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Endocrine Answer Key
Endodontics/Radiography (American Career College)
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1. A nurse is preparing to administer a client’s daily dose of NPH insulin at 0730. The nurse should expect this type of
insulin to peak within which of the following timeframes after administration?
A. 30 min to 3 hr
Rationale: Rapid-acting insulin peaks in 30 min to 3 hr. NPH insulin is not a rapid-acting insulin.
B. 1 to 5 hr
Rationale: Short-acting insulin peaks in 1 to 5 hr. NPH insulin is not short acting insulin.
C. 4 to 14 hr
Rationale: NPH insulin, an intermediate-acting insulin, peaks at 4 to 14 hr following administration.
D. 2 to 6 hr
Rationale: Long-acting insulin does not have a discernible peak level. NPH insulin is not long-acting insulin.
2. A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical manifestations should the
nurse expect to observe? (Select all that apply.)
A. Buffalo hump
B. Purple striations
C. Moon face
D. Tremors
E. Obese extremities
Rationale: Buffalo hump is correct. Cushing's syndrome is a disease caused by an increased production
of cortisol or by excessive use of corticosteroids. Buffalo hump, a collection of fat between the
shoulders, is a common manifestation of Cushing's syndrome.
Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts
are a common manifestation of Cushing's syndrome. This is due to the collection of body fat in
these areas.
Moon face is correct. Moon face is a common manifestation of Cushing's syndrome. Clients
who have this manifestation present with a round, red, full face.
Tremors is incorrect. Tremors are not a common finding of Cushing's syndrome.
Obese extremities is incorrect. Clients who have Cushing's syndrome have truncal obesity, a
protuberant abdomen, with thin extremities, which is due to an alteration in protein metabolism.
3. A nurse is preparing to administer levothyroxine 100 mcg PO to a client who has hypothyroidism. Available is
levothyroxine 50 mcg tablets. How many tablets should the nurse administer? (Round the answer to the nearest
whole number. Use a leading zero if it applies. Do not use a trailing zero.)
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2 tablets
Correct Rationale: Ratio and Proportion
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
What is the dose the nurse should administer? Dose to administer= Desired 100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg STEP 4: Should the
nurse convert the units of measurement? No STEP 5: What is the quantity of the dose
available? 1 tablet STEP 6: Set up an equation and solve for X. Have/Quantity =
Desired/X 50 mcg/1 tablet = 100/X tablet X = 2 tablets STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If there
are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2
tablets. The nurse should administer levothyroxine 2 tablets PO.
Desired Over Have
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
What is the dose the nurse should administer? Dose to administer= Desired 100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg STEP 4: Should the
nurse convert the units of measurement? No STEP 5: What is the quantity of the dose
available? 1 tablet STEP 6: Set up an equation and solve for X. Desired x Quantity/Have
= X 100 mcg x 1 tablet/50 mcg = XX = 2 tablets STEP 7: Round if necessary. STEP 8:
Reassess to determine whether the amount to administer makes sense. If there are 50
mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2 tablets. The
nurse should administer levothyroxine 2 tablets PO.
Dimensional Analysis
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
What is the quantity of the dose available? 1 tablet STEP 3: What is the dose available?
Dose available = Have 50 mcg STEP 4: What is the dose the nurse should administer?
Dose to administer= Desired 100 mcg STEP 5: Should the nurse convert the units of
measurement? No
STEP 6: Set up an equation and solve for X. X = Quantity/Have x Conversion
(Have)/Conversion (Desired) x Desired/ X tablet = 1 tablet/50 mcg x 100 mcg/1 X = 2
tabletsSTEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount
to administer makes sense. If there are 50 mcg/tablet and the prescription reads 100 mcg,
it makes sense to administer 2 tablets. The nurse should administer levothyroxine 2 tablets
PO.
InCorrect Rationale: Ratio and Proportion
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
What is the dose the nurse should administer? Dose to administer= Desired 100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg STEP 4: Should
the nurse convert the units of measurement? No STEP 5: What is the quantity of the
dose available? 1 tablet STEP 6: Set up an equation and solve for X. Have/Quantity =
Desired/X 50 mcg/1 tablet = 100/X tablet X = 2 tablets STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If there
are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2
tablets. The nurse should administer levothyroxine 2 tablets PO.
Desired Over Have
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
What is the dose the nurse should administer? Dose to administer= Desired 100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg STEP 4: Should
the nurse convert the units of measurement? No STEP 5: What is the quantity of the
dose available? 1 tablet STEP 6: Set up an equation and solve for X. Desired x
Quantity/Have = X 100 mcg x 1 tablet/50 mcg = XX = 2 tablets STEP 7: Round if
necessary. STEP 8: Reassess to determine whether the amount to administer makes
sense. If there are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to
administer 2 tablets. The nurse should administer levothyroxine 2 tablets PO.
Dimensional Analysis
STEP 1: What is the unit of measurement the nurse should calculate? Tablet STEP 2:
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What is the quantity of the dose available? 1 tablet STEP 3: What is the dose available?
Dose available = Have 50 mcg STEP 4: What is the dose the nurse should administer?
Dose to administer= Desired 100 mcg STEP 5: Should the nurse convert the units of
measurement? No
STEP 6: Set up an equation and solve for X. X = Quantity/Have x Conversion
(Have)/Conversion (Desired) x Desired/ X tablet = 1 tablet/50 mcg x 100 mcg/1 X = 2
tabletsSTEP 7: Round if necessary. STEP 8: Reassess to determine whether the
amount to administer makes sense. If there are 50 mcg/tablet and the prescription reads
100 mcg, it makes sense to administer 2 tablets. The nurse should administer
levothyroxine 2 tablets PO.
4. A nurse administers subcutaneous NPH insulin at 0700 to a child who has diabetes. At which of the following times
should the nurse observe for hypoglycemia caused by the onset of the medication?
A. 0715
Rationale: Insulin lispro, a rapid-acting insulin, has an expected onset of 15 min. NPH insulin is not a
rapid-acting insulin; therefore, the nurse should not observe for hypoglycemia caused by the
onset of the medication beginning at 0715.
B. 0730
Rationale: Regular insulin, a short-acting insulin, has an expected onset of 30 to 60 min. NPH insulin is not
a short-acting insulin; therefore, the nurse should not observe for hypoglycemia caused by the
onset of the medication beginning at 0730.
C. 0900
Rationale: NPH insulin is an intermediate-acting insulin, and has an expected onset of 1½ to 4 hr with a
peak of 4 to 12 hours. Therefore, the nurse should observe for hypoglycemia caused by the
onset of the medication beginning at 0900.
D. 1200
Rationale: NPH insulin is an intermediate-acting insulin, and has an expected onset of 1½ to 4 hr.
Therefore, the nurse should observe for hypoglycemia caused by the onset of the medication
before 1200.
5. A nurse is reviewing a client's admission laboratory findings that indicate the client has hyponatremia. Which of the
following laboratory findings should the nurse also expect to be below the expected reference range?
A. Magnesium
Rationale: Hyponatremia refers to a decrease in the sodium level. The loss of sodium does not result in the
loss of magnesium.
B. Calcium
Rationale: Hyponatremia refers to a decrease in the sodium level. The loss of sodium does not result in the
loss of calcium.
