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1. Which of the following is a key symptom of hyperthyroidism?
- A. Weight loss.
- B. Weight gain.
- C. Tachycardia.
- D. Dry skin.
Correct answer: A
Rationale: The correct answer is weight loss. In hyperthyroidism, there is an excess production of thyroid hormones leading to an increased metabolic rate. This increased metabolism can result in weight loss despite normal or increased appetite. Choice B (Weight gain) is more commonly associated with hypothyroidism where the metabolic rate is decreased. Choice C (Tachycardia) is another common symptom of hyperthyroidism due to the effects of thyroid hormones on the heart, causing an increased heart rate. Choice D (Dry skin) is not a typical symptom of hyperthyroidism; instead, it is more commonly associated with hypothyroidism.
2. The nurse is caring for a client with chronic renal failure who is receiving peritoneal dialysis. Which of the following findings should be reported immediately to the physician?
- A. Clear dialysate outflow.
- B. Increased blood pressure.
- C. Cloudy dialysate outflow.
- D. Decreased urine output.
Correct answer: C
Rationale: Cloudy dialysate outflow should be reported immediately to the physician. It is indicative of peritonitis, a severe infection of the peritoneal cavity and a serious complication of peritoneal dialysis. Prompt medical attention is crucial to prevent further complications or systemic infection. Clear dialysate outflow (Choice A) is a normal finding in peritoneal dialysis. Increased blood pressure (Choice B) and decreased urine output (Choice D) are common in clients with chronic renal failure and may not require immediate reporting unless they are significantly abnormal or accompanied by other concerning symptoms.
3. A young adult is burned when wearing a shirt that was splashed with lighter fluid and caught on fire while attempting to light a charcoal grill. The client ripped off the shirt immediately, without unbuttoning the sleeves, which caused circumferential burns to both wrists. When the client is admitted, which intervention should the nurse implement first?
- A. Monitor pulse intensity.
- B. Evaluate extremity sensation.
- C. Assess range of motion.
- D. Place sterile bandage on both wrists.
Correct answer: A
Rationale: Monitoring pulse intensity is the priority to ensure circulation is not compromised due to circumferential burns.
4. What do crackles heard on lung auscultation indicate?
- A. Cyanosis.
- B. Bronchospasm.
- C. Airway narrowing.
- D. Fluid-filled alveoli.
Correct answer: D
Rationale: Crackles heard on lung auscultation are caused by the popping open of small airways that are filled with fluid. This is commonly associated with conditions such as pulmonary edema, pneumonia, or heart failure. Cyanosis (Choice A) is a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood, not directly related to crackles. Bronchospasm (Choice B) refers to the constriction of the airway smooth muscle, causing difficulty in breathing but does not typically produce crackles. Airway narrowing (Choice C) can lead to wheezing but is not directly linked to crackles heard on auscultation.
5. A client is receiving continuous ambulatory peritoneal dialysis. Which of the following statements indicates the need for more teaching by the nurse?
- A. I should take all my medications every morning.
- B. The catheter should always remain in place.
- C. The catheter should be flushed daily with sterile saline.
- D. If I gain 2 pounds, I should skip dialysis that day.
Correct answer: D
Rationale: The correct answer is D. Gaining weight is a sign that the client may be retaining fluid, indicating a need for dialysis to remove excess fluid. Skipping dialysis based on weight gain can lead to fluid overload, electrolyte imbalances, and other serious complications. Choices A, B, and C are all correct statements regarding peritoneal dialysis care: taking medications as prescribed is essential for overall health, ensuring the catheter remains in place is crucial to prevent infection, and flushing the catheter with sterile saline daily helps maintain its patency and reduce the risk of infections.
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