Lisette’s NCLEX MED SURG Study #1

A 62-year-old client is admitted for hypertension, and serum electrolyte studies have yielded abnormal results. The scheduled workup includes a scan for an aldosteronoma. The nurse concludes that this scan is ordered to rule out disease of the:

1. Kidney cortex

2. Thyroid gland

3. Pituitary gland

4. Adrenal cortex (Nugent 28-29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 An aldosteronoma is an aldosterone-secreting adenoma of the adrenal cortex.

1 An aldosteronoma is not a tumor of the kidney cortex.

2 An aldosteronoma is not a tumor of the thyroid gland.

3 An aldosteronoma is not a tumor of the pituitary gland. (Nugent 110)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with an aldosterone-secreting adenoma is scheduled for surgery to remove the tumor. The client wonders what will happen if surgery is canceled. The nurse bases a response on the fact that:

1. Heart and kidney damage may occur if the tumor is not removed

2. Surgery will prevent the tumor from metastasizing to other organs

3. Chemotherapy is as reliable as surgery to treat adenomas of this type

4. Radiation therapy or surgery can be just as effective if the tumor is small (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Renal and cardiac complications will occur if hypertension is not arrested.

2 An aldosteronoma is a benign tumor; metastasis is not possible.

3 Drugs are not used; the tumor must be removed.

4 This is not true; the tumor must be removed by surgical means. (Nugent 110)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Late in the postoperative period after resection of an aldosterone-secreting adenoma, the nurse expects the client’s blood pressure to:

1. Gradually return to near normal levels

2. Rise quickly above the preoperative level

3. Fluctuate greatly during this entire period

4. Drop very low, then increase rapidly to normal levels (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Once the excessive secretion of aldosterone is stopped, the blood pressure gradually drops to a near normal level.

2 The blood pressure drops gradually; it does not rise.

3 Blood pressure will fluctuate if the hypervolemia is overcorrected; this is not expected.

4 The blood pressure drops gradually in response to decreasing serum corticosteroid levels; a rapid drop immediately after surgery may indicate hemorrhage. (Nugent 110)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The wife of a client who has had a resection of an aldosterone-secreting tumor of an adrenal gland says, “I hope this is the end of the problem and that my husband will be back to work soon.” Based on an understanding of the health problem, the nurse should:

1. Caution the wife about high expectations because the outcome for this problem is variable

2. Explain that surgery will effect a cure because the remaining adrenal gland will meet the body’s needs

3. Advise the wife to investigate other occupational alternatives for her husband if he plans to return to work

4. Tell her that although her husband will require hormone supplements for the rest of his life, he should be able to work (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The body has two adrenal glands; an aldosteronoma is a unilateral tumor.

1 The prognosis usually is excellent; this is unnecessarily alarming.

3 This is unnecessary; the prognosis usually is excellent.

4 Hormones are not necessary; there is another adrenal gland that will secrete an adequate amount of hormones. (Nugent 110)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse expects the diagnostic studies of a client with Cushing’s syndrome to indicate:

1. Moderately increased serum potassium levels

2. Increased numbers of eosinophils in the blood

3. High levels of 17-ketosteroids in a 24-hour urine test

4. Normal to low levels of adrenocorticotropic hormone (ACTH) (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This is a urinary metabolite of steroid hormones that are excreted in large amounts in hyperaldosteronism.

1 With aldosterone hypersecretion, sodium is retained and potassium is excreted, resulting in hypernatremia and hypokalemia.

2 With Cushing’s syndrome, the eosinophil count is decreased, not increased.

4 ACTH levels usually are high in Cushing’s syndrome. (Nugent 110-111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A female client has a tentative diagnosis of Cushing’s syndrome. The nurse’s physical assessment of this client probably will reveal the presence of:

1. Fever and tachycardia

2. Lethargy and constipation

3. Hypertension and moon face

4. Hyperactivity and exophthalmos (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Increased glucocorticoids cause sodium and water retention, hypertension, and fat deposition, resulting in a moon face.

1 These characteristics are associated with hyperthyroidism.

2 These characteristics are associated with hypothyroidism.

4 These characteristics are associated with hyperthyroidism. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 49-year-old female is admitted to the hospital with a possible diagnosis of Addison’s disease. What is an important nursing responsibility during a 24-hour urine collection for the client suspected of having Addison’s disease?

1. Keep the client quiet and reduce stress

2. Assess the client for signs and symptoms of edema

3. Monitor the client for an elevation in blood pressure

4. Restrict the client’s fluid intake during the day of the test (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Stress and activity increase the secretion of ACTH and adrenocortical hormones, elevating the urine values for the byproducts of these hormones, thus invalidating the test results.

2 Clients with Addison’s disease are chronically dehydrated and do not have edema.

3 Because of fluid deficits, the client will be hypovolemic and the blood pressure will be decreased.

4 Adequate fluid intake is necessary for urine production; Addison’s disease involves salt wasting and dehydration, which necessitates an increased fluid intake, not a restriction of fluid intake. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A female college freshman visits the health center because she feels nervous, irritable, and extremely tired. She complains that, although she eats large amounts of food, she has frequent bouts of diarrhea and is losing weight. The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be ordered to determine the cause of these signs and symptoms?

1. PTT and PT

2. T3, T4, and TSH

3. VDRL and CBC

4. ACTH, ADH and CRF (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 These tests provide a measure of thyroid hormone production; an increase is associated with the client’s signs and symptoms.

1 Prothrombin time (PT) and partial thromboplastin time (PTT) assess blood coagulation.

3 The VDRL test is for syphilis; the CBC assesses the hematopoietic system.

4 Adrenocorticotropic hormone (ACTH) stimulates the synthesis and secretion of adrenal cortical hormones. Antidiuretic hormone (ADH) increases water reabsorption by the kidney. Corticotropin-releasing factor (CRF) triggers the release of ACTH. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a home visit to a client, the nurse identifies tremors of the client’s hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Which problem should be reported to the practitioner?

1. Increased appetite

2. Recent weight loss

3. Feelings of warmth

4. Fluttering in the chest (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure.

1 Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening.

2 Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening.

3 Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for:

1. Fatigue

2. Dry skin

3. Anorexia

4. Bradycardia (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Excessive metabolic activity associated with hyperthyroidism causes fatigue.

2 Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism.

3 Increased appetite is expected because of the increased metabolism associated with hyperthyroidism.

4 Tachycardia is expected because of the increased metabolism associated with hyperthyroidism. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Before obtaining blood for protein-bound iodine, T3, and T4 tests the nurse should ask a client, suspected of having a hyperactive thyroid, if the client has had:

1. Allergies to seafood

2. More protein intake than usual

3. Anything to drink before the test

4. Recent x-rays using radiopaque dye (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Many radiopaque dyes contain iodine, which will alter the protein-bound iodine test results.

1 The tests ordered do not require this information.

2 This is not specifically related to these studies.

3 This is not specifically related to these studies. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When assessing a client with Graves’ disease, the nurse expects to identify:

1. Constipation, dry skin, and weight gain

2. Lethargy, weight gain, and forgetfulness

3. Weight loss, exophthalmos, and restlessness

4. Weight loss, protruding eyeballs, and lethargy (Nugent 29)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Weight loss and restlessness occur because of an increased basal metabolic rate; exophthalmos occurs because of peribulbar edema.

1 These are associated with hypothyroidism because of the decreased metabolic rate.

2 Lethargy and weight gain are associated with hypothyroidism as a result of a decreased metabolic rate; forgetfulness is not related.

4 Although weight loss and exophthalmos occur with hyperthyroidism, the client will be hyperactive, not hypoactive. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When assessing a female client with Graves’ disease (hyperthyroidism) the nurse expects to identify a history of:

1. Diaphoresis

2. Menorrhagia

3. Dry, brittle hair

4. Sensitivity to cold (Nugent 29-30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Increased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin.

2 This problem is associated with hypothyroidism.

3 This problem is associated with hypothyroidism.

4 This problem is associated with hypothyroidism. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. The nurse evaluates that the teaching is understood when the client states, “I should:

1. eliminate excessive blinking.”

2. not move my extraocular muscles.”

3. elevate the head of my bed at night.”

4. avoid using a sleeping mask at night.” (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The mask may irritate or scratch the eyes if the mask moves during sleep.

