Saunders Endocrine Study Questions 140/189

A 33-year-old client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1Amenorrhea 2Menorrhagia 3Metrorrhagia 4Dysmenorrhea

1Amenorrhea Rationale:Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproductive system; however, they are not typical manifestations of Graves' disease.

The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse would provide the client with which best instruction? 1Eat meals at approximately the same time each day. 2Adjust mealtimes depending on blood glucose levels. 3Vary mealtimes if insulin is not administered at the same time every day. 4Avoid being concerned about the time of meals as long as snacks are taken on time.

1Eat meals at approximately the same time each day. Rationale:Mealtimes must be approximately the same each day to maintain a stable blood glucose level. The client would not be instructed that mealtimes can be varied depending on blood glucose levels, insulin administration, or consumption of snacks.

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1Hypotension and fever 2Mental status changes and hypertension 3Subnormal temperature and hypotension 4Complaints of weakness and hypertension

1Hypotension and fever Rationale:The nurse would be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

A nurse is assigned to care for a client with type 1 diabetes mellitus. During the shift, the nurse would monitor for which manifestation as a sign of hypoglycemia? 1Tremors 2Anorexia 3Hot, dry skin 4Muscle cramps

1Tremors Rationale: Decreased blood glucose levels trigger autonomic nervous system signs and symptoms, such as nervousness, irritability, and tremors. Hot, dry skin accompanies hyperglycemia. Anorexia and muscle cramps are unrelated to hypoglycemia.

The nurse has provided home care measures to the client with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further instruction? 1"I need to always wear a MedicAlert bracelet." 2"I would perform my exercise at peak insulin time." 3"I would always carry a quick-acting carbohydrate when I exercise." 4"I would avoid exercising at times when a hypoglycemic reaction is likely to occur."

2"I would perform my exercise at peak insulin time." Rationale:The client would be instructed to avoid exercise at peak insulin time because this is when a hypoglycemic reaction is likely to occur. If exercises are performed at this time, the client would be instructed to eat an hour before the exercise and drink a carbohydrate liquid. The remaining options are correct statements regarding exercise, insulin, and diabetic control.

A client with Cushing's syndrome is anxious and verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement would the nurse plan to make to the client? 1"Don't be concerned; this problem can be covered with clothing." 2"Usually these physical changes slowly improve following treatment." 3"This is permanent, but looks are deceiving and are not that important." 4"Try not to worry about it; there are other things to be concerned about."

2"Usually these physical changes slowly improve following treatment." Rationale:The client with Cushing's syndrome need to be reassured that most physical changes resolve with treatment. All other options are not therapeutic responses.

The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse would ensure that which piece of medical equipment is at the client's bedside? 1Cardiac monitor 2Tracheotomy set 3Intermittent gastric suction device 4Underwater seal chest drainage system

2Tracheotomy set Rationale:Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postoperative client who has had a parathyroidectomy. An emergency tracheotomy set is routinely placed at the bedside of the client who has undergone this type of surgery in anticipation of this complication. The items in the remaining options are not specifically needed with this surgical procedure.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1A platelet count of 200,000 mm3 (200 × 109/L) 2A blood glucose level of 99 mg/dL (5.5 mmol/L) 3A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) Rationale:The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, elevated plasma cortisol and adrenocorticotropic hormone levels among other abnormalities. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence? 1Increased use of glucose 2Overproduction of insulin 3Increased production of glucose 4Increased osmotic movement of water

3Increased production of glucose Rationale:Hyperglycemia results from decreased use and increased production of glucose. Increased use of glucose and overproduction of insulin would most likely cause hypoglycemia. Option 4 is incorrect.

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse would provide the client with which information? 1It indicates nerve damage. 2The hoarseness is permanent. 3It is normal during this time and will subside. 4It will worsen before it subsides, which may take 6 months.

3It is normal during this time and will subside. Rationale:Hoarseness in the postoperative period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client would be reassured that the effects are transitory. The other options are incorrect.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1Hypoglycemia 2Level of hoarseness 3Respiratory distress 4Edema at the surgical site

3Respiratory distress Rationale:Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse would include which priority intervention in the plan of care? 1Describe the use of loperamide. 2Restrict fluids to 1000 mL per day. 3Walk down the hall for 15 minutes 3 times a day. 4Describe the administration of aluminum hydroxide gel.

3Walk down the hall for 15 minutes 3 times a day. Rationale:Mobility of the client with hyperparathyroidism would be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids would not be restricted. Discussing the use of medications is not the priority with this client.

