Endocrine System and Disorders test bank

The primary function of insuln is to: A. Lower blood glucose levels B. Produce melanin C. regulate the bodys metabolic rate D. stimulate release of digestive enzymes

A. Insulin, a protein substance, which is the key regulator of carbohydrate, protein, and fat metabolism and storage. Its primary function is to control the blood's glucose (sugar) level. Lowers blood sugar. Melanocytes produce melanin. Thyroid hormones regulate the body's metabolic rate and Cholecystokinin stimulate release of digestive enzymes.

The parathyroid glands play a major role in regulating which substances? A. Calcium and Phosphorus B. Cholride and potassium C. Potassium and calcium D. Sodium and potassium a. Calcium and Phosphorus

A. The chief cells of the parathyroids secrete a hormone, parathormone or parathyroid hormone (PTH), that regulates the amounts of calcium and phosphorus in the blood, which in turn affects nerve and muscle irritability.

An indication of Chvostek' sign is: Answers: A. Twitching of the lips after tapping the face B. Elevated blood sugar after glucose infusion C. Inability to hold one's arms straight D. Spasms of the hand after blood circulation is cut off

A. Twitching of the lips after tapping the face in the right place is an indication of Chvostek's sign and a sign of hypocalcemia Spasms of the hand are associated with Trousseau's sign.

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A. antidiuretic hormone (ADH). B. thyroid-stimulating hormone (TSH). C. follicle-stimulating hormone (FSH). D. luteinizing hormone (LH).

A. ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A. Acromegaly B. Type 1 diabetes mellitus C. Hypothyroidism D. Deficient growth hormone

A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? a. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone

A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

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

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.

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

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.

Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? A. Oral anticoagulants B. Anabolic steroids C. Beta-adrenergic blockers D. Thiazide diuretics

A. As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn't interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic). b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.

A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Nurse Wayne is aware that a positive Chvostek's sign indicate? A. Hypocalcemia B. Hyponatremia C. Hypokalemia D. Hypermagnesemia

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.

A "sweat test" or newborn screening may be used to detect: a. Cystic fibrosis b. Adrenal insufficiency c. Grave's disease d. Hypothyroidism

A. Cystic fibrosis is the most common inherited fatal disease of children and young adults in the United States. Cystic fibrosis is usually diagnosed by the time an affected child is three years old. Often, the only signs are a persistent cough, a large appetite but poor weight gain, an extremely salty taste to the skin, and large, foul-smelling bowel movements. A simple sweat test is currently the standard diagnostic test. The test measures the amount of salt in the sweat; abnormally high levels are the hallmark of the disorder.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A. Fluid intake is less than 2,500 ml/day. B. Urine output measures more than 200 ml/hour. C. Blood pressure is 90/50 mm Hg. D. The heart rate is 126 beats/minute.

A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.

A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

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

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.

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. 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 mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

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

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.

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).

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, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? A. Related to bone demineralization resulting in pathologic fractures B. Related to exhaustion secondary to an accelerated metabolic rate C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces D. Related to tetany secondary to a decreased serum calcium level

A. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.

When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? A. sulfisoxazole (Gantrisin) B. mexiletine (Mexitil) C. prednisone (Orasone) D. lithium carbonate (Lithobid)

A. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

An ACTH stimulation test is commonly used to diagnose: a. Grave's disease b. Adrenal insufficiency and Addison's disease c. Cystic fibrosis d. Hashimoto's disease

B. The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.

Which of the following statements by a client with Type II Diabetes indicates the need for further education? Answers: A. I should avoid hot tubs B. I should aim for an HbA1C level of 5.5% C. I may need insulin at times D. My life expectancy is likely reduced by 10 years

B. While an HbA1C level of 5.5% would be below the threshold for diabetes, it is an unrealistic target. Data has shown that trying to lower the HbA1C level too much can lead to an increase in complications.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? 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." D. "You must report ringing in your ears immediately."

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 elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

Persons at increased risk of developing Hashimoto's disease include all of the following except: a. Persons with vitiligo b. Asian-Americans c. Persons with rheumatoid arthritis d. Persons with Addison's disease

B. Along with the above-mentioned groups, persons with type 1 diabetes and persons suffering from pernicious anemia (insufficient vitamin b12) are at increased risk of developing Hashimoto's disease. Because it tends to run in families, there is likely a genetic susceptibility as well. Environmental factors such as excessive iodine consumption and selected drugs also have been implicated as potential risk factors.

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? a. At least once a week b. At least three times a week c. At least five times a week d. Every day

B. Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn't achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement.

After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? A. Initiate insulin therapy. B. Switch the client to a different oral antidiabetic agent. C. Prescribe an additional oral antidiabetic agent. D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.

All of the following organs may be affected by multiple endocrine neoplasia type 1 except: a. Parathyroid glands b. Kidneys c. Pancreas and Duodenum d. Pituitary gland

B. Multiple endocrine neoplasia type 1, also known as Werner's syndrome, is a heritable disorder that causes tumors in endocrine glands and the duodenum. Although the tumors associated with multiple endocrine neoplasia type 1 are generally benign, they can produce symptoms chemically by releasing excessive amounts of hormones or mechanically by pressing on adjacent tissue.

A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: a. prefers to take insulin orally. b. has type 2 diabetes. c. has type 1 diabetes. d. is pregnant and has type 2 diabetes.

B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

The nurse interviews a 50-year-old man with a history of type 2 diabetes mellitus, chronic bronchitis, and osteoarthritis who has a fasting blood glucose of 154 mg/dL. Which medications, if taken by the patient, may raise blood glucose levels? A. Glargine (Lantus) B. Prednisone (Deltasone) C. Metformin (Glucophage) D. Acetaminophen (Tylenol)

B. Prednisone is a corticosteroid that may cause glucose intolerance in susceptible patients by increasing gluconeogenesis and insulin resistance. Insulin (e.g., glargine) and metformin (an oral hypoglycemic agent) decrease blood glucose levels. Acetaminophen has a glucose-lowering effect.

The most common benign tumor of the pituitary gland is a: a. Glioma b Prolactinoma c. Carcinoid tumor d. Islet cell tumor

B. Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction and libido may be impaired.

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

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).

A nurse is caring for a client with Addison's disease. Which of the following nursing considerations should be employed when caring for this client? a. avoid sodium in the clients diet b. monitor and protect skin integrity c. document the specific gravity of urine d. monitor increases in blood pressure

C. Also document the volume and specific gravity of each voiding. Rationale: All these measurements help determine the body's fluid and electrolyte balance.

