Bullets Ms 2: Diaphragmatic Hiatal Hernia

BULLETS MS 2
GASTROINTESTINAL SYSTEM
DIAPHRAGMATIC HIATAL HERNIA
>contraindicated with a hiatal hernia
Lying recumbent following meals
GERD
>instructions should the nurse stress
Reduce intake of caffeine beverages
>statement that would support a nursing diagnosis of knowledge deficit

“I will lie down for 30 minutes after meals”
>position after taking antacids

On the left side with the head of bed elevated 30 degrees
PEPTIC ULCER DISEASE

>primary cause of peptic ulcer disease
“Infection with Helicobacter pylori causes ulcers”
>peptic ulcer disease à states that stress frequently causes exacerbation of the disease à most likely
responsible for the exacerbations:
Frequent need to work overtime on short notice
>medication to avoid because of the irritating effects on the lining of the gastrointestinal (GI) tract
Ibuprofen (Motrin)
>most frequent symptoms of duodenal ulcer

Pain that is relieved by food intake
>pain characteristic of a duodenal ulcer

Aching in the epigastric area that awakens her from sleep
>indicate perforation of the ulcer

A rigid boardlike abdomen
>pyloroplasty involves
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the
stomach to the duodenum
>purpose of vagotomy:
Reduce the stimulus to acid secretions
>definition of Billroth I
“In Billroth I, the cardia of the stomach is anastomosed to the first part of the duodenum.”
>perform Billroth II procedure

Gastrojejunostomy
JULY 2010
>nasogastric tube attached to intermittent suction

Pressure should not exceed: 25 mmHg
>following a Billroth II procedure -- postoperative order the nurse should question and verify
Irrigating the nasogastric tube
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>intestinal obstruction and has a Miller-Abbott tube in place – how to assess proper placement?
Check the distance markings on the tube
>experiences nausea following the removal of a nasogastric tube – first action:

Auscultate the patient for bowel sounds
>food/drinks/diet to be limited or eliminated

Wine, Coffee, Citrus fruits
>diet that is appropriate for patient with PUD

Green leafy vegetables
Baked chicken
Lab results reveal an elevated titer of Helicobacter Pylori –statement indicating an understanding
“Treatment will include Pepto-Bismol and antibiotics”
>admitted with bleeding peptic ulcer – associated intervention

Checking the blood pressure and pulse rates each shift
>bowel surgery – purpose of sulfasuxidine and neomycin

Reduce the bacterial content of the colon
DUMPING SYNDROME
>total gastrectomy -- complains of weakness, palpitations, diarrhea and reactive hypoglycaemia --best
explanation for these S/S:
Rapid distention of the jejunal loop anastomosed to the stomach
>symptoms of dumping syndrome

diaphoresis and lightheadedness
>early signs and symptoms of dumping syndrome

Sweating and pallor
>statement would indicate a correct understanding of the instructions

“I will avoid concentrated sugars.”
>instruction to avoid dumping syndrome

“Avoid fluid intake with your meals”
>preventing dumping syndrome

Avoid fluids taken with meals
Supine position
Avoid carbohydrates
Small frequent feeding
PERNICIOUS ANEMIA
>cause of pernicious anemia in an elderly patient
Atrophy of the stomach lining
>intrinsic factor is absorb cyanocobalamine (Vitamin B12) in the

Small intestine
>Schilling’s test -- the test will require the nurse to

Initiate a 24-hour urine collection
>indicate that the goal of care has been achieved

The patient's tongue has lost its beefy red color

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APPENDICITIS
>pain in appendicitis is most likely located in
McBurney’s point
JUNE 2009
>acute appendicitis the report of laboratory tests

Elevated leukocyte count
>diagnosis of appendicitis -- most important for the nurse to follow-up

Cessation of abdominal pain
à begins to complain of increased abdominal pain and begins to vomit à notes that
>diagnosis of appendicitis
the abdomen is distended and bowel sounds are diminished à most appropriate nursing intervention:
Notify the physician
>checking for rebound tenderness

At the end of examination
>appendicitis is suspected à would question which of the following physician’s orders

Administer 30 ml of milk of magnesia
DIVERTICULOSIS & DIVERTICULITIS

>risk factor of diverticulosis
Low intake of dietary fibers
>indicate that the patient is following the diet plan correctly

“I eat green salad everyday”
>diverticulosis à should include avoidance of:

Peanuts and popcorn
CROHN’S DISEASE
>stool characteristics would the nurse expect
Diarrhea
>teaching instructions
“Reduce stress in your lifestyle”
>indicate that the corticosteroids therapy has been effective

Decreased complaints of abdominal pain
ULCERATIVE COLITIS
>severe rectal bleeding, 16 diarrheal stools a day, severe abdominal pain, tenesmus, and dehydration à what
disease?
Ulcerative colitis
>expected manifestation:
Bloody diarrhea
>noted on assessment of the client that the nurse will report to the physician
Rigid and painful abdomen
>therapeutic diet for ulcerative colitis:

Low roughage with milk

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>admitted to the hospital for a total colectomy and creation of an ileostomy à measures should be given
priority preoperatively:
Correcting the patients fluid imbalance
>priority nursing diagnoses:

Fluid volume deficit
Fluid and electrolyte imbalance
Altered nutrition: < body requirements
>indicates patient needs teaching if what food is eaten:

Celery à high in fiber
COLOSTOMY & ILEOSTOMY

>total colectomy and creation of an ileostomy à priority measure in the patient's preoperative care plan
Correcting the patients fluid imbalance
>creation of an ileostomy à purpose of surgery:

Remove the diseased portion of the bowel
>ileostomy à avoid which of the following foods:

Popcorn
>statement a nurse would include in the preoperative instructions for a patient who is scheduled for an
ileostomy:
“You will have a nasogastric tube in your nose after surgery”
>“I will have to be isolated for the rest of my life because no one will be able to stand this terrible odor.” à
response that is most likely reassuring:
“There are techniques that can reduce the odor.”
>ileostomy à foods that thicken the stool:

