NU102 Exam 3 Endocrine and Eye

The nurse administers 20 units of Humulin N insulin to a hospitalized client with diabetes mellitus at 7:00 am. The nurse should monitor the client most closely for a hypoglycemic reaction at which time? 1. 4:00 pm 2. 9:00 am 3. 10:00 am 4. 12:00 midnight

1. 4:00 pm Rationale: Humulin N is an intermediate-acting insulin with an onset of action in 3 to 4 hours, a peak action in 6 to 12 hours, and a duration of action of 18 to 28 hours. A hypoglycemic reaction is most likely to occur at peak time. The correct option is the only one that represents a time frame within the peak hours after administration of the Humulin N insulin.

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1. Insomnia 2. Weight loss 5. Mild heat intolerance Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin (DDAVP) is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. It relieves the headaches. 2. It increases water reabsorption. 3. It stimulates the production of aldosterone. 4. It decreases the production of the antidiuretic hormone.

2. It increases water reabsorption. Rationale: Desmopressin is an antidiuretic hormone used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of antidiuretic hormone.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2. Maintain a patent airway. Rationale: The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

Betaxolol hydrochloride eyedrops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side/adverse effects of this medication? 1. Monitoring temperature 2. Monitoring blood pressure 3. Assessing peripheral pulses 4. Assessing blood glucose level

2. Monitoring blood pressure Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side/adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 3, and 4 are not specifically associated with this medication.

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2. Test the drainage for glucose. Rationale: After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the health care provider (HCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the health care provider immediately? 1. Laryngeal stridor 2. Abdominal cramps 3. Difficulty in voiding 4. Mild to moderate incisional pain

1. Laryngeal stridor Rationale: During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which causes swelling and compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration; stridor is caused by compression of the trachea, leading to respiratory distress. Stridor is an acute emergency situation that requires immediate attention to avoid complete obstruction of the airway. Options 2, 3, and 4 do not identify signs of a life-threatening complication.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

1. Withdraws the NPH insulin first Rationale: When preparing a mixture of short-acting insulin such as regular insulin with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement should the nurse make to the client? 1. "Don't be concerned; this problem can be covered with clothing." 2. "Usually these physical changes slowly improve following treatment." 3. "This is permanent, but looks are deceiving and are not that important." 4. "Try not to worry about it; there are other things to be concerned about."

2. "Usually these physical changes slowly improve following treatment." Rationale: The client with Cushing's syndrome should be reassured that most physical changes resolve with treatment. All other options are not therapeutic responses.

Tonometry is performed on a client with a suspected diagnosis of glaucoma. The nurse looks at the test results documented in the client's chart, knowing that which is the range for normal intraocular pressure? 1. 2 to 7 mm Hg 2. 10 to 21 mm Hg 3. 22 to 30 mm Hg 4. 31 to 35 mm Hg

2. 10 to 21 mm Hg Rationale: Tonometry is a method of measuring intraocular fluid pressure, using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mm Hg are considered within the normal range.

Which medication, if prescribed for the client with glaucoma, should the nurse question? 1. Betaxolol (Betoptic) 2. Atropine sulfate (Isopto Atropine) 3. Pilocarpine hydrochloride (Isopto Carpine) 4. Pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40)

2. Atropine sulfate (Isopto Atropine) Rationale: Options 1, 3, and 4 are miotic agents used to treat glaucoma. The correct option is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

Pilocarpine hydrochloride (Isopto Carpine) is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity? 1. Anorexia 2. Bradycardia 3. Tachycardia 4. Hypertension

2. Bradycardia Rationale: Systemic absorption of pilocarpine hydrochloride can produce toxicity, manifested as vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Atropine sulfate is the antidote for systemic reactions that occur with pilocarpine.

The nurse is caring for a client who was recently diagnosed with primary open-angle glaucoma (POAG). Which assessment finding is specific to this type of glaucoma? 1. Client report of blurred vision 2. Client report of "tunnel vision" 3. Client report of ocular erythema 4. Client report of halos around lights

2. Client report of "tunnel vision" Rationale: POAG results from obstruction to outflow of aqueous humor and is the most common type. Assessment findings include painless vision changes and "tunnel vision." Primary angle-closure glaucoma (PACG) is another type of glaucoma that results from blocking the outflow of aqueous humor into the trabecular meshwork. Assessment findings include blurred vision, ocular erythema, and halos around lights.

A client with diabetes mellitus demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the most appropriate intervention to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety so that they will soon disappear. 4. Make sure that the client knows all the correct medical terms to understand what is happening.

2. Convey empathy, trust, and respect toward the client. Rationale: The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client's anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.

An older client is seen in the health care clinic, and an eye examination is performed. The client is diagnosed with a refraction error. The nurse anticipates that which treatment will most likely be prescribed for this client? 1. Contact lenses 2. Corrective lenses 3. A surgical keratoplasty 4. Eye drops to lower intraocular pressure

2. Corrective lenses Rationale: Errors of refraction include astigmatism, presbyopia, myopia, and hyperopia. Eyeglasses (corrective lenses) are most commonly used to treat the disorder. Insertion of contact lenses requires skill and dexterity and may be difficult for an older client. Surgery is not the primary treatment, and eye drops will not resolve the condition. A keratoplasty is a surgical procedure for cataracts. Eye drops that lower intraocular pressure are used to treat glaucoma.