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C. Chloride
Rationale: Hyponatremia refers to a decrease in the sodium level. The loss of sodium, a positively-charged
ion, results in the loss of chloride, a negatively-charged ion, because these electrolytes have an
electrical attraction to each other.
D. Potassium
Rationale: Hyponatremia refers to a decrease in the sodium level. The loss of sodium does not result in the
loss of potassium.
6. A nurse is reinforcing teaching with a client who has diabetes mellitus and self-administers insulin. The client
reports drinking an occasional glass of wine. Which of the following is an appropriate response by the nurse?
A. “Wine is loaded with carbohydrates, so you should try to avoid it.”
Rationale: Wine contains carbohydrates in varying amounts and may raise the client’s blood glucose level
or place the client at risk of nighttime hypoglycemia. Limiting the number of drinks per day can
prevent diabetic complications.
B. “You may have no more than three drinks a day.”
Rationale: The client who has diabetes mellitus may drink alcohol in moderation. For women, that means
one drink or less per day and for men, two drinks or less per day because of the high
carbohydrate content.
C. “Drinking plenty of water with your wine will lessen its effects.”
Rationale: Water will not reduce the client’s risk of hypoglycemia when drinking alcohol. Alcohol beverages
are high in carbohydrates even when diluted.
D. “It is best for you to drink an occasional glass of wine with a meal.”
Rationale: Ingesting alcohol with a meal helps reduce the risk of nighttime hypoglycemia for clients who
receive insulin therapy.
7. A nurse in a provider's office is collecting data from a client who has hypothyroidism. Which of the findings should
the nurse expect?
A. Blurred vision
Rationale: Blurred vision is an expected finding for a client who has hyperthyroidism, not hypothyroidism.
B. Moist skin
Rationale: Moist skin is an expected finding for a client who has hyperthyroidism, not hypothyroidism.
C. Bradycardia
Rationale: Reduced thyroid hormone levels (hypothyroidism) reduce the body's metabolic rate and thus
slow down various body functions. Bradycardia reflects slowed cardiovascular function.
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D. Insomnia
Rationale: Insomnia is an expected finding for a client who has hyperthyroidism, not hypothyroidism.
8. A nurse is reinforcing teaching about manifestations of hypoglycemia with an adolescent who has type 1 diabetes
mellitus. Which of the following manifestations should the nurse include in the teaching?
A. Headache
Rationale: A headache is a manifestation of hypoglycemia. Other manifestations of hypoglycemia include
nervousness, dizziness, tachycardia, and sweating.
B. Acetone breath
Rationale: Acetone breath is a manifestation of hyperglycemia. A client who has hypoglycemia will have a
normal breath odor.
C. Rapid respirations
Rationale: Rapid respirations, or Kussmaul breathing, is a manifestation of hyperglycemia. A client who
has hypoglycemia will have shallow breathing.
D. Diminished reflexes
Rationale: Diminished reflexes is a sign of hyperglycemia. A client who has hypoglycemia will have
tremors.
9. A nurse is assisting with meal planning for a client who has hypothyroidism. The nurse should reinforce with the
client that she should increase her daily intake of which of the following nutrients?
A. Fiber
Rationale: Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase
her fiber and fluid intake to help prevent constipation.
B. Monounsaturated fats
Rationale: Because hypothyroidism slows the metabolic rate, weight gain is a common problem for clients
who have this disorder. They should follow a low-fat, low-calorie diet.
C. Protein
Rationale: Because hypothyroidism slows the metabolic rate, weight gain is a common problem for clients
who have this disorder. They should follow a low-fat, low-calorie diet. Protein in excessive
amounts can add unnecessary calories.
D. Polyunsaturated fats
Rationale: Because hypothyroidism slows the metabolic rate, weight gain is a common problem for clients
who have this disorder. They should follow a low-fat, low-calorie diet.
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10. A nurse is collecting data from a client who takes metformin for type 2 diabetes. Which of the following
medications is contraindicated for this client due its effect on blood glucose levels?
A. Ranitidine
Rationale: Medications that increase plasma glucose levels are contraindicated for this client. Ranitidine
can cause a reversible decreases in the WBC but does not affect blood glucose levels.
B. Cephalexin
Rationale: Medications that increase plasma glucose levels are contraindicated for this client. Cephalexin
can cause a false–positive urine glucose test result but does not affect blood glucose levels.
C. Prednisone
Rationale: Medications that increase plasma glucose levels are contraindicated for this client.
Corticosteroids, such as prednisone, increase plasma levels of glucose levels and cause
hyperglycemia and glycosuria.
D. Levothyroxine
Rationale: Medications that increase plasma glucose levels are contraindicated for this client.
Levothyroxine can cause insomnia and headaches but does not affect blood glucose levels.
11. A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about self-care during illness. Which
of the following instructions should the nurse include in the teaching?
A. "Test your blood glucose level every 6 hours."
Rationale: The nurse should instruct the client to test his blood glucose level every 3 to 4 hr.
B. "Administer your usual daily dose of insulin."
Rationale: The nurse should instruct the client to continue his usual daily dose of insulin during illness and
to eat small meals of carbohydrates to maintain blood glucose levels.
C. "Report a blood glucose level greater than 300."
Rationale: The nurse should instruct the client to report a blood glucose level that is greater than 200
mg/dL.
D. "Limit juices, soda, and gelatin."
Rationale: The nurse should the client to drink frequent carbohydrate drinks to prevent dehydration and
supply calories.
12. A nurse reviewing the laboratory of a client who had a total thyroidectomy discovers that his calcium level is
7mg/dL. Which of the following client findings should the nurse expect?
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A. Muscle tetany
Rationale: This calcium level is below the expected reference range. Therefore, the nurse should check
the client for tetany as a finding of hypocalcemia.
B. Hypertension
Rationale: Hypertension
C. Increased thirst
Rationale: The nurse should monitor for this finding in a client who has hypernatremia.
D. Diaphoresis
Rationale: The nurse should monitor for this finding in a client who has hypermagnesemia.
13. A nurse is reviewing a client’s medical record. Which of the following laboratory tests should the nurse examine to
determine risk factors for metabolic syndrome?
A. Liver function studies and bilirubin
Rationale: The nurse can review the client’s HDL cholesterol level, since a finding less than 40 mg/dl for
male clients or less than 50 mg/dL for female clients is a risk factor for metabolic syndrome.
B. Fasting glucose and triglycerides
Rationale: The nurse should review the client’s findings for a fasting glucose equal to or above 100 mg/dL,
a triglyceride level greater than 150 mg/dL, or taking medicine to treat either condition are risk
factors for metabolic syndrome. The nurse should also examine the client’s waist
circumference, HDL cholesterol level, and blood pressure readings.
C. CBC and BUN
Rationale: The nurse should review the client’s blood pressure, since a blood pressure at or above 130/85
mm Hg, or taking treatment for hypertension, are risk factors for metabolic syndrome.
D. Basic metabolic profile and troponin I
Rationale: The nurse can measure the client’s waist circumference, since a measurement greater than
102 cm (40 in) for men or 88 cm (35 in) for women is a risk factor for metabolic syndrome.
14. A nurse is reinforcing teaching with a client who has hypothyroidism and a prescription for levothyroxine. Which of
the following statements should the nurse make to the client?
