MED SURG 57-59

17. With which signs and symptoms will the nurse teach a client to take action to prevent harm as indicators of mild hypoglycemia? Select all that apply. A. Headache B. Weakness C. Cold, clammy skin D. Irritability E. Pallor F. Tachycardia

A,B,D

1. Which physiologic actions result from normal insulin secretion? Select all that apply. A. Increased liver storage of glucose as glycogen B. Increased gluconeogenesis C. Increased cellular uptake of blood glucose D. Increased breakdown of lipids (fats) for fuel E. Increased production and release of epinephrine F. Decreased storage of free fatty acids in fat cells G. Decreased blood glucose levels H. Decreased blood cholesterol levels

A,C,G,H

25. Which techniques will the nurse teach a client with diabetes about how to prevent harm from loss of insulin potency? Select all that apply. A. "Avoid exposing insulin to temperatures below 36°F (2.2°C) or above 86°F (30°C)." B. "Freeze bottles of insulin for long-term storage." C. "Always shake NPH insulin to assure it is evenly cloudy." D. "Avoid exposing insulin to heat or light." E. "Store unopened insulin bottles in a refrigerator." F. "A slight loss in potency may occur for bottles in use for more than 30 days but can still be used."

A,D,E

28. Which precaution is most important for the nurse to teach to prevent harm in a client prescribed oral corticosteroids for hormone replacement therapy after a bilateral adrenalectomy? A. "Do not stop taking this drug without consulting your primary health care provider." B. "Avoid crowds and people who are ill." C. "Be sure to take this drug with food." D. "Reduce your salt intake."

A. "Do not stop taking this drug without consulting your primary health care provider."

2. Which side effect will the nurse teach a male client receiving androgen therapy to expect? A. Increased testicular size B. Loss of body hair C. Gynecomastia D. Weight gain

C. Gynecomastia

5. What is the nurse's best response to a male client with a prolactinoma tumor of the anterior pituitary gland when he asks why he has not been able to achieve an erection? A. "The high levels of prolactin suppress release of your normal sex hormones." B. "You are probably embarrassed by the fact that fluid is coming from your nipples." C. "Don't worry. This problem is temporary and will most likely resolve after treatment." D. "Most men who are told they have a brain tumor experience psychological impotence."

A. "The high levels of prolactin suppress release of your normal sex hormones."

20. What is the best action for a nurse to take to prevent harm when a client with diabetes, who just received a premeal dose of regular insulin, is picked up by transportation to the radiation department for a scheduled x-ray before she has a chance to eat her lunch? A. Calling the radiation department and rescheduling the x-ray B. Sending the client's lunch with her to the radiation department C. Administering glucagon by the intramuscular route immediately D. Reminding the transporter that this client must be seen first in the radiation department

A. Calling the radiation department and rescheduling the x-ray

19. Which assessment finding of a client 10 hours after a subtotal thyroidectomy indicates to the nurse possible airway obstruction? A. Client is drooling. B. Oxygen saturation is 97%. C. Dressing has a moderate amount of serosanguinous drainage. D. Client responds to questions correctly but does not open the eyes while talking.

A. Client is drooling. major indication of swelling in the neck that could result in airway obstruction

12. The client who has been taking synthetic thyroid hormone replacement therapy (HRT) for 3 months reports all of the following conditions. Which condition indicates to the nurse that the drug dosage may need to be adjusted? A. Difficulty sleeping B. Increased urine output C. Decreased sense of smell D. Difficulty remembering to take the drug

A. Difficulty sleeping

5. Which assessment finding will the nurse expect in a client with diabetes who has peripheral neuropathy of the motor neurons? A. Muscle weakness B. Orthostatic hypotension C. Absence of feeling in the feet D. Increased risk for myocardial infarction

A. Muscle weakness

32. What type of exercise will the nurse recommend for the client with diabetic retinopathy? A. Non-weight-bearing activities such as swimming B. Weight-bearing activities such as jogging C. Gradually increasing aerobic and resistance exercises D. Weight training and heavy lifting

A. Non-weight-bearing activities such as swimming

12. Which precaution is a priority for the nurse to teach a client prescribed dulaglutide to prevent harm? A. Only take this drug once weekly. B. Do not drink alcohol when taking this drug. C. Take this drug right before or with the first bite of a meal. D. Report any genital itching to your diabetes health care provider immediately.

A. Only take this drug once weekly. This drug is an incretin mimetic (GLP1-agonist) that works with insulin to prevent hyperglycemia. It is taken as an injection only once per week. If taken more frequently, the client is at risk for an overdose. This drug is not associated with fasciitis of the perineum and does not require total abstinence from alcohol.