In preparation for cataract surgery, the nurse is to administer cyclopentolate (Cyclogyl) eyedrops. The nurse understands that which characterizes the medication action? 1. Produces miosis of the operative eye 2. Dilates the pupil of the operative eye 3. Constricts the pupil of the operative eye 4. Provides lubrication to the operative eye

2. Dilates the pupil of the operative eye Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease Rationale: Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places the highest priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2. Inadequate fluid volume Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the subject of the question.

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication should be included on the list? 1. Shakiness 2. Increased thirst 3. Profuse sweating 4. Decreased urine output

2. Increased thirst Rationale: The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level 6. Low plasma bicarbonate level

3. Deep, rapid breathing 5. Elevated blood glucose level 6. Low plasma bicarbonate level Rationale: In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 cells/mm3 2. A blood glucose level of 110 mg/dL 3. A potassium (K+) level of 3.1 mEq/L 4. A white blood cell (WBC) count of 6000 cells/mm3

3. A potassium (K+) level of 3.1 mEq/L Rationale: The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The laboratory values listed in options 1, 2, and 4 would not be noted in the client with Cushing's syndrome.

A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response? 1. Omit the insulin. 2. Administer half the prescribed dose. 3. Administer the full dose as prescribed. 4. Wait until noon before making a decision.

3. Administer the full dose as prescribed. Rationale: When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore, options 1, 2, and 4 are incorrect.

A client is started on tolbutamide (Orinase) once daily. The nurse should instruct the client to monitor for which intended effect of this medication? 1. Weight loss 2. Resolution of infection 3. Decreased blood glucose 4. Decreased blood pressure

3. Decreased blood glucose Rationale: Tolbutamide is an oral hypoglycemic agent. It is not used to enhance weight loss, treat infection, or decrease blood pressure.

A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin (Pitressin). The nurse explains that this medication works by which mechanism? 1. Decreasing peristalsis 2. Producing vasodilation 3. Decreasing urinary output 4. Inhibiting contraction of smooth muscle

3. Decreasing urinary output Rationale: Vasopressin is a vasopressor and an antidiuretic. It increases reabsorption of water by the renal tubules, resulting in a decreased urinary flow rate. It also directly stimulates contraction of smooth muscle, causing vasoconstriction and stimulating peristalsis.

Growth hormone is prescribed for the client with pituitary dwarfism. Which statement is accurate related to the expected outcome of this medication? 1. Growth begins in 4 to 5 years. 2. Growth spurts will occur every 2 years. 3. There will be an immediate increase in growth. 4. An increase in height will begin in late adulthood.

3. There will be an immediate increase in growth. Rationale: Growth hormone may be used in the treatment of dwarfism. When treatment is started, height may be increased by as much as 6 inches. The increase is immediate and continual. To monitor treatment, height and weight should be measured monthly. All other options indicate delayed or sporadic increases in growth, which are incorrect.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

3. To treat hypocalcemic tetany Rationale: Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. The nurse reviews the client's medical record and should question the prescription if which data is noted in the client's history? 1. Insomnia 2. Neuralgia 3. Use of nitroglycerin 4. Use of multivitamins

3. Use of nitroglycerin Rationale: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Insomnia and neuralgia are side effects of the medication.

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which most important statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery."

4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." Rationale: Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site.

The nurse is performing an admission assessment on a client with a diagnosis of a detached retina. Which sign/symptom is associated with this eye disorder? 1. Total loss of vision 2. Pain in the affected eye 3. A yellow discoloration of the sclera 4. A sense of a curtain falling across the field of vision

4. A sense of a curtain falling across the field of vision Rationale: A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options 1 and 3 are not characteristics of this disorder. A retinal detachment is an ophthalmic emergency and even more so if visual acuity is still normal.

Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. The nurse should tell the client that which is the most common side effect of the medication? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal (GI) disturbances

4. Gastrointestinal (GI) disturbances Rationale: The most common side effect of metformin (Glucophage) is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; in fact, clients lose an average of 7 to 8 lb because the medication causes nausea and decreased appetite. Although flushing, palpitations, and hypoglycemia can occur, they are not the most common side effects.

Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal disturbances

4. Gastrointestinal disturbances Rationale: The most common side effect of metformin (Glucophage) is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

The health care provider has prescribed Humulin R insulin 6 units and Humulin N insulin 20 units subcutaneously to be administered every morning. How should the nurse prepare to administer insulin? 1. Shaking the Humulin N insulin vial to distribute the suspension 2. Administering Humulin R and Humulin N insulin in separate syringes 3. Drawing up the Humulin R first and then the Humulin N insulin in the same syringe 4. Drawing up the Humulin N insulin first and then the Humulin R in the same syringe

3. Drawing up the Humulin R first and then the Humulin N insulin in the same syringe Rationale: Humulin R is always drawn up before Humulin N insulin, and Humulin N insulin can be drawn into the same syringe as for the Humulin R. Insulins usually are administered 15 to 30 minutes before a meal. To mix the Humulin N insulin suspension, the vial should be gently rotated. Shaking introduces air bubbles into the solution.

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1. At noon 2. At bedtime 3. Early morning 4. Any time, at the same time, each day

3. Early morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9 am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Options 1, 2, and 4 are incorrect.

