Midterm Review

1. Midterm Review

2. A nurse is completing an assessment on an elderly client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? • Diarrhea • Polyuria • Polyphagia • Weight gain

3. 2) A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing’s disease. Which statement by the student indicates an accurate understanding of this disorder? • “It is characterized by an oversecretion of glucocorticoid hormones.” • “It is characterized by an undersecretion of glucocorticoid hormones.” • “It is characterized by an oversecretion of insulin.” • “It is characterized by an undersecretion of corticotropic hormones.”

4. 3) A nurse is monitoring a client with Grave’s disease for signs of thyrotoxic crisis (thyroid storm). Which of the following signs and symptoms, if noted in the client, will alert the nurse to the presence of this crisis? • Low grade fever and tachycardia • Fever and tachycardia • Restlessness and bradycardia • Agitation and bradycardia

5. 4) A nurse is assessing a client with a diagnosis of goiter. Which of the following would the nurse expect to note during the assessment of the client? • Client complaints of slow wound healing • Client complaints of chronic fatigue • An enlarged thyroid gland • The presence of heart damage

6. 5) A nurse administers 20 units of NPH insulin to a hospitalized client with diabetes mellitus at 7:00am. The nurse would monitor the client most closely for a hypoglycemic reaction at: • 9:00 AM • 10:00 AM • 4:00 PM • 12:00 midnight

7. 6) A client arrives in the ER complaining of severe thirst and polyuria. The client tells a nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL. Which of the following would the nurse anticipate to be initially prescribed for the client? • Glyburide (DiaBeta) by the oral route • Glucagon by the oral route • Regular insulin by the IV route • NPH insulin by the SC route

8. 7) A home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse that he/she is planning to eat a dinner meal at a local restaurant this week. The client asks the nurse if eating at a restaurant will affect the diabetic control and if this is allowed. Which nursing response is most appropriate? • “You are not allowed to eat in restaurants.” • “If you plan to eat in a restaurant you need to skip the lunchtime meal.” • “You should order a half portion meal and have fresh fruit for dessert.” • “You should increase your daily dose of insulin by half on the day that you plan to eat in the restaurant.”

9. 8) A nurse is monitoring a client receiving chlorpropamide (Diabinese). The nurse knows that which of the following is not a therapeutic outcome for this client? • A decrease in polyuria • A fasting blood glucose of 110 mg/dL • A decrease in polyphagia • A glycosated hemoglobin of 10%

10. 9) “A nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement, if made by the client, indicates a need for further teaching?” • “I need to drink diet soft drinks.” • “I’ll eat a balanced meal plan.” • “I need to purchase special dietetic foods.” • “I’ll snack on fruit instead of cake.”

11. 10) The female adult client with diabetes mellitus has been instructed in the dietary exchange system. The client tells the nurse that she would like to eat 8 oz of nonfat yogurt with breakfast. The nurse determines that the client understands the principles of the exchange system if the client states that she will: • Not eat ice cream for one week • Omit 8 oz. of skim milk at that meal • Omit salad dressing and butter for the day • Eat only half of a meat exchange at supper

12. 11) A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose of 120 mg/dL, temperature of 101F, pulse of 88, respirations of 22, and blood pressure of 140/84 mmHg. Which finding would be of most concern to the nurse? • Pulse • Blood pressure • Respiration • Temperature

13. 12) A client received 20 units of NPH insulin subcutaneously at 8:00AM. The nurse should assess the client for a hypoglycemic reaction at: • 10:00AM • 11:00AM • 5:00PM • 11:00PM

14. 13) A nurse is caring for a client admitted to the ER with diabetic ketoacidosis. (DKA). In the acute phase, the priority nursing action is to prepare to: • Administer IV regular insulin • Administer IV 5% Dextrose • Correct the acidosis • Apply an EKG monitor

15. 14) A nurse is providing dietary instructions to a client newly diagnosed with diabetes mellitus who will be taking insluin about measures to control the diabetes. The nurse instructs the client that it is best to: • Eat meals at approximately the same time each day. • Adjust meal times depending on blood glucose levels. • Avoid being concerned about the time of meals as long as snacks are taken on time. • Vary meal times if insulin is not administered at the same time every day.

