NUR 150 Exam # 2 Review

The nurse is teaching a client newly diagnosed with diabetes about the importance of glucose monitoring. Which of the following blood glucose levels should the nurse identify as hypoglycemia? 1 58 mg/dL 2 68 mg/dL 3 78 mg/dL 4 88 mg/dL

1 58 mg/dL Clients who have blood glucose levels below 60 may experience hypoglycemia; 70 mg/dL, 78 mg/dL, and 88 mg/dL are normal blood glucose levels. Study Tip: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.

A client is receiving total parenteral nutrition. The nurse assesses for which client response that indicates hyperglycemia? 1 Polyuria 2 Paralytic ileus 3 Respiratory rate below 16 4 Serum glucose of 105 mg/100 mL

1 Polyuria When blood glucose exceeds the renal threshold for glucose reabsorption in the kidney tubules, it acts as an osmotic diuretic, resulting in polyuria. Paralytic ileus is not associated with hyperglycemia. With hyperglycemia there is hyperventilation. Serum glucose of 105 mg/100 mL is within the expected range.

The nurse is planning discharge instructions for a client who had a thyroidectomy. For which signs of surgically induced hypothyroidism should the nurse alert the client? Select all that apply. 1 Fatigue 2 Dry skin 3 Insomnia 4 Excitability 5 Weight loss 6 Intolerance to heat

1 Fatigue 2 Dry skin Fatigue results from the decreased metabolic rate associated with hypothyroidism. Dry skin is caused by decreased glandular function. Insomnia is associated with hyperthyroidism because of the increased metabolic rate. Lethargy, not excitability, is associated with hypothyroidism because of the decreased metabolic rate. Weight gain, not loss, is associated with hypothyroidism because of the decreased metabolic rate. Intolerance to heat is associated with hyperthyroidism.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? Select all that apply. 1 Thirst 2 Headache 3 Nervousness 4 Fruity breath odor 5 Excessive urination

1 Thirst 4 Fruity breath odor 5 Excessive urination Thirst (polydypsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia and hyperglycemia because of central nervous system irritation.

A client with a diagnosis of Graves disease refuses to have radioactive iodine (RAI) therapy, and a subtotal thyroidectomy is performed. What should the nurse do postoperatively to reduce the risk of thyroid storm? 1 Provide a high-calorie diet. 2 Prevent infection at the surgical site. 3 Encourage postoperative breathing exercises. 4 Demonstrate how to support the neck after surgery.

2 Prevent infection at the surgical site. Conditions such as trauma and infection can precipitate thyroid storm (thyroid crisis, thyrotoxic crisis). A high-calorie diet does not prevent crisis; it restores glycogen reserves depleted by an increased metabolic rate. Postoperative breathing exercises prevent respiratory complications, not thyroid storm. Learning how to support the neck after surgery limits tension on the suture line, thereby decreasing the risk of hemorrhage, not thyroid storm.

A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply. 1 Polyuria 2 Obese trunk 3 Hypotension 4 Sleep disturbance 5 Thin arms and legs

2 Obese trunk 4 Sleep disturbance 5 Thin arms and legs Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of sodium and water retention.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Lethargy 2 Tachycardia 3 Weight gain 4 Constipation 5 Exophthalmos

2 Tachycardia 5 Exophthalmos Tachycardia is associated with hyperthyroidism and is caused by the increase in the basal metabolic rate. Exophthalmos is associated with hyperthyroidism and results from accumulation of fluid behind the eyeball. Lethargy is associated with hypothyroidism; hyperactivity occurs with hyperthyroidism. Weight gain occurs with hypothyroidism; weight loss occurs with hyperthyroidism because of the high metabolic rate. Constipation is associated with hypothyroidism; frequent loose stools occur with hyperthyroidism.

A client has a bone marrow aspiration performed. After the procedure, what is the first nursing action? 1 Position the client on the affected side. 2 Cleanse the site with an antiseptic solution. 3 Briefly apply pressure over the aspiration site. 4 Begin frequent monitoring of the client's vital signs.

3 Briefly apply pressure over the aspiration site. Brief pressure generally is enough to prevent bleeding. No special positioning is required. The site is cleansed before aspiration. Frequent monitoring is unnecessary.

A health care provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide as to why the client needs to follow this diet? 1 "The use of salt probably contributed to the disease." 2 "Excess weight will be gained if sodium is not limited." 3 "The loss of excess sodium and potassium in the urine requires less renal stimulation." 4 "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

4 "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium." Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, not increased or high sodium intake, is the problem. Although sodium retention causes fluid retention and weight gain, the need for increased potassium also must be considered. Because of steroid therapy, excess sodium may be retained, although potassium may be excreted.

