Question

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

Answer 1

Correct Answers:

Turkey and cheese sandwich

Rationale :

🧂 A turkey and cheese sandwich indicates an understanding of dietary teaching for a client with Addison’s disease because clients with adrenal insufficiency often require increased sodium intake due to decreased aldosterone production.

🧂 Aldosterone normally helps the kidneys retain sodium and water while excreting potassium. When aldosterone levels are low, clients are at risk for hyponatremia, dehydration, and hypotension.

🧂 A turkey and cheese sandwich contains sodium, which can help support fluid balance and blood pressure.

🧂 Clients with Addison’s disease should also avoid excessive intake of potassium-rich foods because they are at risk for hyperkalemia.

🧂 The nurse should teach clients to follow prescribed corticosteroid therapy and maintain appropriate sodium intake.

🧂 This answer is correct because a salty snack helps replace sodium lost due to reduced adrenal hormone function.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 2

Correct Answers:

Hypertension

Rationale :

🔥 Hypertension is a finding the nurse should report because it can occur during a thyroid storm, a life-threatening complication of Graves’ disease caused by an excessive release of thyroid hormones.

🔥 Thyroid storm causes a hypermetabolic state with increased sympathetic nervous system activity, leading to elevated blood pressure, tachycardia, fever, agitation, and altered mental status.

🔥 Early recognition of thyroid storm is critical because it can rapidly progress to cardiovascular collapse, heart failure, and death if untreated.

🔥 The nurse should monitor vital signs closely, especially temperature, heart rate, and blood pressure.

🔥 Treatment may include medications such as beta-blockers, antithyroid drugs, iodine, and corticosteroids to reduce thyroid hormone effects.

🔥 This answer is correct because hypertension is consistent with the increased sympathetic activity seen in thyroid storm.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 3

Correct Answers:

Men and women who are obese

Rationale :

🍩 Men and women who are obese should be included in type 2 diabetes mellitus screening because obesity is one of the strongest risk factors for developing insulin resistance and impaired glucose regulation.

🍩 Excess adipose tissue, especially abdominal fat, reduces the body’s ability to use insulin effectively, leading to increased blood glucose levels.

🍩 Obesity increases the risk of developing type 2 diabetes regardless of sex.

🍩 Community screening programs often target individuals with risk factors such as obesity, older age, family history of diabetes, hypertension, and sedentary lifestyle.

🍩 Early identification allows clients to begin lifestyle changes and treatment to prevent or delay diabetes complications.

🍩 The nurse should encourage weight management, physical activity, and healthy dietary habits as part of diabetes prevention.

🍩 This answer is correct because obesity significantly increases the risk of type 2 diabetes due to insulin resistance.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 4

Correct Answers:

"Wear a medical alert identification tag when you exercise."

Rationale :

🏃 Wearing a medical alert identification tag is the correct teaching because clients with type 1 diabetes mellitus are at risk for hypoglycemia during or after exercise.

🏃 A medical alert tag allows others to recognize that the client has diabetes and provide appropriate emergency care if the client becomes confused, unconscious, or unable to communicate.

🏃 Exercise increases glucose uptake by muscles and can lower blood glucose levels, especially in clients using insulin.

🏃 Clients should also monitor blood glucose before and after exercise, carry a fast-acting carbohydrate source, and understand how activity affects insulin needs.

🏃 Proper preparation helps prevent exercise-related complications such as severe hypoglycemia.

🏃 This answer is correct because medical identification improves safety during exercise-related glucose emergencies.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 5

Correct Answers:

Hyponatremia

Rationale :

💧 Hyponatremia is an expected finding in syndrome of inappropriate antidiuretic hormone secretion (SIADH) because excessive release of antidiuretic hormone causes the kidneys to retain too much water.

💧 The retained water dilutes the sodium concentration in the blood, resulting in low serum sodium levels.

💧 Clients with SIADH may develop manifestations related to low sodium, including headache, confusion, nausea, seizures, and altered mental status.

💧 The nurse should monitor sodium levels, neurological status, intake and output, and fluid balance.

💧 Treatment may include fluid restriction, medications that block ADH effects, and correction of the underlying cause.

💧 This answer is correct because excess ADH causes water retention leading to dilutional hyponatremia.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 6

Correct Answers:

Bronze pigmentation of skin

Rationale :

🧂 Bronze pigmentation of the skin is an expected finding in a client with Addison’s disease because the adrenal glands produce insufficient amounts of cortisol and aldosterone.

🧂 When cortisol levels decrease, the pituitary gland releases more adrenocorticotropic hormone (ACTH) to stimulate the adrenal glands.

