NCLEX IMMUNE SYS

A client receiving ferrous sulfate therapy to treat an iron deficiency reports taking an antacid frequently to relieve heartburn. Which instruction should the nurse provide?

"Take ferrous sulfate and the antacid at least 2 hours apart."

"For a client with hyperglycemia, which data collection finding best supports a nursing diagnosis of Deficient fluid volume?

Increased urine osmolarity

Adrenal Corti For a client with an exacerbation of rheumatoid arthritis, the physician prescribes the corticosteroid prednisone. When caring for this client, the nurse should monitor for which adverse drug reactions?

Increased weight, hypertension, and insomnia

THYROID Para HYPER "When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which action?

Increasing fluid intake

A client with acquired immunodeficiency syndrome (AIDS) is prescribed zidovudine (azidothymidine, AZT), 200 mg by mouth every 4 hours. When teaching the client about this drug, the nurse should provide which instruction?

"Take zidovudine exactly as prescribed."

DIABETES MIX "Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

70% NPH insulin and 30% regular insulin

Adrenal Corti. "A client is prescribed prednisone Deltasone daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning?

Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse?

"I won't donate blood because I don't want to get AIDS."

A client recovering from a stroke has residual dysphagia. When assisting the client to eat, which educational points should the nurse provide? Select all that apply.

"After you swallow food, wait a few seconds and then swallow again." "Tuck your chin in when you swallow." "Turn your head toward your weaker side when you swallow."

"Which instruction about insulin administration should the nurse give to a client?

"Always follow the same order when drawing the different insulins into the syringe.

THYROID HYPO The nurse is collecting data from an older adult client being screened for hypothyroidism. Which statement by the nurse demonstrates understanding the effects of aging? "Thyroid disorders are rare in the older adult population." "Hypothyroidism can be difficult to diagnose in older adults because symptoms may resemble normal aging." "Older adults diagnosed with hypothyroidism require larger doses of thyroid replacement." "Older adults receiving thyroid replacement drugs have a decreased risk of adverse reactions."

"Hypothyroidism can be difficult to diagnose in older adults because symptoms may resemble normal aging." Explanation: Hypothyroidism is more difficult to diagnose in the aging population because many of the symptoms closely resemble normal aging and other chronic diseases. Dosages of thyroid replacement drugs are lower in older adults. Therapy is initiated more slowly, and doses are increased with caution. Older adults have an increased risk of adverse reactions associated with cardiac function.

A client diagnosed with systemic lupus erythematous (SLE) is experiecing an exacerbation. Which statement made by the client indicates further education should be reinforced?

"I don't have to worry if I get strep throat."

A nurse is reinforcing nutritional counseling to the parent of a child with celiac disease. Which statement by the parent indicates understanding of the diet?

"I need to read food labels carefully to avoid gluten additives in foods.

Which statement by a client with sickle cell disease indicates further education is needed to reinforce the therapeutic regimen?

"I should take one baby aspirin daily to help prevent sickle cell crisis."

DIABETES e Which statement made by the nurse to the client and parents about diabetic ketoacidosis is most accurate? "It's a normal outcome of diabetes." "It's a life-threatening situation." "It's a situation that can easily be treated at home." "It's a situation that's best treated in the pediatrician's office."

"It's a life-threatening situation." Explanation: Diabetic ketoacidosis, the most complete state of insulin deficiency, is a life-threatening situation. The child should be admitted to an intensive care facility for management, which consists of rapid assessment, adequate insulin to reduce the elevated blood glucose level, fluids to overcome dehydration, and electrolyte replacement (especially potassium).

A 27-year-old client with end-stage acquired immunodeficiency syndrome (AIDS) is being cared for by his wife at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about advance directives. At the next visit, the client states that since he and his wife filled out the advance directive form he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client 's concerns?

"Your physician will continue to care for you. Advance directives document in writing your wishes regarding your care in case you're unable to communicate them to the physician yourself."

Adrenal Corti "In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in:

"low " serum glucose level .

"A client with Cushing's syndrome is admitted to the medical-surgical unit. While collecting data, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

Depression

The nurse is caring for a client with pneumonia. The health care provider orders 600 mg of ceftriaxone oral suspension to be given once per day. The medication label indicates that the strength is 125 mg/5 mL. How many milliliters of medication should the nurse administer? Record your answer using a whole number.

24

DIABETES MIX Ins. "The nurse administered isophane insulin suspension (NPH) to a diabetic client at 7 a.m. At what time would the nurse expect the client to be most at risk for a hypoglycemic reaction?

4 p.m.

"The nurse should expect a client with hypothyroidism to report which health concerns?

Puffiness of the face and hands

The nurse is observing a client with cerebral edema for evidence of increasing intracranial pressure. The client's current blood pressure is 170/80 mm Hg. What's the client's pulse pressure? Record your answer using a whole number.

90

"A female client who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly

Which nursing diagnosis should the nurse expect to see in a plan of care for a client in sickle cell crisis?

Acute pain related to sickle cell crisis

"A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

Adrenal cortex

DIABETES "The nurse is teaching the client about risk factors for diabetes mellitus. Which risk factor for diabetes mellitus is nonmodifiable?

Advanced age

ADRENAL "Which of the following is the most common cause of hyperaldosteronism?

An adrenal adenoma

"The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Antidiuretic hormone (ADH)

Which nursing intervention takes priority for a client infected with Pneumocystis carinii pneumonia?

Auscultating breath sounds

"The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

Calibrate the machine after installing a new battery.

"Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

Confusion and seizures

"A client is diagnosed with diabetes mellitus. Which data collection finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

Crying whenever diabetes is mentioned

"A nurse is teaching a group of certified nursing assistants (CNAs) about blood glucose monitoring. Which finding indicates that the CNA understands how to use a blood glucose meter?

Demonstrating correct technique

"The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?

Decreased cardiac output

DIABETES e. "When teaching a client about insulin administration, the nurse should include which instruction?

Draw up clear insulin first when mixing two types of insulin in one syringe.

A client arrives at the emergency department reporting chest and stomach pain and a history of black, tarry stools for the past 2 months. Which orders should the nurse anticipate?

ECG, complete blood count, testing for occult blood, and comprehensive serum metabolic panel

A nurse is reviewing the laboratory results of a client with anemia and anticipates which lab value would be decreased?

Erythrocyte count of 3.1 × 106/µL (3.10 × 1012/L)

DIABETES e. "A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan?

Exercise and a weight reduction diet

"The nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse a hypoglycemic reaction, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Glucagon

Adrenal Corti "The adrenal cortex is responsible for producing which substances?

Glucocorticoids and androgens

"A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, which test should be performed?

