N320 MedSurg Exam 2 Review: Cellular Regulation, Glucose Regulation and Hormone Regulation

The nurse correlates a positive Chvostek sign to hyposecretion of which hormone? A. Thyroxin (T4) B. Thyrocalcitonin C. Parathyroid hormone (PTH) D. Triiodothyronine (T3)

C. Parathyroid hormone (PTH)

Which assessment findings does the nurse monitor in response to catecholamine release by the adrenal gland? (Select all that apply.) A. Increased heart rate B. Increased blood pressure C. Increased perspiration D. Decrease blood sugar

A. Increased heart rate B. Increased blood pressure C. Increased perspiration

The nurse monitors for which effects of daily cortisol therapy for a patient with adrenal cortex hyperfunction on the patient's circulating levels of adrenocorticotropic hormone (ACTH) and aldosterone? A. Decreased ACTH, decreased aldosterone B. Decreased ACTH, increased aldosterone C. Increased ACTH, decreased aldosterone D. Increased ACTH, increased aldosterone

A. Decreased ACTH, decreased aldosterone

A nurse is caring for a client who has syndrome of inappropriate diuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply.) A. Decreased blood sodium B. Urine specific gravity 1.001 C. Blood osmolarity 230 mOsm/L D. Polyuria E. Increased thirst

A. Decreased blood sodium C. Blood osmolarity 230 mOsm/L

A nurse is caring for a patient who had an adrenalectomy. What hormone imbalance will be experienced? A. Hypoaldosteronism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperpituitarism

A. Hypoaldosteronism

The nurse correlates which clinical manifestation to the pathophysiology of decreased ACTH production from the anterior pituitary gland? A. Hypotension B. Polyuria C. Diarrhea D. Pruritus

A. Hypotension

A patient has been receiving doses of prednisone for treatment of rheumatoid arthritis for the past 3 months. If this medication is suddenly discontinued, for which complication is the patient at risk? A. Hypovolemia B. Hypernatremia C. Hypothermia D. Hyperglycemia

A. Hypovolemia

A nurse is teaching about a glycosylated hemoglobin test. Which statement indicates the need for further teaching? A. "A glycosylated hemoglobin test should be done after 8 hours of fasting." B. "Physical activity and stress do not alter the results of a glycosylated hemoglobin test." C. "A glycosylated hemoglobin test does not yield accurate results in patients with diabetic renal disease." D. "A glycosylated hemoglobin test measures the plasma glucose concentration over a period of 120 days."

A. "A glycosylated hemoglobin test should be done after 8 hours of fasting." Rationale: A glycosylated hemoglobin test can be done in patients at any time in the day and does not require fasting. The glycosylated hemoglobin test measures the average plasma glucose concentration over the life of RBCs, which is about 120 days.

The nurse is providing discharge instructions to a patient and his family after a diagnosis of diabetes insipidus (DI). Which instructions should be included? (Select all that apply.) A. "Check body weight daily at the same time and on the same scale." B. "Report weight changes of more than 5 pounds per day." C. "Drink plenty of fluids." D. "Maintain adequate mouth care." E. "Know that overuse of desmopressin may lead to dehydration."

A. "Check body weight daily at the same time and on the same scale." C. "Drink plenty of fluids." D. "Maintain adequate mouth care." Rationale: The patient has fluid loss because of the lack of ADH. The nurse should encourage the patient to drink plenty of fluids to compensate for the fluid loss and to weigh themselves each day. Since the patient is at risk for fluid volume deficiency, they will require mouth care to minimize complications of dry mucous membranes.

A patient with osteoporosis and a recent fracture asks the nurse what the provider meant by saying it could be caused by hormone deficiency. How should the nurse reply? A. "Growth hormone, when low, can decrease bone density." B. "Luteinizing hormone is important in strengthening the bones." C. "Follicle-stimulating hormone allows for the stimulation of strong bone formation." D. "Adrenocorticotropic hormone acts on the bones, making them stronger."

A. "Growth hormone, when low, can decrease bone density."

A nurse is teaching on the preoperative management of a patient with a pheochromocytoma. Which statement indicates the need for further teaching? (Select all that apply.) A. "I will put the patient on bedrest in the supine position." B. "I will place the patient on a cardiac monitor to assess for cardiac dysrhythmias." C. "I will administer a smooth muscle relaxant." D. "I will monitor the patient for hypotensive crisis." E. "I will monitor the patient for hemorrhage."

A. "I will put the patient on bedrest in the supine position." D. "I will monitor the patient for hypotensive crisis." E. "I will monitor the patient for hemorrhage." Rationale: In a critical care setting, the patient having signs of hypertension, tachycardia, and other clinical manifestations of a pheochromocytoma should be put on bedrest with the head of the bed elevated. As the vascular pheochromocytoma is manipulated and removed during the surgical procedure, the patient is at risk of hypertensive crisis. Postoperatively, the patient is at risk for hemorrhage.

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? A. "Take this medication on an empty stomach." B. "Take this medication with an antacid." C. "Change position slowly while taking this medication." D. "Limit your fluid intake while taking this medication."

A. "Take this medication on an empty stomach."

The nurse is delivering an insulin injection. Which of the following is true regarding subcutaneous insulin injection? A. A thin person should receive the injection at a 45ᵒ angle. B. The insulin should always be delivered at a 90ᵒ angle. C. The angle depends on the location of the injection. D. The angle depends on the quantity of insulin being delivered.

A. A thin person should receive the injection at a 45ᵒ angle.

A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take? A. Administer IV hydrocortisone sodium. B. Give oral spironolactone. C. Infuse 1 unit of platelets. D. Restrict daily fluid intake.

A. Administer IV hydrocortisone sodium. Rationale: Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency.

Which interventions should the nurse implement with a patient with hypercalcemia? (Select all that apply.) A. Administer IV normal saline (0.9% sodium chloride) B. Massage calves to encourage blood return to the heart C. Monitor for ECG changes D. Encourage adequate intake of Vitamin D

A. Administer IV normal saline (0.9% sodium chloride) C. Monitor for ECG changes

A nurse is planning care for a client who has malnutrition due to cancer. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Advise the client to keep a food diary B. Encourage the client to brush teeth before and after meals C. Assess the laboratory report of ferritin D. Eat nutrient-dense foods last at meal time E. Encourage the client to limit drinking fluids during meals

A. Advise the client to keep a food diary B. Encourage the client to brush teeth before and after meals C. Assess the laboratory report of ferritin E. Encourage the client to limit drinking fluids during meals

Debbie is a 45 year old female who is a manager in a flower shop. As a result of history and physical exam findings, she is admitted to the medical surgical floor. She states, "I am feeling tired. My heart races at times." She enjoys hiking, yoga and Zumba. Her mother-in-law has thyroid problems. The healthcare provider suspects hyperthyroidism. Which factor in Debbie 's history lends itself to a thyroid problem? A. Age and gender B. Stressors in life C. Positive family history D. Works in floral shop

A. Age and gender Rationale: Debbie is a textbook candidate for Graves' disease, she is a female under the age of 50. There is no family history as it is her mother-in-law with the thyroid problem.

A nurse is comparing the hormones of the pituitary gland in preparation for care of a patient undergoing a posterior lobe removal. Which hormone is secreted through the posterior lobe of the pituitary gland? A. Antidiuretic hormone (ADH) B. Follicle-stimulating hormone (FSH) C. Growth-stimulating hormone (GSH) D. Adrenocorticotropic hormone (ACTH)

A. Antidiuretic hormone (ADH)

A nurse is planning care for a client who has a platelet count of 10,000/mm^3. Which of the following interventions should the nurse include in the plan of care? A. Apply prolonged pressure to puncture site after blood sampling B. Administer epoetin alfa as prescribed C. Place the client in a private room D. Have the client use an oral topical anesthetic before meals

A. Apply prolonged pressure to puncture site after blood sampling

After spending an hour in the PACU, Debbie returns to the medical-surgical unit and the following is noted: Drowsy but responsive, able to move all extremities, Temp: 98F, P:88, RR:14, BP:110/72, breath sounds clear, IV infusing at 125 ml/hr. Incisional pain 4 (0-10 scale).Which action should the nurse take next? A. Assess neck dressing B. Obtain oxygen saturation C. Administer pain medication D. Monitor IV infusion and check site.

A. Assess neck dressing Rationale: Overall clinical judgment of Debbie is good, her presentation is normal. Airway and breathing appear normal as her vitals are normal and breath sounds are clear. There are no signs of respiratory distress or hypoxia; her airway and breathing are stable. The oxygen saturation is not immediately needed to determine that her airway is impaired. The next level to check would be her circulation. You would next look at the neck dressing to assess for any bleeding, as this would indicate an issue in circulation.

A nurse is caring for a client who has lung cancer and is exhibiting manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report the provider? (Select all that apply.) A. Behavioral changes B. Client report of headache C. Urine output 40 mL/hr D. Client report of nausea E. Increased urine specific gravity

A. Behavioral changes B. Client report of headache D. Client report of nausea

The presence of which traits indicates that a patient is at risk for metabolic syndrome? (Select all that apply.) A. Body mass index (BMI) is 34. B. Serum triglycerides are 180 mg/dL. C. Blood pressure is 120/80 mm Hg. D. Fasting blood glucose is 90 mg/dL. E. High-density lipoprotein (HDL) is 30 mg/dL.

