BULLETS MS 2
nasogastric tube – first action:
GASTROINTESTINAL SYSTEM
DIAPHRAGMATIC HIATAL HERNIA
>contraindicated with a hiatal hernia
Lying recumbent following meals
GERD
>instructions should the nurse stress
Reduce intake of caffeine beverages
>statement that would support a nursing diagnosis
of knowledge deficit
“I will lie down for 30 minutes after meals”
>position after taking antacids
On the left side with the head of bed
elevated 30 degrees
PEPTIC ULCER DISEASE
>primary cause of peptic ulcer disease
“Infection with Helicobacter pylori causes
ulcers”
>peptic ulcer disease  states that stress
frequently causes exacerbation of the disease 
most likely responsible for the exacerbations:
Frequent need to work overtime on short
notice
>medication to avoid because of the irritating
effects on the lining of the gastrointestinal (GI)
tract
Ibuprofen (Motrin)
>most frequent symptoms of duodenal ulcer
Pain that is relieved by food intake
>pain characteristic of a duodenal ulcer
Aching in the epigastric area that awakens
her from sleep
>indicate perforation of the ulcer
A rigid boardlike abdomen
>pyloroplasty involves
An incision and resuturing of the pylorus to
relax the muscle and enlarge the opening from
the stomach to the duodenum
>purpose of vagotomy:
Reduce the stimulus to acid secretions
>definition of Billroth I
“In Billroth I, the cardia of the stomach is
anastomosed to the first part of the
duodenum.”
>perform Billroth II procedure
Gastrojejunostomy
JULY 2010
>nasogastric tube attached to intermittent suction
Pressure should not exceed: 25 mmHg
>following a Billroth II procedure -- postoperative
order the nurse should question and verify
Irrigating the nasogastric tube
>intestinal obstruction and has a Miller-Abbott tube
in place – how to assess proper placement?
Check the distance markings on the tube
>experiences nausea following the removal of a
Auscultate the patient for bowel sounds
>food/drinks/diet to be limited or eliminated
Wine, Coffee, Citrus fruits
>diet that is appropriate for patient with PUD
Green leafy vegetables
Baked chicken
Lab results reveal an elevated titer of Helicobacter
Pylori –statement indicating an understanding
“Treatment will include Pepto-Bismol and
antibiotics”
>admitted with bleeding peptic ulcer – associated
intervention
Checking the blood pressure and pulse
rates each shift
>bowel surgery – purpose of sulfasuxidine and
neomycin
Reduce the bacterial content of the colon
DUMPING SYNDROME
>total gastrectomy -- complains of weakness,
palpitations, diarrhea and reactive hypoglycaemia
--best explanation for these S/S:
Rapid distention of the jejunal loop
anastomosed to the stomach
>symptoms of dumping syndrome
diaphoresis and lightheadedness
>early signs and symptoms of dumping syndrome
Sweating and pallor
>statement would indicate a correct understanding
of the instructions
“I will avoid concentrated sugars.”
>instruction to avoid dumping syndrome
“Avoid fluid intake with your meals”
>preventing dumping syndrome
Avoid fluids taken with meals
Supine position
Avoid carbohydrates
Small frequent feeding
PERNICIOUS ANEMIA
>cause of pernicious anemia in an elderly patient
Atrophy of the stomach lining
>intrinsic factor is absorb cyanocobalamine
(Vitamin B12) in the
Small intestine
>Schilling’s test -- the test will require the nurse to
Initiate a 24-hour urine collection
>indicate that the goal of care has been achieved
The patient's tongue has lost its beefy red
color
APPENDICITIS
>pain in appendicitis is most likely located in
McBurney’s point
JUNE 2009
>acute appendicitis the report of laboratory tests
Elevated leukocyte count

