1. The client who is receiving Furadantin for a urinary tract infection may also receive ascorbic acid.

The rationale for this additional agent is to a. Acidify the urine. b. Alkalinize the urine. c. Fortify mucosal resistance. d. Promote tissue repair. 2. A client receiving a blood transfusion begins to wheeze and her skin becomes flushed with hives. The nurse knows that these symptoms are characteristic of a (n) a. Allergic reaction. b. Thrombic crisis. c. Hemolytic reaction. d. Transfusion reaction. 3. When assessing a client for Coumadin therapy, the condition that will exclude this client from Coumadin therapy is a. Diabetes. b. Pregnancy. c. Peptic ulcer disease. d. Arthritis. 4. The most important nursing action for clients on IPPB therapy with a nebulizer is to a. Start the IPPB treatment and leave the client to complete it. b. Make the client comfortable in a supine position during the treatment. c. Complete postural drainage before IPPB therapy. d. Monitor blood pressure, pulse, and respirations. 5. You are caring for a client who has been on Prev-acid, trazadone, and Zoloft for the past 8 weeks. This client has an absolute neutrophil count of 300/mm3 and a white blood cell count of 1500/mm3. The nurse should consider which of the following implementations as the priority? a. Frequent vital signs. b. Maintaining neutropenic precautions. c. Regularly scheduled administration of Prevacid, trazadone, and Zoloft to maintain blood levels. d. Rapid administration of packed cells to raise blood count. 6. A client who recently started taking a daily dose of the drug methyldopa (Aldomet) for hypertension complains of drowsiness and lethargy when the nurse makes a home visit. The nursing intervention would be to a. Suggest that the client take the medication in the evening and reevaluate on the next visit. b. Explain that these are expected side effects

and he will have to live with them. c. Ask the physician to prescribe another antihypertensive. d. Notify the physician of the negative side effects so the dose can be reduced. 7. A client has the diagnosis of diabetes. His physician has ordered short- and long-acting insulin. When administering two types of insulin, the nurse would a. Withdraw long-acting insulin, inject air into regular insulin, and withdraw insulin. b. Withdraw the short-acting insulin into the syringe before the long-acting insulin. c. Draw up in two separate syringes, then combine into one syringe. d. Withdraw the long-acting insulin into the syringe before the short-acting insulin. 8. A blood transfusion is started at how many macrodrops per minute, for how long a time? a. 25 to 50 drops for 15 minutes. b. 10 drops for 10 minutes. c. 120 drops for 15 minutes. d. 20 drops for 10 minutes. 9. A female client with rheumatoid arthritis has been on aspirin gr. xx TID and prednisone 10 mg BID for the last 2 years. The most important assessment question for the nurse to ask related to the client s drug therapy is whether she has a. Decreased appetite. b. Tarry stools. c. Blurred vision. d. Headaches. 10. A client is about to be discharged on the drug bishydroxycoumarin (Dicumarol). Of the principles below, which is the most important to teach the client before discharge? a. It is the responsibility of the physician to do the teaching for this medication. b. He should be sure to take the medication before meals. c. If he misses a dose, he should double the dose at the next scheduled time. d. He should shave with an electric razor. 11. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PCWP). The physician orders dopamine to improve ventricular function. The nurse will know the medication is working if the client s a. Cardiac index falls. b. Blood pressure rises. c. Blood pressure decreases. d. PCWP rises.