29. What is the nurse's best response when a client who must continue to take a corticosteroid asks why an H2 histamine blocker has been prescribed? A. "The drug therapy increases the development of allergies." B. "Corticosteroids are associated with an increased risk for gastric ulcers." C. "When taken together, the H2 histamine blocker improves the absorption of the corticosteroid." D. "The H2 histamine blocker counteracts the increased appetite stimulated by the corticosteroid."

B. "Corticosteroids are associated with an increased risk for gastric ulcers."

18. Which statement by a client undergoing radioactive iodine (RAI) therapy demonstrates to the nurse that the client has correct understanding of postprocedure precautions? A. "I will wear a wig until my hair grows back in." B. "I will be sure to use only one toilet and not let others use it for 2 weeks." C. "I will avoid crowds and people who are ill to reduce the risk for an infection." D. "I will avoid having a manicure or pedicure during the first month after treatment."

B. "I will be sure to use only one toilet and not let others use it for 2 weeks."

13. Which client will the nurse consider to be at highest risk for development of Graves disease? A. 25-year-old who has been taking thyroid hormone replacement therapy for 9 years B. 35-year-old who has type 1 diabetes mellitus C. 45-year-old who eats a vegan diet that includes seaweed D. 55-year-old who lives near a uranium-processing plant

B. 35-year-old who has type 1 diabetes mellitus

27. With which client will the nurse be aware of an increased risk for hyperparathyroidism? A. 28-year-old woman with pregnancy-induced hypertension B. 45-year-old man receiving dialysis for end-stage kidney disease C. 55-year-old man with moderate heart failure after myocardial infarction D. 60-year-old woman on home oxygen therapy for chronic obstructive pulmonary disease

B. 45-year-old man receiving dialysis for end-stage kidney disease Clients who have chronic renal failure do not completely activate vitamin D and poorly absorb calcium from the GI tract.

2. Which history information provided by a client with hypothyroidism will the nurse consider as a possible cause of the disorder? A. Egg and peanut allergy B. Previous thyroid radiation C. Mother with Graves disease D. Has been pregnant three times in the past 4 years

B. Previous thyroid radiation

21. Which complication does the nurse suspect when a client who had a thyroidectomy 1 day ago now has a weak voice and hoarseness? A. Impending hemorrhage B. Laryngeal nerve damage C. Partial airway obstruction D. Irritation from the endotracheal tube

B. Laryngeal nerve damage

1. Which statements regarding hypothyroidism are accurate? Select all that apply. A. Has a sudden onset of symptoms B. Can be diagnosed by the presence of a goiter C. Reduces cardiac and central nervous system function D. Often occurs weeks after a bacterial or viral infection E. Is much more common among women than among men F. Most common form has an autosomal dominant pattern of inheritance

C,D,E

15. With which classes of antidiabetic drugs will the nurse most emphasize to the client with diabetes how to recognize and manage hypoglycemia? A. Alpha-glucosidase inhibitors B. Biguanides C. Insulin D. Incretin mimetics E. Meglitinide analogs F. Second-generation sulfonylureas

C,D,E,F Insulin, incretin mimetics, meglitinide analogs, and sulfonylureas all increase blood insulin levels or insulin action and greatly increase the risk for hypoglycemia if the client does not match his or her food intake with peak drug action.

8. Which assessment findings in a client with myxedema coma indicate to the nurse that therapy is effective? Select all that apply. A. SpO2 is 89%. B. Skin is cool and dry. C. Pulse is 62 beats/min. D. Blood pressure is 98/60. E. Urine output is greater about 10 mL/hr. F. Core body temperature is 98.6°F (36.8°C).

C,D,F

36. How many grams of carbohydrate (CHO) will the nurse provide to a client who has symptoms of hypoglycemia with a blood glucose level between 69 mg/dL (3.9 mmol/L) and 50 mg/dL (2.8 mmol/L) to correct the problem and prevent harm? A. 5 g B. 10 g C. 15 g D. 30 g

C. 15 g Current recommendations and guidelines for managing hypoglycemia in an alert client follow the 15-15 rule. With this rule, 15 g of CHO are given if the blood glucose level is less than 70 mg/dL (3.9 mmol/L) (or 30 g if less than 50 mg/dL [2.8 mmol/L]) or if the client is experiencing symptoms of hypoglycemia and can swallow safely. If the blood glucose recheck within 15 minutes is still low, the same treatment is given again.

4. Which laboratory values does the nurse specifically expect to find in a client who has primary hypothyroidism? A. Total serum T4 1 mcg/dL (22 nmol/L) B. Thyrotropin receptor antibodies (TRAbs) 0% C. Thyroid-stimulating hormone (TSH) 8 mU/mL D. White blood cell (WBC) count 6200/mm3 (6.2 × 109/L)

C. Thyroid-stimulating hormone (TSH) 8 mU/mL This high level is trying to force unresponsive thyroid tissue cells to secrete thyroid hormones.

