1. Answer: A
A bladder retraining program, such as use of a toileting schedule, may be
helpful to clients experiencing urinary incontinence.
B. A Foley catheter should
be used only when necessary because of the risk of infection.
C&D. Use of the diaper
or pad is the least acceptable alternative because of the risk of skin
breakdown.
2. Answer: B
Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V.
infusion of hydrocortisone and saline solution. The client is usually given a
dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until
the client's blood pressure returns to normal.
A. Insulin isn't indicated in this
situation because adrenal insufficiency is usually associated with hypoglycemia.
C. Potassium isn't indicated because these clients are usually hyperkalemic.
D.The
client needs normal — not hypotonic — saline solution.
3. Answer: D
Chlorpropamide (Diabenese) is an oral hypoglycemic agent given to reduce the
serum glucose level and the signs and symptoms of hyperglycemia. Therefore a
decrease in polyuria and polyphagia and symptoms of hyperglycemia would denote
a beneficial response to chlorpropamide. Laboratory values also are used to
assess the client’s response to treatment. A fasting blood glucose level of 110
mg/dL is within normal limits. However, a glycosylated hemoglobin of 10%
denotes poor glycemic control.
4.
A client with aldosteronism is being
treated with spironolactone (Aldactone). Which of the following indicates to
the nurse that the medication is effective?
A.
A decrease in blood pressure
B.
A decrease in sodium excretion
C.
A decrease in plasma potassium
D.
A decrease in body metabolism
Answer: A
Spironolactone is a potassium-sparing diuretic that antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus spironolactone produces a decrease in blood pressure by increasing the excretion of sodium and water. Potassium is retained. Spironolactone has no effect on body metabolism.
5. Answer: A
Divalproex sodium (Depakote), an anticonvulsant, can cause a potentially fatal
hapatotoxicity. The nurse should instruct the client about the importance of
monitoring the results of liver function studies and ammonia levels. Options B,
C, and D are not studies that are required with the use of this medication.
6. Answer: D
An elevated temperature may indicate infection. Infection is a leading cause of
hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. The
other findings noted in the question are within normal limits.
7. Answer: A
Diabetic ketoacidosis is marked by the presence of excessive ketone bodies.
Because of the acidosis, the pH and serum bicarbonate level would decrease.
Hyponatremia is not related to diabetic ketoacidosis.
8. Answer: C
The client with Cushing’s syndrome and a nursing diagnosis of Excess Fluid
Volume should be maintained on a high-potassium and low-sodium diet. Decreased
sodium intake decreases renal retention of sodium and water. Options A, B, and D are appropriate interventions for the client with a nursing diagnosis of
excess fluid volume.
9. Answer: B
A quick check of the blood glucose level will confirm whether the client is hypoglycemic.
A. This is inaccurate and does not reflect the present status.
C. Although this might be appropriate to
counter hypoglycemia, it does not determine whether the client is being
hypoglycemic or is being manipulating.
D. Although this might be
appropriate to counter hypoglycemia, it does not determine whether the client
is being hypoglycemic or is being manipulating.
10. Answer: A
The client who has undergone a thyroidectomy is at risk for developing
hypocalcemia from inadvertent removal or damage to the parathyroid gland. The
client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle
contraction when the facial nerve in front of the ear is tapped) and a positive
Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few
minutes). These signs aren't present with hypercalcemia, hypokalemia, or
hyperkalemia.
11. Answer: B
Graves' disease, an autoimmune disease causing hyperthyroidism, is most
prevalent in middle-age females. In thyroiditis, there is a low (≤2%)
radioactive iodine uptake. In Hashimoto's thyroiditis, the most common form of
hypothyroidism, TSH levels would be high and thyroid hormone levels low.
Multinodular goiter will show an uptake in the high-normal range (3% to 10%).
12. Answer: A
Renal and cardiac complications will occur if the hypertension
caused by the tumor is not arrested.
B. An aldosteronoma is a benign
tumor; metastasis is not possible.
C. This is not true; surgery is
required to remove the tumor.
D. Drugs are not used; the tumor must
be removed.
13. Answer: D
Adequate dietary iodine is needed to produce thyronine (T3) and thyroxine (T4).
The other requirements for adequate T3 and T4 production are not intact and a
functional hypothalamic-pituitary-thyroid feedback system. Options A, B, and C are not related directly to the function of T3 and T4.
14. Answer: D
The client should be instructed that insulin injection sited should be rotated
within one anatomical area before moving to another area. This rotation process
promotes uniform absorption of insulin and reduces the chances of irritation.
Options A, B, and C are not associated with the condition (skin leakage of
insulin) presented in the question.
15. Answer: D
The client with Addison’s disease will require life long replacement of adrenal
hormones. The medications must be taken daily and an alternate route of
administration must be used if the client cannot take oral medications for any
reason, such as nausea and vomiting. Additional doses of glucocorticoids will
be needed during times of stress. The nurse must emphasize that the client must
call the physician to obtain a prescription for a dosage increase when
experiencing stressful situations. Abrupt withdrawal of this medication can
result in addisonian crisis. Although side effects are not severe at lower
doses, side effects occur with long-term glucocorticoid administration. To stop
taking the medication without first consulting the physician is unsafe.
16. Answer: B
Calcitonin can lower plasma calcium levels in clients with hyperparathyroidism.
The therapeutic effect in this client situation would be a reduction in serum
calcium levels. Options A, C, and D are incorrect outcome criteria.
17. Answer: D
A client in ketoacidosis receives normal saline as a solution because it is isotonic and does not contain glucose. The client receives this solution until the blood glucose level approaches the normal range. The rate, or units given per hour, is based on the child's weight.
A. A child in ketoacidosis has elevated blood glucose levels. A 2.5% dextrose
is not used because its glucose content would only serve to further elevate the
child's glucose levels.
B. A child in ketoacidosis has elevated blood glucose
levels. A 5% dextrose solution is not used because its glucose content would
only serve to further elevate the child's glucose levels.
