Anorexia
A nurse is caring for a client admitted with severe anorexia nervosa. During breakfast, the client repeatedly cuts food into small pieces and moves it around the plate without eating. What is the best nursing action?
A. Remove the tray after 10 minutes
B. Sit with the client and encourage the client to eat during the scheduled meal time
C. Allow the client to skip the meal and offer a snack later
D. Inform the client that a feeding tube will be required if food is not eaten
Answer: B
Rationale: Clients with anorexia often engage in food avoidance behaviors. Sitting with the client during meals provides structure, support, and accountability, which helps encourage intake.
A client with bulimia nervosa reports frequent vomiting after meals. Which complication is the priority concern?
A. Dental erosion
B. Cardiac dysrhythmias
C. Esophageal irritation
D. Weight fluctuation
Answer: B
Rationale: Vomiting causes potassium loss, increasing risk for life-threatening arrhythmias.
A nurse is caring for a client with Syndrome of Inappropriate Antidiuretic Hormone Secretion who has a sodium level of 118 mEq/L. Which assessment finding requires immediate intervention?
A. Headache and confusion
B. Increased urine output
C. Excessive thirst
D. Dry skin
Answer: A
Rationale:
Severe hyponatremia can cause cerebral edema, leading to confusion, seizures, and neurological deterioration.
A client with Diabetes Insipidus reports extreme thirst and frequent urination. Which laboratory value supports this diagnosis?
A. Urine specific gravity 1.002
B. Sodium 132 mEq/L
C. Urine specific gravity 1.030
D. Potassium 5.5 mEq/L
Answer: A
Rationale:
DI produces very dilute urine with low specific gravity.
A client with Hyperthyroidism reports palpitations and heat intolerance. Which assessment finding would the nurse expect?
A. Bradycardia
B. Weight gain
C. Tremors
D. Constipation
Answer: C
Rationale:
Hyperthyroidism causes increased metabolic activity, resulting in tremors and tachycardia.
A nurse assesses a client with Hypothyroidism. Which finding is most consistent with this condition?
A. Heat intolerance
B. Bradycardia
C. Weight loss
D. Diarrhea
Answer: B
Rationale:
Hypothyroidism slows metabolism, causing bradycardia and fatigue.
A nurse is caring for a client with Addison's Disease who develops sudden weakness, abdominal pain, and blood pressure of 82/48 mmHg after a severe infection. Which provider order should the nurse implement first?
A. Administer IV hydrocortisone
B. Restrict oral fluids
C. Prepare the client for dialysis
D. Administer potassium supplements
Answer: A
Rationale:
These findings suggest an Addisonian crisis, which is life-threatening. Immediate IV corticosteroid replacement is the priority to restore cortisol levels and stabilize blood pressure.
A nurse caring for a client with Cushing's Disease notes the client has thin skin and multiple bruises. Which pathophysiologic process explains this finding?
A. Decreased aldosterone secretion
B. Excess cortisol causing protein breakdown
C. Reduced thyroid hormone production
D. Increased insulin resistance
Answer: B
Rationale:
Excess cortisol causes protein catabolism, leading to fragile skin, bruising, and poor wound healing.
A nurse provides dietary teaching to a client who needs to increase iron intake. Which client statement indicates the need for further education?
A. “I will eat more spinach and fortified cereals.”
B. “Drinking coffee with my iron-rich meal will help me absorb the iron.”
C. “Red meat is a good source of iron.”
D. “Eating vitamin C foods with iron can help with absorption.”
Answer: B
Rationale:
Coffee and tea inhibit iron absorption due to tannins. Vitamin C improves iron absorption, especially non-heme iron.
A nurse is monitoring a client with anorexia nervosa who has recently begun nutritional rehabilitation. Which finding should the nurse recognize as a sign of refeeding syndrome?
A. Serum phosphorus 1.6 mg/dL
B. Blood glucose 100 mg/dL
C. Heart rate 88 bpm
D. Sodium 138 mEq/L
Answer: A
Rationale: Hypophosphatemia is the hallmark of refeeding syndrome. Rapid reintroduction of calories shifts phosphorus into cells and can cause cardiac and respiratory failure.
During assessment the nurse notices calluses on the client’s knuckles. What is the priority nursing action?
A. Assess serum electrolyte levels
B. Schedule dental evaluation
C. Encourage increased fluid intake
D. Document and reassess later
Answer: A
Rationale: Russell’s sign indicates repeated vomiting. The priority is assessing for electrolyte imbalance, particularly hypokalemia.
Which physician order should the nurse question for a client diagnosed with SIADH?
