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c. Increased PCO2
d. Decreased HCO3
c. 200mg/dl
d. 180mg/dl
6. Which test results should the nurse check to ascertain how well the client is managing her diabetes
mellitus overall?
a. Blood glucose level
b. Glucose tolerance test
c. Glycosylated haemoglobin
d. Radioimunnoassay of insulin
7. A parent asks the nurse why home blood glucose monitoring is being recommended for her child
with diabetes. The nurse should base the explanation on which of the following?
a. It is a less expensive method of testing
b. It is an easier method of testing
c. Children are better able to manage the diabetes
d. Children have a greater sense of control over the diabetes
8. A client has developed diabetes mellitus type 1 and no longer produces insulin. What cells of the
pancreas have become dysfunctional?
a. Beta cells
b. Alpha cells
c. Acinar cells
d. Kupffer cells
9. The nurse is discussing the treatment regimen for a client newly diagnosed with Type 1 Diabetes
Mellitus. During the discussion of insulin administration, the client asks the nurse, Why cant I just
take a pill like my friend does? Which of the following statement indicates the client understands
the nurses explanation?
a. My body does not produce insulin; therefore I must receive the injections.
b. I will be on insulin for a short while, and then I can take the pills.
c. The pills are not as effective as the insulin injections.
d. When my body starts making insulin again, I can stop taking the injections.
10. The mother of an 11 year old child with IDDM asks why her child cannot avoid all those shots and
take pills as her uncle does. Which of the following is the nurses best reply?
a. the pills work with an adult pancreas only
b. the drugs affect fat and protein metabolism, not sugar
c. Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of
insulin
d. Perhaps when your child is older the pancreas will produce its own insulin, and then your child
can take oral hypoglycemics
11. The nurse knows that a client newly diagnosed with insulin-dependent diabetes (Type I) will require
further teaching when which of the following statements is made?
a. I will notify my healthcare provider if my glucose levels run higher or lower than target range.
b. I will take my insulin as prescribed, and I will not miss a dose.
c. I will not take my insulin if I am sick and cannot eat.
12. During a routine check-up, an insulin-dependent diabetic has his glycosylated haemoglobin
checked. The results indicate a level of 11%. Based on this result, what teaching should the nurse
emphasize?
a. Rotation of injection sites
b. Insulin mixing and preparation
13. The nurse is caring for a woman at 37 weeks gestation. The client was diagnosed with insulindependent diabetes mellitus at age 7. The client states, I am so thrilled that I will be breastfeeding
my baby. Which of the following responses by the nurse is best?
a. You will probably need less insulin while you are breastfeeding.
b. You will need to initially increase your insulin after the baby is born.
c. You will be able to take an oral hypoglycemic instead of insulin after the baby is born.
d. You will probably require the same dose of insulin than you are now taking.
14. Clinical manifestations associated with a diagnoses of type 1 DM include all of the following except:
a. Hypoglycaemia
b. Hyponatremia
c. Ketonuria
d. Polyphagia
15. What is the physiologic basis for the polyuria manifested by individuals with untreated diabetes
mellitus?
a. Inadequate secretion of antidiuretic hormone (ADH)
