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ANSWER & RATIONALE – INTEG EXAM 4

INTEGRATED EXAM 4 – ANSWER & RATIONALE
1. ANSWER: A
ECG changes include a depressed ST segment and prolonged PR interval (but also present in hyperkalemia), flat T waves
(hyperkalemia –tall and tented T-waves), and elevated U wave-this is specific to hypokalenmia.
2. ANSWER: D
Potassium is never administered IV push or intramuscularly. IV potassium must be administered using an infusion pump to
avoid replacing potassium too quickly.
3. ANSWER: B
When serum potassium levels are dangerously elevated, it may be necessary to administer calcium gluconate. Within
minutes after administration, the calcium antagonizes the action of hyperkalemia on the heart. Infusion of calcium does not
reduce the serum potassium but immediately antagonizes the adverse cardiac conduction abnormalities.
4. ANSWER: A
Sodium polystyrene (Kayexalate) is a cation-exchange resin. As it passes along the intestine or is retained in the colon after
enema administration, sodium ions are partially released and replaced by potassium ions, allowing for fecal excretion of
potassium ions. This drug is extremely unpalatable and may be administered in syrup, chilled, or mixed in the diet, and if
necessary, administered directly into the stomach per nasogastric tube. Side effects of administration
include anorexia, nausea, vomiting, constipation, hypokalemia, hypocalcemia, and sodium retention.
5. ANSWER: A
Options b, c and d can be found in clients with hypercalcemia. It is tetany that is the most characteristic symptom of
hypocalcemia and hypomagnesemia. It refers to the entire symptom complex induced by increased neural excitability.
6. ANSWER: D
Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional
antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.
7. ANSWER: B
The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing a
respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base
control.
8. ANSWER: D
The original ABG analysis reveals respiratory acidosis commonly seen with a pneumothorax. After chest tube insertion, the
patient’s respiratory status has improved; pH is increasing toward normal, and the Paco2. Assessment findings are more
important than ABG analysis in determining if the patient requires intubation or if respiratory arrest is imminent.
9. ANSWER: A
Third degree burns destroy the entire dermal layer. Included in this destruction is the regenerative tissue. For this reason,
tissue regeneration does not occur, and skin grafting is necessary (A). Options B, C, and D are simply false.
10. ANSWER: B
The nurse should first slow the IV flow rate to keep vein open (KVO) rate (option B) to prevent further risk of fluid volume
overload, then gather additional assessment data, such as when the IV solution was started (option A) and the appearance
of the IV insertion site (option C) before contacting the healthcare provider (option D) for further instructions.
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11. ANSWER: A
Supplying bleach solution to patients who are at risk for HIV infection can be done by staff members with health assistant
education. Pre-operative/post-operative test counseling may be done by non-RN personnel with specialized training;
however, a nurse would be better prepared to answer questions that are likely to be asked by at risk individuals. Education
and community assessment are RN-level skills.
12. ANSWER: D
Although the HIV antigen is detectable approximately 2 weeks after exposure, seroconversion to HIV positive may take up to
6 to 12 weeks (option D) after exposure, so the client should return to repeat the serum screen for the presence of HIV
antibodies during that time frame. Option A will delay treatment if the client tests positive. Options B and C may provide
inaccurate results because the time frame maybe too early to reevaluate the client.
13. ANSWER: B
Advance directives are written statements of a person's wishes regarding medical care, and verbal directives may be given
to a healthcare provider with specific instructions in the presence of two witnesses. To obtain this prescription, the client
should discuss his choice with the healthcare provider (option B). Option A is insufficient to implement the client's request
without legal consequences. Although (C and D) provide legal protection of the client's wishes, the present request needs
additional action.