Which of the following would be a nursing priority for a client just DX with Addison's disease? a. avioding unnecessary activity b. encouraging client to wear a med alert tag c. ensuring the client is adequately hydrated d. explaining that the client will need life long hormone therapy

C. Because this client is dehydrated, fluid replacement is key.

Symptoms of Grave's ophthalmopathy include all of the following except: a. Bulging eyeballs b. Dry, irritated eyes and puffy eyelids c. Cataracts d. Light sensitivity

C. Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes.

A client presents with hypocalcemia, hyperphosphatemia, muscle cramps, and positive Trosseau's sign. What diagnosis does this support? Answers: A. Diabetes insipidus B. Conn's syndrome C. Hypoparathyroidism D. Acromegaly

C. Hypoparathyroidism often leads to the symptoms mentioned. Conn's syndrome is an aldosterone-producing adenoma.

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? a. Cool, clammy skin b. Distended neck veins c. Increased urine osmolarity d. Decreased serum sodium level

C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

The nurse smells a sweet fruity odor on the breath of a client admitted with DM. This odor may be associated with? a. alcohol intoxication b. insulin shock c. ketoacidosis d. macrovacular complications

C. In ketoacidosis, the body produces a volatile substance called acetone, which has a characteristic sweetish odor (like nail-polish remover) that can be detected on the client's breath in late stages of ketoacidosis.

A nurse is instructing a 50yr diabetic client about the steps to be followed for self admin of insulin. Which of the following instructions should be included in the client teaching? a. instruct client to aviod injections to the abdomen b. encourage client to always inject insulin in the same site c. inform client about the type of syringe to use d. encourage client to do active exercise after injection

C. When insulin is prescribed, teach clients about the type of insulin and syringe, along with dosages and self-injection.

All of the following statements about Hashimoto's disease are true except: a. Many patients are entirely asymptomatic b. Not all patients become hypothyroid c. Most cases of obesity are attributable to Hashimoto's disease d. Hypothyroidism may be subclinical

C. Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.

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.

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.

The nurse is caring for a group of older patients in a long-term care setting. Which physical changes in the patients should the nurse investigate as signs of possible endocrine dysfunction? A. Absent reflexes, diarrhea, and hearing loss B. Hypoglycemia, delirium, and incontinence C. Fatigue, constipation, and mental impairment D. Hypotension, heat intolerance, and bradycardia

C. Changes of aging often mimic clinical manifestations of endocrine disorders. Clinical manifestations of endocrine dysfunction such as fatigue, constipation, or mental impairment in the older adult are often missed because they are attributed solely to aging.

The nurse is caring for a 36-year-old woman with possible hypoparathyroidism after a thyroidectomy. It is most appropriate for the nurse to assess for which clinical manifestations? A. Polyuria, polydipsia, and weight loss B. Cardiac dysrhythmias and hypertension C. Muscle spasms and hyperactive deep tendon reflexes D. Hyperpigmentation, skin ulcers, and peripheral edema

C. Common assessment abnormalities associated with hypoparathyroidism include tetany (muscle spasms) and increased deep tendon reflexes. Hyperpigmentation is associated with Addison's disease. Skin ulcers occur in patient with diabetes. Edema is associated with hypothyroidism. Polyuria and polydipsia occur in patients with diabetes mellitus or diabetes insipidus. Weight loss occurs in hyperthyroidism or diabetic ketoacidosis. Hypertension and cardiac dysrhythmias may be caused by hyperthyroidism, hyperparathyroidism, or pheochromocytoma.

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.

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.

For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? A. They contain exudate and provide a moist wound environment. B. They protect the wound from mechanical trauma and promote healing. C. They debride the wound and promote healing by secondary intention. D. They prevent the entrance of microorganisms and minimize wound discomfort.

C. For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing.

Grave's disease is: a. The most common cause of hypothyroidism b. The most common cause of hyperparathyroidism c. The most common cause of hyperthyroidism d. The most common cause of adrenal insufficiency

C. Grave's disease is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: A. Thyroid storm. B. Cretinism. C. myxedema coma. D. Hashimoto's thyroiditis.

C. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A. Infusing I.V. fluids rapidly as ordered B. Encouraging increased oral intake C. Restricting fluids D. Administering glucose-containing I.V. fluids as ordered

C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered

C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? A. Restricting fluids B. Restricting sodium C. Forcing fluids D. Restricting potassium

C. Forcing fluids The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

A client is admitted to the hospital with a medical DX of hyperthyroidism. When taking a history which information would be most significant? A. edema, intolerance to cold, lethargy b. peri-orbital edema, lethargy mask like face c. weight loss, intolerance to cold, muscle wasting d. weight loss, intolerance to heat, exophthalmos

D. The client with hyperthyroidism is highly excitable and overactive and may have tremors that make eating impossible without help. The pulse is rapid; the person may have heart palpitations and an increased incidence of arrhythmias. The systolic blood pressure is elevated. The person feels hot, and eats voraciously—yet loses weight. The skin becomes thickened and takes on a characteristic salmon color. In women, menstruation may cease. Another common symptom is bulging eyes (exophthalmos). The neck is swollen, and pressure from the thyroid gland may cause hoarseness or difficulty swallowing. If untreated, this disorder may cause intense nervousness, delirium, and finally death as a result of persistent cardiac overload.

A nurse is assigned to care for and monitor any complications in a 40 yr client with chronic diabetes. Which of the following is a macrovascular complication of diabetes. a. neuropathy b. retinopathy c. nephropathy d. Arteriosclerosis

D. The macrovascular (large blood vessels) complications associated with diabetes is when arteriosclerosis narrows the lumen of blood vessels. Neuropathy, retinopathy and nephropathy are microvascular complications.

Nurse John is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to: a. Encourage the client to ask questions about personal sexuality. b. Provide time for privacy. c. Provide support for the spouse or significant other. d. Suggest referral to a sex counselor or other appropriate professional.

D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? a. "The head of your bed must remain flat for 24 hours after surgery." b. "You should avoid deep breathing and coughing after surgery." c. "You won't be able to swallow for the first day or two." d. "You must avoid hyperextending your neck after surgery."

D. To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

All of the following are symptoms of Cushing's syndrome except: a. Severe fatigue and weakness b. Hypertension and elevated blood glucose c. A protruding hump between the shoulders d. Hair loss

D. Cushing's syndrome also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and thighs.

Endocrine disorders may be triggered by all of the following except: a. Stress b. Infection c. Chemicals in the food chain and environment d. Cell phone use

D. Endocrine function may be influenced by myriad factors. In addition to the above-mentioned, there is evidence that exposure to naturally occurring and man-made endocrine disruptors such as tributyltin, certain bioaccumulating chlorinated compounds, and phytoestrogens is widespread and in susceptible individuals, may trigger endocrine disorders.

