ATI Book - Med Surg 2 Chapter 76 - 83
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply.) A. Decreased serum sodium B. Urine specific gravity 1.001 C. Serum osmolarity 230 mOsm/L D. Polyuria E. Increased thirst
A. Decreased serum sodium C. Serum osmolarity 230 mOsm/L A decrease in serum sodium is caused by an increase in the secretion of ADH. A decrease in serum osmolarity is caused by an increase in the secretion of ADH
A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Drink 2 L fluids daily. B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribed when ill. D. Notify the provider when blood glucose is 200 mg/dL. E. Report ketones in the urine after 24 hr of illness.
A. Drink 2 L fluids daily. B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribed when ill. E. Report ketones in the urine after 24 hr of illness. Drinking 2 L fluids daily can prevent dehydration if the client develops diabetic ketoacidosis. Blood glucose tends to increase during illness. Blood glucose should be monitored every 4 hr. Illness often causes blood glucose to increase. Regular doses of insulin should be administered. The provider should be notified if there are ketones in the urine after 24 hr of illness.
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (Select all that apply.) A. Eat less meat and processed foods. B. Decrease intake of saturated fats. C. Increase daily fiber intake. D. Limit saturated fat intake to 15% of daily caloric intake. E. Include omega‑3 fatty acids in the diet.
A. Eat less meat and processed foods. B. Decrease intake of saturated fats. C. Increase daily fiber intake. E. Include omega‑3 fatty acids in the diet. Healthy nutrition should include decreasing the consumption of meats and processed foods, which can prevent diabetes and hyperlipidemia. Healthy nutrition should include lowering LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia. Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. Healthy nutrition should include omega‑3 fatty acids for secondary prevention of diabetes and heart disease.
A nurse is reviewing the health record of a client who has hyperglycemic‑hyperosmolar state (HHS). The nurse should identify that which of the following data confirm this diagnosis? (Select all that apply.) A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. No insulin production
A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years The client who has type 2 diabetes mellitus and had a myocardial infarction is at risk for developing HHS. This is due to the increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin. The client who has type 2 diabetes mellitus can be at risk for developing HHS when the BUN is 35 mg/dL because it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine. A calcium channel blocker is one of several medications that increase the risk for HHS in a client who has type 2 diabetes mellitus. The older adult client is at risk for developing type 2 diabetes mellitus and can be unaware of associated manifestations, increasing the risk for HHS.
A nurse in a provider's office 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 the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech
A. Hand tremors The nurse should identify hand tremors as a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. The nurse should report this finding to the provider due to the possible need for a decrease in the dosage of medication.
A nurse is planning care for a client who has Cushing's disease. The nurse should recognize that clients who have Cushing's disease are at increased risk for which of the following? (Select all that apply.) A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia
A. Infection B. Gastric ulcer D. Bone fractures Suppression of the immune system places the client at risk for infection. The overproduction of cortisol inhibits the production of a protective mucus lining in the stomach and causes an increase in the amount of gastric acid. These factors place clients who have Cushing's disease at increased risk for gastric ulcers. Clients who have Cushing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis.
A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? (Select all that apply.) A. Low sodium B. High potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity
A. Low sodium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity SIADH results in water retention, causing a low sodium level. SIADH results in an increase in urine osmolality due to the decreased urine volume. SIADH results in water retention, causing a high urine sodium level. SIADH results in water retention, causing an increase in urine specific gravity.
A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Monitor CBC. B. Monitor triiodothyronine (T3). C. Instruct the client to increase consumption of shellfish. D. Advise the client to take the medication at the same time every day. E. Inform the client that an adverse effect of this medication is iodine toxicity.
A. Monitor CBC. B. Monitor triiodothyronine (T3). D. Advise the client to take the medication at the same time every day. Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. The nurse should monitor CBC. Methimazole reduces thyroid hormone production. The nurse should monitor T3. Methimazole should be taken at the same time every day to maintain blood levels.
A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output
A. No change in plasma cortisol No change in plasma cortisol indicates primary adrenal insufficiency (Addison's disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol.
A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply.) A. Observe cardiac monitor for dysrhythmias. B. Observe for evidence of urinary tract infection. C. Initiate IV fluids using 0.9% sodium chloride. D. Administer a levothyroxine IV bolus. E. Provide warmth using a heating pad.
A. Observe cardiac monitor for dysrhythmias. B. Observe for evidence of urinary tract infection. C. Initiate IV fluids using 0.9% sodium chloride. D. Administer a levothyroxine IV bolus. A client who has myxedema can have a flat or inverted T wave as well as ST deviations. An infection, such as in the urinary tract, can precipitate myxedema coma. The nurse should observe the client for manifestations of infection so that the underlying illness can be treated. Hyponatremia is an expected finding in the presence of myxedema coma. IV therapy is administered using 0.9% sodium chloride. Myxedema coma is a severe complication of hypothyroidism that if left untreated can lead to coma or death. Levothyroxine is administered IV bolus to treat the condition.
