NUR2120 ch 28-31

1 unit of insulin for every

15 g of carbs

Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? (CH29) A) kidneys B) cardiac atria C) brain D) liver

A) Kidneys

Cystitis (Ch28)

Inflammation of urinary bladder

polyphagia (Ch30)

excessive hunger

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?

3 months

Exophthalmos (Ch29)

abnormal protrusion of the eyeball, "Bulging eyes"

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? (CH29) A) adrenal function B) thyroid function C) thymus function D) parathyroid function

A) Adrenal function

Cushing's syndrome or excess in adrenocortical hormones

caused by prolonged exposure to high levels of cortisol Manifestations: moon face facial hair buffalo hump truncal obesity

Which of the following statements by patients should prompt the nurse to assess for potential failure of the adrenal cortex? (Ch29) A) "I'm always exhausted these days, and I never really feel like eating." B) "Lately, I find that I'm more irritable and impatient than normal." C) "The last little while I get numbness and tingling in my lips and fingers a lot." D) "My thirst is almost insatiable these days, and my mouth always feels dry."

A) "I'm always exhausted these days, and I never really feel like eating." When considering failure of the adrenal cortex, the nurse asks about symptoms of weakness, fatigue, poor appetite, and weight loss as they are prominent features of Addison's disease. This particular endocrine dysfunction does not result in thirst, dry mouth, irritability, or numbness and tingling.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? (Ch30) A) 100 units of regular insulin in normal saline solution B) 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution C) 100 units of regular insulin in dextrose 5% in water D) 100 units of NPH insulin in dextrose 5% in water

A) 100 units of regular insulin in normal saline solution. Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results? (Ch29) A) A client who was given salicylates last month B) A client who avoids kelp C) A client diagnosed with low blood sugar D) A client who received corticosteroids 4 months ago

A) A client who was given salicylates last month Drugs such as salicylates and corticosteroids affect the results of thyroid tests if taken within past 3 months. Therefore, inaccurate thyroid test results will be obtained for the client who was given salicylates last month but not for the client who was administered corticosteroids 4 months ago. Kelp is high in iodine, which affects the thyroid test results. However, this factor will not affect the results of the thyroid test for a client avoiding kelp. A client's history of low blood sugar will not affect thyroid test results.

For a client with hyperthyroidism, treatment is most likely to include: (CH31) A) a thyroid hormone antagonist. B) thyroid extract. C) a synthetic thyroid hormone. D) emollient lotions.

A) A thyroid hormone antagonist Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? (Ch28) A) Acute pain B) Risk for infection C) Impaired urinary elimination D) Imbalanced nutrition: Less than body requirements

A) Acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

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? (Ch31) A) Adrenal cortex B) Pancreas C) Adrenal medulla D) Parathyroid

A) Adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? (Ch28) A) Anticholinergic B) Diuretics C) Anticonvulsant D) Cholinergic

A) Anticholinergic Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.

Insulin is secreted by which of the following types of cells? (Ch30) A) Beta cells B) Melanocytes C) Neural cells D) Basal cells

A) Beta cells Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.

The nurse is caring for a patient diagnosed with Hashimoto's thyroiditis. When assessing this patient what symptom would the nurse expect in a patient with hypothyroidism?(CH29) A) Bradycardia B) Bulging eyes C) Palpitations D) Flushed skin

A) Bradycardia Symptoms of hypothyroidism include weight gain, dry skin, nonpitting edema, fatigue, mental and physical sluggishness, bradycardia, cold intolerance, and constipation. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? (Ch29) A) Cushing syndrome B) Addison disease C) Graves disease D) Hashimoto disease

A) Cushing syndrome The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for? (Ch31) A) Diabetes insipidus (DI) B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Pituitary tumor D) Hypothyroidism

A) DI Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload? (CH31) A) dyspnea and hypertension B) pulmonary congestion and muscle cramps C) confusion and diarrhea D) hypertension and weight gain without edema

A) Dyspnea and hypertension Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.