A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A. Diabetes mellitus B. Diabetes insipidus C. Hypoparathyroidism D. Hyperparathyroidism

D. Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

Symptoms of polycystic ovarian syndrome (PCOS) may include all of the following except: a. Pelvic pain b. Acne, oily skin, and dandruff c. Infertility d. Weight Loss

D. In addition to the above-mentioned symptoms, PCOS may cause menstrual irregularities, thinning hair or male-pattern baldness, thick skin or dark patches of skin and excessive hair growth on the face, chest, abdomen, thumbs and toes.

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Body image disturbance related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

D. In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

An 18-year-old male patient is undergoing a growth hormone stimulation test. The nurse should monitor the patient for A. hypothermia. B. hypertension. C. hyperreflexia. D. hypoglycemia.

D. Insulin or arginine (agent that stimulates insulin secretion) is administered for a growth hormone stimulation test. The nurse should monitor the patient closely for hypoglycemia. Hypothermia and hypertension are not expected in response to insulin or arginine. Hyperreflexia is an autonomic complication of spinal cord injury.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: A. a blood pressure of 130/70 mm Hg. B. a blood glucose level of 130 mg/dl. C. bradycardia. D. a blood pressure of 176/88 mm Hg.

D. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options.

A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? A. Serum potassium level B. Serum sodium level C. Arterial blood gas (ABG) values D. Serum osmolarity

D. Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

An analysis of data from the Women's Health Initiative questioned the use of which therapy to prevent heart disease? a. Synthetic thyroid hormone b. Oral contraceptives c. Weight-loss drugs d. Postmenopausal hormone replacement therapy

D. The results of the Women's Health Initiative study prompted the U.S. Food and Drug Administration (FDA) to advise against using hormone therapy (estrogen-alone or estrogen-plus-progestin) to prevent heart disease. When hormone replacement therapy is used to treat moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy it should used at the lowest doses for the shortest duration needed to achieve treatment objectives.

Short stature and undeveloped ovaries suggest which of the following disorders: a. Polycystic ovarian syndrome b. Prolactinoma c. Grave's disease d. Turner syndrome

D. Turner syndrome results from a chromosomal abnormality and occurs in an estimated 1 in 2,500 female births. It occurs more frequently in preterm pregnancies. Affected women are shorter than average and are infertile because they lack ovarian function. They also may have webbed necks, broad chests, arms that turn out from the elbow, lymphedema of the hands and feet and skeletal, cardiac, and renal problems.

The nurse is caring for a client with pheochromocytoma. Which of the following must be included in planning the nursing care for this client ? a. Monitor blood pressure frequently, assessing for hypertension. b. Assess only for physical stressors present. c. Collect a random urine sample. d. Prepare the client for chemotherapy to shrink the tumor.

A Pheochromocytomas are tumors of chromaffin tissues in the adrenal medulla. These tumors which are usually benign produce catecholamines (epinephrine or norepinephrine) that stimulate the sympathetic nervous system. Although many organs are affected, the most dangerous effects are peripheral vasoconstriction and increased cardiac rate and contractility with resultant paroxysmal hypertension. Systolic blood pressure may rise to 200 to 300 mmHg, the diastolic to 150 to 175 mmHg. A is correct because the careful monitoring of blood pressure is essential. Attacks are often precipitated by physical, emotional, or environmental stimuli, so B is incorrect because more than physical stressors are considered. This condition is life threatening and is usually treated with surgery as the preferred treatment. C is incorrect because it is a random sample and not a 24 hour urine collection. Because catecholamine secretion is episodic, a 24-hour urine is a better surveillance method than serum catecholamines. (Pagana & Pagana, 2002). Surgical removal of the tumor(s) by adrenalectomy is the treatment of choice. D is incorrect because surgery would be the treatment usually completed.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation

A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

In educating a client, the nurse is likely to explain the following is the cause of Hashimoto's disease: Answers: A. Antibodies attacking the thyroid gland B. Inflammation in the kidneys C. An adenocarcinoma in the brain D. Overactivation of the pituitary gland

A. Hashimoto's disease is caused by autoimmunity to the thyroid gland, often involving antibodies.

The nurse assessing a female client with Cushing's syndrome would expect to note which of the following? a) hirsutism b) hypotension c) hypoglycemia d) pallor

A. An increased production of androgens that accompanies a rise in cortisol levels with Cushing's syndrome produces hirsutism and acne in women. Other clinical findings of Cushing's syndrome include hypertension caused by sodium retention, impaired glucose tolerance or diabetes mellitus caused by cortisol's anti-insulin effect and ability to enhance gluconeogenesis, and skin changes including bruising and purplish red striae caused by protein catabolism.

A nurse is preparing to perform an assessment on a client being admitted to the hospital with a diagnosis of Cushing's syndrome. When performing the assessment, the nurse checks for which significant manifestation of the disorder? a) fluid retention b) stretch marks c) goiter d) melanosis

A. Excessive secretion of adrenocortical hormones results in water and sodium reabsorption, causing fluid retention. Stretch marks (striae) are a common feature and can result in a disturbed body image, but are not significant and do not represent a life-threatening situation. Goiter is not a manifestation of Cushing's syndrome. Melanosis is a common manifestation associated with Addison's disease.

A husband of a client with graves' disease expresses concern regarding his wife's health because during the past 3 months she has been experiencing nervousness, inability to concentrate even on trivial tasks, and outbursts of temper. On the basis of this information, which nursing diagnosis would the nurse identify as appropriate for the client? a) ineffective coping b) disturbed sensory perception c) social isolation d) grieving

A. Frequently, family and friends may report that the client with Graves' disease has become more irritable or depressed. The signs and symptoms in the question are supporting data for the nursing diagnosis of Ineffective coping and are not related to options B, C, and D. The question does not provide data to support options B, C, and D.

A client newly diagnosed with diabetes mellitus is admitted to the hospital for evaluation and control of the disease. When analyzing the assessment data, which of the following would the nurse likely expect to find? a) hyperglycemia b) hypoglycemia c) weight gain d) hematuria

A. Hyperglycemia is characteristic of newly diagnosed diabetes mellitus. Newly diagnosed diabetic clients present a variety of symptoms, which may include polydipsia, polyuria, polyphagia, weakness, weight loss, and dehydration.

A client with type 1 diabetes mellitus tells the nurse that mealtimes are not important and that she eats whenever it is convenient. It is important for the nurse to explain that mealtimes: a) must be approximately the same time each day to maintain a stable blood glucose b) can be varied as long as the time of insulin administration is also varied c) are not important as long as the client monitors the blood glucose regularly d) are not important as long as snack foods are readily available

A. It is important for clients with type 1 diabetes mellitus to correlate eating with insulin administration to prevent hypoglycemia. Insulin should be given at approximately the same time each day, and meals should be eaten at approximately the same time each day. This will establish regular patterns of glucose availability that approximate glucose availability in a nondiabetic body. Options B, C, and D are incorrect because they infer that mealtimes are not important.

