Endocrine And Metabolic Disorders (Part 2)

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  • 1/102 Questions

    A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

    • Use commercial preparations to remove corns.
    • Cut the toenails by rounding edges.
    • Wash and inspect the feet daily.
    • Walk barefoot at least once each day.
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About This Quiz

Endocrine and metabolic diseases span a vast range of conditions. Together, they affect many millions of Americans and can profoundly decrease the quality of life. The disorders can result in hormone overproduction or underproduction. At the end of studying part two, take the quiz below to test what you have understood so far. All the best!

Endocrine And Metabolic Disorders (Part 2) - Quiz

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  • 2. 

    After a 3-month trial of dietary therapy, a client with type 2 diabetesstill has blood glucose levels above 180 mg/dl. The physician adds glyburide (DiaBeta), 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:

    • 30 minutes before breakfast.

    • In mid-morning.

    • 30 minutes after dinner.

    • At bedtime.

    Correct Answer
    A. 30 minutes before breakfast.
    Explanation
    RATIONALE: Like other oral antidiabetic agents ordered in a single daily dose, glyburide should be taken with breakfast or 30 minutes before breakfast. If the client takes glyburide later, such as in mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 576.

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  • 3. 

    A client with type 1 diabeteshas a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating:

    • "The test must be repeated following a 12-hour fast."

    • "It looks like you aren't following the ordered diabetic diet."

    • "It tells us about your sugar control for the last 3 months."

    • "Your insulin regimen must be altered significantly."

    Correct Answer
    A. "It tells us about your sugar control for the last 3 months."
    Explanation
    RATIONALE: The nurse is providing accurate information to the client when she states that 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.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1376.

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  • 4. 

    An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, andangina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

    • 2 to 5 g of a simple carbohydrate.

    • 10 to 15 g of a simple carbohydrate.

    • 18 to 20 g of a simple carbohydrate.

    • 25 to 30 g of a simple carbohydrate.

    Correct Answer
    A. 10 to 15 g of a simple carbohydrate.
    Explanation
    RATIONALE: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1411.

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  • 5. 

    A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

    • Polyuria, headache, and fatigue

    • Polyphagia and flushed, dry skin

    • Polydipsia, pallor, and irritability

    • Nervousness, diaphoresis, and confusion

    Correct Answer
    A. Nervousness, diaphoresis, and confusion
    Explanation
    RATIONALE: 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.Polydipsia,polyuria, andpolyphagiaare symptoms associated withhyperglycemia.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1410.

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  • 6. 

    Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

    • Hypokalemia and hypoglycemia

    • Hypocalcemia and hyperkalemia

    • Hyperkalemia and hyperglycemia

    • Hypernatremia and hypercalcemia

    Correct Answer
    A. Hypokalemia and hypoglycemia
    Explanation
    RATIONALE: Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemiaorhypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1413.

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  • 7. 

    A nurse teaches a client with newly diagnosed hypothyroidismabout the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?

    • Methimazole (Tapazole)

    • Thyroid USP desiccated (Thyroid USP Enseals)

    • Liothyronine (Cytomel)

    • Levothyroxine (Synthroid)

    Correct Answer
    A. Levothyroxine (Synthroid)
    Explanation
    RATIONALE: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1453.

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  • 8. 

    A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

    • Encourage the client to ask questions about personal sexuality.

    • Provide time for privacy.

    • Provide support for the spouse or significant other.

    • Suggest referral to a sex counselor or other appropriate professional.

    Correct Answer
    A. Suggest referral to a sex counselor or other appropriate professional.
    Explanation
    RATIONALE: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1419.

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  • 9. 

    A client with diabetes mellitusmust learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulinsuspension(NpH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?

    • "Inject insulin into healthy tissue with large blood vessels and nerves."

    • "Rotate injection sites within the same anatomic region, not among different regions."

    • "Administer insulin into areas of scar tissue or hypertrophy whenever possible."

    • "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

    Correct Answer
    A. "Rotate injection sites within the same anatomic region, not among different regions."
    Explanation
    RATIONALE: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy(such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1407.

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  • 10. 

    A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:

    • Hypotension.

    • Thick, coarse skin.

    • Deposits of adipose tissue in the trunk and dorsocervical area.

    • Weight gain in arms and legs.

    Correct Answer
    A. Deposits of adipose tissue in the trunk and dorsocervical area.
    Explanation
    RATIONALE: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1480.

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  • 11. 