C. A 0.45% saline
solution would not be used. Physicians typically order a 0.9% saline solution
because it is isotonic and more nearly matches the concentration of a child's blood.
18. Answer: A
Once the excessive secretion of aldosterone is stopped, the BP
gradually drops to a near normal level.
B. The BP drops gradually; it
does not rise.
C. The BP will only fluctuate if the hypervolemia is
overcorrected, causing hypovolemia; this is not expected.
D. The BP
drops gradually in response to decreasing serum corticosteroid levels; a rapid
drop immediately following surgery may indicate hemorrhage.
19. Answer: A
Antidiuretic hormone is secreted by the posterior pituitary gland. The other
hormone stored in the posterior pituitary gland is oxytocin. Antidiuretic
hormone and oxytocin are produced by the hypothalamus and stored in the
posterior pituitary gland. These hormones are released as needed into the
bloodstream for use. The anterior pituitary gland produces growth hormone,
follicle-stimulating hormone, and luteinizing hormone.
20. Answer: B
Shakiness is a sign of hypoglycemia and would indicate the need for food or
glucose. A fruity breath odor, blurred vision, and polyuria are signs of
hyperglycemia.
21. Answer: A
The client should be instructed to avoid exercise at peak insulin time because
at this time a hypoglycemic reaction is likely to occur. If the client performs
exercises at this time, the nurse should instruct the client to eat an hour
before the exercise and drink a carbohydrate liquid. Options B, C, and D are
correct statements regarding exercise, insulin, and diabetic control.
22. Answer: A
Addisonian crisis results in hyperkalemia; therefore, administering potassium
chloride is contraindicated. Because the client will be hyponatremic, normal
saline solution is indicated. Hydrocortisone and fludrocortisone are both
useful in replacing deficient adrenal cortex hormones.
23. Answer: B
The nurse teaches the client to avoid tension on the suture line; otherwise,
hemorrhage may develop. One way of reducing incisional tension is to teach the
client how to support the neck when coughing or being repositioned. Likewise,
during the postoperative period, the client should avoid any unnecessary
movement of the neck. That is why sandbags and pillows frequently are used to
support the head and neck. Removal of the thyroid does not necessarily mean
that the client will be taking antithyroid medications postoperatively. If a
client experiences tingling in the fingers, toes, and lips, it is probably due
to injury to the parathyroid gland during surgery, resulting on hypocalcemia.
These signs and symptoms need to be reported immediately.
24. Answer: D
Hyperthyroidism is manifested clinically by goiter (increase in the size of the
thyroid gland) and exothalmos (bulging eyeballs). Clinical manifestations also
include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance.
Other signs found in this disorder include tachycardia, shortness of breath,
excessive sweating, fine muscle tremors, thin silky hair and skin, infrequent
blinking, and a staring appearance.
25. Answer: D
Thyroid crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature.
A. During thyroid crisis there is usually no increase in the
difference between the apical and peripheral pulse rates (pulse deficit).
B. The blood pressure will rise to meet the oxygen demand caused by
the increased metabolic rate during thyroid crisis.
C. Because of the
increased metabolic rate, the pulse and respiratory rates increase to meet the
body's oxygen needs.
26. Answer: B
The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroids; calcium gluconate is the treatment of choice.
A. This is prescribed for hyperthyroidism because it inhibits the
release of thyroid hormones.
C. This
is prescribed for hypomagnesemia or to prevent convulsions in eclampsia or
preeclampsia.
D. This is prescribed for hypokalemia.
27. Answer: B
Management of children with early morning hyperglycemia depends on whether the hyperglycemia is due to insulin-waning, a progressive rise in blood glucose throughout the day, or rebound hyperglycemia (Somogyi effect; an increase in blood sugar glucose at bedtime, a drop at about 2:00 AM, then a rebound rise early in the morning). Information about the child's blood glucose levels would provide clues to determine which event is occurring.
A. Telling the mother that this is normal is inappropriate. Management of
children with early morning hyperglycemia depends on whether the hyperglycemia
is due to insulin-waning, a progressive rise in blood glucose throughout the
day, or rebound hyperglycemia (Somogyi effect; an increase in blood sugar
glucose at bedtime, a drop at about 2:00 AM, then a rebound rise early in the
morning). Information about the child's blood glucose levels would provide
clues to determine which event is occurring.
C. Early morning hyperglycemia is not unusual nor is it an
emergency situation. Management of children with early morning hyperglycemia
depends on whether the hyperglycemia is due to insulin-waning, a progressive
rise in blood glucose throughout the day, or rebound hyperglycemia (Somogyi
effect; an increase in blood sugar glucose at bedtime, a drop at about 2:00 AM,
then a rebound rise early in the morning). Information about the child's
blood glucose levels would provide clues to determine which event is occurring.
D. Although questioning the mother to gain more information is appropriate,
asking her specifically about avoiding sweets may imply the mother is at fault
for not monitoring the child's intake closely. Additionally, carbohydrates,
not sweets, are implicated in diabetes. Management of children with early
morning hyperglycemia depends on whether the hyperglycemia is due to
insulin-waning, a progressive rise in blood glucose throughout the day, or
rebound hyperglycemia (Somogyi effect; an increase in blood sugar glucose at
bedtime, a drop at about 2:00 AM, then a rebound rise early in the morning).
Information about the child's blood glucose levels would provide clues to
determine which event is occurring.
28. Answer: C
The hypothalamus exerts influence on the anterior and posterior pituitary
gland. Abnormalities can result in excess or deficit of substances normally
mediated by the pituitary. Antidiuretic hormone could be affected by disease of
the hypothalamus because the hypothalamus produces antidiuretic hormone and
stores it in the posterior pituitary gland. The adrenal cortex is responsible
for the production of glucocorticoids and mineralocorticoids. The pineal gland
is responsible for melatonin production.