12. A client in acute renal failure receives an IV infusion of 10 percent dextrose in water with 20 units of regular insulin. The nurse understands that the rationale for this therapy is to a. Correct the hyperglycemia that occurs with acute renal failure. b. Provide calories to prevent tissue catabolism and azotemia. c. Facilitate the intracellular movement of potassium. d. Force potassium into the cells to prevent arrhythmias. 13. The nurse explains to the client that decreasing dietary oxalate intake can reduce the formation of calcium-oxalate renal stones. The client is prepared to make correct diet choices when he tells the nurse he knows that foods to avoid on such a diet include a. Rice, potatoes, breads. b. Carrots, spinach, tomatoes, green beans. c. Bananas, apples, apricots. d. Red meats, butter, cheese. 14. A client has just been admitted with a diagnosis of detached retina and surgery is scheduled. The preoperative ophthalmic medication that will most likely be ordered for this client will be a. Timolol maleate. b. Atropine sulfate. c. Carbamylcholine. d. Pilocarpine. 15. A client with Congestive Heart Failure is placed on several medications including the Beta Blocker Atenolol. The nurse understands that Beta Blockers exert their influence by: a. Reducing myocardial Oxygen demand b. Cause vasodilation of coronary vessels c. Increase heart rate and force of contraction d. Decrease heart rate and force of contraction 1. A. Furadantin antimicrobial activity is more potent in an acid urine. Ascorbic acid or vitamin C tablets acidify the urine. 2. A. These signs, in addition to laryngeal edema, are characteristic of an allergic reaction that is, less spe- cifically, a transfusion reaction. Chills, increased temp- erature, and pain in the kidney region are indications of a hemolytic reaction. 3. B. Coumadin therapy is contraindicated in the pregnant woman because it crosses the placenta. The pregnant client should be taught heparin administration with a heparin lock if anticoagulation therapy must be continued. The arthritic client (2) may take aspirin or

NSAIDs, which potentiate the effects of Coumadin, and should be watched for gastrointestinal bleed, as should the client with ulcer disease (4). 4. D. Alterations in vital signs could be an indication of side effects of nebulizer medication. The client should be in sitting position, either in the bed or in a chair. Postural drainage would not be done before IPPB therapy. The nurse would not leave the client during this treatment. 5. B. Maintaining neutropenic precautions is the most important implementation for this client. The client is at risk for infection. Low neutrophil and white blood cell counts are often found in clients with aplastic anemia or malignancies or in clients who have received cytotoxic therapy. These low blood counts are most likely due to the Prevacid, trazadone, and Zoloft. Administration of blood (1) is not indicated; frequent vital signs (2) is important, but not the highest priority; continuing the medications that are the most likely cause of the low blood count (4) will only make the situation worse. 6. A. These side effects may be present with this medication, but may be alleviated by taking the drug in the evening. Often, taking one dose in the evening will minimize the sedation. The nurse needs to follow up with this client and report to the physician. 7. B. Short-acting insulin is withdrawn first in order to prevent possible contamination of the short-_acting insulin bottle by the longeracting insulin. 8. A. A blood transfusion should be started slowly (from 25 to 50 drops per minute) for the first 15 minutes because slow administration allows time to observe for an adverse reaction. Most reactions occur in the first 15 minutes. Continuing rate is 100 mL/hr. 9. B. Aspirin impedes clotting by blocking prosta-glandin synthesis, which can lead to bleeding. A side effect of prednisone is gastric irritation, also leading to bleeding. Tarry stools indicate bleeding in the upper GI system. 10. D. Dicumarol is an anticoagulant drug and one of the dangers involved is bleeding. Using a safety razor can lead to bleeding through cuts. The drug should be given at the same time daily but not related to meals (1). Due to danger of bleeding, missed doses (3) should not be made up.

11. B. If dopamine has a positive effect, it will cause vasoconstriction peripherally, but increase renal perfusion and the blood pressure will rise. The cardiac index will also rise and the PCWP should decrease. 12. C. Dextrose with insulin helps move potassium into cells and is immediate management therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed. This type of infusion is often administered before cardiacsurgery to stabilize irritable cells and prevent arrhythmias; in this case KCl is also added to the infusion. 13. B. Foods high in oxalate include spinach, green and wax beans, beets, and chocolate. 14. B. Mydriatic drugs are used preoperatively so that the pupil is widely dilated. Either atropine sulfate or epinephrine HCl is commonly used. Pilocarpine (3) and carbamylcholine (2) are miotics used for glaucoma and certain types of lens implants. Timolol maleate (4) is a beta blocker used for glaucoma. 15. D. Beta blockers act to decrease heart rate and force of contraction and reduce vasoconstriction by antagonizing Beta receptors in the myocardium and vasculature. Choices (1) and (2) refer to the action of nitrates as well as Calcium Channel Blockers such as Diltiazem. Choice (3) is not applicable. 1. A 2 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time? a. Use aseptic technique during dressing changes b. Maintain central line catheter integrity c. Monitor serum glucose levels d. Check results of liver function tests 2. Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the following assessments requires the nurse s immediate attention? a. Temperature of 37.5 degrees Celsius b. Urine output of 300 cc in 4 hours c. Poor skin turgor d. Blood glucose of 350 mg/dl 3. Nurse Susan administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent asks why this medication is being given. What is the nurse s best response?

