NR-325 Adult Health II - Set 1 - Part 2

Correct Answer: "I will check my feet every day for injury."

Neuropathy removes the pain that would normally announce a blister or cut, so a daily look at the soles and between the toes is the only reliable way to catch injury early. Option b is incorrect because soaking softens and macerates the skin and strips away protective oils, leaving cracks where bacteria enter. Feet are washed briefly with mild soap and warm water instead. Option c is incorrect because bare feet meet tacks, splinters and hot floors that an insensate foot never registers. Slippers with soles are worn indoors, and shoes go on before any step outside. Option d is incorrect because a heating pad on a numb foot produces deep burns the client cannot feel. Warmth comes from socks worn at night, never from an applied heat source.

Correct Answer: Hold the dose and contact the provider promptly

Beta blockade without alpha blockade leaves alpha driven vasoconstriction unopposed and can send the pressure into a crisis. The nurse withholds the drug and calls the provider so alpha blockade is established first. Option a is incorrect because giving the drug is the dangerous move in this sequence. Losing beta mediated vasodilation while catecholamines still constrict vessels can spike the pressure within minutes, and rechecking a pulse afterward does not undo that. Option b is incorrect because laboratory values are not what makes this order unsafe. The problem is drug order rather than chemistry, so waiting on morning results delays the conversation the prescriber needs to have with the nurse. Option c is incorrect because an extra cuff reading offers no protection against unopposed vasoconstriction. Monitoring detects a crisis after it begins, while the safe choice prevents one by keeping the beta blocker out of the client entirely.

Correct Answer: "I will keep taking my insulin even when I cannot eat solids."

Illness drives up counterregulatory hormones and raises insulin requirements even when appetite disappears. Basal insulin continues at the usual dose, with carbohydrate taken in liquid form when solid food will not stay down. Option b is incorrect because stopping insulin during illness is the single most dangerous move a client with type one disease can make. Glucose rises within hours once the hormone is missing. Option c is incorrect because once a day testing is far too infrequent for a sick day. Checks belong every three to four hours so that rising readings are caught while correction doses can still help. Option d is incorrect because withholding fluid worsens the dehydration that illness already causes. The goal runs the other way, roughly two to three liters daily, with sugar free choices when the glucose is high.

Correct Answer: Offer crackers with cheese as a snack

Simple sugar clears quickly, so a snack pairing complex carbohydrate with protein holds the level up until the tray arrives. Crackers with cheese, half a sandwich or milk all serve that purpose. Option a is incorrect because the reading has already climbed above the treatment threshold. Repeating fast sugar now overshoots into hyperglycemia and teaches the client to overtreat every future episode out of fear. Option c is incorrect because two hours without food invites a second drop. Glucose tablets are absorbed and gone within about an hour, leaving nothing behind to sustain the level until lunch. Option d is incorrect because giving insulin here reverses the entire point of the intervention. Correction doses are held after a low until the client has eaten and the level has been stable for a while.

Correct Answer: Administer the hydrocortisone and notify the surgeon

Hypotension with tachycardia after this surgery means hemorrhage or adrenal crisis, and both are emergencies. Giving the steroid on time covers the crisis while the surgeon evaluates the client for bleeding. Option a is incorrect because rechecking numbers that are already dangerous only buys the problem more time. Vital signs are taken every fifteen minutes in this period precisely so deterioration triggers action, not another wait. Option b is incorrect because pain rating is comfort assessment while circulation is failing. The headache here is a symptom of the falling pressure, so treating the cause outranks measuring how badly it hurts. Option d is incorrect because sitting a hypotensive client upright drops cerebral perfusion further. Lying flat with the legs raised supports the pressure until steroid and fluid take hold, which is the opposite of this choice.

Correct Answer: Constipation, bone pain and lethargy

Calcium quiets nerve and muscle tissue, so a high level slows the bowel, dulls the mind and leaves clients weak. Bone pain follows the resorption that released the calcium in the first place. Option a is incorrect because twitching and brisk reflexes come from nerves that fire too easily, which happens when calcium is low. A high level produces the opposite, sluggish response. Option b is incorrect because seizures with perioral tingling and laryngeal tightness describe tetany from hypocalcemia. Those findings would send the nurse looking for damaged parathyroid glands, not an overactive one. Option c is incorrect because loose stools with tremor and an intolerance of heat describe thyroid hormone excess. Parathyroid disease acts through calcium and does not speed up the metabolic rate.

Correct Answer: "I will throw out an opened vial after twenty eight days."

An in use vial kept at room temperature is discarded twenty eight days after it is opened, whatever volume remains. Potency falls after that point even though the printed expiration date has not arrived. Option b is incorrect because freezing ruins insulin permanently. A vial that has frozen must be thrown away even after it thaws, since the protein structure has already been damaged beyond repair. Option c is incorrect because direct sunlight and heat degrade the drug quickly. Unopened supplies belong in the refrigerator and the vial in use belongs somewhere cool and shaded, away from windows and appliances. Option d is incorrect because cargo holds on aircraft drop below freezing. Insulin travels in the carry on bag with a cooling pack in hot weather, along with a prescription or letter from the provider.

