1. The nurse monitors the client taking octreotide acetate (Sandostatin) for acromegaly for which most common side effect of this medication?DiarrheaRational: Octreotide acetate (Sandostatin) is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of this medication are diarrhea, nausea, gallstone formation, and abdominal discomfort. Hypertension, although rare, may occur. Constipation, bradycardia, and dyspnea are not associated with use of this medication.

2. A client is told by the health care provider to take aluminum hydroxide (Amphojel) as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication?ConstipationRational: Because of the antacid's aluminum base, aluminum hydroxide causes constipation as a side effect. The other side effect is hypophosphatemia, which is noted by monitoring serum laboratory studies. The other options are not side effects of this medication.

3. A client is experiencing an episode of hypoglycemia. The nurse understands that the physiological mechanism that should take place to combat this decrease in the blood glucose level is which mechanism?Increased glucagon secretionRational: Glucagon is secreted from the alpha cells in the pancreas in response to declining blood glucose levels. At the same time, hypoglycemia triggers increased cortisol release, increased epinephrine release, and decreased secretion of insulin. Options 1, 2, and 3 are not physiological mechanisms that take place to combat the decrease in the blood glucose level.

4. During physical examination of a client, which finding is characteristic of hypothyroidism?Periorbital edemaRational: Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Knowing this should direct you to option 1. Options 2, 3, and 4 are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state.

5. An older client takes cascara sagrada for ongoing management of chronic constipation. The nurse assesses the client's laboratory results for which electrolyte imbalance related to long-term use of this medication?HypokalemiaRational: Hypokalemia can result from long-term use of cascara sagrada, a laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. Options 2, 3, and 4 are not specifically associated with the use of this medication.

6. The ambulatory care nurse is providing instructions to a client who is scheduled for a small bowel biopsy. What should the nurse tell the client?A signed informed consent form will need to be obtained.Rational: A signed informed consent form is required for this procedure. The client is instructed to maintain a clear liquid diet for 24 to 48 hours before the biopsy and to withhold all food and fluids after the evening meal before the day of the scheduled biopsy. A small bowel biopsy involves removal of a tissue specimen from the small intestine for examination and aids in the diagnosis of diseases of the small intestine. A small biopsy tube is passed through the client's mouth and is monitored fluoroscopically until it reaches the desired location in the jejunum. A normal diet may be resumed after the procedure as soon as the gag reflex returns.

7. A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure?Assessing for the presence of the gag reflexRational: Following the procedure, the client remains NPO until the gag reflex returns, which is usually in 1 to 2 hours. The remaining options are not specific assessments related to this procedure.

8. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item?Intravenous fluids containing dextroseRational: During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

9. A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which concept?Systematically rotate insulin injections within one anatomical site.Rational: njection sites should be rotated systematically within one anatomical site. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. If ketones are found in the urine, it may indicate the need for additional insulin. Insulin doses should not be adjusted or increased before excessive exercise.

10. Pancreatin (Viokase) is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication?The stool is less fatty and decreases in frequency.Rational: Pancreatin aids in the digestion of protein, carbohydrate, and fat in the gastrointestinal tract. It is used to treat steatorrhea associated with postgastrectomy syndrome after bowel resection. The nurse should record the number of stools per day and the stool consistency to monitor the effectiveness of this enzyme therapy. If it is effective, the stools should become less frequent and less fatty. Options 1, 2, and 3 are not indications of a therapeutic effect of the medication.

11. The nurse should instruct a client with an ileostomy to include which action as part of essential care of the stoma?Cleanse the peristomal skin meticulously.Rational: The peristomal skin must receive meticulous cleansing because ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. The area below the ileostomy may be massaged as needed if the ileostomy becomes blocked by high-fiber foods. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. Fluid intake should be at least six to eight glasses of water per day to prevent dehydration.

12. The nurse instructs a client taking aluminum hydroxide (Amphojel) that the most common side effect associated with administration of this medication is which effect?ConstipationRational: Aluminum-containing antacids are constipating, so the client should be instructed to take a stool softener or additional bulk-type laxatives to relieve this uncomfortable side effect. Options 1, 2, and 4 are not side effects of this medication.