a. It will slow down the replication of the virus. b. This medication will improve your child s overall health status. c. This medication is used to prevent bacterial infections. d. It will increase the effectiveness of the other medications your child receives. 4. When caring for a client with total parenteral nutrition (TPN), what is the most important action on the part of the nurse? a. Record the number of stools per day b. Maintain strict intake and output records c. Sterile technique for dressing change at IV site d. Monitor for cardiac arrhythmias 5. The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse s immediate action? a. Stomatitis lesion in the mouth b. Severe nausea and vomiting c. Complaints of pain at site of infusion d. A rash on the client s extremities 6. Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing instructions about precautions with this medication, the nurse should instruct the client to: a. Avoid chocolate and cheese b. Take frequent naps c. Take the medication with milk d. Avoid walking without assistance 7. While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The BEST response to this client should be: a. As you urinate more, you will need less medication to control fluid. b. You will have to take this medication for about a year. c. The medication must be continued so the fluid problem is controlled. d. Please talk to your physician about medications and treatments. 8. George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home? a. Chorea. b. Polyarthritis. c. Subcutaneous nodules. d. Erythema marginatum. 9. An order is written to start an IV on a 74year-old client who is getting ready to go to the

operating room for a total hip replacement. What gauge of catheter would best meet the needs of this client? a. 18 b. 20 c. 21 butterfly d. 25 10. A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment. Which drug, used to treat clients with rheumatoid arthritis, has both an anti-inflammatory and immunosuppressive effect? a. Gold sodium thiomalate (Myochrysine) b. Azathioprine (Imuran) c. Prednisone (Deltasone) d. Naproxen (Naprosyn) 11. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? a. The impact of lithium on the client s energy level and life-style. b. The need for consistent blood level monitoring. c. The potential side effects of lithium. d. What the client s friends think of his need to take medication 12. Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? a. The impact of lithium on the client s energy level and life-style. b. The need for consistent blood level monitoring. c. The potential side effects of lithium. d. What the client s friends think of his need to take medication. 13. The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently taking. What is the primary reason for this action? a. Multiple medications can lead to dementia b. The medications can provide clues regarding his medical background c. Ability to recall medications is a good assessment of the client s level of orientation. d. Medications taken by a client are part of every nursing assessment.

14. A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy? a. Are you sure all this insulin won t hurt my baby? b. I ll probably need my daily insulin dose raised. c. I will continue to take my regular dose of insulin. d. These finger sticks make my hand sore. Can I do them less frequently? 15. Mrs. Johanson. s physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson s nursing history for allergies, the nurse notes that Mrs. Johanson s is also taking oral contraceptives. What is the most appropriate initialnursing intervention? a. Administer the dose of tetracycline. b. Notify the physician that Mrs. Johanson is taking oral contraceptives. c. Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline. d. Tell Mrs. Johanson, to use another form of birth control for at least two months. 16. An adult client s insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The client should be taught to expect the first insulin peak: a. as soon as food is ingested. b. in two to four hours. c. in six hours. d. in ten to twelve hours. 17. An adult is hospitalized for treatment of deep electrical burns. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered bid. While applying the Sulfamylon to the wound, it is important for the nurse to prepare the client for expected responses to the topical application, which include: a. severe burning pain for a few minutes following application. b. possible severe metabolic alkalosis with continued use. c. black discoloration of everything that comes in contact with this drug.

d. chilling due to evaporation of solution from the moistened dressings. 18. Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol s solution for the client. The nurse understands that the primary reason for giving Lugol s solution preoperatively is to: a. decrease the risk of agranulocytosis postoperatively. b. prevent tetany while the client is under general anesthesia. c. reduce the size and vascularity of the thyroid and prevent hemorrhage. d. potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia. 19. A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is: a. bradypnea. b. failure to thrive. c. tachycardia. d. vomiting. 20. Mr. Bates is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time? a. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia. b. Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery. c. Administer hydrocortisone until vital signs stabilize, then discontinue the IV. d. Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection.