Pasta
Boiled rice
Low – fat cheese
*if needs further teaching: Bran
>statement the nurse would include in the preoperative instruction of a patient who is scheduled for an
ileostomy:
“The stool drainage will be of liquid consistency”
>essential care of the stoma in ileostomy:

Cleanse the peristomal skin meticulously
>ileostomy à most frequent complications of this type of surgery:

Fluid and electrolyte imbalance
COLOSTOMY
A colostomy can BEST be defined as
Cutting the colon and bringing the proximal end through the abdominal wall
JUNE 2007
>abdominoperineal resection àpatient should be informed he/she will have a:

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Permanent colostomy
JUNE 2007
>double-barrel colostomy à type of drainage from the patient's bowel

Mucoid drainage from the distal stoma
Fecal material from the proximal stoma
>patient is at risk for fluid volume deficit

A client with colostomy
ACTUAL BOARD QUESTION
>sigmoid colostomy à indicates to a nurse that the patient needs further instruction
“I will have continuous drainage of liquid stool” – this is for ileostomy
>creation of a colostomy à nursing diagnosis the nurse would include in the plan of care
Body image disturbance
>colostomy à foods in the diet to reduce odor

Yogurt
>colostomy à to avoid flatulence should not eat the following EXCEPT

Mangoes and pineapples
*if to avoid
Corn and peanuts
Cabbage and asparagus
Chewing gum and carbonated beverages
DECEMBER 2006
>instructions to a client who has a new colostomy

à diet for the first 4-6 weeks postoperatively:
Low residue
>sign of stoma prolapse:

Protruding and swollen stoma
>expected color of the stoma

Red/ beefy red
>colostomy à beginning to pass malodorous flatus from the stoma after 2 days:
This is a normal, expected event
>appropriate nursing interventions during colostomy irrigation:

Insert 2-4 inches of an adequately lubricated catheter to the stoma
Position client in semi-Fowler
Hang the solution 18 inches above the stoma
*if EXCEPT:
Increase the irrigating solution flow rate when abdominal cramps is felt
>colostomy irrigation àinstruction to enhance the effectiveness of the irrigation

Increase fluid intake
>colostomy irrigation à most appropriate nursing action when client begins to complain of abdominal cramps
Stop the irrigation temporarily

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>colostomy care à ostomy appliance care:
Care of the appliance
Care of the skin
Care of the stoma
Acceptance of body image
JUNE 2009
TOTAL PARENTAL NUTRITION

>essential measure before this order is initiated:
A subclavian catheter is patent and a chest x-ray is done to confirm placement
>substances that may be administered piggy-backed to a TPN infusion

Lipids
>During the first 24 hours after total parenteral nutrition (TPN) therapy is started, the nurse should:
Evaluate blood glucose levels
>the nurse would closely monitor laboratory values for

Glucose
A client with TPN suddenly develops tremors, dizziness, weakness and diaphoresis. The client said “I feel weak”
à replacement is already 3 hours late à probable complication:
Hypoglycemia
>TPN solution via the central line à equipment BEFORE hanging the solution:
Electronic infusion pump
*if during infusion:
Blood glucose meter
>weaned from total parental nutrition à anticipated order:

Decrease TPN rate to 50mL/hr
>change the total parenteral nutrition TPN solution bag and tubing à instructions during tubing changes:
Hold the breath and bear down
HEMORRHOIDS
>instruction regarding treatment of hemorrhoid à indicates a need for further instruction:
“I should apply heat packs to the hemorrhoids to help the hemorrhoids shrink”
CHOLECYSTITIS & CHOLELITHIASIS

>indicate a predisposition for developing cholecystitis:
Obesity
>blockage of the common bile duct à will experience difficulty digesting:

Fats
>best describes Murphy’s Sign

On deep inspiration, pain is elicited and breathing stops
>an assessment finding supports her diagnosis of cholecystitis:

Pain that radiate to midsternal area or right shoulder
JULY 2010
>patient with jaundice à laboratory value that is expected to be elevated:

Serum bilirubin

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>right upper quadrant pain and has been placed on a low fat diet à acceptable food:
Skim milk, lean fish, tapioca pudding
*if avoided:
Liver, fried potatoes and avocado
Whole milk, rice and pastry
Ham, mashed potatoes, cream peas
JUNE 2007
>has gas pains following a laparoscopic cholecystectomy à instruction:

“Get up and move around.”
>undergone cholecystectomy à Her teaching on diet will be based on the knowledge that after a
cholecystectomy:
The client will regain a normal diet
JULY 2010
> has had a cholecystectomy à statement that indicates a correct understanding of dietary instructions:
“I can eat whatever I can tolerate”
>preoperative instructions to a patient who is scheduled for a laparoscopic cholecystectomy:

“You will have four small incisions on your abdomen.”
>preoperative teaching instruction à scheduled for a laparoscopic cholecystectomy

“Your abdomen will be inflated with gas during surgery.”
24 hours following a cholecystectomy à T tube has drained 500 ml of green-brown drainage à most
appropriate nursing intervention:
Document the findings
PANCREATITIS
>chronic pancreatitis à most likely causative factor:
Use of alcohol
>important question for a nurse to ask when gathering data from a patient with pancreatitis:
“How much alcohol do you drink in a week?”
>acute pancreatitis à pain is:

Severe and unrelenting, located in the epigastric area and radiating to the back
> clinical manifestation of paralytic ileus

Inability to pass flatus
>laboratory value à expected to be elevated

Elevated serum amylase
>chronic pancreatitis à indicates a serum amylase level of

300 units/L
>dietary modifications à teach the client to limit

Fat

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>instruct a patient with pancreatitis to avoid which of the following types of foods:
Meats
>acute pancreatitis à avoids which of the following foods:

