Nclex Endocrine

1. Which statement by the client would make the nurse suspect the client may have type 1 diabetes? l 1. "I have gained about 30 pounds in the last few years." l 2. "I have to go to the bathroom and urinate all the time." l 3. "I have a sore on my big toe that is not healing." l 4. "I have a granddaughter who had gestational diabetes."

1. Correct answer 2: Polyuria, polyphagia, and polydip- sia are the three classic symptoms of type 1 diabetes. Being overweight and a non-healing wound are signs of type 2 diabetes.

10. The client newly diagnosed with type 1 diabetes asks the nurse, "Why am I hungry all the time?" Which statement is the nurse's best response? l 1. "You do not have enough insulin to allow sugar into the cells." l 2. "The insulin you have circulating is not effective for glucose metabolism." l 3. "The high sugar level in your blood causes the brain to think you are hungry." l 4. "The high glucose level prevents carbohydrates from being broken down."

10. Correct answer 1: Polyphagia occurs because there 11. is not enough insulin to allow glucose to enter the cell; therefore, the cell is starved for glucose, which makes the client feel hungry. Content-Medical;

12. The nurse is teaching a client newly diagnosed with type 2 diabetes. Which statement indicates the client needs more teaching? l 1. "IfI lose weight, it may help decrease my blood glucose level." l 2. "I must start counting my carbohydrates to help my diabetes." l 3. "I am so glad my children won't have to worry about getting diabetes." l 4. "IfI get any types of cuts on my feet, I need to watch them closely."

12. 13. Correct answer 3: A risk factor for developing type 2 diabetes is a family history; therefore, this state ment indicates the client needs more teaching. Obesity, carbohydrate counting, and delayed wound healing indicate the client understands the client teaching.

14. The nurse is caring for the client diagnosed with hyperglycemic, hyperosmolar nonketotic (HHNK) coma. Which intervention warrants immediate intervention by the nurse? l 1. The client's arterial blood gas reveals metabolic acidosis. l 2. The client's urine has 4+ ketones. l 3. The client's skin turgor is tented. l 4. The client has bilateral crackles in the lungs.

14. Correct answer 4: Bilateral crackles indicate the client is in fluid volume overload from fluid replacement. This requires immediate intervention. Metabolic acidosis and ketonuria occur in type 1 diabetes, not type 2 diabetes. The client in HHNK would be dehydrated; therefore, tented skin turgor would not warrant immediate intervention.

15. The nurse is administering metformin (Glucophage) to the client diagnosed with type 2 diabetes. Which statement best describes the scientific rationale for administering this medication? l 1. Glucophage prevents the breakdown of glucose in the liver. l 2. The medication increases the production of insulin in the beta cells. l 3. Metformin causes the muscle cells to be more receptive to circulating insulin. l 4. This medication slows the absorption of carbohydrates in the intestines.

15. 16. Correct answer 1: This is the scientific rationale for administering metformin (Glucophage) to a client with type 2 diabetes. Content-Medical; Category of Health Alteration-Drug

17. The charge nurse noted that the primary nurse administered metformin (Glucophage) to a client diagnosed with type 2 diabetes who is scheduled for a CT scan with contrast. Which action should the charge nurse implement first? l 1. Complete an adverse occurrence report. l 2. Notify the client's health-care provider (HCP). l 3. Call radiology and cancel the CT scan. l 4. Do not take any action at this time.

17. 18. Correct answer 3: Glucophage must be held 2 days before and 2 days after the contrast dye is adminis- tered to the client. The charge nurse should first can- cel the CT scan, then notify the HCP, and complete an adverse occurrence report.

19. The unlicensed assistive personnel (UAP) tells the nurse the client has a glucometer reading of 40. Which action should the nurse implement? l 1. Assess the client immediately. l 2. Tell the UAP to give the client orange juice. l 3. Prepare to administer an oral hypoglycemic medication. l 4. Contact the laboratory to confirm the client's blood glucose level.

19. 20. Correct answer 1: The client's blood glucose level is low (70-100 mg/dL); therefore, the nurse should assess the client immediately. The nurse cannot dele- gate an unstable client to the UAP.

2. The client diagnosed with type 1 diabetes is complaining of being jittery and nervous and has a headache. Which action should the nurse implement first? l 1. Check the client's SERUM glucose level. l 2. Determine the last time the client received insulin. l 3. Give the client one glass of orange juice. l 4. Assess the client's vital signs.

2. Correct answer 3: The client is having signs/symptoms of hypoglycemia; therefore, the nurse should provide the client with a simple carbohydrate. A serum glucose level requires a venipuncture, and then the laboratory must perform the test, which will take too long. The nurse can check the last insulin administration and assess vital signs after treating the client.

21. Which signs/symptoms should the nurse assess for the client diagnosed with Graves disease? l 1. Fatigue and bradycardia. l 2. Polyuria and polyphagia. l 3. Diarrhea and heat intolerance. l 4. Weight gain and thick brittle nails.

21. 22. Correct answer 3: Graves disease, a type of hyper- thyroidism, results in an increase in metabolism that results in symptoms that include weight loss, increased appetite, diarrhea, heat intolerance, and nervousness.

23. The nurse is caring for the client who is immediate postoperative thyroidectomy. Which data would warrant immediate intervention by the nurse? l 1. The client's hemoglobin/hematocrit is 12/36. l 2. The client's vital signs are T 99.4, AP 98, R 20, B/P 142/88 . l 3. The client is agitated and extremely anxious . l 4. The client's surgical dressing is dry and intact.

