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Medical Surgical QuestionsFrom Lippincott's_Review_for_NCLEXNursing Care of Clients with Disorders ofthe Pituitary GlandAfter suffering head trauma, a client develops signs andsymptoms of diabetes insipidus.1. Which characteristic symptom of the client’s disorderwould the nurse expect to fi nd during an assessment?[ ] 1. Polyphagia[ ] 2. Polyuria[ ] 3. Glycosuria[ ] 4. Hyperglycemia2. How does the nurse expect the urine that is collectedfor a routine urinalysis to appear?[ ] 1. Tea-colored[ ] 2. Pale yellow[ ] 3. Colorless[ ] 4. Light pink3. Which nursing intervention is essential for monitoringthe client’s condition?[ ] 1. Measuring intake and output[ ] 2. Analyzing blood glucose levels[ ] 3. Inserting a Foley catheter[ ] 4. Sending urine samples to the laboratoryThe nursing care plan indicates that the client must beweighed each day.4. When directing the nursing assistant to weigh theclient, which instruction is most important for obtainingaccurate data?[ ] 1. Have the client stand on a bedside scale.[ ] 2. Weigh the client at the same time each day.[ ] 3. Ask that slippers be removed when being weighed.[ ] 4. Ask about the client’s pre-disease weight.The client is treated with intranasal lypressin (Diapid),2 sprays q.i.d. and as needed.5. The nurse observes the client self-administering themedication. Which action indicates that the client is usingthe medication correctly?[ ] 1. The client shakes the medication vigorously[ ] 2. The client’s head is tilted to the side.[ ] 3. The client inverts the drug container.[ ] 4. The client inhales with each spray.6. Before the client is discharged, the physician orderslypressin (Diapid) to be administered p.r.n. When instructingthe client about how to take this drug at home, thenurse tells the client to administer the drug when experiencingwhich sign or symptom?[ ] 1. Increased thirst[ ] 2. Onset of a headache[ ] 3. Dark yellow urine[ ] 4. A runny noseThe nurse is assessing a client who is experiencing signsand symptoms related to a diagnosis of acromegaly.7. During the physical assessment of this client, whichfi nding is the nurse most likely to observe?[ ] 1. Shortened height[ ] 2. Enlarged hands[ ] 3. Gonadal atrophy[ ] 4. Loss of teeth8. Which nursing diagnosis should the nursing teamconsider when developing this client’s care plan?[ ] 1. Activity intolerance[ ] 2. Self-care defi cit[ ] 3. Ineffective breathing[ ] 4. Impaired swallowingBecause medical treatment was unsuccessful, the clientwith acromegaly is scheduled for a trans-sphenoidal hypophysectomy.The night before surgery, the nurse providesthe client with information about what to expect during thepostoperative period.9. Which statement by the client indicates a misunderstandingof the expected surgical outcome?[ ] 1. “My appearance will gradually become normal.”[ ] 2. “I’ll need to take replacement hormones.”[ ] 3. “I’ll need to see my physician regularly.”[ ] 4. “The surgical incision will be inconspicuous.”10. Immediately after surgery, the nurse assesses theclient for bleeding. Where is the best location to assess forbleeding?[ ] 1. The skull[ ] 2. The nose[ ] 3. The ear canal[ ] 4. The tongueNursing Care of Clients with Disorders ofthe Thyroid GlandA 35-year-old seeks medical attention to determine thereason menstruation has ceased. The physician orders aradioactive iodine uptake test.11. After the test, the nurse provides the client withinstructions. Which statement of the nurse is mostaccurate?[ ] 1. “You must remain isolated until the radiation leveldecreases suffi ciently.”[ ] 2. “You’re free to go without further precautionaryinstructions.”[ ] 3. “You must follow special precautions for a shortperiod of time.”[ ] 4. “You’ll be given an antidote to reduce the radioactivitylevel.”The results of the diagnostic tests confi rm that the clienthas myxedema.12. In addition to amenorrhea, which other signs of myxedemais the nurse likely to observe in this client? Selectall that apply.[ ] 1. Hoarse, raspy voice[ ] 2. Oily skin with large pores[ ] 3. Thin trunk and extremities[ ] 4. Extreme restlessness[ ] 5. Low body temperature[ ] 6. Decreased blood pressure13. When the nurse conducts an admission history, whichsubjective symptom is the client likely to describe?[ ] 1. Diffi culty urinating[ ] 2. Intolerance to cold[ ] 3. Profuse perspiration[ ] 4. Excessive appetiteThe client with myxedema is treated with levothyroxine(Synthroid), one tablet P.O. every day.14. Which statement provides the best evidence that theclient understands the prescribed drug therapy?[ ] 1. “I must take this drug after meals.”[ ] 2. “I should avoid driving when sleepy.”[ ] 3. “I’ll need to take this drug life-long.”[ ] 4. “I can skip a dose if I’m nauseated.”15. Because the client is receiving levothyroxine (Synthroid)for the fi rst time, the nurse recognizes the need toobserve the client for adverse effects related to thyroidreplacement therapy. For which signs and symptomsshould the nurse assess? Select all that apply.[ ] 1. Dyspnea[ ] 2. Palpitations[ ] 3. Excessive bruising[ ] 4. Raised, red rash[ ] 5. Hyperactivity[ ] 6. InsomniaA client seeks medical attention after noticing fullness inthe neck. After several diagnostic tests, a large endemicgoiter is diagnosed.16. As the nurse provides care for the client newly diagnosedwith a large goiter, which interventions should beimplemented? Select all that apply.