Glycosylated hemoglobin level

THYROID HYPER "A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and her eyes feeling "gritty." Thyroid function tests reveal the following: a thyroid-stimulating hormone (TSH) level of 0.02 units/ml, a thyroxine level of 20 g/dl, and a triiodothyronine level of 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these findings, the nurse would suspect:

Graves' disease. # butterfly-shaped

DIABETES MIX Ins. "A client with type 1 diabetes has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? Hyperglycemia Hypoglycemia Hyperuricemia # abnormally large amount of uric acid in the blood Hypochondria # is an obsolete term for an illness-anxiety disorder, which is abnormal anxiety about one's health with a false belief that one has a disease.

Hypoglycemia Explanation: 1 Hypoglycemia # Headache, sweating, tremor, pallor, and nervousness + may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension, which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. 2 Hyperglycemia, in contrast, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia.

DIABETES "A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?

I'm thirsty all the time. I just can't get enough to drink.

"A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?

Initiate fluid replacement therapy.

"Which intervention is the most critical for a client with myxedema coma?

Maintaining a patent airway

"For a client with Graves' disease, which nursing intervention promotes comfort?

Maintaining room temperature in the low-normal range

Which action must a nurse take first before drawing a blood sample for human immunodeficiency virus (HIV) testing?

Make sure that an informed consent form has been signed.

Adrenal Corti "Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following? Muscle weakness Tremors Diaphoresis Constipation

Muscle weakness Explanation: Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia

"A nurse is caring for a client with type 1 diabetes, who underwent a right hemicolectomy for colon cancer the day before. A physician prescribes the following sliding scale of regular insulin coverage every 6 hours for the client. Which action should the nurse take if the client's glucose level is 181 mg/dl?

Notify the physician.

THYROID Ectomy hypocalcemia "The nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

DIABETES MED Glucagon "A nurse administers glucagon to her diabetic client and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

Oral anticoagulants

The physician prescribes didanosine (ddI), 200 mg by mouth every 12 hours, for a client with acquired immunodeficiency syndrome (AIDS) who is intolerant to zidovudine (azidothymidine, AZT). Which condition in the client's history warrants cautious use of this drug?

Peripheral neuropathy

A client who is receiving cyclosporine must practice good oral hygiene, including regular brushing and flossing of the teeth, to minimize gingival hyperplasia. Good oral hygiene also is essential to minimize gingival hyperplasia during long-term therapy with certain drugs. Which of the following drugs falls into this category?

Phenytoin

"Which of the following is an adverse reaction to glipizide (Glucotrol)?

Photosensitivity

"The nursing care for the client in addisonian crisis should perform which intervention?

Place the client in a private room.

"A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting fluids

"Which nursing diagnosis is most appropriate for a client with Addison's disease?

Risk for infection

DIABETES 2 "A client who has had type 2 diabetes for 20 years tells the nurse that sometimes she has diarrhea and other times constipation. In addition, she sometimes feels ""full"" after eating small amounts. Which of the following would be an appropriate response for the nurse to make?

Sometimes people with diabetes have problems with their digestion. Did you tell your physician about this?

THYROID Para "Parathyroid hormone (PTH) has which effect on the kidneys?

Stimulation of calcium reabsorption and phosphate excretion

DIABETES Inter. "A client with type 2 diabetes comes to the clinic with a diabetic foot ulcer on his left heel that hasn't responded to treatment. Which action should a nurse take after assessing the ulcer? Clean the ulcer with povidone-iodine solution, and wrap it with clean gauze. Tell the patient that this is to be expected. Suggest a consult with a wound care specialist. Complete the client's vital signs, document any increase in temperature, and set up an appointment for the next week.

Suggest a consult with a wound care specialist.

DIABETES "A client with type 2 diabetes was diagnosed with retinopathy. While a nurse reviews the client's medication dosage, the client states, ""I can't read the names on the medicine bottles, so I hope I'm taking the right pills at the right time."" What should the nurse do with this information?

Teach the client how to tell the difference between the medicine bottles.

"A nurse is prioritizing care for her four-client assignment. Which client should she attend to first?

The client who requires an insulin injection before eating breakfast

"A nurse administers bromocriptine (Parlodel) to a client diagnosed with acromegaly. After administering the medication, the nurse realizes that she gave the medication to the wrong client. What could have been done to prevent this error?

Verifying the client's identity on the identification band and medication administration record before providing the medication

THYROID HYPO "Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis?

Weight gain, decreased appetite, and constipation

"The nurse is collecting data on a client with hyperthyroidism. What findings should the nurse expect?

Weight loss, nervousness, and tachycardia

pituitary hypophysectomy "A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

You must avoid coughing, sneezing, and blowing your nose.

"When caring for a client who's being treated for hyperthyroidism, the nurse should:

balance the client's periods of activity and rest.

"When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of foods such as:

bananas and potatoes.

"The nurse is caring for a client who's hypoglycemic. This client will have a blood glucose level:

below 70 mg/dl.

While gathering data about a child's skin integrity, the nurse observes a papular pruritic rash with some vesicles. The rash is profuse on the trunk and sparse on the distal limbs. What does the nurse correlate this finding with?

chickenpox

A nurse is caring for newly admitted client diagnosed with a fever 5 days after a chemotherapy treatment. Which diagnostic study should the nurse anticipate to be ordered initially? Select all that apply.

complete blood count chest X -Ray urine culture throat culture

"The client is being evaluated for hypothyroidism. The nurse should stay alert for:

decreased body temperature and cold intolerance.

A multidisciplinary oncology team of physicians, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply.

decreased platelets decreased white blood cells decreased red blood cells

The nurse is caring for a client who is receiving antibiotics to treat a gram-negative bacterial infection. Because antibiotics destroy the body's normal flora, the nurse must monitor the client for:

diarrhea.

While obtaining a health history, the nurse learns that the client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which medication on hand?

diphenhydramine hydrochloride

A pregnant woman arrives at the emergency department with abruptio placentae at 34 weeks gestation. Which blood dyscrasia should the nurse closely monitor for?

disseminated intravascular coagulation (DIC)

THYROID GH The nurse is reinforcing education with parents of a child with growth hormone deficiency. What sport should the nurse encourage? basketball field hockey football gymnastics

gymnastics Explanation: Children with growth hormone deficiency can be just as active as other children if directed to size-appropriate sports, such as gymnastics, swimming, wrestling, or soccer.

"A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:

has type 2 diabetes.