23. 24. 25. Correct answer 3: Thyroid storm is a life-threatening event caused by an oversecretion of thyroid hormone. It results in agitation, anxiety, fever, tachycardia, and hypertension?

3. The nurse administered 20 units of NPH intermediate- acting insulin to a client diagnosed with type 1 diabetes at 1630. Which intervention should the nurse implement? l 1. Give the client the bedtime snack. l 2. Ensure the client eats the evening meal. l 3. Perform a glucometer check at 1800. l 4. Check the client's urine for ketones.

3. Correct answer 1: The intermediate-acting insulin peaks in 6-8 hours, and the client needs glucose to prevent hypoglycemia; therefore, the client needs to eat a bedtime snack.

33. The nurse is caring for a client diagnosed with Addison disease. Which nursing interventions should be implemented? l 1. Place the client in contact isolation. l 2. Administer intravenous and oral steroid medications. l 3. Provide a brightly lit room and recreational activities. l 4. Consult occupational therapy for work retraining.

33. 34. Correct answer 2: Clients diagnosed with Addison disease have adrenal gland hypofunction. The client will require glucocorticosteroids, mineral steroids, and androgens.

35. The client admitted for chronic obstructive pulmonary disease (COPD) has developed iatrogenic Cushing disease. Which is a scientific rationale for the development of this problem? l 1. The client's chronic lack of oxygen has destroyed the adrenal glands. l 2. The client has a pituitary tumor that causes an overproduction of cortisol. l 3. The client has been taking steroid medications for an extended time. l 4. The HCP cannot explain why the client has this problem.

35. Correct answer 3: Iatrogenic means that a problem has been caused by the medical treatment or procedure used to treat another problem. Clients taking exoge- nous steroids over a period of time, such as those with COPD, develop the clinical manifestations of Cushing disease. Disease processes for which long-term steroids are prescribed include COPD, cancer, and arthritis.

36. The nurse is performing discharge teaching for a client diagnosed with Cushing disease. Which statement made by the client indicates the client needs further discharge instructions? l 1. "I will be sure to notify my HCP ifI start to run a fever." l 2. "Before I stop taking the prednisone, I will be taught how to taper it off." l 3. "IfI get thirsty and urinate a lot, I should let my doctor know." l 4. "I should be sure and take safety precautions to prevent an injury."

36. Correct answer 2: The client has too much cortisol and would not be on prednisone, a steroid medica- tion. The nurse should clarify the instructions with the client. Content-Medical; Category of Health Alteration-Endocrine;

37. The charge nurse of an intensive care unit (ICU) is making assignments for the night shift. Which client should be assigned to the least experienced ICU nurse? l 1. The client with respiratory failure who is on a ventilator who has a tension pneumothorax. l 2. The client with iatrogenic Cushing disease with a pH 7.35, O2 88, PCO2 44, and HCO3 22. l 3. The client with Addison disease who is lethargic and has BP 80/45, P 124, R 28. l 4. The client who has undergone a thyroidectomy and has a positive Trousseau sign.

37. Correct answer 2: This client has normal arterial blood gases. The nurse with the least experience should be able to care for this client. A tension pneumothorax is an emergency; the client diagnosed with Addison disease may be in crisis; and a positive Trousseau sign indicates hypocalcemia.

4. The nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA) who has a blood glucose level of 510 mg/dL. Which priority intervention should the intensive care nurse implement? l 1. Administer intravenous regular insulin. l 2. Monitor the client's intake and output. l 3. Check the client's glucose level frequently. l 4. Turn the client every 2 hours.

4. Correct answer 1: Administering intravenous regular insulin is priority because the blood glucose must be lowered to help reverse the client's metabolic acidosis. Assessing the glucose level, urine output, and turning the client are appropriate interventions, but they are not priority over decreasing the glucose level.

42. The nurse is caring for a client who is 8 hours post transphenoidal hyposphysectomy for a pituitary tumor. Which data would warrant immediate intervention by the nurse? l 1. The client has clear straw-colored fluid draining from the nose. l 2. The client has an 8-hour urine output of 330 mL and an input of 280 mL. l 3. The client's vital signs are T 97.6ºF, P 88, R 20, BP 130/80. l 4. The client has a 3-cm amount of dark red drainage on the turban dressing.

42. 43. Correct answer 1: A transphenoidal hypophysectomy is performed by surgical access above the gum line; therefore, the nurse should test the drainage from the nose to determine if it is cerebrospinal fluid. The input and output is within normal limits; the vital signs are stable; and the client does not have a turban (head) dressing.

44. The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which intervention should the nurse implement when conducting a fluid deprivation test? l 1. Have the client drink 500 mL of hyperosmolar fluid and obtain a serum sodium level hourly. l 2. Inject an antidiuretic hormone and measure the client's urine output for 8-10 hours. l 3. Keep the client NPO and check vital signs and weight hourly until the end of the test . l 4. Initiate an IV line with normal saline and do not allow the client to urinate until the sonogram is completed.

44. Correct answer 3: The client is deprived of all fluids; if the client has DI, the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated.