A nurse on a general medical-surgical unit is caring for a client with Cushing's syndrome. Which of the following statements is correct about the medication regimen for Cushing's syndrome? a. Mitotane is used to treat metastatic adrenal cancer. b. Aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors before surgery is performed. c. Ketoconazole increases cortisol synthesis by the adrenal cortex. d. Somatostatin analog increases ACTH secretion in some clients.

A. Mitotane directly suppresses activity of the adrenal cortex and decreases peripheral metabolism of corticosteroids. It is used to treat metastatic adrenal cancer. B is incorrect because aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors that cannot be surgically removed. C is incorrect because ketoconazole inhibits, not increases, cortisol synthesis by the adrenal cortex. D is incorrect because somatostatin suppresses, not increases, ACTH secretion.

A nurse is gathering data from a client newly diagnosed with diabetes mellitus concerning events leading to the client's seeking medical attention. The nurse identifies which of the following as the major symptoms of diabetes mellitus? a) polydipsia, polyuria, and polyphagia b) dyspepsia, polyuria, and polyphagia c) hypoglycemia, polyuria, and dysphagia d) hypoglycemia, polyuria, and dysphasia

A. Polydipsia, polyuria, and polyphagia are the classic signs and symptoms of diabetes mellitus. Dyspepsia, dysphagia, and dysphasia are associated with other body systems (gastric and neurological). Hyperglycemia also occurs.

A client is diagnosed with type 2 diabetes mellitus and is started on glyburide (Micronase) 2.5 mg orally. The client smiles and says, "Oh, good, as long as I take this pill I can eat whatever I want." In this situation, the nurse's intervention is focused on addressing which coping mechanism? a) denial b) anger c) depression d) acceptance

A. The client is denying the experience of a chronic illness that will require her to make lifestyle changes. There is no evidence of anger or depression in the statement made by the client. The client has not accepted the disease if expectations are unrealistic.

An adult client with diabetes mellitus reports to the health care clinic for a glycosylated hemoglobin A (HgbA1c) level. Which laboratory result indicates client compliance with the prescribed diabetic regimen? a) 5% b) 8% c) 10% d) 15%

A. The normal level for HgbA1C is 4.5% to 7.5%. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in blood glucose will cause elevations in the amount of glycosylation. Elevations indicate continued need for teaching related to prevention of hyperglycemic episodes.

A client with acromegaly will most likely experience which symptom? A. Bone pain B. Frequent infections C. Fatigue D. Weight loss

A. Acromegaly is an increase in secretion of growth hormone. The growth hormones cause expansion and elongation of the bones. Answers B, C, and D are not directly associated with acromegaly, so they are incorrect.

A diabetic client has been maintained on Glucophage (metformin) for regulation of his blood glucose levels. Which teaching should be included in the plan of care? A. Report changes in urinary pattern. B. Allow six weeks for optimal effects. C. Increase the amount of carbohydrates in your diet. D. Use lotions to treat itching.

A. Glucophage (metformin) can cause renal complications. The client should be monitored for changes in renal function. In answer B, the medication begins working immediately, so it is incorrect. In answer C, the amount of carbohydrates should be regulated with a diabetic diet, so it is incorrect. The use of lotions in answer D is unnecessary, so it is incorrect.

The client with a suspected pituitary tumor will most likely exhibit symptoms of: A. Alteration in visual acuity B. Frequent diarrhea C. Alterations in blood glucose D. Urticaria

A. The pituitary is located in the middle of the skull adjacent to the optic nerve and brain. Pressure on the optic nerve can cause an increase in intracranial pressure. Clients frequently complain of headache, nausea, vomiting, and decreasing visual acuity as the intracranial pressure increases. B, C, and D are incorrect because they are not associated with a pituitary tumor.

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: a. Trousseau's sign. b. Homans' sign. c. Hegar's sign. d. Goodell's sign.

A. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

The nurse is caring for a client who is about to undergo an adrenalectomy. Which of the following Preoperative interventions is most appropriate for this client? a. Maintain careful use of medical and surgical asepsis when providing care and treatments. b. Teach the client about a diet high in sodium to correct any potential sodium imbalances preoperatively. c. Explain to the client that electrolytes and glucose levels will be measured postoperatively. d. Teach the client how to effectively cough and deep breathe once surgery is complete.

A. Use careful medical and surgical asepsis when providing care and treatments since Cortisol excess increases the risk of infection. B is incorrect. Nutrition should be addressed preoperatively. Request a dietary consultation to discuss with the client about a diet high in vitamins and proteins. If hypokalemia exists, include foods high in potassium. Glucocorticoid excess increases catabolism. Vitamins and proteins are necessary for tissue repair and wound healing following surgery. C is incorrect. Monitor the results of laboratory tests of electrolytes and glucose levels. Electrolyte and glucose imbalances are corrected

Women with PCOS are at increased risk for all of the following except: a. Pregnancy b. Diabetes c. Cardiovascular disease d. Metabolic syndrome

A. Women with PCOS produce excessive amounts of androgens and do not release ova during ovulation, which seriously compromises their ability to conceive. Although women with PCOS can become pregnant, often by using assistive reproductive technology, they are at increased risk for miscarriage.

A client presents to the emergency room with a history of Graves' disease. The client reports having symptoms for a few days, but has not previously sought or received any additional treatment. The client also reports having had a cold a few days back. Which of the following interventions would be appropriate to implement for this client, based on the history and current symptoms? Select all that apply. a. Administer aspirin b. Replace intravenous fluids c. Induce shivering d. Relieve respiratory distress e. Administer a cooling blanket

B, C. D, E. Thyroid storm (also called thyroid crisis) is an extreme state of hyperthyroidism that is rare today because of improved diagnosis and treatment methods (Porth, 2005). When it does occur, those affected are usually people with untreated hyperthyroidism (most often Graves' disease) and people with hyperthyroidism who have experienced a stressor, such as an infection, trauma. The rapid increase in metabolic rate that results from the excessive TH causes the manifestations of thyroid storm. The manifestations include hyperthermia, with body temperatures ranging from 102°F (39°C) to 106°F (41°C); tachycardia; systolic hypertension; and gastrointestinal symptoms (abdominal pain, vomiting, diarrhea). Agitation, restlessness, and tremors are common, progressing to confusion, psychosis, delirium, and seizures. The mortality rate is high. Rapid treatment of thyroid storm is essential to preserve life. Treatment includes cooling without aspirin (which increases free TH) or inducing shivering, replacing fluids, glucose, and electrolytes, relieving respiratory distress, stabilizing cardiovascular function, and reducing TH synthesis and secretion. A is incorrect because cooling happens without the use of aspirin. All of the other choices are correct.