A child is seeing the health care provider for bone and joint pain. Which other signs and symptoms may suggest leukemia?

petechiae

Adrenal CORTI HYPO. "Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for:

hypocortisolism

THYROID HYPO A client reports weight gain and fatigue. The nurse obtains data that reveal the following: blood pressure 120/74 mm Hg, pulse rate 52 beats/minute, respiratory rate 20 breaths/minute, and temperature 98° F. Laboratory results show low thyroxine (T4) and triiodothyronine (T3) levels. The nurse determines these symptoms are associated with which condition? tetany hypothyroidism hyperthyroidism hypokalemia

hypothyroidism Explanation: Weight gain, lethargy, and slow pulse rate along with decreased T3 and T4 levels indicate hypothyroidism. T3 and T4 are thyroid hormones that affect growth and development as well as metabolic rate. Tetany is related to low calcium levels. Hypokalemia is a low potassium level.

A client who is receiving a unit of packed red blood cells reports nausea, chills, and itching. Which nursing interventions are most important? Select all that apply.

notify the healthcare provider. obtain the client's vital signs stop the transfusion notify the blood bank

The nurse is caring for a client receiving chemotherapy. Which should the nurse consider the priority?

nutrition

The nurse is caring for a child who has just been diagnosed with sickle cell anemia. Which initial action will be most therapeutic?

offer emotional support

"Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:

onset to be at 2:30 p.m. and its peak to be at 4 p.m.

A client has been diagnosed with scarlet fever. Which medication does the nurse anticipate reinforcing education to the parents?

penicillin

A nurse is caring for a client with deep vein thrombosis (DVT). The client suddenly reports shortness of breath, blood-tinged sputum, and chest pain. The nurse suspects that the client has developed which complication?

pulmonary embolism

The nurse is reinforcing nutritional information with a client with a leukocyte (WBC) count of 2,500/µL (2.50 × 109/L). What food should the nurse be sure to have the client avoid?

raw carrot sticks

A nurse is monitoring a client who's receiving a blood transfusion for volume replacement. The client reports itching about 20 minutes after the infusion begins. What is the priority action by the nurse?

report the symptom so that the infusion can be stopped immediately

Which communicable disease requires isolating infected children from pregnant women?

rubella

A nurse is caring for a client newly diagnosed with Human Immunodeficiency Virus (HIV). Which action by the nurse violates the client's confidentiality?

sharing the client's information with the clergy who is visiting with the client

The nurse is meeting with a client who has recently been diagnosed with human immunodeficiency virus (HIV). The client is concerned about the impact of sharing the recent diagnosis with friends and family. What information can the nurse provide to the client?

sharing the diagnosis with friends and family members will provide a needed source of support

"A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse would be accurate in telling him the regimen includes the use of:

short-acting insulin only.

When discussing activities that are safe for the school-age child with hemophilia, which activities should the nurse encourage? Select all that apply.

swimming leisure walking

The nurse is collecting data on a client who has been experiencing black stools for the past month. The client suddenly reports chest and stomach pain. Which action should the nurse perform first?

take vital signs

THYROID HYPER A client is admitted with Graves' disease. Which laboratory test should the nurse expect to be ordered? serum glucose serum calcium lipid panel thyroid panel

thyroid panel Graves' disease is also known as hyperthyroidism. The nurse should expect a thyroid panel to be ordered.

THYROID Para HYPO "The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and:

vitamin D.

DIABETES comp. "The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

wash and inspect his feet daily.

A nurse has instructed a client about taking ferrous sulfate liquid preparation. Which statement by the client indicates the need for additional education?

"I should take the iron with an antacid to prevent gastric distress."

A client was admitted with human immunodeficiency virus (HIV). Which statement by the client would indicate the need for further education regarding safer sex practices?

"I should use plenty of oil-based lubricant to prevent latex condom tearing."

The nurse is reinforcing teaching instructions to a client with trigeminal neuralgia on how to minimize pain episodes. Which comments by the client would indicate correct understanding of instructions? Select all that apply.

"I'll drink fluids at room temperature." "I'll chew food on the unaffected side." "I'll perform mouth care after meals."

A nurse is reinforcing the education plan with the parent of a child who has asthma triggered by a dust mite allergy. Which statement by the parent indicates that education has been effective?

"I'll wash all of the bedding in hot (130° F (54 degrees C)) water every week."

"Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience:

heat intolerance and systolic hypertension.

A nurse is caring for a cleint with non-Hodgkin's lymphoma. Which statement indicates that the client diagnosed with non-Hodgkin's lymphoma needs further reinforcement from the education plan?

"If I stay healthy and eat right, I can cure this disease."

The nurse is meeting with a 17 year-old client who has recently tested positive for human immunodeficiency virus (HIV). The client states, "What information will be disclosed to others." What information should be provided by the nurse?

"In some jurisdictions laws may require you share this information with future sexual partners."

Which instruction would be appropriate for the nurse to reinforce during education with a client who has human immunodeficiency virus (HIV) and is at high risk for altered oral mucous membranes?

"It is important to lubricate your lips."

A client presents to the emergency department with flu-like symptoms. During data collection, the nurses note the client returned from vacation 3 weeks ago, had a blood transfusion 3 years ago, and the sclera appears yellow in color. After being diagnosed with Hepatitis A virus (HAV), the client states, "How could I have gotten hepatitis?" Which nursing response given is most accurate?

"It may have happened if the food handler in a restaurant had the virus."

The parents of a child diagnosed with leukemia have stated that they'll give aspirin to their child for pain relief. Which statement by the nurse about aspirin would be most accurate?

"It's contraindicated because it promotes bleeding tendencies."

The parents of an infant report they are concerned about giving their child immunizations due to their association with autism. Which response by the nurse is appropriate?

"Studies do not support a link between autism and immunizations."

A client with rheumatoid arthritis reports flatulence and heartburn after taking piroxicam. Which instruction should the nurse reinforce to address the client's concern?

"Take an antacid at the same time that you take the medication."

A 40-year-old client with mild dementia related to end-stage acquired immunodeficiency syndrome (AIDS) is preparing for discharge. She has decided against further curative treatment. Before discharge, she develops ocular cytomegalovirus (CMV). Her physician recommends treatment with a ganciclovir-impregnated implant, which requires a surgical procedure. The client's husband feels the implant won't help the client and asks the nurse if the implant will cure CMV. Which response best answers the husband's question while promoting client advocacy?

"The implant won't cure the virus, but it may help preserve her vision. If she can't see you or her surroundings, it may worsen her dementia and make caring for her at home more difficult."

A parent asks the clinic nurse how often the influenza virus vaccine should be given to a child. Which response would be most accurate?

"The vaccine is usually given annually to children with certain risk factors."

A client arrives at the allergy clinic for allergy shots and asks, "Why do I need to have these shots weekly?" What is the nurse's best response?

"Weekly shots help decrease the production of the antibodies that cause allergies."

A 1-year-old infant is pale, but the physical examination is normal. Blood studies reveal a hematocrit of 24% (0.24). Which question by the nurse to the parents would be most useful in helping to establish a diagnosis of anemia?

"What's the infant's usual daily diet?"

