Midterm Review Questions Chapters: 17, 53, 54

Question 1

Which information provided by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?

a. Insulin is not used to control 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 glucose levels with type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic
coma.

Answer 1

c. Changes in diet and exercise may control glucose levels with type 2 diabetes.

Question 2

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). Which information will the nurse plan to teach the patient?

a. Self-monitoring of glucose

b. Using small doses of regular insulin

c. Lifestyle changes to lower the glucose

d. Effects of oral hypoglycemic medications

Answer 2

c. Lifestyle changes to lower the glucose

Question 3

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates a need for the nurse to 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.

Answer 3

d. The patient increases daily exercise when ketones are present in the urine.

Question 4

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. Which finding would the nurse anticipate?

a. Anorexia
b. Weight loss
c. Dark colored urine
d. Craving sugary drinks

Answer 4

b. Weight loss

Question 5

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. Fasting blood glucose
b. Glycosylated hemoglobin
c. Oral glucose tolerance test
d. Urine dipstick for glucose and ketones

Answer 5

b. Glycosylated hemoglobin

Question 6

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 32 kg/m 2. Which goal in the plan of care 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.

Answer 6

a. The patient will reach a glycosylated hemoglobin level of less than 7%.

Question 7

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. Which advice would the clinic nurse plan to give the patient?

a. Increase the morning dose of NPH insulin (Novolin N).

b. Check glucose level before, during, and after swimming.

c. Time the morning insulin injection to peak while swimming.

d. Delay eating the noon meal until after finishing the swimming.

Answer 7

b. Check glucose level before, during, and after swimming.

Question 8

Which statement by the person who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse?

a. “I will need a bedtime snack because I take an evening dose of NPH insulin.”

b. “I can choose any foods, as long as I use enough insulin to cover the calories.”

c. “I can have an occasional beverage with alcohol if I include it in my meal plan.”

d. “I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.”

Answer 8

b. “I can choose any foods, as long as I use enough insulin to cover the calories.”

Question 9

Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise?

a. Determine what types of activities the patient enjoys.

b. Remind the patient that exercise improves 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.

Answer 9

a. Determine what types of activities the patient enjoys.

Question 10

Which patient statement to the nurse indicates a need for additional instruction in administering insulin?

a. “I should inject the insulin into a muscle that I plan to exercise vigorously.”

b. “I can buy the 0.5-mL syringes because the line markings are easier to see.”

c. “I do not need to aspirate the plunger to check for blood before injecting insulin.”

d. “I should draw up the regular insulin first, after injecting air into the NPH bottle.”

Answer 10

a. “I should inject the insulin into a muscle that I plan to exercise vigorously.”

Question 11

Which patient action indicates accurate understanding of the nurse’s teaching about administration of aspart (NovoLog) insulin?

a. The patient cleans the skin with soap and water before the injection.

b. The patient avoids injecting the insulin into the upper abdominal area.

c. The patient stores the insulin in the freezer between prescribed doses.

d. The patient pushes the plunger down while removing the syringe from the injection site.

Answer 11

a. The patient cleans the skin with soap and water before the injection.

Question 12

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?

a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM

Answer 12

a. 10:00 AM

Question 13

Which patient action indicates an accurate 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 restarts it each morning.

d. The patient plans a diet with more calories than usual when using the pump.

Answer 13

a. The patient programs the pump for an insulin bolus after eating.

Question 14

A patient who has diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse explain for mealtime coverage?

a. Lispro (Humalog)

b. Glargine (Lantus)

c. Detemir (Levemir)

d. NPH (Humulin N)

Answer 14

a. Lispro (Humalog)

Question 15

Which information about glyburide would the nurse include when teaching a patient who has type 2 diabetes?

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 glucose level is low.

d. Glyburide should not be used for 48 hours after receiving IV contrast media.

Answer 15

b. Glyburide stimulates insulin production and release from the pancreas.

Question 16

The nurse has been teaching a patient who has type 2 diabetes about managing 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.”

Answer 16

d. “My diabetes won’t cause complications because I don’t need insulin.”