[ ] 1. Observe the client’s respiratory status[ ] 2. Elevate the head of the client’s bed[ ] 3. Provide a diet high in iodized salt[ ] 4. Obtain an order for a soft diet[ ] 5. Assess for high fever[ ] 6. Administer prescribed antibioticsA client is undergoing treatment for Graves’ disease.17. Which characteristic facial feature would the nurseexpect to note during a physical examination of this client?[ ] 1. Bulging eyes[ ] 2. Bulbous nose[ ] 3. Thick lips[ ] 4. Large tongueThe physician prescribes propylthiouracil (Propyl-Thyracil)to treat the client’s condition.18. Before administering this medication, what is essentialfor the nurse to ask the client?[ ] 1. “Do you have trouble swallowing?”[ ] 2. “Do you prefer a liquid form of medication?”[ ] 3. “Have you had digestive disorders in the past?”[ ] 4. “Is there a possibility you could be pregnant?”19. Because propylthiouracil (Propyl-Thyracil) can causeagranulocytosis, the nurse advises the client to notify thephysician if which problem occurs?[ ] 1. Persistent sore throat[ ] 2. Occasional heart palpitations[ ] 3. Fatigue on exertion[ ] 4. Prolonged bleeding with traumaAfter diagnostic testing, a client with Graves’ diseaseis informed that it is necessary to undergo a subtotalthyroidectomy. The physician prescribes potassium iodide(Lugol’s solution) 4 gtt P.O. to be taken for 10 days beforethe scheduled surgery.20. When the nurse teaches the client how to self-administerpotassium iodide (Lugol’s solution), which instructionis most appropriate?[ ] 1. Swallow the drug quickly.[ ] 2. Take the drug before meals.[ ] 3. Dilute the drug in fruit juice.[ ] 4. Chill the drug before taking it.The client asks the nurse to explain the purpose of thepreoperative drug therapy.21. Which response by the nurse about potassium iodide(Lugol’s solution) is correct?[ ] 1. It fi rms the gland so it is easily removed.[ ] 2. It decreases the postoperative recovery time.[ ] 3. It decreases the risk of postoperative bleeding.[ ] 4. It eliminates the need for hormone replacement.22. Preoperatively, which information is most importantto teach the client before the subtotal thyroidectomy?[ ] 1. Techniques for changing positions[ ] 2. Reasons for performing leg exercises[ ] 3. The necessity for daily dressing changes[ ] 4. Postoperative use of the incentive spirometer23. To prepare for potential postoperative complicationsrelated to the thyroidectomy, which item is necessary tokeep at the client’s bedside?[ ] 1. Dressing change kit[ ] 2. Tracheostomy tray[ ] 3. Ampule of epinephrine[ ] 4. Mechanical ventilatorAfter surgery, the client is returned to the nursing unit instable condition.24. In which position should the client be maintainedafter the subtotal thyroidectomy?[ ] 1. Supine[ ] 2. Sims’[ ] 3. Semi-Fowler’s[ ] 4. Recumbent25. Postoperatively, the nurse should consult the physicianbefore encouraging the client who has undergone asubtotal thyroidectomy to perform which activity?[ ] 1. Forced coughing[ ] 2. Deep breathing[ ] 3. Ambulating[ ] 4. Dangling legs26. Which intervention is most appropriate to add to theclient’s care plan when monitoring for incisional bleedingafter a subtotal thyroidectomy?[ ] 1. Observe for signs of hypovolemic shock.[ ] 2. Assess for dampness at the back of the client’s neck.[ ] 3. Remove the dressing to directly inspect the wound.[ ] 4. Weigh all gauze dressings before and after changing.27. Which assessment technique is most appropriatewhen checking for laryngeal nerve damage in a client whohas had a thyroidectomy?[ ] 1. Turning the client’s head from side to side[ ] 2. Observing the client swallowing[ ] 3. Looking for tracheal deviation[ ] 4. Asking the client to say “Ah”28. The nurse should assess for hypocalcemia based onwhich client statements after a subtotal thyroidectomy?Select all that apply.[ ] 1. “I feel like I could vomit.”[ ] 2. “My lips feel numb and tingly.”[ ] 3. “Light seems to bother my eyes.”[ ] 4. “I feel weak when I walk.”[ ] 5. “I have cramps in my legs.”[ ] 6. “I feel like my throat is constricting.”Because the client is exhibiting signs and symptomsof hypocalcemia after surgery, the nurse assesses forChvostek’s sign.29. Place an X in the area of the head that the nurse should assess to determine a positive or negativeChvostek’s sign.A day after a client undergoes subtotal thyroidectomy, thenurse suspects that the client is developing clinical manifestationsrelated to thyroid crisis.30. Which signs and symptoms related to thyroid crisisrequire immediate notifi cation of the physician? Select allthat apply.[ ] 1. High fever[ ] 2. Falling blood pressure[ ] 3. Regular noisy respirations[ ] 4. Hand spasms[ ] 5. Heart palpitations[ ] 6. Decreased urine outputBased on the client’s clinical presentation, a diagnosis ofthyroid crisis is made.31. Which nursing interventions are most appropriate atthis time? Select all that apply.[ ] 1. Take the client’s vital signs at least every hour.[ ] 2. Assess Trousseau’s sign every shift.[ ] 3. Limit the client’s activity.[ ] 4. Administer antipyretics per order.[ ] 5. Encourage a diet high in iodized salt.[ ] 6. Make sure I.V. calcium gluconate is available.32. At the beginning of thyroid replacement therapy aftera thyroidectomy, the nurse must monitor the client closelyfor side effects. Which fi ndings would the nurse expectto detect if the client is receiving more thyroid hormonereplacement than required? Select all that apply.[ ] 1. Hyperglycemia[ ] 2. Tachycardia[ ] 3. Insomnia[ ] 4. Hirsutism[ ] 5. Tremors[ ] 6. HypertensionNursing Care of Clients with Disorders ofthe Parathyroid GlandsA client who develops a benign parathyroid tumor manifestssigns of hyperparathyroidism.33. When the nurse reviews the client’s history, whichassessment fi nding is closely associated with the client’sdiagnosis?