A patient presents to the clinic complaining of symptoms that suggest diabetes mellitus. What criteria would support a diagnosis of diabetes mellitus? (Ch30) A) Fasting plasma glucose ≥126 mg/dL B) Random plasma >150 mg/dL C) Fasting plasma glucose >100 mg/dL D) Random plasma glucose >126 mg/dL

A) Fasting plasma glucose ≥126 mg/dL

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands? (CH29) A) four B) three C) two D) one

A) Four The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.

A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms? (Ch31) A) hyperpituitarism B) hypopituitarism C) panhypopituitarism D) panhyperpituitarism

A) Hyperpituitarism Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.

The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: (Ch29) A) Hypocalcemia. B) Decreased levels of vitamin D. C) Increased serum levels of phosphate. D) Cardiac arrhythmias.

A) Hypocalcemia Hypoparathyroidism results in hypocalcemia, which triggers a series of physiologic responses, including the choices presented.

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: (Ch30) A) hypoglycemia B) polyuria C) blurred vision D) polydipsia

A) Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

A nurse is teaching a client with an endocrine disorder how the nervous system and endocrine system are linked. Which structure would the nurse identify as the link between the two systems. (Ch29) A) hypothalamus B) brain C) medulla oblongata D) pancreas

A) Hypothalamus The hypothalamus is the link between the nervous system and the endocrine system. The hypothalamus controls the pituitary gland, which secretes hormones to influence the target glands through the action of the secreting hormones. The brain and medulla oblongata are part of the nervous system. The pancreas is an endocrine organ.

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? (CH29) A) increase serum calcium level B) inhibit release of calcium into extracellular fluid C) decrease serum calcium level D) promote urinary secretion of calcium

A) Increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.

An adult patient is experiencing a temporary decrease in serum levels of T3 and T4. What physiological response is this state likely to result in? (CH29) A) Increased release of TSH B) Increased resorption of T3 and T4 in the renal tubules C) Release of sequestered T3 and T4 by the spleen D) Compensatory release of T5 by the parathyroid

A) Increased release of TSH If the thyroid hormone concentration in the blood decreases, the release of TSH increases, which causes increased output of T3 and T4. Low levels of thyroid hormone are not resolved by the action of the kidneys. Thyroid hormone is not sequestered in the spleen, and T5 does not exist.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? (Ch30) A) Increases ability for glucose to get into the cell and lowers blood sugar B) Creates an overall feeling of well-being and lowers risk of depression C) Decreases need for pancreas to produce more cells D) Decreases risk of developing insulin resistance and hyperglycemia

A) Increases ability for glucose to get into the cell and lowers blood sugar. Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? (Ch29) A) metabolic rate B) growth C) fluid/electrolyte balance D) sleep/wake cycles

A) Metabolic rate The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.

During a period of heavy work and family pressures, an adult male patient with type 1 diabetes has become ill with influenza. This combination of psychological and physiological stress has culminated in ketoacidosis. The nurse who is now providing this patient's care should be aware that the presence of ketones in the blood result from: (CH30) A) Metabolism of fat B) Increased insulin resistance C) Glycogenolysis D) Hypoglycemia

A) Metabolism of fat Fat metabolism releases ketones, which can accumulated in the type 1 diabetic and result in ketoacidosis. Insulin resistance, glycogenolysis, and hypoglycemia do not directly cause this pathophysiological phenomenon.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? (Ch30) A) NPH B) Iletin II C) Lispro (Humalog) D) Glargine (Lantus)

A) NPH Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? (Ch31) A) Observe stool color. B) Monitor bowel patterns. C) Monitor vital signs every 4 hours. D) Observe urine output.

A) Observe stool color The nurse should observe the color of each stool and test the stool for occult blood.