b. Early-stage renal failure causing a loss of urine concentrating capacity
c. Chronic stimulation of the detrusor muscle by the ketone bodies in the urine
d. Hyper osmolarity of the extracellular fluids secondary to hyperglycemia
16. Which of the following chronic complications is associated with diabetes?
a. Dizziness, dyspnea on exertion, and coronary artery disease
b. Retinopathy, neuropathy, and coronary artery disease
c. Leg ulcers, cerebral ischemic events, and pulmonary infarcts
d. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrythmias
17. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired
peripheral arterial circulation includes all of the following except:
a. Integumentary inspection for the presence of brown spots on the lower extremities
b. Observation for paleness of the lower extremities
c. Observation for blanching of the feet after the legs are elevated for 60 seconds
d. Palpation for increased pulse volume in the arteries of the lower extremities
18. A 67-year old client with non-insulin dependent diabetes should be instructed to contact the outpatient clinic immediately if the following findings are present
a. Temperature of 37.5 degrees Celsius with painful urination
b. An open wound on their heel
c. Insomnia and daytime fatigue
d. Nausea with 2 episodes of vomiting
19. Nausea Mrs. Moore, 62-year-old, with diabetes is in the emergency department. She stepped on a
sharp sea shell while walking barefoot along the beach. Mrs. Moore did not notice that the object
pierced the skin until later that evening. What problem does the client most probably have?
a. Nephropathy
b. Macroangiopathy
20. At a senior citizens meeting, a nurse talks with a client who has diabetes mellitus type 1. Which
statement by the client during the conversation is most predictive of a potential for impaired skin
integrity?
23. Which of the following nursing interventions should be implemented when performing foot care to a
patient with DM?
a. Inspect the feet carefully and daily for calluses, corns, blisters, abrasions, redness, and nail
abnormalities
b. Bathe the feet daily in hot water
c. Use lanolin, nivea cream, or other cream moisturizers especially between the toes to prevent
maceration
d. Wear well-fitting, compressive shoes and socks-long enough, wide enough, soft, supple and
high-heeled
24. A nurse preparing a teaching plan for a client with diabetes mellitus regarding proper foot care.
Which instruction is included in the plan?
a. Soak feet in hot water
b. Apply moisturizer lotion to dry feet but not in between the toes
c. Always have a podiatrist cut your toenails; never cut them yourself
d. Avoid using mild soap on the feet
25. Ernest had DM for 20 years. He is admitted to the hospital with dry gangrene of the right toe. When
the nurse is working with the client, what information is most important to ascertain?
a. His age when DM developed
b. His understanding of hygienic skin measures
c. His technique in administering insulin
d. His willingness to look at, touch, or talk about his gangrene foot
26. When assessing a gangrenous toe, the nurse least likely expects which of the following?
a. Intense pain in affected area
b. Extension of the metatarsal
c. Changes in skin temperature of both feet
d. His willingness to look at, touch, or talk about his gangrenous foot
27. The physician orders sodium hypochlorite and boric acid (Dakins solution) for a gangrene lesion
and petroleum jelly for the adjoining healthy skin. Which of the following best describes their
actions?
a. Dakins solution is an anti-inflammatory agent; petroleum jelly is an anti-absorbent agent
b. Dakins solution debrides the wound; petroleum jelly protects the healthy tissue
c. Dakins solution dries out the lesion; petroleum jelly lubricates the surrounding tissue
d. Dakins solution cleanses the wound; petroleum jelly moisturizes the skin
28. Mr. Smith is scheduled for an above-the-knee amputation. After the surgery he was transferred to
the nursing care unit. The nurse assigned to him knows that 72 hours after the procedure the client
should be positioned properly to prevent contractures. Which of the following is the best position to
the client?
a. Sidelying, alternating left and right
c. Lying on abdomen several times daily
sides
d. Supine with stump elevated at least 30
b. Sitting in a reclining chair twice a day
degrees
29. A client complains of some discomfort after a below knee amputation. Which action by the nurse is
appropriate to do initially?
a. Conduct guided imagery or distraction
32. A client with DM demonstrates acute anxiety when first admitted for the treatment of
hyperglycemia. The most appropriate intervention to decrease the clients anxiety would be to:
a. Administer sedative
b. Make sure the client knows all the correct medical terms to understand what is happening
c. Ignore the signs and symptoms of anxiety so that they will soon disappear
d. Convey empathy, trust and respect toward the client
33. Manifestations of hypoglycaemia include which of the following?
a. Lethargy
b. Confusion
34. A client with Type 1 DM calls the nurse to report recurrent episodes of hypoglycaemia while
exercising. Which statement by the client indicates an inadequate understanding of the peak action
of NPH insulin and exercise?