The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? 1. Avoid overuse of the eyes. 2. Decrease the amount of salt in the diet. 3. Eye medications will need to be administered for life. 4. Decrease fluid intake to control the intraocular pressure.

3. Eye medications will need to be administered for life. Rationale: The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life. Options 1, 2, and 4 are not accurate instructions.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face Rationale: Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperglycemic hyperosmolar state (HHS). The nurse understands that the hyperglycemia associated with this disorder results from which occurrence? 1. Increased use of glucose 2. Overproduction of insulin 3. Increased production of glucose 4. Increased osmotic movement of water

3. Increased production of glucose Rationale: Hyperglycemia results from decreased use and increased production of glucose. Increased use of glucose and overproduction of insulin would most likely cause hypoglycemia. Option 4 is incorrect.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

3. Take a blood glucose test before exercising. Rationale: A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtime places the client at risk for hypoglycemia. Insulin should be administered as prescribed.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101° F, pulse of 88 beats/minute, respirations of 22 breaths/minute, and blood pressure of 100/72 mm Hg. Which assessment would be of most concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3. Temperature Rationale: An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar state or diabetic ketoacidosis. The other findings noted in the question are within normal limits.

The nurse is conducting a health screening clinic for glaucoma. A client reports to the clinic for an eye examination, and the nurse performs a tonometry test on the client. The results of the test indicate an intraocular pressure of 24 mm Hg. On the basis of this finding, what information should the nurse provide to the client? 1. The pressure is low. 2. The pressure is normal. 3. The pressure is elevated, necessitating follow-up treatment. 4. The test will need to be repeated because the findings are inconclusive.

3. The pressure is elevated, necessitating follow-up treatment. Rationale: Tonometry is an effective screening test to detect glaucoma in its early stages. The normal intraocular pressure is 12 to 22 mm Hg. An intraocular pressure of 24 mm Hg is an elevated finding, and the client should be referred for follow-up treatment.

The community health nurse visits a client at home. Prednisone, 10 mg orally daily, has been prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds a week, I will call my health care provider (HCP)."

1. "I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the HCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 pounds or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

An ambulatory care nurse is providing instructions to a client who underwent a laser trabeculoplasty for the treatment of primary open-angle glaucoma. Which statement, if made by the client, would indicate an understanding of the postprocedure instructions? 1. "I need to avoid activities that cause straining." 2. "I should have the vision that I lost back within 1 week." 3. "I may lift objects as long as they do not weigh more than 35 pounds." 4. "I'm so glad that I had this type of surgery because I can resume all my activities immediately."

1. "I need to avoid activities that cause straining." Rationale: Laser trabeculoplasty is performed in an outpatient/ambulatory care department and takes about 30 minutes. The client should avoid activities that produce strain after the procedure. This procedure can prevent further visual loss, but lost vision cannot be restored. The client should avoid lifting heavy objects because this will produce strain on the surgical site. Thirty-five pounds is an excessive amount of weight. The client may resume all normal activity, including returning to work, within 1 to 2 days as prescribed.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms."

1. "I need to stop my insulin." Rationale: When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones.

The nurse is reviewing the instillation technique for both eye ointment and eye drops with the parent of a pediatric client diagnosed with bacterial conjunctivitis. Which statement, if made by the parent, would indicate that learning has taken place? 1. "I will be careful not to touch the eye or eyelid during administration." 2. "I will place my child on the left side to administer drops in the right eye." 3. "I will administer the eye ointment and then wait 5 minutes and administer the eye drops." 4. "I will have my child blink after the instillation to encourage thorough distribution of the eye drops."

1. "I will be careful not to touch the eye or eyelid during administration." Rationale: Touching the eye or eyelid during medication administration can contaminate the dropper and cause eye injury. The child should be placed in a supine position with the neck slightly hyperextended for administration. Eye drops should be administered before eye ointment is administered. Blinking will increase the loss of medication.

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side/adverse effects such as a sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1. Administer methimazole with food. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side/adverse effects such as a sore throat, fever, or headaches. Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider (HCP) should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

A client is prescribed an eyedrop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. Administer the eyedrop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eyedrop. 3. Administer the eyedrop, wait 15 minutes and administer the eye ointment. 4. Administer the eye ointment, wait 15 minutes, and administer the eyedrop

1. Administer the eyedrop first, followed by the eye ointment. Rationale: When an eyedrop and an eye ointment are scheduled to be administered at the same time, the eyedrop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol Rationale: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride (Isopto Carpine) eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride? 1. Atropine sulfate 2. Disulfiram (Antabuse) 3. Naloxone hydrochloride 4. Cyclopentolate (Cyclogyl)

1. Atropine sulfate Rationale: Pilocarpine hydrochloride is a cholinergic agent. Atropine sulfate must be available in the event of systemic toxicity from pilocarpine hydrochloride. Pilocarpine toxicity is manifested by vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Disulfiram is an alcohol deterrent used in the management of alcoholism in selected clients. Naloxone hydrochloride is an opioid antagonist used to reverse opioid-induced respiratory depression. Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication used preoperatively for surgical procedures on the eye.

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan? Select all that apply. 1. Avoid activities that require bending over. 2. Contact the surgeon if eye scratchiness occurs. 3. Place an eye shield on the surgical eye at bedtime. 4. Episodes of sudden severe pain in the eye are expected. 5. Contact the surgeon if a decrease in visual acuity occurs. 6. Take acetaminophen (Tylenol) for minor eye discomfort.