14. ANSWER: B
Toxoplasmosis is an opportunistic infection and a parasite of birds and mammals. The oocysts remain infectious in moist
soil for about 1 year. Eating raw or undercooked meat, not vegetables, is a mode of transmission. The parasite is transmitted
through ingestion, not air. Ingestion of oocysts from cat feces is the most common mode of oral infection in the United
States. Cats do not have to be avoided, but handling of litter should be avoided, and hand washing would be essential for a
patient who is immunocompromised.
15. ANSWER. C.
AIDS patients are sometimes afflicted with a blood vessel tumor (originally called "idiopathic multiple pigmented sarcoma
of the skin") that has since been eponymously named Kaposi's sarcoma .
16. ANSWER: D
AIDS is diagnosed when one of several processes defined by the CDC is present in an individual who is not otherwise
immunosuppressed (option D) (PCP, candidiasis, crytpococcus, cryptosporidiosis, Kaposi’s sarcoma, CNS lymphomas).
Options A and B identify the presence of HIV, indicating a high probability that in time the individual will develop AIDS, but
do not necessarily denote the presence of AIDS. Option C is telling the client how he/she feels (afraid) and is dismissing the
situation to the minister. This client is asking a question and specific medical information needs to be provided.
17. ANSWER: C
Individuals with allergic reactions to these fruits have a high incidence of latex allergy. More information and/or testing are
needed to determine whether the new employee has a latex allergy, which might affect ability to provide direct patient care.
The other findings would be important to include in documenting the employee’s health history, but would not affect ability
to provide patient care.
18. ANSWER: B
Visual changes leading to blindness can occur in children with JRA. Regular eye exams (B) can help to prevent this
complication. (A, C, and D) are not routinely necessary for management of JRA.

19. ANSWER: A
Splints may be used at night by clients with rheumatoid arthritis to prevent deformities (A) caused by muscle spasms and
contractures. Splints are not used for (B). Option C is usually treated with medications, particularly those classified as non-
steroidal antiinflammatory drugs (NSAIDs). For (optionD), a prescribed exercise program is indicated.
20. ANSWER: D
The nurse should first provide an immediate comfort measure to address the client's complaint about the linens and drape
the linens over the footboard of the bed (D) instead of tucking them under the mattress, which can add pressure perceived
by the client as the source of her pain. (Options A, B, and C) may be components of the client's plan of care, but the nurse
should first address the client's complaint.
21. ANSWER: B
The varicella (chickenpox) vaccine is a live virus vaccine and should not be administered to patients who are receiving
immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone dose should be
tapered gradually when patients have been on long-term steroid therapy, but tapering is not necessary for short-term
prednisone use. CRP levels are not the most specific test for monitoring treatment but are inexpensive and frequently used.
High doses of NSAIDS such as gastrointestinal bleeding but are useful in treating the joint pain associated with SLE
exacerbation.
22. Answer: D
Because exposure to ultraviolet light can active systemic lupus eryhthematosus, the patient should avoid direct exposure to
sunlight and wear sunscreen and protective clothing to filter out reflected rays. Giving the patient no restrictions or telling
her she can sunbathe for a limited time may lead to dangerous exposure to ultraviolet light. The patient shouldn’t keep her
medication outside near the pool; it could get wet.
23. ANSWER: D
Abnormal lung sounds are indicative of respiratory insufficiency from pleural effusions or infiltrations. Pleural effusions may
occur with myocarditis, which might manifest as pericardial friction rub assessed during the cardiovascular exam
24. ANSWER: B
The halo effect is a cognitive bias whereby the perception of one trait (i.e. a characteristic of a person or object) is influenced
by the perception of another trait (or several traits) of that person or object. An example would be judging a good-looking
person as more intelligent.
25. Answer: B
Likert Scale, is an attitude measurement used in research, where, in place of a numerical scale for answers, answers are
given on a scale ranging from complete agreement on one side to complete disagreement on the other side, with no opinion
in the middle.
