ATI LS 3.0 Endocrine

A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. which of the following statements by the client indicates an understanding of the teaching? a. "My cells are resistant to the effects of insulin." b. "My body breaks down sugars too efficiently." c. "My pancreas does not produce insulin." d. "My body produces antibodies against pancreatic beta cells."

"My cells are resistant to the effects of insulin." The client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. The client who has type 2 diabetes mellitus does not secrete enough insulin by the pancreatic beta cells to break down enough glucose. The client who has type 1 diabetes mellitus does not secrete insulin because of the destruction of the beta cells by the body. Although insulin is still produced by the client who has type 2 diabetes mellitus, it is of insufficient quantity to maintain homeostasis. The client who has type 1 diabetes mellitus has destruction of the beta cells because of the body producing blood antibodies. This is not a manifestation of type 2 diabetes mellitus.

A nurse if assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? a. Purple striae on the chest and abdomen b. Butterfly rash across the bridge of the nose c. Bronze pigmentation of skin d. Jaundice of the face and sclera

Bronze pigmentation of skin The client who has Addison's disease will have a darkening of the skin in both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). The client who has hepatic, biliary, or gallbladder disease should have jaundice of the face and sclera. The client who has systemic lupus erythematosus should have a butterfly rash across the bridge of the nose. The client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen.

A nurse if caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as the therapeutic effect of the procedure? a. Calcium b. Sodium c. Potassium d. Phosphorous

a. Calcium The parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bone by maintaining a balance between the mineral levels in the blood and the bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client's condition.

A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocortioids following the procedure to enhance which of the therapeutic effects? a. Compensate for decrease in cortisol levels b. Inhibit glucose metabolism c. Act as a diuretic to maintain urine output d. Decrease susceptibility to infection

a. Compensate for decrease in cortisol levels The client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which, if untreated, is fatal. The client who has an adrenalectomy has increased blood glucose levels due to the increase in production of glucocorticoids. Glucocorticoids stimulate gluconeogenesis and are not given to inhibit glucose metabolism. The client who has an adrenalectomy has fluid retention from the increase in production of glucocorticoids. Glucocorticoids have fluid retention properties and do not act as a diuretic to increase urine output. The client who has an adrenalectomy has an increased risk for infection due to the increase in production of glucocorticoids. Glucocorticoids have potent anti-inflammatory and immunosuppressive properties and increase the client's susceptibility to infection.

A nurse is checking laboratory values to determine if a client who has diabetes mellitus is adhering to the treatment plan. which of the following tests should the nurse use to make this determination? a. Glycosylated hemoglobin levels b. Urine sugar and acetone c. Glucose tolerance test d. Fasting serum glucose

a. Glycosylated hemoglobin levels Checking glycosylated hemoglobin levels, or HbA1c, is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the life span of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication.

A nurse is providing teaching to a client who has diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? a. Shakiness b. urinary frequency c. dry mucous membranes d. excess thirst

a. shakiness The client who has hypoglycemia can experience early manifestations of shakiness. Other early manifestations include fatigue, headache, difficulty thinking, sweating, and nausea. The client who has hyperglycemia will have manifestations of increased urination called polyuria. The client who has hyperglycemia will have manifestations of dehydration, such as dry mucous membranes and sunken eyeballs. The client who has hyperglycemia will have manifestations of excess thirst called polydipsia.

A nurse if planning care for a client who has Cushing's syndrome due to chronic corticosteriod use. which of the following actions should the nurse include in the plan of care? a. Check the client's blood b. glucose for hypoglycemia. b. Check the client's urine specific gravity. c. Weigh the client weekly. d. Insert an indwelling urinary catheter for the client.

b. Check the client's urine specific gravity. The nurse should check the client's urine specific gravity to assess for fluid volume overload. The nurse should weigh the client at the same time each day because treatment decisions are based on the findings. The nurse should have the client save all urine output to accurately record it every 24 hr. An indwelling urinary catheter needlessly exposes the client to a potential urinary tract infection.

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestation of hyperglycemia. which of the following findings should indicate to the nurse that the client has hyperglycemia? a. Hunger b. Increased urination c. Cold, clammy skin d. Tremors

b. Increased urination Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. Increased hunger is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. Tremulousness is a manifestation of hypoglycemia due to an adrenergic response from central glucose deprivation.

A nurse if planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in this screening? a. Men who smoke b. Men and women who are obese c. Women who have hepatitis d. Men and women who consume high-protein and low-carbohydrate foods

b. Men and women who are obese There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells. This is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance.

A nurse if preparing a 24-hour urine specimen for a client who is suspected to have phechromocytoma. Which of the following laboratory test from the 24-hour urine specimen should the nurse use to determine the client's condition? a. Creatinine clearance b. Vanillylmandelic acid (VMA) c. 17-hydroxycorticosteroids (17-OHCS) d. Protein

b. Vanillylmandelic acid (VMA) The nurse should expect the 24-hr urine specimen to test for VMA. This test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hr urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate. 17-hydroxycorticosteroids (17-OHCS) A 24-hr urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating the glomerular filtration rate of the kidneys. A 24-hr urine specimen for 17-OHCS is used to determine if the client is producing an adequate amount of cortisol. An increase of cortisol in the 24-hr urine specimen can indicate the client has Cushing's disease. A 24-hr urine specimen for protein is used to evaluate the client's renal function.