1.Answer C. Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the high-glucose load of the TPN solution. Thus, a chief nursing responsibility is blood glucose testing. 2. Answer D. Total parenteral nutrition formulas contain dextrose in concentrations of 10% or greater to supply 20% to 50% of the total calories. Blood glucose levels should be checked every 4 to 6 hours. A sliding scale dose of insulin may be ordered to

maintain the blood glucose level below 200mg/dl. 3. Answer C. Intravenous gamma globulin is given to help prevent as well as to fight bacterial infections in young children with AIDS. 4. Answer C. Clients receiving TPN are very susceptible to infection. The concentrated glucose solutions are a good medium for bacterial growth. Strict sterile technique is crucial in preventing infection at IV infusion site. 5. Answer C. A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall, with or without inflammation. 6. Answer A. Foods high in tryptophan, tyramine and caffeine, such as chocolate and cheese may precipitate hypertensive crisis. 7. Answer C. This is the most therapeutic response and gives the client accurate information. 8. Answer B. Chorea is the restless and sudden aimless and irregular movements of the extremities suddenly seen in persons with rheumatic fever, especially girls. Polyarthritis is characterized by swollen, painful, hot joints that respond to salicylates. Subcutaneous nodules are nontender swellings over bony prominences sometimes seen in persons with rheumatic fever. Erythema marginatum is a skin condition characterized by nonpruritic rash, affecting trunk and proximal extremities, seen in persons with rheumatic fever. 9. Answer A. Clients going to the operating room ideally should have an 18- gauge catheter. This is large enough to handle blood products safely and to allow rapid administration of large amounts of fluid if indicated during the perioperative period. An 18-gauge catheter is recommended. A 20gauge catheter is a second choice. A 21-gauge needle is too small and a butterfly too unstable for a client going to surgery. A 25-gauge needle is too small. 10. Answer C. Gold sodium thiomalate is usually used in combination with aspirin and nonsteroidal anti-inflammatory drugs to relieve pain. Gold has an immunosuppressive affect. Azathioprine is used for clients with life-threatening rheumatoid arthritis for its immunosuppressive effects. Prednisone is used to treat persons with acute exacerbations

of rheumatoid arthritis. This medication is given for its anti-inflammatory and immunosuppressive effects. Naproxen is a nonsteroidal anti-inflammatory drug. Immunosuppression does not occur. 11. Answer D. The impact of lithium on the client s energy level and life style are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor, drowsiness, diarrhea, polyuria, thirst, weight gain, and fatigue can be disturbing to the client. While the client s social network can influence the client in terms of compliance, the influence is typically secondary to that of the other factors listed. 12. Answer D. The impact of lithium on the client s energy level and life style are great determinants to compliance. The frequent blood level monitoring required is difficult for clients to follow for a long period of time. Potential side effects such as fine tremor, drowsiness, diarrhea, polyuria, thirst, weight gain, and fatigue can be disturbing to the client. While the client s social network can influence the client in terms of compliance, the influence is typically secondary to that of the other factors listed. 13. Answer A. Drugs commonly used by elderly people, especially in combination, can lead to dementia. Assessment of the medication taken may or may not provide information on the client s medical background. However, this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome. Ability to recall medications may indicate short-term memory and recall. However, that is not the primary reason for assessing medications in a client with sundown syndrome. Medication history should be a part of the nursing assessment. In this client there is an even more important reason for evaluating the medications taken. 14. Answer B. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen, insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding.

Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued. 15. Answer B. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should be notified. The physician should be notified. Tetracycline decreases the effectiveness of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed. Note on the client s chart that the physician was notified. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The nurse should not tell the client to stop taking oral contraceptives unless the physician orders this. The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. If the physician chooses to keep the client on tetracycline, the client should be encouraged to use another form of birth control. The first intervention is to notify the physician. 16. Answer B. The first insulin peak will occur two to four hours after administration of regular insulin. Regular insulin is classified as rapid acting and will peak two to four hours after administration. The second peak will be eight to twelve hours after the administration of NPH insulin. This is why a snack must be eaten mid-morning and also three to four hours after the evening meal. The first insulin peak will occur two to four hours after administration of regular insulin. The first insulin peak will occur two to four hours after administration of regular insulin. The second peak will occur eight to twelve hours after the administration of NPH insulin. 17. Answer A. Mafenide acetate 10% (Sulfamylon) does cause burning on application. An analgesic may be required before the ointment is applied. Mafenide acetate 10% (Sulfamylon) is a strong carbonic anhydrase inhibitor that affects the renal tubular buffering system, resulting in metabolic acidosis. Mafenide acetate 10% (Sulfamylon) does not cause discoloration. Silver nitrate solution, another topical antibiotic used to treat burn sepsis, has the disadvantage of turning everything it touches black. Mafenide acetate 10% (Sulfamylon) is an ointment that is applied directly to the wound. It has the ability to diffuse rapidly through the eschar. The wound may be left open or dry dressing may be applied. Silver