A child tests positive for the sickle cell trait, and the parents ask the nurse what this means. Which response by the nurse would be most appropriate?

"Your child is a carrier but doesn't have the disease."

adrenal corti HYPER"SATA - A 45-year-old female client is admitted to the hospital with Cushing's syndrome # hypercortisolism. Which nursing interventions are appropriate for this client?

(1) Assess for peripheral edema (3) Measure intake and output (5) Weigh the client daily

"(SELECT ALL THAT APPLY) A client is seen in the clinic with suspected parathormone (PTH) deficiency. Part of the diagnosis of this condition includes the analysis of serum electrolyte levels. Which electrolyte levels would the nurse expect to be abnormal in a client with PTH deficiency?

(1) Calcium (6) Phosphorous

"(SELECT ALL THAT APPLY) After falling off a ladder and suffering a brain injury, a client develops syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment he's receiving is effective?

(1) Decrease in body weight (4) Increased urine output (5) Decreased urine osmolarity

DIABETES "SATA" A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client?

(1) Excessive thirst (4) Excessive hunger (6) Frequent, high-volume urination

THYROID Ectomy hypocalcemia"SATA - A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms?

(1) Numbness (3) Tingling (4) Muscle twitching and spasms

THYROID Scan A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should the nurse include in her client teaching to ensure that this client is prepared for the test?

(1) Stop using iodized salt or iodized salt substitutes 1 week before the scan. (2) Stop eating seafood 1 week before the scan. (4) Don't take any prescribed thyroid medication on the day of the scan.

THYROID HYPER SATA- A client is diagnosed with a goiter after traveling in a foreign country for 3 months. During her trip, the client wasn't able to tolerate food. Which signs and symptoms would the nurse expect to see in this client?

(2) Dizziness when raising her arms above her head (3) Dysphagia (5) Respiratory distress

"(SELECT ALL THAT APPLY) A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan?

(2) High-fiber, low-calorie diet (4) Use of stool softeners (5) Thyroid hormone replacements

"(SELECT ALL THAT APPLY) A 56-year-old female client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client?

(2) Take thyroid replacement medication, as ordered. (3) Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician.

"(SELECT ALL THAT APPLY) A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching?

(2) Wear cotton socks. (3) Apply foot powder after bathing. (5) See a podiatrist regularly to have your feet checked.

A nurse is gathering data for a young adult with a temperature of 103°F (39°C), a sore throat, and swollen lymph glands. No adventitious breath sounds or cardiac disorders are noted. To complete gathering data for a potential Epstein-Barr viral infection, place an X on the quadrant of the abdomen which the nurse would carefully palpate?

*** An Epstein-Barr infection is a common viral infection. Symptoms include a fever, sore throat, and swollen lymph glands. Additionally, a swollen liver or spleen may develop. Assessment of the liver and spleen is essential. The spleen is located in the left upper quadrant of the abdomen. It is posterior and slightly inferior to the stomach. The nurse should stop palpating immediately if the nurse feels the spleen because compression can cause rupture.

DIABETES Inter. "An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

10 to 15 g of a simple carbohydrate.

DIABETES Inter. "The nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

15 to 20 g of a fast-acting carbohydrate such as orange juice.

"A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that the client's initial dose for the thyroid replacement would be:

25 mcg/day.

DIABETES INTER. "After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl. The physician adds glyburide (DiaBeta), 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take glyburide: 30 minutes before breakfast. in the mid-morning. 30 minutes after dinner. at bedtime.

30 minutes before breakfast. Explanation: Like other oral antidiabetic agents prescribed in a single daily dose, glyburide should be taken at breakfast or 30 minutes before breakfast. If the client takes glyburide later, such as in the mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.

A client has been prescribed 600 mg/day of ferrous sulfate for iron deficiency anemia. The nurse needs to administer in two divided doses with a solution of 300 mg/5 mL. How many mL of the medication will the nurse administer per dose? Record your answer using a whole number.

5

DIABETES Inter. "The nurse teaches a diabetic client that diet plays a crucial role in managing diabetes mellitus. When evaluating dietary intake, the nurse knows the client is eating the right foods if total daily caloric intake consists of:

55% to 60% carbohydrate, 30% fat, and 10% to 15% protein.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safe sex practices for persons with HIV is accurate?

A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.

After undergoing testing, a client comes to a physician's office for a follow-up appointment. During the appointment, the physician informs the client that she has systemic lupus erythematosus (SLE). Which resource might be helpful for a nurse to recommend to this client?

A support group for clients with SLE

DIABETES test "Laboratory studies indicate that a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose utilization?

A test of serum glycosylated hemoglobin (Hb A1c)

A clinical nurse specialist (CNS) is orienting a new licensed practical nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. A well-informed new graduate would know the greatest likelihood of an acute hemolytic reaction would occur when giving:

A-positive blood to an A-negative client.

The nurse is obtaining a dietary history from a newly admitted client. Which food eaten by the client does the nurse recognize is a common allergen?

strawberries

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless, temporary change?

Bluish urine

A client was admitted with a platelet count of 95,000/µl (95 × 109/L). What would the nurse anticipate observing during data collection?

Bruising and petechiae

"A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

You'll need less insulin when you exercise or reduce your food intake.

"The nurse understands that for the parathyroid hormone to exert its effect, what must be present?

Adequate vitamin D level

"Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?

Administer 2 to 3 L of I.V. fluid over 2 to 3 hours.

adrenal corti. HYPER "The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?

An irregular apical pulse

A client's blood studies reveal a deficiency in all of the blood's formed elements. The physician suspects that the client's bone marrow is failing to generate enough new cells. Which disorder is most likely affecting this client?

Aplastic anemia

A child with von Willebrand disease (vWD) is brought to the clinic with epistaxis. What is the priorty action by the nurse?

Apply pressure to the nose.

DIABETES e. "A client brings her food journal containing her dietary intake for the past 3 days to the diabetic clinic. A nurse notes that despite dietary teaching about carbohydrate intake, the client consumed 3 servings of bread each day. What should the nurse do with this information?

Ask the diabetes educator to review with the client ways to decrease carbohydrate intake.

"During the first 24 hours after a client is diagnosed with addisonian crisis, which task should the nurse perform frequently?

Assess vital signs.

The nurse is caring for a client who has been newly diagnosed with systemic lupus erythematosus (SLE). Which information should be included when the nurse is assisting with the teaching plan that focuses on home care? Select all that apply.

Avoid exposure to sunlight. Keep exercise to a minimal level. Avoid over-the-counter (OTC) medications unless approved by the health care provider. Take rest periods as needed.

A nurse is assigned to a client experiencing Stage 3 hypovolemic shock. Which findings should the nurse expect to notice?