26. ANSWER: A
Plagiarism (from Latin plagiare "to kidnap") is the practice of claiming, or implying, original authorship or
incorporating material from someone else's written or creative work, in whole or in part, into one's own without adequate
acknowledgement. Unlike cases of forgery, in which the authenticity of the writing, document, or some other kind of object,
itself is in question, plagiarism is concerned with the issue of false attribution.
27. Answer: D
Grounded theory is a type of research where focus is placed on the generation of categories or hypotheses that explains
patterns of behavior or the people in the study. It is used to understand social structures and social processes.
28. Answer: B
A pilot study is referred to a “dress rehearsal” before the actual study begins. By identifying the problems or flaws during the
pilot study, the researchers can refine the proposed plan and strengthen the methodology.
29. ANSWER: D
PSA levels are prescribed to screen for prostatic cancer which is often detected by DRE and manifested as small, hard, or
stony, irregularly-shaped nodules on the surface of the prostate (option D). Although PSA levels are prescribed for routine
screening, the findings suggestive of BPH (option A), normal texture (option B) or infection (option C) do not suggest cancer
of the prostate, which requires further evaluation.
30. ANSWER: D
Human papillomavirus (option D) is known to alter cervical epithelium cytology, which is consistent with early changes of
cervical cancer. Although STIs (options A, B, and C) place the client at risk for exposure to HPV, these are likely to place the
client at risk for pelvic inflammatory disease, infertility sequela, and painful reoccurrence.
31. ANSWER: B
The most predictive risk factors for development of breast cancer are over 40 years of age and a positive family history
(occurrence in the immediate family, i.e., mother or sister). Other risk factors include nulliparity, no history of breastfeeding,
early menarche and late menopause. Although all of the women described have one of the risk factors for developing breast
cancer, option B has the greater risk over (options A, C, and D).
32. ANSWER: C
Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and
progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive
to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which
is one of the most important prognostic factors in early-stage breast cancer, not (option A). Larger tumors are more likely to
indicate poor prognosis, not (option B). Stage I indicates the cancer is localized and has not spread systemically (option D).
33. ANSWER: A
A radical mastectomy interrupts lymph flow, and the increased lymph flow that occurs in response to the insect bite
increases the risk for the occurrence of lymphedema (option A). Option B is not a factor. Lymphedema is not significantly
related to vascular circulation (option C). Only overuse of the arm, such as weight-lifting, would cause lymphedema--(option
D) would not.
34. ANSWER: D
Inflammatory breast cancer, which has a thickened appearance like an orange peel (peau d'orange), is the most aggressive
form of breast malignancies (option D). Staging classifies cancer by the extension or spread of the disease, and (option A)
indicates limited local spread. Option B indicates cancer cells have spread from the ducts into the surrounding breast tissue
only. TNM classification is used to indicate the extent of the disease process according to tumor size, regional spread lymph
nodes involvement, and metastasis, and (option C) indicates early cancer with small in situ involvement, no lymph node
involvement, and no distant metastases.
35. ANSWER: B
TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia. A serum calcium level of 5 (option B),
which is low, is an indicator of possible tumor lysis syndrome. (Options A, C, and D) are not particularly related to TLS.

36. ANSWER: C
The current breast screening recommendation is a yearly mammogram after age 40 (option ). Breast self-exam (option A)
continues to be a priority recommendation for all women because a small lump (or tumor) is often first felt by a woman
before a mammogram is obtained. The radiation exposure from a mammogram is low, so (option B) is not normally
provided. The frequency of using routine and ultrasound mammograms (option D) in women with high-risk variables, such as
a history of breast cancer, the presence of BRC1 and BRC2 genes, or 2 first-degree relatives with breast cancer, should be
recommended and followed closely by the healthcare provider.
37. ANSWER: D
Competent clients have the right to refuse treatment, so the nurse should first ensure that the client is competent (option D).
Options A and C are not necessary for a competent client to refuse treatment. The nurse cannot document (option C) until
the healthcare provider is notified of the client's wishes and a discharge prescription is obtained.