Question 17

A patient who takes metformin (Glucophage) to manage type 2 diabetes developed an allergic rash from an unknown cause and the health care provider prescribed prednisone. Which change in the plan of care at would the nurse anticipate?

a. The patient may need a diet higher in calories while receiving prednisone.

b. The patient may develop acute hypoglycemia while taking the prednisone.

c. The patient may require administration of insulin while taking prednisone.

d. The patient may have rashes caused by metformin-prednisone interactions.

Answer 17

c. The patient may require administration of insulin while taking prednisone.

Question 18

A hospitalized patient who has diabetes 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. Which nursing action would be the best way to prevent the patient from experiencing hypoglycemia?

a. Plan to decrease the evening dose of insulin.

b. Save the lunch tray for the patient’s later return.

c. Request that if testing is further delayed, the patient must eat lunch first.

d. Send a glass of orange juice to the patient in the diagnostic testing area.

Answer 18

c. Request that if testing is further delayed, the patient must eat lunch first.

Question 19

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching?

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.

Answer 19

b. Chooses a puncture site in the center of the finger pad.

Question 20

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action would the nurse take first?

a. Assess the patient’s perception of what it means to have diabetes.

b. Ask the patient’s family to participate in the diabetes education program.

c. Demonstrate how to check glucose using the patient’s blood glucose monitor.

d. Discuss the need for the patient to actively participate in diabetes management.

Answer 20

a. Assess the patient’s perception of what it means to have diabetes.

Question 21

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). Which action would the nurse anticipate taking?

a. Giving 50% dextrose

b. Inserting an IV catheter

c. Initiating O2 by nasal cannula

d. Administering glargine (Lantus) insulin

Answer 21

b. Inserting an IV catheter

Question 22

A 26-yr-old female who has 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 reports a glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. Which action would the nurse advise the patient to take?

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 contact the clinic if it rises.

d. Decrease carbohydrates until glycosylated hemoglobin is less than 7%.

Answer 22

c. Monitor blood glucose every 4 hours and contact the clinic if it rises.

Question 23

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6 AM glucose is 230 mg/dL. Which action would the nurse teach the patient to take?

a. Check the glucose during the night.

b. Avoid snacking right before bedtime.

c. Increase the rapid-acting insulin dose.

d. Administer a larger dose of long-acting insulin.

Answer 23

a. Check the glucose during the night.

Question 24

Which action would the nurse take after a 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.

Answer 24

b. Give the patient a snack of peanut butter and crackers.

Question 25

Which information would the nurse include in teaching a 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 a callus remover for corns or calluses.

d. Soak feet in warm water for an hour each day.

Answer 25

a. Choose flat-soled leather shoes.

Question 26

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

a. The patient’s glucose level is 174 mg/dL.

b. The patient is scheduled for a chest x-ray in an hour.

c. The patient has gained 2 lb (0.9 kg) in the past 24 hours.

d. The patient’s estimated glomerular filtration rate is 42 mL/min.

Answer 26

d. The patient’s estimated glomerular filtration rate is 42 mL/min.

Question 27

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information would the nurse teach the patient about the purpose of amitriptyline?

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.

Answer 27

b. Amitriptyline helps prevent transmission of pain impulses to the brain.

Question 28

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

a. The patient’s glucose is 128 mg/dL.

b. The patient’s most recent A1C was 7.5%.

c. The patient took the prescribed metformin today.

d. The patient took the prescribed enalapril 4 hours ago.

Answer 28

c. The patient took the prescribed metformin today.

Question 29

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 discards the open vials of glargine and regular insulin after 4 weeks.

d. The patient draws up the regular insulin and then the glargine in the same syringe.

Answer 29

c. The patient discards the open vials of glargine and regular insulin after 4 weeks.

Question 30

A patient with diabetes rides a bicycle to and from work every day. Which site would the nurse teach the patient to use to administer the morning insulin?

a. Thigh
b. Buttock
c. Abdomen
d. Upper arm

Answer 30

c. Abdomen

Question 31

The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take?

a. Schedule the patient for a fasting glucose level.

b. Teach the patient about administering regular insulin.

c. Teach about an increased risk for fetal problems with gestational diabetes.

d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.

Answer 31

a. Schedule the patient for a fasting glucose level.

Question 32

A 27-yr-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 would the nurse implement first?

a. Place the patient on a cardiac monitor.

b. Administer IV potassium supplements.

c. Ask the patient about home insulin doses.

d. Start an insulin infusion at 0.1 units/kg/hr.