A client with type 1 diabetes mellitus tells the nurse, "I usually begin to feel sick late in the afternoon; is there something wrong with me?" The appropriate response by the nurse is which of the following? a) don't worry about that. Most diabetics feel that way b) can you describe what you mean by feeling sick? c) let me know if that happens today d) most people feel tired late in the afternoon

B. An excess of insulin relative to the amount of blood glucose induces hypoglycemia. Depending on the length of action of the insulin administered, the risk of hypoglycemia may be greatest in the late afternoon. The nurse needs to collect more data to determine if the client is actually experiencing hypoglycemia. Asking the client to describe the sick feeling provides the nurse with more data. Options A, C, and D are nontherapeutic communication statements.

A nurse is assessing a lethargic client who was brought to the emergency department by emergency medical services and notes a fruity odor to the client's breath. The nurse immediately suspects that the client has: a) hyperglycemic hyperosmolar nonketotic syndrome (HHNS) b) diabetic ketoacidosis (DKA) c) ethanol oxide intoxication d) hypoglycemia

B. Clients with DKA accumulate large amounts of ketone bodies in extracellular fluids. A fruity odor to the breath develops due to the volatile nature of acetone. A fruity odor is not a manifestation associated with the conditions noted in options A, C, and D.

A client with diabetes mellitus says that it is very difficult to adhere to the diabetic treatment plan. The nurse interprets the client's concern and determines that the appropriate response is: a) if you don't take your insulin you will develop diabetic ketoacidosis (DKA) b) let's go over your diet again to be sure it contains foods you like c) do you understand what noncompliance can mean to your future health? d) let's check your blood glucose now

B. It is important to determine and deal with a client's concerns and to identify measures that will assist the client to comply with the diabetic regimen. The nurse should determine if a knowledge deficit exists and if the client's treatment plan maintains normalcy as much as is possible with the lifestyle. Scare tactics as described in options A and C should not be used. Positive reinforcement is necessary instead of focusing on negative behaviors. Option D does not address the subject of the question.

A client with Cushing's syndrome should be instructed to: A. Avoid alcoholic beverages B. Limit the sodium in her diet C. Increase servings of dark green vegetables D. Limit the amount of protein in her diet

B. A client with Cushing's syndrome has adrenocortical hypersecretion, so she retains sodium and water. The client may drink alcohol in moderation, so answer A is incorrect, and there is no need to eat more green vegetables or limit protein, so answers C and D are incorrect.

A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the post-operative period? A. Maintaining fluid and electrolyte balance B. Assessing the client's airway C. Providing needed nutrition and fluids D. Providing pain relief with narcotic analgesics

B. A goiter is hyperplasia of the thyroid gland. Removal of a goiter can result in laryngeal spasms and airway occlusion. The other answers are lesser in priority.

A client with Addison's disease will most likely exhibit which symptom? A. Hypertension B. Bronze pigmentation C. Hirsutism D. Purple striae

B. Answer B is correct because a bronze pigmentation is a sign of Addison's disease. Answers A, C, and D are symptoms of Cushing's syndrome, making them incorrect.

A client newly diagnosed with Addison's disease is giving a return explanation of teaching done by the primary nurse. Which of the following statements indicates that further teaching is necessary? a. "I need to increase how much I drink each day." b. "I need to weigh myself if I think I am losing or gaining weight." c. "I need to maintain a diet high in sodium and low in potassium." d. "I need to take my medications each day."

B. The client is at risk for ineffective therapeutic regimen management. Clients with Addison's disease must learn to provide lifelong self-care that involves varied components: medications, diet, and recognizing and responding to stress. Changes in lifestyle are difficult to maintain permanently. The client needs to take the medications on a daily basis. The client needs to perform daily weights to monitor for signs of dehydration. The client needs to maintain a diet high in sodium and low in potassium, as well as maintain an increased fluid intake. B is incorrect because daily weights need to be performed instead of weighing when a problem is suspected.

A client with polyuria, polydipsia, and polyphagia is diagnosed with diabetes mellitus. The nurse would expect that these symptoms are related to A. Hypoglycemia B. Hyperglycemia C. Hyperparathyroidism D. Hyperthyroidism

B. The client with hyperglycemia will exhibit polyuria, polydipsia, or increased thirst, and polyphagia, or increased hunger. A, C, and D are incorrect because they are not signs of hypoglycemia.

A diabetic client is taking Lantus insulin for regulation of his blood glucose levels. The nurse should know that this insulin will most likely be administered: A. Prior to each meal B. At night C. Midday D. Prior to the evening meal

B. This insulin, unlike others, is most frequently administered at night. Its duration is 24-36 hours. A, C, and D are incorrect they are incorrect times to administer Lantus insulin.

Which vitamin is directly involved in the metabolism of the hormones secreted by the parathyroid? A. Vitamin C B. Vitamin D C. Vitamin K D. Vitamin B9

B. Vitamin D is related to absorption of calcium and phosphorus. A, C, and D are incorrect because they are not related to the absorption of calcium and phosphorus.

A client has been diagnosed with goiter. The nurse looks for documentation of which of the following in the client's medical record? a) decreased wound healing b) chronic fatigue c) enlarged thyroid gland d) heart damage

C. An enlarged thyroid gland occurs in goiter. Decreased wound healing, chronic fatigue, and heart damage are not specifically associated with this condition.

A nurse is admitting a client with a diagnosis of Addison's disease to the hospital. On assessment, the nurse would expect to note which finding that is a manifestation of this disorder? a) peripheral edema b) excessive facial hair c) lower than normal blood glucose level d) high blood pressure

C. Blood glucose levels are low in Addison's disease as a result of decreased secretion of glucocorticoids (cortisol). Edema is absent, and aldosterone secretion is decreased so the client develops a deficient fluid volume. Facial hair increases with adrenocortical hyperfunction. Clients with Addison's disease develop hypotension as a result of deficient fluid volume. Options A, B and D are unrelated to Addison's disease.

A nurse receives a report that an adult client with delirium has a blood glucose level of 33 mg/dL. The nurse analyzes this report as: a) higher than normal, indicating a cause of the delirium b) a normal reading for this client c) a lower than normal reading, indicating a cause for the delirium d) insignificant and unrelated to the delirium

C. Blood glucose levels for an adult normally range between 60 and 120 mg/dL. A level of 33 mg/dL indicates hypoglycemia. Metabolic disorders can be an etiological factor of delirium.

