AH Exam 3
A nurse is reviewing the laboratory reports of a client and notes elevated thyroid-stimulating hormone level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis
Answer: A Bradycardia
A 48 year old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120mg/dL. The nurse will plan to teach the patient about: A. Self monitoring of blood glucose B. Using low doses of regular insulin C. Lifestyle changes to lower blood glucose D. Effects of oral hypoglycemic medications
Answer: C. Lifestyle changes to lower blood glucose
4. A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. D. The patient may be excreting sodium and retaining potassium from malnutrition. E. This level shows adequate treatment of the cellulitis and acceptable glucose control.
Answer: A, B, C
A nurse is providing education to a patient taking exenatide. Which instructions should the nurse include? (Select all that apply) A. Inject the drug subcutaneously B. Expect peak effect in 2hrs C. Use the drug as a supplement to an oral hypoglycemic D. Inject the drug 1 hr after a meal E. Discard used pens after 10 days of use
Answer: A, B, C
A nurse is providing teaching to a patient about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? Select all that apply. A. Obtain weight measurement daily B. Report weakness and palpitations C. Have blood pressure checked regularly D. Eat more iron rich foods E. Avoid drinking grapefruit juice
Answer: A, B, C
The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should be included in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Limit fluids to 1000 mL/day. C. Administer diuretics as ordered. D. Monitor for signs of hypernatremia. E. Minimize turning and range of motion. F. Elevate the head of the bed at 10 degrees or less.
Answer: A, B, C, F
A nurse is caring for a client taking propylthouracil to treat hypothyroidism. Which of the following adverse effects should the patient report? Select all that apply. A. Sore throat B. Joint pain C. Insomnia D. Bradycardia E. Rash
Answer: A, B, D, E
Which statements will the nurse include while teaching a patient scheduled for oral glucose tolerance testing in the outpatient clinic? Select all that apply. A. You will need to avoid smoking before this test B. Exercise should be avoided until the testing is complete C. Several blood samples will be obtained during the test D. You should follow a low calorie diet the day before the test E. The test requires that you fast for at least 8 hours before testing
Answer: A, C, E
Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal? (Select all that apply.) A. BP 80/50 B. Heart rate 54 C. Glucose 63 mg/dL D. Sodium 148 mEq/L E. Potassium 6.3 mEq/L F. Temperature 101.1° F
Answer: A, C, E, F
8. Abnormal findings during an endocrine assessment include (select all that apply) A. Excess facial hair on a woman B. Blood pressure of 100/70 mmHg C. Soft, formed stool every other day D. 3-lb weight gain over last 6 months E. Hyperpigmented coloration in lower legs
Answer: A, E
11. The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75° F) for up to 1 month."
Answer: A. "I will discard any insulin bottle that is cloudy in appearance"
A nurse administers pramlintide at 0800 to a client with type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert it's peak action? A. 0820 B. 0900 C. 1030 D. 1100
Answer: A. 0820
A patient receives aspart (NovoLog) insulin at 8am. WHich time will it be most important for the nurse to monitor for symptoms of hypoglycemia? A. 10:00 AM B. 12:00 PM C. 2:00 PM D. 4:00 PM
Answer: A. 10:00 AM
A 38 year old patient who has type 1 diabetes plans to swim laps daily at 1pm. The clinic nurse will plan to teach the patient to: A. Check glucose level before, during and after swimming B. Delay eating the noon meal until after the swimming class C. Increase the morning dose of neutral protamine Hagedorn (NPH) insulin D. Time the morning insulin injection so that the peak occurs while swimming
Answer: A. Check the glucose level before, during and after swimming
A nurse is teaching a patient about acarbose therapy to treat type 2 diabetes. Which of the following instructions should the nurse include? A. Eat more iron-rich foods B. Avoid drinking grapefruit juice C. Increase fiber intake D. Avoid drinking green tea
Answer: A. Eat more iron rich foods
The nurse has administered 4oz of orange juice to an alert patient with a BG of 62mg/dL. Fifteen minutes later, the BG is 67mg/dL. Which action should the nurse take next? A. Give the patient 4-6oz more orange juice B. Administer the PRN glucagon 1mg IM C. Have the patient eat some peanut butter with crackers D. Notify the healthcare provider about the hypoglycemia
Answer: A. Give the patient 4-6oz more orange juice
7. To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to A. Increase calcium intake to 1500 mg/day B. Perform glucose monitoring for hypoglycemia C. Obtain immunizations due to high risk for infections D. Avoid abrupt position changes because of orthostatic hypotension
