ENDOCRINE AND METABOLIC DISEASES1 .A client is admitted to the medical intensive care unit with a diagnosis of pancreatitis. Which nursing intervention is most appropriate? 1. Providing generous servings at mealtime 2. Reserving an antecubital site for a peripherally inserted central catheter (PICC) 3. Providing the client with plenty of P.O. fluids 4. Limiting I.V. fluid intake according to the physician's order Correct Answer: 2 Your Answer: 3 RATIONALES: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

2 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 frequently in women over 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.

3 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 thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

4. 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 assessment findings, the nurse would suspect which disorder? 1. Diabetes mellitus 2. Diabetes insipidus 3. Hypoparathyroidism 4. Hyperparathyroidism Correct Answer: 4 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 hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

5. When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. fresh fruits. 2. dairy products. 3. processed meats. 4. cereals and grains. Correct Answer: 1 Your Answer: 1 RATIONALES: Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

6. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience: 1. heat intolerance and systolic hypertension. 2. weight gain and heat intolerance. 3. diastolic hypertension and widened pulse pressure. 4. anorexia and hyperexcitability. Correct Answer: 1 Your Answer: 4 RATIONALES: An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss not gain occurs due to the increased metabolic rate. Diastolic blood pressure decreases due to decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite not anorexia.

7. A client is seen in the clinic with a possible parathormone deficiency. Diagnosis of this condition includes the analysis of serum electrolytes. Which electrolytes would the nurse expect to be abnormal? 1. Sodium 2. Potassium 3. Calcium 4. Chloride 5. Glucose 6. Phosphorous Correct Answer: 3,6 Your Answer: 3,6 RATIONALES: A client with a parathormone deficiency has abnormal calcium and phosphorous values because parathormone regulates these two electrolytes. Potassium, chloride, sodium, and glucose aren't affected by a parathormone deficiency.

8. Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium reabsorption and phosphate excretion 2. Stimulation of phosphate reabsorption and calcium excretion 3. Increased absorption of vitamin D and excretion of vitamin E 4. Increased absorption of vitamin E and excretion of vitamin D Correct Answer: 1 Your Answer: 1 RATIONALES: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

9. A 71-year-old client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding would the nurse expect in this client? 1. Arterial pH 7.25 2. Plasma bicarbonate 12 mEq/L 3. Blood glucose level 1,300 mg/dl 4. Blood urea nitrogen 15 mg/dl Correct Answer: 3 Your Answer: 3 RATIONALES: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most frequently in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially the client produces large quantities of urine, if fluid intake isn't increased at this time the client becomes dehydrated causing blood urea nitrogen levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

10 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 frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

11. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client? 1. "Take the drug on an empty stomach." 2. "Take the drug with meals." 3. "Take the drug in the evening." 4. "Take the drug whenever convenient." Correct Answer: 1 Your Answer: 1 RATIONALES: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release). 12. The nurse explains to a client with thyroid disease that the thyroid gland normally produces: 1. iodine and thyroid-stimulating hormone (TSH). 2. thyrotropin-releasing hormone (TRH) and TSH. 3. TSH, T3, and calcitonin. 4. T3, T4, and calcitonin. Correct Answer: 4 Your Answer: 4 RATIONALES: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. TSH is produced by the pituitary gland to regulate the thyroid gland. TRH is produced by the hypothalamus gland to regulate the pituitary gland.

13. A 56-year-old female client is being discharged after undergoing a thyroidectomy. Which discharge instructions would be appropriate for this client? 1. "Report 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, and report these changes to the physician." 4. "Recognize the signs of dehydration." 5. "Carry injectable dexamethasone at all times." Correct Answer: 2,3 Your Answer: 2,3,5 RATIONALES: After the removal of the thyroid gland, the client needs to take thyroid replacement medication. The client also needs to report such changes as lethargy, restlessness, cold sensitivity, and dry skin, which may indicate the need for a higher dosage of medication. The thyroid gland doesn't regulate blood glucose levels; therefore, signs and symptoms of hypoglycemia aren't relevant for this client. Dehydration is seen in diabetes insipidus. Injectable dexamethasone isn't needed for this client.

14. A client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse would be most accurate in stating: 1. "The test needs to be repeated following a 12-hour fast." 2. "It looks like you aren't following the prescribed diabetic diet." 3. "It tells us about your sugar control for the last 3 months." 4. "Your insulin regimen needs to be altered significantly." Correct Answer: 3 Your Answer: 3 RATIONALES: The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

15. Because diet and exercise have failed to control a 63-year-old client's blood glucose level, the client is prescribed glipizide (Glucotrol). After oral administration, the onset of action is: 1. 15 to 30 minutes 2. 30 to 60 minutes 3. 1 to 1 hours 4. 2 to 3 hours Correct Answer: 1 Your Answer: 1 RATIONALES: Glipizide begins to act in 15 to 30 minutes. The other options are incorrect.