BP 87/58 mm Hg, HR 123, urine output of 20 ml/hour, clammy skin

"The nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?

Below-normal serum potassium level

A client receiving antiplatelet therapy is being monitored for adverse reactions. For which most commonly produced adverse reaction would the nurse observe this client?

Bleeding

"The nurse should expect to administer which medication to a client with gout?

Colchicine

"A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

Coma, anxiety, confusion, headache, and cool, moist skin

"When collecting data on a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:

a blood pressure of 176/88 mm Hg.

DIABETES The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? Take off gloves before removing the test strip. Smear the drop of blood onto the reagent pad. Calibrate the machine after installing a new battery. Start the timer on the machine while gathering supplies.

Calibrate the machine after installing a new battery.

"While administering morning medications, a nurse enters the room of a client who recently had a thyroidectomy. She observes that the client is sitting up in bed but appears unresponsive. After confirming unresponsiveness, what should the nurse do next?

Call for help.

"A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?

Cerebral edema

Adrenal CORTI. A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

a corticotropin-secreting pituitary adenoma.

A nurse is reinforcing discharge instructions for a client with systemic lupus erythematosus (SLE). Which intervention is most important for the nurse to include?

apply sunscreens with SPF higher than 15 daily

Following a kidney transplantation, a client is prescribed a combination of medications that includes steroids and cyclosporine. Which client education should the nurse reinforce?

avoid being in crowded places

A client is placed on neutropenic precaution. Which nursing action is appropriate?

avoiding yogurt for breakfast

"A client is admitted with a serum glucose level of 618 mg/dl. The client is awake and oriented, with hot, dry skin; a temperature of 100.6° F (38.1° C); a heart rate of 116 beats/minute; and a blood pressure of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority?

Deficient fluid volume related to osmotic diuresis

"A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented. He has hot, dry skin and the following vital signs: a temperature of 100.6° F (38.1° C), a heart rate of 116 beats/minute, and a blood pressure of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority?

Deficient fluid volume related to osmotic diuresis

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

Deficient knowledge.

"A client becomes upset when the physician diagnoses diabetes mellitus as the cause of his signs and symptoms. The client tells the nurse, ""This must be a mistake. No one in my family has ever had diabetes."" Based on this statement, the nurse suspects the client is using which coping mechanism?

Denial

DIABETES "An obese Hispanic client, age 65, is diagnosed with type 2 diabetes mellitus. Which statement about diabetes mellitus is true?

Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites.

"A client with type 2 diabetes tells a nurse that he stopped walking at the mall because of his ""bad leg pain."" How should the nurse respond to this client?

Did you notify your physician when you started to have the leg pains?

A client with human immunodeficiency virus (HIV) infection is preparing for discharge from the hospital when he reports to a nurse that he continually feels weak. How should the nurse intervene?

Explain to the client that he should schedule periods of rest throughout the day.

THYROID HYPO The nurse is caring for a client with hypothyroidism. Which client data would the nurse expect to collect? polyuria, polydipsia, and weight loss heat intolerance, nervousness, weight loss, and hair loss coarsening of facial features and extremity enlargement fatigue, cold intolerance, weight gain, and constipation

Fatigue, cold intolerance, weight gain, and constipation Explanation: Tiredness, cold intolerance, weight gain, and constipation are symptoms of hypothyroidism, secondary to a decrease in cellular metabolism. Polyuria, polydipsia, and weight loss are symptoms of type 1 diabetes. Hyperthyroidism has symptoms of heat intolerance, nervousness, weight loss, and hair loss. Coarsening of facial features and extremity enlargement are symptoms of acromegaly.

DIABETES Inter. "Which outcome indicates that the treatment of a client with diabetes insipidus has been effective?

Fluid intake is less than 2,500 ml/day.

DIABETES inter. "During a class on exercise for clients with diabetes mellitus, a client asks the nurse how often he should exercise. Which answer by the nurse is appropriate?

Follow a regular, individualized exercise plan.

"Which instructions should be included in the discharge teaching plan for a client after a thyroidectomy for Graves' disease?

Have regular follow-up care.

Adrenal Corti. "A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's wife reports that she noticed that he acted confused and was extremely weak when he woke up in the morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. Which of the following would the nurse expect to administer by I.V. infusion?

Hydrocortisone

"Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism?

Hypercalcemia

"The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find?

Hyperkalemia

"What does a positive Chvostek's sign indicate?

Hypocalcemia

THYROID Ectomy hypocalcemia "On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? Hypocalcemia Hyponatremia Hyperkalemia Hypermagnesemia

Hypocalcemia Explanation: Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

DIABETES e. "A client is taking an oral antidiabetic agent, to treat type 2 diabetes. Which statement indicates the need for further client teaching about the treatment of this disease?

I often skip lunch because I don't feel hungry.

"A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands her condition and how to control it?

I should avoid becoming dehydrated and pay attention to my need to urinate, drink, or eat more than usual.

"KIDNEY Transplant A 78-year-old client with type 2 diabetes needs a kidney transplant. The client's daughter volunteers to donate a kidney, but the client voices concerns about her daughter's health to the nurse. Which response by the nurse is appropriate?

I'll notify your physician of your concerns and see if he can discuss the procedures with you.

Which immunoglobulin is specific to an allergic response?

IgE

"Which nursing diagnosis takes highest priority for a client with hyperthyroidism?

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

A 33-year-old client who tested positive for the human immunodeficiency virus (HIV) is admitted to the medical unit with pancreatitis. A nurse director from another unit comes into the medical unit nurses' station and begins reading the client's chart. The staff nurse questions the director, who says that the client is her neighbor's son. What should the nurse do to protect the client's right to privacy?

Inform the nurse director that she's violating the client's right to privacy and ask her to return the chart.

DIABETES MIX Ins. "A client, age 23, is diagnosed with type 1 diabetes. The physician prescribes 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles the appropriate equipment, washes her hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?

Inject 35 units of air into the NPH vial + inject 15 units of air into the regular insulin vial & withdraw 15 units of regular insulin + withdraw 35 units of NPH.

"The nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare to absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

DIABETES Inter "A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse would be most accurate in stating: "The test needs to be repeated following a 12-hour fast." "It looks like you aren't following the prescribed diabetic diet." "It tells us about your sugar control for the last 3 months." "Your insulin regimen needs to be altered significantly."

It tells us about your sugar control for the last 3 months. Explanation: The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse doesn't have enough information to conclude that the finding is the result of poor dietary management or inadequate insulin coverage.

"While reviewing the food diary of a client with type 2 diabetes, a nurse notices that the client typically skips breakfast. Which instruction by the nurse would be helpful for this client.

It's important to maintain a stable blood sugar throughout the day. Can I help you devise a plan so you can eat breakfast each day?

