Practice Questions (4701 exam 1)

A patient with cirrhosis has blood drawn at 06:00 and their serum potassium is reported to be 3.2 mEq/L. The nurse is administering 08:00 medications to this patient and notices doses of both spironolactone and furosemide are due at 08:00. Which action should the nurse take? A. Administer only the spironolactone B. Administer only the furosemide C. Hold both drugs D. Give both drugs

*A. Administer only the spironolactone* -spironoloactone is potassium sparing -furosemide: loop diuretic would flush out fluid, and potassium would go lower too *a good way to remember spironolactone is potassium sparing is that it starts with "sp" -- "sparing potassium"

Will these events inhibit or stimulate the release of ADH? 1. Hemorrhage 2. Hypotension 3. Drinking a liter of water in 10 minutes 4. A serum osmolality of 275 mOsm/kg

1. stimulate (ADH release is triggered by high osmolality and/or hypotension) 2. stimulate (ADH release is triggered by high osmolality and/or hypotension) 3. inhibit (too much fluid!!) 4. inhibit (this is a low normal osmolalilty; ADH is triggered by HIGH osmolality)

You are caring for a patient following surgical removal of a pituitary adenoma using a transsphenoidal approach. Your postoperative care for this patient will include A. maintaining the HOB at a 30 degree angle B. monitoring surgical drainage for presence of glucose C. assessing for changes in peripheral vision D. reporting a urine output of >200 mL/hour for more than 3 consecutive hours

A, B, C, D A: decreases pressure on the sella turcica and decreases headaches B: presence of glucose could indicate a possible CSF leak, increasing risk for meningitis C: hematoma at the site could compress the optic nerve D: could signal diabetes insipidus

A nursing student is helping the nurse care for a patient who is post-op day 2 after undergoing an open cholecystectomy to treat cholecystitis. The patient has a T-tube in place. Which information will the nurse teach the student regarding T-tube care. (Select all that apply) A. The drainage in the T-tube bag should be yellowish/green in color B. The T-tube should routinely be clamped 1 hour before and 1 hour after meals C. The T-tube is located in the common bile duct. D. T-tube bag should be below or at the patient's waist level

A, C, D

Which IV solution can be used to treat hypernatremia? A. 0.45% Normal Saline B. 0.9% Normal Saline C. Lactated Ringers (LR) D. 3% Normal Saline

A. 0.45% Normal Saline This is a hypotonic solution When a patient is HYPERtonic, they will receive HYPOtonic solutions

Which conditions do each of these lab results suggest? A. elevated cortisol levels in plasma, urine, and/or saliva B. elevated plasma ACTH levels & elevated cortisol levels C. low plasma ACTH levels and elevated cortisol levels

A. Cushing's Syndrome B. Pituitary tumor (Cushing's disease) - because ACTH is released from the pituitary and in this case, the pituitary would likely be releasing too much ACTH from the tumor and the adrenal glands are just responding to it (so the problem is in the pituitary) C. Adrenal tumor (tumor in adrenal gland causing excess excretion, and pituitary gland is just responding by inhibiting ACTH release)

A nurse is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech

A. Hand tremors

Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter

A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F A patient is at risk for experiencing thyroid storm after a thyroidectomy because of manipulation of the thryroid gland that could cause excessive T3 and T4 to enter into the bloodstream during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 'F are classic signs of thyroid storm and this requires nursing intervention.

A patient has a total serum calcium level of 3 mg/dL. If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal A. decreased serum PTH B. increased serum ACTH C. increased serum glucose D. decreased serum cortisol levels

A. decreased serum PTH normal Ca = 8.6-10.2 PTH increases serum calcium

A high calcium, low phosphorus diet is most appropriate for a patient with A. hypoparathyroidism B. hyperparathyroidism C. posterior pituitary disorders D. normal thyroid function

A. hypoparathyroidism hypoparathyroidism results in low serum calcium and high serum phosphorus. Dietary adjustments may be part of the collaborative care plan for the patient

A patient is receiving radioactive iodine treatment for hyperthyroidism. What will you include in your patient education to this patient about this type of treatment? A. Taste changes and swollen salivary glands B. Constipation C. Excessive thirst D. Sun protection

A: taste changes and swollen salivary glands

The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Note: Select all that apply A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland

B, C, and E T3 and T4 burn calories (not store them) and increases body temperature (not decrease).