Answer 32

a. Place the patient on a cardiac monitor.

Question 33

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action would the nurse implement first?

a. Infuse 1L of normal saline rapidly.

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.

Answer 33

a. Infuse 1L of normal saline rapidly.

Question 34

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 would 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.

Answer 34

c. Obtain a glucose reading using a finger stick.

Question 35

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

a. Hemoglobin A1C level of 6.2%

b. Heart rate at rest of 58 beats/min

c. Blood pressure of 140/88 mmHg

d. High-density lipoprotein (HDL) level of 65 mg/dL

Answer 35

c. Blood pressure of 140/88 mmHg

Question 36

A 30-yr-old patient has a new diagnosis of type 2 diabetes. When would the nurse recommend the patient schedule a dilated eye examination?

a. Every 2 years

b. Every 6 months

c. As soon as available

d. At the age of 39 years

Answer 36

c. As soon as available

Question 37

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which finding would the nurse promptly discuss with the health care provider?

a. Hemoglobin A1C level is 7.9%.

b. Glomerular filtration rate is decreased.

c. Last eye examination was 18 months ago.

d. Patient has questions about the prescribed diet.

Answer 37

b. Glomerular filtration rate is decreased.

Question 38

The nurse has administered 4 oz of orange juice to an alert patient whose glucose was 62 mg/dL. Fifteen minutes later, the glucose is 67 mg/dL. Which action would 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.

Answer 38

a. Give the patient 4 to 6 oz more orange juice.

Question 39

Which nursing action can the nurse delegate to experienced assistive personnel (AP) 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.

Answer 39

a. Measure the ankle-brachial index.

Question 40

After change-of-shift report, which patient will the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who was admitted with dawn

phenomenon

b. A 60-yr-old patient with type 1 diabetes whose most recent glucose reading was 230 mg/dL

c. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and reports burning foot pain

d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

Answer 40

d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

Question 41

After change-of-shift report, which patient would the nurse assess first?

a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%

b. A 23-yr-old patient with type 1 diabetes who has a glucose of 40 mg/dL

c. A 50-yr-old patient who uses exenatide and is reporting acute abdominal pain

d. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL

Answer 41

b. A 23-yr-old patient with type 1 diabetes who has a glucose of 40 mg/dL

Question 42

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually? (SATA)

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

Answer 42

b. Blood pressure
c. Serum creatinine
d. Urine for microalbuminuria
f. Monofilament testing of the foot

Question 43

Which assessment action would help the nurse determine if an obese patient has metabolic syndrome?

a. Take the patient’s apical pulse.

b. Check the patient’s blood pressure.

c. Ask the patient about dietary intake.

d. Dipstick the patient’s urine for protein.

Answer 43

b. Check the patient’s blood pressure.

Question 44

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include?

a. Blood glucose test

b. Cardiac enzyme tests

c. Postural blood pressures

d. Resting electrocardiogram

Answer 44

a. Blood glucose test

Question 45

A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question would 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?”

Answer 45

b. “Do you have to wear larger shoes now?”

Question 46

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 evening.

c. Blood glucose levels may decrease when taking the medication.

d. Stop taking the medication if swelling of the hands or feet occurs.

Answer 46

b. Inject the medication subcutaneously every evening.

Question 47

Which finding indicates to the nurse that demeclocycline has been effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

a. Weight has increased.

b. Urinary output has increased.

c. Peripheral edema has increased.

d. Urine specific gravity has increased.

Answer 47

b. Urinary output has increased.

Question 48

Which patient statement indicates to the nurse that further instruction is needed about chronic syndrome of inappropriate antidiuretic hormone (SIADH)?

a. “I should weigh myself daily and report sudden weight loss or gain.”

b. “I need to shop for foods low in sodium and avoid adding salt to food.”

c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”

d. “I should eat foods high in potassium because diuretics cause potassium loss.”

Answer 48

b. “I need to shop for foods low in sodium and avoid adding salt to food.”

Question 49

Which problem would the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?

a. Generalized edema
b. Respiratory distress
c. Fluid volume overload
d. Disturbed sleep pattern

Answer 49

d. Disturbed sleep pattern

Question 50

Which information will the nurse teach a patient who has been newly diagnosed with Graves’ disease?

a. Antithyroid medications may take months for full effect.

b. Restriction of iodine intake will help reduce thyroid activity.

c. Exercise is contraindicated to avoid increasing metabolic rate.

d. Surgery will eventually be required to remove the thyroid gland.

