NURSING MISC : Endo Nclex Test Bak
- The nurse is collecting data regarding a client after a thyroidectomy and notes that
the client has developed hoarseness and a weak voice. Which nursing action is
appropriate?
Reassure the client that this is usually a temporary condition - The nurse is assisting with preparing a teaching plan for the client with diabetes
mellitus regarding proper foot care. Which instruction should be included in the plan
of care?
Apply a moisturizing lotion to dry feet, but not between the toes. - The nurse provides dietary instructions to a client with diabetes mellitus regarding
the prescribed diabetic diet. Which statement made by the client indicates the need
for further teaching?
“I need to buy special dietetic foods.” - A client who has been newly diagnosed with diabetes mellitus has been stabilized
with daily insulin injections. Which teaching information should the nurse reinforce
upon discharge?
Rotate the insulin injection sites systematically. - The nurse reinforces teaching with a client with diabetes mellitus regarding
differentiating between hypoglycemia and ketoacidosis. The client demonstrates an
understanding of the teaching by stating that glucose will be taken if which symptom
develops?
Shakiness - When the nurse is reinforcing instructions to a client who has been newly diagnosed
with type 1 diabetes mellitus, which statement by the client would indicate that
teaching has been effective?
“I will notify my health care provider if my blood glucose level is consistently
greater than 250 mg/dL.” - The nurse is monitoring a client who has been newly diagnosed with diabetes
mellitus for signs of complications. Which statement made by the client would
indicate hyperglycemia and thus warrant health care provider notification?
“I am urinating a lot.” - The nurse is reinforcing instructions with a client with diabetes mellitus who is
recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a
recurrence. Which instruction is important for the nurse to emphasize?
Monitor blood glucose levels frequently. - The nurse is reinforcing discharge teaching with a client who has Cushing’s
syndrome. Which statement by the client indicates that the instructions related to
dietary management were understood?
“I can eat foods that contain potassium.” - The nurse educator is asking the nursing student to recall the signs/symptoms of
hypothyroidism. The nurse educator determines that the student understands this
disorder if which are included in the student’s response? Select all that apply.
Irritability, Constipation, Cold intolerance - The nurse is caring for a postoperative parathyroidectomy client. Which would
require the nurse’s immediate attention?
Laryngeal stridor - The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both
upper thighs. Which further information should the nurse obtain from the client
during data collection?
Plan for injection rotation
13.A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of
hypoglycemia. Which statement by the client indicates a correct understanding of
Humulin N insulin and exercise?
“I should not exercise in the late afternoon.” - The nursing instructor asks a student to describe the pathophysiology that occurs in
Cushing’s disease. Which statement by the student indicates an accurate
understanding of this disorder?
“Cushing’s disease is characterized by an oversecretion of glucocorticoid
hormones.” - A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse
is reinforcing instructions to the client regarding the program. Which should the
nurse include in the instructions?
Take a blood glucose test before exercising. - The nurse should expect to note which interventions in the plan of care for a client
with hypothyroidism? Select all that apply.
Instruct the client about thyroid replacement therapy.
Encourage the client to consume fluids and high-fiber foods in the diet.
Instruct the client to contact the health care provider if episodes of chest pain
occur.
17.Which client complaint should alert the nurse to a possible hypoglycemic reaction?
Tremors and double vision
18.Which nursing action would be appropriate to implement when a client has a
diagnosis of pheochromocytoma?
Monitor the client’s blood pressure. - The nurse is caring for a client with pheochromocytoma. The client is scheduled for
an adrenalectomy. During the preoperative period, the priority nursing action
should be to monitor which criterion?
Vital signs - The nurse is caring for a client with pheochromocytoma. The client asks for a snack
and something warm to drink. Which is the appropriate choice for this client to meet
nutritional needs?
Graham crackers and warm milk - The nurse is caring for a client with pheochromocytoma. Which data are indicative of
a potential complication associated with this disorder?
Congestion heard on auscultation of the lungs - The nurse is caring for a client after a thyroidectomy and monitoring for signs of
thyroid storm. The nurse determines that which sign/symptom is indicative that a
thyroid storm may be occurring?
Blood pressure of 80/60 mmHg
23.When caring for a client who is having clear drainage from his nares after
transsphenoidal hypophysectomy, which action by the nurse is essential?
Obtain a culture of the drainage.
24.After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse
understands that which signs/symptoms are indicative of this disorder?
Excessive thirst and urine output