The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which would the nurse expect to note on assessment of the client? 1Skin atrophy 2The presence of sunken eyes 3Drooping on one side of the face 4A rounded "moonlike" appearance to the face

4A rounded "moonlike" appearance to the face Rationale:With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. The remaining options are not associated with the assessment findings in Cushing's syndrome.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse would suspect dysfunction of which endocrine gland? 1Thyroid 2Pituitary 3Parathyroid 4Adrenal cortex

1Thyroid Rationale:The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. 1Viruses 2Genetic factors 3Autoimmune factors 4Human leukocyte antigen (HLA) 5Primary failure of glucagon secretion

1Viruses 2Genetic factors 3Autoimmune factors 4Human leukocyte antigen (HLA) Rationale:Viruses and autoimmune factors are thought to play a role in the development of type 1 diabetes mellitus. Other causes of type 1 diabetes mellitus include genetic factors, specifically the presence of HLA. This factor is found in many clients with type 1 diabetes mellitus. The problem with type 1 diabetes mellitus is destruction of the beta cells. It is not caused by a primary failure of glucagon secretion.

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most appropriately monitor which item in the preoperative period? 1Vital signs 2Fluid balance 3Anxiety level 4Creatinine levels

1Vital signs Rationale:Hypertension is the hallmark symptom of pheochromocytoma. Severe hypertension can precipitate a stroke (brain attack) or sudden blindness. Although all of the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1"Cortisol will be secreted." 2"Aldosterone will be secreted." 3"Additional glucagon will be produced." 4"Adrenocorticotropic hormone production will increase."

2"Aldosterone will be secreted." Rationale:Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids.

The nurse has provided instructions to the client with hyperparathyroidism regarding home care measures to manage the symptoms of the disease. Which statement by the client indicates a need for further instruction? 1"I need to avoid bed rest." 2"I need to avoid doing any exercise at all." 3"I need to space activity throughout the day." 4"I need to gauge my activity level by my energy level."

2"I need to avoid doing any exercise at all." Rationale:The client with hyperparathyroidism would pace activities throughout the day and plan for periods of uninterrupted rest. The client would plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client would be instructed to avoid bed rest and use energy levels as a guide to activity. The client also would be instructed to avoid high-impact activity or contact sports.

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1A client with hypothyroidism 2A client with Graves' disease who is having surgery 3A client with diabetes mellitus scheduled for a diagnostic test 4A client with diabetes mellitus scheduled for debridement of a foot ulcer

2A client with Graves' disease who is having surgery Rationale:Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a potential complication after thyroidectomy. The client conditions in the remaining options are not associated with thyrotoxicosis.

A client with suspected Cushing's syndrome is scheduled for adrenal venography. A nurse has provided instructions to the client regarding the test. Which statement by the client indicates a need for further instruction? 1"I need to sign an informed consent." 2"The insertion site will be locally anesthetized." 3"I will be placed in a high-sitting position for the test." 4"I may feel a burning sensation after the dye is injected."

3"I will be placed in a high-sitting position for the test." Rationale:The test aids in determining whether signs and symptoms are caused by abnormalities in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is informed that the supine position is necessary to access the femoral vein. An informed consent form is required, the insertion site will be locally anesthetized, and the client will experience a transient burning sensation after the dye is injected.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous infusion of normal saline Rationale:The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction would the nurse include in the teaching plan? 1Try to exercise before mealtimes. 2Administer insulin after exercising. 3Take a blood glucose test before exercising. 4Exercise is best performed during peak times of insulin.

3Take a blood glucose test before exercising. Rationale:A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtimes places the client at risk for hypoglycemia. Insulin needs to be administered as prescribed.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101° F (38.3° C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1Pulse 2Respiration 3Temperature 4Blood pressure

3Temperature Rationale:In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits or are expected.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1Bradycardia 2Flaccid paralysis 3Tingling around the mouth 4Absence of Chvostek's sign

3Tingling around the mouth Rationale:After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1To treat thyroid storm 2To prevent cardiac irritability 3To treat hypocalcemic tetany 4To stimulate release of parathyroid hormone

3To treat hypocalcemic tetany Rationale:Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate needs to be readily available in the nursing unit.

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions would include which statement? 1"Your hair will need to be shaved." 2"You will receive spinal anesthesia." 3"You will need to ambulate after surgery." 4"Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4"Brushing your teeth needs to be avoided for at least 2 weeks after surgery." Rationale:A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site.

The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 1"I need to eat foods high in potassium." 2"I need to drink at least 2 to 3 L of fluid daily." 3"I need to eat small, frequent meals and snacks if nauseated." 4"I need to increase my intake of dietary items that are high in calcium."

4"I need to increase my intake of dietary items that are high in calcium." Rationale:The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption of calcium. Dietary restriction of calcium may be used as a component of therapy. The client needs to eat foods high in potassium, especially if the client is taking furosemide. Drinking 2 to 3 L of fluid daily and eating small, frequent meals and snacks if nauseated are appropriate instructions for the client.

A client with type 1 diabetes mellitus is having trouble remembering the types, duration, and onset of the action of insulin. The client tells the nurse that family members have not been supportive. Which response by the nurse is best? 1"What is it that you don't understand?" 2"You can't always depend on your family to help." 3"It's not really necessary for you to remember this." 4"Let me go over the types of insulins with you again."