THYROID HYPO "The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?

Levothyroxine (Synthroid)

"A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan?

Maintain a moderate exercise program.

THYROID Para Hyper A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan? Maintain a moderate exercise program. Rest as much as possible. Lose weight. Jog at least 2 miles (3.2 km) per day.

Maintain a moderate exercise program. Explanation: A moderate exercise program will help strengthen bones and prevent the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging would be contraindicated. Weight loss might be beneficial, but it isn't as important as developing a moderate exercise program.

How can a nurse best ensure the safety of a client who has a latex allergy?

Make sure that the latex allergy is properly documented.

Adrenal Corti "When administering spironolactone Aldactone to a client who has had unilateral adrenalectomy, the nurse should instruct the client about which possible adverse effect of the drug?

Menstrual irregular

The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

Monitor body temperature.

A nurse is caring for a child with celiac disease. How should the nurse evaluate the effectiveness of nutritional therapy?

Monitor the appearance, size, and number of stools.

A licensed practical nurse (LPN) is coassigned with a registered nurse (RN) for the care of a client with hemophilia. The physician prescribes a blood transfusion for this client. Which task associated with blood transfusion is the responsibility of the LPN?

Monitoring the client during the transfusion

THYROID Inter "A client receiving thyroid replacement therapy develops the flu and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which life-threatening complication?

Myxedema coma

"Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

Neck vein distention

"Which of the following signs and symptoms would be seen in a client experiencing hypoglycemia?

Nervousness, diaphoresis, and confusion

Which of the following is the most numerous type of white blood cell (WBC)?

Neutrophil

"DIABETES Inter. A family member is observed looking at the blood glucose flow sheet for a client in the next bed. Which of the following actions would be an appropriate measure for the nurse to take?

Notify the charge nurse about this breach in the client's personal health information.

"A client with type 2 diabetes hasn't received insulin coverage for his afternoon blood glucose levels for 2 days. After further investigation, a nurse discovers that the afternoon blood glucose levels were phoned in from the laboratory but weren't documented in the client's medical record. What should the nurse do with this information?

Notify the physician and complete an incident report.

A nurse administers etanercept by subcutaneous injection to a client with ankylosing spondylitis. Which action should the nurse take to prevent a needle-stick injury?

Place the uncapped needle in the designated puncture-resistant container.

A nurse receives laboratory results for a hospitalized adult client who has acute leukemia. Referring to the provided laboratory slip, which result requires immediate reporting by the nurse?

Platelet count

DIABETES MIX Ins. "A client with type 1 diabetes takes 15 units of isophane insulin suspension (Humulin N) before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills and learns that the client is unaware that certain over-the-counter OTC preparations and other medications may interact with insulin. The nurse should advise the client to avoid which OTC preparations?

Preparations containing salicylates

"After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine (Synthroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

Primary hypothyroidism

Which factor is most important when planning care for a client with a bleeding disorder?

Prioritization

Which nursing intervention takes priority for a client with human immunodeficiency virus (HIV) infection?

Protecting the client from infection

"A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse

Two days after a client undergoes splenectomy, a nurse changes his abdominal dressings according to the physician's order. How should the nurse proceed with the dressing change?

Remove the soiled dressings using clean gloves.

A nurse is preparing a teaching plan for a client with sickle cell disease. She includes periods of rest in her plan. Why is this point important to include?

Rest relieves stress, which may precipitate sickle cell crisis.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

Risk for injury

DIABETES MIX Ins. "A client with type 1 diabetes must learn how to self-administer insulin. The physician has prescribed 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?

Rotate injection sites within the same anatomic region, not among different regions.

"A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes, which is controlled by tolazamide (Tolinase). What is the most important laboratory test for confirming HHNS?

Serum osmolarity

A client is admitted with hemophilia. Which sports should the nurse recommend for this client? Select all that apply.

Swimming Golf

"The nurse explains to a client with thyroid disease that the thyroid gland normally produces:

T3, T4, and calcitonin.

"A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse drug effect?

Tachycardia

THYROID HYPO "Which instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client?

Take the drug on an empty stomach.

"During preoperative teaching for a client who will undergo a subtotal thyroidectomy, the nurse should include which statement?

You must avoid hyperextending your neck after surgery.

In community health and epidemiologic studies, which definition of disease prevalence is correct?

The number of individuals affected by a particular disease at a specific time

Adrenal Corti HYPER "A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome # hypercortisolism and chronic obstructive pulmonary disease COPD the nurse helps formulate a nursing diagnosis of:

The risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion.

"A client with type 2 diabetes tells the nurse in the clinic, ""I keep gaining weight even though I'm not eating all that much. I can't exercise anymore because of these ulcers on my feet. I don't know what to do."" What would be an appropriate response for the nurse to make to this client?

There are other types of exercise that you can do even though you have ulcers on your feet.

"A diabetic client develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect may these findings have on his need for insulin?

They will increase the need for insulin.

The nurse is caring for a child who is receiving steroid therapy as a part of the cancer treatment plan. The child tearfully asks the nurse," Why does my face looks so "fat?" What information should be included in the nurse's response?

This change is temporary and will subside once the steroid medication has been discontinued.

"Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Thyroid crisis

DIABETES inter. "A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subQ. She awakens in 5 minutes. Why should her husband offer a complex carbohydrate snack to her as soon as possible?

To restore liver glycogen and prevent secondary hypoglycemia

"A client is being returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?

Tracheostomy set

THYROID ECTOMY A client is being returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? Indwelling urinary catheter kit Tracheostomy set Cardiac monitor Humidifier

Tracheostomy set Explanation: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

"A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:

Trousseau's sign.

A client with blood type B needs a blood transfusion. Which type of blood can this client receive?

Type B or type O blood

The nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections.

DIABETES "When caring for a client with diabetes insipidus, the nurse expects to administer:

Vasopressin (Pitressin Synthetic).

A client seeks medical evaluation for fatigue, night sweats, and a 20-lb weight loss in 6 weeks. To confirm that the client has been infected with the human immunodeficiency virus (HIV), the nurse expects the physician to order:

Western blot test with ELISA.

DIABETES "A client who has diabetic retinopathy comes to the emergency department with injuries sustained from tripping on a lamp cord. Which of the following statements would be appropriate for the nurse to make?

When you are ready to go home, would you like a home health care nurse to come, too? She can check for things that can be done to make sure you don't fall again.

"A client with type 1 diabetes tells a nurse in the clinic, ""I sometimes skip my insulin dose in the morning so I won't gain back any of the weight I've lost."" Which of the following would be an appropriate response for the nurse to make to this client?

You are worried about your weight? There are safer ways to prevent weight gain.