Correct Answer: A headache with nausea and rising weight

Headache, nausea and climbing weight signal that too much desmopressin has retained water, producing an iatrogenic version of inappropriate antidiuretic hormone with falling sodium. Confusion and seizures follow if nobody intervenes. Option a is incorrect because mild nasal irritation is a common local effect of the spray. It warrants comfort measures and a check of technique, not an urgent visit, unless congestion begins blocking absorption of the dose. Option c is incorrect because easing thirst after a dose shows the drug is working. Effectiveness is judged exactly this way, together with falling urine volume, rising specific gravity and a steady daily weight. Option d is incorrect because urine naturally looks lighter as the last dose wears off overnight. That pattern prompts a discussion about dose timing rather than an emergency, since the client is not in danger from it.

Correct Answer: It works steadily with no pronounced peak

Glargine releases at a nearly flat rate for roughly eighteen to twenty four hours, so there is no defined peak. That steady profile covers background needs and is why the timing does not follow meals. Option a is incorrect because a sharp four hour peak belongs to intermediate acting NPH. Glargine was engineered specifically to avoid that hump, which is what makes it useful as a background insulin. Option b is incorrect because glargine is never combined in a syringe with any other insulin. Its acidic formulation reacts on contact with neutral products, and both drugs lose the action they were meant to have. Option d is incorrect because mealtime dosing describes rapid and short acting products. Basal insulin is taken at the same hour every day whether the client eats or not, since it covers the fasting state.

Correct Answer: Push fluids and institute fall precautions

Volume expansion dilutes the calcium and drives it out through the kidneys while preventing stones. Weak muscles, brittle bones and a clouded mind together make falls the other pressing hazard. Option a is incorrect because stripping calcium from the diet prompts the glands to release still more hormone. Intake stays moderate, and the calcium supplements and calcium containing antacids are what get stopped. Option b is incorrect because lying still accelerates bone breakdown and sends even more calcium into the blood. Keeping the client moving, with help and safe footwear, works against the problem. Option c is incorrect because thiazides make the kidney hold on to calcium and push the level higher. They are avoided in this disorder, whereas a loop diuretic may be used after fluids.

Correct Answer: Hold the drug for forty eight hours afterward

Metformin is withheld at the time of the study and for forty eight hours afterward. It resumes only once kidney function has been rechecked and the provider confirms that the values are stable. Option a is incorrect because taking the drug as usual defeats the whole purpose of the hold. Contrast can blunt kidney clearance briefly, and metformin sitting in the bloodstream during that window is the hazard. Option b is incorrect because no protocol ever calls for a doubled dose around imaging. Raising the amount in a client whose clearance is temporarily reduced pushes the risk in precisely the wrong direction. Option d is incorrect because nurses do not exchange one antidiabetic agent for another, and a sulfonylurea brings its own hypoglycemia risk. The plan is a temporary pause, not a substitution of drug classes.

Correct Answer: Weighing the client before breakfast each day

Weighing is a standardized measurement with a predictable outcome, so it fits within the assistive role. The nurse still interprets the number and acts on any gain that signals fluid retention. Option b is incorrect because client education is a nursing responsibility that cannot be handed off. Assistive personnel may reinforce a menu choice already taught, yet the original instruction about sodium stays with the licensed nurse. Option c is incorrect because skin assessment demands clinical judgment about tissue at risk. The aide may report redness noticed during bathing, but deciding what that redness means and what to do belongs to the nurse. Option d is incorrect because judging a medication response requires knowledge of the drug, the target value and the client's trend. That evaluation sits squarely inside the nursing process and is never assigned downward.

Correct Answer: Hold the potassium and report the urine output

Potassium is excreted by the kidney, so a client making less than thirty milliliters an hour cannot clear a load. Output is confirmed before replacement runs, and this finding goes to the provider. Option a is incorrect because giving potassium to oliguric kidneys stacks the electrolyte in the blood, and monitoring will only show the arrhythmia after it appears. Prevention beats detection with this drug. Option b is incorrect because dilution changes the concentration of the solution, not the client's ability to excrete what is infused. Failing kidneys will retain the same total dose however slowly it arrives. Option c is incorrect because a catheter measures output more precisely but does not make urine appear. Placing one without an order also adds infection risk while the electrolyte hazard remains completely unaddressed.