10. Which client admitted to a surgical unit will the nurse recognize as having a higher risk for having type 2 diabetes? A. 30-year-old Hispanic female runner B. 36-year-old white female who has rheumatoid arthritis C. 40-year-old black male who is 10 lb (4.5 kg) underweight D. 48-year-old obese male American Indian

D. 48-year-old obese male American Indian

3. Which health problems that are complications of chronic hyperglycemia will the nurse reinforce to the client with diabetes could be delayed or prevented with long-term good glucose control? Select all that apply. A. Amputations B. Blindness C. Chronic kidney disease D. Heart attack E. Erectile dysfunction F. Stroke

A,B,C,D,E,F

6. Which assessment findings in a 33-year-old female client indicate to the nurse that she has an increased risk for type 2 diabetes? Select all that apply. A. A1C is 5.8% B. Weight is 25 lb (11.3 kg) above ideal C. Had a 10 lb (4.5 kg) baby 2 years ago D. Has irritable bowel syndrome with constipation E. Fasting blood glucose (FBG) level is 119 mg/dL (6.5 mmol/L) F. Mother, sister, and maternal grandmother all have type 2 diabetes

A,B,C,E,F

15. Which changes in laboratory values will the nurse expect in a client who has untreated syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. A. Increased urine sodium B. Serum potassium 2.9 mEq/mL (mmol/L) C. Urine specific gravity 1.053 D. Serum osmolarity 250 mOsm/L E. Increased hematocrit F. Serum sodium 119 mEq/mL (mmol/L)

A,B,C,F

34. Which points will the nurse, in collaboration with a registered dietitian nutritionist, use to individualize a meal plan for a client with diabetes? Select all that apply. A. Maintaining blood glucose levels at or near the client's target range B. Allowing client food preferences whenever possible C. Permitting clients to eat as much as they desire D. Honoring the client's cultural preferences E. Limiting food choices to proteins and vegetables F. Suggesting the client avoid all forms of dietary fats

A,B,D

28. Which additional health problems will the nurse expect the client with chronic hyperparathyroidism to be at risk for if management is not effective? Select all that apply. A. Psychosis B. Kidney stones C. Thyroid cancer D. Bone deformities E. Chronic diarrhea F. Peptic ulcer disease

A,B,D,F

35. Which points are essential for the nurse to include in the teaching plan when instructing a client with diabetes how to select and wear appropriate shoes? A. "Have your shoes fitted by an experienced shoe fitter such as a podiatrist." B. "Make sure the shoes are 1 to 1.5 inches longer than your longest toe." C. "The heels of the shoes should be less than 2 inches high." D. "Avoid tight-fitting shoes that can damage your feet." E. "Rotate your shoes so you don't wear the same shoes 2 days in a row." F. "Get measured for shoes later in the day, when feet are normally larger."

A,C,D,E,F

8. Which postoperative actions are appropriate for the nurse to take when caring for a client who is recovering from a transsphenoidal hypophysectomy? Select all that apply. A. Monitoring fluid and electrolyte balance closely B. Instructing the client how to perform incision care C. Performing neurologic checks hourly for first 24 hours D. Urging the client to cough vigorously every 2 hours while awake E. Encouraging the client to perform hourly deep-breathing exercises F. Instructing the client to use a soft-bristled toothbrush for oral hygiene

A,C,E A hypophysectomy removes all pituitary tissue and results in deficiency of all pituitary hormones, including antidiuretic hormone, which can lead to profound disturbances of fluid and electrolyte balance.

23. Which physical assessment findings will the nurse expect in a client with long-term Cushing disease? Select all that apply. A. "Moon-face" B. Body hair loss C. Truncal obesity D. Prominent lower jaw E. Thin, easily damaged skin F. Extremity muscle wasting

A,C,E,F

24. Which situations or conditions will the nurse teach a client with diabetes are common causes of hypoglycemia? Select all that apply. A. Too much insulin taken compared with food intake B. Increased food intake especially after missed or delayed meals C. Insulin injected at the wrong time relative to food intake and physical activity D. Decreased insulin sensitivity as a result of regular exercise and weight loss E. Decreased insulin clearance from progressive kidney failure F. Decreased liver glucose production after alcohol ingestion

A,C,E,F

6. Which assessment findings will the nurse expect to see in a 30-year-old client who has just been diagnosed with acromegaly? Select all that apply. A. Thickened lips B. Near-sightedness C. Hyperglycemia D. Hyponatremia E. Extremely long arms and legs F. Protruding lower jaw

A,C,F

29. For which situations will the nurse teach a client to perform urine ketone testing? A. Anytime he or she is acutely ill or severely stressed B. When blood glucose levels are above 200 mg/dL (11.1 mmol/L) C. When symptoms of diabetic ketoacidosis (DKA) are present D. While participating in a weight-loss program E. Before engaging in strenuous exercise F. After eating citrus fruit or drinking alcohol