29. Answer: D
Diabinese is a sulfonamide, a sulfur-based drug, used to treat type 2
diabetes. It would be contraindicated in a patient with an allergy to sulfur.
Therefore, the physician should be notified.
A. Aspirin is a non-steroidal
anti-inflammatory drug. It is a salicylate and not related to sulfur-based
medications.
B. Penicillin is a broad-spectrum antibiotic and is frequently the
next choice of drug to treat bacterial infections when the patient is allergic
to sulfur.
C. Iodine is a nonmetallic element that aids in the development of
the thyroid gland. It is used to treat goiter.
30. Answer: B
Ketones are a by-product of fat metabolism. When this process occurs to
extreme, this process is called ketoacidosis. Options A, C, and Dare
incorrect.
31. Answer: C
After a thyroidectomy the thyroxine output is usually inadequate to maintain an appropriate metabolic rate.
A. Hypothyroidism is a decrease in thyroid functioning, not a
slowing of the entire body's functions.
B. In hypothyroidism the
level of thyroid-stimulating hormone (TSH) from the pituitary is usually
increased.
D. Atrophy of
the thyroid tissue remaining after surgery does not occur.
32. Answer: D
With long- term use Phenytoin can cause gingival hyperplasia, so it is
essential that the client understand how to provide proper oral hygiene.
A. Phenytoin does not lead to the development of diabetes, but it can affect the
diabetics' blood glucose levels and require adjustment of their hypoglycemic
agents.
B. The client cannot substitute various brands of phenytoin because
they are not bioequivalent.
C. It is not necessary for the client to take
potassium supplements.
33. Answer: C
Wound healing in a client with diabetes will be delayed. Providing the client
with a time frame could give the client false information.
34. Answer: A
Physical symptoms can interfere with an individual’s ability to learn and also
can indicate to the teacher that the learner lacks motivation to learn, if the
symptoms repeatedly recur when teaching is initiated. Options B, C, and Didentify
active client participation in learning.
35. Answer: C
Small amounts of fluid may be tolerated even when vomiting is present. The
nurse should encourage liquids containing glucose and electrolytes every hour.
Options A, B, and D will not provide the adequate intake needed by the client
with diabetes mellitus.
36. Answer: A
Glucagon, produced by the alpha cells in the islets of Langerhans, is an
insulin antagonist. It mobilizes glycogen storage in the liver, leading to an
increased blood glucose level.
B. This stimulates an increase in blood glucose,
not glycogen.
C. Glucagon does not compete with insulin; it promotes the
conversion of glycogen to glucose.
D. Glucagon is not a glucose substitute.
37. Answer: C
Because the client in addisonian crisis is unstable, vital signs and fluid and
electrolyte balance should be assessed every 30 minutes until he's stable.
Daily weights are sufficient when assessing the client's condition. The client
shouldn't have ketones in his urine, so there is no need to assess the urine
for their presence. Oral hydrocortisone isn't administered during the first 24
hours in severe adrenal insufficiency.
38. Answer: C
Oral calcium supplements need to be administered with food to enhance
absorption and to decrease gastrointestinal irritation. Options A, B, and Dare
unrelated to oral calcium therapy.
39. Answer: A
Regular insulin is rapid acting (30 to 60 minutes) and is used to meet a
client's immediate insulin needs.
B. This is an intermediate-acting insulin,
which has an onset of 1 to 2 1/2 hours; in diabetic acidosis the individual
needs rapid-acting insulin.
C. This is an intermediate-acting insulin, which
has an onset of 1 to 2 hours; in diabetic acidosis the individual needs
rapid-acting insulin.
D. This is a long-acting insulin, with an onset of 4 to 8
hours and a peak of 10 to 30 hours.
40. Answer: C
During the postoperative period, the nurse carefully observes the client for
signs of hemorrhage, which causes swelling and compression of adjacent tissue.
Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and
expiration; stridor is caused by compression of the trachea, leading to
respiratory distress. Stridor is an acute emergency situation that requires
immediate attention to avoid complete obstruction of the airway. Options A, B,
and D do not identify signs of a life-threatening complication.
41. Answer: B
Bed-wetting in a previously continent child is a sign suggesting
hyperglycemia. The enuresis is due to polyuria, one of the cardinal signs of
insulin-dependent diabetes mellitus. Other signs include polydipsia (excessive
thirst) and polyphagia (excessive hunger).
A. Typically the child with
hyperglycemia secondary to insulin-dependent diabetes is slightly lethargic.
C. Although the child with insulin-dependent diabetes experiences excessive
hunger, the child loses weight even though he or she is eating more.
D. Another
cardinal sign of insulin-dependent diabetes is polyphagia, or excessive hunger.
The child eats more even though he loses weight. Excessive thirst is also a
typical sign.
42. Answer: C
The causes of type 1 diabetes mellitus include an involvement of genetic
factors, specifically the presence of the human leukocyte antigen. This factor
is found in many clients with type 1 diabetes mellitus. Autoimmune factors and
viruses also are thought to play a role in its development. The problem with
type 1 diabetes mellitus is the destruction of the beta cells. Type 1 diabetes
mellitus is not due to a primary failure of glucagon secretion.
43. Answer: D
The pancreas produces endocrine and exocrine secretions as part of its normal
function. The organ secretes insulin as a key endocrine hormone to regulate the
blood glucose level. Other pancreatic endocrine hormones are glucagon, and
somatostatin. The exocrine pancreas produces digestive enzymes such as amylase,
lipase, and trypsin.
44. Answer: A
PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and
converts vitamin D to its active form: 1,25-dihydroxyvitamin D. PTH doesn't
have a role in the metabolism of vitamin E.
45. Answer: C
Diabetes mellitus can lead to metabolic acidosis. When the body does not have
sufficient circulating insulin, the blood glucose level rises. At the same
time, the cells of the body use all available glucose. The body then breaks
down glycogen and fat for fuel. The by-products of fat metabolism are acidotic
and can lead to the condition known as diabetic ketoacidosis. Options A, B, and
D are incorrect.