13. A client's serum calcium level is high. The nurse plans care knowing that which hormones are directly responsible for maintaining the free or unbound portion of the serum calcium within normal limits?Parathyroid hormoneRational: Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Thyroid hormone is responsible for maintaining a normal metabolic rate in the body. Follicle-stimulating hormone and adrenocorticotropic hormone are produced by the anterior pituitary gland. They are responsible for growth and maturation of the ovarian follicle and stimulation of the adrenal glands, respectively

14. A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse should assess the client for a history of chronic use of which medication?Acetaminophen (Tylenol)Rational: Acetaminophen is a potentially hepatotoxic medication. Use of this medication and other hepatotoxic agents should be investigated whenever a client presents with signs and symptoms compatible with liver disease (such as ascites and jaundice). Hepatotoxicity is not an adverse effect of the medications identified in options 1, 2, and 4.

15. After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?Pernicious anemiaRational: Billroth I surgery involves removing one half to two thirds of the stomach and reanastomosing the remaining segment of the stomach to the duodenum. With the loss of this much of the stomach, development of pernicious anemia is not uncommon. Pernicious anemia is a macrocytic anemia that most commonly is caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion of the parietal cells, which are responsible for producing intrinsic factor (a necessary component for vitamin B12 absorption), are removed. In this anemia, the red cell is larger than usual and hence does not last as long in the circulation as normal red blood cells do, causing the client to have anemia with resultant fatigue. Vitamin B12 also is necessary for normal nerve function. Because of the lack of the necessary intrinsic factor, persons with pernicious anemia also experience paresthesias, impaired gait, and impaired balance. Although the symptoms could possibly indicate the other options listed, pernicious anemia is the most logical based on the surgery the client underwent.

16. The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis?Does the pain in your stomach radiate to the back?"Rational: The pain that is associated with acute pancreatitis is often severe and is located in the epigastric region and radiates to the back. Options 2, 3, and 4 are incorrect because they are not specific for the pain experienced by the client with pancreatitis.

17. The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease?Loose, watery stoolRational: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four or five stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.

18. A client has been diagnosed with gastroesophageal reflux disease (GERD). The nurse plans care, knowing that the client has dysfunction of which part of the digestive system?Lower esophageal sphincter (LES)Rational: The LES is a functional sphincter that normally remains closed except when food or fluids are swallowed. If relaxation of this sphincter occurs, the client may experience symptoms of GERD. The chief cells of the stomach secrete pepsinogen, a precursor to pepsin, which helps to digest proteins. The parietal cells of the stomach secrete hydrochloric acid (gastric acid) and intrinsic factor. The UES is formed by the cricopharyngeus muscle attached to the cricoid cartilage.

19. A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which complete proteins to maximize the availability of essential amino acids?MeatsRational: Complete proteins contain all of the essential amino acids, which are acids that the body cannot produce from other available sources. Complete proteins derive from animal sources, such as meat, cheese, milk, and eggs. Incomplete proteins can be found in fruits, vegetables, nuts, cereals, breads, and legumes.

20. The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laennec's cirrhosis. This type of cirrhosis is most commonly caused by which long-term condition?Alcohol abuseRational: Laennec's cirrhosis results from long-term alcohol abuse. Cardiac cirrhosis most commonly is caused by long-term right-sided heart failure. Exposure to hepatotoxins, chemicals, or infections, or a metabolic disorder can cause postnecrotic cirrhosis. Biliary cirrhosis results from a decrease in bile flow and is most commonly caused by long-term obstruction of bile ducts.

21. A nurse is assigned to the care of a client who has an altered production of cortisol. The nurse anticipates that the client is experiencing difficulty with synthesis of which type of substance?GlucocorticoidsRational: Cortisol is a glucocorticoid, which is produced by the adrenal cortex. Androgens and mineralocorticoids are other substances produced by the adrenal cortex. Catecholamines (epinephrine and norepinephrine) are produced by the adrenal medulla.