Which finding is an early indicator of bladder cancer? (CH28) A) Painless hematuria B) Occasional polyuria C) Nocturia D) Dysuria

A) Painless hematuria Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

Which glands regulate calcium and phosphorous metabolism? (CH29) A) Parathyroid B) Thyroid C) Adrenal D) Pituitary

A) Parathyroid Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

An adult patient has admitted to his primary care provider that he has been experiencing an unprecedented loss of libido in recent months. This complaint should prompt the clinician to assess the patient for dysfunction of what endocrine gland? (CH29) A) Pituitary gland B) Thyroid gland C) Parathyroid gland D) Endocrine pancreas

A) Pituitary gland Pituitary dysfunction has the potential to result in changes in sex response. The thyroid, parathyroid, and pancreas are less likely to cause this symptom.

A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? (CH31) A)Provide a high-sodium diet. B) Examine extremities for pitting edema. C) Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. D) Administer prescribed diuretics.

A) Provide a high sodium diet Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water.

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? (Ch30) A) Serum potassium level B) Serum calcium level C) Serum sodium level D) Serum chloride level

A) Serum potassium level The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.

The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? (Ch31) A) Symptoms of acute coronary syndrome B) Dietary intake of foods with saturated fats C) Symptoms of pneumonia D) Heat intolerance

A) Symptoms of acute coronary syndrome The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).

When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? (CH29) A) The secretions are released directly into the blood stream. B) The glands contain ducts that produce the hormones. C) The secreted hormones act like target cells. D) The glands play a minor role in maintaining homeostasis.

A) The secretions are released directly into the blood stream The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.

The nurse is assisting with the preparation of a patient who will undergo a radioactive iodine uptake (RAIU) test. The nurse should understand that this patient is being assessed for dysfunction of the: (CH29) A) Thyroid gland B) Adrenal cortex C) Adrenal medulla D) Anterior pituitary

A) Thyroid gland The rate of iodine uptake by thyroid gland increases in hyperthyroidism and decreases in hypothyroidism. It is unaffected by changes in the structure or function of the pituitary or adrenal glands.

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization? (Ch28) A) type and size of the catheter to be used B) administration of cleansing enemas C) procedure for insertion of the catheter D) placement of the catheter

A) Type and size of the catheter to be used Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: (Ch30) A) 10 g of carbohydrates. B) 15 g of carbohydrates. C) 20 g of carbohydrates. D) 25 g of carbohydrates.

B) 15 g of carbohydrates

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? (Ch30) A) "The spleen releases ketones when your body can't use glucose." B) "Ketones will tell us if your body is using other tissues for energy." C) "Ketones can damage your kidneys and eyes." D) "Ketones help the physician determine how serious your diabetes is."

B) ketones will tell us if your body is using other tissue for injury

A nurse practitioner is aware of the high incidence and prevalence of hypothyroidism and regularly encourages many patients to undergo screening of their thyroid secreting hormone (TSH) levels. Which of the following individuals likely faces the greatest risk of developing hypothyroidism? (Ch31) A) A 49-year-old man who works in an iron smelter B) A 55-year-old woman who complains of fatigue C) A 30-year-old man with poorly controlled type 2 diabetes D) A 71-year-old man who has experienced nausea and vomiting secondary to influenza

B) A 55- year old woman who complains of fatigue Hypothyroidism has been shown to affect women five times more frequently than men and occurs most often between the ages of 30 and 60 years. Hence, screening of TSH levels is recommended for women older than 50 years of age presenting with one or more symptoms, such as persistent fatigue. Hyperglycemia, infections, and work in industrial settings are not risk factors for hypothyroidism

The nurse has implemented a bladder retraining program with a 65-year-old woman after the removal of her indwelling urinary catheter. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient has 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? (CH28) A) Perform a straight catheterization on this patient. B) Avoid further interventions at this time, as this is an acceptable finding. C) Place an indwelling urinary catheter. D) Press on the patient's bladder in an attempt to encourage complete emptying.

