Exam 1 MS practice question

An RN and LPN/LVN are caring for a group of clients on the medical-surgical unit. Which client will be the best to assign to the LPN/LVN? A.Client with Graves' disease who needs discharge teaching after a total thyroidectomy B.Client with hyperparathyroidism who is just being admitted for a parathyroidectomy C.Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone (Deltasone) D.Newly diagnosed client with hypothyroidism who needs education about the use of thyroid supplements

Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone

In addition to monitoring blood glucose levels, what other labs would you check? A. calcium B.BUN C. Hemoglobin D.Uric acid E. Potassium

Hemoglobin Potassium BUN Calcium

Which manifestations are most often seen in general hyperthyroidism? Select all that apply. A Increased appetite B. Cold intolerance C. Constipation D. Increased sweating E. Insomnia F. Palpitations G. Tremors H. Weight gain

Increased appetite Increased sweating Palpitations Tremors Insomnia

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? A.Desmopressin (DDAVP) B.Dopamine hydrochloride (Intropin) C.Prednisone D.Tolvaptan (Samsca)

desmopressin

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this client? A.Administering furosemide (Lasix) B.Providing isotonic fluids C.Replacing potassium losses D.Restricting sodium

providing isotonic fluids

Which health problems are considered results of microvascular complications from long-term or poorly controlled diabetes mellitus? A.Obesity and hyperglycemia B.Systolic hypertension and heart failure C.Retinal hemorrhage and male erectile dysfunction D.Diabetic ketoacidosis and hyperglycemic-hyperosmolar state

retinal hemorrhage and male erectile dysfunction

What information in the patient's history would cause concern with the patient taking Synthroid? SATA A. allergy to aspirin B. patient enjoys peaches, strawberries and pears C. takes calcium supplement daily D. prefers to take medications with tea or lemonade E. eats last meal at 7pm

Allergy Peaches, strawberries and pears Ca supplement Take meds with tea or lemonade

Patient has been fatigue, gained weight and has not been interested in her normal daily activities. With the patient's history and current signs and symptoms, what tests would you expect to be done? A. CBC B. Blood chemistries C. ABGs D. TSH and T4 E. CXR

CBC Blood chemistries TSH and T4

A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client A.ACTH suppression test B. Chest x-ray C.CT D.Renal sonography

CT

The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? A.Calcium gluconate B.Emergency tracheotomy kit C.Furosemide (Lasix) D.Hypertonic saline E.Oxygen F.Suction

Ca Gluconate Emergency trach Oxygen Suction

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. check the blood glucose level every 2 to 4 hours. ◦ 3. drink cool fluids with high glucose content. ◦ 4. use a less strenuous form of exercise than usual until the illness resolves.

Check glucose every 2-4 hours

Which patient with diabetes mellitus is at greatestrisk for developing retinopathy? A.28-year-old with gestational diabetes B.36-year-old with type 1 diabetes and hypertension C.62-year-old with fasting blood glucose level of 120 mg/dL D.54-year-old with type 2 diabetes mellitus and hypertension

D

The patient with diabetes is at high risk for death from: A.Cerebrovascular accident B.Diabetic nephropathy C.Myocardial infarction D.Diabetic ketoacidosis

DKA

The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor A.Decrease in metabolism B.Decrease in ADH C.Decrease in glucose tolerance

Decrease in ADH

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify ◦1. fluid overload resulting from aggressive fluid replacement. ◦ 2. the presence of hypovolemic shock related to osmotic diuresis. ◦ 3. dysrhythmias resulting from hypokalemia. ◦ 4. cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.

Dysrhythmias resulting from hypokalemia

After the consent has been signed for the radioactive iodine uptake, What assessment data are most important for the nurse to obtain prior? SATA A. Reaction to Bee sting B. Allergic reaction to peanuts C. OTC meds such as cough syrup D. OTC meds such as multivitamin and herbal E. has the patient eaten in the past 4 hours

Bee sting Cough syrup Multivitamin and herbal

Patient has been fatigue, gained weight and has not been interested in her normal daily activities. Her vitals are as shown: Temp: 96 HR 52 BP: 140/80 RR: 16 With the initial history and vitals, what questions would you ask? SATA A. Have you noticed any changes in bowel habits B. have you noticed any changes in urinary frequency C. Do you still feel tired in the morning after having a good nights rest? D. have you noticed any changes in nail and hair? E. Do you think your weight gain is r/t how much you are eating?