A nurse is caring for a client following thyroidectomy and is monitoring for complications. Which of the following if noted in the client, would indicate a need for physician notification? a) surgical pain in the neck area b) voice hoarseness c) numbness and tingling around the mouth d) weakness of the voice

C. Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or traumatized during surgery. If the client develops numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the physician should be called immediately. A hoarse or weak voice may occur temporarily if there has been unilateral injury to the laryngeal nerve during surgery. Pain is expected in the postoperative period. Calcium gluconate ampules should be available at the bedside, and the client should have a patent intravenous (IV) line in the event that hypocalcemic tetany occurs

A clinic nurse is performing an assessment on a client recently diagnosed with diabetes mellitus. Which assessment question is appropriate when assessing the client's degree of adaptation to this disorder? a) you really don't think you caused your disorder, do you? b) your family is helping you stick to your diet, aren't they? c) how do you feel about your progress? d) are you feeling anxious?

C. Open-ended questions allow the client to take the lead in the conversation. Options A and B denote judgment and may block communication. Option D allows the client to answer with a yes or no response and does not provide the client an opportunity to share feelings. Option C is open-ended and focuses on the subject of the question, the client's degree of adaptation to the disorder.

A nursing student is studying for a test on care of the client with endocrine disorders. Which of the following statements demonstrates an understanding of the difference between hyperthyroidism and hypothyroidism? a. "Deficient amounts of TH cause abnormalities in lipid metabolism, with decreased serum cholesterol and triglyceride levels." b. "Graves' disease is the most common cause of hypothyroidism." c. "Decreased renal blood flow and glomerular filtration rate reduces the kidney's ability to excrete water, which may cause hyponatremia." d. "Increased amounts of TH cause a decrease in cardiac output and peripheral blood flow."

C. Option A. is incorrect because deficient amounts of TH cause abnormalities in lipid metabolism with elevated serum cholesterol and triglyceride levels. Option B is incorrect because Graves' disease is the most common cause of hyperthyroidism, not hypothyroidism. Option D is incorrect because increased amounts of TH cause an increase in cardiac output and peripheral blood flow.

A nurse is monitoring a client for complications following thyroidectomy. The nurse notes that the client's voice is very hoarse, and the client is concerned about the hoarseness and asks the nurse about it. The nurse makes which response to alleviate the client's concern? a) hoarseness and weak voice indicate permanent damage to the nerves b) this complication is expected c) this problem is temporary and will probably subside in a few days d) it is best that you not talk at all until the problem is further evaluated

C. Temporary hoarseness and a weak voice may occur if there has been unilateral injury to the laryngeal nerve during surgery. If hoarseness or a weak voice is present, the client is reassured that the problem will probably subside in a few days. Unnecessary talking is discouraged to minimize hoarseness. The statements in options A, B, and D will not alleviate the client's concern.

A nurse provides dietary instructions to a client with a diagnosis of hyperparathyroidism. Which statement by the client indicates the need for further instructions? a) I need to drink 3000 ml of fluid per day b) I should drink cranberry juice daily c) I should eat foods high in calcium d) I should eat foods high in fiber

C. The client with hyperparathyroidism should consume at least 3000 mL of fluid per day. Measures to prevent dehydration are necessary because dehydration increases serum calcium levels and promotes the formation of renal stones. Cranberry juice and prune juice help make the urine more acidic. A high urinary acidity helps prevent renal stone formation because calcium is more soluble in acidic urine than in alkaline urine. Clients should be on a low-calcium, low-vitamin D diet. High-fiber foods are important to prevent constipation and fecal impaction resulting from the hypercalcemia that occurs with this disorder.

Which of the following nursing implications is most important in a client being medicated for Addison's disease? a. Administer oral forms of the drug with food to minimize its ulcerogenic effect. b. Monitor capillary blood glucose for hypoglycemia in the diabetic client. c. Instruct the client to never abruptly discontinue the medication. d. Teach the client to consume a diet that is high in potassium, low in sodium, and high in protein.

C. The primary medical treatment of Addison's disease is replacement of corticosteroids and mineralcorticoids, accompanied by increased sodium in the diet. The client needs to know the importance of maintaining a diet high is sodium and low in potassium. Medications should never be discontinued abruptly because crisis can ensue. Oral forms of the drug are given with food in Cushing's disease.

Which laboratory test conducted on the client with diabetes mellitus indicates compliance? A. Fasting blood glucose B. Two-hour post-prandial C. Hgb A-1C D. Dextrostix

C. The Hgb A-1C indicates that the client has been compliant for approximately three months. Answers A, B, and D tell the nurse the client's blood glucose at the time of the test, so they are incorrect.

A client is admitted for treatment of hypoparathyroidism. Based on the client's diagnosis, the nurse would anticipate an order for: A. Potassium B. Magnesium C. Calcium D. Iron

C. The parathyroid is responsible for calcium and phosphorus absorption. Clients with hypoparathyroidism have hypocalcemia. Answers A, B, and D are not associated with hypoparathyroidism therefore they are incorrect.

A Clinical Instructor is questioning a student nurse about disorders of the parathyroid glands. Which statement by the nursing student, would indicate the need for further teaching? a. "Hyperparathyroidism results in an increased release of calcium and phosphorus by bones, with resultant bone decalcification." b. "Hyperparathyroidism results in deposits in soft tissues and the formation of renal calculi." c. "Hypoparathyroidism results in impaired renal tubular regulation of calcium and phosphate." d. "Hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the pancreas."

D Choices A, B, and C are all correct statements. D demonstrates a need for further teaching because hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the intestines, not the pancreas.

A clinic nurse is performing an assessment on a client who has hypothyroidism. The nurse would expect to note which clinical manifestation? a) complaints of difficulty sleeping b) complaints of diarrhea c) significant weight loss since the last clinic visit d) complaints of intolerance to cold weather

D. An insufficient level of thyroid hormone causes a decrease in metabolic rate and heat production. Intolerance to cold would be noted. Options A, B and C are clinical manifestations of hyperthyroidism.

A nurse is caring for a client with hypoparathyroidism. In planning for discharge from the hospital, the nurse identifies which of the following as a potential psychosocial nursing diagnosis? a) impaired comfort related to cold intolerance secondary to decreased metabolic rate b) constipation related to decreased peristaltic action secondary to decreased metabolic rate c) high risk for impaired skin integrity related to edema d) anxiety related to the need for lifelong dietary interventions to control the disease

D. Medical management of hypoparathyroidism is aimed at correcting the hypocalcemia. This is accomplished with prescribed medications as well as lifelong compliance to dietary guidelines, which include consumption of foods high in calcium but low in phosphorus. Knowing that the interventions are lifelong can create some anxiety for the client, and this problem needs to be addressed before hospital discharge. The other options are unrelated to this condition and to a psychosocial concern.