>diagnosis of appendicitis -- most important for the
nurse to follow-up
Cessation of abdominal pain
>diagnosis of appendicitis  begins to complain of
increased abdominal pain and begins to vomit 
notes that the abdomen is distended and bowel
sounds are diminished  most appropriate nursing
intervention:
Notify the physician
>checking for rebound tenderness
At the end of examination
>appendicitis is suspected  would question which
of the following physician’s orders
Administer 30 ml of milk of magnesia
DIVERTICULOSIS & DIVERTICULITIS
>risk factor of diverticulosis
Low intake of dietary fibers
>indicate that the patient is following the diet plan
correctly
“I eat green salad everyday”
>diverticulosis  should include avoidance of:
Peanuts and popcorn
CROHN’S DISEASE
>stool characteristics would the nurse expect
Diarrhea
>teaching instructions
“Reduce stress in your lifestyle”
>indicate that the corticosteroids therapy has been
effective
Decreased complaints of abdominal pain
ULCERATIVE COLITIS
>severe rectal bleeding, 16 diarrheal stools a day,
severe abdominal pain, tenesmus, and dehydration
 what disease?
Ulcerative colitis
>expected manifestation:
Bloody diarrhea
>noted on assessment of the client that the nurse
will report to the physician
Rigid and painful abdomen
>therapeutic diet for ulcerative colitis:
Low roughage with milk
>admitted to the hospital for a total colectomy and
creation of an ileostomy  measures should be
given priority preoperatively:
Correcting the patients fluid imbalance
>priority nursing diagnoses:
Fluid volume deficit
Fluid and electrolyte imbalance
Altered nutrition: < body requirements
>indicates patient needs teaching if what food is
eaten:
Celery  high in fiber
COLOSTOMY & ILEOSTOMY
>total colectomy and creation of an ileostomy 
priority measure in the patient's preoperative care
plan
Correcting the patients fluid imbalance
>creation of an ileostomy  purpose of surgery:
Remove the diseased portion of the bowel
>ileostomy  avoid which of the following foods:
Popcorn
>statement a nurse would include in the
preoperative instructions for a patient who is
scheduled for an ileostomy:
“You will have a nasogastric tube in your
nose after surgery”
>“I will have to be isolated for the rest of my life
because no one will be able to stand this terrible
odor.”  response that is most likely reassuring:
“There are techniques that can reduce the
odor.”
>ileostomy  foods that thicken the stool:
Pasta
Boiled rice
Low – fat cheese
*if needs further teaching: Bran
>statement the nurse would include in the
preoperative instruction of a patient who is
scheduled for an ileostomy:
“The stool drainage will be of liquid
consistency”
>essential care of the stoma in ileostomy:
Cleanse the peristomal skin meticulously
>ileostomy  most frequent complications of this
type of surgery:
Fluid and electrolyte imbalance
COLOSTOMY
A colostomy can BEST be defined as
Cutting the colon and bringing the proximal
end through the abdominal wall
JUNE 2007
>abdominoperineal resection patient should be
informed he/she will have a:
Permanent colostomy
JUNE 2007
>double-barrel colostomy  type of drainage from
the patient's bowel
Mucoid drainage from the distal stoma
Fecal material from the proximal stoma
>patient is at risk for fluid volume deficit
A client with colostomy
ACTUAL BOARD QUESTION
>sigmoid colostomy  indicates to a nurse that the
patient needs further instruction
“I will have continuous drainage of liquid
stool” – this is for ileostomy
>creation of a colostomy  nursing diagnosis the
nurse would include in the plan of care
Body image disturbance
>colostomy  foods in the diet to reduce odor
Yogurt
>colostomy  to avoid flatulence should not eat
the following EXCEPT
Mangoes and pineapples
*if to avoid
Corn and peanuts
Cabbage and asparagus
Chewing gum and carbonated beverages
DECEMBER 2006
>instructions to a client who has a new colostomy
 diet for the first 4-6 weeks postoperatively:
Low residue
>sign of stoma prolapse:
Protruding and swollen stoma
>expected color of the stoma
Red/ beefy red
>colostomy  beginning to pass malodorous flatus
from the stoma after 2 days:
This is a normal, expected event
>appropriate nursing interventions during
colostomy irrigation:
Insert 2-4 inches of an adequately
lubricated catheter to the stoma
Position client in semi-Fowler
Hang the solution 18 inches above the
stoma
*if EXCEPT:
Increase the irrigating solution flow rate
when abdominal cramps is felt
>colostomy irrigation instruction to enhance the
effectiveness of the irrigation
Increase fluid intake
>colostomy irrigation  most appropriate nursing
action when client begins to complain of abdominal
cramps
Stop the irrigation temporarily
>colostomy care  ostomy appliance care:
Care of the appliance
Care of the skin
Care of the stoma
Acceptance of body image
JUNE 2009
TOTAL PARENTAL NUTRITION
>essential measure before this order is initiated:
A subclavian catheter is patent and a chest
x-ray is done to confirm placement
>substances that may be administered piggy-
backed to a TPN infusion
Lipids
>During the first 24 hours after total parenteral
nutrition (TPN) therapy is started, the nurse should:
Evaluate blood glucose levels
>the nurse would closely monitor laboratory values
for
Glucose
A client with TPN suddenly develops tremors,
dizziness, weakness and diaphoresis. The client said
“I feel weak”  replacement is already 3 hours late
 probable complication:
Hypoglycemia
>TPN solution via the central line  equipment
BEFORE hanging the solution:
Electronic infusion pump
*if during infusion:
Blood glucose meter
>weaned from total parental nutrition  anticipated
order:
Decrease TPN rate to 50mL/hr
>change the total parenteral nutrition TPN solution
bag and tubing  instructions during tubing
changes:
Hold the breath and bear down
HEMORRHOIDS
>instruction regarding treatment of hemorrhoid 
indicates a need for further instruction:
“I should apply heat packs to the hemorrhoids
to help the hemorrhoids shrink”
CHOLECYSTITIS & CHOLELITHIASIS
>indicate a predisposition for developing
cholecystitis:
Obesity
>blockage of the common bile duct  will
experience difficulty digesting:
Fats
>best describes Murphy’s Sign
On deep inspiration, pain is elicited and
breathing stops
>an assessment finding supports her diagnosis of
cholecystitis:
Pain that radiate to midsternal area or
right shoulder
JULY 2010
>patient with jaundice  laboratory value that is
expected to be elevated:
Serum bilirubin
>right upper quadrant pain and has been placed on
a low fat diet  acceptable food:
Skim milk, lean fish, tapioca pudding
*if avoided:
Liver, fried potatoes and avocado
Whole milk, rice and pastry
Ham, mashed potatoes, cream peas
JUNE 2007
>has gas pains following a laparoscopic
cholecystectomy  instruction:
“Get up and move around.”
>undergone cholecystectomy  Her teaching on
diet will be based on the knowledge that after a
cholecystectomy:
The client will regain a normal diet
JULY 2010
> has had a cholecystectomy  statement that
indicates a correct understanding of dietary
instructions:
“I can eat whatever I can tolerate”
>preoperative instructions to a patient who is
scheduled for a laparoscopic cholecystectomy:
“You will have four small incisions on your
abdomen.”
>preoperative teaching instruction  scheduled for
a laparoscopic cholecystectomy
“Your abdomen will be inflated with gas
during surgery.”
24 hours following a cholecystectomy  T tube has
drained 500 ml of green-brown drainage  most
appropriate nursing intervention:
Document the findings
PANCREATITIS
>chronic pancreatitis  most likely causative
factor:
Use of alcohol
>important question for a nurse to ask when
gathering data from a patient with pancreatitis:
“How much alcohol do you drink in a
week?”
>acute pancreatitis  pain is:
Severe and unrelenting, located in the
epigastric area and radiating to the back
> clinical manifestation of paralytic ileus
Inability to pass flatus
>laboratory value  expected to be elevated
Elevated serum amylase
>chronic pancreatitis  indicates a serum amylase
level of
300 units/L
>dietary modifications  teach the client to limit
Fat
>instruct a patient with pancreatitis to avoid which
of the following types of foods:
Meats
>acute pancreatitis  avoids which of the following
foods:
Steak and potatoes
>chronic pancreatitis  necessary to control
Alcohol intake
LIVER CIRRHOSIS
>to accurately assess for jaundice in a patient with
dark skin pigmentation, the nurse should examine
which body areas:
Hard palate of the mouth
>ascites  most appropriate nursing measure
Measuring abdominal girth
>admitted to the hospital with anorexia, weight
loss, and ascites  Serum SGOT (AST), SGPT (ALT)
and total bilirubin are significantly elevated Based
on the lab results  expected assessment:
Jaundice
>best explanation for the development of edema is
that it is due to
Decrease concentration pf plasma albumin
>cirrhosis has been following a diet with optimal
amounts of protein because neither nor a deficiency
of protein has been helpful  most satisfactory if
the total protein level is which of the following
values
6.4 g/dL
>ascites is schedule for a paracentesis  position
will the nurse assist the client to assume for this
procedure:
Upright position/High Fowlers
>discharge teaching for a patient who has been
diagnosed with liver cirrhosis
“Avoid alcoholic beverages.”
>piece of equipment should a nurse has available
when caring for a patient with esophageal varices:
Sengstaken-Blakemore tube
>Sengstaken-Blakemore tube  ordered for a
patient who has bleeding esophageal varices in
order to
Apply direct pressure to the area
Sengstaken-Blakemore tube  complains of severe
pain of abrupt onset and difficulty breathing 
appropriate nursing action:
Cut the tube
>esophageal varices begin to experience severe
gastrointestinal bleeding  plan of care to meet the
client’s fluid needs  priority strategy:
Rapid blood and fluid administration
HEPATIC ENCEPHALOPATHY
>priority nursing diagnosis to a patient who has
cirrhosis of the liver and an elevated serum
ammonia level
Altered thought processes
>presence of asterixis  assess for the presence of
this sign  the nurse would do
Ask the client to extend the arms
>cirrhosis of the liver  indicates that the patient’s
condition is worsening
Flapping hand tremors
>cirrhosis and notes that the ammonia level is
elevated anticipated diet most likely be prescribed
for this client:
Low protein
>cirrhosis of the liver has been treated for hepatic
encephalopathy  indicates an understanding of
foods that are low in protein
Vegetable soup and tossed green salad
Avoid:
Cheese
Meat Loaf
Baked chicken
Tuna fish
>receiving neomycin  desired effect of the drug is
to:
Decrease the serum ammonia
HEPATITIS
>contracted the infection from contaminated foods
 type of hepatitis
Hepatitis A
>causal factor in the transmission of hepatitis A:
Consuming shellfish
>Hepatitis B is transmitted through:
Transfusion and injection
>clinical manifestation(s) are primarily
characteristics of the pre-icteric phase:
Fatigue, anorexia, and nausea

