NURS 270 Unit 4

The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 1. An enlarged thyroid gland 2. The presence of heart damage 3. Client complaints of chronic fatigue 4. Client complaints of slow wound healing

1

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agitation and bradycardia 4. Restlessness and bradycardia

1

The nurse is performing a physical assessment on a client during her first prenatal visit to the clinic. The nurse takes the client's temperature and notes that the temperature is 99.2° F. Based on this finding, which nursing action is most appropriate? 1. Document the temperature. 2. Notify the health care provider. 3. Retake the temperature by the rectal route. 4. Inform the client that the temperature is elevated and antibiotics may be required.

1

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

1

the nurse is planning the care of a client dx with SIADH. which interventions should be implemented? select all that apply 1. restrict fluids per health care provider order 2. assess level of consciousness every 2 hours 3. provide an atmosphere of stimulation 4. monitor urine and serum osmolality 5. weigh the client every 3 days

1, 2, 4, restrict fluids per hcp, assess LOC, monitor urine and serum osmolality: fluids are restricted to 500 to 600 mL/24 hrs. Orientation to person, place, and time should be assessed every 2 hours or more often. Urine and serum osmolality are monitored to determine fluid volume status. 3. a safe environment, not a stimulating one, is provided. 5. the client should be weighed daily not every 3 days

the nurse is admitting a client dx with SIADH. which clinical manifestations should be reported to the hcp? 1. serum sodium of 112 mEq/L and a headache 2. serum potassium of 5.0 mEq/L and a heightened awareness 3. serum calcium of 10 mg/dL and tented tissue turgor 4. serum magnesium of 1.2 mg/dL and large urinary output

1, serum sodium of 112 mEq/L and a headache: A serum sodium level of 112 is dangerously low, and the client is at risk for seizures. a headache is a symptom of a low sodium level. 2.this is a normal potassium level, and a heightened level of awareness indicates drug usage 3. this is a normal calcium level and the client is fluid overloaded, not dehydrated, so there would not be tented tissue turgor. 4. this is a normal magnesium level, and a large urinary output is desired

which lab value should be monitored by the nurse for the client dx with DI (diabietes insipidus)? 1. serum sodium 2. serum calcium 3. urine glucose 4. urine white blood cells

1. serum sodium: the client will have an elevated sodium level as a result of low circulating blood volume. the fluid is being lost through the urine. diabetes means to pass through in greek, indicating polyuria, a symptom shared with diabetes mellitus. diabetes insipidus is a totally separate disease process

A client visits the health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 1. Weight loss and tachycardia 2. Complaints of weakness and lethargy 3. Diaphoresis and increased hair growth 4. Increased heart rate and respiratory rate

2

A nurse has a prescription to administer a medication to a client who is experiencing shivering as a result of hyperthermia. Which medication should the nurse anticipate to be prescribed? 1. Buspirone (BuSpar) 2. Chlorpromazine (Thorazine) 3. Prochlorperazine (Compazine) 4. Fluphenazine (Prolixin Decanoate)

2

The nurse has applied a hypothermia blanket to a client with a fever. A priority for the nurse is to inspect the skin frequently to detect which complication of hypothermia blanket use? 1. Frostbite 2. Skin breakdown 3. Venous insufficiency 4. Arterial insufficiency

2

The nurse is caring for a child after surgical removal of a brain tumor. The nurse should assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure? 1. Inability to swallow 2. Elevated temperature 3. Altered hearing ability 4. Orthostatic hypotension

2

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features

2

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for a diagnostic test 4. A client with diabetes mellitus scheduled for débridement of a foot ulcer

2

the client dx with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). which interventions should the nurse implement? 1. assess for dehydration and monitor blood glucose levels 2. assess for nausea and vomiting and weigh daily 3. monitor potassium levels and encourage fluid intake 4. administer vasopressin IV and conduct a fluid deprivation test

