Week 1 EAQ/HESI

Question 1

The nurse suspects hypofunctioning of the adrenal gland based on which finding? Select all that apply. One, some, or all responses may be correct.

Increased calcium

Decreased cortisol

Weight loss

Decreased sodium

Vitiligo

Decreased potassium

Increased glucose

Hyperpigmentation

Answer 1

Increased calcium

Decreased cortisol

Weight loss

Decreased sodium

Vitiligo

Hyperpigmentation

Question 2

After assessing a female client, the nurse suspects that the client has hyperpituitarism. Which questions asked by the nurse are relevant to the diagnosis? Select all that apply. One, some, or all responses may be correct.

“Is there any change in your vision?”

“Do you experience severe headaches?”

“Are you suffering from frequent urination?”

“Have you noticed any back pain?”

“Do you eat more than five times a day?”

“Do you experience joint pain?”

“Is there any change in your menstrual cycle?”

“Do your shoes feel tight when you put them on?

Answer 2

“Is there any change in your vision?”

“Do you experience severe headaches?”

“Have you noticed any back pain?”

“Do you experience joint pain?”

“Is there any change in your menstrual cycle?”

“Do your shoes feel tight when you put them on?

Question 3

A 24-hour urine specimen to assess the presence of vanillylmandelic acid (VMA) is ordered to assist in confirmation of the diagnosis of a pheochromocytoma. Which information would the nurse include in the teaching plan regarding this test? Select all that apply. One, some, or all responses may be correct.

The client may take chlorpromazine during the test.

Encourage the client to engage in usual activities while testing.

Only salicylates can be taken for discomfort during the test.

All urine excreted over the 24-hour period must be saved and refrigerated.

Avoid chocolate and citrus fruit for 3 days before and during the test.

Fluids can include coffee and tea but avoid colored drinks and sodas.

The client should avoid skipping meals while testing.

The use of monoamine oxidase (MAO) inhibitors should be reported before testing.

Answer 3

All urine excreted over the 24-hour period must be saved and refrigerated.

Avoid chocolate and citrus fruit for 3 days before and during the test.

The client should avoid skipping meals while testing.

The use of monoamine oxidase (MAO) inhibitors should be reported before testing.

Question 4

Which physiological response would the nurse expect when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Bradycardia

Blurred vision

Cold intolerance

Tremors

Insomnia

Increased appetite

Widened pulse pressure

Diaphoresis

Answer 4

Blurred vision

Tremors

Insomnia

Increased appetite

Widened pulse pressure

Diaphoresis

Question 5

_____________ can cause constipation, sleep disturbances, & hair loss and brittle nails.

Answer 5

Hypothyroidism

Question 6

The client has signed the consent for the radioactive iodine uptake test. What are the most important assessments for the nurse to obtain prior to the test? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Ask if the client has been taking any OTC medications such as cough syrups.

Determine if the client has eaten in the past 4 hours.

Investigate the client’s use of over the counter (OTC) multivitamin and herbal products.

Find out if the client has ever had a reaction to a bee sting.

Assess the client’s history for allergic reaction to peanuts.

Answer 6

Ask if the client has been taking any OTC medications such as cough syrups.

Investigate the client’s use of over the counter (OTC) multivitamin and herbal products.

Find out if the client has ever had a reaction to a bee sting.

Question 7

Based on the HCP’s assessment and interpretation of the diagnostics, the client is diagnosed with hypothyroidism. Which other lab should be monitored after the diagnosis of hypothyroidism is confirmed?

Albumin

Triglycerides and cholesterol

PT/PTT

Uric acid

Answer 7

Triglycerides and cholesterol

Question 8

The client asks the nurse how she got hypothyroidism. Which explanation by the nurse is accurate?

Hypothyroidism is inherited from parents.

Viral infections cause hypothyroidism.

A bacterial infection causes hypothyroidism.

An autoimmune dysfunction causes thyroid dysfunction.

Answer 8

An autoimmune dysfunction causes thyroid dysfunction.