46. Answer: B
Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine
is pale, and the specific gravity is low. Anorexia and weight loss occur.
Options A and Dare not specific to this disorder.
47. Answer: C
NPH is intermediate-acting insulin. The onset of action of NPH insulin is 1 to
2 hours, it peaks in 6 to 14 hours, and its duration of action is 24 hours.
Hypoglycemic reactions most likely occur during peak time.
48. Answer: C
Bacon is a component of the fat group in the exchange system. One teaspoon of
butter is equal to 1 tsp margarine, 1 tsp of any oil, 1 tbs of salad dressing,
1 strip of bacon, 5 large olives, or 10 whole peanuts.
49. Answer: B
Clients with type 2 diabetes mellitus have decreased or impaired insulin
secretion. Oral hypoglycemic agents are given to these clients to facilitate
glucose utilization. Insulin injections may be given during times of
stress-induced hyperglycemia. Oral insulin is not available because of the
breakdown of the insulin by digestion. Options A, C, and D are incorrect.
50. Answer: A
There is a greater incidence of both gestational diabetes and preexisting
diabetes among women older than 35 years. In addition, clients of Native
American and Hispanic descent have a greater incidence of gestational diabetes
than the general population.
B. The client does not present symptoms that would
warrant testing of chorionic villi.
C. The client does not present symptoms
that would warrant a urine culture and sensitivity test.
D. The client does not
present symptoms that would warrant testing for hepatitis D.
51. Answer: A
The glycosylated hemoglobin measures the amount of glucose that has become
permanently bound to the red blood cells from circulating glucose. The glycosylated
hemoglobin in a diabetic client with good control will be 7.5% or less.
Elevations in blood glucose will cause elevations in the amount glycosylation.
Elevations indicated continued need for teaching related to prevention of
hyperglycemic episodes.
52. Answer: C
Regular insulin, which is a short-acting insulin, has an onset of 15 to 30
minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2
p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from
4 p.m. to 6 p.m.
53. Answer: B
Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium
levels produce osmotic diuresis and thus polyuria. The diuresis leads to
dehydration (weight loss rather than weight gain). Options A and C are
gastrointestinal symptoms and are not associated with the common
gastrointestinal symptoms typical of hyperparathyroidism (nausea, vomiting,
anorexia, constipation).
54. Answer: A
Foods high in dietary fiber are recommended by the American Diabetes
Association because they tend to blunt the rise in blood glucose levels after
meals. Dietary fiber is the part of food not broken down and absorbed during
digestion. Most fibers come from plants; good sources include whole grains,
legumes, vegetables, fruits, and nuts.
B. Dairy products are poor sources of
fiber and meats.
C. Foods fortified with vitamins are satisfactory if they also
contain fiber. However, many foods fortified with vitamins contain either no
dietary fiber (such as fortified milk) or little fiber (such as products
fortified with vitamins but made with refined grains).
D. Meats are poor
sources of fiber.
55. Answer: B
Symptoms of hypoglycemia include tachycardia, shakiness, and cool clammy skin.
Options A, C, and D are not symptoms of hypoglycemia.
56. Answer: C
Snacks are included in the diabetic diet to offset periods of peak insulin
action. Because of the lack of pancreatic functioning, the child does not
receive differing amounts of insulin in response to the glucose level in the
bloodstream. The child with diabetes mellitus is given insulin at specific
times; dietary intake must be matched to the insulin peaks and troughs.
A. The
risk of hyperglycemia is not eliminated through regular snacks, although
spreading the calories throughout the day may help the child achieve a more
steady blood glucose level.
B. Snacks are not used to decrease the amount of
food eaten at meals.
D. Snacks are not used to offset hunger for sweets.
57. Answer: B
Strenous exercise, such as running, should be avoided if the adolescent's
blood glucose level is 240 ng/dLmg/dL or above. When insulin levels are not
adequate, the cells cannot receive glucose even though the blood glucose level
is high. With low insulin levels, glucagons acts to increase hepatic glucose
production thus raising the blood glucose level, which cannot be used at the
muscle site.
A. Vigorous muscle contraction increases local blood flow and
absorption of insulin injected into that area, placing the adolescent at risk
for hypoglycemia. This action should be avoided.
C. Because exercise decreases
blood glucose levels, snacks would be given before strenuous exercise to
prevent hypoglycemia. Taking extra insulin and the effects of exercise place
the adolescent at high risk for hypoglycemia.
D. Snacks are used before
strenuous exercise to prevent hypoglycemia. If the adolescent cannot tolerate
the extra needed food, insulin dosage may be reduced but only on the advice of
the physician.
58. Answer: C
The glycosylated Hb test provides an objective measure of glycemic control over
a 3-month period. The test helps identify trends or practices that impair
glycemic control, and it doesn't require a fasting period before blood is drawn.
The nurse can't conclude that the result occurs from poor dietary management or
inadequate insulin coverage.
59. Answer: C
The client's trouble stems from perceptual difficulties; the preset syringe removes the need to differentiate between 24 and 42 units.
A. This would not solve the transposition of the numbers; the
problem is not caused by the inability to see the numbers but by the child's
perception of them.
B&D. This would not solve the transposition of the
numbers.
60. Answer: B
Cushing’s syndrome is characterized by an excess of cortisol, a glucocorticoid.
Glucocorticoids are produced by the adrenal cortex. Epinephrine and
norepinephrine are produced by the adrenal medulla. Calcium is unrelated to
this disorder.
61. Answer: B
Headache is common after the procedure, but neck stiffness, especially on
flexion, and pain should be reported because they signal meningeal irritation.
The nurse also monitors the client for allergic reactions to the dye such as
confusion, dizziness, tremors, and hallucinations. Feelings of fatigue may be
normal, and back discomfort may be due to the positions required for the
procedure.
