HESI PRACTICE TEST ENDOCRINE
A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement? 1 Regulated food intake is basic to control. 2 Salt and sugar restriction is the main concern. 3 Small, frequent meals are better for digestion. 4 Large meals can contribute to a weight problem
1 An understanding of the diet is imperative for adherence. A balance of carbohydrates, proteins, and fats, usually apportioned over three main meals and two between-meal snacks, needs to be tailored to the client's specific needs, with consideration of exercise and pharmacological therapy. A total dietary regimen proportioning carbohydrates, proteins, and fats must be followed, not just sugar restriction; salt is not restricted. That small, frequent meals are better for digestion is true; however, digestion is not the basis for the client's problems. Total caloric intake, rather than the size of meals, is the major factor in weight gain.Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always , never , all , every , and none . Answers containing these key words are rarely correct.
A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? 1 Checking the client's serum glucose level 2 Assisting the client out of bed into a chair 3 Placing the client in the high-Fowler position 4 Ensuring the client's residual limb is elevated
1 Because the client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. To prevent flexion contractures of the hip, the client should not sit for a prolonged time; this is not the priority. Raising the head of the bed flexes the hips, which may result in hip flexion contractures; this is not the priority. Ensuring the client's residual limb is elevated may result in a hip flexion contracture and should be avoided.
A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiological changes that are associated with a long history of diabetes? 1 Blurry, spotty, or hazy vision 2 Arthritic changes in the hands 3 Hyperactive knee and ankle jerk reflexes 4 Dependent pallor of the feet and lower legs
1 Blurry, spotty, or hazy vision, floaters or cobwebs in the visual field, cataracts, and complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.
The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit: 1 Lability of mood 2 Hair thinning 3 Increased skin thickness 4 Ectomorphism
1 Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Increased secretion of androgens results in hirsutism. Capillary fragility results in multiple ecchymotic areas, not skin thickness. Ectomorphism is a term for a tall, thin, genetically determined body type and is not related to adaptations to Cushing syndrome.
A client is admitted to the hospital with diabetic ketoacidosis. The nurse identifies that the elevated ketone level present with this disorder is caused by the incomplete oxidation of: 1 Fats 2 Protein 3 Potassium 4 Carbohydrates
1 Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism results in nitrogenous waste production, causing elevated blood urea nitrogen (BUN). Potassium is not oxidized. Ketones do not result when there are alterations in potassium levels. Carbohydrates do not contain fatty acids that are broken down into ketones
A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? 1 Ketoacidosis 2 Somogyi phenomenon 3 Hypoglycemic reaction 4 Hyperosmolar nonketotic coma
1 Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.
A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response? 1 The tumor must be removed to prevent heart and kidney damage. 2 Surgery will prevent the tumor from metastasizing to other organs. 3 Radiation therapy can be just as effective as surgery if the tumor is small. 4 Chemotherapy is as reliable as surgery for the treatment of adenomas of this type in some people.
1 Renal and cardiac complications will occur if hypertension caused by the tumor is not arrested. Aldosteronomas are benign tumors; metastasis is not possible. Radiation is not used to treat this type of adenoma. Chemotherapy is not recommended treatment for this particular adenoma.
The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that the teaching is understood when the client states, "Instead of asparagus, broccoli, and mushrooms, I can eat: 1 String beans, beets, or carrots." 2 Corn, lima beans, or dried peas." 3 Baked beans, potatoes, or parsnips." 4 Corn muffins, corn chips, or pretzels."
1 String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.
A nurse is caring for a client after a thyroidectomy. Because of concerns about potential nerve injury associated with this type of surgery, the nurse should assess for which functional ability? 1 Speaking 2 Swallowing 3 Pursing the lips 4 Turning the head
1 The laryngeal nerve is close to the operative site and may be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. Pursing the lips assesses the seventh cranial (facial) nerve, which is not affected by thyroid surgery. Muscles and nerves involved in turning the head are not near the thyroid gland.
A client in thyroid storm tells the nurse, "I know I'm going to die. I'm very sick." What is the nurse's best response? 1 "You must feel very sick and frightened." 2 "Tell me why you feel you are going to die." 3 "I can understand how you feel, although people do not die from this problem." 4 "If you would like, I will call your family and tell them to come to the hospital."