22. The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement?"It will help to remove gas and fluids from my stomach and intestine."Rational: Treatment of intestinal obstruction is directed toward decompression of the intestine by removal of gas and fluid. Nasogastric tubes may be used to decompress the stomach and bowel. Continuous gastric suction does not provide nourishment. The purpose of tracheal suctioning (not gastric suctioning) is to remove excess mucus that has led to congestion. Although gastric contents may be sent for laboratory analysis, it is not the main purpose for continuous gastric suction.

23. The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client?Bulging eyeballsRational: Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

24. The nurse should incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply.Consume multiple small meals throughout the day.Allow the client to select foods that are most appealing.Eliminate fatty foods from the meal trays until nausea subsides.Rational: Because the client with hepatitis experiences general malaise, small, more frequent meals are better tolerated than large meals, with breakfast being the best tolerated meal of the day. Self-selection of foods may enhance appetite over randomly selected foods. Fatty foods can exacerbate nausea and need to be avoided during the acute phase. The diseased liver may be unable to metabolize large amounts of protein at this time. The client should receive a diet high in carbohydrates to assist with meeting increased caloric needs. Anorexia typically increases as the day goes on.

25. The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record?DiarrheaRational: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn's disease

26. The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.InsomniaWeight lossMild heat intoleranceRational: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

27. An 8-year-old boy is being treated with desmopressin (DDAVP). Understanding the purpose of this medication, the nurse should set which client goal?The boy will have 5 nights in sequence without enuresis.Rational: Desmopressin may be used to treat nocturnal enuresis; therefore the client goal will be several nights in sequence without enuresis. The medication does not increase urine output and does not have an effect on white blood cells. The medication is not indicated as an intervention in the client with asthma.

28. The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for in the client's focused assessment?Signs and symptoms of hypovolemiaRational: Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. Thus, a deficiency can cause hypovolemia. A deficiency of adrenocortical hormones (such as after adrenalectomy) does not cause the clinical manifestations noted in options 1, 2, and 4.

29. The nurse is providing instructions regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that additional instruction is needed if the client identifies which as a cause of hypoglycemia?Decreased daily insulin dosageRational: Decreasing the dose of insulin will lead to hyperglycemia. Causes for hypoglycemic reactions include delayed consumption of meals and lack of necessary amounts of food. Other causes include the administration of excessive insulin or oral hypoglycemic medications, vomiting associated with illness, and strenuous exercise, which may potentiate the action of insulin.

30. The nurse is preparing the client's morning Humulin N insulin dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding?Draw the dose from a new vial.Rational: The nurse should always inspect the vial of insulin before use for changes that may signify loss of potency. Humulin N insulin normally is uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial. Therefore, options 2, 3, and 4 are incorrect

31. The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to include which information in the teaching session?Activity should be limited to prevent fatigue.Rational: Rest is necessary for the client with hepatitis, and the client with viral hepatitis should limit activity to avoid fatigue. The diet should be optimal in calories, proteins, and carbohydrates. The client should take in several small meals per day. Alcohol is strictly forbidden.

32. The nurse is assessing a client with a duodenal ulcer. The nurse interprets that which sign/symptom is most consistent with the typical presentation of duodenal ulcer?Pain that is relieved by food intakeRational: The most typical finding with duodenal ulcer is pain that is relieved by food intake. The pain is often described as a burning, heavy, sharp, or "hunger pang" pain that often localizes in the midepigastric area. It does not radiate down the right arm. The client with duodenal ulcer does not usually experience weight loss or nausea and vomiting; these symptoms are more typical in the client with a gastric ulcer.

33. A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching?Whole MilkRational: Bile acids or bile salts are produced by the liver to emulsify or break down fats. Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum, thus preventing breakdown of fatty intake. Knowledge of this should direct you to option 2. Dairy products, such as whole milk, ice cream, butter, and cheese, are high in cholesterol and fat and should be avoided.

34. The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client?Body image changesRational: Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia or hirsutism. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications.