38. ANSWER: A
The components of every pain assessment should include sensory patterns, area, intensity, and nature (PAIN) of the pain
(option A) and are essential in identifying appropriate therapy for the client's specific type and severity of pain, which may
indicate the onset of disease progression or complications. Triggers (option B), current drug usage (option C), and
sympathetic responses (option D), such as tachycardia, diaphoresis, and elevated blood pressure, are important, but should
be obtained after focusing on (option A).
39. ANSWER: C
The nurse should first assess what the client desires (option C). Option A is somewhat judgmental and attempts to solve the
problem for the client without eliciting the client's feelings. Though a referral to the social worker (option B) may be
indicated, the nurse should first offer support. Time is likely to help the client cope with this news (option D), but the nurse
should first provide support and assess what the client wants to see happen with her children.
40. ANSWER: D
The ribs lie in the radiation pathway and lose density over time, becoming thin and brittle, so the occurence of two right-
sided ribs with pathological fractures resulting without evidence of trauma (option D) is related to radiation damage. The
heart (B), esophagus (C), and larger bronchi (A) are not usually in the radiation path.
41. ANSWER: D
Initiating chemotherapy while the tumor is small provides a better chance of eradicating all cancer cells because 50% of
cancer cells or tumor cells are killed with each dose. (Options A, B, and C) vary based on the type of cancer.
42. ANSWER: C
Low sperm count and loss of motility are seen in males with Hodgkin's disease before any therapy. Radiotherapy often
results in permanent aspermia, or sterility (option C). Options A, B, and D are inaccurate.
43. ANSWER: C
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are
key signs of antimetabolite toxicity (option C). Options A, B, and D are not typical interventions associated with the
administration of antimetabolites.
44. ANSWER: A
Ondansetron (Zofran), a serotonin antagonist, is the most effective antiemetic in suppressing nausea and vomiting caused
by cancer chemotherapy-induced emesis or emetogenic anticancer drugs. Common side effects include headache (Option
A), diarrhea, dizziness, and fatigue. Options B, C, and D are not usual side effects of Zofran.
45. ANSWER: C
Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so
maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (option C) to promote excretion of serum
calcium. Although the client is at risk for pathologic fractures due to diffuse osteoporosis, mobilization and weight bearing
(option A) should be encouraged to promote bone reabsorption of circulating calcium, which can cause renal complications.
Option B is a component of ongoing assessment. Chronic pain management (option D) should be included in the plan of
care, but prevention of complications related to hypercalcemia is most important.
46. ANSWER: B
Because clients receiving internal radiation emit radiation while the implant is in place, contacts with the health care team
are guided by the principles of time, distance and shielding. Options, a, c and d are all correct. Option b should be-seeing
that the visitors maintain a distance 6-feet away from the client/radiation source.
47. ANSWER: A
First step of the nursing process is to assess, examine patient’s mouth thoroughly every 4 hours, document size, character,
and drainage.
Option B – commercially prepared mouthwashes contain alcohol, which is drying to the mucous membranes, patient should
rinse with plain water or saline hourly.
Option C – appropriate action, but should first assess.
Option D – offer mouth care before and after meals.
48. ANSWER: B
The first action is to stop the infusion and notify the physician. The nurse should not wait to stop the IV until confirmation of
extravasation by the physician. The needle should not be removed as it will be used to aspirate drug from the site to treat
extravasation. The drug should not be restarted until the extravasation has been properly treated and according to the order
of the physician.
49. ANSWER: B
Palliative surgery is done only to relieve symptoms or improve function. It is not curative.
50. ANSWER: D
Patients who may seem overwhelmed need to talk and express their feelings, even if they are not sure of what they are.
