CHARLES

EXAM PRACTICE
Therapeutic diet and Nutrition
1. 
An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

2. 
A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?

3. 
Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he’s impotent and says he’s concerned about its effect on his marriage. In planning this client’s care, the most appropriate intervention would be to:

4. 
During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?

5. 
Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

6. 
A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

7. 
A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders?

8. 
When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:

9. 
The nurse is aware that the following is the most common cause of hyperaldosteronism?

10. 
A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

11. 
Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following?

12. 
Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

13. 
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

14. 
For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

15. 
When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect:

16. 
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

17. 
A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:

18. 
Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

19. 
Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?

20. 
Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

21. 
An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of:

22. 
A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:

23. 
When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

24. 
After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

25. 
During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement?

26. 
Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:

A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

27. 
A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

28. 
Nurse Wayne is aware that a positive Chvostek’s sign indicate?

29. 
In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:

30. 
A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?

31. 
Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose’s:

32. 
A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

33. 
Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

34. 
After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

35. 
Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

36. 
A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

37. 
A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands?

38. 
Nurse Troy is aware that the most appropriate for a client with Addison’s disease?

39. 
Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states:

40. 
A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

41. 
Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

42. 
For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

43. 
When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following?

44. 
Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

45. 
A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

46. 
A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

47. 
Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

48. 
Which instruction about insulin administration should nurse Kate give to a client?

49. 
Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

50. 
For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek’s sign and Trousseau’s sign because they indicate which of the following?

51. 
The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test?

52. 
During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as:

53. 
The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication?

54. 
The nurse has conducted discharge teaching for a client who had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?

55. 
A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?

56. 
The nurse has notes that the physician has a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing the condition is:

57. 
A client with Meniere’s disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo?

58. 
The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which diet will most likely be prescribed?

59. 
A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear?

60. 
A nurse would question an order to irrigate the ear canal in which of the following circumstances?

61. 
Which of the following interventions is essential when instilling Cortisporin suspension, 2 gtt right ear?

62. 
When teaching the client about Meniere’s disease, which of the following instructions would a nurse give about vertigo?

63. 
The part of the ear that contains the receptors for hearing is the:

64. 
The ear bones that transmit vibrations to the oval window of the cochlea are found in the:

65. 
Nerve deafness would most likely result from an injury or infection that damaged the:

66. 
A labyrinthectomy can be performed to treat Meniere’s syndrome. This procedure results in:

67. 
Otosclerosis is a common cause of conductive hearing loss. Which such a partial hearing loss:

68. 
A client who is complaining of tinnitus is describing a symptom that is:

69. 
Physiologically, the middle ear, containing the three ossicles, serves primarily to:

70. 
The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the following identifies the accurate procedure for this visual acuity test?

71. 
The clinic nurse notes that the following several eye examinations, the physician has documented a diagnosis of legal blindness in the client’s chart. The nurse reviews the results of the Snellen’s chart test expecting to note which of the following?

72. 
The client’s vision is tested with a Snellen’s chart. The results of the tests are documented as 20/60. The nurse interprets this as:

73. 
Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client’s chart and understands that normal intraocular pressure is:

74. 
The nurse is developing a plan of care for the client scheduled for cataractsurgery. The nurse documents which more appropriate nursing diagnosis in the plan of care?

75. 
The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is:

76. 
In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled?

77. 
During the early postoperative period, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to:

78. 
The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions?

79. 
The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is:

80. 
The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care?

81. 
 The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which of the following is associated with this eye disorder?

82. 
The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of the retinal detachment?

83. 
The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which intervention is initiated immediately?

84. 
The client arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye, what is the initial nursing action?

85. 
The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to:

1. Begin visual acuity testing
2. Irrigate the eye with sterile normal saline
3. Swab the eye with antibiotic ointment
4. Cover the eye with a pressure patch.

86. 
The nurse is caring for a client following enucleation. The nurse notes the presence of bright red blood drainage on the dressing. Which nursing action is appropriate?

87. 
When using a Snellen alphabet chart, the nurse records the client’s vision as 20/40. Which of the following statements best describes 20/40 vision?

88. 
Which of the following instruments is used to record intraocular pressure?

89. 
After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic examination, which of the following instructions would be given to the client?

90. 
Which of the following procedures or assessments must the nurse perform when preparing a client for eye surgery?

91. 
Cataract surgery results in aphakia. Which of the following statements best describes this term?

92. 
When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress?

93. 
For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications?

94. 
Which of the following symptoms would occur in a client with a detached retina?

95. 
 A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the client’s wife to:

96. 
 Which of the following arteries primarily feeds the anterior wall of the heart?

97. 
 When do coronary arteries primarily receive blood flow?

98. 
 Which of the following illnesses is the leading cause of death in the US?

99. 
Which of the following conditions most commonly results in CAD?

100. 
Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

101. 
Which of the following risk factors for coronary artery disease cannot be corrected?

102. 
 Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?

103. 
Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease?

104. 
Medical treatment of coronary artery disease includes which of the following procedures?

105. 
 Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?

106. 
Which of the following is the most common symptom of myocardial infarction?

107. 
Which of the following landmarks is the correct one for obtaining an apical pulse?

108. 
Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration?

109. 
A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?

110. 
Which of the following blood tests is most indicative of cardiac damage?

111. 
What is the primary reason for administering morphine to a client with myocardial infarction?

112. 
Which of the following conditions is most commonly responsible for myocardial infarction?

113. 
What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?

114. 
 After myocardial infarction, serum glucose levels and free fatty acids are both increased. What type of physiologic changes are these?

115. 
 Which of the following complications is indicated by a third heart sound (S3)?

116. 
Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

117. 
What is the first intervention for a client experiencing myocardial infarction?

118. 
What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?

119. 
Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

120. 
What is the most common complication of a myocardial infarction?

121. 
With which of the following disorders is jugular vein distention most prominent?

122. 
What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention?

123. 
Which of the following parameters should be checked before administering digoxin?

124. 
Toxicity from which of the following medications may cause a client to see a green halo around lights?

125. 
Which of the following symptoms is most commonly associated with left-sided heart failure?

126. 
 In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?

127. 
Which of the following symptoms might a client with right-sided heart failure exhibit?

128. 
 Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?

129. 
Stimulation of the sympathetic nervous system produces which of the following responses?

130. 
 Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?

131. 
What is the most common cause of abdominal aortic aneurysm?

132. 
 In which of the following areas is an abdominal aortic aneurysm most commonly located?

133. 
A pulsating abdominal mass usually indicates which of the following conditions?

134. 
What is the most common symptom in a client with abdominal aortic aneurysm?

135. 
 Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

136. 
What is the definitive test used to diagnose an abdominal aortic aneurysm?

137. 
Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?

138. 
Which of the following blood vessel layers may be damaged in a client with an aneurysm?

139. 
When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

140. 
Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?

141. 
Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?

142. 
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?

143. 
Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?

144. 
 Which hereditary disease is most closely linked to aneurysm?

145. 
Which of the following treatments is the definitive one for a ruptured aneurysm?

146. 
Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?

147. 
 Which of the following types of cardiomyopathy can be associated with childbirth?

148. 
 Septal involvement occurs in which type of cardiomyopathy?

149. 
Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?

150. 
What is the term used to describe an enlargement of the heart muscle?

151. 
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?

152. 
Which of the following types of cardiomyopathy does not affect cardiac output?

A. Dilated
B. Hypertrophic
C. Restrictive
D. Obliterative

153. 
 Which of the following cardiac conditions does a fourth heart sound (S4) indicate?

154. 
Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?

X