Steak and potatoes
>chronic pancreatitis à necessary to control

Alcohol intake
LIVER CIRRHOSIS
>to accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine which
body areas:
Hard palate of the mouth
>ascites à most appropriate nursing measure

Measuring abdominal girth
>admitted to the hospital with anorexia, weight loss, and ascites à Serum SGOT (AST), SGPT (ALT) and total
bilirubin are significantly elevated àBased on the lab results à expected assessment:
Jaundice
>best explanation for the development of edema is that it is due to

Decrease concentration pf plasma albumin
>cirrhosis has been following a diet with optimal amounts of protein because neither nor a deficiency of protein
has been helpful à most satisfactory if the total protein level is which of the following values
6.4 g/dL
>ascites is schedule for a paracentesis à position will the nurse assist the client to assume for this procedure:
Upright position/High Fowlers
>discharge teaching for a patient who has been diagnosed with liver cirrhosis
“Avoid alcoholic beverages.”
>piece of equipment should a nurse has available when caring for a patient with esophageal varices:
Sengstaken-Blakemore tube
>Sengstaken-Blakemore tube à ordered for a patient who has bleeding esophageal varices in order to
Apply direct pressure to the area
Sengstaken-Blakemore tube à complains of severe pain of abrupt onset and difficulty breathing à appropriate
nursing action:
Cut the tube
>esophageal varices àbegin to experience severe gastrointestinal bleeding à plan of care to meet the client’s
fluid needs à priority strategy:
Rapid blood and fluid administration
HEPATIC ENCEPHALOPATHY
>priority nursing diagnosis àto a patient who has cirrhosis of the liver and an elevated serum ammonia level

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Altered thought processes
>presence of asterixis à assess for the presence of this sign à the nurse would do
Ask the client to extend the arms
>cirrhosis of the liver à indicates that the patient’s condition is worsening

Flapping hand tremors
>cirrhosis and notes that the ammonia level is elevated àanticipated diet most likely be prescribed for this
client:
Low protein
>cirrhosis of the liver has been treated for hepatic encephalopathy à indicates an understanding of foods that
are low in protein
Vegetable soup and tossed green salad
Avoid:
Cheese
Meat Loaf
Baked chicken
Tuna fish
>receiving neomycin à desired effect of the drug is to:

Decrease the serum ammonia
HEPATITIS
>contracted the infection from contaminated foods à type of hepatitis
Hepatitis A
>causal factor in the transmission of hepatitis A:

Consuming shellfish
>Hepatitis B is transmitted through:

Transfusion and injection
>clinical manifestation(s) are primarily characteristics of the pre-icteric phase:

Fatigue, anorexia, and nausea
>Serum SGOT (AST), SGPT (ALT), LDH, and total billirubin are significantly elevated à will expect to find:
Jaundice
>suspected of having hepatitis à diagnostic test will assist in confirming this diagnosis:
Elevated serum bilirubin level
>To detect the development of a chronic carrier state in a client with hepatitis, the nurse should assess the
client’s serum laboratory results for:
Hepatitis B surface antigen (HBsAg)
>hepatitis B à statement by the patient would indicate the need for further instruction:
“I should avoid any drugs”
*if correct understanding:
“I can never donate blood.”

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“I can never have unprotected sex.”
“I can't share needles.”
>Hepatitis à priority in the teaching care plan

Promoting bed rest
Scheduling rest periods throughout the day
>hepatitis B à would support a nursing diagnosis of knowledge deficit related to disease transmission
“I should keep my utensils separate from those of others”

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ENDOCRINE SYSTEM
GIGANTISM & ACROMEGALY
>If hypersecretion of growth hormone occurs after epiphyseal plate closure à condition observed by the nurse:
Acromegaly
>Coarsening of facial features and enlargement of the hands and feet are early clinical manifestations of:
Acromegaly
>During the assessment of an adult patient diagnosed with acromegaly, the nurse expects to find all of the
following manifestations, except one:
Progressively increasing height (gigantism)
Other options:
Enlarged tongue
Transverse enlargement of hands and feet
Enlarged facial features
(JULY 2010)
>acromegaly à priority nursing diagnosis:

Risk for ineffective airway clearance related to obstruction of airway by the tongue
>pharmacologic treatment for a client with acromegaly:

octreotide (Sandostatin)
(JULY 2010)

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>usual route of octreotide (Sandostatin)
Subcutaneous
(JULY 2010)
>common side effect of octreotide (Sandostatin)

Diarrhea
(JULY 2010)
DWARFISM
>comment made by a parent to the nurse would indicate the possibility of dwarfism (hypopituitarism)
“Usually my child wears out his clothes before his size changes”
>planning to give growth hormone at home à the nurse should explain that optimum is achieved when growth
hormone is administered:
At bedtime
DIABETES INSIPIDUS
>A client has a closed head injury. Vital signs are T: 103 F, PR: 100, RR 24 BP: 110/84. Hourly urine output is
200 ml/hour à best understanding of the cause of these findings:
Damage to the hypothalamus resulting in decrease hormone production
>diabetes insipidus à symptoms as a sign of this disorder:

Polyuria and Polydipsia
>develops diabetes insipidus after removal of a pituitary tumor à expected finding:

Polyuria (5 liters per day)
>diabetes insipidus à unassociated with this disorder:

Concentrated urine (common in SIADH)
>A patient who has a head injury has a urine output of 200ml/hour for three consecutive hours à most
appropriate nursing measure:
Measuring urine specific gravity
>sustained a head injury is administered vasopressin (Pitressin) {route: IM} à indicate to the nurse that the
drug is effective:
Urinary output of 50 ml/hour (normal UO: 30-60 ml/hour) or
The client’s urinary output has decreased
> receiving desmopressin (DDAVP) [route: intranasal] à lab indicating that the medication is having its
intended effect:
Urine specific gravity 1.020 à normalize
If increase: SIADH (concentrated)
If decrease: DI (diluted)
>pituitary tumor à had a transphenoidal hypophysectomy à appropriate intervention:

Elevate the head of bed 30 degree
>after hypophysectomy à nurse notices clear nasal drainage from the client’s nostril à initial nursing action:

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Test the drainage for glucose
>transphenoidal hypophysectomy à accurate statement by the nurse immediate post-operative period

“You will be unable to brush your teeth.”
“Avoid sucking through a straw”
SIADH
>a client with syndrome of inappropriate antidiuretic hormone (SIADH) à monitor for:
Hyponatremia (Dilutional)
>syndrome of inappropriate antidiuretic hormone (SIADH) à unassociated characteristic of this disorder:

Hypernatremia à should be dilutional hyponatremia
Correct options:
Signs of water intoxication
High urine osmolality
Low serum osmolality
High Urine Specific Gravity
>action a nurse should include in the care plan for a patient who has water intoxication
Measure urine specific gravity
HYPERTHYROIDISM
>not a characteristic clinical manifestation of hyperthyroidism:
Dry skin (correct: warm moist skin)
>Grave’s Disease à admitting assessment expected:

Weight loss
Following a thyroidectomy à care plan to detect possible laryngeal nerve damage:

Asking the patient to speak
>subtotal thyroidectomy à nurse planning care for the day knows that it is important to
Ask the client questions every hour or two to assess hoarseness
>subtotal thyroidectomy à returns from the post anesthesia care unit à the nurse should immediately:
Place a tracheostomy set at the bedside
JUNE 2007
>thyroidectomy à nurse should keep which of the following at the bedside

A tracheostomy
>undergone a thyroidectomy à would be predisposed to the development of:

Hypocalcemia
>accidental injury to the parathyroid gland during a thyroidectomy à client might develop:
Tetany
JUNE 2009
>after a subtotal thyroidectomy à the client tells the nurse, I feel numbness and my face is twitching” à
nurse’s best initial action

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>total thyroidectomy à complaining of tingling around the mouth and in fingers and toes ànurse’s next action
Check the calcium level
>thyroidectomy à a client develops hypocalcemia and tetany à medication the nurse should anticipate to
administer:
Calcium Gluconate (IV)
>form of severe hyperthyroidism is life-threatening and produces high fever, extreme tachycardia and altered
mental status:
Thyroid Storm
>A pregnant client with hyperthyroidism is scheduled for caesarian section à nurse monitoring the client should
watch for signs and symptoms of thyroid storm which includes:
High fever which is 39.8 * Celsius
JULY 2010
>hyperthyroidism is taking methimazole (Tapazole) à evaluate effectiveness of Tapazole therapy, the nurse
should consider asking;
Has the patient’s pulse rate decreased?
>measure the nurse should take after administering a patient’s initial dose of propylthiouracil:
Performing a white blood cell count à common: Agranulocytosis
>prescribed propylthiouracil for a client with hyperthyroidism à priority nursing assessment to be included in
the plan regarding this medication is to assess for:
Signs and symptoms of hypothyroidism
DEC 2006
>a client treated with (131) Iodine to eradicate residual thyroid tissue à Because of this treatment, the nurse
should:
Consider all discharges including urine and feces to be radioactive
HYPOTHYROIDISM
>suspected of having hypothyroidism à expected to have:
Facial Edema
>assessing a patient who has hypothyroidism à expected to report:

Intolerance to cold
>comment made by the mother at her 4 month-old infant should alert the nurse to suspect hypothyroidism:
“My baby is unusually quiet and good”
>appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism:

Activity intolerance related to tiredness associated with disorder
JUNE 2007
>type of diet a patient with hypothyroidism should avoid:

High cholesterol à risk for atherosclerosis
>hypothyroidism frequently complains of feeling cold à tell the client that she will be more comfortable if she:
Dresses extra layers of clothing

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>A client with hypothyroidism who experiences trauma, emergency surgery or severe infection is at risk for
developing
Myxedema coma à severe hypothyroidism
>has gained a lot of weight recently, feels cold all the time, is always tired, and can’t get anything done à
reports her hair is falling out à the woman most likely to have
Myxedema
>Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of
the following characteristic:
Hypothermia
(ACTUAL BOARD QUESTION)
>diagnosis of myxedema à initial assessment of the client would reveal the symptoms of:
Weight gain, lethargy, slowed pulse, and decreased respiratory rate
>levothyroxine sodium (Synthroid) for hypothyroidism à indicate that the medication is producing the desired
effect:
Increased alertness
>levothyroxine (Synthroid) for a client with myxedema à statement indicating that the client understands the
nurse’s teaching regarding medication:
“I will check my heart rate before taking the medication”
>levothyroxine à instruction to be given:

“You will take medication for the rest of your life”
>discussed the need for medication with the parents of an infant with hypothyroidism à nurse can reinforce
the physician’s teaching by telling the parents that
The medication will be needed throughout the child’s lifetime
Always remember: All hypo drugs: LIFETIME!!!!
HYPERPARATHYROIDISM
>medication is contraindicated in the treatment of clients with hyperparathyroidism:
chlorthiazide (Diuril) à Ca+ sparing
HYPOPARATHYROIDISM
>Hyperphosphatemia and hypocalcemia are indicative of
Hypoparathyroidism
>A client with hypoparathyroidism is being monitored for hypocalcemia àsign used to check for hypocalcemia:
Chvostek’s Sign
>Discharge teaching for the client with hypoparathyroidism should include which of the following instructions:
Supplement calcium intake
DEC 2006
>diagnosis of hypoparathyroidism à instructs the client to include which of the following items in the diet
Vegetables à green leafy (high in Ca, low in P)

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The client should limit meat, poultry, fish, eggs, cheese, and cereals (high in P also)
CUSHING’S DISEASE
>Cushing’s syndrome à condition is caused by:
Excessive amounts of cortisol (other term for glucocorticoids)
>tentative diagnosis of adrenocortical hyperfunction