B) Avoid further interventions at this times, as this is an acceptable finding. The residual urine amount is acceptable, and intervention is not required by the nurse. Retraining the bladder begins immediately after the indwelling catheter is removed. The patient is placed on a timed voiding schedule, usually every 2 to 3 hours and, at the given time intervals, is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner. If 100 mL or more of urine remains in the bladder, straight catheterization may be performed for complete bladder emptying.

A 59-year-old patient is being assessed for hypoparathyroidism. The nurse should anticipate that this patient is likely to require what diagnostic test? A) CT of the abdomen B) Bone density testing C) Cardiac stress testing D) 24-hour urine

B) Bone density testing In cases of actual or suspected parathyroid dysfunction, serum calcium levels and serum PTH levels, as well as bone density studies, may be ordered.

Which diagnostic test is done to determine a suspected pituitary tumor? (CH29) A) Radiography of the abdomen B) Computed tomography C) Measuring blood hormone levels D) Radioimmunoassay

B) Computed tomography CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? (Ch28) A) Increased urine production due to metabolic conditions B) Decreased pelvic muscle tone due to multiple pregnancies C) Bladder irritation related to urinary tract infections D) Obstruction due to fecal impaction or enlarged prostate

B) Decreased pelvic muscle tone due to multiple pregnancies. Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

Nursing management of the client with a urinary tract infection should include: (Ch28) A) Teaching the client to douche daily B) Discouraging caffeine intake C) Instructing the client to limit fluid intake D) Administering morphine sulfate

B) Discouraging caffeine intake

Which of the following would the nurse expect to find in a client with severe hyperthyroidism? (Ch31) A) Tetany B) Exophthalmos C) Buffalo hump D) Striae

B) Exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? (Ch31) A) Capillary blood glucose test B) Fluid deprivation test C) Serum ketone test D) Urine glucose test

B) Fluid deprivation test The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.

A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that 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. What should the nurse expect to administer by IV infusion? (CH29) A) Insulin B) Hydrocortisone C) Potassium D) Hypotonic saline

B) Hydrocrotisone Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? (CH31) A) Hypocalcemia B) Hypercalcemia C) Hyperphosphatemia D) Hypophosphaturia

B) Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

A nurse is presenting at a community health promotion fair that is focused on disease prevention and screening. A middle-aged participant has brought up an article that she recently read about bladder cancer and has asked the nurse about prevention measures. How should the nurse respond to this woman's inquiry? (CH28) A) "The majority of people who develop bladder cancer have a family history of the disease, so genetics play a large part." B) "If you smoke cigarettes, quitting will greatly reduce your risk of bladder cancer." C) "People who tend not to drink enough fluids put themselves at an increased risk of bladder cancer." D) "An unhealthy diet is the most significant risk factor for the development of bladder cancer."

B) If you smoke cigarettes, quitting will greatly reduce your risk of bladder cancer Cigarette smoking exceeds the significance of family history, fluid intake, and diet in the etiology of bladder cancer.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? (Ch30) A) Numbness B) Increased hunger C) Fatigue D) Dizziness

B) Increased hunger The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? (Ch28) A) Nitrofurantoin B) Phenazopyridine C) Ciprofloxacin D) Levofloxacin

B) Phenaxopyridine Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland? (Ch29) A) Anterior pituitary B) Posterior pituitary C) Adrenal D) Thyroid

B) Posterior pituitary Antidiuretic hormone is secreted by the posterior pituitary gland.

A nurse should expect a client with hypothyroidism to report: (CH31) A) increased appetite and weight loss. B) puffiness of the face and hands. C) nervousness and tremors. D) thyroid gland swelling.

