To assess whether there is any improvement in a patient’s dysuria, which question will the nurse ask?
a.”Do you have to urinate at night?”
b.”Do you have blood in your urine?”
c.”Do you have to urinate frequently?”
d.”Do you have pain when you urinate?”
D. Dysuria is painful urination.
When a patient’s urine dipstick test indicates a small amount of protein, the nurse’s next action should be to:
a. send a urine specimen to the laboratory to test for ketones.
b. obtain a clean-catch urine for culture and sensitivity testing.
c. inquire about which medications the patient is currently taking.
d. ask the patient about any family history of chronic renal failure.
ANS: C
Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings.
A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?
a. Urinary catheter
b. Cleaning towelettes
c. Large container for urine
d. Sterile urine specimen cup
ANS: C
Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection.
A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for
a. renal failure.
b. kidney stones.
c. pyelonephritis.
d. bladder cancer.
ANS: D
Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk.
Which medication taken at home by a 47-year-old patient with decreased renal function will be of most concern to the nurse?
a. ibuprofen (Motrin)
b. warfarin (Coumadin)
c. folic acid (vitamin B9)
d. penicillin (Bicillin LA)
ANS: A
The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function.
A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?
a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured.
d. Pad the patient’s bed to accommodate overflow incontinence.
ANS: B
The patient’s age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients.
The nurse completing a physical assessment for a newly admitted male patient is unable to feel either kidney on palpation. Which action should the nurse take next?
a. Obtain a urine specimen to check for hematuria.
b. Document the information on the assessment form.
c. Ask the patient about any history of recent sore throat.
d. Ask the health care provider about scheduling a renal ultrasound.
ANS: B
The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be palpable under normal circumstances, so no action except to document the assessment information is needed.
How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis?
a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs along the midaxillary line.
ANS: B
Checking for flank pain is best performed by percussion of the CVA and asking about pain.
What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min?
a. 60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min
ANS: A
The creatinine clearance approximates the GFR.
The nurse assessing the urinary system of a 45-year-old female would use auscultation to
a. determine kidney position.
b. identify renal artery bruits.
c. check for ureteral peristalsis.
d. assess for bladder distention.
ANS: B
The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm.
A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patient’s care?
a. The patient has not had food or drink for 8 hours.
b. The patient lists allergies to shellfish and penicillin.
c. The patient complains of costovertebral angle (CVA) tenderness.
d. The patient used a bisacodyl (Dulcolax) tablet the previous night.
ANS: B
Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started.
A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate?
a. “Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys.”
b. “Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney.”
c. “Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray.”
d. “Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked.”
ANS: C
In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken.
The nurse caring for a patient after cystoscopy plans that the patient
a. learns to request narcotics for pain.
b. understands to expect blood-tinged urine.
c. restricts activity to bed rest for a 4 to 6 hours.
d. remains NPO for 8 hours to prevent vomiting.
ANS: B
Pink-tinged urine and urinary frequency are expected after cystoscopy.
A patient has elevated blood urea nitrogen (BUN) and serum creatinine levels. Which bowel preparation order would the nurse question for this patient who is scheduled for a renal arteriogram?
a. Fleet enema
b. Tap-water enema
c. Senna/docusate (Senokot-S)
d. Bisacodyl (Dulcolax) tablets
ANS: A
High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure.
A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will
a. have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void.
b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.
c. insert a short sterile “mini” catheter attached to a collecting container into the urethra and bladder to obtain the specimen.
d. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.
ANS: B
This answer describes the technique for obtaining a clean-catch specimen.clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container
The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care?
a. Monitor the urine output after the procedure.
b. Assist with monitored anesthesia care (MAC).
c. Give oral contrast solution before the procedure.
d. Insert a large size urinary catheter before the IVP.
ANS: A
Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient’s urine output.
Which nursing action is essential for a patient immediately after a renal biopsy?
a. Check blood glucose to assess for hyperglycemia or hypoglycemia.
b. Insert a urinary catheter and test urine for gross or microscopic hematuria.
c. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function.
d. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.
ANS: D
A pressure dressing is applied and the patient is kept on the affected side for 30 to 60 minutes to put pressure on the biopsy side and decrease the risk for bleeding.
A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first?
a. Notify the patient’s health care provider.
b. Teach correct midstream urine collection.
c. Ask the patient about current medications.
d. Question the patient about urinary tract infection (UTI) risk factors.
ANS: C
A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium).
