NR-325 Adult Health II - Set 1 - Part 1

Correct Answer: The bradycardic client has hypothyroidism

Fatigue and hair loss appear in both thyroid disorders, so they cannot separate them. The slow pulse paired with constipation marks the underactive gland, while the fast pulse with frequent stools marks the overactive one. Option b is incorrect because a racing heart with loose stools comes from a metabolic rate driven upward, not downward. Assigning hypothyroidism to that client reverses the two presentations entirely. Option c is incorrect because opposite cardiac and bowel findings cannot arise from one disorder. Shared complaints such as tiredness and thinning hair overlap widely and never establish a single diagnosis. Option d is incorrect because thyroid hormone sets the pace of the heart and the gut, so these findings sit at the center of thyroid assessment. Dismissing them would miss two treatable diagnoses.

Correct Answer: Schedule a dilated eye examination now and then yearly

Type two diabetes is usually silent for years, so retinal damage may already exist at diagnosis. A dilated examination starts immediately and repeats each year, because symptoms appear only when damage is advanced. Option a is incorrect because waiting for blurred vision means waiting for established retinal injury. Early non proliferative changes cause no symptoms at all, which is precisely why a scheduled examination exists. Option b is incorrect because the five year delay belongs to type 1 disease, where the onset date is known and abrupt. Applying that interval here lets silent damage progress without any surveillance. Option d is incorrect because floaters signal bleeding from fragile new vessels, a late and sight threatening development. Screening exists to find disease long before the client notices anything unusual in the visual field.

Correct Answer: "I will count my ice chips and soup toward the limit."

Every liquid counts against the allowance, including ice chips, gelatin, soup and ice cream. Recognizing that hidden fluid is what keeps the restriction honest and lets the serum sodium climb back safely. Option b is incorrect because the problem is retained water, not excess salt. Dietary sodium is usually increased in this disorder, and drinking freely would push the serum sodium lower and bring back confusion. Option c is incorrect because weekly weighing is far too infrequent to catch water creeping back on. A gain of one kilogram signals about a liter retained, so the scale is used every morning. Option d is incorrect because dry mouth is managed with mouth rinses, hard candy and lip balm rather than swallowed liquid. Thirst continues here and cannot be allowed to set the daily intake.

Correct Answer: Record intake and output each shift

Measuring and recording fluid intake and urine output is a standard task with clear limits and no judgment required. The nurse keeps the assessment and teaching that follow from those numbers. Option a is incorrect because client education requires professional judgment about what the client already knows and what matters most. Explaining why a very high calorie intake is needed sits squarely with the nurse. Option b is incorrect because auscultating a gland for a bruit is a physical assessment skill outside the scope of unlicensed staff. The neck examination shapes the plan of care and belongs to licensed practice. Option d is incorrect because judging whether a drug worked means interpreting heart rate, tremor and anxiety against a baseline. That analysis is nursing evaluation and cannot be handed to unlicensed staff.

Correct Answer: Moon face, truncal obesity and purple striae

Long term glucocorticoid moves fat to the face and trunk while catabolizing limb muscle, and it thins the dermis until stretched skin shows the underlying vessels as wide purple striae. Option a is incorrect because bronzed skin with salt hunger and steady weight loss describes primary adrenal insufficiency, driven by high ACTH and lost aldosterone. Steroid excess produces the reverse picture in every one of those findings. Option b is incorrect because pallor with drenching sweat and a pounding headache is the catecholamine surge of a medullary tumor. Prednisone acts on the cortex hormones and never generates those paroxysmal attacks. Option c is incorrect because growing hands, thickened features and a deepened voice come from growth hormone excess after the growth plates close. That is a pituitary problem unrelated to how much prednisone a client swallows.

Correct Answer: Hypotension, hyperkalemia and low blood glucose

Without cortisol the vessels will not respond to catecholamines and the pressure collapses, while lost aldosterone lets potassium build up. Gluconeogenesis stops as well, so the blood glucose falls at the same time. Option a is incorrect because that combination is what steroid excess looks like. A client flooded with glucocorticoid runs a high pressure, spills potassium into the urine and becomes hyperglycemic, which is the mirror of this emergency. Option b is incorrect because the blood pressure direction is wrong. Cortisol keeps vessels responsive, so its sudden absence produces profound hypotension rather than hypertension, even though the potassium and glucose values listed here do fit. Option d is incorrect because it borrows two values from cortisol excess. Potassium rises rather than falls once aldosterone disappears, and glucose sinks rather than climbs once gluconeogenesis has no hormonal driver.

Correct Answer: Start the prescribed isotonic saline infusion

Circulation comes first. Isotonic saline restores the intravascular volume that has poured out as dilute urine, lifting the pressure before any attempt to correct tonicity or replace the missing hormone. Option b is incorrect because sending a specimen confirms a diagnosis the numbers already suggest. Laboratory work runs alongside resuscitation, and no result changes the fact that this client is losing perfusion right now. Option c is incorrect because nasal absorption is unreliable in an unconscious client and the hormone does nothing for an empty vascular space. Desmopressin follows once volume is restored, usually by a parenteral route. Option d is incorrect because an hour of watching allows shock to deepen in a client who cannot ask for water. Repositioning moves nothing back into the circulation and wastes the window for preventing hypernatremic injury.