>Serum SGOT (AST), SGPT (ALT), LDH, and total

billirubin are significantly elevated  will expect to
find:
Jaundice

>suspected of having hepatitis  diagnostic test

will assist in confirming this diagnosis:
Elevated serum bilirubin level

>To detect the development of a chronic carrier

state in a client with hepatitis, the nurse should
assess the client’s serum laboratory results for:
Hepatitis B surface antigen (HBsAg)

>hepatitis B  statement by the patient would

indicate the need for further instruction:
“I should avoid any drugs”
*if correct understanding:
“I can never donate blood.”
“I can never have unprotected sex.”
“I can't share needles.”

>Hepatitis  priority in the teaching care plan

Promoting bed rest
Scheduling rest periods throughout the day

>hepatitis B  would support a nursing diagnosis of

knowledge deficit related to disease transmission
“I should keep my utensils separate from
those of others”
 >diabetes insipidus  unassociated with this
disorder:
ENDOCRINE SYSTEM Concentrated urine (common in SIADH)
GIGANTISM & ACROMEGALY
>If hypersecretion of growth hormone occurs after >A patient who has a head injury has a urine
epiphyseal plate closure  condition observed by output of 200ml/hour for three consecutive hours 
the nurse: most appropriate nursing measure:
Acromegaly Measuring urine specific gravity

>Coarsening of facial features and enlargement of >sustained a head injury is administered

the hands and feet are early clinical manifestations vasopressin (Pitressin) {route: IM}  indicate to
of: the nurse that the drug is effective:
Acromegaly Urinary output of 50 ml/hour (normal UO:
30-60 ml/hour) or
>During the assessment of an adult patient
diagnosed with acromegaly, the nurse expects to The client’s urinary output has decreased
find all of the following manifestations, except
one:
> receiving desmopressin (DDAVP) [route:
Progressively increasing height
intranasal]  lab indicating that the medication is
(gigantism)
having its intended effect:
Urine specific gravity 1.020  normalize
Other options: If increase: SIADH (concentrated)
Enlarged tongue If decrease: DI (diluted)
Transverse enlargement of hands and feet
Enlarged facial features >pituitary tumor  had a transphenoidal
(JULY 2010) hypophysectomy  appropriate intervention:
Elevate the head of bed 30 degree
>acromegaly  priority nursing diagnosis:
Risk for ineffective airway clearance >after hypophysectomy nurse notices clear nasal
related to obstruction of airway by the tongue drainage from the client’s nostril  initial nursing
action:
>pharmacologic treatment for a client with Test the drainage for glucose
acromegaly:
octreotide (Sandostatin) >transphenoidal hypophysectomy  accurate
(JULY 2010) statement by the nurse immediate post-operative
period
>usual route of octreotide (Sandostatin) “You will be unable to brush your teeth.”
Subcutaneous “Avoid sucking through a straw”
(JULY 2010)

