Ad. Health Exam 3
A nurse is caring for a client who has diabetes mellitus and developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to his feet?: 1. examine the skin and feet weekly for alterations in skin integrity 2. monitor the temperature of bath water with a thermometer 3. shop for shoes early in the day 4. round the edges of toenails when trimming them
ANSWER: monitor the temperature of bath water with a thermometer RATIONALE: -peripheral neuropathy makes it difficult to determine of bath water is too hot -therefore, to prevent injury, the client should use a bath thermometer to ensure a water temperature below 43.3 C (110 F)
A nurse is performing an assessment on a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessment data should the nurse report?: 1. sodium 110 mEq/L 2. 2+ deep-tendon reflexes 3. potassium 3.7 mEq/L 4. urine specific gravity 1.025
ANSWER: sodium 110 mEq/L RATIONALE: a client who has SIADH retains fluids, which causes dilutional hypoatremia
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when a patient develops: 1. muscle weakness and weight loss 2. hyperthermia and severe tachycardia 3. hypertension and difficulty swelling 4. laryngospasms and tingling in the hands and feet
laryngospasms and tingling in the hands and feet
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings?: 1. cold intolerance 2. lethargy 3. tremors 4. sunken eyes
tremors
A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect?: 1. decreased blood pressure 2. weight loss 3. hirsutism 4. increased skin thickness
ANSWER: hirsutism RATIONALE: increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production
The client with type 1 diabetes is taught to take NPH (Humulin N) at 5 p.m. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at which time?: 1. 11 a.m. shortly before lunch 2. 1 p.m. shortly after lunch 3. 6 p.m. shortly after dinner 4. 1 a.m. while sleeping
1 a.m. while sleeping
The healthcare provider prescribes Levothyroxine (Synthroid) for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says: 1. "I can expect the medication dose may need adjusted." 2. "I only need to take this drug until my symptoms improve." 3. "I can expect to return to normal function with the use of this drug." 4. "I will report any chest pain or difficulty breathing to the doctor right away."
"I only need to take this drug until my symptoms improve."
A nurse is providing teaching for a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements indicates that the client understands the teaching?: 1. "I should stop taking my insulin if I feel nauseous." 2. "I will test my urine for protein when I start to feel ill." 3. "I will call my doctor if my blood sugar is more than 250 mg/dL." 4. "I should check my blood glucose level every 8 hours."
"I will call my doctor if my blood sugar is more than 250 mg/dL."
The nurse is caring for an immunocompromised patient. Which of the following statements about infection in this patient is true? (Select all that apply): 1. classic symptoms of infection are often absent 2. fever may be the only symptom of infection 3. infections with opportunistic pathogens must be assessed 4. the condition is always permanent
-classic symptoms of infection are often absent -fever may be the only symptom of infection -infections with opportunistic pathogens must be assessed
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to (Select all that apply): 1. increase Ca intake to 1500 mg/day 2. perform glucose monitoring for hypoglycemia 3. obtain immunizations due to high risk for infections 4. avoid abrupt position changes because of orthostatic hypotension
-increase Ca intake to 1500 mg/day -obtain immunizations due to high risk for infections
Important nursing intervention(s) when caring for a patient with Cushing syndrome include (Select all that apply): 1. restricting protein intake 2. monitoring blood glucose levels 3. observing for signs of hypotension 4. administering medication in equal doses 5. protecting patient from exposure to infection
-monitoring blood glucose levels -protecting patient from exposure to infection
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following effects should the nurse include? (Select all that apply): 1. osteoporosis 2. moon-shaped face 3. increased risk of infection 4. hearing loss 5. weight loss
-osteoporosis -moon-shaped face -increased risk of infection
A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia?: 1. strong, bounding pulse 2. decreased bowel sounds 3. tingling and numbness of the hands and feet 4. diminished deep-tendon reflexes
ANSWER: RATIONALE: hypocalcemia causes paresthesias, which usually starts in the hands and feet
A nurse is providing discharge teaching for a client who has diabetes insipidus and has a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?: 1. "Depress the pump once before using the nasal spray for the first time." 2. "Blow your nose gently prior to using the nasal spray." 3. "Administer the nasal spray while in a side-lying position." 4. "Instill the medication four times per day."