Bowel habits Tired Nail and hair

When should a type 1 diabetic patient avoid exercise? A.When serum glucose is less than 150 B.During colder months C.When ketones are present in the urine D.When emotional stressors are high for the patient

When ketones are present

Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation? A. "The abdominal site is best because it is closest to the pancreas." B. "I can reach my thigh best, so I will use different areas of the same thigh." C. "By rotating sites within one area, my chance of having skin changes is less." D. "If I change my injection site from the thigh to an arm, the inulin absorption may be different."

abdominal site is the best because it is closest to the pancreas

A client with syndrome of inappropriate antidiuretic hormone is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider does the nurse address first? A.administer infusion of 150 mL of 3% NaCl over 3 hours. B.Draw blood for hemoglobin and hematocrit. C.Insert retention catheter and monitor urine output. D.Weigh the client on admission and daily thereafter.

administer infusion of 150 ml of 3% NaCl over 3 hours

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? A.Administer insulin and dextrose in normal saline to shift potassium into cells. B.Give spironolactone (Aldactone) 100 mg orally. C.Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. D.Obtain arterial blood gases to assess for peaked T waves.

administer insulin and dextrose in NS to shift potassium into cells

The nurse reviews the vital signs of a client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? A.administers acetaminophen B.Alerts the Rapid Response Team C.Asks any visitors to leave D.Assesses the client's cardiac status completely

assess the client's cardiac status completely

When developing a postoperative plan of care for a patient after a total thyroidectomy, the nurse knows the plan should include which intervention? A.Avoiding extending the patient's neck B.Assessing the patient's voice once per shift C.Encouraging the patient to be out of bed in a chair D.Administering oxygen via nasal cannula as needed

avoiding extending the patient's neck

A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? A.Causes and treatment of hyperglycemia B.Causes and treatment of hypoglycemia C.Dietary control D.Insulin administration

causes and treatment of hypoglycemia

◦A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action does the nurse take first? A.Check the blood glucose. B.Administer oxygen. C.Offer reassurance. D.Attach a cardiac monitor.

check blood glucose

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? A.Dry lips and oral mucosa on examination B.Nasal drainage that tests negative for glucose C.Client report of a headache and stiff neck D.Urine specific gravity of 1.016

client report of headache and stiff neck

Which symptom requires immediate intervention during a hypoglycemic episode? A.Confusion B.Anxiousness C.Hunger D.Tachycardia

confusion

The nurse is teaching a client about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone. What does the nurse tell the client to look for? A.Daily weight gain of less than 2 pounds B.Dry mucous membranes C.Increasing heart rate D.Muscle spasms

daily weight gain of less than 2 lbs

◦The nurse receives report on a 52-year-old client with type 2 diabetes:Physical AssessmentDiagnostic FindingsProvider PrescriptionsLungs clearGlucose 179 mg/dLRegular insulin 8 units if blood glucose 250 to 275 mg/dL and cold to touchRight great toe mottledHemoglobin A1c 6.9%Regular insulin 10 units if glucose 275 to 300 mg/dLClient states wears eyeglasses to readWhich complication of diabetes does the nurse report to the provider? A.Poor glucose control B.Visual changes C.Respiratory distress D.Decreased peripheral perfusion

decreased peripheral perfusion

As the nurse is assessing a patient with Grave's disease, which finding requires immediate attention? A. Elevated temperature B. Elevated blood pressure C. Change in respiratory rate D.Irregular heart rate and rhythm

elevated temperature

While assessing the client who has had diabetes for 15 years, the nurse finds that he has decreased sensory perception in both feet. What is the nurse's best first action? ◦Document the finding as the only action. ◦B. Examine the feet for manifestations of injury. ◦C. Test the sensory perception of the client's hands. ◦D. Tell the client that he now has peripheral neuropathy.

examine the feet for manifestations of injury

A client with diabetes insipidus (DI) has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first? A.Force fluids B.Apply chapstick C.Perform 24-hour urine test D.Withhold desmopressin acetate (DDAVP)

force fluids

◦The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? A.I should drink a glass of water." B."three graham crackers." C."I should give myself 1 mg of glucagon." D."I should sit down and rest."

