PART II Endocrine

ARA | Enhancement | Endocrine 2
Your score: 63% (63/100)
1.
1 / 1 point
The nurse is caring for a client with diabetic ketoacidosis (DKA). The client suddenly
becomes confused. Which of the following actions should the nurse perform first?
Your Answer: Correct
Check the client's glucose level

Check the client's vital signs
Check the client's pupillary reaction
Call the provider
Explanation:
If a client with DKA becomes confused, they may be hypoglycemic OR hyperglycemic.
The nurse should check the glucose level, then obtain a set of vitals, then call the
provider.
2.
1 / 1 point
The nurse enters a client’s room to find that the client is becoming confused. The nurse
checks the client’s blood glucose and gets a result of 40, but the client is alert and
talking. What is the first thing the nurse should do?
Get the client orange juice

Get a set of vitals
Call the provider
Re-check the glucose
Explanation:
Because the client's glucose is so low, the nurse must act quickly to bring the glucose
level up. If the client's level of consciousness is high enough so that they can safely
swallow orange juice, the nurse would give this as a quick carb right away.
3.
0 / 1 point
The nurse is preparing to receive a postoperative client following parathyroidectomy
surgery. The nurse is aware that which of the following are potential occurrences with
this type of surgery? Select all that apply.
Your Answer: Incorrect
Removal of one or more parathyroid glands

Irritation of the thyroid gland
Transplantation of parathyroid tissue in the forearm
Postoperative hypercalcemic crisis
Bleeding at the surgical site

Explanation:
A parathyroidectomy is performed to remove diseased glands. There are 4 parathyroid
glands, and a parathyroidectomy will involve the removal of 1 gland, or up to all of the
glands.
Because the parathyroid glands are located behind the thyroid, this structure is at risk of
irritation during surgery.
When all parathyroid glands must be removed, some parathyroid tissue is transplanted
to either the forearm or near the sternocleidomastoid muscle so that PTH will continue
to be excreted.
As with any surgery, bleeding at the surgical site can occur. The nurse will monitor the
neck dressing for bleeding.
4.
1 / 1 point
A nurse is caring for a term newborn infant who was born to a diabetic mother. Which of
the following signs or symptoms would the nurse look for that would demonstrate
hypoglycemia in this infant? Select all that apply
Poor feeding
Low temperature
Breathing rate of 46/min
Cyanosis
Tremor
Explanation:
"Cyanosis", "Tremor", "Poor feeding", and "Low temperature" are correct. An infant of a
diabetic mother is at risk of developing blood glucose abnormalities after birth, which
can lead to neonatal hypoglycemia. The infant with decreased blood glucose levels will
demonstrate symptoms of tremor and jitters, poor feeding abilities, cyanosis, and low
temperature. "Breathing rate of 46/min" is incorrect. A normal newborn respiratory rate
is 40-60 breaths per minute.
References:
 https://www.stanfordchildrens.org/en/topic/default?id=hypoglycemia-in-the-
newborn-90-P01961
5.
1 / 1 point
A 60-year-old client with diabetes is at the healthcare center for treatment of diabetic
neuropathy. The nurse provides teaching to the client about foot care to prevent skin
breakdown and infection. Which of the following information should the nurse include as
part of this teaching?
Do not wear open-toe or open-heel shoes

Use only commercial remedies to remove calluses or corns that have developed on the
feet
Cut toenails and cuticles at night before going to bed
Thoroughly dry the feet after a shower, using a starched washcloth between the toes
Explanation:
"Do not wear open-toe or open-heel shoes" is correct. Diabetic clients are at higher risk
of wounds because of alterations in circulation and changes in sensation to the lower
legs and feet. Because a diabetic client may have an injury and not know it, the nurse
should counsel the client to check feet regularly and provide specific care. The client
should avoid wearing open-toe or open-heel shoes or sandals, as these shoes expose
the feet and increase the risk of injury. "Use only commercial remedies to remove
calluses or corns that have developed on the feet" is incorrect. A corn or callus on the
foot of a person with diabetes warrants a trip to the podiatrist. It should not be treated
with over-the-counter treatments, because the harsh chemicals in these treatments can
cause skin breakdown. "Cut toenails and cuticles at night before going to bed" is
incorrect. Cutting cuticles is not recommended due to the risk of cutting the skin. Every
person has bacteria on the skin, and if an opening develops on the foot, the diabetic
client is at a high risk for infection AND slow wound healing. "Thoroughly dry the feet
after a shower, using a starched washcloth between the toes" is incorrect. Feet should
be kept dry, but using something rough between the toes could lead to an abrasion
which may not be noticeable to the client, and therefore pose a risk for infection and
slow wound healing.
References:
 Tanenbaum, J. C. (n.d.). Foot Care. Retrieved December 4, 2018, from
https://www.diabetesselfmanagement.com/managing-diabetes/complications-
prevention/foot-care/
6.
1 / 1 point
A nurse is taking care of a patient who has just returned from a session of hemodialysis.
The physician has ordered a percutaneous nephrolithotomy for the patient and the
nurse does not schedule the procedure until 8 hours later. What is the rationale for
this?
The patient is at risk of bleeding because of heparin administered with dialysis

The patient is in too much pain after having dialysis
The patient most likely has an infection that needs treatment first
The patient should receive fluids for several hours after hemodialysis
Explanation:
"The patient is at risk of bleeding because of heparin administered with dialysis" is
correct. A nephrolithotomy is an incision into the kidney to remove a stone. Following
hemodialysis, the nurse should avoid scheduling the patient for any type of invasive
procedure for several hours. The patient most likely received heparin during the
hemodialysis and is at higher risk of bleeding. If the patient undergoes an invasive
procedure, they could suffer a hemorrhage because of the heparin. "The patient is in too
much pain after having dialysis" is incorrect because after dialysis the patient is not
commonly in pain. They may feel slightly nauseous, or "off", but not in pain. "The patient
most likely has an infection that needs treatment first" is incorrect because dialysis does
not lead to infection unless the dialysis nurse contaminated the patient in some way.
Dialysis nurses use strict aseptic technique during the procedure. "The patient should
receive fluids for several hours after hemodialysis" is incorrect because, while the
patient can become hypotensive after a dialysis session, fluid therapy would not prevent
that patient from having an invasive procedure. Additionally, due to the common side
effect of swelling in dialysis patients, fluid therapy is not prescribed for post-dialysis
hypotension.
7.
1 / 1 point
A nurse is caring for a client who is being treated for acute pyelonephritis. The nurse
explains to the client that the risk factors for acute pyelonephritis include which of the
following? Select all that apply.

Septic shock
Suppressed immunity
Urinary stones
Increased fluid intake
Catheter use
Explanation:
If a client has an issue that interrupts the flow of urine, they are susceptible to acute
pyelonephritis. These include prostatic hypertrophy, urinary stones, abnormal anatomy
of the genitourinary tract, immunocompromised clients, catheter use, and spinal cord
damage.
References:
 DiMaria, C., Solan, M., & Gotter, A. (2018, April 4). Pyelonephritis. Retrieved
February 19, 2019, from https://www.healthline.com/health/pyelonephritis
8.
1 / 1 point
The client is scheduled for a paracentesis. Which of the following responses is
appropriate for the nurse to educate the client about the procedure?
A needle is inserted to remove ascitic fluid

A sample of liver tissue will be taken
There is a high risk of bleeding
A needle is inserted into the peritoneum to collect sterile urine
Explanation:
A paracentesis involves inserting a needle into the abdominal cavity to remove fluid in a
client with ascites. It is done to relieve pressure for the client, as ascites becomes
uncomfortable as the peritoneum becomes full with fluid. It is also done for diagnostic
purposes to determine the source of ascites.
9.
0 / 1 point
A 58-year-old client with a diabetic foot wound needs the dressing changed by the
nurse caring for him. The nurse uses sterile technique as part of the wound dressing
change. Which of the following techniques would be included as part of sterile
technique? Select all that apply.

The nurse removes the old dressing with a gloved hand
The nurse opens a dressing package and does not allow anything to touch the inside of
the package
The nurse washes the wound with soap and water
The nurse does not allow any of the wound debridement instruments to go below the
level of the waist
The nurse does not turn his or her back on the instruments used for the dressing
change
Explanation:
A nurse may perform a dressing change using sterile technique to prevent infection.
Sterile items are kept in the package sterile before use, and no sterile items are brought
below the waist, nor does the nurse turn his or her back on these items. Any part of the
sterile field that leaves the nurse's field of vision can no longer be considered sterile.
It is not possible to maintain a sterile field while washing a wound with soap and water.
Yes, the nurse removes the old dressing using a non-sterile gloved hand, but this is
before beginning sterile technique for the dressing change.
10.
1 / 1 point
After having surgery for a shoulder replacement under general anesthesia, the client
became excessively hot with a temperature of 104.5F. The nurse would be concerned
about which of the following?
Malignant hyperthermia
Neuroleptic malignant syndrome
Pacemaker malfunction
Diabetic ketoacidosis
Explanation:
This client could have malignant hyperthermia, which is when the body reacts to
anesthetic agents, releasing calcium ions from muscle cells and making the muscle
fibers contract creating excessive heat.
Neuroleptic malignant syndrome is caused by the body’s reaction to antipsychotic

medication due to dopamine receptor blockade. A fever after anesthesia would not
result in pacemaker malfunction. There are no indications that this client could have
DKA. DKA would not cause hyperthermia.
11.
1 / 1 point
A nurse is caring for a client with hypoparathyroidism. The nurse knows that which of
the following supplements might be administered to a client for treatment of
hypoparathyroidism?

Thiamine
Calcium
Phosphorus
Folic acid
Explanation:
Hypoparathyroidism is treated with calcium supplements due to the low PTH levels
caused by hypoparathyroidism. Low PTH causes hypocalcemia in the blood.
Hypoparathyroidism is not treated with thiamine supplements. Calcium supplements

are needed. In hypoparathyroidism there is hypocalcemia. Hypoparathyroidism is not
treated with phosphorus supplements; the phosphorus levels are high. Calcium
supplements are needed. In hypoparathyroidism there is hypocalcemia.
Hypoparathyroidism is not treated with folic acid. Calcium supplements are needed. In
hypoparathyroidism there is hypocalcemia.
12.
0 / 1 point
An 18-year-old client is receiving treatment for chronic abuse of anabolic steroids to
support bodybuilding. Which of the following has been shown to be a complication of
steroid abuse in teens and young adults? Select all that apply.
Severe acne
Hair loss
Excess bone growth

Weight loss
Hypotension
Explanation:
Anabolic steroids may sometimes be abused by teens and young adults. They are
most commonly used in bodybuilding circles and to build muscle and endurance. Some
athletes abuse anabolic steroids to increase strength and speed in their sport. These
steroids are made up of male sex hormones and are most often abused by young men.
Abuse of these drugs leads to breast development in men, acne, male pattern baldness
and testicular atrophy.
While anabolic steroid use can increase bone density, this is a desired effect, not a
complication. Steroid use leads to increased muscle mass rather than weight loss.
Steroid use can lead to chronic hypertension and increased risk of stroke or heart
attack.
References:
 Hoffman, J. R., & Ratamess, N. A. (2006). Medical Issues Associated with

Anabolic Steroid Use: Are They Exaggerated? Journal of Sports Science &
Medicine, 5(2), 182–193.
13.
1 / 1 point
A nurse is caring for a client who was recently diagnosed with diabetes and is receiving
treatment for hypoglycemia. The nurse gives the client a nursing diagnosis of Fear
related to the diabetes diagnosis based on the client’s behavior and sense of anxiety
when she talks about managing her disease. What type of nursing intervention is most
applicable for this nursing diagnosis?
Encourage the client to learn and practice self care

Ask the client to tell the nurse how she sees herself in 10 years
Focus on treatment of the disease and not on the client's feelings
Tell the client about personal fears of the nurse
Explanation:
Rationale
"Encourage the client to learn and practice self care" is correct. A diagnosis of diabetes
may cause some clients to be quite fearful because of unknown factors associated with
the illness. In this situation, the nurse can best help the client by instructing in self care
and encouraging the client to practice these techniques. This type of bedside instruction
from the nurse helps the client to feel supported and can alleviate fear. "Ask the client to
tell the nurse how she sees herself in 10 years" is incorrect. When this question is
asked of the client while they are in a fearful state, it may cause them to think of
negative answers, which is counterproductive to the client's situation. "Focus on
treatment of the disease and not on the client's feelings" is incorrect. Nursing is a multi-
dimensional art, encompassing disease treatment AND emotional, social and spiritual
aspects. "Tell the client about personal fears of the nurse" is incorrect because this
would bring the thoughts of the fearful client in a negative direction. The nurse should
direct the conversation in a positive way by focusing on what the client can learn and
master, rather than focusing on the client's fears.
14.
1 / 1 point
Which best describes the appearance of Charcot foot in a diabetic client?
Deformity of the lateral arch
Cracked and bleeding heels
Small, thin toes
Rocker-bottom appearance
Explanation:
Charcot foot is a complication of diabetes that may develop when tiny fractures in the
bones of the feet cause structural changes. The client's arch may drop and the foot
takes on a rocker-bottom, or rounded appearance. The condition can be very painful,
but if a client has peripheral neuropathy, they may not be aware of the pain and may not
notice the deformity.
References:
 Shah, M. (2018, June 21). Charcot Arthropathy: Background, Anatomy,

Pathophysiology. Retrieved August 31, 2018, from
https://emedicine.medscape.com/article/1234293-overview#a11
15.
1 / 1 point
A client has severe lung fibrosis and as the nurse completes the admission history,
which of the following diseases should the client be asked about?

