NU102 Extra Questions PrepU
What important considerations would the nurse make when teaching and caring for a newly diagnosed client with diabetes mellitus? a) Having the client work closely with a peer who has diabetes to learn about the condition and control b) Allowing the client to develop the teaching plan and assess readiness to learn about different aspects of the disease c) Informing the client about complications that could occur if the client is noncompliant d) Involving the client in the development of the teaching plan and encouraging questions and active participation
d) Involving the client in the development of the teaching plan and encouraging questions and active participation Rationale: Actively involving the client in the teaching usually results in better understanding and compliance with the plan of care.
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias? a) Serum chloride level b) Serum calcium level c) Serum sodium level d) Serum potassium level
d) Serum potassium level Rationale: The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias
A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? a) The client with diabetic ketoacidosis. b) The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion. c) The client with diabetes mellitus. d) The client with diabetes insipidus.
d) The client with diabetes insipidus. Rationale: Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus. Diabetes mellitus does not involve vasopressin deficiencies or an intracranial disorder, but rather a disturbance in the production or use of insulin. Diabetic ketoacidosis results from severe insulin insufficiency. An excess of vasopressin leads to SIADH, causing the client to retain fluid.
A nurse is teaching a client about how to recognize when treatment for hypothyroidism is effective. Which of the following statements from the client would indicate that the nurse's teaching has been effective? a) "Hopefully I won't lose any more weight." b) "I will start feeling more energetic." c) "I won't feel hot and sweaty anymore." d) "It will be a relief to be able to sleep more hours."
b) "I will start feeling more energetic." Rationale: A client will show understanding of the treatment for hypothyroidism when he/she can identify what changes will signify improvement. An increase in energy will demonstrate that therapy has been effective and the thyroid levels are rising. The other choices are all examples of hyperthyroidism.
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? a) "Rotate injection sites within the same anatomic region, not among different regions." b) "Administer insulin into sites above muscles that you plan to exercise heavily later that day." c) "Administer insulin into areas of scar tissue or hypertrophy whenever possible." d) "Inject insulin into healthy tissue with large blood vessels and nerves."
a) "Rotate injection sites within the same anatomic region, not among different regions." Rationale: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.
A child with diabetes insipidus receives desmopressin acetate. When evaluating for therapeutic effectiveness, the nurse should interpret which finding as a positive response to this drug? a) Decreased urine output b) Decreased blood pressure c) Relief of nausea d) Increased urine glucose level
a) Decreased urine output Rationale: The primary action of desmopressin acetate is to stimulate water reabsorption by the kidneys, thereby decreasing the urine output. Desmopressin acetate has no effect on glucose levels, blood pressure, or nausea.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a) Graves' disease. b) multinodular goiter. c) Hashimoto's thyroiditis. d) thyroiditis.
a) Graves' disease. Rationale: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a) decreased body temperature and cold intolerance. b) systolic murmur at the left sternal border. c) flushed, warm, moist skin. d) exophthalmos and conjunctival redness.
a) decreased body temperature and cold intolerance. Rationale: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism
Clients with diabetes mellitus require frequent vision assessment. The nurse should instruct the client about which vision problem most likely to be associated with diabetes mellitus? a) retinopathy b) cataracts c) glaucoma d) astigmatism
a) retinopathy Rationale: The major cause of blindness in people with diabetes mellitus is diabetic retinopathy. Corneal problems, cataracts, refractive changes, glaucoma, and extraocular muscle changes are also noted, but retinopathy is the most common problem. Astigmatism has not been associated with diabetes mellitus.
Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? a) Dizziness. b) Rapid weight gain. c) Anorexia. d) Poor skin turgor.
b) Rapid weight gain. Rationale: Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.
A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which of the following is the most important effect to report to the physician? a) Increased temperature and metabolic rate b) Increased energy level and reduction of edema c) Palpitations and chest pain on exertion d) Insomnia and loss of weight
c) Palpitations and chest pain on exertion Rationale: Assessment of the effects of severe hypothyroidism on the circulatory system is important. Serum cholesterol levels are also elevated in clients with hypothyroidism. As the metabolic rate increases with the thyroid replacement therapy, there is more demand on the heart, and angina and palpitations may occur. All of the choices are expected effects once the replacement hormone is started. There is an increase in temperature, a loss in weight, and increased energy levels.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? a) Serum sodium level of 134 mEq/L (134 mmol/L) b) Blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L) c) Serum potassium level of 5.8 mEq/L (5.8 mmol/L) d) Blood glucose level of 90 mg/dl (4.9 mmol/L)
c) Serum potassium level of 5.8 mEq/L (5.8 mmol/L) Rationale: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse? a) "I will increase daily caloric consumption." b) "I should stop taking the prescribed daily aspirin." c) "I should stop attending group activities." d) "I will increase fiber and fluids in my diet."
d) "I will increase fiber and fluids in my diet." Rationale: Clients with hypothyroidism typically have constipation. A diet high in fiber and fluids can help prevent this. Group activities have nothing to do with the current issue. A nurse would not change medical prescriptions by telling the client to stop taking the prescribed aspirin. Increasing caloric consumption is not appropriate with hypothyroidism.
