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Which instruction by the nurse concerning the test procedure is most accurate?
- A. You need to eat a large meal just before the test.
- B. You can drink coffee or tea in the morning before the test.
- C. You will be given a sweetened drink before the test.
Correct Answer: C
Rationale: A glucose tolerance test involves administering a sweetened drink to assess the body's response to glucose.
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Which nursing assessment is most helpful in evaluating the status of a client with Addison's disease?
- A. Blood pressure
- B. Bowel sounds
- C. Breath sounds
- D. Heart sounds
Correct Answer: A
Rationale: Hypotension is a key sign of Addison's disease due to decreased aldosterone and cortisol.
When developing the client's care plan, which intervention is most appropriate to add?
- A. Encourage the client to use an electric razor.
- B. Tell the client to file rather than cut toenails.
- C. Make sure that the client receives mouth care twice per day.
- D. Advise the client to use deodorant soap when bathing.
Correct Answer: B
Rationale: Filing toenails prevents injury and infection in diabetic clients with poor healing.
The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client?
- A. Explain it will take up to a month for symptoms of hyperthyroidism to subside.
- B. Teach the iodine therapy will have to be tapered slowly over one (1) week.
- C. Discuss the client will have to be hospitalized during the radioactive therapy.
- D. Inform the client after therapy the client will not have to take any medication.
Correct Answer: A
Rationale: Radioactive iodine takes weeks to reduce hyperthyroid symptoms, requiring client understanding. Tapering, hospitalization, and stopping medications are incorrect.
The nurse observes a colleague caring for the client who had a hypophysectomy via the transsphenoidal approach 12 hours ago. Which action would require the observing nurse to intervene?
- A. Elevates the head of the client's bed to 30 degrees
- B. Gathers supplies to replace the bloody nasal packing
- C. Moisturizes the client's oral mucous membranes
- D. Places a cold washcloth over the client's swollen eyes
Correct Answer: B
Rationale: Nasal packing is left in place for 3-4 days post-hypophysectomy and should not be changed without an HCP order.
The client diagnosed with Cushing's syndrome is admitted with fluid volume overload. The client weighed 190 lb on admission and 179 lb after treatment. The nurse estimates that the amount of fluid the client lost was how many milliliters?
- A. 3000 mL
- B. 4000 mL
- C. 5000 mL
- D. 6000 mL
Correct Answer: C
Rationale: One liter of fluid (1000 mL) weighs approximately 2.2 lb. An 11-lb weight loss equals 5000 mL (11 lb / 2.2 lb = 5 L × 1000 mL per L = 5000 mL).