A. "Take this medication until manifestations of hypothyroidism are gone and then discontinue."
Rationale: Medication replacement therapy is typically a lifelong treatment.
B. "Tremors, nervousness, and insomnia can indicate that your dose is too high."
Rationale:
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Tremors, nervousness, and insomnia can indicate an overdose of the medication and the
provider should be contacted.
C. "Take levothyroxine at bedtime daily."
Rationale: The client should take levothyroxine at the same time every morning to prevent insomnia.
D. "Levothyroxine will decrease your metabolic rate and body temperature."
Rationale: Levothyroxine treats hypothyroidism by acting on thyroid hormone receptors, which increases
metabolic rate, cardiac output, and body temperature.
15. A nurse is reinforcing teaching of a female client who has a family history of type 2 diabetes mellitus. The nurse
should include which of the following risk factors for developing type 2 diabetes mellitus in the teaching?
A. Recent viral infection
Rationale: Viral infections have been linked to the development of type 1 diabetes mellitus, but are not
associated with type 2 diabetes mellitus.
B. Blood glucose of 98 mg/dL
Rationale: The client is not at risk for type 2 diabetes mellitus with a blood glucose of 98 mg/dL, which is
within the normal reference range.
C. Triglyceride level of 100 mg/dL
Rationale: The client is not at risk for type 2 diabetes mellitus with triglyceride level of 100 mg/dL, which is
within the normal reference range.
D. Sedentary lifestyle
Rationale: Risk factors for the development of type 2 diabetes mellitus include obesity, a sedentary
lifestyle, and a high-calorie diet.
16. A nurse is caring for a client who is prescribed 15 units of NPH insulin to be administered at 0700. At which of the
following times of day is most appropriate for the nurse plan to offer a snack?
A. 0730
Rationale: The client is at risk for hypoglycemia due to taking insulin. However, since the onset of action
for NPH insulin is 1 to 2 hr after administration, there is another time that is more appropriate
for the nurse to offer a snack. Clients taking rapid acting insulin, such as insulin lispro, can
require food just before or immediately after insulin administration.
B. 0900
Rationale: The client is at risk for hypoglycemia due to taking insulin. However, since the onset of action
for NPH insulin is 1 to 2 hr after administration and the 0900 time frame falls just after
breakfast, there is another time is more appropriate for the nurse to plan to offer a snack.
Clients taking regular insulin are at high risk for hypoglycemia 2 hr after administration.
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C. 1230
Rationale: The client is at risk for hypoglycemia due to taking insulin. However, since the peak action for
NPH insulin begins 4 to 6 hr after administrations and the 1230 time frame falls just after lunch,
there is another time is more appropriate for the nurse to plan to offer a snack.
D. 1500
Rationale: Taking NPH insulin indicates that this client is at greatest risk for hypoglycemia about 8 hr after
administration, in the middle of the peak action time. The nurse should plan to offer the client a
snack during the middle of the afternoon between lunch and dinner to maintain the client’s
blood glucose level.
17. A nurse is assisting with the care of a client who 1 day postoperative following a thyroidectomy and reports severe
muscle spasms of the lower extremities. Which of the following actions should the nurse take?
A. Monitor the client's peripheral pulses.
Rationale: This client is experiencing hypocalcemia following a thyroidectomy, so there is no indication the
peripheral pulses are diminished. Therefore, there is no need for the nurse to monitor them at
this time.
B. Determine the client's calcium level.
Rationale: The nurse should determine the client's calcium level. A client who has had a thyroidectomy is
at risk of hypocalcemia due to possible disruption of the parathyroid gland during surgery. The
parathyroid glands are four small glands located inside the thyroid gland. They are responsible
for calcium regulation and, if they are damaged during a thyroidectomy, there is a risk of
hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers
and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive
reflexes. If a client develops any of these symptoms following a thyroidectomy, it would be
important to see what the latest calcium level is.
C. Administer intravenous normal saline solution.
Rationale: In acute hypercalcemia, rather than hypocalcemia, normal saline solution is administered to
dilute plasma calcium. In this client, administering fluids to dilute calcium would increase the
muscle spasms and cause the client's condition to deteriorate.
D. Give the client an oral potassium supplement.
Rationale: Giving the client an oral potassium supplement is indicated for hypokalemia, rather than
hypocalcemia. An oral potassium supplement would not improve this client's condition.
18. A nurse is caring for a client who has type 1 diabetes mellitus and observes mild hand tremors. Which of the
following snacks should the nurse offer the client after obtaining a glucometer reading of 60 mg/dL?
A. 4 oz of regular soda
Rationale: The nurse should plant to administer 15 to 20 g of fast-acting carbohydrates to treat the client’s
blood glucose. A half-cup of fruit juice or soda is appropriate treatment.
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B. One to two oral glucose tablets
Rationale: The nurse should provide the client with 3 to 4 oral glucose tablets to provide the appropriate
amount of carbohydrates.
C. Three to four pieces of hard candy
Rationale: The nurse should provide the client with 5 to 6 pieces of hard candy to provide the appropriate
amount of carbohydrates.
D. 6 oz of milk
Rationale: The nurse should provide the client with 8 oz of milk to provide the appropriate amount of
carbohydrates.
19. A nurse is reinforcing discharge teaching about self-administered peritoneal dialysis with a client. Which of the
following statements by the client indicates an understanding of the teaching?
A. "The fluid from my abdomen will be slightly cloudy."
Rationale: Fluid that is discolored, cloudy, or has an odor can indicate the presence of an infection. The
client should expect the dialysate output to be clear.
B. "The catheter can be handled using clean precautions."
Rationale: The client should use aseptic technique when handling the catheter and equipment to prevent
infection of the peritoneal cavity.
C. "I should use the microwave in my kitchen to warm the solution before using it."
Rationale: The client should use a dialysate warmer to warm the solution prior to use.
D. "The amount of the liquid output should be greater than what was put in."
Rationale: Dialysis is used to remove excess fluid and waste from the body. If less fluid is drained than
was initially instilled, the nurse should have the client change positions to allow the fluid to shift
in the abdomen so that the catheter can remove it.
20. A nurse is monitoring a client who received desmopressin (DDAVP) to treat diabetes insipidus. Which of the
following findings indicates effectiveness of the medication?
A. Serum sodium 150 mEq/L
Rationale: The nurse should recognize that diabetes insipidus causes hypernatremia. This finding is
above the expected reference range; therefore, this finding does not indicate effective
treatment.
B. Decreased blood pressure
Rationale: The nurse should recognize that diabetes insipidus causes hypotension; therefore, this finding
does not indicate effective treatment.
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C. Urine specific gravity 1.015
Rationale: Diabetes insipidus occurs when the posterior pituitary gland does not secrete enough
antidiuretic hormone causing excessive, diluted urine. Desmopressin provides replacement
posterior pituitary hormone; therefore, the nurse should identify a urine specific gravity level
within the expected reference range indicates effectiveness of the medication.
D. Increased heart rate
Rationale: The nurse should recognize that diabetes insipidus causes tachycardia; therefore, this finding
does not indicate effective treatment.
21. A nurse is collecting data from a client who has been taking methimazole for hyperthyroidism. For which of the
following findings should the nurse monitor to identify that the medication is effective?
A. Weight loss
Rationale: A client who has hyperthyroidism has an increased metabolism and is at risk for weight loss.