51. ANSWER: A
Pancreatic cancer is more common in blacks, males, and smokers. Other links include use of alcohol, diabetes, obesity,
history of pancreatitis, organic chemicals, a high-fat diet, and previous abdominal radiation. Focus: prioritization
52. ANSWER: C
The nurse should ensure that the patient understands that a stoma will be formed and that he’ll need too wear a pouch. The
nurse will care for the stoma immediately after surgery; self-care will begin when the patient is physically able. The patient
will be encouraged to get out of bed the first day after surgery to prevent complications of immobility. Urine flow can’t be
controlled through a stoma.
53. ANSWER: C
There are few physical restraints on activity postoperatively, but the client may have emotional problems resulting from the
body image changes.
A - Swimming is not prohibited because water does not harm to stoma.
B - Independence should be encouraged, however, some activities may require after 3 months before resumption.
D - No changes in activities are necessary.
54. ANSWER: D
A stoma should be beefy red. Blue or black coloration is an indication of poor circulation and should be reported
immediately. Swelling and a small amount of blood around the stoma are normal in early postoperative days.
55. ANSWER: B
Placement of the pouch should be comfortable in all positions, but not too snug on the stoma for fear of laceration. The
pouch need only cover enough of the abdomen to allow for a firm fit.
56. ANSWER: B
The problem of odor is a frequent cause of anxiety to the colostomy patient. Gas is the main cause of odor production.
Omission of gas-causing foods can reduce gas and odor, mainly by the trial and error method. Odor is noticeable to both the
patient and others.
57. ANSWER: A
The syndrome of inappropriate anti-diuretic hormone (SIADH) secretion includes excessive ADH secretion from the pituitary
gland even in the face of subnormal serum osmolality. Clients with this disorder cannot excrete dilute urine. They retain
fluids and develop a sodium deficiency known as dilutional hyponatremia. Anorexia, nausea, and malaise are the earliest
findings, followed by headache, irritability, confusion, muscle cramps, weakness, obtundation, seizures, and coma. These
occur as osmotic fluid shifts result in cerebral edema and increased intracranial pressure. Dilute urine is seen in clients with
Diabetes insipidus.
58. ANSWER: B
The parathyroid gland is responsible for the absorption of calcium and phosphorus. Clients with hyperparathyroidism may
have hypocalcemia.
59. ANSWER: C
The client with Cushing’s disease has adrenocortical hypersecretion. This increase level in cortisone causes the client to be
immunosuppressed. The client with diabetes, Graves disease and MI are not immunosuppressed and poses no risk to other
clients.
60. ANSWER: B
Diabetes insipidus is a disorder of the posterior lobe of the pituitary gland characterized by a deficiency of the anti-diuretic
hormone (ADH) or vasopressin. Without the action of ADH, an enormous daily output of urine which is very dilute and has a
specific gravity of 1.001-1.005 occurs. All the other options are not indicative of D.I.
61. ANSWER: A
Antidiuretic hormone or ADH is a hormone secreted by the posterior pituitary gland that causes the nephrons in the kidneys
to reabsorb water.
62. ANSWER: B
A client with Cushing’s disease has an elevated cortisol level. Elevations in cortisol suppresses the inflammatory response
and contributes to the development of infection. The other answers are of lesser priority.
63. ANSWER: B

The child must be monitored for signs and symptoms of hyponatremia, which creates secondary central nervous system
alterations such as changes in level of consciousness, seizure, and coma (option B). Fluid overload occurs with SIADH, not
(option A) (which occurs with diabetes insipidus). Option C is caused by hypersecretion of growth hormone, not SIADH.
Option D is not found in children with SIADH because edema is caused by an excess of both water and sodium.
64. ANSWER: C
The dietician (option C) can provide the best expertise regarding diet and mealtime planning for clients with diabetes
mellitus. The pharmacist's (option A) expertise focuses on medications, not the client's management of hypoglycemia,
which includes both food intake and medication actions. The occupational therapist (OT) (option B) is skilled in
implementing interventions to help the client improve small manipulative skills, but the OT does not have the expertise
related to medication administration, which is a nursing responsibility. The physical therapist's (option D) expertise involves
a treatment plan in therapeutic exercises, but may not focus on the scheduling of activity with diet and medication actions,
such as peak, and duration.