[ ] 1. Nightly leg cramps[ ] 2. Recurrent kidney stones[ ] 3. Loose bowel movements[ ] 4. Excessive energy levelThe nursing assistant assigned to this client asks why thecare plan indicates that the client is at risk for falls andinjury.34. Which is the best explanation by the nurse concerningan effect of hyperparathyroidism?[ ] 1. The inability to maintain balance[ ] 2. The risk of developing seizures[ ] 3. Fainting when changing positions[ ] 4. Pathologic bone fracturesThe client has three of the four lobes of the parathyroidgland surgically removed.35. After the client returns from surgery and resumeseating, the nurse should encourage the client to eat foodsfrom which food group?[ ] 1. Bread and cereals[ ] 2. Milk and cheese[ ] 3. Meat and seafood[ ] 4. Fruit and vegetablesA client diagnosed with hypoparathyroidism develops tetanyand comes to the emergency department for treatment.36. Which I.V. medication can the nurse expect the physicianto order to treat the client’s condition?[ ] 1. Calcium gluconate[ ] 2. Ferrous sulfate[ ] 3. Potassium chloride[ ] 4. Sodium bicarbonateNursing Care of Clients with Disorders ofthe Adrenal GlandsThe nurse is caring for a client with a disorder of theadrenal glands.37. Place an X where the adrenal glands are located in the diagram below.The nurse cares for a client with Addison’s disease.38. Which characteristic fi ndings would the nurse expect toassess in a client with Addison’s disease? Select all that apply.[ ] 1. Salt craving[ ] 2. Skin blemishes[ ] 3. Moon-shaped face[ ] 4. Bronzed skin[ ] 5. Hypoglycemia[ ] 6. Weight loss39. Which nursing assessment is most helpful in evaluatingthe status of a client with Addison’s disease?[ ] 1. Blood pressure[ ] 2. Bowel sounds[ ] 3. Breath sounds[ ] 4. Heart soundsThe client’s care plan indicates that the nurse shouldassist the client in selecting foods that are good sources ofsodium as part of the treatment for Addison’s disease.40. If the following foods are available, which one shouldthe nurse recommend?[ ] 1. Graham crackers[ ] 2. Cheddar cheese[ ] 3. Raw carrots[ ] 4. Canned fruitThe nurse documents that the client has recurrent episodesof hypoglycemia.41. If a regular diet is ordered, which between-mealsnack should the nurse offer to help regulate the client’sblood glucose level?[ ] 1. Lemonade and peanuts[ ] 2. Cola and potato chips[ ] 3. Coffee and a muffi n[ ] 4. Milk and crackers42. Because this client is at risk for developing addisoniancrisis, which is also known as acute adrenal insufficiency and adrenal crisis, a life-threatening condition,what should the nurse instruct the client to avoid?[ ] 1. Stress-producing situations[ ] 2. Consuming alcoholic beverages[ ] 3. Eating complex carbohydrates[ ] 4. Getting too little sleep43. A client with Addison’s disease is admitted to thehospital with a history of nausea and vomiting for the past3 days. The registered nurse (RN) administers methylprednisolone(Solu-Medrol), a glucocorticoid, intravenously.Which nursing action is most important for the licensedpractical nurse (LPN) to implement in the client’s plan ofcare?[ ] 1. Glucometer measurements[ ] 2. Intake and output volumes[ ] 3. Daily weights[ ] 4. Frequent oral careA 38-year-old client is hospitalized after developing symptomsthat resemble those of Cushing’s syndrome. The nursecompletes admission documentation.44. Based on the client’s condition, which fi ndings willthe nurse most likely document after completing the initialphysical assessment? Select all that apply.[ ] 1. The client has very thin legs.[ ] 2. The client looks emaciated.[ ] 3. The client has bulging eyes.[ ] 4. The client’s skin is pale.[ ] 5. The client has bruising.[ ] 6. The client’s scalp hair is thin.The nurse develops the care plan and documents anexpected outcome that states, “The client will be free ofinfection during the hospital stay.”45. Based on the nurse’s understanding of this diseaseprocess, for what reasons is the expected outcome justified? Select all that apply.[ ] 1. The client is at risk for skin breakdown related tothinning of the skin and edema.[ ] 2. Wound healing is prolonged in clients with thisdisorder.[ ] 3. The immunosuppressive effects of the disordermask symptoms of infection.[ ] 4. The client is at risk for aspiration pneumoniarelated to laryngeal nerve damage.[ ] 5. The client’s admission white blood cell count iselevated.[ ] 6. The client’s admission temperature is withinnormal limits.The physician orders a 24-hour urine collection to aid inthe diagnosis of Cushing’s syndrome.46. The nurse is most accurate in telling the client that theurine collection will begin when?[ ] 1. With the client’s next voiding[ ] 2. After the client’s next voiding[ ] 3. After drinking a pitcher of water[ ] 4. With the fi rst voiding in the morning47. Which statement is correct concerning the collectionof urine for a 24-hour specimen?[ ] 1. The volume of each voiding is measured andrecorded.[ ] 2. The urine is placed in a container of preservative.[ ] 3. Each voiding is taken immediately to the laboratory.[ ] 4. The client voids directly into the specimen container.After the health care team meets to discuss the client’snursing needs, the nursing diagnosis “Disturbed bodyimage” is added to the care plan.48. The best rationale for adding this nursing diagnosisto the care plan in the case of a female is that females withCushing’s syndrome typically experience which physiologiceffect?