1. Avoid activities that require bending over. 3. Place an eye shield on the surgical eye at bedtime. 5. Contact the surgeon if a decrease in visual acuity occurs. 6. Take acetaminophen (Tylenol) for minor eye discomfort. Rationale: Following eye surgery, some scratchiness and mild eye discomfort may occur in the operative eye and usually, is relieved by mild analgesics. If the eye pain becomes severe, the client should notify the surgeon because this may indicate hemorrhage, infection, or increased intraocular pressure. The nurse also would instruct the client to notify the surgeon of increased purulent drainage, increased redness, or any decrease in visual acuity. The client is instructed to place an eye shield over the operative eye at bedtime to protect the eye from injury during sleep and to avoid activities that increase intraocular pressure, such as bending over.

A client is diagnosed with glaucoma. Which nursing assessment data identifies a risk factor associated with this eye disorder? 1. Cardiovascular disease 2. Frequent urinary tract infections 3. A history of migraine headaches 4. Frequent upper respiratory infections

1. Cardiovascular disease Rationale: Hypertension, cardiovascular disease, diabetes mellitus, and obesity are associated with the development of glaucoma. Options 2, 3, and 4 do not identify risk factors associated with this eye disorder.

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the health care provider (HCP) has prescribed atropine sulfate and pilocarpine hydrochloride (Isopto Carpine) eye drops. The nurse should contact the HCP before the home visit for which reason? 1. Clarify the prescription for the atropine sulfate. 2. Clarify the prescription for the pilocarpine hydrochloride. 3. Determine the date of the scheduled follow-up HCP visit. 4. Determine the extent of the intraocular pressure caused by glaucoma.

1. Clarify the prescription for the atropine sulfate. Rationale: Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and cause increased intraocular pressure in the eye. Pilocarpine hydrochloride is a miotic agent used in the treatment of glaucoma. It is unnecessary to contact the HCP regarding the date for follow-up treatment. In fact, the client may know this date, which the nurse can ask about during the home care visit. It is unnecessary to know the extent of the intraocular pressure caused by the glaucoma in planning care for the client.

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should provide which instructions to the client? Select all that apply. 1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6. Muscle pain is an expected effect of metformin and may be treated with acetaminophen (Tylenol).

1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect of metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate (Cyclogyl) eye drops as prescribed. The client asks the nurse why this medication is needed. What should the nurse explain about cyclopentolate? 1. Dilates the pupil of the operative eye 2. Constricts the pupil of the operative eye 3. Is needed for the initiation of miosis in the operative eye 4. Provides the necessary lubrication to the nonoperative eye

1. Dilates the pupil of the operative eye Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication that is used preoperatively to dilate the eye. It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. The statements in the other options are incorrect.

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

1. Dry skin Rationale: Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features, dry skin, and dry, coarse hair and eyebrows. Options 2, 3, and 4 are noted in the client with hyperthyroidism.

A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1. Fever 2. Nausea 4. Tremors 5. Confusion Rationale: Thyroid storm is an acute and life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL. Which medication should the nurse anticipate to be prescribed for the client? 1. Glucagon 2. Humulin N insulin 3. Humulin R insulin 4. Glyburide (DiaBeta)

1. Glucagon Rationale: A blood glucose lower that 50 mg/dL is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Humulin N insulin and Humulin R insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. Additionally, an oral medication would not be administered to an unconscious client.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

1. Hypoglycemia may be experienced before dinnertime. 3. The insulin should be administered at room temperature. Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 0.5 hour, it peaks in 2 to 5.5 hours, and its duration is 5 to 8 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the adverse effects of this medication by taking which assessment action? 1. Monitoring body weight 2. Assessing the glucose level 3. Assessing peripheral pulses 4. Monitoring body temperature

1. Monitoring body weight Rationale: This medication is an antiglaucoma medication and a β-adrenergic blocker. The nurse assesses for evidence of heart failure manifested by dizziness, night cough, peripheral edema, and distended neck veins. Intake greater than output, weight gain, and decreased urine output also may indicate heart failure. Hypotension (manifested as dizziness), nausea, diaphoresis, headache, fatigue, and constipation or diarrhea also are potential systemic effects of the medication. Nursing interventions include monitoring body weight; periodically evaluating blood pressure for hypotension; and assessing the apical or radial pulse for strength, weakness, irregular heart rate, and bradycardia.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

1. Polyuria Rationale: Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Options 2, 3, and 4 are not signs of hyperglycemia.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a b-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. Rationale: The clinical manifestations of hypothyroidism are the result of decreased metabolism caused by low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and measures to support the signs and symptoms related to a decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement will be needed. The client would notify the health care provider if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client tells the nurse, "will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate education before discharge. 2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 3. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. 4. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.

1. The client needs immediate education before discharge. Rationale: If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the HCP should be notified. The client's statement in this question indicates a need for immediate education to prevent HHNS, a life-threatening emergency. Although all other options may be true, the most appropriate analysis is that the client requires immediate education.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaints would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1. Tremors 3. Irritability 4. Nervousness Rationale: Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the signs of hypoglycemia. In hypoglycemia, usually the client feels hunger.

