NCLEX 3000-ENDO
"While reviewing the food diary of a client with type 2 diabetes, a nurse notices that the client typically skips breakfast. Which instruction by the nurse would be helpful for this client.
It's important to maintain a stable blood sugar throughout the day. Can I help you devise a plan so you can eat breakfast each day?
"A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?
You'll need less insulin when you exercise or reduce your food intake.
"(SELECT ALL THAT APPLY) A 56-year-old female client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client?
(2) Take thyroid replacement medication, as ordered. (3) Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician.
"(SELECT ALL THAT APPLY) A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching?
(2) Wear cotton socks. (3) Apply foot powder after bathing. (5) See a podiatrist regularly to have your feet checked.
"For a client with hyperglycemia, which data collection finding best supports a nursing diagnosis of Deficient fluid volume?
Increased urine osmolarity
"The nurse teaches a diabetic client that diet plays a crucial role in managing diabetes mellitus. When evaluating dietary intake, the nurse knows the client is eating the right foods if total daily caloric intake consists of:
55% to 60% carbohydrate, 30% fat, and 10% to 15% protein.
"Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?
70% NPH insulin and 30% regular insulin
"A client becomes upset when the physician diagnoses diabetes mellitus as the cause of his signs and symptoms. The client tells the nurse, ""This must be a mistake. No one in my family has ever had diabetes."" Based on this statement, the nurse suspects the client is using which coping mechanism?
Denial
"Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following?
Muscle weakness
"While administering morning medications, a nurse enters the room of a client who recently had a thyroidectomy. She observes that the client is sitting up in bed but appears unresponsive. After confirming unresponsiveness, what should the nurse do next?
Call for help.
"The nurse should expect to administer which medication to a client with gout?
Colchicine
"The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output
"Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism?
Hypercalcemia
"A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?
Initiate fluid replacement therapy.
"Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?
Neck vein distention
"The nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
"Which of the following is an adverse reaction to glipizide (Glucotrol)?
Photosensitivity
"The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and:
vitamin D.
"Which instruction about insulin administration should the nurse give to a client?
"Always follow the same order when drawing the different insulins into the syringe.
"Which nursing diagnosis is most appropriate for a client with Addison's disease?
Risk for infection
"The adrenal cortex is responsible for producing which substances?
Glucocorticoids and androgens
"A client with primary diabetes insipidus is prescribed desmopressin (DDAVP). Which instruction should the nurse provide before the client is discharged?
You may not be able to use desmopressin nasally if you have nasal discharge or blockage.
"A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?
Rapid, thready pulse
"A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
"The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find?
Hyperkalemia
"(SELECT ALL THAT APPLY) A 45-year-old female client is admitted to the hospital with Cushing's syndrome. Which nursing interventions are appropriate for this client?
(1) Assess for peripheral edema (3) Measure intake and output (5) Weigh the client daily
"(SELECT ALL THAT APPLY) A client is seen in the clinic with suspected parathormone (PTH) deficiency. Part of the diagnosis of this condition includes the analysis of serum electrolyte levels. Which electrolyte levels would the nurse expect to be abnormal in a client with PTH deficiency?
(1) Calcium (6) Phosphorous
"A female client who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?
Acromegaly
"The nurse understands that for the parathyroid hormone to exert its effect, what must be present?
Adequate vitamin D level
"Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
Administer 2 to 3 L of I.V. fluid over 2 to 3 hours.
"A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?
Coma, anxiety, confusion, headache, and cool, moist skin
"Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?
Confusion and seizures
"A client is diagnosed with diabetes mellitus. Which data collection finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?
Crying whenever diabetes is mentioned
"Which instructions should be included in the discharge teaching plan for a client after a thyroidectomy for Graves' disease?
Have regular follow-up care.
"A client is admitted with a serum glucose level of 618 mg/dl. The client is awake and oriented, with hot, dry skin; a temperature of 100.6° F (38.1° C); a heart rate of 116 beats/minute; and a blood pressure of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
"A nurse is teaching a group of certified nursing assistants (CNAs) about blood glucose monitoring. Which finding indicates that the CNA understands how to use a blood glucose meter?
Demonstrating correct technique
"A client receiving thyroid replacement therapy develops the flu and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which life-threatening complication?
Myxedema coma
"Which of the following signs and symptoms would be seen in a client experiencing hypoglycemia?
Nervousness, diaphoresis, and confusion
"A family member is observed looking at the blood glucose flow sheet for a client in the next bed. Which of the following actions would be an appropriate measure for the nurse to take?
Notify the charge nurse about this breach in the client's personal health information.
"The nursing care for the client in addisonian crisis should perform which intervention?
Place the client in a private room.