    A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

    • An ectopic corticotropin-secreting tumor.

    • Adrenal carcinoma.

    • A corticotropin-secreting pituitary adenoma.

    • An inborn error of metabolism.

    Correct Answer
    A. A corticotropin-secreting pituitary adenoma.
    Explanation
    RATIONALE: A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1479.

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  • 12. 

    A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspectshyperthyroidism. Exophthalmos is characterized by:

    • Dry, waxy swelling and abnormal mucin deposits in the skin.

    • Protruding eyes and a fixed stare.

    • A wide, staggering gait.

    • More than 10 beats/minute difference between the apical and radial pulse rates.

    Correct Answer
    A. Protruding eyes and a fixed stare.
    Explanation
    RATIONALE: Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advancedhypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1440.

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  • 13. 

    A client with primary diabetes insipidusis ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

    • "Administer desmopressin while the suspension is cold."

    • "Your condition isn't chronic, so you won't need to wear a medical identification bracelet."

    • "You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

    • "You won't need to monitor your fluid intake and output after you start taking desmopressin."

    Correct Answer
    A. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage."
    Explanation
    RATIONALE: The nurse should advise the client that desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 363.

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  • 14. 

    Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

    • Fasting blood glucose test

    • 6-hour glucose tolerance test

    • Serum glycosylated hemoglobin (Hb A1c)

    • Urine ketones

    Correct Answer
    A. Serum glycosylated hemoglobin (Hb A1c)
    Explanation
    RATIONALE: Hb A1cis the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

    CLIENT NEEDS CATEGORY: Health promotion and maintenance
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1376.

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  • 15. 

    A client with a history of Addison's diseaseand flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion?

    • Insulin

    • Hydrocortisone

    • Potassium

    • Hypotonic saline

    Correct Answer
    A. Hydrocortisone
    Explanation
    RATIONALE: 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 blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated withhypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — nothypotonic— saline solution.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1478.

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  • 16. 

    Which instruction about levothyroxine (Synthroid) administration should a nurse teach a client?

    • "Take the drug on an empty stomach."

    • "Take the drug with meals."

    • "Take the drug in the evening."

    • "Take the drug whenever convenient."

    Correct Answer
    A. "Take the drug on an empty stomach."
    Explanation
    RATIONALE: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 693.

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  • 17. 

    Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use?

    • Verbalizing an understanding of blood glucose meter use

    • Documenting a normal blood glucose level

    • Providing documentation of previous certification

    • Demonstrating correct technique

    Correct Answer
    A. Demonstrating correct technique
    Explanation
    RATIONALE: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Application

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 323.

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  • 18. 

    A client is diagnosed with syndrome of inappropriate antidiuretic hormone(SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

    • Restricting fluids to 800 ml/day

    • Administering vasopressin as ordered

    • Elevating the head of the client's bed to 90 degrees

    • Restricting sodium intake to 1 gm/day

    Correct Answer
    A. Restricting fluids to 800 ml/day
    Explanation
    RATIONALE: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidusa condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 317.

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  • 19. 

    A nurse is preparing a client with type 1 diabetesfor discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?

    • Home health nurse

    • Dietitian

    • Psychiatrist

    • Social worker

    Correct Answer
    A. Dietitian
    Explanation
    RATIONALE: The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.

    CLIENT NEEDS CATEGORY: Health promotion and maintenance
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1410.

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  • 20. 

    A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?

    • Insulin is absorbed more slowly at abdominal injection sites than at other sites.

    • Insulin is absorbed rapidly regardless of the injection site.

    • Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

    • Insulin is absorbed unpredictably at all injection sites.

    Correct Answer
    A. Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
    Explanation
    RATIONALE: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1408.

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  • 21. 

    During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

    • "The head of your bed must remain flat for 24 hours after surgery."

    • "You should avoid deep breathing and coughing after surgery."

    • "You won't be able to swallow for the first day or two."

    • "You must avoid hyperextending your neck after surgery."

    Correct Answer
    A. "You must avoid hyperextending your neck after surgery."
    Explanation
    RATIONALE: To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1469.

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  • 22. 

    When referred to a podiatrist, a client newly diagnosed with diabetes mellitusasks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

    • "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."

    • "The circulation in your feet can help us determine how severe your diabetes is."

    • "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

    • "It's easier to get foot infections if you have diabetes."

    Correct Answer
    A. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
    Explanation
    RATIONALE: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infectionor stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1408.

