EXIT HESI Review (latest update 2023) solved

EXIT HESI Review (latest update 2023) solvedAfter a teaching session, the nurse evaluates the client's understanding of hypoparathyroidism. Which statement made by the client indicates the need for further education? A) "I should eat an orange a day." B) "I should include yogurt in my diet." C) "I should perform mild exercises daily." D) "I should sit outside in the sun." B) "I should include yogurt in my diet." - Further education is needed for the client. Clients with hypoparathyroidism have hypocalcemia. In order to replenish the calcium levels of the body, the client should consume foods that are rich in calcium. However, foods rich in phosphorus such as yogurt, processed cheese, and milk should be avoided. All the other comments are correct and require no further education by the nurse. Oranges are good source of vitamin C and fibers. They help to improve healing and remove wastes from the body. Exercising is good for overall health. Sitting in the sun allows exposure of the client to sunlight, which is a natural source of vitamin D. Vitamin D helps in the absorption of calcium from the gastrointestinal tract. A nurse is teaching a client with diabetes about the treatment of hypoglycemia. The nurse knows that teaching was effective if the client picks which foods to treat a hypoglycemic attack? A) Fruit juice and a lollipop. B) Sugar and a slice of bread. C) Chocolate candy and a banana. D) Peanut butter crackers and a glass of milk. B) Sugar and a slice of bread. - The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response. Fruit juice and a lollipop are fast-acting sugars, and neither of them will provide a sustained response. The fat content of chocolate candy decreases the rate of absorption of glucose. Neither peanut butter crackers nor a glass of milk is a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised. A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information? A) "Eat your usual breakfast." B) "Have clear liquids for breakfast." C) "Take your medication before the test." D) "Do not ingest anything before the test." D) "Do not ingest anything before the test." - Fasting before the test is indicated for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients. Food should not be ingested before the test; food will increase the serum glucose level, negating accuracy of the test. Instructing the client to have clear liquids for breakfast is inappropriate; some clear fluids contain simple carbohydrates, which will increase the serum glucose level. Medications are withheld before the test because of their influence on the serum glucose level. What are the cardiovascular manifestations observed in a client with adrenal insufficiency? A) Fatigue B) Salt craving C) Weight loss D) Hyponatremia D) Hyponatremia - Hyponatremia is a decrease in serum sodium levels, which is the cardiovascular manifestation of adrenal insufficiency. Fatigue is a neuromuscular manifestation observed in clients with adrenal insufficiency, while salt cravings and weight loss are the abdominal manifestations observed in clients with adrenal insufficiency. A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply. A) Cool skin B) Photophobia C) Constipation D) Periorbital edema E) Decreased appetite A) Cool skin C) Constipation D) Periorbital edema E) Decreased appetite - Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edemas are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism. A registered nurse is teaching the student nurse the precautions to follow when blood samples are collected. Which statement made by the student nurse indicates effective learning? A) "I can place the specimen with other samples." B) "I can use a single-lumen line to obtain samples." C) "I should not reveal the test procedure to the client." D) "I should not place the blood samples collected for adrenaline on ice." B) "I can use a single-lumen line to obtain samples." - Usage of double- or triple-lumen lines for obtaining samples may contaminate the sample. Therefore, only single-lumen lines should be used. The samples should be stored separately to avoid contamination. The procedure of testing should be discussed with the client to obtain proper results. Blood samples drawn for catecholamines must be placed on ice and taken to the laboratory immediately. An older adult with a history of small cell lung carcinoma reports muscle cramping, thirst, and fatigue. The primary healthcare provider diagnoses the client with a pituitary disorder and is treating the client accordingly. Which is an effective outcome of the treatment? A) Urine output of 10 L/day B) Urine specific gravity less than 1.025 C) Urine osmolarity of 80 mOsm/kg (80 mmol/kg) D) Serum osmolarity of 600 mOsm/kg (600 mmol/kg) B) Urine specific gravity less than 1.025 - Because the specific gravity is less than 1.025 after treatment, the outcome is considered positive. In syndrome of inappropriate antidiuretic hormone (SIADH), the