>common side effect of octreotide (Sandostatin)

SIADH
Diarrhea >a client with syndrome of inappropriate
(JULY 2010) antidiuretic hormone (SIADH)  monitor for:
Hyponatremia (Dilutional)

>syndrome of inappropriate antidiuretic hormone

DWARFISM (SIADH)  unassociated characteristic of this
>comment made by a parent to the nurse would disorder:
indicate the possibility of dwarfism Hypernatremia  should be dilutional
(hypopituitarism) hyponatremia
“Usually my child wears out his clothes
before his size changes” Correct options:
Signs of water intoxication
>planning to give growth hormone at home  the High urine osmolality
nurse should explain that optimum is achieved Low serum osmolality
when growth hormone is administered: High Urine Specific Gravity
At bedtime
>action a nurse should include in the care plan for
DIABETES INSIPIDUS a patient who has water intoxication
>A client has a closed head injury. Vital signs are Measure urine specific gravity
T: 103 F, PR: 100, RR 24 BP: 110/84. Hourly urine
output is 200 ml/hour  best understanding of the HYPERTHYROIDISM
cause of these findings: >not a characteristic clinical manifestation of
Damage to the hypothalamus resulting in hyperthyroidism:
decrease hormone production Dry skin (correct: warm moist skin)

>diabetes insipidus  symptoms as a sign of this >Grave’s Disease  admitting assessment