a. The best time for me to exercise is every afternoon
b. The best time for me to exercise is after I eat
c. The best time for me to exercise is after breakfast
d. The best time for me to eat is before bedtime
35. A nurse is caring for a client with Type DM. which client complaint would alert the nurse of the
presence of a possible hypoglycemic reaction?
a. Hot, dry skin
b. Muscle cramps
c. Anorexia
d. Tremors
36. Mr. Park is 32-year-old, a badminton player and has a type 1 diabetes mellitus. After the game, the
client complains of diaphoresis and light-headedness. The client asks the nurse how to avoid this
reaction. The nurse will recommend to:
a. Allow plenty of time after the insulin injection and before beginning the match
b. Eat a carbohydrate snack before and during the badminton match
c. Drink plenty of fluids before, during, and after bed time
d. Take insulin just before starting the badminton match
37. Nurse Jim is providing dietary instructions to a male client with hypoglycaemia. To control
hypoglycemic episodes, the nurse should recommend:
a. Increasing the saturated fat intake and fasting in the afternoon
b. Increasing the intake of Vitamins B and D and taking iron supplements
c. Eating a candy bar if lightheadedness occurs
d. Consuming a low-carbohydrate, high-protein diet and avoid fasting
38. A 26 year old man comes to the emergency room with complaints of nausea, vomiting, and
abdominal pain. He is a Type 1 Diabetic. Four days earlier, he reduced his insulin dose when flu
symptoms prevented him from eating. The nurse performs an assessment of the patient which
reveals poor skin turgor, dry mucous membranes, and fruity breath odor. The nurse should be alert
for which of the following problems?
a. Hypoglycaemia
b. Viral illness
c. Ketoacidosis
d. Hyperglycemic hyperosmolar
nonketotic coma
39. A client with a diagnosis of DKA is being treated in the ER. Which finding would nurse expect to note
as confirming the diagnosis?
a. Elevated blood glucose level and low plasma bicarbonate
b. Decreased urine output
c. Increased respirations and increase in pH
d. Comatose state
40. In the acute phase of the situation above, the priority nursing action is to prepare to:
a. Administer regular insulin
intravenously
b. Administer 5% dextrose intravenously
c. Correct the acidosis
d. Apply an ECG monitor
41. If the patients DKA progresses, which of the following symptoms might the nurse see?
a. Kussmauls respirations and a fruity odor on the breath
b. Shallow respirations and severe abdominal pain
c. Decreased respirations and increased urine output
d. Cheyne-stokes respirations and foul-smelling urine
42. A male client has just been diagnosed with DM Type 1. When teaching the client and family how
diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
a. Youll need more insulin when you exercise or increase your food intake
b. Youll need less insulin when you exercise or reduce your food intake
c. Youll need less insulin when you increase your food intake
d. Youll need more insulin when you exercise or decrease your food intake
43. The insulin that would be administered in patients with DKA is:
a. Human NPH Insulin
b. Human Regular insulin
44. Which instruction about insulin administration should nurse Kate give to a client?
e. Always follow the same order when drawing the different insulins into the syringe
f. Shake the vials before withdrawing the insulin
g. Store unopened vials of insulin in the freezer at temperatures well below freezing
h. Discard the intermediate-acting insulin if it appears cloudy
45. A nurse provides instructions to a client newly diagnosed with Type 1 Dm. the nurse recognizes
accurate understanding of measures to prevent DKA when the client states:
a. I will stop taking my insulin if Im too sick to eat
b. I will decrease my insulin dose during times of illness
c. I will notify my physician if my blood glucose level is greater than 250mg/dL
d. I will adjust my insulin dose according to the level of glucose in my urine
46. Which of the following causes of HHNS is most common?
a. Insulin overdose
b. Removal of adrenal gland
c. Undiagnosed, untreated
hyperpituitarism
d. Undiagnosed, untreated DM
47. A client is brought to the emergency room in an unresponsive state, and a diagnosis of
hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would prepare
immediately initiate which of the following anticipated physicians orders?