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  • 23. 

    A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?

    • To decrease the possibility of nausea and vomiting

    • To restore liver glycogen and prevent secondary hypoglycemia

    • To stimulate her appetite

    • To decrease the amount of glycogen in her system

    Correct Answer
    A. To restore liver glycogen and prevent secondary hypoglycemia
    Explanation
    RATIONALE: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1411.

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  • 24. 

    A nurse is caring for a client with type 1 diabeteswho exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:

    • I.M. or subcutaneous glucagon.

    • I.V. bolus of dextrose 50%.

    • 15 to 20 g of a fast-acting carbohydrate such as orange juice.

    • 10 units of fast-acting insulin.

    Correct Answer
    A. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
    Explanation
    RATIONALE: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1411.

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  • 25. 

    A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?

    • Diabetes mellitus

    • Goiter

    • Diabetes insipidus

    • Cushing's syndrome

    Correct Answer
    A. Goiter
    Explanation
    RATIONALE: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms ofdiabetes mellitusincludepolydipsia,polyuria, andpolyphagia. Signs and symptoms ofdiabetes insipidusinclude extreme polyuria (4 to 16 L/day) and symptoms ofdehydration(poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension).Cushing's syndromecauses buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1466.

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  • 26. 

    A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?

    • Serum potassium level of 6.8 mEq/L

    • Blood urea nitrogen (BUN) level of 2.3 mg/dl

    • Serum sodium level of 156 mEq/L

    • Serum glucose level of 236 mg/dl

    Correct Answer
    A. Serum potassium level of 6.8 mEq/L
    Explanation
    RATIONALE: A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs glyconeogenesis.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1478.

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  • 27. 

    A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer?

    • 5% dextrose and normal saline solution

    • Lactated Ringer's solution

    • Half-normal saline solution

    • 10% dextrose in water

    Correct Answer
    A. Lactated Ringer's solution
    Explanation
    RATIONALE: Lactated Ringer's solution, with an osmolalityof approximately 273 mOsm/L, isisotonic. The nurse shouldn't give half-normal saline solution because it'shypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions arehypertonic.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 311.

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  • 28. 

    Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks the charge nurse to change her assignment. She is frustrated because she has had to devote so much time and energy to helping a newly licensed nurse provide discharge teaching for clients with diabetes mellitus. The charge nurse should:

    • Reassign the new graduate to another staff member.

    • Offer to assist with the discharge teaching needs.

    • Try to provide the staff member with a float nurse.

    • Insist that the nurse follow through with the assignment.

    Correct Answer
    A. Offer to assist with the discharge teaching needs.
    Explanation
    RATIONALE: Staff members need to know the charge nurse is a supportive leader who respects their honesty and stands behind them. By offering to help with discharge teaching, the charge nurse is actively engaging with her staff at a time of need. Changing all the assignments on this extremely busy floor would be counterproductive. Insisting that the staff member follow through with her assignment disrespects her request and genuine need. Providing a float nurse could help, but there are no guarantees a float nurse is available.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Analysis

    REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 120.

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  • 29. 

    A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in:

    • Serum glucose level.

    • Hair loss.

    • Bone mineralization.

    • Menstrual flow.

    Correct Answer
    A. Serum glucose level.
    Explanation
    RATIONALE: Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines.Osteoporosisoccurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases.Amenorrheadevelops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1480.

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  • 30. 

    A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect:

    • Thyroiditis.

    • Graves' disease.

    • Hashimoto's thyroiditis.

    • Multinodular goiter.

    Correct Answer
    A. Graves' disease.
    Explanation
    RATIONALE: Graves' disease, an autoimmune disease causinghyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form ofhypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (≤2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1459.

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  • 31. 

    While reviewing the day's charts, a nurse who's been under a great deal of personal stress realizes that she forgot to administer insulin to client with diabetes mellitus. She's made numerous errors in the past few weeks and is now afraid her job is in jeopardy. What is her best course of action?

    • Administer the medication immediately and chart it as given on time.

    • Report the error and request a private meeting with the unit manager.

    • Report the error, complete the proper paperwork, and meet with the unit manager.

    • Contact the physician and follow his instructions.