Correct Answer: Distal symmetric peripheral neuropathy

Damage starts in the longest nerves, so symptoms appear in the toes and climb the leg in a stocking pattern. Burning and numbness together are the hallmark of that distal sensory loss. Option a is incorrect because a sudden arterial blockage produces a cold, pale, pulseless limb with severe pain over minutes. This client describes a slow bilateral change, not an abrupt one sided emergency. Option b is incorrect because retinopathy damages retinal capillaries and shows up as floaters or blurred central vision. Nothing about it explains sensation in the feet, since the injury sits inside the eye. Option c is incorrect because Charcot changes are a bony collapse of the arch that follows years of unfelt trauma. The client reports altered sensation, with no deformity or swelling described yet.

Correct Answer: Dimming of colors in one eye

Loss of color vision points to compression of the optic nerve behind a proptotic globe, which threatens sight. This finding goes to the provider at once for urgent ophthalmology evaluation. Option a is incorrect because a gritty feeling reflects overnight corneal dryness, the ordinary nuisance that lubricating ointment is meant to ease. Reinforcing the bedtime ointment or taping the lids addresses it. Option b is incorrect because periorbital swelling after lying flat comes from fluid pooling in inflamed orbital tissue. Elevating the head of the bed, limiting salt and applying cool compresses will reduce it. Option d is incorrect because tearing in a breeze is a protective response of an exposed eye that cannot blink fully. Dark glasses shield the cornea from wind and dust and settle the symptom.

Correct Answer: Contrast can reduce clearance and allow lactic acidosis

Iodinated contrast can temporarily lower kidney function. Metformin leaves the body through the kidneys, so a drop in clearance lets the drug build up, and accumulation is what sets off lactic acidosis. Option b is incorrect because no chemical binding occurs between the two agents. The interaction is indirect and travels through the kidney, where a brief dip in filtration changes how much drug stays in circulation. Option c is incorrect because image quality has nothing to do with this precaution. Radiologists worry about the client's kidneys afterward, not about anything metformin might do to the pictures they obtain. Option d is incorrect because allergy to contrast media is an immune response unrelated to oral antidiabetic therapy. Clients with a dye allergy receive premedication, and that plan has no bearing on the metformin question.

Correct Answer: "I will use a stool softener to avoid straining."

Straining at stool pushes pressure straight back to the fresh surgical site and can open a cerebrospinal fluid leak. Stool softeners, fluid and fiber keep the bowel moving without that pressure. Option a is incorrect because the incision sits under the upper lip and a toothbrush would disturb it. For roughly ten to fourteen days the client uses rinses, warm saline gargles and flossing instead. Option c is incorrect because forceful nose blowing transmits sinus pressure to the repair and can dislodge the graft. Congestion is expected for a while and is managed without ever clearing the nose that way. Option d is incorrect because bending at the waist raises intracranial pressure just as coughing and lifting do. The client should squat or ask for help, and the restriction lasts several weeks after going home.

Correct Answer: Stopping smoking with structured cessation support

Nicotine constricts vessels and speeds the arterial disease that turns a small foot wound into an amputation. Quitting is the single strongest modifiable protection against limb loss, and nurses deliver that support well. Option a is incorrect because vitamins do not alter atherosclerosis, perfusion or wound healing in diabetes. Supplements have a place when a specific deficiency exists, yet none of them protects an ischemic foot. Option b is incorrect because raising the legs helps venous congestion, and the threat here is arterial inflow. Elevation can actually reduce perfusion to an already ischemic foot and worsen rest pain. Option c is incorrect because compression garments are prescribed for venous disease and can be harmful when arterial supply is poor. They also press on skin that a neuropathic client cannot monitor by feel.

Correct Answer: Weight loss, hypernatremia and low specific gravity

Water pours out because antidiuretic hormone is missing, so the urine stays dilute while the blood concentrates. The client sheds weight with the lost fluid and the serum sodium climbs above normal. Option b is incorrect because weight gain with a falling sodium describes water being held, not lost. A client retaining water passes little urine, so pairing that gain with dilute urine contradicts itself. Option c is incorrect because concentrated urine means the kidney is reabsorbing water normally. This client cannot do that, and a low serum sodium would not fit the dehydration and thirst already described. Option d is incorrect because it mixes findings from opposite disorders. Rising sodium belongs with the client who is drying out, yet weight gain and dense urine belong to the client whose kidneys are hoarding water.