65. ANSWER: D
The nursing diagnosis of ineffective health maintenance refers to an inability to identify, manage, and/or seek out help to
maintain health, and is best exemplified in the client belief or understanding about diet and health maintenance (option D).
Option A indicates noncompliance with an action to be done in the management of diabetes. Option B represents
inattentiveness. Option C reflects knowledge deficit.
66. ANSWER: A
Sweating, dizziness, and trembling are signs of hypoglycemic reactions related to the release of epinephrine as a
compensatory response to the low blood sugar (option A). Options B, C, and D do not describe common symptoms of
hypoglycemia.
67. ANSWER: A
A history of diabetes mellitus poses the greatest risk for developing a CVA. Options B, C, and D may place the client at some
risk due to immobility, but do not present a risk as great as (option A).
68. ANSWER: A
In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal
body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are
symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive
dose of thyroid hormone.
69. ANSWER: B
Patients with hyperthyroidism have an increased basal metabolic rate (BMR) and increased T3 and T4. Increased serum
cholesterol (Answer 1), increased TSH (Answer 3), and increased menstrual volume (Answer 4) are findings consistent with
hypothyroidism. Menstruation in hyperthyroidism characteristically is decreased in volume. Cycle lengths may be shortened
or prolonged, but eventually amenorrhea develops.
70. ANSWER: A
The patient with hyperthyroidism has an increased metabolic rate due to excess serum thyroxine leading to symptoms of
systolic hypertension, heat intolerance, widened pulse pressure, and emotional excitability. Answer 2 is incorrect because
the diastolic blood pressure reduces due to decreased peripheral resistance.Weight loss (not gain, as in Answer 3) occurs
because of increased catabolism despite an increase in appetite. Anorexia in Answer 4 is incorrect because the patient has
increased appetite.

71. ANSWER: A
Thyroid storm may be precipitated by a number of stresses, such as infection, real or threatened loss of a loved one, or
thyroid surgery undertaken before the patient was prepared adequately with antithyroid drugs. A change heralding thyroid
storm is a fever: the patient’s temperature may rise as high as 106°F (41°C). Answers 2, 3, and 4 are symptoms of
hyperthyroidism and become exaggerated during thyroid storm.Without treatment, the patient progresses from delirium to
coma; death ensues as the result of heart failure.
72. ANSWER: C
Nursing care for Graves’ disease/hyperthyroidism include limiting of activities to quiet and provide frequent rest periods;
advise light, cool clothing; avoid stimulants; use calm, unhurried approach; administer antithyroid medication, irradiation
with I131 PO. Post-thyroidectomy care include low or semi-Fowler’s position; support head, neck, shoulders to prevent
flexion or hyperextension of suture line; tracheostomy set at bedside; observe for complications-laryngeal nerve injury,
thyroid storm, hemorrhage, respiratory obstruction, tetany (decreased calcium from parathyroid involvement), check
Chvostek’s and Trousseau’s signs. Carpal spasms indicate hypocalcemia.
73. ANSWER: D
PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (option D). It is often
prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by
the pituitary gland, and PTU does not affect the pituitary (options A and B). PTU inhibits the synthesis of all thyroid
hormones--both T3 and T4 (option C).
74. ANSWER: C
An effective oral form of insulin has not yet been developed (C) because when insulin is taken orally, it is destroyed by
digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.
Options A, B, and D do not provide accurate information.
75. ANSWER: B
Option B is the typical triad of symptoms of tumors of the adrenal medulla (symptoms depend on the relative proportions of
epinephrine and norepinephrine secretion). Option A lists the signs of latent tetany, exhibited by clients diagnosed with
hypoparathyroidism. Option C lists the signs of an Addisonian (adrenal) crisis. Option D lists the signs of
hyperparathyroidism.