    Correct Answer
    A. Report the error, complete the proper paperwork, and meet with the unit manager.
    Explanation
    RATIONALE: Making an error can be very stressful and a nurse may feel great pressure to hide her mistake or not follow protocol. Discussing the problem with the unit coordinator may help the nurse address some of the underlying stress that led up to making the error. Nonetheless, she must still report the error and complete the proper paperwork. The nurse should contact the physician and follow his instructions, but she shouldn't bypass proper protocol.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Management of care
    COGNITIVE LEVEL: Analysis

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 966.

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  • 32. 

    A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?

    • Indwelling urinary catheter kit

    • Tracheostomy set

    • Cardiac monitor

    • Humidifier

    Correct Answer
    A. Tracheostomy set
    Explanation
    RATIONALE: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomyset at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

    CLIENT NEEDS CATEGORY: Safe, effective care environment
    CLIENT NEEDS SUBCATEGORY: Safety and infection control
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1469.

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  • 33. 

    A client is diagnosed with syndrome of inappropriate antidiuretic hormone(SIADH). The nurse informs the client that the physician will orderdiuretictherapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?

    • Cerebral edema

    • Hypovolemic shock

    • Severe hyperkalemia

    • Tetany

    Correct Answer
    A. Cerebral edema
    Explanation
    RATIONALE: Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema. Hypovolemicshockresults from, severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur.Tetanyresults from hypocalcemia, an electrolyte disturbance not associated with SIADH.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 318.

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  • 34. 

    A client with Addison's diseasecomes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:

    • Calcium and phosphorus abnormalities.

    • Chloride and magnesium abnormalities.

    • Sodium and chloride abnormalities.

    • Sodium and potassium abnormalities.

    Correct Answer
    A. Sodium and potassium abnormalities.
    Explanation
    RATIONALE: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1478.

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  • 35. 

    Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

    • Hypocalcemia

    • Hypercalcemia

    • Hyperphosphatemia

    • Hypophosphaturia

    Correct Answer
    A. Hypercalcemia
    Explanation
    RATIONALE: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1471.

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  • 36. 

    A client with hypothyroidismis afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns?

    • "When your thyroid levels are stable, we won't have to draw your blood as often."

    • "It's only a little stick. It'll be over before you know it."

    • "The physician has ordered this test so you can get better sooner."

    • "I'll stay here with you while the technician draws your blood."

    Correct Answer
    A. "I'll stay here with you while the technician draws your blood."
    Explanation
    RATIONALE: The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear.

    CLIENT NEEDS CATEGORY: Psychosocial integrity
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Analysis

    REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1458.

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  • 37. 

    A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease?

    • "I always carry hard candy to eat in case my blood sugar level drops."

    • "I avoid exposure to the sun as much as possible."

    • "I always wear my medical identification bracelet."

    • "I skip lunch when I don't feel hungry."

    Correct Answer
    A. "I skip lunch when I don't feel hungry."
    Explanation
    RATIONALE: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1384.

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  • 38. 

    A client with newly diagnosed type 2 diabetesis admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?

    • Maintenance of blood glucose levels between 180 and 200 mg/dl

    • Smoking reduction but not complete cessation

    • An eye examination every 2 years until age 50

    • Weight reduction through diet and exercise

    Correct Answer
    A. Weight reduction through diet and exercise
    Explanation
    RATIONALE: Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1384.

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  • 39. 

    Which instruction about insulin administration should a nurse give to a client?

    • "Always follow the same order when drawing the different insulins into the syringe."

    • "Shake the vials before withdrawing the insulin."

    • "Store unopened vials of insulin in the freezer at temperatures well below freezing."

    • "Discard the intermediate-acting insulin if it appears cloudy."

    Correct Answer
    A. "Always follow the same order when drawing the different insulins into the syringe."
    Explanation
    RATIONALE: The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Comprehension

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1406.

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  • 40. 

    A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?

    • Blood urea nitrogen (BUN) level of 12 mg/dl

    • Blood glucose level of 90 mg/dl

    • Serum sodium level of 134 mEq/L

    • Serum potassium level of 5.8 mEq/L

    Correct Answer
    A. Serum potassium level of 5.8 mEq/L
    Explanation
    RATIONALE: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1478.

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  • 41. 

    A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

    • Tetany

    • Hemorrhage

    • Thyroid storm

    • Laryngeal nerve damage

    Correct Answer
    A. Tetany
    Explanation
    RATIONALE: Tetanymay result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized bytachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severehyperthyroidism— not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1470.

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  • 42. 

    A client has recently undergone surgical removal of a pituitary tumor. The physician orders corticotropin (Acthar), 20 units I.M. q.i.d., as a replacement therapy. What is the mechanism of action of corticotropin?

