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Ana Corona, MSN, FNP-C Nursing Instructor July 2007
A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy
Answer C is correct. Autonomic neuropathy can cause inability to urinate.
A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? A: Decreased HR B: Paresthesias C: Muscle weakness of the extremities D: Migraines
Answer D is correct. Answer choices A-C were symptoms of acute hyperkalemia
Question 3 A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute? A: Vomiting B: Extreme Thirst C: Weight gain D: Acetone breath smell .
3 Answer C is correct. Weight loss would be expected .
even on warm days. Which of the following tests is most likely to be performed? A: CBC (complete blood count) B: ECG (electrocardiogram) C: Thyroid function tests D: CT scan . The patient also has the heater running in his house 24 hours a day.Question 4 A 84 year-old male has been loosing mobility and gaining weight over the last 2 months.
. Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function.4 Answer C is correct.
Question 5 A 28 year old male has been found wandering around in a confused pattern. Which of the following tests is most likely to be performed first? A: Blood sugar check B: CT scan C: Blood cultures D: Arterial blood gases . The male is sweaty and pale.
5 Answer A is correct. With a history of diabetes. the first response should be to check blood sugar levels. .
Measure the urinary output B. Check the vital signs C. and mental confusion. polydipsia. Weigh the client . The priority intervention for this client is: A. Encourage increased fluid intake D.Question 6 The client with a history of diabetes insipidus is admitted with polyuria.
making answer C incorrect. . Encouraging fluid intake will not correct the problem. Measuring the urinary output is important. The loss of electrolytes would be reflected in the vital signs.6 Answer B is correct. but the stem already says that the client has polyuria. so answer A is incorrect. Answer D is incorrect because weighing the client is not necessary at this time. The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected.
Temperature C. To prevent complications. Blood pressure B. Specific gravity .Question 7 A client has had a unilateral adrenalectomy to remove a tumor. Output D. the most important measurement in the immediate postoperative period for the nurse to take is: A.
answers B. The remaining gland might have been suppressed due to the tumor activity. Blood pressure is the best indicator of cardiovascular collapse in the client who has had an adrenal gland removed.7 Answer A is correct. decreased output would be a clinical manifestation but would take longer to occur than blood pressure changes. . and specific gravity changes occur with other disorders. therefore. and D are incorrect. Temperature would be an indicator of infection. C.
Question 8 A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. Intake/output measurements C. Glucometer readings as ordered B. Which of the following interventions would the nurse implement? A. Sodium and potassium levels monitored D. The client is receiving IV glucocorticoids (Solu-Medrol). Daily weights .
8 Answer A is correct. . C. therefore. Answer B is not necessary at this time. IV glucocorticoids raise the glucose levels and often require coverage with insulin. and daily weights is unnecessary. and D are incorrect. answers B. sodium and potassium levels would be monitored when the client is receiving mineral corticoids.
Obtain a crash cart B. Check the calcium level C. Assess the blood pressure for hypertension . Assess the dressing for drainage D. What would the nurses' next action be? A.Question 9 A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes.
. The tingling is due to low calcium levels. thus. answer A is incorrect. The parathyroid glands are responsible for calcium production and can be damaged during a thyroidectomy. The crash cart would be needed in respiratory distress but would not be the next action to take. so answers C and D are incorrect. Hypertension occurs in thyroid storm and the drainage would occur in hemorrhage.9 Answer B is correct.
there is a weight gain of 30 pounds in 4 months. Her pulse is 52. Impaired physical mobility related to decreased endurance B. Disturbed thought processes r/t interstitial edema D.Question 10 A 32-year-old mother of three is brought to the clinic. Hypothermia r/t decreased metabolic rate C. and the client is wearing two sweaters. Which of the following nursing diagnoses is of highest priority? A. Decreased cardiac output r/t bradycardia . The client is diagnosed with hypothyroidism.
therefore. . answers A. B. The decrease in pulse can affect the cardiac output and lead to shock.10 Answer D is correct. which would take precedence over the other choices. and C are incorrect.
Which statement indicates that the client knows when the peak action of the insulin occurs? A. "I can save my dessert from supper for a bedtime snack.Question 11 The physician has prescribed Novalog insulin for a client with diabetes mellitus." D. "I will need to carry candy or some form of sugar with me all the time. "I will make sure I eat breakfast within 10 minutes of taking my insulin." B." . "I will eat a snack around three o'clock each afternoon." C.
so it is incorrect. Answer D is incorrect because there is no need to save the dessert until bedtime.11 Answer A is correct. Answer B does not address a particular type of insulin. . It may not be 3 p. NPH insulin peaks in 8–12 hours. so a snack should be eaten at the expected peak time. as stated in answer C.m. Novalog insulin onsets very quickly. so food should be available within 10–15 minutes of taking the insulin.
Weight gain .Question 12 A 25-year-old client with Grave's disease is admitted to the unit. What would the nurse expect the admitting assessment to reveal? A. Bradycardia B. Exophthalmos D. Decreased appetite C.
and weight loss. The client with hyperthyroidism will often exhibit tachycardia. B. increased appetite. answers A. and D are incorrect. Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. therefore. .12 Answer C is correct.
There is no need to take thyroid medication because the fetus's thyroid produces a thyroid-stimulating hormone. D. Fetal growth is arrested if thyroid medication is continued during pregnancy. C. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. B.Question 13 A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism. . The nurse's response is based on the knowledge that: A.
Fetal growth is not arrested if thyroid medication is continued. Answer C is incorrect because the thyroid function does not slow.13 Answer B is correct. the thyroid gland triples in size. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. During pregnancy. so answer D is incorrect. This makes it more difficult to regulate thyroid medication. .
Administering an enema D. Increasing fluid intake B. Withholding food for 8 hours . Limiting ambulation C. Preparation for an ultrasound includes: A.Question 14 A client with diabetes has an order for ultrasonography.
Therefore. and there is no need to withhold food for 8 hours. the client should be taught to drink plenty of fluids and not void.14 Answer A is correct. The client may ambulate. an enema is not needed. C. . Before ultrasonography. answers B. and D are incorrect.
The client with hypertension being maintained on Lisinopril C. The client with diabetes with a blood glucose of 95mg/dL B.Question 15 The nurse should visit which of the following clients first? A. The client with chest pain and a history of angina D. The client with Raynaud's disease .
The client in answer A has a blood glucose within normal limits. The client in answer D is in no distress. . The client with chest pain should be seen first because this could indicate a myocardial infarction.15 Answer C is correct. The client in answer B is maintained on blood pressure medication.
"I will eat a snack around three o'clock each afternoon.Question 16 The physician has prescribed NPH insulin for a client with diabetes mellitus." B. "I can save my dessert from supper for a bedtime snack. Which statement indicates that the client knows when the peak action of the insulin occurs? A. "I will make sure I eat breakfast within 2 hours of taking my insulin." . "I will need to carry candy or some form of sugar with me all the time." D." C.
so answer A is incorrect.16 Answer C is correct. NPH insulin peaks in 8–12 hours. but the client should eat a bedtime snack. so a snack should be offered at that time. . NPH insulin onsets in 90–120 minutes. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect.
Question 17 The physician has ordered a thyroid scan to confirm the diagnosis. Tell the client he will be asleep D. Assess the client for allergies B. the nurse should: A. Bolus the client with IV fluid C. Before the procedure. Insert a urinary catheter .
so answers B. will not be asleep.17 Answer A is correct. and will not have a urinary catheter inserted. A thyroid scan uses a dye. so the client should be assessed for allergies to iodine. C. The client will not have a bolus of fluid. . and D are incorrect.
Infection requires close contact. The client should be placed in a room with negative pressure. Infection requires skin-to-skin contact and is prevented by hand washing. the door may remain open. and a gown. Transmission is highly likely. B. Which statement is true regarding precautions for infections spread by contact? A.Question 18 A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. gloves. C. . so the client should wear a mask at all times. therefore. D.
so answer C is incorrect. The door should remain closed. Gloves. the nurse should wear the mask. It is not necessary for the client to wear the mask at all times. It is cultured from the nasal passages of the client. but a negative-pressure room is not necessary. so the client should be instructed to cover his nose and mouth when he sneezes or coughs. The client with MRSA should be placed in isolation. MRSA is spread by contact with blood or body fluid or by touching the skin of the client.18 Answer D is correct. a gown. so answers A and B are incorrect. . and a mask should be used when caring for the client and hand washing is very important.
Question 19 The client has recently returned from having a thyroidectomy. A tracheotomy set B. An endotracheal tube D. The nurse should keep which of the following at the bedside? A. An airway . A padded tongue blade C.
. The client who has recently had a thyroidectomy is at risk for tracheal edema. the endotracheal tube or airway will not correct the problem. A padded tongue blade is used for seizures and not for the client with tracheal edema. If the client experiences tracheal edema. so answers C and D are incorrect. so answer B is incorrect.19 Answer A is correct.
" An I. When questioned. she tells you that She has been on a high-protein diet for "about 6 weeks.5 mg/dl. line is started and blood is drawn for laboratory studies. Her serum calcium level is 5.Situation: A 17-year-old female model comes to your ER complaining of generalized cramps and numbness in her fingers. . Medical history is noncontributory.V.
Applying a (BP) cuff to the upper arm. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory alkalosis. . Chvostek's sign is elicited by: A.Question 20 In assessing this patient for hypocalcemia. B. D. C. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on same side as stimulation. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on side opposite stimulation. and observing for carpopedal spasm. inflating it.
