Adult health hesi exam testbank

1. Nurse Ronn is assessing a client with

possible Cushing’s syndrome. In a client with

Cushing’s syndrome, the nurse would expect

to find:

a. Hypotension.

b. Thick, coarse skin.

c. Deposits of adipose tissue in the trunk and

dorsocervical area.

d. Weight gain in arms and legs.

1. Answer C. Because of changes in fat distribution,

adipose tissue accumulates in the trunk, face

(moonface), and dorsocervical areas (buffalo hump).

Hypertension is caused by fluid retention. Skin

becomes thin and bruises easily because of a loss of

collagen. Muscle wasting causes muscle atrophy and

thin extremities.

2. A male client with primary diabetes

insipidus is ready for discharge on

desmopressin (DDAVP). Which instruction

should nurse Lina provide?

a. “Administer desmopressin while the

suspension is cold.”

b. “Your condition isn’t chronic, so you won’t

need to wear a medical identification bracelet.”

c. “You may not be able to use desmopressin

nasally if you have nasal discharge or

blockage.”

d. “You won’t need to monitor your fluid

intake and output after you start taking

desmopressin.”

2. Answer C. Desmopressin may not be absorbed if

the intranasal route is compromised. Although

diabetes insipidus is treatable, the client should wear

medical identification and carry medication at all

times to alert medical personnel in an emergency and

ensure proper treatment. The client must continue to

monitor fluid intake and output and receive adequate

fluid replacement.

3. Nurse Wayne is aware that a positive

Chvostek’s sign indicate?

a. Hypocalcemia

b. Hyponatremia

c. Hypokalemia

d. Hypermagnesemia

a. Hypocalcemia

b. Hyponatremia

c. Hypokalemia

d. Hypermagnesemia

3. Answer A. Chvostek’s sign is elicited by tapping

the client’s face lightly over the facial nerve, just

below the temple. If the client’s facial muscles

twitch, it indicates hypocalcemia. Hyponatremia is

indicated by weight loss, abdominal cramping,

muscle weakness, headache, and postural

hypotension. Hypokalemia causes paralytic ileus and

muscle weakness. Clients with hypermagnesemia

exhibit a loss of deep tendon reflexes, coma, or

cardiac arrest.

4. In a 29-year-old female client who is

being successfully treated for Cushing’s

syndrome, nurse Lyzette would expect a

decline in:

a. Serum glucose level.

b. Hair loss.

c. Bone mineralization.

d. Menstrual flow.

a. Serum glucose level.

b. Hair loss.

c. Bone mineralization.

d. Menstrual flow.

4. Answer A. Hyperglycemia, which develops

from glucocorticoid excess, is a manifestation of

Cushing’s syndrome. With successful treatment of

the disorder, serum glucose levels decline. Hirsutism

is common in Cushing’s syndrome; therefore, with

successful treatment, abnormal hair growth also

declines. Osteoporosis occurs in Cushing’s

syndrome; therefore, with successful treatment, bone

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mineralization increases. Amenorrhea develops in

Cushing’s syndrome. With successful treatment, the

client experiences a return of menstrual flow, not a

decline in it.

5. A male client has recently undergone

surgical removal of a pituitary tumor. Dr.

Wong prescribes corticotropin (Acthar), 20

units I.M. q.i.d. as a replacement therapy.

What is the mechanism of action of

corticotropin?

a. It decreases cyclic adenosine

monophosphate (cAMP) production and affects

the metabolic rate of target organs.

b. It interacts with plasma membrane

receptors to inhibit enzymatic actions.

c. It interacts with plasma membrane

receptors to produce enzymatic actions that

affect protein, fat, and carbohydrate

metabolism.

d. It regulates the threshold for water

resorption in the kidneys.

5. Answer C. Corticotropin interacts with plasma

membrane receptors to produce enzymatic actions

that affect protein, fat, and carbohydrate metabolism.

It doesn’t decrease cAMP production. The posterior

pituitary hormone, antidiuretic hormone, regulates

the threshold for water resorption in the kidneys.

6. Capillary glucose monitoring is being

performed every 4 hours for a female 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 Vince should expect the dose’s:

a. Onset to be at 2 p.m. and its peak to be at 3

p.m.

b. Onset to be at 2:15 p.m. and its peak to be

at 3 p.m.

c. Onset to be at 2:30 p.m. and its peak to be

at 4 p.m.

d. Onset to be at 4 p.m. and its peak to be at 6

p.m.

6. Answer C. Regular insulin, which is a shortacting 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.

7. A female client with Cushing’s syndrome

is admitted to the medical-surgical unit.

During the admission assessment, nurse Tyzz

notes that the client is agitated and irritable,

has poor memory, reports loss of appetite, and

appears disheveled. These findings are

consistent with which problem?

a. Depression

b. Neuropathy

c. Hypoglycemia

d. Hyperthyroidism

7. Answer A. Agitation, irritability, poor memory,

loss of appetite, and neglect of one’s appearance may

signal depression, which is common in clients with

Cushing’s syndrome. Neuropathy affects clients with

diabetes mellitus — not Cushing’s syndrome.

Although hypoglycemia can cause irritability, it also

produces increased appetite, rather than loss of

appetite. Hyperthyroidism typically causes such

signs as goiter, nervousness, heat intolerance, and

weight loss despite increased appetite.

8. Nurse Ruth is assessing a client after a

thyroidectomy. The assessment reveals

a. Tetany

b. Hemorrhage

8. Answer A. Tetany may result if the parathyroid

glands are excised or damaged during thyroid

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muscle twitching and tingling, along with

numbness in the fingers, toes, and mouth area.

