Exam 1 Test Banks F&E Flashcards
A patient presents to the emergency room complaining of vomiting with severe back and leg pain. The patient’s home medications include daily oral corticosteroids. Vital signs reveal a low blood pressure and there are peaked T waves on the electrocardiogram. What is the nurse’s priority intervention?
a. Start an intravenous line
b. Collect urine specimen
c. Administer antiemetic
d. Administer narcotic analgesia
a. Start an intravenous line
Rationale: The patient is exhibiting signs of adrenal insufficiency (Addison disease) given the regular use of corticosteroids.
Cortisone, hydrocortisone (Cortef), prednisone, and fludrocortisone (Florinef) are used for the treatment of adrenocortical deficiency.
Treatment of Addisonian crisis includes the administration of hydrocortisone, saline solution, and sugar (dextrose) to correct the insufficiency.
The priority intervention is to start an intravenous line so that appropriate treatments may be administered. A urine
specimen may be collected but is not the priority intervention.
Since the patient is vomiting, administration of antiemetics or analgesia would be given through an intravenous line.
The nurse should also assess for changes in the level of consciousness; so the administration of analgesia may be contraindicated if any decrease in the level of consciousness occurs.
Which important teaching point should the nurse include in the plan of care for a patient diagnosed with Cushing disease?
a. Daily weight using same scale
b. Wash hands frequently
c. Use exfoliating soaps when bathing
d. Avoid yearly influenza vaccine
b. Wash hands frequently
Rationale: Cushing syndrome is characterized by chronic excess glucocorticoid (cortisol) secretion from the adrenal cortex.
This is caused by the hypothalamus, or the anterior pituitary gland, or the adrenal cortex. Cushing syndrome can also be caused by taking corticosteroids in the form of medication (such as prednisone) over time—referred to as exogenous Cushing syndrome.
Regardless of the cause, excess secretion of cortisol has a systemic effect affecting immunity, metabolism, and fat distribution
(truncal obesity), reduced muscle mass, loss of bone density, hypertension, fragility to the microvasculature, as well as thinning of
the skin.
Washing hands is important because the patient’s immune system is suppressed due to the excess glucocorticoid level.
Daily weights are not indicated. Exfoliating soaps may damage thin skin. The patient should receive vaccinations due to being
immunocompromised.
The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What is the nurse’s best action?
a. Encourage increased fluid and water intake
b. Teach about risk for malignancies
c. Monitor for changes in Level Of Consciousness
d. Assess labwork for potassium level changes
c. Monitor for changes in Level Of Consciousness
Rationale: As the name suggests, SIADH is a condition in which antidiuretic hormone (ADH) is secreted despite normal or low plasma
osmolarity, resulting in water retention and dilutional hyponatremia.
In response to increased plasma volume, aldosterone secretion increases and further contributes to sodium loss.
Hyponatremia frequently manifests with changes in level of consciousness from confusion to coma.
A large number of clinical conditions can cause SIADH including malignancies,
pulmonary disorders, injury to the brain, and certain pharmacologic agents.
Malignancies often lead to SIADH versus SIADH causing malignant conditions. Water intoxication can lead to hyponatremia, therefore water intake is restricted.
The most affected electrolyte from SIADH is sodium versus potassium.
Following a parathyroidectomy, which electrolyte should the nurse most closely monitor?
a. Potassium
b. Sodium
c. Magnesium
d. Calcium
d. Calcium
Rationale: Because the parathyroids are located on the thyroid gland, similar concerns for postoperative monitoring apply. Additionally, calcium levels are monitored to avoid hypocalcemic crisis.
Radioactive iodine is indicated for the treatment of hyperthyroidism. Which item should the nurse include in the plan of care?
a. Isolation is required for 6–8 weeks.
b. Continued thyroid monitoring is required.
c. Thyroid replacement therapy is prescribed.
d. An overnight hospital stay is required.
b. Continued thyroid monitoring is required.
Rationale: Radioactive iodine (RAI) is indicated for the treatment of hyperthyroidism.
It is given as an oral preparation, usually as a single dose on an outpatient basis. The radioactive iodine makes its way to the thyroid gland where it destroys some of the cells that produce thyroid hormone.
The RAI is completely eliminated from the body after about 4 weeks. The extent of thyroid cell destruction is variable, thus the patient has ongoing monitoring of thyroid function.
If thyroid production remains too high a
second dose may be needed. The goal of this procedure is to destroy thyroid hormone producing cells; additional thyroid
hormone is not prescribed.
The nurse is caring for a patient who has undergone a thyroidectomy. Which patient complaint is highest priority requiring further evaluation?
a. Pain at surgical site
b. Thirst
c. Hoarseness
d. Nausea
c. Hoarseness
Rationale: Thyroidectomy involves a surgical incision in the anterior neck. Hoarseness may be a sign of airway edema.
A patent airway is
always a priority of care for any post-operative patient.
