Endocrine

Question 1

The nurse assesses a client with Cushing syndrome. Which clinical manifestations should the nurse
expect? Select all that apply.
1. Hyperglycemia
2. Hypertension
3. Hyponatremia
4. Truncal obesity
5. Weight

Answer 1

1. Hyperglycemia
2. Hypertension
3. Truncal obesity

Question 2

A client with type I diabetes mellitus is brought to the emergency department by his wife. The client has
fruity breath with rapid, deep respirations at 36 breaths per minute, reports abdominal pain, and appears
weak. The nurse should anticipate implementation of which prescription(s)? Select all that apply.
1. Administer dextrose 50 mg intravenous (IV) push
2. Instruct client to breathe into a paper bag to treat hyperventilation
3. Perform a fingerstick and serum blood glucose test
4. Prepare to administer an IV infusion of regular insulin
5. Start an IV line and administer a bolus of normal saline

Answer 2

3. Perform a fingerstick and serum blood glucose test
4. Prepare to administer an IV infusion of regular insulin
5. Start an IV line and administer a bolus of normal saline

Question 3

A client with type 1 diabetes is prescribed NPH insulin before breakfast and dinner. Although the client
reports feeling well, the 6 AM blood glucose level has averaged 60 mg/dL (3.3 mmol/L) over the past week.
Which action is appropriate for the nurse to recommend to the client?
1. Collect urine sample to check for urine ketones
2. Consume a snack of milk and cereal at bedtime
3. Increase carbohydrate intake at each meal
4. Take only the prebreakfast dose of NPH

Answer 3

2. Consume a snack of milk and cereal at bedtime

Question 4

The nurse cares for a client with type 2 diabetes mellitus and hemoglobin A1C results of 8% at an outpatient
health clinic. Which statement by the nurse will best address these results?
1. “It is important for us to review the signs and symptoms of a hypoglycemic reaction.”
2. “Let’s review your diet, exercise, and medication regimen over the past 2-3 months.”
3”Please describe what you have eaten in the last 24-48 hours.
4.”You should fast for at least 8 hours prior to your morning blood work.”

Answer 4

2. “Let’s review your diet, exercise, and medication regimen over the past 2-3 months.”

Question 5

The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse question?
1. 0.45% sodium chloride (NaCI) solution prescribed for a client with syndrome of inappropriate
antidiuretic hormone secretion who has a sodium level of 120 mEq/L (120 mmol/L)
2. 0.9% NaCI solution prescribed for a client with gastrointestinal bleeding who has a hemoglobin
level of 8.9 g/dL (89 g/L)
3. 1,000 mL bolus of 0.9% NaCI solution prescribed for a client with septic shock who has a white
blood cell count of 18,000/mm3 (18.0 × 10%)
4. Lactated Ringer’s solution prescribed for a male client with hypovolemic shock and a thermal
burn who has a hematocrit level of 56% (0.56)

Answer 5

1. 0.45% sodium chloride (NaCI) solution prescribed for a client with syndrome of inappropriate
   antidiuretic hormone secretion who has a sodium level of 120 mEq/L (120 mmol/L)

Question 6

The nurse prepares to administer a dose of radioactive iodine (RAl) to a 39-year-old female client with
Graves’ disease. Which action is most important for the nurse to take?
1. Ask client when her last menstrual cycle occurred
2. Confirm pregnancy test result is negative
3. Obtain a baseline assessment of the mouth and throat
4. Teach the client the signs and symptoms of hypothyroidism

Answer 6

2. Confirm pregnancy test result is negative

Question 7

The nurse assesses a 40-year-old client with acromegaly in an outpatient health clinic. Which new finding is
most important to report to the health care provider?
1. Compläints of knee pain when walking (8%)
2. Dark leathery skin (14%)
3. Fasting blood glucose 126 mg/dL (7.0 mmol/L) (6%)
4. Presence of S3 and S4 heart sound

Answer 7

4. Presence of S3 and S4 heart sound

Question 8

In the intensive care unit, the nurse cares for a client admitted with a head injury who develops syndrome of
inappropriate antidiuretic hormone. Which data should the nurse expect with the onset of this condition?
Select all that apply.
1. Decreased serum osmolality
2. High serum osmolality
3. High urine specific gravity
4. Increased urine output
5. Low serum sodium