1 Blinking of the eyes will bathe the eyes and prevent corneal ulceration.

2 This will not relieve edema or prevent ulceration of the eyes.

3 Although this will help reduce periorbital edema, it will not prevent ulceration of the cornea. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is scheduled to have a thyroidectomy for cancer of the thyroid. Preoperative instructions for the postoperative period include teaching the client to:

1. Cough and deep breathe every two hours

2. Perform range-of-motion exercises of the head and neck

3. Support the head with the hands when changing position

4. Apply gentle pressure against the incision when swallowing (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This relieves tension on the incision and limits the risk of dehiscence.

1 Coughing should be avoided during the early postoperative period to prevent trauma to the operative site.

2 This should be avoided until advised by the practitioner, usually after initial healing of the incision occurs.

4 Pressure against the operative area is not necessary to promote the integrity of the incision, and it may act to inhibit swallowing. (Nugent 111)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is diagnosed with hyperthyroidism and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, the nurse plans to instruct the client to:

1. Consciously attempt to calm down

2. Eliminate coffee, tea, and cola from the diet

3. Keep the home warm and use an extra blanket at night

4. Schedule activities during the day to overcome lethargy (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 These beverages contain caffeine, which may increase thyroid activity.

1 Hyperactivity is a physiological response; it is not under conscious control.

3 The increased metabolic rate associated with hyperthyroidism will make the client feel warm; a cool environment is needed.

4 Hyperactivity is a problem, and the client should be encouraged to rest. (Nugent 111-112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with cancer of the thyroid is scheduled for a thyroidectomy. Postoperatively the nurse plans to have a:

1. Quiet, dimly lit room for the client

2. Tracheostomy set at the client’s bedside

3. Large soft pillow for use under the client’s head

4. Suction machine set on intermittent suction at the client’s bedside (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A tracheostomy set should be available in the event there is excessive edema at the surgical site, which can cause tracheal compression.

1 This is not necessary after a thyroidectomy.

3 The head should be kept in anatomical alignment, the neck not flexed or hyperextended; a small soft pillow can be used to accomplish alignment.

4 Intermittent suction does not provide the constant suction needed to clear the airway. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. Immediately after the thyroidectomy, the nurse’s priority action for this client is to:

1. Place in low-Fowler’s position to limit edema of the neck

2. Monitor intake and output strictly to assess for fluid overload

3. Encourage coughing and deep breathing to prevent atelectasis

4. Assess level of consciousness to determine recovery from anesthesia (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The inflammatory response and trauma of surgery may cause edema; elevating the head facilitates drainage preventing compression of the trachea.

2 Although this is an important assessment for any postoperative client, it is not the priority for this client.

3 Although deep breathing should be encouraged, coughing this early in the postoperative period is too traumatic to the operative site.

4 Although this is an important assessment for any postoperative client, it is not the priority for this client. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Immediately after a subtotal thyroidectomy the nurse plans to assess a female client for unilateral injury of the laryngeal nerve every 30 to 60 minutes by:

1. Checking the throat for edema

2. Asking her to state her name out loud

3. Eliciting spasms of her facial muscles

4. Palpating the neck for seepage of blood (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 If the laryngeal nerve is damaged during surgery, the client will be hoarse and have difficulty speaking.

1 This does not indicate injury to the laryngeal nerve; this is part of the assessment for a compromised airway.

3 Eliciting the Chvostek sign assesses for hypocalcemia resulting from inadvertent removal of the parathyroid glands.

4 This assesses for bleeding and possible hemorrhage, not laryngeal nerve injury. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When providing care for a client in the first 24 hours after a thyroidectomy, the nurse includes:

1. Checking the back and sides of the operative site

2. Supporting the head during mild range-of-motion exercises

3. Encouraging the client to ventilate feelings about the surgery

4. Advising the client that regular activities can be resumed immediately (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Bleeding may occur, and blood will pool in the back of the neck because the blood will flow via gravity.

2 ROM exercises will increase pain and put tension on the suture line.

3 Talking should be avoided in the immediate postoperative period except to assess for a change in pitch or tone, which may indicate laryngeal nerve damage.

4 Activity should be gradually resumed, and frequent rest periods encouraged. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the early postoperative period after a subtotal thyroidectomy, the concern that has the priority is:

1. Hemorrhage

2. Thyrotoxic crisis

3. Airway obstruction

4. Hypocalcemic tetany (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life.

1 Although important, it does not exceed patency of the airway in priority.

2 Although important, it does not exceed patency of the airway in priority.

4 Although important, it does not exceed patency of the airway in priority. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a “funny, jittery feeling.” On the basis of this statement, the nurse’s best action is to:

1. Explain that this reaction is expected and not a concern

2. Take the vital signs and place the client in a high-Fowler’s position

3. Request stat serum calcium and phosphorus levels and chart the results

4. Test for Chvostek’s and Trousseau’s signs and notify the practitioner of the complaints (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy.

1 These symptoms may be related to postoperative anxiety, but the priority is to assess for impending tetany.

2 This is not helpful for the complaint made by the client; further assessment for tetany is indicated.

3 Physical assessment and notification of the practitioner are the priorities. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a thyroidectomy a client should be monitored for thyrotoxic crisis, which is evidenced by:

1. An increased pulse deficit

2. A decreased blood pressure

3. A decreased heart rate and respirations

4. An increased temperature and pulse rate (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Thyrotoxic crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature.

1 During crisis there usually is no increase in the difference between the apical and the peripheral pulse rates (pulse deficit).

2 The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during crisis.

3 Because of the increased metabolic rate, the pulse and respiratory rates increase to meet the body’s oxygen needs. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After treatment with propylthiouracil for hyperthyroidism, a client has the thyroid ablated with 131I. On a visit to the endocrine clinic, the client exhibits signs and symptoms of thyrotoxic crisis (thyroid storm). What is often associated with thyrotoxic crisis?

1. Deficiency of iodine

2. Decreased serum calcium

3. Increased sodium retention

4. Excessive hormone replacement (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Thyrotoxic crisis (thyroid storm) is the body’s response to excessive circulating thyroid hormones.

1 A deficiency of iodine results in a deficiency in thyroid hormone production.

2 A decreased serum calcium causes tetany.

3 Sodium retention is unrelated to thyrotoxic crisis; thyrotoxic crisis is caused by excessive circulating thyroid hormones. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? Select all that apply.

1. _____ Diaphoresis

2. _____ Weight loss

3. _____ Constipation

4. _____ Protruding eyes

5. _____ Cold intolerance (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 2, 4

1 Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia.

2 Weight loss occurs with hyperthyroidism because of increased metabolism.

3 Diarrhea occurs because of increased body processes, specifically increased gastrointestinal peristalsis.

4 Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retro-orbital tissue, which causes the eyeballs to enlarge and push forward.

5 Heat intolerance occurs because of the increased metabolism associated with hyperthyroidism. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, “I should call my physician if I develop:

1. dry hair and an intolerance to cold.”

2. muscle cramping and sluggishness.”

3. fatigue and an increased pulse rate.”

4. tachycardia and an increase in weight.” (Nugent 30)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine.

2 Muscle cramping is associated with hypocalcemia.

3 Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate.

4 Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia. (Nugent 112)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:

1. Hypothyroidism is a gradual slowing of the body’s function

2. There will be a decrease in pituitary thyroid-stimulating hormone

3. There may not be enough thyroid tissue to supply adequate thyroid hormone

4. Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones (Nugent 30-31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 After a subtotal thyroidectomy the thyroxine output may be inadequate to maintain an appropriate metabolic rate.

1 Hypothyroidism is a decrease in thyroid functioning, not a slowing of the entire body’s functions.

2 In hypothyroidism the level of thyroid-stimulating hormone (TSH) from the pituitary is usually increased.

4 Atrophy of the remaining thyroid tissue does not occur. (Nugent 112-113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse teaches a client, who has had a thyroidectomy for thyroid cancer, to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? Select all that apply.

1. _____ Dry skin

2. _____ Lethargy

3. _____ Insomnia

4. _____ Tachycardia

5. _____ Sensitivity to cold (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 2, 5

1 This is a response to hypothyroidism that is related to the associated decreased metabolic rate.

2 This is a symptom related to hypothyroidism that is associated with a decreased metabolic rate.

3 This is related to hyperthyroidism, not hypothyroidism.

4 This is related to hyperthyroidism, not hypothyroidism.

5 This is a symptom reflective of hypothyroidism that is associated with a decreased metabolic rate. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report the classic signs of diabetes, which are:

1. Irritability, polydipsia, polyuria

2. Polyuria, polydipsia, polyphagia

3. Nocturia, weight loss, polydipsia

4. Polyphagia, polyuria, diaphoresis (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body’s inability to metabolize glucose adequately.