disorder: expected:
Polyuria and Polydipsia Weight loss

>develops diabetes insipidus after removal of a Following a thyroidectomy  care plan to detect
pituitary tumor  expected finding: possible laryngeal nerve damage:
Polyuria (5 liters per day) Asking the patient to speak
>subtotal thyroidectomy  nurse planning care for
the day knows that it is important to
Ask the client questions every hour or two
to assess hoarseness
>subtotal thyroidectomy  returns from the post
anesthesia care unit  the nurse should
immediately:
Place a tracheostomy set at the bedside
JUNE 2007
>thyroidectomy  nurse should keep which of the
following at the bedside
A tracheostomy
>undergone a thyroidectomy  would be
predisposed to the development of:
Hypocalcemia
>accidental injury to the parathyroid gland during a
thyroidectomy  client might develop:
Tetany
JUNE 2009
>after a subtotal thyroidectomy  the client tells
the nurse, I feel numbness and my face is
twitching”  nurse’s best initial action
Notify the physician
>total thyroidectomy  complaining of tingling
around the mouth and in fingers and toes nurse’s
next action
Check the calcium level
>thyroidectomy  a client develops hypocalcemia
and tetany  medication the nurse should
anticipate to administer:
Calcium Gluconate (IV)
>form of severe hyperthyroidism is life-threatening
and produces high fever, extreme tachycardia and
altered mental status:
Thyroid Storm
>A pregnant client with hyperthyroidism is
scheduled for caesarian section  nurse monitoring
the client should watch for signs and symptoms of
thyroid storm which includes:
High fever which is 39.8 * Celsius
JULY 2010
>hyperthyroidism is taking methimazole (Tapazole)
 evaluate effectiveness of Tapazole therapy, the
nurse should consider asking;
Has the patient’s pulse rate decreased?
>measure the nurse should take after administering
a patient’s initial dose of propylthiouracil:
Performing a white blood cell count 
common: Agranulocytosis
>prescribed propylthiouracil for a client with
hyperthyroidism  priority nursing assessment to
be included in the plan regarding this medication is
to assess for:
Signs and symptoms of hypothyroidism
DEC 2006
>a client treated with (131) Iodine to eradicate
residual thyroid tissue  Because of this treatment,
the nurse should:
Consider all discharges including urine and
feces to be radioactive
HYPOTHYROIDISM
>suspected of having hypothyroidism  expected
to have:
Facial Edema
>assessing a patient who has hypothyroidism 
expected to report:
Intolerance to cold
>comment made by the mother at her 4 month-old
infant should alert the nurse to suspect
hypothyroidism:
“My baby is unusually quiet and good”
>appropriate nursing diagnosis for Zeny who is
suffering from hypothyroidism:
Activity intolerance related to tiredness
associated with disorder
JUNE 2007
>type of diet a patient with hypothyroidism should
avoid:
High cholesterol  risk for atherosclerosis
>hypothyroidism frequently complains of feeling
cold  tell the client that she will be more
comfortable if she:
Dresses extra layers of clothing
>A client with hypothyroidism who experiences
trauma, emergency surgery or severe infection is at
risk for developing
Myxedema coma  severe hypothyroidism
>has gained a lot of weight recently, feels cold all
the time, is always tired, and can’t get anything
done  reports her hair is falling out  the woman
most likely to have
Myxedema
>Myxedema coma is a life threatening complication
of long standing and untreated hypothyroidism with
one of the following characteristic:
Hypothermia
(ACTUAL BOARD QUESTION)
>diagnosis of myxedema  initial assessment of
the client would reveal the symptoms of:
Weight gain, lethargy, slowed pulse, and
decreased respiratory rate
>levothyroxine sodium (Synthroid) for
hypothyroidism  indicate that the medication is
producing the desired effect:
Increased alertness
>levothyroxine (Synthroid) for a client with
myxedema  statement indicating that the client
understands the nurse’s teaching regarding
medication:
“I will check my heart rate before taking
the medication”
>levothyroxine  instruction to be given:
“You will take medication for the rest of
your life”
>discussed the need for medication with the
parents of an infant with hypothyroidism  nurse
can reinforce the physician’s teaching by telling the
parents that
The medication will be needed throughout
the child’s lifetime
Always remember: All hypo drugs: LIFETIME!!!!
HYPERPARATHYROIDISM
>medication is contraindicated in the treatment of
clients with hyperparathyroidism:
chlorthiazide (Diuril)  Ca+ sparing
HYPOPARATHYROIDISM
>Hyperphosphatemia and hypocalcemia are
indicative of
Hypoparathyroidism
>A client with hypoparathyroidism is being
monitored for hypocalcemia sign used to check
for hypocalcemia:
Chvostek’s Sign
>Discharge teaching for the client with
hypoparathyroidism should include which of the
following instructions:
Supplement calcium intake
DEC 2006
>diagnosis of hypoparathyroidism  instructs the
client to include which of the following items in the
diet
Vegetables  green leafy (high in Ca, low in P)
The client should limit meat, poultry, fish, eggs,
cheese, and cereals (high in P also)
CUSHING’S DISEASE
>Cushing’s syndrome  condition is caused by:
Excessive amounts of cortisol (other term for
glucocorticoids)
>tentative diagnosis of adrenocortical hyperfunction
 Observable sign the nurse would chart is
Moon face
Sodium and water retention in a client with
Cushing’s syndrome contributes to which of the
following commonly seen disorders:
Hypertension and congestive heart failure
>should be assigned to a private room if only one is
available
The client with Cushing’s Disease  prone
to infection due to increase glucocorticoids
>Cushing’s Syndrome  statement indicating that
instructions related to dietary management were
understood:
“I can eat foods that have lot of potassium
in them”
Diet: High potassium
Low sodium
>Following an adrenalectomy, a patient is to take
the steroid therapy after discharge from the
hospital  instruction given to the patient:
“You should call the physician if you have
temperature elevation”
>unilateral adenalectomy to remove a tumor 
most important measurement in the immediate
postoperative period for the nurse to take is:
Blood pressure
>bilateral adrenalectomy  statement the client
makes indicating to the nurse that further
discharge teaching is needed
“I will gradually discontinue the hormone
pills in a few months when I feel better.”
PHEOCHROMOCYTOMA
>client is scheduled for adrenalectomy  In the
preoperative period the priority nursing action
would be to monitor:
Vital Signs
ACTUAL BOARD QUESTION
>diagnosis of pheochromocytoma  nurse assesses
for the major symptom associated with this
disorder when the nurse:
Takes the client’s blood pressure
>Pheochromocytoma nurse monitors for
hypertensive crisis  anticipate that the most likely
medication to be prescribed would be:
phentolamine mesylate (Regitine)
ADDISON’S DISEASE
>A client with muscle weakness, anorexia, dark
pigmentation of the skin and laboratory findings of
low sodium and high potassium levels may be
presenting with which of the following conditions
Addison’s Disease
>Addison’s Disease  expect to note which of the
following on assessment
Hypotension
>admitted with acute with acute adrenal crisis 
the nurse can expect to find that the client:
Low blood pressure
>characteristic bronze appearance of the distal
extremities of a patient with Addison’s Disease is
caused by:
Increased production of melanocyte-
stimulating hormone(MSH)
>client with adrenal insufficiency  nursing
diagnosis should receive priority
Fluid volume deficit  due to hyponatremia
>instructions to a client with Addison’s Disease
regarding diet therapy  diet most likely would be
prescribed for this client
Normal sodium intake or Increase
Decrease potassium
>Nursing care for a client with Addison’s Disease
may include which of the following goals:
Participation in relaxation technique 
stress can precipitate Addisonian Crisis
>Addison’s Disease  asks the nurse what he
needs to know to manage his condition  The
nurse should give priority:
Emphasizing the need for strict adherence
to his medication regimen  steroids drugs are
lifetime in addison’s
>Cortisone (Cortone) is prescribed for a client with
Addison’s disease  statement if made by the
patient indicating a need for further teaching:
“I will stop the medication when I feel better”
“I will need to take daily medications until my
symptoms decrease.”
*Because lifetime
>long-term corticosteroid therapy would include
which of the following instructions
Eye examinations yearly to assess for
cataract formation
 >encourage exercise in the management of
diabetes, because it:
Decrease total triglyceride levels
DIABETES MELLITUS
Improves glucose utilization
>characteristic of Chandler is the most significant
Lowers blood glucose
risk factor for his development of type 2 diabetes?
Obesity
>type 1 DM wants to play soccer 
recommendations a nurse would make to the child
>Miguel asks what caused his diabetes  the nurse
“Eat an extra sugar exchange during the
should reply that type 2 diabetes is:
game”
Caused by insulin resistance
JUNE 2009
>taking glyburide (diaBeta) 1.25mg daily to treat
type 2 DM  statement indicating the need for
>question the nurse should ask when assessing a
further teaching
10-year-old patient for type 1 DM:
“I often skip dinner because I don’t feel
“Are you going to the bathroom to pass
hungry”
your water more often?”
>home care measures to the client with diabetes
>A physiologic mechanism that results in an
mellitus regarding exercise and insulin
increased risk of foot infection in a patient
administration  statement by the client indicating
diagnosed with type 1 DM is
a need for further instruction:
hyperglycemia
“I should perform my exercise at peak
insulin time.”  can further cause hypoglycemia
>manifestations most likely indicating complication
in a patient who has chronic diabetes mellitus
>diagnosed with diabetes mellitus  client tells the
Decreased peripheral sensation  peripheral
nurse that he is planning to eat a dinner meal at a
neuropathy
local restaurant this week  He asks the nurse if
eating in a restaurant will affect the diabetic control
>diabetes mellitus experiences peripheral
and if this is allowed  appropriate response:
neuropathy  priority nursing diagnosis should be
“You should order half-portion meal and
Risk for impaired skin integrity
have fresh fruit for dessert.”