The nurse should suspect which

complication?

c. Thyroid storm

d. Laryngeal nerve damage

surgery. Hemorrhage is a potential complication

after thyroid surgery but is characterized by

tachycardia, hypotension, frequent swallowing,

feelings of fullness at the incision site, choking, and

bleeding. Thyroid storm is another term for severe

hyperthyroidism — not a complication of

thyroidectomy. Laryngeal nerve damage may occur

postoperatively, but its signs include a hoarse voice

and, possibly, acute airway obstruction.

9. After undergoing a subtotal

thyroidectomy, a female client develops

hypothyroidism. Dr. Smith prescribes

levothyroxine (Levothroid), 25 mcg P.O.

daily. For which condition is levothyroxine

the preferred agent?

a. Primary hypothyroidism

b. Graves’ disease

c. Thyrotoxicosis

d. Euthyroidism

9. Answer A. Levothyroxine is the preferred agent

to treat primary hypothyroidism and cretinism,

although it also may be used to treat secondary

hypothyroidism. It is contraindicated in Graves’

disease and thyrotoxicosis because these conditions

are forms of hyperthyroidism. Euthyroidism, a term

used to describe normal thyroid function, wouldn’t

require any thyroid preparation.

10. Which of these signs suggests that a

male client with the syndrome of

inappropriate antidiuretic hormone (SIADH)

secretion is experiencing complications?

a. Tetanic contractions

b. Neck vein distention

c. Weight loss

d. Polyuria

10. Answer B. SIADH secretion causes antidiuretic

hormone overproduction, which leads to fluid

retention. Severe SIADH can cause such

complications as vascular fluid overload, signaled by

neck vein distention. This syndrome isn’t associated

with tetanic contractions. It may cause weight gain

and fluid retention (secondary to oliguria).

11. A female client with a history of

pheochromocytoma is admitted to the hospital

in an acute hypertensive crisis. To reverse

hypertensive crisis caused by

pheochromocytoma, nurse Lyka expects to

administer:

a. phentolamine (Regitine).

b. methyldopa (Aldomet).

c. mannitol (Osmitrol).

d. felodipine (Plendil).

11. Answer A. Pheochromocytoma causes

excessive production of epinephrine and

norepinephrine, natural catecholamines that raise the

blood pressure. Phentolamine, an alpha-adrenergic

blocking agent given by I.V. bolus or drip,

antagonizes the body’s response to circulating

epinephrine and norepinephrine, reducing blood

pressure quickly and effectively. Although

methyldopa is an antihypertensive agent available in

parenteral form, it isn’t effective in treating

hypertensive emergencies. Mannitol, a diuretic, isn’t

used to treat hypertensive emergencies. Felodipine,

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an antihypertensive agent, is available only in

extended-release tablets and therefore doesn’t reduce

blood pressure quickly enough to correct

hypertensive crisis.

12. A male client with a history of

hypertension is diagnosed with primary

hyperaldosteronism. This diagnosis indicates

that the client’s hypertension is caused by

excessive hormone secretion from which of

the following glands?

a. Adrenal cortex

b. Pancreas

c. Adrenal medulla

d. Parathyroid

12. Answer A. Excessive secretion of aldosterone

in the adrenal cortex is responsible for the client’s

hypertension. This hormone acts on the renal tubule,

where it promotes reabsorption of sodium and

excretion of potassium and hydrogen ions. The

pancreas mainly secretes hormones involved in fuel

metabolism. The adrenal medulla secretes the

catecholamines — epinephrine and norepinephrine.

The parathyroids secrete parathyroid hormone.

13. Nurse Troy is aware that the most

appropriate for a client with Addison’s

disease?

a. Risk for infection

b. Excessive fluid volume

c. Urinary retention

d. Hypothermia

13. Answer A. Addison’s disease decreases the

production of all adrenal hormones, compromising

the body’s normal stress response and increasing the

risk of infection. Other appropriate nursing

diagnoses for a client with Addison’s disease include

Deficient fluid volume and Hyperthermia. Urinary

retention isn’t appropriate because Addison’s disease

causes polyuria.

14. Acarbose (Precose), an alphaglucosidase inhibitor, is prescribed for a

female client with type 2 diabetes mellitus.

During discharge planning, nurse Pauleen

would be aware of the client’s need for

additional teaching when the client states:

a. “If I have hypoglycemia, I should eat some

sugar, not dextrose.”

b. “The drug makes my pancreas release more

insulin.”

c. “I should never take insulin while I’m

taking this drug.”

d. “It’s best if I take the drug with the first

bite of a meal.”

14. Answer A. Acarbose delays glucose

absorption, so the client should take an oral form of

dextrose rather than a product containing table sugar

when treating hypoglycemia. The alpha-glucosidase

inhibitors work by delaying the carbohydrate

digestion and glucose absorption. It’s safe to be on a

regimen that includes insulin and an alphaglucosidase inhibitor. The client should take the drug

at the start of a meal, not 30 minutes to an hour

before.

15. A female client whose physical findings

suggest a hyperpituitary condition undergoes

an extensive diagnostic workup. Test results

reveal a pituitary tumor, which necessitates a

transphenoidal hypophysectomy. The evening

a. “You must lie flat for 24 hours after

surgery.”

b. “You must avoid coughing, sneezing, and

blowing your nose.”

c. “You must restrict your fluid intake.”

15. Answer B. After a transsphenoidal

hypophysectomy, the client must refrain from

coughing, sneezing, and blowing the nose for several

days to avoid disturbing the surgical graft used to

close the wound. The head of the bed must be

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