45. The nurse is caring for clients in a medical department. Which client should the nurse assess first? l 1. The client diagnosed with SIADH who is lethargic and confused. l 2. The client diagnosed with diabetes insipidus (DI) who has urinated 10,450 mL of urine in the last 24 hours. l 3. The client diagnosed with SIADH who is complaining of being thirsty. l 4. The client diagnosed with DI who is complaining of urinating every hour during the night.

45. 46. Correct answer 1: If the client with SIADH devel ops lethargy and confusion, it could lead to seizures and coma. Therefore, this client needs to be assessed first. The other options include signs/symptoms associated with the disease process.

47. The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which interventions should be implemented? Select all that apply. l 1. Restrict fluid intake to no more than 1000 mL/day. l 2. Administer DDAVP, an anti-diuretic hormone. l 3. Assess the client for signs of water intoxication. l 4. Place the client on seizure precautions.

47. 48. Correct answer: 2, 3, 5. The treatment for DI is hormone replacement with DDAVP and assessment for signs of hyponatremia, water intoxication, weight gain, and headache, which indicate the medication is not effective. Interventions for syndrome of inappro- priate antidiuretic hormone include restricting fluids and seizure precautions.

49. The UAP complains to the nurse that the client keeps asking for cold water to drink. The client is diagnosed with a closed head injury. Which intervention should the nurse implement first? l 1. Tell the UAP to give the client cold water. l 2. Evaluate the client's intake and output. l 3. Ask the UAP to check the client's weight. l 4. Check the client's BUN and creatinine levels.

49. 50. Correct answer 2: Diabetes insipidus is a complica tion of head trauma; therefore, the nurse should evaluate the client's intake and output to determine if the client has increased urinary output. Then, the nurse could document the client's weight, check renal function (BUN and creatinine levels), and give the client cold water.

5. The nurse is teaching the client newly diagnosed with type 1 diabetes. Which information should the nurse include in the teaching plan? Select all that apply. l 1. Discuss the importance of checking the feet weekly. l 2. Encourage the client to walk for at least 30 minutes a day. l 3. Recommend the client to the American Diabetic Association (ADA). l 4. Explain the need to wear SPF 30 sunscreen when in the sun. l 5. Tell the client to get an ophthalmology check-up yearly.

5. Correct answer 2, 3, 5: The treatment for type 1 diabetes is insulin, exercise, and diet. The ADA is an excellent resource for clients. Diabetic retinopathy is a long-term complication; therefore, regular eye check- ups are needed. The client should check the feet daily, not weekly. Sunscreen is not a part of diabetic teach- ing.

51. The nurse is admitting a client diagnosed with rule-out (R/O) acute pancreatitis. Which laboratory value should the nurse monitor? l 1. Serum SGOT and serum SGPT. l 2. Hemoglobin and hematocrit. l 3. Serum amylase and lipase . l 4. Serum bilirubin and calcium.

51. 52. Correct answer 3: Serum amylase rises within 2-12 hours of onset of acute pancreatitis to two to three times normal and returns to normal in 3-4 days; lipase elevates and remains elevated for 7-14 days. Amylase and lipase are produced by the pancreas.

6. The client diagnosed with DKA asks the nurse, "Why are you checking my urine with that stick?" Which statement is the nurse's best response? l 1. "I am checking your urine to see if glucose is spilling into the urine." l 2. "This test determines if ketones from fat breakdown are in your urine." l 3. "Your doctor needs to know the specific gravity of your urine." l 4. "I need to find out if there is any protein in your urine output."

6. Correct answer 2: Fat breakdown results in ketone production, and the urine is checked for ketonuria. The glucose level is checked by glucometer readings, not in urine output.

60. The client diagnosed with an acute exacerbation of chronic pancreatitis has a nasogastric tube and is NPO. Which interventions should the nurse implement? Select all that apply. l 1. Monitor serum amylase and lipase. l 2. Weigh the client weekly. l 3. Assess the intravenous site. l 4. Provide perineal care. l 5. Monitor blood glucose levels.

60. 61. Correct answer 1, 3, 5: Amylase and lipase are pan- creatic enzymes and are monitored to assess the sta- tus of the problem. The nurse should assess the IV for signs of infection or infiltration. Blood glu- cose levels are monitored because clients with chronic pancreatitis can develop diabetes mellitus. Content-Medical; Category of Health Alteration-

62. The charge nurse is reviewing laboratory data. Which data require immediate intervention? l 1. A creatinine level of 2.8 mg/dL in a client diagnosed with primary hyperparathyroidism. l 2. A serum calcium level of 9.2 mg/dL in a client diagnosed with Addison disease. l 3. A serum triglyceride level of 130 mg/dL in a client diagnosed with diabetes mellitus type 2. l 4. A sodium level of 135 mEq/L in a client diagnosed with an acute exacerbation of diabetes insipidus.

62. Correct answer 1: This would indicate the client is in renal failure, which is a complication of hyper- parathyroidism. Stones related to the increased urinary excretion of calcium and phosphorus form in the kidneys. This occurs in about 55% of clients with primary hyperparathyroidism and can lead to renal failure. All other values are within normal limits.

63. The nurse and UAP are caring for a client diagnosed with a pheochromocytoma. Which nursing task should the nurse delegate to the UAP? l 1. Instruct the UAP to show the client how to work the call light system. l 2. Inspect the client's skin for signs of lesions or discoloration. l 3. Talk to the client about providing a family history of adrenal tumors. l 4. Ask how the high blood pressure has made the client feel in the past.