1 Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy.

3 Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it.

4 Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When obtaining the history of a 24-year-old graduate student recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:

1. Edema

2. Anorexia

3. Weight loss

4. Hypoglycemic episodes (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting.

1 Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia.

2 Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs.

4 Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has recently been diagnosed with type 1 diabetes. A glucose tolerance test is ordered. The order reads, “Administer glucose 1g/kg.” The client weighs 240 pounds. How much glucose should the nurse administer?

1. 100 grams

2. 109 grams

3. 115 grams

4. 118 grams (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The nurse must administer 109 grams of glucose. Solve the problem using ratio and proportion. 2.2 pounds equals 1 kilogram.

2402.2=x12.2=240x=109grams

1 This is an incorrect calculation.

3 This is an incorrect calculation.

4 This is an incorrect calculation. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The practitioner orders daily fasting blood glucose levels for a client with diabetes mellitus. The goal of treatment is that the client will have glucose levels within the range of:

1. 40 to 65 mg/dL of blood

2. 70 to 105 mg/dL of blood

3. 110 to 145 mg/dL of blood

4. 150 to 175 mg/dL of blood (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This is the expected range for blood glucose.

1 This range is indicative of hypoglycemia.

3 This range is indicative of hyperglycemia.

4 This range is indicative of hyperglycemia. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

hen assessing the laboratory values of a client with type 2 diabetes, the nurse expects the results to reveal:

1. Ketones in the blood but not the urine

2. Glucose in the urine but not in the blood

3. Urine and blood positive for glucose and ketones

4. Urine negative for ketones and glucose in the blood (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The reason for the lack of ketonuria in type 2 diabetes is unknown. One theory is that extremely high hyperglycemia and hyperosmolarity levels block the formation of ketones, stimulating lipogenesis rather than lipolysis.

1 This does not occur with type 2 diabetes.

2 This is impossible; if glycosuria is present, there must first be a level of glucose in the blood exceeding the renal threshold of 160 to 180 mg/dL.

3 This is expected in type 1 diabetes. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing because it is:

1. More accurate

2. Easier to perform

3. Done by the client

4. Not influenced by drugs (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder.

2 Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge.

3 Both procedures can be done by the client.

4 This is not a factor. Although some urine tests are influenced by drugs, there are methods to test urine to bypass this effect. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is diagnosed as having type 2 diabetes. A priority teaching goal is, “The client will be able to:

1. perform foot care daily.”

2. administer insulin as ordered.”

3. test urine for both sugar and acetone.”

4. identify pending hypoglycemia or hyperglycemia.” (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to client health and well-being and essential for survival.

1 Although this is important, it is not the priority.

2 The client has type 2 diabetes, which usually is controlled by oral hypoglycemics.

3 Self-serum glucose monitoring is more accurate than sugar and acetone (S&A) urine measurements to identify serum glucose levels. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. The nurse evaluates that the teaching was effective when the client says, “I should:

1. massage my feet and legs with oil or lotion.”

2. apply heat intermittently to my feet and legs.”

3. eat foods high in protein and carbohydrate kilocalories.”

4. control my blood glucose with diet, exercise, and medication.” (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Controlling the diabetes decreases the risk of infection; this is the best prevention.

1 If not completely absorbed, these may provide a warm, moist environment for bacterial growth.

2 Coexisting neuropathy may result in injury from heat application.

3 Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 25-year-old physical fitness instructor is feeling increasingly tired and seeks medical care. Type 1 diabetes is diagnosed. The nurse explains that the increased fatigue is the result of:

1. Increased metabolism at the cellular level

2. Increased glucose absorption from the intestine

3. Decreased production of insulin by the pancreas

4. Decreased glucose secretion into the renal tubules (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue.

1 With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells.

2 Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose.

4 Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:

1. Decrease insulin sensitivity

2. Stimulate glucagon production

3. Improve the cellular uptake of glucose

4. Reduce metabolic requirements for glucose (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise.

1 Regular vigorous exercise increases cell sensitivity to insulin.

2 Glucagon action raises blood glucose but does not affect cell uptake or utilization of glucose.

4 Cellular requirements for glucose increase with exercise. (Nugent 113)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra pill should be taken before exercise. The best response by the nurse is:

1. “You will need to decrease your exercise.”

2. “An extra pill will help your body use glucose correctly.”

3. “When taking medicine your diet will not be affected by exercise.”

4. “No, but you should observe for signs of hypoglycemia while exercising.” (Nugent 31)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia.

1 Exercise should not be decreased because it improves glucose metabolism.

2 An extra tablet will probably result in hypoglycemia because exercise alone improves glucose metabolism.

3 Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy. (Nugent 113-114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. The nurse advises the client to:

1. Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed

2. Avoid food, drink clear liquids, take a daily temperature, and stay in bed

3. Eat as much as possible, increase fluid intake, and call the office again the next day

4. Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test before meals and at hour of sleep (Nugent 31-32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring serum glucose levels permits early intervention if necessary.

1 Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored.

2 Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken, and serum glucose levels should be monitored.

3 These are incomplete instructions; oral hypoglycemics should be taken, and serum glucose levels should be monitored; eating as much as possible can precipitate hyperglycemia. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An obese client with type 2 diabetes asks about the intake of alcohol or special “dietetic” food in the diet. The nurse teaches the client that:

1. Alcohol can be used, with its calories counted in the diet

2. Unlimited amounts of sugar substitutes can be used as desired

3. Alcohol should not be used in cooking because it adds too many calories

4. Special “dietetic” foods are needed because many regular foods cannot be used (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 In the overweight individual with type 2 diabetes, occasional alcohol can be ingested with caloric substitution for equivalent fat exchanges in the diet because it is metabolized like fat.

2 Moderation is vital; these may not be used in unlimited quantities and they must be accounted for in the dietary calculations.

3 Alcohol can be used as long as it is accounted for in the diet.

4 This is untrue; regular foods can be used in the diet of individuals with diabetes. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse’s most appropriate response is:

1. “You can order diabetic foods on most airlines and in restaurants.”

2. “You should plan your food ahead and carry it with you from home.”

3. “You can monitor your blood glucose level frequently and can eat accordingly.”

4. “You should make regular food choices and follow your food plan wherever you are.” (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 According to an individual’s needs, consistency and regularity in the food plan should be maintained; this is a basic principle of dietary management of diabetes.

1 This is not necessary; the client can make selections from regular food choices.

2 This cannot always be done; it is unnecessary because choices can be made within the food plan

3 The client should follow the food plan. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with newly diagnosed diabetes indicates a hatred for asparagus, broccoli, and mushrooms. When reviewing the exchange list with the client, the nurse evaluates that the teaching about the exchange list is understood when the client states, “Instead of these foods I can eat:

1. string beans, beets, or carrots.”

2. corn, lima beans, or dried peas.”

3. baked beans, potatoes, or parsnips.”

4. corn muffins, corn chips, or pretzels.” (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 These vegetables are in the vegetable exchange, as are asparagus, broccoli, and mushrooms.

2 These are starchy vegetables and are listed as bread exchanges.

3 These are starchy vegetables and are listed as bread exchanges.

4 These foods are from the bread exchange list. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While hospitalized, a client with diabetes is observed picking at calluses on the feet. The nurse should immediately:

1. Warn the client of the danger of infection

2. Suggest that the client wear white cotton socks

3. Teach the client the importance of effective foot care

4. Check the client’s shoes for their fit in the area of the calluses (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Inadequate foot care can lead to skin breakdown, poor healing, and subsequent infection.

1 This can increase anxiety and reduce the client’s ability to learn.

2 This is only one aspect of effective foot care; synthetic fibers that wick moisture are preferred.

4 Although important, this is not comprehensive foot care. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a surgical procedure for cancer of the pancreas that included the removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, the postoperative manifestation by the client that requires immediate attention by the nurse is:

1. Jaundice

2. Indigestion

3. Weight loss

4. Hyperglycemia (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 4 When the head of the pancreas is removed, the client has a greatly reduced number of insulin-producing cells and hyperglycemia will occur; immediate treatment is necessary.