The healthcare provider prescribes levothyroxine for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines further instruction is needed when the patient says: A. "I can expect the medication dose may need to be adjusted." B. "I only need to take this drug until my symptoms are improved." C. "I can expect to return to normal function with the use of this drug." D. "I will report any chest pain or difficulty breathing to the doctor right away."

B. "I only need to take this drug until my symptoms are improved."

In liver failure, a prolonged INR will decrease (improve) with the administration of vitamin K. A. True B. False

B. False Usually vitamin K would help with clotting in a coumadin overdose, however, since this example involves liver failure, the liver is not making clotting factors (factor XII) so vitamin K wouldn't be enough to fix the coagulation cascade *would give fresh frozen plasma instead

The goal for Lactulose for the person with hepatic encephalopathy is to have how many bowel movements per day? A. One B. Two to three C. Four to five D. Six to seven

B. Two to three

Chovstek's sign and Trousseau's sign are indicators of A. hypophosphatemia B. hypocalcemia C. hypercalcemia D. postoperative swelling

B. hypocalcemia

Which liver function test is most likely to be elevated when a person is experiencing common bile duct inflammation? A. Aspartate aminotransaminase B. Alanine aminotransferase C. Alkaline phosphatase

C. Alkaline phosphatase

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include A. hypernatremia and edema B. muscle spasticity and hypertension C. low urine output and hyponatremia D. weight gain and decreased glomerular filtration rate

C. low urine output and hyponatremia SIADH might cause edema and weight gain (but the other answers with these options were wrong)

Which of the following is true about a patient receiving Radioactive Iodine Therapy for hyperthyroidism? A. the patient should experience immediate relief of symptoms B. hypothyroidism may occur, but is a very rare side effect of treatment C. the patient may experience dryness and irritation of the mouth and throat D. there is no need for the patient to take extra precautions because he/she cannot expose others to radiation following treatment

C. the patient may experience dryness and irritation of the mouth and throat

Which of the following complications of cholelithiasis presents with fever, tachycardia, and jaundice? A. Cholecystitis B. Cholangitis C. Pancreatitis D. All of the above

D. All of the above

A patient has just been diagnosed with obstructive jaundice that is caused by gallstones in the common bile duct. This could result in: A. A normal Unconjugated (indirect) Bilirubin B. An elevated Conjugated (direct) Bilirubin C. An elevated Total Bilirubin D. All of the above

D. All of the above conjugated bilirubin is unable to travel to the common bile duct, so conjugated bilirubin leaks into bloodstream (?)

A patient has a diagnosis of obstructive jaundice due to gallstones in the common bile duct. The nurse would expect to observe for: A. Dark brown stools and straw yellow urine B. Green stools and pale yellow urine C. Melena D. Clay colored stools and dark orange urine

D. Clay colored stools and dark orange urine

A nurse is reviewing the health record of a patient who is being evaluated for Graves' disease. The nurse identifies the following lab result as an expected finding: A. Decreased thyrotropin receptor antibodies B. Decreased free T4 C. Decreased T3 D. Decreased TSH

D. Decreased TSH

Which of the following is NOT a risk factor for cholesterol gallstones? A. Pregnancy B. Rapid weight loss C. Being female D. Hypertension

D. Hypertension

A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism

D. Hypothyroidism Iodine helps make T3 and T4....if a person does not consume enough iodine they are at risk for developing HYPOTHYROIDISM

A common clinical manifestation of covert hepatic encephalopathy is: A. Inappropriate behavior B. Drowsiness C. Slurred speech D. Short term memory loss

D. Short term memory loss they look pretty normal in the covert stage

Which is the most sensitive test for detecting thyroid dysfunction? A. Calcitonin B. Free T4 C. T3 D. TSH

D. TSH hyperthyroidism: low TSH hypothyroidism: high TSH

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops A. muscle weakness and weight loss B. hyperthermia and severe tachycardia C. hypertension and difficulty swallowing D. laryngospasms and tingling in the hands and feet

D. laryngospasms and tingling in the hands and feet hypocalcemia can cause laryngeal stridor and spasms of smooth and skeletal muscle

A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply: A. Fentanyl B. Tylenol C. Morphine D. Dilaudid

The answers are A, C, and D. Patients who have hypothyroidism are very sensitive to narcotics and should take NON-NARCOTICS for pain relief. Fentanyl, Morphine, and Dilaudid are all narcotics, whereas, Tylenol is not.

