NCLEX Daily Practical Exercise 16


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6. Which of the following laboratory test results would suggest to the nurse Len that a client has a corticotropin-secreting pituitary adenoma?

Correct Answer: A

Answer Explanation:

A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels.

Option A: Cortisol levels should also be elevated in corticotropin-secreting pituitary adenoma.
Option B: Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.
Option D: A low corticotropin level with a low cortisol level would be associated with hypocortisolism.

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7. A male client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by doing which of the following?

Correct Answer: D

Answer Explanation:

The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia.

Option A: Urine ketone testing isn’t indicated because the client does secrete insulin and, therefore, isn’t at risk for ketosis.
Option B: Urine specific gravity isn’t indicated because although fluid balance can be compromised, it usually isn’t dangerously imbalanced.
Option C: Temperature regulation may be affected by excess cortisol and isn’t an accurate indicator of infection.

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8. Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Mariner should expect the dose’s:

Correct Answer: C

Answer Explanation:

Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.

Option A: 2 p.m. is when the insulin was given; onset does not occur at the same time as the medication was given
Option B: The peak starts 2 to 4 hours after the insulin was given, which will be at 4 p.m.
Option D: Onset of 4 p.m. is very late; 15 to 30 minutes is the expected onset of insulin. Peak shoud start at 4 p.m.

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9. The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?

Correct Answer: A

Answer Explanation:

In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism.

Option B: A decreased TSH level indicates a pituitary deficiency of this hormone.
Option C: If the TSH level rises after 30 minutes, then the client has no hyperthyroidism.
Option D: Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from the administration of phenytoin and certain other drugs.

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10. Rico with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?

Correct Answer: B

Answer Explanation:

The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next.

Option A: Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue, or other deviations.
Option C: Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn’t inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically.
Option D: Exercise speeds drug absorption, so the client shouldn’t inject insulin into sites above muscles that will be exercised heavily.

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