A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first?
a. Ask about the usual urinary pattern and any measures used for bladder control.
b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying.
c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity.
d. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
ANS: A
Before planning any interventions, the nurse should complete the assessment and determine the patient’s normal bladder pattern and the usual measures used by the patient at home.
Which information from a patient’s urinalysis requires that the nurse notify the health care provider?
a. pH 6.2
b. Trace protein
c. WBC 20 to 26/hpf
d. Specific gravity 1.021
ANS: C
The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation
Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider?
a. “My urine looks pink.”
b. “My IV site is bruised.”
c. “My sleep was restless.”
d. “My temperature is 101.”
ANS: D
The patient’s elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started.
Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse?
a. The heart rate is 58 beats/minute.
b. The patient complains of a dry mouth.
c. The respiratory rate is 38 breaths/minute.
d. The urine output is 400 mL after 2 hours.
ANS: C
The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patient’s oxygen saturation and breath sounds.
When working in the urology/nephrology clinic, which patient could the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
a. Patient who is scheduled for a renal biopsy after a recent kidney transplant
b. Patient who will need monitoring for several hours after a renal arteriogram
c. Patient who requires teaching about possible post-cystoscopy complications
d. Patient who will have catheterization to check for residual urine after voiding
ANS: D
LPN/LVN education includes common procedures such as catheterization of stable patients.
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
ANS: C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control.
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
a.self-monitoring of blood glucose.
b. using low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
ANS: C
The patient’s impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes.
A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.
ANS: D
When the patient is ketotic, exercise may result in an increase in blood glucose level.
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask?
a. “Are you anorexic?”
b. “Is your urine dark colored?”
c. “Have you lost weight lately?”
d. “Do you crave sugary drinks?”
ANS: C
Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level
ANS: D
The glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of glucose over 90 to 120 days.
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
ANS: A
The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels.
A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to
a. check glucose level before, during, and after swimming.
b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
d. time the morning insulin injection so that the peak occurs while swimming.
ANS: A
The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration.
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?
a. “I can have an occasional alcoholic drink if I include it in my meal plan.”
b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
c. “I can choose any foods, as long as I use enough insulin to cover the calories.”
d. “I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.”
ANS: C
Most patients with type 1 diabetes need to plan diet choices very carefully
In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take?
a. Determine what type of activities the patient enjoys.
b. Remind the patient that exercise will improve self-esteem.
c. Teach the patient about the effects of exercise on glucose level.
d. Give the patient a list of activities that are moderate in intensity.
ANS: A
Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program.
Which statement by the patient indicates a need for additional instruction in administering insulin?
a. “I need to rotate injection sites among my arms, legs, and abdomen each day.”
b. “I can buy the 0.5 mL syringes because the line markings will be easier to see.”
c. “I should draw up the regular insulin first after injecting air into the NPH bottle.”
d. “I do not need to aspirate the plunger to check for blood before injecting insulin.”
ANS: A
Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently.
Which patient action indicates good understanding of the nurse’s teaching about administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient stores the insulin in the freezer after administering the prescribed dose.
d. The patient pushes the plunger down while removing the syringe from the injection site.
ANS: B
Cleaning the skin with soap and water or with alcohol is acceptable
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours.
Which patient action indicates a good understanding of the nurse’s teaching about the use of an insulin pump?
a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient plans for a diet that is less flexible when using the insulin pump.
ANS: A
In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake.
A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?
a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N)
ANS: A
Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy.
Which information will the nurse include when teaching a 50-year-old patient who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.
ANS: B
The sulfonylureas stimulate the production and release of insulin from the pancreas
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching?
a. “If I overeat at a meal, I will still take the usual dose of medication.”
b. “Other medications besides the Glucotrol may affect my blood sugar.”
c. “When I am ill, I may have to take insulin to control my blood sugar.”
d. “My diabetes won’t cause complications because I don’t need insulin.”
ANS: D
The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin.
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the patient may
a. need a diet higher in calories while receiving prednisone.
b. develop acute hypoglycemia while taking the prednisone.
c. require administration of insulin while taking prednisone.
d. have rashes caused by metformin-prednisone interactions.
ANS: C
Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
a. save the lunch tray for the patient’s later return to the unit.
b. ask that diagnostic testing area staff to start a 5% dextrose IV.
c. send a glass of milk or orange juice to the patient in the diagnostic testing area.
d. request that if testing is further delayed, the patient be returned to the unit to eat.