a. 100 units of NPH insulin
b. Endotracheal intubation
48. A nurse performs physical assessment on a client with DM 2. Findings include a fasting blood
glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a BP of 140/80. Which
finding would be of most concern of the nurse?
a. Pulse
b. BP
c. Respiration
d. Temperature
49. Which action should you suggest to the client who has difficulty controlling hypoglycaemia to
REDUCE rate of insulin absorption from the site?
a. Massage the injection site
b. Exercise within an hour of administration
c. Inject into the muscle instead of subcutaneously
d. Using refrigerated insulin without warming it to room temperature
50. Hypoglycemia followed by rebound hyperglycemia is seen in:
a. Somogyi effect
b. dawn phenomenon
c. diabetic ketoacidosis (DKA)
d. hyperosmolar hyperglycemic nonketosis syndrome (HHNKS)
51. While examining the oral cavity of a client, the nurse detects a fruity odor to the clients breath. The
nurse should do which of the following?
a. Instruct to use mouthwash after meals
b. Instruct client on good oral hygiene
52. The nurse practitioner would expect which manifestation as a side effect of Metformin?
a. GI upset
b. Photophobia
c. Hyperglycemia
d. Skin eruptions
53. The client with Type 1 DM is switching from an animal-source regular insulin to a synthetically
derived human regular insulin. What precaution should you explain?
c. Phosphorus
d. Potassium
55. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with
diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose
results. At 2 pm, the client has a capillary glucose level of 250mg/dl for which he receives 8 U of
regular insulin. Nurse Charlene should expect the doses:
a. Onset to be at 2pm and its peak at
3pm
b. Onset to be at 2:15pm and its peak to
be at 3pm
56. The nurse teaches the diabetic client about NPH and regular insulin. Which statement indicates that
the client understood the instructions?
a. Ill draw up NPH insulin first
b. I must keep the insulin in the
refrigerator
57. The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer
these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.
1. Inject air equal to NPH dose into NPH vial
2. Invert regular insulin bottle and withdraw regular insulin dose
3. Inject air equal to regular dose into regular insulin bottle
4. Invert NPH vial and withdraw NPH dose
a. 1-2-3-4
b. 1-4-3-2
c. 1-4-2-3
d. 1-3-2-4
58. Rotation sites for insulin injection should be separated from one another by 2.5cm or 1 inch and
should be used only every:
a. Third day
b. Week
c. 2-3 weeks
d. 2-4 weeks
59. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin?
a. Lipodystrophy can result and is extremely painful
b. Poor rotation technique can cause superficial haemorrhaging
c. Lipodystrophic areas can result, causing erratic insulin absorption rates from these
d. Injection sites can never be reused
60. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most
common time for a hypoglycemic reaction to occur is:
a. 2 to 4hours after administration
b. 4 to 12 hours after administration
61. An 11 year old boy has recently been diagnosed with diabetes. The nurses teaching plan for daily
injections should be based on which of the following?
a. The parents do not need to learn the procedure
b. He is old enough to give most of his own injections
c. Self-injections will be possible when he is closer to adolescence
d. He can learn about self-injections when he is able to reach all injection sites
62. An external insulin pump is prescribed for a client with diabetes mellitus. The client asks Eddie
about the function of the pump. He bases the response on the information that the pump:
a. is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn
releases the insulin into the bloodstream.
b. is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific
intervals
c. continuously infuses small amounts of NPH insulin into the bloodstream while regularly
monitoring blood glucose levels
d. gives a small continuous dose of regular insulin, and the client can self-bolus with an additional
dosage from the pump prior to each meal.