B. Decreased heart rate
Rationale: Hyperthyroidism results in an increase in physiologic processes such as elevated heart rate,
palpitations, insomnia, and agitation. Therefore, a decreased heart rate can indicate the
effectiveness of methimazole.
C. Increased urine output
Rationale: Hyperthyroidism results in an increase in physiologic processes such as thirst and increased
urinary output.
D. Elevated temperature
Rationale: Hyperthyroidism results in an increase in physiologic processes such as elevated temperature.
22. A nurse is caring for a client who has capillary blood glucose 48 mg/dL. Which of the following findings should the
nurse expect?
A. Tremors
Rationale: This finding is below the expected reference range. Hypoglycemic effects on the autonomic
nervous system include tremors, irritability, and anxiety.
B. Flushed skin
Rationale: This finding is below the expected reference range. The nurse should expect the client to have
pale skin.
C. Bradycardia
Rationale: This finding is below the expected reference range. The nurse should expect the client to have
tachycardia.
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D. Decreased appetite
Rationale: This finding is below the expected reference range. The nurse should expect the client to report
hunger.
23. A nurse is collecting data from a client who has Cushing's syndrome. Which of the following findings should the
nurse expect?
A. Butterfly rash
Rationale: A butterfly rash is a manifestation of systemic lupus erythematosus.
B. Moon face
Rationale: Moon face is a manifestation of Cushing's syndrome (hypercortisolism).
C. Positive Chvostek's sign
Rationale: A positive Chvostek's sign is a manifestation of primary aldosteronism.
D. Muscle hypertrophy
Rationale: Muscle atrophy is a manifestation of Cushing's syndrome.
24. A nurse is caring for a client who is taking levothyroxine for hypothyroidism. Which of the following indicates the
client's dose is too high?
A. Decreased temperature
Rationale: A client who has thyrotoxicosis from excessive amounts of thyroid hormone will more likely
have hyperthermia due to increased metabolic rate.
B. Bradycardia
Rationale: A client who has thyrotoxicosis from excessive amounts of thyroid hormone will more likely
have tachycardia due to stimulation of the heart.
C. Weight gain
Rationale: A client who has thyrotoxicosis from excessive amounts of thyroid hormone will more likely
have weight loss due to increased metabolic rate.
D. Tachypnea
Rationale: A client who has thyrotoxicosis from excessive amounts of thyroid hormone will have increased
metabolic processes, which will increase cardiac output and oxygen demand. The client's
respiratory and cardiac rate increase dramatically and the client can have weakness, insomnia,
tremulousness and agitation.
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25. A nurse is collecting data from a client who has hypoparathyroidism. Which of the following findings should the
nurse expect?
A. Flaccid muscles
Rationale: Excessive muscle contractions are a manifestation of hypoparathyroidism.
B. Numbness of the hands
Rationale: Numbness and tingling of the mouth or hands and feet results from associated hypocalcemia
and are manifestations of hypoparathyroidism.
C. Negative Chvostek’s sign
Rationale: A positive Chvostek's sign is a manifestation of hypoparathyroidism.
D. Hypercalcemia
Rationale: Hypocalcemia is a manifestation of hypoparathyroidism.
26. A nurse is collecting data from a client. The provider suspects the client may have syndrome of inappropriate
antidiuretic hormone (SIADH). When obtaining a medical history, the nurse should ask for additional information
about which of the following conditions? (Select all that apply.)
A. Osteoarthritis
B. Lung cancer
C. Liver cirrhosis
D. Dyspepsia
E. Seizures
Rationale: Osteoarthritis is incorrect. It is not necessary for the nurse to ask about osteoarthritis when
obtaining a medical history because it does not impact the secretion of antidiuretic hormone.
Lung cancer is correct. The nurse should ask the client about lung cancer when obtaining a
medical history because some of the treatment options for small cell lung cancer can cause
secretion of antidiuretic hormone. This results in the body retaining water and can cause
SIADH.Liver cirrhosis is incorrect. It is not necessary for the nurse to ask about liver cirrhosis
when obtaining a medical history because it does not impact the secretion of antidiuretic
hormone.Dyspepsia is incorrect. It is not necessary for the nurse to ask about dyspepsia
when obtaining a medical history because it does not impact the secretion of antidiuretic
hormone.Seizures is correct. The nurse should ask the client about seizures when obtaining a
medical history. Due to increase fluid volume, the excess results in hyponatremia which can
cause confusion.
27. A nurse is reinforcing discharge teaching with the parent of a child who has a new diagnosis of diabetes mellitus.
Which of the following statements by the parent requires a clarification of the teaching?
A. "The onset of low blood glucose usually occurs rapidly."
Rationale:
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Hypoglycemia typically occurs rapidly, within minutes.
B. "My son might complain of feeling shaky when he has a low blood glucose level."
Rationale: A shaky feeling is a consistent finding of hypoglycemia.
C. "Sweating can occur with hypoglycemia."
Rationale: The appearance of pallor and sweating occurs with hypoglycemia.
D. "My son might have nausea and vomiting with hypoglycemia."
Rationale: This statement requires clarification because nausea and vomiting occur with hyperglycemia.
28. A nurse in a clinic is caring for a client who has a new diagnosis of hypothyroidism. Which of the following findings
should the nurse expect?
A. Protruding eyeballs
Rationale: The nurse should expect protruding eyeballs (exophthalmos) in a client who has
hyperthyroidism.
B. Palpitations
Rationale: The nurse should expect a client who has hypothyroidism to have bradycardia.
C. Weight gain
Rationale: The nurse should expect the client to experience weight gain caused by a decreased metabolic
rate. The client may report anorexia and decreased dietary intake.
D. Diaphoresis
Rationale: The nurse should expect a client who has hypothyroidism to have coarse, dry skin.
29. A nurse is reviewing the medical record of a client who has hyperthyroidism (Graves' disease). Which of the
following serum laboratory findings should the nurse expect to be below the expected reference range?
A. Thyroid stimulating hormone (TSH) level
Rationale: Graves' disease is a form of primary hyperthyroidism resulting from impaired function of the
thyroid gland. The nurse should expect the TSH level to be below the expected reference
range, due to increased thyroid hormone levels.
B. Triiodothyronine (T3) level
Rationale: The nurse should expect the T3 level to be above the expected reference range.
C. Thyroxine (T4) level
Rationale: The nurse should expect the T4 level to be either within or above the expected reference
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range.
D. Glucose level
Rationale: The nurse should expect a client who has hypothyroidism to have a serum glucose level below
the expected reference range.
30. A nursing is reviewing nutrition therapy with a client who has Cushing's disease. Which of the following dietary
modifications should the nurse include in this discussion?
A. Limit potassium rich foods in the diet.
Rationale: The nurse should instruct the client to consume a high-potassium diet.
B. Decrease sodium intake.
Rationale: Clients who have Cushing's disease experience the impaired breakdown of nutrients resulting
in hypernatremia, hyperglycemia, and hypokalemia. Therefore, the nurse should instruct the
client to decrease sodium intake.
C. Increase calorie intake.
Rationale: The nurse should instruct the client to consume a low-calorie diet.
D. Consume more calories from carbohydrates than protein.
Rationale: The nurse should instruct the client to consume a low-carbohydrate diet. The client may require
extra protein due to impaired protein catabolism by the body.