A nurse administers a tube of glucose gel to a client who is hypoglycemic. What should the nurse consider about this reversal of hypoglycemia? 1 It liberates glucose from hepatic stores of glycogen. 2 Insulin action is blocked as it competes for tissue sites. 3 Glycogen is supplied to the brain as well as other vital organs. 4 It provides a glucose substitute for rapid replacement of deficits

4 It provides a glucose substitute for rapid replacement of deficits The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon (GlucaGen). It is a drug that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.

Which clinical manifestation should a nurse expect a client with diabetes insipidus to exhibit? 1 Increased blood glucose 2 Decreased serum sodium 3 Increased specific gravity 4 Decreased urine osmolarity

4 Decreased urine osmolarity Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity. Diabetes insipidus does not affect glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine.

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease? 1 Estrogens 2 Androgens 3 Glucocorticoids 4 Mineralocorticoids

4 Mineralocorticoids Mineralocorticoids, such as aldosterone, cause the kidneys to retain sodium ions. With sodium, water is also retained, elevating blood pressure. Absence of this hormone thus causes hypotension. Estrogen is a female sex hormone produced by the ovaries; it does not affect blood pressure. Androgens are produced by the adrenal cortex. Androgens have an effect similar to that of the male sex hormones; they do not affect blood pressure. The major effect of glucocorticoids, such as hydrocortisone, is on glucose metabolism, not on sodium and water concentrations; absence of this hormone will not cause significant hypotension.

A nurse is caring for a client with Addison disease. What should the nurse teach the client to do regarding an appropriate diet? 1 Add extra salt to food 2 Limit intake to 1200 calories 3 Omit protein foods at each meal 4 Restrict the daily intake of fluids to 1 L

1 Add extra salt to food Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to develop hyponatremia. Therefore, the addition of salt to the diet is advised. Intake of calories and fluid is determined on an individual basis, not because the client has Addison disease. Protein is not omitted from the diet; ingestion of essential amino acids is necessary for optimum metabolism. Fluids are not restricted for clients with Addison disease.

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? Select all that apply. 1 Dry skin 2 Lethargy 3 Insomnia 4 Tachycardia 5 Sensitivity to cold

1 Dry skin 2 Lethargy 5 Sensitivity to cold Dry skin is a response to hypothyroidism that is related to the associated decreased metabolic rate. Lethargy and sensitivity to cold are symptoms related to hypothyroidism that are associated with a decreased metabolic rate. Insomnia and tachycardia are related to hyperthyroidism, not hypothyroidism.

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? 1 Urine output 2 Glucose level 3 Serum potassium 4 Immune response

2 Glucose level As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

Which is an important intervention that the nurse should include in the plan of care that is specific for a client with Addison disease? 1 Encouraging the client to exercise 2 Protecting the client from exertion 3 Restricting the client's fluid intake 4 Monitoring the client for hypokalemia

2 Protecting the client from exertion Exertion, either physical or emotional, places additional stress on the adrenal glands, which may precipitate an Addisonian crisis Because of increased metabolic demands as a result of exercise, decreased levels of adrenocortical hormones will cause fatigue. Restricting fluid intake is contraindicated because of the risk for hypovolemia. The nurse should assess for hyperkalemia and hyponatremia.

What should the nurse emphasize when providing discharge instructions for a client with the diagnosis of Addison disease? 1 Limit physical activity 2 Restrict sodium in the diet 3 Continue steroid replacement therapy 4 Schedule frequent health care appointments

3 Continue steroid replacement therapy Clients with Addison disease must take glucocorticoids regularly to enable them to adapt physiologically to stress and prevent an Addisonian crisis, a medical emergency similar to shock. Activity is permitted as tolerated. Sodium should be taken as desired because hyponatremia frequently occurs from diminished mineralocorticoid secretion. Frequent visits to a health care provider are not necessary after control has been established.

A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia, and 15 g of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia? 1 Inhibits glycogenesis 2 Stimulates release of insulin 3 Increases blood glucose levels 4 Provides more storage of glucose

3 Increases blood glucose levels A simple sugar provides glucose to the blood for rapid action. It does not inhibit glycogenesis. It does not stimulate the release of insulin. It does not stimulate the storage of glucose.

A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription? 1 High-protein, high-carbohydrate diet 2 Iodine preparations 3 Antithyroid drugs 4 Drugs to increase the blood pressure

4 Drugs to increase the blood pressure Having a normally functioning thyroid (euthyroid) decreases the risk of thyrotoxic crisis after surgery. Ideally the client should be normotensive; some clients are slightly hypertensive because of the increased metabolic rate associated with hyperthyroidism. Weighing in the expected range may be impossible; the client may be underweight because of the increased metabolic rate associated with hyperthyroidism. The client should be in a positive nitrogen balance to promote wound healing.