A charge nurse is providing information about fat emulsion added to total parenteral nutrition (TPN) to a group of nurses. Which of the following statements by the charge nurse are appropriate? (select all that apply). a. "Concentration of lipid emulsion can be up to 30%" b. "Adding lipid emulsion gives the solution a milky appearance" c. "Check for allergies to soybean oil" d. "Lipid emulsion prevents essential fatty acid deficiency" e. "Lipids provide calories by increasing the osmolality of the PN solution"

a, b, c, d

A nurse is planning care for a client who has a new prescription for peripheral parenteral nutrition (PPN). Which of the following actions should the nurse include in the plan of care? (Select all that apply). a. Examine trends in weight loss b. Review prealbumin finding c. Administer an IV solution of 20% dextrose d. Add a micron filter to IV tubing e. Use an IV infusion pump

a, b, d, e

A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag of an assigned client is empty. Which of the following solutions readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? a. 10% dextrose in water. b. 5% dextrose in water. c. 5% dextrose in normal saline. d. 5% dextrose in lactated Ringer solution

a. 10% dextrose in water. The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the highest amount of glucose until the new parenteral nutrition solution becomes readily available.

A nurse is caring for a client who is receiving TPN through a central venous access device, but the next bag of solution is not available for administration at this time. Which of the following is an appropriate action by the nurse? a. Administer 20% dextrose in water IV until the next bag is available b. Slow the infusion rate of the current bag until the solution is available c. Monitor for hyperglycemia d. Monitor for hyperosmolar diuresis

a. Administer 20% dextrose in water IV until the next bag is available

A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order? a. Decrease the PN rate to 60ml/hr. b. Start 0.9% normal saline at 30 ml/hr. c. Maintain the present infusion rate. d. Discontinue the PN.

a. Decrease the PN rate to 60ml/hr.

A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials? a. Send them to the laboratory for culture. b. Save them for a return to the manufacturer. c. Return them to the hospital pharmacy. d. Discard them in the unit trash.

a. Send them to the laboratory for culture.

A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions? a. Take another bottle of solution. b. Runs the bottle solution under a warm water. c. Rolls the bottle solution gently. d. Shake the bottle solution vigorously.

a. Take another bottle of solution.

A charge nurse is teaching a group of nurses about medication compatibility with TPN. Which of the following statements should the charge nurse make? a. "Use the y-port on the TPN IV tubing to administer antibiotics." b. "Regular insulin can be added to the TPN solution." c. "Administer heparin through a port on the TPN tubing." d. "Administer vitamin K IV bolus via a Y-port on the TPN tubing

b. "Regular insulin can be added to the TPN solution."

A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse gives: a. 20% lipid emulsion b. 5% dextrose solution c. 0.45% normal saline solution d. 5% lactated ringer's solution

b. 5% dextrose solution

A patient is admitted with a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test? a. Urinary 17-ketosteroids b. Antidiuretic hormone level c. Growth hormone stimulation test d. Adrenocorticotropic hormone level

b. Antidiuretic hormone level Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient's hyponatremia.

A patient is receiving total parenteral nutrition (TPN). What is the primary intervention the nurse should follow to prevent a central line infection? a. Institute isolation precautions b. Clean the central line port through which the PN is infusing with antiseptic c. Change the PN tubing every 24 hours d. Monitor glucose levels to watch and assess for glucose intolerance

b. Clean the central line port through which the PN is infusing with antiseptic

A nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse ask the client to take which essential action during the tube change? a. Turn the head to the right. b. Inhale deeply, hold it, and bear down. c. Breathe normally. d. Exhale slowly and evenly

b. Inhale deeply, hold it, and bear down. The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tube changes. The nurse asks the client to take a deep breath, hold it, and bear down. Option A is incorrect because if the intravenous line is on the right, the client turns his or head to the left. This position increases intrathoracic pressure. Options C and D can cause the potential for an air embolism during the tube change.

A nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions? a. Adjust the infusion rate to catch up over the next hour. b. Make sure the infusion rate is infusing at the ordered rate. c. Increase the infusion rate to catch up over the next few hours. d. Adjust the infusion rate to full blast until the solution is back on time.

b. Make sure the infusion rate is infusing at the ordered rate.

During a physical examination, the nurse finds that a patients thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patients neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

b. document that the thyroid was nonpalpable. The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition? a. A 55-year-old with persistent nausea and vomiting from chemotherapy. b. A 44-year old client with ulcerative colitis. c. A 59-year old client who had an appendectomy. d. A 25-year old client with a Hirschprung's Disease

c. A 59-year old client who had an appendectomy.