A. Body mass index (BMI) is 34. B. Serum triglycerides are 180 mg/dL. E. High-density lipoprotein (HDL) is 30 mg/dL.

Which assessment findings can the nurse expect to find in patient with hyperparathyroidism? (Select all that apply.) A. Bradycardia B. Leg cramping C. Hyperactive bowel sounds D. Ineffective respiratory movements E. Muscular weakness

A. Bradycardia D. Ineffective respiratory movements E. Muscular weakness

A patient presents to the emergency department with the following symptoms: hair that is dry, coarse, thin, and fragile; lateral eyebrows thin; periorbital edema; facial puffiness; sky dry and coarse due to lack of sweating. What additional assessments should the nurse perform? A. Bradycardia, hypothermia, and weight gain B. Heat intolerance, nervousness, and fatigue C. Muscle twitching, hypotension, and cramping D. Muscle weakness, low back pain, and constipation

A. Bradycardia, hypothermia, and weight gain Rationale: These are symptoms consistent with hypothyroidism and should be evaluated upon admission.

The nurse correlates which clinical manifestation to the pathophysiology of hypothyroidism? A. Cold intolerance B. Weight loss C. Insomnia D. Diarrhea

A. Cold intolerance

Which interventions should the nurse implement when caring for the patient who has undergone a transsphenoidal hypophysectomy? (Select all that apply.) A. Conduct a neurological assessment. B. Maintain the head of the bed at a 30° angle. C. Provide frequent mouth care. D. Monitor the nasal drainage pad. E. Obtain urine-specific gravity every hour.

A. Conduct a neurological assessment. C. Provide frequent mouth care. D. Monitor the nasal drainage pad. E. Obtain urine-specific gravity every hour. Rationale: The neurological assessment is conducted each hour to monitor for signs of increased intracranial pressure. The nurse should ensure the head of the bed is at a 45-degree angle to ensure ICP does not get too high. Frequent mouth care should be performed as the patient will be breathing through their mouth postoperatively due to nasal packing. The nasal drainage pad should be monitored at regular intervals to assess for CSF.

The nurse suspects hypoparathyroidism after reviewing the laboratory reports of a patient. Which findings support the nurse's suspicion? (Select all that apply.) A. Decreased calcium levels B. Increased vitamin D levels C. Increased magnesium levels D. Elevated phosphate levels E. Decreased parathyroid hormone

A. Decreased calcium levels D. Elevated phosphate levels E. Decreased parathyroid hormone

Increased secretion of ADH results in which action? A. Decreased urine output B. Increased urine output C. Decreased serum potassium D. Increased serum potassium

A. Decreased urine output

A nurse is planning care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse include in the plan of care? A. Determine the need for informed consent B. Send testing results to the client's insurance agency C. Verify the prescription for a tumor marker assay D. Ensure the client is placed in a recovery position after testing

A. Determine the need for informed consent Rationale: Genetic testing involves collection of blood or saliva. Recovery positioning is not required following testing.

A nurse is providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? (Select all that apply.) A. Drink 2 L of 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 of 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

A nurse in a clinic is talking with a client scheduled for a sentinel lymph node biopsy. Which of the following information should the nurse include? A. Dye is used during the procedure B. The lymph nodes closest to the tumor are removed during the biopsy C. A small amount of chemotherapy is used to test the lymph node response D. A 2 mm plug of tissue is removed during the biopsy

A. Dye is used during the procedure

The nurse recognizes that a deficiency in a clotting factor may cause which finding(s)? (Select all that apply.) A. Easy bruising and cutaneous hematoma formation with minor trauma (e.g., an injection) B. Bleeding from the gums and prolonged bleeding following minor injuries or cuts C. Enhanced platelet aggregation and increased clumping of RBCs D. Fibrin molecules form fibrin threads to increase wound healing E. Yellowish skin color

A. Easy bruising and cutaneous hematoma formation with minor trauma (e.g., an injection) B. Bleeding from the gums and prolonged bleeding following minor injuries or cuts

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 at regular intervals 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 at regular intervals B. Decrease intake of saturated fats C. Increase daily fiber intake E. Include omega-3 fatty acids in the diet

A nurse is caring for a client who has a pheochromocytoma. Which of the following actions should the nurse take? A. Elevate the head of the client's bed. B. Palpate the client's abdomen. C. Monitor the client for hypotension. D. Check the client's urine specific gravity.

A. 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.

A nurse is reviewing the health history of a client who has diabetes mellitus type 2. Which of the following are risk factors for hyperglycemic-hyperosmolar state (HHS)? (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. Daily insulin injections

A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years

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? A. Fasting blood glucose 96 mg/dL B. Postprandial blood glucose 195 mg/dL C. Random blood glucose 210 mg/dL D. Preprandial blood glucose 60 mg/dL

A. Fasting blood glucose 96 mg/dL

The nurse correlates which laboratory value with the diagnosis of DM? A. Fasting blood glucose greater than 140 mg/dL B. Hemoglobin A1c, 5.8% C. Random blood glucose, 150 mg/dL D. OGTT, 155 mg/dL

A. Fasting blood glucose greater than 140 mg/dL

Which clinical manifestations are most likely to be seen in a patient with diabetes mellitus? (Select all that apply.) A. Fatigue B. Weight gain C. Excessive thirst D. Decreased appetite E. Increased urine output

A. Fatigue C. Excessive thirst E. Increased urine output

A nurse in a provider's office is assessing a client who recently began taking levothyroxine to treat hypothyroidism. 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 is caring for a patient after a transsphenoidal hypophysectomy. Which assessment changes are most concerning? A. Heart rate is increased. B. Pulse is full and bounding. C. Blood pressure is increased. D. Serum osmolality is decreased.

A. Heart rate is increased. Rationale: Diabetes insipidus is associated with the removal of the posterior pituitary gland. It is caused by decreased secretion of ADH. In such condition, heart rate is increased.

The nurse prioritizes which nursing diagnosis in the patient after partial parathyroidectomy? A. High risk for ineffective airway clearance linked to hypocalcemia B. High risk for ineffective breathing pattern linked to hypercalcemia C. High risk for hyperventilation linked to hypersecretion of triiodothyronine D. High risk for airway compromise linked to insufficient iodine stores

A. High risk for ineffective airway clearance linked to hypocalcemia

The nurse suspects laryngeal nerve damage in a patient who has undergone a thyroidectomy. Which symptom supports the nurse's suspicion? A. Hoarseness of the voice B. Bleeding around the dressing C. Difficulty in breathing D. Increased viscosity in nasal secretions

A. Hoarseness of the voice

A nurse is planning care for a client who has Cushing's disease. The nurse should identify 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

Which hormonal responses can the nurse anticipate when a patient presents with hyponatremia? A. Inhibition of ADH B. Release of renin C. Increased aldosterone D. Secretion of corticotropin-releasing hormone

A. Inhibition of ADH

A home health nurse is planning the first home visit for a 60 year old patient newly diagnosed with type 2 diabetes. The patient is instructed to take 70/30 Insulin in the morning and at supper time. Which interventions should the nurse include in the patient's plan of care? (Select all that apply.) A. Instruct the patient to inspect his feet daily B. Ensure that the patient eats a bedtime snack C. Assess the patient's ability to read small print D. Teach the patient to perform a hemoglobin A1C test E. Instruct the patient to store the prefilled syringes in the refrigerator F. Teach the patient to take one unit of 70/30 insulin if his blood sugar reads above 250 mg/dL

A. Instruct the patient to inspect his feet daily B. Ensure that the patient eats a bedtime snack C. Assess the patient's ability to read small print E. Instruct the patient to store the prefilled syringes in the refrigerator

Age-related changes that affect the hematological system include which findings? (Select all that apply.) A. Iron binding decreases. B. The number of stem cells in the marrow increases. C. Lymphocyte function, especially cellular immunity, decreases. D. Platelet adhesiveness decreases. E. Hematocrit decreases.

A. Iron binding decreases. C. Lymphocyte function, especially cellular immunity, decreases.

The nurse recognizes which of the following statements as correct in relation to the pathophysiology of type 2 DM? (Select all that apply.) A. It is due to a relative lack of insulin. B. It is due to insulin resistance. C. It is due to an absolute lack of insulin. D. It remains stable over time. E. It is due to an autoimmune process that destroys the beta cells of the pancreas.

A. It is due to a relative lack of insulin. B. It is due to insulin resistance.

The nurse recognizes which statement as correct about blood cell formation? A. It occurs mostly in the marrow found in flat bones such as the sternum, ribs, and pelvis B. It occurs mostly in the marrow found in the shaft of long bones C. It occurs outside the marrow, once it enters the circulatory system D. It occurs after birth until late adolescence

A. It occurs mostly in the marrow found in flat bones such as the sternum, ribs, and pelvis

A nurse is monitoring a client who is 24 hr postoperative after a total thyroidectomy. Which of the following findings should the nurse report to the provider? A. Laryngeal stridor B. Productive cough C. Pain with hyperextension of the neck D. Hoarse, weak voice

A. Laryngeal stridor

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

The nurse recognizes that blood glucose monitoring before meals and at bedtime is done to achieve which outcomes? (Select all that apply.) A. Maintain glycemic control B. Prevent complications of long-term hyperglycemia C. Facilitate insulin administration that mimics the healthy pancreas D. Provide frequent practice with the finger-stick technique E. Prevent acute complications of type 1 diabetes

A. Maintain glycemic control B. Prevent complications of long-term hyperglycemia C. Facilitate insulin administration that mimics the healthy pancreas

A nurse is reviewing orders for patients newly diagnosed with type 2 DM. What initial medication orders should be anticipated? A. Metformin PO twice a day B. Nutritional insulin subcutaneously prior to meals C. Basal insulin subcutaneously before bed D. Correctional insulin subcutaneously after meals

A. Metformin PO twice a day

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 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 T3 D. Advise the client to take the medication at the same time every day

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 Rationale: 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.