35. The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of Humulin N and Humulin R insulin. The nurse should instruct the client that which is the first step in this procedure?Inject air equal to the amount of Humulin N prescribed into the vial of Humulin N insulin.Rational: The initial step in preparing an injection of insulin that is a mixture of Humulin N and regular is to inject air into the Humulin N bottle equal to the amount of insulin prescribed. The client would then be instructed to next inject an amount of air equal to the amount of prescribed insulin into the Humulin R bottle. The regular insulin would then be withdrawn, followed by the Humulin N insulin. Contamination of regular insulin with Humulin N insulin will convert part of the Humulin R insulin into a longer-acting form.

36. The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition?HypertensionRational: Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms

37. Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse should tell the client that it is best to take the insulin at which time?At bedtimeRational: Insulin glargine is a long-acting recombinant DNA human insulin that is used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, usually at bedtime. Therefore, options 2, 3, and 4 are incorrect times.

38. A client with a colostomy has a prescription for irrigation of the colostomy. Which solution should the nurse use for the irrigation?Tap waterRational: Warm tap water or saline solution is used to irrigate a colostomy. If the tap water is not suitable for drinking, then bottled water should be used. The other options are incorrect solutions.

39. The nurse is instructing a client who is taking levothyroxine (Synthroid) and tells the client that full therapeutic benefits will be seen when?In 1 to 3 weeksRational: It takes up to 1 month for plateau levels of levothyroxine to be achieved, so clients must be told that full benefits will not be seen for 1 to 3 weeks. Therefore, options 1, 3, and 4 are incorrect.

40. The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which statement, if made by the client, indicates an understanding of these measures?"Beet greens, parsley, or yogurt will help to control the colostomy odor."Rational: The client should be taught to include deodorizing foods in the diet such as beet greens, parsley, buttermilk, and yogurt. Spinach also may reduce odor, but it is a gas-forming food and should be avoided. Cucumbers, eggs, and broccoli also are gas-forming foods and should be avoided or limited by the client

41. A client with a new colostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse should teach the client to include which food in the diet to reduce odor?YogurtRational: The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas-forming food as well. Broccoli, cucumbers, and eggs are gas-forming foods.

42. The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply.Monitor for changes in mentationEncourage fluid intake of at least 3000 mL per day.Monitor vital signs, skin turgor, and intake and output.Rational: The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase intake of sodium, protein, and complex carbohydrates. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required. Options 1, 4, and 5 are appropriate interventions for the client at risk for a deficient fluid volume.

43. A nurse is reviewing laboratory test results for a client with liver disease and notes that the client's albumin level is low. The nurse next assesses the client for which physiological effect of decreased circulating albumin?Peripheral edemaRational: Albumin is responsible for maintaining the osmolality of the blood. When the albumin level is low, osmotic pressure is decreased, which in turn can lead to peripheral edema. The client will not experience cerebral edema. Clotting factors produced by the liver (not albumin) are responsible for coagulation. The total protein level may decrease if the albumin level is low.

44. A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply.High urine osmolalityLow serum osmolalityHypotonicity of body fluidsContinued release of antidiuretic hormoneRational: SIADH is characterized by inappropriate continued release of antidiuretic hormone (ADH). This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

45. A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client?Assessment of vital signsRational: The priority nursing action is to assess the vital signs. This would indicate the amount of blood loss that has occurred and provide a baseline by which to monitor the progress of treatment. The client may be unable to provide subjective data until the immediate physical needs are met. Although an abdominal examination and an assessment of the precipitating events may be necessary, these actions are not the priority. Insertion of a nasogastric tube is not the priority; in addition, the vital signs should be checked before performing this procedure.

46. The nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication?Runny NoseRational: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Options 1, 2, and 4 are side effects if the medication is administered by the intravenous route.

47. A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol (Cytotec). The nurse determines that the new medication is effective if the client states relief from which problem?Epigastric painRational: A client who chronically uses aspirin is prone to gastric mucosal injury, which causes epigastric pain as a symptom. Misoprostol is a gastric protectant specifically given to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Bleeding and joint aches are not relieved by misoprostol.

48. A nurse is caring for a client postoperatively following creation of a colostomy. Which client problem should the nurse include in the plan of care?Upset about appearanceRational: Being upset about appearance relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). There are no data in the question to support the remaining problems.

