Med-Surg Exam 4 Questions
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? Dry lips and oral mucosa on examination Nasal drainage that tests negative for glucose Client report of a headache and stiff neck Urine specific gravity of 1.016
Client report of a headache and stiff neck (symptoms of meningitis)
A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? -"Can you please tell me more?" - "Don't worry. That is normal." - "How does she feel?" - "Should I make an appointment with a counselor?"
"Can you please tell me more?"
The nurse is instructing a client who will undergo a suppression test. Which statement by the client indicates that teaching was effective? "I am being tested to see whether my hormone glands are hyperactive." "I am being tested to see whether my hormone glands are hypoactive." "I am being tested to see whether my kidneys work at all." "I will be given more hormones as a trigger."
"I am being tested to see whether my hormone glands are hyperactive."
The nurse is assessing a client for endocrine dysfunction. Which comment by the client indicates a need for further assessment? "I am worried about losing my job because of cutbacks." "I don't have any patience with my kids. I lose my temper faster." "I don't seem to have any stressors now." "My weight has been stable these past few years."
"I don't have any patience with my kids. I lose my temper faster."
The nurse is providing discharge instructions to a client on spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? "I must call the provider if I am more tired than usual." "I need to increase my salt intake." "I should eat a banana every day." "This drug will not control my heart rate."
"I should eat a banana every day."
The nurse is teaching a client about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the client indicates a need for further teaching? - "I should keep the urine container cool in a separate refrigerator or cooler." -"I should not eat any protein when I am collecting urine for this test." -"I won't save the first urine sample." - "To end the collection, I must empty my bladder, adding it to the collection."
"I should not eat any protein when I am collecting urine for this test."
A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? "Don't mind this. The disease is causing this." "I need to check the client's cortisol level." "The disease can sometimes affect emotional responses." "Medication is available to help with this."
"The disease can sometimes affect emotional responses."
After receiving change-of-shift report about these four clients, which client does the nurse attend to first? Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L Client with pituitary adenoma who is reporting a severe headache
Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL
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? Administer infusion of 150 mL of 3% NaCl over 3 hours. Draw blood for hemoglobin and hematocrit. Insert retention catheter and monitor urine output. 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? Administer insulin and dextrose in normal saline to shift potassium into cells. Give spironolactone (Aldactone) 100 mg orally. Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. Obtain arterial blood gases to assess for peaked T waves.
Administer insulin and dextrose in normal saline to shift potassium into cells.
Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use? Client with hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena Client with right upper quadrant pain unrelieved for the past 2 days, dark-brown urine, and clay-colored stools Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week Client with three emergency department visits in the past month for edema, shortness of breath, weight gain, and jugular venous distention
Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week
The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor? Antidiuretic hormone (ADH) production General metabolism Glucose tolerance Ovarian production of estrogen
Antidiuretic hormone (ADH) production
A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? Avoids palpating the abdomen Monitors for pulmonary edema with a chest x-ray Obtains a 24-hour urine specimen on admission Places the client in a room with a roommate for distraction
Avoids palpating the abdomen
for which client does the nurse question the prescription for androgen replacement therapy?
62-year-old man with a history of prostate cancer (androgen therapy is avoided in men with prostate cancer)
A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client? Adrenocorticotropic hormone (ACTH) suppression test Chest x-ray Cranial computed tomography (CT) Renal sonography
Cranial computed tomography (CT)
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? Daily weight gain of less than 2 pounds Dry mucous membranes Increasing heart rate Muscle spasms
Daily weight gain of less than 2 pounds
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? Desmopressin (DDAVP) Dopamine hydrochloride (Intropin) Prednisone Tolvaptan (Samsca)
Desmopressin (DDAVP)
to BEST determine how well a client with diabetes mellitus is controlling blood glucose, which test does the nurse monitor? -Fasting blood glucose -Glycosylated hemoglobin (HbA1c) -Oral glucose tolerance test -Urine glucose level
Glycosylated hemoglobin (HbA1c)
Which statement is true about hormones and their receptor sites? Hormone activity is dependent only on the function of the receptor site. Hormones need a specific receptor site to work. Hormones need to be plasma-bound to activate the receptor site. Hormone stores are available for activation until needed.
Hormones need a specific receptor site to work.
Which laboratory result indicates that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? Decreased hematocrit Decreased serum osmolality Increased serum sodium Increased urine specific gravity
Increased serum 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? Decreases the risk for cerebrovascular disease Increases the risk for depression Inhibits the release of some pituitary hormones Stimulates the release of some pituitary hormones
Inhibits the release of some pituitary hormones
A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? Encourages the client to cough and deep-breathe Instructs the client not to strain during a bowel movement Instructs the client to blow the nose for postnasal drip Places the client in the Trendelenburg position
Instructs the client not to strain during a bowel movement
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? Administering furosemide (Lasix) Providing isotonic fluids Replacing potassium losses Restricting sodium
Providing isotonic fluids
the nurse is reviewing the laboratory test results for a client admitted with a possible pituitary disorder. which information has the MOST immediate implication for the client's care? -Blood glucose 125 mg/dL -Blood urea nitrogen (BUN) 40 mg/dL -Serum potassium 5.2 mEq/L -Serum sodium 110 mEq/L
Serum sodium 110 mEq/L
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? Asks another nurse to care for the client Monitors the client for cold-like symptoms Refuses to care for the client Wears a facemask when caring for the client
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? Asks another nurse to care for the client Monitors the client for cold-like symptoms Refuses to care for the client Wears a facemask when caring for the client Correct
How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? Blocks reabsorption of sodium Increases blood pressure Increases cardiac output Works as an antidiuretic hormone (ADH) in the kidneys
Works as an antidiuretic hormone (ADH) in the kidneys
Which gland releases catecholamines? Adrenal Pancreas Parathyroid Thyroid
adrenal
A client with diabetes insipidus (DI) has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first? Force fluids Offer lip balm Perform a 24-hour urine test Withhold desmopressin acetate (DDAVP)
force fluids
Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? Alpha cells of the pancreas Beta cells of the pancreas Glucagon release Insulin release
glucagon release
The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? Anxiety Headache Nausea Weight loss
headache
In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose? Glucose intolerance Homeostasis Insulin intolerance Negative feedback
homeostasis
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?
increased sodium; increased glucose
The nurse is teaching a client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish? - Iodized salt for cooking -More red meat - More green vegetables -Salt substitute for cooking
iodized salt for cooking
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?
urinate at the end of 24 hours and add that sample to the collection container
which urine properties indicate to the nurse that the client with syndrome of inappropriate antidiuretic hormone (SIADH) is responding to interventions?
urine output volume increased; urine specific gravity decreased
A client with Cushing's disease says that she has lost 1 pound. What does the nurse do next? Auscultates the lungs for crackles Checks urine for specific gravity Forces fluids Weighs the client
weight the client