"A client with type 2 diabetes comes to the clinic with a diabetic foot ulcer on his left heel that hasn't responded to treatment. Which action should a nurse take after assessing the ulcer?
Suggest a consult with a wound care specialist.
"The nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, T4, and calcitonin.
"A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse drug effect?
Tachycardia
"Which instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client?
Take the drug on an empty stomach.
"A client with type 2 diabetes was diagnosed with retinopathy. While a nurse reviews the client's medication dosage, the client states, ""I can't read the names on the medicine bottles, so I hope I'm taking the right pills at the right time."" What should the nurse do with this information?
Teach the client how to tell the difference between the medicine bottles.
"The nurse is collecting data on a client with hyperthyroidism. What findings should the nurse expect?
Weight loss, nervousness, and tachycardia
"In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in:
serum glucose level.
"A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse would be accurate in telling him the regimen includes the use of:
short-acting insulin only.
"(SELECT ALL THAT APPLY) A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should the nurse include in her client teaching to ensure that this client is prepared for the test?
(1) Stop using iodized salt or iodized salt substitutes 1 week before the scan. (2) Stop eating seafood 1 week before the scan. (4) Don't take any prescribed thyroid medication on the day of the scan.
"(SELECT ALL THAT APPLY) A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan?
(2) High-fiber, low-calorie diet (4) Use of stool softeners (5) Thyroid hormone replacements
"Which intervention is the most critical for a client with myxedema coma?
Maintaining a patent airway
"During the first 24 hours after a client is diagnosed with addisonian crisis, which task should the nurse perform frequently?
Assess vital signs.
"(SELECT ALL THAT APPLY) A client is diagnosed with a goiter after traveling in a foreign country for 3 months. During her trip, the client wasn't able to tolerate food. Which signs and symptoms would the nurse expect to see in this client?
(2) Dizziness when raising her arms above her head (3) Dysphagia (5) Respiratory distress
"An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
10 to 15 g of a simple carbohydrate.
"The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?
Antidiuretic hormone (ADH)
"The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?
Calibrate the machine after installing a new battery.
"Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse would expect the client's symptoms to subside:
in 1 to 2 weeks.
"A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented. He has hot, dry skin and the following vital signs: a temperature of 100.6° F (38.1° C), a heart rate of 116 beats/minute, and a blood pressure of 108/70 mm Hg. Based on these findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
"The nurse should expect a client with hypothyroidism to report which health concerns?
Puffiness of the face and hands
"(SELECT ALL THAT APPLY) After falling off a ladder and suffering a brain injury, a client develops syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment he's receiving is effective?
(1) Decrease in body weight (4) Increased urine output (5) Decreased urine osmolarity
"(SELECT ALL THAT APPLY) A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms?
(1) Numbness (3) Tingling (4) Muscle twitching and spasms
"The nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
"A client brings her food journal containing her dietary intake for the past 3 days to the diabetic clinic. A nurse notes that despite dietary teaching about carbohydrate intake, the client consumed 3 servings of bread each day. What should the nurse do with this information?
Ask the diabetes educator to review with the client ways to decrease carbohydrate intake.
"The nurse administered isophane insulin suspension (NPH) to a diabetic client at 7 a.m. At what time would the nurse expect the client to be most at risk for a hypoglycemic reaction?
4 p.m.
"Laboratory studies indicate that a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose utilization?
A test of serum glycosylated hemoglobin (Hb A1c)
"The nurse is teaching the client about risk factors for diabetes mellitus. Which risk factor for diabetes mellitus is nonmodifiable?
Advanced age
"Which of the following is the most common cause of hyperaldosteronism?
An adrenal adenoma
"The nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Below-normal serum potassium level
"A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?
Cerebral edema
"A client with type 2 diabetes tells a nurse that he stopped walking at the mall because of his ""bad leg pain."" How should the nurse respond to this client?
Did you notify your physician when you started to have the leg pains?
"The nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse a hypoglycemic reaction, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?
Glucagon
"A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, which test should be performed?
Glycosylated hemoglobin level
"What does a positive Chvostek's sign indicate?
Hypocalcemia
"A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands her condition and how to control it?
I should avoid becoming dehydrated and pay attention to my need to urinate, drink, or eat more than usual.
"Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
"A client, age 23, is diagnosed with type 1 diabetes. The physician prescribes 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles the appropriate equipment, washes her hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?
Inject 35 units of air into the NPH vial; inject 15 units of air into the regular insulin vial and withdraw 15 units of regular insulin; and withdraw 35 units of NPH.
"A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan?
Maintain a moderate exercise program.
"For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range
"When administering spironolactone (Aldactone) to a client who has had a unilateral adrenalectomy, the nurse should instruct the client about which possible adverse effect of the drug?