1 This is not immediately life threatening and will take time to develop.

2 This is not immediately life threatening and will take time to develop.

3 This is not immediately life threatening and will take time to develop. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to:

1. Administer an oral hypoglycemic

2. Institute urine glucose monitoring

3. Give supplemental doses of regular insulin

4. Decrease the rate of the intravenous infusion (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes.

1 The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective.

2 Blood glucose levels are far more accurate than urine glucose levels.

4 The rate may be increased because polyuria often accompanies hyperglycemia. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has type 1 diabetes is admitted to the hospital for major surgery. Before surgery the client’s insulin requirements are elevated but well controlled. Postoperatively, the nurse anticipates that the client’s insulin requirements will:

1. Decrease

2. Fluctuate

3. Increase sharply

4. Remain elevated (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period.

1 Insulin requirements will remain elevated rather than decrease.

2 Fluctuating insulin requirements are usually associated with noncompliance, not surgery.

3 A sharp increase in the client’s insulin requirements may indicate sepsis, but this is not expected. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted to the hospital with diabetic ketoacidosis. The nurse identifies that the elevated ketone level present with this disorder is caused by the incomplete oxidation of:

1. Fats

2. Protein

3. Potassium

4. Carbohydrates (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Incomplete oxidation of fat results in fatty acids that further break down to ketones.

2 Protein metabolism results in nitrogenous waste production, causing elevated blood urea nitrogen (BUN).

3 Potassium is not oxidized. Ketones do not result when there are alterations in potassium levels.

4 Carbohydrates do not contain fatty acids that are broken down into ketones. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L. When monitoring the ECG tracing, the nurse expects to observe:

1. Abnormal P waves and depressed T waves

2. Peaked T waves and widened QRS complexes

3. Abnormal Q waves and prolonged ST segments

4. Peaked P waves and an increased number of T waves (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results.

1 P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The T wave is depressed in hypokalemia.

3 Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. The ST segment becomes depressed.

4 The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change. (Nugent 114)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with type 1 diabetes is placed on an insulin pump. The most appropriate short-term goal when teaching this client to control the diabetes is: “The client will:

1. adhere to the medical regimen.”

2. remain normoglycemic for 3 weeks.”

3. demonstrate the correct use of the administration equipment.”

4. list 3 self-care activities that are necessary to control the diabetes.” (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This is a short-term goal, client oriented, necessary for the client to control the diabetes, and measurable when the client performs a return demonstration for the nurse.

1 This is not a short-term goal.

2 This is measurable, but it is a long-term goal.

4 Although this is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge. (Nugent 114-115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a nurse plans to teach a client with type 1 diabetes about the use of an insulin pump, it is of major importance that the client understand that the:

1. Insulin pump’s needle should be changed every day

2. Pump is an attempt to mimic the way a healthy pancreas works

3. Pump will be implanted in a subcutaneous pocket near the abdomen

4. Insulin pump’s advantage is that it requires glucose monitoring once a day (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals.

1 The subcutaneous needle may be left in place for as long as 3 days.

3 Most insulin pumps are external to the body and access the body via a subcutaneous needle.

4 Blood glucose monitoring is done a minimum of 4 times a day. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which is the best advice regarding foot care to give a client with the diagnosis of diabetes?

1. Remove corns on the feet

2. Wear shoes that are larger than the feet

3. Examine the feet weekly for potential sores

4. Wear synthetic fiber socks when exercising (Nugent 32)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Research demonstrates that socks with synthetic fibers wick away moisture better than other fabrics when participating in vigorous activities.

1 Self-removal of corns can result in injury to the feet.

2 Shoes that do not fit appropriately will create friction causing sores, blisters, and calluses.

3 The feet should be examined daily, not weekly. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with type 1 diabetes of long duration takes Novolin 70/30 (combination of Novolin N 70% and Novolin R 30%) every morning. At noon, before eating lunch, the client is admitted to the emergency department with an acute myocardial infarction. Two hours later the client’s serum glucose level drops to 30 mg/dL, and insulin coma is diagnosed. The nurse concludes that the reason for the development of acute hypoglycemia in this client is that:

1. Glycogenolysis increased when lunch was not eaten after taking Novolin N insulin

2. The stress brought on by the chest pain increases the use of serum glucose available to the client

3. Glucose levels that are controlled by insulin drop more quickly than those controlled by oral antidiabetics

4. The client’s body became sensitive to the prescribed dose of insulin after long use causing blood glucose levels to drop erratically (Nugent 32-33)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The dose of exogenous insulin causes a rapid drop in the blood glucose level, especially if food is not eaten.

1 This leads to hyperglycemia.

2 Stress usually contributes to hyperglycemia because of glycogenolysis and gluconeogenesis.

4 The use of insulin over long periods does not build tolerance to insulin or cause blood glucose levels to fluctuate dramatically. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When assisting a client with type 1 diabetes, the nurse identifies a 5-cm nodule on the upper arm, where the client states she has been injecting her insulin at home. The nurse concludes that the nodule, which is neither warm nor painful, is a result of:

1. Keratosis

2. An allergy

3. An infection

4. Lipodystrophy (Nugent 33)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits.

1 Injections of insulin will not cause a horny growth such as a wart or callus.

2 An allergic response will precipitate a localized or systemic inflammatory response.

3 Hyperthermia and localized heat, erythema, and pain are associated with an infection. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse concludes that a client with type 1 diabetes is experiencing hypoglycemia. Which responses support this conclusion? Select all that apply.

1. _____ Vomiting

2. _____ Headache

3. _____ Tachycardia

4. _____ Cool clammy skin

5. _____ Increased respirations (Nugent 33)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 2, 3, 4

1 Vomiting occurs with hyperglycemia because of the effects of metabolic acidosis.

2 Headache is a neuroglycopenic response directly related to brain glucose deprivation.

3 Tachycardia occurs with hypoglycemia because of a neurogenic adrenergic response; it is a sympathetic nervous system response precipitated by a low blood glucose level.

4 Cool, clammy skin is a neurogenic cholinergic response; it is a sympathetic nervous system response precipitated by a low serum glucose level.

5 Increased respirations are a sign of hyperglycemia and are related to metabolic acidosis; this is a compensatory response in an attempt to blow off carbon dioxide and increase the pH level. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with diabetic ketoacidosis, who is receiving intravenous fluids and insulin, complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. The nurse concludes that these symptoms indicate:

1. Hypokalemia

2. Hypoglycemia

3. Hypernatremia

4. Hypercalcemia (Nugent 33)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose.

2 Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor.

3 Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching and/or seizures.

4 Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse evaluates that a client with diabetes understands the teaching about the treatment of hypoglycemia when the client says, “If I become hypoglycemic I should initially eat:

1. fruit juice and a lollipop.”

2. sugar and a slice of bread.”

3. chocolate candy and a banana.”

4. peanut butter crackers and a glass of milk.” (Nugent 33)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response.

1 These are fast-acting sugars, and neither of them will provide a sustained response.

3 The fat content of chocolate candy decreases the rate of absorption of glucose.

4 Neither of these is a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised. (Nugent 115)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Polycythemia is frequently associated with chronic obstructive pulmonary disease (COPD). When assessing for this complication, the nurse should monitor for:

1. Pallor and cyanosis

2. Dyspnea on exertion

3. Elevated hemoglobin

4. Decreased hematocrit (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The body attempts to compensate for decreased oxygen to tissues by increasing the number of blood cells, the oxygen-carrying component of the blood.

1 With polycythemia, the skin, especially the face, appears flushed, not pale.

2 This is not specific to polycythemia; there is more than one cause of dyspnea on exertion.

4 The hematocrit is increased with polycythemia. (Nugent 96)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The practitioner orders 2 units of packed red blood cells for a client who is bleeding. Before blood administration the nurse’s priority is:

1. Obtaining the client’s vital signs

2. Letting the blood reach room temperature

3. Monitoring the hemoglobin and hematocrit levels

4. Determining proper typing and crossmatching of blood (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is absolutely necessary to prevent an acute immunological reaction if the donated blood is not compatible with the client’s blood.

1 Although important, this is not the highest priority.

2 Blood must be kept cool until ready to use. If blood is at room temperature for 30 minutes prior to administration it should be returned to the blood bank; after it is started, blood must be administered within 4 hours.