The charge nurse is reviewing orders for a newly admitted patient with type 1 DM. It is a priority for the charge nurse to follow up with the provider about which order? A. NovoLog insulin subcutaneous at bedtime B. NovoLog insulin subcutaneous 15 minutes prior to meals C. Basal insulin subcutaneous at bedtime D. Correctional and nutritional insulin administered immediately after the meal

A. NovoLog insulin subcutaneous at bedtime

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 UTI 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 UTI C. Initiate IV fluids using 0.9% sodium chloride D. Administer a levothyroxine IV bolus

The nurse monitors the calcium levels closely in the patient taking digoxin (Lanoxin) because hypocalcemia may lead to which complication? A. Elevated heart rate B. Dysrhythmias C. Increased cardiac contractility D. Hypertension

B. Dysrhythmias

The RN is working with an UAP and LPN. Which patient should the nurse delegate to the LPN? A. Obtaining a fingerstick glucose from a diabetic patient B. Assess the chest pain in patient with hypothyroidism C. Dipstick the urine for glucose in the diabetic patient D. Provide discharge teaching to the patient after pituitary surgery

A. Obtaining a fingerstick glucose from a diabetic patient

A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following adverse effects should the nurse include? (Select all that apply.) A. Osteoporosis B. Moon-shaped face C. Increased risk of infection D. Hearing loss E. Weight loss

A. Osteoporosis B. Moon-shaped face C. Increased risk of infection

Based on the following laboratory results, which of the following patients is MOST likely to have Addison's disease? Patient A: cortisol (morning) 2 mcg/dL, glucose 68 mg/dL Patient B: cortisol (morning) 24 mcg/dL, glucose 118 mg/dL Patient C: cortisol (morning) 19 mcg/dL, glucose 82 mg/dL Patient D: cortisol (morning) 26 mcg/dL, glucose 130 mg/dL A. Patient A B. Patient B C. Patient C D. Patient D

A. Patient A Rationale: In the morning, the normal range of cortisol should be greater than 19 mcg/dL. The normal range of glucose is 70-100 mg/dL. In Addison's disease, the cortisol level in the morning is less than 3 mcg/dL. The glucose level is also decreased. Therefore, Patient A is most likely to have Addison's disease.

The nurse is assessing the health record of four different patients. Which patient's medical report indicates a risk for laryngospasm? A. Patient A with a serum calcium level of 4.5 mg/dL B. Patient B with a serum calcium level of 8.3 mg/dL C. Patient C with a serum calcium level of 9 mg/dL D. Patient D with a serum calcium level of 10 mg/dL

A. Patient A with a serum calcium level of 4.5 mg/dL Rationale: Normal serum calcium levels are in a range of 8.5-10.5 mg/dL. Patient A has a calcium level of 4.5, indicating hypocalcemia. Tetany and laryngospasm are manifestations that commonly occur in hypothyroidism.

The nurse is receiving hand-off reports for four patients. Which patient presents with a serum sodium level consistent with diabetes insipidus (DI)? A. Patient A with sodium level 148 mg/dL B. Patient B with sodium level 140 mg/dL C. Patient C with sodium level 136 mg/dL D. Patient D with sodium level 128 mg/dL

A. Patient A with sodium level 148 mg/dL Rationale: Diabetes insipidus is a disorder that is associated with the posterior pituitary gland. It is caused by decreased secretion of ADH. Serum sodium level is increased in DI. The normal range of serum sodium is 135 to 145 mg/dL. Patient A's level is above the normal range.

Which patients may require a CT scan? (Select all that apply.) A. Patient with suspected abdominal bleeding B. Patient with suspected pulmonary embolism C. Patient with a fever and a bladder infection D. A pregnant female with a femur fracture

A. Patient with suspected abdominal bleeding B. Patient with suspected pulmonary embolism

A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? (Select all that apply.) A. Permit visitors to stay with the client 30 min at a time B. Warn pregnant individuals to visit the room only once daily C. Wear a dosimeter when in the client's room D. Place soiled dressings in a biohazard bag before discarding in the regular trash E. Dispose soiled linens in the hamper outside the client's room

A. Permit visitors to stay with the client 30 min at a time B. Warn pregnant individuals to visit the room only once daily C. Wear a dosimeter when in the client's room

The nurse monitors for which clinical manifestations in the patient newly diagnosed with type 1 DM? (Select all that apply.) A. Polyuria B. Fatigue C. Weight loss D. Polyphagia E. Decreased appetite

A. Polyuria B. Fatigue C. Weight loss D. Polyphagia

A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Which of the following indicates that the client is having a therapeutic response? A. Reduction of the effects of thyroid hormone on the heart B. Blockage of the release of thyroid hormone from the thyroid gland C. Increase in the heart's sensitivity to thyroid hormone D. Increase in the uptake of thyroid hormone by the thyroid gland

A. Reduction of the effects of thyroid hormone on the heart

The nurse prioritizes which nursing diagnosis in the plan of care for the patient with type 2 DM? A. Risk for infection B. Risk for falls C. Risk for impaired gas exchange D. Risk for injury

A. Risk for infection

The nurse correlates which laboratory values with being diagnostic for DKA? (Select all that apply.) A. Serum bicarbonate of 18 mEq/L B. Negative anion gap C. Serum glucose of 350 mg/dL D. Positive anion gap E. Arterial pH of 7.36

A. Serum bicarbonate of 18 mEq/L C. Serum glucose of 350 mg/dL D. Positive anion gap

The nurse correlates which laboratory value as an indication that desmopressin is effective in the treatment of diabetes insipidus (DI)? A. Serum sodium of 140 mEq/L B. Serum osmolality of 305 mOsm/kg C. Urine-specific gravity of 1.004 D. Serum hematocrit of 48%

A. Serum sodium of 140 mEq/L

A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider? A. Sodium 110 mEq/L B. 2+ deep-tendon reflexes C. Potassium 3.7 mEq/L D. Urine specific gravity 1.025

A. Sodium 110 mEq/L

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. 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. BUN 28 mg/dL

A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings should the nruse 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

Which medication is most likely to be administered to a patient with a pheochromocytoma who develops an intraoperative hypertensive episode? A. Sodium nitroprusside (Nipride) B. Polystyrene sulfonate (Kayexalate) C. Pasireotide D. Dexamethasone

A. Sodium nitroprusside (Nipride)

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

A nurse is reviewing the medical record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2-N 3-MX. Which of the following findings should the nurse identify as a supporting diagnosis? A. The tumor is moderate in size B. No lymph nodes contain cancer cells C. The tumor is receptive to current medication therapy D. The cancer has metastasized to other areas in the body

A. The tumor is moderate in size

The nurse correlates an increase in which laboratory value to the diagnosis of primary hyperthyroidism? A. Thyroxine (T4) B. Thyroid-stimulating hormone (TSH) C. Serum calcium D. Serum iodine

A. Thyroxine (T4)

A patient with hypothyroidism is on thyroid replacement therapy. The primary health-care provider instructs the patient to take the medication in the morning at the same time every day. Which is the rationale for this instruction? A. To mimic the normal circadian rhythm B. To prevent an increase in cholesterol levels C. To prevent vasodilation and hypotension D. To avoid accelerated cardiovascular function

A. To mimic the normal circadian rhythm

Debbie undergoes a thyroidectomy after treatment with medications and RAI fails .The nurse is preparing the room for Debbie to return from thyroid surgery. What equipment does the nurse ensure is immediately available at the bedside? (Select all that apply.) A. Tracheostomy set B. IV Calcium gluconate C. Suction equipment D. Mini Sandbags E. Synthroid (levothyroxine)

A. Tracheostomy set B. IV Calcium gluconate C. Suction equipment D. Mini Sandbags Rationale: The things you need at the bedside are those things that you would need IMMEDIATELY in the event of an emergency postoperatively. Tracheostomy set and suction equipment are needed for the event of airway compromise. IV Calcium gluconate is for the event of hypocalcemia if parathyroid is damaged/removed. Mini sandbags are used to maintain the alignment of the head and neck.

A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation of 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 Rationale: 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 nurse is screening patients for the risk of developing type 2 DM. The nurse should consider which patients at risk? (Select all that apply.) A. Women with a history of gestational diabetes B. Women with a history of multiple births C. Men with a history of pancreatic cancer D. Men who are overweight or obese E. Men and women with cardiovascular disease

A. Women with a history of gestational diabetes D. Men who are overweight or obese E. Men and women with cardiovascular disease

A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis. Which of the following results should the nurse expect? A. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L B. pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L C. pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L D. pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L

A. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L

The nurse understands that type 1 DM is caused by which of the following conditions? (Select all that apply.) A. Gestational diabetes B. A history of mumps or rubella C. Family history of autoimmune disorders D. Autoimmune destruction of the beta cells of the pancreas E. Obesity

B. A history of mumps or rubella D. Autoimmune destruction of the beta cells of the pancreas

A nurse is providing discharge teaching to a client who has diabetes insipidus and a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching? A. "Depress the pump once before using the nasal spray for the first time." B. "Blow your nose gently prior to using the nasal spray." C. "Administer the nasal spray while in a side-lying position." D. "Notify the provider if you develop numbness or tingling around the mouth."