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority? 1. Vital signs 2. Intake and output 3. Blood urea nitrogen results 4. Urine for glucose and ketones

1. Vital signs Rationale: Pheochromocytoma is a catecholamine-producing tumor. Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.

The nurse is preparing to administer eyedrops. Which interventions should the nurse take to administer the drops? Select all that apply. 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheek bone. 5. Instruct the client to squeeze the eyes shut after instilling the eyedrop. 6. Instruct the client to tilt the head forward, open the eyes, and look down.

1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheek bone. Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? 1. Withhold the medication and call the HCP, questioning the prescription for the client. 2. Administer the medication within 60 minutes before the morning and evening meal. 3. Monitor the client for gastrointestinal side effects after administering the medication. 4. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

1. Withhold the medication and call the HCP, questioning the prescription for the client. Rationale: Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should withhold the medication and question the HCP regarding this prescription. Although options 2 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

After cataract surgery, a client is taught to avoid strain on the operated eye. Which statement, if made by the client, would alert the nurse that further teaching is needed? 1. "I cannot rub my eye." 2. "I can lie on my operated side." 3. "I can't lift more than 5 pounds." 4. "I need to take stool softeners to prevent straining."

2. "I can lie on my operated side." Rationale: After cataract surgery the client needs to be instructed to lie on the nonoperated side to prevent swelling and pressure in the operative area. Options 1, 3, and 4 are correct measures to take after cataract surgery to reduce strain on the operated eye.

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? 1. "I will need to limit the amount of protein in my diet." 2. "I should eat foods that have a lot of potassium in them." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."

2. "I should eat foods that have a lot of potassium in them." Rationale: A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue.

The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is most appropriate at this time? 1. Call a code to obtain needed assistance immediately. 2. Obtain a capillary blood glucose level and perform a focused assessment. 3. Ask the unlicensed assistive personnel (UAP) to stay with the client while obtaining 15 to 30 g of a carbohydrate snack for the client to eat. 4. Stay with the client and ask the UAP to call the health care provider (HCP) for a prescription for intravenous 50% dextrose.

2. Obtain a capillary blood glucose level and perform a focused assessment. Rationale: Diaphoresis and confusion are signs of moderate hypoglycemia. A likely cause of the client's change in condition could be related to the administration of insulin without the client eating enough food. However, an assessment is necessary to confirm the presence of hypoglycemia. The nurse would obtain a capillary blood glucose level to confirm the hypoglycemia and perform a focused assessment to determine the extent and cause of the client's condition. Once hypoglycemia is confirmed, the nurse stays with the client and asks the unlicensed assistive personnel (UAP) to obtain the appropriate carbohydrate snack. A code is called if the client is not breathing or if the heart is not beating.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? 1. Diarrhea 2. Polyuria 3. Polyphagia 4. Weight gain

2. Polyuria Rationale: Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Options 1, 3, and 4 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting,and, constipation.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hyperactive bowel sounds

2. Positive Trousseau's sign Rationale: Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. Options 1, 3, and 4 are not related to the presence of hypocalcemia.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? 1. Insulin glargine (Lantus) 2. Regular humulin (Humulin R) 3. Isophane insulin NPH (Humulin N) 4. 50% human insulin isophane/50% human insulin (Humulin 50/50)

2. Regular humulin (Humulin R) Rationale: Regular insulin can be administered by the IV route. Insulin glargine (Lantus) is a long-acting insulin. Isophane insulin NPH (Humulin N) and 50% human insulin isophane/50% human insulin (Humulin 50/50) are intermediate-acting insulin.

A female client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution (Lugol's solution). The client complains to the nurse that she experiences a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client? 1. Dilute the medication in 8 ounces of water. 2. Report the symptom to the health care provider (HCP). 3. Continue to take the medication because the symptoms are normal. 4. Take one-half dose of the prescribed medication for the next 2 days.

2. Report the symptom to the health care provider (HCP). Rationale: The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the HCP if these symptoms are noted.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Lightheadedness Rationale: Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.

A client reports to the health care clinic for an eye examination, and a diagnosis of macular degeneration is made. Which nursing assessment question will most specifically elicit information regarding the clinical manifestations associated with this disorder? 1. "Do bright lights bother you?" 2. "Do you have any pain in your eye?" 3. "Have you had any blurred vision?" 4. "Are you having difficulty seeing things out of the sides of your eyes?"

3. "Have you had any blurred vision?" Rationale: Blurred central vision occurs with macular degeneration. Glare from bright lights is a common complaint in the client with a cataract. Pain in the eye is not specifically associated with macular degeneration. Changes in peripheral visual acuity most often occur with glaucoma.

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1. "I should keep the insulin in the cabinet during the day only." 2. "I know I have to keep my insulin in the refrigerator at all times." 3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." 4. "The best place for my insulin is on the window sill, but in the cupboard is just as good."

3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." Rationale: An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

The nurse has provided instructions to a client with glaucoma regarding measures that will prevent an increase in intraocular pressure. Which statement, if made by the client, would indicate a need for further teaching? 1. "I should eat foods that are high in fiber." 2. "I should avoid lifting objects that weigh more than 20 pounds." 3. "I should limit my fluid intake to prevent an increase in pressure." 4. "I should move objects by using my feet and pushing them along the floor, rather than by lifting them."