Answer 8

1. Decreased serum osmolality
2. High urine specific gravity
3. Low serum sodium

Question 9

The clinic nurse is taking vital signs on a client who reports being fatigued every day and gaining weight
lately despite not eating much. The nurse should also ask about which symptoms? Select all that apply.
1. Cold intolerance
2. Constipation
3. Fever
4. Menstrual irregularity
5. Night sweats
6. Tachycardia

Answer 9

1. Cold intolerance
2. Constipation
3. Menstrual irregularity

Question 10

The nurse teaches proper foot care to a client with diabetes mellitus. Which statement by the client indicates
that further teaching is needed?
1. “I will apply lanolin to my feet to prevent dry skin.”
2. “I will make sure my flip flops are made of leather.”
3.”I will not apply a heating pad directly to my feet.”
4.”I will test the water with a thermometer before bathing.”

Answer 10

2. “I will make sure my flip flops are made of leather.”

Question 11

The nurse is caring for an adolescent client diagnosed with type 1 diabetes. The client exhibits hot, dry skin
and a glucose level of 350 mg/dL (19.4 mmol/L). Arterial blood gases show a pH of 7.27. STAT serum
chemistry labs have been drawn. Cardiac monitoring shows a sinus rhythm with peaked T waves, and the
client has minimal urine output. What is the nurse’s next priority action?
1. Administer IV regular insulin
2. Administer normal saline infusion
3. Obtain urine for urinalvsis
4. Request prescription for potassium infusion

Answer 11

2. Administer normal saline infusion

Question 12

A client is admitted to the intensive care unit with diagnoses of a brain tumor complicated by transient
diabetes insipidus. Which client data related to this complication should the nurse expect? Select all that
apply.
1. Dark amber urine with sediment
2. High serum osmolality
3. Low urine specific gravity
4. Recent weight gain
5. Reports of excessive thirs

Answer 12

2. High serum osmolality
3. Recent weight gain
4. Reports of excessive thirst

Question 13

The nurse is conducting a health-screening clinic at an industrial work site. The nurse should be most
concerned about which client’s risk for metabolic syndrome?

1. 27-year-old woman with triglycerides of 210 mg/dL (2.4 mmol/L), blood pressure of 128/82 mm
   Hg, and fasting blood glucose of 98 mg/dL (5.4 mmol/L)
2. 45-year-old man with waist circumference of 38 inches (96.5 cm), high-density lipoprotein of 49
   mg/dL (1.3 mmol/L), and fasting blood glucose of 118 mg/dL (6.6 mmol/L)
3. 55-year-old woman with waist circumference of 37 inches (94 cm), triglycerides of 190 mg/dL
   (2.2 mmol/L), and fasting blood glucose of 120 mg/dL (6.7 mmol/L)
   4.82-year-old man with high-density lipoprotein of 45 mg/dL (1.2 mmol/L), blood pressure of
   148/88 mm Hg, and fasting blood glucose of 104 mg/dL (5.8 mmol/L)

Answer 13

3. 55-year-old woman with waist circumference of 37 inches (94 cm), triglycerides of 190 mg/dL
   (2. 2 mmol/L), and fasting blood glucose of 120 mg/dL (6.7 mmol/L)

Question 14

The nurse is caring for a client with suspected Graves disease. Which assessment finding requires priority
Intervention?
1. Agitation and confusion
2. Heat intolerance
3. Pulse of 110/min, irregular rhythm
4. Red and bulging eyes

Answer 14

1. Agitation and confusion

Question 15

The nurse is assessing a group of clients in the community health clinic for metabolic syndrome. Which
clients exhibit features of the syndrome? Select all that apply.
1. Female with a low-density lipoprotein (LDL) level of 96 mg/dL (2.5 mmol/L)
2. Female with a waist circumference of 38 inches (96.5 cm)
3. Female with blood pressure of 148/90 mm Hg
4. Male with a fasting blood glucose of 99 mg/dL (5.5 mmol/L)
5. Male with a triglyceride level of 201 mg/dL (2.3 mmol/L)

Answer 15

2. Female with a waist circumference of 38 inches (96.5 cm)
3. Female with blood pressure of 148/90 mm Hg
4. Male with a triglyceride level of 201 mg/dL (2.3 mmol/L)