63. 64. Correct answer 1: The UAP can orient a new client to the room and make sure the client is able to work the call light system. The other options include obtaining assessment data, and the nurse must perform these tasks. A family history of adrenal tumors is a risk factor for a pheochromocytoma.

66. The charge nurse on a medical unit is making rounds after the shift report. Which client should the charge nurse assess first? l 1. The adolescent male client who uses anabolic steroids to increase his muscle size for football. l 2. The elderly client diagnosed with COPD who expectorated rusty-colored sputum during the night. l 3. The female client who refuses to remove her gown because of the striae from taking steroids. l 4. The client whose blood glucose reading averages 140 mg/dL since being placed on steroids.

66. 67. Correct answer 2: Clients diagnosed with COPD are placed on long-term steroids because of the inflammation in their lungs. This can mask infection. Frequently the only sign of an infection in these clients is a change in the character of the sputum or a rusty color. The charge nurse should see this client first.

7. The nurse is discussing exercise with the client diagnosed with type 1 diabetes. Which intervention should the nurse discuss with the client? l 1. Instruct the client to eat a simple source of carbohydrate before walking. l 2. Tell the client to wear open-toed supportive shoes when walking. l 3. Explain that the client should carry hard candies when exercising. l 4. Recommend the client perform isometric exercises three times a week.

7. Correct answer 3: The client should carry a simple carbohydrate, such as hard candies, while exercising in case the client becomes hypoglycemic. The client should eat a complex carbohydrate prior to walking, wear closed toes tennis shoes, and perform isotonic exercises. Isometric is weight-lifting.

8. The intensive care nurse is caring for the client diagnosed with DKA. Which data indicate the client is responding to the medical regime? l 1. The client is exhibiting Kussmaul breathing. l 2. The client's serum glucose level is 220 mg/dL. l 3. The client buccal mucosa is pink and moist. l 4. The client's arterial blood gases (ABGs) are pH 7.34, PaO2 90,PaCO2 44, HCO3 20.

8. Correct answer 3: A pink and moist buccal mucosa indicates the client is well hydrated, which means the client is responding to the medical regime. Kussmaul breathing, an elevated glucose level, and metabolic acidosis indicate the medical regime is not effective.

9. The client diagnosed with type 1 diabetes called the clinic and told the nurse, "I am nauseated and vomiting. I think I have a bug." Which statement should be the nurse's best response? l 1. "I will make an appointment for you to come to the clinic today." l 2. "Do not take your routine insulin dosage if you cannot eat." l 3. "Is anyone else in your home nauseated and vomiting?" l 4. "Take your insulin and drink foods high in carbohydrates such as Jello."

9. Correct answer 4: The client must continue to take the routine insulin dosage because illness increases the glucose level. The client should consume foods high in carbohydrates, such as Jello, orange juice, puddings, and regular Coke, to prevent hypoglycemia.

52. The nurse is caring for a client diagnosed with acute pancreatitis on a medical unit. Which client problems should be included in the client's plan of care? Select all that apply. l 1. Risk for hemorrhage. l 2. Alteration in comfort. l 3. Imbalanced nutrition: less the body requirements. l 4. Knowledge deficit. l 5. Impaired gas exchange.

Correct answer 1, 2, 3, 4: Clients diagnosed with pancreatitis are at risk for hemorrhage if the digestive juices erode a blood vessel. Autodigestion of the pancreas results in severe epigastric pain accompa- nied by nausea and vomiting. The client will have nothing by mouth, so nutrition is a problem, and acute problems usually have some knowledge deficit.

22. The client is postoperative bilateral thyroidectomy. Which intervention should the nurse implement? l 1. Place a tracheostomy tray at the bedside. l 2. Have potassium chloride easily accessible. l 3. Administer propylthiouracil (PTU), an antithyroid medication. l 4. Monitor the client's thyroid hormone levels, T3 and T4.

Correct answer 1: A postoperative complication of a bilateral thyroidectomy is laryngeal edema; therefore, a tracheostomy tray, oxygen, and a suction machine should be placed at the bedside. PTU may be administered preoperatively; the T3 and T4 levels are not monitored after surgery.

50. The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory data would warrant intervention by the nurse? l 1. The client has a serum sodium of 120 mEq/L. l 2. The client has a serum potassium of 5.0 mEq/L. l 3. The client has serum creatinine of 1.8 g/day. l 4. The client has negative glucose in the urine.

Correct answer 1: A serum sodium level of 120 mEq/L is dangerously low, and the client is at risk for seizures; therefore, the nurse should inter- vene. All the other laboratory data are normal. Content-Medical;

38. The nurse writes a problem of "altered glucose metabolism" for a client diagnosed with Cushing disease. Which interventions should the nurse implement? l 1. Monitor blood glucose levels before meals and at bedtime. l 2. Perform a head-to-toe assessment every shift. l 3. Use therapeutic communication to allow the client to discuss feelings. l 4. Assess bowel sounds and temperature every 4 hours.

Correct answer 1: Blood glucose levels should be obtained to monitor for the effects of insulin resis- tance caused by Cushing disease.

The nurse assessing the client diagnosed with pancreatitis notes the client has a bluish discoloration around the umbilicus. Which intervention should the nurse implement next? l 1. Assess the left flank for bruising. l 2. Check the chart for the latest hemoglobin. l 3. Note the finding in the chart. l 4. Notify the HCP.