16. A 55-year-old diabetic client is admitted with hypoglycemia. Which information should the nurse include in her client teaching? 1. "Hypoglycemia can result from excessive alcohol consumption." 2. "Skipping meals can cause hypoglycemia." 3. "Symptoms of hypoglycemia include thirst and excessive urinary output." 4. "Strenuous activity may result in hypoglycemia." 5. "Symptoms of hypoglycemia include shakiness, confusion, and headache." 6. "Hypoglycemia is a relatively harmless situation." Correct Answer: 1,2,4,5 Your Answer: 1,2,4 RATIONALES: Alcohol consumption, missed meals, and strenuous activity may lead to hypoglycemia. Symptoms of hypoglycemia include shakiness, confusion, headache, sweating, and tingling sensations around the mouth. Thirst and excessive urination are symptoms of hyperglycemia. Hypoglycemia can become a life-threatening disorder involving seizures and death to brain cells; the client shouldn't be told that the condition is relatively harmless.

17. The nurse is teaching a client with type 1 diabetes mellitus 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. Epinephrine 2. 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, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

18. A 71-year-old client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding would the nurse expect in this client? 1. Arterial pH 7.25 2. Plasma bicarbonate 12 mEq/L 3. Blood glucose level 1,300 mg/dl 4. Blood urea nitrogen 15 mg/dl Correct Answer: 3 Your Answer: 3 RATIONALES: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most frequently in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially the client produces large quantities of urine, if fluid intake isn't increased at this time the client becomes dehydrated causing blood urea nitrogen levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

19. A client with diabetes mellitus has a prescription for 5 U of U-100 regular insulin and 25 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? 1. Hyperglycemia 2. Hypoglycemia 3. Hyperuricemia 4. Hypochondria Correct Answer: 2 Your Answer: 2 RATIONALES: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in contrast, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. Hyperuricemia refers to an abnormally large amount of uric acid in the blood. Hypochondria is abnormal anxiety about one's health, with a false belief that one has a disease.

20. 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 more common in Hispanics and Blacks than in Whites. 3. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. 4. Approximately one-half of the clients diagnosed with type 2 are obese. Correct Answer: 2 Your Answer: 2 RATIONALES: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.

21. Which condition would the nurse expect to find in a client diagnosed with hyperparathyroidism? 1. Hypocalcemia 2. Hypercalcemia 3. Hyperphosphatemia 4. Hypophosphaturia Correct Answer: 2 Your Answer: 2 RATIONALES: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased. 22. A client becomes upset when the physician diagnoses diabetes mellitus as the cause of current signs and symptoms. The client tells the nurse, "This must be a mistake. No one in my family has ever had diabetes." Based on this statement, the nurse suspects the client is using which coping mechanism?

1. Denial 2. Withdrawal 3. Anger 4. Resolution Correct Answer: 1 Your Answer: 1 RATIONALES: Initially, many clients use denial to cope with unpleasant or shocking news, such as a diagnosis of diabetes mellitus. Although withdrawal, anger, and resolution also are coping mechanisms, they surface later in the readjustment period, after the client realizes the information is correct. 23. The physician diagnoses type 1 diabetes mellitus in a client who has classic manifestations of the disease and a random blood glucose level of 350 mg/dl. In addition to dietary modifications, the physician prescribes insulin. Initially, most clients receive the least antigenic form of insulin. Therefore, the nurse expects the physician to prescribe: 1. beef insulin. 2. fish inulin. 3. human insulin. 4. pork insulin. Correct Answer: 3 Your Answer: 3 RATIONALES: Human insulin is the least antigenic form of insulin because its composition is identical to that of endogenous insulin. Animal insulins, such as beef, fish, and pork insulins, differ in composition from endogenous insulin and are therefore more antigenic.

24. Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia as indicated by: 1. muscle weakness. 2. tremors. 3. diaphoresis. 4. constipation.

Correct Answer: 1 Your Answer: 1 RATIONALES: Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

25. 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 assessment findings, the nurse would suspect which disorder? 1. Diabetes mellitus 2. Diabetes insipidus 3. Hypoparathyroidism 4. Hyperparathyroidism Correct Answer: 4 Your Answer: 3 RATIONALES: Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

26. A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: 1. Risk for imbalanced fluid volume related to excessive sodium loss. 2. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. 3. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. 4. Decreased cardiac output related to hypotension secondary to Cushing's syndrome. Correct Answer: 2 Your Answer: 2 RATIONALES: Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

27. The nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings should the nurse expect to note during the assessment? 1. Extreme polyuria 2. Excessive thirst 3. Elevated systolic blood pressure 4. Low urine specific gravity 5. Bradycardia 6. Elevated serum potassium level Correct Answer: 1,2,4 Your Answer: 1,2,4 RATIONALES: Signs and symptoms of diabetes insipidus include an abrupt onset of extreme polyuria, excessive thirst, dry skin and mucous membranes, tachycardia, and hypotension. Diagnostic studies reveal low urine specific gravity and osmolarity and elevated serum sodium. Serum potassium levels are likely to be decreased, not increased.