General anesthesia is used for this surgery requiring the insertion of an
artificial airway, therefore throat irritation, and thirst is expected.
Nausea may be a side effect from anesthesia. Pain is expected at the surgical site.
Which statement made by a student nurse indicates the need for additional teaching about pituitary insufficiency?
a. “Synthetic human growth hormone may be prescribed for children who are small for gestational age.”
b. “Testosterone supplements may be prescribed for women with gonadotropin deficiency.”
c. “Estrogen is known to regulate the action of growth hormone in men and women.”
d. “Chronic kidney disease treatment may include synthetic growth hormone replacement.”
b. “Testosterone supplements may be prescribed for women with gonadotropin
deficiency.”
Rationale: Synthetic human growth hormone (HGH) is used for growth hormone deficiencies caused by pituitary insufficiency, as well as other conditions such as Turner syndrome, chronic kidney disease, and children small for gestation age.
Testosterone is used as a supplement for men with gonadotropin deficiency. Estrogen and progesterone supplements, also referred to as hormone replacement therapy (HRT), are indicated for women with gonadotropin deficiency and for the relief of post-menopausal symptoms.
Estrogen is also known to regulate secretion and action of GH in men and women.
The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following drugs while taking insulin?
a. Aldactone (Spironolactone)
b. Dicumarol (Bishydroxycoumarin)
c. Reserpine (Serpasil)
d. Cimetidine (Tagamet)
a. Aldactone (Spironolactone)
Rationale: Aldactone is a loop potassium-sparing diuretic that can affect serum glucose levels and also lead to hypokalemia; its use is
contraindicated with insulin.
Dicumarol, an anticoagulant; reserpine, an anti-hypertensive; and cimetidine, an H2 receptor antagonist, do not affect blood glucose levels.
When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dL?
a. “Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity.”
b. “The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel.”
c. “Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP.”
d. “The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis.”
b. “The central nervous system cannot store glucose and needs a continuous supply
of glucose for fuel.”
Rationale: The brain cannot synthesize or store significant amounts of glucose; thus a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system.
The nurse associates which assessment finding in the diabetic patient with decreasing renal function?
a. Ketone bodies in the urine during acidosis
b. Glucose in the urine during hyperglycemia
c. Protein in the urine during a random urinalysis
d. White blood cells in the urine during a random urinalysis
c. Protein in the urine during a random urinalysis
Rationale: Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal insufficiency or diabetic nephropathy
with subsequent progression to end-stage renal disease.
Chronic elevated blood glucose levels can cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature.
This leaking allows protein to be filtered into the urine.
What is the nurse’s best response about developing diabetes to the patient whose father has type 1 diabetes mellitus?
a. “You have a greater susceptibility for development of the disease because of your family history.”
b. “Your risk is the same as the general population, because there is no genetic risk for development of type 1 diabetes.”
c. “Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for becoming diabetic is 50%.”
d. “Because you are a woman and your father is the parent with diabetes, your risk is not increased for eventual development of the disease. However, your brothers
will become diabetic.”
a. “You have a greater susceptibility for development of the disease because of your family history.”
Rationale: Even though type 1 diabetes does not follow a specific genetic pattern of inheritance, those with one parent with type 1 diabetes are at an increased risk for development of the disease.
The nurse recognizes which patient as having the greatest risk for undiagnosed diabetes mellitus?
a. Young white man
b. Middle-aged African-American man
c. Young African-American woman
d. Middle-aged Native American woman
d. Middle-aged Native American woman
Rationale: The highest incidence of diabetes in the United States occurs in Native Americans. With age, the incidence of diabetes increases
in all races and ethnic groups.
A diabetic patient is brought into the emergency department unresponsive. The arterial pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis?
a. Decreased hunger sensation
b. Report of no urine output
c. Increased respiratory rate
d. Decreased thirst
c. Increased respiratory rate
Rationale: Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of the brain to buffer the effects of the
increasing acidosis.
The rate and depth of respirations are increased (Kussmaul respirations) to excrete more acids by exhalation.
Usually polydipsia (increased thirst), polyphagia (increased hunger), and polyuria (increased urine output) are seen with
hyperglycemia and ketoacidosis.
Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a
hypoglycemic reaction? (Select all that apply.)
a. Tremors
b. Nervousness
c. Extreme thirst
d. Flushed skin
e. Profuse perspiration
f. Constricted pupils
a. Tremors
b. Nervousness
e. Profuse perspiration
Rationale: When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous system responses such as tremors,
nervousness, and profuse perspiration. Dilated pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and constricted pupils are consistent with hyperglycemia.
The nurse assesses an older client. What age-related physiologic changes would the nurse expect?
a. Heat intolerance
b. Rheumatoid arthritis
c. Dehydration
d. Increased appetite
c. Dehydration
Rationale: As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production.
This change, in addition to less body fluid being present as one ages, can cause dehydration.
Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age-related change; osteoarthritis causes primarily by aging.
A client is scheduled to have a glycosylated hemoglobin (A1C) drawn and asks the nurse why she has to have it. How would the nurse respond?
a. “It measures your average blood glucose level for the past 3 months.”
b. “It determines what type of anemia you may have.”
c. “It measures the amount of liver glycogen you have.”
d. “It determines you have some type of leukemia or other blood cancer.”
a. “It measures your average blood glucose level for the past 3 months.”
Rationale: A1C measures the average blood glucose level to determine if the client is a diabetic or how controlled a diabetic client is.
The nurse assesses a client who is scheduled to have a laboratory test to determine if the client’s adrenal glands are hypoactive. What type of testing would the client likely have?
a. Catecholamine testing
b. Suppression testing
c. Bone marrow testing
d. Provocative testing
d. Provocative testing
Rationale: Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland.
A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding would indicate that the medication is effective?
a. Heart rate of 92 beats/min
b. Respiratory rate of 18 breaths/min
c. Oxygenation saturation of 92%
d. Blood pressure of 144/69 mm Hg
a. Heart rate of 92 beats/min
Rationale: Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions.
The nurse expects an increase in heart rate and increased cardiac output. The other vital signs are within normal limits and do not indicate any response to the medication.
A nurse collaborates with assistive personnel (AP) to provide care for a client who is prescribed a 24-hour urine specimen
collection. Which statement would the nurse include when teaching the AP about this activity?
a. “Note the time of the client’s first void and collect urine for 24 hours.”
b. “Add the preservative to the container at the end of the test.”
c. “Start the collection by saving the first urine of the morning.”
d. “It is okay if one urine sample during the 24 hours is not collected.”
a. “Note the time of the client’s first void and collect urine for 24 hours.”
Rationale: The collection of a 24-hour urine specimen is often delegated to AP.
The nurse must ensure that the AP understands the proper process for collecting the urine.
The 24-hour urine collection specimen is started after the client’s first urination.
The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client’s first void is noted.
The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection.
The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.
A nurse assesses a female client who presents with hirsutism. Which question would the nurse ask when assessing this client?
a. “How do you plan to pay for your treatments?”
b. “How do you feel about yourself?”
c. “What medications are you prescribed?”
d. “What are you doing to prevent this from happening?”
b. “How do you feel about yourself?”
Rationale: Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders.
This may cause a disruption in body
image, especially for female clients.
The nurse would inquire into the client’s body image and self-perception.
Asking about the client’s financial status or current medications does not address the client’s immediate problem.
The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.
A nurse is caring for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition?
a. Decreased blood pressure
b. Increased pulse
c. Decreased respiratory rate
d. Increased urine output
b. Increased pulse
Rationale: Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be
correlated with tachycardia.
Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.
The nurse is teaching assistive personnel (AP) about hormones that are produced by the adrenal glands. Which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition?
a. Sodium
b. Magnesium
c. Aldosterone
d. Renin
c. Aldosterone
Rationale: Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume.
Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure.
Magnesium and sodium are electrolytes and not hormones.
The nurse reviews the function of thyroid gland hormones. What is the primary function of calcitonin?
a. Sodium and potassium balance
b. Magnesium balance
c. Norepinephrine balance
d. Calcium and phosphorus balance
d. Calcium and phosphorus balance
Rationale: Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.
A nurse teaches an older woman who has a decreased production of estrogen. Which statement would the nurse include in this client’s teaching to decrease injury?
a. “Drink at least 2 quarts (2 L) of fluids each day.”
b. “Walk around the neighborhood for daily exercise.”
c. “Bathe your perineal area twice a day.”
d. “You should check your blood glucose before meals.”
b. “Walk around the neighborhood for daily exercise.”
Rationale: An older female with decreased production of estrogen is at risk for decreased bone density and fractures.
The nurse would encourage the client to participate in weight-bearing exercises such as walking.
Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.
A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones would the nurse expect to be decreased as a result? (Select all that apply.)
a. Thyroid-stimulating hormone
b. Vasopressin
c. Follicle-stimulating hormone
d. Calcitonin
e. Growth hormone
a. Thyroid-stimulating hormone
c. Follicle-stimulating hormone
e. Growth hormone
Rationale: Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland.
Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.
A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine
disorder? (Select all that apply.)
a. Excessive thyroid-stimulating hormone—increased bone formation
b. Excessive melanocyte-stimulating hormone—darkening of the skin
c. Excessive parathyroid hormone—synthesis and release of corticosteroids
d. Excessive antidiuretic hormone—increased urinary output
e. Excessive adrenocorticotropic hormone—increased bone resorption
a. Excessive thyroid-stimulating hormone—increased bone formation
b. Excessive melanocyte-stimulating hormone—darkening of the skin
Rationale: Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone.
Melanocyte-stimulating hormone
stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption.
Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output.
Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.