>client diabetes mellitus has hyperglycemia 

>client with diabetes mellitus is starting prednisone
priority nursing diagnosis would be to:
(Deltasone) therapy for severe arthritis  nurse
Fluid volume deficit
should expect:
Worsened diabetes control
>assessment factor as one of the best indicator of a
client’s control of his diabetes during the preceding
>characterized by a sudden drop in blood glucose,
3-4 months:
followed by rebound hyperglycemia caused by the
A glycosylated hemoglobin level
gradual and excessive administration of insulin:
Somogyi Phenomenon  Rebound
>glycosylated hemoglobin assay (Hgb A1c) by hyperglycemia
explaining that the Hgb A1c
Reflects blood glucose level over a 3-4
>Chandler is obese and unable to look directly at
month period.
the bottom of his feet to assess for skin problems
related to his diabetes suggestion to complete his
>glycosylated hemoglobin of a 40 year old client
foot assessment:
with diabetes mellitus is 2.5%  nurse understands
Use a mirror for better visualization
that:
The client has a good control of her
>suspected of having DKA  expected laboratory
diabetes
result:
Blood glucose level of 500 mg/dL
Normal: <7% *others
Fair: 7.1 -8.9 Metabolic acidosis  decrease pH
DM (unable to control): >9% (+) ketones in urine
>most important self-care measure for an obese
>During periods of illness the nurse should
adult with newly diagnosed Type 2 (Non-Insulin
anticipate which of the following occurrences in the
Dependent) DM:
patient with diabetes mellitus
Reducing body weight
The need for insulin is increased  stress
and illness precipitates DKA
>external insulin pump  patient asks for the
function  bases the response on the information
>A nurse performs a physical assessment on a
that the pump:
client with type 1 DM. Findings include an Fasting
Gives a small continuous dose of regular
Blood Glucose of 120mg/dL, temperature of 101 F,
insulin, and the client can self-bolus with an
pulse of 88, respiration of 22 and blood pressure of
additional dosage from the pump prior to each
130/90mm Hg  finding of most concern to the
meal
nurse:
DEC 2006
Temperature  infection/illness precipitates
DKA
>exercise  The nurse’s best response should be
based on the theory that exercise will
>complication of Diabetes Mellitus is indicated by
Decrease the body’s need for insulin
Kussmaul’s respiration:
Diabetic ketoacidosis
>The nurse is teaching an insulin-dependent
diabetic client to self-test her blood glucose  The
nurse tells her that if she obtains a result that is
over 250 mg/dL, she should
Test her urine for ketones
>type 1 DM experiences weakness and tremors 
Action a nurse would take first:
Checking the patient’s most recent blood
glucose or
Give the patient a glass of juice to drink

>effects must be carefully monitored when
administering IV insulin to a client diagnosed with
DKA:
Hypokalemia and Hypoglycemia
>diabetic ketoacidosis is on intravenous (IV) insulin
drip  laboratory results requiring immediate
interventions
Serum potassium level of 2.8 mEq/L
>In the event that DKA has occurred the nurse
would anticipate that the most likely medication to
be prescribed would be:
Regular insulin  can be given IV
>Primary management for treating DKA includes
administration of which of the following treatments
Insulin and IV fluids
>Type 1 DM takes his morning dose of insulin and
leaves for school  At 10 AM, he feels faint and is
brought to the nurse’s office  has tachycardia,
diaphoresis and is unresponsive  most appropriate
intervention by the nurse at this time is to
administer:
Glucagon S.C.  since unconscious
>action if performed by the client would indicate
the need for further teaching:
Withdraw the NPH insulin first
>recommendation for preventing for hypoglycemia
in an adolescent with type 1 should the nurse make
Carry crackers or fruit to eat before or
during periods of increased activity

>Hyperosmolar Hyperglycemic Nonketotic

Syndrome (HHNS) can be differentiated from DKA
by which of the following condition
Absence of ketones

>can begin to self-administer insulin  The nurse

would recommend that the child begin this
procedure at age
Nine (9)

>glipizide (Glucotrol) {OHA}should be assessed by

the nurse for which of the following side effects
Agranulocytosis

>chlorpropamide (Diabenese)  The nurse should

notify the physician if the patient reports being
allergic to
Sulfur sulfonylureas are sulfur based drugs

>prescribes regular insulin  begins to exert an

effect:
In 30-60 minutes

>isophane insulin (NPH insulin) injection  be alert

for symptoms of hypoglycemia at which of the
following times after insulin administration:
8 hours (6-8/6-12 hours)

>NPH insulin SQ at 8 AM  nurse should assess the

client for hypoglycemic reaction at:
5 PM

>administer his insulin  receives 10U of NPH and

12 U of regular insulin each morning  statement
reflecting understanding of the nurse’s teaching
“When drawing up insulin, I should draw
up the regular first”

>The client asks the nurse about the length of time

an unrefrigerated vial of insulin will maintain its
potency. The most appropriate response to the
client is which of the following
1 month

HYPOGLYCEMIA
>condition that could possibly cause hypoglycemia
Excessive exercise without a carbohydrate
snack

URINARY/RENAL SYSTEM
RENAL FAILURE
>indicates the type(s) of acute renal failure
Three types: prerenal, intrarenal and
postrenal
(DEC 2007)
>oliguric phase of acute renal failure (ARF) 
most important nursing intervention:
Limiting fluid intake
>renal disease  the most common factors
contributing to renal failure is
diabetes mellitus
Hypertension
>chronic renal failure  assessed for which of the
following manifestation
Fatigue
>review of the laboratory results  the nurse would
most likely expect to note:
Elevated blood urea nitrogen (BUN)
>laboratory test a nurse should expect a physician
to order for a patient who has renal insufficiency
Creatinine clearance
>After noting the amount of urine output and urine
characteristics, the nurse then proceeds to assess
which of the following as the best indirect indicator
of renal status:
Blood pressure
>nurse should expect a patient who has chronic
renal failure to be given epoetin alfa (Epogen) to
Stimulate the synthesis of red blood cells
>acute renal failure has hyperkalemia  drug the
nurse should anticipate administering to the patient
Sodium polystyrene sulfonate (Kayexalate)
>low – potassium diet to select food items from the
menu
Lima beans
>acute renal failure has a serum potassium (K)
level of 5.8 mEq/L  a priority action:
Place the client on a cardiac monitor
HEMODIALYSIS
>patient with an arteriovenous (AV) fistula, the
nurse should assess for which of the following
sounds on auscultation:
Bruit
>patient with a left arm arteriovenous (AV) shunt
prior to hemodialysis  should be reported to the
physician
Absence of a palpable thrill over the shunt
>has an arteriovenous fistula created in his left
forearm  indicates that the patient needs
instruction in self-care
He wears a watch on his left wrist
A client with chronic renal failure (CRF) returns to
the nursing unit following a hemodialysis treatment
 nurse notes that the client’s temperature is
100.2° F  most appropriate nursing action
Continue to monitor vital sign {dialysis
machine warms the blood slightly}
>risk for disequilibrium syndrome  during dialysis
a nurse assesses the client for:
Headache, deteriorating level of
consciousness, and twitching
>nurse is performing an assessment on a client has
returned from the dialysis unit following
hemodialysis  client is complaining of a headache
and nausea  most appropriate nursing action
Notify the physician
>chronic renal failure has completed a hemodialysis
treatment  standard indicators to evaluate the
client’s status after dialysis
Vital signs and weight
>the most reliable evidence that a patient’s
hemodialysis treatment has been effective
Body weight
>hemodialysis client about self – monitoring
between hemodialysis treatments  the client best
understands the information given if the client
states to record on a daily basis:
Intake and output, weight
PERITONEAL DIALYSIS
A patient who is scheduled to begin peritoneal
dialysis treatments in the home asks a nurse what
to expect  most accurate response by the nurse:
“Fluid will be instilled into your abdominal
cavity on a routine basis.”
>receiving continuous ambulatory peritoneal
dialysis  indicates the need for further teaching
“I should limit my fluids to three glasses of
water a day.”
>list of components of the peritoneal dialysis
solution with a client  client asks the nurse about
the purpose of the glucose contained in the solution
 bases the response on knowledge that the
glucose:
Increases osmotic pressure to produce
ultrafiltration
>instructing a client with diabetes mellitus about
peritoneal dialysis  nurse tells the client that it is
important to maintain the dwell time for the dialysis
at the prescribed time because of the risk of:
Hyperglycemia
>assessment finding the nurse would observe first
in a patient who is undergoing peritoneal dialysis
and is developing peritonitis
Cloudy dialysate returns
>preparing to care for a receiving peritoneal
dialysis  would be included in the nursing plan of
care to prevent the major complication associated
with peritoneal dialysis
Maintain strict aseptic technique
>chronic renal failure has an indwelling catheter for
peritoneal dialysis in the abdomen  client spills
water on the dressing while bathing A nurse
should plan to immediately:
Change the dressing
>diagnosed with renal failure will be receiving
peritoneal dialysis  During the infusion of the
dialysate the client complains of abdominal pain 
most appropriate action by the nurse is:
Explain that the pain will subside after the
first few exchanges
KIDNEY TRANSPLANT
>client develops oliguria  nurse anticipate to be
prescribed as the treatment for the oliguria:
Administration of diuretics
>after kidney transplantation, a client develops a
fever of 101° F, the blood pressure is elevated, and
the kidney is tender  x – ray results indicate that
the transplanted kidney is enlarged  a nurse
would suspect:
Acute rejection
>blood chemistry laboratory results in a patient
who is in the post-operative period of a renal
transplant  indicating success
Creatinine 1.0 mg/dL
>discharged to home after renal transplantation
has a nursing diagnosis of risk for infection related
to immunosuppressive therapy  determines that
the client needs further instruction on measures to
prevent and control infection if the client states:
Monitor urine character and output at least
1 day each week
URINARY TRACT INFECTION
>The nurse recognizes that the MOST common
causative organism in pyelonephritis is:
E.Coli
ACTUAL BOARD QUESTION
>diagnosis of pyelonephritis  a nurse should
expect the patient to report which of the following
symptoms
Flank pain
>tentative diagnosis of urethritis  assesses the
client for which of the following manifestations of
the disorder
Dysuria and penile discharge
>complains of fever, perineal pain, urinary urgency
and frequency, and dysuria  related to prostatitis
 nurse would look at the results of the prostate
examination, which should reveal that the prostate
glands are:
Tender, indurated, and warm to the touch
>nurse is caring for an 88–year–old woman
suspected of having a urinary tract infection (UTI)
 would alert the nurse to the possibility of the
presence of a UTI
Confusion (if elderly)
>Urinary tract infection is the most common site of
nosocomial infection particularly with urinary
catheterization. It can be reduced significantly by
through:
Closed system drainage
ACTUAL BOARD QUESTION
>has an indwelling urinary catheter  How should
you collect a urine specimen for culture and
sensitivity?
Wipe the self-sealing aspiration port with
antiseptic solution and aspirate urine with a
sterile needle
ACTUAL BOARD QUESTION
>female client diagnosed with urethritis resulting
from infection with Chlamydia  plan to include the
following points in the teaching session
The most serious complication of this
infection is sterility
>administered phenazopyridine hydrochloride
(Pyridium)  indicates to a nurse that the
medication is effective
“It does not hurt me to urinate” {urinary
analgesics}
>recommendations a nurse should make to a
patient who has a diagnosis of chronic prostatitis:
“Daily sitz baths will provide comfort.”
>prostatitis secondary to kidney infection  A
nurse evaluates that the client verbalized the
intention to:
Use warm sitz baths and analgesics to
increase comfort
>care plan for a woman with cystitis  most
appropriate to include in the care plan
Encouraging voiding every 2-3 hours
URINARY CALCULI
>client with urolithiasis has a history of chronic
urinary tract infections (UTIs)  client most likely
has which of the following types urinary stones
Struvite
>severe left flank pain, nausea and vomiting 
tentative diagnosis of right ureterolithiasis 
PRIORITY nursing diagnosis:
Acute pain
ACTUAL BOARD QUESTION
with renal stones  skin and mucous membranes
are dry and her 24 hour intake and output record
reveal an oral intake of 900 ml and a urinary output
of 700 ml + urine is dark amber  nursing
diagnosis is:
Fluid volume deficit
ACTUAL BOARD QUESTION
>admitted to the hospital with a diagnosis of renal
calculi  experiencing severe flank pain, nauseated
and with a temperature of 39˚C  most immediate
goal of the nurse would be
Alleviate pain
ACTUAL BOARD QUESTION
>appropriate intervention for BL who has
ureterolithiasis
Administering opioid analgesics preferably
intravenously
ACTUAL BOARD QUESTION
>transfer from the postanesthesia care unit a client
who has had percutaneous ultrasonic lithotripsy for
calculi in the renal pelvis  will involve monitoring
which of the following
Nephrostomy tube
>composed of calcium oxalate  the nurse include
in the dietary instructions
Avoid green leafy vegetables, such as
spinach
>has a history of gout is also diagnosed with
urolithiasis  nurse gives the client instructions in
foods to limit, which include:
 Liver The nurse should:
Notify the physician
>benign prostatic hyperplasia (BPH)  presence of
which of the following early symptoms URINARY DIVERSION
Decreased force in the stream of urine >has an ileal conduit (ileal loop) following a
cystectomy for bladder cancer  Should teach the
>suspected of having hypertrophy of the prostate patient that the type of drainage expected from the
 expected symptom stoma is
Residual urine of more than 50ml Urine and mucous shreds