Correct answer 1: Bluish discoloration around the umbilicus (Cullen sign) is an indicator of intraperi- toneal hemorrhage. Grey-Turner sign is bluish discoloration in the left flank area. The nurse should complete the assessment of the client before notifying the HCP, documenting the finding, or looking at lab values. Content-Medical;

31. The nurse is admitting a client who has been diagnosed with primary adrenal cortex insufficiency (Addison disease). Which signs and symptoms support the diagnosis of Addison disease? l 1. Bronze pigmentation, hypotension, and anorexia. l 2. Moon face, buffalo hump, and hyperglycemia. l 3. Hirsutism, fever, and irritability. l 4. Tachycardia, bulging eyes, and goiter.

Correct answer 1: Bronze pigmentation of the skin, particularly of the knuckles and other areas of skin creases, occurs in Addison disease. Hypotension and anorexia also occur. Moon face, buffalo hump, and hyperglycemia are due to Cushing syndrome, which is hyperfunction of the adrenal gland.

55. The charge nurse is transcribing orders for a client diagnosed with chronic pancreatitis. The HCP ordered Librium intravenously every 8 hours. Which action by the charge nurse would be most appropriate? l 1. Move the client to a room near the nurse's station. l 2. Question the HCP about the medication. l 3. Do nothing except transcribe the order as is. l 4. Have the lab draw a serum Librium level.

Correct answer 1: Chronic pancreatitis is frequently caused by alcoholism. Librium is prescribed to limit the neurological effect of alcohol withdrawal. The client should be moved close to the nurse's station for observation. Content-Medical;

57. The male client diagnosed with chronic pancreatitis reports to the clinic nurse that he has been having a lot of "gas" and frothy, foul-smelling stools. Which statement is the nurse's best response? l 1. "How often and when do you take your pancreatic enzymes?" l 2. "Can you bring a stool specimen to the clinic for analysis?" l 3. "You must come into the clinic and see the HCP." l 4. "You should stay on low-fat diet or this will continue to happen."

Correct answer 1: Clients diagnosed with chronic pancreatitis are prescribed replacement enzymes that should be taken with every meal and snack. The nurse should assess if the client is compliant with the medication regimen before telling the client to come in to see the HCP.

43. The nurse is discharging the client newly diagnosed with diabetes insipidus (DI). Which statement made by the client indicates the client understands the discharge teaching? l 1. "I will keep a list of my medications with me and wear a Medic-Alert bracelet." l 2. "I should take my medication in the morning and leave it refrigerated at home." l 3. "I should weigh myself once a week and keep a journal of my weight." l 4. "It is not uncommon to develop a tightness in my chest early in the morning."

Correct answer 1: DI is a chronic illness that requires daily medication; therefore, the client should keep a list of medication being taken and wear a Medic-Alert bracelet. DI medication is taken every 8-12 hours and should be kept close at hand. The client should weigh daily, and it is not common to have chest tightness. Content-Medical;

24. The clinic nurse is caring for a client diagnosed with hyperthyroidism. Which information should the nurse discuss with the client? l 1. Maintain a calm, restful environment. l 2. Eat a low-calorie, low-protein diet. l 3. Take the thyroid hormone with food. l 4. Wear thick-weaved clothes in the sun.

Correct answer 1: The client is nervous and anxious; therefore, maintaining a calm, restful environment is an appropriate intervention. The client should eat a high-calorie, high-protein, low-caffeine diet.

67. Which client should the charge nurse in the ICU assign to the most experienced nurse? l 1. The client diagnosed with thyroid storm who is 1 hour postoperative thyroidectomy. l 2. The client diagnosed with end-stage renal failure (ESRD) who had 30 mL of urine output on the last shift. l 3. The client diagnosed with diabetic ketoacidosis whose last serum glucose was 220 mg/dL. l 4. The client diagnosed with pheochromocytoma whose blood pressure is 146/92.

Correct answer 1: This client has the greatest potential for being unstable and requires an experi- enced ICU nurse. The nurse should assess for signs/symptoms of complications. Any output in a client with ESRD is good. A serum glucose under 240 mg/dL means the client is no longer in diabetic ketoacidosis. A pheochromocytoma causes extremely high blood pressure readings. This client is stable.

68. The home health nurse is caring for a client recently placed on thyroid hormone replacement medication. Which signs/symptoms would indicate to the nurse the client is taking too much medication? l 1. Complaints of weight loss and fine tremors. l 2. Complaints of excessive thirst and urination. l 3. Complaints of constipation and being cold. l 4. Complaints of delayed wound healing and belching.

Correct answer 1: This would make the nurse sus- pect the client is taking too much thyroid hormone because these are symptoms of hyperthyroidism. Excessive thirst and urination are symptoms of diabetes. Constipation and feeling cold indicate that the client is not taking enough thyroid hormone. Delayed wound healing and belching would indicate Cushing disease.

26. The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid), a hormone replacement. Which data indicate the medication is effective? l 1. The client has lost 4 lb in 1 week. l 2. The client's radial pulse is 88. l 3. The client complains of being cold. l 4. The client's temperature is 97.0ºF.

Correct answer 2: A radial pulse between 60 and 100 indicates the medication is effective. Weight loss indicates taking too much medication. Being cold and having a subnormal temperature indicate not enough medication.