[ ] 1. Masculine characteristics[ ] 2. Heavy menstrual fl ow[ ] 3. Extreme weight loss[ ] 4. Large, pendulous breastsDiagnostic tests confi rm that the client’s adrenal glands areproducing excessive amounts of adrenocortical hormones.49. When the nurse explains the disorder to the client’sspouse, it is accurate to stress that the client is also likelyto experience which effect?[ ] 1. Anxiety and occasional panic attacks[ ] 2. Depression and suicidal tendencies[ ] 3. Impulsiveness and poor self-control[ ] 4. Forgetfulness and memory changesThe physician orders a low-sodium diet to help treat theclient’s Cushing’s syndrome.50. Which action by the nurse provides the best data formonitoring the client’s therapeutic response to sodiumrestriction?[ ] 1. Monitoring sodium intake[ ] 2. Measuring pedal edema[ ] 3. Assessing skin turgor[ ] 4. Weighing the client51. Which nursing interventions are most appropriatefor managing the basic needs of a client with Cushing’ssyndrome? Select all that apply.[ ] 1. Have the client sleep on a convoluted (egg-crate)foam mattress.[ ] 2. Ambulate the client at frequent intervals.[ ] 3. Advise the client to ask for assistance whengetting up.[ ] 4. Offer high-carbohydrate nourishment.[ ] 5. Check the client frequently for suicidal ideation.[ ] 6. Instruct the client to wear loose-fi tting clothing.Eventually, the client undergoes a bilateral adrenalectomyto correct Cushing’s syndrome.52. To detect complications of surgery in the immediatepostoperative period, which assessment component is mostimportant for the nurse to monitor?[ ] 1. Blood pressure[ ] 2. Urine output[ ] 3. Temperature[ ] 4. Specifi c gravity53. Which documentation fi nding provides the best indicationthat the client has successfully avoided an adrenal(addisonian) crisis after surgery?[ ] 1. Urine output is approximately 2,000 mL/day.[ ] 2. The client’s pedal edema has lessened.[ ] 3. Capillary blood glucose level is within normallimits.[ ] 4. Vital signs are within preoperative ranges.54. Based on the knowledge that clients with Cushing’ssyndrome heal slowly, which nursing measure is mostappropriate during the client’s postoperative period?[ ] 1. Monitoring infusion of I.V. antibiotics[ ] 2. Removing tape toward the incision site[ ] 3. Increasing the client’s dietary protein intake[ ] 4. Covering the wound with gauze55. Which statement provides the best evidence that theclient who has undergone a bilateral adrenalectomy understandsthe postoperative course?[ ] 1. “I should avoid people with infectious diseases.”[ ] 2. “I need to limit my fl uid intake to 1 quart per day.”[ ] 3. “My appearance will never be the same as it wasbefore.”[ ] 4. “No other treatment is necessary after I recoverfrom surgery.”Nursing Care of Clients with PancreaticEndocrine DisordersA 23-year-old client manifests symptoms of hyperinsulinism.56. In response to a question about timing of symptomsduring the nursing history, when is the client most likely todescribe that symptoms typically occur?[ ] 1. After fasting more than 6 hours[ ] 2. About 2 hours after eating a meal[ ] 3. Late in the evening, before bedtime[ ] 4. Early in the morning, before breakfastA glucose tolerance test is ordered to determine if theclient has functional hypoglycemia.57. Which instruction by the nurse concerning the testprocedure is most accurate?[ ] 1. “You need to eat a large meal just before the test.”[ ] 2. “Bring a voided urine specimen to the laboratory.”[ ] 3. “You can drink coffee or tea in the morning beforethe test.”[ ] 4. “You will be given a sweetened drink before thetest.”58. To reduce or eliminate the symptoms that a clientwith functional hypoglycemia experiences, it is best for thenurse to recommend eating fi ve or six small meals containingwhich nutrient?[ ] 1. Simple sugars[ ] 2. Complete proteins[ ] 3. Complex carbohydrates[ ] 4. Unsaturated fats59. Which of the following provides the best evidencethat the dietary measures to control functional hypoglycemiaare therapeutic?[ ] 1. The client experiences fewer incidences of weaknessand tremors.[ ] 2. The client experiences fewer incidences of thirstand dry mouth.[ ] 3. The client experiences fewer incidences of musclespasms and fatigue.[ ] 4. The client experiences fewer incidences of hungerand abdominal cramps.A nurse participates in a community-wide screeningto identify adults who may have undiagnosed diabetesmellitus.60. If the screening includes a measurement of postprandialblood glucose, the nurse is correct in explaining thatblood will be drawn at which time?[ ] 1. Approximately 2 hours before breakfast[ ] 2. Approximately 2 hours after a meal[ ] 3. Approximately 2 hours before bedtime[ ] 4. Approximately 2 hours after fasting61. Which statement indicates that a client with anelevated 2-hour postprandial blood glucose level understandsthe signifi cance of the screening test?[ ] 1. “I need to eat less frequently.”[ ] 2. “I need to stop eating candy.”[ ] 3. “I need to consult my physician.”[ ] 4. “I need to begin taking insulin.”62. Which signs and symptoms are most appropriate forthe nurse to investigate when screening adults who havecome to have their blood glucose tested?[ ] 1. Diarrhea, anorexia, and weight gain[ ] 2. Constipation, weight loss, and thirst[ ] 3. Polycholia, polyemia, and polyplegia[ ] 4. Polyuria, polydipsia, and polyphagiaAfter the screening test, one client is referred to a physicianfor additional follow-up. Further diagnostic testsconfi rm that the client has type 2 diabetes mellitus.63. When given the news, the client denies the diagnosisand becomes angry, stating there has been a mistake in thetests. Which nursing action is most appropriate at this time?