B. "Blow your nose gently prior to using the nasal spray." Rationale: The nurse should instruct the client to blow his nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions.

The nurse is teaching a client about a thoracentesis. How would the nurse best describe this procedure? A. "You will be asleep when they make the incision." B. "Fluid will be drawn off the area around your lung." C. "It involves lying very still in a large, noisy machine." D. "Your doctor will be able to see inside your lung."

B. "Fluid will be drawn off the area around your lung."

A nurse is caring for a client who asks why the provider bases the medication regimen on HbA1c results instead of the 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 you 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 your doctor should adjust your insulin dosage."

B. "HbA1c indicates how well you have regulated your blood glucose over the past 120 days."

Labs reveal an increased T3, T4 and decreased TSH level. Therefore Debbie is scheduled to undergo a thyroid scan. Which statements by the patient requires immediate action by the nurse? (Select all that apply.) A. "I use a salt substitute on my foods" B. "I had a CAT scan two weeks ago to check my gall bladder" C. "The seafood I ate two nights ago made me sick" . D. "My thyroid gland is getting so big that it looks ugly and it makes me feel uncomfortable." E. "I think I am going through menopause. My last menstrual period was 2 months ago."

B. "I had a CAT scan two weeks ago to check my gall bladder" C. "The seafood I ate two nights ago made me sick" . E. "I think I am going through menopause. My last menstrual period was 2 months ago." Rationale: Before proceeding with the thyroid scan, you should ask the patient if her CAT scan 2 weeks ago used contrast. The contrast will affect the results of the thyroid scan. You should ask her about the type of seafood she had, to ensure that she did not eat shellfish as shellfish reacts with iodine. Even though she is 45, she is still of childbearing years. A pregnancy test should be done before giving her radioactive iodine. Potassium levels have no impact on thyroid scan. Her struggles with her appearance are not immediate concerns and they are expected concerns for someone who would be receiving a thyroid scan.

Which statement by the patient indicates that teaching about chemotherapy was effective? A. "I know everyone loses their hair with chemo." B. "I know it is important that I monitor my temperature." C. "I know I should eat whatever I want so that I don't lose weight while on chemo." D. "I understand that I can skip a chemo treatment if I don't feel well."

B. "I know it is important that I monitor my temperature."

The nurse is teaching a patient with type 2 diabetes mellitus about the diet to be followed for maintenance of the disease. Which statement made by the patient indicates the need for further teaching? A. "I should decrease my dietary trans-fat intake." B. "I should decrease the intake of foods rich in fiber." C. "I should decrease my alcohol intake to one glass per day." D. "I should include 45 to 60 grams of carbohydrate per meal in my diet."

B. "I should decrease the intake of foods rich in fiber." Rationale: Intake of fiber-rich foods helps to control blood sugar levels by delaying gastric emptying. Therefore, the patient should increase the intake of fiber.

The student nurse is reviewing care of patients post-bronchoscopy. Which statement by the student warrants action by the instructor? A. "I will check the pulse ox frequently." B. "I will encourage fluids to flush out the dye." C. "I will check the sputum for blood." D. "I will monitor for any strider or wheezing."

B. "I will encourage fluids to flush out the dye."

A nurse is providing teaching for a client who is scheduled for a bone marrow biopsy of the iliac crest. Which of the following statements made by the client indicates an understanding of the teaching? A. "This test will be performed while I am lying flat on my back." B. "I will need to stay in bed for about an hour after the best." C. "This test will determine which antibiotic I should take for treatment." D. "I will receive general anesthesia for the test."

B. "I will need to stay in bed for about an hour after the best."

The patient with acromegaly and diabetes mellitus undergoes a hypophysectomy. Which patient statement warrants intervention by the nurse? A. "I know I may be sterile the rest of my life" B. "I will now require larger does of insulin." C. "I will need to take a thyroid hormone for the rest of my life." D. "It looks like I will need to take steroids forever."

B. "I will now require larger does of insulin."

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."

A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching? A. "I need to fast after midnight the night before the test." B. "This test's result is a good indicator of my average blood glucose levels." C. "A level of 8 to 10 percent suggests adequate blood glucose control." D. "I will use my hemoglobin A1c level to adjust my daily insulin doses."

B. "This test's result is a good indicator of my average blood glucose levels."

A nurse is teaching a client who is scheduled for nuclear imaging for suspected cancer. Which of the following statements should the nurse give? A. "The presence of a liver enzyme will be identified." B. "You will be given an injection of a radioactive substance." C. "An endoscope will be inserted through your mouth." D. "The tumor will be aspirated."

B. "You will be given an injection of a radioactive substance."

Which patient scheduled for a MRI with contrast requires immediate action by the nurse? A. An 18-year-old who has a suspected muscle tear in the right thigh muscle and is in severe pain is scheduled for an MRI of the leg B. A 30-year-old with chronic renal failure and lower back pain is scheduled for an MRI of the spine C. A 40-year-old with a history of migraines that are getting worse is scheduled for an MRI of the head D. A 75-year-old with right sided leg pain and difficulty walking is scheduled for an MRI of the hip

B. A 30-year-old with chronic renal failure and lower back pain is scheduled for an MRI of the spine

The nurse recognizes that which patient is at greatest risk for hypothyroidism? A. A 19-year-old male B. A 35-year-old female C. A 45-year-old male D. An 80-year-old female

B. A 35-year-old female

The nurse recognizes which patient is at greatest risk for adrenal insufficiency? A. A 19-year-old male B. A 35-year-old female C. A 45-year-old male D. An 80-year-old female

B. A 35-year-old female

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 take? 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

The laboratory test results of a patient show a significant hyponatremia. What hormone imbalance should the nurse consider as the cause? A. Cortisol B. Aldosterone C. Growth hormone D. Follicle-stimulating hormone (FSH)

B. Aldosterone

Which hormones are released from the posterior pituitary gland? (Select all that apply). A. Aldosterone B. Antidiuretic hormone C. Follicle-stimulating hormone D. Luteinizing hormone E. Oxytocin

B. Antidiuretic hormone E. Oxytocin

The nurse suspects a patient has developed diabetic ketoacidosis. Which parameters assessed in the patient supports the nurse's conclusion? (Select all that apply.) A. Hematuria B. Arterial pH of 6.9 C. Ketonuria D. Serum glucose level of 200 E. Serum bicarbonate level of 12

B. Arterial pH of 6.9 C. Ketonuria E. Serum bicarbonate level of 12

A nurse is reviewing laboratory reports of a client who has HHS. Which of the following findings should the nurse expect? A. Blood pH 7.2 B. Blood osmolarity 350 mOsm/L C. Blood potassium 3.8 mg/dL D. Blood creatinine 0.8 mg/dL

B. Blood osmolarity 350 mOsm/L

The nurse understands that an important laboratory assessment parameter for a patient with cancer that has metastasized to bone is which of the following? A. White blood cell count B. Calcium level C. Glucose level D. Sodium/potassium level

B. Calcium level

The nursing student asks the nurse how central diabetes insipidus (DI) is different from nephrogenic DI. How should the nurse respond? A. Central DI occurs because the kidneys are resistant to ADH. B. Central DI is caused by decreased secretion of ADH. C. Central DI is observed in patients with chronic renal insufficiency. D. Central DI occurs when the kidneys are unable to concentrate urine.

B. Central DI is caused by decreased secretion of ADH.

Which assessment is essential for the nurse to make following a bronchoscopy? A. Check level of consciousness B. Check gag reflex C. Check neuromuscular function D. Check pedal pulses

B. Check gag reflex

A patient with type 1 diabetes calls the clinic and complains of nausea and vomiting. Which instruction is essential for the nurse to provide to the patient? A. Hold the regular dose of insulin B. Check the blood glucose level every 2-4 hours C. Drink cool liquids with high glucose content D. Use a less strenuous form of exercise than usual until the illness resolves

B. Check the blood glucose level every 2-4 hours

Which is a major function of the hormones produced by the adrenal (cortex) gland? A. "Fight or Flight" response B. Control of glucose, sodium and water C. Regulation of cell growth D. Calcium and stress regulation

B. Control of glucose, sodium and water Rationale: Adrenal cortex hormones are cortisol, aldosterone and androgens. Epinephrine and norepinephrine function to regulate the fight or flight response, but these come from the medulla.

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? A. Rapid, deep respirations B. Cool, clammy skin C. Abdominal cramping D. Orthostatic hypotension

B. Cool, clammy skin Rationale: Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion.

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? A. Elevated T4 B. Decreased T3 C. Elevated TSH D. Decreased cholesterol

B. Decreased T3

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 TSH C. Decreased free thyroxine index D. Decreased triiodothyronine

B. Decreased TSH

For a patient with a thoracentesis, which assessment would be of concern? A. Decrease in accessory muscles B. Decreased breath sounds C. Pain at the puncture site D. Increased appetite

B. Decreased breath sounds

The nurse correlates which findings with age-related changes of the endocrine system in a 55-year-old female? (Select all that apply.) A. Breast enlargement B. Decreased libido C. Increased sweating D. Vaginal dryness E. Insomnia

B. Decreased libido D. Vaginal dryness E. Insomnia

A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis findings should the nurse expect? A. Presence of glucose B. Decreased urine specific gravity C. Presence of ketones D. Presence of red blood cells

B. Decreased urine specific gravity

A malfunctioning (under-functioning) posterior pituitary gland can result in which patient conditions? (Select all that apply.) A. Hypothyroidism B. Dehydration C. Dilute urine D. Growth retardation E. Electrolyte imbalance

B. Dehydration C. Dilute urine E. Electrolyte imbalance

The nurse is asked to obtain a differential after the results of the CBC reveal an elevated WBC count. Which statement is true about a differential? A. Determines the percentage of platelets in the circulating blood B. Determines the proportion of each type of WBC in a blood sample C. If the infection is bacterial, then the neutrophil count will be decreased. D. If the basophils are elevated, then the patient has a viral infection.