A. Restrict fluids to 1 L/day
B. Administer hypertonic saline
C. Encourage oral fluids
D. Monitor daily weight
Answer: C
Rationale:
SIADH causes water retention and dilutional hyponatremia, so increasing fluid intake would worsen the condition.
A nurse is caring for a client with untreated diabetes insipidus. Which complication is the nurse most concerned about?
A. Fluid overload
B. Severe dehydration
C. Hypoglycemia
D. Hyperkalemia
Answer: B
Rationale:
Excessive urination can lead to dangerous dehydration and hypovolemia
A client with hyperthyroidism suddenly develops fever, agitation, and tachycardia. Which complication should the nurse suspect?
A. Myxedema coma
B. Thyroid storm
C. Addisonian crisis
D. SIADH
Answer: B
Rationale:
These symptoms indicate thyroid storm, a life-threatening emergency.
A client with severe hypothyroidism becomes confused and hypothermic. Which complication should the nurse suspect?
A. Thyroid storm
B. Myxedema coma
C. Addisonian crisis
D. Cushing crisis
Answer: B
Rationale:
Myxedema coma is a life-threatening complication of severe hypothyroidism.
A client with Addison’s disease reports dizziness when standing and persistent fatigue. Which laboratory finding would the nurse expect?
A. Potassium 2.9 mEq/L
B. Sodium 128 mEq/L
C. Glucose 160 mg/dL
D. Calcium 11 mg/dL
Answer: B
Rationale:
Addison’s disease causes low aldosterone, resulting in sodium loss and hyponatremia, contributing to hypotension and dizziness.
A client with Cushing’s disease develops a temperature of 101.8°F (38.8°C) and productive cough. What is the priority nursing action?
A. Encourage oral fluids
B. Administer acetaminophen
C. Notify the provider immediately
D. Place the client on fluid restriction
Answer: C
Rationale:
Cortisol suppresses immune function, placing clients at high risk for infection. Fever may indicate a serious infection requiring immediate treatment.
A client with bleeding gums and poor wound healing may be deficient in which vitamin?
A. Vitamin B12
B. Vitamin C
C. Vitamin D
D. Vitamin E
Answer: B
Rationale:
Vitamin C deficiency causes scurvy.
A client with anorexia nervosa becomes lightheaded when standing. What should the nurse assess first?
A. Orthostatic blood pressure
B. Daily caloric intake
C. Weight changes
D. Thyroid hormone levels
Answer: A
Rationale: Severe malnutrition can cause orthostatic hypotension, which increases fall risk. The nurse should assess cardiovascular stability first.
A client with bulimia reports sudden severe chest pain after forceful vomiting. What complication should the nurse suspect?
A. Peptic ulcer
B. Gastritis
C. Esophageal rupture
D. GERD
Answer: C
Rationale: Violent vomiting can cause Boerhaave syndrome (esophageal rupture), a life-threatening emergency.
Which laboratory finding supports the diagnosis of SIADH?
A. Dilute urine with low specific gravity
B. Concentrated urine with high specific gravity
C. Elevated serum sodium
D. Decreased urine sodium
Answer: B
Rationale:
SIADH causes excess water reabsorption, producing concentrated urine.
A nurse notes a client with DI has a urine output of 600 mL/hr. What is the nurse’s priority action?
A. Restrict fluids
B. Encourage oral fluids
C. Administer potassium
D. Elevate the head of the bed
Answer: B
Rationale:
Clients lose large amounts of water and require fluid replacement.
Which diet should the nurse recommend for a client with hyperthyroidism?
A. High-calorie diet
B. Low-protein diet
C. Low-carbohydrate diet
D. Fluid restriction
Answer: A
Rationale:
The increased metabolic rate requires higher caloric intake.
Which diet recommendation is appropriate for hypothyroidism?
A. High fiber
B. High sodium
C. Low protein
D. Fluid restriction
Answer: A
Rationale:
Hypothyroidism slows GI motility, leading to constipation, so fiber helps
A nurse teaches a client with Addison’s disease about managing their condition during illness. Which client statement indicates correct understanding?
A. “I should stop my steroid medication if I have a fever.”
B. “I should double my corticosteroid dose during times of stress.”
C. “I should limit my salt intake during illness.”
D. “I should avoid drinking fluids during illness.”
Answer: B
Rationale:
Stress, illness, or surgery increases cortisol demand. Clients with Addison’s disease must increase corticosteroid doses (“stress dosing”) to prevent adrenal crisis.
Which laboratory finding is most consistent with Cushing’s disease?