ANS: D
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time.
The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose
a. washes the puncture site using warm water and soap.
b. chooses a puncture site in the center of the finger pad.
c. hangs the arm down for a minute before puncturing the site.
d. says the result of 120 mg indicates good blood sugar control.
ANS: B
The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve endings along the side of the finger pad.
The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?
a. Ask the patient’s family to participate in the diabetes education program.
b. Assess the patient’s perception of what it means to have diabetes mellitus.
c. Demonstrate how to check glucose using capillary blood glucose monitoring.
d. Discuss the need for the patient to actively participate in diabetes management.
ANS: B
Before planning teaching, the nurse should assess the patient’s interest in and ability to self-manage the diabetes.
An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to
a. give a bolus of 50% dextrose.
b. insert a large-bore IV catheter.
c. initiate oxygen by nasal cannula.
d. administer glargine (Lantus) insulin.
ANS: B
HHS is initially treated with large volumes of IV fluids to correct hypovolemia.
A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to
a. use only the lispro insulin until the symptoms are resolved.
b. limit intake of calories until the glucose is less than 120 mg/dL.
c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
ANS: C
Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
The health care provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
a. Avoid snacking at bedtime.
b. Increase the rapid-acting insulin dose.
c. Check the blood glucose during the night
d. Administer a larger dose of long-acting insulin.
ANS: C
If the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM.
Which action should the nurse take after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of peanut butter and crackers.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours.
ANS: B
Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia.
Which question during the assessment of a diabetic patient will help the nurse identify autonomic neuropathy?
a. “Do you feel bloated after eating?”
b. “Have you seen any skin changes?”
c. “Do you need to increase your insulin dosage when you are stressed?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”
ANS: A
Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient.
Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
a. Choose flat-soled leather shoes.
b. Set heating pads on a low temperature.
c. Use callus remover for corns or calluses.
d. Soak feet in warm water for an hour each day.
ANS: A
The patient is taught to avoid high heels and that leather shoes are preferred.
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?
a. The patient’s blood glucose level is 174 mg/dL.
b. The patient has gained 2 lb (0.9 kg) since yesterday.
c. The patient is scheduled for a chest x-ray in an hour.
d. The patient’s blood urea nitrogen (BUN) level is 52 mg/dL.
ANS: D
The BUN indicates possible renal failure, and metformin should not be used in patients with renal failure.
A diabetic patient who has reported burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?
a. Amitriptyline decreases the depression caused by your foot pain.
b. Amitriptyline helps prevent transmission of pain impulses to the brain.
c. Amitriptyline corrects some of the blood vessel changes that cause pain.
d. Amitriptyline improves sleep and makes you less aware of nighttime pain.
ANS: B
Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain
Which information is most important for the nurse to report to the health care provider before a patient with type 2 diabetes is prepared for a coronary angiogram?
a. The patient’s most recent HbA1C was 6.5%.
b. The patient’s admission blood glucose is 128 mg/dL.
c. The patient took the prescribed metformin (Glucophage) today.
d. The patient took the prescribed captopril (Capoten) this morning.
ANS: C
To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram and should not be used for 48 hours after IV contrast media are administered.
Which action by a patient indicates that the home health nurse’s teaching about glargine and regular insulin has been successful?
a. The patient administers the glargine 30 minutes before each meal.
b. The patient’s family prefills the syringes with the mix of insulins weekly.
c. The patient draws up the regular insulin and then the glargine in the same syringe.
d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
ANS: D
Insulin can be stored at room temperature for 4 weeks.
A 26-year-old patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to administer the morning insulin?
a. thigh.
b. buttock.
c. abdomen.
d. upper arm.
ANS: C
Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption.
The nurse is interviewing a new patient with diabetes who receives rosiglitazone (Avandia) through a restricted access medication program. What is most important for the nurse to report immediately to the health care provider?
a. The patient’s blood pressure is 154/92.
b. The patient has a history of emphysema.
c. The patient’s blood glucose is 86 mg/dL.
d. The patient has chest pressure when walking.
ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication
The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first?
a. Teach the patient about administering regular insulin.
b. Schedule the patient for a fasting blood glucose level.
c. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.
d. Provide teaching about an increased risk for fetal problems with gestational diabetes.
ANS: B
Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit.
A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?
a. Place the patient on a cardiac monitor.
b. Administer IV potassium supplements.
c. Obtain urine glucose and ketone levels.
d. Start an insulin infusion at 0.1 units/kg/hr.
