Endocrine 7

A client is brought into the emergency department with a brain stem contusion. Two days after admission, the client has a large amount of urine and a serum sodium level of 155 mEq/ dl. Which condition may be developing? A. Myxedema coma B. Diabetes insipidus C. Type 1 diabetes mellitus D. Syndrome of inappropriate antidiuretic hormone (SIADH)

B. Diabetes insipidus

A nurse is caring for a client following surgical ablation of the pituitary gland. Which condition must she be alert for? A. Addison's disease B. Cushing's syndrome C. Diabetes insipidus D. Hypothyroidism

C. Diabetes insipidus

Four hours after surgery, the blood glucose level of a client who has type 1 diabetes is elevated. The nurse should expect to: A. Administer an oral hypoglycemic B. Institute urine glucose monitoring C. Give supplemental doses of regular insulin D. Decrease the rate of the intravenous infusion

C. Give supplemental doses of regular insulin

A client has recently been diagnosed with type 1 diabetes. A glucose tolerance test is ordered. The order reads, "Administer glucose 1.0 g/kg." The client weighs 240 pounds. The nurse should administer: _____________________

109 Grams

A client presents to the emergency department with weakness, thirst, warmth and an inability to concentrate. His laboratory results are serum glucose 712 mg/ dl, urine negative for ketones, and minimal electrolyte imbalance. Which complication should the client be evaluated for? A. Hypoglycemia B. Diabetes insipidus C. Diabetic ketoacidosis (DKA) D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

22. A client presents to the emergency department with weakness, thirst, warmth and an inability to concentrate. His laboratory results are serum glucose 712 mg/ dl, urine negative for ketones, and minimal electrolyte imbalance. Which complication should the client be evaluated for? A. Hypoglycemia B. Diabetes insipidus C. Diabetic ketoacidosis (DKA) D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A client presents with a temperature of 1030 F (39.40 C), hypotension, dry mucus membranes, and a blood glucose level of 590 mg/ dl. Which of the following conditions would the nurse suspect for this client? A. Diabetes mellitus B. Diabetes insipidus C. Diabetic ketoacidosis D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

23. A client presents with a temperature of 1030 F (39.40 C), hypotension, dry mucus membranes, and a blood glucose level of 590 mg/ dl. Which of the following conditions would the nurse suspect for this client? A. Diabetes mellitus B. Diabetes insipidus C. Diabetic ketoacidosis D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. is being infused via an infusion pump and the pump is currently set at 10 mllhour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.

33 units

Treatment for Cushing's syndrome may involve removal of one of the adrenal glands, which could cause a temporary state of which condition? A. Hyperkalemia B. Adrenal insufficiency C. Excessive adrenal hormone D. Syndrome of inappropriate antidiuretic hormone (SIADH)

B. Adrenal insufficiency

A 48-year-old client has been admitted with complaints of acute abdominal pain in the mid epigastric region, back tenderness, nausea, and vomiting. The nurse recognizes these findings to be associated with which condition? A. Acute pancreatitis B. Crohn's disease C. Hypophysectomy D. Pheochromocytoma

A. Acute pancreatitis

Adrenal insufficiency develops secondary to inadequate secretion of which pituitary hormone? A. Corticotropin B. Antidiuretic hormone (ADH) C. Follicle-stimulating hormone (FSH) D. Thyroid-stimulating hormone (fSH)

A. Corticotropin

A client who suffered a brain injury after falling off a ladder has recently developed syn- drome of inappropriate antidiuretic hormone (SIADH). What findings indicate that the treatment he's receiving for SIADH is effective? Select all that apply: A. Decrease in body weight B. Rise in blood pressure; drop in heart rate C. Absence of wheezes in the lungs D. Increase in urine output E. Decrease in urine osmolarity

A. Decrease in body weight D. Increase in urine output E. Decrease in urine osmolarity

After a client is admitted with an adrenal malfunction, the nurse demonstrates an under- standing of the function of the adrenal gland by identifying which hormones as being released by the adrenal medulla? A. Epinephrine and norepinephrine. B. Glucocorticoids, mineralocorticoids, and androgens. C. Thyroxine, triiodothryonine, and calcitonin. D. Insulin, glucagon, and somatostatin.