B) Puffiness of the face and hands Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

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, the nurse formulates a nursing diagnosis of: (CH31) A) Risk for imbalanced fluid volume related to excessive sodium loss. B) Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. C) Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. D) Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

B) Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

Dilutional hyponatremia occurs in which disorder? (Ch31) A) Diabetes insipidus (DI) B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Pheochromocytoma D) Addison disease

B) SIADH Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

A client with diabetes mellitus 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? (Ch30) A) Serum glucose level of 450 mg/dl B) Serum glucose level of 52 mg/dl C) Serum calcium level of 8.9 mg/dl D) Serum calcium level of 10.2 mg/dl

B) Serum glucose level of 52 mg/dl Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

Parathyroid hormone (PTH) has which effects on the kidney? (Ch29) A) Stimulation of calcium reabsorption and phosphate excretion B) Stimulation of phosphate reabsorption and calcium excretion C) Increased absorption of vitamin D and excretion of vitamin E D) Increased absorption of vitamin E and excretion of vitamin D

B) Stimulation of phosphate reabsorption and calcium excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

A nurse caring for a hospitalized patient with hypoparathyroidism reviews his electrocardiogram (ECG) strip and completes a cardiac assessment. The nurse recognizes the diagnostic sign of: (Ch31) A) Bradycardia. B) Prolonged QT interval. C) First-degree AV heart block. D) Third-degree AV heart block.

B) prolonged QT interval Hypoparathyroidism is associated with hypocalcemia, which decreases myocardial contractility and prolongs the QT interval. Hypercalcemia causes bradycardia and heart blocks.

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? (Ch31) A) A decrease in blood pressure B) A decrease in blood glucose levels C) A decrease in urine output D) A decrease in appetite

C) A decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

Which statement is true regarding gestational diabetes? (Ch30) A) It occurs in the majority of pregnancies. B) Onset usually occurs in the first trimester. C) A glucose challenge test should be performed between 24 to 28 weeks. D) There is a low risk for perinatal complications.

C) A glucose challenge test should be performed between 24 to 28 weeks. All women of average risk should undergo a glucose challenge test between 24 to 48 weeks of gestation. It occurs in 2% to 5% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.

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 formulate a nursing diagnosis of: (CH30) A) Impaired adjustment. B) Defensive coping. C) Deficient knowledge (treatment regimen). D) Health-seeking behaviors (diabetes control).

C) Deficient knowledge (Treatment regimen) The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? (CH29) A) "Do you have to get up at night to empty your bladder?" B) "Have you experienced any headaches or sinus problems?" C) "Do you experience fatigue even if you have slept a long time?" D) "Can you describe the amount of stress in your life?"

C) Do you experience fatigue even if you have slept a long time? With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress? (Ch29) A) Testosterone B) Mineralocorticoids C) Glucocorticoids D) Estrogen

C) Glucocorticoids Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: (Ch31) A) hypotension. B) thick, coarse skin. C) deposits of adipose tissue in the trunk and dorsocervical area. D) weight gain in arms and legs.

C) deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? (Ch30) A) Fasting blood glucose level B) Glucose via a urine dipstick test C) Glycosylated hemoglobin level D) Glucose via an oral glucose tolerance test

C) Glycosylated hemoglobin level Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? (Ch29) A) Keep an accurate record of intake and output. B) Use nasal desmopressin acetate (DDAVP). C) Have regular follow-up care. D) Exercise to improve cardiovascular fitness.

C) Have regular follow-up care The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? (CH28) A) Incontinence B) Dysuria C) Hematuria D) Frequency

C) Hematuria The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? (Ch30) A) In diabetes, the autonomic nerves are affected. B) Motor neuropathy causes muscles to weaken and atrophy. C) High blood sugar decreases blood circulation to nerves. D) Nephropathy is a common complication of diabetes mellitus.

C) High blood sugar decreases blood circulation to nerves. Diabetic neuropathy results from poor glucose control and decreased blood circulation to nerve tissues. The lack of sensitivity increases the potential for soft tissue injury without awareness. Autonomic neuropathy is a complication of diabetes mellitus but not significant with peripheral injuries. Motor neuropathy does occur with poor glucose control but not specific to this injury. Nephropathy is a common complication that directly affects the kidneys.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? (CH30) A) With diabetes, drinking more results in more urine production. B) Increased ketones in the urine promote the manufacturing of more urine. C) High sugar pulls fluid into the bloodstream, which results in more urine production. D) The body's requirement for fuel drives the production of urine.