When obtaining the health history from a client with retinal detachment, a nurse expects the client to report: a) frequent episodes of double vision. b) headaches, nausea, and redness of the eyes. c) a recent driving accident while changing lanes. d) light flashes and floaters in front of the eye.
d) light flashes and floaters in front of the eye. Rationale: The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.
The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings? a) Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet b) Edema and coolness in the ankles and feet c) Redness, inflammation, and sharp pain with calf muscle contraction d) Capillary refill in the toes within 3 seconds
a) Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet Rationale: This choice is the most accurate description of an interference with arterial circulation. The dorsalis pedis is one of the most peripheral pulses, its absence along with coolness indicates compromised arterial flow. Impaired blood flow will also affect the nervous status in the foot, resulting in decreased sensation. Capillary refill in 2 seconds is normal; edema and coolness is more an indication of venous impairment; inflammation and calf pain likely indicate a thrombophlebitis.
A school nurse is called to assess a 12-year-old child with type 1 diabetes mellitus who is experiencing lightheadedness, tachycardia, pallor, headache, and confusion during gym class. What is the priority action by the nurse? a) Notify the parents that the child is ill. b) Provide a snack of hard candy or raisins. c) Administer insulin to the child. d) Encourage the child to exercise more.
b) Provide a snack of hard candy or raisins. Rationale: The increased exercise has caused a drop in serum glucose levels, producing symptoms of hypoglycemia. The first action is to give the child a sugary snack to raise the glucose level.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a) They cause wide fluctuations in the need for insulin. b) They increase the need for insulin. c) They decrease the need for insulin. d) They have no effect.
b) They increase the need for insulin. Rationale: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
For a client with hyperthyroidism, treatment is most likely to include: a) thyroid extract. b) a thyroid hormone antagonist. c) a synthetic thyroid hormone. d) emollient lotions.
b) a thyroid hormone antagonist. Rationale: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: a) calcium and phosphorus abnormalities. b) sodium and chloride abnormalities. c) sodium and potassium abnormalities. d) chloride and magnesium abnormalities.
c) sodium and potassium abnormalities. Rationale: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
To reduce the risk of developing type 2 diabetes mellitus the nurse should instruct the client to: a) obtain a high-cholesterol diet. b) stop cigarette smoking. c) prevent hypertension. d) maintain weight within normal limits.
d) maintain weight within normal limits. Rationale: The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-cholesterol diet does not necessarily predispose to diabetes mellitus, but it may contribute to obesity and hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus
Which indicates that the client with diabetes insipidus understands how to manage care? a) The client will state dietary restrictions. b) The client will maintain normal fluid and electrolyte balance. c) The client will select a diabetic diet correctly. d) The client will exhibit serum glucose level within normal range.
b) The client will maintain normal fluid and electrolyte balance. Rationale: Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.
The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? a) "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." b) "My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day." c) "I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids." d) "Glucocorticoids are cumulative, so I will take a dose every third day."
a) "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." Rationale: The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, Addisonian crisis could result. Two-thirds of the daily dose should be taken at about 0800 and the remainder at about 1600. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 0400 and 0600 and lowest levels in the evening.
Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? a) increasing activity b) relieving pain c) obtaining adequate food intake d) managing own health
c) obtaining adequate food intake Rationale: The priority goal for the client with diabetes mellitus who is experiencing vomiting with influenza is to obtain adequate nutrition. The diabetic client should eat small, frequent meals of 50 g of carbohydrate or food equal to 200 cal every 3 to 4 hours. If the client cannot eat the carbohydrates or take fluids, the health care provider (HCP) should be called, or the client should go to the emergency department. The diabetic client is in danger of complications with dehydration, electrolyte imbalance, and ketoacidosis. Increasing the client's health management skills is important to lifestyle behaviors, but it is not a priority during this acute illness of influenza. Pain relief may be a need for this client, but it is not the priority at this time; neither is increasing activity during the illness.
A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: a) hair loss. b) menstrual flow. c) serum glucose level. d) bone mineralization.
c) serum glucose level. Rationale: Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