Answer: A. Increase calcium intake to 1500mg/day
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
Answer: A. Increased thyroxine (T4) level
Which patient action indicates good understanding of the nurse's teaching about the use of an insulin pump? A. The patient programs the pump for an insulin bolus after eating B, The patient changes the location of the insertion site weekly C. The patient takes the pump off at bedtime and starts it again each morning D. The patient plans for a diet that is less flexible when using the insulin pump
Answer: A. The patient programs the pump for an insulin bolus after eating
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is most important for the nurse to communicate to the healthcare provider? A. The patient uses oral contraceptives B. The patient runs several days a week C. The patient has been pregnant 3 times D. The patient has family history of diabetes
Answer: A. The patient takes oral contraceotives
A 55 year old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? A. The patient will reach a glycosylated hemoglobin level of less than 7% B. The patient will follow a diet and exercise plan that results in weight loss C. The patient will choose a diet that distributes calories throughout the day D. The patient will state the reasons for eliminating simple sugars in the diet
Answer: A. The patient will reach a glycosylated hemoglobin level of less than 7%
7. Which assessment parameter has highest priority when caring for a patient undergoing a water deprivation test? A. Weight B. Oral temperature C. Arterial blood gases D. Serum glucose levels
Answer: A. Weight
A nurse is teaching a client who had a vaginal hysterectomy with a bilateral oophorectomy. Which of the following pieces of information should the nurse include in the teaching? A. "Plan to use some type of birth control for up to 6 weeks following surgery" B. "Use a water based lubricant when having sexual intercourse" C. "Expect to have increase in bloody vaginal discharge during the first 10 days after surgery" D. "Plan to start some sort of aerobic exercise such as swimming within a week of surgery"
Answer: B "Use a water based lubricant when having sexual intercourse"
A nurse is caring for a patient with type 1 diabetes mellitus and a capillary blood glucose reading of 48mg/dL. WHich of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria
Answer: B Diaphoresis
A nurse is caring for a client diagnosed with an Addisonian crisis and has a blood pressure of 74/42. WHich of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide
Answer: B Hydrocortisone
Which action by a new RN caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? A. The RN checks the blood pressure on both arms B. The RN palpates the neck thoroughly to check thyroid size C. The RN lowers the thermostat to decrease the temperature in the room D. The RN orders nonmedicated eye drops to lubricate the patient's bulging eyes
Answer: B The RN palpates the neck thoroughly to check thyroid size
The nurse is caring for a 45 year old male patient during a water deprivation test. WHich finding is most important for the nurse to communicate to the healthcare provider? A. The patient complains of intense thirst B. The patient has a 5lb weight loss C. The patient's urine osmolality doesn;t increase D. The patient feels dizzy when sitting on the edge of the bed
Answer: B The patient has a 5 lb weight loss
A nurse is planning care for a client with syndrome of inappropriate antidiuretic hormone secretion. The nurse should expect the provider to prescribe which of the following medications? A. Chlorpropamide B. Tolvaptan C. Vasopressin D. Desmopressin
Answer: B Tolvaptan
A 40 year old male patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease? A. Ideal weight B. Value system C. Activity level D. Visual changes
Answer: B Value system
A nurse is caring for a patient who is to begin taking pioglitazine to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following values? (Select all that apply) A. Thyroid-stimulating hormone B. Alanine aminotransferase (ALT) C. LDL D. CBC E. Creatinine clearance
Answer: B, C
8. Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the school track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9%
Answer: B. A 73 year old patient who takes propanolol
A 34 year old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam: A. every 2 years B. As soon as possible C. when the patient is 39 years old D. within the first year after diagnosis
Answer: B. As soon as possible
The nurse is preparing to teach a 43 year old male newly diagnosed with tyoe 2 diabetes about home management of the disease. WHich action should the nurse take first? A. Ask the patient's family to participate in the diabetes education program B. Assess the patient's perception of what it means to have diabetes mellitus C> Demonstrate how to check glucose using capillary BG monitoring D. Discuss the need for the patient to actively participate in diabetes management