"A client with adrenal hypofunction has been asked to participate in a research study for a new medication. The client is unsure about participating in the study. What would be an appropriate response for the nurse to make to this client?

You have the right to refuse to participate in the study.

"A client with primary diabetes insipidus is prescribed desmopressin (DDAVP). Which instruction should the nurse provide before the client is discharged?

You may not be able to use desmopressin nasally if you have nasal discharge or blockage.

THYROID HYPER A client who is diagnosed with hyperthyroidism is admitted to the hospital. The nurse anticipates that the client's treatment is most likely to include which medication? A thyroid hormone antagonist Thyroid extract A synthetic thyroid hormone Emollient lotions

a thyroid hormone antagonist. Explanation: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland. Both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

A client was admitted with Pneumocystis jirovecii pneumonia (PJP). Which history would the nurse expect to see in the client's chart?

history of acquired immunodeficiency syndrome (AIDS)

alcoholism A client with alcoholism is hospitalized with cirrhosis of the liver. The nurse notes hand tremors, irritability, and anxiety developing 24 hours after admission. What complication does the nurse suspect the client is developing? portal hypertension esophageal varices acute alcohol withdrawal panic disorder

acute alcohol withdrawal Explanation: Early signs of alcohol withdrawal include hand tremors, irritability, anxiety, nausea, and slight sweating. Later signs include hypertension, hallucinations, seizures, vomiting, tachycardia, and marked confusion. Portal hypertension and esophageal varices are complications of cirrhosis but do not present with these symptoms. Panic disorder is less likely than acute alcohol withdrawal considering the client's medical history.

Which type of leukemia with fast growing immature lymphocytes accounts for most cases of childhood leukemia?

acute lymphocytic leukemia (ALL)

When conducting an information session for a group of clients with genital herpes which medication information should the nurse include?

acyclovir

Which intervention does the nurse determine has the most impact in delaying the development of acquired immunodeficiency syndrome (AIDS) once a client has been infected with human immunodeficiency virus (HIV)?

adherence with the complete therapeutic regimen

Which instructions should the nurse include when reinforcing education to the parents about caring for a child with chickenpox?

administer antipruritics as ordered

Which nursing intervention is most effective in maximizing tissue perfusion for a child in vaso-occlusive crisis?

administer oxygen as prescribed

Which aspect is most important for successful management of the child with Reye syndrome?

early diagnosis

A child with hemophilia is hospitalized with bleeding into the knee. Which action should the nurse take first?

elevate the affected part

"The nurse is explaining the action of insulin to a client newly diagnosed with diabetes mellitus. During the teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the:

beta cells of the pancreas.

"A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial data collection findings, the nurse realizes the client's risk for injury is related to:

bone demineralization resulting in pathologic fractures.

The nurse is caring for a teen diagnosed with acute lymphocytic leukemia (ALL). A review of the laboratory report indicates a platelet count of 125,500/?L. When gathering data, which finding is most consistent with this laboratory result?

bruising

In a client who has human immunodeficiency virus (HIV) infection, CD4+ levels are measured to determine the:

extent of immune system damage.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:

sit upright, leaning slightly forward.

The client is starting the first chemotherapy treatment after a diagnosis of lymphoma. What priority nursing action can be delegated to the LPN?

completing vital signs

"The nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

consuming a low-carbohydrate, high-protein diet and avoiding fasting.

A nurse is reinforcing discharge instructions to a client after treatment for a severe allergic reaction from a bee sting. What instructions should the nurse include? Select all that apply.

fill the prescription for injectable epinephrine to carry with you obtain diphenhydramine to take following a bee sting

Which instruction regarding the proper administration of oral iron supplements would the nurse include in the education plan for parents?

give the medicine via a dropper or through a straw

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

sodium and potassium abnormalities.

A nurse is caring for a child with juvenile arthritis (JA) who has oral prednisone prescribed. The nurse knows that the drug will be given at the lowest possible dosage and for the shortest period of time in order to avoid which adverse effects?

growth retardation and increased risk of infection

A nurse obtains data from a client receiving a blood transfusion and determines that the client is wheezing, has chills, and back pain. What is the priority action of the nurse?

stop the transfusion.

Which would the nurse incorporate when reinforcing education for the parents of a neonate diagnosed with sickle cell anemia?

demonstrate how to take an accurate temperature

The nurse is collecting data on a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

deposits of adipose tissue in the trunk and dorsocervical area.

A nurse is caring for a client with multiple myeloma. Which intervention should be stressed when reinforcing education to the client?

drinking 3 qt (2.8 L) of fluid daily

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. The vital sign values that would most support the nurse's suspicions are:

drop in blood pressure and rise in heart rate.

DIABETES 1 The physician diagnoses type 1 diabetes in a client who has classic manifestations of the disease and a random blood glucose level of 350 mg/dl. In addition to dietary modifications, the physician prescribes insulin. Initially, most clients receive the least antigenic form of insulin. Therefore, the nurse expects the physician to prescribe: beef insulin. fish insulin. human insulin. pork insulin.

human insulin. Explanation: Human insulin is the least antigenic form of insulin because its composition is identical to that of endogenous insulin. Animal insulins, such as beef, fish, and pork insulins, differ in composition from endogenous insulin and therefore are more antigenic. In fact, beef insulin is no longer used in the United States.human insulin.

The nurse is caring for a client with multiple myeloma. Which condition should the client be closely monitored for?

hypercalcemia

"A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these findings, the nurse would suspect:

hyperparathyroidism.

THYDROI HYPER A client has flushed skin, bulging eyes, and perspiration, and states he or she has been "irritable" and having palpitations. Which interpretation of these findings might the nurse suspect? hyperthyroidism myocardial infarction (MI) pancreatitis type 1 diabetes

hyperthyroidism Explanation: Signs and symptoms of hyperthyroidism include nervousness, palpitations, irritability, bulging eyes, heat intolerance, weight loss, and weakness. MI usually involves chest pain, which may radiate to the arms, back, or neck, and shortness of breath. Pancreatitis involves severe abdominal pain and back tenderness. Type 1 diabetes involves polyuria, polydipsia, and weight loss. Remediation: Add a Note Question 14

A child is admitted to the hospital for an asthma exacerbation. The nursing history reveals this client was exposed to chickenpox 1 week ago. When would this client require isolation if he or she were to remain hospitalized?

immediate isolation is required

"Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse would expect the client's symptoms to subside:

in 1 to 2 weeks.

A client is receiving the drug epoetin alfa. Which findings would indicate the effectiveness of the drug?

increase in red blood cells

The nurse is reinforcing education for a client who has hemorrhagic cystitis caused by bladder irritation from chemotherapeutic medications. Which suggestion can the nurse make to prevent this occurance?

increasing fluid intake

Which nursing action is most important to decrease the risk of postoperative complications in a child with sickle cell anemia?

increasing fluids

A nurse is caring for a client with herpes zoster. The family is requesting to visit the client. Which action should the nurse take?

instruct the family on contact precautions before they visit the client

During the admission process, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for:

joint abnormalities.