A,D,E

14. Which issues regarding diabetes management will the nurse consider delaying to teach about to a client with newly diagnosed type 1 diabetes until after the initial phase? Select all that apply. A. Discussing exactly what causes type 1 diabetes B. Preparing and administering insulin C. Implementing sick-day management rules D. Recognizing indications of hypoglycemia and hyperglycemia E. Explaining the risk for passing on type 1 diabetes to one's children F. Monitoring urine ketone levels

A,E,F

10. Which assessments have the highest priority for the nurse to perform on a 76-year-old client who began thyroid hormone replacement therapy (HRT) 2 weeks ago? Select all that apply. A. Checking for tremors B. Measuring blood pressure C. Checking oxygen saturation D. Asking about sleep patterns E. Asking about changes in appetite F. Determining the presence or absence of chest pain

A,F

24. What is the nurse's best response when a client who is about to have a unilateral adrenalectomy for an adenoma that is causing hypercortisolism asks if she will have to continue the severe sodium restriction after surgery? A. "No, once the tumor has been removed and your cortisol levels have normalized, you will not retain excess sodium anymore." B. "No, after surgery you will have to take oral cortisol, which can easily be controlled so that your sodium levels do not rise." C. Yes, the fact that you are retaining sodium and have high blood pressure is related to your age and lifestyle, not the tumor." D. "Yes, sodium is very bad for people and everyone needs to eliminate sodium completely from their diets for the rest of their lives."

A. "No, once the tumor has been removed and your cortisol levels have normalized, you will not retain excess sodium anymore."

11. Which assessment finding is most important for the nurse to report in a client with diabetes insipidus (DI)? A. Poor skin turgor B. Respirations of 26 beats/min C. Blood pressure of 130/80 mm Hg D. Potassium level of 4.8 mEq/L (mmol/L)

A. Poor skin turgor

13. Which action will the nurse instruct assistive personnel (AP) to avoid when caring for a client with diabetes insipidus (DI) to prevent harm? A. Restricting fluids B. Taking blood pressures C. Urging the client to cough D. Allowing the client to sit with knees bent

A. Restricting fluids

7. Which laboratory value in a client being managed for hypothyroidism will the nurse report to the primary health care provider immediately? A. Sodium 125 mEq/L (mmol/L) B. Potassium 3.0 mEq/L (mmol/L) C. Fasting blood glucose 68 mg/dL D. Platelet count of 220,000/mm3 (220 × 109/L)

A. Sodium 125 mEq/L (mmol/L) The client with hypothyroidism is at risk for hypovolemic shock and reduced excitability of cardiac and nerve membranes. The low sodium level greatly increases the risk for shock and dysfunction of the cardiac and nervous systems.

18. Which serum laboratory value in a client receiving conivaptin therapy for syndrome of inappropriate antidiuretic hormone (SIADH) will the nurse report immediately to the primary health care provider to prevent harm? A. Sodium 148 mEq/L (mmol/L) B. Potassium 3.2 mEq/L (mmol/L) C. Glucose 204 mg/mL (11.4 mmol/L) D. Arterial pH of 7.42

A. Sodium 148 mEq/L (mmol/L) conivaptan, is to induce water loss without

8. How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 91 mg/dL (5.1 mmol/L) and an A1C of 8.2%? A. The client's glucose control for the past 24 hours has been good but the overall control is poor. B. The client's glucose control for the past 24 hours has been poor but the overall control is good. C. The values indicate that the client has poorly managed his or her disease. D. The values indicate that the client has managed his or her disease well.

A. The client's glucose control for the past 24 hours has been good but the overall control is poor.

27. Which action taken by the nurse is most likely to reduce skin complications in a client who has hypercortisolism? A. Using roller gauze to anchor an IV B. Massaging the client's feet and calves C. Applying pressure after IM injections D. Applying dressings to areas with striae

A. Using roller gauze to anchor an IV

15. In collaboration with the registered dietitian nutritionist, which dietary modifications will the nurse suggest to a client with hyperthyroidism? Select all that apply. A. Increased salt water fish or seafood B. Increased overall calories C. Elimination of fatty food D. Increased carbohydrates E. Increased protein F. Fluid restriction

B,D,E

3. Which symptoms will the nurse expect to find on assessment of a client with hypothyroidism? Select all that apply. A. Increased appetite B. Cold intolerance C. Constipation D. Hypotension E. Exophthalmia F. Palpitations G. Tremors H. Weight gain

B,C,D,H

7. A client who has been receiving bromocriptine therapy for 1 month to manage hyperpituitarism now has all of the following symptoms or changes. Which ones will the nurse report to the primary health care provider immediately to prevent harm? Select all that apply. A. Nausea B. Possible pregnancy C. Headaches D. Irregular heart beat E. Taste changes F. Watery nasal discharge

B,D,F Bromocriptine can cause serious cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage. It is also contraindicated during pregnancy.

11. Which lifestyle changes will the nurse suggest to a 35-year-old client who has prediabetes to reduce the risk for developing type 2 diabetes? Select all that apply. A. Increasing fluid intake B. Increasing physical activity C. Quitting smoking and vaping D. Eliminating all dietary carbohydrates E. Reducing consumption of empty calories F. Keeping body weight at or slightly below ideal

B,E,F

20. Which actions will the nurse take to help prevent strain on the suture line for a client who had a total thyroidectomy for thyroid cancer yesterday? Select all that apply. A. Keeping the client on total bedrest B. Placing a small pillow under the client's head C. Maintaining the head of the bed in the flat position D. Instructing the client to avoid deep-breathing exercises E. Applying an elastic wrap around the neck over the dressing F. Instructing the client to place both hands on the back of the neck while moving

B,F

25. Which substances does the nurse expect to be prescribed for a client who has hypoparathyroidism to manage the symptoms? Select all that apply. A. Sodium supplement B. Calcium supplement C. Potassium supplement D. Phosphorus supplement E. Vitamin C F. Vitamin D

B,F The client with hypoparathyroidism is calcium deficient and will need to take calcium supplements. Vitamin D helps increase GI absorption of calcium and also is prescribed.

9. Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "Somogyi phenomenon" to achieve better control? A. "Avoid eating any carbohydrate with your evening meal." B. "Eat a bedtime snack containing equal amounts of protein and carbohydrates." C. "Inject the insulin into your arm rather than into the abdomen around the navel." D. "Take your evening insulin dose right before going to bed instead of at supper time."

B. "Eat a bedtime snack containing equal amounts of protein and carbohydrates." Eating a bedtime snack to prevent nighttime hypoglycemia can result in suppression of counterregulatory hormone release. Somogyi BG levels during the night, has morning hyperglycemia caused by nighttime hypoglycemia

11. What is the nurse's best response when a client with hypothyroidism asks how long hormone replacement therapy will be needed? A. "After your goiter is surgically removed, you should be able to stop HRT." B. "HRT will be needed for the rest of your life because hypothyroidism has no cure." C. "You will be able to stop HRT as soon as your blood levels of thyroid hormones rise to normal ranges." D. "Regardless of when your blood levels of thyroid hormones return to normal, HRT must be continued until all your symptoms subside."

B. "HRT will be needed for the rest of your life because hypothyroidism has no cure."

19. Which statement made by the client with type 1 diabetes during nutritional counseling indicates to the nurse that he or she correctly understands his or her nutritional needs? A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level."

20. Which action will the nurse instruct assistive personnel to perform to prevent harm for a client who has adrenal insufficiency? A. Padding the side rails of the client's bed B. Assisting the client to change positions slowly C. Using a lift sheet when repositioning the client D. Placing suctioning equipment at the client's bedside

B. Assisting the client to change positions slowly risk for falls**

31. Which class of antidiabetic drug will the nurse hold for a client after an imaging test using contrast medium until adequate kidney function is established? A. Alpha-glucosidase inhibitors B. Biguanides C. Meglitinides D. Second-generation sulfonylureas

B. Biguanides Metaformin can cause lactic acidosis in patients with kidney impairment

21. Which response on blood glucose level does the nurse expect to find in a client with diabetes who is now receiving corticosteroid therapy for an acute inflammation? A. Hypoglycemia B. Hyperglycemia C. Ketoacidosis D. No specific change

B. Hyperglycemia

16. Which change in laboratory values indicates to the nurse that the fluid restriction ordered for a client with syndrome of inappropriate antidiuretic hormone (SIADH) is having the desired effect? A. Decreased hematocrit B. Increased serum sodium C. Decreased serum osmolarity D. Increased urine specific gravity

B. Increased serum sodium

1. Why is a deficiency in the production of the anterior pituitary hormone adrenocorticotropin hormone (ACTH) life threatening? A. Reduces sexual maturation leading to untreatable sterility B. Inhibits adrenal production of cortisol, which is necessary for life C. Reduces excretion of extracellular fluid leading to fluid overload and heart failure D. Lack of reabsorption of sodium and potassium leads to serious fluid and electrolyte imbalances

B. Inhibits adrenal production of cortisol, which is necessary for life

4. Which assessment action is a priority for the nurse to perform first to prevent harm for a client with diabetes whose blood osmolarity is 345 mOsm/L? A. Checking skin turgor B. Measuring blood pressure C. Testing for ketones in the urine D. Checking the most recent serum electrolyte values

B. Measuring blood pressure The priority assessment action is to measure blood pressure because the severe dehydration can cause profound hypotension with orthostatic hypotension leading to dangerously reduced organ perfusion and increasing the risk for falls.