    • It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.

    • It interacts with plasma membrane receptors to inhibit enzymatic actions.

    • It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.

    • It regulates the threshold for water resorption in the kidneys.

    Correct Answer
    A. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
    Explanation
    RATIONALE: Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. Antidiuretic hormone regulates the threshold for water resorption in the kidneys.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 324.

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  • 43. 

    An admitting nurse on a rehabilitation unit notices that an elderly client with a fractured hip and severe hypothyroidismis dirty and disheveled and that his personal hygiene is very poor. As the nurse gathers admission data, she further notes that the client has few personal connections, is depressed, and doesn't seem to care about his appearance. How should the nurse improve the client's performance of self-care activities?

    • Offer to take the client to the shower and help him fix his hair.

    • Provide complete hygienic care and make an appointment for the client to see the hospital barber.

    • Ask the physician to refer the client to social services for a full evaluation and follow-up.

    • Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses.

    Correct Answer
    A. Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses.
    Explanation
    RATIONALE: Low thyroid levels can cause depression, which can explain many of this client's symptoms. Rather than assuming the client doesn't care about his appearance, the nurse should provide supportive hygienic care and observe for mood changes as the client's thyroid levels improve. Offering to escort the client to the shower and help with his hair, providing complete hygienic care and making an appointment with the hospital barber, and asking the physician to refer the client to social services are appropriate interventions to take if the client's behavior doesn't improve as thyroid level improves.

    CLIENT NEEDS CATEGORY: Psychosocial integrity
    CLIENT NEEDS SUBCATEGORY: None
    COGNITIVE LEVEL: Analysis

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 318.

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  • 44. 

    When caring for a client with diabetes insipidus, the nurse expects to administer:

    • Vasopressin (Pitressin).

    • Furosemide (Lasix).

    • Regular insulin.

    • 10% dextrose.

    Correct Answer
    A. Vasopressin (Pitressin).
    Explanation
    RATIONALE: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiencespolyuria. Insulin and dextrose are used to treatdiabetes mellitusand its complications, not diabetes insipidus.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1448.

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  • 45. 

    A nurse should perform which intervention for a client with Cushing's syndrome?

    • Offer clothing or bedding that's cool and comfortable.

    • Suggest a high-carbohydrate, low-protein diet.

    • Explain that the client's physical changes are a result of excessive corticosteroids.

    • Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

    Correct Answer
    A. Explain that the client's physical changes are a result of excessive corticosteroids.
    Explanation
    RATIONALE: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients withAddison's diseasemust increase sodium intake and fluid intake in times of stress of prevent hypotension.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Physiological adaptation
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1482.

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  • 46. 

    A client with diabetes mellitushas a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulinsuspension(NpH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

    • Serum glucose level of 450 mg/dl

    • Serum glucose level of 52 mg/dl

    • Serum calcium level of 8.9 mg/dl

    • Serum calcium level of 10.2 mg/dl

    Correct Answer
    A. Serum glucose level of 52 mg/dl
    Explanation
    RATIONALE: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals.Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness,polyuria, andpolydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1410.

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  • 47. 

    Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by:

    • Muscle weakness.

    • Tremors.

    • Diaphoresis.

    • Constipation.

    Correct Answer
    A. Muscle weakness.
    Explanation
    RATIONALE: Muscle weakness, bradycardia, nausea, diarrhea, andparesthesiaof the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Application

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1477.

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  • 48. 

    What is the most common cause of hyperaldosteronism?

    • Excessive sodium intake

    • A pituitary adenoma

    • Deficient potassium intake

    • An adrenal adenoma

    Correct Answer
    A. An adrenal adenoma
    Explanation
    RATIONALE: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    COGNITIVE LEVEL: Knowledge

    REFERENCE: Smeltzer, S.C., et al. Brunner and Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1473.

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  • 49. 

    Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:

    • Onset to be at 2 p.m. and its peak to be at 3 p.m.

    • Onset to be at 2:15 p.m. and its peak to be at 3 p.m.

    • Onset to be at 2:30 p.m. and its peak to be at 4 p.m.

    • Onset to be at 4 p.m. and its peak to be at 6 p.m.

    Correct Answer
    A. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
    Explanation
    RATIONALE: 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 to 2:30 p.m. and the peak from 4 to 6 p.m.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
    COGNITIVE LEVEL: Application

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 630.

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