Question 16

A client is diagnosed with diabetic ketoacidosis (DKA). The client reports frequent urination, thirst, and
weakness. The nurse assesses a temperature of 102.4 F (39.1 C), fruity breath, deep labored respirations
with a rate of 30/min, and dry mucous membranes. What is the priority nursing diagnosis (ND) at this
time?
1. Deficient fluid volume related to osmotic diuresis
2. Imbalanced nutrition, less than body requirements related to inability to metabolize glucose
3. Ineffective breathing pattern related to the presence of metabolic acidosis
4. Ineffective health maintenance related to the inability to manage DM during illness

Answer 16

1. Deficient fluid volume related to osmotic diuresis

Question 17

hyperglycemic state. The nurse understands which characteristics are commonly associated with this
complication? Select all that apply.
1. Abdominal pain
2. Blood glucose level >600 mg/dL (33.3 mmol/L)
3. History of type 2 diabetes
4. Kussmaul respirations
5. Neurological manifestations

Answer 17

2. Blood glucose level >600 mg/dL (33.3 mmol/L)
3. History of type 2 diabetes
4. Neurological manifestations

Question 18

A client’s diabetes is controlled with a morning dose of glargine and a scheduled, fixed dose of lispro with
meals. Before breakfast, the client’s fingerstick glucose is 105 mg/dL (5.8 mmol/L). The tray is in the room,
and the client is eager to eat. What action should the nurse take?
1. Administer both insulins as prescribed
2. Hold both glargine and lispro insulin
3. Hold the glargine insulin
4. Hold the lispro insulin

Answer 18

1. Administer both insulins as prescribed

Question 19

The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with
tingling around the mouth and muscle twitching in the right arm. Which action is most important for the
nurse to implement first?
1. Change the surgical dressing to assess for bleeding
2. Document the findings in the electronic medical record
3. Draw arterial blood gases
4.Obtain a serum calcium level

Answer 19

4.Obtain a serum calcium level

Question 20

The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison disease). The
nurse recognizes which finding associated with the disease?
1. Bronze pigmentation of skin
2. Increased body or facial hair
3. Purple or red striae on the abdomen
4. Supraclavicular fat pad

Answer 20

1. Bronze pigmentation of skin

Question 21

When no changes are made to the diet or prescribed insulin, which client with type 1 diabetes mellitus does
the nurse anticipate having the highest risk of developing hypoglycemia?
1. 29-year-old with new onset of influenza
2. 40-year-old experienced cyclist who rides an extra 10 miles (16 km)
3. 65-year-old with cellulitis of the right leg
4. 72-year-old with emphysema who is taking prednisone

Answer 21

2. 40-year-old experienced cyclist who rides an extra 10 miles (16 km)

Question 22

The nurse is assigned to care for a client who had a thyroidectomy 24 hours ago. On initial assessment,
which finding requires the most immediate action by the nurse?
1. Calcium 8.8 mg/dL (2.20 mmol/L)
2. Heart rate 110/min
3. Laryngeal stridor
4. Pain rated 8 out of 10

Answer 22

3. Laryngeal stridor

Question 23

The nurse cares for a client diagnosed with type I diabetes mellitus who came to the emergency department
with the acute complication of diabetic ketoacidosis (DKA). After checking the blood glucose, which
prescription should the nurse implement first?
1. Insert an indwelling urinary catheter for accurate output calculation
2. Obtain serum potassium level results and report to the primary health care provider
3. Prepare an insulin drip for intravenous (IV) infusion as prescribed
4. Start an IV line and infuse normal saline as prescribed

Answer 23

4. Start an IV line and infuse normal saline as prescribed

Question 24

The nurse receives report on 4 clients. Which client should the nurse assess first?
1. A client 4 hours after a thyroidectomy due to hyperthyroidism who has a temperature of 99.9 F
(37.7 C) and reports feeling anxious
2. A client 12 hours after a transurthral resection of the prostate with a continuous bladder
irrigation who reports bladder spasms
3. A client with pancreatitis who reports a pain rating of 8 on a scale of 0-10 and has a heart rate of
99/min
4. A client who received a dose of nitroglycerin to treat chronic angina reports a headache and has
a blood pressure of 109/72 mm