à Observable sign the nurse would chart is
Moon face
Sodium and water retention in a client with Cushing’s syndrome contributes to which of the following commonly
seen disorders:
Hypertension and congestive heart failure
>should be assigned to a private room if only one is available

The client with Cushing’s Disease à prone to infection due to increase glucocorticoids
>Cushing’s Syndrome à statement indicating that instructions related to dietary management were
understood:
“I can eat foods that have lot of potassium in them”
Diet: High potassium
Low sodium
>Following an adrenalectomy, a patient is to take the steroid therapy after discharge from the hospital à
instruction given to the patient:
“You should call the physician if you have temperature elevation”
>unilateral adenalectomy to remove a tumor à most important measurement in the immediate postoperative
period for the nurse to take is:
Blood pressure
>bilateral adrenalectomy à statement the client makes indicating to the nurse that further discharge
teaching is needed
“I will gradually discontinue the hormone pills in a few months when I feel better.”
PHEOCHROMOCYTOMA
>client is scheduled for adrenalectomy à In the preoperative period the priority nursing action would be to
monitor:
Vital Signs
>diagnosis of pheochromocytoma à nurse assesses for the major symptom associated with this disorder when
the nurse:
Takes the client’s blood pressure
>Pheochromocytoma à nurse monitors for hypertensive crisis à anticipate that the most likely medication to
be prescribed would be:
phentolamine mesylate (Regitine)
ADDISON’S DISEASE
>A client with muscle weakness, anorexia, dark pigmentation of the skin and laboratory findings of low sodium
and high potassium levels may be presenting with which of the following conditions
Addison’s Disease

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>Addison’s Disease à expect to note which of the following on assessment
Hypotension
>admitted with acute with acute adrenal crisis à the nurse can expect to find that the client:
Low blood pressure
>characteristic bronze appearance of the distal extremities of a patient with Addison’s Disease is caused by:
Increased production of melanocyte-stimulating hormone(MSH)
>client with adrenal insufficiency à nursing diagnosis should receive priority

Fluid volume deficit à due to hyponatremia
>instructions to a client with Addison’s Disease regarding diet therapy à diet most likely would be prescribed
for this client
Normal sodium intake or Increase
Decrease potassium
>Nursing care for a client with Addison’s Disease may include which of the following goals:
Participation in relaxation technique à stress can precipitate Addisonian Crisis
>Addison’s Disease à asks the nurse what he needs to know to manage his condition à The nurse should give
priority:
Emphasizing the need for strict adherence to his medication regimen à steroids drugs are lifetime in
addison’s
>Cortisone (Cortone) is prescribed for a client with Addison’s disease à statement if made by the patient
indicating a need for further teaching:
“I will stop the medication when I feel better”
“I will need to take daily medications until my symptoms decrease.”
*Because lifetime
>long-term corticosteroid therapy àwould include which of the following instructions

Eye examinations yearly to assess for cataract formation
DIABETES MELLITUS
>characteristic of Chandler is the most significant risk factor for his development of type 2 diabetes?
Obesity
>Miguel asks what caused his diabetes à the nurse should reply that type 2 diabetes is:
Caused by insulin resistance
JUNE 2009
>question the nurse should ask when assessing a 10-year-old patient for type 1 DM:
“Are you going to the bathroom to pass your water more often?”
>A physiologic mechanism that results in an increased risk of foot infection in a patient diagnosed with type 1
DM is
hyperglycemia

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>manifestations most likely indicating complication in a patient who has chronic diabetes mellitus
Decreased peripheral sensation à peripheral neuropathy
>diabetes mellitus experiences peripheral neuropathy à priority nursing diagnosis should be

Risk for impaired skin integrity
>client diabetes mellitus has hyperglycemia à priority nursing diagnosis would be to:
>assessment factor as one of the best indicator of a client’s control of his diabetes during the preceding 3-4
months:
A glycosylated hemoglobin level
>glycosylated hemoglobin assay (Hgb A1c) by explaining that the Hgb A1c
Reflects blood glucose level over a 3-4 month period.
>glycosylated hemoglobin of a 40 year old client with diabetes mellitus is 2.5% à nurse understands that:
The client has a good control of her diabetes
Normal: <7%
Fair: 7.1 -8.9
DM (unable to control): >9%
>most important self-care measure for an obese adult with newly diagnosed Type 2 (Non-Insulin Dependent)
DM:
Reducing body weight
>external insulin pump à patient asks for the function à bases the response on the information that the
pump:
Gives a small continuous dose of regular insulin, and the client can self-bolus with an additional
dosage from the pump prior to each meal
DEC 2006
>exercise à The nurse’s best response should be based on the theory that exercise will
Decrease the body’s need for insulin
>encourage exercise in the management of diabetes, because it:

Decrease total triglyceride levels
Improves glucose utilization
Lowers blood glucose
>type 1 DM wants to play soccer à recommendations a nurse would make to the child
“Eat an extra sugar exchange during the game”
>taking glyburide (diaBeta) 1.25mg daily to treat type 2 DM à statement indicating the need for further
teaching
“I often skip dinner because I don’t feel hungry”
>home care measures to the client with diabetes mellitus regarding exercise and insulin administration à
statement by the client indicating a need for further instruction:
“I should perform my exercise at peak insulin time.” à can further cause hypoglycemia

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>diagnosed with diabetes mellitus à client tells the nurse that he is planning to eat a dinner meal at a local
restaurant this week à He asks the nurse if eating in a restaurant will affect the diabetic control and if this is
allowed à appropriate response:
“You should order half-portion meal and have fresh fruit for dessert.”
>client with diabetes mellitus is starting prednisone (Deltasone) therapy for severe arthritis à nurse should
expect:
Worsened diabetes control
>characterized by a sudden drop in blood glucose, followed by rebound hyperglycemia caused by the gradual
and excessive administration of insulin:
Somogyi Phenomenon à Rebound hyperglycemia
>Chandler is obese and unable to look directly at the bottom of his feet to assess for skin problems related to
his diabetes àsuggestion to complete his foot assessment:
Use a mirror for better visualization
>suspected of having DKA à expected laboratory result:

Blood glucose level of 500 mg/dL
*others
Metabolic acidosis à decrease pH
(+) ketones in urine
>During periods of illness the nurse should anticipate which of the following occurrences in the patient with
diabetes mellitus
The need for insulin is increased à stress and illness precipitates DKA
>A nurse performs a physical assessment on a client with type 1 DM. Findings include an Fasting Blood Glucose
of 120mg/dL, temperature of 101 F, pulse of 88, respiration of 22 and blood pressure of 130/90mm Hg à
finding of most concern to the nurse:
Temperature à infection/illness precipitates DKA
>complication of Diabetes Mellitus is indicated by Kussmaul’s respiration:

Diabetic ketoacidosis
>The nurse is teaching an insulin-dependent diabetic client to self-test her blood glucose à The nurse tells her
that if she obtains a result that is over 250 mg/dL, she should
Test her urine for ketones
>effects must be carefully monitored when administering IV insulin to a client diagnosed with DKA:
Hypokalemia and Hypoglycemia
>diabetic ketoacidosis is on intravenous (IV) insulin drip à laboratory results requiring immediate interventions
Serum potassium level of 2.8 mEq/L
>In the event that DKA has occurred the nurse would anticipate that the most likely medication to be
prescribed would be:
Regular insulin à can be given IV
>Primary management for treating DKA includes administration of which of the following treatments
Insulin and IV fluids

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>Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) can be differentiated from DKA by which of the
following condition
Absence of ketones
>can begin to self-administer insulin à The nurse would recommend that the child begin this procedure at age
Nine (9)
>glipizide (Glucotrol) {OHA}should be assessed by the nurse for which of the following side effects
Agranulocytosis
>chlorpropamide (Diabenese) à The nurse should notify the physician if the patient reports being allergic to
Sulfur àsulfonylureas are sulfur based drugs
>prescribes regular insulin à begins to exert an effect:

In 30-60 minutes
>isophane insulin (NPH insulin) injection à be alert for symptoms of hypoglycemia at which of the following
times after insulin administration:
8 hours (6-8/6-12 hours)
>NPH insulin SQ at 8 AM à nurse should assess the client for hypoglycemic reaction at:
5 PM
>administer his insulin à receives 10U of NPH and 12 U of regular insulin each morning à statement reflecting
understanding of the nurse’s teaching
“When drawing up insulin, I should draw up the regular first”
>The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its
potency. The most appropriate response to the client is which of the following
1 month
HYPOGLYCEMIA
>condition that could possibly cause hypoglycemia
Excessive exercise without a carbohydrate snack
>type 1 DM experiences weakness and tremors à

Action a nurse would take first:
Checking the patient’s most recent blood glucose or
Give the patient a glass of juice to drink
>Type 1 DM takes his morning dose of insulin and leaves for school à At 10 AM, he feels faint and is brought to
the nurse’s office à has tachycardia, diaphoresis and is unresponsive à most appropriate intervention by the
nurse at this time is to administer:
Glucagon S.C. à since unconscious
>action if performed by the client would indicate the need for further teaching:
Withdraw the NPH insulin first
>recommendation for preventing for hypoglycemia in an adolescent with type 1 should the nurse make
Carry crackers or fruit to eat before or during periods of increased activity

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Page 22 of 29
URINARY/RENAL SYSTEM
RENAL FAILURE
>indicates the type(s) of acute renal failure
Three types: prerenal, intrarenal and postrenal
(DEC 2007)
>oliguric phase of acute renal failure (ARF) à most important nursing intervention:
Limiting fluid intake
>renal disease à the most common factors contributing to renal failure is

diabetes mellitus
Hypertension
>chronic renal failure à assessed for which of the following manifestation

Fatigue
>review of the laboratory results à the nurse would most likely expect to note:
Elevated blood urea nitrogen (BUN)
>laboratory test a nurse should expect a physician to order for a patient who has renal insufficiency
Creatinine clearance
>After noting the amount of urine output and urine characteristics, the nurse then proceeds to assess which of
the following as the best indirect indicator of renal status:
Blood pressure
>nurse should expect a patient who has chronic renal failure to be given epoetin alfa (Epogen) to
Stimulate the synthesis of red blood cells
>acute renal failure has hyperkalemia à drug the nurse should anticipate administering to the patient
Sodium polystyrene sulfonate (Kayexalate)
>low – potassium diet to select food items from the menu

Lima beans
>acute renal failure has a serum potassium (K) level of 5.8 mEq/L à a priority action:
Place the client on a cardiac monitor
HEMODIALYSIS
>patient with an arteriovenous (AV) fistula, the nurse should assess for which of the following sounds on
auscultation:
Bruit