28. A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan? 1. Maintenance of blood glucose levels between 180 and 200 mg/dl 2. Smoking reduction but not complete cessation 3. An eye examination every 2 years until age 50 4. Exercise and a weight reduction diet Correct Answer: 4 Your Answer: 4 RATIONALES: Type 2 diabetes is often obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.

29. A client with type 1 diabetes mellitus has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse would be accurate in telling him the regimen includes the use of: 1. intermediate- and long-acting insulins. 2. short- and long-acting insulins. 3. short-acting insulin only. 4. short- and intermediate-acting insulins.

Correct Answer: 3 Your Answer: 1 RATIONALES: Continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate- or long-acting insulins.

30. A client with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? 1. "Inject insulin into healthy tissue with large blood vessels and nerves." 2. "Rotate injection sites within the same anatomic region, not among different regions." 3. "Administer insulin into areas of scar tissue or hypotrophy whenever possible." 4. "Administer insulin into sites above muscles that you plan to exercise heavily later that day." Correct Answer: 2 Your Answer: 2 RATIONALES: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily. 31. An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1. 2 to 5 g of a simple carbohydrate. 2. 10 to 15 g of a simple carbohydrate. 3. 18 to 20 g of a simple carbohydrate. 4. 25 to 30 g of a simple carbohydrate. Correct Answer: 2 Your Answer: 2 RATIONALES: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

32. When caring for a client with a history of hypoglycemia, the nurse should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? 1. sulfisoxazole (Gantrisin) 2. mexiletine (Mexitil) 3. prednisone (Orasone) 4. lithium carbonate (Lithobid) Correct Answer: 1 Your Answer: 1 RATIONALES: Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

33. A 20-year-old client comes to the clinic because she has experienced a weight loss of 20 lb over the last month, even though her appetite has been "ravenous" and she hasn't changed her activity level. She's diagnosed with Graves' disease. Which other signs and symptoms support the diagnosis of Graves' disease? 1. Rapid, bounding pulse 2. Bradycardia 3. Heat intolerance 4. Mild tremors 5. Nervousness 6. Constipation Correct Answer: 1,3,4,5 Your Answer: 1,3,4,5 RATIONALES: Graves' disease, or hyperthyroidism, is a hypermetabolic state that's associated with rapid, bounding pulses; heat intolerance; tremors; and nervousness. Bradycardia and constipation are signs and symptoms of hypothyroidism.

34. 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. Constipation 2. Menstrual irregularities 3. Hypokalemia 4. Hypernatremia Correct Answer: 2 Your Answer: 3 RATIONALES: Spironolactone can cause menstrual irregularities and decreased libido. Men may also experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spirolactone.

35. A client is being treated for hypothyroidism. The nurse knows that thyroid replacement therapy has been inadequate when she notes which findings? 1. Prolonged QT interval on electrocardiogram 2. Tachycardia 3. Low body temperature 4. Nervousness 5. Bradycardia 6. Dry mouth Correct Answer: 1,3,5 Your Answer: 1,3,5 RATIONALES: In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.

36. The nurse is caring for a client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: 1. I.M. or subcutaneous glucagon. 2. I.V. bolus of dextrose 50%. 3. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 4. 10 U 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.

37. 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/min; 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: 1 RATIONALES: A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and fluid volume deficit. In this client, tachycardia is more likely to result from a fluid volume deficit than from decreased cardiac output because the 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, eliminating Ineffective thermoregulation as the top priority.

38. The physician prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? 1. "Be sure to take glipizide 30 minutes before meals." 2. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." 3. "You won't need to check your blood glucose level after you start taking glipizide." 4. "Take glipizide after a meal to prevent heartburn." Correct Answer: 1 Your Answer: 1 RATIONALES: The client should take glipizide twice per day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor blood glucose levels during glipizide therapy.

39. Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? 1. Confusion and seizures 2. 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, and tetany are unrelated to water intoxication.

40. The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: 1. hypotension. 2. thick, coarse skin. 3. deposits of adipose tissue in the trunk and dorsocervical area. 4. weight gain in arms and legs. Correct Answer: 3 Your Answer: 3 RATIONALES: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

41. A 55-year-old diabetic client is admitted with hypoglycemia. Which information should the nurse include in her client teaching? 1. "Hypoglycemia can result from excessive alcohol consumption." 2. "Skipping meals can cause hypoglycemia." 3. "Symptoms of hypoglycemia include thirst and excessive urinary output." 4. "Strenuous activity may result in hypoglycemia." 5. "Symptoms of hypoglycemia include shakiness, confusion, and headache." 6. "Hypoglycemia is a relatively harmless situation." Correct Answer: 1,2,4,5 Your Answer: 1,2,4,5 RATIONALES: Alcohol consumption, missed meals, and strenuous activity may lead to hypoglycemia. Symptoms of hypoglycemia include shakiness, confusion, headache, sweating, and tingling sensations around the mouth. Thirst and excessive urination are symptoms of hyperglycemia. Hypoglycemia can become a life-threatening disorder involving seizures and death to brain cells; the client shouldn't be told that the condition is relatively harmless.