A. Epinephrine and norepinephrine.

The wife of a client who has had a resection of an aldosterone-secreting tumor of the adrenal glands says, "I hope this is the end of the problem and that my husband will be back to work soon." Based on an understanding of the health problem, the nurse should: A. Explain that surgery will affect a cure, and the left adrenal gland is functioning to meet the body's needs. B. Caution the wife against setting her expectations too high, since the outcome for this problem is variable. C. Advise the wife to investigate other occupational alternatives for her husband if he plans to return to work. D. Tell her that although her husband will require hormone supplements for the rest of his life, he should be able to work.

A. Explain that surgery will affect a cure, and the left adrenal gland is functioning to meet the body's needs.

A client is in diabetic ketoacidosis, secondary to infection. As the condition progresses, which symptoms might the nurse see? A. Kussmaul's respirations and a fruity odor on the breath B. Shallow respirations and severe abdominal pain C. Decreased respirations and increased urine output D. Cheyne-Stokes respirations and foul smelling urine

A. Kussmaul's respirations and a fruity odor on the breath

A client who is started on metformin and glyburide would have initially presented with which symptoms? A. Polydipsia, polyuria, and weight loss B. Weight gain, tiredness, and bradycardia C. Irritability, diaphoresis, and tachycardia D. Diarrhea, abdominal pain, and weight loss

A. Polydipsia, polyuria, and weight loss

Which intervention is the priority for a client with addisonian crisis? A. Preventing shock B. Preventing infection C. Relieving anxiety D. Lowering blood pressure

A. Preventing shock

A client with newly diagnosed diabetes indicates a hatred for asparagus, broccoli, and mushrooms. When reviewing the exchange list with the client, the nurse would know that the teaching about the exchange list was understood when the client states, "Instead of these foods I can eat: A. String beans, beets, or carrots." B. Corn, lima beans, or dried peas." C. Baked beans, potatoes, or parsnips." D. Corn muffins, corn chips, or pretzels."

A. String beans, beets, or carrots."

A client newly diagnosed with diabetic ketoacidosis has a serum glucose level of 485 mg/ dl. After treatment, the serum glucose level drops to 185 mg/ dl, and the cardiac moni- tor starts to show ventricular ectopic beats. Which factor is the most probablecause of the arrhythmia? A. Decreased serum chloride level B. Decreased serum potassium level C. Elevated serum glucose level D. Elevated serum sodium level

B. Decreased serum potassium level

A 49-year-old female is admitted to the hospital with a possible diagnosis of Addison's disease. An important nursing responsibility during a 24-hour-urine collection for the client suspected of having Addison's disease would be to: A. Assess the client for signs of edema B. Keep the client quiet and reduce stress C. Monitor the client for an elevation of blood pressure D. Restrict the client's fluid intake for the 24 hours

B. Keep the client quiet and reduce stress

When caring for a client with a diagnosis of diabetes insipidus, which nursing intervention should be the priority? A. Watching for signs and symptoms of septic shock. B. Maintain adequate fluid intake. C. Check weight every 3 days. D. Monitor urine for specific gravity greater than 1.030.

B. Maintain adequate fluid intake.

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client would indicate that the nurse's teaching has been effective? Select all that apply: A. "I have to take my steroids for 10 days." B. "I need to weigh myself daily to be sure I don't eat too many calories." C. "I need to call my physician to discuss my steroid needs before I have dental work." D. "I will call the physician if I suddenly feel profoundly weak or dizzy." E. "If I feel like I have the flu, I'll carryon as usual because this is an expected response." F. "I need to obtain and wear a medical alert bracelet."

C. "I need to call my physician to discuss my steroid needs before I have dental work." D. "I will call the physician if I suddenly feel profoundly weak or dizzy." F. "I need to obtain and wear a medical alert bracelet."

The nurse is administering corticosteroid therapy to a client. The nurse should be alert for which of the following adverse effects of this therapy? A. Hyponatremia B. Hypoglycemia C. Change in metabolism D. Change in pituitary secretions

C. Change in metabolism

A client with type 1 diabetes of long duration takes Humulin Nand Humulin R insulin every morning. At noon, before eating lunch, the client is admitted to the emergency depart ment with an acute myocardial infarction. Two hours later, the client's serum glucose level drops to 30 mg/dl, and insulin coma is diagnosed. The nurse understands the reason for the development of acute hypoglycemia in this client is that: A. Glycogenolysis increased when lunch was not eaten after taking Humulin N insulin B. The stress brought on by the chest pain increases the use of serum glucose available to the client C. Glucose levels that are controlled by insulin drop more quickly than those controlled by oral antidiabetics D. The client's body became sensitive to the prescribed dose of insulin after long use, and the blood glucose level dropped erratically