Answer 24

1. A client 4 hours after a thyroidectomy due to hyperthyroidism who has a temperature of 99.9 F
   (37. 7 C) and reports feeling anxious

Question 25

The nurse is giving report to a licensed practical nurse (LPN) who will be helping to monitor a client who just
had a total thyroidectomy. What will the nurse emphasize as most important to report immediately?
1. Elevated blood pressure
2. Heart rate irregularity
3. Low oxygen saturation
4. Noisy breathing

Answer 25

4. Noisy breathing

Question 26

The clinic nurse is reviewing the laboratory results of a 35-year-old client who reports fatigue for the last
month. Based on the laboratory results, which additional clinical manifestations would the nurse expect?
Click on the exhibit button for additional information. Select all that apply.
1. Bradycardia
2. Cold intolerance
3. Constipation
4. Hair losS
5. Warm. moist skin
6. Weight loss

Answer 26

1. Bradycardia
2. Cold intolerance
3. Constipation
4. Hair loss

Question 27

The nurse in the endocrinology clinic is reviewing phone messages from clients. Which client would be the
priority to call first?
1. Client with a history of thyroidectomy who needs a refill for levothyroxine
2. Client with Addison disease who is taking corticosteroids and reports new mood swings
3. Client with diabetes who reports blood sugars of 250-300 mg/dL (13.9-16.7 mmol/L) in the past
week
4. Client with hyperthyroidism who has a new temperature reading of 101.5 F (38.6 C)

Answer 27

4. Client with hyperthyroidism who has a new temperature reading of 101.5 F (38.6 C)

Question 28

The nurse in the emergency department is caring for a client recently diagnosed with Graves’ disease who
was admitted following a motor vehicle accident. The nurse notes the vital signs shown in the exhibit. The
nurse alerts the primary health care provider that the client may be experiencing which condition? Click on
the exhibit button for additional information. (exhibit)

1. Hypertensive crisis
2. Malignant hyperthermia
3. Serotonin syndrome
4. Thyroid

Answer 28

4. Thyroid

Question 29

The nurse is caring for a client recovering from a thyroidectomy to treat hyperthyroidism. Which assessment
finding would require the nurse to immediately notify the health care provider?
1. 0.4 in? (2.6 cm?) of bright-red blood on the surgical dressing on the client’s neck
2. Client report of sore throat while talking and burning when swallowing
3. Pain rated as 8 on a scale of 0-10 at the surgical incision site
4. Temperature increase to 100 F (37.8 C) from 98.9 F (37.2 C) 30 minutes prior

Answer 29

4. Temperature increase to 100 F (37.8 C) from 98.9 F (37.2 C) 30 minutes prior

Question 30

A client diagnosed with septic shock has an upward-trending glucose level (180-225 mg/dL [10.0-12.5
mmol/L]) requiring control with insulin. The client’s spouse asks why insulin is needed as the client is not a
diabetic. What is the most appropriate response by the nurse?

1. “It is common for critically ill clients to develop type Il diabetes. We give insulin to keep the
   glucose level under control (<140 mg/dL [7.8 mmol/L]).”
   2.”The client was diabetic before, but you just didn’t know it. We give insulin to keep the glucose
   level in the normal range (70-110 mg/dL [3.9-6.1 mmol/L]).”
2. “The increase in glucose is a normal response to stress by the body. We give insulin to keep
   the level at 140-180 mg/dL (7.8-10.0 mmol/L).”
   4.”This increase is common in critically ill clients and affects their ability to fight off infection. We
   give insulin to keep the glucose level in the normal range (70-110 mg/dL [3.9-6.1 mmol/L]).’

Answer 30

3. “The increase in glucose is a normal response to stress by the body. We give insulin to keep the level at 140-180 mg/dL (7.8-10.0 mmol/L).”