ANSWER: "Blow your nose gently prior to using the nasal spray." RATIONALE: this action prevents dilution of the medication with nasal secretions
A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching?: 1. "I will let my feet air dry after washing." 2. "I will wear sandals to allow air to circulate around my feet." 3. "I will buy over-the-counter medicine to treat the calluses on my feet." 4. "I will apply lotion to the dry areas of my feet, but not between my toes."
ANSWER: "I will apply lotion to the dry areas of my feet, but not between my toes." RATIONALE: lotion can be used for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth
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?: 1. "Start fasting at midnight prior to the day of the test." 2. "Begin the 24-hour urine collection with the first morning urination." 3. "Take low-dose Aspirin for pain during the testing period." 4. "Restrict coffee intake 2-3 days prior to the test."
ANSWER: "Restrict coffee intake 2-3 days prior to the test." RATIONALE: the client should avoid coffee and tea (even if they are decaffeinated), bananas, chocolate, and vanilla 2-3 days prior to the test
A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement. Which of the following instructions should the nurse plan to include?: 1. "Take this medication on an empty stomach." 2. "Take this medication with an antacid." 3. "Change position slowly while taking this medication." 4. "Limit your fluid intake while taking this medication."
ANSWER: "Take this medication on an empty stomach." RATIONALE: to promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30-60 mins after taking it
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following statements by the client indicates an understanding of the information about this test?: 1. "I need to fast after midnight the night before the test." 2. "This test's result is a good indicator of my average blood glucose levels." 3. "A level of 8-10% suggests adequate blood glucose control." 4. "I will use my hemoglobin A1C level to adjust my daily insulin doses."
ANSWER: "This test's result is a good indicator of my average blood glucose levels." RATIONALE: HbA1C reflects the client's glucose levels over a 120-day period, which is the life span of RBCs
A nurse is preparing to give a client information about an adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders?: 1. diabetes insipidus 2. hyperthyroidism 3. pheochromocytoma 4. Addison's disease
ANSWER: Addison's disease RATIONALE: -the nurse should instruct the client that the ACTH stimulation test is the standard test for Addison's disease -it measures the cortisol response to ACTH -the response is absent or very decreased in clients who have primary adrenal insufficiency
A nurse is managing care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take?: 1. administer IV hydrocortisone sodium 2. give oral spironolactone 3. infuse 1 unit of platelets 4. restrict daily fluid intake
ANSWER: administer IV hydrocortisone sodium succinate RATIONALE: hydrocortisone sodium succinate necessary to replace the cortisol deficiency that occurs with adrenal insufficiency
A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect?: 1. moon face 2. weight gain 3. calcium 12.8 mg/dL 4. sodium 150 mEq/L
ANSWER: calcium 12.8 mg/dL RATIONALE: a client who has adrenal insufficiency has a calcium level above the expected reference range
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: 1. hold the regular dose of insulin 2. drink cool fluids with high glucose content 3. check the blood glucose level every 2-4 hours 4. use a less strenuous form of exercise than usual until the illness resolves
ANSWER: check the blood glucose level every 2-4 hours 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
A nurse is preparing insulin for a client who has diabetes mellitus. The client is to receive evening doses of insulin glargine and regular insulin. Which of the following actions should the nurse take to administer these two medications safely?: 1. inject the insulins intramuscularly 2. shake the insulins vigorously prior to administration 3. draw up the insulins into separate syringes 4. expect the insulins to appear cloudy
ANSWER: draw up the insulins into separate syringes RATIONALE: the nurse should instruct the client to draw up the insulins into separate syringes because insulin glargine is not compatible with other insulins
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify: 1. dysrhythmias resulting from hypokalemia 2. fluid overload resulting from aggressive fluid replacement 3. the presence of hypovolemic shock related to osmotic diuresis 4. cardiovascular collapse resulting from the effects of excess glucose on cardiac cells
