Endo Practice Questions from Elsevier

A primary health care provider has prescribed methimazole for a client with hyperthyroidism. The nurse would question the client about which of the following that is a contraindication to the use of this treatment?

Pregnancy

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?

Red blood cells (RBCs)

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?

Regular insulin

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?

Renal insufficiency

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis?

Serum potassium is 6.8 mEq/L (6.8 mmol/L). Movement of hydrogen ions from the extracellular to the intracellular fluid promotes the movement of potassium from intracellular to extracellular fluid. Thus, the serum potassium level will rise.

During health history taking, the client complains of weight loss and diarrhea and says "I can feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the primary health care provider (PHCP) in order to determine the underlying condition leading to the client's signs and symptoms?

Serum thyroid-stimulating hormone (TSH)

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?

Severe abdominal pain

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?

"Aldosterone will be secreted."

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time would the nurse plan to assess the client for a hypoglycemic reaction?

1700 he onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

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?

Amenorrhea

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?

Tremors

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?

A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L)

A client has overactivity of the thyroid gland. The nurse would expect which finding?

Nutritional Deficiencies

A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse would assess the client for a hypoglycemic reaction at which times?

Between 1:00 and 3:00 p.m. Its onset of action is 15 minutes; it peaks in 1 to 3 hours, and its duration of action is 3 to 5 hours.

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?

"I need to eat foods that have a lot of potassium in them."

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions?

"I need to place my hands behind my neck when I have to cough or change positions."

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?

"I would perform my exercise at peak insulin time."

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements would the nurse include in the discharge teaching instructions? Select all that apply.

"Include adequate fiber and fluids in your diet. Wear slip-on shoes rather than those that need to be tied." "Brushing your teeth will not be permitted for at least 2 weeks after surgery. Contact your primary health care provider immediately if you develop any headache, fever, or neck stiffness."

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?

"Insulin production will be decreased."

The nurse is interviewing a client with type 2 diabetes mellitus who is taking a sulfonylurea. Which statement by the client indicates an understanding of this treatment for this disorder?

"The medications I'm taking help release the insulin I already make."

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?

"Usually these physical changes slowly improve following treatment."

The family of a bedridden client with type 2 diabetes mellitus and chronic kidney disease calls the nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question would the nurse ask the family to determine a possible problem?

"What is the client's capillary blood glucose level?"

The nurse is caring for a client with Addison's disease. The client asks the nurse about the risks associated with this disease, specifically about addisonian crisis. Regarding prevention of this complication, how would the nurse inform the client?

"You need to increase salt in your diet, particularly during stressful situations."

A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA?

Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, Paco2 30, Hco3- 14.

The nurse is caring for a client diagnosed with type 1 diabetes mellitus experiencing the Somogyi effect. Which blood glucose results and treatment would the nurse expect?

0300 blood glucose 68 mg/dL (3.8 mmol/L) and 0700 blood glucose 200 mg/dL (11.1 mmol/L). Instruct to decrease amount of evening insulin.

The primary health care provider's prescription reads levothyroxine, 150 mcg orally daily. The medication label reads levothyroxine, 0.1 mg per tablet. The nurse would plan to administer how many tablet(s) to the client? Fill in the blank.

1.5

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?

Increased thirst

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care would the nurse review with the client's primary health care provider?

A decreased dosage of warfarin sodium

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?

A rounded "moonlike" appearance to the face

The nurse would include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply.

A thyroid-releasing inhibitor will be prescribed. Encourage the client to consume a well-balanced diet.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication?

Achieves normal thyroid hormone levels

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?

An increased amount of NPH insulin daily

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?

Antidiuretic hormone (ADH)

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?

Antidiuretic hormone (ADH) excess or deficit

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action?

Assess urine specific gravity.

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?

Bulging eyeballs

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?

Calcium

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?

Calcium level of 8 mg/dL (2.0 mmol/L)

The nurse caring for a client who underwent intracranial surgery is suspected of having diabetes insipidus. Which finding noted by the nurse is consistent with this complication of surgery?

Complaints of excessive thirst

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse would expect an excess of which substance?

Cortisol

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data would the nurse identify as a possible complication of thyroid surgery?