A nurse is caring for a client with Cushing's syndrome who demonstrates withdrawn behavior. The nurse recognizes that this client's behavior is likely related to which nursing diagnosis? a) deficient diversional activity b) powerlessness c) hopelessness d) disturbed body image

D. Physical changes in the client's appearance can occur with Cushing's syndrome. Such changes include hirsutism, moon face, buffalo hump, acne, and striae. These changes cause a body image disturbance. Options A, B, and C are not commonly associated with Cushing's syndrome.

A nurse provides instructions to a client who is scheduled for a radioactive iodine uptake test. Which statement by the client indicates a need for further instructions? a) the test measures the rate of iodine uptake by my thyroid gland b) I will need to drink a small dose of radioactive iodine before the test c) a 24 hour urine specimen will need to be collected to measure iodine excretion d) I need to minimize close contact with others in my family for a period of 48 hours after the test because of the radioactivity in my system

D. The client undergoing a radioactive iodine uptake test needs to be reassured that the amount of radioactive iodine used is very small, that it is not harmful to the client, and that the client will not be radioactive. The other options are correct regarding this diagnostic test.

A client with Addison's disease makes all of the following statements. Which one does the nurse analyze as requiring further discussion? a) I wear a Medic-Alert bracelet at all times b) I need to weigh myself daily and record it c) It is important that I drink enough fluids and increase my salt intake d) my medication doses will not need to be adjusted for any reason

D. The client with Addison's disease is experiencing deficits of mineralocorticoids, glucocorticoids, and androgens. Aldosterone deficiency affects the ability of the nephrons to conserve sodium, so the client experiences sodium and fluid volume deficit. The client needs to manage this problem with daily hormone replacement and increased fluid and sodium intake. Clients are instructed to weigh themselves daily as a means of monitoring fluid volume balance. Glucocorticoids and mineralocorticoids are essential components of the stress response. Additional doses of hormone replacement therapy are needed with any type of physical or psychological stressor. This information needs to be conveyed to the client and requires that the client wear a Medic-Alert bracelet so that health care professionals are aware of this problem if the client were to experience a medical emergency.

A nurse is caring for a client with hyperthyroidism and is instructing the client about dietary measures. The nurse tells the client that it is important to eat foods that are: a) high in bulk and fiber b) low in calories c) low in carbohydrates and fats d) high in calories

D. The client with hyperthyroidism is usually extremely hungry because of increased metabolism. The client should be instructed to consume a high-calorie diet with six full meals a day. The client should be instructed to eat foods that are nutritious and contain ample amounts of protein, carbohydrates, fats, and minerals. Clients should be discouraged from eating foods that increase peristalsis and thus result in diarrhea, such as highly seasoned, bulky, and fibrous foods.

A nurse is caring for a hospitalized older client with a diagnosis of dehydration who also has diabetes mellitus. The client is alert but disoriented, pale, and slightly diaphoretic, and the nurse suspects that the client is hypoglycemic. The initial nursing intervention would be to: a) administer oral glucose b) assist the client to bed, put the side rails up, and call the physician c) seat the client at the nurse's desk while checking the physician's order d) obtain a fingerstick blood specimen and test the glucose level

D. The nurse should confirm that the client is hypoglycemic by checking the blood glucose. Option A is incorrect because hypoglycemia has not been determined. More information should be gathered before calling the physician, so option B is incorrect. Option C does not meet the client's immediate needs.

A nurse on a surgical floor is caring for a post-operative client who has just had a subtotal thyroidectomy. Which of the following assessments should be completed first on the client? a. Assess for signs of tetany by checking for Chvostek's and Trousseau's signs b. Assess dressing (if present) and the area under the client's neck and shoulders for drainage. c. Administer analgesic pain medications as ordered, and monitor their effectiveness. d. Assess respiratory rate, rhythm, depth, and effort.

D. All of the above assessments have importance, but airway and breathing in a client should always be addressed first when prioritizing care. Assess for signs of latent tetany due to calcium deficiency, including tingling of toes, fingers, and lips; muscular twitches; positive Chvostek's and Trousseau's signs; and decreased serum calcium levels. However, tetany may occur in 1 to 7 days after thyroidectomy so A is not the highest priority. Assessing for hemorrhage is always important, but the danger of hemorrhage is greatest in the first 12 to 24 hours after surgery, and as this client is immediately post operative it is not the main concern at this time. Pain medication is important but according to Maslow, pain is a psychosocial need to be addressed after a physiologic need.

Which item should be kept at the bedside of a client who has just returned from having a thyroidectomy? A. A padded tongue B. An endotracheal tube C. An airway D. A tracheostomy set

D. Laryngeal swelling is not uncommon in clients following a thyroidectomy. A tracheostomy tray should be kept available. The ventilator is not necessary, so answer A is incorrect. The endotracheal tube is very difficult, if not impossible, to intubate if swelling has already occurred, so answer B is incorrect. The airway will do no good because the swelling is in the trachea, so answer C is incorrect.

A client with diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to: A. Take his insulin each day at 1400 hours B. Engage in physical activity daily C. Increase the amount of regular insulin D. Eat a protein and carbohydrate snack at bedtime

D. Somogyi's is characterized by a drop in glucose levels at approximately 2 a.m. or 3 a.m. followed by a false elevation. Eating a protein and carbohydrate snack before retiring prevents the hypoglycemia and rebound elevation. Answers A, B, and C are incorrect because they do not prevent Somogyi's effect.

A 26 year old female client presents with the symptom of unwanted facial hair. What of the following conditions is most likely? Answers: A. Graves' disease B. PCOS C. Hyperthyroidism D. Addison's disease

B. PCOS is well known to cause hormonal irregularities in women which can result in hair growth.

A nurse is caring for a 60yr client affected with hypoparathyroidism. When checking the lab report, the nurse finds that the clients calcium level was very low. Which of the following vitamins regulates the calcium level in the body? a. A b. D c. E d. K

B. PTH also affects the kidneys by promoting calcitriol formation. This is a hormone synthesized from vitamin D, which increases the rate of calcium, magnesium, and phosphorus absorption from the gastrointestinal tract into the blood.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling

B. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

What is the treatment for hyperparathyroidism? a. Synthetic thyroid hormone b. Desiccated thyroid hormone c. Surgical removal of the glands d. Calcium and phosphate

C. When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and teeth may lose the minerals needed to remain strong.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A. vasopressin (Pitressin Synthetic). B. furosemide (Lasix). C. regular insulin. D. 10% dextrose.