62. Answer: A
Regular insulin administered intravenously is the treatment choice for diabetic
ketoacidosis (DKA). This short-acting insulin is the only insulin that can be
given intravenously and is titrated to the client’s blood glucose levels. NPH
insulin is intermediate-acting insulin and thus is not appropriate for
treatment of DKA. Glucagon is used treat hypoglycemia because it increases
blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat
type 2 diabetes mellitus. Both of these agents are also inappropriate.
63. Answer: B
With over activity of the thyroid gland, metabolism is increased, including fat
metabolism. The increased metabolism leads to decreased levels of fat in the
bloodstream, including cholesterol, and decreased body fat stores. Weight loss
occurs as a result of the increased metabolic activity. Glucose tolerance is
decreased, and the client experiences hyperglycemia. Although the client has an
increased appetite, food intake does not meet energy demands, and nutritional
deficiencies can develop.
64. Answer: A
Digital subtraction is a radiographic method to study the blood vessels. The
nurse should explain to the client that the test provides information about the
blood vessels. Options B, C, and Dare incorrect.
65. Answer: B
Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases
cellular metabolism. Levothyroxine should be given in the morning in a single
dose to prevent sleeplessness and should be given at the same time each day to
maintain an adequate drug level.
66. Answer: B
The most effective and accurate measure for testing blood glucose is to test
the level before each meal and at bedtime. Checking the level after the meal
will provide an inaccurate assessment of diabetic control. Checking the level
once daily will not provide enough data related to controlling the diabetes
mellitus.
67. Answer: D
Insulin dosages not be adjusted and should not be increased before unusual
exercise. If acetone is found in the urine, it possibly may indicate the need
for additional insulin. To minimize the discomfort associated with insulin
injections, insulin should be administered at room temperature. Injection sites
should be rotated systematically from one area to another.
68. Answer: B
Decreased blood glucose levels trigger autonomic nervous system symptoms such
as nervousness, irritability, and tremors. Hot, dry skin accompanies
hyperglycemia. Anorexia and muscle cramps are unrelated to hypoglycemia.
69. Answer: C
Clients with diabetes mellitus are instructed to make adjustments in their
total daily intake to plan for meals at restaurants or parties. Some useful
strategies include ordering a half portion, salads with dressing on the side,
fresh fruit for dessert, and baked or steamed entrees. Clients are not
instructed to skip meals or to increase their prescribed insulin dosage.
70. Answer: C
Foot soaks macerate the skin and increase the risk for breaks. Water-soluble
lotions are recommended to moisturize the feet. Nail files are preferred over
nail clippers or scissors. Antiperspirants may be used when foot perspiration
exists.
71. Answer: D
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are
removed accidentally in during surgery. Manifestations develop 1 to 7 days
after surgery. If the client develops numbness and tingling around the mouth,
fingertips, or toes; muscle spasms; or twitching, the physician is notified
immediately. Calcium gluconate should be kept at the bed side.
72. Answer: B
Epinephrine and norepinephrine are produced by the adrenal medulla. The other
substances listed (cortisol, aldosterone, and the androgens) are produces by
the adrenal cortex.
73. Answer: A
When a client is scheduled for a fasting blood glucose level drawn, the client
should not eat or drink anything except water after midnight. This restriction
is needed to ensure accurate test results, which form the basis for adjustments
or continuance of treatment. Options B, C, and D are inaccurate, and the client
should not consume these items before the test.
74. Answer: A
Following thyroidectomy, the nurse assesses the client for signs of
hypocalcemia and tetany. Early signs include tingling around the mouth and in
the fingertips, muscle twitching or spasms, palpitations or dysrhythmias, and a
positive Chvostek’s and Trousseau’s sign. Options B, C, and D are not signs of
hypocalcemia.
75. Answer: B
The nurse should instruct the client with Cushing’s syndrome to take the
medications exactly as prescribed. The nurse should emphasize the importance of
continuing medications, consulting with the physician before purchasing any
over-the-counter medications, and maintaining regular outpatient follow-up
care. The nurse also should instruct the client about the signs and symptoms of
hypoadrenalism and hyperadrenalism.
76. Answer: D
Discharge instructions for the client hospitalized for hyperthermia includes
prevention of heat-related disorders, increased fluid intake for 24 hours,
self-monitoring of voiding, and the importance of staying in cool environment
and resting.
77. Answer: C
Eight- to 10-year-olds are developmentally ready to begin to give their own
injections with adult supervision. Their fine motor skills are developed enough
to accomplish this skill.
A. Beginning to recognize symptoms of hypoglycemia is
appropriate for 4- to 6-year-olds because of their beginning ability to
verbalize how they feel.
B. Measuring insulin accurately in a syringe is more
appropriate for 10- to 12-year-olds who have better fine motor skills.
D. Because of the complexity of disease management, assuming responsibility for
self-care is appropriate for an older adolescent.
78. Answer: D
Expected outcomes for this nursing diagnosis in an unconscious client include
stable weight, intake equaling output, evidence of wound healing, and normal
blood urea nitrogen, total protein, and hemoglobin levels. The only abnormal
finding is the protein level.
79. Answer: C
With chronic high circulating blood glucose levels, some glucose binds
irreversibly onto the red blood cells and remains there for the life of the red
blood cells. The average life span of a red blood cell is 120 days. The
measurement of glycosylated hemoglobin (HbA 1c), which detects glucose binding
on the red blood cell membrane, is expressed as a percent. One of the problems
with diabetes is that there may be an inability of muscle and adipose cells to
transport glucose across cell membranes. Glucose does not bind onto platelets
in diabetes mellitus.
80. Answer: C
Desired outcomes for nursing interventions to prevent cold discomfort and in
the development of accidental hypothermia include the following: hands and
limbs are warm, body is relaxed and not curled, body temperature is greater
than 97°F, the client is not shivering, and the client has no complaints of
feeling cold.