Answer 50

a. Antithyroid medications may take months for full effect.

Question 51

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. Plan for emergency tracheostomy.

b. Administer IV calcium gluconate.

c. Prepare for endotracheal intubation.

d. Begin thyroid hormone replacement.

Answer 51

b. Administer IV calcium gluconate.

Question 52

Which action will the nurse include in the plan of care for a 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.

Answer 52

b. Elevate the head of the patient’s bed to reduce periorbital fluid.

Question 53

A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information would the nurse include in discharge teaching?

a. Take radioactive precautions with all body secretions.

b. Symptoms of hyperthyroidism should be relieved in about a week.

c. Symptoms of hypothyroidism will occur as the RAI therapy takes effect.

d. Discontinue the antithyroid medications that were taken before the RAI therapy.

Answer 53

c. Symptoms of hypothyroidism will occur as the RAI therapy takes effect.

Question 54

Which nursing assessment of a 70-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

Answer 54

b. Apical pulse rate

Question 55

An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism. Which prescribed drug would the nurse discuss with the health care provider?

a. Docusate (Colace)

b. Ibuprofen (Motrin)

c. Diazepam (Valium)

d. Cefoxitin (Mefoxin)

Answer 55

c. Diazepam (Valium)

Question 56

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?

a. Delay teaching until closer to discharge date.

b. Provide written reminders of information taught.

c. Offer multiple options for management of therapies.

d. Ensure privacy for teaching by asking the family to leave.

Answer 56

b. Provide written reminders of information taught.

Question 57

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. Which topic would the nurse plan to teach the patient?

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

Answer 57

b. Calcium supplements to normalize serum calcium levels

Question 58

A patient who has hypothyroidism and hypertension is prescribed levothyroxine (Synthroid).

Which finding indicates that the nurse should contact the health care provider before administering the medication?

a. Increased thyroxine (T 4 ) level

b. Blood pressure 112/62 mm Hg

c. Distant and difficult to hear heart sounds

d. Elevated thyroid stimulating hormone level

Answer 58

a. Increased thyroxine (T 4 ) level

Question 59

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding 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

Answer 59

c. Purplish streaks on the abdomen

Question 60

A patient with Cushing syndrome is admitted for an adrenalectomy. Which information would likely help the patient cope with a 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.

Answer 60

d. Remind the patient that most of the physical changes caused by Cushing syndrome
will resolve after surgery.

Question 61

Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency?

a. Increasing serum sodium levels

b. Decreasing blood glucose levels

c. Decreasing serum chloride levels

d. Increasing serum potassium levels

Answer 61

a. Increasing serum sodium levels

Question 62

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching?

a. “I frequently eat at restaurants, and my food has a lot of added salt.”

b. “I had the 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.”

Answer 62

b. “I had the flu earlier this week, so I couldn’t take the hydrocortisone.”

Question 63

Which action would the nurse take when providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism?

a. Check blood glucose level every 4 hours.

b. Monitor the blood pressure every 4 hours.

c. Elevate the patient’s legs to prevent edema.

d. Order the patient a potassium-restricted diet.

Answer 63

b. Monitor the blood pressure every 4 hours.

Question 64

Which finding would the nurse plan to assess for in a patient diagnosed with a pheochromocytoma?

a. Flushing

b. Headache

c. Bradycardia

d. Hypoglycemia

Answer 64

b. Headache

Question 65

Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

a. Encourage fluids to 2 to 3 L/day.

b. Offer the patient sugarless gum to chew.

c. Monitor for increasing peripheral edema.

d. Keep head of bed elevated to 30 degrees.

Answer 65

b. Offer the patient sugarless gum to chew.

Question 66

A patient has just arrived on the unit after a thyroidectomy. Which action would 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.

Answer 66

c. Assess the patient’s respiratory effort.

Question 67

The nurse is caring for a patient following an adrenalectomy. Which goal is the highest priority in the immediate postoperative period?

a. Protecting the patient’s skin

b. Monitoring for signs of infection

c. Balancing fluids and electrolytes

d. Preventing emotional disturbances

Answer 67

c. Balancing fluids and electrolytes

Question 68

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.