1 The response "You must feel very sick and frightened" reflects the client's feelings and encourages further exploration of concerns. The response "Tell me why you feel you are going to die" is abrupt and does not reflect the client's feelings; also, the client may not be able to answer this question. The response "I can understand how you feel, although people do not die from this problem" is false reassurance; thyroid storm can cause death. The response "If you would like, I will call your family and tell them to come to the hospital" may reinforce the client's anxiety and avoids discussion of the client's concerns; it cuts off communication.
The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client states, "I will drink orange juice and eat a slice of bread when I feel: 1 Nervous and weak." 2 Flushed and short of breath." 3 Thirsty and have a headache." 4 Nauseated and have abdominal cramps."
1 These are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.
Before a client's discharge after a thyroidectomy, the nurse teaches the client to observe for signs of surgically induced hypothyroidism. What clinical indicators identified by the client provide evidence that the nurse's instructions are understood? (Select all that apply.) 1 Fatigue 2 Dry skin 3 Insomnia 4 Intolerance to heat 5 Progressive weight loss
1 4 Fatigue is caused by a decreased metabolic rate. Dry skin is caused by decreased glandular function associated with a decreased metabolic rate. Insomnia is caused by an increased metabolic rate associated with hyperthyroidism, not hypothyroidism. Intolerance to heat is associated with hyperthyroidism. Intolerance to cold is associated with hypothyroidism. Progressive weight loss is associated with hyperthyroidism. Progressive weight gain is associated with hypothyroidism because of the reduced metabolic rate.STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.
A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client? 1 Emotional stress 2 Presence of infection 3 Increased insulin dose 4 Inadequate food intake
2 Infection increases the body's metabolic rate, and insulin is not available for increased demands. Although emotional stress will affect glucose levels, diabetic ketoacidosis will rarely result. Increased insulin dose will lead to insulin coma (hypoglycemia) if diet is not increased as well. Inadequate food intake will result in insulin coma.Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? (Select all that apply.) 1 Decreased urinary output 2 Excessive thirst 3 Hyperactivity 4 Fruity-scented breath 5 Confusion
2 4 5 Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternate fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.
After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which manifestations of excessive levels of ADH should the nurse assess the client? (Select all that apply.) 1 Polyuria 2 Weight gain 3 Hypotension 4 Hyponatremia 5 Decreased specific gravity
2. 4 Excessive levels of ADH cause inappropriate free water retention; for every liter of fluid retained, the client will gain approximately 2.2 lb. Free water retention results in a hypoosmolar state with dilutional hyponatremia. Oliguria , not polyuria, occurs as ADH acts on nephrons to cause water to be reabsorbed from the glomerular filtrate. Because of water reabsorption, blood volume may increase, causing hypertension, not hypotension. This increases, not decreases, as a result of increased urine concentration.STUDY TIP: Try to decrease your workload and maximize your time by handling items only once. Most of us spend a lot of time picking up things we put down rather than putting them away when we have them in hand. Going straight to the closet with your coat when you come in instead of throwing it on a chair saves you the time of hanging it up later. Discarding junk mail immediately and filing the rest of your bills and mail as they come in rather than creating an ever-growing stack saves time when you need to find something quickly. Filing all items requiring further attention in some fashion helps you remember to take care of things on time rather than being so engrossed in your schoolwork that you forget about them. Many nursing students have had their power or telephone service cut off because the bill simply was forgotten or buried in a pile of old mail.
A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to: 1 Decrease insulin sensitivity 2 Stimulate glucagon production 3 Improve the cellular uptake of glucose 4 Reduce metabolic requirements for glucose
3 Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it.
A health care provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client? 1 Decrease in eosinophils 2 Increase in lymphoid tissue 3 Restoration of electrolyte balance 4 Improvement of carbohydrate metabolism
3 Lack of mineralocorticoids causes hyponatremia, hypovolemia, and hyperkalemia. Dietary modification and administration of cortical hormones are aimed at correcting these electrolyte imbalances, which can be life threatening. There is no disturbance in the eosinophil count. Lymphoid tissue does not change. Although glucocorticoids are involved in metabolic activities, including carbohydrate metabolism, the primary aim of therapy is to restore electrolyte imbalance.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.