Question 9

Which symptoms are the client with hypothyroidism most likely to exhibit? (Select all that apply. One, some, or all options may be correct.)

Tachycardia and palpitations

Somnolence and fatigue

Coarse dry skin

Somnolence and cold intolerance

Diarrhea and weight loss

Answer 9

Somnolence and fatigue

Coarse dry skin

Somnolence and cold intolerance

Question 10

Which approach by the nurse describes the action of the levothyroxine?

Blocks the production of thyroid hormone.

Increases fat, protein, carbohydrate metabolism.

Decreases the size of the thyroid gland.

Decreases the blood flow to the thyroid gland.

Answer 10

Increases fat, protein, carbohydrate metabolism.

Question 11

Which information in the client’s history would be of concern to the nurse related to the use of levothyroxine? Select all that apply

The client has an allergy to nonsteroidal anti-inflammatories (NSAID) medications.

The client eats her last meal of the day around 7:00 p.m.

The client takes a daily calcium supplement.

The client prefers to take her medications with a full glass of water.

Answer 11

The client takes a daily calcium supplement.

Calcium should be taken at least four hours after the levothyroxine dose to prevent interference with absorption.

Question 12

The client tells the nurse she has a hard time taking medications regularly. She asks how long she will need to take the levothyroxine. What is the nurse’s best response?

The HCP will let you know when it is time to stop the medication.

You will be able to stop the medicine in the next four to six months.

The HCP will stop the medication when TSH level returns to normal.

You will need to take this medication for the remainder of your life.

Answer 12

You will need to take this medication for the remainder of your life.

This medication is a replacement hormone and will need to be taken for life.

Question 13

Which instructions should the nurse include when teaching the client about levothyroxine sodium? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

This medication should be taken twice a day with food.

This medication requires periodic lab work to monitor levels.

When refilling this medication, ask the pharmacist for the least expensive brand of the medication.

Report chest pain, a rapid heartbeat, or increased nervousness to the HCP.

Wear a medical alert bracelet.

Answer 13

This medication requires periodic lab work to monitor levels.

Report chest pain, a rapid heartbeat, or increased nervousness to the HCP.

Wear a medical alert bracelet.

Question 14

Prior to the administration of each dose of levothyroxine, it is important to obtain which assessments? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Administer the medication prior to eating breakfast.

Record blood glucose.

Ensure that the heart rate is less than 100.

Record intake for the past 12 hours.

Assess the client’s bowel sounds.

Answer 14

Administer the medication prior to eating breakfast.

Ensure that the heart rate is less than 100.

Question 15

Which behavior indicates to the nurse that the client understands the instructions related to the new medication? [ Thyroid Hormone Replacement ]

The client selects menu choices that include several low-fat, high-protein products.

The client states to the nurse that she will only have to get a refill of the medication when her symptoms don’t subside.

The client states that she will need to notify the HCP of any chest pain.

The client demonstrates how to check her temperature using a digital thermometer.

Answer 15

The client states that she will need to notify the HCP of any chest pain.

Chest pain can indicate a problem with the cardiovascular system. Clients should be instructed to monitor their pulse and to report tachycardia, an irregular pulse, or palpitations to the HCP.

Question 16

The client reports to the nurse that she took an antidepressant for several months and because of how she’s feeling, she’d like to restart her medication [along with Thyroid Hormone Replacement]. Which is the most important advice by the nurse?

Advise the client that it is ok to restart the antidepressant medication.

Ask if she took the medication at night or in the a.m.

Advise her to check with the HCP first.

Encourage her to seek counseling for any depression she is experiencing.

Answer 16

Advise her to check with the HCP first.

Sedatives can increase the sensitivity to hormone replacement therapy. These medications should only be used if approved by the HCP.

Question 17

Myxedema is a rare life-threatening condition that is a decompensated state of severe
______________.

Answer 17

hypothyroidism

Question 18

Upon admission, the nurse should give the highest priority to meeting which need of a client who is brought to the ED with myxedema crisis? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Assess cardiac system.

Insert a Foley catheter.

Ask about current immunizations and medications.

Start an IV of sodium chloride at prescribed rate.

Cover the client with warm blankets.

Answer 18

Assess cardiac system.

Start an IV of sodium chloride at prescribed rate.

Cover the client with warm blankets.

Question 19

Client’s blood gases are as follows:
pH: 7.33
pCO2: 50
PaO2: 99
HCO3: 24

Based on the nurse’s assessment of these labs which finding accurately describes the results?

Metabolic alkalosis

Respiratory alkalosis

Metabolic acidosis

Respiratory acidosis

Answer 19

Respiratory acidosis

Question 20

What information should the nurse provide as a potential cause of a myxedema crisis?

Contracting the flu.

The stress of continuing school.

Working full time.

Failure to lose weight.

Answer 20

Contracting the flu.

Viral infections can be a trigger for a myxedema crisis. Other triggers include the use of drugs (such as opioids, tranquilizers, or barbiturates), exposure to cold, and trauma.

Question 21

At her six week appointment, the client reports of fatigue, some increasing constipation, and weight gain. Her serum TSH level is still elevated. Based on the clinical manifestations and lab results, what change in medication should the nurse anticipate?

Increase her dose of levothyroxine.

Decrease her dose of levothyroxine.

Discontinue the levothyroxine.

Change to a new hormone replacement medication.

Answer 21

Increase her dose of levothyroxine.

The client is still exhibiting symptoms of hypothyroidism, which will require an increase in her dose of levothyroxine. Her dose will be increased as needed.

Question 22

“Foods that I should include in my diet include tuna, yogurt, and macaroni.”
All of these foods are good sources of _________ .

Answer 22

iodine

Question 23

________ can have a variety of etiologies including viral hepatitis, non-alcoholic fatty liver disease, hemochromatosis, Wilson’s disease, cystic fibrosis, biliary atresia, infections, and medications.

Answer 23

Cirrhosis

Question 24

The nurse continues the focused risk assessment by asking about etiologic factors related to cirrhosis. Which assessment finding provides the most likely indication that the client is at high risk for cirrhosis?

Previous diagnosis of Hepatitis C.

Steady diet of high protein foods.

Exposure to toxic substances at work.

Familial evidence of cirrhosis.

Answer 24

Previous diagnosis of Hepatitis C.

Hepatitis C is directly linked to cirrhosis, as well as Hepatitis B and D.

Question 25

After the client undergoes the paracentesis, which nursing assessment warrants immediate intervention?

Cloudy, yellow tinged fluid draining from puncture site

Unchanged abdominal girth measurement

Faint, hypoactive bowel sounds

Increasing abdominal pain

Answer 25

Increasing abdominal pain

This may be the result of diaphragmatic, liver, or spleen perforation and may be life threatening.

Question 26

In the client with cirrhosis, which lab values does the nurse anticipate will be increased from the normal value? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Total serum bilirubin

AST/ALT

Serum albumin

APTT, PT/INR

Sodium and potassium

Answer 26

Total serum bilirubin

AST/ALT

APTT, PT/INR

Question 27

Based on the prolonged APTT and PT/INR what clinical manifestation would the nurse anticipate visualizing upon assessment?

Weight loss

Peripheral edema

Jaundice

Petechiae

Answer 27

Petechiae

The client with cirrhosis has impaired coagulation related to a decrease in the production of clotting factors by the liver, decreased absorption of vitamin K in the intestines, and thrombocytopenia. Manifestations may include epistaxis, purpura, and petechiae

Question 28

With a confirmed diagnosis of Laennec’s cirrhosis, which assessment finding warrants immediate intervention? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Increased girth

Scleral jaundice

Hematemesis

Melena

Pruritus

Answer 28

Hematemesis

Melena

Question 29

Which medication places the client at risk for hyperkalemia?

Spironolactone.

Furosemide.

Folic acid.

Thiamine.

Answer 29

Spironolactone.

This potassium-sparing diuretic prevents potassium from being excreted, so the client should be monitored for signs of hyperkalemia.

Question 30

While administering the albumin infusion via a vein in the right hand, the nurse notes that the peripheral edema in the client’s arms and hands has changed from 3+ to 2+. It is most important for the nurse to implement which intervention?

Administer a diuretic.

Change the IV site.

Stop and check the client’s blood pressure.

Continue the albumin infusion.

Answer 30

Continue the albumin infusion.

This finding reflects a decrease in edema. Since this indicates the albumin is having the desired effect, it should be continued. Albumin is administered to pull fluid from the peritoneal cavity and peripheral tissues. Excessive use of albumin without adequate diuresis may result in pulmonary edema, which is manifested by symptoms such as abnormal breath sounds and jugular vein distention.

Question 31

Ethical-Legal Considerations: Discharge Against Medical Advice (AMA)
The client becomes increasingly angry and leaves the hospital without discharge orders from the HCP.

Who should the nurse notify of the client’s action? (Select all that apply. One, some, or all options may be correct.)

The client’s next of kin.

The charge nurse.

The police.

The client’s HCP.

The local Alcoholics Anonymous group.

Answer 31

The charge nurse.

The client’s HCP.

Question 32

The client is minimally responsive and has a Glasgow Coma Scale rating of 8. The client is admitted with a diagnosis of hepatic encephalopathy. Which of the client’s serum laboratory values requires intervention by the nurse?

Serum ammonia 157 mcg/dL (112.1 mcmol/L)

pH 7.50

PaCO2 50 mmHg

Serum albumin 0.60 g/dL (6 g/L)

Answer 32

Serum ammonia 157 mcg/dL (112.1 mcmol/L)

Increased ammonia levels are toxic to CNS tissue, resulting in encephalopathy. Serum ammonia levels increase in cirrhosis as the liver becomes less efficient in converting ammonia to urea. The client is disoriented to time, loss of meaningful conversation, marked confusion, incomprehensible speech. Serum ammonia normal range 10.0-80.0 mcg/dL (7.14-57.12 mcmol/L).

Question 33

Which outcome indicates to the nurse that the lactulose and rifaximin are having the desired effect?

Increased mental alertness.

Decreased craving for alcohol.

Decreased serum albumin level.

Clay-colored bowel movements.

Answer 33

Increased mental alertness.

One of the primary goals of treatment is to improve the client’s neurologic status. The prescribed medications are administered to increase the frequency of bowel movements, which increases the excretion of ammonia in the bowel, thereby reducing the elevated serum ammonia level that is causing the toxic effects on the CNS.

Question 34

The treatment goal for cirrhosis is to slow the progression, prevent and treat any complications. Which interventions are most important for the nurses to include in the client’s plan of care? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

Stress the importance of following a low sodium diet.

Empasize the need for B-complex vitamins.

Encourage low-carbohydrate foods.

Teach the client to change positions frequently.

Use moisturizing lotion to the skin to minimize scratching.

Answer 34

Stress the importance of following a low sodium diet.

Empasize the need for B-complex vitamins.

Use moisturizing lotion to the skin to minimize scratching.

Question 35

Management of ascites is focused on sodium restriction diet, diuretic therapy, and fluid removal. While monitoring the client’s fluid volume, what action should the nurse take?

Instruct the client to perform self-catheterization.

Measure abdominal girth daily.

Administer PRN antiemetics before meals.

Encourage the client to eat frequent high-protein snacks.

Answer 35

Measure abdominal girth daily.

Assessment of the effectiveness of treatment for fluid volume excess includes measuring abdominal girth and edema, auscultation of breath sounds, and daily weights. Ascites frequently returns after paracentesis. Another important intervention is to maintain fluid and sodium restrictions. Fluids may be restricted to 1 liter or less a day, and sodium may be restricted to 1 g or less a day.

Question 36

To support the admitting diagnosis of acute pancreatitis, what information should the nurse obtain from the client?

History or current use of tobacco products.

How often alcohol is consumed and date of last drink.

Medication taken in the last 24 hours.

Weight loss or gain in the last 6 months.

Answer 36

How often alcohol is consumed and date of last drink.