76. ANSWER: B
Daily weight measurement is the most accurate means of monitoring hydration status at home. The patient should be
encouraged to increase dietary intake of both sodium and potassium, particularly if diuretics are prescribed. Pulse checks
and urine specific gravity measurements are unnecessary in a patient with chronic SIADH.
77. ANSWER: B
Lassitude and muscle weakness are early clinical signs of Cushing’s syndrome. Catabolism from gluconeogenesis
occasionally results in a marked decrease in skeletal mass, and the patient’s extremities may appear wasted. Answer 1 is
incorrect because gluconeogenesis from excess cortisol secretion results in hyperglycemia. Answer 3 is partially correct:
hypersecretion of aldosterone in Cushing’s disease is rare; however, large quantities of cortisol tend to increase sodium and
water retention and potassium excretion. Edema and hypokalemia occur only in severe cases.
Discoloration and hyperpigmentation (Answer 4) occur with adrenal insufficiency.
78. ANSWER: D

Type 2 diabetes is diagnosed with two fasting blood glucose levels> 126 mg/dl or a casual plasma glucose level > 200
mg/dl and symptoms. Because his first fasting blood glucose level was > 126 mg/dl, it must be repeated to make the
diagnosis of type 2 diabetes.
79. ANSWER: B
Short acting insulin or regular insulin have an onset of 30 minutes to 1 hour, peak action of 2-3 hours and duration of 4-6
hours. Option A-is the peak if the insulin taken was rapid acting
Option C- is the peak if the insulin taken was intermediate acting
Option D- is the peak if the insulin taken was long acting
80. ANSWER: A
Clients with Addison’s disease have a disturbance of sodium and potassium metabolism. In severe cases this may lead to a
severe marked depletion of sodium and water and severe, chronic dehydration. Immediate treatment is directed toward
restoring blood circulation, restoring fluid balance by administering fluids, corticosteroids, monitoring vital signs. To provide
information about the fluid balance and adequacy of the hormone replacement the nurse assesses the client’s skin turgor,
mucous membranes and weight while instructing the client to report increased thirst. The nurse also encourages the client
to consume food and fluids that will assist in restoring fluid and electrolyte balance. Options C and D may be present in a
client with Addison’s disease but it not the priority.
81. ANSWER: C
Nursing management for a client with Addison’s disease include monitoring the blood pressure and the pulse rate to detect
inadequate fluid volume, assesses the client’s skin color and turgor for changes related to chronic adrenal insufficiency and
hypovolemia. Other key assessments include checking daily weights, and efforts are made to detect the signs of infection or
the presence of other stressors.
82. ANSWER: B
Diarrhea, loose stools, nausea and abdominal discomfort were each seen in 34%-61% of acromegalic patients. The
frequency of these symptoms was not dose-related, but diarrhea and abdominal discomfort generally resolved more quickly
in patients treated with 300 mcg/day than in those treated with 750 mcg/day. Back pain occurs in 1-4% of the patient
taking this drug. Headache and nystagmus are not seen.
83. ANSWER: B
IGF1 provides the most sensitive and useful lab test for the diagnosis of acromegaly. A single value of the Growth hormone
(GH) is not useful in view of its pulsatality (levels in the blood vary greatly even in healthy individuals). GH levels taken 2
hours after a 75 or 100 gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 µg/L in
normal people, and levels higher than this cutoff are confirmatory of acromegaly. There is no Acromegaly serum analysis.
84. ANSWER: B
The charge nurse should be notified immediately after the transfusion is stopped. The charge nurse will notify the physician
and the lab or blood bank. The head of the bed should be raised to aid in respiration and O2 should be administered in high
doses. The blood tubing and the bag should not be discarded because the blood bank will want it to check the accuracy of
the typing.