63. A 23-year old patient has history of IDDM. The patient takes NPH insulin 30 u q AM. The nurse
knows that patients taking NPH insulin should eat a snack at which of the following times of day in
order to avoid a hypoglycemic reaction?
a. Mid-morning
b. Mid-afternoon
c. Early evening
d. Before bedtime
64. A client newly diagnosed with DM has been stabilized with insulin injections daily. A nurse prepares
a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the
following concept?
a. Increase the amount of insulin prior to unusual exercise
b. Acetone in the urine will signify a need for insulin
c. Always keep insulin vials refrigerated
d. Systematically rotate insulin injection sites
65. The only type of insulin that may be given IV is:
a. rapid-acting
b. zinc
c. NPH
d. Humalog
66. When a patient with DM is being treated with sulfonylurea and uses alcohol, what reaction would
you anticipate?
a. Bradycardic episode
b. Hyperglycemic episode
c. Vomiting, dizziness
d. Edema
67. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing
diagnosis would be:
a. High risk for deficient fluid volume
b. Deficient knowledge: disease process and treatment
c. Imbalanced nutrition: less than body requirements
d. Disabled family coping: compromised
68. Which among the following findings would strongly indicate possible cirrhosis?
a. Dry skin
c. Peripheral edema
b. Hepatomegaly
d. Pruritus
69. Hepatic fat accumulation in a 55-year old male is usually a result of which type of cirrhosis?
a. Biliary
c. Postnecrotic
b. Metabolic
d. Laennecs
70. A client with cirrhosis may have alterations in which of the following laboratory values?
a. Carbondioxide level
c. Prothrombin time (PT)
b. pH
d. White Blood Cell Count (WBC)
71. Which among the following clients is most likely to acquire hepatitis?
a. A child with a bacterial infection
c. A client with metastasis of liver cancer
b. A client with dysfunction of the biliary
d. An adult with varicella zoster
system
72. In reviewing the possible causes of Hepatitis A in a 22-year old male, which of the following would
be the most likely factor?
a. Contact with blood in his profession as a policeman
b. Receiving a blood transfusion during surgery
c. Eating shrimp at the local pub
d. Admitting to be sexually active
73. A concerned mother doesnt understand how her child acquired Hepatitis A, when he was perfectly
healthy up to a week ago. One characteristic of Hepatitis A that may help her to understand is that
Hepatitis A has:
a. An incubation period of 60 to 180 days
c. A positive carrier state
b. A fecal-oral mode of transmission
d. A sexual mode of transmission
74. A 65-year-old female with a history of hepatic encephalopathy is hospitalized for pneumonia and
dehydration. When she complains to the nurse about the small portions of meat ordered by the
dietitian, the best response would be:
a. ask your doctor about it in the morning
b. I will call and order larger portions for you
c. The amount of meat on your tray is dictated by certain blood test results
d. Your protein is being limited, but you can have more food from another group
75. A client is admitted to the unit with complaints of malaise, nausea and vomiting, anorexia, and
headaches. The lab work shows abnormal electrolytes and elevated aspartate aminotransferase
(AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP); Hepatitis B surface antigen
(HBsAG) is present. The nurse would assume the client has:
a. Hepatitis A
c. Cirrhosis
b. Hepatitis B
d. Pancreatitis
76. The physical assessment of a 55-year-old female with end-stage cirrhosis reveals a protuberant
abdomen with bulging flanks and dullness to the dependent side while lying on the right. The
appropriate terminology for documentation of this assessment is:
a. Fluid overload
c. Ascites
b. Malnutrition
d. Distention
77. The physical assessment findings of spider angiomas, palmar erythema, peripheral edema, ascites
and change in mental status are consistent with which of the following disorders?
a. Cholelithiasis
c. Cirrhosis
b. Cholecystitis
d. Pancreatitis
78. When providing discharge teaching to the client with chronic cirrhosis, his wife asks the nurse to
explain why there is so much emphasis on bleeding precautions. Which of the following provides
the most appropriate response?