30. Which medication teaching should the nurse discuss with the client diagnosed with hypothyroidism who is prescribed levothyroxine (Synthroid)? l 1. Explain the need to monitor thyroid levels daily. l 2. Inform the client to avoid foods high in iodine. l 3. Instruct the client to monitor weight monthly. l 4. Tell the client chest pain may occur while taking medication.

Correct answer 2: Foods high in iodine will cause the levothyroxine not to be effective. Thyroid level is monitored monthly, not daily. Weights should be daily, not monthly. Synthroid should be adminis- tered cautiously in clients with cardiovascular disease.

53. The nurse is preparing to administer morning medications to the following clients. Which medication should the nurse question before administering? l 1. The pancreatic enzymes to the client who is no longer NPO. l 2. The pain medication morphine to the client diagnosed with pancreatitis. l 3. The loop diuretic to the client diagnosed with heart failure. l 4. The beta-blocker to the client who has an apical pulse of 78 beats per minute (bpm).

Correct answer 2: Morphine causes spasms of the sphincter of Oddi; the pain medication of choice for clients diagnosed with pancreatitis is meperidine.

34. The nurse is admitting the client diagnosed with rule-out Cushing syndrome. Which laboratory tests would confirm the diagnosis of Cushing syndrome? l 1. Complete blood count (CBC) and erythrocyte sedimentation rate (ESR). l 2. Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol. l 3. 24-hour urine for metanephrine and catecholamine. l 4. Early morning spot urine specimen for protein and glucose.

Correct answer 2: The adrenal gland secretes cortisol; the pituitary gland secretes adrenocorticotropic hormone (ACTH), a hormone used by the body to stimulate the production of cortisol. Twenty-four-hour urine specimens for 17-hydroxycorticosteroids and 17-ketosteroids may be collected to determine the client's urine cortisol level.

41. The client diagnosed with a pituitary tumor has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which intervention should the nurse implement? l 1. Assess the client for tented skin turgor. l 2. Weigh the client daily at the same time. l 3. Monitor the client's serum potassium level. l 4. Perform a fluid deprivation test on the client.

Correct answer 2: The client with SIADH is pro- ducing a hormone that will not allow the client to urinate; therefore, weighing the client daily would be appropriate. The client experiences fluid volume overload, not dehydration, so assessment for skin turgor is not needed. Dilutional hyponatremia is assessed to detect the level of sodium, not potassium, in the blood, and a water challenge test is performed, not a fluid deprivation test.

28. The clinic nurse is teaching the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? l 1. Tell the client to decrease fluid intake to 1000 mL a day. 2 Encourage the client to eat foods high in fiber. 3 Recommend the client take a daily laxative. 4. Discourage the client from eating fresh fruits and vegetables.

Correct answer 2: The client with hypothyroidism experiences constipation; therefore, the client should have a diet high in fiber. The client should also increase fluid intake to 3000 mL a day. The nurse should dis- courage daily laxatives or enemas. Content-Medical; Category of Health Alteration-Endocrine;

20. The clinic nurse is caring for a client newly diagnosed with type 2 diabetes. Which referral would be most appropriate for the nurse to discuss with the client? l 1. Refer the client to an endocrinologist. l 2. Refer the client to a registered dietitian. l 3. Refer the client to the home health nurse. l 4. Refer the client to a social worker.

Correct answer 2: The client with type 2 diabetes needs to be on a carbohydrate counting diet; there- fore, a referral to the registered dietitian would be most appropriate. The nurse does not refer a client to an endocrinologist. A home health nurse or social worker would not be appropriate referrals for a newly diagnosed type 2 diabetic client. Content- Medical; Category of Health Alteration-Endocrine;

65. The female client diagnosed with Cushing disease asks the nurse. "How long will I look like this? I feel like a freak." Which response by the nurse best illustrates the ethical principal of fidelity? l 1. "You feel like you look abnormal? We should discuss how you are feeling about your body." l 2. "Some of the changes to your body may improve with treatment, but there is no guarantee." l 3. "Your body will return to the way it looked before after your adrenalectomy surgery." l 4. "I am not sure what you mean by 'freak.' Tell why you are bothered about your body."

Correct answer 2: The ethical principal of fidelity means to treat all clients the same and how the nurse would like to be treated. It is the principle on which the nurse-client relationship is built. This option tells the client the truth and provides the client with the opportunity to ask for more clarification.

39. The client diagnosed with possible Addison disease is admitted to the emergency department. The client is lethargic, confused, and weak. Which intervention should the emergency department implement first? l 1. Have the lab draw serum cortisol levels stat. l 2. Check the client's medic alert bracelet to confirm Addison disease. l 3. Administer replacement steroids intravenously. l 4. Start an intravenous line and administer normal saline rapidly.

Correct answer 2: The nurse should look for an iden- tification band alerting the health-care professional of a chronic disease and then start the intravenous line and administer steroids.

61. The nurse is teaching a class to teachers in an elementary school about children diagnosed with hyperinsulinemia. Which would explain the development of hyperinsulinemia in children? l 1. The islet cells in the pancreas stop producing any insulin, leading to type 2 diabetes. l 2. The child has an excessive intake of calories related to the amount of energy the child uses. l 3. The pituitary gland signals the pancreas to increase the amount of insulin produced. l 4. Hyperinsulinemia is a precursor to developing type 1 diabetes mellitus in children.

