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1. A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?

• Urine output
• Glucose level
• Serum potassium
• Immune response

2. A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client?

• IV fluids
• Potassium
• NPH insulin (Novolin N)
• Sodium polystyrene sulfonate (Kayexalate)

3. A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?

• Stress response
• Electrolyte balance
• Metabolic processes
• Respiratory function

4. After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client?

• Serum osmolarity increases
• Urine concentration decreases
• Glomerular filtration decreases
• Tubular reabsorption of water increases

5. A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. What concern about the client requires the nurse to notify the health care provider?

• Analgesia and mild sedation will be required to ensure rest.
• Steroid replacement medication therapy will have to be reduced.
• There is a decreased ability to handle stress despite steroid therapy.
• Feelings of exhaustion and lethargy may result from the emotional stress.

6. A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?

• Methimazole (Tapazole)
• Pituitary extract (Pituitrin)
• Regular insulin (Novolin R)
• Hydrocortisone succinate (Solu-Cortef)

7. Before discharge, a client who had a colostomy for colorectal cancer questions the nurse about resuming activity. What should the nurse teach the client about activity?

• “With guidance, a near-normal lifestyle, including complete sexual function, is possible.”
• “Activities of daily living should be resumed as quickly as possible so you avoid being depressed.”
• “Most sports activities, except for swimming, can be resumed based on your overall physical condition.”
• “After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation.”

8. A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes:

• onset of the disease is slow
• excessive weight is a contributing factor
• complications are not present at the time of diagnosis
• treatment involves diet, exercise, and oral medications

9. A client is admitted with a head injury. The nurse identifies that the client’s urinary retention catheter is draining large amounts of clear, colorless urine. What does the nurse iden­ tify as the most likely cause?

• Increased serum glucose
• Deficient renal perfusion
• Inadequate ADH secretion
• Excess amounts of IV fluid

10. A client is diagnosed with cancer of the rectum and has surgery for an abdominoperineal resection and colostomy. Which nursing care should be implemented during the postoperative period?

• Limiting fluid intake for several days
• Withholding fluids for seventy-two hours
• Having the client change the colostomy bag
• Keeping the clients skin around the stoma clean

11. A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

• Pituitary hypoplasia
• Hyperplasia of the adrenal cortex
• Deprivation of adrenocortical hormones
• Insufficient adrenocorticotropic hormone production

12. A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client’s health history for possible situations in which exposure may have occurred. Which event does the nurse determine is the most likely source of this infection?

• Had a small tattoo on the arm 3 months ago
• Assisted in the emergency birth of a baby 2 weeks ago
• Worked for a month in an undeveloped area in Mexico 4 months ago
• Attended an ecologic conference in a large urban center 2 months ago

13. Which is an important intervention that the nurse should include in the plan of care that is specific for a client with Addison disease?

• Encouraging the client to exercise
• Protecting the client from exertion
• Restricting the clients fluid intake
• Monitoring the client for hypokalemia

14. A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?

• Fluid loss
• Glycosuria
• Kussmaul respirations
• Increased blood glucose level

15. How many inches should the nurse insert a catheter into the stoma when performing a transverse colostomy irrigation?

• 5 cm (2 inches)
• 8 cm (3 inches)
• 15 cm (6 inches)
• 20 cm (8 inches)

16. A client has a transverse loop colostomy. What should the nurse do when inserting a catheter for the colostomy irrigation?

• Use an oil-based lubricant.
• Instruct the client to bear down.
• Apply gentle but continuous pressure.
• Direct it toward the clients right side.

17. A nurse is caring for a client with a nasointestinal tube. Which solution should the nurse use when instilling the tube to ensure its patency?

• Sterile water
• Isotonic saline
• Hypotonic saline
• Hypertonic glucose

18. A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

• Insulin lispro (Humalog)
• Insulin glargine (Lantus)
• NPH insulin (Novolin N)
• Regular insulin (Novolin R)

19. A client who is receiving TPN reports experiencing nausea, thirst, and a headache. Which clinical factor should the nurse monitor initially to further assess the clients status?

• Blood glucose
• Urinary output
• Blood pressure
• Oral temperature

20. A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition?

• Sodium bicarbonate, causing alkalosis
• Ketones as a result of rapid fat breakdown, causing acidosis
• Nitrogen from protein catabolism, causing ammonia intoxication
• Glucose from rapid carbohydrate metabolism, causing drowsiness

21. A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider?

• Ketosis
• Obesity
• Type 1 diabetes
• Reduced insulin production

22. A client is scheduled for ligation of hemorrhoids. Which diet does the nurse expect to be ordered in preparation for this surgery?

• Bland
• Clear liquid
• High-protein
• Low-residue

23. A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids?

• Foster accumulation of glycogen in the liver
• Increase the inflammatory action to promote scar formation
• Facilitate urinary excretion of salt and water following surgery
• Compensate for sudden lack of these hormones following surgery

24. A health care provider orders a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide as to why the client needs to follow this diet?

• “The use of salt probably contributed to the disease.”
• “Excess weight will be gained if sodium is not limited.”
• “The loss of excess sodium and potassium in the urine requires less renal stimulation.”
• “Excessive aldosterone and cortisone cause retention of sodium and loss of potassium.”

25. Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

• Providing oxygen
• Encouraging carbohydrates
• Administering fluid replacement
• Teaching facts about dietary principles

26. A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be ordered for this client?

• Administer IV steroids
• Provide a high-protein diet.
• Collect a 24-hour urine specimen.
• Withhold all medications for 48 hours

27. A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?

• Hypovolemia
• Hyperkalemia
• Hypoglycemia
• Hypernatremia

28. A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus?

• Cortical hormones stimulate rapid weight loss.
• Tissue catabolism results in a negative nitrogen balance.
• Glucocorticoids accelerate the process of gluco-neogenesis.
• Excessive adrenocorticotropic hormone secretion da-mages pancreatic tissue.

29. What should the nurse do when collecting a 24-hour urine specimen?

• Check to verify if a preservative is needed.
• Weigh the client before starting the collection.
• Discard the last voided specimen of the 24-hour period.
• Assess the client’s intake and output for the previous 24-hour period

30. A client with cancer of the colon had surgery for a resection of the tumor and the creation of a colostomy. During the 6-week postoperative checkup, the nurse teaches the client about nutrition. The nurse evaluates that learning has taken place when the client states, “I should follow a diet that is:

• rich in protein.”
• low in fiber content.”
• as close to usual as possible.”
• higher in calories than before.”

31. Which statement by an older adult most strongly supports the nurse’s conclusion that the client is impacted with stool?

• “I have a lot of gas pains.”
• “I don’t have much of an appetite.”
• “I feel like I have to go and just can’t.”
• “I haven’t had a bowel movement for several days.”

32. A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake?

• Increased amounts of potassium are needed to replace renal losses.
• Increased protein is needed to heal the adrenal tissue and thus cure the disease.
• Supplemental vitamins are needed to supply energy and assist in regaining the lost weight.
• Extra salt is needed to replace the amount being lost due to lack of sufficient aldosterone to conserve sodium.

33. A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. An increase in which component in the blood is a direct cause of this type of acidosis?

• Ketones
• Glucose
• Lactic acid
• Glutamic acid

34. A client is experiencing chronic constipation and the nurse discusses how to include more bulk in the diet. The nurse concludes that learning has occurred when the client states, “Bulk in the diet promotes defecation by:

• irritating the bowel wall.”
• stimulating the intestinal mucosa chemically.”
• acting on the microorganisms in the large intestine.”
• stretching intestinal smooth muscle, which causes it to contract.”

35. A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated?

• Hypotension
• Hyperglycemia
• Sodium retention
• Potassium excretion

36. During a colostomy irrigation, a client reports feeling abdominal cramps. What should the nurse do in response to the client’s statement?

• Discontinue the irrigation.
• Lower the container of fluid.
• Clamp the catheter for a few minutes.
• Advance the catheter approximately an inch.

37. When teaching irrigation of a colostomy, how many inches above the stoma should the nurse teach the client to place the container?

• 15 cm (6 inches)
• 25 cm (10 inches)
• 30 cm (12 inches)
• 45 cm (18 inches)

38. A low-residue diet is recommended for a client. Which food should the nurse encourage the client to select from a menu?

• Steamed broccoli
• Creamed potatoes
• Raw spinach salad
• Baked sweet potato

39. A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?

• Estrogens
• Androgens
• Glucocorticoids
• Mineralocorticoids

40. A nurse is monitoring a client’s laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic?

• 40 and 60 mg/dL
• 80 and 99 mg/dL
• 100 and 125 mg/dL
• 126 and 140 mg/dL

41. A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, “I know I will:

• be sterile for the rest of my life.”
• require larger doses of insulin than I did preoperatively.”
• have to take cortisone or a similar drug for the rest of my life.”
• have to take thyroxine or a similar medication for the rest of my life.”

42. A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which most frequently ordered antidiarrheal drug does the nurse expect the health care provider to prescribe?

• Bisacodyl (Dulcolax)
• Psyllium (Metamucil)
• Loperamide (Imodium)
• Docusate sodium (Colace)

43. A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiologic finding should be the nurse’s focus when collecting additional data about this client?

• Starvation
• Alcoholism
• Bone healing
• Positive nitrogen balance

44. After having a transverse colostomy, the client asks what physical effect the surgery will have on future sexual relationships. Which information should the nurse include in a teaching plan for this client?

• “You will be able to resume usual sexual relationships.”
• “Surgery will temporarily decrease your sexual impulses.”
• “Your sexual activity must be curtailed for several weeks.”
• “Partners should be told about the surgery before any sexual activity.”

45. A nurse is caring for a postoperative client who has diabe-tes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client?

• Emotional stress
• Presence of infection
• Increased insulin dose
• Inadequate food intake

46. A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client’s clinical manifestations?

• Fluid balance
• Electrolyte levels
• Protein anabolism
• Masculinizing hormones

47. A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations?

• Urinary retention
• Respiratory distress
• Bleeding at the suture line
• Increased intracranial pressure

48. A health care provider writes orders addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client?

• Decrease in eosinophils
• Increase in lymphoid tissue
• Restoration of electrolyte balance
• Improvement of carbohydrate metabolism

49. Which information from the client’s history does the nurse identify as a risk factor for developing osteoporosis?

• Receives long-term steroid therapy
• Has a history of hypoparathyroidism
• Engages in strenuous physical activity
• Consumes high doses of the hormone estrogen

50. An older adult client who is accustomed to taking enemas periodically to avoid constipation is admitted to a long-term care facility. In addition to medications, the health care provider prescribes bed rest and a regular diet. Which action should be implemented to help prevent the client from developing constipation?

• Arrange to have enemas ordered for the client.
• Obtain a prescription for a daily laxative for the client.
• Place a commode by the bedside to facilitate defecation.
• Offer a large glass of prune juice with warm water each morning.