). What should the nurse be sure to include when discussing this with the patient? Select all that apply 1 Perform leg exercises 2 Change position frequently 3 Maintain high-Fowler's position 4 Avoid pressure under the knees 5 Massage legs when they get stiff in bed

> Perform leg exercises > Change position frequently > Avoid pressure under the knees - The high Fowler's position causes stasis and pooling of blood, which leads to deep vein thrombosis (DVT). Therefore avoid the high-Fowler's position to minimize pooling of blood. - Leg exercise promotes circulation in post hysterectomy patients. - Massaging of the legs is contraindicated since it may dislodge a clot that is present. - Avoidance of pressure under the knees will minimize pooling and stasis of blood.

A small (4.5 cm) abdominal aortic aneurysm (AAA) has been detected in a patient. The nurse recognizes that which medications may be prescribed to slow the growth rate of the aneurysm? Select all that apply. 1 Aspirin 2 Heparin 3 Propranolol 4 Doxycycline 5 Aminophylline

> Propranolol > Doxycycline - Aortic aneurysm is an enlargement of the aorta. Doxycycline is administered to reduce the growth of the aneurysm and prevent infection. - Propranolol is a β-adrenergic blocking agent used to reduce the growth of the aortic aneurysm. - Aspirin acts as a blood thinner and is used to treat venous thromboembolism. - Heparin is an anticoagulant and is used to treat venous thromboembolism. - Aminophylline is used to treat asthma.

Which nursing intervention would be beneficial for an obese patient who is at risk for deep venous thrombosis after surgery? Select all that apply. 1 Providing compression stockings 2 Administering low-dose heparin 3 Administering aspirin medication 4 Encouraging range-of-motion exercises 5 Instructing in cough and deep-breathing techniques

> Providing compression stockings > Administering low-dose heparin > Encouraging range-of-motion exercises - Compression stockings help to prevent the formation of blood clots. - Heparin is an anticoagulant, which helps reduce the risk of blood clots. - Range-of-motion exercise will help reduce the risk of blood clots. - Aspirin increases the risk of bleeding, so the nurse should not administer aspirin. - Cough and deep-breathing techniques help reduce pulmonary complications associated with bariatric surgery.

A patient with type 1 diabetes mellitus reports feeling shaky and lightheaded. The patient's skin is pale and sweaty. The nurse should take what immediate action? 1 Administering glucagon subcutaneously 2 Providing the patient with a glucose tablet 3 Administering supplemental regular insulin 4 Offering the patient a complex carbohydrate snack

> Providing the patient with a glucose tablet - The described symptoms represent mild-to-moderate hypoglycemia. Rapid treatment involves providing the alert and awake patient with a rapid-dissolving buccal glucose tablet or, if unavailable, a glass of glucose-containing liquid such as orange juice. - The patient is experiencing hypoglycemia when the blood sugar is already low. Therefore, insulin should not be given. - Administering glucagon is not necessary; the patient is awake and able to take food and fluids orally. - After consuming a simple sugar, the patient requires a complex carbohydrate snack and protein to sustain the blood glucose and prevent rebound hypoglycemia.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol. The nurse should withhold the dose and consult the prescribing health care provider for which vital sign taken just before administration? 1 Pulse 48 2 Respirations 24 3 Blood pressure 118/74 4 Oxygen saturation 93%

> Pulse 48 - Because esmolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse-rate limits. - Respirations, blood pressure, and oxygen saturation are not a source of concern in this case.

A 22-year-old healthy patient with a family history of hypertension asks the nurse about how to reduce the risk of developing high blood pressure. What recommendations should the nurse give to the patient? Select all that apply. 1 Restrict sodium intake to less than or equal to 2300 mg/day. 2 Limit alcohol intake; one drink is defined as 24 oz of regular beer. 3 Eat fish, such as salmon and catfish, at least two times per week. 4 Perform moderate-intensity aerobic physical activity for 20 minutes a day, three days a week. 5 Jog at a pace that substantially increases the pulse; this is an example of moderate physical activity.

> Restrict sodium intake to less than or equal to 2300 mg/day. > Eat fish, such as salmon and catfish, at least two times per week. - Healthy adults should restrict sodium intake to less than or equal to 2300 mg/day. For healthy adults with no history of heart disease, the American Heart Association recommends eating fish at least two times per week; fatty fish such as catfish and salmon are recommended. - Jogging at a pace that substantially increases the pulse is considered to be vigorous activity. - One drink is defined as 12 oz of regular beer. - Moderate-intensity aerobic physical activity should be performed for 30 minutes a day, at least five days a week.