A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (Select all that apply.) A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Blood urea nitrogen (BUN) 28 mg/dL E. Fasting blood glucose 148 mg/dL
A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Blood urea nitrogen (BUN) 28 mg/dL This finding is below the expected reference range. In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Hyponatremia is an expected finding. This finding is above the expected reference range. Hyperkalemia is an expected finding for a client who has Addison's disease. This finding is above the expected reference range. Hypercalcemia is an expected finding for a client who has Addison's disease. This BUN level is above the expected reference range, which is an expected finding for a client who has Addison's disease due to dehydration.
A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings should the nurse expect for this client? (Select all that apply.) A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL D. Lymphocyte count 35% E. Fasting glucose 145 mg/dL
A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL E. Fasting glucose 145 mg/dL This finding is above the expected reference range. Hypernatremia is an expected finding for clients who have Cushing's disease. This finding is below the expected reference range. Hypokalemia is an expected finding for clients who have Cushing's disease. This finding is below the expected reference range. Hypocalcemia is an expected finding for clients who have Cushing's disease. This finding is above the expected reference range. Clients who have Cushing's disease have an elevated fasting blood glucose because the disorder affects glucose metabolism.
A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply.) A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray
A. Suction equipment B. Humidified oxygen D. Tracheostomy tray The client can require oral or tracheal suctioning. The nurse should ensure that suctioning equipment is available. The client can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available. The client can experience respiratory obstruction. A tracheostomy tray should be available at the bedside.
A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation which of the following substances as an indication that the client has this disorder A. Triiodothyronine B. Plasma-free metanephrine C. Urine cortisol D. Urine osmolality
A. Triiodothyronine Increased triiodothyronine (T3) indicates hyperthyroidism.
At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following findings is the priority? A. Weight gain B. Fatigue C. Fragile skin D. Joint pain
A. Weight gain The greatest risk to a client who has Cushing's disease is fluid retention, which can lead to pulmonary edema, hypertension, and heart failure; therefore, this is the priority finding.
A nurse is caring for a client who asks why the provider bases his medication regimen on his HbA1c instead of his log of morning fasting blood glucose results. Which of the following responses should the nurse make? A. "HbA1c measures how well insulin is regulating your blood glucose between meals." B. "HbA1c indicates how well your have regulated your blood glucose over the past 120 days." C. "HbA1c is the first test your doctor prescribed to determine that you have diabetes." D. "HbA1c determines if the your doctor should adjust your insulin dosage."
B. "HbA1c indicates how well your have regulated your blood glucose over the past 120 days." HbA1c measures blood glucose control over the past 120 days
A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "An adverse effect of this medication is jaundice." B. "Take your pulse before each dose." C. "The purpose of this medication is to decrease production of thyroid hormone." D. "You should stop taking this medication if you have a sore throat."
B. "Take your pulse before each dose." Propranolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult the provider.
A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement? A. Check blood glucose immediately after breakfast. B. Administer insulin when breakfast arrives. C. Hold breakfast for 1 hr after insulin administration. D. Clarify the prescription because insulin should not be administered at this time.
B. Administer insulin when breakfast arrives. Administer insulin aspart when breakfast arrives to avoid a hypoglycemic episode. Insulin aspart is rapid‑acting, and should be administered 5 to 10 min before breakfast.
A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected for a client who has this condition? A. Elevated serum T4 B. Decreased serum T3 C. Elevated serum thyroid stimulating hormone D. Decreased serum cholesterol
B. Decreased serum T3 Decreased serum T3 is an expected finding for a client who has hypothyroidism.
A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse anticipate? A. Absence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells
B. Decreased specific gravity The urine of a client who has diabetes insipidus will be dilute with a urine specific gravity of less than 1.005.
A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following laboratory results is an expected finding? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid‑stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine
B. Decreased thyroid‑stimulating hormone (TSH) In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated.
A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (Select all that apply.) A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis
B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis Fruity odor of breath is a manifestation of elevated ketone levels that lead to metabolic acidosis. Abdominal pain is a GI manifestation of increased ketones and acidosis. Kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. Metabolic acidosis is caused by glucose, protein, and fat breakdown, which produces ketones.
A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply.) A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
B. Heat intolerance D. Palpitations E. Weight loss Hyperthyroidism increases the client's metabolism, causing heat intolerance. Hyperthyroidism increases the client's metabolism, causing palpitations. Hyperthyroidism increases the client's metabolism, causing weight loss.
A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow‑up serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.
B. Medication should not be discontinued without the advice of the provider. C. Follow‑up serum TSH levels should be obtained. D. Take the medication on an empty stomach. The provider carefully titrates the dosage of this medication. It should be increased slowly until the client reaches a euthyroid state. The client should not discontinue the medication unless directed to do so by the provider. Serum TSH levels are used to monitor the effectiveness of the medication. The medication should be taken on an empty stomach to promote absorption.