49. The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period?"When my bowels begin to function again, and I begin to pass gas."Rational: NG tubes are discontinued when normal function returns to the GI tract. Food would not be administered unless bowel function returns. The tube will be removed before GI healing. Although the HCP determines when the NG tube will be removed, option 4 does not determine effectiveness of teaching and the need for the NG tube.

50. A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply.Orthopnea, dyspneaPetechiae and ecchymosesInguinal or umbilical herniaAbdominal distention and tendernessRational: Excess fluid volume, related to the accumulation of fluid in the peritoneal cavity and dependent areas of the body, can occur in the client with cirrhosis. Ascites can cause physical problems because of the overdistended abdomen and resultant pressure on internal organs and vessels. These problems include respiratory difficulty, petechiae and ecchymoses, development of hernias, abdominal distention, and tenderness. Option 4 is unrelated to increased abdominal pressure.

51. A sulfonamide is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide (Orinase). Because the client will be taking these two medications, which prescription should the nurse anticipate for this client?Decreased dosage of tolbutamideRational: Sulfonamides can intensify the effects of warfarin sodium (Coumadin), phenytoin (Dilantin), and orally administered hypoglycemics such as tolbutamide (Orinase). When combined with sulfonamides, these medications may require a reduction in dosage

52. The nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which behavior indicates to the nurse that the client is not ready to learn?The client complains of fatigue whenever the nurse plans a teaching session.Rational: Physical symptoms can interfere with an individual's ability to learn and can indicate to the teacher that the student lacks motivation to learn if the symptoms repeatedly recur when teaching is initiated. The remaining options identify active client participation in learning.

53. A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client tells the nurse, "will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge?The client needs immediate education before discharge.Rational: If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the HCP should be notified. The client's statement in this question indicates a need for immediate education to prevent HHNS, a life-threatening emergency. Although all other options may be true, the most appropriate analysis is that the client requires immediate education.

54. A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. The nurse caring for the client would perform which action to minimize the risk of dumping syndrome?Remove fluids from the meal tray.Rational: Factors to minimize dumping syndrome after gastric surgery include having the client lie down for at least 30 minutes after eating; giving small, frequent meals; having the client maintain a low Fowler's position while eating if possible; avoiding liquids with meals; and avoiding high-carbohydrate food sources. Antispasmodic medications also are prescribed as needed to delay gastric emptying.

55. Lactulose (Chronulac) is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated?The fecal pH is acidic.Rational: Lactulose is an osmotic laxative used to decrease ammonia levels, which are elevated in hepatic encephalopathy. The desired effect is two or three soft stools per day with an acid fecal pH. Lactulose creates an acid environment in the bowel, resulting in a fall of the colon's pH from 7 to 5. This causes ammonia to leave the circulatory system and move into the colon for excretion. Diarrhea may indicate excessive administration of the medication. Options 1 and 4 do not determine that a desired effect has occurred.

56. A client has begun medication therapy with pancrelipase (Pancrease MT). Which finding indicates that the medication is effective?A decrease in the amount of fat in the stoolsRational: Pancrelipase is a pancreatic enzyme used as a digestive aid for clients with pancreatitis. It should reduce the amount of fatty stools (steatorrhea). Another recognized beneficial effect is improved nutritional status. It is not used to treat heartburn or abdominal pain and does not regulate blood glucose.

57. A client with a history of duodenal ulcer is taking calcium carbonate (Tums) chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication?Heartburn is relieved.Rational: Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (serum calcium level increases) or to bind phosphorus in the gastrointestinal tract with chronic kidney disease (serum phosphorus level decreases). Option 2 is incorrect, although adequate calcium levels are needed for proper neurological function.

58. Lispro insulin (Humalog) is prescribed for the client, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin?Immediately before eatingRational: Lispro insulin acts more rapidly than regular insulin and has a shorter duration of action. The effect of lispro insulin begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

59. A client is taking lansoprazole (Prevacid) for the chronic management of peptic ulcer disease. The nurse expects that the health care provider will advise the client to take which product if needed for a headache?Acetaminophen (Tylenol)Rational: The client with peptic ulcer disease should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). The client should be advised to take acetaminophen for a headache.