A client who is suspected of having leukemia has a bone marrow aspiration. Immediately after the procedure, the nurse should: 1 Apply brief pressure to the site 2 Have the client lie on the affected side 3 Swab the site with an antiseptic solution 4 Monitor vital signs every hour for four hours

1 Apply brief pressure to the site Brief pressure is generally enough to prevent bleeding at the aspiration site. Complications are rare; no special positions are required. The site is cleaned before aspiration. Complications are rare; frequent monitoring is unnecessary.

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis? 1 Breakdown of fat stores for energy 2 Ingestion of too many highly acidic foods 3 Excessive secretion of endogenous insulin 4 Increased amounts of cholesterol in the extracellular compartment

1 Breakdown of fat stores for energy In the absence of insulin, which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35). The pH of food ingested has no effect on the development of acidosis. The opposite of excessive secretion of endogenous insulin is true. Cholesterol level has no effect on the development of acidosis.

A client is admitted to the hospital with a possible diagnosis of Addison disease. What is an important nursing responsibility during a 24-hour urine collection for this client? 1 Keeping the client quiet and reducing stress 2 Assessing the client for signs and symptoms of edema 3 Monitoring the client for an elevation in blood pressure 4 Restricting the client's fluid intake during the day of the test

1 Keeping the client quiet and reducing stress Stress and activity increase the secretion of adrenocorticotropic hormone (ACTH) and adrenocortical hormones, elevating the urine values for the byproducts of these hormones, thus invalidating the test results. Clients with Addison disease chronically are dehydrated and do not have edema. Because of fluid deficits, the client will be hypovolemic and the blood pressure will be decreased. Adequate fluid intake is necessary for urine production; Addison disease involves salt wasting and dehydration, which necessitates an increased fluid intake, not a restriction of fluid intake.

The nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these, if found, are signs of Cushing disease? Select all that apply. 1 Round face 2 Dependent edema in the feet and ankles 3 Increased fatty deposition in the extremities 4 Thin, translucent skin with bruising 5 Increased fatty deposition in the neck and back

1 Round face 2 Dependent edema in the feet and ankles 4 Thin, translucent skin with bruising 5 Increased fatty deposition in the neck and back Changes in fat distribution may result in fat pats on the neck, back, shoulders, and a round face. There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushing syndrome. This increased fluid retention results in dependent peripheral edema. Skin changes result from increased blood vessel fragility and include bruises and thin or translucent skin. The extremities appear thin because of muscle wasting and weakness, not increased by fatty deposition. Hypertension, not hypotension, is expected because of sodium and water retention.

A client undergoes pituitary surgery via the transsphenoidal route. Which foods should the nurse instruct the client to avoid after surgery? Select all that apply. 1 Toast 2 Celery 3 Shellfish 4 Grapefruit 5 Aged cheese

1 Toast 2 Celery Because roughage, such as toast, can irritate the surgical wound and lead to hemorrhage, toast is contraindicated in the postsurgical period of transsphenoidal surgery. Celery is a form of roughage that can irritate the surgical wound and jeopardize the surgical site. Shellfish is not contraindicated in the diet of a client who has undergone transsphenoidal surgery because it is nonirritating. Grapefruit is not contraindicated in the diet of a client who has undergone transsphenoidal surgery because it will not irritate the tissue. Aged cheese is not contraindicated in the diet of a client who has undergone transsphenoidal surgery because it is nonirritating.

One week after beginning antithyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis. The nurse determines that the most important intervention for this client is: 1 Limiting fluid intake 2 Reducing body temperature and heart rate 3 Observing for an exaggerated response to sedatives 4 Treating the associated hyperglycemia and ketoacidosis

2 Reducing body temperature and heart rate Immediate treatment in this emergency focuses on reduction of oxygen demands and thus cardiac workload to prevent cardiac decompensation. The need is for an increase, not decrease, in fluid intake to compensate for that lost because of the high metabolic rate. A response to sedatives is not likely because drugs are metabolized more rapidly with thyrotoxic crisis; there is a danger of exaggerated effects of the drug with hypothyroidism. Clients with thyrotoxic crisis are more apt to develop hypoglycemia from the high metabolic rate.

A nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? Select all that apply. 1 Thirst 2 Palpitations 3 Diaphoresis 4 Slurred speech 5 Hyperventilation

2 Palpitations 3 Diaphoresis 4 Slurred speech Palpitations, an adrenergic symptom, occur as the glucose level decreases; the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the central nervous system (CNS) becomes depressed. Thirst occurs with hyperglycemia in response to dehydration associated with osmotic diuresis. Hyperventilation occurs with diabetic ketoacidosis; Kussmaul respirations are an effort to counteract the effects of a buildup of ketones as the body seeks acid-base balance.