C) High sugar pulls fluid into the bloodstream, which results in more urine production. The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? (CH30) A) Polyuria B) Hypertonicity C) Low blood glucose concentration D) Allergic reactions

C) Low blood glucose concentration Clients who switch from animal to synthesized human insulin should initially be monitored for low blood glucose concentrations because the human form of insulin is used more effectively. Human insulin causes fewer allergic reactions than insulin obtained from animal sources. Polyuria and hypertonicity are symptoms of diabetes mellitus.

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: (CH28) A) limit oral fluid intake for 1 to 2 weeks. B) report the presence of fine, sandlike particles through the nephrostomy tube. C) notify the physician about cloudy or foul-smelling urine. D) report bright pink urine within 24 hours after the procedure.

C) Notify the physician about cloudy or foul-smelling urine. The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.

An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? (Ch29) A) Somatotropin B) Prolactin C) Oxytocin D) Adrenocorticotropic hormone

C) Oxytocin The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.

Which action would be appropriate when evaluating a client's neck for thyroid enlargement? (CH29) A) Inspect changes in pigmentation in the neck. B) Perform repeated palpation of the thyroid gland. C) Palpate the thyroid gland gently. D) Examine the skin of the neck for excessive oiliness

C) Palpate the thyroid gland gently The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which may have serious implications. Pigment changes in the neck and excessive oiliness of the skin are not related to assessment for thyroid enlargement.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? (Ch29) A) Thymus gland, thymosin B) Parathyroid glands, parathormone C) Pineal gland, melatonin D) Adrenal cortex, corticosteroids

C) Pineal gland, melatonin

The PACU staff have brought a patient to the unit following a thyroidectomy. To promote comfort for this patient, how should the nurse position this patient? (Ch31) A) Side-lying (lateral) with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowler's with the head supported on two pillows D) Flat, with a small roll supporting the neck

C) Semi-Fowlers will the head supported on two pillows When moving and turning the patient, the nurse carefully supports the patient's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler's position, with the head elevated and supported by pillows.

Laboratory studies indicate 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 use? (Ch30) A) Fasting blood glucose test B) 6-hour glucose tolerance test C) Serum glycosylated hemoglobin (Hb A1c) D) Urine ketones

C) Serum glycosylated hemoglobin Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

Which of the following nursing actions is most important in caring for the client following lithotripsy? (Ch28) A) Monitor the continuous bladder irrigation. B) Administer allopurinol (Zyloprim). C) Strain the urine carefully for stone fragments. D) Notify the physician of hematuria.

C) Strain the urine carefully for stone fragments The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

A 62-year-old male patient was diagnosed with type 2 diabetes 5 years ago but has not implemented measures to closely monitor or control his blood sugar levels. As a result, he has begun to experience some of the sequelae of diabetes, including flaccid bladder. In cases of flaccid bladder, what pathophysiological process takes place? (CH28) A) An incompetent sphincter results in a constant dribbling of urine. B) Because of a neurological lesion, the patient has no control over when the bladder empties. C) The patient's bladder overfills, leading to overflow incontinence without the patient's knowledge. D) Due to a lesion, the patient experiences inappropriate urges to void that are unrelated to the quantity of urine in the bladder.

C) The patient's bladder overfills, leading to overflow incontinence without the patient's knowledge. Flaccid bladder is caused by a lower motor neuron lesion, commonly resulting from trauma, but increasingly being recognized in patients with diabetes mellitus. The bladder continues to fill and becomes greatly distended, and overflow incontinence occurs. The problem does not lie with the sphincter or bladder neck.