3. "I should limit my fluid intake to prevent an increase in pressure." Rationale: The client should be instructed to consume a high intake of liquids and to maintain a diet high in fiber, unless contraindicated, to prevent constipation and straining at stool. Objects weighing 20 pounds or more should be moved by pushing the object along the floor using the feet, rather than by bending over. Activities such as bending over and straining at stool will increase intraocular pressure.

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 pm." 2. "I will check my blood glucose level 1 hour after each meal." 3. "I will check my blood glucose level 2 hours after each meal." 4. "I will check my blood glucose level before each meal and at bedtime."

3. "I will check my blood glucose level 2 hours after each meal." Rationale: The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing should be done during the nighttime hours. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data related to control the diabetes mellitus.

A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question? 1. "It will boost the cells in your pancreas if you have insufficient insulin." 2. "It will help promote insulin absorption when your glucose levels are high." 3. "It is for the times when your blood glucose is too low from too much insulin." 4. "It will help prevent lipoatrophy from the multiple insulin injections over the years."

3. "It is for the times when your blood glucose is too low from too much insulin." Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. When consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 1. "The best time for me to exercise is after I eat." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "The best time for me to exercise is after my morning snack."

3. "The best time for me to exercise is mid- to late afternoon." Rationale: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Options 1, 2, and 4 do not address peak action times.

A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? 1. "The medication will help dilate the eye to prevent pressure from occurring." 2. "The medication will relax the muscles of the eyes and prevent blurred vision." 3. "The medication causes the pupil to constrict and will lower the pressure in the eye." 4. "The medication will help block the responses that are sent to the muscles in the eye."

3. "The medication causes the pupil to constrict and will lower the pressure in the eye." Rationale: Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride (Isopto Carpine) eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication? 1. "The medication prevents blurred vision by relaxing the muscles of the eyes." 2. "The medication dilates the eye to prevent increased pressure from occurring." 3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye." 4. "The medication blocks responses that are sent to the brain that direct the actions of the muscles in the eye."

3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye." Rationale: Pilocarpine hydrochloride is a miotic that is used to lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction? 1. 10:00 2. 11:00 3. 17:00 4. 23:00

3. 17:00 Rationale: Humulin N is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin (Coumadin). Which modification to the plan of care should the nurse review with the client's health care provider? 1. A decreased dosage of levothyroxine 2. An increased dosage of levothyroxine 3. A decreased dosage of warfarin sodium 4. An increased dosage of warfarin sodium

3. A decreased dosage of warfarin sodium Rationale: Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin (Coumadin) are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur. Rationale: The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1. Ampule of 50% dextrose 2. NPH insulin subcutaneously 3. Intravenous fluids containing dextrose 4. Phenytoin (Dilantin) for the prevention of seizures

3. Intravenous fluids containing dextrose Rationale: During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous infusion of normal saline Rationale: The primary goal of treatment in a hyperglycemic hyperosmolar state (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the medication at which time? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

3. On an empty stomach Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? 1. Fatigue 2. Diarrhea 3. Polydipsia 4. Weight gain

3. Polydipsia Rationale: Diabetes insipidus is characterized by hyposecretion of antidiuretic hormone, and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur. Option 1 is a vague symptom. Options 2 and 4 are not specific to this disorder.

A client has just been admitted to the nursing unit following a thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

3. Respiratory distress Rationale: Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status as any swelling to the surgical site could cause respiratory distress. Although all the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

The nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin

3. Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Options 1, 2, and 4 are side effects if the medication is administered by the intravenous route.

The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "Cushing's disease results from an oversecretion of insulin." 2. "Cushing's disease results from an undersecretion of corticotropic hormones." 3. "Cushing's disease results from an undersecretion of mineralocorticoid hormones." 4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."

4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone." Rationale: Cushing's disease is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of adrenocorticotropic hormone (ACTH) secreted by the pituitary gland. Addison's disease is characterized by the hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids) from the adrenal gland, resulting in a deficiency of the corticosteroid hormones. Options 1, 2, and 3 are inaccurate regarding Cushing's disease.

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."

4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL." Rationale: During illness, the client should monitor blood glucose levels and should notify the HCP if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

A client with type 1 diabetes mellitus is having trouble remembering the types, duration, and onset of the action of insulin. The client tells the nurse that the family members have not been supportive. Which response by the nurse is best? 1. "What is it that you don't understand?" 2. "You can't always depend on your family to help." 3. "It's not really necessary for you to remember this." 4. "Let me go over the types of insulin with you again."

4. "Let me go over the types of insulin with you again." Rationale: Reinforcement of knowledge and behaviors is vital to the success of the client's self-care. All other options do not address the need for client instructions and are not therapeutic responses.

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, should the nurse include in the teaching session? 1. "Sulfonylureas decrease insulin resistance." 2. "Sulfonylureas inhibit carbohydrate digestion." 3. "Sulfonylureas decrease glucose production by the liver." 4. "Sulfonylureas promote insulin secretion by the pancreas."

4. "Sulfonylureas promote insulin secretion by the pancreas." Rationale: Sulfonylureas promote insulin secretion by the pancreas and may also increase tissue response to insulin. Thiazolidinediones decrease insulin resistance. α-Glucosidase inhibitors inhibit carbohydrate digestion. Biguanides decrease glucose production by the liver.