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the: 1 Client will need a higher serum glucose level while on bed rest. 2 Possibility of acidosis is greater when a client is on oral hypoglycemics. 3 Dosage can be adjusted to changing needs during recovery from surgery. 4 Stress of surgery may precipitate uncontrollable periods of hypoglycemia.

3 Dosage can be adjusted to changing needs during recovery from surgery. There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin.

A client undergoes removal of a pituitary tumor through a transsphenoidal approach. Postoperatively the nurse should: 1 Provide oral hygiene and include brushing the teeth 2 Encourage the client to deep breathe and cough frequently 3 Maintain the head of the bed at a 30 degree angle continuously 4 Continue giving nothing by mouth until the nasal packing is removed

3 Maintain the head of the bed at a 30 degree angle continuously Maintaining the head of the bed at a 30 degree angle continuously decreases pressure on the sella turcica and promotes venous return, thus limiting cerebral edema. Gentle oral hygiene is performed, excluding brushing of teeth, to prevent trauma to the surgical site. Although deep breathing is encouraged, initially coughing is discouraged to prevent increasing intracranial pressure. There is no need to limit oral fluids because of the presence of nasal packing.

A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs? 1 Give the client 8 oz of orange juice. 2 Seek a prescription to increase the insulin dose at bedtime. 3 Encourage the client to eat smaller, more frequent meals. 4 Collaborate with the health care provider to alter the insulin prescription.

4 Collaborate with the health care provider to alter the insulin prescription. The client is experiencing the Somogyi effect. It is a paradoxical situation in which sudden decreases in blood glucose are followed by rebound hyperglycemia. The body responds to the hypoglycemia by secreting glucagon, epinephrine, growth hormone, and cortisol to counteract the low blood sugar; this results in an excessive increase in the blood glucose level. It most often occurs in response to hypoglycemia when asleep. The health care provider may choose to decrease the insulin dose and then reassess the client. Giving the client 8 oz of orange juice will increase further the serum glucose level and is contraindicated. Increasing the insulin dose at bedtime will further worsen the problem. Encouraging the client to eat smaller, more frequent meals will not address the hypoglycemia and rebound hyperglycemia that occurs when sleeping. However, a bedtime snack may help minimize this event. Study Tip: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.

An adolescent is undergoing radiation for Hodgkin's lymphoma. The nurse talks with the family about the importance of: 1 Keeping up with schoolwork 2 Accelerated sexual maturation 3 Consistent skin care with lotion 4 Overwhelming fatigue and the need for rest

4 Overwhelming fatigue and the need for rest The major side effect of radiation therapy is overwhelming fatigue. Lotions can cause irritation if the skin reacts to the radiation. Schoolwork is not a major concern at this time. Accelerated sexual maturation is not an effect of irradiation.

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. 1 Tremors 2 Bradycardia 3 Somnolence 4 Heat intolerance 5 Decreased blood pressure

1 Tremors 4 Heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Dry skin 2 Weight loss 3 Tachycardia 4 Restlessness 5 Constipation 6 Exophthalmos

2 Weight loss 3 Tachycardia 4 Restlessness 6 Exophthalmos Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response? 1 Hypothyroidism is a gradual slowing of the body's function. 2 A decrease in pituitary thyroid-stimulating hormone (TSH) will occur. 3 Less thyroid tissue is available to supply thyroid hormone after surgery. 4 Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones.

3 Less thyroid tissue is available to supply thyroid hormone after surgery. After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy.

A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations? 1 Fluid balance 2 Electrolyte levels 3 Protein anabolism 4 Masculinizing hormones

3 Protein anabolism Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.

A client with a parotid tumor and enlarged lymph nodes in the neck is undergoing radiation therapy on an outpatient basis. For what physiologic response to the radiation should the nurse assess the client during the return visit to the radiology department? 1 Ataxia 2 Hypoxia 3 Arthralgia 4 Dysphagia

4 Dysphagia The proximity of the parotid gland to the esophagus necessitates assessment of swallowing because dysphagia may be a result of damage to surrounding tissue. Ataxia, an impairment in muscle coordination, is not a side effect of radiation therapy to the neck region unless the central nervous system is involved. Hypoxia, an oxygen deficiency in body tissues, should not occur because the lungs are not being radiated. Arthralgia, pain in a joint, is not a side effect of radiation therapy for this client.

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake? 1 Increased amounts of potassium are needed to replace renal losses. 2 Increased protein is needed to heal the adrenal tissue and thus cure the disease. 3 Supplemental vitamins are needed to supply energy and assist in regaining the lost weight. 4 Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium.

4 Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium. Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and thus cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing, nor will they help the client gain weight.