Answer 68

a. The patient is confused and lethargic.

Question 69

Which prescribed medication would the nurse expect will have the most rapid effect on a patient admitted to the emergency department in thyroid storm?

a. Iodine

b. Methimazole

c. Propylthiouracil

d. Propranolol (Inderal)

Answer 69

d. Propranolol (Inderal)

Question 70

Which assessment finding for an adult admitted with Graves’ disease requires the most rapid intervention by the nurse?

a. Heart rate 136 beats/min

b. Severe bilateral exophthalmos

c. Temperature 103.8F (40.4C)

d. Blood pressure 166/100 mm Hg

Answer 70

c. Temperature 103.8F (40.4C)

Question 71

A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon?

a. Difficult to awaken

b. Increasing neck swelling

c. Reports 7/10 incisional pain

d. Cardiac rate 112 beats/min

Answer 71

b. Increasing neck swelling

Question 72

A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

a. Titrate the infusion of 5% dextrose in water.

b. Administer prescribed subcutaneous DDAVP.

c. Assess the patient’s overall hydration status every 8 hours.

d. Teach the patient to use desmopressin (DDAVP) nasal spray.

Answer 72

b. Administer prescribed subcutaneous DDAVP.

Question 73

After receiving change-of-shift report about the following four patients, which patient would the nurse assess first?

a. A 31-year-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL

b. A 70-year-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134

c. A 53-year-old male patient who has Addison’s disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef)

d. A 22-year-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

Answer 73

b. A 70-year-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134

Question 74

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. Elevation in the patient’s T3 and T4 levels

c. Resting apical pulse rate 112 beats/min

d. Bruit audible bilaterally over the thyroid gland

Answer 74

a. New-onset changes in the patient’s voice

Question 75

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. “Have you had a recent neck injury?”

d. “Are your immunizations up to date?”

Answer 75

b. “What medications are you taking?”

Question 76

Which information obtained by the nurse in the clinic about a patient who has been taking prednisone 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.

Answer 76

c. Patient stopped taking the medication 2 days ago.

Question 77

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient would 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 IV hydrocortisone twice daily

Answer 77

b. Patient with tetany who has a new order for IV calcium chloride

Question 78

A 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.

Answer 78

b. Encourage 4000 mL of fluids daily.

Question 79

The nurse is caring for a patient who has a massive burn injury and possible hypovolemia.

Which assessment data would be of most concern to the nurse?

a. Urine output is 30 mL/hr.

b. Blood pressure is 90/40 mm Hg.

c. Oral fluid intake is 100 mL for 8 hours.

d. Skin tenting over the sternum is prolonged.

Answer 79

b. Blood pressure is 90/40 mm Hg.

Question 80

A patient with multiple draining wounds is admitted for hypovolemia. Which information would provide the most accurate way for the nurse to evaluate fluid balance?

a. Skin turgor

b. Daily weight

c. Urine output

d. Edema presence

Answer 80

b. Daily weight

Question 81

The home health nurse cares for an alert and oriented older adult patient who has a history of dehydration. Which instruction would the nurse give this patient?

a. “Drink more fluids in the late evening.”

b. “More fluids are needed if you feel thirsty.”

c. “Increase the fluids if your mouth feels dry.”

d. “If you feel confused, you need more fluids.”

Answer 81

c. “Increase the fluids if your mouth feels dry.”

Question 82

A patient who is taking a potassium-depleting diuretic for treatment of hypertension reports generalized weakness. Which action would the nurse to take?

a. Assess for facial muscle spasms.

b. Ask the patient about loose stools.

c. Recommend the patient avoid drinking orange juice with meals.

d. Suggest that the health care provider order a basic metabolic panel.

Answer 82

d. Suggest that the health care provider order a basic metabolic panel.

Question 83

Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient. Which statement by the patient indicates that the teaching about this medication has been effective?

a. “I will try to drink at least 8 glasses of water every day.”

b. “I will use a salt substitute to decrease my sodium intake.”

c. “I will increase my intake of potassium-containing foods.”

d. “I will drink apple juice instead of orange juice for breakfast.”