Answer: B. Assess the patient's perception of what it means to have diabetes mellitus
A 63 year old patient with primary hyperparathyroidism has a serum phosphorous level of 1.7mg/dL and calcium of 14mg/dL. Which nursing action should be included in the plan of care? A. Restrict the patient to bedrest B. ENcourage 4000mls of fluids daily C. Institute routine seizure precautions D. Assess for positive Chvostek;s sign
Answer: B. Encourage 4000mls of fluids daily
A 38 year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease? A. I frequently eat at restaurants and my food has a lot of added salt B. I had the stomach flu earlier this week so I couldn't take the hydrocortisone C. I always double my dose of hydrocortisone on the days when I go for a long run D. I take twice as much hydrocortisone in the morning dose as I do in the afternoon
Answer: B. I had the stomach flu earlier this week so I couldn't take the hydrocortisone
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. WHich nursing action should be included? A. Palpate extremities for edema B. Measure urine volume hourly C. CHeck hematocrit every 2 hrs for 8 hours D. Monitor continuous pulse oximetry for 24 hours
Answer: B. Measure urine volume hourly
Which laboratory value reported to the nurse by the unlicensed assistive personnel indicates the most urgent need for the nurse's assessment of the patient? A. Bedtime glucose of 140mg/dL B. Noon blood glucose of 52mg/dL C. Fasting blood glucose of 130mg/dL D. 2 hr postprandial glucose of 220mg/dL
Answer: B. Noon glucose of 52 mg/dL
Which intervention will the nurse include in the plan of care for a 52 year old male with SIADH? A. Monitor for peripheral edema B. Offer patient hard candies to suck on C. Encourage fluids to 2-3 liters per day D. Keep head of bed elevated to 30 degrees
Answer: B. Offer patient hard candies to suck on
Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient stores the insulin in the freezer after administering the prescribed dose. d. The patient pushes the plunger down while removing the syringe from the injection site.
Answer: B. The patient cleans the skin with soap and water before insulin administration.
A nurse is providing teaching to a client with type 2 diabetes mellitus. The client states "I eat pasta every day. I can't imagine giving it up". WHich of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary" B. "Is there another favorite dish you can substitute?" C. "You don;t have to give up pasta- just adjust the amount you eat" D. "You can use no salt added tomato products on your pasta"
Answer: C "You don't have to give up pasta- just adjust the amount you eat"
A 29 year old patient in the clinic will be scheduled for blood cortisol testin. Which instruction will the nurse provide? A. Avoid adding any salt to your foods for 24 hours before the test B. You will need to lie down for 30 minutes before blood is drawn C. Come to the laboratory to have the blood drawn early in the morning D. Do not have anything to eat or drink before before the blood test is obtained
Answer: C Come to the laboratory to have the blood drawn early in the morning
A 60 year old patient is taking spironolactone which blocks the action of aldosterone on the kidney for hypertension. The nurse will monitor for: A. increased serum sodium B. decreased urinary output C. Elevated serum potassium D. Evidence of fluid overload
Answer: C Elevated serum potassium
A nurse is monitoring a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). WHich of the following findings should the nurse expect? A. Polyuria B. Dehydration C. Hyponatremia D. Hyperthermia
Answer: C Hyponatremia
Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.
Answer: C The serum albumin level is low
A nurse is caring for a client taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following adverse effects? A. joint pain B. Constipation C. Weight gain D. Dilated pupils
Answer: C Weight gain
A nurse is caring for a client who is taking somatropin. What labs need to be monitored? A. Blood amylase B. Creatinine clearance C. Urine calcium D. Blood glucose E. CBC
Answer: C, D
8. The hypothalamus secretes releasing hormones and inhibiting hormones. What is the target tissue of these releasing hormones and inhibiting hormones? A. Pineal B. Adrenal cortex C. Anterior pituitary D. Posterior pituitary
Answer: C. Anterior pituitary
A 42 year old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During properative teaching, the nurse instructs the patient about the need to: A. COugh and deep breathe every 2 hrs postoperatively B. Remain on bed rest for the first 48 hours after surgery C. Avoid brushing teeth for at least 10 days after the surgery D. Be positioned flat with sandbags at the head postoperatively
Answer: C. Avoid brushing teeth for at least 10 days after the surgery
An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).