The nurse is interviewing a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder? 1. "I take oral insulin instead of shots." 2. "By taking these medications, I am able to eat more." 3. "When I become ill, I need to increase the number of pills I take." 4. "The medications I'm taking help release the insulin I already make."

4. "The medications I'm taking help release the insulin I already make." Rationale: Clients with type 2 diabetes mellitus have decreased or impaired insulin secretion. Oral hypoglycemic agents are given to these clients to facilitate glucose uptake. Insulin injections may be given during times of stress-induced hyperglycemia. Oral insulin is not available because of the breakdown of the insulin by digestion. Options 1, 2, and 3 are incorrect.

A client with aldosteronism is being treated with spironolactone (Aldactone). Which finding indicates to the nurse that the medication is effective? 1. A decrease in body metabolism 2. A decrease in sodium excretion 3. A decrease in potassium excretion 4. A decrease in aldosterone production

4. A decrease in aldosterone production Rationale: Aldactone antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus, it produces a decrease in blood pressure. It increases the excretion of sodium and plasma potassium. It has no effect on body metabolism.

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A coagulation time of 5 minutes 2. A urinary output of 50 mL/hour 3. A blood urea nitrogen level of 20 mg/dL 4. A heart rate that is 90 beats/minute and irregular

4. A heart rate that is 90 beats/minute and irregular Rationale: The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagulation time of 5 minutes is normal. A urinary output of 50 mL/hour is an adequate output. A blood urea nitrogen level of 20 mg/dL is a normal finding.

The nurse is providing instructions to a client who will be self-administering eyedrops. To minimize systemic absorption of the eyedrops, the nurse should instruct the client to take which action? 1. Eat before instilling the drops. 2. Swallow several times after instilling the drops. 3. Blink vigorously to encourage tearing after instilling the drops. 4. Occlude the nasolacrimal duct with a finger after instilling the drops.

4. Occlude the nasolacrimal duct with a finger after instilling the drops. Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine (Synthroid) is prescribed. What is an expected outcome of the medication? 1. Alleviate depression 2. Increase energy levels 3. Increase blood glucose levels 4. Achieve normal thyroid hormone levels

4. Achieve normal thyroid hormone levels Rationale: Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.

A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)? 1. Hearing acuity 2. Blood glucose level 3. Presence of calf pain 4. Blood pressure and apical pulse

4. Blood pressure and apical pulse Rationale: Betaxolol is an antiglaucoma medication and a β-adrenergic blocker. Systemic effects of this medication are hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea. The client should have the blood pressure monitored for hypotension and the pulse assessed for strength, weakness, irregular rate, and bradycardia. Bowel activity and evidence of heart failure also should be assessed. The other options are incorrect and not associated with this medication.

The nurse is performing an assessment on a client with a suspected diagnosis of cataract. What is the chief clinical manifestation that the nurse expects to note in the early stages of cataract formation? 1. Diplopia 2. Eye pain 3. Floating spots 4. Blurred vision

4. Blurred vision Rationale: A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception. Options 1, 2, and 3 are not characteristics of a cataract.

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1. Infertility 2. Gynecomastia 3. Sexual dysfunction 4. Body image changes

4. Body image changes Rationale: Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia or hirsutism. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications.

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost (Xalatan) eye drops. Which assessment finding would indicate a side effect of these eye drops? 1. Irregular pulse 2. Periorbital edema 3. Elevated blood pressure 4. Brown pigmentation of the iris

4. Brown pigmentation of the iris Rationale: Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation does not progress further once the medication is discontinued but does not regress. The other options are not noted with this medication.

A client is diagnosed with pheochromocytoma. The nurse understands that pheochromocytoma is a condition that has which characteristic? 1. Causes profound hypotension 2. Is manifested by severe hypoglycemia 3. Is not curable and is treated symptomatically 4. Causes the release of excessive amounts of catecholamines

4. Causes the release of excessive amounts of catecholamines Rationale: Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamine also results in an excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. Pheochromocytoma is curable. The primary treatment is surgical removal of one or both of the adrenal glands, depending on whether the tumor is unilateral or bilateral.

A client with glaucoma is given a prescription for a pilocarpine ocular system. The nurse plans to provide which instruction to the client on how to use the medication? 1. Apply ½ inch into the eye at bedtime. 2. Apply 1 drop of the solution four times a day. 3. Remove and replace the ocular system every 48 hours. 4. Check the eye each morning to make sure that the system is in place.

4. Check the eye each morning to make sure that the system is in place. Rationale: The pilocarpine ocular system has a bilayered membrane surrounding a reservoir of pilocarpine solution. The tiny unit, which is placed in the conjunctival sac, slowly releases medication. The unit should be changed once a week. Because the unit may fall out during sleep, the client should check the eye each morning for its presence.