31. A nurse is caring for a client who has diabetes insipidus. Which of the following findings should the nurse expect?
A. Decreased urine specific gravity
Rationale: The nurse should expect a client who has diabetes insipidus to experience dilute urine as a
result of excessive urinary output (about 15 L daily). Therefore, the nurse should expect a client
who has diabetes insipidus to have a urine specific gravity below the expected reference range
of 1.005 to 1.030.
B. Bounding peripheral pulses
Rationale: The nurse should expect weak peripheral pulses as a finding of diabetes insipidus.
C. Bradycardia
Rationale: The nurse should expect tachycardia as a finding of diabetes insipidus.
D. Moist mucous membranes
Rationale: The nurse should expect dry mucous membranes as a finding of diabetes insipidus.
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32. A nurse is caring for a client undergoing hemodialysis who will be discharged in the morning. Which of the
following client statements most influences the current plan of care?
A. "My son thinks that it will be safer for me to move to an apartment complex for older adults."
Rationale: The home living environment is important when planning for discharge. This statement says
that a change could take place and may need to be discussed with the client; however, this is
not the priority statement for the nurse to address.
B. "My neighbor who drives me everywhere wrecked the car this morning."
Rationale: When using Maslow’s hierarchy of needs, the nurse determines the priority finding is the
client’s lack of transportation. Clients receiving hemodialysis will require access to
transportation to the dialysis center several times each week. It is essential for the nurse to
communicate this information to the interdisciplinary team. It may be necessary for the social
worker to arrange for transportation within the next few days for the client to receive
hemodialysis. The nursing staff also would need to adjust teaching to ensure the client knows
how to contact resources by phone for follow-up care that would require transportation.
C. "Every time I leave home, I worry about who will take care of my little dog."
Rationale: It is important for the nurse to listen to clients who are sharing home concerns that affect the
response to health care. Although this client concern can be important in adherence to the
treatment plan, this is not the priority statement for the nurse to address.
D. "I just hate feeling so useless. Getting older and sicker is frustrating."
Rationale: The nurse should address the client’s feelings of frustration by implementing choices that
promote independence and a sense of empowerment; however, this is not the priority
statement for the nurse to address.
33. A nurse is caring for a client who has type I diabetes mellitus and is not adhering to guidelines for therapy. Which
of the following factors should the nurse consider as contributing to the nonadherence? (Select all that apply.)
A. Gender
B. Culture
C. Allergies
D. Dexterity
E. Motivation
Rationale: Gender is incorrect. There is no documented research to support gender as a basis for
nonadherence to therapy.Culture is correct. Cultural heritage, beliefs, practices, values, and
traditions can significantly affect a client’s adherence or nonadherence to a prescribed therapy.
Allergies is incorrect. A client’s allergies can affect the choice of medications used for
treatment, but they do not contribute to a client’s nonadherence to therapy.Dexterity is
correct. Dexterity, physical strength, endurance, movement, and coordination all can affect the
client’s ability to manipulate equipment for glucose monitoring and medication administration.
Motivation is correct. It is important to monitor the client’s motivation to follow the prescribed
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treatment plan. The client’s perception of the seriousness of the illness also can affect
adherence.
34. A nurse is assisting with the plan of care for a client who is 4 hr postoperative from a subtotal thyroidectomy.
Which of the following implementations should the nurse recommend?
A. Place the client in a side-lying position.
Rationale: The nurse should place the client in Fowler’s position with the head and neck supported by
sandbags. This position promotes oxygenation and reduces stress on the surgical incision.
B. Ensure that acetylcysteine IV is readily available.
Rationale: Acetylcysteine is the antidote for acetaminophen and is not needed for this client. The nurse
should assure that calcium chloride IV or calcium gluconate is readily available because the
client is at risk for hypocalcemia due to accidental removal of the parathyroid glands.
C. Check the client for Asterixis.
Rationale: The nurse should check a client who has cirrhosis for Asterixis. The nurse should check the
client who is postoperative from a subtotal thyroidectomy for a positive Chvostek's sign.
D. Check for bleeding on the dressing at the back of the client’s neck.
Rationale: The client is at risk for hemorrhage due to the vascularity of the surrounding tissue. The nurse
should check the dressing on the back of the client’s neck for evidence of hemorrhage
35. A nurse finds a client who has type 1 diabetes mellitus lying in bed, sweating, tachycardic, and reporting feeling
lightheaded and shaky. Which of the following complications should the nurse suspect?
A. Hypoglycemia
Rationale: The client who has hypoglycemia manifests sweating, tachycardia, tremors, palpitations,
hunger, and lightheadedness.
B. Nephropathy
Rationale: The client who has diabetic nephropathy manifests hypertension, lethargy, drowsiness,
headache, and dry skin and mucous membranes.
C. Hyperglycemia
Rationale: The client who has hyperglycemia manifests dry skin and mucous membranes, rapid
respirations, and changes in consciousness.
D. Ketoacidosis
Rationale: The client who has ketoacidosis manifests tachycardia, but also dry mucous membranes,
altered consciousness, seizures, and hypotension.
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36. A nurse receives a new prescription from the provider that reads "Give regular insulin 14 units and NPH insulin 28
units subcutaneously at breakfast." How many syringes should the nurse prepare?
1 syringe
Correct Rationale: The nurse may mix regular insulin and NPH insulin in the same syringe because they are
compatible; therefore, to minimize injury the nurse should administer the insulin with the
least number of injections and use only one syringe.
InCorrect Rationale: The nurse may mix regular insulin and NPH insulin in the same syringe because they
are compatible; therefore, to minimize injury the nurse should administer the insulin
with the least number of injections and use only one syringe.
37. A nurse is assisting with the plan of care for a client who has hypothyroidism with myxedema. Which of the
following interventions should the nurse include in the plan of care?
A. Check the client for weight loss.
Rationale: The nurse should check the client for weight gain, not weight loss, associated with myxedema
because of his slowed metabolic rate.
B. Apply warm blankets.
Rationale: The nurse should apply warm blankets to the client because he may have cold intolerance
related to hypothyroidism.
C. Limit high-fiber foods.
Rationale: The nurse should offer high-fiber food to help move feces through the intestines by increasing
fecal mass. The client who has hypothyroidism has constipation due to the slowed metabolism.
D. Place the client on bedrest.
Rationale: The nurse should encourage the client who has hypothyroidism to exercise and rest due to
decrease metabolism. Activity also stimulates peristalsis, which will help with constipation.
38. A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for lispro and Lantus
insulins. Which of the following statements by the client indicates an understanding of the teaching?
A. "Insulin injected into the thigh is the most rapidly absorbed."
Rationale: Insulin injected into the abdomen is the most rapidly absorbed, followed by the arms, thighs,
and buttocks.
B. "Unopened vials of insulin should be kept in my refrigerator."
Rationale: Prior to opening vials of insulin, they should be stored in the refrigerator. After opening, insulin
can be stored in a cool place for up to 4 weeks.
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C. "I should shake the bottle of insulin before withdrawing the medication."
Rationale: The client should roll the insulin vial to ensure that it is adequately suspended and to avoid the
bubbles that are created by shaking the vial.