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings should the nurse expect? (Select all that apply.) A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness
B. Menorrhagia C. Dry skin E. Hoarseness Abnormal menstrual periods, including menorrhagia and amenorrhea, are manifestations of hypothyroidism. Dry skin is a manifestation of hypothyroidism. Hoarseness is a manifestation of hypothyroidism.
A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? (Select all that apply.) A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low‑sodium diet.
B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly. Physical and emotional stress increase the need for hydrocortisone. The provider may increase the dosage when stress occurs. Weakness and dizziness are indications of adrenal insufficiency. The client should report these indications to the provider. Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. If hydrocortisone is to be discontinued, the dose should be tapered.
A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs
B. Orthostatic hypotension The nurse should monitor for orthostatic hypotension resulting from dehydration during a water deprivation test.
A nurse in an acute care facility is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse anticipate? (Select all that apply.) A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide
B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide Clients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. Hydrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. Clients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. Loop and thiazide diuretics promote potassium excretion and are administer to treat hyperkalemia.
A nurse is reviewing laboratory reports of a client who has hyperglycemic‑hyperosmolar state (HHS). The nurse should expect which of the following findings? A. Serum pH 7.2 B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL
B. Serum osmolarity 350 mOsm/L A client who has HHS would have a serum osmolarity greater than 320 mOsm/L.
A nurse is planning to teach a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base her instructions to the client on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.
C. ACTH is a hormone produced by the pituitary gland. Secretion of corticotropin‑releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH.
A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe. B. Draw up the glargine insulin then the regular insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.
C. Draw up and administer regular and glargine insulin in separate syringes.
A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. The nurse should identify which of the following findings as indicative of thyroid crisis? (Select all that apply.) A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion
C. Dyspnea D. Abdominal pain E. Mental confusion Excessive levels of thyroid hormone can cause the client to experience dyspnea. When thyroid crisis occurs, the client can experience gastrointestinal conditions, such as vomiting, diarrhea, and abdominal pain. Excessive thyroid hormone levels can cause the client to experience mental confusion.
A nurse is providing discharge reaching for a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? (Select all that apply.) A. Brush your teeth after every meal or snack. B. Avoid bending at the knees. C. Eat a high‑fiber diet. D. Notify the provider of any sweet‑tasting drainage. E. Notify the provider of a diminished sense of smell.
C. Eat a high‑fiber diet. D. Notify the provider of any sweet‑tasting drainage. To avoid constipation, which contributes to increased intracranial pressure, the client should eat a high‑fiber diet and take docusate. Sweet‑tasting fluid is an indication of a cerebrospinal fluid leak. The client should notify the provider.
A nurse is caring for a client who is 6 hr postoperative following a transsphenoidal hypophysectomy. The nurse should test the client's nasal drainage for the presence of which of the following? A. RBCs B. Ketones C. Glucose D. Streptococci
C. Glucose Cerebral spinal fluid contains glucose. The nurse should test nasal drainage for glucose.
A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Remove calluses using over‑the‑counter remedies. B. Apply lotion between toes. C. Perform nail care after bathing. D. Trim toenails straight across. E. Wear closed‑toe shoes.
C. Perform nail care after bathing. D. Trim toenails straight across. E. Wear closed‑toe shoes. Perform nail care after bathing, when toenails are soft and easier to trim. Trim toenails straight across to prevent injury to soft tissue of the toes. Wear closed‑toe shoes to prevent injury to soft tissue of the toes and feet.
A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 min. B. Provide a carbohydrate and protein food. C. Provide 4 oz grape juice. D. Report findings to the provider.
C. Provide 4 oz grape juice. The greatest risk to the client is injury from hypoglycemia; therefore, the priority action the nurse should take is to administer a rapidly absorbed carbohydrate, such as grape juice, takes priority when treating the blood glucose of 52 mg/dL.
A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the following actions should the nurse take? A. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr. B. Administer an IV infusion of 0.45% sodium chloride. C. Rapidly administer an IV infusion of 0.9% sodium chloride. D. Add glucose to the IV infusion when serum glucose is 350 mg/dL.
C. Rapidly administer an IV infusion of 0.9% sodium chloride. The nurse should rapidly administer an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs.
A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my bloo glucose levels." C. "I should expect to gain weight during this illness." D. "Muscle weakness is a symptom of diabetes insipidus."
D. "Muscle weakness is a symptom of diabetes insipidus." Muscle weakness, weight loss, extreme thirst, headache, constipation, and dizziness are manifestations of dehydration that occurs with diabetes insipidus.
A nurse is planning care for client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low‑Fowler's position. B. Encourage deep breathing and coughing. C. Encourage the client to brush his teeth when awake and alert. D. Observe dressing drainage for the presence of glucose.
D. Observe dressing drainage for the presence of glucose. The nurse should monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate the presence of CSF. Notify the provider if this occurs.