Category: Substance Abuse, Eating Disorders, Impulse

Control Disorders

Flumazenil (Romazicon) has been ordered for a client who has

overdosed on oxazepam (Serax). Before administering the medication,
the nurse should be prepared for which common adverse effect?

CORRECT ANSWER a) SeizuresReason: Seizures are the most common

serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The
effect is magnified if the client has a combined tricyclic antidepressant and
benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and
chest pain.

b) Shivering

c) Anxiety

d) Chest pain

A client is diagnosed with protein-energy malnutrition secondary to colitis. Which

findings would support this diagnosis? (Select all that apply.)

Sodium 146 mEq/L

Increased lean body mass

Hemoglobin 10.9 g/dL

Correct response

Total lymphocyte count (LTC) 1000/mm3

Correct response

Cholesterol 110 mg/dL

This is a part of the correct response

High blood pressure

Incorrect

INCORRECT.

Learning Objective: Lesson 5

TLC is used to assess immune function and is below 1500 when a client is malnourished.
Hemoglobin may be low, secondary to low serum albumin, catabolism and anemia. A
cholesterol level below 160 mg/dL has been identified as a possible indicator of malnutrition.
Sodium is not typically affected by protein-energy malnutrition (and the results are within
normal limits in this scenario). With protein-energy malnutrition, there is a decrease in lean
body mass, the heart rate is slower than normal, blood pressure is lower than normal and the
person's temperature may be elevated.

A two-month-old infant is brought to the pediatrician's office for a well-baby visit.

During the examination, congenital subluxation of the left hip is suspected. The
nurse knows that symptoms of congenital hip dislocation include
A. lengthening of the limb on the affected side.
B. deformities of the foot and ankle.
C. asymmetry of the gluteal and thigh folds
D. plantar flexion of the foot.

Answer:
The correct answer is C.
What will you see with congenital hip dislocation?
Strategy: Form a mental image of the deformity.
Needed Info: Subluxation: most common type of congenital hip dislocation. Head of
femur remains in contact with acetabulum but is partially displaced. Diagnosed in
infant less than 4 weeks old S/S: unlevel gluteal folds, limited abduction of hip,
shortened femur affected side, Ortolani's sign (click). Treatment: abduction splint, hip
spica cast, Bryants traction, open reduction.
A. lengthening of the limb on the affected side - inaccurate
B. deformities of the foot and ankle - inaccurate
C. asymmetry of the gluteal and thigh folds - CORRECT: restricted movement on
affected side

D. plantar flexion of the foot - seen with clubfoot

Which patient is an appropriate assignment for the LPN/LVN?

Needed Info: LPN/LVN: assists with implementation of care; performs
procedures; differentiates normal from abnormal; cares for stable
patients with predictable conditions; has knowledge of asepsis and
dressing changes; administers medications (varies with educational
background and state nurse practice act).
A. A 72-year-old patient with diabetes who requires a dressing change for a
stasis ulcer - CORRECT: stable patient with an expected outcome
B. A 42-year-old patient with cancer of the bone complaining of pain - requires
assessment; RN is the appropriate caregiver
C. A 55-year-old patient with terminal cancer being transferred to hospice home
care - requires nursing judgement; RN is the appropriate caregiver
D. A 23-year-old patient with a fracture of the right leg who asks to use the urinal
- standard unchanging procedure; assign to the nursing assistant

83/100

Which of the following is the most common cause of hyperaldosteronism?

1.

Excessive sodium intake

2.

A pituitary adenoma

3.

Deficient potassium intake

4.

An adrenal adenoma

Correct Answer: 4

Your Answer: 4

RATIONALES: An autonomous aldosterone-producing adenoma is the most common cause of

hyperaldosteronism. Hyperplasia is the second most common cause. Aldosterone secretion is independent
of sodium and potassium intake and pituitary stimulation.

A female client who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that
her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has
large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the
client's hyperglycemia?
1.

4.

Acromegaly

2.

Type 1 diabetes

3.

Hypothyroidism

Deficient growth hormone

Correct Answer: 1

Your Answer: 1

RATIONALES: Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone,
is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain.
Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The
accompanying soft tissue swelling causes hoarseness and often sleep apnea.Type 1 diabetes is usually
seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't
associated with hyperglycemia, nor is growth hormone deficiency.

.
Which of the following is an adverse reaction to glipizide (Glucotrol)?
1.

2.

Heartburn

Excess hair growth

3.

4.

Hypotension

Photosensitivity

Correct Answer: 4

Your Answer: 3

RATIONALES: Glipizide may cause adverse skin reactions, such as rash, pruritus, and photosensitivity. It
doesn't cause heartburn, excess hair growth, or hypotension.

A client is admitted with a serum glucose level of 618 mg/dl. The client is awake and oriented, with hot, dry
skin; a temperature of 100.6 F (38.1 C); a heart rate of 116 beats/minute; and a blood pressure of 108/70
mm Hg. Based on these findings, which nursing diagnosis takes highest priority?
1. Deficient fluid volume related to osmotic diuresis

2. Decreased cardiac output related to increased heart rate

3. Imbalanced nutrition: Less than body requirements related to insulin deficiency

4. Ineffective thermoregulation related to dehydration

Correct Answer: 1

Your Answer: 4

RATIONALES: A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and
deficient fluid volume. In this client, tachycardia is more likely to result from deficient fluid volume than
decreased cardiac output because his blood pressure is normal. Although the client's serum glucose level
is elevated, food isn't a priority because fluids and insulin should be administered to lower the serum
glucose level. Therefore, Imbalanced nutrition: Less than body requirements isn't an appropriate nursing
diagnosis. A temperature of 100.6 F (38.1 C) isn't life-threatening, which eliminates Ineffective
thermoregulation as the top priority.

The nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic
nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
1.

Elevated serum acetone level

2.

Serum ketone bodies

3.

4.
Correct Answer: 4

Serum alkalosis

Below-normal serum potassium level

Your Answer: 3

RATIONALES: A client with HHNS has an overall body deficit of potassium resulting from diuresis, which
occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An

elevated serum acetone level and serum ketone bodies are characteristic of diabetic
ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
NURSING PROCESS STEP: Data collection
CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

Laboratory studies indicate that a client's blood glucose level is 185 mg/dl. Two hours have passed since
the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's
glucose utilization?
1.

2.

A fasting blood glucose test

A 6-hour glucose tolerance test

3. A test of serum glycosylated hemoglobin (Hb A1c)

4.

A test for urine ketones

Correct Answer: 3

Your Answer: 3

RATIONALES: Hb A1c is the most reliable indicator of glucose utilization because it reflects blood glucose
levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test
yield information about a client's utilization of glucose, the results are influenced by other factors such as
whether the client recently ate breakfast. The presence of ketones in the urine also provides information
about glucose utilization, but this finding is limited in its diagnostic significance.

What does a positive Chvostek's sign indicate?

1.

Hypocalcemia

2.

Hyponatremia

3.

Hypokalemia

4.
Correct Answer: 1

Hypermagnesemia
Your Answer: 1

RATIONALES: Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below
the temple. If the client's facial muscles twitch, the client has hypocalcemia. Signs of hyponatremia are
weight loss, abdominal cramping, muscle weakness, headache, and orthostatic hypotension. Hypokalemia
causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon
reflexes, coma, or cardiac arrest.

A 45-year-old female client is admitted to the hospital with Cushing's syndrome. Which nursing
interventions are appropriate for this client?
Select all that apply:
1.

Assess for peripheral edema.

2. Stress the need for a high-calorie, high-carbohydrate diet.

3.

Measure intake and output.

4.

Encourage oral fluid intake.

5.

Weigh the client daily.

6. Instruct the client to avoid foods high in potassium.

Correct Answer: 1,3,5

Your Answer: 2,3,5,6

RATIONALES: Because weight gain and edema are common symptoms of Cushing's syndrome,
appropriate interventions include assessing for peripheral edema, measuring intake and output, and
weighing the client daily. A low-calorie, low-carbohydrate, high-protein diet is ordered for a client with this
disorder. Fluid restriction is often prescribed as well. Treatment of Cushing's syndrome includes the
administration of potassium replacements; therefore, restricting foods high in potassium wouldn't be
appropriate

The nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes,
the nurse should recommend:
1. increasing saturated fat intake and fasting in the afternoon.

2. increasing intake of vitamins B and D and taking iron supplements.

3. eating a candy bar if light-headedness occurs.

4. consuming a low-carbohydrate, high-protein diet and avoiding fasting.

Correct Answer: 4

Your Answer: 4

RATIONALES: To control hypoglycemic episodes, the nurse should instruct the client to consume a lowcarbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and
increasing vitamin supplementation wouldn't help control hypoglycemia.

A client with type 2 diabetes hasn't received insulin coverage for his afternoon blood glucose levels for 2
days. After further investigation, a nurse discovers that the afternoon blood glucose levels were phoned in
from the laboratory but weren't documented in the client's medical record. What should the nurse do with
this information?
1. Administer insulin with the next afternoon glucose level.

2. Notify the physician and complete an incident report.

3. Call the responsible individual at home and discuss the reason for her failure to document the
client's blood glucose levels.
4. Leave a note on the chart for the physician informing him of the name of the nurse who didn't
document the blood glucose results.
Correct Answer: 2

Your Answer: 2

RATIONALES: It's the responsibility of the nurse who discovers an error to notify the physician and begin
the incident reporting process. Doing nothing is never appropriate and wouldn't prevent the incident from
happening again. Calling the individual at home to discuss the reasons for the omission isn't appropriate;
this information will be gathered by the manager. The physician should be informed by phone about the
lack of coverage; leaving a note with the name of the nurse who didn't document the results is
inappropriate.

Which of the following would indicate that a client has developed water intoxication secondary to treatment
for diabetes insipidus?
1.

2.

Confusion and seizures

Sunken eyeballs and spasticity

3.

Flaccidity and thirst

4. Tetany and increased blood urea nitrogen (BUN) levels.

Correct Answer: 1

Your Answer: 1

RATIONALES: Classic signs of water intoxication include confusion and seizures, both of which are
caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels
indicate fluid volume deficit. Spasticity, flaccidity, andtetany are unrelated to water intoxication.

Which instructions should be included in the discharge teaching plan for a client after
a thyroidectomy for Graves' disease?
1. Keep an accurate record of intake and output.

2. Use nasal desmopressin acetate (DDAVP).

3.

Have regular follow-up care.

4. Exercise to improve cardiovascular fitness.

Correct Answer: 3

Your Answer: 1

RATIONALES: Regular follow-up care for the client with Graves' disease is critical because most cases
eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to
recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Intake
and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is
used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, for this
client the importance of regular follow-up is most critical.

The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing
intervention demonstratesproper use of a blood glucose monitor?
1. Take off gloves before removing the test strip.

2. Smear the drop of blood onto the reagent pad.

3. Calibrate the machine after installing a new battery.

4. Start the timer on the machine while gathering supplies.

Correct Answer: 3

Your Answer: 3

RATIONALES: To obtain accurate readings, the nurse should calibrate the machine when a new battery is
installed. To adhere tostandard precautions and prevent contact with blood, the nurse should wear gloves
throughout blood glucose testing. The nurse should drop the blood not smear it on the reagent pad;
smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the
timer until the blood sample is collected.

A 78-year-old client with type 2 diabetes needs a kidney transplant. The client's daughter volunteers to
donate a kidney, but the client voices concerns about her daughter's health to the nurse. Which response
by the nurse is appropriate?
1. "I can see that you might be concerned about your daughter needing both of her kidneys."

2. "Donating a kidney is a great sacrifice; it's a shame you aren't younger."

3. "There's a chance that she may not be able to donate anyway; she might not be a compatible
donor."
4. "I'll notify your physician of your concerns and see if he can discuss the procedures with you."
Correct Answer: 4

Your Answer: 1

RATIONALES: The nurse should notify the physician of the client's concerns about the procedures. The
client's daughter is willing to donate a kidney to help her mother, so the nurse should be supportive of her
decision. There is no way to predict whether the daughter will have the same kidney disease as her mother
when she is older. The comments about the sacrifice that the daughter is making and her compatibility as a
donor are also inappropriate.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the
client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the
disorder. If the client doesn't comply with the recommended treatment, which complication may arise?
1.

Cerebral edema

2.

Hypovolemic shock

3.

Severe hyperkalemia

4.
Correct Answer: 1

Tetany
Your Answer: 1

RATIONALES: 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 of
cerebral edema. Hypovolemic shock results from severe fluid volume deficit; in contrast, SIADH causes
excessive 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. Tetany results from hypocalcemia, an electrolyte disturbance not
associated with SIADH.

A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should
the nurse include in her client teaching to ensure that this client is prepared for the test?
Select all that apply:
1. Stop using iodized salt or iodized salt substitutes 1 week before the scan.

2. Stop eating seafood 1 week before the scan.

3. Don't consume any food or fluids after midnight on the night before the scan.

4. Don't take any prescribed thyroid medication on the day of the scan.

5. Don't take prescribed thyroid medication until the results of the scan are known.

6. Maintain bed rest for 24 hours after the scan.

Correct Answer: 1,2,4

Your Answer: 1,2,4

RATIONALES: A thyroid scan visualizes the distribution of radioactive dye in the thyroid gland.
Interventions before the scan include stopping the ingestion of iodine, which is found in iodized salt, salt
substitutes, and seafood. The client should also be instructed not to take thyroid medication because it
may interfere with the scan. The client doesn't have to refrain from consuming food or fluids after midnight
if the scan is done on an outpatient basis. The radioactive dye is administered intravenously. Routinely
prescribed medications can be taken after the scan. Bed rest is maintained with a thyroid biopsy, not a
scan.

Which nursing diagnosis is most appropriate for a client with Addison's disease?

1.

2.

Risk for infection

Excess fluid volume

3.

4.

Urinary retention

Hypothermia

Correct Answer: 1

Your Answer: 3

RATIONALES: Addison's disease decreases the production of all adrenal hormones, compromising the
body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for
a client with Addison's disease includeDeficient fluid volume and Hyperthermia. Urinary retention isn't
appropriate because Addison's disease causes polyuria.

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic
workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The
evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the
client earlier. Which postoperative instruction should the nurse emphasize?
1. "You must lie flat for 24 hours after surgery."

2. "You must avoid coughing, sneezing, and blowing your nose."

3.

"You must restrict your fluid intake."

4. "You must report ringing in your ears immediately."

Correct Answer: 2

Your Answer: 2

RATIONALES: After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing,
and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The
head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24
hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not
restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes mellitus. Which statement about
diabetes mellitus is true?

1. Nearly two-thirds of clients with diabetes mellitus are older than age 60.

2. Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites.

3. Type 2 diabetes is less common than type 1 diabetes.

4. Approximately one-half of the clients diagnosed with type 2 diabetes are obese.
Correct Answer: 2

Your Answer: 4

RATIONALES: Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites. Only
about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2
diabetes. At least 80% of clients diagnosed with type 2 diabetes are obese.

The nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse a
hypoglycemic reaction, the client ideally should ingest an oral carbohydrate. However, this treatment isn't
always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on
hand?
1.

2.

Epinephrine

Glucagon

3.

50% dextrose

4.

Hydrocortisone

Correct Answer: 2

Your Answer: 2

RATIONALES: During a hypoglycemic reaction, a layperson may administer glucagon, an

antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral
carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat
hypoglycemia, a skilled health care professional must administer it by the I.V. route. Hydrocortisone takes a
relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

Which instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a
client?
1.

"Take the drug on an empty stomach."

2.

3.

"Take the drug with meals."

"Take the drug in the evening."

4. "Take the drug whenever it's convenient."

Correct Answer: 1

Your Answer: 1

RATIONALES: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote
absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

A client who has had type 2 diabetes for 20 years tells the nurse that sometimes she has diarrhea and other
times constipation. In addition, she sometimes feels "full" after eating small amounts. Which of the following
would be an appropriate response for the nurse to make?
1. "Stop taking any laxatives. This will clear up."

2. "Sometimes people with diabetes have problems with their digestion. Did you tell your physician
about this?"
3. "I'll phone the physician so you can have a laxative to use when you are constipated."