[ ] 1. Emphasizing the importance of treatment[ ] 2. Reassuring the client that the disease is easilymanaged[ ] 3. Explaining that many people live with diabetes[ ] 4. Listening as the client expresses current feelingsThe client with newly diagnosed type 2 diabetes mellitus isreferred to the diabetes clinic for teaching.64. When the client asks the nurse why regular exerciseis recommended for diabetic clients, the best answer is thatexercise tends to facilitate which positive outcome?[ ] 1. Regular exercise helps to control weight.[ ] 2. Regular exercise helps to decrease appetite.[ ] 3. Regular exercise helps to reduce blood glucose levels.[ ] 4. Regular exercise helps to improve circulation tothe feet.A dietitian explains how to use the American DiabetesAssociation exchange list.65. Which statement by the client provides the bestevidence that the client understands the principle of anexchange list for meal planning?[ ] 1. “I can eat one serving from each category on theexchange list per day.”[ ] 2. “Measured amounts of food in each category areequal to one another.”[ ] 3. “The number of servings from the exchange list isunlimited.”[ ] 4. “I need to use the exchange list to determine thenutrition in food.”66. The nurse knows the diabetic client understandswhat “free” foods on the exchange list means if the clientexcludes which one of the following from a meal plan?[ ] 1. Iced tea[ ] 2. Flavored water[ ] 3. Light beer[ ] 4. Club sodaThe physician prescribes glyburide (DiaBeta) orally forthe client to treat diabetes.68. When the client asks why a diabetic relative cannottake insulin orally, what is the best answer?[ ] 1. Insulin is inactivated by digestive enzymes.[ ] 2. Insulin is absorbed too quickly in the stomach.[ ] 3. Insulin is irritating to the gastric mucosa.[ ] 4. Insulin is incompatible with many foods.69. The diabetic client tells the nurse that breakfast isalways skipped. Which response by the nurse is mostappropriate?[ ] 1. “If you drink a glass of milk and eat a breakfastbar, that will be suffi cient for breakfast.”[ ] 2. “You should eat each meal and snack at the sametime each day.”[ ] 3. “If you skip breakfast, eat a high-calorie snack atmidmorning.”[ ] 4. “Wait to take your medication until you eat yourfi rst meal of the day.”After the client is discharged from the hospital, thephysician wants the client to continue to self-monitor theresponse to the diet and medication management.70. Which monitoring approach is best for the nurse torecommend?[ ] 1. Testing the urine with a chemical reagent strip[ ] 2. Using a glucometer to check capillary bloodglucose levels[ ] 3. Having laboratory personnel draw venous bloodsamples[ ] 4. Arranging for testing by a home health agencyNurseEmergency medical personnel bring a client who is lethargicand confused to the emergency department. A tentativediagnosis of type 1 diabetes mellitus and diabetic ketoacidosis(DKA) is made.71. Which assessment fi ndings would the nurse expect todocument if the client has DKA? Select all that apply.[ ] 1. The client is hypertensive and tachycardic.[ ] 2. The client is dyspneic and hypotensive.[ ] 3. The client breathes noisily and smells of acetone.[ ] 4. The client stares blankly and smells of alcohol.[ ] 5. The client has warm, fl ushed skin and has vomited.[ ] 6. The client complains of abdominal pain and isthirsty.The nurse documents that Kussmaul’s respirations weredetected during the initial assessment.72. Which respiratory pattern is the best description ofthe client’s breathing?[ ] 1. Fast, deep, labored respirations[ ] 2. Shallow respirations, alternating with apnea[ ] 3. Slow inhalation and exhalation through pursed lips[ ] 4. Shortness of breath with pausesThe nurse plans to monitor the client’s response to insulintherapy closely with an electronic glucometer and instructsthe emergency department technician to take periodiccapillary blood glucose measurements.73. Which techniques are correct when using an electronicglucometer to monitor the client’s capillary bloodglucose level? Select all that apply.[ ] 1. Clean the client’s fi nger with povidone-iodine(Betadine).[ ] 2. Take a set of vital signs before the test.[ ] 3. Pierce the central pad of the client’s fi nger.[ ] 4. Apply a large drop of blood to a test strip or area.[ ] 5. Don gloves before piercing the client’s fi nger.[ ] 6. Perform a quality control before the test.After using the glucometer, the emergency departmenttechnician reports to the nurse that the client’s capillaryblood glucose measures 498 mg/dL.74. Based on the client’s blood glucose measurement, thenurse immediately reevaluates the client. Which physicianorders should the nurse anticipate? Select all that apply.[ ] 1. STAT serum blood glucose[ ] 2. Intravenous regular insulin[ ] 3. Vital signs every 2 hours[ ] 4. A diet of six small, frequent meals[ ] 5. Electronic glucometer measurements before mealsand at bedtime[ ] 6. Continuous cardiac monitoringAfter stabilization in the emergency department, the clientwith diabetic ketoacidosis (DKA) is admitted to a stepdownunit for further observation and treatment. Afterseveral episodes of hyperglycemia, the physician orderssliding-scale regular insulin administered subcutaneouslyfor the client.75. How soon after administering the client’s dose ofregular insulin subcutaneously should the nurse assess forsigns of hypoglycemia?