Menstrual irregularities
"A client with type 1 diabetes takes 15 units of isophane insulin suspension (Humulin N) before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills and learns that the client is unaware that certain over-the-counter (OTC) preparations and other medications may interact with insulin. The nurse should advise the client to avoid which OTC preparations?
Preparations containing salicylates
"After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine (Synthroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
Primary hypothyroidism
"A client with type 1 diabetes must learn how to self-administer insulin. The physician has prescribed 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?
Rotate injection sites within the same anatomic region, not among different regions.
"A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes, which is controlled by tolazamide (Tolinase). What is the most important laboratory test for confirming HHNS?
Serum osmolarity
"Parathyroid hormone (PTH) has which effect on the kidneys?
Stimulation of calcium reabsorption and phosphate excretion
"A client is being returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
"A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
Trousseau's sign.
"A nurse administers bromocriptine (Parlodel) to a client diagnosed with acromegaly. After administering the medication, the nurse realizes that she gave the medication to the wrong client. What could have been done to prevent this error?
Verifying the client's identity on the identification band and medication administration record before providing the medication
"A client who has diabetic retinopathy comes to the emergency department with injuries sustained from tripping on a lamp cord. Which of the following statements would be appropriate for the nurse to make?
When you are ready to go home, would you like a home health care nurse to come, too? She can check for things that can be done to make sure you don't fall again.
"A client with type 1 diabetes tells a nurse in the clinic, ""I sometimes skip my insulin dose in the morning so I won't gain back any of the weight I've lost."" Which of the following would be an appropriate response for the nurse to make to this client?
You are worried about your weight? There are safer ways to prevent weight gain.
"A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?
You must avoid coughing, sneezing, and blowing your nose.
"When collecting data on a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:
a blood pressure of 176/88 mm Hg.
"A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:
a corticotropin-secreting pituitary adenoma.
"When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of foods such as:
bananas and potatoes.
"The nurse is caring for a client who's hypoglycemic. This client will have a blood glucose level:
below 70 mg/dl.
"The nurse is explaining the action of insulin to a client newly diagnosed with diabetes mellitus. During the teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the:
beta cells of the pancreas.
"A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial data collection findings, the nurse realizes the client's risk for injury is related to:
bone demineralization resulting in pathologic fractures.
"The client is being evaluated for hypothyroidism. The nurse should stay alert for:
decreased body temperature and cold intolerance.
"A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:
has type 2 diabetes.
"A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these findings, the nurse would suspect:
hyperparathyroidism.
"A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:
performing capillary glucose testing frequently.
"A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:
protruding eyes and a fixed stare.
"(SELECT ALL THAT APPLY) A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client?
(1) Excessive thirst (4) Excessive hunger (6) Frequent, high-volume urination
"(PUT IN ORDER) A client is ordered to receive 20 units of isophane insulin suspension (Humulin N) and 5 units of regular insulin (Humulin R) by subcutaneous injection. Place in chronological order the steps to take when mixing different types of insulin in a syringe. Use all the options.
(2) Inject 20 units of air into the Humulin N Vile (4) Withdrawl the syringe; don't withdrawl the insulin, (5) Inject 5 units of air into the Humulin R vile (1) Invert the vial and withdrawl the Humulin R Dose (3) Insert the syringe needle into the Humulin N vial (6) Invert the vial and withdral the Humulin N dose.
"A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that the client's initial dose for the thyroid replacement would be:
25 mcg/day.
"A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should help formulate a nursing diagnosis of:
Deficient knowledge.
"After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl. The physician adds glyburide (DiaBeta), 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take glyburide:
30 minutes before breakfast.
"A client with Cushing's syndrome is admitted to the medical-surgical unit. While collecting data, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
Depression
"A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?
Adrenal cortex
"The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
"A nurse is caring for a client with type 1 diabetes, who underwent a right hemicolectomy for colon cancer the day before. A physician prescribes the following sliding scale of regular insulin coverage every 6 hours for the client. Which action should the nurse take if the client's glucose level is 181 mg/dl?
Notify the physician.
"A nurse administers glucagon to her diabetic client and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?
Oral anticoagulants
"A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse helps formulate a nursing diagnosis of:
Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion.
"A client who has had type 2 diabetes for 20 years tells the nurse that sometimes she has diarrhea and other times constipation. In addition, she sometimes feels ""full"" after eating small amounts. Which of the following would be an appropriate response for the nurse to make?
Sometimes people with diabetes have problems with their digestion. Did you tell your physician about this?
"A nurse is prioritizing care for her four-client assignment. Which client should she attend to first?