4. "Eating small amounts is good for you. Your body is telling you that you should stop eating."
Correct Answer: 2

Your Answer: 2

RATIONALES: The nurse is correct in stating that clients with diabetes sometimes have digestive problems
caused by gastroparesis and that the physician should be made aware of the symptoms. The nurse
shouldn't tell the client to take or not take any medications. Phoning the physician to ask for a laxative for
this client might not be the correct treatment for her condition. Telling the client that she should be eating
small amounts and that feeling full is expected is also an inappropriate response, and it doesn't address
the client's problems.

A 56-year-old female client is being discharged after having a thyroidectomy. Which discharge instructions
are appropriate for this client?
Select all that apply:
1. Report any signs and symptoms of hypoglycemia.

2. Take thyroid replacement medication, as ordered.

3. Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry
skin. Report them to the physician.
4.

Recognize the signs of dehydration.

5.

Avoid over-the-counter medications.

6. Carry injectable dexamethasone at all times.

Correct Answer: 2,3

Your Answer: 1,2,3,5

RATIONALES: After removal of the thyroid gland, the client needs to take thyroid replacement medication.
The client needs to report to the physician changes in body functioning, such as lethargy, restlessness,
cold sensitivity, and dry skin. These changes may indicate the need to increase the medication dose. The
thyroid gland doesn't regulate the serum glucose level; therefore, the client wouldn't need to recognize the
signs and symptoms of hypoglycemia. Dehydration is seen in diabetes insipidus. A client with Addison's
disease should avoid over-the-counter medications and carry injectable dexamethasone.

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:
1. an ectopic corticotropin-secreting tumor.

2.

adrenal carcinoma.

3. a corticotropin-secreting pituitary adenoma.

4.
Correct Answer: 3

an inborn error of metabolism.

Your Answer: 2

RATIONALES: 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 often associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A
female with an inborn error of metabolism wouldn't be menstruating.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with
estrogen and progesterone. Which instruction would be most important to include in the client's teaching
plan?
1. Maintain a moderate exercise program.

2.

Rest as much as possible.

3.

4.

Lose weight.

Jog at least 2 miles per day.

Correct Answer: 1

Your Answer: 2

RATIONALES: A moderate exercise program will help strengthen bones and prevent the bone loss that
occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise.
Because of weakened bones, a rigorous exercise program such as jogging would be contraindicated.
Weight loss might be beneficial, but it isn't as important as developing a moderate exercise program.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
1. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess

2. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing

3. Disturbed body image related to weight gain and edema

4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
Correct Answer: 4

Your Answer: 2

RATIONALES: In the client with hyperthyroidism, excessive thyroid hormone production leads to
hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen
balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization
and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced
nutrition: Less than body requirements the most important nursing diagnosis. Options 2 and 3 may be
appropriate for a client with hypothyroidism, which slows the metabolic rate.

The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat
this disorder. The nurse should state that the physician probably will prescribe daily supplements
of calcium and:
1.

folic acid.

2.

vitamin D.

3.

potassium.

4.
Correct Answer: 2

iron.
Your Answer: 2

RATIONALES: Typically, clients with hypoparathyroidism are prescribed daily supplements of vitamin D
along with calcium because calcium absorption from the small intestine depends on vitamin D.
Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client
doesn't require daily supplements of these substances to maintain a normal serum calcium level.

After falling off a ladder and suffering a brain injury, a client develops syndrome of inappropriate antidiuretic
hormone (SIADH). Which findings indicate that the treatment he's receiving is effective?
Select all that apply:
1.

Decrease in body weight

2. Rise in blood pressure and drop in heart rate

3.

Absence of wheezes in his lungs

4.

5.

Correct Answer: 1,4,5

Increased urine output

Decreased urine osmolarity

Your Answer: 1,3,4

RATIONALES: SIADH is an abnormality in which there is an abundance of the antidiuretic hormone. The
predominant features are hyponatremia, oliguria, edema, and weight gain. Evidence of successful
treatment includes a reduction in weight, an increase in urine output, and a decrease in the urine's
concentration (urine osmolarity).

Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic
nonketotic syndrome (HHNS)?
1. Administer 2 to 3 L of I.V. fluid over 2 to 3 hours.

