1. The physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? a. No increase in thyroid-stimulating hormone level after 30 minutes during the TSH stimulation test b. A decreased TSH level c. An increase in the TSH level after 30 minutes during the TSH test d. Below-normal levels of serum triiodthyronine (T4) and serum thyroxine (T4) as detected by radioimmunoassay 2. A client is prescribed prednisone (Deltasone) daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning? a. Taking the drug at the same time everyday establishes a regular routine, reducing the risk of forgetting a dose b. Prednisone has a longer half-life with morning administration, making it more effective c. Morning administration of prednisone mimics the bodys natural corticosteroid secretion pattern d. Prednisone is best absorbed when taken on an empty stomach first thing in the morning 3. Which of the following is the most critical intervention needed for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway 4. Which of the following would the nurse expect to assess in an elderly client with Hashimotos thyroiditis? a. Weight loss, increased appetite, and hyperdefecation b. Weight loss, increased urination, and increased thirst c. Weight gain, decreased appetite, and constipation d. Weight gain, increased urination, and purplish-red striae 5. For aclient with Graves disease, which nursing intervention promotes comfort? a. Restricting intake of oral fluids b. Placing extra blankets on the clients bed c. Limiting intake of high-carbohydrate foods d. Maintaining room temperature in the low-normal range 6. Which of the following instructions should be included in the discharge teaching plan for a client after thyroidectomy for Graves disease? a. Keep an accurate record of intake and output b. Use nasal desmopressin acetate c. Be sure to get regular follow-up care d. Be sure to exercise to improve cardiovascular fitness 7. A client has just been diagnosed with type 1 diabetes mellitus. W hen teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? a. Youll need more insulin when you exercise or increase your food intake b. Youll need less insulin when you exercise or reduce your food intake c. Youll need less insulin when you increase your food intake d. Youll need more insulin when you exercise or decrease you food intake 8. W hen caring for a client with diabetes insipidus, the nurse expects to administer? a. Vasopressin (Pitressin synthetic) b. Furosemide (Lasix) c. Regular insulin d. 10% dextrose 9. A client is transferred to a rehabilitation center after treated in the hospital for a cerebrovascular accident. Because the client has history of Cushings syndrome and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: a. Risk for fluid volume imbalance related to excessive sodium b. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion c. Altered health maintenance related to frequent hypoglycemic episodes secondary to Cushings syndrome d. Decreased cardiac output related to hypotension secondary to Cushings syndrome 10. A nurse administers glucagons to her diabetic client, and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagons? a. Oral anticoagulants b. Anabolic steroids c. Beta-adrenergic blockers d. Thiazide diuretics 11. A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered 12. A client is admitted to the health care facility for evaluation for Addisons disease. Which laboratory test result best supports a diagnosis of Addisons disease? a. Blood urea nitrogen level of 12 mg/dl b. Blood glucose level of 90 mg/dl c. Serum sodium serum level 134meq/L d. Serum potassium level of 5.8 mEq/L 13. A client is diagnosed with syndrome of inappropriate antidiuretic hormone. The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client does not comply with recommended treatment, which complication may arise? a. Cerebral edema c. Hypovolemic shock b. Severe Hyperkalemia d. Tetany 14. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach the client? a. Take the drug on an empty stomach b. Take the drug with meals c. Take the drug in the evening d. Take the drug whatever convenient 15. The nursing care for the client in addisonian crisis should include which of the following interventions? a. Encouraging independence with activities of daily living b. Allowing ambulation as tolerated c. Offering extra blankets and raising the heat in the room to keep the client warm d. Placing the client in a private room 16. Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? a. Confusion and seizures b. Sunken eyeballs and spasticity c. Flaccidity and thirst d. Tetany and increased blood urea nitrogen levels 17. A client, age 23, is diagnosed with diabetes mellitus. The physician prescribes 15 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspensions (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U- 100 insulin syringe, which sequence should the nurse use? a. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial, withdraw 15 U regular insulin; withdraw 35 U NPH b. Inject 15 U air into regular insulin vial; inject 35 U air into NPH vial, withdraw 35 U o0f NPH; withdraw 15 U regular insulin c. Inject 15 U air into regular insulin vial, withdraw 15 units of regular insulin; inject 35 U air into NPH vial and withdraw 35 U NPH d. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial; withdraw 35 U NPH; withdraw 15 U regular insulin 18. When teaching a client about insulin therapy, the nurse should instruct the client to avoid which over-the-counter preparation that can interact with insulin? a. Antacids b. Acetaminophen preparations c. Vitamins with iron d. Salicylate preparations 19. A middle-age complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling gritty. Thyroid function tests reveal the following: TSH 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hr radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse would suspect which of the following? a. Thyroiditis b. Graves disease c. Hashimotos thyroiditis d. Multinodular goiter 20. During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse includes which statement? a. The head of your bed must remain flat for 24 hours after the surgery b. You should avoid deep breathing and coughing after surgery c. You wont be able to swallow for the first day or two d. You must avoid hyperextending your neck after surgery 21. A client is admitted with a serum glucose level of 618 mg/dl. The client is awake and oriented, with hot, dry skin; a temperature of 38.1 C; A HR of 116 beats/min; and a BP of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority? a. Fluid volume deficit related to osmotic diuresis b. Decreased cardiac output related to increased heart rate c. Altered nutrition: Less than body requirements related to insulin deficiency d. Ineffective thermoregulation related to dehydration 22. A diabetic client develops sinusitis and otitis media accompanied by a fever of 38.2C. What effect may this have on his need for insulin? a. It will have no effect b. It will decrease the need for insulin c. It will increase the need for insulin d. It will cause wide fluctuations in the need for insulin 23. Because diet and exercise have failed to control a 63- year-old clients blood glucose level, the client is prescribed glipizide (Glucotrol). After oral administration, the onset of action is: a. 15 to 30 minutes b. 30 to 60 minutes c. 1 to 1 hours d. 2 to 3 hours 24. Early this morning, aclient had a subtotal thyroidectomy. During the evening rounds, the nurse assesses the client, who now has nausea, a temperature of 40.5C, tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany 25. The nurse is planning care for a 52-year-old old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a. Risk for infection b. Decreased cardiac output c. Impaired physical mobility d. Altered nutrition: Less than body requirements 26. A client with an indwelling urinary catheter is suspected of having urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by: a. Disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container b. Wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle c. Draining urine from the drainage bag into a sterile container d. Clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine 27. A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the clients history to check for significant findings, the nurse should ask about: a. Chronic, excessive acetaminophen use b. Recent streptococcal infection c. Childhood asthma d. Family history of pernicious anemia 28. A client receiving total parenteral nutrition is prescribed a 24 hour urine test. When initiating a 24-hour urine specimen, the collection time should: a. Start with the first voiding b. Start after a known voiding c. Always be with first morning urine d. Always be the last evenings void as the last sample 29. The nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a. The need for the use of petroleum products b. Why the disease is only transmittable when visible lesions are present c. The option of disregarding safer-sex practices now what hes already infected d. Then importance of informing his partner of the disease 30. After having transurethral resection of the prostate, a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the clients catheter is occluded? a. The urine in the drainage bag appears red to pink b. The client reports bladder spasms and the urge to void c. The normal saline irrigant is infusing at rate of 50 drops/minute d. About 1,000 ml of irrigant have instilled;1,200 ml of drainage have been returned 31. A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should the nurse include in a bladder retraining program? a. Establishing a predetermined fluid intake pattern for the client b. Encouraging the client to increase the time between voidings c. Restricting fluid intake to reduce the need to void d. Assessing present elimination patterns 32.. A client develops decreased renal function and requires a change in antibiotic dosage. On which factor would the physician base the dosage change? a. GI absorption b. Therapeutic index c. Creatinine clearance d. Liver function studies 33. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure? a. Blood urea nitrogen level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Temperature of 37.6 C d. Urine output of 400 ml/24 hours 34. The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: a. Hypernatremia b. Hypokalemia c. Hyperkalemia d. Hypercalcemia 35. A triple-lumen indwelling catheter is inserted for continuous bladder irrigation following a transurethral resection, the functions of the three lumens include: A. Continuous inflow and outflow of irrigation solution B. Intermittent inflow and continuous outflow of irrigation solution C. Continuous inflow and intermittent outflow of irrigation solution D. Intermittent flow of irrigation solution and prevention of hemorrhage 36. A client with genitourinary problem is being examined in the emergency department. When palpating the clients kidneys, the nurse should keep which anatomical fact in mind? a. The left kidney usually is slightly higher than the right one b. The kidneys are situated just above the adrenal glands c. The average kidney is approximately 5 cm long and 2 to 3 cm wide d. The kidneys lie between the 10 th and 12 th thoracic vertebrae 37. During a routine examination, the nurse notes that the client seems unusually anxious. Anxiety can affect the genitourinary system by: a. Slowing the glomerular filtration rate b. Increasing sodium resorption c. Decreasing potassium excretion d. Stimulating or hindering micturation 38. A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a. Confusion, headache, and seizures b. Acute bone pain and confusion c. Weakness, tingling, and cardiac arrhythmias d. Hypotension, tachycardia, and tachypnea 39. A client admitted to an acute care facility with heart failure is found to have a cystocele. When planning care for this client, the nurse is most likely to formulate which nursing diagnosis? a. Total incontinence b. Functional incontinence c. Reflex incontinence d. Stress incontinence 40. The nurse is planning a group teaching session on the topic of urinary tract infection prevention. Which point would the nurse want to include? a. Limit fluid intake to reduce the need to urinate b. Take the medication prescribed for a UTI until the symptoms subside c. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs d. Wear only nylon underwear to reduce the chance of irritation 41. The nurse is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client to avoid a urinary tract infection? a. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg b. Limiting fluid intake to 1 L/day c. Encouraging the client to use a feminine deodorant after bathing d. Encouraging the client to douche once a day after removal of the indwelling urinary catheter 42. A client is admitted for treatment of chronic renal failure. The nurse knows that this disorder increases the client risk of: a. Water and sodium retention secondary to severe decrease in the glomerular filtration rate b. A decreased serum phosphate level secondary to kidney failure c. An increased serum calcium level secondary to kidney failure d. Metabolic alkalosis secondary to retention of hydrogen ions 43. Which steps should the nurse follow to insert a straight urinary catheter? a. Create a sterile filed, drape client, clean meatus, and insert catheter only 6 b. Put on gloves, prepare equipment, create a sterile field, expose urinary meatus, and insert catheter 6 c. Prepare the client and equipment, create a sterile field, put on gloves, clean urinary meatus, and insert catheter until urine flows d. Prepare client and equipment, create a sterile field, test catheter balloon, clean meatus, and insert catheter until urine flows 44. The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is important? a. Administering a sitz bath twice a day b. Increasing fluid intake to 3 L/day c. Using an indwelling catheter to measure urine output accurately d. Encouraging the client to drink cranberry juice to acidify the urine 45. A female client has just been diagnosed with condylomata acuminate. What information is appropriate to tell his client? a. This condition puts her at a higher risk for a cervical cancer, therefore, she should have a Papanicolaou (Pap) smear b. The most common treatment is metronidazole which should eradicate the problem within 7 to 10 days