16. Which assessment finding in a client with long-standing diabetes will the nurse interpret as an early sign of diabetic nephropathy? A. Positive urine red blood cells B. Microalbuminuria C. Positive urine glucose D. Positive urine white blood cells

B. Microalbuminuria

6. Which condition does the nurse recognize as a life-threatening emergency and serious complication when a client's hypothyroidism is not treated or is undertreated? A. Exophthalmos B. Myxedema coma C. Toxic multinodular goiter D. Hashimoto thyroiditis

B. Myxedema coma

33. Which action will the nurse teach a client with diabetes performing self-monitoring of blood glucose (SMBG) levels to prevent harm from bloodborne infections? A. Washing hands before beginning the test B. Not sharing the monitoring equipment with others C. Blotting away any excess blood from the strip D. Using gloves during monitoring

B. Not sharing the monitoring equipment with others

18. For which client complication of diabetes will the nurse expect to administer glucagon intramuscularly? A. Diabetic retinopathy B. Severe hypoglycemia C. Diabetic ketoacidosis (DKA) D. Hyperglycemic-hyperosmolar state (HHS)

B. Severe hypoglycemia

23. Which laboratory value indicates to the nurse that a client who had a subtotal thyroidectomy for thyroid cancer several months ago may now have a recurrence of the disorder? A. Thyrotropin receptor antibody level of 0% B. Thyroglobulin level of 120 ng/mL (mcg/L) C. Serum calcium level of 10.0 mg/dL (2.37 mmol/L) D. Serum triiodothyronine (T3) 70 ng/dL (3.4 nmol/L)

B. Thyroglobulin level of 120 ng/mL (mcg/L) A hallmark of primary thyroid cancer or recurrence after surgery is an elevated serum thyroglobulin (Tg) level. The normal Tg level is 0.5 to 53.0 ng/mL (mcg/L) for men and 0.5 to 43.0 ng/mL (mcg/L) for women.

12. Which urine characteristics indicate to the nurse that a client being managed for diabetes insipidus requires another dose of desmopressin? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

B. Urine output volume increased; urine specific gravity decreased water is excessively excreted, causing a decrease in blood volume and an increase in urine volume. Blood is concentrated indicating dehydration and urine is very dilute, as measured by specific gravity, which is very low.

26. What problem does the nurse suspect when a client with well-controlled diabetes develops an unexpected increase in blood glucose level 2 days after surgery? A. Family bringing in food for client consumption B. Wound infection occurring before fever C. Response to interactions of newly prescribed drugs D. Progression of disease severity to type 1 diabetes

B. Wound infection occurring before fever

14. Which assessment findings that are unique to Graves disease will the nurse expect in a client who has hyperthyroidism? A. Goiter B. Fine tremors C. Protruding eyes D. Elevated body temperature E. Dry, waxy swelling on shins F. Multiple nodules in the thyroid gland

C,E Only the Graves disease form of hyperthyroidism results in exophthalmos and the buildup of mucinous tissue on the shins that presents as dry and waxy (pretibial edema).

9. Which report from a client who has hypothyroidism and is taking synthetic thyroid hormone replacement therapy indicates to the nurse that more teaching is necessary? A. "I take the drug at the same time every day." B. "I always drink a full glass of water when I take the pill." C. "Even though the pill is small, I mix it with pudding to make it easier to swallow." D. "Most often, I take the drug as early in the morning as possible to prevent it from keeping me awake at night."

C. "Even though the pill is small, I mix it with pudding to make it easier to swallow." Medicine should be taken on an empty stomach... 4 hours before or after meal.. full glass of water

2. What is the nurse's best response when a client who has type 1 diabetes asks why he shouldn't try to keep his blood glucose level as close to zero (0) as possible? A. "That would only frustrate you because there are many ways your body prevents your blood glucose level from going below 50 mg/L (2.8 mmol/L)." B. "You would have to eat absolutely no carbohydrates to accomplish this and just about all food contains some carbohydrates." C. "Glucose is an important nutrient, especially for your brain, and you cannot live if your blood glucose level gets too low." D. "Maintaining such a low glucose level would require a lot of very expensive drugs and not reduce the complications."

C. "Glucose is an important nutrient, especially for your brain, and you cannot live if your blood glucose level gets too low."

5. Which precaution has the highest priority for the nurse to teach a client starting thyroid hormone replacement therapy (HRT) to prevent harm? A. "Take the drug at the same time every day." B. "Avoid caffeinated beverages and foods." C. "Take the drug exactly as prescribed." D. "Get plenty of sleep and rest."