B. Determines the proportion of each type of WBC in a blood sample

The nurse is providing care for a patient newly diagnosed with type 1 diabetes. Which lifestyle modifications need to be included in the plan of care? A. Limiting exercise, carbohydrate counting, self-monitoring of blood glucose B. Distributing carbohydrate intake throughout the day, controlling weight, limiting alcohol C. Carbohydrate counting, self-monitoring of blood glucose, healthcare provider visits as needed D. Limiting protein intake, distributing carbohydrate intake throughout the day, regular healthcare provider visits

B. Distributing carbohydrate intake throughout the day, controlling weight, limiting alcohol

A nurse is planning care for a client who is undergoing chemotherapy and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Encourage a high-fiber diet B. Eliminate standing water in the room C. Have the client wear a mask when leaving the room D. Have the client-specific equipment remain in the room E. Eliminate raw foods from the client's diet

B. Eliminate standing water in the room C. Have the client wear a mask when leaving the room D. Have the client-specific equipment remain in the room E. Eliminate raw foods from the client's diet

Despite treatment with PTU, thyroid hormones remain elevated and now other treatments such as Radioactive Iodine Therapy (RAI) and surgery are being considered. Which nursing action is important if Debbie undergoes RAI? A. Monitor for voice hoarseness B. Encourage Debbie to drink plenty of fluids C. Isolate Debbie for 24 hours after treatment D. Maintain alignment of head and avoid hyperextension

B. Encourage Debbie to drink plenty of fluids Rationale: Debbie should drink plenty of fluids to flush the RAI and contrast dye from her system. These agents can cause renal damage in the body. Isolation is NOT needed after RAI. There will be precautions implicated, but she does not need to be isolated.

The nurse is assessing a patient with adrenal insufficiency. What is the reason for skin pigmentation characterized as "darkened, bronzed hyperpigmentation"? A. Excess CRH release B. Excess ACTH release C. Decreased cortisol release D. Decreased aldosterone release

B. Excess ACTH release Rationale: Because melanocyte-stimulating hormone (MSH) and ACTH share a progenitor (ancestor) hormone, there is an associate increase in secretion of MSH, leading to a darkened, bronzed hyperpigmentation that accompanies the increased secretion of ACTH. CRH stimulates the pituitary to release ACTH, but does not cause the bronze skin color.

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

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

The patient is undergoing a bilateral adrenalectomy. Which medication can the nurse anticipate will be ordered for the patient post-op? A. ACTH B. Hydrocortisone C. Regular Insulin D. ADH

B. Hydrocortisone

A patient is admitted with complications from poorly maintained hypothyroidism. What symptoms should the nurse anticipate? A. Tetany B. Hypoventilation C. Renal stones D. Graves' disease

B. Hypoventilation Rationale: Patients with hypothyroidism may develop myxedema, which results in hypoxia and hypercarbia from hypoventilation.

A nurse is caring for a client who is receiving warfarin for anticoagulation therapy. Which of the following laboratory test results indicates to the nurse that the client needs an increase in the dosage? A. aPTT 38 seconds B. INR 1.1 C. PT 22 seconds D. D-dimer negative

B. INR 1.1

A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? A. Decreased heart rate B. Increased hematocrit C. High urine specific gravity D. Low BUN level

B. Increased hematocrit Rationale: Increased hematocrit is an expected finding of diabetes insipidus due to dehydration.

The patient experiencing diabetes insipidus (DI) is ordered to receive desmopressin (DDAVP). The nurse monitors for which therapeutic effect of these medications? A. Increased urine output B. Increased urine-specific gravity C. Increased serum sodium D. Increased serum potassium

B. Increased urine-specific gravity

A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include? A. Consume no more than three servings of alcohol per day. B. Ingest food with alcohol to reduce alcohol-induced hypoglycemia. C. Increase insulin dosage before planned exercise. D. Rest for 3 days between periods of vigorous exercise.

B. Ingest food with alcohol to reduce alcohol-induced hypoglycemia.

A patient reports insomnia, weight loss, and increased appetite. The laboratory reports of the patient indicate elevated serum triiodothyronine (T3) and thyroxine (T4). Which action is the priority? A. Administer sedatives. B. Manage cardiac function. C. Ensure adequate fluid intake. D. Provide a stress-free environment.

B. Manage cardiac function.

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 blood 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 blood TSH levels should be obtained D. Take the medication on an empty stomach

Which is considered the earliest sign of diabetic nephropathy? A. Positive urine RBCs B. Microalbuminuria C. Positive urine glucose D. Positive urine WBCs

B. Microalbuminuria

A nurse is caring for a client who has diabetes mellitus and has developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to the client's feet? A. Examine the skin of the feet feet weekly for alterations in skin integrity. B. Monitor the temperature of bath water with a thermometer. C. Shop for shoes early in the day. D. Round the edges of toenails when trimming them.

B. Monitor the temperature of bath water with a thermometer. Rationale: Peripheral neuropathy makes it difficult to determine if 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 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

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 questions which order in the patient who has undergone transsphenoidal hypophysectomy for a pituitary tumor? A. Offer clear fluids once alert and awake B. Oxygen 2 L via nasal cannula C. Maintain head of the bed at a 45- to 60-degree angle D. Apply lip balm prn

B. Oxygen 2 L via nasal cannula

The nurse is assigned to a patient with thrombocytopenia. What is the priority goal of nursing care? A. Prevention of infection B. Prevention of injury C. Prevention of dehydration D. Prevention of nutritional deficit

B. Prevention of injury

Debbie is admitted to the intensive care unit with suspected myxedema coma. Which assessment finding warrants immediate action by the nurse? A. Blood glucose 74mg/dL B. Pulse oximetry 91% C. HR 58 and regular D. Lethargy and sleeps a great deal

B. Pulse oximetry 91% Rationale: A drop in pulse ox indicates that there are gas exchanged issues. A patient can have a drop in RR, but still have a normal pulse ox. BG 74 mg/dL is within normal range. HR 58 is slightly bradycardic, but not low enough to be concerned because her heart rhythm has remained regular. Lethargy and excessive sleep is expected in myxedema coma.

A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (Select all that apply.) A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortison sodium succinate D. Sodium polystyrene sulfonate E. Furosemide

B. Regular insulin C. Hydrocortison sodium succinate D. Sodium polystyrene sulfonate E. Furosemide

A nurse is collecting information from a client in a provider's office. Which of the following findings should the nurse identify as an indication of possible cancer? (Select all that apply.) A. Temperature 102F (38.9C) for more than 48 hr B. Sore that does not heal C. Difficulty swallowing D. Unusual discharge E. Weight gain 4 lb (1.8 kg) in 2 weeks

B. Sore that does not heal C. Difficulty swallowing D. Unusual discharge E. Weight gain 4 lb (1.8 kg) in 2 weeks

A patient is admitted with severe dehydration and hypotension. Which hormone, when delivered, increases water reabsorption? A. Oxytocin B. Vasopressin C. Luteinizing hormone D. Adrenocorticotropic hormone

B. Vasopressin Rationale: ADH is also known as vasopressin.

Cancer is the _______ most common cause of death in the United States. A. first B. second C. third D. fourth

B. second

A patient with a pheochromocytoma has undergone unilateral adrenalectomy. Which condition should the nurse monitor in the patient postoperatively? A. Hyperhidrosis B. Hypermetabolism C. Hypovolemic shock D. Cardiac arrhythmias

C. Hypovolemic shock Rationale: Postoperatively, the nurse should closely monitor the patient for hemorrhage and hypovolemic shock.

A patient with hypoparathyroidism has a positive Chvostek sign. Which statement made by the patient indicates a need for better understanding of the condition? A. "I should eat foods rich in calcium." B. "I should maintain adequate hydration." C. "I should eat foods rich in phosphorus." D. "I should be knowledgeable about signs of hypocalcemia."

C. "I should eat foods rich in phosphorus." Rationale: A patient with hypoparathyroidism and positive Chvostek sign should avoid foods high in phosphorus because phosphorus can bind with calcium in plasma and further decrease calcium levels.

A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching? A. "I should stop taking my insulin if I feel nauseous." B. "I will test my urine for protein when I start to feel ill." C. "I will call my doctor if my blood sugar is more than 250." D. "I should check my blood sugar level every 8 hours."

C. "I will call my doctor if my blood sugar is more than 250."

A nurse is teaching about direct measurements of plasma catecholamines in patients with a pheochromocytoma. Which statement indicates the need for further teaching? A. "I will place the patient in a supine position for 30 minutes prior to the test." B. "I will place small IV catheters about 30 minutes prior to the actual collection of the blood samples." C. "I will collect urine samples for 12 hours." D. "I will ensure that the patient does not eat a banana."