The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug: 1 Increases the uptake of iodine 2 Causes the thyroid gland to atrophy 3 Interferes with the synthesis of thyroid hormone 4 Decreases the secretion of thyroid-stimulating hormone (TSH)
3 PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.
When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of: 1 Edema 2 Anorexia 3 Weight loss 4 Hypoglycemic episodes
3 Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.
A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations? 1 Urinary retention 2 Respiratory distress 3 Bleeding at the suture line 4 Increased intracranial pressure
4 Because the pituitary gland is located in the brain, edema after surgery may result in increased intracranial pressure. Early signs include decreased visual acuity, papilledema, and unilateral pupillary dilation. Urinary retention may follow any surgery because of the effects of anesthesia and is not a specific occurrence following cranial surgery. Respiratory distress is a later, not early, sign of increased intracranial pressure. This is a decompensated response indicated by altered respiratory pattern, decreased respiratory rate, and, finally, respiratory arrest. This occurs because of increasing pressure on the medulla. Bleeding at the suture line may occur with any surgery, not just a hypophysectomy.
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1 Nervousness and tachycardia 2 Erythema toxicum rash and pruritus 3 Diaphoresis and altered mental state 4 Deep respirations and fruity odor to the breath
4 Deep respirations and a fruity odor to the breath are classic signs of DKA because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremor, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.
A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra pill should be taken before exercise. The best response by the nurse is: 1 "You will need to decrease your exercise." 2 "An extra pill will help your body use glucose correctly." 3 "When taking medicine, your diet will not be affected by exercise." 4 "No, but you should observe for signs of hypoglycemia while exercising.
4 Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacological therapy.
A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information? 1 "Eat your usual breakfast." 2 "Have clear liquids for breakfast." 3 "Take your medication before the test." 4 "Do not ingest anything before the test."
4 Fasting before the test is indicated for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients. Food should not be ingested before the test; food will increase the serum glucose level, negating accuracy of the test. Instructing the client to have clear liquids for breakfast is inappropriate; some clear fluids contain simple carbohydrates, which will increase the serum glucose level. Medications are withheld before the test because of their influence on the serum glucose level.
A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The health care provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should: 1 Provide 12 ounces of non-diet soda 2 Give 25 mL dextrose 50% by slow intravenous (IV) push 3 Have the client drink 8 ounces of fruit juice 4 Ask the client to ingest one tube of glucose gel
4 One tube of glucose gel contains 15 g of carbohydrate and is the most appropriate intervention in this situation. Providing 12 ounces of non-diet soda is too much carbohydrate; 4 to 6 ounces is adequate. Administering dextrose by IV push is not appropriate for an alert client who is able to eat and drink. Having the client drink 8 ounces of fruit juice is too much carbohydrate; 4 to 6 ounces is adequate.
A female client receiving cortisone therapy for adrenal insufficiency expresses concern about why she is developing facial hair. How should the nurse respond? 1 "It is just another sign of the illness." 2 "Do not worry because it will disappear with therapy." 3 "This is not important as long as you are feeling better," 4 "The drug contains a hormone that causes male characteristics."
4 Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. The response "Do not worry because it will disappear with therapy" denies the client's concerns; hirsutism results from therapy, which is provided on a long-term basis. The response "This is not important as long as you are feeling better" denies the client's feelings.Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question.
A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment? 1 Dry 2 Moist 3 Flushed 4 Smooth
1 Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T3 and T4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist and smooth skin occur with hyperfunction of the thyroid and an increase in the basal metabolic rate.
A client is receiving total parenteral nutrition. The nurse assesses for which client response that indicates hyperglycemia? 1 Polyuria 2 Paralytic ileus 3 Respiratory rate below 16 4 Serum glucose of 105 mg/100 mL
1 When blood glucose exceeds the renal threshold for glucose reabsorption in the kidney tubules, it acts as an osmotic diuretic, resulting in polyuria. Paralytic ileus is not associated with hyperglycemia. With hyperglycemia there is hyperventilation. Serum glucose of 105 mg/100 mL is within the expected range.