>follow-up home visit is conducted on an elderly
patient after recent hospitalization  instruction by
the nurse would most effectively address the
patient’s nocturia:
“Avoid liquids after 5 pm”
>include in the discharge plan for a patient who has
a transurethral resection of the prostate
Limit intake of caffeinated beverages (can
cause bladder spasm)
>appropriate patient outcome for a patient who has
a nursing diagnosis of altered urinary elimination
following creation of an ileal conduit
The patient monitors for skin irritation
>undergone surgery for creation of an ileal conduit
is scheduled for discharge  able to manage self-
care at home  nurse would assess the patient’s
ability to
Change the stoma appliance

>has a cold is seen in the emergency room with POLYCYSTIC KIDNEY DISEASE
inability to void  history of benign prostatic >polycystic kidney disease  the nurse will look for
hyperplasia (BPH)  medication use that should be which of the following as the most common
questioned manifestation of this disorder
Decongestants Flank pain and hematuria
>nurse observes the development of clots in the
continuous bladder irrigation tubing of a patient
who had a transurethral resection of the prostate FLUIDS AND ELECTROLYTES
(TURP) four hours ago  first action to take: RESPIRATORY ACIDOSIS
Increase the flow rate of the irrigation -COPD
solution. -Asthma
-Narcotics Overdose
>undergoing transurethral resection of the prostate
(TURP) on the first day after surgery, the client RESPIRATORY ALKALOSIS
reports bladder pain  the nurse should do first -Anxiety (hyperventilation)
Assess the irrigation catheter for patency -Fever
and drainage.
JUNE 2009
METABOLIC ACIDOSIS
>diagnosis of benign prostates hyperplasia, and a -Burns
transurethral resection of the prostate (TURP) is -Renal Failure
performed  assessment finding indicating the -Ileostomy
need to notify the physician -Diarrhea
Blood pressure of 100/50 mm Hg, pulse of -Excessive Increase Glucose (DKA)
130 beats per minutes -Shock

>following surgery for an enlarged prostate gland METABOLIC ALKALOSIS

 most appropriate nursing measure for a patient -Vomiting
who complains of pain during the immediate
-Suctioning
postoperative period
Checking the patency of the indwelling
-Cushing’s
urinary catheter
ELECTROLYTES IMBALANCE
>being treated for benign prostatic hypertrophy HYPOCALCEMIA
(BPH)  indicates that the treatment is having the -prolonged ST interval (DEC 2011)
desired effect -prolonged QT interval (DEC 2011)
Decreased urinary dribbling
HYPERCALCEMIA
BLADDER TRAUMA -shortened ST interval
>arrives at an emergency department with -widened T wave
complaints of low abdominal pain and hematuria 
Afebrile  assesses the client to determine a
history of:
HYPOKALEMIA
Blow or trauma to the bladder or abdomen -prominent U wave
-ST depression
>pain is referred to which of the following areas
Shoulder HYPERKALEMIA
-tall T wave
A female client is admitted to an emergency -widened QRS complex
department following a fall from a horse  insertion
of a Foley catheter  nurse note blood at the
urinary meatus while preparing for the procedure 