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>patient with a left arm arteriovenous (AV) shunt prior to hemodialysis à should be reported to the physician
Absence of a palpable thrill over the shunt
>has an arteriovenous fistula created in his left forearm à indicates that the patient needs instruction in self-
care
He wears a watch on his left wrist
A client with chronic renal failure (CRF) returns to the nursing unit following a hemodialysis treatment à nurse
notes that the client’s temperature is 100.2° F à most appropriate nursing action
Continue to monitor vital sign {dialysis machine warms the blood slightly}
>risk for disequilibrium syndrome à during dialysis a nurse assesses the client for:
Headache, deteriorating level of consciousness, and twitching
>nurse is performing an assessment on a client has returned from the dialysis unit following hemodialysis à
client is complaining of a headache and nausea à most appropriate nursing action
>chronic renal failure has completed a hemodialysis treatment à standard indicators to evaluate the client’s
status after dialysis
Vital signs and weight
>the most reliable evidence that a patient’s hemodialysis treatment has been effective
Body weight
>hemodialysis client about self – monitoring between hemodialysis treatments à the client best understands
the information given if the client states to record on a daily basis:
Intake and output, weight
PERITONEAL DIALYSIS
A patient who is scheduled to begin peritoneal dialysis treatments in the home asks a nurse what to expect à
most accurate response by the nurse:
“Fluid will be instilled into your abdominal cavity on a routine basis.”
>receiving continuous ambulatory peritoneal dialysis à indicates the need for further teaching
“I should limit my fluids to three glasses of water a day.”
>list of components of the peritoneal dialysis solution with a client à client asks the nurse about the purpose
of the glucose contained in the solution à bases the response on knowledge that the glucose:
Increases osmotic pressure to produce ultrafiltration
>instructing a client with diabetes mellitus about peritoneal dialysis à nurse tells the client that it is important
to maintain the dwell time for the dialysis at the prescribed time because of the risk of:
Hyperglycemia
>assessment finding the nurse would observe first in a patient who is undergoing peritoneal dialysis and is
developing peritonitis
Cloudy dialysate returns

Page 24 of 29
>preparing to care for a receiving peritoneal dialysis à would be included in the nursing plan of care to prevent
the major complication associated with peritoneal dialysis
Maintain strict aseptic technique
>chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen à client spills water on
the dressing while bathing àA nurse should plan to immediately:
Change the dressing
>diagnosed with renal failure will be receiving peritoneal dialysis à During the infusion of the dialysate the
client complains of abdominal pain à most appropriate action by the nurse is:
Explain that the pain will subside after the first few exchanges
KIDNEY TRANSPLANT
>client develops oliguria à nurse anticipate to be prescribed as the treatment for the oliguria:
Administration of diuretics
>after kidney transplantation, a client develops a fever of 101° F, the blood pressure is elevated, and the kidney
is tender à x – ray results indicate that the transplanted kidney is enlarged à a nurse would suspect:
Acute rejection
>blood chemistry laboratory results in a patient who is in the post-operative period of a renal transplant à
indicating success
Creatinine 1.0 mg/dL
>discharged to home after renal transplantation has a nursing diagnosis of risk for infection related to
immunosuppressive therapy à determines that the client needs further instruction on measures to prevent and
control infection if the client states:
Monitor urine character and output at least 1 day each week
URINARY TRACT INFECTION

>The nurse recognizes that the MOST common causative organism in pyelonephritis is:
E.Coli
>diagnosis of pyelonephritis à a nurse should expect the patient to report which of the following symptoms
Flank pain
>tentative diagnosis of urethritis à assesses the client for which of the following manifestations of the disorder
Dysuria and penile discharge
>complains of fever, perineal pain, urinary urgency and frequency, and dysuria à related to prostatitis à
nurse would look at the results of the prostate examination, which should reveal that the prostate glands are:
Tender, indurated, and warm to the touch
>nurse is caring for an 88–year–old woman suspected of having a urinary tract infection (UTI) à would alert
the nurse to the possibility of the presence of a UTI
Confusion (if elderly)
>Urinary tract infection is the most common site of nosocomial infection particularly with urinary
catheterization. It can be reduced significantly by through:

Page 25 of 29
Closed system drainage
>has an indwelling urinary catheter à How should you collect a urine specimen for culture and sensitivity?
Wipe the self-sealing aspiration port with antiseptic solution and aspirate urine with a sterile
needle
>female client diagnosed with urethritis resulting from infection with Chlamydia à plan to include the following
points in the teaching session
The most serious complication of this infection is sterility
>administered phenazopyridine hydrochloride (Pyridium) à indicates to a nurse that the medication is effective
“It does not hurt me to urinate” {urinary analgesics}
>recommendations a nurse should make to a patient who has a diagnosis of chronic prostatitis:
“Daily sitz baths will provide comfort.”
>prostatitis secondary to kidney infection à A nurse evaluates that the client verbalized the intention to:
Use warm sitz baths and analgesics to increase comfort
>care plan for a woman with cystitis à most appropriate to include in the care plan
Encouraging voiding every 2-3 hours
URINARY CALCULI
>client with urolithiasis has a history of chronic urinary tract infections (UTIs) à client most likely has which of
the following types urinary stones
Struvite
>severe left flank pain, nausea and vomiting à tentative diagnosis of right ureterolithiasis à PRIORITY nursing
diagnosis:
Acute pain
with renal stones à skin and mucous membranes are dry and her 24 hour intake and output record reveal an
oral intake of 900 ml and a urinary output of 700 ml + urine is dark amber à nursing diagnosis is:
>admitted to the hospital with a diagnosis of renal calculi à experiencing severe flank pain, nauseated and with
a temperature of 39˚C à most immediate goal of the nurse would be
Alleviate pain
>appropriate intervention for BL who has ureterolithiasis

Administering opioid analgesics preferably intravenously
>transfer from the postanesthesia care unit a client who has had percutaneous ultrasonic lithotripsy for calculi
in the renal pelvis à will involve monitoring which of the following
Nephrostomy tube

Page 26 of 29
>composed of calcium oxalate à the nurse include in the dietary instructions
Avoid green leafy vegetables, such as spinach
>has a history of gout is also diagnosed with urolithiasis à nurse gives the client instructions in foods to limit,
which include:
Liver
>benign prostatic hyperplasia (BPH) à presence of which of the following early symptoms
Decreased force in the stream of urine
>suspected of having hypertrophy of the prostate à expected symptom