60. The clinic nurse is performing an abdominal assessment on a client and preparing to auscultate bowel sounds. The nurse should place the stethoscope in which quadrant first? Refer to figure. CRational: To auscultate bowel sounds, the nurse should begin in the right lower quadrant, at the ileocecal valve area, because normally bowel sounds are always present there. The diaphragm end piece is used because bowel sounds are relatively high pitched. The stethoscope is held lightly against the skin because pressing too hard can stimulate more bowel sounds.

61. The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client?A potassium (K+) level of 5.5 mEq/LRational: The client with Cushing's syndrome experiences hyperkalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The laboratory values listed in options 1, 2, and 4 would not be noted in the client with Cushing's syndrome.

62. Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction?"I will stop the medication when I feel better."Rational: To prevent acute adrenal insufficiency, glucocorticoids should not be abruptly discontinued. These medications can cause sodium and water retention and the loss of potassium, so clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with clients who are ill. Additionally, adequate dietary intake is important.

63. The health care provider has prescribed Humulin R insulin 6 units and Humulin N insulin 20 units subcutaneously to be administered every morning. How should the nurse prepare to administer insulin?Drawing up the Humulin R first and then the Humulin N insulin in the same syringeRational: Humulin R is always drawn up before Humulin N insulin, and Humulin N insulin can be drawn into the same syringe as for the Humulin R. Insulins usually are administered 15 to 30 minutes before a meal. To mix the Humulin N insulin suspension, the vial should be gently rotated. Shaking introduces air bubbles into the solution.

64. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply.ShakinessPalpitationsLightheadednessRational: Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.

65. A client with liver dysfunction exhibits low serum levels of thrombin. The nurse provides care, knowing that this client is most at risk for which complication?BleedingRational: Thrombin is produced by the liver and is necessary for normal clotting. The client who has an insufficient level of this substance is at risk for bleeding. Options 2, 3, and 4 are incorrect and not associated with thrombin.

66. A client received 5 units of aspart insulin (NovoLog) subcutaneously just before eating lunch at 12:00 pm. The nurse should assess the client for a hypoglycemic reaction at which times?Between 1:00 and 3:00 pmRational: Aspart insulin (NovoLog) is a rapid-acting insulin. Its onset of action is 15 minutes; it peaks in 1 to 3 hours, and its duration of action is 3 to 5 hours. Hypoglycemic reactions are most likely to occur during peak time

67. The nurse is caring for a client following a Billroth II procedure. Which postoperative prescription should the nurse question and verify?Irrigating the nasogastric tubeRational: In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

68. A client has begun medication therapy with propylthiouracil (PTU). The nurse should assess the client for which condition as an adverse effect of this medication?HypothyroidismRational: PTU is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. PTU is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.

69. A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia?PolyuriaRational: Classic signs and symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. It is important to regularly assess the client for hyperglycemia to prevent the development of more serious complications, such as diabetic ketoacidosis. Options 2, 3, and 4 are not manifestations of hyperglycemia.

70. A nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food?PorkRational: Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in the vitamin. Other good sources include peanuts, asparagus, and whole grain and enriched cereals.

71. The nurse is administering senna (Senokot) to an older client for the treatment of constipation. The client's spouse asks the nurse how the medication works. The nurse incorporates which information in formulating a reply?It increases peristalsisRational: Senna works by altering the transport of water and electrolytes in the large intestine, which causes accumulation of water in the mass of stool and increased peristalsis. The other options are incorrect actions for this medication.

72. The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?"I should eat foods that have a lot of potassium in them."Rational: A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue.

73. The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis?Leukocytosis with a shift to the leftRational: Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells). Options 1, 3, and 4 are incorrect because they are not associated findings in acute appenditis.

74. A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation?Frequent need to work overtime on short noticeRational: Psychological or emotional stressors that exacerbate peptic ulcer disease may be found either at home or in the workplace. Of the items listed, the frequent need to work overtime on short notice is potentially the most stressful because it is the item over which the client has the least control. An ability to work at home periodically is not necessarily stressful because it allows increased client control over timing and location of work. Adequate rest and proper dietary pattern (options 1 and 3) should alleviate symptoms, not worsen them.