A nurse is planning care for a client who is experiencing the somogyi effect and takes intermittent-acting insulin. which of the following actions should the nurse include in the plan? a. Move the evening intermediate-acting insulin dose to 90 min before dinner. b. Increase the client's morning caloric intake. c. Omit the client's evening snack. d. Monitor the client's nighttime blood glucose levels.

d. Monitor the client's nighttime blood glucose levels. The Somogyi effect is a swing of a high blood glucose level in the morning after an extremely low blood glucose level during the night. The swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect. The nurse should ensure the client receives a bedtime snack to decrease the chance for hypoglycemia during the night. The nurse should evaluate the client's evening caloric intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to the Somogyi effect. The nurse should plan to administer a smaller dose of intermediate-acting insulin at bedtime, or increase the client's bedtime snacks, to avoid conditions that can lead to the Somogyi effect.

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? a. sliced bananas b. baked potatoes c. turkey and cheese sandwich d. plain yogurt with peaches

turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. Baked potatoes are high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia. Bananas are high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia. Plain yogurt with peaches is high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia.

a nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. The nurse should understand that which of the following laboratory values is consistent with diabetic ketoacidosis? a. Blood glucose 30 mg/dL b. Negative urine ketones c. Blood pH 7.38 d. Bicarbonate level 12 mEq/L

Bicarbonate level 12 mEq/L The client who has diabetic ketoacidosis should have a bicarbonate level less than 15 mEq/L because the client has an increased production of counter-regulatory hormones that lead to metabolic acidosis. The client who has diabetic ketoacidosis should have a blood glucose level greater than 250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis.

A nurse if caring for a client who had a thyroidectomy to treat hyperthyroidism caused by adenoma. Which of the following findings should the nurse report to the provider? (select all that apply.) a. Tachycardia and hypertension b. Respiratory rate 16/min c. Negative Chvostek's sign d. Laryngeal stridor and hoarseness e. Positive Trousseau's sign

a, d, e Tachycardia and hypertension are correct. Tachycardia and hypertension are unexpected findings, which can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxic, or thyroid storm, is a life-threatening condition with a sudden onset that includes tachycardia, fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. A respiratory rate of 16/min is incorrect. This is within the expected reference range. A negative Chvostek's sign is incorrect. An expected finding is a positive Chvostek's sign (facial muscle spasm after tapping the facial nerve in front of the ear), which indicates hypocalcemia, a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired. Laryngeal stridor and hoarseness are correct. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is correct. A Positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.

A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. which of the following statements should the nurse include in the teaching? a. "You should exercise during a peak insulin time." b. "Wear a medical alert identification tag when you exercise." c. "Exercise can decrease the effects of insulin and cause the blood glucose levels to increase." d. "You will get the most benefit from exercise when your glucose levels are higher than normal."

b. "Wear a medical alert identification tag when you exercise." The client should wear a medical alert identification tag in the event of a hypoglycemic response, because exercise can potentiate the effects of insulin and cause the blood glucose levels to decrease. The nurse should teach the client to avoid exercising within 1 hr of receiving the insulin, or at the peak time of insulin, because exercise can increase the absorption of the insulin at the injection site and cause the client to have a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1 hr before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. The client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease. The client who has poorly controlled insulin-dependent diabetes mellitus is taught not to exercise when blood glucose levels are greater than 250 mg/dL, or if ketones are noted in the urine, because there is not an adequate amount of insulin for transporting glucose.

A nurse is assessing a client who has graves disease. which of the following should the nurse expect the client to display? a. Constipation b. Cold intolerance c. Difficulty sleeping d. Anorexia

c. Difficulty sleeping The client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone The client who has Graves' disease can experience heat intolerance due to the overproduction of thyroid hormone. The client who has Graves' disease should report experiencing diarrhea due to the overproduction of thyroid hormone. The client who has Graves' disease should have an increase in appetite and still experience weight loss because of the overproduction of thyroid hormone.

A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following signs should the nurse expect? a. Polyuria b. Dehydration c. Hyponatremia d. Hyperthermia

c. Hyponatremia The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia.

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? a. Proteinuria b. Oliguria c. Polyuria d. Glycosuria Proteinuria Oliguria Polyuria Glycosuria Proteinuria Oliguria Polyuria Glycosuria

c. Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.

A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? a. Thinning of skeletal bone structure b. Concave chest wall c. High-pitched voice d. Increased head size

d. Increased head size The client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. It results in the gradual enlargement of the client's body tissues, such as the bones of the face, jaw, hands, feet, and skull.

a nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? a. constipation b. headache c. bradycardia d. hypertension

hypertension The client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of the thyroid hormone.