🧂 ACTH is produced from a precursor molecule that also stimulates melanocytes, causing increased melanin production and a characteristic bronze or hyperpigmented appearance of the skin.

🧂 Hyperpigmentation is often noticeable in areas exposed to pressure or friction, such as the elbows, knees, knuckles, and skin folds.

🧂 The nurse should also monitor for other Addison’s manifestations, including hypotension, fatigue, weight loss, hyponatremia, and hyperkalemia.

🧂 This answer is correct because increased ACTH causes excess melanin production leading to bronze skin discoloration.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 7

Correct Answers:

Increased head size

Rationale :

🦴 Increased head size is an expected finding in a client with acromegaly because excessive growth hormone (GH) secretion after adulthood causes enlargement of bones and soft tissues.

🦴 Acromegaly commonly causes enlargement of the skull, jaw (prognathism), facial bones, nose, and tongue.

🦴 Clients may also develop enlarged hands and feet, requiring larger rings, shoes, or gloves.

🦴 Excess GH stimulates increased production of insulin-like growth factor 1 (IGF-1), which promotes abnormal tissue and bone growth.

🦴 Other manifestations include coarse facial features, thickened skin, excessive sweating, joint pain, and possible glucose intolerance.

🦴 This answer is correct because adult excess growth hormone causes enlargement rather than reduction of bone structures.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 8

Correct Answers:

Shakiness

Rationale :

🍬 Shakiness is an expected manifestation of hypoglycemia because a low blood glucose level triggers a sympathetic nervous system response.

🍬 When blood glucose drops, the body releases hormones such as epinephrine, which causes symptoms including tremors, shakiness, sweating, anxiety, and palpitations.

🍬 Clients with type 1 diabetes mellitus should be taught to recognize early signs of hypoglycemia so they can treat it quickly.

🍬 The nurse should teach the client to consume a fast-acting carbohydrate, such as glucose tablets or juice, when hypoglycemia occurs.

🍬 Severe hypoglycemia can progress to confusion, seizures, loss of consciousness, and coma if untreated.

🍬 This answer is correct because shakiness is a classic early warning sign of low blood glucose.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 9

Correct Answers:

Tachycardia and hypertension
Laryngeal stridor and hoarseness
Positive Trousseau's sign

Rationale :

🦋 Tachycardia and hypertension should be reported because they may indicate thyroid storm, a life-threatening complication after thyroid surgery in clients treated for hyperthyroidism.

🦋 Thyroid storm occurs from excessive thyroid hormone activity and can cause rapid heart rate, elevated blood pressure, fever, agitation, and cardiac complications.

🫁 Laryngeal stridor and hoarseness should be reported because they may indicate laryngeal nerve injury or airway obstruction after thyroidectomy.

🫁 Stridor is a serious airway warning sign because swelling or damage near the vocal cords can compromise breathing.

⚡ Positive Trousseau's sign should be reported because it indicates hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or removed during thyroid surgery.

⚡ Hypocalcemia can lead to tetany, muscle spasms, seizures, and cardiac changes, requiring prompt treatment.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 10

Correct Answers:

Weigh the client weekly

Rationale :

🦋 Weighing the client weekly should be included in the plan of care because clients with Cushing’s syndrome are at risk for fluid retention and weight gain due to excessive cortisol effects.

🦋 Chronic corticosteroid use can cause increased fat deposition, especially around the face, abdomen, and upper back, as well as increased sodium and water retention.

🦋 Monitoring weight helps the nurse evaluate changes in fluid balance and the effectiveness of interventions.

🦋 The nurse should also monitor for complications of Cushing’s syndrome, including hypertension, hyperglycemia, infection, and osteoporosis.

🦋 Regular weight assessment provides an important indicator of worsening fluid retention or metabolic changes.

🦋 This answer is correct because weight monitoring helps detect the effects of excess cortisol and steroid therapy.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

QLexNursing

1 :
A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

2 :
A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

3 :
A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening?

4 :
A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include in the teaching?

5 :
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect?

6 :
A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find?

7 :
A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect?

8 :
A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

9 :
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.)

10 :
A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care?

QLexNursing

1 : A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

2 : A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

3 : A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening?

4 : A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include in the teaching?

5 : A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect?

6 : A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find?

7 : A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect?

8 : A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

9 : A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.)

10 : A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care?

1 :
A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

2 :
A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

3 :
A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening?

4 :
A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include in the teaching?

5 :
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect?

6 :
A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find?

7 :
A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect?

8 :
A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

9 :
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.)

10 :
A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care?