81. Answer: A
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics,
and potassium supplements. Options B, a B- blocker, and C, a monoamine oxidase
inhibitor, have their own intrinsic hypoglycemic activity. Option D decreases
urinary excretion of sulfonylurea agents, causing increased levels of the oral
agent, which lead to hypoglycemia.
82. Answer: B
A high-complex-carbohydrate and high-protein diet will be prescribed for the
client with Addison’s disease. To prevent excess fluid and sodium loss, the
client is instructed to maintain a normal salt intake daily (3 g) and to
decrease salt intake during hot weather, before strenuous exercise, and in
response to fever, vomiting, or diarrhea.
83. Answer: A
When a client with diabetes mellitus is unable to eat normally because of
illness, the client still should take the prescribed insulin or oral
medication. The client should consume additional fluids and should notify the
physician. The client should monitor the blood glucose level every 3 to 4
hours.
84. Answer: D
The nurse should advise the mother to allow the child to go trick-or-treating. Children need to be treated like their peers. Sheltering them from all temptation does not allow them the opportunity to develop coping strategies for dealing with the restraints made necessary by their disease.
A. Eating sweets can result in hyperglycemia. Although not desired, hyperglycemia
is not life-threatening in this context.
B. Trust between the parent and child
is essential in managing this disease. Telling the mother that she must go with
her child and watch her would not promote trust.
C. It would not be advisable
to give extra insulin because this action could result in severe hypoglycemia,
especially if this usually compliant child remains faithful to the treatment
regimen.
85. Answer: D
Fosamax is used to treat osteoporosis in post-menopausal women. The patient
should be instructed to remain upright for 30 minutes after taking the dose of
Fosamax to prevent esophageal irritation. Gastrointestinal side effects of
Fosamax include anorexia, abdominal pain, nausea, vomiting, constipation and
esophageal ulceration.
A. Fosamax should be taken in the morning before food is
consumed. It should not be crushed and mixed with food.
B. Fosamax should be
taken with six to eight ounces of water.
C. Fosamax should not be taken
sublingually. It should be taken orally with six to eight ounces of water in
the morning before food and other medications.
86. Answer: B
In the client with diabetic ketoacidosis, the nurse would expect to note blood
glucose levels between 350 and 1500 mg/dL, ketonuria, venous blood pH between
6.8 and 7.2, and a serum bicarbonate less than 9 mEq/dL. The serum potassium
results would be inversely proportional to the pH.
87. Answer: B
Infection is a physiological stressor that can cause an increase in the level
of epinephrine in the body. An increase in epinephrine causes an increase in
blood glucose levels. When the client is under stress, such as when an
infection exists, the client will require an increase in the dose of insulin to
facilitate the transport of excess glucose into the cells. The client would not
necessarily need an adjustment in the daily diet.
88. Answer: C
With congenital hypothyroidism, failure of normal development occurs during the embryonic period or when an inborn error of metabolism prevents the normal synthesis of thyroxine. Although the condition is present at birth, maternal thyroxine can pass through the placenta to the fetus, supplying the fetus and neonate sufficiently. Thus, in most neonates, the signs of hypothyroidism are commonly masked at birth.
A. Telling the mother that she didn't bring the child in for 2 weeks implies
that the mother was at fault, possibly causing the mother to become defensive.
B. With congenital hypothyroidism, failure of normal development occurs during
the embryonic period or when an inborn error of metabolism prevents the normal
synthesis of thyroxine. Although the condition is present at birth, maternal
thyroxine can pass through the placenta to the fetus, supplying the fetus and neonate
sufficiently. Thus, in most neonates, the signs of hypothyroidism are commonly
masked at birth.
D. Telling the mother
that she couldn't be reached is not therapeutic and may cause the mother to
become defensive, implying that she was at fault.
89. Answer: B
Thyrotoxicosis usually occurs in clients with Grave’s disease with the symptoms
precipitated by a major stressor. This complication typically occurs during
periods of severe physiological or psychological stress such as trauma, sepsis,
delivery, or major surgery. Grave’s disease also must be recognized as a
potential complication following thyroidectomy.
90. Answer: C
Insulin should not be frozen. If the nurse notes that the vial of insulin is
frozen, the nurse should discard the insulin and obtain a new vial. Options A,
B, and D are incorrect actions.
91. Answer: C
Metformin should be used with caution in clients with kidney or liver disease,
heart failure, chronic lung disease, and a history of heavy alcohol
consumption. Options A, B, and D are not associated caution of
contraindications in the use of this medication.
92. Answer: D
Standard measures to lower body temperature include removing bed covers,
providing cool sponge baths, using an electric fan in the room, administering
acetaminophen, and placing a hypothermia blanket under the client. Ice packs
are avoided because they could cause shivering, which increases cellular oxygen
demands and could increase intracranial pressure. If shivering occurs, it is
managed with chlorpromazine (Thorazine).
93. Answer: A
Cushing’s syndrome is a condition caused by excessive amounts of cortisol.
Options B, C and D are inaccurate descriptions of this disorder.
94. Answer: D
Signs and symptoms associated with hypoglycemia include nervousness,
diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability,
headache, hunger, tachycardia, and changes in speech, hearing, or vision. If
untreated, signs and symptoms may progress to unconsciousness, seizures, coma,
and death. Polyuria, polyphagia, and polydipsia are symptoms associated with
hyperglycemia.
95. Answer: A
Acarbose delays glucose absorption, so the client should take an oral form of
dextrose rather than a product containing table sugar when treating
hypoglycemia. The alpha-glucosidase inhibitors work by delaying the
carbohydrate digestion and glucose absorption. It's safe to be on a regimen
that includes insulin and an alpha-glucosidase inhibitor. The client should
take the drug at the start of a meal, not 30 minutes to an hour before.