2. assess for nausea and vomiting and weigh daily: early signs and symptoms are nausea and vomiting. the client has the syndrome of inappropriate secretion of antidiuretic (against allowing the body to urinate) hormone. in other words, the client is producing a hormone that will not allow the client to urinate. Vasopressin is the name of the antidiuretic hormone. giving more increases the clients problem. also, water challenge test is performed, not a fluid deprivation test.

the nurse is discharging a client dx with diabetes insipidus. Which statement made by the client warrants further intervention? 1. i will keep a list of my medications in my wallet and wear a medic alert bracelet 2. i should take my medication in the morning and leave it refrigerated at home 3. i should weigh myself every morning and record any weight gain 4. if i develop a tightness in my chest, i will call my hcp

2. i should take my medication in the morning and leave it refrigerated at home: medication for DI is usually taken every 8 to 12 hours, depending on the client. The client should keep the medication close at hand. The client should keep a list of medication being taken and wear a medic alert bracelet. the client is at risk for fluid shifts. weighing every morning allows the client to follow the fluid shifts. wt gain indicates too much medication. tightness in the chest could be an indicator the medication is not being tolerated; if this occurs, the client should notify the hcp. (the medical treatment of DI involves replacement of ADH. In acute cases, vasopressin, a synthetic form of ADH, is given by the IV or subcu route, in long term therapy synthetic ADH in the form of a nasal spray is used (desmopressin or DDAVP))

A client arrives at the postpartum unit after delivery of her infant. On performing an assessment, the nurse notes that the client is shaking uncontrollably. Which nursing action would be appropriate? 1. Massage the fundus. 2. Contact the health care provider. 3. Cover the client with a warm blanket. 4. Place the client in Trendelenburg's position

3

A client with a neurological problem is experiencing hyperthermia. Which measure would be least appropriate for the nurse to use in trying to lower the client's body temperature? 1. Giving tepid sponge baths 2. Applying a hypothermia blanket 3. Placing ice packs in the axilla and groin areas 4. Administering acetaminophen (Tylenol) per protocol

3

A newborn is delivered via spontaneous vaginal delivery. On reception of the crying newborn, the nurse's priority is to perform which action? 1. Determine Apgar score. 2. Auscultate the heart rate. 3. Thoroughly dry the newborn. 4. Take the newborn's rectal temperature.

3

A nurse is caring for a client with a thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse should assess for which sign or symptom? 1. Bradycardia 2. Constipation 3. Hypertension 4. Low-grade temperature

3

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response? 1. "It depends on the results of the laboratory tests." 2. "Most clients require medication for about 1 year." 3. "The medication will need to be continued for life." 4. "You will need to ask your health care provider."

3

the UAP complains to the nurse she has filled the water pitcher 4 times during the shift for a client dx with a closed head injury and the client has asked for the pitcher to be filled again. which intervention should the nurse implement first? 1. tell the UAP to fill the pitcher with ice cold water 2. instruct the UAP to start measuring the clients I and O's 3. asess the client for polyuria and polydipsia 4. check the clients BUN and creatinine levels

3, assess the client for polyuria and polydipsia: the first action should be to determine if the client is experiencing polyuria and polydipsia as a result of developing diabetes insipidus, a complication of the head trauma. 1. the client should have the water pitcher filled, but this is not the first action. 2. this should be done but not before assessing the problem 4. this could be done, but it will not give the nurse info. about DI (the nurse must apply a systematic approach to answering priority questions. maslows hierarchy of needs should be applied if it is a physiological problem and the nursing process if it is a question of this nature. assessment is the first step in the nursing process)

the male client dx with SIADH secondary to cancer of the lung tells the nurse he wants to discontinue the fluid restriction and does not care if he dies. which action by the nurse is an example of the ethical principle of autonomy? 1.discuss the info the client told the nurse with the hcp and significant other 2. explain it is possible the client could have a seizure if he drank fluid beyond the restrictions 3. notify the hcp of the clients wishes and give the client fluids as desired 4. allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the hcp