42.The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: 1. exophthalmos and conjunctival redness 2. flushed, warm, moist skin 3. systolic murmur at the left sternal border 4. decreased body temperature and cold intolerance Correct Answer: 4 Your Answer: 4 RATIONALES: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. The other options are typical findings in a client with hyperthyroidism.

43. A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which nursing diagnosis is most appropriate for this client? 1. Deficient fluid volume related to inability to conserve water 2. Imbalanced nutrition: Less than body requirements related to hypermetabolic state 3. Deficient fluid volume related to osmotic diuresis induced by hypernatremia 4. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency Correct Answer: 3 Your Answer: 4 RATIONALES: The client has signs and symptoms of diabetes insipidus, probably caused by the failure of her renal tubules to respond to antidiuretic hormone as a consequence of pyelonephritis. The hypernatremia is secondary to her water loss. Imbalanced nutrition related to hypermetabolic state or catabolic effect of insulin deficiency is an inappropriate nursing diagnosis for the client.

44. The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone that's lacking in clients with diabetes insipidus? 1. Antidiuretic hormone (ADH) 2. Thyroid-stimulating hormone (TSH) 3. Follicle-stimulating hormone (FSH) 4. Luteinizing hormone (LH) Correct Answer: 1 Your Answer: 1 RATIONALES: ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

45. A client with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? 1. "Inject insulin into healthy tissue with large blood vessels and nerves." 2. "Rotate injection sites within the same anatomic region, not among different regions." 3. "Administer insulin into areas of scar tissue or hypotrophy whenever possible." 4. "Administer insulin into sites above muscles that you plan to exercise heavily later that day." Correct Answer: 2 Your Answer: 2 RATIONALES: The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

46. The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? 1. methimazole (Tapazole) 2. thyroid USP desiccated (Thyroid USP Enseals) 3. liothyronine (Cytomel) 4. levothyroxine (Synthroid) Correct Answer: 4 Your Answer: 4 RATIONALES: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content gives it predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

47. 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 g/day, initially. 2. 100 g/day, initially. 3. delayed until after thyroid surgery. 4. initiated before thyroid surgery. Correct Answer: 1 Your Answer: 1 RATIONALES: Elderly clients and clients with cardiac disease should begin with low-dose levothyroxine increased at 2- to 4-week intervals until 100 g/day is reached. This slow titration prevents further cardiac stress. Younger clients would be started on the usual maintenance dose of 100 g/day. Clients with Hashimoto's thyroiditis don't require surgical intervention.

48. Because diet and exercise have failed to control a 63-year-old client's blood glucose level, the client is prescribed glipizide (Glucotrol). After oral administration, the onset of action is: 1. 15 to 30 minutes 2. 30 to 60 minutes 3. 1 to 1 hours 4. 2 to 3 hours Correct Answer: 1 Your Answer: 1 RATIONALES: Glipizide begins to act in 15 to 30 minutes. The other options are incorrect.

49. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: 1. sodium. 2. potassium. 3. magnesium. 4. phosphorus. Correct Answer: 4 Your Answer: 4 RATIONALES: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

50. The nurse is explaining the action of insulin to a newly diagnosed diabetic client. During the teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the: 1. adenohypophysis. 2. beta cells of the pancreas. 3. alpha cells of the pancreas. 4. parafollicular cells of the thyroid. Correct Answer: 2 Your Answer: 2 RATIONALES: The beta cells of the pancreas secrete insulin. The adenohypophysis or anterior pituitary gland secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.

51. When teaching a client about insulin administration, the nurse should include which instruction? 1. "Take insulin after the first meal of the day." 2. "Inject insulin at a 45-degree angle into the deltoid muscle." 3. "Shake the insulin vial vigorously before withdrawing the medication." 4. "Draw up clear insulin first when mixing two types of insulin in one syringe." Correct Answer: 4 Your Answer: 4 RATIONALES: When mixing two types of insulin, the client should draw clear (regular) insulin into the syringe first. The daily insulin dose typically is administered before the first meal of the day and is injected into fatty tissue at a 90-degree angle. If cloudy (NPH or Humulin N) insulin must be administered, the client should roll the vial between the palms gently before withdrawing the medication.

52. A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: 1. Trousseau's sign. 2. Homans' sign. 3. Hegar's sign. 4. Goodell's sign. Correct Answer: 1 Your Answer: 1 RATIONALES: This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

53. A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty". Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hr radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: 1. thyroiditis. 2. Graves' disease. 3. Hashimoto's thyroiditis. 4. multinodular goiter. Correct Answer: 2 Your Answer: 2 RATIONALES: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-age females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, there is a low (2%) radioactive iodine uptake, and multinodular goiter will show an uptake in the high-normal range (3% to 10%).