Correct answer 2: The pancreas responds to exces- sive caloric intake by secreting more insulin to main- tain a normal blood glucose level. Hyperinsulinemia can be identified by markers known as acanthosis nigricans. This is a precursor to type 2 diabetes. Clients with type 1 diabetes have no insulin produc- tion, and the pituitary gland does not stimulate insulin production.

13. The client newly diagnosed with type 2 diabetes tells the nurse, "I don't understand why I need to keep my sugar down. I don't feel bad." Which statement is the nurse's best response? l 1. "You are concerned you don't feel bad because your sugar level is high." l 2. "With time your high sugar level can cause blindness or kidney failure." l 3. "If you don't keep your sugar down you may start feeling bad." l 4. "A high sugar level can cause you to gain weight over time."

Correct answer 2: Type 2 diabetes can lead to long-term complications such as blindness, diabetic nephropathy, peripheral neuropathy, and heart disease.

46. The HCP has ordered 60 g/24 hours of intranasal vasopressin for a client diagnosed with diabetes insipidus. Each metered spray delivers 10 g. The client takes the medication every 12 hours. How many sprays are delivered at each dosing time? Answer: ____________________

Correct answer 3 sprays per dose: 60 g of medication every 24 hours to be given every 12 hours. Twelve hours into 24 hours = 2, so there will be 2 dosing times. Sixty divided by 2 = 30 g of medication per dose. 30 g divided by 10 g per spray = 3 sprays per dose.

70. Which laboratory data indicate the client's pancreatitis is deteriorating? l 1. The amylase and lipase serum levels are decreased. l 2. The white blood cell count (WBC) is decreased. l 3. The hematocrit has decreased by 5% in a 24-hour period. l 4. The blood urea nitrogen (BUN) serum level is decreased.

Correct answer 3: A 5% decrease in the hematocrit excruciating pain because the enzymes are autodi- gesting the pancreas; severe abdominal pain is the hallmark symptom of pancreatitis. Content-Medical; Category of Health Alteration-Endocrine; Integrated Process-Diagnosis; Client Needs-Physiological Integrity, Physiological Adaptation; Cognitive Level-Application. level indicates the client is bleeding, probably from the pancreatic enzymes eating into a blood vessel. Hemorrhage indicates the client's condition is deteriorating. Decreased amylase and lipase would mean the client is improving.

56. The nurse is completing discharge teaching to the client diagnosed with acute pancreatitis. Which instruction should the nurse discuss with the client? l 1. Instruct the client to decrease the amount of smoking. l 2. Explain the need to avoid all stress. l 3. Discuss the importance of avoiding alcohol. l 4. Teach the correct way to take pancreatic enzymes.

Correct answer 3: Alcohol must be avoided entirely because it can cause stones to form, blocking pancre- atic ducts and the outflow of pancreatic juice, which, in turn, causes further inflammation and destruction of the pancreas. The client should stop smoking. Pancreatic enzymes are prescribed for chronic pancreatitis. Content-Medical;

27. Which statement by the client would make the nurse suspect the client has hypothyroidism? l 1. "I wake up at night feeling hot all over." l 2. "I have a bowel movement once a day." l 3. "I keep putting lotion on my dry skin." l 4. "I have trouble going to sleep at night."

Correct answer 3: The client with hypothyroidism has dry skin; thin, dry hair; cold intolerance, consti pation, dull emotions, and fatigue.

59. The nurse is caring for a client diagnosed with acute pancreatitis. The client is complaining of mid-epigastric pain unrelieved by narcotic pain medication administered 45 minutes ago. The narcotic medication is prescribed every 4 hours prn. Which intervention should the nurse implement next? l 1. Tell the client to lie in the prone position with legs extended. l 2. Call the HCP for an increase in the pain medication. l 3. Place the client in side-lying position with knees flexed. l 4. Explain that the nurse cannot administer more medication for 3 hours.

Correct answer 3: The fetal position decreases pain caused by stretching of the peritoneum due to edema. If nonpharmacological methods fail to relieve the client's pain, then the nurse should discuss the client's pain level with the HCP. Content-Medical;

16. The nurse in the diabetes clinic is triaging phone calls from clients. Which client should the nurse call first? l 1. The client who needs to reschedule an appointment as soon as possible. l 2. The client who needs a prescription refill for oral hypoglycemics. l 3. The client who has a wound on the left foot that looks infected. l 4. The client who has had loose runny stools for the last 2 days.

Correct answer 4: Acute illness leads to an increase in the client's glucose level and may lead to dehydra- tion; therefore, the nurse should return this client's call first. Then, call the client who has an infected foot.

64. The nurse is caring for a client 3 days postoperative unilateral adrenalectomy. Which statement by the client indicates the client understands the discharge teaching? l 1. "I will need to taper off my steroid medications when I no longer need them." l 2. "I will use my intranasal vasopressin when I start to go to the bathroom a lot." l 3. "My urinary catheter will have to stay in until I can develop bladder control." l 4. "I should call my surgeon ifI start running a temperature over 101ºF."

Correct answer 4: Any temperature greater than 101ºF would indicate an infection, and the client will need to be on antibiotics; therefore, the health- care provider must be notified. The client still has one adrenal gland and will not be on steroid medica- tions. The client does not have diabetes insipidus and will not be on vasopression. The client will not go home with an indwelling catheter.