85. ANSWER: D
Fatigue and weakness are seen in all anemias. Other options are unnecessary.
86. ANSWER: B
The patient with pernicious anemia lacks intrinsic factor, found in the stomach, which is essential for vitamin B12
absorption.
87. ANSWER: D
All interventions should be implemented prior to administering blood, but (D) has the highest priority. Any time blood is
administered, the nurse should ensure the accuracy of the blood type match in order to prevent a possible hemolytic
reaction.
88. ANSWER: D
Eating green leafy vegetables, fortified and whole grains and organ and red meats and using cast iron cookware will
increase dietary intake of iron. Fish and white rice are suggested for a low residue diet. Dairy products and sardines add
calcium to the diet. Eggs and cheese are dietary sources of vitamin B12
89. ANSWER: A
Patients with hemophilia have severe pain due to bleeding into the joints.
90. ANSWER: C
Newborns can develop hemolytic anemias resulting from blood incompatibility to their mother. These are typical signs of
hemolytic anemia in the newborn.
91. ANSWER: C
Epoetin alfa is a biological response modifier that is used to stimulate the formation of red blood cells (C). Option A
describes agents, such as filgrastim, used to decrease the risk for infection in clients with chemotherapy-induced
neutropenia. Immunomodulators, a subtype of biologic response modifiers, such as interferon, provide a specified action in
the immune system (option B) used in chemotherapeutic protocols. (Option D) specifies the therapeutic response of agents,
such as sargramostim, which also inhibits neutrophil migration and is primarily used to accelerate
myeloid recovery during bone marrow transplantation.
92. ANSWER: B
Platelet counts less than 100,000/mm3 are indicative of thrombocytopenia, a common side effect of chemotherapy. A
client with thrombocytopenia should be assessed frequently for occult bleeding in the emesis, sputum, feces (option B),
urine, nasogastric secretions, or wounds. Option A does not minimize the risk for bleeding associated with
thrombocytopenia. Option C may cause increased bleeding in a client with thromobcytopenia. Option D assesses for
infection, not risk for bleeding.
93. ANSWER: D
Sickle cell anemia is a genetic disease carried by the recessive genes of both parents, who will not have any symptoms of
the disease at all.
94. ANSWER: A
Platelet transfusions are given when the platelet count falls below 20,000/mm3. One unit is expected to raise the count by
5000 to 10,000/mm3.
95. ANSWER: B
Bleeding gums are indicative of general bleeding tendencies. Sleep and frequency of periods are not significant, but the
heaviness of the period is significant. History can reveal information pertinent to assisting the physician in making a
diagnosis.

96. ANSWER: A
Fresh blood on the pressure dressing 20 minutes after the aspiration needs to be addressed. Usually, redressing with a
pressure dressing and an ice pack are sufficient. Feelings of bruising and pain on extraction are to be expected. Thirst is of
no clinical significance.
97. ANSWER: A
Blood must be started within 30 minutes of its receipt after it has been checked by two licensed staff members. The best
option is to send the second unit back immediately, with an explanation that it will be called for later. A unit of blood usually
takes about 2 to 4 hours to run.
98. ANSWER: B
NSAIDs and liver disorders enhance the probability of bleeding. The valve replacement of a few months ago suggests that
the patient is using anticoagulant drugs.
99. ANSWER: C
All the Z-track method ensures is that there will be no iron staining the skin after injection. The amount of pain is the same
and, after all IM injections, the needle is cleaned on withdrawal. Injections are never given at recent injection sites.
100. ANSWER: C
The appropriate sequence is the following: explain the procedure; when the patient indicates understanding, get the
permission form signed; assist the patient to abdomen and drape hip and lower extremities; confirm the presence of
laboratory personnel to stain the specimen; apply a pressure dressing and assist the patient to lie on his or her back.


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ANSWER & RATIONALE – INTEG EXAM 4

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