[ ] 1. 5 minutes later[ ] 2. 30 minutes later[ ] 3. 6 hours later[ ] 4. 10 hours later76. The nurse teaches the client with newly diagnoseddiabetes mellitus about the signs and symptoms of hypoglycemia.Which of the following should the nurse stressin teaching? Select all that apply.[ ] 1. Sleepiness[ ] 2. Shakiness[ ] 3. Thirst[ ] 4. Hunger[ ] 5. Diaphoresis[ ] 6. ConfusionDuring the midmorning after receiving insulin, the clientreports feeling weak, shaky, and dizzy. The nurse asks thenursing assistant to obtain a capillary blood glucose measurementwith a glucometer.77. The nursing assistant reports to the nurse that the client’sblood glucose reading is 58 mg/dL. What is the mostappropriate nursing action at this time?[ ] 1. Administer the next scheduled dose of insulin.[ ] 2. Give the client ? cup of sweet fruit juice.[ ] 3. Report the client’s symptoms to the physician.[ ] 4. Perform a complete head-to-toe assessment.The client with type 1 diabetes mellitus must learn to combinetwo insulins—regular and intermediate-acting—andself-administer the injection before being discharged.78. Which action is the best indication that the clientneeds more practice in combining two insulins in onesyringe?[ ] 1. The client rolls the vial of intermediate-actinginsulin to mix it with its additive.[ ] 2. The client instills air into both the fast-acting andintermediate-acting insulin vials.[ ] 3. The client instills the intermediate-acting insulininto the vial of rapid-acting insulin.[ ] 4. The client inverts each vial before withdrawing thespecifi ed amount of insulin.79. When the client practices self-administration of theinsulin, which action is correct?[ ] 1. Piercing the skin at a 30-degree angle[ ] 2. Using a syringe calibrated in minims[ ] 3. Using a 29-gauge needle on the syringe[ ] 4. Rotating abdominal sites for each injectionThe nurse implements a diabetes teaching plan in anticipationof the client’s discharge.81. Which statement indicates that the client has misunderstoodthe nurse’s teaching?[ ] 1. “I may need more insulin during times of stress.”[ ] 2. “I may need more food when exercising strenuously.”[ ] 3. “My insulin needs may change as I get older.”[ ] 4. “My dependence on insulin may stop eventually.”82. The nurse discusses the long-term effects of diabetesmellitus with the client and realizes that the client needsfurther teaching when the client identifi es which occurrenceas a complication of this disease?[ ] 1. Blindness[ ] 2. Stroke[ ] 3. Renal failure[ ] 4. Liver failure83. When the client asks how to store an opened vial ofinsulin, which answer by the nurse offers the most correctinstruction?[ ] 1. The best place for storing insulin is in the bathroom,close to the shower.[ ] 2. The best place to store insulin is in the refrigerator.[ ] 3. The best way to store insulin is at room temperature.[ ] 4. The best place for storing insulin is in a warmlocation but out of sunlight.The nurse includes foot care as a component of diabetesteaching.84. Which statement by the client about foot care indicatesa need for further teaching?[ ] 1. “I need to inspect my feet daily.”[ ] 2. “I should soak my feet each day.”[ ] 3. “I need to wear shoes whenever I’m not sleeping.”[ ] 4. “I need to schedule regular appointments with thepodiatrist.”After 3 months, the client returns for a follow-up appointmentwith the physician to evaluate the progress ofs elf-care.85. Which information is most important for the nurseto elicit from the client to effectively evaluate compliancewith the prescribed therapy?[ ] 1. The dosage and frequency of insulinadministration[ ] 2. The client’s glucose monitoring records for thepast week[ ] 3. The client’s weight and vital signs before the offi ceinterview[ ] 4. The symptoms experienced in the past month86. Which laboratory test is most important for the nurseto monitor to determine how effectively the client’s diabetesis being managed?[ ] 1. Fasting blood glucose[ ] 2. Blood chemistry profi le[ ] 3. Complete blood count[ ] 4. Glycosylated hemoglobin (HbA1c)During the physician’s visit, the client reports researchingthe use of insulin pumps on the Internet and wants to knowthe possibility of being a candidate. After evaluating theclient and discussing the request, the physician asks thenurse to provide instructions about management of the client’sdiabetes using a continuous insulin infusion pump.87. The nurse teaches the client how the infusion pumpoperates and correctly points out that the infusion is typicallyadministered in which location?[ ] 1. In a vein within the nondominant hand[ ] 2. In the muscular tissue of the thigh[ ] 3. In the subcutaneous tissue of the abdomen belowthe belt line[ ] 4. In an implanted I.V. catheter threaded into the neckThe nurse cares for an older client who is insulin dependentand lives in a long-term care facility.88. When developing the client’s care plan, which interventionis most appropriate to add?[ ] 1. Encourage the client to use an electric razor.[ ] 2. Tell the client to fi le rather than cut toenails.[ ] 3. Make sure that the client receives mouth care twiceper day.[ ] 4. Advise the client to use deodorant soap when bathing89. The nurse has prepared 24 units of Humulin N insulinfor subcutaneous administration. Identify with an X thepreferred location for insulin administration to facilitaterapid absorption.90. Which sign is most suggestive that a client with type2 diabetes is developing hyperosmolar hyperglycemicnonketotic syndrome (HHNS)?[ ] 1. The client’s serum glucose level is 650 mg/dL.