a. The liver affected by cirrhosis is unable to produce clotting factors
b. The low protein diet will result in reduced clotting factors
c. The increased production of bile decreases clotting factors
d. The required medications reduce clotting factors
79. Which among the following statements is true regarding viral hepatitis infection?
a. Hepatitis B is transmitted by the fecal-oral route
b. Hepatitis A is a sexually transmitted disease
c. The posticteric phase follows jaundice and lasts several weeks
d. Hepatitis D has a slow onset
80. When explaining the rationale for the use of lactulose (Chronulac) syrup to the client with chronic
cirrhosis, the nurse would use which of the following statements?
a. Chronulac syrup reduces constipation, which is a frequent complaint with cirrhosis
b. Chronulac syrup suppresses the metabolism of ammonia and aids in its elimination through the
feces
c. Chronulac syrup helps reverse cirrhosis of the liver
d. Chronulac syrup can be taken intermittently to reduce side effects
81. A client is admitted with possible liver cancer. Which of the tests below would be the most
confirming diagnosis?
a. Abdominal ultrasound
c. Alpha-fetoprotein markers
b. Abdominal flat plate X-ray
d. Computed tomography (CT) scan
Situation: Nurse Nelly is assessing Mr. Shick who is in the early stages of cirrhosis of the liver.
82. Which early sign would Nurse Nelly anticipates finding?
a. Peripheral edema
c. Anorexia
b. Ascites
d. Jaundice
83. What diet should be implemented for Mr. Shick who is in the early stages of cirrhosis?
a. High calorie, high carbohydrate
c. Low fat, low protein
b. High protein, low fat
d. High carbohydrate, low sodium
84. Mr. Shick complains that his skin always feels itchy and that he scratches himself raw while he
sleeps. Nurse Nelly should recognize that the itching is the result of which abnormality associated
with cirrhosis?
a. Folic acid deficiency
c. Increased bilirubin level
b. Prolonged prothrombin time
d. Hypokalemia
85. Few days after, Mr. Shick is developing ascites. Nurse Nelly should recognize that the pathologic
basis for the development of ascites in clients with cirrhosis is portal hypertension and:
a. an excess serum Na level
c. a decreased flow of hepatic lymph
b. an increased metabolism of aldosterone
d. a decreased serum albumin level
86. Which of the following health promotion activities would be appropriate for Nurse Nelly to suggest
to his client add to the daily routine at home?
a. Supplement the diet with multivitamins
c. Take a sleeping pill at bedtime
b. Limit daily alcohol intake
d. Limit contact with people
Situation: Nurse Rihanna together with her colleagues at San Lazaro Hospital is conducting a community
education on how to prevent the transmission of hepatitis.
87. Which of the following types of hepatitis is considered to be primarily a sexually transmitted
disease?
a. Hepatitis A
c. Hepatitis C
b. Hepatitis B
d. Hepatitis D
88. Nurse Rihanna knows that during the icteric phase of viral hepatitis, the client will exhibit which of
the following symptoms?
a. Tarry stools
c. Shortness of breath
b. Yellowed sclera
d. Light, frothy urine
89. Which of the following precautions would Nurse Rihanna and her colleagues indicate as essential
when caring for clients with Hepatitis A?
a. Gowning when entering a clients room
b. Wearing a mask when providing care
Recipe for success: Study while others are sleeping; work while others are loafing; prepare while others
are playing; and dream while others are wishing. -- William A. Ward
1. A client admitted with pheochromocytoma. The nurse assesses the clients blood pressure
frequently. This is based on the knowledge that pheochromocytoma of the adrenal medulla releases
excessive amounts of:
a. Renin
b. Aldosterone
c. Catecholamines
d. Glucocorticoids
2. The most important nursing intervention during the medical and surgical treatment of the patient
with a pheochromocytoma is
a. administering IV fluids
b. monitoring blood pressure
c. monitoring I&O and daily weights
c. Palpitation
d. Drowsiness
11. A client newly diagnosed of hypothyroidism is placed on Levothyroxine 0.1 mg PO daily. Follow-up
should include:
a. Weekly CBC monitoring
b. The client should come back in 4-6 weeks
c. The client should have weekly determination of levothyroxine levels
d. Client should have monthly CBC to rule out agranulocytosis
12. Iodine solution may cause which of the following effect?
a. Yellow eyes
b. Staining of teeth
c. Loss of teeth
d. Graying of hair
13. Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up
emergency equipment, which should include:
a. A crash cart with bed board
b. A tracheostomy set and oxygen
14. 8 hours post thyroidectomy, the nurse assesses the patient for laryngeal nerve damage by:
a. Asking the patient to hyperextend the kneed and palpating for hematoma or edema
b. Asking the patient to state his name
c. Asking the patient to make small sips of water and observe if the patient can swallow without
difficulty
c. Synthroid
d. Tagamet
29. The nurse is providing care to a client with myxedema coma. Priority nursing care would include
which of the following?
a. Measures to decrease body temperature
b. Measures to decrease heart rate
c. Measures to maintain airway, fluid and electrolyte balance, and cardiovascular status
d. Measure to decrease blood pressure
30. In collaboration with the dietician, what dietary modification should the nurse suggest for the client
with hyperthyroidism?
a. Decrease calories and proteins and increase carbohydrates
b. Eliminate carbohydrates and increase proteins and fats
c. Increase calories, proteins, and carbohydrates
d. No dietary modification is needed
31. Which statement made by the client alerts the nurse to the possibility of hypothyroidism?
a. My sister has thyroid problems
c. Food just doesnt taste good without a lot of
b. I seem to feel the heat more than
salt
other people
d. I am always tired, even when I get 10 or 12
hours of sleep
32. Which medication should the nurse be prepared to administer to a client with bradycardia as a
result of hypothyroidism?
a. Atropine sulfate
c. Propranolol
b. Levothyroxine sodium
d. Epinephrine
33. A client with exophthalmos as a result of Graves disease has expressed a desire for the
medications to hurry up and work so that my eyes will go down. The nurses response to the
client will be based on which of the following?
a. Reversal of exophthalmos occurs after a therapeutic level of the antithyroid medication is
achieved.
b. Reversal of exophthalmos occurs after treatment with ophthalmic medications.
c. Changes in the eyes as a result of Graves disease are not reversible, even after treatment of
the disease.
d. Exopthalmos as a result of Graves disease is only a temporary symptom, and should resolve
spontaneously.
34. A client is returning from a subtotal thyroidectomy for the treatment of hyperthyroidism. The
immediate priority in assessing this client would include which of the following?
a. Assess for respiratory distress
c. Assess neurological status
b. Asses fluid volume status
d. Assess for pain
35. Discharge teaching for the client with hypoparathyroidism should include which of the following
instructions:
a. use OTC vitamin D preparation
b. avoid strenuous ex ercises
c. supplement calcium intake
36. A patient is admitted to the Endocrine unit. The patient states that he has recently lost 15 lbs over
two and one-half months, although there has been no change in his eating habits, and if anything,
his appetite has increased. The patient also complains of palpitations, and says that his eyes look
like they are going to pop out. Based on this data, the nurse can infer that this patient is most
likely exhibiting symptoms of:
a. Hyperparathyroidism
c. Hypothyroidism
b. Hyperthyroidism
d. Addisonian crisis
37. When caring for client in thyroid crisis, the nurse would question an order for:
a. IV fluid
c. Prophylthiouracil
b. Propanolol (Inderal)
d. A hyperthermia blanket
38. A client is suspected to develop tetany after subtotal thyroidectomy. Which of the following
symptoms might indicate tetany?
a. Tingling in the fingers
c. Tension on the suture lines
b. Pain in the hands and feet
d. Bleeding on the back of the dressing
39. On the second postoperative day after the subtotal thyroidectomy, the client tells the nurse that he
feels numbness and tingling around the mouth. What is the nurses best first action?