C. "Take the drug exactly as prescribed."

19. Which client will the nurse recognize as having a high risk for developing secondary adrenal insufficiency? A. 25-year-old using oral contraceptives B. 35-year-old with diabetes insipidus C. 45-year-old who suddenly stops taking high-dose corticosteroid therapy D. 55-year-old with an adrenal tumor causing excessive secretion of cortisol

C. 45-year-old who suddenly stops taking high-dose corticosteroid therapy

14. Which client will the nurse recognize as being at increased risk for development of syndrome of inappropriate antidiuretic hormone (SIADH)? A. 27-year-old on high-dose steroids B. 47-year-old with acute renal failure C. 58-year-old with small cell lung cancer D. 60-year-old who had a myocardial infarction last year

C. 58-year-old with small cell lung cancer SIADH is more common among clients who have any type of continuing respiratory problem, especially lung cancer being managed with chemotherapy.

23. For which client will the nurse question the diabetes health care provider's prescription for rosiglitazone? A. 22-year-old with new-onset asthma B. 40-year-old with hyperthyroidism C. 60-year-old with heart failure D. 65-year-old with kidney disease

C. 60-year-old with heart failure Rosiglitazone is a thiazolidinedione that has an increased risk for heart-related complications and deaths, bone fractures, and macular edema.

10. Which hormone deficiency does the nurse associate with a client who has diabetes insipidus? A. Insulin B. Aldosterone C. Antidiuretic hormone D. Adrenocorticotropic hormone

C. Antidiuretic hormone

24. For which laboratory value will the nurse immediately assess the reflexes of a client who has hypoparathyroidism? A. Sodium 131 mEq/L (mmol/L) B. Potassium 5.1 mEq/L (mmol/L) C. Calcium 7.8 mg/dL (1.76 mmol/L) D. pH 7.33

C. Calcium 7.8 mg/dL (1.76 mmol/L) seizure activity

9. Which additional assessment is a priority for the nurse to perform on a client who develops a fever of 102°F (38.9°C) the day after a transsphenoidal hypophysectomy? A. Listening to breath sounds B. Checking pupillary responses C. Checking neck range of motion D. Asking about pain and burning on urination

C. Checking neck range of motion Nuchal rigidity is a major indication of meningitis, a potential postoperative complication associated with this surgery.

21. Which change in a client's condition indicates to the nurse that corticosteroid therapy for the client in acute adrenal crisis is effective? A. Urine output is increased. B. Pitting edema has resolved. C. Client is alert and oriented. D. Blood glucose level is 60 mg/dL (3.3 mmol/L)

C. Client is alert and oriented.

13. Which serum electrolyte level is most important for the nurse to monitor closely to prevent harm in a client who has hyperglycemia? A. Sodium B. Chloride C. Potassium D. Magnesium

C. Potassium

25. For which complications will the nurse assess, when planning prevention strategies with other interprofessional team members for client with hypercortisolism? A. Anorexia, constipation, hypotension B. Kidney stones, weight loss, cataracts C. Skin breakdown, infection, GI ulceration D. Diabetes insipidus, bradycardia, arthritis

C. Skin breakdown, infection, GI ulceration

22. Which diuretic will the nurse expect to be prescribed by the primary health care provider to manage a client who has hyperaldosteronism? A. Mannitol B. Furosemide C. Spironolactone D. Ethacrynic acid

C. Spironolactone Aldosterone enhances the reabsorption of water and sodium, along with excretion of potassium. Clients with hyperaldosteronism have fluid overload, hyponatremia, and hypokalemia. Correction of these imbalances requires a diuretic, such as spironolactone, that increases sodium and water excretion and conserves potassium. Mannitol is an osmotic diuretic that promotes only water excretion. Furosemide and ethacrynic acid promote sodium and potassium loss along with water loss.

4. Which disorders will the nurse expect that a client with an abnormally functioning posterior pituitary gland could possibly have? Select all that apply. A. Hypothyroidism B. Bone density loss C. Growth retardation D. Diabetes insipidus (DI) E. Excessive virilization F. Syndrome of inappropriate antidiuretic hormone (SIADH)

D,F

3. Which statement made by a female client receiving hormone replacement therapy with estrogen and progesterone for anterior pituitary hypofunction indicates to the nurse correct understanding of the drug therapy? A. "I will switch to vaping instead of smoking cigarettes." B. "Reducing my use of hot showers and baths may help my dry skin." C. "If my breast sizes increase, I will report it to my primary health care provider." D. "I will report any leg pain or swelling immediately to my primary health care provider."