Question 31

The nurse cares for a group of clients on a medical surgical floor. The client with which condition is at
highest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)?
1. Carpal tunnel syndrome
2. Diabetes mellitus
3. Sciatica
4. Small cell lung cancer

Answer 31

4. Small cell lung cancer

Question 32

The nurse teaches disease management to a group of clients with type I diabetes mellitus. Which of the
following should the nurse teach as signs or symptoms associated with hypoglycemia? Select all that
apply.
1. Diaphoresis
2. Flushing
3. Pallor
4.Polyuria
5. trembling

Answer 32

1. Diaphoresis
2. Pallor
3. trembling

Question 33

The nurse cares for a client who is experiencing exophthalmos as a complication of Graves’ disease.
Which nursing action(s) should be included in the client’s plan of care? Select all that apply.
1. Administer artificial tears to moisten the conjunctiva
2. If eyelids don’t close during sleep, lightly tape them shut
3. Recommend the use of dark glasses to prevent irritation
4. Teach about the importance of smoking cessation
5. Teach avoidance of eye movement to prevent further damage

Answer 33

1. Administer artificial tears to moisten the conjunctiva
2. If eyelids don’t close during sleep, lightly tape them shut
3. Recommend the use of dark glasses to prevent irritation
4. Teach about the importance of smoking cessation

Question 34

The nurse cares for a client with Addison’s disease who was involved in a motor vehicle accident and
hospitalized for a fracture of the right femur. Which client information is most important to report to the
primary health care provider (PHCP)?
1. Blood pressure change from 128/80 mm Hg to 90/50 mm Hg
2. Development of a 1st-degree atrioventricular (AV) block on electrocardiogram (ECG)
3. Reports of right femur pain of 7 on a scale of 1-10
4. Vesicular breath sounds auscultated over the lung tissue

Answer 34

1. Blood pressure change from 128/80 mm Hg to 90/50 mmHg

Question 35

The nurse cares for a client with type 1 diabetes mellitus. Which laboratory result is most important to report
to the primary health care provider?
1. Fasting blood glucose 99 mg/dL (5.5 mmol/L)
2. Serum creatinine 2.0 mg/dL (177 umol/L)
3. Serum potassium 3.9 mEq/L (3.9 mmol/L)
4. Serum sodium 140 mEq/L (140 mmol/L)

Answer 35

2. Serum creatinine 2.0 mg/dL (177 umol/L)

Question 36

The nurse assesses a client with hyperparathyroidism who had a parathyroidectomy 4 hours ago. Which
assessment technique should the nurse use to check for complications in this client?
1. Ask client to place backs of the hands against each other to provide hyperflexion of the wrist
while the elbows remain flexed
2. Instruct client to lie down and run the heel of one foot down the shin of the other leg
3. Perform Romberg test by asking the client to stand with eyes closed and feet together
4. Place blood pressure (BP) cuff on arm, inflate to pressure > than systolic BP, and hold in place
for 3

Answer 36

4. Place blood pressure (BP) cuff on arm, inflate to pressure > than systolic BP, and hold in place
   for 3

Question 37

The nurse cares for a newly admitted client with type 1 diabetes mellitus. The nurse reviews the electronic
health record before the breakfast trays arrive on the unit and contacts the health care provider for which
reason? Click on the exhibit button for additional information. (exhibit)
1. To increase the detemir prescription
2. To question the spironolactone prescription
3. To report the serum potassium level
4. To request a prescription for insulin lispro

Answer 37

4. To request a prescription for insulin lispro

Question 38

The nurse cares for a client admitted to the hospital due to confusion. The client has a nonmetastatic lung
mass and a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Which action(s) should
the nurse expect to implement? Select all that apply.
1. Fluid bolus (normal saline)
2. Fluid restriction
3. Salt restriction in the diet
4. Seizure precautions
5. Strict record of fluid intake and output

Answer 38

2. Fluid restriction
3. Seizure precautions
4. Strict record of fluid intake and output

Question 39

A client is admitted to the intensive care unit with suspected pheochromocytoma. The client’s vital signs are
temperature of 99.6 F (37.5 C), blood pressure (BP) of 200/110 mm Hg, heart rate of 110/min, and
respirations of 20/min. The client is sweating profusely and reports a severe headache. Which prescription
should the nurse implement first?
1. Draw labs to assess electrolyte panel
2. Give acetaminophen 650 mg by mouth as needed for headache
3. Place a fan in the client’s room
4. Start nitroprusside infusion at 0.5 mcg/kg/min