A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Hashimoto's disease is: a. Chronic inflammation of the thyroid gland b. Diagnosed most frequently in Asian-Americans and Pacific Islanders c. A form of hyperthyroidism d. A rare form of hypothyroidism

A. Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? A. Muscle weakness B. Tremors C. Diaphoresis D. Constipation

A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: A. Trousseau's sign. B. Homans' sign. C. Hegar's sign. D. Goodell's sign.

A. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

Which of the following symptoms is not typical of Cushing's syndrome? Answers: A. Osteoporosis B. Weight loss C. Diabetes D. Mood instability

B. Cushing's syndrome tends to produce rapid weight gain, not weight loss.

Which nursing action is most appropriate for a client in ketoacidosis? a. admin of carbs b. admin of IV fluids c. applying cold compress d. giving glucagon IV

B. Intervention for a client in ketoacidosis must include IV fluids and electrolytes as well as insulin replacement

Untreated hyperthyroidism during pregnancy may result in all of the following except: a. Premature birth and miscarriage b. Low birthweight c. Autism d. Preeclampsia

C. In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.

A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: a. "The test needs to be repeated following a 12-hour fast." b. "It looks like you aren't following the prescribed diabetic diet." c. "It tells us about your sugar control for the last 3 months." d. "Your insulin regimen needs to be altered significantly."

C. The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

The most common causes of death in people with cystic fibrosis is: a. Dehydration b. Opportunistic infection c. Lung cancer d. Respiratory failure

D. Declining pulmonary function is a hallmark of cystic fibrosis. Drugs such as Pulmozyme (dornase alfa) and Zithromax (azithromycin) can slow the progression of lung disease and mechanical physical therapy devices help CF patients to breathe more easily by loosening and dislodging mucus. For some patients with severe lung damage, lung transplantation is a treatment option.

The nurse is aware that the following is the most common cause of hyperaldosteronism? a. Excessive sodium intake b. A pituitary adenoma c. Deficient potassium intake d. An adrenal adenoma

D. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

In explaining the condition to a client, a nurse would say that Cushing's syndrome is caused primarily by: Answers: A. Low levels of glucocorticoids B. Excess secretion of sodium C. Autoimmunity in the pancreas D. Elevated levels of cortisol

D. Cushing's syndrome is caused by elevated levels of cortisol. Glucocorticoids tend to cause this.

Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a. Increasing saturated fat intake and fasting in the afternoon. b. Increasing intake of vitamins B and D and taking iron supplements. c. Eating a candy bar if light-headedness occurs. d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.

D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.

What is a hormone secreted from the posterior lobe of the pituitary gland? Answers: A. LH B. MSH C. ADH D. GnRH

C. ADH is secreted from the posterior pituitary. LH comes from the anterior pituitary, MSH from the intermediate. GnRH is released from the hypothalamus.

A nurse is preparing a diet plan for a 50yr with simple goiter. Which of the following should be included in the clients diet to decrease the enlargement of he thyroid gland? a. iodine b. sodium c. potassium d. calcium

A. A lack of dietary iodine may cause an enlarged thyroid gland (goiter).

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).

A. ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

Acromegaly is most frequently diagnosed in: a. Middle-aged adults b. Newborns c. Children ages 2 to 5 d. Adults age 65 and older

A. Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.

Which of the following would be an indication of Androgen Insensitivity Syndrome? Answers: A. A 33 year old woman with a karyotype of XY B. A 16 year old male with reduced kidney function C. Failure to respond to cortisol therapy D. Several pregnancies all of which ended in miscarriages

A. Androgen Insensitivity Syndrome is when the body does not respond to androgens such as testosterone. This can result in genetic males being born with the appearance of women.

A client asks what the purpose of the Hb A1c test is. The nurses best explanation would be that the test measures the average: a. blood sugar lvl's over a 6-10 week period b. hemoglobin lvl's over a 6 - 10 week period c. protien lvl over a 3 month period d. vanillylmandelic acid lvl's

A. Hemoglobin A1c is also known as glycosylated hemoglobin, glycohemoglobin, or glycated hemoglobin, with various acronyms such as HA1c, HbA1c, or A1c. This is a measurement that reflects the client's average blood glucose level over the previous 2 to 3 months.

Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? A. Tetany B. Hemorrhage C. Thyroid storm D. Laryngeal nerve damage

A. Tetany may result if the parathyroid glands are excised or damaged during thyroid 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.

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? A. Hypocalcemia B. Hypercalcemia C. Hypokalemia D. Hyperkalemia

A. The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

A nurse is caring for a client in the late stage of Ketoacidosis. The nurse notices that the clients breath has a characteristic fruity odor. Which of the following substances is responsible for the fruity smell in the breath? a. iodine b. acetone c. alcohol d. glucose

B. In ketoacidosis, the body produces a volatile substance called acetone, which has a characteristic sweetish odor (like nail-polish remover) that can be detected on the client's breath in late stages of ketoacidosis.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A. Diabetic ketoacidosis B. Thyroid crisis C. Hypoglycemia D. Tetany

B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting: a. 2 to 5 g of a simple carbohydrate. b. 10 to 15 g of a simple carbohydrate. c. 18 to 20 g of a simple carbohydrate. d. 25 to 30 g of a simple carbohydrate.

B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

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."

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.

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? A. Dysuria B. Leg cramps C. Tachycardia D. Blurred vision

C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren't associated with levothyroxine.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: a. a blood pressure of 130/70 mm Hg. b. a blood glucose level of 130 mg/dl. c. bradycardia. d. a blood pressure of 176/88 mm Hg.

D. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options.

A client with Graves' disease experiences a thyroid storm and has tachycardia and hypertension. What medication is most likely to be used? Answers: A. Levofloxcin B. Chlorothiazide C. Percocet D. Propylthiouracil

D. Propylthiouracil is a commonly used medication for treating hyperthyroidism. Levofloxacin is an antibiotic, chlorothiazide is a diuretic, and Percocet a painkiller.

The nurse is aware that the following is the most common cause of hyperaldosteronism? A. Excessive sodium intake B. A pituitary adenoma C. Deficient potassium intake D. An adrenal adenoma

D. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

Which of the following conditions is caused by long-term exposure to high levels of cortisol? a. Addison's disease b. Crohn's disease c. Adrenal insufficiency d. Cushing's syndrome

D. Cushing's syndrome is a form of hypercortisolism. Risk factors for Cushing's syndrome are obesity, diabetes, and hypertension. Cushing's syndrome is most frequently diagnosed in persons ages 20 to 50 who have characteristic round faces, upper body obesity, large necks, and relatively thin limbs.