75. A nurse is caring for a client recently diagnosed with type 2 diabetes mellitus who has been prescribed glipizide (Glucotrol XL). What is the most important point for the nurse to include in teaching this client about this medication?Swallow the medication whole and never crush or chew it.Rational: Glucotrol XL is designed to be slowly absorbed form the gastrointestinal tract. Crushing or chewing the tablet alters absorption of the medication. It must be taken 30 minutes before eating because absorption is delayed by food. Hypoglycemia may occur when taking this medication, especially with insufficient caloric intake. Glucotrol XL has a duration of action of 24 hours and is taken once a day.

76. A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP). The nurse should contact the HCP to question which prescription if noted in the client's record?Apply a heating pad to the lower abdomen for comfortRational: Appendicitis should be suspected in a client with an elevated WBC count who is complaining of acute right lower quadrant abdominal pain. A semi-Fowler's position is maintained for comfort. The client would be on NPO status and given IV fluids in preparation for possible surgery. Heat should never be applied to the abdomen because this may increase circulation to the appendix, potentially leading to increased inflammation and perforation.

77. A client who has a gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact, and does not speak to the family or visitors. Which type of coping mechanism should the nurse assess that this client is using?Distancing Rational: Distancing is an unwillingness or inability to discuss events. Self-control is demonstrated by stoicism and hiding feelings. Problem solving involves making plans and verbalizing what will be done. Accepting responsibility places the responsibility for a situation on oneself.

78. A client is resuming a diet after hemigastrectomy and the nurse provides dietary instructions. Which statement by the client indicates a need for further teaching?"I will drink plenty of liquids with meals."Rational: The client who has had a hemigastrectomy is at risk for dumping syndrome. This client should be placed on a diet that is high in protein, moderate in fat, and high in calories. The client should avoid drinking liquids with meals. Frequent small meals are encouraged, and the client should avoid concentrated sweets.

79. A client has a prescription for magnesium citrate to prevent constipation after undergoing barium studies of the gastrointestinal tract. How should the nurse administer the magnesium citrate?After it is chilled in the refrigeratorRational: Magnesium citrate is available as an oral solution and should be served chilled to make it more palatable. The other options are incorrect.

80. A client who visits the health care provider's office for a routine physical reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations?Complaints of weakness and lethargyRational: Weakness and lethargy are common complaints associated with hypothyroidism. Other common symptoms include weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

81. A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure?Vagus nerveRational: Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the production of gastric acid. The portal vein drains venous blood from the stomach. The celiac artery brings arterial blood to the stomach. The pyloric valve separates the stomach from the duodenum. The pyloric valve may undergo surgical repair if it becomes stenosed; this procedure is known as pyloroplasty

82. The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is most appropriate at this time?Obtain a capillary blood glucose level and perform a focused assessment.Rational: Diaphoresis and confusion are signs of moderate hypoglycemia. A likely cause of the client's change in condition could be related to the administration of insulin without the client eating enough food. However, an assessment is necessary to confirm the presence of hypoglycemia. The nurse would obtain a capillary blood glucose level to confirm the hypoglycemia and perform a focused assessment to determine the extent and cause of the client's condition. Once hypoglycemia is confirmed, the nurse stays with the client and asks the unlicensed assistive personnel (UAP) to obtain the appropriate carbohydrate snack. A code is called if the client is not breathing or if the heart is not beating.

83. A nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients?Small bowel resectionRational: The small intestine is responsible for the absorption of most nutrients. The client who has undergone removal of a segment of the small bowel is the one who has a decreased area with which to absorb nutrients. Decreased absorption is not a likely complication with the surgical procedures identified in options 1, 2, and 3.

84. A nurse who is caring for an older client is aware that the client is at risk for prolonged medication effects as a result of the normal aging process. The nurse would be most concerned with this effect if the client had a history of disease of which organ?LiverRational: An important function of the liver is to break down medications and other toxic substances. The older client with liver disease is at increased risk for toxic medication effects and should be monitored carefully for adverse effects. Diseases of the stomach, pancreas, and gallbladder are a lesser concern for prolonged medication effects.