ANSWER: dysrhythmias resulting from hypokalemia RATIONALE: -electrolytes are depleted in diabetic ketoacidosis -osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate -hypokalemia may lead to ventricular dysrhythmias such as premature ventricular complexes and bradycardia
A nurse is planning preoperative care for a client who has pheochromocytoma. Which of the following interventions should the nurse anticipate as being the priority?: 1. elevate the head of the client's bed 2. palpate the client's abdomen 3. monitor the client for hypotension 4. check the client's urine specific gravity
ANSWER: elevate the head of the client's bed RATIONALE: the nurse should elevate the head of the client's bed to reduce blood pressure and abdominal pressure
Ideally, the goal of patient diabetes education is to: 1. make all patients responsible for the management of their disease 2. involve the patient's family and significant others in the care of the patient 3. enable the patient to become the most active participant in the management of the diabetes 4. provide the patient with as much information as soon as possible to prevent complications of diabetes
ANSWER: enable the patient to become the most active participant in the management of the diabetes RATIONALE: the goal of diabetes education is to enable the patient to become the most active participant in his/her own care
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings?: 1. decreased heart rate 2. increased hematocrit 3. high urine specific gravity 4. low BUN
ANSWER: increased hematocrit RATIONALE: an expected finding resulting from dehydration
A nurse is planning dietary teaching for a client who has type 1 diabetes mellitus. Which of the following information should the nurse include regarding alcohol consumption?: 1. consume no more than 3 servings of alcohol per day 2. ingest alcohol with food to reduce alcohol-induced hypoglycemia 3. increase insulin dosage before planned exercise 4. rest for 3 days between periods of vigorous exercise
ANSWER: ingest alcohol with food to reduce alcohol-induced hypoglycemia RATIONALE: -alcohol inhibits the liver from producing glucose -consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia
A nurse is monitoring a client's status 24 hr after a total thyroidectomy. Which of the following findings should the nurse report to the provider?: 1. laryngeal stridor 2. productive cough 3. pain with hyperextension of the neck 4. hoarse, weak voice
ANSWER: laryngeal stridor RATIONALE: -laryngeal stridor is a harsh, high-pitched sound with inspiration that indicates respiratory obstruction -the nurse should take immediate action to preserve the client's airway
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect?: 1. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L 2. pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L 3. pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L 4. pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L
ANSWER: pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L RATIONALE: metabolic acidosis is a common manifestation of DKA, with pH characteristically low, carbon dioxide within the expected reference range, and bicarbonate low
A nurse is preparing to administer Propranolol by IV bolus to a client experiencing a thyroid storm. Which of the following findings indicates the client is having a therapeutic response?: 1. reduction of the effects of thyroid hormone on the heart 2. blockage of the release of thyroid hormone from the thyroid gland 3. increase in the heart's sensitivity to thyroid hormone 4. increase in the uptake of thyroid hormone by the thyroid gland
ANSWER: 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
A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmol/L). The nurse explains to the patient that this value: 1. is diagnostic for diabetes 2. is normal and diabetes is not a problem 3. reflects impaired glucose tolerance, which is an early stage of diabetes 4. indicates an intermediate stage between normal glucose use and diabetes
ANSWER: reflects impaired glucose tolerance, which is an early stage of diabetes RATIONALE: -impaired fasting glucose (fasting blood glucose level between 100 and 126 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
A nurse is preparing a teaching plan for a client who has diabetes insipidus and is receiving intranasal Desmopressin. Which of the following information should the nurse include in the teaching plan?: 1. drink at least 3 L of fluid per day 2. weight yourself weekly while wearing similar clothing at the same time of day 3. notify the provider of a weight loss of 0.45 kg (1 lb) or more per week 4. report nocturia because it requires a dosage adjustment
ANSWER: report nocturia because it requires a dosage adjustment RATIONALE: -the client should receive the initial dose of Desmopressin in the evening -the provider will increase the dosage until the client no longer has nocturia