3 This is not the highest priority; these laboratory results were part of the data used to determine the need for the blood. (Nugent 96)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is scheduled for a modified radical mastectomy decides to have family members donate blood in the event it is needed. The client has type A-negative blood. Blood can be used from relatives whose blood is:

1. Type O positive

2. Type AB positive

3. Type A or O negative

4. Type A or AB negative (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Both A- and O-negative blood are compatible with the client’s blood. A-negative is the same as the client’s blood type and preferred; in an emergency, type O-negative blood also may be given.

1 Although type O blood may be used, it will have to be Rh negative; Rh-positive blood is incompatible with the client’s blood and will cause hemolysis.

2 Type AB-positive blood is incompatible with the client’s blood and will cause hemolysis.

4 Type A-negative blood is compatible with the client’s blood but type AB-negative is incompatible and will cause hemolysis. (Nugent 96-97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The practitioner orders a transfusion of 2 units of packed red blood cells for a client. When administering blood, the priority nursing intervention is to:

1. Warm the blood to 98° F to prevent chills

2. Use an infusion pump to increase accuracy of infusion

3. Infuse the blood at a slow rate during the first 10 minutes

4. Draw blood samples from the client after each unit is transfused (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A slow rate provides time to recognize a reaction that is developing before too much blood is administered.

1 This is avoided to prevent clotting and hemolysis.

2 Infusion pumps will cause red blood cell damage; blood should flow by gravity through an appropriate filter.

4 This is not necessary. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with esophageal varices is admitted with hematemesis, and 2 units of packed red blood cells are ordered. The client complains of flank pain halfway through the first unit of blood. The nurse’s first action is to:

1. Stop the transfusion

2. Obtain the vital signs

3. Assess the pain further

4. Monitor the hourly urinary output (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Flank pain is an adaptation associated with a hemolytic transfusion reaction; it is caused by agglutination of red cells in the kidneys and renal vasoconstriction. The infusion must be stopped to prevent further instillation of blood, which is being viewed as foreign by the body.

2 Although this will be done eventually, it is not the priority action.

3 Although this will be done eventually, it is not the priority action.

4 Although this will be done eventually, it is not the priority action. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Halfway through the administration of a unit of blood, a client complains of lumbar pain. After stopping the transfusion and replacing the tubing, the nurse should:

1. Obtain vital signs

2. Notify the blood bank

3. Assess the pain further

4. Increase the flow of normal saline (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The blood must be stopped first, tubing must be replaced and then normal saline should be infused to keep the line patent and maintain blood volume.

1 While this assessment is being made, the client’s circulating blood volume will decrease.

2 This can be done later.

3 While this assessment is being made, the client’s circulating blood volume will decrease. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client demonstrates signs and symptoms of a transfusion reaction. The nurse immediately stops the infusion and next:

1. Obtains blood pressure in both arms

2. Sends a urine specimen to the laboratory

3. Hangs a bag of normal saline with new tubing

4. Monitors the intake and output every fifteen minutes (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The tubing must be replaced to avoid infusing the blood left in the original tubing; the normal saline infusion will maintain an open line for any further IV treatment.

1 All vital signs should be taken eventually; blood pressure may be taken on either arm, not necessarily both.

2 A urine sample is collected after the blood transfusion is stopped, the tubing replaced, and a bag of normal saline hung. The specimen will be analyzed to determine kidney function.

4 Although the intake, and especially the output, should be monitored to assess kidney function, this is not the priority. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A male client with chronic liver disease reports that his gums bleed spontaneously. In addition, the nurse identifies small hemorrhagic lesions on his face. The nurse concludes that the client needs additional:

1. Bile salts

2. Folic acid

3. Vitamin A

4. Vitamin K (Nugent 17)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage.

1 Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly.

2 Folic acid is a coenzyme with vitamins B12 and C in the formation of nucleic acids and heme; thus a deficiency may lead to anemia, not bleeding.

3 Vitamin A deficiency contributes to development of polyneuritis and beriberi, not hemorrhage. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a yearly physical examination a complete blood count (CBC) is performed to determine a client’s hematologic status. It is composed of several tests, one of which is the level of:

1. Blood glucose

2. Hemoglobin (Hb)

3. C-reactive protein

4. Blood urea nitrogen (BUN) (Nugent 17-18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A complete blood count (CBC) includes red blood cell (RBC) count and RBC indices, white blood cell (WBC) count and WBC differential count, hemoglobin (Hb), hematocrit (Hct), and platelet count.

1 A blood glucose level is not part of a CBC.

3 The C-reactive protein level is not part of a CBC.

4 Blood urea nitrogen (BUN) is not part of a CBC. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After years of unprotected sex, a 20-year-old man is diagnosed as having AIDS. The client states, “I’m not worried because they have a cure for AIDS.” The best response by the nurse is:

1. “Repeated phlebotomies may be able to rid you of the virus.”

2. “You may be cured of AIDS after prolonged pharmacologic therapy.”

3. “Perhaps you should have worn condoms to prevent contracting the virus.”

4. “There is no cure for AIDS but there are drugs that can slow down the virus.” (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is an honest response that corrects the client’s misconception about the effectiveness of the current antiviral medications.

1 Phlebotomy is not the treatment used to remove the virus from the client’s body.

2 Current pharmacological treatment does not eliminate the virus from the body; it can slow its progress and may even effect a remission (although the medications are never discontinued), but there is no known cure.

3 This is a nontherapeutic, judgmental response that can alienate the client and precipitate feelings of guilt. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nursing staff has a team conference on AIDS and discusses the routes of transmission of the human immunodeficiency virus (HIV). The discussion reveals that there is no risk of exposure to HIV when an individual:

1. Has intercourse with just the spouse

2. Makes a donation of a pint of whole blood

3. Uses a condom each time there is sexual intercourse

4. Limits sexual contact to those without HIV antibodies (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Equipment used in blood donation is disposable; the donor does not come into contact with anyone else’s blood.

1 The risk depends on the spouse’s prior behavior.

3 Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact.

4 An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse explains to a client that a positive diagnosis for HIV infection is made based on:

1. Positive ELISA and Western blot tests

2. Performance of high-risk sexual behaviors

3. Evidence of extreme weight loss and high fever

4. Identification of an associated opportunistic infection (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 These tests confirm the presence of HIV antibodies that occur in response to the presence of the human immunodeficiency virus.

2 This places someone at risk but does not constitute a positive diagnosis.

3 These do not confirm the presence of HIV; these adaptations are related to many disorders, not just HIV infection.

4 The diagnosis of just an opportunistic infection is not sufficient to confirm the diagnosis of HIV. An opportunistic infection (included in the CDC surveillance case definition for AIDS) in the presence of HIV antibodies indicates that the individual has AIDS. (Nugent 97)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Blood screening tests of the immune system of a client with AIDS indicates:

1. A decrease in CD4 T cells

2. An increase in thymic hormones

3. An increase in immunoglobulin E

4. A decrease in the serum level of glucose-6-phosphate dehydrogenase (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The HIV infects helper T-cell lymphocytes; therefore, 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS.

2 The thymic hormones necessary for T-cell growth are decreased.

3 This finding is associated with allergies and parasitic infections.

4 This finding is associated with drug induced hemolytic anemia and hemolytic disease of the newborn. (Nugent 97-98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When taking the blood pressure of a client who has AIDS, the nurse must:

1. Don clean gloves

2. Use barrier techniques

3. Put on a mask and gown

4. Wash the hands thoroughly (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Because this procedure does not involve contact with blood or secretions, additional protection is not indicated.

1 These are necessary only when there is risk of contact with blood or body fluid.

2 These are necessary only when there is risk of contact with blood or body fluid.

3 A mask and gown are indicated only if there is a danger of secretions or blood splattering on the nurse (for example, during suctioning). (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with AIDS and Cryptococcus pneumonia frequently is incontinent of feces and urine and produces copious sputum. When providing care for this client, the nurse’s priority is to:

1. Wear goggles when suctioning the client’s airway

2. Use gown, mask, and gloves when bathing the client

3. Use gloves to administer oral medications to the client

4. Wear a gown when assisting the client with the bedpan (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 These items prevent contact with feces, sputum, or other body fluids during intimate body care.