specific gravity is greater than 1.025. Small cell lung cancer is a risk factor of SIADH. Muscle cramping, thirst, and fatigue are clinical manifestations of SIADH. A serum osmolarity of 600 mOsm/kg indicates central diabetes insipidus. A urine output 10 L/day and a urine osmolarity of 80 mOsm/kg indicate diabetes insipidus. The nurse is caring for a client with diabetes mellitus. What is the primary fluid shift that occurs with this condition? A) Intravascular to interstitial because of glycosuria B) Interstitial to extracellular because of hypoproteinemia C) Intracellular to intravascular because of hyperosmolarity D) Intercellular to intravascular because of increased hydrostatic pressure C) Intracellular to intravascular because of hyperosmolarity - The osmotic effect of hyperglycemia pulls fluid from the intracellular and interstitial compartments, resulting in dehydration. Hyperglycemia pulls fluid from the interstitial to the intravascular compartment, eventually spilling into the urine. Interstitial fluid is part of the extracellular compartment; the osmotic pull of glucose exceeds other osmotic forces. An increase in hydrostatic pressure results in an intravascular to interstitial shift. A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs? A) Give the client 8 oz (240 mL) of orange juice. B) Seek a prescription to increase the insulin dose at bedtime. C) Encourage the client to eat smaller, more frequent meals. D) Collaborate with the primary healthcare provider to alter the insulin prescription D) Collaborate with the primary healthcare provider to alter the insulin prescription - The client is experiencing the Somogyi effect. It is a paradoxical situation in which sudden decreases in blood glucose are followed by rebound hyperglycemia. The body responds to the hypoglycemia by secreting glucagon, epinephrine, growth hormone, and cortisol to counteract the low blood sugar; this results in an excessive increase in the blood glucose level. It most often occurs in response to hypoglycemia when asleep. The primary healthcare provider may choose to decrease the insulin dose and then reassess the client. Giving the client 8 oz (240 mL) of orange juice will further increase the serum glucose level and is contraindicated. Increasing the insulin dose at bedtime will further worsen the problem. Encouraging the client to eat smaller, more frequent meals will not address the hypoglycemia and rebound hyperglycemia that occurs when sleeping. However, a bedtime snack may help minimize this event. A client has a thyroidectomy for cancer of the thyroid. When evaluating for nerve injury, what should the client be asked to do? A) Speak B) Swallow C) Purse the lips D) Turn the head A) Speak - The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland. A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? A) Cortical hormones stimulate rapid weight loss. B) Tissue catabolism results in a negative nitrogen balance. C) Glucocorticoids accelerate the process of gluconeogenesis. D) Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue. C) Glucocorticoids accelerate the process of gluconeogenesis. - Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas. A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? A) Checking the client's serum glucose level B) Assisting the client out of bed into a chair C) Placing the client in the high-Fowler position D) Ensuring the client's residual limb is elevated A) Checking the client's serum glucose level - Because the client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. To prevent flexion contractures of the hip, the client should not sit for a prolonged time; this is not the priority. Raising the head of the bed flexes the hips, which may result in hip flexion contractures; this is not the priority. Ensuring the client's residual limb is elevated may result in a hip flexion contracture and should be avoided. A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies further teaching about the hypophysectomy is necessary when the client states, "I know I will.. A) be sterile for the rest of my life." B) require larger doses of insulin than I did preoperatively." C) have to take cortisone or a similar drug for the rest of my life." D) have to take thyroxine or a similar medication for the rest of my life" B) require larger doses of insulin than I did preoperatively." - The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy, any elevation of blood glucose level caused by somatotropin will also stop. A nurse is caring for a client who had a hypophysectomy. For which complications specific to this surgery should the nurse assess the client for early clinical manifestations? A) Urinary retention B) Respiratory distress C) Bleeding at the suture line D) Increased ICP D) Increased ICP - Because the pituitary gland is located in the brain, edema after surgery may result in increased ICP. Early signs include decreased visual acuity, papilledema, and unilateral pupillary dilatation. Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis? A) Receives long-term steroid therapy B) Has a history of hypoparathyroidism C) Engages in strenuous physical activity D) Consumes high doses of the hormone estrogen A) Receives long-term steroid therapy - Increased levels of steroids increase bone demineralization. A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes: A) Onset of the disease is slow B) Excessive weight is a contributing factor C) Complications are not present at the time of diagnosis D) Treatment involves diet, exercise and oral medications C) Complications are not present at the time of diagnosis - Clinical presentation of type 1 diabetes is characterized by ACUTE (ABRUPT) onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease. A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. A) Hirsutism B) Menorrhagia C) Buffalo hump D) Dependent edema E) Migraine headaches A) Hirsutism C) Buffalo hump Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply. A) Lability of mood B) Slow wound healing C) A decrease in the growth of hair D) Ectomorphism with a moon face E) An increased resistance to bruising A) Lability of mood B) Slow wound healing A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply. A) Polyuria B) Obese trunk C) Hypotension D) Sleep disturbance E) Thin arms and legs B) Obese trunk D) Sleep disturbance E) Thin arms and legs What should the nurse do when collecting a 24-hour urine specimen? A) Check to verify if a preservative is needed B) Weigh the client before starting the collection C) Discard the last voided specimen of the 24-hour period D) Assess the client's intake and output for the previous 24-hour period A) Check to verify if a preservative is needed A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated? A) Hypotension B) Hyperglycemia C) Sodium retention D) Potassium excretion A) Hypotension - After an adrenalectomy, adrenal insufficiency causes hypotension because of fluid and electrolyte imbalances. A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infections process does the nurse conclude is impaired as a result of this disease? A) Stress response B) Electrolyte balance C) Metabolic process D) Respiratory function A) Stress response - Because of diminished glucocorticoid production, there is a decreased response to stress, reducing the ability to fight infection. A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations? A) Fluid balance B) Electrolyte levels C) Protein anabolism D) Masculinizing hormones C) Protein anabolism - Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in the breakdown of protein and fats as energy sources. Fludrocortisone is prescribed for a client with adrenal insufficiency. Which responses to the medication should the nurse instruct the client to report? Select all that apply. A) Edema B) Rapid weight gain C) Fatigue in the afternoon D) Unpredictable changes in mood E) Increased frequency of urination A) Edema B) Rapid weight gain A client admitted to the ED has ketones in the blood and urine. Which situation associated with this physiologic finding should be the nurse's focus when collecting additional data about this client? A) Starvation B) Alcoholism C) Bone healing D) Positive nitrogen balance A) Starvation - In starvation there are inadequate carbohydrates available for immediate energy, and stored fats are used in excessive amounts, producing ketones. A nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? Select all that apply. A) Thirst B) Palpitations C) Diaphoresis D) Slurred speech E) Hyperventilation B) Palpitations C) Diaphoresis D) Slurred speech A nurse is caring for a postoperative client who has diabetes. WHich is the MOST common cause of DKA that the nurse needs to consider when caring for this client? A) Emotional stress B) Presence of infection C) Increased insulin dose D) Inadequate food intake B) Presence of infection A client is learning alternative site testing for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary? A) "I need to rub my forearm vigorously until warm before testing at this site." B) "The fingertip is prefered for glucose monitoring if hyperglycemia is suspected." C) "Alternative site testing is unsafe if I am experiencing a rapid change in glucose levels." D) "I have to make sure that my current glucose monitor can be used at an alternative site." B) "The fingertip is prefered for glucose monitoring if hyperglycemia is suspected." - The fingertip is prefered for glucose monitoring if HYPOGLYCEMIA is suspected, not hyperglycemia. A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question? A) "There is no difference between readings." B) These types of monitors are meant for children." C) "Readings are on a different scale for each monitor." D) "Faster readings can be obtained from a fingerstick." A) "There is no difference between readings." A nurse is monitoring a client's fasting plasma glucose. At which FPG level should the nurse identify that the client has prediabetes? A) 70 mg/dL B) 100 mg/dL C) 130 mg/dL D) 160 mg/dL D) 160 mg/dL A nurse is collecting information about a client who has type 1 diabetes and who is being admitted because of diabetic ketoacidosis coma. Which factors can predispose a client to this condition? Select all that apply. A) Taking too much insulin B) Getting too much exercise C) Excessive emotional stress D) Running a fever with the flu E) Eating fewer calories than prescribed C) Excessive emotional stress D) Running a fever with the flu - A nurse is caring for a client admitted to the hospital for DKA. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. A) Sweating B) Retinopathy C) Acetone breath D) Increased arterial bicarbonate level E) Decreased arterial CO2 level C) Acetone breath E) Decreased arterial CO2 level A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. What should the nurse expect the HCP to prescribe? A) Acetylcysteine before the test B) Renal-friendly contrast medium for the test C) Forced diuresis with mannitol after the test D) Hydration with dextrose and water throughout the test A) Acetylcysteine before the test - Acetylcysteine is an antioxidant that scavenges oxygen free radicals, which are released when contrast medium causes cell death to renal tubular tissue; it also induces slight vasodilation. A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. What response should the nurse assess this client for? A) Hypovolemia B) Hyperkalemia C) Hypoglycemia D) Hypernatremia D) Hypernatremia - A client with Cushing syndrome secretes excess amounts of cortisol, a corticosteroid that acts to retain sodium and water, resulting in hypernatremia and edema. Hypervolemia, not hypovolemia, is caused by fluid retention. Hypokalemia, not hyperkalemia, occurs because potassium is lost when there is sodium retention. Hyperglycemia, not hypoglycemia, results from cortisol-induced glucose intolerance. Which hormones are secreted by the client's hypothalamus? Select all that apply. A) Growth hormone B) Follicle-stimulating hormone C) Prolactin-inhibiting hormone D) Corticotropin-releasing hormone E) Melanocyte-stimulating hormone C) Prolactin-inhibiting hormone D) Corticotropin-releasing hormone - The hormones that are secreted by the hypothalamus include prolactin-inhibiting hormone and corticotropin-releasing hormone. Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the anterior pituitary gland. The nurse is assessing a client admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these are signs of Cushing disease? Select all that apply. A) Round face B) Dependent edema in the feet and ankles C) Increased fatty deposition in the extremities D) Thin, translucent skin with bruising E) Increased fatty deposition in the neck and back A) Round face B) Dependent edema in the feet and ankles D) Thin, translucent skin with bruising E) Increased fatty deposition in the neck and back - Changes in fat distribution may result in a round face and fat pads on the neck, back, and shoulders. There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushing syndrome. This increased fluid retention results in dependent peripheral edema. Skin changes result from increased blood vessel fragility and include bruises and thin or translucent skin. The extremities appear thinner from muscle wasting and weakness, not thicker from fatty deposition. Hypertension, not hypotension, is expected because of sodium and water retention. A client with a brain tumor develops a urine output of 300 mL/hr, dry skin, and dry mucous membranes. Which nursing intervention is the most appropriate to perform for this client? A) Evaluate urine specific gravity. B) Implement fluid restrictions. C) Provide emollients to the skin to prevent breakdown. D) Slow down the intravenous (IV) fluids and notify the primary healthcare provider A) Evaluate urine specific gravity. - Urine output of 300 mL/hr may indicate diabetes insipidus, which is a failure of the pituitary to produce antidiuretic hormone. This may occur with increased intracranial pressure and head trauma; the nurse evaluates for low urine specific gravity, increased serum osmolarity, and dehydration. There is no indication to reduce fluids. Providing emollients to prevent skin breakdown is important but does not assist with determining the underlying cause of the increased urine output. Slowing the rate of IV fluid would contribute to dehydration when polyuria is present. Which glands secrete hormones that regulate metabolism of carbohydrates, proteins, and fats? Select all that apply. A) Pancreas B) Thyroid gland C) Adrenal cortex D) Adrenal medulla E) Parathyroid gland A) Pancreas B) Thyroid gland C) Adrenal cortex - The pancreas secretes insulin and glucagon, which affects the body's metabolism of carbohydrates, proteins, and fats. The thyroid gland secretes thyroid hormones T3 and T4 that regulate carbohydrates, proteins, and fat metabolism. Cortisol is a glucocorticoid secreted by the adrenal cortex that affects carbohydrates, proteins, and fat metabolism. Adrenal medulla secretes catecholamines, which do not affect metabolism of carbohydrates, proteins, and fats. Hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism. The nurse is providing care for a client with small-cell carcinoma of the lung who develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply. A) Edema B) Polyuria C) Bradycardia D) Hypotension E) Hyponatremia A) Edema E) Hyponatremia - Edema results as fluid is retained because of the increased secretion of antidiuretic hormone. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia. A decreased urine output occurs with SIADH because ADH causes reabsorption of fluid in the kidney glomeruli. The increased fluid volume associated with SIADH results in tachycardia, tachypnea, and crackles. The increased fluid volume associated with SIADH results in hypertension, not hypotension. The nurse is caring for a client who is diagnosed with hyperpituitarism due to a prolactin-secreting tumor. Which clinical manifestation can help confirm the diagnosis? A) Hypertrophy of skin B) Enlargement of liver C) Hypertrophy of the heart D) Absence of menstruation D) Absence of menstruation - A prolactin-secreting tumor is a common type of pituitary adenoma that results from excessive secretion of prolactin. Therefore, ultimately, there are associated clinical symptoms, such as absence of galactorrhea and menstruation and infertility. Excessive production of growth hormone is manifested by clinical symptoms, such as skin hypertrophy and enlargement of organs (e.g., liver and heart). Which drug can cause diabetes insipidus? A) Cabergoline B) Metyrapone C) Demeclocycline D) Aminoglutethimide C) Demeclocycline - Prolonged administration of demeclocycline may cause diabetes insipidus, as this drug decreases the production of antidiuretic hormone by the kidneys. Cabergoline inhibits the release of growth hormone and prolactin by stimulating dopamine receptors in the brain. Metyrapone and aminoglutethimide decrease cortisol production. A client is diagnosed with hyperthyroidism and is treated with 131I. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms should be included in the teaching? Select all that apply. A) Fatigue B) Dry skin C) Insomnia D) Intolerance to heat E) Progressive weight gain A) Fatigue B) Dry skin E) Progressive weight gain - Fatigue is caused by a decreased metabolic rate associated with hypothyroidism. Dry skin most likely is caused by decreased glandular function associated with hypothyroidism. Progressive weight gain is associated with hypothyroidism in response to a decrease in the metabolic rate because of insufficient thyroid hormone. Insomnia is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone. Intolerance to heat is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone. A client with a family history of goiter is experiencing changes in voice and breathing. Which diagnostic study does the nurse consider to be beneficial in confirming a diagnosis? A) Thyroglobulin B) Thyroid antibodies C) Thyroxine (free T4), total D) Thyroid-stimulating hormone (TSH) B) Thyroid antibodies - Changes in voice and breathing can be seen in Hashimoto's thyroiditis if the thyroid gland enlarges rapidly and constricts the trachea and laryngeal nerves. Clients with a family history of goiter may have this condition. A thyroid antibody test is used diagnose Hashimoto's thyroiditis by differentiating thyroid dysfunction from thyroiditis. Thyroglobulin is used to detect thyroid cancer. Thyroxine (free T4), total and TSH are used to evaluate thyroid function. A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. What clinical manifestations might the nurse identify when assessing this client? Select all that apply. A) Muscle tremors B) Abdominal cramps C) Increased peristalsis D) Cardiac dysrhythmias E) Hypoactive bowel sounds D) Cardiac dysrhythmias E) Hypoactive bowel sounds - When the serum calcium level is increased, initially it causes tachycardia; as it progresses, it depresses electrical conduction in the heart, causing bradycardia. Hypercalcemia causes decreased peristalsis identified by constipation and hypoactive or absent bowel sounds. Muscle tremors occur with hypocalcemia, not hypercalcemia. Abdominal cramps occur with hypocalcemia, not hypercalcemia. Increased intestinal peristalsis occurs with hypocalcemia, not hypercalcemia. After assessing a client, the nurse anticipates that the client has hyperpituitarism. Which questions asked by the nurse helps confirm the diagnosis? Select all that apply. A) "Is there any change in your vision?" B) "Do you experience severe headaches?" C) "Are you suffering with frequent urination?" D) "Do you eat more than five times a day?" E) "Is there any change in your menstrual cycle? A) "Is there any change in your vision?" B) "Do you experience severe headaches?" E) "Is there any change in your menstrual cycle? - Hyperpituitarism manifests with vision disturbances and severe headaches. Due to hypersecretion of prolactin in females, a change in menstrual cycle may also be observed. Frequent urination is observed in a client with diabetes insipidus. Clients with diabetes mellitus experience intense hunger. The nurse is teaching a nursing student about caring for a client who is undergoing blood studies for antidiuretic hormone stimulation. Which statements made by the nursing student indicate effective instruction? Select all that apply. A) "I will assess the pulse rate after rehydrating the client." B) "I will perform the test if the serum sodium level is high." C) "I will perform the test if the osmolarity is 200 mOsm (mmol)/kg." D) "I will hydrate the client with oral fluids before performing the test." E) "I will discontinue the test if the client's weight loss is greater than 4.4 lbs (2 kg)." A) "I will assess the pulse rate after rehydrating the client." C) "I will perform the test if the osmolarity is 200 mOsm (mmol)/kg." E) "I will discontinue the test if the client's weight loss is greater than 4.4 lbs (2 kg)." - The client's pulse rate and blood pressure should be assessed after rehydration for orthostatic hypertension after the procedure to ensure adequate fluid volume. The test should be performed if the serum osmolarity is less than 300 mOsm (mmol)/kg to avoid severe dehydration in clients who have central or nephrogenic diabetes insipidus. The test should be discontinued if the client's weight loss is greater than 2 kg. The test should not be performed if the serum sodium levels are high because severe dehydration may develop in central or nephrogenic diabetes insipidus clients. The client should have nothing by mouth before the test. Oral fluids are given to the client to rehydrate if the client is experiencing dehydration during the test. Because of multiple physical injuries and emotional concerns, a hospitalized client is at high risk to develop a stress ulcer (Curling). Which of these is evidence of a stress ulcer? A) Unexplained shock B) Melena for several days C) A sudden massive hemorrhage D) A gradual drop in the hematocrit value C) A sudden massive hemorrhage - Stress ulcers are asymptomatic until they produce massive hematemesis and rectal bleeding. Shock is the outcome of massive hemorrhage; it is not unexplained because the sudden gastrointestinal bleeding will be identified. Sudden massive bleeding occurs, not the slow oozing that causes melena. A gradual drop in the hematocrit value indicates slow blood loss. During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner? A) Increased appetite B) Recent weight loss C) Feelings of warmth D) Fluttering in the chest D) Fluttering in the chest - Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening. Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? A) Urine output B) Specific gravity C) Urine osmolarity D) Serum osmolarity C) Urine osmolarity - Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus. A nurse administers the prescribed regular insulin (Novolin R) to a client in DKA. In addition, the nurse anticipates that the IV solution prescribed will contain potassium to replenish potassium ions in the extracellular fluid that are being: A) Rapidly lost from the body by copious diaphoresis present during coma B) Carried with glucose to the kidneys to be excreted in the urine in increased amounts C) Quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose D) Moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose D) Moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose - Insulin stimulates cellular uptake of glucose and also stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement? A) Regulated food intake is basic to control B) Salt and sugar restriction is the main concern C) Small, frequent meals are better for digestion D) Large meals can contribute to weight problems A) Regulated food intake is basic to control A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include that will decrease the risk of complications? Select all that apply. A) Examining the feet daily B) Wearing well-fitting shoes C) Performing regular exercise D) Powdering the feet after showering E) Visiting the HCP weekly F) Testing bathwater with the toes before bathing A) Examining the feet daily B) Wearing well-fitting shoes C) Performing regular exercise Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? A) Monitoring for signs of hypoglycemia as a result of treatment B) Withholding glucose in any form until the situation is corrected C) Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D) Regulating insulin dosage according to the amount of ketones found in the client's urine A) Monitoring for signs of hypoglycemia as a result of treatment - During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Whole milk and fruit juices are high in carbohydrates which are contraindicated in DKA (Option C). Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. A) Diarrhea B) Listlessness C) Weight loss D) Bradycardia E) Decreased appetite A) Diarrhea C) Weight loss A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client's condition after this therapy should the nurse consider when providing care? A) Not radioactive and can be handled as any other individual B) Highly radioactive and should be isolated as much as possible C) Mildly radioactive but should be treated with routine safety precautions D) Not radioactive but may still transmit some dangerous radiations and must be treated with precautions. C) Mildly radioactive but should be treated with routine safety precautions A nurse is assessing a client with a diagnosis of hypothyroidism. Which clinical manifestation should the nurse expect when assessing this client? Select all that apply. A) Dry skin B) Brittle hair C) Weight loss D) Resting tremors E) Heat intolerance A) Dry skin B) Brittle hair A client is diagnosed with hyperthyroidism and is experincing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. A) Use tinted glasses B) Use warm, moist compresses C) Elevated the HOB 45 degrees D) Tape eyelids shut at night if they do not close E) Apply a petroleum-based jelly along the lower eyelid A) Use tinted glasses C) Elevated the HOB 45 degrees D) Tape eyelids shut at night if they do not close A nurse is transferring a client with a diagnosis of pheochromocytoma from a bed to a chair. What is the MOST important nursing intervention associated with this procedure for this client? A) Supporting the client on the weak side B) Ensuring that the chair is close to the client's bed C) Placing sturdy shoes with rubber soles on the client's feet D) Having the client sit on the side of the bed for a few minutes before the transfer D) Having the client sit on the side of the bed for a few minutes before the transfer - Having the client sit on the side of the bed for several minutes allows time for the blood pressure to adjust to the vertical position; this avoids dizziness and the potential for fainting or falling. A nurse is planning a community health program about screening for cancer. Which information recommended by the American Cancer Society (ACS) should the nurse include? A) Mammography should be performed annually after age 35 years for women B) Fecal occult blood testing should be performed yearly beginning at age 50 years C) Breast self-examination should be performed monthly beginning at age 30 years D) Digital rectal exams and PSA testing should be done yearly after age 40 for men B) Fecal occult blood testing should be performed yearly beginning at age 50 years A nurse is teaching an athletic teenager about nutrients that provide the quickest source of energy. Which food selected from the menu indicates to the nurse that the adolescent understands the teaching? A) Glass of milk B) Slice of bread C) Chocolate candy bar D) Glass of orange juice D) Glass of orange juice A nurse is caring for a client who is cachexic. What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client? A) Releases glucose for energy B) Regulates cholesterol production C) Uses lipoproteins for fat transport D) Stores triglycerides for energy reserves D) Stores triglycerides for energy reserves A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all of the cholesterol in my body so it isn't a problem? Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question? A) Blood clotting B) Bone formation C) Muscle contraction D) Cellular metabolism D) Cellular metabolism A nurse provides dietary teaching about a low-sodium diet for a client with HTN. Which nutrient selected by the client indicates an understanding about foods that are low in natural sodium? A) Milk B) Meat C) Fruits D) Vegetables C) Fruits A nurse is teaching about excellent food sources of vitamin A for a client who is deficient in this vitamin. WHich foods should the nurse include in the teaching? Select all that apply. A) Carrots B) Oranges C) Tomatoes D) Skim milk E) Leafy greens A) Carrots E) Leafy greens A client with the diagnosis of cancer of the stomach expresses aversion to meals and eats only small amounts. What should the nurse provide? A) Nourishment between meals B) Small portions more frequently C) Supplementary vitamins to stimulate the client's appetite D) Only foods the client likes in small portions at mealtimes B) Small portions more frequently A HCP orders an upper GI series and a barium enema. The client asks, "Why do I have to have barium for these tests?" The nurse's best response is "Barium: A) gives off visible light, illuminating the alimentary tract" B) provides fluorescence, thereby lighting up the alimentary tract" C) dyes the structures of the alimentary tract, making them more visible" D) gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays." D) gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays." A HCP orders intermittent NG tube feeding to supplement a client's oral nutritional intake. Which hazard associated with NG tube feeding will be reduced if the nurse administers this feeding over 60 