85. The nurse has given instructions to a client who has just been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions?"This medication should only be taken with water."Rational: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

86. A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder?PolyuriaRational: Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

87. The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client?Dry skinRational: Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features, dry skin, and dry, coarse hair and eyebrows. Options 2, 3, and 4 are noted in the client with hyperthyroidism.

88. A nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels?Palpating for peripheral edemaRational: Albumin is responsible for maintaining the osmolality of the blood. When there is a low albumin level, there is decreased osmotic pressure, which in turn can lead to peripheral edema. Options 1, 2, and 4 are incorrect and are not associated with a low albumin level.

89. The nurse is educating a client about medroxyprogesterone (Depo-Provera). The nurse should provide the client with which information about the medication?Should be administered intramuscularly every 3 monthsRational: Medroxyprogesterone is given intramuscularly in the deltoid or gluteus maximus muscle. Injections should be administered every 12 weeks. Advantages of medroxyprogesterone include contraceptive effectiveness comparable to combined oral contraceptives and long-lasting effects. Additionally, injections are required only four times a year. Disadvantages are prolonged amenorrhea or uterine bleeding, increased risk of venous thrombosis and thromboembolism, and no protection against sexually transmitted infections.

90. A client has been hospitalized for an endocrine system dysfunction of the pancreas. The nurse providing care for the client anticipates that he or she will exhibit impaired secretion of which substances?InsulinRational: The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin.

91. The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on this data, the nurse should ask the client about a history of which symptom?HeartburnRational: Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. It also can be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with chronic kidney disease. The other options are incorrect and are not indications for the use of calcium carbonate.

92. A client with spinal cord injury (SCI) is participating in a bowel retraining program. The nurse develops a plan that is based in part on the knowledge that defecation is normally a result of which phenomena?Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal cordRational: The principal reflex center for defecation is located in the parasympathetic center at the S1 to S4 level of the spinal cord. This center is most active after the first meal of the day. Other factors that contribute to satisfactory stool passage are sufficient fluid and roughage in the diet and the Valsalva maneuver (which is lost with SCI). During defecation, the anal sphincter relaxes.

93. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?ConfusionRational: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

94. A nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) is/are primarily characteristic of the preicteric phase?Fatigue, anorexia, and nauseaRational: In the preicteric phase the client has nonspecific complaints of fatigue, anorexia, nausea, cough, and joint pain. The remaining options are clinical manifestations that occur in the icteric phase. In the posticteric phase, jaundice decreases, the color of urine and stool returns to normal, and the client's appetite improves.

95. A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response?Administer the full dose as prescribedRational: When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

96. A nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action?Stop the irrigation temporarily.Rational: If cramping occurs during colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The HCP does not need to be notified. Medicating the client for pain is not the appropriate action in this situation.

97. The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should provide which instructions to the client? Select all that apply.Diarrhea may occur secondary to the MetforminThe repaglinide is not taken if a meal is skipped.The repaglinide is taken 30 minutes before eatingA simple sugar food item is carried and used to treat mild hypoglycemia episodesRational: Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

98. The nurse is preparing to discharge a client who has had a parathyroidectomy. The discharge instructions include medication administration of oral calcium supplements that the client will need daily. Which statement by the nurse would be most appropriate regarding the oral calcium supplement therapy?Take the tablets following a meal.Rational: Oral calcium supplements can be administered with food to enhance its absorption as well as decrease gastrointestinal irritation. The remaining options are unrelated to oral calcium therapy.

99. A nurse is reviewing the health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify?Morphine sulfateRational: Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium (Synthroid), a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium (Colace), are prescribed to prevent constipation. Acetaminophen (Tylenol) can be taken.

100. The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is at the client's bedside?Tracheotomy setRational: Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postoperative client who has had a parathyroidectomy. An emergency tracheotomy set is always routinely placed at the bedside of the client who has undergone this type of surgery, in anticipation of this complication. Options 1, 3, and 4 are not specifically needed with the surgical procedure.