1 Goggles alone are inadequate because the client is producing copious sputum.

3 Gloves are not necessary because touching body fluids when giving oral medication is not likely.

4 Gloves are necessary when assisting the client with a bedpan because the nurse may be exposed to the client’s excreta. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In addition to Pneumocystis jiroveci, a client with AIDS also has an ulcer 4 cm in diameter on the leg. Considering the client’s total health status, the most critical concern is:

1. Skin integrity

2. Gas exchange

3. Social isolation

4. Nutritional status (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Pneumocystis jiroveci, now believed to be a fungus, causes pneumonia in immunosuppressed hosts; it can cause death in 60% of the clients. The client’s respiratory status is the priority.

1 Although this is a concern, the client’s respiratory status is the priority.

3 Although this is a concern, the client’s respiratory status is the priority.

4 Although this is a concern, the client’s respiratory status is the priority. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a Schilling test is ordered for a client suspected of having cobalamin deficiency because of pernicious anemia, the nurse plans to:

1. Give medications on time

2. Order foods low in vitamin B12

3. Keep an accurate intake and output

4. Collect a 24- to 48-hour urine specimen (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This test assesses parietal cell function. After radioactive cobalamin is administered, its excretion is measured; if cobalamin cannot be absorbed as in pernicious anemia, very little is excreted in the urine.

1 This test is not affected by medications.

2 The results of this test are not affected by food; with pernicious anemia there is a deficiency of intrinsic factor, which is necessary for vitamin B12 use.

3 Intake and output records are not necessary with a Schilling test. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A Schilling test is ordered for a client who is suspected of having pernicious anemia. The nurse considers that the primary purpose of the Schilling test is to determine the client’s ability to:

1. Store vitamin B12

2. Digest vitamin B12

3. Absorb vitamin B12

4. Produce vitamin B12 (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Pernicious anemia is caused by the inability to absorb vitamin B12 resulting from a lack of intrinsic factor in gastric juices; for the Schilling test, radioactive vitamin B12 is administered and its absorption and excretion can be ascertained.

1 This is not measured by this test.

2 This is not measured by this test.

4 Vitamin B12 is not produced in the body. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, the nurse explains that:

1. Weekly Z-track injections provide needed control

2. Daily intramuscular injections are required for control

3. Intramuscular injections once a month will maintain control

4. Oral tablets of vitamin B12 taken daily will provide symptom control (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 IM injections bypass the vitamin B12 absorption defect (lack of intrinsic factor, the transport carrier component of gastric juices). A monthly dose is usually sufficient because it is stored in active body tissues such as the liver, kidney, heart, muscles, blood, and bone marrow.

1 The Z-track method need not be used as it is for iron dextran injections.

2 Because it is stored and only slowly depleted, injections once a month usually are sufficient.

4 Vitamin B12 cannot be taken by mouth because of the lack of intrinsic factor. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse evaluates that the teaching regarding the use of vitamin B12 injections to treat pernicious anemia is understood when a client states, “I must take the drug:

1. when feeling fatigued.”

2. until my symptoms subside.”

3. monthly, for the rest of my life.”

4. during exacerbations of anemia.” (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Because the intrinsic factor does not return to gastric secretions even with therapy, B12 injections will be required monthly for the remainder of the client’s life.

1 B12 injections must be taken for the rest of the client’s life.

2 B12 injections must be taken for the rest of the client’s life.

4 Intramuscular injections of B12 must be taken monthly for the rest of the client’s life. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with Hodgkin’s disease enters a remission period and remains symptom-free for 6 months when a relapse occurs. The client is diagnosed at stage IV. The therapy option the nurse expects to be implemented at this time is:

1. Radiation therapy

2. Combination chemotherapy

3. Radiation with chemotherapy

4. Surgical removal of the affected nodes (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols generally are used.

1 Radiation, alone or in combination with chemotherapy, is used in stages IA, IB, IIA, IIB, and IIIA.

3 This is recommended for use in stage IIIA.

4 This is not a therapy for Hodgkin’s disease at any stage. The nodes may be removed for biopsy or irradiated as part of therapy. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A young woman is admitted to the oncology unit with a diagnosis of Hodgkin’s disease. Staging is done and the client’s spleen is found to be grossly involved, and it is surgically removed. A complication specifically related to a splenectomy for which the nurse should monitor the client is:

1. Pulmonary embolism

2. Inadequate lung aeration

3. Hypoactive bowel sounds

4. Postoperative hemorrhage (Nugent 18)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Because of the location of the spleen, postoperative pain will cause splinting and shallow breathing and underaeration of the lung’s left lower lobe.

1 This is true of any abdominal surgery and is not specific to a splenectomy.

3 This is true of any abdominal surgery and is not specific to a splenectomy.

4 This is true of any abdominal surgery and is not specific to a splenectomy. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client receiving chemotherapy and a steroid has a white blood cell count of 12,000/mm3 and a red blood cell count of 4.5 million/mm3. What is the priority instruction that the nurse should teach the client is?

1. Omit the daily dose of prednisone

2. Avoid large crowds and persons with infections

3. Shave with an electric rather than a safety razor

4. Increase the intake of high-protein foods and red meats (Nugent 18-19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Moderate leukopenia increases the risk of infection; the client should be taught protective measures.

1 Leukopenia is a side effect of cyclophosphamide (Cytoxan), not prednisone.

3 The platelet count is not given, so bleeding precautions are not indicated.

4 These are measures to correct anemia; protection from infection takes priority. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An older adult develops severe bone marrow suppression from chemotherapy for cancer. The nurse should:

1. Monitor for signs of alopecia

2. Encourage an increase in fluids

3. Monitor intake and output of fluids

4. Advise use of a soft toothbrush for oral hygiene (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums.

1 Although alopecia does occur, it is not related to bone marrow suppression.

2 Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis.

3 This is not related to bone marrow suppression. (Nugent 98)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The laboratory results of a client following chemotherapy for cancer indicate bone marrow suppression. The nurse should encourage the client to:

1. Use an electric razor when shaving

2. Drink citrus juices frequently for nourishment

3. Increase activity level by ambulating frequently

4. Sleep with the head of the bed slightly elevated (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets.

2 This will not affect the bone marrow. Citrus juices should be avoided by the client receiving chemotherapy because of the side effects of stomatitis.

3 With bone marrow suppression there is a decrease in red blood cells; rest should be encouraged.

4 With bone marrow suppression the red blood cells are decreased in number and there is a decreased oxygen-carrying capacity of the blood. This position will not increase the number of red blood cells. (Nugent 98-99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is suspected of having leukemia has a bone marrow aspiration. Immediately after the procedure, the nurse should:

1. Apply brief pressure to the site

2. Have the client lie on the affected side

3. Swab the site with an antiseptic solution

4. Monitor vital signs every hour for 4 hours (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Brief pressure is generally enough to prevent bleeding at the aspiration site.

2 Complications are rare; no special positions are required.

3 The site is cleaned prior to aspiration.

4 Complications are rare; frequent monitoring is unnecessary. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On admission, the bloodwork of a young adult with leukemia indicates elevated blood urea nitrogen (BUN) and uric acid levels. The nurse determines that these laboratory results may be related to:

1. Lymphadenopathy

2. Thrombocytopenia

3. Hypermetabolic status

4. Hepatic encephalopathy (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The hypermetabolic state associated with leukemia causes more urea and uric acid (end products of metabolism) to be produced and to accumulate in the blood.

1 Enlarged lymph nodes will not increase blood urea and uric acid.

2 Thrombocytopenia causes a decrease in platelets, which causes bleeding.

4 Hepatic encephalopathy is associated with liver disease, not leukemia. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When obtaining a health history from a client with probable acute lymphoblastic leukemia (ALL), the clinical manifestation the nurse expects to be present is:

1. Alopecia

2. Insomnia

3. Ecchymosis

4. Splenomegaly (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Bleeding tendencies occur because of bone marrow suppression and rapidly proliferating leukocytes.

1 There is no change in hair growth in the absence of chemotherapy.

2 The client will more likely be sleeping excessively.

4 Splenomegaly occurs with chronic lymphoblastic leukemia (CLL) and chronic myelogenous leukemia (CML), not acute lymphoblastic leukemia (ALL). (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which client manifestations should alert the nurse to the possible development of the life-threatening response of thrombocytopenia? Select all that apply.