Answer 83

d. “I will drink apple juice instead of orange juice for breakfast.”

Question 84

A patient with new-onset confusion and hyponatremia is being admitted. Which action would the charge nurse take when making room assignments?

a. Assign the patient to a semi-private room.

b. Assign the patient to a room near the nurse’s station.

c. Place the patient in a room nearest to the water fountain.

d. Place the patient on telemetry to monitor for peaked T waves.

Answer 84

b. Assign the patient to a room near the nurse’s station.

Question 85

IV potassium chloride (KCl) 60 mEq is prescribed for a patient with severe hypokalemia. Which action would the nurse take?

a. Administer the KCl as a rapid IV bolus.

b. Infuse the KCl at a maximum rate of 10 mEq/hr.

c. Discontinue cardiac monitoring during the infusion.

d. Monitor deep tendon reflexes during the infusion.

Answer 85

b. Infuse the KCl at a maximum rate of 10 mEq/hr.

Question 86

A patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient’s serum sodium level is 127 mEq/L (127 mmol/L). Which prescribed therapy would the nurse question?

a. Infuse 5% dextrose in water intravenously at 125 mL/hr.

b. Administer IV morphine sulfate 4 mg every 2 hours PRN.

c. Give IV metoclopramide 10 mg every 6 hours PRN for nausea.

d. Administer 3% saline intravenously at 50 mL/hr for a total of 200 mL.

Answer 86

a. Infuse 5% dextrose in water intravenously at 125 mL/hr.

Question 87

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How would the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?

a. Metabolic acidosis

b. Metabolic alkalosis

c. Respiratory acidosis

d. Respiratory alkalosis

Answer 87

d. Respiratory alkalosis

Question 88

A patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action would the nurse take?

a. Give the prescribed PRN lorazepam (Ativan).

b. Encourage the patient to take deep slow breaths.

c. Start the prescribed PRN oxygen at 2 to 4 L/min.

d. Administer the prescribed fluid bolus and insulin.

Answer 88

d. Administer the prescribed fluid bolus and insulin.

Question 89

An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. Which clinical manifestation would the nurse expect?

a. Pallor
b. Edema
c. Confusion
d. Restlessness

Answer 89

b. Edema

Question 90

A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor while the patient is receiving this infusion?

a. Lung sounds

b. Urinary output

c. Peripheral pulses

d. Peripheral edema

Answer 90

a. Lung sounds

Question 91

The long-term care nurse is evaluating the effectiveness of protein supplements for an older resident who has a low serum total protein level. Which assessment finding indicates that the patient’s condition has improved?

a. Hematocrit 28%

b. Absence of skin tenting

c. Decreased peripheral edema

d. Blood pressure 110/72 mm Hg

Answer 91

c. Decreased peripheral edema

Question 92

A patient who is lethargic with deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO 2 88 mm Hg, PaCO 2 35 mm Hg, and HCO 3 16 mEq/L. How would the nurse interpret these results?

a. Metabolic acidosis

b. Metabolic alkalosis

c. Respiratory acidosis

d. Respiratory alkalosis

Answer 92

a. Metabolic acidosis

Question 93

A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. the nurse would alert the health care provider immediately that the patient is on which medication?

a. Digoxin (Lanoxin) 0.25 mg/day

b. Ibuprofen 400 mg every 6 hours

c. Lantus insulin 24 U every evening

d. Metoprolol (Lopressor) 12.5 mg/day

Answer 93

a. Digoxin (Lanoxin) 0.25 mg/day

Question 94

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which action would the nurse include in the plan of care?

a. Maintain the patient on bed rest.

b. Auscultate lung sounds every 4 hours.

c. Encourage fluid intake up to 4000 mL daily.

d. Monitor for Trousseau’s and Chvostek’s signs.

Answer 94

c. Encourage fluid intake up to 4000 mL daily.