The nurse is caring for a child with hemophilia. What is the most common site for the nurse to suspect bleeding?

joint cavities

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which data collected by the nurse suggests that the decongestant has been effective?

less sneezing

A nurse is caring for a client who has had a bone marrow transplant. Which nursing intervention has priority?

listening to the breath sounds every 2 hours

The nurse is caring for a client diagnosed with leukemia who is going to have a chemotherapy treatment. Which test would the nurse expect to be done to evaluate the client's ability to metabolize chemotherapeutic agents?

liver function studies

A client with allergic rhinitis is prescribed loratadine (Claritin). On a follow-up visit, the client tells the nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes that the client requires additional teaching about this medication because:

loratadine should be taken once daily for allergic rhinitis.

A client is injected with radiographic contrast medium and immediately shows signs of dyspnea, flushing, and pruritus. Which intervention should take priority?

make sure the airway is patent

When caring for a child with sickle cell anemia in vaso-occlusive crisis, what does the nurse identify as the priority nursing intervention?

manage pain

A client with human immunodeficiency virus (HIV) experiences frequent bouts of diarrhea. The nurse determines dietary teaching is effective when the client states which food to avoid?

milk

An anxious client is brought to the walk in clinic with difficulty breathing following a bee sting. Which of the following is the nurse's priority action?

monitor the client's airway

Parents of a child with Kawasaki disease should be taught the importance of keeping follow-up appointments to monitor and prevent which complication?

myocardial infarction

"An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

myxedema coma.

A nurse in a family health clinic is caring for a client with anemia. What education does the nurse reinforce?

needs to have activities spaced to allow for rest periods

DIABETES HYPO "A client with diabetes mellitus has just been prescribed insulin. When teaching the client about hypoglycemia, the nurse should mention that this reaction may cause:

nervousness, diaphoresis, and confusion. # hypoglycemia

DIABETES MIX Ins. "PUT IN ORDER A client is ordered to receive 20 units of isophane insulin suspension (Humulin N) and 5 units of regular insulin (Humulin R) by subcutaneous injection. Place in chronological order the steps to take when mixing different types of insulin in a syringe. Use all the options.

order the steps mixing insulin in a syringe 1 Inject 20 units of air into the Humulin N Vile 2 Withdrawl the syringe; don't withdraw the insulin 3 Inject 5 units of air into the Humulin R vile 4 Invert the vial and withdraw the Humulin R Dose 5 Insert the syringe needle into the Humulin N vial 6 Invert the vial and withdraw the Humulin N dose.

Adrenal Corti A client diagnosed with systemic lupus erythematosus and taking daily prednisone reports severe back pain after manually opening a garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

osteoporosis

When collecting data on a child with sickle cell anemia, which finding would indicate the child is experiencing vaso-occlusive crisis?

pain with ambulation

When reinforcing education to parents about preventing nutritional iron deficiency, the nurse should emphasize which foods are significant sources of dietary iron? Select all that apply.

peas spinach dried fruits

Adrenal Corti Which additional health care provider order should a nurse anticipate for a client who has been prescribed corticosteroids?

perform blood glucose checks every six hours.

"A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

performing capillary glucose testing frequently.

"During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:

phosphorus.

A nurse is caring for a client who received 1 unit of fresh frozen platelets (FFP) for a platelet count of 20,000 mm3. Which repeat laboratory values will be of greatest concern to the nurse?

platelet count 22,000 mm3

A child with Reye syndrome is exhibiting signs of increased intracranial pressure (ICP). Which nursing intervention would be most appropriate for this child?

position the child with the head elevated and the neck in a neutral position

A nurse is assigned to a Muslim client. Which cultural considerations should the nurse expect in the care plan? Select all that apply.

preference to be treated by health care worker of same sex meat products not ritually slaughtered are forbidden right hand should be used in handing over items

A nurse is caring for a client with multple myeloma. When assisting with the plan of care, which nursing intervention is most appropriate?

preventing bone injury

THYROID hypopara"A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of:

profound neuromuscular irritability.

"A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:

protruding eyes and a fixed stare.

The nurse is caring for a child experiencing a sickle cell crisis. What priority nursing intervention should the nurse perform?

provide oral and IV fluids

hypoxemia A nurse is evaluating a client for signs of hypoxemia. Which diagnostic procedure would the nurse expect to perform first to monitor the client's respiratory status? chest radiograph pulmonary function tests (PFTs) pulse oximetry arterial blood gases (ABGs)

pulse oximetry Explanation: Pulse oximetry is a quick and non-invasive method of monitoring the arterial oxygenation status of the client, so it would be the first data the nurse collects. The other diagnostic tests may be performed later. An ABG requires skill and time to draw, and results are not available immediately. PFTs and chest radiographs may provide information on the client's underlying disease process causing hypoxemia. Remediation: Diaphoresis

DIABETES A client with diabetes is being taught about possible complications. The nurse should include which conditions in the discussion with the client? dizziness, dyspnea on exertion, and angina retinopathy, neuropathy, and coronary artery disease leg ulcers, cerebral ischemic events, and pulmonary infarcts fatigue, nausea, vomiting, muscle weakness, and cardiac dysrhythmias

retinopathy, neuropathy, and coronary artery disease Explanation: Retinopathy, neuropathy, and coronary artery disease are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and angina are symptoms of aortic valve stenosis. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia. Hyperparathyroidism causes fatigue, nausea, vomiting, muscle weakness, and cardiac dysrhythmias.

Which clinical manifestations should a nurse expect to see in a child in stage V of Reye syndrome?

seizures, flaccidity, and respiratory arrest

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. What should the nurse instruct the client to do?

sit upright, leaning slightly forward

"The nurse is assigned to care for a postoperative client who has diabetes mellitus. During data collection, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

suggest referral to a sex counselor or other appropriate professional.

The nurse is reinforcing education for a client with hepatitis B about prevention of infection transmission. What strategies are included in the teaching? Select all that apply.

wear a condom when engaging in sexual intercourse do not share razors, nail clippers, toothbrush, or any other personal care item that comes in contact with blood or body fluids do not share needles with anyone, and avoid recapping all needles do not donate blood.

THYDROI HYPER A nurse is evaluating a client with hyperthyroidism. Which findings should the nurse anticipate that correlate with the diagnosis? appetite loss, constipation, and lethargy weight loss, nervousness, and tachycardia exophthalmos, diarrhea, and cold intolerance cold intolerance, fever, and decreased sweating

weight loss, nervousness, and tachycardia Explanation: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.