A patient who is currently in the hospital recovering from orthopedic surgery has always considered herself to be a "borderline diabetic" who prides herself on maintaining acceptable blood glucose levels through diet and lifestyle modifications. Consequently, she is surprised that her primary care provider has ordered a sliding scale of insulin while she is in the hospital. Why might this patient require insulin at this particular time? (Ch29) A) Fluid and electrolyte changes surrounding surgery may increase her blood sugar levels. B) Immobility may cause decreased thyroid hormone levels, decreased metabolic demand, and consequent increased blood sugar. C) The stress of hospitalization and surgery may cause increased release of glucocorticoids. D) The action of anesthetic may temporarily blunt the normal release of endogenous insulin by the patient's pancreas.

C) The stress of hospitalization and surgery may cause increased release of glucocorticoids. Glucocorticoids are released in times of stress and have major effects on the metabolism of almost all organs because of their influence on glucose metabolism (elevation of blood glucose levels). As a result, this patient may be more prone to hyperglycemia than she otherwise would be. This phenomenon does not primarily involve changes in pancreatic function, thyroid hormone levels, or fluid and electrolyte imbalances.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? (Ch30) A) Applying a heating pad B) Debriding the wound three times per day C) Using sterile technique during the dressing change D) Cleaning the wound with a povidone-iodine solution

C) Using sterile technique during the dressing change. The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

The nurse is assessing a patient diagnosed with Graves' disease. What physical characteristics of Graves' would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue

C) bulging eyes Graves' disease is defined by hyperthyroidism. Clinical manifestations of this endocrine disorder include exophthalmos (bulging eyes) and fine tremor in the hands.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? (CH30) A) Between 8:00 and 10:00 a.m. B) Between 4:00 and 6:00 p.m. C) Between 7:00 and 9:00 p.m. D) This insulin has no peak action and does not cause a hypoglycemic reaction.

D) This insulin has no peak action and does not cause a hypoglycemic reaction. "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? (Ch30) A) "This transplant will provide me with a cure for my diabetes." B) "I will receive a whole organ with extra cells to produce insulin." C) "They'll need to create a connection from the pancreas to allow enzymes to drain." D) "I might need insulin later on but probably not as much or as often."

D) "I might need insulin later on but probably not as much or as often." Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? (Ch31) A) 50 pg/mL B) 100 pg/mL C) 100 to 300 pg/mL D) 450 pg/mL

D) 450 pg/mL Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.

The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? (Ch29) A) A rise in serum calcium stimulates the release of T lymphocytes. B) A rise in serum calcium stimulates the release of erythropoietin. C) A rise in serum calcium inhibits the release of calcitonin. D) A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.

D) A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland

What is the most common cause of hyperaldosteronism? (Ch31) A) Excessive sodium intake B) A pituitary adenoma C) Deficient potassium intake D) An adrenal adenoma

D) An adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.

A 42-year-old man with a history of pheochromocytoma is being treated in the intensive care unit after experiencing an acute exacerbation of his condition. This patient will require the nurse to perform which of the following assessments most frequently? (Ch31) A) Motor and sensory function B) Orientation and cognition C) Urine testing for osmolality D) Blood pressure (BP) and heart rate

D) BP and HR Blood pressures exceeding 250/150 mm Hg have been recorded in cases of pheochromocytoma. Such BP elevations are life-threatening and can cause severe complications. Consequently, constant monitoring of BP and heart rate is a priority over other assessments, even though each of the listed assessments is relevant and appropriate.

When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: (CH29) A) Thyroxine B) Phosphorus C) Parathyroid D) Calcitonin

D) Calcitonin Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? (CH28) A) Set up a routine schedule of every 4 hours to check for residual urine. B) Check for residual after the client reports the urge to void. C) Record the volume of urine obtained. D) Catheterize the client immediately after the client voids.

D) Catheterize the client immediately after the client voids. To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.