4"Let me go over the types of insulins with you again." Rationale:Reinforcement of knowledge and behaviors is vital to the success of the client's self-care. All of the other options do not address the need for client instructions and are not therapeutic responses.

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 1"Are you rotating the injection site?" 2"Are you aspirating before you inject the insulin?" 3"Are you using a 1-inch needle to give the injection?" 4"Are you placing an air bubble in the syringe before injection?"

1"Are you rotating the injection site?" Rationale:The client would be instructed that insulin injection sites need to be rotated within one anatomical area before moving on to another area. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. The remaining options are not associated with the condition (skin leakage of insulin) presented in the question.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1"I need to stop my insulin." 2"I need to increase my fluid intake." 3"I need to monitor my blood glucose every 3 to 4 hours." 4"I need to call the primary health care provider (PHCP) because of these symptoms."

1"I need to stop my insulin." Rationale:When a client with diabetes mellitus is unable to eat normally because of illness, the client still needs to take the prescribed insulin or oral medication. The client would consume additional fluids and needs to notify the PHCP. The client needs to monitor the blood glucose level every 3 to 4 hours. The client would also monitor the urine for ketones during illness.

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1Calcium level of 8 mg/dL (2.0 mmol/L) 2Calcium level of 11.2 mg/dL (2.8 mmol/L) 3Potassium level of 2.9 mEq/L (2.9 mmol/L) 4Potassium level of 5.6 mEq/L (5.6 mmol/L)

1Calcium level of 8 mg/dL (2.0 mmol/L) Rationale:Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]), this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse would expect the calcium level to be low. Therefore, option 1 is the correct answer.

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding would the nurse expect to note in this client? 1Dry skin 2Thin, silky hair 3Bulging eyeballs 4Fine muscle tremors

1Dry skin Rationale:Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1Fever and tachycardia 2Pallor and tachycardia 3Agitation and bradycardia 4Restlessness and bradycardia

1Fever and tachycardia Rationale:Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100° F (37.8° C), severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL (2.28 mmol/L). Which medication would the nurse anticipate will be prescribed for the client? 1Glucagon 2Glyburide 3Metformin 4Regular insulin

1Glucagon Rationale:A blood glucose level lower than 50 mg/dL (2.85 mmol/L) is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide and metformin are oral hypoglycemic agents used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. In addition, an oral medication would not be administered to an unconscious client.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which prescriptions would the nurse anticipate receiving? Select all that apply. 1Initiate an infusion of 3% NaCl. 2Administer intravenous furosemide. 3Restrict fluids to 800 mL over 24 hours. 4Elevate the head of the bed to high-Fowler's. 5Administer a vasopressin antagonist as prescribed.

1Initiate an infusion of 3% NaCl. 3Restrict fluids to 800 mL over 24 hours. 5Administer a vasopressin antagonist as prescribed. Rationale:Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation would also occur and serum potassium levels would be monitored. To promote venous return, the head of the bed would not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1Iodine 2Calcium 3Phosphorus 4Magnesium

1Iodine Rationale:Adequate dietary iodine is needed to produce T3 and T4. The other requirements for adequate T3 and T4 production are an intact thyroid gland and a functional hypothalamus-pituitary-thyroid feedback system. The remaining options are not responsible for the abnormal amounts of circulating T3 and T4.

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1Irritability 2Complaints of nausea 3Sodium level of 128 mEq/L (128 mmol/L) 4Potassium level of 3.2 mEq/L (3.2 mmol/L) 5Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1Irritability 2Complaints of nausea 3Sodium level of 128 mEq/L (128 mmol/L) 5Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg Rationale:Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomiting, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthostatic hypotension. Irritability and depression may also occur in primary adrenal hypofunction.

A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1Laryngeal stridor 2Difficulty voiding 3Mild incisional pain 4Absence of bowel sounds

1Laryngeal stridor Rationale:During the early postoperative period, the nurse carefully observes the client for signs of bleeding, which may cause swelling and compression of adjacent tissues. Laryngeal stridor results from compression of the trachea and is a harsh, high-pitched sound heard on inspiration and expiration. Laryngeal stridor is an acute emergency, necessitating immediate attention to avoid complete obstruction of the airway. The other options describe usual postoperative problems that are not life threatening.

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions would be included in the care plan for this client? Select all that apply. 1Monitor daily weight. 2Maintain a high-sodium diet. 3Maintain a low-potassium diet. 4Monitor intake and output. 5Assess extremities for edema.