Answer 39

4. Start nitroprusside infusion at 0.5 mcg/kg/min

Question 40

A nurse is teaching a nutrition class for clients with newly diagnosed type 2 diabetes. Which meal represents
the best adherence to the principles of and recommendations for diabetic meal planning?
1. Baked tilapia with tomato salsa, steamed white rice
2. Black bean chili with brown rice, mixed green salad
3. Grilled chicken breast with baked French fries
4. Hamburger on a whole wheat bun with lettuce and tomato

Answer 40

2. Black bean chili with brown rice, mixed green salad

Question 41

The nurse cares for a client with type I diabetes mellitus. Which action, by the nurse, best assesses the
chronic complication of autonomic neuropathy?
1. Assess how far the client can walk
2. Check sensation in fingers and toes
3. Inspect extremities for diabetic ulcers
4. Take the blood pressure sitting and standing

Answer 41

4. Take the blood pressure sitting and standing

Question 42

A nurse is assessing a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which
client data obtained by the nurse is most important to bring to the attention of the health care provider?
1. Bilateral pitting edema in ankles
2. Blood pressure is 140/88 mm Hg
3. Most recent HbA1c is 6.7%
4. Retinal photocoagulation in right eye

Answer 42

1. Bilateral pitting edema in ankles

Question 43

The nurse is providing medication teaching to a client who has been prescribed oral hydrocortisone for
newly diagnosed Addison disease. Which of the following statements by the nurse are appropriate to
include in the teaching? Select all that apply.
1”Discontinue hydrocortisone if you have mood changes or disruptions in behavior.”
2.”Report even a low-grade fever to the health care provider immediately.”
3.”Report signs of hyperglycemia, including increased urine, hunger, and thirst.”
4.”The dose of hydrocortisone may need to be increased during times of stress.”
5. “This medication should be taken on an empty stomach to enhance absorption.”

Answer 43

2. “Report even a low-grade fever to the health care provider immediately.”
3. “Report signs of hyperglycemia, including increased urine, hunger, and thirst.”
4. “The dose of hydrocortisone may need to be increased during times of stress.”

Question 44

The nurse performs medication reconciliation for a 94-year-old client who has type 2 diabetes,
hypothyroidism, and heart failure caused by a previous myocardial infarction. Due to risks outweighing
benefits, the nurse,plans to talk with the health care provider about discontinuing which medication?
1. Aspirin 81 mg PO once a day
2. Furosemide 40 mg PO once a day
3. Glyburide 10 mg PO once a day
4. Levothyroxine 50 mcg PO once a day

Answer 44

3. Glyburide 10 mg PO once a day

Question 45

The nurse is administering medications to a client who is being evaluated for a brain malignancy. The client
is scheduled for a CT scan with IV iodinated contrast the next morning. Which medication should the nurse
clarify with the health care provider?
1. Amlodipine
2. Gabapentin
3. Metformin
4.phenytoin

Answer 45

3. Metformin

Question 46

A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client
concerning this drug? Select all that apply.
1. Drinking 8 glasses of water daily
2. Stopping the medicine if blood is present in stool
3. Stopping the medicine if urine turns an orange-yellow color
4. Taking folic acid supplements
5. Wearing sunscreen when outdoors

Answer 46

1. Drinking 8 glasses of water daily
2. Taking folic acid supplements
3. Wearing sunscreen when outdoors

Question 47

A nurse is caring for a client with a diagnosis of fibromyalgia. During care, the client reports having suicidal thoughts. What currently
prescribed medication should the nurse question in regard to this new finding?
1. Amitriptyline
2. Celecoxib
3. Cyclobenzaprine
4. Hydrocodone

Answer 47

1. Amitriptyline

Question 48

A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug’s adverse effects should the nurse include in the teaching plan?
1. Have an ophthalmologic examination every 6 months
2. Take the medication on an empty stomach
3 Take vitamin D and calcium supplements
4. Wear a MedicAlert bracelet

Answer 48

1. Have an ophthalmologic examination every 6 months

Question 49

The nurse is preparing medications for the following 4 clients. Which prescription should the nurse clarify with the health care provider before administration?