After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? Select all that apply. 1 Polyuria 2 Polydipsia 3 Polyphagia 4 Polyphrasia 5 Polydysplasia

1 Polyuria 2 Polydipsia 3 Polyphagia Polyuria is excessive urination associated with osmotic diuresis. Polydipsia is excessive thirst associated with hyperglycemia; thirst is the response to osmotic diuresis and glycosuria. Polyphagia is associated with the catabolic state induced by insulin deficiency. Polyphrasia is excessive talking associated with mental illness, not hyperglycemia. Polydysplasia is related to multiple developmental abnormalities and is unrelated to hyperglycemia.

A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment? 1 Dry 2 Moist 3 Flushed 4 Smooth

1 Dry Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T3 and T4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist and smooth skin occur with hyperfunction of the thyroid and an increase in the basal metabolic rate.

A client is diagnosed with cancer of the jaw, and a course of radiation therapy is to be followed by surgery. The client is concerned about the side effects of the radiation treatments. For which major side effect of radiation therapy should the nurse prepare the client? 1 Fatigue 2 Alopecia 3 Vomiting 4 Leukopenia

1 Fatigue Fatigue is a major problem caused by an increase in waste products because of catabolic processes. Alopecia can occur when the hair on the head is in the field of radiation, but it is not a major side effect. Vomiting is not common unless the stomach or intestine receives radiation. Leukopenia is not a problem unless 25% or more of the bone marrow is in the treatment field.

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? 1 Ketoacidosis 2 Somogyi phenomenon 3 Hypoglycemic reaction 4 Hyperosmolar nonketotic coma

1 Ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

A nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify? 1 Retention of sodium and water 2 Hypotension and a rapid, thready pulse 3 Increased fatty deposition in the extremities 4 Hypoglycemic episodes in the early morning

1 Retention of sodium and water There are increased levels of steroids and aldosterone causing sodium and water retention in clients with Cushing syndrome. Hypertension, not hypotension, is expected because of sodium and water retention. The extremities will be thin; subcutaneous fat deposits occur in the upper trunk, especially the back between the scapulae. Hyperglycemia, not hypoglycemia, occurs because of increased secretion of glucocorticoids. Hyperglycemia is sustained and not restricted to the morning hours.

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. 1 Polyuria 2 Polydipsia 3 Paralytic ileus 4 Serum glucose of 105 mg/dL 5 Respiratory rate of 16 breaths per minute

1 Polyuria 2 Polydipsia Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia, excessive thirst, and fluid intake are the responses to excess fluid loss related to osmotic diuresis. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL, by most standards, is within the expected range of 60-110 mg / dL. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced.

A nurse teaches a client with type 1 diabetes about the treatment of hypoglycemia. If the teaching is effective, which foods does the client identify to manage hypoglycemia? 1 Hard candy and fruit juice 2 Cheese sandwich and sugar 3 Chocolate candy and an orange 4 Peanut butter crackers and a glass of milk

2 Cheese sandwich and sugar The suggested treatment for hypoglycemia is to give a conscious client a simple sugar (e.g., two packets of sugar) followed by a complex carbohydrate (e.g., bread) and protein (e.g., cheese); the simple sugar elevates blood glucose rapidly; the complex carbohydrate and protein produce a more sustained response. Hard candy and fruit juice are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Chocolate candy and an orange are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Neither peanut butter crackers nor a glass of milk are fast-acting sugars; peanut butter crackers and milk can be used to maintain the glucose level after it has been raised.

A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? 1 Arterial blood pH 2 Intake and output 3 Fasting serum glucose 4 Pulse and respiratory rates

2 Intake and output DDAVP replaces antidiuretic hormone (ADH), facilitating reabsorption of water and consequent return of a balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although correction of tachycardia is consistent with correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected.

A health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the antithyroid medication, the client calls the nurse and complains of feeling tired and looking pale. What should the nurse do? 1 Advise the client to get more rest. 2 Schedule the client for an appointment. 3 Instruct the client to skip one dose daily. 4 Tell the client to increase the medication.

2 Schedule the client for an appointment. The client should be examined by the health care provider and blood tests prescribed; anemia may result because of the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe advice; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a health care provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a health care provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse.

A client is admitted with a diagnosis of Cushing syndrome. For which clinical manifestations should the nurse observe when assessing this client? Select all that apply. 1 Polyuria 2 Weakness 3 Hypertension 4 Truncal obesity 5 Intermittent tonic spasms

2 Weakness 3 Hypertension 4 Truncal obesity Weakness occurs in response to the excessive catabolism of proteins and resulting loss of muscle mass. Hypertension occurs in response to excessive cortisol that causes an increase in circulating volume or an arteriole response to circulating catecholamines. Truncal obesity is caused by abnormal fat metabolism and deposition of fat in the mesenteric bed. Polyuria, excessive urination, occurs with hyperglycemia and is associated with diabetes mellitus. Intermittent tonic spasms of the extremities are associated with tetany, a neuromuscular manifestation, because of a decrease in ionized calcium occurring in hypoparathyroidism, not Cushing syndrome.