nitrate solution is applied by soaking the wound dressings and keeping them constantly wet, which may cause chilling and hypotension. 18. Answer. Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol s solution does not potentiate any other preoperative medication. 19. Answer D. Bradypnea (slow breathing) is not associated with digitalis toxicity. Bradycardia is associated with digitalis toxicity. Although children with congestive heart failure often have a related condition of failure to thrive, it is not directly related to digitalis administration. It is more related to chronic hypoxia. Tachycardia is not a sign of digitalis toxicity. Bradycardia is a sign of digitalis toxicity. The earliest sign of digitalis toxicity is vomiting, although one episode does not warrant discontinuing medication. 20. Answer A. Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal operation. The client is encouraged to change position, cough, and deep breathe to prevent postoperative complications such as pneumonia or thrombophlebitis. Maintenance doses of hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary for six months to two years or until the remaining gland recovers. The client undergoing an adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about wound care, but not at this time while he is in the ICU 1. Nurse Ronn is assessing a client with possible Cushing s syndrome. In a client with Cushing s syndrome, the nurse would expect to find: a. Hypotension. b. Thick, coarse skin. c. Deposits of adipose tissue in the trunk and dorsocervical area. d. Weight gain in arms and legs.

2. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? a. Administer desmopressin while the suspension is cold. b. Your condition isn t chronic, so you won t need to wear a medical identification bracelet. c. You may not be able to use desmopressin nasally if you have nasal discharge or blockage. d. You won t need to monitor your fluid intake and output after you start taking desmopressin. 3. Nurse Wayne is aware that a positive Chvostek s sign indicate? a. Hypocalcemia b. Hyponatremia c. Hypokalemia d. Hypermagnesemia 4. In a 29-year-old female client who is being successfully treated for Cushing s syndrome, nurse Lyzette would expect a decline in: a. Serum glucose level. b. Hair loss. c. Bone mineralization. d. Menstrual flow. 5. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? a. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. b. It interacts with plasma membrane receptors to inhibit enzymatic actions. c. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. d. It regulates the threshold for water resorption in the kidneys. 6. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose s: a. Onset to be at 2 p.m. and its peak to be at 3 p.m. b. Onset to be at 2:15 p.m. and its peak to be

at 3 p.m. c. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. d. Onset to be at 4 p.m. and its peak to be at 6 p.m. 7. A female client with Cushing s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression b. Neuropathy c. Hypoglycemia d. Hyperthyroidism 8. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage 9. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism b. Graves disease c. Thyrotoxicosis d. Euthyroidism 10. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria 11. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer: a. phentolamine (Regitine). b. methyldopa (Aldomet). c. mannitol (Osmitrol). d. felodipine (Plendil). 12. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates

that the client s hypertension is caused by excessive hormone secretion from which of the following glands? a. Adrenal cortex b. Pancreas c. Adrenal medulla d. Parathyroid 13. Nurse Troy is aware that the most appropriate for a client with Addison s disease? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia 14. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client s need for additional teaching when the client states: a. If I have hypoglycemia, I should eat some sugar, not dextrose. b. The drug makes my pancreas release more insulin. c. I should never take insulin while I m taking this drug. d. It s best if I take the drug with the first bite of a meal. 15. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? a. You must lie flat for 24 hours after surgery. b. You must avoid coughing, sneezing, and blowing your nose. c. You must restrict your fluid intake. d. You must report ringing in your ears immediately. 16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. Be sure to take glipizide 30 minutes before meals. b. Glipizide may cause a low serum sodium level, so make sure you have your sodium level