A nurse is caring for a client who has type 2 diabetes mellitus and is admitted with hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect?: 1. serum pH of 7.32 2. blood glucose of 250 mg/dL 3. blood glucose of 425 mg/dL 4. serum pH of 7.45
ANSWER: 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 levels will be above 600 mg/dL
A nurse is caring for a client who is taking Propylthiouracil (PTU). The nurse should recognize that the client has met the treatment goals when she reports an increase in which of the following effects?: 1. sweating 2. stools 3. weight 4. appetite
ANSWER: weight RATIONALE: -Propylthiouracil suppresses the production of thyroid hormones and therefore, allows for weight gain -however, excessive weight gain could indicate that the dose is too high
A client who had received 25 mL of packed red cells has low back pain and pruritis. After stopping the infusion, the nurse should take what action next?: 1. administer prescribed antihistamine and Aspirin 2. collect blood and urine samples and send to the lab 3. administer prescribed diuretics 4. administer prescribed vasopressors
collect blood and urine samples and send to the lab
A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic?: 1. rapid, deep respirations 2. cool, clammy skin 3. abdominal cramping 4. orthostatic hypotension
cool, clammy skin
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to: 1. monitor blood glucose levels 2. restrict fluid and sodium intake 3. administer potassium-sparing diuretics 4. advise the patient to make postural changes slowly
administer potassium-sparing diuretics
A nurse is providing teaching for a client who has diabetes mellitus. Which of the following findings associated with diabetic ketoacidosis (DKA) should the nurse include?: 1. decreased urine output 2. weight gain of 0.45 kg (1 lb) in 24 hr 3. rapid, shallow respirations 4. blood glucose levels above 300 mg/dL
blood glucose levels above 300 mg/dL
Following a transphenoidal hypophysectomy, the nurse should assess the client for: 1. cerebrospinal fluid (CSF) 2. fluctuating blood glucose levels 3. Cushing's syndrome 4. cardiac arrythmias
cerebrospinal fluid (CSF)
The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is: 1. once a day at bedtime 2. every other day on awakening 3. on arising and in the late afternoon 4. at constant intervals every 6-8 hours
on arising and in the late afternoon
A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy?: 1. fasting blood glucose 96 mg/dL 2. postprandial blood glucose 195 mg/dL 3. casual blood glucose 210 mg/dL 4. preprandial blood glucose 60 mg/dL
fasting blood glucose 96 mg/dL
A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse should expect that which of the following laboratory findings to be elevated?: 1. lymphocyte count 2. potassium 3. calcium 4. glucose
glucose
The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy?: 1. acromegaly 2. Cushing's disease 3. diabetes mellitus 4. hypopituitarism
hypopituitarism
A home health nurse is assessing a client who is on lifelong hormone replacement therapy for treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect?: 1. increased urine output 2. persistent diarrhea 3. tachycardia 4. hypotension
hypotension
The patient is admitted with an elevated temperature and general malaise. The nurse suspects that the patient may have an infection. Which laboratory value would be evaluated first?: 1. eosinophils 2. erythrocytes 3. leukocytes 4. platelets
leukocytes
A patient with thrombocytopenia (platelet level of 20,000 mL) is to get multiple transfusions of platelets. The nurse notifies the physician that the patient has a history of febrile reactions whenever she receives blood transfusions. The nurse expects that the physician will most likely: 1. cancel the transfusion 2. order a D-dimer for further evaluation of the patient 3. order Diphenhydramine (Benadryl) to be given before the transfusion 4. proceed with the transfusion as ordered and monitor every 30 mins
order Diphenhydramine (Benadryl) to be given before the transfusion
The client with Cushing's needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?: 1. increase calories 2. restrict sodium 3. restrict potassium 4. reduce fat to 10%
restrict sodium
The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following?: 1. tachycardia 2. bradycardia 3. decreased PaCO2 4. narrowed pulse pressure
tachycardia
A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat: 1. within 10-15 mins after the injection 2. 1 hr after the injection 3. at any time because timing of meals with lispro injections is unnecessary 4. 2 hrs before the injection
within 10-15 mins after the injection