[ ] 2. The client’s urinary output is 3,000 mL/24 hours.[ ] 3. The client’s skin is cool and moist.[ ] 4. The client’s urine contains acetone.A client with type 1 diabetes mellitus comes to the cliniccomplaining of persistent bouts of nausea, vomiting,and diarrhea for the past 4 days. The client has skippedinsulin injections because of not being able to eat or keepanything down.91. Which instruction should the nurse give the clientabout insulin administration during periods of illness?[ ] 1. Monitor blood glucose levels every 2 to 4 hours.[ ] 2. Eat candy or sugar frequently.[ ] 3. Attempt to drink a high-calorie beverage everyhour.[ ] 4. Test urine daily for protein.92. During change of shifts, a nurse discovers that ahospitalized client with diabetes received two doses ofinsulin. After notifying the physician, which nursingaction is most appropriate?[ ] 1. Completing an incident report[ ] 2. Calling the intensive care unit (ICU)[ ] 3. Performing frequent neurologic checks[ ] 4. Monitoring the client’s blood glucose******************************************************************* From 1Saunders_Comprehensive_ReviewPractice Questions571. A client is brought to the emergency departmentin an unresponsive state, and a diagnosis ofhyperglycemic hyperosmolar nonketotic syndromeis made. The nurse would immediatelyprepare to initiate which of the following anticipatedphysician’s prescriptions?1. Endotracheal intubation2. 100 units of NPH insulin3. Intravenous infusion of normal saline4. Intravenous infusion of sodium bicarbonate572. An external insulin pump is prescribed for aclient with diabetes mellitus and the client asksthe nurse about the functioning of the pump.The nurse bases the response on the informationthat the pump:1. Is timed to release programmed doses of regularor NPH insulin into the bloodstream atspecific intervals2. Continuously infuses small amounts of NPHinsulin into the bloodstream while regularlymonitoring blood glucose levels3. Is surgically attached to the pancreas and infusesregular insulin into the pancreas, which in turnreleases the insulin into the bloodstream4. Gives a small continuous dose of regular insulinsubcutaneously, and the client can selfadministera bolus with an additional dosefrom the pump before each meal573. A client with a diagnosis of diabetic ketoacidosis(DKA) is being treated in an emergency department.Which finding would a nurse expect tonote as confirming this diagnosis?1. Comatose state2. Decreased urine output3. Increased respirations and an increase in pH4. Elevated blood glucose level and low plasmabicarbonate level574. A nurse teaches a client with diabetes mellitusabout differentiating between hypoglycemia andketoacidosis. The client demonstrates an understandingof the teaching by stating that a formof glucose should be taken if which of the followingsymptoms develops?1. Polyuria2. Shakiness3. Blurred vision4. Fruity breath odor575. A client with diabetes mellitus demonstratesacute anxiety when first admitted for the treatmentof hyperglycemia. The appropriate interventionto decrease the client’s anxiety is to:1. Administer a sedative.2. Convey empathy, trust, and respect towardthe client.3. Ignore the signs and symptoms of anxiety sothat they will soon disappear.4. Make sure that the client knows all the correctmedical terms to understand what is happening.576. A nurse provides instructions to a client newlydiagnosed with type 1 diabetes mellitus. The nurserecognizes accurate understanding of measures toprevent diabetic ketoacidosis when the client states:1. “I will stop taking my insulin if I’m too sickto eat.”2. “I will decrease my insulin dose during timesof illness.”3. “I will adjust my insulin dose according to thelevel of glucose in my urine.”4. “I will notify my physician if my blood glucoselevel is higher than 250 mg/dL.”577. A client is admitted to a hospital with a diagnosisof diabetic ketoacidosis (DKA). The initialblood glucose level was 950 mg/dL. A continuousintravenous infusion of regular insulin isinitiated, along with intravenous rehydrationwith normal saline. The serum glucose level isnow 240 mg/dL. The nurse would next prepareto administer which of the following?1. Ampule of 50% dextrose2. NPH insulin subcutaneously3. Intravenous fluids containing 5% dextrose4. Phenytoin (Dilantin) for the prevention ofseizures578. A nurse is monitoring a client newly diagnosedwith diabetes mellitus for signs of complications.Which of the following, if exhibited in the client,would indicate hyperglycemia and warrant physiciannotification?1. Polyuria2. Diaphoresis3. Hypertension4. Increased pulse rate579. A nurse is preparing a plan of care for a clientwith diabetes mellitus who has hyperglycemia.The priority nursing diagnosis would be:1. Deficient knowledge2. Deficient fluid volume3. Compromised family coping4. Imbalanced nutrition, less than bodyrequirements580. A home health nurse visits a client with a diagnosisof type 1 diabetes mellitus. The client relates ahistory of vomiting and diarrhea and tells thenurse that no food has been consumed for thelast 24 hours. Which additional statement bythe client indicates a need for further teaching?1. “I need to stop my insulin.”2. “I need to increase my fluid intake.”3. “I need to monitor my blood glucose every 3to 4 hours.”4. “I need to call the physician because of thesesymptoms.”581. A nurse is caring for a client after hypophysectomy.The nurse notices clear nasal drainagefrom the client’s nostril. The initial nursingaction would be to:1. Lower