1. Acetaminophen for a client with a temperature of 102.2 F (39 C) with productive cough
2. Azathioprine for a client with Crohn disease with leukopenia who is reporting malaise
3. Baclofen for a client with multiple sclerosis who reports dizziness when changing positions
4. Colchicine for a client with an acute gout attack who reports intense, burning left toe pain

Answer 49

2. Azathioprine for a client with Crohn disease with leukopenia who is reporting malaise

Question 50

The nurse provides teaching about methotrexate to a client with rheumatoid arthritis. It is most important to address which topic regarding this drug?

1. Need for an eye examination
2. Need for sunblock
3. Risk for infection
4. Risk for kidney injury

Answer 50

3. Risk for infection

Question 51

The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the health care provider before administering? Select all that apply.

1. Bumetanide in the client with heart failure who has hypokalemia
2. Calcium acetate in the client with chronic kidney disease who has hyperphosphatemia
3. Carvedilol in the client with heart failure who has an elevated B-type natriuretic peptide level
4. Isoniazid in the client with latent tuberculosis who has elevated liver enzymes
5. Metronidazole in the client with Clostridium difficile infection who has leukocytosis

Answer 51

1. Bumetanide in the client with heart failure who has hypokalemia
2. Isoniazid in the client with latent tuberculosis who has elevated liver enzymes

Question 52

The nurse has provided education about proper use of an epinephrine auto-injector to a client with a history of a severe hypersensitivity reaction to bee stings. Which of the following client statements indicate that teaching has been effective? Select all that apply.

1. “I may have a rapid heartbeat and palpitations after injecting the medication.”
2. “I must call an ambulance or go to the nearest hospital following an injection.”
3. “I should avoid storing my device in extremely hot or cold temperatures.”
4. “The area to be injected should be cleansed with alcohol or soap and water.”
5. “The medication is injected at a 90-degree angle into the outer thigh.”

Answer 52

1. “I may have a rapid heartbeat and palpitations after injecting the medication.”
2. “I must call an ambulance or go to the nearest hospital following an injection.”
3. “I should avoid storing my device in extremely hot or cold temperatures.”
4. “The medication is injected at a 90-degree angle into the outer thigh.”

Question 53

The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation?

1. “I am taking an antibiotic for a urinary tract infection.’
2. “I had a negative tuberculosis skin test 2 weeks ago.”
3. “I just received my yearly flu shot a week ago.”
4. “I will continue taking naproxen at night to help with pain.”

Answer 53

1. “I am taking an antibiotic for a urinary tract infection.’

Question 54

The nurse provides teaching about methotrexate to a 28-year-old client with rheumatoid arthritis. Which client statement indicates the need for further instruction regarding this drug?

1. “I know my resistance to germs will be lower, so I should get a flu shot this year.”
2. “I should take precautions to prevent pregnancy while I take this medicine.”
3. “I will have an eye examination every 6 months to check for damage caused by my medication.”
4. “It will be a difficult change for me, but I will not have wine with dinner anymore.”

Answer 54

3. “I will have an eye examination every 6 months to check for damage caused by my medication.”

Question 55

The client comes to the emergency department with hypotension, throat tightness, and a diffuse rash following a bee sting. One IM injection of epinephrine was administered by emergency transport services 8 minutes ago, which has not improved the client’s condition. Which medication should the nurse administer next?

1. IM epinephrine injection
2. IV methylprednisolone
3. Lactated Ringer solution
4. Nebulized albuterol

Answer 55

1. IM epinephrine injection

Question 56

The clinic nurse is preparing to administer an allergy immunotherapy injection to a client recently initiated on the therapy. Which statement by the client indicates a need for further teaching?

1. “I can leave right after the shot as I didn’t have a reaction last time.”
2. “I will be back in a week for my next allergy shot.”
3. “I will let the doctor know if I get any itchy hives tonight.”
4. “It is okay if I have some redness at the injection site tonight.”

Answer 56

1. “I can leave right after the shot as I didn’t have a reaction last time.”

Question 57

A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks, why, the client responds, “Because I’m not depressed!” What is the nurse’s most appropriate response?

1. “Depression is common with fibromyalgia, but a low dose of this drug can prevent it.”
2. “It can relieve your chronic pain and help you sleep better at night.”
3. “It helps to relieve the adverse effects of your other prescribed drugs.”
4. “You have the right to refuse. I will notify your health care provider (HCP).”

Answer 57

2. “It can relieve your chronic pain and help you sleep better at night.”