3, notify the hcp of the clients wishes and give the client fluids as desired: this is an example of autonomy (the client has the right to decide for himself) 1. discussing the info with others is not allowing the client to decide what is best for himself. 2. this could be an example of beneficence (to do good) if the nurse did this so the client has info on which to base a decision on whether to continue the fluid restriction 4. this is an example of dishonesty and should never be tolerated in a health care setting

the nurse is caring for clients on a medical floor. which client should be assessed first? 1. the client dx with syndrome of inappropriate antidiuretic hormone (SIADH) who has a wt. gain of 1.5 lbs since yesterday 2. the client dx with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1500 mL and an output of 1600 mL in the last 8 hours 3. the client dx with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching 4. the client dx with diabetes insipidus (DI) who is c/o feeling tired after having to get up at night

3. the client dx with syndrome of inappropriate antidiuretic hormone who is having muscle twitching: muscle twitching is a sign of early sodium imbalance. if an immediate intervention isnt made, the client could begin to seize. 1. clients with SIADH have a problem with retaining fluid. this is expected. 2. this clients intake and output are relatively the same 4.the client has to get up all night to urinate, so the client feeling tired is expected

the client is admitted to the medical unit with a dx of rule out diabetes insipidus. Which instructions should the nurse teach regarding a fluid deprivation test? 1. the client will be asked to drink 100 ml of fluid as rapidly as possible and then will not be allowed fluid for 24 hours 2. the client will be administered an injection of ADH, and urine output will be measured for 4 to 6 hours 3. the client will be NPO, and v/s and weights will be done hourly until the end of the test 4. an IV will be started with NS, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done

3. the client will be NPO, and v/s and wts will be done hourly until the end of the test: the client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and wts are taken every hour to determine circulatory status. if a marked decrease in wt or vital signs occurs, the test is immediately terminated. 1.The client is not allowed to drink during the test. 2.this test does not require any meds to be administered, and vasopressin will treat the DI, not help dx it. 4. no fluid is allowed and a sonogram is not involved

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine (Synthroid) is prescribed. The nurse informs the client that which is the expected outcome of the medication? 1. Alleviate depression 2. Increase energy levels 3. Increase blood glucose levels 4. Achieve normal thyroid hormone levels

4

A client complains of being cold, and the nurse notes the presence of "goose flesh" on the client's arms. The nurse plans care, knowing that which structure is responsible for this response? 1. Arterioles 2. Sweat glands 3. Collagen fibers 4. Arrector pili muscles

4

A client has begun medication therapy with propylthiouracil (PTU). The nurse should assess the client for which condition as an adverse effect of this medication? 1. Joint pain 2. Renal toxicity 3. Hyperglycemia 4. Hypothyroidism

4

A client's baseline vital signs are as follows: temperature 98.8° F oral, pulse 74 beats/min, respirations 18 breaths/min, and blood pressure 124/76 mm Hg. The client's temperature suddenly spikes to 103° F. Which corresponding respiratory rate should the nurse anticipate in this client as part of the body's response to the change in status? 1. Respiratory rate of 12 breaths/min 2. Respiratory rate of 16 breaths/min 3. Respiratory rate of 18 breaths/min 4. Respiratory rate of 22 breaths/min

4

A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse develops a plan of care for the client. The nurse should assess for which condition as a priority? 1. Relief of pain 2. Signs of renal toxicity 3. Signs of hyperglycemia 4. Signs of hypothyroidism

4

The nurse has just administered ibuprofen (Motrin) to a child with a temperature of 38.8° C (102° F). The nurse should also take which action? 1. Withhold oral fluids for 8 hours. 2. Sponge the child with cold water. 3. Plan to administer salicylate (aspirin) in 4 hours. 4. Remove excess clothing and blankets from the child.

4

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing intervention would be the least helpful in managing this symptom? 1. Keep liquids at the bedside. 2. Make sure the pillow has a plastic cover. 3. Keep a change of bed linens nearby in case they are needed. 4. Administer an antipyretic after the client has a spike in temperature.