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? 1. Is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals 2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream 4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal Rationale: An insulin pump provides a small continuous dose of short-duration (rapid or short-acting) insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL. Which intervention should the nurse anticipate to be initially prescribed for the client? 1. Glucagon via the subcutaneous route 2. Glyburide (DiaBeta) via the oral route 3. Humulin N insulin via the subcutaneous route 4. Humulin R insulin via the intravenous (IV) route

4. Humulin R insulin via the intravenous (IV) route Rationale: The client is most likely in diabetic ketoacidosis (DKA). Humulin R insulin via the IV route is the preferred treatment for DKA. Humulin R insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemia agent used to treat diabetes mellitus type 2. Humulin N insulin is an intermediate-acting insulin and is not appropriate for the emergency treatment of DKA.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1. Glycosuria 2. Diaphoresis 3. Weight loss 4. Hypertension

4. Hypertension Rationale: Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms.

Lispro insulin (Humalog) is prescribed for the client, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin? 1. 45 minutes before eating 2. 60 minutes before eating 3. 90 minutes before eating 4. Immediately before eating

4. Immediately before eating Rationale: Lispro insulin acts more rapidly than regular insulin and has a shorter duration of action. The effect of lispro insulin begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction should the nurse include in the plan of care? 1. Instruct the client to maintain a low-potassium diet. 2. Encourage the client to consume a fluid intake of 3000 mL/day. 3. Encourage the client to increase the amounts of sodium intake in the diet. 4. Instruct the client to return to the clinic for monitoring of blood glucose levels.

4. Instruct the client to return to the clinic for monitoring of blood glucose levels. Rationale: Corticosteroid therapy can cause calcium and potassium depletion, sodium retention, and glucose intolerance. The client should be monitored for hyperglycemia. Also, an increase in potassium and a decrease in sodium intake are recommended to prevent potassium depletion and sodium retention while taking the corticosteroid. Although increased fluids are important for the client with emphysema to maintain thin respiratory secretions, this action is not specific to the use of corticosteroids.

Fludrocortisone acetate (Florinef) is prescribed for a client with Addison's disease. The nurse prepares to administer the medication. What is the primary action of this medication? 1. It promotes the excretion of water in the distal tubules of the kidney. 2. It promotes the retention of potassium in the distal tubules of the kidney. 3. It promotes the retention of hydrogen ions in the distal tubules of the kidney. 4. It enhances the reabsorption of sodium and chloride ions in the distal tubules of the kidney.

4. It enhances the reabsorption of sodium and chloride ions in the distal tubules of the kidney. Rationale: Fludrocortisone acetate has mineralocorticoid activity and also has a modest glucocorticoid effect. It acts primarily on the kidney distal tubules, enhancing the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. It promotes water retention.

The home care nurse is visiting a client with glaucoma who is receiving acetazolamide (Diamox) daily. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Diarrhea 2. Irritability 3. Lacrimation 4. Low back pain

4. Low back pain Rationale: Acetazolamide is a carbonic anhydrase inhibitor with possible harmful effects on the liver and kidneys. For a client with glaucoma, the medication is used to lower intraocular pressure. Manifestations of toxicity include dark-colored urine and stools, pain in the lower back, jaundice, dysuria, crystalluria, renal colic, and calculi. Bone marrow depression also may occur.

A client with retinal detachment is admitted to the nursing unit in preparation for a scleral buckling procedure. Which prescription should the nurse anticipate? 1. Allowing bathroom privileges only 2. Elevating the head of the bed to 45 degrees 3. Wearing dark glasses to read or watch television 4. Placing an eye patch over the client's affected eye

4. Placing an eye patch over the client's affected eye Rationale: The nurse places an eye patch over the client's affected eye to reduce eye movement. Some clients may need bilateral patching. Depending on the location and size of the retinal break, activity restrictions may be needed immediately. These restrictions are necessary to prevent further tearing or detachment and to promote drainage of any subretinal fluid. Therefore, reading and watching television are not allowed. The client's position is prescribed by the health care provider; normally the client's prescription is to lie flat.

A client must learn how to mix Humulin R and Humulin N insulin in the same syringe. The nurse should include which teaching point in the instructions to the client? 1. Keep both bottles in the refrigerator at all times. 2. Take all of the air out of the bottle before mixing. 3. Draw up the Humulin N insulin into the syringe first. 4. Rotate the Humulin N insulin bottle in the hands before mixing.

4. Rotate the Humulin N insulin bottle in the hands before mixing. Rationale: Before mixing different types of insulin, the Humulin N bottle should be rotated for at least 1 minute between both hands to resuspend the insulin and warm the medication. Humulin R insulin is drawn up before Humulin N insulin. Insulin can be stored at room temperature. Additional bottles of insulin for future use should be stored in the refrigerator. Air does not have to be removed from the insulin bottle.

The nurse is caring for a client with a diagnosis of Addison's disease. The nurse is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

4. Severe abdominal pain Rationale: Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in Addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. Options 1, 2, and 3 do not identify clinical manifestations associated with Addisonian crisis.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1. To stop the medication if side effects occur 2. To avoid taking the medication if nausea occurs 3. That minimal side effects will occur with use of this medication 4. That an increased dose of medication may be needed during times of stress

4. That an increased dose of medication may be needed during times of stress Rationale: The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the health care provider (HCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the HCP.

A client's vision is tested with a Snellen chart. The results of the tests are documented as 20/60. How should the nurse interpret this finding? 1. The client is legally blind. 2. The client's vision is normal. 3. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet. 4. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet.

4. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet. Rationale: Vision that is 20/20 is normal-that is, the client is able to read from 20 feet what a person with normal vision can read from 20 feet. A client with a visual acuity of 20/60 can only read at a distance of 20 feet what a person with normal vision can read at 60 feet.