1. _____ Fever

2. _____ Diarrhea

3. _____ Headache

4. _____ Hematuria

5. _____ Ecchymosis (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 4, 5

1 Fever is unrelated to thrombocytopenia. Fever is a sign of infection; infection results when the white blood cells are reduced (leukopenia).

2 Diarrhea is unrelated to thrombocytopenia; diarrhea may result from the effects of chemotherapy on the rapidly dividing cells of the gastrointestinal system.

3 Headache is unrelated to thrombocytopenia; headache may be caused by the effects of chemotherapy on central nervous system cells or indicate that the leukemia has invaded the central nervous system.

4 Hematuria is blood in the urine. Thrombocytes are involved in the clotting mechanism; thrombocytopenia is a reduced number of thrombocytes in the blood.

5 Ecchymosis is a superficial bruise caused by bleeding under the skin or mucous membrane. With thrombocytopenia, bleeding occurs because there are insufficient platelets. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has bone pain of insidious onset is suspected of having multiple myeloma. The nurse expects that one of the diagnostic findings specific for multiple myeloma is:

1. Occult blood in the stool

2. Low serum calcium levels

3. Bence Jones protein in the urine

4. Positive bacterial culture of sputum (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This protein (globulin) results from tumor cell metabolites. It is present in clients with multiple myeloma.

1 This is not specific for the diagnosis of multiple myeloma; it is a late complication of multiple myeloma related to coagulation defects.

2 Hypercalcemia, not hypocalcemia, occurs with multiple myeloma because of bone erosion.

4 Multiple myeloma is not caused by a bacterial infection. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse expects that the most definitive test to confirm a diagnosis of multiple myeloma is:

1. Bone marrow biopsy

2. Serum test for hypercalcemia

3. Urine test for Bence-Jones protein

4. X-ray films of the ribs, spine, and skull (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 A definite confirmation of multiple myeloma can only be made through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction.

2 Although calcium is lost from bone tissue and hypercalcemia results, this is not a confirmation of the disease.

3 Although this protein is found in the urine, it does not confirm the disease.

4 X-ray films will show the characteristic “punched-out” areas caused by the increased number of plasma cells, which contributes to the making of the diagnosis. The definitive diagnosis is made on biopsy. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with multiple myeloma is scheduled to have a chest x-ray examination and a bone scan. For this client, the primary responsibility of the nursing and radiology staff is to:

1. Explain the procedure and its purpose

2. Observe the client for the presence of pallor

3. Provide for rest periods during the procedure

4. Handle the client with supportive movements (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Because of bone erosion, pathological fractures are a common complication of multiple myeloma.

1 Although this is done, the priority is to prevent injury.

2 Although this is an adaptation to the associated anemia, it is not life threatening.

3 Although this is important, preventing pathological fractures is the priority. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client diagnosed with multiple myeloma asks the practitioner about what treatment will be administered. The nurse expects the practitioner to reply:

1. “Alpha-interferon therapy.”

2. “Radiation therapy on an outpatient basis.”

3. “Surgery to remove the lesion and lymph nodes.”

4. “Chemotherapy utilizing a combination of drugs.” (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 A variety of drugs affect rapidly dividing cells at different stages of cell division.

1 Although this is an acceptable therapy, it is not the first treatment used.

2 This is not a primary approach; it may be used to alleviate pain and treat acute vertebral lesions.

3 Multiple myeloma is a disorder of the bone; there are no lesions that can be removed. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with multiple myeloma, who is receiving chemotherapy, has a temperature that has risen 3 degrees during a 6-hour period and is now 102.2° F. The nurse should:

1. Administer the prescribed antipyretic and notify the practitioner

2. Obtain the other vital signs and recheck the temperature in 1 hour

3. Assess the amount and color of urine and obtain a specimen for a urinalysis

4. Note the consistency of respiratory secretions and obtain a specimen for culture (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia can then be initiated.

2 More vigorous intervention is necessary. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system.

3 This is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs.

4 This is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma. (Nugent 99)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with multiple myeloma asks how the disease and therapy may progress. When teaching this client, the nurse discusses the possibility that:

1. Blood transfusions may be necessary

2. Frequent urinary tract infections may result

3. IV fluid therapy may be administered in the home

4. The disease is exacerbated by exposure to ultraviolet rays (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Blood products (packed RBCs or platelets) are administered when warranted.

2 Renal insufficiency, not infections, may occur due to chronic hypercalcemia, proteinemia, and hyperuricemia.

3 Fluid replacement should be provided in carefully supervised clinical settings because if dehydration occurs it may result in renal shutdown.

4 Ultraviolet rays are not related to exacerbations. (Nugent 99-100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a client who is receiving azathioprine (Imuran), cyclosporine, and prednisone before kidney transplant. These medications are administered to:

1. Stimulate leukocytosis

2. Provide passive immunity

3. Prevent iatrogenic infection

4. Reduce antibody production (Nugent 19)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 These drugs suppress the immune system, decreasing the body’s production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection.

1 Leukocytosis is inhibited by these drugs.

2 These drugs do not provide immunity; they interfere with natural immune responses.

3 Because these drugs suppress the immune system, they increase the risk of infection. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has an exacerbation of systemic lupus erythematosus. The dosage of steroid medication is increased, and a home health care nurse is to provide health teaching. To reduce the frequency of exacerbations, the nurse teaches the client:

1. Basic principles of hygiene

2. Techniques to reduce stress

3. Measures to improve nutrition

4. Signs of an impending exacerbation (Nugent 19-20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Systemic lupus erythematosus is an autoimmune disorder and physical and emotional stresses have been identified as contributing factors to the occurrence of exacerbations.

1 Although this should be done, inadequate hygiene is not known to produce exacerbations.

3 Although this should be done, nutritional status is not significantly correlated to exacerbations.

4 Knowledge of the symptoms will not decrease the occurrence of exacerbations. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A farmer steps on a rusty nail and the puncture site becomes swollen and painful. Tetanus antitoxin is prescribed. The nurse explains that this is used because it:

1. Provides antibodies

2. Stimulates plasma cells

3. Produces active immunity

4. Facilitates long-lasting immunity (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Tetanus antitoxin provides antibodies, which confer immediate passive immunity.

2 Antitoxin does not stimulate production of plasma cells, the precursors of antibodies.

3 Passive, not active, immunity occurs.

4 Passive immunity, by definition, is not long lasting. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A tuberculin skin test with purified protein derivative (PPD) tuberculin is performed as part of a routine physical examination. The nurse instructs the client to make an appointment so the test can be read in:

1. 3 days

2. 5 days

3. 7 days

4. 10 days (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 It takes this length of time for antibodies to respond to the antigen and form an indurated area.

2 This is longer than necessary; the site will reveal induration in 2 to 3 days.

3 This is longer than necessary; the site will reveal induration in 2 to 3 days.

4 This is longer than necessary; the site will reveal induration in 2 to 3 days. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted with cellulitis of the left leg and a temperature of 103° F. The practitioner prescribes IV antibiotics. Before instituting this therapy, the nurse should:

1. Determine whether the client has allergies

2. Apply a warm, moist dressing over the area

3. Measure the amount of swelling in the client’s leg

4. Obtain the results of the culture and sensitivity tests (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Drug hypersensitivity and anaphylaxis are most common with antimicrobial agents.

2 This is a dependent function; it is not crucial to starting antibiotic therapy.

3 This is an important assessment, but it is not crucial to starting antibiotic therapy.

4 Withholding treatment until culture results are available may extend the infection. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After multiple bee stings a client has an anaphylactic reaction. The nurse determines that the symptoms the client is experiencing are caused by:

1. Respiratory depression and cardiac arrest

2. Bronchial constriction and decreased peripheral resistance

3. Decreased cardiac output and dilation of major blood vessels

4. Constriction of capillaries and decreased peripheral circulation (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Hypersensitivity to a foreign substance can cause an anaphylactic reaction; histamine is released, causing bronchial constriction, increased capillary permeability, and dilation of arterioles; this decreased peripheral resistance is associated with hypotension and inadequate circulation to major organs.