A patient with pheochromocytoma has been admitted for an adrenalectomy tomorrow. The patient is to start IV medication this evening to prevent adrenal insufficiency. What medication is the patient most likely to require? (CH29) A) Antibiotics B) Antihypertensives C) Parenteral nutrition D) Corticosteroid

D) Corticosteroids The adrenal cortex produces corticosteroids. As a result, corticosteroids would be administered to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency.

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? (Ch30) A) Administer the total daily dosage in 2 doses. B) Draw up the drug first, then add regular insulin. C) Glargine is rapidly absorbed and has a fast onset of action. D) Do not mix with other insulins.

D) DO not mix with other insulins Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: (Ch31) A) exophthalmos and conjunctival redness. B) flushed, warm, moist skin. C) systolic murmur at the left sternal border. D) decreased body temperature and cold intolerance.

D) Decreased body temp and cold intolerance Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? (Ch31) A) Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B) Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C) Disturbed body image related to weight gain and edema D) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

D) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess. In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland? (Ch29) A) Attached to the thalamus in the brain B) Positioned above the kidneys C) Connected by a stalk to the hypothalamus in the brain D) In the upper part of the chest above or near the heart

D) In the upper part of the chest above or near the heart. The thymus gland is located in the upper part of the chest above or near the heart. The pineal gland is attached to the thalamus, and the pituitary gland is connected by a stalk to the hypothalamus in the brain. The adrenal glands are located above the kidneys.

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: (CH29) A) Fatigue B) Weight gain C) Constipation D) Intolerance to heat

D) Intolerance to heat With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? (CH31) A) Glaucoma B) Corneal abrasions C) Retinal detachment D) Pressure on the optic nerve

D) Pressure on the optic nerve Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? (CH30) A) Provides best information on the body's ability to maintain normal blood functioning B) Best indicator for the nutritional state of the client C) Is less costly than performing daily blood sugar test D) Reflects the amount of glucose stored in hemoglobin over past several months.

D) Reflects the amount of glucose stored in hemoglobin over past several months. Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels.

A postpartum client is receiving intravenous oxytocin (Pitocin) after birth. Why will this medication be used for this client after the birth of her child? (CH29) A) Will prevent lactation for a woman who is bottle feeding her newborn B) Decreases the postpartum cramping C) Helps treat nausea D) Stimulates the contraction of the uterus and prevents bleeding

D) Stimulates the contraction of the uterus and prevents bleeding Oxytocin (Pitocin) is released from the pituitary gland and stimulates contraction of pregnant uterus and release of breast milk after childbirth. It will not prevent lactation or help treat nausea. It will increase lactation.

Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? A) Overflow B) Urge C) Reflex D) Stress

D) Stress Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: (CH30) A) encourage the client to ask questions about personal sexuality. B) provide time for privacy. C) provide support for the spouse or significant other. D) suggest referral to a sex counselor or other appropriate professional.

D) Suggest referral to a sex counselor or other appropriate professional. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

A hospital patient's most recent blood work reveals a Ca2+ level of 14.2 mg/dL (normal 8.5 to 10.5 mg/dL) and a phosphorus level of 1.4 mg/dL (normal 3.0 to 4.5 mg/dL). What hormone has the potential to cause this alteration in the patient's electrolyte levels? (CH29) A) Calcitonin B) Corticotropin-releasing hormone (CRH) C) Thyroid hormone D) Parathyroid hormone

D) parathyroid hormone Increased secretion of parathormone results in "osteoclast" growth and bone resorption. When bone resorption is increased, calcium is released from the bone into the blood, thereby increasing the serum or blood calcium level. Parathormone also tends to lower the blood phosphorus level. Calcitonin decreases serum calcium levels, whereas thyroid hormone and CRH do not directly affect them.

ketoacidosis (Ch30)

excessive production of ketones, making the blood acid fruity smell

Interstitial nephritis (Ch28)

inflammation of the connective tissue that lies between the renal tubules

pyelonephritis (Ch28)

inflammation of the renal pelvis and the kidney

Urethritis (Ch28)

inflammation of the urethra