96. Answer: B,A,C,D,E
The client is experiencing symptoms of mild hypoglycemia. If symptoms such as
hunger, irritability, shakiness, or weakness occur, the nurse first would check
the client’s blood glucose level to verify that the client is experiencing
hypoglycemia. Once this is verified, the nurse would give the client 10 to 15 g
of carbohydrates. The nurse would retest the blood glucose in 15 minutes. In
the mean time, the nurse would check the client’s vital signs. The nurse would
give the client another 10- to 15-g carbohydrate food item if the client’s
symptoms do not resolve. Otherwise, the nurse would provide a small snack of
carbohydrates and protein if the client’s next scheduled meal is more than an
hour away from the time of the occurrence. Following the treatment and
resolution of the hypoglycemic event, the nurse would document the occurrence,
actions taken, and outcome.
97. Answer: A
Glipizide begins to act in 15 to 30 minutes. The other options are incorrect.
98. Answer: D
The client with Cushing’s syndrome should be reassured that most physical
changes resolve with treatment. Options A, B, and C are not therapeutic responses.
99. Answer: D
The nurse informs the client that the test aids in determining whether symptoms
are caused by abnormalities in the adrenal gland. The nurse assesses the client
for allergies to iodine before the test. The nurse tells the client that the
client may experience a transient burning sensation after the dye is injected,
that the client will be placed in a supine position, and that the insertion
site will be anesthetized locally. An informed consent form is required.
100. Answer: B
Myxedema is a deficiency of thyroid hormone. The client has a puffy edematous
face especially around the eyes, periorbital edema, coarse facial features, dry
skin, and dry, coarse hair and eyebrows. Options A, C, and D are noted in the
client with hyperthyroidism.
101. Answer: D
Serum osmolarity is the most important test for confirming HHNS; it's also used
to guide treatment strategies and determine evaluation criteria. A client with
HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium,
serum sodium, and ABG values are also measured, but they aren't as important as
serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS
typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis,
and the potassium level is variable.
102. Answer: B
Special foods are not required for a client with diabetes, nor should
certain foods (except refined sugars) be eliminated entirely from the diet.
More important is that meal times, meal size, and meal composition are
consistent. Pasta may be included in the diet as part of the bread and cereal
exchange.
A. Pasta can be included in the client's diet as long as it is
counted in the exchanges.
C. Pasta sauces may be used if they are taken into
account in the total diet.
D. A client's ethnic, religious, and cultural food
preferences should be taken into account in meal planning. If these preferences
are not considered, a client may eat foods without making proper adjustments or
may reject the diet entirely. As long as the pasta is counted in the exchanges,
it will not necessarily cause hyperglycemia.
103. Answer: C
An enlarged thyroid gland occurs in a client with goiter because an excessive
amount of thyroxine occurs in the thyroid gland, causing it to enlarge. Slow
wound healing can occur with zinc deficiency. Heart damage can occur with
selenium deficiency. Additionally, heart damage would not likely be noted
during the nursing assessment. Further diagnostic tests, in addition to
assessment, would be necessary to determine heart damage.
104. Answer: C
Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of
hypothyroidism. It's seen most frequently in women over age 40. Weight gain,
decreased appetite, constipation, lethargy, dry cool skin, brittle nails,
coarse hair, muscle cramps, weakness, and sleep apnea are symptoms of
Hashimoto's thyroiditis. Weight loss, increased appetite, and hyperdefecation
are characteristic of hyperthyroidism. Weight loss, increased urination, and
increased thirst are characteristic of uncontrolled diabetes mellitus. Weight
gain, increased urination, and purplish-red striae are characteristic of
hypercortisolism.
105. Answer: A
Common manifestations of Addison’s disease include postural hypotension from
fluid loss, syncope, and muscle weakness. Anorexia, nausea and vomiting,
abdominal cramps, weight loss, depression, and irritability. Options B, C, and
D do not occur with this disease.
106. Answer: D
After computed tomography scanning, the client may resume all usual activities.
The client should be encouraged to consume extra fluids to replace those lost
with diuresis form the contrast dye.
107. Answer: A
Because diabetes insipidus results from decreased antidiuretic hormone
(vasopressin) production, the nurse should expect hormone replacement therapy
with synthetic vasopressin. The diuretic furosemide is contraindicated because
the client is experiencing polyuria. Insulin and dextrose are used to treat
diabetes mellitus and its complications — not diabetes insipidus.
108. Answer: D
A triad clinical symptoms including excessive thirst, Polydipsia, and polyuria
often occurs suddenly in the client with diabetes insipidus. The urine is
dilute with a specific gravity less than 1.006, and the serum osmolality is
increased beyond 280 mOsm/L. (SR 7604)
109. Answer: C
A GTT indicates a diagnosis of diabetes mellitus when the 2-hour blood glucose
level is greater than 200 mg/dl. Confirmation occurs when at least one
subsequent result is greater than 200 mg/dl.
110. Answer: A
Clients with Addison's disease and their family members should know how to
administer I.M. hydrocortisone during periods of stress. It's important to keep
well hydrated during stress, but the critical component in this situation is to
know how and when to use I.M. hydrocortisone. Capillary blood glucose
monitoring isn't indicated in this situation because the client doesn't have
diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
111. Answer: C
Asymptomatic proteinuria is an initial sign of diabetic nephropathy.
Microscopic proteinuria should be monitored yearly in all clients with diabetes
for over 5 years.
A. Polyuria is a symptom of poorly managed diabetes.
B. Ketonuria is a sign of diabetic ketoacidosis.
D. Increasing glycosuria is a
symptom of poorly managed diabetes.
112. Answer: A
Classic signs of water intoxication include confusion and seizures, both of
which are caused by cerebral edema. Weight gain will also occur. Sunken
eyeballs, thirst, and increased BUN levels indicate fluid volume deficit.
Spasticity, flaccidity, and tetany are unrelated to water intoxication.