1Monitor daily weight. 4Monitor intake and output. 5Assess extremities for edema. Rationale:The client with Cushing's syndrome and a problem of excess fluid volume would be on daily weights and intake and output and have extremities assessed for edema. The client needs to be on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions would the nurse include in the plan of care? Select all that apply. 1Monitor for changes in mentation. 2Encourage an intake of low-protein foods. 3Encourage an intake of low-sodium foods. 4Encourage fluid intake of at least 3000 mL per day. 5Monitor vital signs, skin turgor, and intake and output.

1Monitor for changes in mentation. 4Encourage fluid intake of at least 3000 mL per day. 5Monitor vital signs, skin turgor, and intake and output.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1Polyuria 2Diaphoresis 3Pedal edema 4Decreased respiratory rate

1Polyuria Rationale:Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.

A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 1Polyuria 2Diaphoresis 3Hypertension 4Increased pulse rate

1Polyuria Rationale:Classic signs and symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. It is important to regularly assess the client for hyperglycemia to prevent the development of more serious complications, such as diabetic ketoacidosis. The remaining options are not manifestations of hyperglycemia.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1Polyuria 2Diarrhea 3Polyphagia 4Weight gain

1Polyuria Rationale:Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1Polyuria 2Polydipsia 3Concentrated urine 4Complaints of excessive thirst 5Specific gravity lower than 1.005

1Polyuria 2Polydipsia 4Complaints of excessive thirst 5Specific gravity lower than 1.005 Rationale:A triad of clinical symptoms—polyuria, polydipsia, and excessive thirst—often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1Polyuria 2Headache 3Bone pain 4Nervousness 5Weight gain

1Polyuria 3Bone pain Rationale:The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call my doctor the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1The client needs immediate education before discharge. 2The client requires follow-up teaching regarding the administration of oral antidiabetics. 3The client's statement is inaccurate, and the client needs to be scheduled for outpatient diabetic counseling. 4The client's statement is inaccurate, and the client needs to be scheduled for educational home health visits.

1The client needs immediate education before discharge. Rationale:If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the physician needs to be notified. The client's statement indicates a need for immediate education to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other options may be true, the most appropriate analysis is that the client requires immediate education.

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions would be included on the list? Select all that apply. 1The signs and symptoms of hypoadrenalism 2The signs and symptoms of hyperadrenalism 3Instructions to take the medications exactly as prescribed 4The importance of maintaining regular outpatient follow-up care 5A reminder to read the labels on over-the-counter medications before purchase

1The signs and symptoms of hypoadrenalism 2The signs and symptoms of hyperadrenalism 3Instructions to take the medications exactly as prescribed 4The importance of maintaining regular outpatient follow-up care Rationale:The client with Cushing's syndrome needs to be instructed to take the medications exactly as prescribed. The nurse needs to emphasize the importance of continuing medications, consulting with the primary health care provider (PHCP) before purchasing any over-the-counter medications, and maintaining regular outpatient follow-up care. The nurse also would instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

A client has been hospitalized for an endocrine system dysfunction of the pancreas. The registered nurse asks the new orientee nurse what kind of problem a client hospitalized for endocrine dysfunction of the pancreas would expect. The new orientee nurse demonstrates understanding if which statement is made? 1"Lipase levels will decrease." 2"Insulin production will be decreased." 3"There will be overproduction of trypsin." 4"Amylase will be secreted in excess amounts."

2"Insulin production will be decreased." Rationale:The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. When there is endocrine dysfunction, insulin production is affected due to damage to beta cells. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1"I would not exercise since I am taking insulin." 2"The best time for me to exercise is after breakfast." 3"The best time for me to exercise is mid- to late afternoon." 4"NPH is a basal insulin, so I need to exercise in the evening."

2"The best time for me to exercise is after breakfast." Rationale: Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps to control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients need to exercise either an hour after mealtime or after consuming a 10- to 15-gram carbohydrate snack, and they would check their blood glucose level before exercising. Option 1 is incorrect because clients with diabetes would exercise, though they need to check with their primary health care provider before starting a new exercise program. Option 3 in incorrect; clients need to avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Option 4 is incorrect; NPH insulin in an intermediate-acting insulin, not a basal insulin.

The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse about planning to eat dinner at a local restaurant this week. The client asks the nurse whether eating at a restaurant will affect diabetic control and whether this is allowed. Which nursing response is most appropriate? 1"You are not allowed to eat in restaurants." 2"You could order a half-portion meal and have fresh fruit for dessert." 3"If you plan to eat in a restaurant, you need to skip the lunchtime meal." 4"You would increase your daily dose of insulin by half on the day that you plan to eat in the restaurant."

2"You could order a half-portion meal and have fresh fruit for dessert." Rationale:Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or parties. Some useful strategies include ordering a half-portion, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrees. Clients are not instructed to skip meals or increase their prescribed insulin dosage.