Answer: C. Diazepam
A nurse is teaching a patient taking levothyroxine to treat hypothyroidism. Which of the following instructions should the nurse include? A. Take levothyroxine with food to increase absorption B. Take with an antacid to reduce gastrointestinal symptoms C. Expect lifelong therapy with the drug D. Carry a carbohydrate snack at all times
Answer: C. Expect lifelong therapy
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first? A. Administer the ordered muscle relaxant B. Give the ordered oral calcium supplement C. Have the patient rebreathe from a paper bag D. Start the PRN oxygen at 2L/min via cannula
Answer: C. Have the patient rebreathe from a paper bag
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? A. I can have an occasional alcoholic drink if I include it in my meal plan B. I will need a bedtime snack because I take an evening dose of NPH insulin C. I can choose any foods, as long as I use enough insulin to cover the calories D. I will eat something at meal times to prevent hypoglycemia even if I'm not hungry
Answer: C. I can choose any foods, as long as I use enough insulin to cover the calories
A 62 year old patient with hyperthyroidism is to be treated with radioactive iodine. The nurse instructs the patient: A. About radioactive precautions to take with all body secretions B. That symptoms of hyperthyroidism should be relieved in about week C. That symptoms of hypothyroidism may occur as the RAI therapy takes effect D. To discontinue the antithyroid medications taken before the radioactive therapy
Answer: C. That symptoms of hypothyroidism may occur as the RAI therapy takes effect
Which information is most important for the nurse ti reoirt ti the healthcare provider before a patient with type 2 diabetes is prepared for a coronary angiogram? A. The patient's most recent HbA1C was 6.5% B. The patient's admission blood glucose is 128mg/dL C. The patient took the prescribed metformin today D. The patient took the prescribed captopril this morning
Answer: C. The patient took the prescribed metformin today
14. The nurse is caring for a group of older patients in a long-term care setting. Which physical assessment findings would indicate a possible endocrine problem? A. Hypoglycemia, delirium, and incontinence B. Impaired reflexes, diarrhea, and hearing loss C. Fatigue, constipation, and mental impairment D. Hypotension, heat intolerance, and bradycardia
Answer: C. fatigue, constipation, and mental impairment
A nurse is teaching a client about the prostate specific antigen test. Which of the following directions should the nurse provide? A. "You should fast for 8 hours after the PSA test" B. "Annual PSA screening should begin at age 40" C. "Expected PSA values will decrease as you get older" D. "You should not ejaculate for 24hrs prior to the PSA test"
Answer: D "You should not ejaculate for 24hrs prior to the PSA test"
A nurse is planning to administer fluids to a client who has 25% total body surface burns. The client has no prior medical history. Which of the following intravenous fluids is contraindicated for this client? A. Whole blood B. Lactated Ringers C. Dextran 40 in 0.9% sodium chloride D. 0.45% sodium chloride
Answer: D 0.45% sodium chloride
An 18 year old male patient with small stature is scheduled for a growth hormone stimulation test. In preparation for the test the nurse will obtain: A. Ice in a basin B. Glargine insulin C. A cardiac monitor D. 50% dextrose solution
Answer: D 50% dextrose solution
A nurse is reviewing the lab results of a client with diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? A. HbA1C 8.5% B. Postprandial blood glucose 190mg/dL C. Casual blood glucose 205mg/dL D. Fasting blood glucose 95mg/dL
Answer: D Fasting blood glucose 95mg/dL
A 61 year old woman admitted with pneumonia has a total calcium level of 13.3mg/dL. The nurse will anticipate the need to teach the patient about testing for ________ levels. A. Calcitonin B. Catecholamine C. Thyroid hormone D. Parathyroid hormone
Answer: D Parathyroid hormone
A nurse is caring for a patient with urolithiasis and requires further diagnostics after an initial test indicated hypercalcemia. Which of the following structures controls calcium concentration? A. Pancreas B. Thyroid gland C. Anterior pituitary gland D. Parathyroid gland
Answer: D parathyroid gland
A nurse is teaching a client about self administering regular insulin. The nurse should instruct the patient to rotate injection sites to prevent which of the following? A. Rapid absorption B. Intradermal injection C. Injection pain D. Lipohypertrophy
Answer: D. Lipohypertrophy
A 44 year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance? 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 the metabolic impact of Cushing syndrome is of more importance than appearance D. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery
Answer: D. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery
A hospitalized diabetic patient received 38U of NPH insulin at 7am. At 1pm the patient has been away from the unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to: A. Save the lunch tray for the patients return to the unit B. Ask that diagnostic testing area staff to start a 5% dextrose IV C. Send a glass of milk or OJ to the patient in the diagnostic testing area D. Request that if testing is further delayed, the patient be returned to the unit to eat
Answer: D. Request that if testing is further delayed, the patient be returned to the unit to eat
2. Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. The patient must receive insulin therapy to prevent ketoacidosis B. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome
Answer: D. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome
The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following? a. "I need to shop for foods low in sodium and avoid adding salt to food." b. "I should weigh myself daily and report any sudden weight loss or gain." c. "I need to limit my fluid intake to no more than 1 quart of liquids a day." d. "I will eat foods high in potassium because diuretics cause potassium loss."
Answer: a. "I need to shop for foods low in sodium and avoid adding salt to food."