113. Answer: A
A moderate exercise program will help strengthen bones and prevent the bone
loss that occurs from excess parathyroid hormone. Walking or swimming provides
the most beneficial exercise. Weight loss might be beneficial but it isn't as
important as developing a moderate exercise program. Because of weakened bones,
a rigorous exercise program such as jogging would be contraindicated.
114. Answer: A
Lack (absolute or relative) of insulin is the primary cause of DKA. Treatment
consists of insulin administration (normal saline initially), and potassium
replacement, followed by correcting acidosis. Applying and electrocardiogram
monitor is not a priority action.
115. Answer: A
Excessive dosing with propylthiouracil may convert the client from a
hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be
reduced. Temporary administration of thyroid hormone may be required.
Propylthiouracil is not used for pain and does not cause hyperglycemia or renal
toxicity.
116. Answer: A
Manifestations of hypothyroidism include cold intolerance, constipation, loss
of initiative, thick dry skin, weight gain, a notably puffy appearance of the
skin around the eyes, slowed intellectual function, including retarded speech
and apathy, and low metabolic rate. Levothyroxine (Synthroid) is used to
correct hypothyroidism. The dosage needs to be increased.
117. Answer: D
Because respirations are depressed in myxedema coma, maintaining a patent
airway is the most critical nursing intervention. Ventilatory support is
usually needed. Thyroid replacement will be administered I.V. Although myxedema
coma is associated with severe hypothermia, a warming blanket shouldn't be used
because it may cause vasodilation and shock. Gradual warming with blankets
would be appropriate. Intake and output are very important but aren't critical
interventions at this time.
118. Answer: A
Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant
thirst, and an unusually high oral intake of fluids. Treatment with the
appropriate drug should decrease urine output and oral fluid intake. A urine
output of 200 ml/hour indicates continuing polyuria. Blood pressure at 90/50 mm
Hg and a pulse rate of 126 beats/minute are signs of compensation for continued
fluid deficit, suggesting that treatment hasn't been effective.
119. Answer: B
The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex CHO (such as a slice of bread), and lastly a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex CHO and protein produce a more sustained response.
A. These are fast-acting sugars, and neither of them will provide a
sustained response.
C. The fat content of
chocolate candy decreases the rate of absorption of glucose.
D. Neither of these are fast-acting sugars; peanut butter crackers
and milk can be used to maintain the glucose level after it has been raised.
120. Answer: B
Spironolactone can cause menstrual irregularities and decreased libido. Men may
also experience gynecomastia and impotence. Breast tenderness, increased facial
hair, and hair loss aren't associated with spironolactone.
121. Answer: A
The client with liver disease has a decreased ability to
metabolize CHO because of a decreased ability to form glycogen (glycogenesis)
and to form glucose from glycogen (glycogenolysis).
B. Hypertension
is not related to a decreased serum glucose level.
C. Clients with
Type 2 diabetes do not depend on exogenous insulin, nor are they prone to
ketosis; the blood glucose levels fall much more slowly, and there is ample
time to monitor signs and symptoms before insulin shock can develop.
D. Hyperthyroidism is not related to a decreased serum glucose level.
122. Answer: D
Exercise increases the use of blood glucose by the muscles, therefore
reducing the body's insulin requirements. Exercise also tends to lower blood
cholesterol and triglyceride levels. In addition, exercise is a healthful
diversionary activity, helps control weight, and promotes circulation.
A. Exercise can precipitate an episode of hypoglycemia if carbohydrates are not
replaced.
B. Exercise does not stimulate overproduction of insulin; it
increases carbohydrate metabolism which, for the diabetic, can result in
hypoglycemia.
C. Exercise does not affect the renal threshold for glucose.
123. Answer: C
Regular follow-up care for the client with Graves' disease is critical because
most cases eventually result in hypothyroidism. Annual thyroid-stimulating
hormone tests and the client's ability to recognize signs and symptoms of
thyroid dysfunction will help detect thyroid abnormalities early. Intake and
output is important for clients with fluid and electrolyte imbalances but not
thyroid disorders. DDAVP is used to treat diabetes insipidus. While exercise to
improve cardiovascular fitness is important, for this client the importance of
regular follow-up is most critical.
124. Answer: C
These are the classic signs associated with hyperthyroidism; weight loss and restlessness occur because of an increased basal metabolic rate; exophthalmos occurs because of peribulbar edema.
A. These are all associated with hypothyroidism because of the
decreased metabolic rate.
B. Lethargy and weight gain are associated
with hypothyroidism as a result of a decreased metabolic rate; forgetfulness is
not related.
D. Although
weight loss and exophthalmos occur with hyperthyroidism, the client would be
hyperactive, not hypoactive.
125. Answer: A
Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands,
feet, tongue, and face are findings associated with hyperkalemia, which is
transient and occurs from transient hypoaldosteronism when the adenoma is
removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.
126. Answer: B
After a subtotal thyroidectomy, swelling of the surgical site (the tracheal
area) may obstruct the airway. For this reason, the nurse should keep a
tracheostomy set at the client's bedside in case of respiratory emergency.
Although an indwelling urinary catheter and cardiac monitor may be used for a
client after a thyroidectomy, the tracheostomy set is most important. A
humidifier isn't indicated for this client.
127. Answer: C
The nurse must emphasize to the client and family that they are not eating a
diabetic diet but rather a balanced meal plan. Adherence to nutrition
principles is an important component of diabetic management, and an
individualized meal plan should be developed for the client. The client does
not need to purchase dietetic foods.
128. Answer: B
The accumulation of ketones, organic acids that readily release free
hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate,
the respiratory buffering system is activated, which results in the child
taking deep, rapid breaths to rid the body of excess carbon dioxide. This
characteristic breathing pattern is known as Kussmaul's respirations.
A. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to
dehydration and loss of electrolytes.
C. Typically with ketoacidosis, the skin
will be dry due to dehydration.
D. With ketoacidosis, hypotension results from
the contracted blood volume secondary to dehydration.
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