Correct Answer: Short acting regular insulin at standard strength

Regular insulin at the standard one hundred unit strength is the preparation given intravenously. It contains no protamine and no protracting modification, so it dissolves fully and acts predictably when infused into a vein. Option a is incorrect because NPH is a cloudy suspension of particles rather than a true solution. Pushing suspended particles into the bloodstream is unsafe, which is why this product stays subcutaneous. Option b is incorrect because glargine is built to precipitate in fatty tissue and release slowly over the day. Delivered into a vein it loses that design entirely and would be both useless and hazardous. Option d is incorrect because the five hundred unit concentration is never given by vein under any circumstance. Its label restricts it to subcutaneous use, and any dosing slip would deliver five times the intended amount.

Correct Answer: "I can stop the steroid once my energy comes back."

Adrenal insufficiency never remits, and stopping replacement leaves the client with no cortisol at all. That plan invites adrenal crisis, so the nurse corrects it and stresses that the medication continues for life. Option a is incorrect because carrying injectable hydrocortisone is exactly what the nurse wants to hear. When vomiting prevents swallowing tablets, the intramuscular dose becomes the only route available, and family should be taught to give it. Option c is incorrect because raising the dose for fever is the stress rule this client must follow. Illness, injury, surgery and dental work all raise cortisol demand, commonly to two or three times the usual amount. Option d is incorrect because a bracelet naming the condition lets a paramedic recognize steroid dependence in an unconscious client. The statement shows sound understanding, and a wallet card listing medications strengthens it further.

Correct Answer: Give the intravenous hydrocortisone and isotonic saline

Circulation comes first, and this shock is caused by missing cortisol. Hydrocortisone restores vascular responsiveness while isotonic saline replaces the sodium and volume lost, so both are started together through the same line. Option a is incorrect because standing a hypotensive confused client on a scale invites syncope and a fall. Daily weight matters later for tracking fluid balance, but it does nothing for the collapsing blood pressure now. Option b is incorrect because waiting on a laboratory value delays the only therapy that reverses this crisis. Blood may be drawn while treatment runs, yet the result never has to arrive before steroid is given. Option d is incorrect because history taking is assessment, and assessment yields to intervention once shock is obvious. The precipitant still needs identifying, though that search belongs after the client is out of immediate danger.

Correct Answer: Applying lotion to the tops and soles only

Dry cracked skin opens a route for bacteria, so lotion belongs on the tops and soles. Between the toes it traps moisture, macerates the skin and grows fungus, so that area is left dry. Option a is incorrect because moisture held between the toes softens skin until it breaks down. That warm damp space is where fungal infection starts, and an insensate client will not feel it beginning. Option b is incorrect because prolonged soaking strips natural oils and waterlogs the outer skin layer. Brief washing with mild soap, followed by careful drying, is the routine taught for a neuropathic foot. Option c is incorrect because a cover does not lower the temperature reaching the skin, and burns occur without warning in a numb foot. Socks are the safe way to warm cold feet.

Correct Answer: Unexplained weight loss with constant hunger

Untreated type one diabetes leaves cells without glucose, so the body burns fat and protein for fuel. Hunger signals fire while weight falls, giving the classic pairing of polyphagia with unexplained weight loss. Option b is incorrect because weight gain and a poor appetite point away from uncontrolled hyperglycemia. This client is losing calories directly into the urine as glucose spills past the kidney threshold, and appetite is driven upward. Option c is incorrect because cool clammy skin with tremor belongs to the low glucose picture, the cold and clammy pattern nurses memorize. Hyperglycemia does the opposite and leaves the skin warm, flushed and dry. Option d is incorrect because urine output rises rather than falls once glucose passes roughly one hundred eighty milligrams per deciliter. Osmotic diuresis pulls water out with the sugar, so edema is not the expected result.

Correct Answer: Take it on waking, before eating anything

Levothyroxine is absorbed best from an empty stomach, so it goes down with water thirty to sixty minutes before breakfast. Calcium and iron are then pushed at least four hours away. Option a is incorrect because calcium binds the hormone in the gut and blocks a large share of the dose from reaching the blood. The two must be separated by at least four hours. Option b is incorrect because food of any kind cuts absorption, and an evening meal offers no advantage over breakfast. A bedtime dose is possible only several hours after the last food. Option d is incorrect because pairing the tablet with iron in applesauce combines two absorption barriers at once. Food and the mineral together strip much of the dose before it can be taken up.

Correct Answer: Stop the infusion and notify the provider

That rise already exceeds the safe ceiling of roughly eight milliequivalents in a day. Pushing further risks osmotic demyelination of the pons, which is permanent, so the nurse halts the infusion and calls the provider. Option a is incorrect because speed is precisely the danger with hypertonic saline. Brain cells that adapted to a dilute environment shrink when osmolality jumps, and the resulting damage to the pons cannot be reversed. Option c is incorrect because waiting until morning lets the sodium climb even higher overnight. This concentrated solution needs verification against protocol and frequent sodium checks, often every two hours, not an unattended run through the night. Option d is incorrect because switching routes does not address an overcorrection already in progress. Salt tablets also raise sodium, so the client would keep gaining ground toward the same neurologic injury the nurse must prevent.