1 These are the problems that result from bronchial constriction and vascular collapse.

3 Dilation of arterioles occurs.

4 Arterioles dilate, capillary permeability increases, and eventually vascular collapse occurs. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The plan of care for a postoperative client who has developed a pulmonary embolus includes monitoring and bed rest. The client asks why all activity is restricted. The nurse’s response is based on the principle that bed rest:

1. Prevents the further aggregation of platelets

2. Enhances the peripheral circulation in the deep vessels

3. Decreases the potential for further dislodgment of emboli

4. Maximizes the amount of blood available to damaged tissues (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Activity may encourage the dislodgment of more microemboli.

1 Bed rest may enhance platelet aggregation and the formation of thrombi because of venous stasis.

2 Venous stasis, rather than enhanced circulation, is supported by bed rest.

4 Bed rest supports venous stasis rather than the circulation of blood to damaged tissues. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a group of clients that nutritional support of natural defense mechanisms indicates the need for a diet high in:

1. Essential fatty acids

2. Dietary cellulose and fiber

3. Tryptophan, an amino acid

4. Vitamins A, C, E, and selenium (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 These nutrients stimulate the immune system.

1 The role of fatty acids in natural defense mechanisms is uncertain.

2 These have no known effect on natural defense mechanisms.

3 Tryptophan has no known effect on natural defense mechanisms. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After receiving 75 mL of packed red blood cells, the client complains of chills and low back pain. The nurse suspects a hemolytic transfusion reaction and stops the infusion. The blood bag and a urine specimen are sent to the laboratory. The reason for sending a urine specimen to the laboratory is to test for:

1. Specific gravity

2. Free hemoglobin

3. Carboxyhemoglobin

4. Disseminated intravascular coagulation (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Blood incompatibility causes lysis of red blood cells with the result that hemoglobin is freed into the circulation; if a sufficient (100 mL or more) amount of incompatible blood is transfused, permanent renal damage can occur. Chills and low back pain indicate kidney involvement.

1 Specific gravity need not be determined.

3 Carboxyhemoglobin need not be determined.

4 Disseminated intravascular coagulation (DIC) is an intravascular clotting disorder that does not occur with a transfusion reaction. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client develops internal bleeding after abdominal surgery. Which signs and symptoms of hemorrhage should the nurse expect the client to exhibit? Select all that apply.

1. _____ Pallor

2. _____ Polyuria

3. _____ Bradypnea

4. _____ Tachycardia

5. _____ Hypertension (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 4

1 Pallor occurs with hemorrhage as the peripheral blood vessels constrict in an effort to shunt blood to the vital organs in the center of the body.

2 Urinary output decreases with hemorrhage because of a lowered glomerular filtration rate secondary to hypovolemia.

3 Respirations increase and become shallow with hemorrhage as the body attempts to take in more oxygen.

4 Heart rate accelerates in hemorrhage as the body attempts to increase blood flow and oxygen to body tissues.

5 Hypotension occurs in response to hemorrhage as the person experiences hypovolemia. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When assessing for hemorrhage after a client has a total hip replacement, the most important nursing action is to:

1. Measure the girth of the thigh

2. Examine the bedding under the client

3. Check the vital signs every four hours

4. Observe for ecchymosis at the operative site (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Because of the recumbent position, drainage may flow by gravity under the client and not be noticed unless the bedding is examined.

1 This assessment is inaccurate when there is a dressing in place.

3 In the immediate postoperative period, vital signs should be taken more frequently than every 4 hours; in addition, observation of the site is a more reliable indicator of hemorrhage.

4 Dressings impede an accurate assessment of the site for ecchymosis. (Nugent 100)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is brought to the emergency service after an automobile collision. The client’s blood pressure is 100/60 mm Hg, and the physical assessment suggests a ruptured spleen. Based on this information, the nurse assesses the client for which early response to decreased arterial pressure?

1. Warm and flushed skin

2. Confusion and lethargy

3. Increased pulse pressure

4. Reduced peripheral pulses (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Hypovolemia results in a decreased cardiac output and a decreased arterial pressure, which are reflected by a feeble, weak peripheral pulse.

1 The skin will be cool and pale because of vasoconstriction.

2 These are late signs of shock.

3 The pulse pressure narrows with decreased cardiac pressure associated with hypovolemic shock. (Nugent 100-101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a client is experiencing hypovolemic shock with decreased tissue perfusion, the nurse expects that the body initially attempts to compensate by:

1. Producing less ADH

2. Producing more red blood cells

3. Maintaining peripheral vasoconstriction

4. Decreasing mineralocorticoid production (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 With shock, arteriolar vasoconstriction occurs, raising the total peripheral vascular resistance and shifting blood to the major organs.

1 With shock, more antidiuretic hormone (ADH) is produced to promote fluid retention, which will elevate the blood pressure.

2 Although this is a response to hypoxia, peripheral vasoconstriction is a more effective compensatory mechanism.

4 With shock the mineralocorticoids increase to promote fluid retention, which elevates the blood pressure. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After sustaining multiple internal injuries in an automobile collision, the nurse identifies that the client’s blood pressure suddenly drops to 80/60 mm Hg. What most likely has caused this drop in blood pressure?

1. Reduction in the circulating blood volume

2. Diminished vasomotor stimulation to the arterial wall

3. Vasodilation resulting from diminished vasoconstrictor tone

4. Cardiac decompensation resulting from electrolyte imbalance (Nugent 20)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 A decreased intravascular volume results in hypovolemia and hypotension, which is evidenced by a decreased blood pressure and a decreased pulse pressure.

2 Vasomotor stimulation to the arterial walls is increased with shock.

3 This is a description of neurogenic shock, which is unlikely in this situation.

4 Although electrolyte imbalances can precipitate cardiac decompensation, cardiogenic shock is unlikely in this situation. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse understands that shock associated with a ruptured abdominal aneurysm is called:

1. Vasogenic shock

2. Neurogenic shock

3. Cardiogenic shock

4. Hypovolemic shock (Nugent 20-21)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 When an abdominal aneurysm ruptures, hypovolemic shock ensues because fluid volume depletion occurs as the heart continues to pump blood out of the ruptured vessel.

1 Vasogenic shock results from humoral or toxic substances acting directly on the blood vessels, causing vasodilation.

2 Neurogenic shock results from decreased neuromuscular tone, causing decreased vasoconstriction.

3 Cardiogenic shock results from a decrease in cardiac output. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has emergency surgery for a ruptured appendix. After determining that the client is manifesting signs and symptoms of shock, the nurse should:

1. Prepare for a blood transfusion

2. Notify the practitioner immediately

3. Elevate the head of the bed thirty degrees

4. Increase the liter flow of oxygen being administered (Nugent 21)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Peritonitis and shock are potentially life-threatening complications following abdominal surgery; prompt, rigorous treatment is necessary.

1 Fluids, not blood, are needed to expand and maintain the circulating blood volume.

3 The head of the bed should be flat to increase tissue perfusion and oxygenation to the vital organs.

4 The practitioner should be notified; the client is already receiving oxygen and the problem still exists. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the progressive stage of shock, anaerobic metabolism occurs. The nurse expects that initially this causes:

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis (Nugent 21)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This occurs during the progressive stage of shock as a result of accumulated lactic acid.

2 Metabolic alkalosis cannot occur with the buildup of lactic acid.

3 Eventually this can result from decreased respiratory function in late shock, further compounding metabolic acidosis.

4 This may occur as a result of hyperventilation during early shock. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is in hypovolemic shock has a hematocrit value of 25%. The nurse anticipates that the practitioner will order:

1. Ringer’s lactate

2. Serum albumin

3. Blood replacement

4. High molecular dextran (Nugent 21)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Blood replacement is needed to increase the oxygen-carrying capacity of the blood; the expected hematocrit for women is 37% to 47% and for men is 42% to 52%.

1 Ringer’s lactate does not increase the oxygen-carrying capacity of the blood.

2 Serum albumin helps maintain volume but does not affect the hematocrit level.

4 Although dextran does expand blood volume, it decreases the hematocrit because it does not replace red blood cells. (Nugent 101)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Respiratory Diagnostic and Therapeutic Procedures: Overview Respiratory diagnostic procedures are used to evaluate a client’s respiratory status by checking indicators such as the oxygenation of the blood, lung functioning, and the integrity of the airway. Respiratory Diagnostic and Therapeutic Procedures: …

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The nurse is planning care for the a client who has fourth degree midline laceration that occurred during vaginal delivery of an 8 pound 10 ounce infant. What intervention has the highest priority? A. Administer Prescribed stool softner B. Administer …

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