the head of the bed.2. Test the drainage for glucose.3. Obtain a culture of the drainage.4. Continue to observe the drainage.582. After several diagnostic tests, a client is diagnosedwith diabetes insipidus. A nurse performs anassessment on the client, knowing that whichsymptom is most indicative of this disorder?1. Fatigue2. Diarrhea3. Polydipsia4. Weight gain583. A client is admitted to an emergency department,and a diagnosis of myxedema coma is made.Which action would the nurse prepare to carryout initially?1. Warm the client.2. Maintain a patent airway.3. Administer thyroid hormone.4. Administer fluid replacement.584. A nurse is caring for a client admitted to theemergency department with diabetic ketoacidosis(DKA). In the acute phase, the priority nursingaction is to prepare to:1. Correct the acidosis.2. Administer 5% dextrose intravenously.3. Administer regular insulin intravenously.4. Apply a monitor for an electrocardiogram.585. A client with type 1 diabetes mellitus calls thenurse to report recurrent episodes of hypoglycemiawith exercising. Which statement by the clientindicates an inadequate understanding ofthe peak action of NPH insulin and exercise?1. “The best time for me to exercise is after I eat.”2. “The best time for me to exercise is afterbreakfast.”3. “The best time for me to exercise is mid- tolate afternoon.”4. “The best time for me to exercise is after mymorning snack.”586. A nurse is completing an assessment on a clientwho is being admitted for a diagnostic workupfor primary hyperparathyroidism. Which clientcomplaint would be characteristic of thisdisorder?1. Diarrhea2. Polyuria3. Polyphagia4. Weight gain587. A nurse is caring for a postoperative parathyroidectomyclient. Which client complaint wouldindicate that a serious, life-threatening complicationmay be developing, requiring immediatenotification of the physician?1. Laryngeal stridor2. Abdominal cramps3. Difficulty in voiding4. Mild to moderate incisional pain588. A client is diagnosed with pheochromocytoma.A nurse prepares a plan of care for the client;while planning, the nurse understands thatpheochromocytoma is a condition that:1. Causes profound hypotension2. Is manifested by severe hypoglycemia3. Is not curable and is treated symptomatically4. Causes the release of excessive amounts ofcatecholamines589. A nurse is caring for a client with pheochromocytomawho is scheduled for adrenalectomy. In thepreoperative period, the priority nursing actionwould be to monitor:1. Vital signs2. Intake and output3. Blood urea nitrogen results4. Urine for glucose and ketones590. A nurse is performing an assessment on a clientwith pheochromocytoma. Which of the followingassessment data would indicate a potentialcomplication associated with this disorder?1. A coagulation time of 5 minutes2. A urinary output of 50 mL per hour3. A blood urea nitrogen level of 20 mg/dL4. A heart rate that is 90 beats/min and irregular591. A nursing instructor asks a student to describethe pathophysiology that occurs in Cushing’s disease.Which statement by the student indicatesan accurate understanding of this disorder?1. “Cushing’s disease results from an oversecretionof insulin.”2. “Cushing’s disease results from an undersecretionof corticotropic hormones.”3. “Cushing’s disease results from an undersecretionof mineralocorticoid hormones.”4. “Cushing’s disease results from an increasedpituitary secretion of adrenocorticotropichormone.”592. A nurse performs a physical assessment on a clientwith type 2 diabetes mellitus. Findingsinclude a fasting blood glucose of 120 mg/dL,temperature of 101 _ F, pulse of 88 beats/min,respirations of 22 breaths/min, and blood pressureof 100/72 mm Hg. Which finding wouldbe of most concern to the nurse?1. Pulse2. Respiration3. Temperature4. Blood pressure593. A nurse is interviewing a client with type2 diabetes mellitus. Which statement by theclient indicates an understanding of the treatmentfor this disorder?1. “I take oral insulin instead of shots.”2. “By taking these medications, I am able to eatmore.”3. “When I become ill, I need to increase thenumber of pills I take.”4. “The medications I’m taking help release theinsulin I already make.”594. A nurse is providing discharge instructions to aclient who has Cushing’s syndrome. Which clientstatement indicates that instructions related todietary management are understood?1. “I can eat foods that have a lot of potassiumin them.”2. “I will need to limit the amount of protein inmy diet.”3. “I am fortunate that I can eat all the saltyfoods I enjoy.”4. “I am fortunate that I do not need to followany special diet.”595. The nurse is caring for a client who is 2 dayspostoperative following an abdominal hysterectomy.The client has a history of diabetes mellitusand has been receiving regular insulinaccording to capillary blood glucose testing fourtimes a day. A carbohydrate-controlled diet hasbeen prescribed but the client has been complainingof nausea and is not eating. On enteringthe client’s room, the nurse finds the client to beconfused and diaphoretic. Which action isappropriate at this time?1. Call a code to obtain needed assistanceimmediately.2. Obtain a capillary blood glucose level andperform a focused assessment.3. Stay with the client and ask the nursing assistantto call the physician for a prescription forintravenous 50% dextrose.4. Ask the nursing assistant to stay with the clientwhile obtaining 15 to 30 g of a carbohydratesnack for the client to eat. ................
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