32. The nurse is caring for a client diagnosed with acquired immune deficiency syndrome (AIDS) who has developed an infection in the adrenal gland. Which client problem has the highest priority? l 1. Altered body image. l 2. Activity intolerance. l 3. Impaired coping. l 4. Fluid volume deficit.

Correct answer 4: Fluid volume deficit (dehydration) can lead to circulatory impairment and hyperkalemia. Fluid volume deficit is the only physiological prob- lem and should be chosen for this reason. Content- Medical; Category of Health Alteration-Endocrine;

29. The client is diagnosed with myxedema coma. Which signs/symptoms would the nurse expect the client to exhibit? l 1. The client's blood pressure is 110/70. l 2. The client's serum sodium level is 138 mEq/L. l 3. The client's respirations are 16 beats per minute. l 4. The client's serum glucose level is 60 mg/dL.

Correct answer 4: The client diagnosed with myxedema coma experiences hypotension, hypother- mia, hypoglycemia, hyponatremia, and respiratory failure. A serum glucose level of 60 mg/dL indicates hypoglycemia. The blood pressure, sodium level, and 30. respirations are within normal limits and would not indicate myxedema coma.

Type 2 Diabetes 11. The nurse is caring for a client newly diagnosed with type 2 diabetes. Which intervention should the nurse implement? l 1. Administer pancreatic enzymes. l 2. Monitor the client's arterial blood gases. l 3. Assess the client for ketonuria. l 4. Administer oral hypoglycemic medications.

Correct answer 4: The client diagnosed with type 2 diabetes is treated with oral hypoglycemics. Changes in arterial blood gases and diabetic ketoacidosis occur in a client diagnosed with type 1 diabetes. Pancreatic enzymes are not administered to clients

48. The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which nursing intervention should be implemented? l 1. Monitor blood glucose before meals and at bedtime. l 2. Restrict caffeinated coffee and colas. l 3. Check the client's urine for ketonuria. l 4. Assess the client's oral mucosa every 4 hours.

Correct answer 4: The client is excreting large amounts of dilute urine. If the client is unable to take in enough fluids, the client will quickly become dehydrated. DI is not diabetes mellitus, so glucose levels and ketones are not checked. There is no caf- feine restriction for DI.

25. The client diagnosed with Graves disease received iodine 131, radioactive iodine. Which statement indicates the client needs more teaching? l 1. "I should not be around young children and pregnant women." l 2. "It is important for me to flush my commode twice after I urinate." l 3. "It is not uncommon to vomit after taking the radioactive iodine." l 4. "I will have to wear a radioactive badge during the treatment."

Correct answer 4: The client is not radioactive and does not have to wear a radioactive badge. The client's body fluids are, however, radioactive; there- fore, the client should not be around young children or pregnant women and should flush the commode 26. twice after urinating. Iodine 131 is very irritating to the gastrointestinal tract and the client may vomit.

58. The nurse is caring for a client who has just returned from an endoscopic retrograde cholangiopancreatogram (ERCP). Which post-procedure intervention should the nurse implement? l 1. Have the client swallow some water. l 2. Place the bed in a semi-Fowler position. l 3. Assess for the gag reflex. l 4. Prop the client in a side-lying position.

Correct answer 4: The client returning from this procedure will have had twilight sleep, and the throat will have been numbed. The client should be allowed to sleep until the medication wears off. Placing the client on the side will prevent aspiration if the client should vomit. After client wakes up, the nurse should check for the gag reflex prior to allow ing the client to swallow water.

18. The nurse is checking laboratory data for clients. Which laboratory data warrant notifying the HCP? l 1. The client with type 2 diabetes whose fasting blood glucose is 185 mg/dL. l 2. The client with type 2 diabetes who has negative ketones in the urine. 3. The client with type 2 diabetes who has a serum creatinine level of 1.8 mg/dL. l 4. The client with type 2 diabetes who has a serum potassium level of 3.3 mEq/L.

Correct answer 4: The client who has a low potassium level (3.5-5.5 mEq is normal) is at risk for dysrhyth- mias; therefore, the nurse should contact the client's HCP. A blood glucose level of 185 mg/dL is not life-threatening

69. The nurse is planning the care of the client diagnosed with acute pancreatitis. Which client problem is the priority concern for the client? l 1. Impaired nutrition. l 2. Altered skin integrity. l 3. Ineffective coping. l 4. Alteration in comfort.

Correct answer 4: The client with pancreatitis is in excruciating pain because the enzymes are autodi- gesting the pancreas; severe abdominal pain is the hallmark symptom of pancreatitis.

40. The client diagnosed with Cushing disease has developed 2+ peripheral edema in the last 24 hours. The primary intravenous rate is 100 mL per hour, and he is receiving an intravenous piggyback (IVPB) medication in 50 mL of fluid every 6 hours. He has an oral intake of 2450 mL and a recorded output of 3000 mL. Which intervention should the nurse implement first? l 1. Convert the intravenous fluids to a saline lock. l 2. Notify the HCP. l 3. Teach the client to measure all output. l 4. Assess the lung fields and jugular vein.

Correct answer 4: The nurse should first perform a complete assessment to determine further evidence of heart failure and make sure that all urine output is measured before slowing the IV and notifying the HCP. The 24-hour intake is 2600 mL of IV fluid 41. + 2450 mL oral intake = 5050 total intake, and total output is 3000 mL.