checked monthly. c. You won t need to check your blood glucose level after you start taking glipizide. d. Take glipizide after a meal to prevent heartburn. 17. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-todry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? a. They contain exudate and provide a moist wound environment. b. They protect the wound from mechanical trauma and promote healing. c. They debride the wound and promote healing by secondary intention. d. They prevent the entrance of microorganisms and minimize wound discomfort. 18. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? a. Restricting fluids b. Restricting sodium c. Forcing fluids d. Restricting potassium 19. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess 20. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? a. Serum potassium level b. Serum sodium level c. Arterial blood gas (ABG) values d. Serum osmolarity 21. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise

affect insulin requirements, Nurse Joy should include which guideline? a. You ll need more insulin when you exercise or increase your food intake. b. You ll need less insulin when you exercise or reduce your food intake. c. You ll need less insulin when you increase your food intake. d. You ll need more insulin when you exercise or decrease your food intake. 22. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? a. Oral anticoagulants b. Anabolic steroids c. Beta-adrenergic blockers d. Thiazide diuretics 23. Which instruction about insulin administration should nurse Kate give to a client? a. Always follow the same order when drawing the different insulins into the syringe. b. Shake the vials before withdrawing the insulin. c. Store unopened vials of insulin in the freezer at temperatures well below freezing. d. Discard the intermediate-acting insulin if it appears cloudy. 24. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: a. I.M. or subcutaneous glucagon. b. I.V. bolus of dextrose 50%. c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. d. 10 U of fast-acting insulin. 25. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek s sign and Trousseau s sign because they indicate which of the following? a. Hypocalcemia b. Hypercalcemia c. Hypokalemia d. Hyperkalemia 1. Answer C. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and

bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities. 2. Answer C. Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement. 3. Answer A. Chvostek s sign is elicited by tapping the client s face lightly over the facial nerve, just below the temple. If the client s facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest. 4. Answer A. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosisoccurs in Cushing s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it. 5. Answer C. Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn t decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys. 6. Answer C. Regular insulin, which is a shortacting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m. 7. Answer A. Agitation, irritability, poor memory, loss of appetite, and neglect of one s appearance may signal depression, which is common in clients with Cushing ssyndrome. Neuropathy affects clients with diabetes

mellitus not Cushing ssyndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite. 8. Answer A. Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction. 9. Answer A. Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn t require any thyroid preparation. 10. Answer B. SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn t associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria). 11. Answer A. Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body s response to circulating epinephrine and norepinephrine, reducing blood pressurequickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn t effective in treating hypertensive emergencies. Mannitol, a diuretic, isn t used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn t reduce blood pressure quickly enough to correct hypertensive crisis.

12. Answer A. Excessive secretion of aldosterone in the adrenal cortex is responsible for the client s hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone. 13. Answer A. Addison s disease decreases the production of all adrenal hormones, compromising the body s normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn t appropriate because Addison s disease causes polyuria. 14. Answer A. Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a product containing table sugar when treating hypoglycemia. The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption. It s safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. The client should take the drug at the start of a meal, not 30 minutes to an hour before. 15. Answer B. After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy. 16. Answer A. The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn t cause hyponatremia and therefore doesn t necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy. 17. Answer C. For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by

secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing. 18. Answer C. The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn t necessary in hyperparathyroidism. 19. Answer D. In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate. 20. Answer D. Serum osmolarity is the most important test for confirming HHNS; it s also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren t as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable. 21. Answer B. Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements. 22. Answer A. As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn t interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics. 23. Answer A. The client should be instructed always to follow the same order when drawing

the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin protein molecules may be damaged. Intermediate-acting insulin is normally cloudy. 24. Answer C. This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn t administer insulin to a client who s hypoglycemic; this action will further compromise the client s condition. 25. Answer A. The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek s sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau s sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren t present with hypercalcemia, hypokalemia, or hyperkalemia. 1. A 4 year old with Celiac Disease is in the hospital with an exacerbation of Celiac Crisis due to improper dietary intake. When teaching the mother the dietary restrictions for her child, which of the following foods must be completely eliminated from the child s diet? a. Whole milk, ice cream and cheese b. Rice, corn and soybeans c. Bread, oatmeal and pretzels d. Beef, liver and veal 2. Following delivery of a normal newborn, the nurse will assess the mother every 15 minutes for the first hour. The most important assessment is for a. Placental fragments. b. Presence of lochia. c. Condition of the fundus. d. Hemorrhage. 3. A breast feeding mother develops mastitis in the left breast and is put on an antibiotic for seven days. She asks the nurse if she can continue breast feeding. The nurse s best answer would be:

a. Only breast feed from the right breast. b. Do not breast feed or stimulate the breasts until the infection is resolved. c. Continue breast feeding, this is not a contraindication. d. Pump the breasts and discard the milk until the infection resolves. 4. The nurse is assigned a client at risk for developing deep vein thrombosis (DVT) following a total knee replacement. The most effective measure to prevent this complication is a. An exercise schedule of dorsiflexion of the feet. b. Maintaining a flat bed from the waist down. c. Instruction in shallow breathing techniques. d. Maintaining the client on bedrest. 5. An elderly man is admitted to the Geriatric Unit for his forgetfulness and severe behavioral changes. He is diagnosed with Alzheimer s Disease. Which of the following should be the primary goal of nursing intervention? a. Keep him away from problems of daily living b. Keep his capacity for self care activities to the optimum c. Keep him isolated d. Keep all available resources to increase his dependency 6. While bathing a 1 year old, the nurse feels a large mass in the abdominal area and notices that his diaper is soiled with pinkish-tinged urine. The initial nursing action is to a. Gently palpate the abdominal mass to determine if it is a Wilms tumor. b. Continue the assessment by observing his behavior indicating pain on palpation. c. Immediately notify the physician. d. Assess if the tumor has spread to the lymph nodes. 7. Which of the following is an INCORRECT statement regarding diet therapy for a patient in renal failure? a. Limit dietary protein b. Provide a diet high in carbohydrates c. Limit Sodium (NA) intake d. Provide a diet high in Potassium rich food 8. Instructions given to clients following cataract surgery include the information that a. Contact lenses will be fitted before discharge from the hospital. b. They must use only one eye at a time to prevent double vision. c. They will be able to judge distances without difficulty.

d. The eye patch will be removed in 3 to 4 days, and the eye may be used without difficulty. 9. In teaching High School students about health practices that promote the prevention of spread of the HIV virus, the nurse should include which of the following: a. Use a latex condom and water soluble lubricant during intercourse b. Abstain from intercourse if the female is menstruating c. Following oral intercourse, use an over-thecounter mouthwash so to destroy the HIV virus d. Shower immediately with an antibacterial soap after intercourse, so to destroy the HIV virus 10. Following delivery of a healthy baby, the nurse completes a postpartum assessment of the new mother. Which of the following symptoms would be indicative of a full bladder? a. Pulse 52 beats/min. b. Fundus 2F above umbilicus. c. Increased uterine contractions. d. Decreased lochia. 11. The parents of a child with Tetralogy of Fallot have been given discharge instructions. Which of the following situations would the parents be instructed to avoid? a. All infant contact with persons outside the home b. Infant contact with persons who have mild colds c. Infant contact with persons who have severe allergies d. Routine immunizations 12. A nursing measure to prevent the complication of deep vein thrombophlebitis following surgery would include a. Wearing elastic hose at all times. b. Having the client sit up TID. c. Placing pillows under the affected limb d. Elevating the foot of the bed. 13. Following Gastric Resection, patients are prone to developing Dumping Syndrome. Which of the following types of dietary intake by the patient would be MOST helpful to either reduce or prevent this syndrome from developing? a. Moderate fat, low carbohydrate b. High fat, high carbohydrate c. Low fat, low carbohydrate d. Moderate fat, high carbohydrate 14. The RN observes the nursing assistant (NA) regulating the IV of an oncology client receiving morphine sulfate for pain. An LVN on