Correct Answer: Dry coarse skin with brittle nails

A slowed metabolic rate reduces sebaceous and sweat gland activity, leaving skin dry, coarse and cool with thick brittle nails. Hair grows coarse and thin, matching the elevated thyroid stimulating hormone. Option a is incorrect because warm moist skin and fine soft hair come from a metabolic rate running fast. That combination belongs to thyrotoxicosis, where heat production and sweating both climb. Option c is incorrect because gut transit slows when thyroid hormone is scarce, which is exactly why she reports constipation. Frequent stools would point the other way, toward an overactive gland. Option d is incorrect because a fast bounding pulse with a wide pulse pressure reflects adrenergic overdrive. Low thyroid hormone does the reverse, producing bradycardia and a narrowed pulse pressure instead.

Correct Answer: Palpating the abdomen for a mass

Deep palpation can squeeze the tumor and dump a bolus of catecholamines into the circulation, driving blood pressure into a hypertensive crisis. The nurse keeps hands off the abdomen and reports the order if palpation is requested. Option a is incorrect because comparing pressures in both arms is safe and useful baseline work. Nothing about a cuff reading disturbs the tumor, and frequent readings are how the paroxysms get documented. Option b is incorrect because a calm, dim environment lowers sympathetic stimulation and helps prevent an attack. Emotional stress is a recognized trigger, so quiet surroundings belong in the plan rather than on a list of hazards. Option d is incorrect because continuous rhythm monitoring is a protective measure here. Catecholamine surges provoke tachycardia and dysrhythmias, and the monitor is what tells the nurse a paroxysm has started before the client reports it.

Correct Answer: Temperature climbing to one hundred four degrees

A soaring temperature in a thyrotoxic client with infection signals thyroid storm, a medical emergency. Fever this high with an underlying precipitant demands urgent treatment before circulatory collapse develops. Option a is incorrect because fine tremor is an ordinary feature of adrenergic overdrive in hyperthyroidism. It is documented and treated with a beta blocker, not escalated ahead of a temperature that is climbing. Option c is incorrect because accelerated gut motility produces frequent stools throughout thyrotoxicosis, so two soft stools overnight fit the baseline disease. The nurse tracks hydration and continues monitoring rather than paging the provider. Option d is incorrect because heat intolerance and restlessness are expected in any client whose metabolic rate is running high. These complaints guide comfort measures such as a cool quiet room, not an emergency call.

Correct Answer: Report the findings and arrange a thyroid level

Palpitations, insomnia and weight loss are the picture of too much hormone. The provider needs to know, and a thyroid stimulating hormone level will show suppression that calls for a dose reduction. Option a is incorrect because these are not transient start up effects that settle on their own. Untreated over-replacement carries a real risk of atrial fibrillation and, over years, bone loss. Option b is incorrect because more hormone would deepen the very problem the client describes. Nurses also do not change a prescribed dose, and this narrow therapeutic index drug is adjusted only by the provider. Option c is incorrect because antacids interfere with absorption rather than treat racing heartbeats. Adding one would lower the hormone level unpredictably and leave the real cause of her symptoms unexamined.

Correct Answer: Elevate the head of the bed and suction

Stridor with a swelling neck means the airway is closing. Sitting the client up and clearing the airway supports breathing immediately, and help is summoned while that is being done. Option b is incorrect because standing by for instructions surrenders the minutes that decide whether this client keeps an airway. The surgeon is called, but supporting breathing happens at the same time. Option c is incorrect because a laboratory result cannot arrive fast enough to matter here, and low calcium is only one possible cause. Blood work follows once the client is breathing safely. Option d is incorrect because measuring a neck that is already obstructing wastes time on documentation. Airway support outranks any measurement, and the dressing is not what is squeezing the trachea.

Correct Answer: Protamine entering the clear vial prolongs regular insulin

NPH carries extra protamine, and regular insulin carries none. A trace of protamine reaching the regular vial binds free insulin there and slows its onset, so later doses no longer cover meals reliably. Option a is incorrect because potency is not lost by contact alone. What actually changes is the timing of the drug, since bound insulin releases slowly and the vial stops behaving as a short acting product. Option b is incorrect because acidity belongs to the glargine story, not to NPH. Glargine sits at a low pH and precipitates when combined with a neutral insulin, which is why it is never mixed. Option d is incorrect because needle obstruction plays no part in the rule. Both preparations pass through a standard insulin needle easily, and the sequence exists purely to keep protamine away from the clear insulin.

Correct Answer: Glucose above the renal threshold drags water out

Once serum glucose passes roughly one hundred eighty milligrams per deciliter, the tubules cannot reabsorb it all. Sugar remaining in the filtrate holds water osmotically, and that water leaves as high volume urine. Option a is incorrect because irritation of the bladder wall produces urgency and small frequent voids, not the large dilute volumes described here. Burning and suprapubic discomfort would also be expected, and neither is reported. Option c is incorrect because the thirst came after the fluid losses started, not before them. Rising serum osmolality triggered the drinking, so intake is the body answering the diuresis rather than causing it. Option d is incorrect because holding sodium would expand volume and shrink urine output. This client shows dry membranes and poor turgor, findings that point to loss of both salt and water through the kidneys.