54. For a client with Graves' disease, which nursing intervention promotes comfort? 1. Restricting intake of oral fluids 2. Placing extra blankets on the client's bed 3. Limiting intake of high-carbohydrate foods 4. Maintaining room temperature in the low-normal range Correct Answer: 4 Your Answer: 4 RATIONALES: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

55. 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.

56. A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, PaCO2 of 43 mm Hg, PaO2 of 75 mm Hg, and HCO3 of 42 mEq/L. Based on these findings, the nurse documents that the patient is experiencing which type of acid-base imbalance? 1. Respiratory alkalosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Metabolic acidosis Correct Answer: 4 Your Answer: 1 RATIONALES: A pH over 7.45 with a bicarbonate level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base bicarbonate. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

57. A client, age 23, is diagnosed with diabetes mellitus. The physician prescribes 15 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use? 1. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial, withdraw 15 U regular insulin; withdraw 35 U NPH. 2. Inject 15 U air into regular insulin vial; inject 35 U air into NPH vial, withdraw 35 U of NPH; withdraw 15 U regular insulin. 3. Inject 15 U air into regular insulin vial, withdraw 15 units of regular insulin; inject 35 U air into NPH vial and withdraw 35 U NPH. 4. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial; withdraw 35 U NPH; withdraw 15 U regular insulin. Correct Answer: 1 Your Answer: 2 RATIONALES: To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. Follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 U of regular insulin in the syringe, carefully withdraw 35 U of NPH, for a total of 50 U in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.

58. During the first 24 hours after a client is diagnosed with Addisonian crisis, which intervention should the nurse perform frequently? 1. Weigh the client. 2. Test urine for ketones. 3. Assess vital signs. 4. Administer oral hydrocortisone. Correct Answer: 3 Your Answer: 3 RATIONALES: Because the client in Addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

59. The nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare to absorption at other sites? 1. Insulin is absorbed more slowly at abdominal injection sites than at other sites. 2. Insulin is absorbed rapidly regardless of the injection site. 3. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. 4. Insulin is absorbed unpredictably at all injection sites. Correct Answer: 3 Your Answer: 3 RATIONALES: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection of the buttocks is less predictable.

60. The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? 1. Risk for infection 2. Decreased cardiac output 3. Impaired physical mobility 4. Imbalanced nutrition: Less than body requirements Correct Answer: 2 Your Answer: 2 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 for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility is also an appropriate nursing diagnosis for the client with Addison's disease, but it isn't a priority in a crisis. Imbalanced nutrition: Less than body requirements is also an important nursing diagnosis for the client with Addison's disease but not a priority during a crisis.

61. The nurse is teaching the client about glipizide (Glucotrol) therapy. The nurse warns the client that glipizide commonly causes hypoglycemia when combined with which over-the-counter preparation? 1. acetaminophen (Tylenol) 2. aspirin 3. St. Johns Wort 4. multivitamins Correct Answer: 2 Your Answer: 2 RATIONALES: When taken in combination with aspirin, glipizide commonly causes hypoglycemia. Acetaminophen, St. John's Wort, and multivitamins may be taken with glipizide without increasing the risk of hypoglycemia.

62. 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. in a few days. 2. in 3 to 4 months. 3. immediately. 4. in 1 to 2 weeks. Correct Answer: 4 Your Answer: 2 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.

63. A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? 1. Infusing I.V. fluids rapidly as ordered 2. Encouraging increased oral intake 3. Restricting fluids 4. Administering glucose-containing I.V. fluids as ordered Correct Answer: 3 Your Answer: 1 RATIONALES: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

64. 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 does not comply with the recommended treatment, which complication may arise? 1. Cerebral edema 2. Hypovolemic shock 3. Severe hyperkalemia 4. Tetany

Correct Answer: 1 Your Answer: 2 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 for cerebral edema. Hypovolemic shock results from, severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH.

65. 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. an inborn error of metabolism. Correct Answer: 3 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.

66. A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. Her family reports that she has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? 1. Inserting a feeding tube and providing tube feedings 2. Administering a 500-ml bolus of normal saline solution 3. Administering 1 ampule of 50% dextrose solution, per physician's order 4. Observing the client for 1 hour, then rechecking the fingerstick glucose level Correct Answer: 3 Your Answer: 3 RATIONALES: The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing her at risk for irreversible brain damage.

67. A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by: 1. testing for ketones in the urine. 2. testing urine specific gravity. 3. checking temperature every 4 hours. 4. performing capillary glucose testing every 4 hours. Correct Answer: 4 Your Answer: 2 RATIONALES: The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia. Urine ketone testing isn't indicated because the client does secrete insulin and, therefore, isn't at risk for ketosis. Urine specific gravity isn't indicated because although fluid balance can be compromised, it usually isn't dangerously imbalanced. Temperature regulation may be affected by excess cortisol and isn't an accurate indicator of infection.

68. A 46-year-old client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? 1. Sweating, tremors, and tachycardia 2. Dry skin, bradycardia, and somnolence 3. Bradycardia, thirst, and anxiety 4. Polyuria, polydipsia, and polyphagia Correct Answer: 1 Your Answer: 1 RATIONALES: Sweating, tremors, and tachycardia are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. In option 3, thirst and anxiety are signs of hypoglycemia, but not bradycardia. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

69. A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? 1. "Administer desmopressin while the suspension is cold." 2. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." 3. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." 4. "You won't need to monitor your fluid intake and output after you start taking desmopressin." Correct Answer: 3 Your Answer: 3 RATIONALES: Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement.

70. Which of the following laboratory test results would suggest to the nurse that a client has a corticotropin-secreting pituitary adenoma? 1. High corticotropin and low cortisol levels 2. Low corticotropin and high cortisol levels 3. High corticotropin and high cortisol levels 4. Low corticotropin and low cortisol levels Correct Answer: 3 Your Answer: 3 RATIONALES: A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels. A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level would be associated with hypocortisolism. Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.

71. The nurse explains to a client with thyroid disease that the thyroid gland normally produces:

1. iodine and thyroid-stimulating hormone (TSH). 2. thyrotropin-releasing hormone (TRH) and TSH. 3. TSH, T3, and calcitonin. 4. T3, T4, and calcitonin. Correct Answer: 4 Your Answer: 4 RATIONALES: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. TSH is produced by the pituitary gland to regulate the thyroid gland. TRH is produced by the hypothalamus gland to regulate the pituitary gland.

72. The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone that's lacking in clients with diabetes insipidus? 1. Antidiuretic hormone (ADH) 2. Thyroid-stimulating hormone (TSH) 3. Follicle-stimulating hormone (FSH) 4. Luteinizing hormone (LH) Correct Answer: 1 Your Answer: 1 RATIONALES: ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

73. Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for which condition? 1. Hypocortisolism 2. Hypoglycemia 3. Hyperglycemia 4. Hypercalcemia Correct Answer: 1 Your Answer: 3 RATIONALES: The nurse should assess for hypocortisolism. Abrupt withdrawal of endogenous cortisol may lead to severe adrenal insufficiency. Steroids should be given during surgery to prevent hypocortisolism from occurring. Signs of hypocortisolism include vomiting, increased weakness, dehydration and hypotension. After the corticotropin-secreting tumor is removed, the client shouldn't be at risk for hyperglycemia. Calcium imbalance shouldn't occur in this situation.

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

1. 9 U regular insulin and 21 U neutral protamine Hagedorn (NPH). 2. 21 U regular insulin and 9 U NPH. 3. 10 U regular insulin and 20 U NPH. 4. 20 U regular insulin and 10 U NPH. Correct Answer: 1 Your Answer: 2 RATIONALES: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 U of NPH and 9 U of regular insulin. The other choices are incorrect dosages for the prescribed insulin.

75. The adrenal cortex is responsible for producing which substances?

1. Glucocorticoids and androgens 2. Catecholamines and epinephrine 3. Mineralocorticoids and catecholamines 4. Norepinephrine and epinephrine Correct Answer: 1 Your Answer: 3 RATIONALES: The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines epinephrine and norepinephrine.

76. The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? 1. Tetany 2. Hemorrhage 3. Thyroid storm 4. Laryngeal nerve damage Correct Answer: 1 Your Answer: 1 RATIONALES: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

77. 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: 4 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.

78. A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which of the following statements indicates that the client understands her condition and how to control it? 1. "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." 2. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." 3. "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." 4. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates." Correct Answer: 1 Your Answer: 1 RATIONALES: Inadequate fluid intake during hyperglycemic episodes often leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of nondiet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.

79. A 46-year-old client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? 1. Sweating, tremors, and tachycardia 2. Dry skin, bradycardia, and somnolence 3. Bradycardia, thirst, and anxiety 4. Polyuria, polydipsia, and polyphagia Correct Answer: 1 Your Answer: 3 RATIONALES: Sweating, tremors, and tachycardia are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. In option 3, thirst and anxiety are signs of hypoglycemia, but not bradycardia. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

80.Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia Correct Answer: 1 Your Answer: 4 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 include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

81. Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium reabsorption and phosphate excretion 2. Stimulation of phosphate reabsorption and calcium excretion 3. Increased absorption of vitamin D and excretion of vitamin E 4. Increased absorption of vitamin E and excretion of vitamin D Correct Answer: 1 Your Answer: 1 RATIONALES: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

82. A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? 1. Dysuria 2. Leg cramps 3. Tachycardia 4. Blurred vision Correct Answer: 3 Your Answer: 3 RATIONALES: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. The other options aren't associated with levothyroxine.

83. A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer a complex carbohydrate snack to her as soon as possible? 1. To decrease the possibility of nausea and vomiting 2. To restore liver glycogen and prevent secondary hypoglycemia 3. To stimulate her appetite 4. To decrease the amount of glycogen in her system Correct Answer: 2 Your Answer: 2 RATIONALES: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system.

84. A 55-year-old diabetic client is admitted with hypoglycemia. Which information should the nurse include in her client teaching? 1. "Hypoglycemia can result from excessive alcohol consumption." 2. "Skipping meals can cause hypoglycemia." 3. "Symptoms of hypoglycemia include thirst and excessive urinary output." 4. "Strenuous activity may result in hypoglycemia." 5. "Symptoms of hypoglycemia include shakiness, confusion, and headache." 6. "Hypoglycemia is a relatively harmless situation." Correct Answer: 1,2,4,5 Your Answer: 1,2,4,5 RATIONALES: Alcohol consumption, missed meals, and strenuous activity may lead to hypoglycemia. Symptoms of hypoglycemia include shakiness, confusion, headache, sweating, and tingling sensations around the mouth. Thirst and excessive urination are symptoms of hyperglycemia. Hypoglycemia can become a life-threatening disorder involving seizures and death to brain cells; the client shouldn't be told that the condition is relatively harmless.

85. The physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test 2. A decreased TSH level 3. An increase in the TSH level after 30 minutes during the TSH stimulation test 4. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay Correct Answer: 1 Your Answer: 1 RATIONALES: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.

86. The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? 1. Ungloving the hands when removing the test strip 2. Smearing the drop of blood onto the reagent pad 3. Calibrating the machine after installing a new battery 4. Starting 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 whenever a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing. The nurse should drop the blood not smear it on the reagent pad because smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer before the blood sample is collected.

87. 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 less 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.

88. Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 1. 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin 2. 70 units of regular insulin and 30 units of NPH insulin 3. 70% NPH insulin and 30% regular insulin 4. 70% regular insulin and 30% NPH insulin Correct Answer: 3 Your Answer: 1 RATIONALES: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.

89. A 20-year-old client comes to the clinic because she has experienced a weight loss of 20 lb over the last month, even though her appetite has been "ravenous" and she hasn't changed her activity level. She's diagnosed with Graves' disease. Which other signs and symptoms support the diagnosis of Graves' disease? 1. Rapid, bounding pulse 2. Bradycardia 3. Heat intolerance 4. Mild tremors 5. Nervousness 6. Constipation Correct Answer: 1,3,4,5 Your Answer: 1,4,5 RATIONALES: Graves' disease, or hyperthyroidism, is a hypermetabolic state that's associated with rapid, bounding pulses; heat intolerance; tremors; and nervousness. Bradycardia and constipation are signs and symptoms of hypothyroidism.

90.An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: 1. thyroid storm. 2. cretinism. 3. myxedema coma. 4. Hashimoto's thyroiditis. Correct Answer: 3 Your Answer: 3 RATIONALES: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

91. The nurse is teaching a client with type 1 diabetes mellitus 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. Epinephrine 2. Glucagon 3. 50% dextrose 4. Hydrocortisone Correct Answer: 2 Your Answer: 3 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, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

91. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience: 1. heat intolerance and systolic hypertension. 2. weight gain and heat intolerance. 3. diastolic hypertension and widened pulse pressure. 4. anorexia and hyperexcitability.

Correct Answer: 1 Your Answer: 1 RATIONALES: An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss not gain occurs due to the increased metabolic rate. Diastolic blood pressure decreases due to decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite not anorexia. 92. A client, age 23, is diagnosed with diabetes mellitus. The physician prescribes 15 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use? 1. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial, withdraw 15 U regular insulin; withdraw 35 U NPH. 2. Inject 15 U air into regular insulin vial; inject 35 U air into NPH vial, withdraw 35 U of NPH; withdraw 15 U regular insulin. 3. Inject 15 U air into regular insulin vial, withdraw 15 units of regular insulin; inject 35 U air into NPH vial and withdraw 35 U NPH. 4. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial; withdraw 35 U NPH; withdraw 15 U regular insulin. Correct Answer: 1 Your Answer: 1 RATIONALES: To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. Follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 U of regular insulin in the syringe, carefully withdraw 35 U of NPH, for a total of 50 U in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.

93. A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery? 1. Administer half of the client's typical morning insulin dose. 2. Administer an oral antidiabetic agent. 3. Administer an I.V. insulin infusion. 4. Administer the client's normal daily dose of insulin. Correct Answer: 1 Your Answer: 1 RATIONALES: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll become hypoglycemic; half the daily insulin dose will provide all that's needed. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

94. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client? 1. "Take the drug on an empty stomach." 2. "Take the drug with meals." 3. "Take the drug in the evening." 4. "Take the drug whenever convenient." Correct Answer: 1 Your Answer: 1 RATIONALES: The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

95. Which of the following is an adverse reaction to glipizide (Glucotrol)? 1. Headache 2. Constipation 3. Hypotension 4. Photosensitivity Correct Answer: 4 Your Answer: 1 RATIONALES: Glipizide may cause adverse skin reactions, such as rash, pruritus, and photosensitivity. It doesn't cause headache, constipation, or hypotension.