Nurse Spencer is caring for an anorexic client who is having total parenteral nutrition solution for the first time. Which of the following assessments requires the most immediate attention? a. Dry sticky mouth. b. Temperature of 100° Fahrenheit. c. Blood glucose of 210 mg/dl. d. Fasting blood sugar of 98 mg/dl

c. Blood glucose of 210 mg/dl.

The patient's blood glucose level is 330 mg/dL. What is the priority nursing intervention? a. Recheck by performing another blood glucose test b. Call the primary health care provider c. Check the medical record to see if there is a medication order for abnormal glucose levels d. Monitor and recheck in 2 hours

c. Check the medical record to see if there is a medication order for abnormal glucose levels

A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse next assesses which of the following items? a. Time of last dressing change. b. Tightness of the tuning connections. c. Client's temperature. d. Expiration date on the bag.

c. Client's temperature.

A nurse is preparing to administer lipid emulsion and notes a layer of fat floting in the IV solution bag. Which of the following actions should the nurse take? a. Shake the bag to mix the fat. b. Turn the bag upside down one time c. Return the bag to the pharmacy d. Administer the bag of solution as is

c. Return the bag to the pharmacy

Your patient has mild jaundice. His serum bilirubin lab results show: -unconjugated (indirect) bilirubin is very elevated -conjugated (direct) bilirubin is normal This could be the result of: a. Bile duct obstruction b. Acute viral hep B infection c. Sickle cell crisis d. tylenol induced hepatitis

c. Sickle cell crisis excessive hemolysis (pre-hepatic jaundice)

A patient with Cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which intervention by the nurse will be most helpful? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. d.Remind the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.

c. Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss

d. Hair loss

The nurse is interviewing a patient who has a possible thyroid disorder. Which question will provide the most useful information? a. What methods do you use to help cope with stress? b. Have you experienced any blurring or double vision? c. Do you have to get up at night to empty your bladder? d. Have you had any recent unplanned weight gain or loss?

d. Have you had any recent unplanned weight gain or loss? Because thyroid function affects metabolic rate, changes in weight may indicate hyper- or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution? a. Glucometer. b. Dressing tray. c. Nebulizer. d. Infusion pump.

d. Infusion pump.

A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation? a. On the right side, with head higher than the feet. b. On the right side, with head lower than the feet. c. On the left side, with the head higher than the feet. d. On the left side, with head lower than the feet

d. On the left side, with head lower than the feet ir embolism happens when air enters the catheter system when the IV tubing disconnects. If it is suspected, the client should be placed in a left-side-lying position. The head should be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.

A patient receiving parenteral nutrition is administered via the following routes except: a. Subclavian line. b. Central Venous Catheter. c. PICC (Peripherally inserted central catheter) line. d. PEG tube.

d. PEG tube

A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy? a. Air embolism. b. Hypervolemia. c. Hyperglycemia. d. Pneumothorax.

d. Pneumothorax. Pneumothorax might happen during a parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement.

The nurse is preparing to hang a bag of fat emulsion and notices a thin oily layer on the surface of the mixture. The nurse should a. Administer the bag using an IV infusion pump and stop the infusion when it reaches the level of the oily layer b. Gently tip the bag back and forth to recombine the contents c. Vigorously shake the bag to ensure that contents are fully recombined before administering d. Return the bag to pharmacy and request a new one

d. Return the bag to pharmacy and request a new one

A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy? a. Blood pressure and temperature. b. Blood pressure and pulse rate. c. Height and weight. d. Temperature and weight.

d. Temperature and weight. temp signifies infection weight monitors for hypervolemia and measures efficacy

A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia? a. High-grade fever, chills, and decreased urination. b. Fatigue, increased sweating, and heat intolerance. c. Coarse dry hair, weakness, and fatigue. d. Thirst, blurred vision, and diuresis.

d. Thirst, blurred vision, and diuresis.

A patient has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for a. calcitonin levels. b. catecholamine levels. c. thyroid hormone levels. d. parathyroid hormone levels.

d. parathyroid hormone levels. Parathyroid hormone is the major controller for blood calcium levels. Although calcitonin secretion is a counter mechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

Does antidiuretic hormone increase or decrease the amount of water that is excreted in the urine?

decrease