16. 15) A nurse develops a plan of care for a client with hyperparathyroidism who is receiving calcitonin salmon (Calcimar). Which of the following outcome criteria has the highest priority regarding this medication? • Absence of side effects • Achievement of normal serum calicum levels. • Relief of pain • Verbalization of appropriate medication knowledge

17. 16) A nurse is caring for a client with diabetes insipidus who is receiving vasopressin (Pitressin). The nurse monitors the client, knowing that wihc of the following is not a therapeutic effect of this medication? • Increased GI tract smooth muscle tone and contractions • Decreased urine output • Increased reabsorption of water by the renal tubules • Vasodilation of vascular vessels

18. 17) After a thyroidectomy a nurse is monitoring a client for signs of hypocalcemia. Which of the following signs, if noted in the client, would most likely indicate the presence of hypocalcemia? • Tingling around mouth • Flaccid paralysis • Negative Chvostek’s sign • Bradycardia

19. 18) A nurse is monitoring a client with diabetes insipidus. Desmopressin (DDAVP, Stimate) has been prescribed for the client. Which of the following outcomes reflects a therapeutic effect of this medication? • Serum osmolality greater than 320 mOsm/kg • Increased blood pressure • Decreased urine output • Urine osmolality less than 100 mOsm/kg

20. 19) A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? • “The best time for me to exercise is every afternoon.” • “The best time for me to exercise is after I eat.” • “The best time for me to exercise is before bedtime.” • “The best time for me to exercise is before breakfast.”

21. 20) A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar nonketotic syndrome (HHNS) precipitated by acute illness. The client tells the nurse, “I will call the doctor next time I can’t eat for more than a day or so.” Which of the following statements reflects the most appropriate analysis of this client’s level of knowledge? • The client needs immediate education before discharge. • The client’s statement is accurate, but knowledge should be evaluated further. • The client’s statement is inaccurate, and the client should be scheduled for outpatient diabetic counseling. • The client requires follow-up teaching regarding the administration of insulin

22. 21) A client is brought to the ER in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would prepare to immediately initiate which of the following anticipated physician’s orders? • 100 units of NPH insulin • Endotracheal intubation • IV replacement of sodium bicarbonate • IV infusion of normal saline

23. 22) An external insulin pump is prescribed for a client with diabetes mellitus. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: • Gives a small continuous dose of regular insulin subcutaneously, and the client can self-bolus with an additional dosage from the pump prior to each meal • Is times to release programmed doses of Regular or NPH insulin into the bloodstream at specific intervals • Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream • Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels

24. 23) A young male client with type 1 diabetes tells a nurse that he might lose his job because he has been having frequent hypoglycemic reactions. His boss thinks that he is drunk during these episodes, and that he has been drinking on the job. Which action by the nurse would best assist this client to meet his needs? • Contact the local employment office to help him find another job • Ask the client if he indeed has been drinking at work • Examine factors with the client that may be causing frequent hypoglycemic episodes • Ask the client what he does to treat his hypoglycemia

25. 24) A nurse is performing an assessment of a client with a diagnosis of Cushing’s syndrome. Which of the following would the nurse expect to note? • A drooping on one side of the face. • Skin atrophy • A rounded “moon-like” appearance to the face • The presence of sunken eyes

26. 25) A nurse is reviewing the assessment findings and lab data of a client with inappropriate secretion of antidiuretic hormones (SIADH). The nurse understands that which of the following is not characteristic of this disorder? • Signs of water intoxication • Hypernatremia • High urine osmolality • Low serum osmolality

27. 26) A nurse is interviewing a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder? • “I am taking oral insulin instead of shots.” • “The medications I’m taking help release the insulin I already make.” • “By taking these medications I am able to eat more.” • “When I become ill, I need to increase the number of pills I take.”

28. 27) A registered nurse (RN) is caring for a client with a diagnosis of Cushing’s syndrome. A licensed practical nurse (LPN) is working with the RN for the day. The RN determines that the LPN has an understanding of Cushing’s syndrome when the LPN states that the condition is caused by which of the following? • Excessive amounts of cortisol • Decreased amounts of cortisol • Excessive amounts of antidiuretic hormone • Decreased amounts of antidiuretic hormone

29. 28) A nurse is assessing a client with a diagnosis of goiter. Which of the following would the nurse expect to note during the assessment of the client? • Client complaints of slow would healing. • Client complaints of chronic fatigue • An enlarged thyroid gland • The presence of heart damage

30. 29) A nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which client behavior indicates to the nurse that the client is not ready to learn? • The client complains of fatigue whenever the nurse plans a teaching session. • The client asks if the spouse can attend the teaching session. • The client asks for written materials about diabetes mellitus before class • The client asks appropriate questions about what will be taught