C. "I will collect urine samples for 12 hours." Rationale: For the direct measurements of plasma catecholamines, specific patient preparation is required for preventing the elevation of circulating catecholamines. Prior to the test, the patient is placed in the supine and resting position for 30 minutes, and small IV catheters are placed for the actual collection of the blood samples about 30 minutes prior to the test. The patient should avoid eating bananas prior to the test as they are high in amines and, therefore, false elevation of vanillymandelic acid may occur.

A nurse is teaching a client about screening prevention for cancer. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to have a mammogram every 2 years beginning at age 45." B. "I should have a colonoscopy every 15 years beginning at age 60." C. "I will need to have an annual breast examination every year after 40." D. "I should have a fecal occult test done every 3 years."

C. "I will need to have an annual breast examination every year after 40."

The nurse is teaching a patient with diabetes mellitus about foot care. Which statement made by the patient indicates the need for further teaching? A. "I will refrain from walking barefoot." B. "I will refrain from soaking my feet in water." C. "I will use lotions between my toes." D. "I will wash my feet daily and dry them thoroughly."

C. "I will use lotions between my toes." Rationale: A diabetic patient should not use lotions between the toes, as this may encourage infection.

The nursing student is explaining the radioactive iodine uptake test and scan to peers in post-conference. Which statement made by the student warrants intervention by the instructor? A. "It measures how much iodine is taken up by your thyroid gland in a certain amount of time." B. "The patient swallows a pill that contains radioactive iodine." C. "The patient needs to be in isolation for 4-6 hours until the radioactivity is excreted in the urine." D. "The patient is instructed to avoid seafood while the test is being completed."

C. "The patient is instructed to be in isolation for 4-6 hours until the radioactivity is excreted in the urine."

A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements should the nurse make? A. "Your nausea will lessen with each course of chemotherapy." B. "Hot food is better tolerated due to the aroma." C. "Try eating several small meals throughout the day." D. "Increase your intake of red meat as tolerated."

C. "Try eating several small meals throughout the day."

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 the instructions 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

The nurse should intervene immediately if a patient has which blood glucose level? A. 200 mg/dL B. 150 mg/dL C. 80 mg/dL D. 40 mg/dL

D. 40 mg/dL

While instructing the patient with diabetes on insulin injections, the nurse is paged by the unit clerk when she learns several patients are having problems that require her attention. Which action should the nurse take first? A. Return to the patient and supervise the insulin inject since the breakfast tray has arrived. B. Administer the dose of antibiotic to the diabetic patient with an infected foot who is scheduled for the OR in an hour. C. Administer IV dextrose to the diabetic patient with a morning blood glucose level of 25 mg/dL. D. Hang a new bag of normal saline for the patient with diabetes with HHNK and morning blood glucose level of 350mg/dL.

C. Administer IV dextrose to the diabetic patient with a morning blood glucose level of 25 mg/dL.

A nurse is caring for a client who has multiple types of skin lesions. Which of the following skin lesions are indicative of a malignant melanoma? (Select all that apply.) A. Diffuse vesicles B. Uniformly colored papule C. Area with asymmetric borders D. Rough, scaly patch E. Irregular colored mole

C. Area with asymmetric borders E. Irregular colored mole

A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? A. Moon-shaped face B. Weight gain C. Calcium 12.8 mg/dL D. Sodium 150 mEq/L

C. Calcium 12.8 mg/dL Rationale: A client who has adrenal insufficiency will have a calcium level above the expected reference range.

After serum testing, it is determined that a patient has a deficiency of adrenocorticotropic hormone (ACTH). What concern should the nurse be aware of? A. Dwarfism B. Osteoporosis C. Circulatory collapse D. Ventricular tachyarrhythmias

C. Circulatory collapse Rationale: The decreased secretion of ACTH would result in decreased glucocorticoids and mineralocorticoids. Therefore, the patient would be unable to maintain an adequate fluid volume status. Such a condition may result in circulatory collapse.

The nurse receives hand-off report for a patient with a history of hypothyroidism. Which symptoms should the nurse ask about to determine how well the patient is managing the illness? A. Insomnia B. Weight loss C. Constipation D. Tachycardia

C. Constipation Rationale: Hypothyroidism decreases metabolism, which can result in symptoms such as constipation, bradycardia, weight gain, and fatigue.

Which intervention is most appropriate for the nurse to provide to the patient with Addison's Disease? A. Monitoring for hypokalemia B. Restrict fluid intake C. Decrease levels of exertion D. Check for hyperglycemia

C. Decrease levels of exertion

A patient with hypercortisolism is hospitalized after experiencing a fall from orthostatic hypotension. Which additional symptom will be present? A. Decreased bone density B. Decreased blood pressure C. Decreased blood glucose level D. Decreased blood potassium level

C. Decreased blood glucose level Rationale: Hypoglycemia is related to decreased secretion of ACTH. This results in decreased secretion of cortisol.

The patient experiencing thyroid storm is ordered to receive beta-adrenergic agents. The nurse monitors for which therapeutic effect of these medications? A. Increased respiratory rate B. Increased appetite C. Decreased heart rate D. Decreased bowel sounds

C. Decreased heart rate

A patient is undergoing a stimulation test to assess adrenal function. After the administration of cortisol, which laboratory result indicates normal function? A. Decreased blood glucose B. Decreased serum sodium C. Decreased serum potassium D. Decreased serum calcium

C. Decreased serum potassium

The nurse correlates which finding to a diagnosis of SIADH? A. Polyuria B. Polyphagia C. Decreased urine output D. Glucosuria

C. Decreased urine output

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 teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include? A. Inject the insulins intramuscularly. B. Shake the insulins vigorously prior to administration. C. Draw up the insulins into separate syringes. D. Expect the insulins to appear cloudy.

C. Draw up the insulins into separate syringes.

A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings is 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

A nurse is providing discharge teaching for a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? (Select all that apply.) A. Brush teeth after every meal or snack B. Avoid bending at the knees C. Eat a high-fiber diet D. Notify the provider of increased swallowing E. Notify the provider of a diminished sense of smell

C. Eat a high-fiber diet D. Notify the provider of increased swallowing

Ideally, which is the primary goal of patient diabetes education? A. Make all patients responsible for management of their illness B. Involve the family in the care of the patient C. Enable the patient to become the most active participant in the management of the diabetes D. Provide the patient with as much information as possible to prevent complications of diabetes

C. Enable the patient to become the most active participant in the management of the diabetes

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

A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect? A. Decreased blood pressure B. Weight loss C. Hirsutism D. Increased skin thickness

C. Hirsutism Rationale: Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production.

Debbie is still reporting constipation, fatigue, shortness of breath with strenuous activity and has not loss weight since starting the levothyroxine 2 weeks ago. Her serum TSH level is elevated. Based upon this information, which action can the nurse expect the physician will perform prior to sending Debbie home? A. Discontinue the medication B. Order a ultrasound of the thyroid C. Increase the dose of levothyroxine D. Change to another thyroid replacement medication

C. Increase the dose of levothyroxine Rationale: The symptoms Debbie is experiencing and elevated serum TSH level indicate that she is experiencing symptoms of hypothyroidism. It will take a long time to build up the level of levothyroxine in the blood, but there are no signs that Debbie is experiencing any complications from the levothyroxine treatment. There is no need to discontinue or change the medication.

The patient is diagnosed with hyperthyroidism (the condition is originating in the thyroid). In addition to the results of the scan, which serum lab values support hyperthyroidism in this patient? A. Increased T4, increased TSH B. Decreased T4, decreased TSH C. Increased T4, decreased TSH D. Decreased T4, increased TSH

C. Increased T4, decreased TSH

A nurse is assessing a client who is taking propylthiouracil (PTU). The nurse should identify which of the following findings as an indication that the medication has been effective? A. Increased ability to sweat B. Increased bowel movements C. Increased body weight D. Increased libido

C. Increased body weight Rationale: Propylthiouracil suppresses the production of thyroid hormones and allows for weight gain. However, excessive weight gain could indicate that the dose of propylthiouracil is too high.

When completing a history and physical examination on a patient with a hematological disorder, which action is appropriate? A. Deeply palpate the spleen to determine the extent of splenomegaly B. Perform a respiratory assessment after moderate exercise for accurate measurement of depth and rhythm C. Inspect oral mucous membranes and the tongue for lesions, swelling, and pain D. Suggest a bone marrow biopsy if the patient reports decreased energy levels

C. Inspect oral mucous membranes and the tongue for lesions, swelling, and pain

Which is true regarding a pheochromocytoma? A. It is the increased secretion of aldosterone. B. It is the excessive secretion of glucocorticoids. C. It is the excessive secretion of catecholamines by adrenal medulla. D. It is the decreased secretion of adrenocorticotropic hormone from the anterior pituitary gland.