Pulmonary embolism
Scleroderma
COPD
Pneumonia
Explanation:
Scleroderma is the overproduction of collagen tissue and leads to tightening and
thickening of tissues. This could cause lung fibrosis.
Blood clots in the lungs and do not cause lung fibrosis. COPD is chronic and disabling
lung diseases that cause shortness of breath and does not cause lung fibrosis.
Pneumonia is an infection in the lungs and does not cause lung fibrosis.
16.
0 / 1 point
A client on the unit is diagnosed with SIRS. The client has a history of congestive heart
failure and chronic kidney disease. The client has received 2 liters of normal saline in
the emergency department and is receiving normal saline at 150/hr. The nurse knows
that which of the following orders should be questioned? Select all that apply.

Furosemide 80 mg IV BID
Potassium 50 mq PO BID with meals
Insert urinary catheter to monitor output
Insert second IV access
Dialysis STAT for fluid removal

Explanation:
Dialysis STAT is not an appropriate order for the client diagnosed with SIRS. The client
needs fluid resuscitation. Diuretics may be given to avoid fluid overload.
Furosemide would be an appropriate medication to give a client with congestive heart

failure that is receiving high amounts of fluids to decrease the risk of fluid overload.
Potassium is an appropriate medication to give the client that will be receiving lasix.
Remember, lasix depletes potassium from the body. A urinary catheter would be
appropriate to monitor the output of the patient’s urine. Second IV access would be
appropriate for the patient with SIRS to provide another access for antibiotics and IV
medications
17.
0 / 1 point
The client is newly diagnosed with Hashimoto’s thyroiditis. The client does not fully
understand the disease so which of the following explanations should the nurse provide
to the client about Hasmioto’s thyroiditis?
It is an autoimmune disorder that occurs because the thyroid is absent
It is an autoimmune disorder that may be triggered by many different factors

It is caused by too many thyroid hormones in the body
It is caused by taking levothyroxine
Explanation:
Hashimoto’s thyroiditis is an autoimmune disorder that may be triggered by many
different factors.
Hashimoto’s thyroiditis is an autoimmune disorder where the thyroid is attacked and
thyroid hormones decrease. This may be triggered by many different factors, NOT
because the thyroid is absent.
18.
1 / 1 point
A 15-year-old female client was diagnosed with type 1 diabetes a year ago. The client is
now being seen in the healthcare clinic because her mother is concerned that she is
losing too much weight. The client admits that she sometimes goes without eating for
long periods and uses very little insulin. Which of the following interventions would be
most appropriate for the nurse to help this client?

Have the client perform self-awareness exercises every day to boost self esteem
Encourage the client to exercise 5 out of 7 days per week
Make arrangements for the client to attend a support group of teens with anorexia
Admit the client to the hospital as an inpatient in a mental health facility
Explanation:
"Make arrangements for the client to attend a support group of teens with anorexia" is
correct. When a teenager presents with an eating disorder, it is important to facilitate
treatment right away. In the adolescent client with diabetes, a behavior that is
sometimes seen is a form of anorexia that involves self starvation followed by very
limited use of insulin, which results in weight loss. This behavior leads to serious
medical complications, such as kidney, retinal and nerve damage. The client in this
situation needs help for her behavior, and as a teen, she would most likely benefit from
a small group with other teens. "Admit the client to the hospital as an inpatient in a
mental health facility" is incorrect, because she does not demonstrate behaviors that
would qualify her for inpatient mental health. "Have the client perform self-awareness
exercises every day to boost self esteem" is incorrect. Group support is more effective
to assist a teen in making positive behavior choices. "Encourage the client to exercise 5
out of 7 days per week" is incorrect. Anorexia is a multi-faceted issue that cannot be
solved by exercise. This teen client needs the support of group therapy. "
References:
 Berry, E. (2015, May 27). Disordered Eating Common in Females With Type 1
Diabetes. Retrieved September 5, 2018, from
https://www.medscape.com/viewarticle/845363
 Diabetes Care 2018 Aug
 41(8): 1623-1630. https://doi.org/10.2337/dc17-2556
19.
0 / 1 point
Following a case of acute pancreatitis, a client’s health continues to decline until
systemic inflammatory response syndrome (SIRS) develops. What vital sign results
would the nurse expect to see in this condition?
White Blood Cell count > 4,000/mcL
Respiratory rate less than 8/min
Temperature greater than 100.4F

Blood pressure >140/90 mmHg
Explanation:
Systemic inflammatory response syndrome (SIRS) is a condition in which the body is
progressing into a state of sepsis. The client with SIRS develops widespread
inflammation, elevated temperature, and tachycardia. If the client has a bacterial
infection that is causing the widespread inflammation, they are in a state of sepsis.
When a client has SIRS, their respiratory rate will be high. 20 breaths per minute or
more is the threshold for SIRS. A white blood cell count (WBC) >4,000 is considered
normal. In systemic inflammatory response syndrome, the WBC is typically <4,000/mcL
or >12,000/mcL. During sepsis, a client's blood pressure will drop rather than increase.
References:
 Kaplan, L. (2018, May 7). Systemic Inflammatory Response Syndrome Clinical

Presentation. Retrieved November 7, 2018, from
https://emedicine.medscape.com/article/168943-clinical
20.
1 / 1 point
A client with a history of diabetes has a blood sugar of 54 mg/dL. They are conscious
and awake, but feel cold and clammy, diaphoretic, weak, and slightly confused. Which
of the following is NOT an appropriate intervention at this time?

Review recent insulin administration
Recheck blood sugar 15 min after intervention
Administer glucagon
Give 4 oz orange juice
Explanation:
The client is awake and alert, the priority is to administer an oral form of glucose.
Glucagon would be indicated if the client is unconscious and doesn't have IV access. If
the client has IV access, they should receiving IV Dextrose.
4 oz orange juice - This is the most appropriate intervention for a client with
hypoglycemia that is awake and alert.
Recheck blood sugar 15 min after intervention- this is appropriate, the nurse should
always recheck the glucose level after 15 minutes to evaluate whether further
intervention is required.
Review recent insulin administration-it is important and appropriate to review how much
insulin the client has received in the last 24 hours, but especially the most recent
administration. It might be that the client's sliding scale is too high and needs adjusting.
The nurse should also review the client's oral and food intake compared to insulin
administration to figure out WHY the client developed hypoglycemia.
21.
1 / 1 point
A client has been diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which of the following is NOT a priority nursing intervention for this patient?

Encourage increased dietary intake of sodium
Initiate seizure precautions
Flush NG tube with normal saline rather than sterile water
Increase fluid intake to at least 2L/day

Explanation:
SIADH causes extreme over-retention of water, therefore these clients should have a
fluid restriction, not an increase. Typically these clients will be restricted to 500-1,000
mL per day to prevent further hemodilution.
Clients with SIADH should be on a free water restriction. They should not be drinking
straight water, nor should their feeding tubes be flushed with water. Clients should
consume juice, coffee, tea, soda, and tubes should be flushed with saline to prevent
further water intoxication. SIADH can cause severe hyponatremia which puts the client
at massive risk for seizures. Seizure precautions should be implemented right away.
SIADH causes significant hyponatremia, therefore clients should be encouraged to
increase dietary intake and/or to take supplemental sodium replacements until the
SIADH is resolved.
22.
1 / 1 point
A 36-year-old woman has been diagnosed with Graves’ disease. The client tells the
nurse that she is very self-conscious about her appearance, particularly since she has
developed exophthalmos. The nurse wants the client to understand that she cares
about her situation. Which best demonstrates the theory of a transpersonal nursing
relationship in this situation?
The nurse and the client are authentic in their behavior in order to seek a relationship of
trust and healing
The nurse provides a spiritual component to her work when she counsels the client
about her illness
The nurse uses the experience for her own good as she treats her family members well
after she leaves the hospital
The nurse develops an empathic attitude based on information presented in the client's
chart
Explanation:
Rationale
"The nurse and the client are authentic in their behavior in order to seek a relationship
of trust and healing" is correct. The theory of transpersonal nursing relationship has
evolved from a theory of caring that is built on a system of trust between the client and
the provider. Both the nurse and the client are authentic in their relationship with each
other. This allows for the building of trust, which promotes a healing environment for the
client. "The nurse develops an empathic attitude based on information presented in the
client's chart" is incorrect, because this answer does not demonstrate relationship
between client and nurse. Instead, this demonstrates information-based knowledge
about a client, taken from a chart. "The nurse uses the experience for her own good as
she treats her family members well after she leaves the hospital" is incorrect, because
this behavior is not involving the client. "The nurse provides a spiritual component to her
work when she counsels the client about her illness" is incorrect. While a spiritual
aspect is certainly part of the Watson's theory of transpersonal nursing, it is not based
on spirituality, but rather based on practicing loving-kindness and authentic presence.
References:
 Wagner, A. L. (2010). Core Concepts of Jean Watson’s Theory of Human

Caring/Caring Science. Retrieved September 5, 2018, from
https://www.watsoncaringscience.org/files/PDF/watsons-theory-of-human-caring-
core-concepts-and-evolution-to-caritas-processes-handout.pdf
23.
1 / 1 point
A nurse is caring for a septic client with hypotension who is tachycardic and tachypneic.
The nurse knows that the client is tachypneic for which of the following reasons?

To lower the blood PH
Restricted bronchioles
An anxiety attack
To increase the blood PH

Explanation:
The client with sepsis will have increased respirations (tachypnea) to blow off excess
CO2 to battle the metabolic acidosis, and in turn, increase the PH of the blood.
The client with sepsis will have increased respirations (tachypnea) to INCREASE the
PH of the blood, not LOWER. The client with sepsis doesn't have high respirations
because of an anxiety attack. Tachypnea occurs to blow off CO2, which is causing the
metabolic acidosis. The client with sepsis does not have restricted bronchioles. A septic
client is infected and will have tachypnea to blow up the excess CO2, which will help
battle the metabolic acidosis. This will increase the blood PH.
24.
1 / 1 point
A nurse is assessing a client with a history of diabetes. The client tells the nurse that
she does not feel well. The nurse checks her blood glucose levels and gets a result of
51 mg/dL. What signs or symptoms would the nurse expect to see with this blood
glucose level? Select all that apply.

