NU373 EAQ Evolve Elsevier: HESI Prep Endocrine
Which client is at risk for developing type 2 diabetes mellitus (DM)? Select all that apply. o 15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol
o 15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol · A sedentary lifestyle, such as that of a teenage client who plays video games 6 hours per day, can lead to obesity. Obesity increases the risk for type 2 DM. Clients with a history of gestational diabetes and/or a body mass index (BMI) greater than 25 kg/m 2 are at increased risk for type 2 DM. Clients with POS are at increased risk because the condition can affect insulin resistance. Clients of Native American ancestry are already at increased risk because of their ethnicity, and abusing alcohol further increases the risk.
A client has undergone nasal hypophysectomy surgery. During postoperative care, the nurse would monitor the client for which indication of cerebrospinal fluid leakage? o Dry mouth o Rigidity of neck muscles o Fall in blood pressure upon standing o A yellow edge around nasal discharge
o A yellow edge around nasal discharge · Nasal hypophysectomy is a surgical procedure performed to treat hyperpituitarism due to pituitary gland tumors. During postoperative care and follow-up, the appearance of light yellow color at the edge of otherwise clear nasal discharge in the dressing indicates leakage of cerebrospinal fluid (CSF). This is called the "halo sign" and is indicative of a CSF leak. Dry mouth after nasal hypophysectomy is normal because the client breathes through the mouth because of the nasal packing. Neck rigidity could be an indication of infection, such as meningitis after the surgery. A fall in blood pressure upon standing is called orthostatic hypotension and is a side effect of bromocriptine.
The provider has ordered endocrine testing for a client. Arrange the steps to be followed for the urine specimen collection in the correct sequence. o Empty bladder and discard the urine. o Note the time. o The timing for the urine collection begins after this specimen. o Empty bladder at the end of the timed period and add urine to the collection.
o Empty bladder and discard the urine. o Note the time. o The timing for the urine collection begins after this specimen. o Empty bladder at the end of the timed period and add urine to the collection. · The procedure to collect urine specimen for endocrine testing involves serial specimens collected over a timed period and begins with emptying the bladder. The initial voiding specimen should be discarded. The client should then note the time at which the specimen is discarded and then begin to collect the urine specimens. At the end of the procedure the client should empty the bladder and add that specimen to the collection.
A client with malignant hot nodules of the thyroid gland has a thyroidectomy. Which is the nurse's priority action immediately postoperative? o Check the neck dressing in the front and back for excessive bleeding. o Monitor the trachea for deviation to the right or left. o Assess the client's level of discomfort and medicate as prescribed. o Encourage coughing and deep breathing to prevent atelectasis.
o Monitor the trachea for deviation to the right or left. · A deviated trachea is an imminent sign of airway compromise, which requires immediate intervention and therefore is the priority. The client is at high risk for bleeding within the first 24 hours postoperative. Bleeding can accumulate at the incision site and in the neck, causing tracheal compression with swelling that may compromise the client's ability to breath. Checking for bleeding may alert the nurse of an increasing risk of airway compromise. Pain management and breathing exercises are standard postoperative interventions.
Which result would the nurse expect to see on the electrocardiogram (ECG) tracing monitor when a client has diabetic ketoacidosis and a potassium level of 5.4 mEq/L (5.4 mmol/L)? o Abnormal P waves and depressed T waves o Peaked T waves and widened QRS complexes o Abnormal Q waves and prolonged ST segments o Peaked P waves and an increased number of T waves
o Peaked T waves and widened QRS complexes · Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.
A primary health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the medication, the client calls the nurse and complains of feeling tired and looking pale. Which action would the nurse take for this client? o Advise the client to get more rest. o Schedule the client for an appointment. o Instruct the client to skip one dose daily. o Tell the client to increase the medication.
o Schedule the client for an appointment. · The client should be examined by the primary health care provider, and blood tests should be prescribed; anemia may result from the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a primary health care provider's prescription; advising the client to alter the dosage of a medication is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a primary health care provider's prescription; advising the client to alter the dosage of a medication is not within the legal role of the nurse.
Which situation associated with the physiological finding of ketones in the blood and urine would be the nurse's focus when collecting additional data about a client? o Starvation o Alcoholism o Bone healing o Positive nitrogen balance
o Starvation · In starvation there are inadequate carbohydrates available for immediate energy, and stored fats are used in excessive amounts, producing ketones. There is no fat in alcohol; fat oxidation does not occur. Bone healing does not require the use of great amounts of fat; calcium is deposited to form callus. A positive nitrogen balance does not require the use of great amounts of fat.
Which instruction would the nurse include in a teaching plan for a client who is taking an oral hypoglycemic daily for type 2 diabetes and is concerned about the need for special care at home if they develop the flu? o Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed. o Avoid food, drink clear liquids, take a daily temperature, and stay in bed. o Eat as much as possible, increase fluid intake, and call the office again the next day. o Take the oral hypoglycemic pill, drink warm fluids, and check blood sugar before meals and at bedtime.
o Take the oral hypoglycemic pill, drink warm fluids, and check blood sugar before meals and at bedtime. · Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration and monitoring blood sugar levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.
The nurse is planning care for a client with hyperparathyroidism and subsequent hypocalcemia and low bone density. Which information would the nurse provide the unlicensed assistive personnel (UAP) to prevent injury? o Record urinary output. o Document respirations. o Initiate cardiac monitoring. o Use a lift sheet for transfers.
o Use a lift sheet for transfers. · Hypocalcemia leads to low bone density, which places the client at risk for pathological bone fractures. Therefore the nurse would instruct the UAP to be careful when moving the client and use a lift sheet for repositioning. Urinary output, respirations, and cardiac monitoring are important interventions, but not for preventing injury.
A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a finger stick. Which is an appropriate response to this question? o "There is no difference between readings." o "These types of monitors are meant for children." o "Readings are on a different scale for each monitor." o "Faster readings can be obtained from a finger stick."
o "There is no difference between readings." · The forearm glucose monitor is calibrated to be consistent with results obtained from a finger stick. Individuals of all ages can use these glucose monitors. A different scale is not used for each monitor; accompanying literature will indicate whether the monitor reading reflects venous blood values even though capillary blood is used. There is no difference in the time required to complete the test.
Which is the most probable cause for Conn syndrome in an adult client? o Genetic cause o Adrenal adenoma o High level of angiotensin II o Elevated level of plasma renin
o Adrenal adenoma · Conn syndrome is primary hyperaldosteronism. Excessive secretion of aldosterone by the adrenal glands due to an adrenal adenoma results in Conn syndrome. Certain types of hyperaldosteronism that are diagnosed in childhood have genetic causes. High levels of angiotensin II that are stimulated by high levels of plasma renin are a cause for secondary hyperaldosteronism.
In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client? o High-calorie diet o Low-sodium diet o High-roughage diet o Mechanical-soft diet
o High-calorie diet · Because of the individual's increased metabolic rate, a high-calorie diet is needed to meet the energy demands of the body and prevent weight loss. Sodium is not restricted because clients with hyperthyroidism perspire heavily and lose sodium. Gastrointestinal motility is increased and does not require the additional stimulus of increased roughage. Modification of dietary consistency is unnecessary.