C. It is the excessive secretion of catecholamines by adrenal medulla.

Which patient in the medical-surgical unit is most likely to have increased aldosterone secretion? A patient who... A. Has excessive salt ingestion B. Drinks a lot of water C. Loses a lot of fluid and sodium D. Loses potassium and water

C. Loses a lot of fluid and sodium

Which intervention is appropriate for the patient post-op transsphenoidal hypophysectomy? (Select all that apply.) A. Encourage the patient to blow their nose frequently B. Observe the cranial incision for bleeding and infection C. Monitor the nose for drainage D. Instruct patient to avoid activities that will increase intracranial pressure

C. Monitor the nose for drainage D. Instruct patient to avoid activities that will increase intracranial pressure

A nurse is caring for a client who is receiving chemotherapy and has mucositis. Which of the following actions should the nurse take? A. Use a glycerin-soaked swab to clean the client's teeth B. Encourage increased intake of citrus fruit juices C. Obtain a culture of the lesions D. Provide an alcohol-based mouthwash for oral hygiene

C. Obtain a culture of the lesions

A nurse is evaluating a patient's outcome. The patient's nursing care plan includes the nursing diagnosis of fluid volume deficit related to HHNK secondary to severe hyperglycemia. The nurse knows that the client has a positive outcome when which serum laboratory value had decreased to a normal range? A. Glucose B. Sodium C. Osmolality D. Potassium

C. Osmolality

What is a probable initial assessment finding for a patient with a low hemoglobin count? A. Increased and bounding peripheral pulses B. Hypertension C. Pallor and fatigue D. Moist mucus membranes

C. Pallor and fatigue

The diabetic patient has the following assessment findings. Which should the RN instruct the LPN to report immediately? A. Finger stick glucose of 185 mg/dL B. Numbness and tingling in both feet C. Perfuse perspiration D. Bunion on left great toe

C. Perfuse perspiration Rationale: BG of 185 is higher than desired, but this is an expected result from a patient diagnosed with diabetes. Numbness and tingling in both feet is indicative of diabetic peripheral neuropathy. This is a chronic illness that has been developing over time. The perfuse perspiration likely indicates the patient has a low blood glucose and this is the priority finding at the time.

The nurse is admitting a patient from home. Which presenting symptom causes the nurse to be concerned that the patient has developed diabetes insipidus (DI)? A. Hypertension B. Bradycardia C. Polyuria D. Decreased serum sodium

C. Polyuria Rationale: The patient with DI lacks ADH. This leads to polyuria, which is the excretion of large volumes of very dilute urine. The patient will have elevated serum sodium and hematocrit. The patient will present with hypotension and tachycardia secondary to hypovolemia.

The patient presents to the emergency department with 1-week symptoms of polyuria, polydipsia, hypernatremia, and tachycardia. The patient has an elevate serum osmolality. A malfunction in which area of the brain is most likely causing these symptoms? A. Hypothalamus B. Anterior lobe of the pituitary C. Posterior pituitary gland D. Sella turcica

C. Posterior pituitary gland Rationale: Diabetes insipidus is caused by a decreased secretion of ADH secondary to damage to the posterior pituitary gland.

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 15 g of simple carbohydrates D. Report findings to the provider

C. Provide 15 g of simple carbohydrates

A nurse is planning care for a 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 their 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 is concerned about high sodium levels in her patient experiencing diabetes insipidus. Which is the priority nursing action? A. Supplement the reciprocal hypokalemia. B. Complete hourly neurological assessments. C. Provide safety precautions for seizures. D. Monitor hourly urine output.

C. Provide safety precautions for seizures. Rationale: Seizures are a complication of hypernatremia, which is a complication associated with diabetes insipidus. Hypernatremia often causes hypokalemia, but this is not the priority.

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect? A. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr B. Administer a slow IV infusion of 3% sodium chloride C. Rapidly administer an IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when blood glucose is 350 mg/dL

C. Rapidly administer an IV infusion of 0.9% sodium chloride

Which medication should be avoided for Debbie now that she has developed hypothyroidism as a result of her thyroidectomy? A. Thyroid hormones B. Oxygen C. Sedatives D. Laxatives

C. Sedatives Rationale: In hypothyroidism, everything is slowed down. Giving a sedative will further slow things down, putting her at risk for respiratory depression.

The nurse monitors the patient with SIADH for which complication secondary to a serum sodium level of 120 mEq/L? A. Hypotension B. Hyperglycemia C. Seizures D. Bradycardia

C. Seizures

The nurse enters the room and suspects Debbie is experiencing complications following her thyroidectomy. Which manifestations requires the nurse to address first? A. Pain and hoarse voice B. Tingling and tremors in arms C. Tachycardia and altered mental status D. IV site slightly red and edematous

C. Tachycardia and altered mental status Rationale: Tachycardia and altered mental status are early signs of hypoxia, indicating that there oxygenation and perfusion have been compromised.

What is the difference between the cells of a benign tumor and the cells of a malignant tumor? A. The cells of benign tumors are typically aplastic. B. The cells of malignant tumors are apoptotic. C. The cells of malignant tumors lack contact inhibition. D. The cells of benign tumors are characterized by uncontrolled cell growth.

C. The cells of malignant tumors lack contact inhibition.

The nurse correlates an increase in the secretion of which hormone with the release of thyrotropin-releasing hormone? A. Triiodothyronine (T3) B. Thyroxine C. Thyroid stimulating hormone (TSH) D. Thyrocalcitonin

C. Thyroid stimulating hormone (TSH)

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? A. Strong, bounding pulse B. Decreased bowel sounds C. Tingling and numbness of the hands and feet D. Diminished deep-tendon reflexes

C. Tingling and numbness of 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? A. Cold intolerance B. Lethargy C. Tremors D. Sunken eyes

C. Tremors

Which assessment maneuver is contraindicated in the patient suspected of having a pheochromocytoma? A. Having the patient attempt to touch the chin to the chest B. Inflating the blood pressure cuff above 200 mm Hg C. Attempting to dorsiflex the feet D. Palpating the abdomen

D. Palpating the abdomen

A nurse is teaching a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates understanding of the procedure? A. "A test of my bone marrow will be performed." B. "A lymph node will be removed." C. "A needle will be inserted into the mass." D. "A small skin sample will be obtained."

D. "A small skin sample will be obtained."

Which assessment is essential for the nurse to ask the patient prior to a MRI procedure? A. "Do you take any sedative medications?" B. "Do you have a history of headaches?" C. "Do you have any hearing issues?" D. "Do you have any metal or implants in your body?"

D. "Do you have any metal or implants in your body?"

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 blood glucose levels." C. "I should expect to gain weight during this illness." D. "I might experience confusion or balance problems."

D. "I might experience confusion or balance problems."

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? A. "I will let my feet air dry after washing." B. "I will wear sandals to allow air to circulate around my feet." C. "I will buy over-the-counter medicine to treat the calluses on my feet." D. "I will apply lotion to the dry areas of my feet but not between my toes."

D. "I will apply lotion to the dry areas of my feet but not between my toes."

The nurse is teaching a patient with hyperparathyroidism about treatment strategies. Which statement by the patient indicates the need for further teaching? A. "I will increase my oral intake of fluids." B. "I will avoid the intake of thiazide diuretics." C. "I will avoid the intake of medications containing vitamin D." D. "I will increase my intake of antacids containing calcium."

D. "I will increase my intake of antacids containing calcium." Rationale: Antacids may contain calcium. Patients with hyperparathyroidism should not consume antacids as this may lead to hypercalcemia and can worsen the condition of hyperparathyroidism.

A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include? A. "Drink at least 3 liters of fluid per day." B. "Weigh yourself weekly while wearing similar clothing at the same time of day." C. "Notify the provider of a weight loss of 1 pound or more per week." D. "Report nocturia because it requires a dosage adjustment."

D. "Report nocturia because it requires a dosage adjustment." Rationale: The client should take the initial dose of desmopressin in the evening. The provider will increase the dosage until the client no longer has nocturia.

A nurse is teaching a client who is scheduled for a vanillylmandelic acid test to screen for a pheochromocytoma. Which of the following statements should the nurse include in the teaching? A. "Start fasting at midnight prior to the day of the test." B. "Begin the 24-hour urine collection with the first morning urination." C. "Take low-dose aspirin for pain during the testing period." D. "Restrict coffee intake 2 to 3 days prior to the test."

D. "Restrict coffee intake 2 to 3 days prior to the test." Rationale: The client should avoid coffee and tea, even if they are decaffeinated, bananas, chocolate, and vanilla for 2 to 3 days prior to the test.

To better locate the isthmus of the thyroid gland in preparation for palpation, the nurse asks the patient to perform which action? A. "Say 'ah.'" B. "Touch your chin to your chest." C. "Look at the ceiling." D. "Swallow a sip of water."

D. "Swallow a sip of water."

A nurse working on a telemetry unit is planning to complete noon assessments for four assigned clients with type 1 diabetes mellitus. All of the clients received subcutaneous insulin aspart (Novalog) at 0800 hours. In which order should the nurse assess the clients? Place each answer option into the correct order. A. A 75-year old patient with a noon fingerstick blood glucose level of 300 g/dL. B. A 60-year old patient who is nauseous and has just vomited for the second time. C. A 50-year old patient with a noon fingerstick blood glucose level of 80mg/dL D. A 45-year old patient who is dyspneic and has chest pressure and new onset atrial fibrillation.

D. A 45-year old patient who is dyspneic and has chest pressure and new onset atrial fibrillation. B. A 60-year old patient who is nauseous and has just vomited for the second time. A. A 75-year old patient with a noon fingerstick blood glucose level of 300 g/dL. C. A 50-year old patient with a noon fingerstick blood glucose level of 80mg/dL

A nurse is teaching a client about the ACTH stimulation test. The nurse should explain that the purpose of this test is to assess for which of the following disorders? A. Diabetes insipidus B. Hyperthyroidism C. Pheochromocytoma D. Addison's disease

D. 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.

The patient with diabetes is found unconscious at home and the family member calls the clinic. What instruction is most appropriate by the nurse? A. Attempt to locate the glucometer and take a blood sugar reading B. Have the patient drink 4 ounces of orange juice and recheck blood sugar C. Call 911 and transport the patient to the hospital immediately D. Administer Glucagon 1 mg intramuscularly or subcutaneously

D. Administer Glucagon 1 mg intramuscularly or subcutaneuosly

Debbie's heart rate decreases and reports feeling better following her thyroidectomy, but the tingling and tremors continue. Which assessment technique would best assist the nurse in evaluating these manifestations? A. Assess for Battle's sign B. Elicit a Babinski reflex C. Perform an Allen's test D. Assess for Trousseau's sign

D. Assess for Trousseau's sign Rationale: Trousseau's sign is indicative of hypocalcemia. Allen's test is done prior to obtaining an ABG to ensure collateral perfusion to the hand. Eliciting a Babinski reflex would be done in a patient with suspected brain injury. Battle's sign is indicative of a skull fracture.