Hot, dry skin
Anxiety
Bradycardia
Tremor
Weakness
Explanation:
The client in this example is suffering from mild hypoglycemia in which blood glucose
levels are between 70 and 41 mg/dL. The nurse would expect to see signs or
symptoms of restlessness and anxiety, weakness, sweating and tremor in this client.
Once the glucose level falls to below 40 mg/dL, the client will experience confusion,
double vision, drowsiness, headache, and slurred speech. When the glucose level falls
below 20 mg/dL, the client can experience seizures and loss of consciousness.
Hot, dry skin is a symptom of hyperglycemia rather than hypoglycemia.
Bradycardia -Mild hypoglycemia causes tachycardia, not bradycardia.

25.
0 / 1 point
The nurse is caring for a client diagnosed with chronic renal failure. Which of the
following would the nurse will expect to see with this condition?
Hypovolemia due to lack of sodium and water excretion

Altered level of consciousness following dialysis
Tingling in the hands, feet, and lips
Increased nitrogenous wastes in the blood
Choice 5
Explanation:
A client with chronic renal failure (CRF) will begin to have symptoms when 75% or more
nephrons cease to function. CRF affects all major body systems, so there are many
signs and symptoms. Many of the symptoms are due to wastes building up in the blood
when the kidneys are unable to filter the blood adequately.
In chronic renal failure, a client may not be able to excrete much sodium and water.
This leads to hypervolemia, rather than hypovolemia.
Tingling in the hands, feet, and lips is a sign of hypocalcemia, which is not common in
clients with chronic renal failure.
Altered level of consciousness following dialysis- Some clients may feel nauseous after
dialysis, but their level of consciousness is improved after dialysis if there was an
alteration in consciousness prior to the procedure.
26.
1 / 1 point
A diabetic client is being transferred to a long-term care facility following hospitalization.
The nurse who is transferring the client is reporting to the receiving facility about skin
care interventions the facility has been utilizing. Which of the following information
should be included as part of the report?

The nurse should apply lotion to the feet after the bath, particularly between the toes
The nurse should inspect the client's feet daily for damage
The client's lower legs should be elevated with the heels supported on a pillow
The feet should be bathed daily with hot water and soap
Explanation:
When transferring a client between a facility or a unit in the healthcare center, the nurse
must ensure providing enough information that the receiving caregivers can adequately
care for the client. A diabetic client requires regular foot care to prevent skin breakdown
and wounds from poor circulation. Preventive foot care includes inspecting feet daily
and monitoring for redness, swelling or skin breakdown.
A client with neuropathy and subsequent decreased sensation in the feet should not be
bathed with hot water. Rather, feet should be washed with warm water and dried
thoroughly. Diabetic foot care includes applying lotion to clean, dry feet, but avoiding
between the toes because moisture accumulation between the toes can lead to irritation
and skin breakdown. Heels should not be in a position where they have excess
pressure, such as when a pillow is supporting them. This can lead to skin breakdown
and pressure ulcers.
27.
0 / 1 point
Which range best describes normal levels of thyroid-stimulating hormone?
12.2 to 15 mU/L
5 to 8.9 mU/L
0.4 to 4.0 mU/L

35 to 45 mU/L
Explanation:
Thyroid-stimulating hormone (TSH) is a test of thyroid function that can determine if a
client has hypo- or hyperthyroidism. The normal range of values for thyroid stimulating
hormone is 0.4 to 4.0 mU/L. If the number is low, it can indicate hyperthyroidism or
secondary hypothyroidism. If the number is high, it can indicate primary
hypothyroidism.
28.
1 / 1 point
Which of the following is considered to be a counterregulatory hormone that works
against the effects of insulin in the bloodstream? Select all that apply.
Glucagon
Cortisol
Estrogen
Melatonin
Growth hormone
Explanation:
Rationale
"Glucagon", "Cortisol" and "Growth hormone" are correct. Insulin lowers blood glucose
by facilitating glucose movement into cells, so when glucose levels rise in the
bloodstream, the body normally responds by secreting insulin. Glucagon, cortisol and
growth hormone, along with adrenaline, are the main counterregulatory hormones.
These work against the action of insulin, therefore protecting the body from
hypoglycemia. Counterregulatory hormones keep glucose in the bloodstream (and out
of the cells). "Estrogen" is incorrect. This is a female sex hormone. "Melatonin" is
incorrect. This is a hormone that regulates sleep and wake cycles.
References:
 Lager, I. (1991). Journal of Internal Medicine. Supplement., 735(41), 7th ser.

Retrieved August 16, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/2043222.
 Dinsmoor, R. (2006, May 18). Counterregulatory Hormones. Retrieved August
16, 2018, from https://www.diabetesselfmanagement.com/diabetes-
resources/definitions/counterregulatory-hormones/ Updated March 27, 2014
29.
0 / 1 point
A client is diagnosed with neuroleptic malignant syndrome. Which of the following
events has the client likely experienced?

Frequent opiate use
Frequent outdoor running
Recent anesthesia
Antipsychotic medication prescription

Explanation:
Neuroleptic malignant syndrome is caused by taking antipsychotic medication. The
body reacts in this manner due to the dopamine receptor blockade. Neuroleptic
malignant syndrome usually includes a very high fever (102 to 104 degrees F), irregular
pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea),
muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting
in high or low blood pressure.
Frequent outdoor running- This client has neurolepetic malignant syndrome and would
not get neuroleptic malignant syndrome from running outdoors. This comes from taking
antipsychotic medication and the body reacts due to dopamine receptor blockade.
Frequent opiate use-the client would not get neuroleptic malignant syndrome from
taking opiates for too long. Clients get neuroleptic malignant syndrome from
antipsychotic medication that causes a dopamine receptor blockade.
Recent anesthesia-the client would not get neuroleptic malignant syndrome from
anesthesia, but could possibly get malignant hyperthermia if the body reacted due to
genetic susceptibility. Neuroleptic malignant syndrome is caused by antipsychotics,
which cause a reaction to the dopamine receptor blockade.
30.
0 / 1 point
A client comes up to the medical unit from the ED with a temperature of 97.9s. Which of
the following actions should the nurse take first?
Place a warming device on the client

Perform CPR
Tell the client to take deep breaths
Give the client warm blankets

Explanation:
The nurse should give the client warm blankets to bring the temperature to normal.
A temp of 97.9F isn’t severe, a warming device isn’t appropriate in this situation. There
are no indications to perform CPR on this client. There is no indication that this client is
having trouble breathing.
31.
0 / 1 point
The nurse is working with a client with acute pyelonephritis. Which of the following is a
complication of this condition?

Dysuria
Renal stones
Septic shock
Acute cystitis
Explanation:
Acute pyelonephritis can be a serious infection of the kidney, with a high incidence of
sepsis and septic shock if not treated properly.
Rather than being complications of acute pyelonephritis, renal stones are a risk factors
for the condition. Rather than being complications of acute pyelonephritis, acute cystitis
is a risk factor for the condition. Dysuria, or pain and burning with urination, is a
symptom of acute pyelonephritis rather than a complication.
32.
1 / 1 point
A client with hyperparathyroidism from a tumor is told that the healthcare provider wants
to remove the parathyroid glands. The client asks the nurse what will happen if the
parathyroid glands are removed. Which of the following is an appropriate answer by the
nurse?

"There won’t be any changes in your symptoms or treatment"
"You will need to take phosphorus supplements for the rest of your life"
"You will have low blood calcium levels, so it will be important to take calcium
supplements"
"You will be at a higher risk for kidney stones, so you will need to monitor your urine"
Explanation:
The removal of the parathyroid glands will result in no PTH production. PTH facilitates
the movement of calcium from the bones, intestinal reabsorption, and kidney
retainment. The lack of PTH will result in decreased calcium levels, so the client will
require calcium supplements.
won’t be any changes in your symptoms or treatment-This is incorrect, as the

parathyroid will be removed causing changes in the calcium and phosphorus levels.
You will be at a higher risk for kidney stones, so you will need to monitor your urine"- the
client will not be at a higher risk for kidney stones as the calcium levels will be
decreased after parathyroid removal.
"You will need to take phosphorus supplements for the rest of your life"- the removal of
the parathyroid will result in no PTH, causing increased phosphorus levels. The client
will not need phosphorus supplements.
33.
1 / 1 point
A client has complaints of being tired all the time, weight gain, and that she can’t seem
to get warm enough to be comfortable. Which of the following tests would the nurse
expect to see ordered to determine a diagnosis for the client? Select all that apply.
Thyroid stimulating hormone (TSH) level

Testosterone levels
Thyroid ultrasound
Anti-thyroid peroxidase (TPO) level

Blood glucose level
Explanation:
The client has signs and symptoms that could be the result of Hashimoto’s thyroiditis. A
TPO level should be drawn, which will show if there are antibodies against the thyroid in
the client’s bloodstream. TSH levels may be elevated in the client with Hashimoto’s
Thyroiditis. A thyroid ultrasound may help to visualize an enlarged thyroid.
34.
0 / 1 point
A nurse is caring for a 34-year-old client who has been infected with HIV for 11 years.
The client presents with diarrhea, weight loss and a fungal infection in the mouth. Which
of the following are appropriate interventions for this client? Select all that apply.
Encourage nutritional supplements
Provide meticulous skin care
Monitor red blood cell count

Teach the client wear a mask to protect visitors from infection
Initiate isolation precautions to protect the client from infection

Explanation:
Rationale
"Initiate isolation precautions to protect the client from infection", "Encourage nutritional
supplements" and "Provide meticulous skin care" are correct. This client has signs of
progression of HIV to AIDS. Assessment findings in the client with AIDS include
malaise, fever, weightloss, diarrhea, fatigue, night sweats, opportunistic infections,
neoplasms, fungal/bacterial/viral infections and lymphadenopathy. Once the client's
condition has progressed to AIDS, they have a profound susceptibility to infection and
malignancy. The nurse can protect the client from further infection by initiating isolation
precautions for anyone entering the client's room. Meticulous skin care of the client will
help prevent the spread of infection. The client may not feel like eating, so adequate
nutritional support is helpful, as well as maintaining fluid and electrolyte balance. "Teach
the client wear a mask to protect visitors from infection" is incorrect. The client and
visitors should be educated on how to prevent the spread of infection, but the
pathogens from other people pose a much greater risk to the client with AIDS than the
risk the client poses for infecting others. "Monitor red blood cell count" is incorrect.
White blood cells, lymphocytes and platelets should be monitored.
35.
1 / 1 point
An 18-year-old client is seen at the healthcare center with swelling of the hands and
face. The client is diagnosed with acromegaly. The nurse knows that this condition is
typically caused by which of the following?

An overproduction of the stress hormone cortisol
Excess secretion of parathyroidhormone after diagnosis of thyroid nodules
Benign tumors on the pituitary that cause excess secretion of growth hormone
A genetic condition that develops as a chromosomal abnormality
Explanation:
A client with acromegaly produces too much growth hormone as a result of small
tumors that develop on the pituitary gland. The condition causes excess growth of
tissue, resulting in enlarged hands, feet, and facial structures.
An overproduction of growth hormone is what causes acromegaly. Thyroid nodules do

not cause excess secretion of any hormone, as most are asymptomatic. Acromegaly is
caused by excess growth hormone production, not a chromosomal abnormality.
36.
0 / 1 point
The nurse is preparing a client for a parathyroidectomy. Which of the following is an
appropriate teaching point?
There may be pain with talking the first few days following surgery
Postoperatively, you will need to be placed in the supine position
A positive Rovsing's sign indicates hypocalcemic crisis

After removal of the parathyroid, calcium supplements will no longer be necessary
Explanation:
The parathyroid is located behind the thyroid gland in the neck. Because surgery
involves manipulation to the area, there is a risk of injury to the nerves that innervate the
vocal chords. The client may experience a hoarse voice or pain with talking for the first
day or two
A positive Trousseau's sign or a positive Chvostek's sign indicate tetany, which occurs
with hypocalcemia. A positive Rovsing's sign indicates appendicitis.
Following a parathyroidectomy, the client must be placed in semi-Fowler's position to

decrease inflammation to the airway. A parathyroidectomy is necessary when the client
has hyperparathyroidism. This condition leads to hypercalcemia. Following a
parathyroidectomy, the client is at risk for hypocalcemia, so calcium and vitamin D
supplements will be prescribed
37.
1 / 1 point
A nurse is caring for a client who has just returned from a thyroidectomy. What would be
the most appropriate position for this client?
Semi-Fowler's
Orthopneic
Supine
Prone
Explanation:
Semi-Fowler's would be the best position after this surgery. The patient is sitting upright,
able to breathe well, and no pressure is being placed on the incision.
The orthopneic position is when the client is sitting upright leaning forward over a table
or pillows. This position is to improve breathing. However, the client leaving head
forward unnecessary pressure on the incision site. This position is not the most
appropriate after a thyroidectomy. Lying flat (supine) would add pressure to the surgical
site due to gravity. It could also cause unnecessary difficulty for the client’s breathing.
Lying prone (on the stomach) would not only add pressure to the incision, it would
prevent the nurse from appropriately visualizing the incision site.
38.
0 / 1 point
A nurse receives a report on 4 clients and knows that which of the following clients is a
priority to provide hypothermia prevention education?

A client that lives in Florida
A homeless client that stays at a shelter
A client that likes to turn the heat up high in his apartment
A client that drinks alcohol daily at bars

Explanation:
The client that drinks daily is at the highest need for hypothermia prevention education
due to the impaired cognition with alcohol.
The homeless client staying at a shelter should is not the priority for hypothermia
education because they are staying at a shelter. The client that likes the heat turned up
high is not a priority to teach hypothermia prevention. The client that lives in Florida is
not the priority to provide hypothermia prevention education to because Florida is not a
cold environment.
39.
0 / 1 point
The nurse is caring for a client with fibromyalgia and knows that which of the following
can help manage this condition?

Administer IV antibiotics daily
Measure strict intake and output
Plan lab draws around sleep schedule

Keep the client in bed and turn every two hours
Explanation:
Planning lab draws around the client’s sleep schedule will help facilitate sleep and
manage the fibromyalgia, because a common symptom is sleep disturbances.
Antibiotics will not improve fibromyalgia. The client with fibromyalgia does not have to
be kept in the bed. Strict intake and output measurement are not indicated for managing
the client with fibromyalgia.
40.
0 / 1 point
The client admitted with COPD has a history of congestive heart failure (CHF). During
shift change, the client complains of shortness of breath. Vital signs were as follows:
Blood pressure 154/74 HR 67 Respirations 24 Temperature 99.1F Pulse oximeter 78%
on room air The nurse auscultates crackles in the lungs and knows that which of the
following orders is not a priority at this time?

Place 2L oxygen on the client
Give metoprolol 50 mg PO OT

Connect the client to continuous pulse oximeter
Give furosemide 80 mg IV OT

Explanation:
Giving metoprolol for a blood pressure of 154/74 is not a priority. The patient is showing
signs of a CHF exacerbation, which should be addressed first.
The nurse should place oxygen on the client because their pulse oximeter reading was
low. Furosemide 80 mg IV is an appropriate order to prioritize as the client is short of
breath, has crackles in the lungs, and has a history of CHF. Diuretics make the kidneys
excrete more fluid out of the body, which would help with the fluid volume overload. The
client should be connected to a continuous pulse oximeter because of his reading of
78%, high respirations, and crackles in the lungs.
41.
1 / 1 point
A client is admitted with scleroderma. Which of the following medications would the
nurse expect to be ordered for the client?

Anti-epileptics
Antidepressants
Vasodilators
Statins
Explanation:
Vasodilators may be ordered because the increased and tightened tissue narrows the
vessels.
Client’s with scleroderma might become depressed but scleroderma affects the tissues,
not mental health. A vasodilator would be ordered to help with the narrowing of tissues
and vessels. Statins aren’t used to treat scleroderma because they aren’t at a higher
risk for high cholesterol. Statins help decrease cholesterol. A vasodilator would be
ordered to help with the narrowing of tissues and vessels. The client with scleroderma
isn’t at a higher risk for seizures, so anti-epileptic drugs aren’t ordered to treat the
disease. A vasodilator would be ordered to help with the narrowing of tissues and
vessels.
42.
1 / 1 point
The nurse is caring for a client with fibromyalgia and cellulitis. Which of the following
can the nurse delegate to the nursing assistant?

Find pulses with doppler
Administer acetaminophen 600 mg PO
Call a psychiatrist for a psychological evaluation
Check manual blood pressure

Explanation:
The nurse may delegate a manual blood pressure check to the nursing assistant.
The nurse should not delegate the administration of any medication to the nursing
assistant. The nurse should not ask the nursing assistant to call the healthcare provider
for a psychological evaluation. The healthcare provider caring for the client can make
referrals to a psychiatrist if needed, but the nurse and the nursing assistant does not.
The nurse should not have the nursing assistant check the pulses with the doppler, this
is a part of the nursing assessment.
43.
1 / 1 point
A 70-year-old diabetic patient is seeking care at a healthcare clinic for treatment of
diabetic peripheral neuropathy. The patient complains of sharp, stabbing pain in his feet
at night when he lies down and pain in his lower legs and feet when he walks. Which of
the following medications would most likely be prescribed for treatment of pain
associated with this condition?

Benazepril (Lotensin)
Amitriptyline (Elavil)
Oxybutynin (Ditropan)
Dobutamine (Dobutrex)
Explanation:
Diabetic peripheral neuropathy causes pain, numbness and tingling in the extremities as
a result of altered blood flow and damaged nerves from diabetes. Amitriptyline is a type
of tricyclic antidepressant that is commonly prescribed for neuropathic pain control.
This is an anticholinergic, antispasmodic drug that is used to treat overactive bladder.

This is an ACE inhibitor used to lower blood pressure. This is an inotropic drug used to
treat heart failure.
44.
1 / 1 point
A nurse is educating a diabetic client about their diet. Which information should the
nurse include in dietary teaching?
Carbohydrate counting is focused on the total grams of carbohydrates eaten per meal
There is not a restriction on eating fruits, because they contain naturally occurring
fructose
Glucose control is best achieved by eating three large meals each day
It is ok for the client to indulge in a normal portion of sugary dessert if they have 'saved'
their carbohydrates through the day
Explanation:
Rationale
"Carbohydrate counting is focused on the total grams of carbohydrates eaten per meal"
is correct. Carbohydrate counting is very important for the diabetic patient, because
carbohydrates not only provide energy, but choosing the right carbs will allow the client
to consume adequate nutrients and prevent glucose imbalances. This approach focuses
on total grams consumed in each meal. For clients on insulin therapy, this method helps
achieve a consistent glucose level over time. The diet should take into account the
client's overall level of health, weight, activity level and any medications they take.
Because good nutrition habits are key to the client's health status, the nurse should
recommend the client follow up with a dietitian for further teaching. "Glucose control is
best achieved by eating three large meals each day" is incorrect because the best
glucose control is achieved by consuming small portions of food more frequently
throughout the day. "There is not a restriction on eating fruits, because they contain
naturally occurring fructose" is incorrect because fructose is still a sugar, and therefore
still counted as a carbohydrate. These carbs must still be added to the carbohydrate
count. "It is ok for the client to indulge in a normal portion of sugary dessert if they have
'saved' their carbohydrates through the day" is incorrect because, while it is ok for the
diabetic client to have dessert, they should take care to consume a smaller portion.
Consuming a sugary dessert will contribute to a spike in blood glucose level, even if the
client has saved their carbohydrates throughout the day.
References:
 Silvestri, L. A. (2017). Saunders comprehensive review for the NCLEX-RN
examination. St. Louis, MO: Elsevier
 American Diabetes Association. (n.d.). Fruits. Retrieved July 20, 2018, from
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-
choices/fruits.html
 American Diabetes Association. (n.d.). What Can I Drink? Retrieved July 20,
2018, from http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-
healthy-food-choices/what-can-i-drink.html
45.
1 / 1 point
A client is admitted for dehydration and on assessment complains of dizziness. The
nurse takes the client’s vitals which are the following: BP 163/86 HR 88 Temperature
100.1 Respirations 18 Blood sugar 43 The nurse knows that which of the following
orders should be implemented first?
Give the client a glucose tablet for blood sugar below 70
Give hydralazine 20 mg IV for high blood pressure with systolic greater than 160
Administer normal saline IV fluid at 100/hr
Give acetaminophen 650 mg PO for fever
Explanation:
The priority in this situation is the client’s low blood sugar level, therefore the nurse
should administer the glucose tablet first. This client is symptomatic.
Although the client does have a slight fever, the nurse should first address the low blood
sugar level. Although the client does have high blood pressure that needs to be treated,
the low blood sugar takes priority. Although the IV fluids will be needed to treat the
dehydration, the nurse should first address the low blood sugar since the client is
symptomatic.
46.
0 / 1 point
The nurse providing education to a client who is newly diagnosed with diabetes mellitus.
Which of the following should the nurse emphasize? Select all that apply.
Inspect feet daily
Wear proper fitting shoes
Don't walk barefoot

Cut toenails with rounded corners
Use a heating pad to keep feet warm
Explanation:
Diabetes Mellitus can cause poor circulation and decreased feeling in the feet. Foot
care is important to prevent sores and ulcers, as these wounds heal slowly and poorly in
the client with uncontrolled glucose levels. Wearing properly fitting shoes helps reduce
the risk of injuries and blisters to the feet. ere is a risk of injury when walking barefoot,
so the client should be taught to always wear shoes.
Toenails should be cut straight across to avoid inadvertently cutting into the corners of
the toes. Heating pads can be dangerous due to the decreased sensation in the feet of
a client with diabetes. The client could be burning him or herself without knowing it,
leading to another slow and poorly healing wound.
47.
1 / 1 point
A 45-year-old diabetic client has been brought in for care of diabetic ketoacidosis. The
client’s blood glucose level is 367 mg/dL and blood pH is 7.28. Which of the following
respiratory rates would the nurse most likely expect to see in this situation?

16/min
36/min
8/min
24/min
Explanation:
The client with diabetic ketoacidosis (DKA) would most likely have Kussmaul
respirations, which are rapid and deep. A respiratory rate of 36/minute is abnormally
high and would most likely be associated with the rapid breathing pattern of DKA. This
is a metabolic acidosis that will continue until the condition is corrected. The rapid
breathing rate is the body's way to compensate for the acidosis, but is unlikely to fully
correct the client's pH level.
This is an abnormally low breathing rate which is not seen in DKA or metabolic acidosis.
This is normal respiratory rates that would not reflect DKA. This is normal respiratory
rates that would not reflect DKA.
48.
0 / 1 point
A 41-year-old client has been diagnosed with type 2 diabetes. The nurse is teaching the
client about how to perform self-monitoring of blood glucose (SMBG) at home. The
nurse instructs the client about how to use a lancet to obtain a blood sample. Which
technique would the nurse most likely include?
Use the same two fingers to check glucose to provide consistency in blood samples
Use the lancet on the tip of the finger to provide the most blood
Use the lancet to puncture deep enough to reach the subcutaneous tissue
Use the lancet on the side of the pad of the finger

Explanation:
When checking blood glucose at home, the client should learn the most appropriate and
easiest method of obtaining a blood sample, as he or she will likely need to check the
blood multiple times per day. The nurse should teach the client to use a lancet on the
side of the pad of the finger. This location is the least painful for the client and will be
less likely to interfere with use of the pad of the finger after the blood draw.
The client only needs one drop of blood, so any location that can provide one drop is
appropriate. The side of the pad of the finger is best because the client keeps the most
used part of the finger intact for use.The client should evenly distribute the sites used to
obtain blood to avoid excess fingersticks to one or two sites. Additionally, the blood
glucose level is uniform throughout the body, so the number does not vary based on
where the sample is obtained. The lancet needs only to puncture the capillary layer,
which is deep enough to draw one drop of blood.
49.
0 / 1 point
A client is admitted to the unit with glomerulonephritis. Which of the following answers is
a common cause of this condition?
Staphylococcus infection
Bacteremia
Acute cystitis
Systemic lupus erythematosus

Explanation:
Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus.
This is most commonly caused by an immunological reaction, such as from systemic
lupus erythematosus or scleroderma. B-hemolytic streptococcal invasion of the skin or
pharynx and history of pharyngitis or tonsillitis can also predispose a person to develop
glomerulonephritis. Loss of kidney function develops as a result of this condition.
Glomerulonephritis is a term used to describe an inflammatory injury to the glomerulus.

A staphylococcus infection does not predispose a person to develop glomerulonephritis.
Bacteremia is a blood infection that does not predispose a person to develop
glomerulonephritis. Acute cystitis is an inflammation of the bladder that does not
predispose a person to develop glomerulonephritis.
50.
0 / 1 point
A nurse is changing the dressing on a diabetic wound for a client with an alginate
dressing in place. The nurse removes it and irrigates the wound bed before applying
another dressing. Which best describes this rationale?

The dressing has produced eschar
The nurse is performing lysosomal debridement
The dressing may leave small fibers in the wound bed
The nurse is assessing for wound tunneling

Explanation:
Rationale
"The dressing may leave small fibers in the wound bed" is correct. Alginate dressings
are made of a type of seaweed and are useful for certain wounds. When removing an
alginate dressing from the wound bed, the nurse should irrigate the wound before
applying another dressing, as the alginate may leave small fibers behind in the wound
bed. "The nurse is performing lysosomal debridement", "The nurse is assessing for
wound tunneling" and "The dressing has produced eschar" are incorrect. These are not
reasons to irrigate the wound.
51.
0 / 1 point
The nurse is caring for a client that has Hashimoto’s thyroiditis. Which of the following
symptoms should the nurse expect to see with this client? Select all that apply.
Fatigue
Long bursts of energy
Weight loss
Overheating
Intolerance of cold
Explanation:
The client would likely be intolerant to the cold due to the injury of the thyroid.
Remember, thyroid chemicals help keep the body warm. The client would be feeling
fatigued due to the lack of thyroid hormones in the body.
52.
1 / 1 point
Which of the following are complications of diabetes mellitus? Select all that apply.
Coronary artery disease
Insulin reaction
Cerebrovascular disease
Fibromyalgia
Diabetic retinopathy
Explanation:
Diabetic retinopathy is a complication associated with diabetes mellitus.
Cerebrovascular disease is a complication often seen in clients with diabetes. Coronary
artery disease is a complication that often develops in a client with diabetes. This
develops much faster when the client has poorly controlled glucose levels over time.
53.
1 / 1 point
A 44-year-old diabetic client is undergoing surgery for a hysterectomy. The client is a
type 1 diabetic who requires regular monitoring of blood glucose levels and insulin
administration on a sliding scale. Which information should be given to the client about
controlling blood glucose levels throughout surgery?

The client will receive dextrose through the IV but will need to take oral diabetic agents
on the day of the surgery
The client will have no dextrose in the IV and should not take any insulin throughout the
perioperative period
The client will have no dextrose in the IV but should still take insulin throughout the
perioperative period
The client will receive IV fluids with dextrose and should still receive insulin throughout
the perioperative period
Explanation:
A diabetic client who is undergoing surgery will receive IV fluids that contain dextrose,
which can raise blood sugar levels. Since a client is nil per os (NPO) for six or more
hours before surgery, the glucose level can drop, so the client should be instructed to
keep blood sugar levels within a normal range by following a sliding scale based on
their glucose level. The blood glucose will be checked throughout the perioperative
period, and insulin will be titrated as necessary to keep the level within a normal range.
 The client would be instructed to hold any oral diabetic agents on the day of
surgery. There must be a way to increase the client's blood glucose in case it is
too low, so an infusion of dextrose IV is given. It is dangerous to not have a way
to control glucose levels in a diabetic client during the perioperative period.
54.
1 / 1 point
A nurse receives report on the following clients and knows that the client with which of
the following diagnosis is at the highest risk for developing SIRS?

Fevers of unknown source and altered mental status
Pneumonia and sepsis

Dehydration and UTI
Cellulitis with MRSA
Explanation:
The client with sepsis is at a higher risk for developing SIRS.
The client with cellulitis and MRSA is at less of a risk for SIRS than the client with
sepsis. The client with fevers of unknown source and altered mental status is at less of
a risk for SIRS than the client that is already septic. The client with dehydration and UTI
has less of a risk of developing SIRS than the patient with sepsis.
55.
1 / 1 point
A client comes into the emergency department with elevated bun and creatinine levels
and on the nurse’s assessment the client has weak pulses and a small amount of
concentrated urine. The clients vitals are the following: Blood pressure 86/68 Heart rate
118 Respirations 18 Temperature 98.9F The nurse knows that which of the following
orders should be implemented first?

Draw ABGs
Vancomycin 1 gm IV
1000ml bolus of NS over one hour

Administer metoprolol 50 mg PO
Explanation:
The nurse should infuse the fluid bolus to address the low blood pressure, elevated
heart rate, and elevated bun and creatinine. This client's vitals an assessment are
showing hypovolemia/dehydration so a liter bolus will help correct this and treat the
vitals.
ABGs are not necessary for this client but if there is order then the bolus should be the
priority and given before drawing ABGs. This client's vitals (low BP, tachycardia) are
showing that the client is dehydrated so fluid replacement is necessary first. The nurse
may administer metoprolol for the high heart rate after the blood pressure is addressed
with the fluids. Once fluids are given and the hypotension is fixed, the heart rate should
correct itself. This client is hypotensive from dehydration. Concentrated urine and
oliguria (small amount of urine) show that the client is dehydrated. Vancomycin is an
antibiotic and there is no indication that the client is infected.
56.
1 / 1 point
The nurse is caring for a diabetic client who takes insulin. Which of the following actions
should the nurse take to avoid complications?

Reuse syringes for a week before replacing
Encourage discarding the needles in the garbage
Mix long acting insulin first
Rotate sites for providing insulin

Explanation:
The nurse should rotate sites for providing insulin to avoid lipodystrophy, which affects
insulin absorption and distribution.
Regular insulin is drawn up first. Needles should be used once then discarded. A
plastic biohazard container is best, although a client may not have access to this. If not,
a thick plastic container with a lid is acceptable.
57.
1 / 1 point
A nurse is assigned a client with the diagnosis of hypoparathyroidism. The nurse knows
that which of the following would be expected in the client’s test results?

High PTH level
High calcium level
Low phosphorus level
Low calcium level

Explanation:
The client with hypoparathyroidism has low calcium levels due to the lack of PTH.
58.
1 / 1 point
The nurse is caring for a client that has a history of fibromyalgia and lupus. The client
complains of pain. The nurse knows that which of the following would be an
inappropriate question to assess the client’s pain?

What number would you rate your pain?
What helps this type of pain for you?
Where is the pain located?
Why are you in pain?

Explanation:
It is not appropriate to ask the patient why they are in pain.
Assessing the location of the pain is appropriate. Asking "Why are you in pain?" is
inappropriate. Assessing pain rating is appropriate. Asking "Why are you in pain?" is
inappropriate. Asking what the client usually does to help this pain is appropriate to
determine treatment for this pain. Asking "Why are you in pain?" is inappropriate.
59.
0 / 1 point
A client is diagnosed with neuroleptic malignant syndrome. Which of the following
events has the client likely experienced?

Frequent outdoor running
Recent anesthesia
Antipsychotic medication prescription

Frequent opiate use
Explanation:
Neuroleptic malignant syndrome is caused by taking antipsychotic medication. The
body reacts in this manner due to the dopamine receptor blockade. Neuroleptic
malignant syndrome usually includes a very high fever (102 to 104 degrees F), irregular
pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea),
muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting
in high or low blood pressure.
60.
1 / 1 point
The healthcare provider notifies the nurse that they are testing for hyperparathyroidism.
Which of the following tests should the nurse expect to see in the client’s orders?

TSH level
Creatinine level
Blood glucose level
PTH level
Explanation:
PTH levels may be drawn to help diagnose hyperparathyroidism, which causes
excessive PTH.
61.
1 / 1 point
A nurse is caring for a term newborn infant who was born to a diabetic mother. Which of
the following signs or symptoms would the nurse look for that would demonstrate
hypoglycemia in this infant? Select all that apply.
Tremor
Breathing rate of 46/min
Poor feeding
Cyanosis
Low temperature
Explanation:
Rationale
"Cyanosis", "Tremor", "Poor feeding", and "Low temperature" are correct. An infant of a
diabetic mother is at risk of developing blood glucose abnormalities after birth, which
can lead to neonatal hypoglycemia. The infant with decreased blood glucose levels will
demonstrate symptoms of tremor and jitters, poor feeding abilities, cyanosis, and low
temperature. "Breathing rate of 46/min" is incorrect. A normal newborn respiratory rate
is 40-60 breaths per minute.
References:
 https://www.stanfordchildrens.org/en/topic/default?id=hypoglycemia-in-the-
newborn-90-P01961
62.
1 / 1 point
The provider has ordered a nephrostomy tube for a client in the nurse’s care. How
should the nurse explain the procedure for nephrostomy tube placement to the client?

The tube is placed in the ureter above the site of the blockage
The tube is placed through the ureter into the renal pelvis
The tube is placed into the renal cortex to facilitate excretion
The tube is placed directly into the kidney to drain urine

Explanation:
In nephrostomy tube placement, the tube is placed directly into the kidney in order to
drain urine. Any handling of the nephrostomy tube must include strict asepsis by the
nurse, since the tube is placed directly into an internal organ. The provider may write
an order to irrigate the tube. Irrigation should only be done IF there is an order, using
strict aseptic technique, with a maximum of 5 mL sterile normal saline per flush.
The tube enters through the skin in the client's back. The nephrostomy tube terminates
in the renal pelvis, or collecting system. The tube is not placed in the ureter, but enters
directly through the kidney.
63.
1 / 1 point
A nurse is caring for a septic client with hypotension who is tachycardic and tachypneic.
The nurse knows that the client is tachypneic for which of the following reasons?

To lower the blood PH
Restricted bronchioles
An anxiety attack
To increase the blood PH

Explanation:
The client with sepsis will have increased respirations (tachypnea) to blow off excess
CO2 to battle the metabolic acidosis, and in turn, increase the PH of the blood.
The client with sepsis doesn't have high respirations because of an anxiety attack.
Tachypnea occurs to blow off CO2, which is causing the metabolic acidosis. The client
with sepsis will have increased respirations (tachypnea) to INCREASE the PH of the
blood, not LOWER. The client with sepsis does not have restricted bronchioles. A septic
client is infected and will have tachypnea to blow up the excess CO2, which will help
battle the metabolic acidosis. This will increase the blood PH.
64.
0 / 1 point
A nurse suspects a client has diabetes insipidus. What are the priority interventions?
Select all that apply.
Monitor for hyponatremia

Monitor for hypernatremia
Monitor urine specific gravity
Monitor neuro status
Monitor strict I&O

Explanation:
Diabetes insipidus causes a massive loss of water via the urinary tract due to
insufficient secretion of ADH. This leads to cellular dehydration and hypernatremia. Both
of these things can cause significant neurological changes, including confusion and
seizures. Monitoring neuro status is a priority.
Due to insufficient ADH, the body dumps large amounts of dilute urine. Monitoring urine
specific gravity helps to monitor the dilution and/or concentration of the urine
Due to excessive loss of water, the client's blood will become concentrated, making the
sodium level go UP. Monitoring for hypernatremia is a priority.
Clients with diabetes insipidus lose large amounts of dilute urine, monitoring strict I&O
measurements is a priority to know the client's fluid status.
Due to excessive loss of water, the client's blood will become concentrated, making
the sodium level go UP, not down. The nurse should be monitoring for hypernatremia,
not hyponatremia.
65.
1 / 1 point
A nurse is assessing a client for fluid volume overload. The nurse knows that which of
the following orders should be implemented to determine if the client is in fluid
overload?

Draw blood cultures
Count client respirations
Take the client to radiology for chest x-ray

Place the client on 5L O2 nasal cannula
Explanation:
A chest x-ray would help to determine whether the client is in fluid overload. The x-ray
will show if the fluid is backing up into the lungs.
Blood culture will not show if a client is in fluid overload, but rather if the client has an
infection in the blood. Counting the respirations will not help the nurse determine if the
client is in fluid overload. Placing the client on 5L O2 nasal cannula will not help the
nurse to determine whether the client is in fluid overload, but may help if the client is
having shortness of breath from the backup of fluid into the lungs.
66.
0 / 1 point
A diabetic client has a foot wound that is most likely infected. The nurse must collect a
sample for culture using a swab. Which actions would be part of the process of
collecting a wound specimen using a swab? Select all that apply.
If pus is present, be sure to collect some of it in the swab

Apply antiseptic solution to the wound before taking the swab
Take some tissue from the periwound area as well as the wound bed
Rotate the swab and apply slight pressure while collecting the specimen
Do not take a swab after a client has started antibiotics

Explanation:
When a client has an open wound, the nurse may culture the wound using a sterile
swab. In this manner, the nurse swabs some of the tissue in the wound bed, places the
swab in the culture medium, and sends the collection for testing. The nurse should
press down slightly with the swab and rotate it while collecting the culture to expel any
available fluid, and should avoid eschar and the periwound area. Once a client starts
antibiotics, the results of the culture will be affected and may not demonstrate
pathogens that were present prior to initiation of antibiotics. The nurse should inform
the ordering provider that antibiotics have started, but some providers may still request
a wound culture.
A wound culture is performed in order to test what types of pathogens are present in the
wound. If the area is treated with an antiseptic solution prior to swab collection, the
collection will be affected, and the test results will not be accurate. The area around the
wound may contain different bacteria than the wound itself. Any organisms that are not
directly from the wound will contaminate the specimen and the results will not be
accurate. The periwound area should be avoided.
67.
1 / 1 point
A client is admitted with scleroderma. Which of the following medications would the
nurse expect to be ordered for the client?

Statins
Vasodilators
Anti-epileptics
Antidepressants
Explanation:
Vasodilators may be ordered because the increased and tightened tissue narrows the
vessels.
Client’s with scleroderma might become depressed but scleroderma affects the tissues,
not mental health. A vasodilator would be ordered to help with the narrowing of tissues
and vessels. Statins aren’t used to treat scleroderma because they aren’t at a higher
risk for high cholesterol. Statins help decrease cholesterol. A vasodilator would be
ordered to help with the narrowing of tissues and vessels. The client with scleroderma
isn’t at a higher risk for seizures, so anti-epileptic drugs aren’t ordered to treat the
disease. A vasodilator would be ordered to help with the narrowing of tissues and
vessels.
68.
1 / 1 point
A nurse is counseling a family whose 9-year-old child has just been diagnosed with type
1 diabetes. Which of the following statements by the nurse is correct when teaching the
family about this disease?

The good news is that this condition can be controlled with diet and oral medications
The disease may not show noticeable symptoms for several months, but we still need to
discuss how to manage it
What kinds of foods do you serve at home? You will need to strictly limit carbohydrates
from now on
If your daughter loses weight, she can prevent many of these symptoms
Explanation:
A child who has been diagnosed with type 1 diabetes requires extensive teaching and
education that should include his or her family. In this case, the family should know how
to manage the disease and what lifestyle changes may be necessary to avoid
complications. In some cases, a child may be diagnosed with type 1 diabetes and
remain asymptomatic for several months, but the disease is still present and should be
managed. Symptoms will eventually develop if it is not properly managed.
Type 1 diabetes requires insulin, and insulin must be given subcutaneously. A pill is not
available for insulin administration at this time. Type 1 diabetes is not a result of obesity,
but rather it results from the destruction of pancreatic beta cells. Beta cells produce
insulin, so without these cells the client has an insulin deficiency and must receive
insulin administration to control blood glucose. A child with diabetes should eat a
balanced diet and have consistent intake of fats, protein and carbohydrates.
Carbohydrates should not be strictly limited, but taken consistently.
69.
0 / 1 point
A diabetic client is talking with a nurse about diet and what foods to avoid. The client
asks the nurse about drinking alcohol. Which response from the nurse would be
correct?
Explain that the alcoholic drink limit is two per day for men and one per day for women
Remind the client that alcohol should not be consumed with food
Tell that client with a diagnosis of diabetes, one should never drink alcohol
Tell the client to only drink beer or wine, not hard liquor
Explanation:
A diabetic client requires extensive teaching regarding what foods and drinks to
consume, and in what amounts. A client with diabetes can drink some alcohol, but the
amount should be controlled carefully. A man should limit his alcohol intake to no more
than two drinks per day, while a woman should not have more than one drink per day.
Any alcoholic drink is fine, but the client must adjust the amount based on the alcohol
content of the drink. For example, one drink equals a 12 ounces of beer, 5 ounces of
wine, or a 1.5 ounces of distilled spirits. A diabetic client should not drink alcohol on an
empty stomach or with a low blood glucose level. Their glucose level should be
checked frequently during and after alcohol consumption. A person with a diagnosis of
diabetes is able to drink alcohol, but on a limited basis and while monitoring their
glucose carefully.
70.
1 / 1 point
Which best describes how high stress levels can impact diabetes management?

Stress and anxiety are more likely to cause skin breakdown
Pancreatic failure requires the adrenal glands to work harder, leading to hypertrophy
Elevated glucose levels cause neurological impairment that affects stress management
skills
Chronic stress can cause increased levels of blood glucose

Explanation:
Rationale
"Chronic stress can cause increased levels of blood glucose" is correct. When stress
occurs, such as during emotional stress, infections or a serious illness, the body
releases specific hormones, including adrenaline, glucagon, growth hormone and
cortisol. Blood sugar levels rise to prepare for 'fight or flight', and insulin production
decreases to ensure the sugar is readily available for energy. This is counter-productive
in the diabetic client, because as blood glucose levels rise, the client must take
increasing amounts of insulin to control their glucose level. "Stress and anxiety are more
likely to cause skin breakdown", "Elevated glucose levels cause neurological
impairment that affects stress management skills", and "Pancreatic failure requires the
adrenal glands to work harder, leading to hypertrophy" are incorrect. Stress does not
cause these effects in a person with diabetes.
71.
0 / 1 point
A nurse receives lab results on a client and knows that which of the following will alert
the nurse that the client has sepsis?
Nasal swab positive for influenza A

WBC 10,001
Lactic acid 5.3

Wound culture positive for MRSA
Explanation:
This shows that the client's organs and tissues are lacking oxygenation resulting in
anaerobic metabolism with the byproduct of lactate. This nurse should be concerned
about sepsis.
The positive wound culture for MRSA does mean that the client has a wound infection,
but it does not mean that the client is septic. A positive nasal swab for influenza A
means that the client has the flu, but does not mean that the patient is septic. This is a
normal white blood cell count. In a septic client, WBC would be elevated.
72.
1 / 1 point
A nurse is caring for a client with fibromyalgia and knows to encourage which of the
following to help manage the fibromyalgia?

Avoid pain medication
Take your simvastatin daily
Talk to someone about the stress you are feeling

Avoid the cold
Explanation:
It is important that people with fibromyalgia try to manage their stress. Talking to
someone about it is helpful.
Simvastatin is given to manage cholesterol and will not help manage the client’s
fibromyalgia. The client with fibromyalgia may need to take pain medication to help with
the widespread pain. There is no indication that the client with fibromyalgia should need
to avoid the cold.
73.
1 / 1 point
A patient must take dexamethasone for treatment of adrenal hyperplasia. Which
information should the nurse provide to this patient about possible complications
associated with this drug?

Endocarditis
Increased infection
Anemia
Nephrotic syndrome
Explanation:
Dexamethasone is a type of corticosteroid that can be used in the management of many
types of patient conditions, including adrenal hyperplasia. Steroids, while effective, can
cause several negative side effects and should not be used with some patients. For
example, dexamethasone can increase a patient's risk of infection, so subsequently not
be used with an immunocompromised patient.
Dexamethasone does not cause this condition. Dexamethasone does not cause
nephrotic syndrome, rather it is used to treat this condition. Dexamethasone does not
cause anemia.
74.
1 / 1 point
The nurse is caring for a client who is being treated for pancreatitis. The provider orders
a metabolic panel as part of routine testing and the nurse notes that the client’s calcium
level is 5.2 mg/dL. The client asks the nurse what this means. Which of the following
responses from the nurse is correct?
Your calcium levels are low, most likely from your condition. I will need to administer a
supplement of calcium through your IV
Your calcium levels are elevated. I will have to give you a diuretic to help your body get
rid of some of the excess
As long as you are feeling all right, I wouldn't worry about this level
Your calcium levels are normal, which is a sign that you are healing
Explanation:
Calcium may be measured as part of a metabolic panel performed with lab testing of the
blood. The normal calcium level is between 8.4 and 10.2 mg/dL for an adult. In this
case, the client has a level of 5.2 mg/dL and the nurse would need to provide calcium
replacement.
The normal Ca+ level for an adult is 8.4 - 10.2 mg/dL, so this level is low. This level is
not elevated. Normal range is 8.4-10.2mg/dl. A client with a calcium level below 7.0
mg/dL usually gets a provider order to replace calcium, regardless of whether the client
is symptomatic.
75.
1 / 1 point
A nurse is utilizing the empowerment approach to educate a diabetic client. Which best
describes the empowerment approach to education in this situation?

Asking the client to describe surgical treatment options in his or her own words
Ensuring that the client is financially secure enough to be able to purchase diabetic
supplies
Demonstrating that the client can perform the step-by-step process of checking his or
her own blood glucose levels
Keeping the client informed about management options for diabetes care in order for
the client to make the most appropriate decisions
Explanation:
Rationale
"Keeping the client informed about management options for diabetes care in order for
the client to make the most appropriate decisions" is correct. While healthcare providers
are often available to offer help and support for clients with diabetes, most clients are
expected to care for their daily needs for medication and glucose control on their own.
This involves in-depth teaching and instruction about management and methods of
care. Some clients may be unwilling to perform the regular duties or they may feel
anxious about caring for this aspect of their health. Client empowerment helps the client
to understand care options and stay informed in order to make appropriate decisions.
"Ensuring that the client is financially secure enough to be able to purchase diabetic
supplies", "Demonstrating that the client can perform the step-by-step process of
checking his or her own blood glucose levels", and "Asking the client to describe
surgical treatment options in his or her own words" are incorrect. Empowerment comes
through education.
76.
1 / 1 point
A client has just been admitted to the unit after a transurethral resection of the prostate
(TURP) and has an order for continuous bladder irrigation (CBI). Which electrolyte
imbalance should the nurse be monitoring most closely for?

Hypocalcemia
Hypernatremia
Hyponatremia
Hyperkalemia
Explanation:
This client is at risk for TURP Syndrome. This complication occurs due to significant
absorption of fluids used to irrigate the bladder. This causes significant volume overload
and a resulting hyponatremia.
Because of the risk for volume overload, this client is at risk for hyponatremia, not
hypernatremia. In significant volume overload, most electrolyte imbalance is
hyponatremia, not hyperkalemia. In many cases, potassium level may also be
decreased. Calcium levels would not be significantly affected in this situation, therefore
this electrolyte imbalance is not the most important thing to monitor for in this client.
77.
1 / 1 point
A nurse is caring for a client who is admitted for pneumonia and sepsis. The nurse is
reviewing orders and knows to implement which of the following prior to hanging
antibiotics?

IV hydralazine 40 mg OT
Midodrine PO TID
Blood culture
Vancomycin trough
Explanation:
The nurse should ensure that the blood cultures are drawn before the antibiotics are
first given to ensure that the antibiotics don’t affect the results of the blood culture.
Hydralazine does not have to be given prior to the antibiotics. Hydralazine is a

vasodilator. Blood cultures need to be drawn prior to antibiotics starting to see what is
growing in the client's blood. Antibiotics will interfere with these results if they are started
before the blood culture is drawn. A vancomycin trough is drawn after the treatment has
begun. The trough is drawn immediately before the NEXT dose, not the FIRST dose.
Midodrine does not need to be given before hanging the first antibiotics. Midodrine is
given to help treat low blood pressure. Blood cultures need to be drawn prior to
antibiotics starting to see what is growing in the client's blood. Antibiotics will interfere
with these results if they are started before the blood culture is drawn so the priority is to
draw the cultures first before antibiotics started.
78.
0 / 1 point
A nurse is counseling a client who has hypertension and type 2 diabetes. During the
initial assessment, the nurse notes that the client has a blood pressure of 148/92
mmHg, a BMI of 28, and a blood glucose level of 161 mg/dL. Which of the following
information about health and wellness would be most beneficial for the nurse to teach
this client?