While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? (Select all that apply.) 1 Diaphoresis 2 Weight loss 3 Constipation 4 Protruding eyes 5 Cold intolerance
1 2 4 Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia. Weight loss occurs with hyperthyroidism because of increased metabolism. Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retro-orbital tissue, which causes the eyeballs to enlarge and push forward. Diarrhea occurs because of increased body processes, specifically increased gastrointestinal peristalsis. Heat intolerance occurs because of the increased metabolism associated with hyperthyroidism.
The nurse is assessing a client with hyperthyroidism. For which signs and symptoms should the nurse assess the client? (Select all that apply.) 1 Amenorrhea 2 Hypotension 3 Facial edema 4 Flushed appearance 5 Short attention span
1 4 5 Amenorrhea is due to hypothalamic or pituitary disturbances associated with hyperthyroidism. The skin is warm and flushed because of a hyperdynamic circulatory state. A short attention span is related to altered cerebral metabolism from excess thyroid hormones. Hypertension is associated with hyperthyroidism; hypotension is associated with hypothyroidism. Facial edema is not related to hyperthyroidism. Hypothyroidism is associated with decreased renal blood flow that results in fluid retention (e.g., peripheral and facial edema).
A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.) 1 Cool skin 2 Photophobia 3 Constipation 4 Periorbital edema 5 Decreased appetite
1, 3. 4. 5 Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edema are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.
The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.) 1 Emotional lability 2 Dyspnea on exertion 3 Abdominal distension 4 Decreased bowel sounds 5 Hyperactive deep tendon reflexes
1. 2. 5 Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurological manifestation related to excessive production of thyroid hormones. Abdominal distension is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.
A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client? 1 Thyroxine (T 4) and x-ray films 2 Thyroid stimulating hormone (TSH) assay and triiodothyronine (T 3) 3 Thyroglobulin level and PO 2 4 Protein-bound iodine and sequential multichannel autoanalyzer (SMA)
2 A decreased TSH assay together with an elevated T 3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T 4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG), and is inadequate for diagnosis when used alone. PO 2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way.
A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms? 1 Partial thromboplastin time (PTT) and prothrombin time (PT) 2 T 3, T 4, and thyroid-stimulating hormone (TSH) 3 Venereal disease research laboratory (VDRL) test and complete blood count (CBC) 4 Adrenocorticotropic hormone (ACTH), antidiuretic hormone ADH, and corticotropin-releasing factor (CRF)
2. T 3, T 4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.
What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? (Select all that apply.) 1 Dry skin 2 Weight loss 3 Tachycardia 4 Restlessness 5 Constipation 6 Exophthalmos
2. 3. 4. 6 Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.
A client is admitted to the hospital for a thyroidectomy. In which position should the nurse maintain the client after this surgery? 1 Prone 2 Supine 3 Left Sims 4 Semi-Fowle
4 The semi-Fowler position limits edema in the operative area via gravity and promotes respirations by facilitating thoracic expansion. The prone, supine, and Sims positions will promote edema in the operative area, which can compromise respirations.
Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies? 1 Calcium 2 Chloride 3 Phosphorus 4 Parathormone
3 Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorous levels decrease (greater than 3 mg/dL; greater than 0.1 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.
The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include? (Select all that apply.) 1 It prevents ketoacidosis 2 It helps cause weight loss 3 It can improve A 1c levels 4 An insulin pump costs less than subcutaneous injections 5 Clients can exercise without eating more carbohydrates
3. 4 Maintaining a consistent acceptable blood glucose level will improve A 1c results. Because insulin is administered only as needed, the client will be able to exercise without having to increase the carbohydrate intake. Ketoacidosis may occur if the catheter becomes dislodged and the client does not receive insulin for hours. Insulin pumps can cause weight gain, not loss. An insulin pump is more expensive than subcutaneous insulin injections.STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.
A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1. Fats 2 Protein 3 Potassium 4 Carbohydrates
1 Fats Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones. Potassium is not oxidized; potassium is not directly associated with ketones. Carbohydrates do not contain fatty acids that are broken down into ketones.
A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? (Select all that apply.) 1 Hirsutism 2 Round face 3 Pitting edema 4 Buffalo hump 5 Hypoglycemia
1. 2. 4 Hirsutism is caused by excess adrenocortical activity associated with Cushing syndrome. A moon face results from an accumulation of adipose tissue associated with hypercortisolism. A Buffalo hump results from an accumulation of adipose tissue associated with hypercortisolism. Pitting edema does not occur except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.
A health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the antithyroid medication, the client calls the nurse and complains of feeling tired and looking pale. What should the nurse do? 1 Advise the client to get more rest. 2 Schedule the client for an appointment. 3 Instruct the client to skip one dose daily. 4 Tell the client to increase the medication
2 The client should be examined by the health care provider and blood tests prescribed; anemia may result because of the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe advice; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a health care provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a health care provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse.
The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin reaction should the nurse particularly be observant? (Select all that apply.) 1 Lethargy 2 Headache 3 Diaphoresis 4 Excessive thirst 5 Deep respirations
2 3 Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Lethargy is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.
A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the: 1 Client will need a higher serum glucose level while on bed rest 2 Possibility of acidosis is greater when a client is on oral hypoglycemics 3 Dosage can be adjusted to changing needs during recovery from surgery 4 Stress of surgery may precipitate uncontrollable periods of hypoglycaemia
3 There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin
A client with type 1 diabetes receives 30 units of Humulin N insulin at 7 am. At 3:30 pm the client becomes diaphoretic, weak, and pale. The nurse determines that these physiological responses are associated with: 1 Diabetic coma 2 Somogyi effect 3 Diabetic ketoacidosis 4 Hypoglycemic reaction
4 These are sympathetic nervous system responses to hypoglycemia; the peak action of Humulin N insulin is 8 to 12 hours after administration, and 8½ hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes, hot, flushed skin, deep, rapid respirations (Kussmaul breathing), acetone odor to the breath, nausea and vomiting, and, as with hypoglycemia, weakness. The Somogyi effect includes wide swings in blood glucose levels between hyperglycemia and a profound hypoglycemia caused by insulin rebound. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.
Levothyroxine (Synthroid) 12.5 mcg orally each day is prescribed for a client with hypothyroidism. Six weeks later, the health care provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the original pill prescription can be completed before starting the new dose. How many of the original pills should the nurse instruct the client to take daily? Record your answer using a whole number. __________ tablets
2 TAB Compute the dose by using ratio and proportion. Desire 25 mcg x tablets------------- = ---------Have 12.5 mcg 1 tablet12.5x = 25x = 25 ÷ 12.5x = 2 tablets
A client with type 1 diabetes mellitus has a finger stick glucose level of 258 mg/dL at bedtime. A prescription for sliding scale regular insulin (Novolin R) exists. What should the nurse do? 1 Call the health care provider. 2 Encourage the intake of fluids. 3 Administer the insulin as prescribed. 4 Give the client a half cup of orange juice
3 A value of 258 mg/dL is above the expected range of 70 to 100 mg/dL; the nurse should administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client a half cup of orange juice is contraindicated because it will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.
A nurse administers a tube of glucose gel to a client who is hypoglycemic. What should the nurse consider about this reversal of hypoglycemia? 1 It liberates glucose from hepatic stores of glycogen. 2 Insulin action is blocked as it competes for tissue sites. 3 Glycogen is supplied to the brain as well as other vital organs. 4 It provides a glucose substitute for rapid replacement of deficits
4 The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon (GlucaGen). It is a drug that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.
A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. The nurse explains that: 1 The client will gain excessive weight if sodium is not limited 2 An inadequate intake of potassium contributed to the disease 3 This type of diet increases emotional stability 4 Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium
4 Clients with Cushing syndrome or those who are receiving cortical hormones must limit their intake of sodium and increase their intake of potassium because the kidneys are retaining sodium and excreting potassium. Although sodium retention causes fluid retention and weight gain, the need for increased potassium must be considered as well. An excessive secretion of adrenocortical hormones in Cushing syndrome, not inadequate potassium intake, is the problem. This type of diet has no direct effect on the client's emotional status.
A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? 1 Cortical hormones stimulate rapid weight loss. 2 Tissue catabolism results in a negative nitrogen balance. 3 Glucocorticoids accelerate the process of gluco-neogenesis. 4 Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue
3 Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.