Decreased calcium level

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?

Dry skin

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?

Eat meals at approximately the same time each day.

The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication?

Elevated pulse; shakiness; cool, clammy skin

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)?

Elevated serum ketones

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?

Increased production of glucose

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?

Fever and tachycardia 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.

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse would include in the client's teaching plan?

Gastrointestinal disturbances The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea.

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?

Glucagon

The nurse caring for a client newly admitted to the hospital who is at risk for diabetes mellitus suspects that the client has metabolic syndrome if which characteristics have been identified in this client? Select all that apply.

Hemoglobin A1C of 6.5% Triglycerides 160 mg/dL (1.81 mmol/L) Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L)

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.

High urine osmolality Low serum osmolality Hypotonicity of body fluids Continued release of antidiuretic hormone (ADH)

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?

Hunger

A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria, weight loss, and weakness. Laboratory results indicate a blood glucose level of 800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the primary health care provider's documentation and expects to note which diagnosis?

Hyperosmolar hyperglycemic syndrome (HHS)

A client has been diagnosed with pheochromocytoma. Which clinical manifestation is most indicative of this condition?

Hypertension

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.

Initiate an infusion of 3% NaCl. Restrict fluids to 800 mL over 24 hours. Administer a vasopressin antagonist as prescribed.

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?

Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin.

The nurse would include which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

Instruct the client about thyroid replacement therapy. Encourage the client to consume fluids and high-fiber foods in the diet. Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

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?

Iodine

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.

Irritability Complaints of nausea Sodium level of 128 mEq/L (128 mmol/L) Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?

Metformin

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.

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

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?

Monitor for neck swelling.

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms would the nurse monitor for? Select all that apply.

Moon face Hypertension Truncal obesity

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?

Morphine

A client's laboratory results indicate the serum calcium is 12 mg/dL (3 mmol/L) and the serum phosphorous is 2.1 mg/dL (0.697 mmol/L). Based on these findings, the nurse suspects imbalance of which hormone?

Parathyroid Parathyroid hormone is responsible for maintaining serum calcium and phosphorous levels within normal range.

During physical examination of a client, which finding is characteristic of hypothyroidism?

Periorbital edema

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?

Persistent Sweating

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?

The best time for me to exercise is after breakfast."

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?

Thyroid

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?

Tingling around the mouth

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?

To treat hypocalcemic tetany

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?

Trach set

A client has been diagnosed with Cushing's syndrome. The nurse would assess the client for which expected manifestations of this disorder?

Truncal obesity

Which findings would raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply.

Urine specific gravity is 1.001. Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

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.

Viruses Genetic factors Autoimmune factors Human leukocyte antigen (HLA)

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?

Walk down the hall for 15 minutes 3 times a day. 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.

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?

intravenous infusion of normal saline The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency.

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.

Polyuria Polydipsia Complaints of excessive thirst Specific gravity lower than 1.005

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply.

Polyuria Polydipsia Polyphagia Dry mouth Flushed, dry skin

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?

Blood glucose level of 500 mg/dL (28.5 mmol/L)

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder?

Polyuria

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?

Polyuria

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.

Polyuria Bone Pain

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?

Hypotension

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?

Hypotension and fever

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

Hypothyroidism

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?

I need to increase my intake of dietary items that are high in calcium."

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?

IV fluids containing dextrose

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.

Periorbital edema Coarse, brittle hair Slow or slurred speech Abdominal distention

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?

Polydipsia

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition?

"Are you experiencing pain in your joints?"

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?

"Are you rotating the injection site?"

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions would include which statement?

"Brushing your teeth needs to be avoided for at least 2 weeks after surgery." avoiding brushing the teeth to prevent disruption of the surgical site.

A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client?

"Flush the toilet at least 3 times after use."

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?

Apply a loose dressing if any clear drainage is noted.

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?

Positive Trousseau's sign

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client?

Respiratory distress

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.

Shakiness Palpitations Lightheadedness

The nurse is caring for a postoperative client who has had an adrenalectomy. What would the nurse check for during the client's focused assessment?

Signs and symptoms of hypovolemia

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?

Take a blood glucose test before exercising.