the RN s team is responsible for the client and has assigned the client to the NA. The RN s intervention is to a. Immediately inform the charge nurse and fill out an incident report. b. Ask the LVN and the NA to meet with the RN to discuss the responsibility -parameters each of them has. c. Inform the LVN so that he/she intervenes to instruct the NA that this -action is not within the realm of responsibility of an NA. d. Call a staff meeting and confront the LVN and the NA. 15. Following Total Gastrectomy patients will require vitamin replacement. Of the following, which vitamin is ESSENTIAL and MUST be given throughout life: a. Vitamin C b. Vitamin B6 c. Vitamin D d. Vitamin B12 1. C. Celiac disease is caused by an intolerance to gluten, which is a protein found in wheat, oats, barley and rye, All the foods in option 3 contain gluten. Option 1 would be eliminated if the child had a lactose intolerance, option 4 would be eliminated if the child had a fat intolerance. 2. D. The most important assessment is vital signs for hemorrhage. The nurse will also check the fundus and for lochia, but the most important is for hemorrhage because it is the most common cause of death in the first hour after delivery. 3. D. Unless the antibiotic is safe for the infant, it is best not to feed the baby, but in order to continue establishment of milk flow, the breasts must be stimulated. 4. A. Exercise, specifically dorsiflexion of the feet, prevents stasis by promoting venous valve and muscle action. Early ambulation, deep breathing and elevating the foot of the bed all increase blood flow. If DVT develops, the client will be placed on bedrest. 5. B. Alzheimer s disease is a progressive disease that takes years until the patient is completely incapacitated. It is best to support the individuals self esteem by helping them maintain as much control of their life through independent functioning of self care and activities of daily living. 6. C. The physician should be notified immediately. A suspected Wilms tumor should never be palpated more than necessary

because of the potential for metastasis and should be treated immediately following discovery. It is really not a nursing responsibility to assess for lymph node enlargement. 7. D. Patients with renal failure should have a diet that provides (high biologic value) proteins rich foods such as eggs, dairy products and meats. These are necessary to maintain a positive nitrogen balance. Foods high in calories are also necessary, and sodium intake should be limited. Foods high in Potassium should be AVOIDED due to decreased ability of the kidney(s) to filter and excrete Potassium. 8. B. The function of the lens is that of accommodation, the focusing of near objects on the retina by the lens; therefore, only the remaining lens will function in this capacity, depending on whether a cataract is present. 9. A. Although abstinence is still the best protection against spread of the HIV virus, the use of a latex condom with a H20 soluble lubricant is the most effective means. All other choices given have no proven validity against the spread of the HIV Virus. 10. B. If the bladder is full, it will push the uterus up out of the pelvis above the umbilicus. The uterus will not contract sufficiently, which could lead to increased bleeding. 11. B. Children with cardiac disease have lowered resistance to upper respiratory infections and should avoid any circumstances that may expose them to even mild infections. Option 1 is unrealistic and option 3 would not put the child at risk since allergies are not contagious, option 4 is wrong because children with cardiac conditions do receive routine immunizations. 12. D. Elevation of the legs promotes circulation and prevents venous stasis and more clot formation. Nursing measures aim at preventing further thrombi from forming and the already present thrombus from detaching. Elastic hose (2) are necessary when the client is up walking again. Placing a pillow under the limb (1) could cause a bend at the groin, with resulting decreased circulation. The client must be kept on bedrest until the danger of emboli passes (4 to 7 days). 13. A. One of the more common problems following Gastric surgery is Dumping Syndrome. Dietary management is the key to reduce or prevent this potential problem from

developing. The diet should contain moderate amounts of fat, as well as below in carbohydrates, especially small molecular carbohydrates such as sucrose and glucose. These dietary modifications will result in decreased hypertonicity of the intestinal contents, and prevent osmotic pull of extracellular fluid into the intestinal area, lessening the possibility for Dumping Syndrome to develop. 14. B. While regulating or even touching an IV is definitely not within the scope of behaviors that an NA can legally perform (1), both teaching and clarification of duties is needed in this situation. Before accusing the NA, a nonpunitive environment should be created so teaching of both the LVN and NA can occur, and this action will not happen again. Unless too much medication was given, an incident report does not need to be filled out (2). Confronting the team members in a staff meeting (3) would not be following good management principles. 15. D. Following Total Gastrectomy the production of Intrinsic Factor is permanently destroyed. This is necessary (Intrinsic Factor) for the absorption of Vitamin B12 from the GI tract. As a result patients MUST receive Vitamin B12 by parenteral route throughout life, or a condition known as Pernicious Anemia will develop, and can prove to be fatal. Regular IM injections on a monthly basis of 100-200ug is the usual therapeutic dose. .