Tapping over a branch of the facial nerve and observing for twitching of the upper lip on the ipsilateral (same) side as stimulation is considered a positive Chvostek's sign. .20 Answer C is correct. A decrease in ionized calcium causes an increase in neuromuscular excitability. Inflating a BP cuff on the upper arm or having the patient hyperventilate will both produce carpopedal spasm and are part of the diagnostic tests used to elicit Trousseau's sign.
. Tapping a finger on the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as stimulation. C. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory acidosis. inflating it.Question 21 Trousseau's sign can be elicited in the hypocalcemic patient by: A. D. B. and observing for carpopedal spasm. Applying a BP cuff to upper arm. Tapping a finger on the supramandibular portion of the parotid cland and observing for twitching of the upper lip on the side opposite to the stimulation.
in which the alkalotic state decreases serum calcium levels. inflating to the patient's systolic pressure. Trousseau's sign is elicited by applying a BP cuff to the patient's arm. . and observing for carpopedal spasm.21 Answer A is correct. Another method for producing this phenomenon is hyperventilation.
On physical examination. 12 breaths/minute. Question next slide . Her BP is 110/74 mm Hg. pulse.) rectally. Her daughter relates a history of "thyroid problem" and noncompliance with medical therapy. 48 beats/minute. The diagnosis of myxedema is made. respirations. (36 degrees C. periorbital edema is present. her temperature is 96. and a yellowish skin pigmentation is noted.Situation: A 71-year-old woman is transported to the ED because of fatigue and a change in mental status.8 degrees F.
Hyperglycemia D.Question 22 The patient admitted with hypothyroid crisis (myxedema coma) would most likely have which of the following electrolyte abnormalities? A. Hypocalcemia . Hyponatremia B. Hypernatremia C.
Also. the hyponatremia is caused by dilution. This usually is a result of inappropriate secretion of antidiuretic hormone (ADH).22 Answer A is correct. owing to the hypometabolic state. Therefore. . Patients with myxedema coma suffer from hyponatremia. Hypoglycemia is also seen in myxedema coma. the myxedematous state results from the interstitial accumulation of a mucopolysaccharide substance that attracts water and produces water retention.
Question 23 Which of the following acid-base imbalances is most likely to occur in this patient? A. Respiratory acidosis B. Metabolic alkalosis D. Respiratory alkalosis without compensation C. Respiratory alkalosis with compensation .
thereby causing hypoventilation. Thus. metabolic acidosis may develop as hypoxia increases serum lactate levels. Respiratory acidosis and CO2 narcosis are a result of lowered thyroxine (T4) and Triiodothyronine (T3) levels.23 Answer A is correct. . These hormones increase metabolic functions. a decrease in T3 and T4 levels depresses respiratory function. In addition. such as respiration.
After the patient eats B. Into the subcutaneous tissue .Question 24 Parental injections of cortisol for patients with addison’s disease should be injected: A. Deep into the deltoid C. Deep into the gluteal muscle D.
24 Answer C is correct. the nurse should inject them deep into the gluteal muscle. not IM injections. Steroid therapy causes GI disturbances with oral administration. Cortisol should not be injected subC because it may cause sterile abscess. Because sufficient muscle mass is necessary or acute injection of parental cortisol preparations. The patient does not have to have food in the stomach before administration. . tissue atrophy and pigmentation abnormalities.
Tolbutamide (Orinase) C. Diazoxide (Hyperstat) .Question 25 Which medication is not an oral hypoglycemic agent? A. Glypizide (Glucotrol) B. Chlorpropamide (diabinese) D.
It is used to treat hypoglycemia by excessive insulin productions. Diazoxide (Hystat) are hypoglycemia agents. Hyperstat is a benzothiadiazide that causes hyperglycemia by inhibiting insulin secretions. (sulfonyrlueas) .25 Answer D is correct.Tolbutamide (Orinase). Glypizide (Glucotrol). Chlorpropamide (diabinese).
80 B. 200 . 160 D. the nurse recognizes that a fasting glucose value of ________________ is within normal limits. A. 120 C.Question 26 While reviewing a clients lab results.
26 Answer A is correct. Normal fasting blood sugar is 70-99 .
D. . Ask the coworker how long the client was unconscious. Assess the client for head trauma. B. Check the client's blood sugar level and start an IV infusion. who found him unconscious on the floor. A nurse would first: A.Question 27 A diabetic client is admitted to the ER by a coworker. Contact the client's family and tell them to come to the hospital immediately. C.
It is priority to assess the client's blood sugar level.27 Answer A is correct. . A low blood sugar level is life threatening & must be corrected immediately.