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NUR 305A Final Exam Questions with Correct Answers
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NUR 305A Final Exam Questions with Correct Answers
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NUR 305A Final Exam Questions withCorrect Answers
Which is a possible outcome for the patient experiencing an age-related decrease in
antidiuretic hormone?
A. Constipation, lethargy, and dry skin
B. Greater-than-ideal body weight
C. Diluted urine and dehydration
D. Yeast infection and polydipsia - Answer-•ANS: C
•Rationale: These are symptoms that result from an age-related decrease in antidiuretic
hormone. The other symptoms listed are not.
Which response in a client with diabetes insipidus indicates to the nurse that another
dose of desmopressin acetate (DDAVP) is needed?
A. Urine output and specific gravity are increased.
B. Urine output is increased and urine specific gravity is decreased.
C. Urine output and specific gravity are decreased.
D. Urine output is decreased and urine specific gravity is increased. - Answer-•ANS: B
•Rationale: Diabetes insipidus (DI) is caused by a failure to secrete sufficient amounts of
antidiuretic hormone (ADH) to maintain blood osmolarity and prevent hyperosmolar
blood and other extracellular fluid. ADH increases the amount of water reabsorbed from
urine and returned to systemic circulation. Without adequate amounts of ADH, more
water is excreted in the urine, increasing urine volume and decreasing urine specific
gravity. DDAVP has a similar action to ADH but it is temporary. When urine volume
increases and the specific gravity decreases, more drug is needed.
•The serum electrolyte values for a client with syndrome of inappropriate antidiuretic
hormone being treated with tolvaptan indicate the following changes within the past 12
hours. Which change does the nurse report immediately to the health care provider?
•A. Serum potassium decrease from 4.2 mEq/L to 3.8 mEq/L
•B. Serum sodium increase from 122 mEq/L to 140 mEq/L
•C. Serum calcium increase from 9.5 mg/dL to 10.2 mg/dL
•D. Serum chloride decrease from 109 mEq/L to 99 mEq/L - Answer-•ANS: B
•Rationale: The purpose of tolvaptan is to restore a normal sodium concentration to the
blood and other extracellular fluid. In the case of SIADH, excessive amounts of
antidiuretic hormone have caused more water to be absorbed, causing the serum
sodium to be diluted. When tolvaptan therapy brings the serum sodium level to normal
levels, it must be discontinued to prevent hypernatremia. A serum sodium of 140 mEq/L
is within the normal range.
A patient is diagnosed with small cell lung cancer. Which endocrine condition is
consistent with this diagnosis?
,A.Syndrome of inappropriate antidiuretic hormone (SIADH)
B.Diabetes insipidus (DI)
C.Cushing's syndrome
D.Adrenal crisis - Answer-•Answer: A
•Rationale: Cancer (especially lung cancers) increases the risk of the patient developing
SIADH. Other risk factors include recent head trauma, cerebrovascular disease, and
tuberculosis or other pulmonary disease. A review of past and current medications is
also important in searching for the cause of SIADH.
•Which precaution is most important for the nurse to teach a client who is prescribed
oral corticosteroids for hormone replacement therapy after a unilateral adrenalectomy?
•A. "Do not stop taking this drug without consulting your prescriber."
•B. "Avoid crowds and people who are ill."
•C. "Be sure to take this drug with food."
•D. "Reduce your salt intake." - Answer-•ANS: A
•Rationale: All of the choices are precautions that the nurse should teach the client
taking an oral corticosteroid chronically. However, the most critical precaution is to not
stop taking the drug because chronic corticosteroid use causes atrophy of the adrenal
glands. With adrenal gland atrophy, the person no longer makes his or her own normal
levels of corticosteroids, which are essential for life. Long-term steroid use should never
be suddenly stopped.
Which patient with Cushing's disease is at greatest risk for developing heart failure?
A.42-year-old with a serum creatinine level of 3.7 mg/dL
B.59-year-old with a history of hypertension
C.32-year-old with a history of hepatitis B infection
D.60-year-old with pneumonia - Answer-•Answer: A
•Rationale: The 42-year-old patient has compromised kidney function evidenced by an
elevated serum creatinine level. Preventing fluid overload that may quickly lead to
pulmonary edema and heart failure is a primary concern for patients with Cushing's
disease. Any patient with Cushing's disease is at risk for developing fluid overload,
regardless of age. However, the older adult or one who has coexisting cardiac
problems, kidney problems, pulmonary problems, or liver problems, is at greater risk.
Which of the following is a priority nursing intervention for a patient with primary adrenal
cortex dysfunction?
A.Monitor vital signs and the patient's physiologic response to stress.
B.Closely measure fluid intake and output.
C.Provide emotional support during stressful situations.
D.Weigh the patient daily. - Answer-•Answer: A
•Rationale: The adrenal cortex makes up about 90% of the adrenal gland. Hormones
secreted from the adrenal cortex are responsible for fluid and electrolyte balance, stress
response, metabolism of nutrients, and emotional and sex hormone responses. Priority
, nursing interventions with adrenal cortex dysfunction focus on the negative feedback
mechanisms of aldosterone and cortisol.
Which assessment finding should trigger a more detailed assessment of the patient's
endocrine system?
A.Weight gain
B.Changes in hair texture and distribution
C.Fatigue
D.Poor peripheral pulses - Answer-•Answer: B
•Rationale: Changes in physical appearance can reflect an endocrine problem. Obvious
changes identified during the physical assessment include hair texture and distribution,
facial contours and eye protrusion, voice quality, body proportions, and secondary
sexual characteristics. Changes in weight and fatigue may also be associated with
endocrine disorders as well as other conditions. Poor peripheral pulses are more likely
associated with cardiovascular diseases.
•Which client assessment finding indicates to the nurse the need to assess further for a
possible endocrine problem?
•A. A history of taking oral contraceptives for more than 2 years
•B. A weight loss of 15 lbs in the past 6 weeks without dieting
•C. The client's father's diagnosis of prostate cancer
•D. A recent need for corrective lenses - Answer-•ANS: B
•Rationale: An unintentional weight loss in excess of 5 lbs is significant. It indicates an
increase in metabolic rate or a problem with excessive fluid loss, either of which could
be associated with an endocrine disorder. Taking oral contraceptives for more than 2
years is not associated with endocrine problems. The father's diagnosis of prostate
cancer may increase the client's risk or predisposition to cancer but not to endocrine
problems. Although a need for corrective lenses can be caused by an endocrine
problem, it is not the common reason for this need.
•A nurse is caring for a client with Addison disease. What should the nurse teach the
client to do regarding an appropriate diet?
a.Add extra salt to food
b.Limit intake to 1200 calories
c.Omit protein foods at each meal
d.Restrict the daily intake of fluids to 1 L - Answer-•A- Add extra salt to food
•
•Because of diminished mineralocorticoid secretion, clients with Addison disease are
prone to develop hyponatremia. Therefore, the addition of salt to the diet is advised.
Intake of calories and fluid is determined on an individual basis, not because the client
has Addison disease. Protein is not omitted from the diet; ingestion of essential amino
acids is necessary for optimum metabolism. Fluids are not restricted for clients with
Addison disease.
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