NURS 270 Unit 4 Questions With Complete Solutions
A 23-year-old patient is admitted with diabetes insipidus. Which
action will be most appropriate for the registered nurse (RN) to
delegate to an experienced licensed practical/vocational nurse
(LPN/LVN)?
a. Titrate the infusion of 5% dextrose in water.
b. Teach the patient how to use desmopressin (DDAVP) nasal
spray.
c. Assess the patient's hydration status every 8 hours.
d. Administer subcutaneous DDAVP. Correct Answer ANS:
D
Administration of medications is included in LPN/LVN
education and scope of practice. Assessments, patient teaching,
and titrating fluid infusions are more complex skills and should
be done by the RN.
A 29-year-old woman with systemic lupus erythematosus has
been prescribed 2 weeks of high-dose prednisone therapy.
Which information about the prednisone is most important for
the nurse to include?
a. "Weigh yourself daily to monitor for weight gain caused by
increased appetite."
b. "A weight-bearing exercise program will help minimize the
risk for osteoporosis."
c. "The prednisone dose should be decreased gradually rather
than stopped suddenly."
d. "Call the health care provider if you experien Correct
Answer ANS: C
Acute adrenal insufficiency may occur if exogenous
corticosteroids are suddenly stopped. Mood alterations and
,weight gain are possible adverse effects of corticosteroid use,
but these are not life-threatening effects. Osteoporosis occurs
when patients take corticosteroids for longer periods.
A 37-year-old patient has just arrived in the postanesthesia
recovery unit (PACU) after a thyroidectomy. Which information
is most important to communicate to the surgeon?
a. The patient reports 7/10 incisional pain.
b. The patient has increasing neck swelling.
c. The patient is sleepy and difficult to arouse.
d. The patient's cardiac rate is 112 beats/minute. Correct
Answer ANS: B
The neck swelling may lead to respiratory difficulty, and rapid
intervention is needed to prevent airway obstruction. The
incisional pain should be treated but is not unusual after surgery.
A heart rate of 112 is not unusual in a patient who has been
hyperthyroid and has just arrived in the PACU from surgery.
Sleepiness in the immediate postoperative period is expected.
A 37-year-old patient is being admitted with a diagnosis of
Cushing syndrome. Which findings will the nurse expect during
the assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Purplish streaks on the abdomen
d. Decreased axillary and pubic hair Correct Answer ANS: C
Purplish-red striae on the abdomen are a common clinical
manifestation of Cushing syndrome. Hypotension and bronzed-
appearing skin are manifestations of Addison's disease.
Decreased axillary and pubic hair occur with androgen
deficiency.
,A 38-year-old male patient is admitted to the hospital in
Addisonian crisis. Which patient statement supports a nursing
diagnosis of ineffective self-health management related to lack
of knowledge about management of Addison's disease?
a. "I frequently eat at restaurants, and my food has a lot of added
salt."
b. "I had the stomach flu earlier this week, so I couldn't take the
hydrocortisone."
c. "I always double my dose of hydrocortisone on the days that I
go for a long run."
d. "I take twice as Correct Answer ANS: B
The need for hydrocortisone replacement is increased with
stressors such as illness, and the patient needs to be taught to
call the health care provider because medication and IV fluids
and electrolytes may need to be given. The other patient
statements indicate appropriate management of the Addison's
disease.
A 42-year-old female patient is scheduled for transsphenoidal
hypophysectomy to treat a pituitary adenoma. During
preoperative teaching, the nurse instructs the patient about the
need to
a. cough and deep breathe every 2 hours postoperatively.
b. remain on bed rest for the first 48 hours after the surgery.
c. avoid brushing teeth for at least 10 days after the surgery.
d. be positioned flat with sandbags at the head postoperatively.
Correct Answer ANS: C
To avoid disruption of the suture line, the patient should avoid
brushing the teeth for 10 days after surgery. It is not necessary to
remain on bed rest after this surgery. Coughing is discouraged
, because it may cause leakage of cerebrospinal fluid (CSF) from
the suture line. The head of the bed should be elevated 30
degrees to reduce pressure on the sella turcica and decrease the
risk for headaches.
A 44-year-old female patient with Cushing syndrome is
admitted for adrenalectomy. Which intervention by the nurse
will be most helpful for a nursing diagnosis of disturbed body
image related to changes in appearance?
a. Reassure the patient that the physical changes are very
common in patients with Cushing syndrome.
b. Discuss the use of diet and exercise in controlling the weight
gain associated with Cushing syndrome.
c. Teach the patient that the metabolic impact of Cushing
syndrome is of more Correct Answer ANS: D
The most reassuring communication to the patient is that the
physical and emotional changes caused by the Cushing
syndrome will resolve after hormone levels return to normal
postoperatively. Reassurance that the physical changes are
expected or that there are more serious physiologic problems
associated with Cushing syndrome are not therapeutic responses.
The patient's physiological changes are caused by the high
hormone levels, not by the patient's diet or exercise choices.
A 45-year-old male patient with suspected acromegaly is seen at
the clinic. To assist in making the diagnosis, which question
should the nurse ask?
a. "Have you had a recent head injury?"
b. "Do you have to wear larger shoes now?"
c. "Is there a family history of acromegaly?"
A 23-year-old patient is admitted with diabetes insipidus. Which
action will be most appropriate for the registered nurse (RN) to
delegate to an experienced licensed practical/vocational nurse
(LPN/LVN)?
a. Titrate the infusion of 5% dextrose in water.
b. Teach the patient how to use desmopressin (DDAVP) nasal
spray.
c. Assess the patient's hydration status every 8 hours.
d. Administer subcutaneous DDAVP. Correct Answer ANS:
D
Administration of medications is included in LPN/LVN
education and scope of practice. Assessments, patient teaching,
and titrating fluid infusions are more complex skills and should
be done by the RN.
A 29-year-old woman with systemic lupus erythematosus has
been prescribed 2 weeks of high-dose prednisone therapy.
Which information about the prednisone is most important for
the nurse to include?
a. "Weigh yourself daily to monitor for weight gain caused by
increased appetite."
b. "A weight-bearing exercise program will help minimize the
risk for osteoporosis."
c. "The prednisone dose should be decreased gradually rather
than stopped suddenly."
d. "Call the health care provider if you experien Correct
Answer ANS: C
Acute adrenal insufficiency may occur if exogenous
corticosteroids are suddenly stopped. Mood alterations and
,weight gain are possible adverse effects of corticosteroid use,
but these are not life-threatening effects. Osteoporosis occurs
when patients take corticosteroids for longer periods.
A 37-year-old patient has just arrived in the postanesthesia
recovery unit (PACU) after a thyroidectomy. Which information
is most important to communicate to the surgeon?
a. The patient reports 7/10 incisional pain.
b. The patient has increasing neck swelling.
c. The patient is sleepy and difficult to arouse.
d. The patient's cardiac rate is 112 beats/minute. Correct
Answer ANS: B
The neck swelling may lead to respiratory difficulty, and rapid
intervention is needed to prevent airway obstruction. The
incisional pain should be treated but is not unusual after surgery.
A heart rate of 112 is not unusual in a patient who has been
hyperthyroid and has just arrived in the PACU from surgery.
Sleepiness in the immediate postoperative period is expected.
A 37-year-old patient is being admitted with a diagnosis of
Cushing syndrome. Which findings will the nurse expect during
the assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Purplish streaks on the abdomen
d. Decreased axillary and pubic hair Correct Answer ANS: C
Purplish-red striae on the abdomen are a common clinical
manifestation of Cushing syndrome. Hypotension and bronzed-
appearing skin are manifestations of Addison's disease.
Decreased axillary and pubic hair occur with androgen
deficiency.
,A 38-year-old male patient is admitted to the hospital in
Addisonian crisis. Which patient statement supports a nursing
diagnosis of ineffective self-health management related to lack
of knowledge about management of Addison's disease?
a. "I frequently eat at restaurants, and my food has a lot of added
salt."
b. "I had the stomach flu earlier this week, so I couldn't take the
hydrocortisone."
c. "I always double my dose of hydrocortisone on the days that I
go for a long run."
d. "I take twice as Correct Answer ANS: B
The need for hydrocortisone replacement is increased with
stressors such as illness, and the patient needs to be taught to
call the health care provider because medication and IV fluids
and electrolytes may need to be given. The other patient
statements indicate appropriate management of the Addison's
disease.
A 42-year-old female patient is scheduled for transsphenoidal
hypophysectomy to treat a pituitary adenoma. During
preoperative teaching, the nurse instructs the patient about the
need to
a. cough and deep breathe every 2 hours postoperatively.
b. remain on bed rest for the first 48 hours after the surgery.
c. avoid brushing teeth for at least 10 days after the surgery.
d. be positioned flat with sandbags at the head postoperatively.
Correct Answer ANS: C
To avoid disruption of the suture line, the patient should avoid
brushing the teeth for 10 days after surgery. It is not necessary to
remain on bed rest after this surgery. Coughing is discouraged
, because it may cause leakage of cerebrospinal fluid (CSF) from
the suture line. The head of the bed should be elevated 30
degrees to reduce pressure on the sella turcica and decrease the
risk for headaches.
A 44-year-old female patient with Cushing syndrome is
admitted for adrenalectomy. Which intervention by the nurse
will be most helpful for a nursing diagnosis of disturbed body
image related to changes in appearance?
a. Reassure the patient that the physical changes are very
common in patients with Cushing syndrome.
b. Discuss the use of diet and exercise in controlling the weight
gain associated with Cushing syndrome.
c. Teach the patient that the metabolic impact of Cushing
syndrome is of more Correct Answer ANS: D
The most reassuring communication to the patient is that the
physical and emotional changes caused by the Cushing
syndrome will resolve after hormone levels return to normal
postoperatively. Reassurance that the physical changes are
expected or that there are more serious physiologic problems
associated with Cushing syndrome are not therapeutic responses.
The patient's physiological changes are caused by the high
hormone levels, not by the patient's diet or exercise choices.
A 45-year-old male patient with suspected acromegaly is seen at
the clinic. To assist in making the diagnosis, which question
should the nurse ask?
a. "Have you had a recent head injury?"
b. "Do you have to wear larger shoes now?"
c. "Is there a family history of acromegaly?"