c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse d. The human papillomavirus, which causes condylomata acuminate, cant be transmitted during oral sex 46. Which of the following clinical findings would the nurse look for in a client with chronic renal failure? a. Hypotension b. Uremia c. Metabolic acidosis d. Polycythemia 47. A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client? a. Altered urinary elimination b. Toileting self-care deficit c. Risk for infection d. Activity intolerance 48. The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted though a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. Limit oral fluid intake for 1 to 2 weeks b. Reporting the presence of fine, sandlike particles through the nephrostomy tube c. Notify the physician about the cloudy or foul-smelling urine d. Report bright pink urine within 24 hours after the procedure 49. A client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure, the nurse would be most accurate in telling the client: a. She will be in private room with unrestricted activities b. A bowel-cleansing procedure will precede radioactive implantation c. She will be expected to use a bedpan for urination d. The preferred positioning in bed will be semi-Fowlers 50. Which statement best describes the therapeutic action of loop diuretics? a. They block reabsorption of potassium on the collecting tubule b. They promote sodium secretion into the distal tubule c. They block sodium reabsorption in the ascending loop and dilate renal vessels d. They promote potassium secretion into the distal tubule and constrict renal vessels 51. A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a. Take your temperature every 4 hours b. Increase your fluid intake to 2 to 3 L per day c. Apply an antibacterial dressing to the incision daily d. Be aware that your urine will be cherry red for 5 to 7 days 52. Which of the following findings would be further evidence of a urethral injury in a client during rectal examination? a. A low-riding prostate b. The presence of a boggy mass c. Absent sphincter tone d. A positive Hemoccult 53. A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic form of acute renal failure? a. Poor perfusion to the kidneys b. Damage to the cells in the adrenal cortex c. Obstruction of the urinary collecting system d. Nephrotoxic injury to use of contrast media 54. A client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this clients pouch, the nurse observes that the stoma is red, weeping, and painful. What should the nurse conclude? A. The skin was not lubricated before the pouch was applied B. The pouch faceplate doesnt fit the stoma C. A skin barrier was applied properly D. Stoma dilation was not performed 55. The nurse is caring for a male client with gonorrhea whos receiving ceftriaxone and doxycycline. The client asks the nurse why hes receiving two antibiotics. How should the nurse respond? a. Because there are many resistant strains of gonorrhea, more than one antibiotic may be required for successful treatment b. The combination of these two antibiotics reduces the risk of reinfection c. Many people infected with gonorrhea are infected with Chlamydia as well d. This combination of medications will eradicate the infection faster than a single antibiotic 56. The nurse is reviewing the report of a clients routine urinalysis. Which value should the nurse consider abnormal? a. Specific gravity of 1.03 b. Urine pH of 3.0 c. Absence of protein d. Absence of glucose 57. Which of the following is a function of antidiuretic hormone? a. Sodium absorption and potassium excretion b. Water reabsorption and urine concentration c. Water reabsorption and urine dilution d. Sodium reabsorption and potassium retention 58. After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, aclient returns to the room with continuous bladder irrigation. On the first day after the surgery, the client reports bladder pain. What should the nurse do first? a. Increase the I. V. flow rate b. Notify the physician immediately c. Assess the irrigation catheter for patency and drainage d. Administer meperidine (Demerol), 50 mg I.M., as prescribed 59. A client with chronic renal failure is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a. Hematuria b. Weight loss c. Increased urine output d. Increased blood pressure 60. The parent of a 9-year-old male calls the physician's office to inform the nurse that the child has persistent throbbing pain and tenderness behind the ear. The parent also notes redness and swelling behind the ear, accompanied by fever. Based on this report, the nurse suspects which of the following? A. Otitis media B. Acute mastoiditis C. Otosclerosis D. Inner ear disorder 61. Nurse Vince, performing a vision screening on a client, notes the client has to stand 20 feet from the chart to read a line that a person with normal vision could read 100 feet from the chart. Nurse Vince documents the reading as which of the following? A. 20/20 B. 100/20 C. 20/100 D. 120 62. Mr. Choy, 50-year-old client has impaired near vision resulting from a loss of elasticity of the lens related to aging. This is called A. myopia. B. hyperopia. C. presbyopia. D. nearsightedness 63. A nurse assessing a client notes yellow plaques on the lid margins. The nurse documents the finding as A. exophthalmos. B. xanthelasma. C. corneal arcus. D. Ptosis. 