Residual urine of more than 50ml
>follow-up home visit is conducted on an elderly patient after recent hospitalization à instruction by the nurse
would most effectively address the patient’s nocturia:
“Avoid liquids after 5 pm”
>include in the discharge plan for a patient who has a transurethral resection of the prostate
Limit intake of caffeinated beverages (can cause bladder spasm)
>has a cold is seen in the emergency room with inability to void à history of benign prostatic hyperplasia
(BPH) à medication use that should be questioned
Decongestants
>nurse observes the development of clots in the continuous bladder irrigation tubing of a patient who had a
transurethral resection of the prostate (TURP) four hours ago à first action to take:
Increase the flow rate of the irrigation solution.
>undergoing transurethral resection of the prostate (TURP) àon the first day after surgery, the client reports
bladder pain à the nurse should do first
Assess the irrigation catheter for patency and drainage.
JUNE 2009
>diagnosis of benign prostates hyperplasia, and a transurethral resection of the prostate (TURP) is performed
à assessment finding indicating the need to notify the physician
Blood pressure of 100/50 mm Hg, pulse of 130 beats per minutes
>following surgery for an enlarged prostate gland à most appropriate nursing measure for a patient who
complains of pain during the immediate postoperative period
Checking the patency of the indwelling urinary catheter
>being treated for benign prostatic hypertrophy (BPH) à indicates that the treatment is having the desired
effect
Decreased urinary dribbling
BLADDER TRAUMA
>arrives at an emergency department with complaints of low abdominal pain and hematuria à
Afebrile à assesses the client to determine a history of:
Blow or trauma to the bladder or abdomen

Page 27 of 29
>pain is referred to which of the following areas
Shoulder
A female client is admitted to an emergency department following a fall from a horseà insertion of a Foley
catheter à nurse note blood at the urinary meatus while preparing for the procedure à
The nurse should:
URINARY DIVERSION
>has an ileal conduit (ileal loop) following a cystectomy for bladder cancer à Should teach the patient that the
type of drainage expected from the stoma is
Urine and mucous shreds
>appropriate patient outcome for a patient who has a nursing diagnosis of altered urinary elimination following
creation of an ileal conduit
The patient monitors for skin irritation
>undergone surgery for creation of an ileal conduit is scheduled for discharge à able to manage self-care at
home à nurse would assess the patient’s ability to
Change the stoma appliance
POLYCYSTIC KIDNEY DISEASE

>polycystic kidney disease à the nurse will look for which of the following as the most common manifestation
of this disorder
Flank pain and hematuria
FLUIDS AND ELECTROLYTES

RESPIRATORY ACIDOSIS
-COPD
-Asthma
-Narcotics Overdose
RESPIRATORY ALKALOSIS
-Anxiety (hyperventilation)
-Fever
METABOLIC ACIDOSIS
-Burns
-Renal Failure
-Ileostomy
-Diarrhea
-Excessive Increase Glucose (DKA)
-Shock
METABOLIC ALKALOSIS
-Vomiting
-Suctioning

Page 28 of 29
-Cushing’s
ELECTROLYTES IMBALANCE
HYPOCALCEMIA
-prolonged ST interval (DEC 2011)

-prolonged QT interval (DEC 2011)
HYPERCALCEMIA
-shortened ST interval
-widened T wave
HYPOKALEMIA
-prominent U wave
-ST depression
HYPERKALEMIA
-tall T wave
-widened QRS complex

Page 29 of 29

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BULLETS MS 2

>statement that would support a nursing diagnosis of knowledge deficit

>position after taking antacids

PEPTIC ULCER DISEASE

>most frequent symptoms of duodenal ulcer

>pain characteristic of a duodenal ulcer

>indicate perforation of the ulcer

>perform Billroth II procedure

>nasogastric tube attached to intermittent suction

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>experiences nausea following the removal of a nasogastric tube – first action:

>food/drinks/diet to be limited or eliminated

>diet that is appropriate for patient with PUD

>admitted with bleeding peptic ulcer – associated intervention

>bowel surgery – purpose of sulfasuxidine and neomycin

>symptoms of dumping syndrome

>early signs and symptoms of dumping syndrome

>statement would indicate a correct understanding of the instructions

>instruction to avoid dumping syndrome

>preventing dumping syndrome

>intrinsic factor is absorb cyanocobalamine (Vitamin B12) in the

>Schilling’s test -- the test will require the nurse to

>indicate that the goal of care has been achieved

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>acute appendicitis the report of laboratory tests

>diagnosis of appendicitis -- most important for the nurse to follow-up

>checking for rebound tenderness

>appendicitis is suspected à would question which of the following physician’s orders

DIVERTICULOSIS & DIVERTICULITIS

>indicate that the patient is following the diet plan correctly

>diverticulosis à should include avoidance of:

>indicate that the corticosteroids therapy has been effective

>therapeutic diet for ulcerative colitis:

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>priority nursing diagnoses:

>indicates patient needs teaching if what food is eaten:

COLOSTOMY & ILEOSTOMY

>creation of an ileostomy à purpose of surgery:

>ileostomy à avoid which of the following foods:

>ileostomy à foods that thicken the stool:

>essential care of the stoma in ileostomy:

>ileostomy à most frequent complications of this type of surgery:

>abdominoperineal resection àpatient should be informed he/she will have a:

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>double-barrel colostomy à type of drainage from the patient's bowel

>patient is at risk for fluid volume deficit

>colostomy à foods in the diet to reduce odor

>colostomy à to avoid flatulence should not eat the following EXCEPT

>instructions to a client who has a new colostomy

>sign of stoma prolapse:

>expected color of the stoma

>appropriate nursing interventions during colostomy irrigation:

>colostomy irrigation àinstruction to enhance the effectiveness of the irrigation

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TOTAL PARENTAL NUTRITION

>substances that may be administered piggy-backed to a TPN infusion

>the nurse would closely monitor laboratory values for

>weaned from total parental nutrition à anticipated order:

CHOLECYSTITIS & CHOLELITHIASIS

>blockage of the common bile duct à will experience difficulty digesting:

>best describes Murphy’s Sign

>an assessment finding supports her diagnosis of cholecystitis:

>patient with jaundice à laboratory value that is expected to be elevated: