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A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.
4. During a class on exercise for diabetic clients, a female client asks the nurse
educator how often to exercise. The nurse educator advises the clients to
exercise how often to meet the goals of planned exercise?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism
8. When caring for a male client with diabetes insipidus, nurse Juliet expects
to administer:
9. The nurse is aware that the following is the most common cause of
hyperaldosteronism?
10. A male client with type 1 diabetes mellitus has a highly elevated
glycosylated hemoglobin (Hb) test result. In discussing the result with the
client, nurse Sharmaine would be most accurate in stating:
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation
12. Nurse Louie is developing a teaching plan for a male client diagnosed with
diabetes insipidus. The nurse should include information about which
hormone lacking in clients with diabetes insipidus?
13. Early this morning, a female client had a subtotal thyroidectomy. During
evening rounds, nurse Tina assesses the client, who now has nausea, a
temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What
is the most likely cause of these signs?
A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany
14. For a male client with hyperglycemia, which assessment finding best
supports a nursing diagnosis of Deficient fluid volume?
17. A female client has a serum calcium level of 7.2 mg/dl. During the physical
examination, nurse Noah expects to assess:
A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.
18. Which outcome indicates that treatment of a male client with diabetes
insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.
19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with
hyperglycemia tells the nurse that her husband sleeps in another room
because her snoring keeps him awake. The nurse notices that she has large
hands and a hoarse voice. Which of the following would the nurse suspect as a
possible cause of the client’s hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone
22. A male client with type 1 diabetes mellitus asks the nurse about taking an
oral antidiabetic agent. Nurse Jack explains that these medications are only
effective if the client:
23. When caring for a female client with a history of hypoglycemia, nurse Ruby
should avoid administering a drug that may potentiate hypoglycemia. Which
drug fits this description?
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)
24. After taking glipizide (Glucotrol) for 9 months, a male client experiences
secondary failure. Which of the following would the nurse expect the
physician to do?
A. “The head of your bed must remain flat for 24 hours after surgery.”
B. “You should avoid deep breathing and coughing after surgery.”
C. “You won’t be able to swallow for the first day or two.”
D. “You must avoid hyperextending your neck after surgery.”
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
27. A male client with primary diabetes insipidus is ready for discharge on
desmopressin (DDAVP). Which instruction should nurse Lina provide?
A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism
A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage
A. Primary hypothyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism
35. Which of these signs suggests that a male client with the syndrome of
inappropriate antidiuretic hormone (SIADH) secretion is experiencing
complications?
A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria
A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).
A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid
38. Nurse Troy is aware that the most appropriate for a client with Addison’s
disease?
41. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for
a male client with type 2 diabetes mellitus who has been having trouble
controlling the blood glucose level through diet and exercise.
Which medication instruction should the nurse provide?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium
44. Which nursing diagnosis takes highest priority for a female client with
hyperthyroidism?
A. Risk for imbalanced nutrition: More than body requirements related to thyroid
hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound
healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone
excess
46. A male client has just been diagnosed with type 1 diabetes mellitus. When
teaching the client and family how diet and exercise affect insulin
requirements, Nurse Joy should include which guideline?
A. “You’ll need more insulin when you exercise or increase your food intake.”
B. “You’ll need less insulin when you exercise or reduce your food intake.”
C. “You’ll need less insulin when you increase your food intake.”
D. “You’ll need more insulin when you exercise or decrease your food intake.”
47. Nurse Noemi administers glucagon to her diabetic client, then monitors
the client for adverse drug reactions and interactions. Which type of drug
interacts adversely with glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
48. Which instruction about insulin administration should nurse Kate give to a
client?
A. “Always follow the same order when drawing the different insulins into the
syringe.”
B. “Shake the vials before withdrawing the insulin.”
C. “Store unopened vials of insulin in the freezer at temperatures well below
freezing.”
D. “Discard the intermediate-acting insulin if it appears cloudy.”
49. Nurse Perry is caring for a female client with type 1 diabetes mellitus who
exhibits confusion, light-headedness, and aberrant behavior. The client is still
conscious. The nurse should first administer:
50. For the first 72 hours after thyroidectomy surgery, nurse Jamie would
assess the female client for Chvostek’s sign and Trousseau’s sign because they
indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
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The nurse should refer this client to a sex counselor or other professional. Making
appropriate referrals is a valid part of planning the client’s care. The nurse doesn’t
normally provide sex counseling.
Diabetic clients must exercise at least three times a week to meet the goals of
planned exercise — lowering the blood glucose level, reducing or maintaining the
proper weight, increasing the serum high-density lipoprotein level, decreasing
serum triglyceride levels, reducing blood pressure, and minimizing stress.
Exercising once a week wouldn’t achieve these goals. Exercising more than three
times a week, although beneficial, would exceed the minimum requirement.
6. Answer: C. Tachycardia
Levothyroxine, a synthetic thyroid hormone, is given to a client with
hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent
include tachycardia. The other options aren’t associated with levothyroxine.
7. Answer: D. Hyperparathyroidism
10. Answer: C. “It tells us about your sugar control for the last 3 months.”
Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet,
tongue, and face are findings associated with hyperkalemia, which is transient and
occurs from transient hypoaldosteronism when the adenoma is removed. Tremors,
diaphoresis, and constipation aren’t seen in hyperkalemia.
ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and
LH levels won’t be affected.
Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes
exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme
restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia,
and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration,
and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis,
and possibly asphyxia.
To reduce water retention in a client with the SIADH, the nurse should restrict
fluids. Administering fluids by any route would further increase the client’s already
heightened fluid load.
To control hypoglycemic episodes, the nurse should instruct the client to consume a
low-carbohydrate, high protein diet, avoid fasting, and avoid simple sugars.
Increasing saturated fat intake and increasing vitamin supplementation wouldn’t
help control hypoglycemia.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral
antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and lactating women
aren’t prescribed oral antidiabetic agents because the effect on the fetus is
uncertain.
23. Answer: A. sulfisoxazole (Gantrisin)
Many clients (25% to 60%) with secondary failure respond to a different oral
antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy
at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping
glucose levels at an acceptable level, insulin may be used in addition to the
antidiabetic agent.
25. Answer: D. “You must avoid hyperextending your neck after surgery.”
To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the
nurse should advise the client to avoid hyperextending the neck. The client may
elevate the head of the bed as desired and should perform deep breathing and
coughing to help prevent pneumonia. Subtotal thyroidectomy doesn’t affect
swallowing.
26. Answer: C. Deposits of adipose tissue in the trunk and dorsocervical area.
Because of changes in fat distribution, adipose tissue accumulates in the trunk, face
(moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid
retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle
wasting causes muscle atrophy and thin extremities.
27. Answer: C. “You may not be able to use desmopressin nasally if you have
nasal discharge or blockage.”
Chvostek’s sign is elicited by tapping the client’s face lightly over the facial nerve,
just below the temple. If the client’s facial muscles twitch, it indicates hypocalcemia.
Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness,
headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle
weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes,
coma, or cardiac arrest.
Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance
may signal depression, which is common in clients with Cushing’s syndrome.
Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome.
Although hypoglycemia can cause irritability, it also produces increased appetite,
rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter,
nervousness, heat intolerance, and weight loss despite increased appetite.
Tetany may result if the parathyroid glands are excised or damaged during thyroid
surgery. Hemorrhage is a potential complication after thyroid surgery but is
characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness
at the incision site, choking, and bleeding. Thyroid storm is another term for severe
hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage
may occur postoperatively, but its signs include a hoarse voice and, possibly, acute
airway obstruction.
39. Answer: A. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
Acarbose delays glucose absorption, so the client should take an oral form of
dextrose rather than a product containing table sugar when treating hypoglycemia.
The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and
glucose absorption. It’s safe to be on a regimen that includes insulin and an alpha-
glucosidase inhibitor. The client should take the drug at the start of a meal, not 30
minutes to an hour before.
40. Answer: B. “You must avoid coughing, sneezing, and blowing your nose.”
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42. Answer: C. They debride the wound and promote healing by secondary
intention.
For this client, wet-to-dry dressings are most appropriate because they clean the
foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by
secondary intention. Moist, transparent dressings contain exudate and provide a
moist wound environment. Hydrocolloid dressings prevent the entrance of
microorganisms and minimize wound discomfort. Dry sterile dressings protect the
wound from mechanical trauma and promote healing.
The client should be encouraged to force fluids to prevent renal calculi formation.
Sodium should be encouraged to replace losses in urine. Restricting potassium isn’t
necessary in hyperparathyroidism.
Serum osmolarity is the most important test for confirming HHNS; it’s also used to
guide treatment strategies and determine evaluation criteria. A client with HHNS
typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium,
serum sodium, and ABG values are also measured, but they aren’t as important as
serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically
has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the
potassium level is variable.
46. Answer: B. “You’ll need less insulin when you exercise or reduce your food
intake.”
48. Answer: A. “Always follow the same order when drawing the different
insulins into the syringe.”
The client should be instructed always to follow the same order when drawing the
different insulins into the syringe. Insulin should never be shaken because the
resulting froth prevents withdrawal of an accurate dose and may damage the insulin
protein molecules. Insulin also should never be frozen because the insulin protein
molecules may be damaged. Intermediate-acting insulin is normally cloudy.
49. Answer: C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
This client is having a hypoglycemic episode. Because the client is conscious, the
nurse should first administer a fast-acting carbohydrate, such as orange juice, hard
candy, or honey. If the client has lost consciousness, the nurse should administer
either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse
shouldn’t administer insulin to a client who’s hypoglycemic; this action will further
compromise the client’s condition.