96. A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer a complex carbohydrate snack to her as soon as possible? 1. To decrease the possibility of nausea and vomiting 2. To restore liver glycogen and prevent secondary hypoglycemia 3. To stimulate her appetite 4. To decrease the amount of glycogen in her system Correct Answer: 2 Your Answer: 2 RATIONALES: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system

97. A client is being treated for hypothyroidism. The nurse knows that thyroid replacement therapy has been inadequate when she notes which findings? 1. Prolonged QT interval on electrocardiogram 2. Tachycardia 3. Low body temperature 4. Nervousness 5. Bradycardia 6. Dry mouth Correct Answer: 1,3,5 Your Answer: 1,4,5 RATIONALES: In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.

98. When teaching a client about insulin therapy, the nurse should instruct the client to avoid which over-the-counter preparation that can interact with insulin? 1. Antacids 2. Acetaminophen preparations 3. Vitamins with iron 4. Salicylate preparations Correct Answer: 4 Your Answer: 1 RATIONALES: Salicylates may interact with insulin to cause hypoglycemia. Antacids, acetaminophen preparations, and vitamins with iron don't interact with insulin.

99. The physician prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? 1. "Be sure to take glipizide 30 minutes before meals." 2. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." 3. "You won't need to check your blood glucose level after you start taking glipizide." 4. "Take glipizide after a meal to prevent heartburn." Correct Answer: 1 Your Answer: 1 RATIONALES: The client should take glipizide twice per day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor blood glucose levels during glipizide therapy.

100. Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. The nurse should expect the dose's: 1. onset to be at 2 p.m. and its peak to be at 3 p.m. 2. onset to be at 2:15 p.m. and its peak to be at 3 p.m. 3. onset to be at 2:30 p.m. and its peak to be at 4 p.m. 4. onset to be at 4 p.m. and its peak to be at 6 p.m. Correct Answer: 3 Your Answer: 3 RATIONALES: Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 to 2:30 p.m. and the peak from 4 to 6 p.m.

101. A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? 1. Coma, anxiety, confusion, headache, and cool, moist skin. 2. Kussmaul's respirations, dry skin, hypotension, and bradycardia. 3. Polyuria, polydipsia, hypotension, and hypernatremia. 4. Polyuria, polydipsia, polyphagia, and weight loss. Correct Answer: 1 Your Answer: 1 RATIONALES: Signs and symptoms of hypoglycemia include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul's respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

102. Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia as indicated by: 1. muscle weakness. 2. tremors. 3. diaphoresis. 4. constipation. Correct Answer: 1 Your Answer: 1 RATIONALES: Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

103. Which of the following statements about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? 1. Administer 2 to 3 L of I.V. fluid rapidly. 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: 1 RATIONALES: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly prescribed fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution.

103. 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. Constipation 2. Menstrual irregularities 3. Hypokalemia 4. Hypernatremia Correct Answer: 2 Your Answer: 4 RATIONALES: Spironolactone can cause menstrual irregularities and decreased libido. Men may also experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spirolactone.

104. 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 frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

105. The physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 1. 5% dextrose and normal saline solution 2. Lactated Ringer's solution 3. Half-normal saline solution 4. 10% dextrose in water Correct Answer: 2 Your Answer: 2 RATIONALES: Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

106. A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: 1. Trousseau's sign. 2. Homans' sign. 3. Hegar's sign. 4. Goodell's sign. Correct Answer: 1 Your Answer: 1 RATIONALES: This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

107. Which of the following laboratory test results would suggest to the nurse that a client has a corticotropin-secreting pituitary adenoma? 1. High corticotropin and low cortisol levels 2. Low corticotropin and high cortisol levels 3. High corticotropin and high cortisol levels 4. Low corticotropin and low cortisol levels Correct Answer: 3 Your Answer: 4 RATIONALES: A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels. A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level would be associated with hypocortisolism. Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.

108. A client with type 1 diabetes is scheduled to receive 30 U of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: 1. 9 U regular insulin and 21 U neutral protamine Hagedorn (NPH). 2. 21 U regular insulin and 9 U NPH. 3. 10 U regular insulin and 20 U NPH. 4. 20 U regular insulin and 10 U NPH. Correct Answer: 1 Your Answer: 1 RATIONALES: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 U of NPH and 9 U of regular insulin. The other choices are incorrect dosages for the prescribed insulin.

109. A client with type 1 diabetes mellitus is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? 1. Initiate fluid replacement therapy. 2. Administer insulin. 3. Correct diabetic ketoacidosis. 4. Determine the cause of diabetic ketoacidosis. Correct Answer: 1 Your Answer: 1 RATIONALES: The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body ef