ANS: A
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium.
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?
a. Infuse 1 liter of normal saline per hour.
b. Give sodium bicarbonate 50 mEq IV push.
c. Administer regular insulin 10 U by IV push.
d. Start a regular insulin infusion at 0.1 units/kg/hr.
ANS: A
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids.
A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
a. Infuse dextrose 50% by slow IV push.
b. Administer 1 mg glucagon subcutaneously.
c. Obtain a glucose reading using a finger stick.
d. Have the patient drink 4 ounces of orange juice.
ANS: C
The patient’s clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient’s glucose with a finger stick or order a stat blood glucose.
A female patient is scheduled for an oral glucose tolerance test. Which information from the patient’s health history is most important for the nurse to communicate to the health care provider?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has been pregnant three times.
d. The patient has a family history of diabetes.
ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values.
Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates the most urgent need for the nurse’s assessment of the patient?
a. Bedtime glucose of 140 mg/dL
b. Noon blood glucose of 52 mg/dL
c. Fasting blood glucose of 130 mg/dL
d. 2-hr postprandial glucose of 220 mg/dL
ANS: B
The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice.
When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery.
b. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.
ANS: C
LPN/LVN education and scope of practice includes administration of insulin.
An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy?
a. Hemoglobin A1C level 6.2%
b. Blood pressure 146/88 mmHg
c. Heart rate at rest 58 beats/minute
d. High density lipoprotein (HDL) level 65 mg/dL
ANS: B
To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the goal blood pressure is usually 130/80.
A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam
a. every 2 years.
b. as soon as possible.
c. when the patient is 39 years old.
d. within the first year after diagnosis.
ANS: B
Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye exam is recommended at the time of diagnosis and annually thereafter.
After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective?
a. “I may feel hungrier than usual when I take this medicine.”
b. “I will not need to worry about hypoglycemia with the Byetta.”
c. “I should take my daily aspirin at least an hour before the Byetta.”
d. “I will take the pill at the same time I eat breakfast in the morning.”
ANS: C
Since exenatide slows gastric emptying, oral medications should be taken at least an hour before the exenatide to avoid slowing absorption.
A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the health care provider?
a. Hemoglobin A1C level is 7.9%.
b. Last eye exam was 18 months ago.
c. Glomerular filtration rate is decreased.
d. Patient has questions about the prescribed diet.
ANS: C
The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication
The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?
a. Give the patient 4 to 6 oz more orange juice.
b. Administer the PRN glucagon (Glucagon) 1 mg IM.
c. Have the patient eat some peanut butter with crackers.
d. Notify the health care provider about the hypoglycemia.
ANS: A
The “rule of 15” indicates that administration of quickly acting carbohydrates should be done 2 to 3 times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care provider
Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the diabetic clinic?
a. Measure the ankle-brachial index.
b. Check for changes in skin pigmentation.
c. Assess for unilateral or bilateral foot drop.
d. Ask the patient about symptoms of depression.
ANS: A
Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure.
After change-of-shift report, which patient will the nurse assess first?
a. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
b. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
d. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
ANS: C
The patient’s diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed.
After change-of-shift report, which patient should the nurse assess first?
a. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
c. 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dL
d. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain
ANS: B
Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose.
To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)?
a. Chest x-ray
b. Blood pressure
c. Serum creatinine
d. Urine for microalbuminuria
e. Complete blood count (CBC)
f. Monofilament testing of the foot
ANS: B, C, D, F
Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes
In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]).
a. Rotate NPH vial.
b. Withdraw regular insulin.
c. Withdraw 20 units of NPH.
d. Inject 20 units of air into NPH vial.
e. Inject 2 units of air into regular insulin vial
ANS:
A, D, E, B, C
When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin.
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?”
d. “Are you experiencing tremors or anxiety?”
ANS: B
Acromegaly causes an enlargement of the hands and feet.
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.
ANS: C
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery.
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?
a. Palpate extremities for edema.
b. Measure urine volume every hour.
c. Check hematocrit every 2 hours for 8 hours.
d. Monitor continuous pulse oximetry for 24 hours.
ANS: B
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential.
The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include
a. high blood pressure.
b. decreased facial hair.
c. elevated blood glucose.
d. tachycardia and cardiac palpitations.
ANS: B
Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH).
Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)?
a. The medication will be needed for 3 to 6 months.
b. Inject the medication subcutaneously every day.
c. Blood glucose levels may decrease when taking the medication.
d. Stop taking the medication if swelling of the hands or feet occurs.