A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland, and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after the surgery? 1 Place two pillows behind the client's head. 2 Monitor for the complication of tetany resulting from hypocalcemia. 3 Assess the sides and back of the client's neck for evidence of bleeding. 4 Encourage the client to perform deep-breathing and coughing exercises.

3 Assess the sides and back of the client's neck for evidence of bleeding In a back-lying (supine) position blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client's head flexes the neck excessively; this increases tension on the suture line and may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Although monitoring for the complication of tetany resulting from hypocalcemia may be a complication of this surgery, tetany will not occur during the first eight hours after surgery. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours, to limit stress on the suture line.

A nurse is helping an adolescent with type 1 diabetes establish a consistent meal pattern. What feedback from the adolescent indicates that further teaching is needed? 1 Weighs portion sizes for several months 2 Reads nutrition labels on prepared foods 3 Avoids complex carbohydrate substitutes 4 Limits sugar alternatives containing sorbitol

3 Avoids complex carbohydrate substitutes Complex carbohydrates may be substituted, depending on caloric content and amount eaten per serving. Flexibility is needed to promote adherence to any dietary regimen. Using consistent portion sizes is a key to maintaining diabetic control. By weighing and measuring portion sizes for several months the adolescent learns to recognize the acceptable amount to be eaten at a glance. The adolescent should read nutrition labels carefully, especially for their carbohydrate and caloric content. Most dietetic foods contain sorbitol. Sorbitol metabolizes to fructose and then glucose, so its use should be restricted when possible.

A health care provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client? 1 Decrease in eosinophils 2 Increase in lymphoid tissue 3 Restoration of electrolyte balance 4 Improvement of carbohydrate metabolism

3 Restoration of electrolyte balance Lack of mineralocorticoids causes hyponatremia, hypovolemia, and hyperkalemia. Dietary modification and administration of cortical hormones are aimed at correcting these electrolyte imbalances, which can be life threatening. There is no disturbance in the eosinophil count. Lymphoid tissue does not change. Although glucocorticoids are involved in metabolic activities, including carbohydrate metabolism, the primary aim of therapy is to restore electrolyte imbalance.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that: 1 Hypothyroidism is a gradual slowing of the body's function 2 There will be a decrease in pituitary thyroid-stimulating hormone (TSH) 3 There may not be enough thyroid tissue to supply adequate thyroid hormone 4 Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones

3 There may not be enough thyroid tissue to supply adequate thyroid hormone After a subtotal thyroidectomy the thyroxine output may be inadequate to maintain an appropriate metabolic rate. Hypothyroidism is a decrease in thyroid functioning, not a slowing of the entire body's functions. In hypothyroidism the level of TSH from the pituitary usually is increased. Atrophy of the remaining thyroid tissue does not occur.

A client has a new diagnosis of hyperthyroidism. Which skin conditions should the nurse expect when performing a physical assessment? Select all that apply 1 Warm 2 Moist 3 Pale 4 Smooth 5 Coarse 6 Dry

1 Warm 2 Moist 4 Smooth Hyperfunction of the thyroid gland causes diaphoresis, making the skin moist, as well as skin that is smooth and warm. Pale, coarse, and dry skin is found with hypothyroidism.

A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease? 1 Stress response 2 Electrolyte balance 3 Metabolic processes 4 Respiratory function

1 Stress response Because of diminished glucocorticoid production, there is a decreased response to stress, reducing the ability to fight an infectious process. Hyponatremia and hyperkalemia occur in this disorder; however, these do not alter the defense against infection. Glucocorticoids are involved with metabolism; however, this does not directly affect susceptibility to infection. The respiratory system is not affected. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: · A sound understanding of the subject · The ability to follow explicitly the directions given at the beginning of the test · The ability to comprehend what is read · The patience to read each question and set of options carefully before deciding how to answer the question · The ability to use the computer correctly to record answers · The determination to do well · A degree of confidence

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug? 1 Supports a better response to stress 2 Promotes a decrease in blood pressure 3 Decreases episodes of shortness of breath 4 Controls an excessive loss of potassium from the body

1 Supports a better response to stress Hydrocortisone is a glucocorticoid that has antiinflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus, it enables the body to adapt to stress. It may promote fluid retention that results in hypertension and edema. Shortness of breath (dyspnea) is caused by hypovolemia and decreased oxygen supply; neither is affected by hydrocortisone. It may cause potassium depletion.