What is the most specific method of diagnosing a malignancy? A. Serum laboratory tests B. MRI C. CT scan D. Biopsy

D. Biopsy

A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of diabetic ketoacidosis (DKA)? A. Decreased urine output B. Weight gain of 0.45 kg (1 lb) in 24 hr C. Rapid, shallow respirations D. Blood glucose levels above 300 mg/dL

D. Blood glucose levels above 300 mg/dL

The patient returns from surgery after a thyroidectomy. Which electrolyte is essential that the nurse monitors? A. Sodium B. Potassium C. Chloride D. Calcium

D. Calcium

The laboratory reports of a patient reveal a pH of 7.28. The patient also has a heart rate of 110 bpm. Which is the patient most likely to have developed? A. Hypoglycemia B. Somogyi effect C. Dawn phenomenon D. Diabetic ketoacidosis

D. Diabetic ketoacidosis

A nurse is reviewing the laboratory results of a client undergoing screening for primary Cushing's disease. The nurse should expect an elevation in which of the following laboratory findings? A. Lymphocyte count B. Potassium C. Calcium D. Glucose

D. Glucose

A nurse in a clinic is caring for a client who has suspected anemia. Which of the following laboratory test results should the nurse expect? A. Iron 90 mcg/dL B. RBC 6.5 million/uL C. WBC 4,00 mm^3 D. Hgb 10 g/dL

D. Hgb 10 g/dL

Which statement accurately demonstrates a direct influence on the release of a hormone by an endocrine gland? A. Increased cortisol stimulates the release of insulin B. Elevated thyroid calcitonin levels are released by TSH C. Increased testosterone levels inhibit the release of estrogen D. High potassium levels will stimulate aldosterone release

D. High potassium levels will stimulate aldosterone release

Which clinical manifestation is the nurse most likely to see in a patient with a pheochromocytoma? (Select all that apply.) A. Bradycardia B. Hypotension C. Hypoglycemia D. Hyperhidrosis E. Hypermetabolism

D. Hyperhidrosis E. Hypermetabolism Rationale: Clinical manifestations of pheochromocytoma include tachycardia, hypertension, hyperglycemia, hyperhidrosis, and hypermetabolism.

The nursing diagnosis "Acute pain related to ureteral pressure and obstruction secondary to calcium-containing renal stones" is most appropriate for the patient with which endocrine disorder? A. Hypothyroidism B. Hypoparathyroidism C. Hyperthyroidism D. Hyperparathyroidism

D. Hyperparathyroidism

The nurse correlates which clinical manifestation with the pathophysiology of adrenal insufficiency? A. Heat intolerance B. Weight gain C. Peripheral edema D. Hypoglycemia

D. Hypoglycemia

A home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hyperthyroidism. The client has not been taking the medication regularly. Which of the following findings should the nurse expect? A. Increased urine output B. Persistent diarrhea C. Tachycardia D. Hypotension

D. Hypotension

The nurse is caring for a patient with adrenocorticotropic hormone (ACTH) deficiency. What should be included in the plan of care? A. Preventing the risk for injury B. Providing a diet rich in calcium C. Increasing the intake of vitamin D D. Maintaining adequate volume of fluid intake

D. Maintaining adequate volume of fluid intake Rationale: Fluid volume deficiency is related to decreased glucocorticoid and mineralocorticoid levels, which is related to ACTH deficiency. Maintaining adequate fluid levels in a patient with ACTH deficiency is an important intervention.

A nurse is reviewing the plan of care for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first? A. Instruct the client to take rest periods throughout the day B. Encourage the client to reposition in bed every 2 hr C. Check temperature every 4 hr D. Monitor platelet counts

D. Monitor platelet counts

Debbie' s condition has stabilized and now she has expressed concerns about her exophthalmia. Which measure should the nurse include when teaching her how to manage the discomfort associated with exophthalmia? A. Encourage the patient to lie supine B. Use warm moist compresses C. Apply petroleum jelly along the eye lid D. Patch the eyelids close at night if needed

D. Patch the eyelids close at night if needed Rationale: Exophthalmia occurs as a result of inflammation and fluid build up. Our ultimate goal with exophthalmia is to protect the eyes. Patching the eyelids closed at night will help her sleep. The patient should not lie supine as it will increase the pressure in her eye. If possible, Debbie should sleep in a semi-Fowler's position. Petroleum is an irritant to the eye. Warm compresses will vasodilate blood vessels and increase blood flow to the eyes, resulting in more edema. In this situation, we could offer cold compresses.

Based on the following laboratory results, which of the following patients is MOST likely to have Cushing's disease? Patient A: cortisol (afternoon) 8 mcg/dL, glucose 80 mg/dL Patient B: cortisol (afternoon) 13 mcg/dL, glucose 90 mg/dL Patient C: cortisol (afternoon) 15 mcg/dL, glucose 98 mg/dL Patient D: cortisol (afternoon) 19 mcg/dL, glucose 110 mg/dL A. Patient A B. Patient B C. Patient C D. Patient D

D. Patient D Rationale: The normal range of cortisol in the afternoon is 3-16 mcg/dL. The normal level of blood glucose is 70-100 mg/dL. In Cushing's disease, the level of glucose and cortisol is elevated. Therefore, Patient D is most likely to have Cushing's disease.

Based on the following laboratory results, which of the following patients is MOST likely to have Conn's syndrome? A. Patient A with a serum sodium level of 142 mg/dL B. Patient B with a serum potassium level of 5.8 mmol/L C. Patient C with a blood pressure of 86/58 mm Hg D. Patient D with a blood pressure of 167/100 mm Hg

D. Patient D with a blood pressure of 167/100 mm Hg Rationale: Conn's syndrome is associated with hyperaldosteronism. Aldosterone is responsible for sodium and water reabsorption and potassium excretion. It can manifest with hypertension from the water retention and hypokalemia from excretion of potassium

The nurse is reviewing the laboratory reports of four patients with histories of diabetes mellitus. Which patient is demonstrating signs of diabetic ketoacidosis? A. Patient A with an arterial pH level of 7.40 B. Patient B with a serum triglyceride level of 90 mg/dL C. Patient C with a plasma glucose level of 115 mg/dL D. Patient D with a serum bicarbonate level of 12 mmol/L

D. Patient D with a serum bicarbonate level of 12 mmol/L

The nurse is reviewing the laboratory reports of four patients. Which patient's test results indicates possible type 2 diabetes mellitus? A. Patient A: fasting BG 98 mg/dL, random BG 50 mg/dL B. Patient B: fasting BG 105 mg/dL, random BG 175 mg/dL C. Patient C: fasting BG 112 mg/dL, random BG 195 mg/dL D. Patient D: fasting BG 135 mg/dL, random BG 230 mg/dL

D. Patient D: fasting BG 135 mg/dL, random BG 230 mg/dL Rationale: The normal fasting plasma glucose level is 70-100 mg/dL. The normal random plasma glucose level is less than 200 mg/dL.

Based upon the lab tests and thyroid scan, Debbie is diagnosed with hyperthyroidism and is started on the following medications: Propylthiouracil (PTU) and Propranolol (Inderal). Which instruction should the nurse provide when Debbie inquires as to why Inderal is ordered? A. Increases blood pressure B. Decreases blood flow to the thyroid C. Decrease the size of the thyroid gland D. Reduces symptoms such as palpitations

D. Reduces symptoms such as palpitations Rationale: Propranolol (Inderal) is a nonselective beta blocker that functions to help manage the cardiac issues associated with hyperthyroidism.

A nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? A. Serum pH 7.32 B. Blood glucose 250 mg/dL C. Blood glucose 425 mg/dL D. Serum pH 7.45

D. Serum pH 7.45 Rationale: A client who is experiencing 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.

Debbie is improving and back on the medical-surgical floor. She is getting prepared to be sent home following her thyroidectomy on levothyroxine (synthroid). Which behavior indicates to the nurse that she understands discharge medication instructions? A. The patient asked her sister to get only one refill of the medication B. The patient plans to take the medication with meals to prevent stomach upset C. The patient makes a schedule to remind her to take the medication in the evenings D. The patient stated that too much medication will have same complaints she experienced prior to surgery

D. The patient stated that too much medication will have same complaints she experienced prior to surgery Rationale: Debbie will require this drug for the rest of her life. The drug should be taken on an empty stomach and in the morning.

What is the role of erythropoietin in the regulation of red blood cells? A. To make Hgb capable of transporting oxygen B. To pick up carbon dioxide from the tissues and deliver it to the lungs C. To decrease RBC production D. To stimulate RBC production

D. To stimulate RBC production

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. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear closed-toe shoes

D. Trim toenails straight across E. Wear closed-toe shoes