minutes? A) Distension B) Flatulence C) Indigestion D) Regurgitation D) Regurgitation A client has a fractured mandible that is immobilized by wires. For which life-threatening postoperative problem should the nurse monitor this client? A) Infection B) Vomiting C) Osteomyelitis D) Bronchospasm B) Vomiting A client who had an I+D of an oral abscess is to be discharged. For which clinical finding, if it should occur, should the nurse instruct the client to notify the HCP? A) Foul odor to the breath B) Pain associated with swallowing C) Pain with swelling after one week D) Tenderness in the mouth when chewing C) Pain with swelling after one week - Pain and swelling should subside before one week. Continued pain and swelling may indicate infection. A nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings should the nurse expect to identify? Select all that apply. A) Halitosis B) Leukoplakia C) Bleeding gums D) Substernal pain E) Alterations in taste F) Enlarged cervical lymph nodes B) Leukoplakia E) Alterations in taste F) Enlarged cervical lymph nodes A nurse is providing discharge instructions for a client with a diagnosis of GERD. What should the nurse advise the client to do to limit symptoms of GERD? Select all that apply. A) Avoid heavy lifting B) Lie down after eating C) Avoid drinking alcohol D) Eat small, frequent meals E) Increase fluid intake with meals F) Wear an abdominal binder or girdle A) Avoid heavy lifting C) Avoid drinking alcohol D) Eat small, frequent meals A client with esophageal cancer is to receive TPN. A right subclavian catheter is inserted. What is the primary reason why the HCP ordered a central line? A) It prevents the development of infection B) There is less chance of this infusion infiltrating C) It is more convenient so clients can use their hands D) The large amount of blood helps to dilate the concentrated solution D) The large amount of blood helps to dilate the concentrated solution Famotidine 20 mg IVBP is prescribed for a client with a duodenal ulcer. The medication is diluted in 50 mL of 5% dextrose and is to infuse over 15 minutes. At what rate should the infusion control device be set. Record your answer using a whole number. 200 mL/hr An exploratory laparotomy is performed on a client with melena, and gastric cancer is discovered. A partial gastrectomy is performed, and a jejunostomy tube is surgically implanted. A NG tube to suction is in place. What should the nurse expect regarding the client's NG tube drainage during the first 24 hours after surgery? A) Green and viscid B) Contain some blood and clots C) Contain large amounts of frank blood D) Similar to coffee grounds in color and consistency B) Contain some blood and clots Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's NG tube is bright red. What should the nurse do first? A) Notify the HCP B) Clamp the NG tube for one hour C) Determine that this is an expected finding D) Irrigate the NG tube with iced saline C) Determine that this is an expected finding A client is admitted to the surgical unit from the PACU with a Salem sump NG tube that is to be attached to wall suction. Which nursing action should the nurse implement when caring for this client? A) Use NS to irrigate the tube B) Employ sterile technique when irrigating the tube C) Withdraw the tube quickly when decompression is terminated D) Allow the client to have small sips of ice water unless nauseated A) Use NS to irrigate the tube A nurse is caring for a client with cholelithasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indication associated with this condition? Select all that apply. A) Ecchymosis B) Yellow sclera C) Dark brown stool D) Straw-colored urine E) Pain in the right upper quadrant A) Ecchymosis B) Yellow sclera E) Pain in the right upper quadrant A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" What information should the nurse include in response to this question? A) Malignant growth B) Pocked of undigested food particles C) Dilated space of necrotic tissue and blood D) Sack filled with fluid and pancreatic enzymes C) Dilated space of necrotic tissue and blood A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply. A) Provide a low-fat diet B) Administer analgesics C) Teach relaxation exercises D) Encourage walking in the hall E) Monitor cardiac rate and rhythm F) Observe for signs of hypercalcemia B) Administer analgesics C) Teach relaxation exercises E) Monitor cardiac rate and rhythm A client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are most appropriate for the nurse to include in the teaching plan for this client? Select all that apply. A) Soft diet B) Regular diet C) Low-protein diet D) High-protein diet E) Low-carbohydrate diet F) High-carbohydrate diet A) Soft diet D) High-protein diet F) High-carbohydrate diet Thiamine (Vitamin B1) and niacin (Vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? A) Neuronal activity B) Bowel elimination C) Efficient circulation D) Prothrombin development A) Neuronal activity