graham crackers

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? A. anxiety B. headache. C. nausea D. weight loss

headache

A client had a parathyroidectomy 18 hours ago. Which finding requires immediate attention A.Edema at the surgical site B.Hoarseness C.Pain on moving the head D.Sore throat

hoarseness

When taking the blood pressure of a client receiving treatment for hyperparathyroidism, the nurse observes the client's hand to undergo flexion contractions. What is the nurse's interpretation of this observation? A.Hyperphosphatemia B.B. Hypophosphatemia C.C. Hypercalcemia D.D. Hypocalcemia

hypocalcemia

What effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client? A.Bradycardia and decreased level of consciousness B.Decreased respiratory rate C.Hypotension and shock D.Hypertension and heart failure

hypotension and HF

What is the priority nursing intervention for an older female patient with a history of hyperparathyroidism? A. Implement fall precautions. B. Encourage oral fluid hydration. C. Encourage small frequent meals. D.Provide pain medications as prescribed.

implement fall precaution

Which laboratory result indicates that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? A.Decreased hematocrit B.Decreased serum osmolality C.Increased serum sodium D.Increased urine specific gravity

increased sodium

A client diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate (Parlodel). As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain A.Decreases the risk for cerebrovascular disease B.Increases the risk for depression C.Inhibits the release of some pituitary hormones D.Stimulates the release of some pituitary hormones

inhibits the release of some pituitary hormones

Which education should the nurse include while teaching patient about Synthroid? SATA A. Taken twice a day with food B. This medication requires frequent monitoring of labs C. Report CP, rapid heartbeat or Increased nervousness D. Wear medical alert bracelet E. Ask for generic brand that is cheaper

medication requires frequent monitoring Report Wear medical alert bracelet

Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II? A.Anaplastic B.Follicular C.Medullary D.Papillary

medullary

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? A.Assess the wound dressing for bleeding. B.Give morphine sulfate 4 to 8 mg IV for pain. C.Monitor oxygen saturation using pulse oximetry. D.Support the head and neck with sandbags.

monitor oxygen sat

Which specific intervention for complication prevention should the nurse teach the client with diabetes who has peripheral neuropathy? ◦A. "Drink at least 3 L of fluid daily." ◦B. "Wear a medical alert bracelet." ◦C. "Never reuse insulin syringes." ◦D. "Never go barefoot."

never go barefoot

◦An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? A.Urine output B.12-lead electrocardiogram (ECG) C.Potassium level D.Rate of IV fluids

potassium level

A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dl. The nurse explains to the patient that this value 1. is normal and diabetes is not a problem. 2. is diagnostic for diabetes. 3. indicates a intermediate stage between normal glucose use and diabetes. 4. reflects impaired glucose tolerance that is an early stage of diabetes.

reflects impaired glucose tolerance that is an early stage of diabetes

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? A.Document symptoms of incisional infection or meningitis. B.Give over-the-counter laxatives if the client is constipated. C.Set up medications as prescribed for the day. D.Test any nasal drainage for the presence of glucose.

test any nasal drainage for the presence of glucose

How is hypoglycemia prevented in the healthy person who does not have diabetes even after fasting for 8 hours? A.Metabolism is so slow when a person sleeps without eating for 8 hours that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur. B.Fasting for 8 hours triggers conversion of proteins into glycogen (glycogenesis) so that hyperglycemia develops rather than hypoglycemia. C.Lipolysis (fat breakdown) in fat stores occurs, converting fatty acids into glucose to maintain blood glucose levels. D.The secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites.

the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites

Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? A.Most clients with type 1 diabetes are born with it. B.People with type 1 diabetes are often obese. C.Those with type 2 diabetes make insulin, but in inadequate amounts. D.People with type 2 diabetes do not develop typical diabetic complications.

those with type 2 make insulin, but in inadequate amounts

Which urine properties indicate to the nurse that the client with syndrome of inappropriate (SIADH) antidiuretic hormone is responding to interventions? ◦A Urine output volume increased; urine specific gravity increased ◦B. Urine output volume increased; urine specific gravity decreased ◦C. Urine output volume decreased; urine specific gravity increased ◦D. Urine output volume decreased; urine specific gravity decreased

urine output volume increased, urine specific gravity decreased.