The client who requires an insulin injection before eating breakfast
"A client with type 2 diabetes tells the nurse in the clinic, ""I keep gaining weight even though I'm not eating all that much. I can't exercise anymore because of these ulcers on my feet. I don't know what to do."" What would be an appropriate response for the nurse to make to this client?
There are other types of exercise that you can do even though you have ulcers on your feet.
"A diabetic client develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect may these findings have on his need for insulin?
They will increase the need for insulin.
"Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
"A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subQ. She awakens in 5 minutes. Why should her husband offer a complex carbohydrate snack to her as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
"Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for:
hypocortisolism
"An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
myxedema coma.
"A client with diabetes mellitus has just been prescribed insulin. When teaching the client about hypoglycemia, the nurse should mention that this reaction may cause:
nervousness, diaphoresis, and confusion.
"Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 units of regular insulin. The nurse should expect the dose's:
onset to be at 2:30 p.m. and its peak to be at 4 p.m.
"During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus.
"An obese Hispanic client, age 65, is diagnosed with type 2 diabetes mellitus. Which statement about diabetes mellitus is true?
Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites.
"When teaching a client about insulin administration, the nurse should include which instruction?
Draw up clear insulin first when mixing two types of insulin in one syringe.
"A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan?
Exercise and a weight reduction diet
"Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
"During a class on exercise for clients with diabetes mellitus, a client asks the nurse how often he should exercise. Which answer by the nurse is appropriate?
Follow a regular, individualized exercise plan.
"A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and her eyes feeling ""gritty."" Thyroid function tests reveal the following: a thyroid-stimulating hormone (TSH) level of 0.02 units/ml, a thyroxine level of 20 g/dl, and a triiodothyronine level of 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these findings, the nurse would suspect:
Graves' disease.
"A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's wife reports that she noticed that he acted confused and was extremely weak when he woke up in the morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. Which of the following would the nurse expect to administer by I.V. infusion?
Hydrocortisone
"On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
Hypocalcemia
"A client with type 1 diabetes has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
Hypoglycemia
"A client is taking an oral antidiabetic agent, to treat type 2 diabetes. Which statement indicates the need for further client teaching about treatment of this disease?
I often skip lunch because I don't feel hungry.
"A 78-year-old client with type 2 diabetes needs a kidney transplant. The client's daughter volunteers to donate a kidney, but the client voices concerns about her daughter's health to the nurse. Which response by the nurse is appropriate?
I'll notify your physician of your concerns and see if he can discuss the procedures with you.
"A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?
I'm thirsty all the time. I just can't get enough to drink.
"When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which action?
Increasing fluid intake
"The nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare to absorption at other sites?
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
"A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse would be most accurate in stating:
It tells us about your sugar control for the last 3 months.
"A client is prescribed prednisone (Deltasone) daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning?
Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern.
"A client with type 2 diabetes hasn't received insulin coverage for his afternoon blood glucose levels for 2 days. After further investigation, a nurse discovers that the afternoon blood glucose levels were phoned in from the laboratory but weren't documented in the client's medical record. What should the nurse do with this information?
Notify the physician and complete an incident report.
"When caring for a client with diabetes insipidus, the nurse expects to administer:
Vasopressin (Pitressin Synthetic).
"Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis?
Weight gain, decreased appetite, and constipation
"A client with adrenal hypofunction has been asked to participate in a research study for a new medication. The client is unsure about participating in the study. What would be an appropriate response for the nurse to make to this client?
You have the right to refuse to participate in the study.
"During preoperative teaching for a client who will undergo a subtotal thyroidectomy, the nurse should include which statement?
You must avoid hyperextending your neck after surgery.
"For a client with hyperthyroidism, treatment is most likely to include:
a thyroid hormone antagonist.
"When caring for a client who's being treated for hyperthyroidism, the nurse should:
balance the client's periods of activity and rest.
"The nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:
consuming a low-carbohydrate, high-protein diet and avoiding fasting.
The nurse is collecting data on a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:
deposits of adipose tissue in the trunk and dorsocervical area.
"Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience:
heat intolerance and systolic hypertension.
"The physician diagnoses type 1 diabetes in a client who has classic manifestations of the disease and a random blood glucose level of 350 mg/dl. In addition to dietary modifications, the physician prescribes insulin. Initially, most clients receive the least antigenic form of insulin. Therefore, the nurse expects the physician to prescribe:
human insulin.
"A client with Addison's disease comes to the clinic for a follow-up visit. When collecting data on this client, the nurse should stay alert for signs and symptoms of:
sodium and potassium abnormalities.
"The nurse is assigned to care for a postoperative client who has diabetes mellitus. During data collection, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
suggest referral to a sex counselor or other appropriate professional.
"The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
wash and inspect his feet daily.
"The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Levothyroxine (Synthroid)
"A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of:
profound neuromuscular irritability.