ANS: B
Somatropin is injected subcutaneously on a daily basis, preferably in the evening.
The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s
a. weight has increased.
b. urinary output is increased.
c. peripheral edema is decreased.
d. urine specific gravity is increased.
ANS: B
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output.
The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following?
a. “I need to shop for foods low in sodium and avoid adding salt to food.”
b. “I should weigh myself daily and report any sudden weight loss or gain.”
c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”
d. “I will eat foods high in potassium because diuretics cause potassium loss.”
ANS: A
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed.
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
a. elevated hematocrit.
b. decreased serum sodium.
c. low urine specific gravity.
d. increased serum chloride.
ANS: B
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient.
An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is
a. excess fluid volume related to intake greater than output.
b. impaired gas exchange related to fluid retention in lungs.
c. sleep pattern disturbance related to frequent waking to void.
d. risk for impaired skin integrity related to generalized edema.
ANS: C
Nocturia occurs as a result of the polyuria caused by diabetes insipidus.
Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves’ disease?
a. Exercise is contraindicated to avoid increasing metabolic rate.
b. Restriction of iodine intake is needed to reduce thyroid activity.
c. Antithyroid medications may take several months for full effect.
d. Surgery will eventually be required to remove the thyroid gland.
ANS: C
Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen.
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?
a. Suction the patient’s airway.
b. Administer IV calcium gluconate.
c. Plan for emergency tracheostomy.
d. Prepare for endotracheal intubation.
ANS: B
The patient’s clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery.
Which nursing action will be included in the plan of care for a 55-year-old patient with Graves’ disease who has exophthalmos?
a. Place cold packs on the eyes to relieve pain and swelling.
b. Elevate the head of the patient’s bed to reduce periorbital fluid.
c. Apply alternating eye patches to protect the corneas from irritation.
d. Teach the patient to blink every few seconds to lubricate the corneas.
ANS: B
The patient should sit upright as much as possible to promote fluid drainage from the periorbital area
A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient
a. about radioactive precautions to take with all body secretions.
b. that symptoms of hyperthyroidism should be relieved in about a week.
c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
d. to discontinue the antithyroid medications taken before the radioactive therapy.
ANS: C
There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism.
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
a. Fluid balance
b. Apical pulse rate
c. Nutritional intake
d. Orientation and alertness
ANS: B
In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias
An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering
a. docusate (Colace).
b. ibuprofen (Motrin).
c. diazepam (Valium).
d. cefoxitin (Mefoxin).
ANS: C
Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use?
a. Provide written reminders of self-care information.
b. Offer multiple options for management of therapies.
c. Ensure privacy for teaching by asking visitors to leave.
d. Delay teaching until patient discharge date is confirmed.
ANS: A
Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care.
A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?
a. Restrict the patient to bed rest.
b. Encourage 4000 mL of fluids daily.
c. Institute routine seizure precautions.
d. Assess for positive Chvostek’s sign.
ANS: B
The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first?
a. Administer the ordered muscle relaxant.
b. Give the ordered oral calcium supplement.
c. Have the patient rebreathe from a paper bag.
d. Start the PRN oxygen at 2 L/min per cannula.
ANS: C
The patient’s symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about
a. bisphosphonates to reduce bone demineralization.
b. calcium supplements to normalize serum calcium levels.
c. increasing fluid intake to decrease risk for nephrolithiasis.
d. including whole grains in the diet to prevent constipation.
ANS: B
Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia.
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?
a. Increased thyroxine (T4) level
b. Blood pressure 112/62 mm Hg
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level
ANS: A
An increased thyroxine level indicates the levothyroxine dose needs to be decreased.
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
ANS: C
Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome
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 importance than appearance.
d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.
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.
Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels
ANS: A
Clinical manifestations of Addison’s disease include hyponatremia and an increase in sodium level indicates improvement.
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 much hydrocortisone in the morning dose as I do in the afternoon.”
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
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 experience mood alterations with the prednisone.”
ANS: C
Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped
A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism. The nurse providing care should
a. monitor the blood pressure every 4 hours.
b. elevate the patient’s legs to relieve edema.
c. monitor blood glucose level every 4 hours.
d. order the patient a potassium-restricted diet.
ANS: A
Hypertension caused by sodium retention is a common complication of hyperaldosteronism
The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for
a. flushing.
b. headache.
c. bradycardia.
d. hypoglycemia.