During assessment of a patient with hypertension, the nurse finds that the patient takes an herbal preparation for treating high blood pressure. What interventions performed by the nurse are appropriate? Select all that apply. 1 Instruct the patient to stop taking the herbal preparation. 2 Seek out information on the safety of the herbal preparation. 3 Communicate personal concerns the nurse has regarding herbal use. 4 Evaluate the appropriateness of the herbal preparation as a treatment. 5 Encourage the patient to provide more information about the healing practice being followed.

> Seek out information on the safety of the herbal preparation. > Evaluate the appropriateness of the herbal preparation as a treatment. > Encourage the patient to provide more information about the healing practice being followed. - When a nurse comes across a patient who takes an herbal preparation for treatment, the nurse should evaluate the appropriateness of the treatment. The nurse should try to find out whether the herbal preparation is safe, such as by evaluating any drug-herb interactions. The nurse should encourage the patient to provide more information about the herbal preparation. If the preparation is found to be effective, it can be incorporated into the patient's treatment plan. Communicating personal concerns to the patient is not appropriate and may hamper communication. Instructing the patient to stop using the herbal preparation may offend the patient.

When caring for a patient admitted with poorly controlled hypertension, the nurse identifies that which laboratory test result indicates the presence of target organ damage? 1 Serum uric acid of 3.8 mg/dL 2 Serum creatinine of 2.6 mg/dL 3 Serum potassium of 3.5 mEq/L 4 Blood urea nitrogen (BUN) of 15 mg/dL

> Serum creatinine of 2.6 mg/dL - The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. - BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.

The nurse recognizes that which interventions may benefit a patient with Buerger's disease? Select all that apply. 1 Stopping all use of marijuana 2 Administering a calcium channel blocker 3 Administering an analgesic 4 Maintaining a cold room temperature 5 Utilizing a nicotine replacement product

> Stopping all use of marijuana > Administering a calcium channel blocker > Administering an analgesic - Buerger's disease is an inflammation characterized by thrombosis in small and medium-sized blood vessels. - Marijuana use will worsen Buerger's disease symptoms. - Calcium channel blockers may be prescribed to decrease pain. - Administering analgesic medications will help manage the ischemic pain. - The patient should avoid cold room temperatures because he or she may have cold sensitivity. - The use of nicotine replacement products is contraindicated in Buerger's disease.

A patient diagnosed with Raynaud's phenomenon has intermittent vasospasms of the fingertips. What does the nurse teach the patient is a trigger for Raynaud's phenomenon? 1 Heat 2 Stress 3 Exercise 4 Inactivity

> Stress - Raynaud's phenomenon can be triggered by stress. In addition to stress, cold, not heat, can trigger Raynaud's phenomenon. - This disorder is not associated with exercise or inactivity.

The nurse reviews the admission history of patient who is hospitalized with deep venous thrombosis (VTE) in the left leg. Which findings from the health history increase the risk for the patient to develop this complication? Select all that apply. - Medical history: GERD-3 yr, osteoarthritis-10 y, dislipidemia, never smoked - Surgical history: Abdominal hysterectomy-10 yr ago, left knee joint replacement-2 weeks ago - Meds at home: Omerprazole, conjugated estrogen, simvastatin 1 Takes simvastatin regularly 2 Takes omeprazole regularly 3 Takes conjugated estrogen regularly 4 Left knee replacement 2 weeks prior to the current hospitalization 5 Negative history for cigarette smoking 6 Abdominal hysterectomy 10 years prior to the current hospitalization

> Takes conjugated estrogen regularly > Left knee replacement 2 weeks prior to the current hospitalization - The risk for developing thromboembolic complications continues for several weeks postoperatively. - The risk is related to possible vascular injury with the procedure, altered fluid status, increased coagulability, and lessened mobility during and after surgery. - The recent left knee joint replacement surgery is significant. - Estrogen, a hormone used for relief of menopausal discomfort, increases clotting factors and enhances coagulation. - Medications such as lipid-lowering agents (simvastatin) and proton pump inhibitors (omeprazole) do not increase the risk for thrombosis. - The patient does not smoke, thereby avoiding the risk factor of smoking. The abdominal hysterectomy performed 10 years earlier is not a current risk factor.

A patient with type 2 diabetes takes oral hypoglycemics and is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide? Insulin acts synergistically with the antibiotic that was prescribed. 2 Insulin should have been prescribed for the patient to take at home. 3 Oral hypoglycemic medications are contraindicated in patients with UTIs. 4 The infection increases the glucose level, resulting in a need for more insulin.

> The infection increases the glucose level, resulting in a need for more insulin. - When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. - Insulin injections are usually required until the illness resolves. - Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with UTIs.

The nurse is teaching care guidelines to the parent of a child with hypothyroidism. During the follow-up visit, the nurse suspects that the child may be receiving ineffective treatment. Which action of the parent supports the nurse's suspicion? 1 The parent is giving the child fiber-rich food. 2 The parent gives the child a thyroid supplement after meals. 3 The mother gives the child a thyroid supplement each morning. 4 The mother encourages the child to increase activity and exercise.

> The parent gives the child a thyroid supplement after meals. - Thyroid supplements should be given on an empty stomach in order to enhance absorption. Therefore, giving thyroid supplements after meals reduces the concentration of medication in the blood. - Thyroid supplements may cause constipation, so the nurse recommends that the parent give the child fiber-rich food. - Thyroid supplements should be given in the morning for effective treatment. - Hypothyroidism causes low metabolic activity, so a gradual increase in activity and exercise will be beneficial for the child.

When discussing long-term management of Addison's disease with a patient, the nurse includes which self-care management measures? Select all that apply. 1 The patient will need to follow a low-sodium diet. 2 When taking antacids, the patient may need to decrease corticosteroid medication. 3 The patient must notify the health care provider whenever experiencing vomiting or diarrhea. 4 The patient will need to take extra medication when experiencing either physical or emotional stress. 5 The patient or patient's caregiver will need to administer corticosteroids subcutaneously in the case of an emergency, and the patient cannot take hormone replacements orally.

> The patient must notify the health care provider whenever experiencing vomiting or diarrhea. > The patient will need to take extra medication when experiencing either physical or emotional stress. - Vomiting and diarrhea can deplete cortisol levels and parenteral replacement may be needed. - The patient with Addison's disease is unable to tolerate physical or emotional stress without exogenous corticosteroids and may need to increase medication at these times. - Patients with Addison's disease will need to increase their sodium intake, because they are at risk for hyponatremia. - Antacid intake will necessitate increased corticosteroid hormone therapy. - Corticosteroids must be given intramuscularly when the patient is unable to take them orally.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate? 1 The patient can expect to experience weight loss resulting from increased diuresis. 2 The patient should alternate nostrils during administration to prevent nasal irritation. 3 The patient should monitor for symptoms of hypernatremia as a side effect of this drug. 4 The patient should report any decrease in urinary elimination to the health care provider

> The patient should alternate nostrils during administration to prevent nasal irritation. - Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled desmopressin acetate can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased and is expected, and hypernatremia should not occur.

Which patient is at high risk for developing irreversible renal failure after an aortic aneurysm surgery? 1 The patient with diabetes 2 The patient with spinal cord injury 3 The patient with critical limb ischemia 4 The patient with hyperhomocysteinemia

> The patient with diabetes - The patient with diabetes may have decreased renal perfusion from embolization of the aortic thrombus or plaque in one or both of the renal arteries. This can cause renal ischemia and can result in permanent renal failure. - The patient with spinal cord injury has risk of venous stasis due to prolonged immobilization. - The patient with critical limb ischemia has a risk of edema. - The patient with hyperhomocysteinemia has a risk of peripheral arterial disease.

A nurse reviewing the recent medical history of a patient with hypoparathyroidism expects to find a history of: 1 Hypertension 2 Thyroidectomy 3 Use of cocaine 4 Hypermagnesemia

> Thyroidectomy - Because of the location of the parathyroid glands within the thyroid gland, a thyroidectomy sometimes results in the accidental surgical removal of one or more of the parathyroid glands, which in turn causes hypoparathyroidism. - Hypertension and cocaine use are important items to note in a medical history, but they are not directly related to hypoparathyroidism. - Hypomagnesemia, not hypermagnesemia, can lead to suppression of parathyroid hormone secretion.

A patient's assessment findings include a waist circumference of 42 inches, current tobacco use, hypertension, and a sedentary lifestyle. The nurse recognizes that which finding is the most important risk factor for peripheral artery disease (PAD)? 1 Tobacco use 2 Excess weight 3 Sedentary lifestyle 4 High blood pressure

> Tobacco use - Significant risk factors for PAD include tobacco use, diabetes, hyperlipidemia, elevated C-reactive protein, and uncontrolled hypertension, with the most important being tobacco use. Excess weight, sedentary lifestyle, and high blood pressure are not significant risk factors for PAD.

A nurse is caring for a patient admitted for hyperthyroidism. What laboratory results will the nurse expect to see in the electronic chart to confirm hyperthyroidism? Select all that apply. 1 Elevated TSH level 2 Undetectable TSH level 3 Low free thyroxine (free T4) level 4 Elevated free thyroxine (free T4) level 5 Low thyroid-stimulating hormone (TSH) level

> Undetectable TSH level > Elevated free thyroxine (free T4) level > Low thyroid-stimulating hormone (TSH) level - Low thyroid-stimulating hormone (TSH) level The primary laboratory findings to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels and elevated free thyroxine levels. - Low free thyroxine levels and elevated TSH levels are found with hypothyroidism.