2. Administer 6 L of I.V. fluid over the first 24 hours.

3. Administer a dextrose solution containing normal saline solution.

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

Correct Answer: 1

Your Answer: 3

RATIONALES: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining
cardiovascular integrity. Therefore, 2 to 3 L of I.V. fluid should be given over 2 to 3 hours. 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 prescribed fluids include dextran (in cases of
hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic halfnormal saline solution.

A client who was diagnosed with type 1 diabetes 14 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?
1.

2.

Correct Answer: 2

Cool, moist skin

Rapid, thready pulse

3.

Trembling arms and legs

4.

Slow, shallow respirations

Your Answer: 2

RATIONALES: This client's abnormally high blood glucose level indicates hyperglycemia, which typically
causes polyuria,polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect
to assess signs of a fluid volume deficit, such as a rapid, thready pulse, decreased blood pressure, and
rapid respirations. Cool, moist skin trembling arms and legs are associated with hypoglycemia. Rapid
respirations not slow, shallow ones are associated with hyperglycemia.

A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease
is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that
the client's initial dose for the thyroid replacement would be:

1.

25 mcg/day.

2.

100 mcg/day.

3.

delayed until after thyroid surgery.

4.

initiated before thyroid surgery.

Correct Answer: 1

Your Answer: 2

RATIONALES: Elderly clients and clients with cardiac disease should begin with 25 mcg/day of
levothyroxine. The dosage is increased at 2- to 4-week intervals until 100 mcg/day is reached. This slow
titration prevents further cardiac stress. Younger clients would be started on the usual maintenance dose of
50 to 200 mcg/day. Clients with Hashimoto's thyroiditis don't require surgical intervention.

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the
client, who now has nausea, a temperature of 105 F (40.5 C), tachycardia, and extreme restlessness.
What is the most likely cause of these signs?
1.

Diabetic ketoacidosis

2.

Thyroid crisis

3.

Hypoglycemia

4.

Tetany

Correct Answer: 2

Your Answer: 2

RATIONALES: Thyroid crisis usually occurs in the first 12 hours after a thyroidectomy and causes
exaggerated signs ofhyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic
ketoacidosis is more likely to produce polyuria,polydipsia, and polyphagia; hypoglycemia is likely to
produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable
muscle spasms, stridor, cyanosis, and possibly asphyxia.

When administering spironolactone (Aldactone) to a client who has had a unilateral adrenalectomy, the
nurse should instruct the client about which possible adverse effect of the drug?
1.

Breast tenderness

2.

Menstrual irregularities

3.

Decreased facial hair

4.

Hair loss

Correct Answer: 2

Your Answer: 2

RATIONALES: Spironolactone can cause menstrual irregularities and decreased libido. Men may also
experience gynecomastia and impotence. Breast tenderness, decreased facial hair, and hair loss aren't
associated with spironolactone.

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and
propylthiouracil (PTU). The nurse would expect the client's symptoms to subside:
1.

2.

3.

4.

in a few days.

in 3 to 4 months.

immediately.

in 1 to 2 weeks.

Correct Answer: 4

Your Answer: 4

RATIONALES: 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 hyperthyroidism in the interim, clients are usually given a
beta-adrenergic blocker such as propranolol.

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

2.

I.M. or subcutaneous glucagon.

I.V. bolus of dextrose 50%.

3. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

4.

10 units of fast-acting insulin.

Correct Answer: 3

Your Answer: 3

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

The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the
physician immediately?
1.

Pitting edema of the legs

2.

An irregular apical pulse

3.

Dry mucous membranes

4.

Frequent urination

Correct Answer: 2

Your Answer: 2

RATIONALES: Because Cushing's syndrome causes aldosterone overproduction, which increases urinary
potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report
signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an
expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous
membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis
should receive the highestpriority?
1.

2.

Risk for infection

Decreased cardiac output

3.

Impaired physical mobility

4. Imbalanced nutrition: Less than body requirements

Correct Answer: 2

Your Answer: 1

RATIONALES: An acute addisonian crisis is a life-threatening event caused by deficiencies of cortisol and
aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to
hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory
collapse. The client with Addison's disease is at risk forinfection; however, reducing infection isn't a priority
during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body
requirements are also appropriate nursing diagnoses for the client with Addison's disease, but they aren't
priorities during a crisis.

