Unit 1 adult health study questions
A nurse is teaching a client about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which disorder?
Addison's disease Rational: this test measures the cortisol response to ACTH, the response is absent or decreased in clients who have primary adrenal insufficiency
The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? A. Hypokalemia B. Fluid overload C. Hypoglycemia D. Hyperphosphatemia
Answer: A Rationale: Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate levels. A patient with diabetic ketoacidosis will be dehydrated (fluid volume deficit), and blood glucose levels would be elevated (hyperglycemia).
The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? A. The patient is alert and oriented. B. The patient's lung sounds are clear. C. The patient's urinary output decreases. D. The patient's potassium level is 5.7 mEq/L.
Answer: A Rationale: The patient in acute adrenal insufficiency will have the following clinical manifestations: hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion. Collaborative care will include administration of corticosteroids. An outcome that would indicate patient improvement would be improved level of consciousness (i.e., alert and oriented).
A patient has a serum calcium (total) level of 13.4 mg/dL (3.35 mmol/L). Which disorder would the nurse suspect? A. Hyperphosphatemia B. Hyperparathyroidism C. Magnesium deficiency D. Type 2 diabetes mellitus
Answer: B Rationale: A normal serum calcium (total) is 8.6 to 10.2 mg/dL (2.15 to 2.55 mmol/L). The patient with a serum calcium level of 13.4 mg/dL has hypercalcemia. Serum calcium levels are increased in hyperparathyroidism.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? A. "You will develop type 2 diabetes within 5 years." B. "You are at increased risk for developing diabetes." C. "The test is normal, and diabetes is not a problem." D. "The laboratory test result is positive for type 2 diabetes."
Answer: B Rationale: Impaired fasting glucose (fasting blood glucose level between 100 and 125 mg/dL) and impaired glucose tolerance (2-hour plasma glucose level between 140 and 199 mg/dL) represent an intermediate stage between normal glucose homeostasis and diabetes. This stage is called prediabetes, and patients are at increased risk for the development of type 2 diabetes.
A patient with thyroid nodules is to undergo a thyroid scan with oral radioactive isotopes. Which instructions, if given by the nurse, are appropriate? A. "The test cannot be completed if you have an allergy to iodine or shellfish." B. "It is important to drink at least 2 to 3 liters of liquids for the next 1 to 2 days." C. "Isolation is required for 24 hours until the radioactive substance is eliminated from the body." D. "Sedation is necessary to ensure that you do not move while the scanner moves over your neck."
Answer: B Rationale: Patients should drink increased amount of fluids for 24 to 48 hours unless this is contraindicated. No special precautions are needed. The radionuclide will be eliminated in 6 to 24 hours. Reaction to iodine in allergic patients is rare because the amount of iodine in preparation is minimal. Sedation is not necessary for this procedure.
An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? A. "The medication prevents sodium and water retention after surgery." B. "The drug prevent clots from forming in the legs during your recovery from surgery." C. "This medicine is given to help your body respond to stress after removal of the adrenal glands." D. "This drug stimulates your immune system and promotes wound healing."
Answer: C Rationale: Hydrocortisone is administered IV during and after a bilateral adrenalectomy to ensure adequate responses to the stress of the procedure.
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to A. Withhold the regular dose of insulin. B. Drink cool fluids with high glucose content. C. Check the blood glucose level every 2 to 4 hours. D. Use a less strenuous form of exercise than usual until the illness resolves.
Answer: C Rationale: If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2- to 4-hour intervals to determine the effects of this stressor on the blood glucose level.
The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goal is most appropriate? A. Make all patients responsible for the management of their disease. B. Involve the family and significant others in the care of these patients. C. Enable the patients to become active participants in the management of their disease. D. Provide the patients with as much information as soon as possible to prevent complications.
Answer: C Rationale: The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.
The nurse is caring for a patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? A. The patient complains of increased thirst. B. The patient reports a sore throat when swallowing. C. The patient supports her head when moving in bed. D. The patient makes harsh, vibratory sounds when breathing.
Answer: D Rationale: After thyroid surgery, the patient may experience an airway obstruction related to excess swelling, hemorrhage, hematoma formation, or laryngeal stridor (harsh, vibratory sound). Emergency equipment should be at the bedside, including oxygen, suction equipment, and a tracheostomy tray.
A patient is exhibiting signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first? A. Total thyroxine (T4) B. Thyroid antibodies (Ab) C. Free triiodothyronine (FT3) D. Thyroid-stimulating hormone (TSH)
Answer: D Rationale: The most sensitive and accurate laboratory test is measurement of TSH, and it is often recommended as a first diagnostic test for evaluation of thyroid function. If the TSH is abnormal, the other laboratory tests may be ordered.
A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include? A. Consume no more than three servings of alcohol per day B. Ingest alcohol with food to reduce alcohol-induced hypoglycemia C. Increase insulin dosage before planned exercise D. Rest for 3 days between periods of vigorous exercise.
B. Ingest alcohol with food to reduce alcohol-induced hypoglycemia Rationale: alcohol inhibits the liver from producing glucose, eating carbs while drinking helps prevent hypoglycemia
A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include? A. Inject the insulin IM B. Shake the insulin's vigorously prior to admin C. Draw up the insulin's into separate syringes D. Expect the insulin's to appear cloudy
C. Draw up the insulin's into separate syringes Rationale: insulin glargine isn't compatible with other insulins
A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of diabetic ketoacidosis (DKA)? A. Decreased urine output B. Weight gain of 0.45 kg (1 lb) in 24 hr C. Rapid, shallow repirations D. Blood glucose levels above 300 mg/dL
D. Blood glucose levels above 300 mg/dL Rationale: levels above 600mg/dL are an expected finding with hyperglycemic-hyperosmolar state
A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse should expect an elevation in which of the following laboratory findings? A. Lymphocyte count B. Potassium C. Calcium D. Glucose
Glucose Rationale: Cushing's syndrome causes elevated sugar levels
A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Which of the following findings indicates that the client is having a therapeutic response? A. Reduction of the effects of thyroid hormone on the heart B. Blockage of the release of thyroid hormone from the thyroid gland C. Increase in the heart's sensitivity to thyroid hormone D. Increase in the uptake of thyroid hormone by the thyroid gland
Reduction of the effects of thyroid hormone on the heart Rationale: propranolol is a beta2-adrenergic blocking agent that decreases the rapid heart rate that excessive thyroid stimulation causes
To screen a client for pheochromocytoma, a nurse schedules a vanillylmandelic acid test. When teaching the client about this test, which of the following instructions should the nurse include? A. "Start fasting at midlight prior to the day or the test." B. "Begin the 24-hr urine collection with the first morning urination" C. "Take low-dose aspirin for pain during the testing period." D. "Restrict coffee intake 2 to 3 days prior to the test."
Restrict coffee intake 2 to 3 days prior to the test Rationale: patients should avoid coffee, tea (even if they are decaffeinated), bananas, chocolate, and vanilla
A nurse is caring for a client who has type 2 diabetes melliltus and has hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? A. Serum pH of 7.32 B. Blood glucose of 250 mg/dL C. Blood glucose of 425 mg/dL D. Serum pH of 7.45
Serum pH of 7.45 Rationale: a client who has HHS produces enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range. Glucose will be above 600mg/dL