A patient is prescribed warfarin following a deep venous thrombosis and pulmonary embolism. What information should the nurse include in the teaching plan? Select all that apply. 1 Eliminate green vegetables from the diet. 2 Use a soft toothbrush and observe the gums for bleeding. 3 Wear a bracelet that identifies the patient is taking an anticoagulant. 4 Blood coagulation testing is needed only for the first 4 to 6 weeks of therapy. 5 Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider.

> Use a soft toothbrush and observe the gums for bleeding. > Wear a bracelet that identifies the patient is taking an anticoagulant. > Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider. - Patients are at risk for bleeding and should use a soft toothbrush. - Wearing an identification bracelet will alert emergency medical personnel in case the patient is unable to inform them about the medication. - Nonsteroidal antiinflammatory medications, including aspirin, potentiate the anticoagulation effect and may cause problems with bleeding. - Green vegetables, which are sources of vitamin K, should be taken in consistent amounts but need not be eliminated. - The patient taking warfarin will continue to need coagulation laboratory testing (PT/INR) while taking the medication because the anticoagulant effect is influenced by many factors, including medications and diet.

What are recommended teaching strategies for self-management of hypertension in the baby boomer population (birth years 1946-1964)? 1 Group teaching 2 Discussing reliable websites 3 Using patient education television channels 4 Using pictures and printed materials such as books

> Using patient education television channels - Using patient education TV channels is a recommended teaching strategy for self-management of hypertension in the baby boomer population. - Group teaching is a better strategy for teaching millennials (birth years 1981-2000). - Using pictures and printed materials such as books is a recommended teaching strategy for veterans born before 1946. - Discussing reliable websites is a recommended teaching strategy for Generation X (birth years 1965-1980).

While assessing a patient with suspected Cushing's syndrome, of what most prominent clinical manifestation is the nurse aware? 1 Dehydration and hypotension 2 "Bulking up" of skeletal muscle 3 Hypoglycemia with intense hunger 4 Weight gain, including truncal obesity

> Weight gain, including truncal obesity - The most prominent clinical manifestation in Cushing's syndrome is weight gain leading to truncal obesity, with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump." Cushing's syndrome's results from an overproduction of adrenocorticosteroids or large doses of steroid medication. - Dehydration and hypotension, bulking of skeletal muscle, and hypoglycemia with intense hunger are not directly associated with Cushing's syndrome.

Which clinical manifestations does the nurse expect to assess in a patient that is diagnosed with hyperthyroidism? Select all that apply. 1 Weight loss 2 Protrusion of the eye balls 3 Thick, cold, and dry skin 4 Elevated blood pressure 5 Purplish red marks on abdomen

> Weight loss > Protrusion of the eye balls > Elevated blood pressure - Weight loss, protrusion of the eyeballs, and elevated blood pressure are clinical manifestations of hyperthyroidism. Weight loss and hypertension are due to increases in metabolic demands; protrusion of the eyeballs is due in part to accumulation of fluid in the eyes. - Thick, cold, and dry skin are symptoms of hypothyroidism. - Purplish red marks on the abdomen are seen in Cushing syndrome.

After discussing prevention of type 1 diabetes complications with the nurse, the patient is correct when making which statement? 1 "I must limit fats in my diet to help prevent neuropathy." 2 "I should use a hot water bottle on my feet when they feel cold." 3 "I should have an eye examination at least once every two years for glaucoma screening." 4 "It is important that I take my blood pressure medication to help prevent kidney damage."

>"I should have an eye examination at least once every two years for glaucoma screening." >"It is important that I take my blood pressure medication to help prevent kidney damage." - Patients with diabetes who have albumin in their urine should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to treat hypertension, which would also delay the progression of nephropathy. - Dietary fat intake will not affect kidney function. Hot water bottle use increases the risk of tissue damage because of the diabetic's neuropathy and delayed healing. - Diabetics should have an eye examination once a year to screen for retinopathy.

A patient has developed diabetes insipidus. Arrange the events in the order they occur in this patient. - Decrease in intravascular fluid volume - Decrease in antidiuretic hormone - Increase in serum osmolality - Decrease in water reabsorption

>>> 1. Decrease in antidiuretic hormone 2. Decrease in water reabsorption 3. Decrease in intravascular fluid volume 4. Increase in serum osmolality - Diabetes insipidus is caused by abnormalities in antidiuretic hormone levels. In patients with diabetes insipidus, the level of antidiuretic hormone is reduced; this leads to decreased reabsorption of water, increasing the urine output, which reduces the intravascular fluid volume and elevates the osmolality in the blood.