ANS: B
The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain
After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for
a. sodium restriction to prevent fluid retention.
b. insulin to maintain normal blood glucose levels.
c. oral corticosteroids to replace endogenous cortisol.
d.chemotherapy to prevent malignant tumor recurrence.
ANS: C
Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy
Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Monitor for peripheral edema.
b. Offer patient hard candies to suck on.
c.Encourage fluids to 2 to 3 liters per day.
d. Keep head of bed elevated to 30 degrees.
ANS: B
Sucking on hard candies decreases thirst for a patient on fluid restriction.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
a.Observe the dressing for bleeding.
b. Check the blood pressure and pulse.
c. Assess the patient’s respiratory effort.
d. Support the patient’s head with pillows.
ANS: C
Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany.
The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to
a. protect the patient’s skin.
b. monitor for signs of infection.
c. balance fluids and electrolytes.
d. prevent emotional disturbances.
ANS: C
After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
a. The patient is confused and lethargic.
b. The patient reports a recent head injury.
c. The patient has a urine output of 400 mL/hr.
d. The patient’s urine specific gravity is 1.003.
ANS: A
The patient’s confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic
Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm?
a.Propranolol (Inderal)
b. Propylthiouracil (PTU)
c. Methimazole (Tapazole)
d. Iodine (Lugol’s solution)
ANS: A
Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm
Which assessment finding for a 33-year-old female patient admitted with Graves’ disease requires the most rapid intervention by the nurse?
a. Bilateral exophthalmos
b. Heart rate 136 beats/minute
c. Temperature 103.8° F (40.4° C)
d. Blood pressure 166/100 mm Hg
ANS: C
The patient’s temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately
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.
ANS: B
The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction
Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse?
a. The blood glucose is 176 mg/dL.
b. The lungs have bibasilar crackles.
c. The blood pressure (BP) is 88/50 mm Hg.
d. The patient reports 5/10 incisional pain.
ANS: C
The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered.
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.
ANS: D
Administration of medications is included in LPN/LVN education and scope of practice.
Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?
a. The patient has a recent weight gain of 9 lb.
b. The patient complains of dyspnea with activity.
c. The patient has a urine specific gravity of 1.025.
d. The patient has a serum sodium level of 118 mEq/L.
ANS: D
A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134
c. A 53-year-old male who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems.
Which question will the nurse in the endocrine clinic ask to help determine a patient’s risk factors for goiter?
a. “How much milk do you drink?”
b. “What medications are you taking?”
c. “Are your immunizations up to date?”
d. “Have you had any recent neck injuries?”
ANS: B
Medications that contain thyroid-inhibiting substances can cause goiter.
Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider?
a. Changes in visual field
b. Milk leaking from breasts
c. Blood glucose 150 mg/dL
d. Nausea and projectile vomiting
ANS: D
Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment
Which finding by the nurse when assessing a patient with Hashimoto’s thyroiditis and a goiter will require the most immediate action?
a. New-onset changes in the patient’s voice
b.Apical pulse rate at rest 112 beats/minute
c. Elevation in the patient’s T3 and T4 levels
d. Bruit audible bilaterally over the thyroid gland
ANS: A
Changes in the patient’s voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider?
a. Patient’s blood pressure is 148/94 mm Hg.
b. Patient has bilateral 2+ pitting ankle edema.
c. Patient stopped taking the medication 2 days ago.
d. Patient has not been taking the prescribed vitamin D.
ANS: C
Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
a. Patient with Hashimoto’s thyroiditis and a heart rate of 102
b. Patient with tetany who has a new order for IV calcium chloride
c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL
d. Patient with Addison’s disease who takes hydrocortisone twice daily
ANS: B
Emergency treatment of tetany requires IV administration of calcium
After obtaining the information shown in the accompanying figure regarding a patient with Addison’s disease, which prescribed action will the nurse take first?
a. Give 4 oz of fruit juice orally.
b. Recheck the blood glucose level.
c. Infuse 5% dextrose and 0.9% saline.
d. Administer oxygen therapy as needed.
ANS: C
The patient’s poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed.
Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)?
a. “You will need to avoid smoking before the test.”
b. “Exercise should be avoided until the testing is complete.”
c. “Several blood samples will be obtained during the testing.”
d. “You should follow a low-calorie diet the day before the test.”
e. “The test requires that you fast for at least 8 hours before testing.”
ANS: A, C, E
Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.