Help the client understand how to lose weight to get their BMI to less than 25
Tell the client to first control the hypertension, and then glucose levels are more likely to
normalize
Describe how the client can limit fat intake in the diet to less than 45% of total daily
calories
Explain to the client that weight loss would be beneficial and that a low-carb diet is best
Explanation:
A BMI of 28 is considered overweight. This client also has an elevated blood glucose
and a high blood pressure reading. Both glucose issues and hypertension can usually
be improved if an overweight client makes lifestyle changes to get to a healthy weight
and normal body mass index. If the nurse helps the client to understand the importance
of weight management, the client can choose to improve their weight and improve their
blood pressure and blood glucose as well.
A low-carb diet is not the best weight loss choice for everyone. A dietician consult can
help the client to choose the best weight loss plan, tailored to their preference and
circumstance. Fat intake should be between 20-35% for adults. The underlying cause of
elevated glucose and hypertension is most likely the client's high BMI. If the BMI is
lowered by weight loss, then the other values will likely normalize.
79.
0 / 1 point
A nurse is counseling a patient about how to use her estrogen replacement therapy
tablets correctly. The patient takes a certain amount of pills each month. The patient
asks the nurse, “What do I do if I have any left over at the end of the month?” Which
response from the nurse is most appropriate for disposing of this type of medication
properly?

To avoid medication waste, you should take an extra pill each day during the last week
of the month
You should scratch out any identifying information on the pill container and throw the
container with the extra pills inside into the trash
You should mix the leftover pills with an unpalatable substance like dirt or coffee
grounds, place the mixture in a sandwich bag and throw it in the trash
To avoid medication waste, you should save the extras for the months in which you run
out of pills
Explanation:
When a patient uses a medication but has some left over, the nurse can teach the
patient about how to best dispose of the medication. In this case, the patient can put
the medication in an unpalatable substance, mix it to contaminate the pills and throw
them away. This is a safe method to minimize the risk of a child or pet ingesting the
medication.
It is possible the container will be discovered by a child and opened. It is best to
remove the pills from the container and mix them with a substance before throwing
them away. Medication should be taken as prescribed. The pills could be discovered by
a child and ingested. Disposal of unused medications is the best way to ensure they
are not accidentally taken by another person.
80.
1 / 1 point
Question
What structure is being identified (highlighted in yellow) in this image?

Renal artery
Urethra
Ureter
Renal tubule
Explanation:
The ureter is the duct by which urine passes from the kidney to the bladder.
81.
1 / 1 point
A 58-year-old woman who is going through menopause has been prescribed hormone
therapy of low-dose estrogen. What best describes the expected benefits of taking this
therapy?

Decreased depression and anxiety
Emotional control and an increased sense of well being
Management of night sweats and hot flashes associated with menopause
Increased energy levels and weight loss
Explanation:
Hormone replacement therapy with low-dose estrogen is designed to control some of
the negative effects associated with low estrogen in menopause. Hormone therapy for
management of menopause symptoms has been shown to improve some symptoms,
including night sweats and hot flashes
82.
1 / 1 point
A nurses receives report on several clients. The nurse knows to be most concerned
about hyperthermia with which of the following client temperatures?

100F
98.9F
104.2F
94.1F
Explanation:
This client has hyperthermia with a temperature that is severely high.
83.
0 / 1 point
A nurse received report on 4 clients and reviews each diagnosis, labs, and vitals. The
nurse knows that of the 4 clients the one with the diagnosis of which of the following is
most at risk for sepsis?

Rhabdomyolysis, a creatinine of 2.45, blood pressure 154/93, heart rate of 85, and
lactic acid 1.0
Pancreatitis with a blood pressure of 132/90, heart rate of 87, white blood cells 8,000,
and lactic acid 1.2
COPD with a blood pressure of 182/100, heart rate of 67, white blood cells 18,000, and
lactic acid 0.2
Urinary tract infection, blood pressure of 85/62, heart rate of 112, white blood cells
16,000, and lactic acid 4.0
Explanation:
This client is the most at risk for sepsis due to the low blood pressure, high heart rate,
high blood cells, and elevated lactic acid.
The lactic acid is normal, and the vitals and lab work are not indicative of sepsis. Lactic
acid above 2.0 is indicative of sepsis and vitals will be low blood pressure, elevated
heart rate, and elevated respiratory rate.
The lactic acid is less than 2. The white blood cells are elevated, but the vital signs are
not indicative of sepsis. Vitals of a septic client will be low blood pressure, elevated
heart rate, and elevated respiratory rate.
The vital signs, white blood cells, and lactic acid are within the normal range. A septic
client would have elevated WBC and low blood pressure, elevated heart rate and
elevated respiratory rate.
84.
0 / 1 point
A nurse receives a report on 4 clients and knows that which of the following clients is a
priority to provide hypothermia prevention education?
A client that likes to turn the heat up high in his apartment

A homeless client that stays at a shelter
A client that lives in Florida
A client that drinks alcohol daily at bars

Explanation:
The client that drinks daily is at the highest need for hypothermia prevention education
due to the impaired cognition with alcohol.
The homeless client staying at a shelter should is not the priority for hypothermia
education because they are staying at a shelter. The client that likes the heat turned up
high is not a priority to teach hypothermia prevention. The client that lives in Florida is
not the priority to provide hypothermia prevention education to because Florida is not a
cold environment.
85.
1 / 1 point
A client is admitted for fluid volume overload. The nurse is about to assess the client
and knows to expect which of the following symptoms?

Shortness of breath after running a long-distance race, pain in legs, dark urine
Shortness of breath while lying down, swelling in legs

Confusion, lethargy, and high ammonia levels
Swelling, pain, and redness in right arm
Explanation:
Shortness of breath while lying down and swelling in legs may be caused by fluid
overload. Fluid backs up putting pressure in areas like the lungs, causing shortness of
breath. Leg swelling occurs because in fluid overload fluid leaks out of vessels and
causes swelling.
Shortness of breath after running long distances, pain in legs, and dark urine does not
describe a client in fluid overload. This client could be dehydrated, or even in
rhabdomyolysis. Swelling, pain, and redness in the right arm don’t describe a client in
fluid overload. These may be symptoms of cellulitis. Confusion, lethargy and high
ammonia levels do not describe a client in fluid overload.
86.
0 / 1 point
A client comes up to the medical unit from the ED with a temperature of 97.9s. Which of
the following actions should the nurse take first?
Place a warming device on the client

Tell the client to take deep breaths
Perform CPR
Give the client warm blankets

Explanation:
The nurse should give the client warm blankets to bring the temperature to normal.
A temp of 97.9F isn’t severe, a warming device isn’t appropriate in this situation. There
are no indications to perform CPR on this client. There is no indication that this client is
having trouble breathing.
87.
1 / 1 point
The nurse is working with a client who has been diagnosed with Cushing’s syndrome.
The nurse has provided teaching about the disease process and management. Which
of the following statements by the client demonstrates a need for additional teaching?

"You are going to monitor my labs closely because electrolyte disturbances are
common"
"I am secreting too much cortisol, which is what's causing my symptoms"
"If we don't treat this, it can become life-threatening"
"I will need to take levothyroxine for the rest of my life"

Explanation:
Taking a thyroid medication is necessary for persons with hypothyroidism rather than
hyperthyroidism. Taking this drug would cause the condition to worsen.
This is a TRUE statement in regards to Cushing's syndrome. If left untreated, Cushing's
syndrome can progress to heart failure, as well as profound glucose abnormalities and
electrolyte imbalances. Electrolyte disturbances seen with Cushing's syndrome include
hypokalemia, hypocalcemia. and hypernatremia.
88.
1 / 1 point
A nurse is caring for a client is undergoing a parathyroidectomy. Which potential risks
must the nurse consider when caring for this client following surgery?

Negative nitrogen balance
Hypocalcemia
Bronchial stridor
Acoustic neuroma
Explanation:
The post-operative parathyroidectomy client is at risk for hypocalcemia, because the
parathyroid secretes parathyroid hormone (PTH), which increases the calcium level in
the bloodstream by causing calcium release from bone tissue. The nurse can expect
that the client who undergoes a parathyroidectomy will have serial calcium lab values
drawn so the level can be closely monitored. Signs of hypocalcemia include tingling
and twitching in the face and extremities.
A negative nitrogen balance is associated with hyperthyroidism, as well as burns and

other tissue injuries and periods of fasting, but not with a parathyroidectomy. This is a
tumor associated with the inner ear and is unrelated to the parathyroid gland. A
parathyroidectomy does not affect the bronchioles.
89.
1 / 1 point
A provider has prescribed hormone replacement therapy for a client who has Addison’s
disease. The nurse who is caring for this client understands the difference between
Addison’s disease and Cushing’s syndrome as which of the following?
Addison's occurs as the result of decreased secretions of hormones while Cushing's

occurs as a result of increased secretion
Addison's is caused by hyperplasia of the adrenal gland while Cushing's is caused by
pituitary enlargement
Addison's causes signs of masculinity in women while Cushing's causes atrophy of skin,
tissues, and hair
Addison's requires treatment with lifetime hormone replacement therapy while
Cushing's does not
Explanation:
Addison's disease and Cushing's syndrome are two conditions that develop as a result
of abnormal secretion of hormones. In the case of Addison's disease, the client does
not secrete enough adrenocortical hormones, and the treatment is to ADD
glucocorticoid or mineralocorticoi medications as prescribed. In Cushing's syndrome,
the client secretes too much cortisol due to a variety of potential factors, including ACTH
secreting tumors or a metabolic disorder.
Cushing's is caused by the administration of glucocorticoids, or excess production of

cortisol. Addison's is caused by the hyposecretion of adrenal cortex hormones. Signs
and symptoms of Addison's include weight loss, GI problems, lethargy and
hyperpigmentation of the skin. Signs and symptoms of Cushing's include generalized
weakness, truncal obesity, and masculine characteristics in women. Addison's requires
lifelong glucocorticoid replacement, and clients with Cushing's who get an
adrenalectomy will also require lifetime hormone replacement.
90.
0 / 1 point
A 41-year-old client has been diagnosed with type 2 diabetes. The nurse is teaching the
client about how to perform self-monitoring of blood glucose (SMBG) at home. The
nurse instructs the client about how to use a lancet to obtain a blood sample. Which
technique would the nurse most likely include?

Use the same two fingers to check glucose to provide consistency in blood samples
Use the lancet to puncture deep enough to reach the subcutaneous tissue
Use the lancet on the side of the pad of the finger
Use the lancet on the tip of the finger to provide the most blood
Explanation:
When checking blood glucose at home, the client should learn the most appropriate and
easiest method of obtaining a blood sample, as he or she will likely need to check the
blood multiple times per day. The nurse should teach the client to use a lancet on the
side of the pad of the finger. This location is the least painful for the client and will be
less likely to interfere with use of the pad of the finger after the blood draw.
The client only needs one drop of blood, so any location that can provide one drop is
appropriate. The side of the pad of the finger is best because the client keeps the most
used part of the finger intact for use. The client should evenly distribute the sites used to
obtain blood to avoid excess fingersticks to one or two sites. Additionally, the blood
glucose level is uniform throughout the body, so the number does not vary based on
where the sample is obtained. The lancet needs only to puncture the capillary layer,
which is deep enough to draw one drop of blood.
91.
1 / 1 point
A client arrives at the healthcare clinic for diagnostic testing for diabetes. After reviewing
the test results, the provider diagnoses the client with prediabetes. Which information
from the nurse would be appropriate to teach this client about prediabetes?

A client with prediabetes is not at increased risk of cardiovascular disease, but may be
more likely develop kidney disease
Prediabetes will eventually become type 2 diabetes over time
Type 2 diabetes can be delayed after a diagnosis of prediabetes if the client takes daily
exogenous insulin
The client may delay onset of type 2 diabetes with weight loss, regular exercise, and
medications
Explanation:
Prediabetes is a condition that typically develops before the onset of diabetes. It
involves decreased insulin sensitivity or impaired glucose tolerance. Prediabetes does
not necessarily have to lead to type 2 diabetes if the client takes steps to care for her
health. The client can delay or prevent the onset of type 2 diabetes with weight loss,
exercise, and medications.
If the client takes steps to lead a healthy lifestyle and keeps weight and glucose intake
under control, they will not necessarily develop type 2 diabetes. Taking insulin does not
delay diabetes, but lifestyle changes can. The risk of both diseases is increased with
diabetes, but not prediabetes.
92.
0 / 1 point
The client is scheduled for a paracentesis. Which of the following responses is
appropriate for the nurse to educate the client about the procedure?
There is a high risk of bleeding

A needle is inserted into the peritoneum to collect sterile urine
A needle is inserted to remove ascitic fluid

A sample of liver tissue will be taken
Explanation:
A paracentesis involves inserting a needle into the abdominal cavity to remove fluid in a
client with ascites. It is done to relieve pressure for the client, as ascites becomes
uncomfortable as the peritoneum becomes full with fluid. It is also done for diagnostic
purposes to determine the source of ascites.
The peritoneum is not a highly vascular area, so bleeding is not much of a risk. The
fluid in ascites is not urine, as this is found in the bladder. It is protein-containing fluid
usually a result of portal hypertension.
93.
1 / 1 point
A client has severe lung fibrosis and as the nurse completes the admission history,
which of the following diseases should the client be asked about?

COPD
Pulmonary embolism
Scleroderma
Pneumonia
Explanation:
Scleroderma is the overproduction of collagen tissue and leads to tightening and
thickening of tissues. This could cause lung fibrosis.
 Blood clots in the lungs and do not cause lung fibrosis.

 COPD is chronic and disabling lung diseases that cause shortness of breath and
does not cause lung fibrosis.
 Pneumonia is an infection in the lungs and does not cause lung fibrosis.
94.
0 / 1 point
A client is undergoing peritoneal dialysis when he develops a fever and abdominal pain
and cramping. Which of the following actions should the nurse perform first?

Help the client to change position and check the fluid
Contact the provider and remove the catheter
Check the catheter site and the dialysate solution

Document the client's temperature and administer acetaminophen
Explanation:
Rationale
"Check the catheter site and the dialysate solution" is correct. The client is displaying
signs of peritonitis, an infection in the abdominal cavity that is a potential complication
associated with peritoneal dialysis. The nurse should first check the catheter site and
the dialysate solution to look for other signs of infection, such as redness around the
entrance site. Although the nurse will eventually need to document her findings and
contact the provider if the client has peritonitis, the nurse's first action is to check the
client. "Document the client's temperature and administer acetaminophen" is incorrect.
The nurse will document findings, but will first check the client and the dialysis set up
and catheter site. "Help the client to change position and check the fluid" is incorrect.
When a client develop a fever, it means there is an infectious process occurring inside
the client. Changing the client's position would not be helpful in this situation. However,
it would be helpful to check the dialysate fluid for any abnormalities. "Contact the
provider and remove the catheter" is incorrect. Eventually the provider will be contacted,
but the nurse would never remove the catheter without a provider order, and she would
troubleshoot by checking the client first.
95.
1 / 1 point
A nurse is caring for a client admitted to the ICU. The client’s family visits often and
stays in the room with the client. The nurse notices that the client’ family member talks
on a cell phone constantly while in the room. Which response of the nurse is accurate?

Please regulate your cell phone use to the area of the room by the window
You should spend more time focusing on your brother instead of talking on your phone
Your cell phone use could disrupt the work of the machines in this room, so please do
not use it in this area
You are increasing your risk for health problems when you use a cell phone as often as
you do
Explanation:
Rationale
"Your cell phone use could disrupt the work of the machines in this room, so please do
not use it in this area" is correct. Cell phone use has been shown to interfere with some
types of hospital medical equipment. Although each facility will have their own policies
regarding cell phone use, it is typically not acceptable for a visitor to constantly talk on a
cell phone while in a client's room in the ICU. The cell phone could not only disrupt
medical equipment, but the process is also distracting to the client's care. "You should
spend more time focusing on your brother instead of talking on your phone" and "You
are increasing your risk for health problems when you use a cell phone as often as you
do" are incorrect. The nurse's job is not to give life advice to a family member, so these
statements should be avoided. "Please regulate your cell phone use to the area of the
room by the window" is incorrect, because the issue with cell phone use is not related to
proximity to the window, but electronic device interference within the room.
References:
 Hans, N., & Kapadia, F. N. (2008). Effects of mobile phone use on specific
intensive care unit devices. Indian journal of critical care medicine : peer-reviewed,
official publication of Indian Society of Critical Care Medicine, 12(4), 170-3.
96.
1 / 1 point
A nurse is caring for a client who has developed diabetic ketoacidosis. The client has a
breathing pattern in which he takes rapid and very deep breaths with large tidal
volumes. Which of the following best describes this type of breathing?

Paroxysmal nocturnal dyspnea
Cheyne-Stokes respirations
Kussmaul's respirations
Biot's respiration
Explanation:
Rationale
"Kussmaul's respirations" is correct. Kussmaul's respirations involve an abnormal

pattern of breathing that is often associated with a condition of metabolic acidosis, such
as with diabetic ketoacidosis. Kussmaul's respirations are characterized by a rapid
breathing rate in which the client takes very deep breaths. The client may breathe in this
manner when the body is trying to compensate in metabolic acidosis. "Cheyne-Stokes
respirations" is incorrect. Cheyne-Stokes respirations are characterized by rhythmic
breathing with periods of apnea. This breathing pattern can indicate a brain problem or
metabolic dysfunction. "Paroxysmal nocturnal dyspnea" is incorrect. This breathing
pattern is characterized by periods of severe dyspnea during sleep that wakens the
client. This is common in the client with heart failure. "Biot's respiration" is incorrect.
This refers to quick, shallow respirations followed by periods of apnea, indicating a
neurological problem.
97.
0 / 1 point
A 42-year-old male client has been tested for testosterone levels because of gradually
declining levels in the body. His provider prescribes hormone replacement therapy of
testosterone. What is the most common method of administering this type of hormone?
Injectable
Orally
Topically
Sublingually
Explanation:
Testosterone supplements may be administered to some patients to increase levels of
testosterone in the body when they are otherwise deficient. The most commonly used
testosterone preparation is a topical gel, applied to the skin on the shoulders or upper
arms.
Topical gel is the most common route of administration for testosterone.
98.
0 / 1 point
Which of the following are signs and symptoms that a client with hypothyroidism would
demonstrate? Select all that apply.
Weight gain
Fatigue
Heat intolerance
Insomnia
Alopecia
Explanation:
Low thyroid levels will slow metabolism, causing fatigue, weight gain, hair loss, brittle
nails, cold intolerance and muscle aches, among other symptoms.
Alopecia is a symptom of hypothyroidism.
Weight gain is a symptom of hypothyroidism.

99.
0 / 1 point
A case management nurse is helping a client with insulin supplies at home. The client
uses pre-filled insulin syringes and the nurse is teaching the client about how to store
them so that they can be accessed easily. Which statement made by the nurse is
correct?
You will need to keep the syringes at cool temperatures and then warm them when you
are ready to use them
Only keep these syringes in the refrigerator, they cannot be left out at room
temperature
You must keep your syringes covered and protect them from the light
You can store your syringes in a cupboard at room temperature

Explanation:
Rationale
"You can store your syringes in a cupboard at room temperature" is correct. Pre-filled
insulin syringes are useful for providing measured amounts of insulin to diabetic clients
without the necessity of drawing up doses into a syringe. Because pre-filled syringes
are one-time use only, they do not need to be preserved after opening them. The client
can store pre-filled insulin syringes at room temperature in a safe place, such as a
cupboard. "You must keep your syringes covered and protect them from the light" is
incorrect. Insulin is not sensitive to light. "Only keep these syringes in the refrigerator,
they cannot be left out at room temperature" is incorrect. Insulin is stable at room
temperature. "You will need to keep the syringes at cool temperatures and then warm
them when you are ready to use them" is incorrect. Insulin can be kept at room
temperature and injected without additional preparation.
100.
1 / 1 point
A client came in with a temperature of 105F. On assessment the nurse notes the client
to be confused. The client is hot to the touch but not sweaty and has a weak pulse. The
nurse should implement which of the following precaution types for this client?

Droplet
Contact
Seizure
Neutropenic
Explanation:
The client is at risk for seizures as is having signs of a heat stroke. This client is
showing signs of overheating and this causes organs to not be perfused properly and
overheat. So this client is at risk for seizures and should be placed on seizure
precautions.
This client is at risk for seizure and should be placed on seizure precautions for client
safety. Contact precautions are used for infections, diseases, or germs that are spread
by touching the patient or items in the room such as MRSA. There is no indication that
this is a concern.
Neutropenic precautions are taken when WBC count is depleted, usually in cancer
clients. There is no indication that the client is neutropenic. This client is showing signs
over heatstroke and nursing should be concerned about the risk for a seizure.
There is no indication that the client has any illnesses in need of droplet precautions.
Droplet precautions are used when viruses/diseases can be spread by droplets from
person to person. Droplet precautions are used with flu and whooping cough as an
example.

PART II Endocrine

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ARA | Enhancement | Endocrine 2

Your score: 63% (63/100)

Your Answer: Correct

Check the client's glucose level

Your Answer: Correct

Get the client orange juice

Your Answer: Incorrect

Removal of one or more parathyroid glands

Transplantation of parathyroid tissue in the forearm

Postoperative hypercalcemic crisis

Bleeding at the surgical site

Your Answer: Correct

Your Answer: Correct

Do not wear open-toe or open-heel shoes

Your Answer: Correct

The patient is at risk of bleeding because of heparin administered with dialysis

Your Answer: Correct

Your Answer: Correct

A needle is inserted to remove ascitic fluid

Your Answer: Incorrect

The nurse washes the wound with soap and water

Your Answer: Correct

Neuroleptic malignant syndrome is caused by the body’s reaction to antipsychotic

Your Answer: Correct

Hypoparathyroidism is not treated with thiamine supplements. Calcium supplements

Your Answer: Incorrect

Excess bone growth

 Hoffman, J. R., & Ratamess, N. A. (2006). Medical Issues Associated with

Your Answer: Correct

Encourage the client to learn and practice self care

 Shah, M. (2018, June 21). Charcot Arthropathy: Background, Anatomy,

Your Answer: Correct

Your Answer: Incorrect

Potassium 50 mq PO BID with meals

Insert urinary catheter to monitor output

Insert second IV access

Dialysis STAT for fluid removal

Furosemide would be an appropriate medication to give a client with congestive heart

Your Answer: Incorrect

It is an autoimmune disorder that occurs because the thyroid is absent

It is an autoimmune disorder that may be triggered by many different factors

Your Answer: Correct

Respiratory rate less than 8/min

Temperature greater than 100.4F

 Kaplan, L. (2018, May 7). Systemic Inflammatory Response Syndrome Clinical

Your Answer: Correct

Your Answer: Correct

Increase fluid intake to at least 2L/day

Your Answer: Correct

 Wagner, A. L. (2010). Core Concepts of Jean Watson’s Theory of Human

Your Answer: Correct

To increase the blood PH

Your Answer: Correct

Hot, dry skin is a symptom of hyperglycemia rather than hypoglycemia.

Bradycardia -Mild hypoglycemia causes tachycardia, not bradycardia.

Your Answer: Incorrect

Hypovolemia due to lack of sodium and water excretion

Your Answer: Correct

Your Answer: Incorrect

0.4 to 4.0 mU/L

Your Answer: Correct

 Lager, I. (1991). Journal of Internal Medicine. Supplement., 735(41), 7th ser.

Your Answer: Incorrect