D. "I will use Lantus insulin immediately before each meal."
Rationale: The client should use lispro insulin prior to eating because it is a short-acting insulin with an
onset of 15 min and duration of 3 to 4 hr. Lantus insulin is a long-acting (basal) insulin with an
onset of 2 hr and duration of 24 hr.
39. A nurse is caring for a client who is postoperative following a thyroidectomy. Which of the following is a priority for
the nurse to monitor during the first 24 hr of care for this client?
A. Airway patency
Rationale: When using the airway, breathing, circulation approach to client care, the nurse determines that
the priority to monitor is airway patency. A thyroidectomy can result in edema or bleeding that
can obstruct the airway. Provide humidification and elevate the client's head of bed to reduce
swelling.
B. Hoarseness
Rationale: The nurse should monitor the client’s speech to check for hoarseness that can indicate
laryngeal nerve damage; however, another data is the priority to monitor.
C. Visual deficits
Rationale: The nurse should monitor the client's vision for visual changes that are caused by
hyperthyroidism and not corrected by the thyroidectomy; however, another data is the priority to
monitor.
D. Pain control
Rationale: The nurse should monitor the client's level of pain to promote comfort; however, another data is
the priority to monitor.
40. A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client’s morning fasting
blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a
reading over 200 mg/dL. Which of the following actions should the nurse identify as the priority?
A. Give the client 15 to 20 g of carbohydrate.
Rationale: It might become necessary to administer a ready source of carbohydrate to counteract the
effects of the unnecessary dose of inulin; however, there is another action that is the nurse’s
first priority.
B. Check the client’s blood glucose level.
Rationale: The first action the nurse should take using the nursing process is to assess or collect data
from the client. The nurse should immediately check the client’s blood glucose level, expecting
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it to be low because of the unnecessary dose of insulin. If it is within the expected reference
range, the nurse should continue to monitor the client for hypoglycemia.
C. Complete an incident report.
Rationale: The nurse will have to complete an incident report detailing the medication error; however,
there is another action that is the nurse’s first priority.
D. Notify the nurse manager.
Rationale: The nurse will have to notify the nurse manager about the medication error; however, there is
another action that is the nurse’s first priority.
41. A nurse is reinforcing teaching for a client who has diabetes mellitus and has a prescription for insulin detemir
injections once daily. Which of the following statements by the client indicates an understanding of the teaching?
A. "If my blood sugar is high, I can mix a dose of regular insulin with my insulin detemir."
Rationale: Insulin detemir should not be mixed with any other insulin in the same syringe.
B. "I should inject by insulin detemir 30 min before a meal to lower my blood sugar."
Rationale: Insulin detemir is absorbed slowly and does not need to be taken before a meal.
C. "I can inject my insulin detemir in the evening before bedtime."
Rationale: When prescribed once daily, insulin detemir is injected in the evening, either with the evening
meal or at bedtime.
D. "I don't have to worry about hypoglycemia while taking insulin detemir."
Rationale: As with other types of insulin, the client should be instructed to monitor for hypoglycemia when
taking insulin detemir and should also learn how to manage manifestations of hypoglycemia.
42. A nurse is reinforcing teaching with a client who is to self-administer regular insulin and NPH insulin from the same
syringe. Which of the following instructions should the nurse provide?
A. Draw up the NPH insulin into the syringe first.
Rationale: The nurse should teach the client that when mixing regular and NPH insulin in the same
syringe, the client should draw up the regular insulin into the syringe first to prevent
contamination of the vial of short acting insulin.
B. Inject air into the regular insulin first.
Rationale: The nurse should teach the client that air should be injected into the NPH vial first and that he
should avoid allowing the end of the needle from coming in contact with the NPH insulin.
C. Shake the NPH insulin until it is well-mixed.
Rationale: The nurse should teach the client to roll the vial of NPH insulin between the palms of the
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hands. The client should avoid shaking the insulin vial because this will cause the insulin
solution to form bubbles, which can result in inaccurate dosage.
D. Discard regular insulin if it appears cloudy.
Rationale: The nurse should teach the client to discard regular insulin that appears cloudy. All insulin
preparations except NPH should be clear. NPH insulin has a cloudy appearance.
43. A nurse is caring for a client who has hyperparathyroidism. Based on this diagnosis, the nurse should monitor the
client for which of the following complications?
A. Impaired skin integrity
Rationale: Impaired skin integrity is not a complication of hyperparathyroidism.
B. Fluid retention
Rationale: Fluid retention is not a complication of hyperparathyroidism.
C. Pathologic fractures
Rationale: Hyperparathyroidism results in the release of calcium and phosphate into the blood, which
decreases bone density and places the client at risk for pathologic fractures.
D. Dysphagia
Rationale: Dysphagia is not a complication of hyperparathyroidism.
44. A nurse is reviewing the laboratory report of a client who has hypoparathyroidism. The nurse should expect which
of the following values?
A. Vitamin D 25 ng/mL
Rationale: This vitamin D level is within the expected reference range. The nurse should expect a client
who has hypoparathyroidism to have a decreased vitamin D level.
B. Magnesium 1.8 mEq/L
Rationale: This magnesium level is within the expected reference range. The nurse should expect a client
who has hypoparathyroidism to have a decreased magnesium level.
C. Calcium 9.8 mg/dL
Rationale: This calcium level is within the expected reference range. The nurse should expect a client who
has hypoparathyroidism to have a decreased calcium level.
D. Phosphate 5.7 mg/dL
Rationale: This phosphate level is above the expected reference range, which is expected with a
diagnosis of hypoparathyroidism.
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45. A nurse is preparing to administer levothyroxine 100 mcg PO daily. Available is levothyroxine 50 mcg tablets. How
many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if
it applies. Do not use a trailing zero.)
2 tablet(s)
Correct Rationale: Ratio and Proportion
STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: Should the nurse convert the units of measurement? No
STEP 5: What is the quantity of the dose available? 1 tablet
STEP 6: Set up an equation and solve for X.
Have/Quantity = Desired/X
50 mcg/1 tablet = 100 mcg/X tablet
X=2
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If there
are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2
tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
Desired Over Have
STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: Should the nurse convert the units of measurement? No
STEP 5: What is the quantity of the dose available? 1 tablet
STEP 6: Set up an equation and solve for X.
Desired x Quantity/Have = X
100 mcg x 1 tablet/50 mcg = X
2=X
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If there
are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2
tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
Dimensional Analysis
STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the quantity of the dose available? 1 tablet
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 5: Should the nurse convert the units of measurement? No
STEP 6: Set up an equation and solve for X.
X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired/
X = 1 tablet/50 mcg x 100 mcg/
X=2
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If there
are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to administer 2
tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
InCorrect Rationale: Ratio and Proportion
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STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: Should the nurse convert the units of measurement? No
STEP 5: What is the quantity of the dose available? 1 tablet
STEP 6: Set up an equation and solve for X.
Have/Quantity = Desired/X
50 mcg/1 tablet = 100 mcg/X tablet
X=2
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If
there are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to
administer 2 tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
Desired Over Have
STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: Should the nurse convert the units of measurement? No
STEP 5: What is the quantity of the dose available? 1 tablet
STEP 6: Set up an equation and solve for X.