C. Glucose levels that are controlled by insulin drop more quickly than those controlled by oral antidiabetics

The nurse would expect the diagnostic studies of a client with Cushing's syndrome to show: A. Moderately increased serum potassium levels B. Increased numbers of eosinophils in the blood C. High levels of 17 -keto steroids in a 24-hour urine test D. Normal to low levels of adrenocorticotropic hormone (ACTH)

C. High levels of 17 -keto steroids in a 24-hour urine test

A previously healthy 70-year-old male client has a serum glucose level of 1,200 mg/ dl, a normal serum bicarbonate level, and urine free from acetone. The nurse should suspect which condition? A. Diabetic ketoacidosis (DKA) B. Diabetes insipidus C. Hyperglycemic hyperosmolar nonketotic coma D. Syndrome of inappropriate antidiuretic hormone (SIADH)

C. Hyperglycemic hyperosmolar nonketotic coma

The nurse is caring for a client with an adrenal medulla tumor. Which of the following symptoms would the nurse expect to assess? A. Carpopedal spasm B. Hyperglycemia C. Hypertension D. "Moonface"

C. Hypertension

A client, newly diagnosed as having type 1 diabetes, is encouraged to exercise on a regular basis primarily because exercise has been shown to: A. Decrease insulin sensitivity B. Stimulate glucagon production C. Improve the cellular uptake of glucose D. Reduce metabolic requirements for glucose

C. Improve the cellular uptake of glucose

If a pancreatitis attack has been brought on by gallstones or gallbladder disease, a client may require reinforcement about the need to follow which type of diet? A. High-calorie, high-protein diet B. High-fiber diet, encouraging fluid intake C. Low-fat diet, avoiding heavy meals D. Diet high in protein, calcium, and vitamin D

C. Low-fat diet, avoiding heavy meals

Clients with insulin-dependent diabetes mellitus may require which change to their daily routine during periods of infection? A. No changes B. Less insulin C. More insulin D. Oral antidiabetic agents

C. More insulin

A client with hypothyroidism who experiences trauma, emergency surgery, or severe infection is at risk for developing which condition? A. Diabetes Insipidus B. Malignant hyperthermia C. Myxedema coma D. Thyroid storm

C. Myxedema coma

A client is scheduled to start an insulin regimen. Based on an understanding of peak effect times, which of the following insulin is prescribed to provide basal coverage? A. Insulin lispro B. Insulin aspart C. Novolin NPH D. Humalin R

C. Novolin NPH

The nurse is teaching a client with hypothyroidism about the thyroid gland. Which of the following statements by the nurse would be the most accurate about which gland controls the secretion of thyroid hormone? A. Adrenal gland B. Parathyroid gland C. Pituitary gland D. Thyroid gland

C. Pituitary gland

A client is scheduled for several tests. Which test should be performed after the thyroid function tests? A. Ultrasound of the carotid arteries. B. EEG. C. Chest X-ray. D. Computed tomography scan of the head with contrast.

D. Computed tomography scan of the head with contrast.

Which disease process releases enough insulin to prevent ketosis but not enough to prevent hyperglycemia? A. Diabetes insipidus B. Diabetic ketoacidosis C. Type 2 diabetes mellitus D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

D. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

Which electrolyte imbalance should a nurse be alert for in a client started on an insulin drip? A. Hypercalcemia B. Hypermagnesemia C. Hypophosphatemia D. Hypokalemia

D. Hypokalemia

Which method of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. I.M. C. I.V. bolus only D. I.V. bolus, followed by continuous infusion

D. I.V. bolus, followed by continuous infusion

Objectives for treating diabetic ketoacidosis (DKA) include administration of which treatment? A. Glucagon B. Blood products C. Glucocorticoids D. Insulin and IV fluids

D. Insulin and IV fluids

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. The nurse should advise the client to: A. Avoid food, drink clear liquids, take a daily temperature, and stay in bed B. Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed C. Eat as much as possible, increase fluid intake, and call the office again the next day D. Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test ac and hs

D. Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test ac and hs

A client is admitted with Graves' disease. Which laboratory test should the nurse expect to be ordered? A. Serum glucose B. Serum calcium C. Lipid panel D. Thyroid panel

D. Thyroid panel

The most common signs and symptoms of hypothyroidism include: A. increased body temperature, tachycardia, and fatigue. B. tachycardia, pitting, and facial edema. C. facial edema, weight gain, and diarrhea. D. cold intolerance, swollen hands and feet, and mental sluggishness.

D. cold intolerance, swollen hands and feet, and mental sluggishness.