A. Decreased blood glucose
B. Elevated cortisol levels
C. Decreased sodium
D. Elevated calcium
Answer: B
Rationale:
Cushing’s disease involves excess cortisol production, which affects metabolism and immune function.
A client with osteoporosis should increase intake of which nutrient?
A. Iron
B. Sodium
C. Calcium
D. Potassium
Answer: C
Rationale:
Calcium is essential for bone mineral density.
Which laboratory finding in a client with anorexia nervosa requires immediate intervention?
A. Sodium 137 mEq/L
B. Hemoglobin 11.8 g/dL
C. Potassium 2.9 mEq/L
D. Calcium 9.0 mg/dL
Answer: C
Rationale: Severe hypokalemia can cause life-threatening cardiac dysrhythmias, making it the priority finding.
A nurse notices a client with bulimia immediately leaving the dining area after meals. What action is most appropriate?
A. Encourage privacy after meals
B. Monitor the client for 30 minutes after eating
C. Encourage the client to rest in bed
D. Provide antiemetic medication
Answer: B
Rationale: Clients with bulimia often purge after meals, so monitoring prevents vomiting.
A client with SIADH is prescribed Tolvaptan. Which outcome indicates the medication is effective?
A. Increased serum sodium
B. Decreased urine output
C. Increased edema
D. Reduced blood glucose
Answer: A
Rationale:
Tolvaptan blocks ADH receptors, allowing water excretion and correction of hyponatremia.
A client with DI receives Desmopressin. Which change indicates the treatment is effective?
A. Increased urine output
B. Decreased urine output
C. Increased thirst
D. Decreased blood pressure
Answer: B
Rationale:
Desmopressin mimics ADH, reducing urine production.
A client is prescribed Methimazole. Which symptom requires immediate reporting?
A. Fever and sore throat
B. Weight gain
C. Dry skin
D. Mild nausea
Answer: A
Rationale:
Fever and sore throat may indicate agranulocytosis, a serious adverse effect.
A client takes Levothyroxine daily. Which instruction is correct?
A. Take with breakfast
B. Take before meals in the morning
C. Take only when symptoms occur
D. Take with calcium supplements
Answer: B
Rationale:
Levothyroxine should be taken on an empty stomach.
A client with Addison’s disease receives Fludrocortisone. Which assessment finding indicates the medication is having the desired effect?
A. Decreased blood glucose
B. Increased potassium levels
C. Improved blood pressure stability
D. Reduced appetite
Answer: C
Rationale:
Fludrocortisone replaces aldosterone, improving sodium retention, fluid balance, and blood pressure.
A client with Cushing’s disease is prescribed Metyrapone. Which outcome indicates the medication is effective?
A. Decreased cortisol levels
B. Increased ACTH secretion
C. Increased blood pressure
D. Increased serum sodium
Answer: A
Rationale:
Metyrapone works by inhibiting cortisol synthesis, reducing cortisol levels.
A client with chronic alcoholism is admitted with confusion, ataxia, and nystagmus. Which vitamin deficiency does the nurse suspect?
A. Vitamin B1 (Thiamine)
B. Vitamin B12
C. Vitamin D
D. Vitamin K
Answer: A
Rationale:
Thiamine deficiency can cause Wernicke’s encephalopathy, characterized by confusion, ataxia, and ocular disturbances.
The nurse assesses a client with severe anorexia nervosa. Which findings are expected? (SATA)
A. Amenorrhea
B. Bradycardia
C. Lanugo hair
D. Hypertension
E. Hypotension
Answer: A, B, C, E
Rationale: Starvation slows metabolism leading to bradycardia, hypotension, amenorrhea, and development of lanugo hair for insulation.
Which complications may occur with bulimia nervosa?
A. Hypokalemia
B. Esophageal tears
C. Dental enamel erosion
D. Hypernatremia
E. Cardiac dysrhythmias
Answer: A, B, C, E
Rationale: Repeated vomiting leads to electrolyte imbalance, dental damage, and esophageal injury, increasing risk for arrhythmias.
Which food choice would be most appropriate for a client with SIADH?
A. Baked potato
B. Pretzels
C. Yogurt
D. Applesauce
Answer: B
Rationale:
Pretzels are high in sodium, which helps correct hyponatremia.
Which laboratory value should the nurse expect in untreated DI?
A. Hypernatremia
B. Hyponatremia
C. Hypocalcemia
D. Hypoglycemia
Answer: A
Rationale:
Excess water loss concentrates sodium, causing hypernatremia.
Which assessment finding is commonly seen in hyperthyroidism?
A. Cold intolerance
B. Decreased appetite
C. Exophthalmos
D. Slow heart rate
Answer: C
Rationale:
Exophthalmos is often seen in Graves’ disease.