a. Offer mouth care
d. Document the finding as the only
b. Loosen the dressing
action
c. Notify the physician
40. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50
mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:
a. Should be taken in the morning
c. Must be stored in a dark container
b. May decrease the clients energy level
d. Will decrease the clients heart rate
41. A client was admitted to the emergency room and a diagnosis of myxedema coma is made. Which
action would the nurse prepare to carry out initially?
c. Maintain oxygenation
d. Administer thyroid hormone
42. The client with hyperthyroid symptoms is having hormone studies done to confirm the diagnosis.
Which set of values indicates non-Graves disease hyperthyroidism?
a. Elevated T3, elevated T4, high TSH levels
b. Elevated T3, normal T4, low TSH levels
c. Elevated T3, low T4, low TSH levels
d. Low T3, normal T4, high TSH levels
43. What is the priority nursing diagnosis for the client newly diagnosed with hyperthyroidism?
a. Decreased cardiac output related to tachycardia
b. Disturbed body image related to weight loss
c. Hyperthermia related to hypermetabolism
d. Fatigue related to energy depletion
44. The nurse is caring for a 45 year old patient who had a thyroidectomy 12 hours ago for treatment of
Graves disease. The nurse would be most concerned if which of the following was observed?
a. BP of 140/80 mmHg; RR of 16cpm; Oral Temp of 99 Degrees F
b. The patient supports his head and neck when turning his head to the right
c. The client spontaneously flexes his wrist when the blood pressure is obtained
d. The client is drowsy and complains of a sore throat
45. What are signs of thyroid crisis from Graves disease?
a. Weight gain to 155 lb with height of 5'8"
b. Heart rate 90 beats/min and respiratory rate 16 breaths/min
c. Hot and moist skin with protrusion of eyeballs
d. Constipation and amenorrhea
46. The client is receiving an antithyroid medication to treat hyperthyroidism. Which of the following
should be included in client education regarding the initiation of this therapy?
a. Increased need for sleep or not tolerating cold like you used to can occur when taking this
medication. If it does, notify your physician.
b. Nausea and vomiting are serious complication of the medication you are taking.
c. Take your pulse everyday, as you were taught. If it is too fast, call your doctor
d. This medication may cause dyspnea or vertigo. Notify your health care provider if this occurs.
47. Which clinical manifestation indicates to the nurse the treatment for the client with hypothyroidism
is effective?
a. The client is thirsty
b. The clients weight has been the same for 3 weeks
c. The clients total white blood cell count is 6000 cells/mm3
d. The client has had a bowel movement every day for 1 week
48. The client with hypothyroidism as a result of Hashimotos thyroiditis asks the nurse how long she
will have to take thyroid medication. What is the nurses best response?
a. You will need to take the thyroid medication until the goiter is completely gone
b. the thyroiditis will be cured with antibiotics, and then you will no longer need the thyroid
medication
c. you will need thyroid replacement hormone therapy for the rest of your life because thyroid
gland function will not return
d. When you thyroid function studies indicate a normal blood level of thyroid hormones, you will
be able to discontinue the medication
49. What is the priority nursing diagnosis for the client with hypothyroidism?
a. Hypothermia
b. Disturbed Body image
c. Disturbed thought process
d. Imbalanced Nutrition: More than Body Requirements
50. You see Mrs. Dizon in the clinic. She is 45 years old with a history of hypothyroidism and has been
treated with L-thyroxine 0.15mg daily. From your assessment of hypothyroidism, the following
nursing interventions are included except:
a. Encourage to increase fluid intake
b. Recommend low residue diet
c. Encourage increased mobility within the patients exercise tolerance
d. Monitor bowel function by recording frequency and consistency of stool
51. Instructions given to Mrs. Dizon include the following except:
a. The need to receive antithyroid therapy for the duration of her life
b. How and when to take medications
c. Signs and symptoms of insufficient and excessive medications, reinforce teaching by providing
written instructions
d. Energy conservation techniques and the need to increase activity
52.