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding would the nurse expect to note in this client? 1Dry skin 2Bulging eyeballs 3Periorbital edema 4Coarse facial features

2Bulging eyeballs Rationale:Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse would next assess the results of which serum laboratory study? 1Sodium 2Calcium 3Potassium 4Magnesium

2Calcium Rationale:After surgery on the thyroid gland, the client may experience a temporary calcium imbalance. This is due to transient malfunction of the parathyroid glands. The nurse also would assess for Chvostek's and Trousseau's signs. The correct treatment is administration of calcium gluconate or calcium lactate. The remaining options are unrelated to the client's complaints.

A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse would expect which electrolyte abnormality? 1Sodium 2Calcium 3Potassium 4Magnesium

2Calcium Rationale:The C cells of the thyroid gland are helpful in maintaining normal plasma calcium levels. They do not affect the levels of sodium, potassium, or magnesium.

A client visits the primary health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 1Weight loss and tachycardia 2Complaints of weakness and lethargy 3Diaphoresis and increased hair growth 4Increased heart rate and respiratory rate

2Complaints of weakness and lethargy Rationale:Weakness and lethargy are the most common complaints associated with hypothyroidism. Other common symptoms include intolerance to cold, weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse would expect an excess of which substance? 1Calcium 2Cortisol 3Epinephrine 4Norepinephrine

2Cortisol Rationale:Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

The clinic nurse is providing instructions to a client with diabetes mellitus about the signs and symptoms of hypoglycemia. The nurse would tell the client that which would be noted in a hypoglycemic reaction? 1Thirst 2Hunger 3Polydipsia 4Increased urine output

2Hunger Rationale:Signs and symptoms of hypoglycemia include hunger, nervousness, anxiety, dizziness, blurred vision, sweaty palms, confusion, and tingling and numbness around the mouth. Polydipsia (thirst) and increased urine output are noted in the client with hyperglycemia.

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication would be included on the list? 1Shakiness 2Increased thirst 3Profuse sweating 4Decreased urine output

2Increased thirst Rationale:The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.

A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse would anticipate that which substance will be elevated? 1Glucose 2Ketones 3Glucagon 4Lactate dehydrogenase

2Ketones Rationale:Ketones are a byproduct of fat metabolism. When this process occurs to an extreme, the resulting condition is called ketoacidosis. The remaining options are not associated with the breakdown of fats.

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention would the nurse include in the plan of care? 1Maintain a supine position. 2Monitor for neck swelling. 3Maintain a pressure dressing on the operative site. 4Encourage deep-breathing exercises and vigorous coughing exercises.

2Monitor for neck swelling. Rationale:After thyroidectomy, the nurse needs to check the client's neck frequently to assess for the occurrence of postoperative edema; edema could lead to airway obstruction. The client would be placed in an upright position to facilitate air exchange and prevent edema at the surgical site. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse would monitor the dressing closely and would loosen the dressing if necessary. The nurse would assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision.

A client has overactivity of the thyroid gland. The nurse would expect which finding? 1Weight gain 2Nutritional deficiencies 3Low blood glucose levels 4Increased body fat stores

2Nutritional deficiencies Rationale:Although the client may experience an increased appetite with overactivity of the thyroid gland, food intake does not meet energy demands, and nutritional deficiencies can develop. Weight loss occurs as a result of the increased metabolic activity. Glucose tolerance is decreased, and the client experiences hyperglycemia. Overactivity of the thyroid gland also causes increased metabolism, including fat metabolism. This leads to decreased levels of fat in the bloodstream, including cholesterol, and decreased body fat stores.

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? Select all that apply. 1Irritability 2Periorbital edema 3Coarse, brittle hair 4Slow or slurred speech 5Abdominal distention 6Soft, silky, thinning hair

2Periorbital edema 3Coarse, brittle hair 4Slow or slurred speech 5Abdominal distention Rationale:The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifestations, such as coarse, brittle hair; thick, brittle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifestations include lethargy, slow or slurred speech, and impaired memory. Gastrointestinal manifestations include complaints of constipation, weight gain, and abdominal distention. Irritability and soft, silky, thinning hair on the scalp are manifestations of hyperthyroidism.

The nurse in a health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the primary health care provider (PHCP). The nurse notes that the PHCP has prescribed acarbose. Which preexisting disorder, if noted in the client's record, would indicate a contraindication to the use of this medication? 1Hypothyroidism 2Renal insufficiency 3Arterial insufficiency 4Coronary artery disease

2Renal insufficiency Rationale:Acarbose is an antidiabetic medication that may be administered alone or in conjunction with another antidiabetic medication. It is contraindicated in clients with significant renal dysfunction. It also is contraindicated in clients with inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose would be taken if which symptom or symptoms develop? Select all that apply. 1Polyuria 2Shakiness 3Palpitations 4Blurred vision 5Light-headedness 6Fruity breath odor

2Shakiness 3Palpitations 5Light-headedness Rationale:Shakiness, palpitations, and light-headedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

A nurse is providing home care instructions to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruction? 1"I need to wear a MedicAlert bracelet." 2"I need to purchase a travel kit that contains cortisone." 3"I will need to take daily medications until my symptoms decrease." 4"I need an increased dose of glucocorticoid medication during stressful minor illnesses."