Which finding suggests excess thyroid hormone replacement?
A. Fatigue
B. Cold intolerance
C. Tachycardia
D. Weight gain
Answer: C
Rationale:
Too much thyroid hormone causes hyperthyroid symptoms.
A nurse is evaluating teaching for a client newly diagnosed with Addison’s disease. Which situation places the client at greatest risk for adrenal crisis?
A. Skipping a single dose of medication
B. Experiencing emotional stress at work
C. Undergoing surgery without steroid coverage
D. Drinking excess water
Answer: C
Rationale:
Surgery causes major physiologic stress. Without additional corticosteroids, clients may develop adrenal crisis with severe hypotension.
A nurse is teaching a client with Cushing’s disease about dietary modifications. Which meal choice indicates correct understanding?
A. Grilled chicken, steamed broccoli, and brown rice
B. Bacon, fried eggs, and hash browns
C. Ham sandwich with potato chips
D. Cheeseburger with fries
Answer: A
Rationale:
Clients need high protein, low sodium diets to prevent muscle wasting and fluid retention.
A nurse is assessing a client with muscle weakness and cardiac dysrhythmias. The provider suspects a magnesium deficiency. Which food should the nurse recommend to help correct this deficiency?
A. Almonds
B. White rice
C. Chicken breast
D. Apples
Answer: A
Rationale:
Nuts, especially almonds, are rich sources of magnesium, which is essential for neuromuscular and cardiac function.
Which nursing intervention is most appropriate to promote weight restoration in a client with anorexia nervosa?
A. Encourage exercise after meals
B. Allow the client to determine meal schedule
C. Provide structured meals with supervision
D. Offer snacks instead of meals
Answer: C
Rationale: Structured, supervised meals reduce food avoidance behaviors and improve intake.
A client with bulimia nervosa is taking Ondansetron to control vomiting. Which side effect should the nurse monitor for?
A. QT prolongation
B. Hyperglycemia
C. Hypertension
D. Increased appetite
Answer: A
Rationale:
Ondansetron can cause QT interval prolongation, which increases risk for dysrhythmias.
A client with SIADH receives Furosemide. Which finding indicates the medication is working?
A. Decreased urine output
B. Increased urine production
C. Increased fluid retention
D. Decreased serum sodium
Answer: B
Rationale:
Loop diuretics promote water excretion, helping reduce fluid overload.
A client with nephrogenic DI is prescribed Hydrochlorothiazide. What is the purpose of this medication?
A. Increase ADH secretion
B. Reduce urine output
C. Increase potassium retention
D. Promote fluid retention
Answer: B
Rationale:
Thiazide diuretics paradoxically reduce urine volume in nephrogenic DI.
A nurse administers Propranolol to a client with hyperthyroidism. Which symptom does this medication primarily control?
A. Tachycardia
B. Thyroid hormone production
C. Weight loss
D. Goiter size
Answer: A
Rationale:
Propranolol reduces sympathetic symptoms such as tachycardia and tremors
A client with myxedema coma receives IV Levothyroxine. What assessment is the priority?
A. Cardiac rhythm monitoring
B. Skin turgor
C. Urine output
D. Reflexes
Answer: A
Rationale:
Rapid increases in thyroid hormone can trigger cardiac dysrhythmias.
A nurse is administering IV Hydrocortisone to a client experiencing adrenal crisis. Which assessment finding indicates improvement?
A. Blood pressure rising from 84/50 to 102/64 mmHg
B. Potassium increasing from 5.0 to 5.8 mEq/L
C. Heart rate increasing from 110 to 130 bpm
D. Urine output decreasing from 40 mL/hr to 10 mL/hr
Answer: A
Rationale:
Corticosteroid replacement improves vascular tone and fluid balance, stabilizing blood pressure.
A client receiving Ketoconazole for Cushing’s disease should be monitored for which serious adverse effect?
A. Liver toxicity
B. Hypoglycemia
C. Severe dehydration
D. Hypercalcemia
Answer: A
Rationale:
Ketoconazole suppresses cortisol production but may cause hepatotoxicity, requiring liver function monitoring.
A nurse is teaching a group of clients about foods rich in vitamin C. Which statement by a client indicates a need for further education?
A. “Eating oranges can help support wound healing.”
B. “Bell peppers are a good source of vitamin C.”
C. “Cooking vegetables for long periods increases vitamin C content.”
D. “Strawberries contain vitamin C.”
Answer: C
Rationale:
Vitamin C is water-soluble and heat sensitive, so prolonged cooking destroys vitamin C, rather than increasing it.