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na (sodium) 149 mEq/L; K (potassium) 3.2 mEq/L; Hb (hemoglobin) 17 g/dL; and glucose 90 mg/dL. What should the nurse teach the client? Select all that apply. 1 Avoid foods high in salt. 2 Restrict your fluid intake. 3 Eat foods high in potassium. 4 Limit your carbohydrate intake. 5 Continue your regular diet as before.

1 Avoid foods high in salt. 3 Eat foods high in potassium. A sodium level of more than 145 mEq is considered hypernatremia; the client should be taught to avoid foods high in sodium (e.g., processed foods, specific condiments). A potassium level less than 3.5 mEq/L is considered hypokalemia. Therefore, the client should be encouraged to eat foods high in potassium. Restricting fluid intake will increase the serum sodium level and therefore is contraindicated. A glucose level of 90 mg/dL is within the expected range of less than 110 mg/dL and is not a concern. The laboratory results for serum sodium and serum potassium are not within the expected values and the client should be taught how to alter the diet.

While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? Select all that apply. 1 Diaphoresis 2 Weight loss 3 Constipation 4 Protruding eyes 5 Cold intolerance

1 Diaphoresis 2 Weight loss 4 Protruding eyes Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia. Weight loss occurs with hyperthyroidism because of increased metabolism. Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retro-orbital tissue, which causes the eyeballs to enlarge and push forward. Diarrhea occurs because of increased body processes, specifically increased gastrointestinal peristalsis. Heat intolerance occurs because of the increased metabolism associated with hyperthyroidism.

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? Select all that apply. 1 Excessive thirst 2 Increased blood glucose 3 Dry mucous membranes 4 Increased blood pressure 5 Decreased serum osmolarity 6 Decreased urine specific gravity

1 Excessive thirst 3 Dry mucous membranes 6 Decreased urine specific gravity As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases.

Before a client's discharge after a thyroidectomy, the nurse teaches the client to observe for signs of surgically induced hypothyroidism. What clinical indicators identified by the client provide evidence that the nurse's instructions are understood? Select all that apply. 1 Fatigue 2 Dry skin 3 Insomnia 4 Intolerance to heat 5 Progressive weight loss

1 Fatigue 2 Dry skin Fatigue is caused by a decreased metabolic rate. Dry skin is caused by decreased glandular function associated with a decreased metabolic rate. Insomnia is caused by an increased metabolic rate associated with hyperthyroidism, not hypothyroidism. Intolerance to heat is associated with hyperthyroidism. Intolerance to cold is associated with hypothyroidism. Progressive weight loss is associated with hyperthyroidism. Progressive weight gain is associated with hypothyroidism because of the reduced metabolic rate.

A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion? Select all that apply. 1 Headache 2 Confusion 3 Extreme thirst 4 Profuse sweating 5 Increased urination

1 Headache 2 Confusion 4 Profuse sweating Neurologic responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. Thirst (polydipsia) is a classic symptom of hyperglycemia. Increased urination (polyuria) is a classic sign of hyperglycemia.

The nurse provides care to the client with diabetes insipidus (DI) following head injury by: Select all that apply. 1 Providing adequate fluids within easy reach 2 Reporting an increasing urine specific gravity 3 Administering prescribed demeclocycline (Declomycin) 4 Assessing for and reporting changes in neurological status 5 Monitoring for constipation, weight loss, hypotension, and tachycardia

1 Providing adequate fluids within easy reach 4 Assessing for and reporting changes in neurological status 5 Monitoring for constipation, weight loss, hypotension, and tachycardia Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluid and electrolyte balance. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotentsion and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. Demaclocycline decreases the renal response to antidiuretic hormone (ADH) or endogenous vasopressin. In diabetes insipidus, ADH production is decreased. The primary pharmacologic treatment for diabetes insipidus, then, is replacement of ADH with an exogenous vasopressin, such as desmopressin acetate (DDAVP). Administering demaclocycline to block the renal response to ADH in the client with decreased ADH production would be deleterious. Demeclocycline is used to treat syndrome of inappropriate antidiuretic hormone (SIADH), a condition of overproduction of ADH.

A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing assessment probably reveal? Select all that apply. 1 Truncal obesity 2 Thin extremities 3 Increased linear growth 4 Loss of hair on the body 5 Decreased blood pressure

1 Truncal obesity 2 Thin extremities An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

Laboratory results of a client's blood after chemotherapy indicate bone marrow depression. What should the nurse encourage the client to do? Select all that apply. 1 Use a soft toothbrush. 2 Sleep with the head of the bed elevated. 3 Increase activity levels and take frequent walks. 4 Drink more citrus juices and eat more citrus fruits. 5 Read the ingredients in over-the-counter drugs before taking them.