Long-term use of alcohol is commonly associated with the development of chronic pancreatitis, and alcohol ingestion is the primary cause of an acute exacerbation of pancreatitis.

Question 37

Which laboratory data indicates that the client is experiencing acute pancreatitis?

Hemoglobin (Hgb) 12.9 g/dL (129 g/L) and hematocrit (HCT) 42% (0.42 Proportion of 1.0).

White blood cell count of 10,000/uL (10 x109/L).

Amylase of 982 U/L (16.4 mckat/L) and lipase of 400 U/L (6.68 ukat/L).

Blood alcohol (ethanol) level of 75 mg/dL (16.28 mmol/L).

Answer 37

Amylase of 982 U/L (16.4 mckat/L) and lipase of 400 U/L (6.68 ukat/L).

Serum amylase and lipase levels can increase to an excess of 3 times their normal upper limits within 24 hours of an acute exacerbation of pancreatitis. Normal levels are amylase < 160 U/L (2.67 ukat/L) and lipase < 160 U/L (2.67 ukat/L).

Question 38

____________ is considered a first line opioid analgesic and one of the most commonly prescribed opioids for moderate to severe pain.

Answer 38

Morphine

Question 39

Which intervention regarding positioning should the nurse implement to help alleviate the client’s pain?
[pancreatitis]

Answer 39

Encourage side lying with legs drawn to chest.

The pain from pancreatitis is caused by stretching of the peritoneum secondary to edema caused by the inflamed pancreas. Sitting up, leaning forward, or lying in a fetal position helps alleviate this pain.

Question 40

Because TPN has a high glucose content which exerts osmotic pressure that is injurious to the intimal lining of peripheral veins, it is administered into the vascular system through a central venous catheter, often inserted into the ______________ vein.

Answer 40

subclavian

Question 41

___________ intake is the number one cause of an attack of acute pancreatitis, and continued use will do further damage to the pancreas.

Answer 41

Alcohol

Question 42

_______ stimulates the pancreas to secrete pancreatic enzymes. Effective management of highly stressful situations can help decrease inflammation of the pancreas.

Answer 42

Stress

Question 43

Clients with chronic ____________ have steatorrhea (fatty, frothy, foul-smelling stools) due to a decrease in pancreatic enzyme production.

Answer 43

pancreatitis

Question 44

Which statement accurately explains the scientific rationale for the use of omeprazole?

Omeprazole decreases gastric secretions.

Omeprazole decreases pancreatic enzyme secretion.

Omeprazole decreases the propulsion of food through the small intestine.

Omeprazole decreases the number of stools and steatorrhea.

Answer 44

Omeprazole decreases gastric secretions.

Omeprazole is a proton-pump inhibitor (PPI) that decreases gastric secretions. Proton-pump inhibitors, such as omeprazole, reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid.

Question 45

Because pancrelipase is made from the pancreas gland of a _____ , the nurse should determine if the client is allergic to pork products.

Answer 45

hog

Question 46

Which additional instruction regarding the use of pancrelipase is important for the nurse to include?

Take the medication with meals or snacks.

Chew the medication 30 minutes before eating.

Spread the capsule crystals over food and chew thoroughly.

Swallow the capsule twice a day in the morning and at bedtime.

Answer 46

Take the medication with meals or snacks.

Pancrelipase enhances the digestion of starches and fats in the GI tract by supplying an exogenous source of the pancreatic enzyme. This medication promotes nutrition and decreases the number of bowel movements.

Question 47

When the nurse is discussing the complications of chronic pancreatitis with the client, which information should be included in the teaching? (Select all that apply. One, some, or all options may be correct.)
Select all that apply

The need to report any painful urinating or dribbling.

The signs and symptoms of hypovolemic shock.

The importance of checking bilirubin levels.

The need to monitor blood glucose levels.

That recurring attacks tend to become more severe in nature.

Answer 47

The need to monitor blood glucose levels.

That recurring attacks tend to become more severe in nature.

Question 48

____________ is a major problem for clients with chronic pancreatitis. It is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.

Answer 48

Weight loss