FINAL exam - RNSG 1343 ENDOCRINE

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. Fresh fruits 2. Dairy products 3. Processed meats 4. Cereals and grains

1 Rationale: Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

Which of the following signs and symptoms is not expected with Diabetes Insipidus? 1. Polyphagia 2. Extreme thirst 3. Polydipsia 4. Polyuria

1.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1. BUN level of 12 mg/dl 2. Blood glucose level of 90 mg/dl 3. Serum sodium level of 134 mEq/L 4. Serum potassium level of 5.8 mEq/L

4 Rationale: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: 1. Calcium and phosphorus abnormalities 2. Chloride and magnesium abnormalities 3. Sodium and chloride abnormalities 4. Sodium and potassium abnormalities

4 Rationales: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

A patient is receiving treatment for Crohn's Disease. Which food found on the patient's food tray should the patient avoid? A. Fresh Salad B. White rice C. Baked chicken D. Cooked skinless apples

A Rationale: Patients who are experiencing flare-ups of Crohn's Disease should avoid high fiber foods, foods that are hard to digest, spicy foods, dairy products etc. Therefore, the patient should avoid a fresh salad. This contain vegetables which are high in fiber and hard to digest. The gut needs to rest. It is best for the patient to consume low fiber and high protein foods. White rice and fruits/vegetables that are cooked/skinless are low in fiber. Baked chicken is a good source of protein for the patient.

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply. A) Epistaxis B) Pallor C) Rapid respiratory rate D) Bounding pulse E) Hypotension

B, C, E Rationale: The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

A nurse teaches a client with Cushing's disease. Which dietary requirements should the nurse include in this client's teaching? (SATA) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

BDE The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

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

C

The nurse is caring for a patient with a diagnosis of Addison's disease. What sign or symptom is most closely associated with this health problem? A) Truncal obesity B) Hypertension C) Muscle weakness D) Moon face

C Rationale: Patients with Addison's disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension.

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse

D

The nurse assesses the client's stoma during the initial postoperative period. Which of the following observations would be reported immediately to the physician?a) The stoma is slightly edematous b) The stoma is dark red to purple c) The stoma oozes a small amount of blood d) The stoma does not expel stool

b

A client with Chron's disease is asking the nurse how to accomplish a low-residue, low-fiber diet. The nurse will tell the client to avoid: a) Refined pasta b) Cooked potatoes c) White bread d) Apples

d Rationale: Crohn's disease is an indicator for a low-residue, low-fiber diet. The diet should include foods that are unlikely to obstruct the intestinal tract if narrowed by inflammation or scarring, or if GI motility is slowed.