64. The nurse, teaching a group of clients with chronic ear complications, plans to include which of the following as being involved in equilibrium? A. The external ear B. The middle ear C. The inner ear D. All three areas of the ear 65. Nurse Pevy while assessing a client's ear with an otoscope, notes the tympanic membrane has white opaque areas. She recognizes this finding as which of the following? A. A normal finding B. Otitis media C. Retraction of the tympanic membrane D. Scars from previous perforations 66. A client asks Nurse Pevy to explain the purpose of ear wax (cerumen). Nurse Pevy knows that which of the following is not a function of cerumen? A. Protects the tympanic membrane from infection B. Protects the middle ear from infections C. Traps foreign bodies D. Serves to direct sound waves into the ear 67. A nursing student studying ear anatomy and physiology recognizes that which of the following helps to equalize the air pressure in the middle ear? A. Tympanic membrane B. Eustachian tube C. Labyrinth D. Cochlea 68. Dyosa, a 24-year old client presents to the clinic complaining of eye pain after scratching the eye with the contact lens. Upon assessment, the nurse notes a deep ulceration on the cornea. Which of the following is the most appropriate action for the nurse? A. Irrigate the eye with antiseptics B. Promptly refer the client to an ophthalmologist for treatment C. Suggest the client avoid wearing contacts until the eye feels better D. Perform a Snellen eye examination 69. Mrs Konchay presents to the emergency department after being splashed with a chemical in the left eye during their heated argument with a neighbor. The physician orders eye irrigation to the affected eye. Which of the following represents the appropriate technique for the nurse to implement? A. Direct fluid from the inner canthus of the left eye to the outer, tipping the client's head slightly to the left. B. Direct fluid from the outer canthus of the left eye to the inner, tipping the client's head slightly to the left. C. Direct fluid from the inner canthus of the left eye to the outer, tipping the client's head slightly to the right. D. Direct fluid from the outer canthus of the left eye to the inner, tipping the client's head slightly to the right. 70. A client has an intraocular pressure of 25 mm Hg. In planning care for this client, the nurse recognizes that the normal intraocular pressure is A. 15 - 20 mm Hg. B. 20 - 25 mm Hg. C. 25 - 30 mm Hg. D. 20 - 30 mm Hg 71. Structure of the eyes that maintain hydrostatic intraocular pressure: a. vitreous humor c. retina b. aqueous humor d. choroid 72. Diagnostic test that measures error of focus: a. ophthalmoscopic examination c. refraction test b. visual acuity test and tonometry d. Snellens chart 73. Post-operative nursing intervention/s to clients with scleral buckling should include: a. administration of miotics as ordered b. position client in a semi-fowlers position for 1 day post-op c. advise client to avoid bending and stooping d. all of the above 74. Characterized by tunnel vision: a. retinal detachment c. glaucoma b. cataract d. macular degeneration 75. Agents used as treatment for glaucoma that act by decreasing the formation of aqueous humor include: a. osmotic diuretics c. sympathomimetics b. prostaglandin inhibitors d. miotics 76. Management for otitis media includes: a. glycerol irrigation c. stapedectomy b. myringotomy d. fenestration 77. Diet that is best advised to client with Menieres Disease: a. bland diet c. low fat diet b. low-sodium diet d. high fiber diet 78. Surgical treatment for laryngeal cancer which retains normal phonation and airway: a. total laryngectomy b. radical neck dissection c. total laryngectomy with laryngoplasty d. partial laryngectomy 79. The best time to encourage speech training to patient who underwent laryngectomy, is: a. 3 days post-op b. 2 weeks post-op c. 1 week post-op d. after recovery from anesthesia 80. For an effective control of bleeding in clients with epistaxis, the nurse best action is: a. Anterior and posterior nasal packing for 15 minutes b. digital compression of the soft, outer protion of the nares against the septum for 5 to 10 minutes c. advise client to avoid nose blowing d. teach client proper mouth breathing technique