D. "I will report any leg pain or swelling immediately to my primary health care provider."

7. How will the nurse respond to the client newly diagnosed with type 2 diabetes who asks, "What does having metabolic syndrome and diabetes mean for me?" A. "Metabolic syndrome is helpful to anyone with diabetes because it increases the sensitivity of your cells to the presence of insulin." B. "People with diabetes and metabolic syndrome usually need to use insulin rather than oral antidiabetic drug to manage their blood glucose levels." C. "Metabolic syndrome is a problem in eliminating drugs from your body, so you will need to be on lower doses of your antidiabetic drugs to prevent severe side effects." D. "Your risk for having cardiovascular disease and a possible heart attack is higher and will require good control of your diabetes, blood pressure, and cholesterol to prevent them."

D. "Your risk for having cardiovascular disease and a possible heart attack is higher and will require good control of your diabetes, blood pressure, and cholesterol to prevent them."

22. Which client does the nurse consider to be at highest risk for a change in thyroid function from thyroiditis? A. 25-year-old woman who received a tetanus vaccination yesterday B. 38-year-old woman taking thyroid hormone replacement therapy C. 50-year-old man who sustained a neck injury in a car crash D. 61-year-old man who had influenza 3 weeks ago

D. 61-year-old man who had influenza 3 weeks ago follows a bacterial or viral infection

26. Which action is most appropriate for the nurse to take in the preoperative holding area when a client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion? A. Requesting a "time-out" to determine whether this is a valid prescription B. Asking the client whether he or she usually takes prednisone C. Holding the dose because the client has a high cortisol level D. Administering the drug as prescribed

D. Administering the drug as prescribed

30. In collaboration with the registered dietitian nutritionists, what principle is most important for the nurse to reinforce to the client about changes in meal planning needed for management of type 1 diabetes? A. Eating at least five smaller meals per day plus a bedtime snack B. Taking extra insulin when planning to eat sweet foods C. Ensuring the inclusion of high-protein, low-carbohydrate, and low-fiber foods D. Considering the effects and peak action times of the prescribed insulin

D. Considering the effects and peak action times of the prescribed insulin

17. Which new-onset problem is most important for the nurse to instruct a client, starting on propylthiouracil as therapy for hyperthyroidism, to notify the primary health care provider immediately? A. Insomnia B. Ringing in the ears C. Heat intolerance D. Dark-colored urine

D. Dark-colored urine Propylthiouracil can cause liver toxicity and must be stopped if this occurs. Persistently dark-colored urine is an indication of liver problems.

22. What is the nurse's first action on finding that the blood glucose level of a client with diabetes who is NPO for surgery in the next hour is 150 mg/dL (8.4 mmol/L)? A. Administer regular insulin IV. B. Administer a dose of glucagon. C. Notify the surgeon immediately. D. Document the finding as the only action.

D. Document the finding as the only action.

27. What is the priority action for the nurse and other members of the interprofessional health care team when caring for an older client admitted with hyperglycemic-hyperosmolar state (HHS)? A. Replacing potassium B. Preventing ketoacidosis C. Decreasing blood glucose levels D. Increasing circulating blood volume

D. Increasing circulating blood volume The client with HHS is severely dehydrated and at risk for death from decreased cardiac output.

37. What is the most appropriate action for the nurse to take when a client who has used insulin for diabetes control for 20 years now has a spongy swelling at the site used most frequently for insulin injection? A. Applying ice to this area B. Documenting the finding as the only action C. Assessing the client for other indications of cellulitis D. Instructing the client to use a different site for insulin injection

D. Instructing the client to use a different site for insulin injection

28. Which condition will the nurse monitor closely for in a client with type 1 diabetes who has blood glucose level of 438 mg/dL (24.4 mmol/L)? A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis

D. Metabolic acidosis This situation leads to diabetic ketoacidosis (DKA), a type of metabolic acidosis, with a low pH as hydrogen ion concentration increases.

16. Which assessment technique will the nurse avoid during the examination of a client with hyperthyroidism to prevent harm? A. Using an oral thermometer for temperature assessment B. Checking hydration status by pinching up the skin C. Measuring blood pressure with an external cuff D. Palpating the thyroid gland

D. Palpating the thyroid gland

26. Which instruction will the nurse give to an assistive personnel (AP) who is providing morning care to a client with severe hypoparathyroidism to prevent harm? A. Apply a warming blanket. B. Offer oral fluids every 2 hours. C. Avoid using a firm-bristled toothbrush. D. Use a lift sheet when moving the client in bed.

D. Use a lift sheet when moving the client in bed. brittle bones

17. Which action will the nurse take to prevent harm related to syndrome of inappropriate antidiuretic hormone (SIADH) when a client with the disorder is receiving feedings through a nasogatric (NG) tube? A. Turning off NG suction for an hour after feedings B. Using tape sparingly when anchoring the NG tube C. Removing the tube as soon as bowel sounds are present D. Using normal saline instead of water as the irrigation fluid

D. Using normal saline instead of water as the irrigation fluid