Endocrine And Metabolic Disorders (Part 2)

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Endocrine And Metabolic Disorders (Part 2) - 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!


Questions and Answers
  • 1. 

    A client who was diagnosed with type 1 diabetes14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

    • A.

      Cool, moist skin

    • B.

      Rapid, thready pulse

    • C.

      Arm and leg trembling

    • D.

      Slow, shallow respirations

    Correct Answer
    B. Rapid, thready pulse
    Explanation
    RATIONALE: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causespolyuria,polyphagia, andpolydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated withhypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

    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. 1382.

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  • 2. 

    A nurse should expect to administer which medication to a client with gout?

    • A.

      Aspirin

    • B.

      Furosemide (Lasix)

    • C.

      Colchicine

    • D.

      Calcium gluconate (Kalcinate)

    Correct Answer
    C. Colchicine
    Explanation
    RATIONALE: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, adiuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps, it doesn't treat gout.

    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. 1918.

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  • 3. 

    A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitusat 7 a.m. At what time should the nurse expect the client to be most at risk forhypoglycemia?

    • A.

      10 a.m.

    • B.

      Noon

    • C.

      4 p.m.

    • D.

      10 p.m.

    Correct Answer
    C. 4 p.m.
    Explanation
    RATIONALE: NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m., the client is at greatest risk for hypoglycemia from 3 to 7 p.m.

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

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 631.

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  • 4. 

    A client with long-standing type 1 diabetesis admitted to the hospital with unstableangina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of:

    • A.

      Impaired adjustment.

    • B.

      Defensive coping.

    • C.

      Deficient knowledge (treatment regimen).

    • D.

      Health-seeking behaviors (diabetes control).

    Correct Answer
    C. Deficient knowledge (treatment regimen).
    Explanation
    RATIONALE: The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustmentandDefensive coping.Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis ofHealth-seeking behaviorsisn't warranted.

    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. 1390.

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  • 5. 

    A nurse is teaching a client with diabetes mellitusabout self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

    • A.

      10 g of carbohydrates.

    • B.

      15 g of carbohydrates.

    • C.

      20 g of carbohydrates.

    • D.

      25 g of carbohydrates.

    Correct Answer
    B. 15 g of carbohydrates.
    Explanation
    RATIONALE: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

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

    REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1387.

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  • 6. 

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

    • A.

      Vasopressin (Pitressin).

    • B.

      Furosemide (Lasix).

    • C.

      Regular insulin.

    • D.

      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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  • 7. 

    A client with type 1 diabeteshas been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:

    • A.

      Intermediate- and long-acting insulins.

    • B.

      Short- and long-acting insulins.

    • C.

      Short-acting insulin only.

    • D.

      Short- and intermediate-acting insulins.

    Correct Answer
    C. Short-acting insulin only.
    Explanation
    RATIONALE: A continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate- or long-acting insulins.

    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. 1397.

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  • 8. 

    A client with type 1 diabetesmust undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

    • A.

      Administer half of the client's typical morning insulin dose as ordered.

    • B.

      Administer an oral antidiabetic agent as ordered.

    • C.

      Administer an I.V. insulin infusion as ordered.

    • D.

      Administer the client's normal daily dose of insulin as ordered.

    Correct Answer
    A. Administer half of the client's typical morning insulin dose as ordered.
    Explanation
    RATIONALE: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Basic care and comfort
    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. 1414.

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  • 9. 

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

    • A.

      Hypocalcemia

    • B.

      Hypercalcemia

    • C.

      Hyperphosphatemia

    • D.

      Hypophosphaturia

    Correct Answer
    B. 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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  • 10. 

    A client with type 1 diabetesis scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:

    • A.

      9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).

    • B.

      21 units regular insulin and 9 units NPH.

    • C.

      10 units regular insulin and 20 units NPH.

    • D.

      20 units regular insulin and 10 units NPH.

    Correct Answer
    A. 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).
    Explanation
    RATIONALE: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin.

    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. 1392.

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  • 11. 

    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:

    • A.

      30 minutes before breakfast.

    • B.

      In mid-morning.

    • C.

      30 minutes after dinner.

    • D.

      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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  • 12. 

    A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

    • A.

      Ungloving the hands when removing the test strip

    • B.

      Smearing the drop of blood onto the reagent pad

    • C.

      Calibrating the machine after installing a new battery

    • D.

      Starting the timer on the machine while gathering supplies

    Correct Answer
    C. Calibrating the machine after installing a new battery
    Explanation
    RATIONALE: To obtain accurate readings, the nurse should calibrate the machine whenever a new battery is installed. To adhere to standard precautionsand prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing. The nurse should drop the blood — not smear it — onto the reagent pad because smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer before the blood sample is collected.

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

    REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1467.

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  • 13. 

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

    • A.

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

    • B.

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

    • C.

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

    • D.

      "You must avoid hyperextending your neck after surgery."

    Correct Answer
    D. "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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  • 14. 

    A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be:

    • A.

      Monitoring blood glucose every 4 hours and as needed.

    • B.

      Checking for the presence of ketones with each void.

    • C.

      Providing client education at every opportunity.

    • D.

      Administering insulin routinely and as needed via a sliding scale.

    Correct Answer
    C. Providing client education at every opportunity.
    Explanation
    RATIONALE: The nurse should use routine care responsibilities as teaching opportunities with the intention of preparing the client to understand and eventually manage his disease. Monitoring blood glucose, checking for the presence of ketones, and administering insulin are important when caring for a client with diabetes, but they aren't the priority of care.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Basic care and comfort
    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. 1402.

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  • 15. 

    A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?

    • A.

      Weight gain, constipation, and lethargy

    • B.

      Weight loss, nervousness, and tachycardia

    • C.

      Exophthalmos, diarrhea, and cold intolerance

    • D.

      Diaphoresis, fever, and decreased sweating

    Correct Answer
    B. Weight loss, nervousness, and tachycardia
    Explanation
    RATIONALE: Weight loss, nervousness, and tachycardiaare signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation,lethargy, decreased sweating, and cold intolerance are signs ofhypothyroidism.

    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. 1459.

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  • 16. 

    A physician orders acarbose (Precose), an alpha-glucosidase inhibitor, for a client with type 2 diabetes. Which statement by the client indicates a need for additional teaching?

    • A.

      "If I have hypoglycemia, I should eat some sugar, not dextrose."

    • B.

      "The drug makes my pancreas release more insulin."

    • C.

      "I can take insulin while I'm taking this drug."

    • D.

      "It's best if I take the drug with the first bite of a meal."

    Correct Answer
    A. "If I have hypoglycemia, I should eat some sugar, not dextrose."
    Explanation
    RATIONALE: The client indicates a need for additional teaching if he states that he'll eat sugar if he has hypoglycemia. Acarbose delays glucose absorption. So when treating hypoglycemia, the client should take an oral form of dextrose rather than a product containing table sugar. The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption, not by stimulating the pancreas to release more insulin. It's safe for the client 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 1 hour before.

    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. 67.

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  • 17. 

    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?

    • A.

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

    • B.

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

    • C.

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

    • D.

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

    Correct Answer
    D. "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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  • 18. 

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

    • A.

      Serum potassium level of 6.8 mEq/L

    • B.

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

    • C.

      Serum sodium level of 156 mEq/L

    • D.

      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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  • 19. 

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

    • A.

      Polyuria, headache, and fatigue

    • B.

      Polyphagia and flushed, dry skin

    • C.

      Polydipsia, pallor, and irritability

    • D.

      Nervousness, diaphoresis, and confusion

    Correct Answer
    D. 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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  • 20. 

    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?

    • A.

      Restricting fluids to 800 ml/day

    • B.

      Administering vasopressin as ordered

    • C.

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

    • D.

      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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  • 21. 

    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?

    • A.

      Home health nurse

    • B.

      Dietitian

    • C.

      Psychiatrist

    • D.

      Social worker

    Correct Answer
    B. 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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  • 22. 

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

    • A.

      Use commercial preparations to remove corns.

    • B.

      Cut the toenails by rounding edges.

    • C.

      Wash and inspect the feet daily.

    • D.

      Walk barefoot at least once each day.

    Correct Answer
    C. Wash and inspect the feet daily.
    Explanation
    RATIONALE: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.

    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. 1419.

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  • 23. 

    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:

    • A.

      An ectopic corticotropin-secreting tumor.

    • B.

      Adrenal carcinoma.

    • C.

      A corticotropin-secreting pituitary adenoma.

    • D.

      An inborn error of metabolism.

    Correct Answer
    C. 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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  • 24. 

    A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis ofIneffective coping related to diabetes mellitus?

    • A.

      Recent weight gain of 20 lb (9.1 kg)

    • B.

      Failure to monitor blood glucose levels

    • C.

      Skipping insulin doses during illness

    • D.

      Crying whenever diabetes is mentioned

    Correct Answer
    D. Crying whenever diabetes is mentioned
    Explanation
    RATIONALE: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen.Skipping insulin doses during illness would support a nursing diagnosis ofDeficient knowledge related to treatment of diabetes mellitus.

    CLIENT NEEDS CATEGORY: Psychosocial integrity
    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. 1417.

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  • 25. 

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

    • A.

      5% dextrose and normal saline solution

    • B.

      Lactated Ringer's solution

    • C.

      Half-normal saline solution

    • D.

      10% dextrose in water

    Correct Answer
    B. 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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  • 26. 

    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?

    • A.

      Insulin

    • B.

      Hydrocortisone

    • C.

      Potassium

    • D.

      Hypotonic saline

    Correct Answer
    B. 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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  • 27. 

    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:

    • A.

      Reassign the new graduate to another staff member.

    • B.

      Offer to assist with the discharge teaching needs.

    • C.

      Try to provide the staff member with a float nurse.

    • D.

      Insist that the nurse follow through with the assignment.

    Correct Answer
    B. 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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  • 28. 

    A client with type 1 diabetestakes 15 units of Humulin N insulin before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when she discovers the client takes which over-the-counter preparations?

    • A.

      Antacids

    • B.

      Salicylate-containing preparations

    • C.

      Vitamins with iron

    • D.

      Acetaminophen-containing preparations

    Correct Answer
    B. Salicylate-containing preparations
    Explanation
    RATIONALE: The client requires additional teaching if he takes salicylates with insulin. Salicylates may interact with insulin, causing hypoglycemia. Antacids, vitamins with iron, and acetaminophen aren't known to interact with insulin.

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

    REFERENCE: Karch, A.M. 2007 Lippincott's Nursing Drug Guide.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 632.

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  • 29. 

    Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside:

    • A.

      In a few days.

    • B.

      In 3 to 4 months.

    • C.

      Immediately.

    • D.

      In 1 to 2 weeks.

    Correct Answer
    D. In 1 to 2 weeks.
    Explanation
    RATIONALE: Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidismin the interim, clients are usually given abeta-adrenergic blockersuch as propranolol (Inderal).

    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. 1462.

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  • 30. 

    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:

    • A.

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

    • B.

      Protruding eyes and a fixed stare.

    • C.

      A wide, staggering gait.

    • D.

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

    Correct Answer
    B. 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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  • 31. 

    Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome?

    • A.

      Administer 2 to 3 L of I.V. fluid rapidly.

    • B.

      Administer 10 L of I.V. fluid over the first 24 hours.

    • C.

      Administer a dextrose solution containing normal saline solution.

    • D.

      Administer I.V. fluid slowly to prevent circulatory overload and collapse.

    Correct Answer
    A. Administer 2 to 3 L of I.V. fluid rapidly.
    Explanation
    RATIONALE: Regardless of the client's medical history, rapid fluid resuscitationis critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly ordered fluids include dextran (in cases ofhypovolemicshock),isotonicnormal saline solution and, when the client is stabilized,hypotonichalf-normal 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. 1416.

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  • 32. 

    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?

    • A.

      Cerebral edema

    • B.

      Hypovolemic shock

    • C.

      Severe hyperkalemia

    • D.

      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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  • 33. 

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

    • A.

      Hypokalemia and hypoglycemia

    • B.

      Hypocalcemia and hyperkalemia

    • C.

      Hyperkalemia and hyperglycemia

    • D.

      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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  • 34. 

    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:

    • A.

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

    • B.

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

    • C.

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

    • D.

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

    Correct Answer
    C. "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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  • 35. 

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

    • A.

      Hypotension.

    • B.

      Thick, coarse skin.

    • C.

      Deposits of adipose tissue in the trunk and dorsocervical area.

    • D.

      Weight gain in arms and legs.

    Correct Answer
    C. 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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  • 36. 

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

    • A.

      Offer clothing or bedding that's cool and comfortable.

    • B.

      Suggest a high-carbohydrate, low-protein diet.

    • C.

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

    • D.

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

    Correct Answer
    C. 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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  • 37. 

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

    • A.

      Serum glucose level.

    • B.

      Hair loss.

    • C.

      Bone mineralization.

    • D.

      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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  • 38. 

    A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation?

    • A.

      Suggest the client find a supportive friend or family member to assist in his care.

    • B.

      Ask the physician to delay the discharge because the client requires further teaching.

    • C.

      Tell the charge nurse she doesn't believe this client will be safe and refuse to rush.

    • D.

      Ask the physician for a referral for a diabetes nurse-educator to see the client before discharge.

    Correct Answer
    B. Ask the physician to delay the discharge because the client requires further teaching.
    Explanation
    RATIONALE: The nurse's primary concern should be the safety of the client after discharge. She should provide succinct information to the physician concerning the client's needs, express her concern about ensuring the client's safety, and ask the physician to delay the client's discharge. The nurse shouldn't suggest that the client rely on a friend or family member because she doesn't know if a friend or family member will be available to help. Refusing to rush and telling the charge nurse she isn't sure the client will be safe demonstrate appropriate intentions, but these actions don't alleviate the pressure to discharge the client. Asking a physician to refer the client to a diabetic nurse-educator addresses the client's needs, but isn't the best response because there's no guarantee a diabetic nurse-educator will be available on such short notice.

    CLIENT NEEDS CATEGORY: Physiological integrity
    CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
    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. 1410.

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  • 39. 

    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:

    • A.

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

    • B.

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

    • C.

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

    • D.

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

    Correct Answer
    C. 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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  • 40. 

    A client with type 1 diabetesis admitted to an acute care facility withdiabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?

    • A.

      Initiate fluid replacement therapy.

    • B.

      Administer insulin.

    • C.

      Correct diabetic ketoacidosis.

    • D.

      Determine the cause of diabetic ketoacidosis.

    Correct Answer
    A. Initiate fluid replacement therapy.
    Explanation
    RATIONALE: The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively. Therefore, insulin administration follows fluid replacement therapy. Determining and correcting the cause of diabetic ketoacidosis are important steps, but the client's condition must first be stabilized to prevent life-threatening complications.

    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. 1414.

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  • 41. 

    A client is scheduled for a transsphenoidal hypophysectomyto remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

    • A.

      Testing for ketones in the urine.

    • B.

      Testing urine specific gravity.

    • C.

      Checking temperature every 4 hours.

    • D.

      Performing capillary glucose testing every 4 hours.

    Correct Answer
    D. Performing capillary glucose testing every 4 hours.
    Explanation
    RATIONALE: The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia. Urine ketone testing isn't indicated because the client does secrete insulin and, therefore, isn't at risk for ketosis. Urine specific gravity testing isn't indicated because although fluid balance can be compromised, it usually isn't dangerously imbalanced. Temperature regulation may be affected by excess cortisol and isn't an accurate indicator of potential complications such asinfection.

    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. 2302.

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  • 42. 

    Which statement best indicates that a client understands how to administer his own insulin injections?

    • A.

      "I need to be sure no air bubbles remain."

    • B.

      "I need to wash my hands before I give myself my injection."

    • C.

      "If I'm not feeling well, I can get a friend or neighbor to help me."

    • D.

      "I wrote down the steps in case I forget what to do."

    Correct Answer
    D. "I wrote down the steps in case I forget what to do."
    Explanation
    RATIONALE: The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps. Awareness of air bubbles and hand washing indicate that the client understands certain aspects of giving an injection, but doesn't confirm he understands all of the steps. Saying that he can ask a friend or neighbor for help indicates a need for further instruction.

    CLIENT NEEDS CATEGORY: Health promotion and maintenance
    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. 1404.

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  • 43. 

    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?

    • A.

      Methimazole (Tapazole)

    • B.

      Thyroid USP desiccated (Thyroid USP Enseals)

    • C.

      Liothyronine (Cytomel)

    • D.

      Levothyroxine (Synthroid)

    Correct Answer
    D. 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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  • 44. 

    A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents?

    • A.

      "Your child will need less blood work as his glucose levels stabilize."

    • B.

      "Your child is young and will soon forget this experience."

    • C.

      "I'll see if the physician can reduce the number of blood draws."

    • D.

      "Our laboratory technicians use tiny needles and they're really good with children."

    Correct Answer
    A. "Your child will need less blood work as his glucose levels stabilize."
    Explanation
    RATIONALE: Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

    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. 1390.

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  • 45. 

    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?

    • A.

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

    • B.

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

    • C.

      "I always wear my medical identification bracelet."

    • D.

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

    Correct Answer
    D. "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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  • 46. 

    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?

    • A.

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

    • B.

      Smoking reduction but not complete cessation

    • C.

      An eye examination every 2 years until age 50

    • D.

      Weight reduction through diet and exercise

    Correct Answer
    D. 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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  • 47. 

    A client with status asthmaticusrequiresendotracheal intubationand mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated withhypoglycemia?

    • A.

      Sweating, tremors, and tachycardia

    • B.

      Dry skin, bradycardia, and somnolence

    • C.

      Bradycardia, thirst, and anxiety

    • D.

      Polyuria, polydipsia, and polyphagia

    Correct Answer
    A. Sweating, tremors, and tachycardia
    Explanation
    RATIONALE: Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin,bradycardia, and somnolence are signs and symptoms associated withhypothyroidism.Polyuria,polydipsia, andpolyphagiaare signs and symptoms ofdiabetes mellitus.

    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. 1410.

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  • 48. 

    A nurse hears a staff member giving incorrect information to the family of a client newly diagnosed with diabetes mellituswho is being discharged to home. The nurse wants to make sure the family has the proper information before the client is discharged. What should she do?

    • A.

      Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity.

    • B.

      Have the nurse step outside of the room and tell her she's giving wrong information to the family.

    • C.

      Go into the room and correct the nurse so the family will be safe in providing home care.

    • D.

      Go into the room, introduce herself to the family, and complete the discharge teaching.

    Correct Answer
    A. Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity.
    Explanation
    RATIONALE: The nurse should use this situation as a learning opportunity for her colleague by asking her to step outside of the room to discuss the situation. Telling the nurse that she's providing incorrect information is too blunt and corrective. Going into the room to correct the teaching would undermine the nurse doing the teaching.

    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. 522.

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  • 49. 

    A client newly diagnosed with diabetes mellitusasks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?

    • A.

      "The spleen releases ketones when your body can't use glucose."

    • B.

      "Ketones will tell us if your body is using other tissues for energy."

    • C.

      "Ketones can damage your kidneys and eyes."

    • D.

      "Ketones help the physician determine how serious your diabetes is."

    Correct Answer
    B. "Ketones will tell us if your body is using other tissues for energy."
    Explanation
    RATIONALE: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

    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. 1391.

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  • 50. 

    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?

    • A.

      Serum glucose level of 450 mg/dl

    • B.

      Serum glucose level of 52 mg/dl

    • C.

      Serum calcium level of 8.9 mg/dl

    • D.

      Serum calcium level of 10.2 mg/dl

    Correct Answer
    B. 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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