Desired x Quantity/Have = X
100 mcg x 1 tablet/50 mcg = X
2=X
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If
there are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to
administer 2 tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
Dimensional Analysis
STEP 1: What is the unit of measurement the nurse should calculate? tablet
STEP 2: What is the quantity of the dose available? 1 tablet
STEP 3: What is the dose available? Dose available = Have 50 mcg
STEP 4: What is the dose the nurse should administer? Dose to administer = Desired
100 mcg
STEP 5: Should the nurse convert the units of measurement? No
STEP 6: Set up an equation and solve for X.
X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired/
X = 1 tablet/50 mcg x 100 mcg/
X=2
STEP 7: Round if necessary.
STEP 8: Reassess to determine whether the amount to administer makes sense. If
there are 50 mcg/tablet and the prescription reads 100 mcg, it makes sense to
administer 2 tablets. The nurse should administer levothyroxine 2 tablets PO per dose.
46. A nurse is collecting data on a client who is receiving liothyronine for treatment of hypothyroidism. Which of the
following findings should the nurse recognize as a therapeutic response to this medication?
A. Loss of appetite
Rationale: A decline in appetite is a manifestation of hypothyroidism. Effective treatment should result in
increased appetite.
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B. Increase in daily weight
Rationale: An increase in weight is a manifestation of hypothyroidism. Effective treatment should not
cause weight gain.
C. Improvement of overall mood
Rationale: Depression, lethargy, and fatigue are manifestations of hypothyroidism. Effective treatment
should result in an increase in energy and mood. Liothyronine is a synthetic preparation of
triiodothyronine (T3), a naturally occurring thyroid hormone. Liothyronine is used to treat and
improve the manifestations of hypothyroidism, which include anorexia, depression, lethargy,
fatigue, cold and dry skin, a pale and puffy face, brittle hair, decreased heart rate, decreased
temperature, weight gain, and intolerance to cold.
D. Decrease in body temperature
Rationale: A decrease in body temperature is a manifestation of hypothyroidism. Effective treatment
should cause body temperature to be within expected reference range.
47. A nurse is reinforcing teaching with a client who takes prednisone orally to prevent organ rejection following a
kidney transplant. Which of the following statements by the client indicates an understanding of the teaching?
A. "I will plan to come to the clinic for periodic testing of my blood glucose."
Rationale: Long-term use of prednisone can cause glucose intolerance even in clients who do not have
diabetes. Therefore, periodic testing for blood glucose is recommended.
B. "I will avoid drinking grapefruit juice while taking this medication."
Rationale: Although clients should avoid drinking grapefruit juice while taking many medications, including
statins, grapefruit juice does not alter the absorption of prednisone.
C. "I will stop taking the medication immediately if I develop a fever."
Rationale: A fever can indicate the presence of infection, which is a risk factor associated with prolonged
prednisone therapy. The client should notify the provider. If discontinuation of the medication is
necessary, the dose is tapered rather than stopped immediately to prevent withdrawal
syndrome.
D. "I will avoid crushing the prednisone tablet."
Rationale: Clients who have difficulty swallowing the tablet can crush it.
48. A nurse is reinforcing teaching for a client who has type 2 diabetes mellitus and is prescribed glipizide. The client
should be taught that glipizide works in which of the following ways?
A. Glipizide promotes the breakdown of glycogen to glucose.
Rationale: Glucagon is used for the hypoglycemia of insulin overdose by promoting the breakdown of
glycogen to glucose.
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B. Glipizide stimulates the pancreas to release adequate insulin.
Rationale: Glipizide is a sulfonylurea agent. It helps lower blood glucose levels by increasing insulin
secretion from the beta cells of the pancreas.
C. Glipizide blocks glucose production in the liver.
Rationale: Metformin, a biguanide medication for type 2 diabetes mellitus, blocks glucose production in
the liver.
D. Glipizide slows gastric emptying and decreases appetite.
Rationale: Exenatide, an incretin mimetic, is an injectable medication for type 2 diabetes, which among
other actions, slows gastric emptying and decreases appetite.
49. A nurse is collecting data from a client who has diabetes mellitus. The client is confused, flushed, and has an
acetone odor on his breath. The nurse should anticipate a prescription for which of the following types of insulin to
treat the client?
A. Detemir
Rationale: Insulin detemir is a long-acting insulin and is contraindicated for use in clients who are
experiencing diabetic ketoacidosis.
B. Regular
Rationale: Regular insulin is the type of insulin used in the emergency treatment of diabetic ketoacidosis
to reduce hyperglycemia and acidosis. It is the only insulin that can be given by IV and it has
an onset of action as rapid as 30 min.
C. Glargine
Rationale: Insulin glargine is a long-acting insulin that is used in the treatment of diabetes mellitus.
However, it is not used for the treatment of diabetic ketoacidosis.
D. NPH
Rationale: NPH insulin is an intermediate-acting insulin and is contraindicated for use in clients who are
experiencing diabetic ketoacidosis.
50. A nurse is teaching a newly licensed nurse about insulin storage. Which of the following statements by the newly
licensed nurse indicates an understanding of the teaching?
A. "I will store unopened vials of insulin in the freezer."
Rationale: Unopened vials of insulin should be stored in the refrigerator but not frozen.
B. "I will return any unused vials of insulin to the pharmacy once they have been on the unit for 1 month."
Rationale: The nurse can use unopened vials of insulin stored under refrigeration until the date of
expiration on the vial.
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C. "I will discard the current vial of insulin after six doses have been withdrawn."
Rationale: The nurse can administer as many doses as needed from the current vial of insulin for up to 1
month.
D. "I can keep the current vial of insulin in use stored at room temperature."
Rationale: The nurse can store the current vial of insulin at room temperature for up to 1 month.
51. A nurse is reinforcing teaching with a client who is taking metformin XR for type II diabetes mellitus. Which of the
following information should the nurse include in the teaching?
A. "Take the medication with a meal."
Rationale: The client should take metformin with a meal to avoid hypoglycemia and gastrointestinal upset.
B. "You may crush or chew the medication."
Rationale: The client should take the medication whole.
C. "This medication can cause an increase in perspiration."
Rationale: Metformin does not cause an increase in perspiration. Sweating can indicate a hypoglycemic
reaction.
D. "This medication can turn your urine orange."
Rationale: Metformin does not alter the color of urine.
52. A nurse is reinforcing teaching to a client who has diabetes mellitus and is to start taking chlorpropamide. The
nurse should teach the client to avoid consumption of which of the following while taking this medication?
A. Grapefruit
Rationale: Grapefruit consumption does not cause an interaction with chlorpropamide.
B. Milk
Rationale: Milk consumption does not cause an interaction with chlorpropamide.
C. Alcohol
Rationale: Chlorpropamide is first generation sulfonylurea that can interact with alcohol to cause a
disulfiram-like reaction. This can lead to flushing, palpitations, and nausea. In addition, alcohol
can promote the hypoglycemic effect of chlorpropamide, causing the client’s blood glucose
level to decrease and cause injury.
D. Shellfish
Rationale: Shellfish consumption does not cause an interaction with chlorpropamide.
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53. A nurse is collecting data on a client who has hyperthyroidism. Which of the following manifestations should the
nurse expect the client to report?
A. Frequent mood changes
Rationale: Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones
that regulate the metabolic rate. Nervousness and frequent mood changes; hand tremors; a
rapid, pounding, irregular heartbeat are common manifestations of hyperthyroidism.
B. Constipation
Rationale: Constipation is a manifestation of hypothyroidism.
C. Sensitivity to cold
Rationale: Heat intolerance and diaphoresis is a manifestation of hyperthyroidism.
D. Weight gain
Rationale: Weight gain is a manifestation of hypothyroidism.
54. A nurse is reviewing data for a client who has a head injury. Which of the following findings should indicate to the
nurse that the client might have diabetes insipidus?
A. Serum sodium 145 mEq/L
Rationale: A client who has diabetes insipidus will have an elevated serum sodium level. This client's
serum sodium level is within the expected range.
B. Urine specific gravity 1.028
Rationale: With diabetes insipidus, the specific gravity of the client's urine will be below the expected
reference range. This client's urine specific gravity is within the expected range.
C. Urine output 650 mL/hr
Rationale: Diabetes insipidus is an endocrine disorder of the anterior pituitary gland. A decrease in
antidiuretic hormone results in an increasingly high output of very dilute urine.
D. Blood glucose 198 mg/dL
Rationale: Diabetes mellitus can cause an elevated serum glucose level.
55. A nurse is caring for a client who is postoperative and has a history Addison's disease. For which of the following
manifestations should the nurse monitor?
A. Hypernatremia
Rationale: The client who has Addison's disease is at risk for developing Addisonian crisis following a
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major physiological stressor such as surgery. The nurse should monitor for the development of
hyponatremia and dehydration in the client who is at risk for Addisonian crisis.
B. Hypotension
Rationale: The client who has Addison's disease is at risk for developing Addisonian crisis following a
major physiological stressor such as surgery. Manifestations such as hypotension and
tachycardia, extreme weakness and a decrease in mental status are noted. Untreated,
Addisonian crisis may result in death.
C. Bradycardia
Rationale: The client who has Addison's disease is at risk for developing Addisonian crisis following a
major physiological stressor such as surgery. Manifestations the nurse should monitor for
include tachycardia.
D. Hypokalemia
Rationale: The client who has Addison's disease is at risk for developing Addisonian crisis following a
major physiological stressor such as surgery. The nurse should monitor for the development of
hyperkalemia and dysrhythmias in the client who is at risk for Addisonian crisis.
56. A nurse is reinforcing teaching with a client who has diabetes mellitus type 1 about sick-day management. Which
of the following is the priority action for the nurse to recommend to the client?
A. "Consume 15 grams of carbohydrates every 1 to 2 hours."
Rationale: The nurse should include the importance of maintaining nutritional intake during periods of
illness. If the client is nauseated or has difficulty eating food, the nurse should recommend
gelatin, flavored ice pops, or regular soft drinks; however, another action is the priority.
B. "Monitor blood glucose levels every 4 hours."
Rationale: The greatest risk to the client is the development of diabetic ketoacidosis, which results from an
absence of insulin and manifests as elevated blood glucose levels. Therefore, the most
important action for the client to take is to monitor the blood glucose level frequently.
C. "Drink 8 ounces of fluid every hour while awake."
Rationale: The nurse should include the importance of fluid intake to prevent dehydration in the client who
is ill; however, another action is the priority.
D. "Take the usual dosage of insulin."
Rationale: The nurse should emphasize the importance of continued insulin use, even in the event of
illness, as the client who has diabetes mellitus type 1 is unable to manufacture insulin. Failure
to take insulin results in the body metabolizing fat to meet metabolic needs. This causes an
increase in circulating ketones and predisposes the client to the development of diabetic
ketoacidosis. Another action, however, is the priority.
57. A nurse is reinforcing teaching about insulin injections with a client who is newly diagnosed with type I diabetes
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mellitus. Which of the following information should the nurse include about site selection?
A. Rotate the injection site to keep insulin levels consistent.
Rationale: The nurse should educate the client to rotate injection sites in the same anatomic area to
decrease lipoatrophy, which is a loss of fat under the skin in the area of the injections.
B. Use cold insulin for injection to minimize site pain.
Rationale: The nurse should instruct the client to warm the insulin to room temperature to minimize
injection pain.
C. Insulin is absorbed most rapidly when injected in the thigh.
Rationale: The nurse should inform the client that insulin is absorbed most rapidly from the abdominal
tissue. It is absorbed a little slower from the arms, then the thighs, with the buttocks being the
site of slowest absorption.
D. Massage the site after injection to promote absorption.
Rationale: The nurse should instruct the client not to massage the injection site because it can decrease
insulin absorption.
58. A nurse is reinforcing teaching for a client who has type 1 diabetes mellitus about foot care. Which of the following
client statements should indicate to the nurse an understanding of the instructions?
A. "I'll wear sandals in warm weather."
Rationale: The client should not wear open-toed shoes or sandals. Open-toe and open-back sandals
increase the risk of foot injuries.
B. "I'll put lotion between my toes."
Rationale: The client should apply lotion to dry areas of the feet, but not between his toes, because it can
create a moist environment that promotes bacterial growth.
C. "I'll check my feet every day for sores and bruises."
Rationale: The client should check his feet daily to monitor for any problems and observe any other
changes before they become serious. He can use a hand mirror to examine areas that are
difficult for him to see.
D. "I'll soak my feet in warm, soapy water every night before I go to bed."
Rationale: The client should not soak his feet for prolonged periods of time, because this can increase the
risk of infection.
59. A nurse is checking the laboratory results of a client who is at risk for diabetes mellitus. Which of the following
laboratory results indicates to the nurse that the client is at risk for diabetes mellitus?
A. HbA1c 5.2%
Rationale:
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The client who has an HbA1c of 5.2% is within the expected reference range. An HbA1c level
between 5.5% and 6.0% is considered an indicator of risk for diabetes mellitus.
B. 2-hr blood glucose 132mg/dL
Rationale: The client who has a 2-hr blood glucose of 132 mg/dL is within the expected reference range.
Values of 140 mg/dL to 199 mg/dL for a 2-hr blood glucose place the client at risk for diabetes
mellitus.
C. Fasting blood glucose155 mg/dL
Rationale: The client who has a fasting blood glucose level above 126 mg/dL is at risk for diabetes
mellitus.
D. Casual blood glucose 178 mg/dL
Rationale: The client who has a casual blood glucose level of 178 mg/dL is within the expected reference
range.
60. A nurse is reinforcing teaching about preventing long-term complications of retinopathy and neuropathy with an
older adult client who has diabetes mellitus. Which of the following actions is the most important for the nurse to
include in the teaching?
A. "Plan to have an eye examination once per year."
Rationale: The nurse should instruct the client who has retinopathy to have an annual eye examination for
early detection of complications; however, another action is the priority.
B. "Examine your feet carefully every day."
Rationale: The nurse should instruct the client who has neuropathy to examine his feet carefully every day
to detect skin alterations; however, another action is the priority.
C. "Wear closed-toed shoes daily."
Rationale: The nurse should instruct the client to wear closed-toed shoes daily to prevent the increase risk
of foot injury; however, another action is the priority.
D. "Maintain stable blood glucose levels."
Rationale: The greatest risk for the client is injury from hyperglycemia that contributes to neuropathic
disease, microvascular complications, and risk factors for macrovascular complications.
Therefore, the most important action is for the client to maintain stable blood glucose levels.
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