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? A.asks another nurse to care for the client B.Monitors the client for cold-like symptoms C.Refuses to care for the client D.Wears a facemask when caring for the client

wears a facemask when caring for patient

◦A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the client the proper use of the machine? A.Day of discharge B.On admission C.When the client states readiness D.While performing the test in the hospital

while performing test in hospital

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? A.Blocks reabsorption of sodium B.Increases blood pressure C.Increases cardiac output D.Works as an antidiuretic hormone (ADH) in the kidneys

works as ADH in kidneys

Prior to administering Synthroid, what assessments should be done? SATA A. Ensure heart rate <100 B. Administer prior to breakfast C. Record blood glucose D> Record intake for the past 12 hours E. assess bowel sounds

Ensure heart rate Administer prior to breakfast

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? A.Alpha B.Beta C.Glucagon release D.Insulin release

Glucagon release

◦The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? A."I should begin exercising for at least an hour a day." B."I should monitor my diet." C."If I lose weight, I may not need to use the insulin anymore." D."Weight loss can be a sign of diabetic ketoacidosis.

I should begin exercising for at least an hour a day

The nurse is providing discharge instructions to a client on spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? A.I must call the provider if I am more tired than usual." B."I need to increase my salt intake." C. "I should eat a banana every day." "This drug will not control my heart rate."

I should eat a banana everyday

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? A."I should have more energy with this medication." B."I should take it every morning." C."If I continue to lose weight, I may need an increased dose." D."If I gain weight and feel tired, I may need an increased dose."

If I continue to lose weight, I may need an increased dose.

For which assessment finding in a client who has severe hyperthyroidism does the nurse notify the Rapid Response Team? A. An increase in premature ventricular heart contractions from 4 per minute to 5 per minute B. An increase in or widening of pulse pressure from 40 mm Hg to 46 mm Hg C. An increase in temperature from 99.5° F (37.5° C) to 101.3° F (38.5° C) D. An increase of 20 mL of urine output per hour

Increase in temperature

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? A.A. Decreased sodium; decreased glucose B.B. Decreased sodium; increased glucose C.C. Increased sodium; decreased glucose D.D. Increased sodium; increased glucose

Increased sodium, increased glucose

A client with hypothyroidism is being discharged. Which environmental change may the client experience in the home A.Frequent home care B.Handrails in the bath C.Increased thermostat setting D.Strict infection-control measures

Increased thermostat setting

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN A Assessing CM for hypopituitarism B. Inject insulin for GH test C. Palpate thyroid for size D.Teach about ACTH stimulation test

Inject insulin for GH test

The client who is about to have a unilateral adrenalectomy for an adenoma that is causing hypercortisolism asks the nurse if she will have to continue the severe sodium restriction after surgery. What is the nurse's best response? ◦A. "No, once the tumor has been removed and your cortisol levels have normalized, you will not retain excess sodium anymore." ◦B. "No, after surgery you will have to take oral cortisol, which can easily be controlled so that your sodium levels do not rise." ◦C. Yes, the fact that you are retaining sodium and have high blood pressure is related to your age and lifestyle, not the tumor." ◦D. "Yes, sodium is very bad for people and everyone needs to eliminate sodium completely from their diets for the rest of their lives."

No, once the tumor has been removed and your cortisol levels have normalized, you will not retain excess sodium anymore.

peak of rapid insulin

1-2 hours

What are the classic symptoms of Diabetes?

3 P's Polyuria Polydipsia Polyphagia

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? A.7:30 a.m. B.11:00 a.m. C.2:00 p.m. D.7:30 p.m.

11

Peak of regular insulin

2-3 hours

For which client does the nurse question the prescription of androgen replacement therapy? 35-year-old man who has had a vasectomy 48-year old man who takes prednisone for severe asthma 62-year-old man who has a history of prostate cancer 70-year-old man who has hypertension and type 2 diabetes

62-year-old man who has history of prostate cancer

Which precaution or action is most important for the nurse to teach the client who is to collect a 24-hour urine specimen for endocrine testing? A Eat a normal diet during the collection period. B. Wear gloves when you urinate to prevent contamination of the specimen. C. Urinate at the end of 24 hours and add that sample to the collection container. D. Avoid walking, running, dancing, or any vigorous exercise during the collection period.

Urinate at the end

Upon admission, the nurse should give the highest priority to meeting which need of the client experiencing myxedema crisis? SATA A. Providing warm blankets B. start an IV of NS at prescribed rate C. Insert foley D. Ask about current meds and immunizations E. Assess cardiac system

Warm blankets IV Assess cardiac