3"I will need to take daily medications until my symptoms decrease." Rationale:Client teaching includes the need for lifelong daily medications. The client also is instructed to carry or wear a medical identification card or bracelet. A travel kit will need to be purchased. It needs to contain oral cortisone along with intramuscular preparations for self-injection and intravenous vials for emergency injection by a primary health care provider. Increased glucocorticoid dosage during stressful minor illnesses will be necessary.

The nurse would include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1Provide a warm environment for the client. 2Instruct the client to consume a low-fat diet. 3A thyroid-releasing inhibitor will be prescribed. 4Encourage the client to consume a well-balanced diet. 5Instruct the client that thyroid replacement therapy will be needed. 6Instruct the client that episodes of chest pain are expected to occur.

3A thyroid-releasing inhibitor will be prescribed. 4Encourage the client to consume a well-balanced diet. Rationale:The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance? 1Growth hormone (GH) 2Luteinizing hormone (LH) 3Antidiuretic hormone (ADH) 4Follicle-stimulating hormone (FSH)

3Antidiuretic hormone (ADH) Rationale:ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH.

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which prescription, if noted on the record, would indicate the need for clarification? 1Assess vital signs and neurological status. 2Instruct the client to avoid blowing the nose. 3Apply a loose dressing if any clear drainage is noted. 4Instruct the client about the need for a MedicAlert bracelet.

3Apply a loose dressing if any clear drainage is noted. Rationale:The nurse needs to observe for clear nasal drainage; constant swallowing; and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted after this procedure, the surgeon needs to be notified. Therefore, clarification is needed regarding application of a loose dressing. The remaining options indicate appropriate postoperative interventions.

A client is admitted to the hospital with a diagnosis of pheochromocytoma. The nurse would check which item to detect the primary manifestation of this disorder? 1Weight 2Urine ketones 3Blood pressure 4Skin temperature

3Blood pressure Rationale:Hypertension is the major symptom associated with pheochromocytoma and is assessed by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are other clinical manifestations of pheochromocytoma; however, hypertension is the major symptom.

The nurse is providing instructions regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that additional instruction is needed if the client identifies which as a cause of hypoglycemia? 1Omitted meals 2Increased intensity of activity 3Decreased daily insulin dosage 4Inadequate amount of fluid intake

3Decreased daily insulin dosage Rationale:Decreasing the dose of insulin will lead to hyperglycemia. Causes for hypoglycemic reactions include delayed consumption of meals and lack of necessary amounts of food. Other causes include the administration of excessive insulin or oral hypoglycemic medications, vomiting associated with illness, and strenuous exercise, which may potentiate the action of insulin. An inadequate amount of fluid intake is not a cause of hypoglycemia but can lead to dehydration.

The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication? 1Slow pulse; lethargy; warm, dry skin 2Elevated pulse; lethargy; warm, dry skin 3Elevated pulse; shakiness; cool, clammy skin 4Slow pulse, confusion, increased urine output

3Elevated pulse; shakiness; cool, clammy skin Rationale:Signs and symptoms of mild hypoglycemia include tachycardia; shakiness; and cool, clammy skin. The remaining options do not specify the manifestations of hypoglycemia.

A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL (25.6 mmol/L). The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 1Hyponatremia 2Rise in serum pH 3Elevated serum ketones 4Elevated serum bicarbonate level

3Elevated serum ketones Rationale:DKA is marked by the presence of elevated serum ketones. As a result of the acidosis, the pH and serum bicarbonate level would decrease. Hyponatremia is not related to DKA.

A hospitalized client is experiencing an episode of hypoglycemia. The client is lethargic and has no available intravenous (IV) access. Which medication would the nurse anticipate administering? 1Insulin 2Cortisone 3Glucagon 4Epinephrine

3Glucagon Rationale:Glucagon, a natural hormone secreted by the pancreas, is available as a subcutaneous injection to be given when a quick response to severe hypoglycemia is needed. Glucagon is useful in the unconscious hypoglycemic client without established IV access. The remaining options are incorrect treatments.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1Hypernatremia 2Signs of water deficit 3High urine osmolality 4Low serum osmolality 5Hypotonicity of body fluids 6Continued release of antidiuretic hormone (ADH)

3High urine osmolality 4Low serum osmolality 5Hypotonicity of body fluids 6Continued release of antidiuretic hormone (ADH) Rationale:SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

A client has been diagnosed with pheochromocytoma. Which clinical manifestation is most indicative of this condition? 1Water loss 2Bradycardia 3Hypertension 4Decreased cardiac output

3Hypertension Rationale:The client with pheochromocytoma has a benign or malignant tumor in the adrenal medulla. Because the medulla secretes epinephrine and norepinephrine, the client will exhibit signs related to excesses of these catecholamines, including tachycardia, increased cardiac output, and increased blood pressure. Vasoconstriction of the renal arteries triggers the renin-angiotensin system, resulting in water reabsorption and retention.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1An ampule of 50% dextrose 2NPH insulin subcutaneously 3IV fluids containing dextrose 4Phenytoin for the prevention of seizures

3IV fluids containing dextrose Rationale:Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The primary health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse would instruct the client that which is the first step in this procedure? 1Draw up the correct dosage of NPH insulin into the syringe. 2Draw up the correct dosage of regular insulin into the syringe. 3Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

3Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. Rationale:The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer-acting form.

The nurse would include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1Provide a cool environment for the client. 2Instruct the client to consume a high-fat diet. 3Instruct the client about thyroid replacement therapy. 4Encourage the client to consume fluids and high-fiber foods in the diet. 5Inform the client that iodine preparations will be prescribed to treat the disorder. 6Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3Instruct the client about thyroid replacement therapy. 4Encourage the client to consume fluids and high-fiber foods in the diet. 6Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur. Rationale:The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

A nurse is reviewing the primary health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription would the nurse question and verify? 1Acetaminophen 2Docusate sodium 3Morphine sulfate 4Levothyroxine sodium

3Morphine sulfate Rationale:Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

A nurse is caring for a client with thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse would assess for which sign or symptom? 1Bradycardia 2Constipation 3Persistent sweating 4Low-grade temperature

3Persistent sweating Rationale:Thyroid storm is an acute, life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Clinical manifestations of thyroid storm include systolic hypertension, tachycardia, diarrhea, persistent sweating, and a fever as high as 106° F. Other manifestations include abdominal pain, dehydration, extreme vasodilation, stupor rapidly progressing to coma, atrial fibrillation, and cardiovascular collapse. Bradycardia, constipation, and low-grade temperature are not a part of the clinical picture in thyroid storm.

A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 1Diarrhea 2Infection 3Polydipsia 4Weight gain

3Polydipsia Rationale:Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Diarrhea is not indicative of the complication. Infection is not associated with diabetes insipidus. Anorexia and weight loss also may occur.

The nurse is caring for a client admitted to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the nurse anticipates that which medication would most likely be prescribed? 1Glucagon 2Glyburide 3Regular insulin 4Neutral protamine Hagedorn (NPH) insulin

3Regular insulin Rationale:Giving regular insulin by the intravenous route is the treatment of choice for DKA. A short-acting insulin is the only insulin that can be given intravenously because it can be titrated to the client's blood glucose levels. Glucagon is used to treat hypoglycemia because it increases blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are inappropriate. NPH insulin is an intermediate-acting insulin and therefore is not appropriate for treatment of DKA.

The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse would instruct the client that it is acceptable to include which item in the diet? 1Fish 2Cereals 3Vegetables 4Meat and poultry

3Vegetables Rationale:The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. Vegetables are allowed in the diet. The client needs to limit meat, poultry, fish, eggs, cheese, and cereals.

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1"I will check my blood glucose level every day at 5:00 p.m." 2"I will check my blood glucose level 1 hour after each meal." 3"I will check my blood glucose level 2 hours after each meal." 4"I will check my blood glucose level before each meal and at bedtime."

4"I will check my blood glucose level before each meal and at bedtime." Rationale:The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing would be done during the nighttime hours. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data to control the diabetes mellitus.

After client education about the importance of sunscreen use and active vitamin production via the skin, the nurse determines that the client understands the teaching when which statement is made? 1"Vitamin B is activated in the outer layer of the skin by the sun." 2"Vitamin E deficiency occurs from lack of exposure to sunlight." 3"Vitamin K can be depleted if exposed to excess ultraviolet light." 4"Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight."

4"Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight." Rationale:Vitamin D is activated in the epidermis by ultraviolet (UV) light, such as sunlight. Once activated, it is distributed by the blood to the gastrointestinal tract to promote uptake of dietary calcium. The vitamins in the remaining options are neither activated nor depleted by UV light, such as sunlight.

The nurse is reviewing the primary health care provider's (PHCP's) prescriptions for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the PHCP's prescriptions? 1A decreased-calorie diet 2An increased-calorie diet 3A decreased amount of NPH insulin daily 4An increased amount of NPH insulin daily

4An increased amount of NPH insulin daily Rationale:Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infection is present, an increase in the dose of insulin will be required to facilitate the transport of excess glucose into the cells. The client will not necessarily need an adjustment in the daily diet.

A client has a tumor that is interfering with the function of the hypothalamus. The nurse would monitor for signs and symptoms related to which imbalance? 1Melatonin excess or deficit 2Glucocorticoid excess or deficit 3Mineralocorticoid excess or deficit 4Antidiuretic hormone (ADH) excess or deficit

4Antidiuretic hormone (ADH) excess or deficit Rationale:The hypothalamus exerts an influence on both the anterior and the posterior pituitary gland. Abnormalities can result in excess or deficit of substances normally mediated by the pituitary. ADH could be affected by disease of the hypothalamus because the hypothalamus produces ADH and stores it in the posterior pituitary gland. The pineal gland is responsible for melatonin production. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result would the nurse expect to note in this disorder? 1Serum pH of 9.0 2Absent ketones in the urine 3Serum bicarbonate of 22 mEq/L (22 mmol/L) 4Blood glucose level of 500 mg/dL (28.5 mmol/L)

4Blood glucose level of 500 mg/dL (28.5 mmol/L) Rationale:In the client with DKA, the nurse would expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1Infertility 2Gynecomastia 3Sexual dysfunction 4Body image changes

4Body image changes Rationale:Because of the location of the incision in the neck area, many clients are afraid of thyroid surgery for fear of having a visible large scar postoperatively. Having all or part of the thyroid gland removed will not cause the client to experience gynecomastia. Sexual dysfunction and infertility could occur if the entire thyroid is removed and the client is not placed on thyroid replacement medications.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 1Encourage the client's expression of feelings. 2Assess the client's understanding of the disease process. 3Encourage family members to share their feelings about the disease process. 4Encourage the client to recognize that the body changes need to be dealt with.

4Encourage the client to recognize that the body changes need to be dealt with. Rationale:Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations? 1Cortisol 2Androgens 3Aldosterone 4Epinephrine

4Epinephrine Rationale:Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dL (34.3 mmol/L) and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and expects to note which diagnosis? 1Hypoglycemia 2Pheochromocytoma 3Diabetic ketoacidosis (DKA) 4Hyperosmolar hyperglycemic syndrome (HHS)

4Hyperosmolar hyperglycemic syndrome (HHS) Rationale:HHS is seen primarily in clients with type 2 diabetes mellitus who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations. DKA typically occurs in type 1 diabetes mellitus.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 1Glycosuria 2Diaphoresis 3Weight loss 4Hypertension

4Hypertension Rationale:Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms.

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 1Edema 2Obesity 3Hirsutism 4Hypotension

4Hypotension Rationale:Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea and vomiting, abdominal cramps, weight loss, depression, and irritability. The remaining options do not occur with this disease.

A client has begun medication therapy with propylthiouracil. The nurse would assess the client for which condition as an adverse effect of this medication? 1Joint pain2Renal toxicity3Hyperglycemia4Hypothyroidism

4Hypothyroidism Rationale:Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse would expect to note which finding on assessment of the client? 1Unresponsive pupils 2Negative Chvostek's sign 3Hyperactive bowel sounds 4Positive Trousseau's sign

4Positive Trousseau's sign Rationale:Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 1Platelets 2Muscle tissue 3Adipose tissue 4Red blood cells (RBCs)

4Red blood cells (RBCs) Rationale:With chronic high circulating blood glucose levels, some glucose binds irreversibly onto RBCs and remains there for the life of the cell. The average life span of an RBC is 120 days. The measurement of glycosylated hemoglobin A (HbA1c), which detects glucose binding on the RBC membrane, is expressed as a percentage. Glucose does not bind onto platelets in diabetes mellitus. One of the problems in diabetes is that muscle and adipose cells may be unable to transport glucose across cell membranes.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that they have a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention would the nurse anticipate to be prescribed initially for the client? 1Glyburide via the oral route 2Glucagon via the subcutaneous route 3Insulin aspart via the subcutaneous route 4Regular insulin via the intravenous (IV) route

4Regular insulin via the intravenous (IV) route Rationale:The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus. Insulin aspart is a short-acting insulin and is not appropriate for the emergency treatment of DKA.

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of Addisonian crisis. The nurse would assess the client for which manifestation that would be associated with this crisis? 1Agitation 2Diaphoresis 3Restlessness 4Severe abdominal pain

4Severe abdominal pain Rationale:Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in Addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. The remaining options do not identify clinical manifestations associated with Addisonian crisis.

A client has been diagnosed with Cushing's syndrome. The nurse would assess the client for which expected manifestations of this disorder? 1Dizziness 2Weight loss 3Hypoglycemia 4Truncal obesity

4Truncal obesity Rationale:The client with Cushing's syndrome may exhibit a number of different manifestations. These may include moon face, truncal obesity, and a "buffalo hump" fat pad. Other signs include hyperglycemia, hypernatremia, hypocalcemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what would the nurse assess next? 1Serum glucose 2Blood pressure 3Respiratory rate 4Urine specific gravity

4Urine specific gravity Rationale:After hypophysectomy, temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse would assess urine specific gravity and notify the primary health care provider if the result is less than 1.005. Although the remaining options may be components of the assessment, the nurse would next assess urine specific gravity.