1 Use a soft toothbrush. 5 Read the ingredients in over-the-counter drugs before taking them. The gums are vascular tissue and prone to bleed easily if the platelet count is low. Drugs such as ibuprofen (e.g., Motrin, Advil) and salicylates (aspirin) in any analgesic or cold medicine should be avoided because they increase the risk of bleeding by inhibiting platelet function. With bone marrow depression, red blood cells are decreased and the oxygen-carrying capacity of the blood is decreased; this position will not increase the number of red blood cells. With bone marrow depression there is a decrease in red blood cells; rest should be encouraged. Citrus fruits and juices will not change the bone marrow depression; they should be avoided because they are acidic and aggravate stomatitis.

A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure? 1 Remain in the house. 2 Avoid holding an infant. 3 Save urine in a lead-lined container. 4 Refrain from using a bathroom used by others.

2 Avoid holding an infant. Infants are particularly sensitive to radioactivity; even the small amount emitted after treatment may affect infants. It is not necessary to avoid leaving the house as long as close proximity to others is avoided. Saving urine in a lead-lined container is not necessary; the same bathroom may be used by all members of the family, but the toilet should be flushed twice after use by the client. Refraining from using a bathroom used by others is not necessary.

Which responses should a nurse expect a client experiencing hypoglycemia to exhibit? Select all that apply. 1 Nausea 2 Palpitations 3 Tachycardia 4 Nervousness 5 Warm, dry skin 6 Increased respirations

2 Palpitations 3 Tachycardia 4 Nervousness Palpitations are of neurogenic origin associated with hypoglycemia; the sympathetic nervous system is stimulated by the decline in blood glucose. Tachycardia occurs with low serum glucose levels because of sympathetic nervous system activity. Nervousness, anxiety, and shakiness occur as a result of sympathetic nervous system stimulation associated with hypoglycemia. Nausea, vomiting, and abdominal cramps are associated with hyperglycemia. The client will feel hungry with hypoglycemia. Warm, dry skin is a sign of hyperglycemia, caused by dehydration associated with osmotic diuresis related to glycosuria. The skin will be cool and moist with hypoglycemia. Increased respirations are signs of ketoacidosis from insufficient insulin to prevent fat breakdown for energy; they are compensatory responses that occur in an attempt to blow off carbon dioxide and raise the serum pH. There is no particular change in respirations with hypoglycemia.

The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. 1 Monitor for signs of alopecia. 2 Encourage an increase in fluids. 3 Wash hands before entering the client's room. 4 Advise use of a soft toothbrush for oral hygiene. 5 Report an elevation in temperature immediately. 6 Encourage the client to eat raw, fresh fruits and vegetables.

3 Wash hands before entering the client's room. 4 Advise use of a soft toothbrush for oral hygiene. 5 Report an elevation in temperature immediately. It is essential to prevent infection in a client with severe bone marrow depression; thorough hand-washing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the health care provider immediately as it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables, and undercooked meat, eggs, and fish to avoid possible exposure to microbes.

A client who has ovarian cancer is to receive intravenous chemotherapy. Before the infusion, the nurse teaches the client how to use imagery to maximize the effects of the chemotherapy. What statement specifically relates to this alternative therapy? 1 "Rest the mind while remaining in the present." 2 "Listen to soothing instrumental music during the infusion." 3 "Light a candle with the scent of lavender during the infusion." 4 "Focus on the droplets of chemotherapy attacking the cancer cells."

4 "Focus on the droplets of chemotherapy attacking the cancer cells." Imagery is the application of the conscious use of the power of imagination with the intention of activating biological, psychological, and spiritual healing. The individual creates mental pictures of what is desired from memories, dreams, fantasies, and hopes. Meditation, not imagery, quiets the mind and focuses on the present to release fears, worries, anxieties, and doubts concerning the past and the future. Music therapy, not imagery, aligns the body, mind, and spirit with its own fundamental frequency, which brings about changes in emotions, organs, hormones, enzymes, cells, and atoms. Aromatherapy, not imagery, uses essential oils to stimulate the olfactory receptors and ultimately the brain, where they are thought to influence emotions, memory, and a variety of bodily functions such as heart rate, blood pressure, breathing, and immune responses.

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client? 1 Hypovolemia 2 Hyperkalemia 3 Hypoglycemia 4 Hypernatremia

4 Hypernatremia A client with Cushing syndrome secretes excess amounts of cortisol, a corticosteroid that acts to retain sodium and water, resulting in hypernatremia and edema. Hypervolemia, not hypovolemia, is caused by fluid retention. Hypokalemia, not hyperkalemia, occurs because potassium is lost when there is sodium retention. Hyperglycemia, not hypoglycemia, results from cortisol-induced glucose intolerance. Study Tip: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.