A 68-year-old client has been complaining of sleeping more, increased urination, anorexia,
weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these
findings, the nurse would suspect:

Correct Answer: 4

1.

diabetes mellitus.

2.

diabetes insipidus.

3.

hypoparathyroidism.

4.

hyperparathyroidism.
Your Answer: 4

RATIONALES: Hyperparathyroidism is most common in older women and is characterized by bone pain
and weakness from excess parathyroid hormone (PTH). Clients also exhibit polyuria. Although clients
with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and they don't
sleep more. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis?
1. Weight loss, increased appetite, and hyperdefecation

2. Weight loss, increased urination, and increased thirst

3. Weight gain, decreased appetite, and constipation

4. Weight gain, increased urination, and purplish-red striae

Correct Answer: 3

Your Answer: 3

RATIONALES: Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of

hypothyroidism. It's seen most commonly in women older than age 40. Weight gain; decreased appetite;
constipation; lethargy; dry, cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea
are symptoms of Hashimoto's thyroiditis. Weight loss, increased appetite, and hyperdefecation are
characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of
uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic
of hypercortisolism.

The nurse teaches a diabetic client that diet plays a crucial role in managing diabetes mellitus. When
evaluating dietary intake, the nurse knows the client is eating the right foods if total daily caloric intake
consists of:
1. 30% to 35% carbohydrate, 40% fat, and 25% to 30% protein.

2. 40% to 45% carbohydrate, 40% fat, and 15% to 20% protein.

3. 50% to 55% carbohydrate, 35% fat, and 10% to 15% protein.

4. 55% to 60% carbohydrate, 30% fat, and 10% to 15% protein.

Correct Answer: 4

Your Answer: 4

RATIONALES: A client with diabetes mellitus should get 55% to 60% of total daily calories from
carbohydrates, no more than 30% from fats, and the remainder (10% to 15%) from proteins. A diet in which
carbohydrates account for fewer than 55% of calories has a higher fat content than recommended for a
healthy diet. Because diabetes mellitus is a risk factor for cardiovascular disease, excessive fat intake
further increases the client's risk for cardiovascular disease.

A client with type 1 diabetes takes 15 units of isophane insulin suspension (Humulin N) 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 and learns that the client is unaware that certain over-thecounter (OTC) preparations and other medications may interact with insulin. The nurse should advise the
client to avoid which OTC preparations?
1.

Antacids

2.

Preparations containing salicylates

3.

Vitamins with iron

4. Preparations containing acetaminophen

Correct Answer: 2

Your Answer: 2

RATIONALES: Large doses of salicylates may interact with insulin and cause hypoglycemia. Antacids,
vitamins with iron, and acetaminophen aren't known to interact with insulin.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse
should observe the client for which symptoms?
Select all that apply:
1.

4.

Numbness

2.

Aphasia

3.

Tingling

Muscle twitching and spasms

5.

6.

Polyuria

Polydipsia

Correct Answer: 1,3,4

Your Answer: 1,3,4

RATIONALES: When the parathyroid gland is removed, the body may not produce enough parathyroid
hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral
numbness, tingling, and muscle spasms. Aphasia isn't a symptom of calcium depletion. Polyuria and
polydipsia are symptoms of diabetes mellitus.

While administering morning medications, a nurse enters the room of a client who recently had a
thyroidectomy. She observes that the client is sitting up in bed but appears unresponsive. After confirming
unresponsiveness, what should the nurse do next?
1.

Place the client flat in bed.

2.

3.

Call the nurse assigned to the client.

4.
Correct Answer: 2

Call for help.

Check for a pulse.

Your Answer: 4

RATIONALES: After determining unresponsiveness, the nurse's next step should be to call for help. This
would summon needed assistance and possibly the cardiac arrest team. Any nurse can institute
emergency resuscitation procedures; therefore, calling the nurse assigned to the client would not be
appropriate and could waste valuable time. Repositioning the client flat in bed would be the next step after
calling for help. After the nurse opens the airway and checks for breathing, she should check the client for
a pulse.