Question 95

A patient with renal failure is on a low-phosphate diet. Which food would the nurse remove from the patient’s food tray?

a. Skim milk

b. Grape juice

c. Mixed green salad

d. Fried chicken breast

Answer 95

a. Skim milk

Question 96

A patient has a magnesium level of 1.3 mg/dL. Which information from the patient’s health history would help the nurse identify a likely cause of this value?

a. Daily alcohol intake

b. Dietary protein intake

c. Daily multivitamin use

d. Occasional laxative use

Answer 96

a. Daily alcohol intake

Question 97

A patient who has been hospitalized for 2 days has a nasogastric tube to low suction and is receiving normal saline IV at 100 mL/hr. Which assessment finding would be a priority for the nurse to report to the health care provider?

a. Oral temperature increased to 100.1F

b. Decreased alertness since admission

c. Weight gain of 2 pounds (1 kg) over 2 days

d. Serum sodium level of 138 mEq/L (138 mmol/L)

Answer 97

b. Decreased alertness since admission

Question 98

A nurse is assessing a newly admitted patient with chronic heart failure who forgot to take prescribed medications. the patient seems confused and short of breath with peripheral edema. Which assessment would the nurse complete first?

a. Skin turgor

b. Heart sounds

c. Mental status

d. Capillary refill

Answer 98

c. Mental status

Question 99

A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. the patient reports anxiety and incisional pain. the patient’s respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis with a normal arterial oxygen level. Which action would the nurse take first?

a. Check to make sure the nasogastric tube is patent.

b. Give the patient the PRN IV morphine sulfate 4 mg.

c. Notify the health care provider about the ABG results.

d. Teach the patient to take slow, deep breaths when anxious.

Answer 99

b. Give the patient the PRN IV morphine sulfate 4 mg.

Question 100

A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider?

a. Stridor

b. Fatigue

c. Constipation for 4 days

d. Numbness around the lips

Answer 100

a. Stridor

Question 101

Following a thyroidectomy, a patient reports “a tingling feeling around my mouth.” Which action would the nurse complete first?

a. Verify the serum potassium level.

b. Test for presence of Chvostek’s sign.

c. Observe for blood on the neck dressing.

d. Confirm a prescription for thyroid replacement.

Answer 101

b. Test for presence of Chvostek‗s sign.

Question 102

A patient is admitted to the emergency department with severe fatigue and confusion. Which laboratory value requires the most immediate action by the nurse?

a. Arterial blood pH is 7.32.

b. Serum calcium is 18 mg/dL.

c. Serum potassium is 5.1 mEq/L.

d. Arterial oxygen saturation is 91%.

Answer 102

b. Serum calcium is 18 mg/dL.

Question 103

A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data require the most rapid response by the nurse?

a. The patient’s radial pulse is 105 beats/min.

b. There are crackles throughout both lung fields.

c. There is sediment and blood in the patient’s urine.

d. The patient’s blood pressure increases to 142/94 mm Hg.

Answer 103

b. There are crackles throughout both lung fields.

Question 104

The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action would the nurse expect to take first?

a. Monitor ionized calcium level.

b. Give oral calcium citrate tablets.

c. Check parathyroid hormone level.

d. Administer vitamin D supplements.

Answer 104

a. Monitor ionized calcium level.

Question 105

A patient who comes to the clinic reports frequent, watery stools for 2 days. Which action would the nurse take first?

a. Check the patient’s blood pressure.

b. Observe the oral mucosa for dryness.

c. Draw blood for serum electrolyte levels.

d. Ask about extremity numbness or tingling.

Answer 105

a. Check the patient’s blood pressure.

Question 106

After receiving a change-of-shift report, which patient would the nurse assess first?

a. Patient with serum sodium level of 145 mEq/L who is asking for water

b. Patient with serum potassium level of 5.0 mEq/L who reports abdominal cramping

c. Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive reflexes

d. Patient with serum phosphorus level of 4.5 mg/dL who has soft tissue calcium-phosphate precipitates

Answer 106

c. Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive reflexes

Question 107

The laboratory technician calls with arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider?

a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%

b. pH 7.35, PaO2 85 mm Hg, PaCO2 50 mm Hg, and O2 sat 95%

c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%

d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

Answer 107

d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

Question 108

Which IV solution would the nurse anticipate administering to a patient with an extracellular fluid (ECF) deficit who requires isotonic fluid replacement? (SATA)

a. Saline 0.9%

b. Saline 0.45%

c. Dextrose 10%

d. Lactated Ringer’s

e. Dextrose 5% in saline 0.25%

Answer 108

a. Saline 0.9%
d. Lactated Ringer’s
e. Dextrose 5% in saline 0.25%