4

The nurse is caring for an unconscious client who is experiencing persistent hyperthermia with no signs of infection. The nurse interprets that the hyperthermia may be related to damage to the client's thermoregulatory center in which structure? 1. Cerebrum 2. Cerebellum 3. Hippocampus 4. Hypothalamus

4

The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2° F. What is the priority nursing action? 1. Document the findings. 2. Retake the temperature in 15 minutes. 3. Notify the health care provider (HCP). 4. Increase hydration by encouraging oral fluids.

4

the nurse is caring for a client dx with DI. which intervention should be implemented? 1. administer sliding scale insulin as ordered 2. restrict caffeinated beverages 3. check urine ketones if blood glucose is >250 4. assess tissue turgor every 4 hours

4, assess tissue turgor every 4 hours: the client is excreting large amounts of dilute urine. if the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently. 1. diabetes insipidus is not diabetes mellitus; sliding scale insulin isnt administered. 2. there is no caffeine restriction for DI. 3. checking urine ketones isn't indicated

A patient with hypothermia is brought to the emergency department. The nurse should explain to the family members that treatment will include A. Core rewarming with warm fluids. B. Ambulation to increase metabolism. C. Frequent oral temperature assessment. D. Gastric tube feedings to increase fluids.

A. Core rewarming with warm fluids. Core rewarming with heated oxygen and administration of warmed oral or intravenous fluids is the preferred method of treatment. The patient would be too weak to ambulate. Oral temperatures are not the most accurate assessment of core temperature because of environmental influences. Warmed oral feedings are advised; gastric gavage is unnecessary.

A homeless person is brought to the emergency department after prolonged exposure to cold weather. The nurse would assess the patient for manifestations of hypothermia, including A. Stupor. B. Erythema. C. Increased anxiety. D. Rapid respirations.

A. Stupor. Stupor may occur with hypothermia because of slowed cerebral metabolic processes. Pallor, not erythema, would be present as a result of peripheral vasoconstriction. Drowsiness occurs; the patient would be unable to focus on anxiety-producing aspects of the situation. Respirations would be decreased.

A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal: A. decreased serum PTH B. increased serum ACTH C. increased serum glucose D. decreased serum cortisol levels

A. decrease serum PTH

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about: A. energy level B. intake of vitamin C C. employment history D. frequency of sexual intercourse

A. energy level

After a hypophysectomy for acromegaly, postoperative nursing care should focus on a. frequent monitoring of serum and urine osmolarity. b. parenteral administration of a GH-receptor antagonist. c. keeping the patient in a recumbent position at all times. d. patient teaching regarding the need for lifelong hormone therapy.

A. frequent monitoring of serum and urine osmolarity

A patient has a serum sodium level of 152 mEq/L. The normal hormonal response to this situation is: A. release of ADH B. release of ACTH C. secretion of aldosterone D. secretion of corticotropin-releasing hormone

A. release of ADH

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm? a. Propranolol (Inderal) b. Propylthiouracil (PTU) c. Methimazole (Tapazole) d. Iodine (Lugol's solution)

ANS: A Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level

ANS: A An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine.

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patient's T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland

ANS: A Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action.

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels

ANS: A Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.

A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism. The nurse providing care should a. monitor the blood pressure every 4 hours. b. elevate the patient's legs to relieve edema. c. monitor blood glucose level every 4 hours. d. order the patient a potassium-restricted diet.

ANS: A Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.

The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following? a. "I need to shop for foods low in sodium and avoid adding salt to food." b. "I should weigh myself daily and report any sudden weight loss or gain." c. "I need to limit my fluid intake to no more than 1 quart of liquids a day." d. "I will eat foods high in potassium because diuretics cause potassium loss."

ANS: A Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic. b. The patient reports a recent head injury. c. The patient has a urine output of 400 mL/hr. d. The patient's urine specific gravity is 1.003.

ANS: A The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use? a. Provide written reminders of self-care information. b. Offer multiple options for management of therapies. c. Ensure privacy for teaching by asking visitors to leave. d. Delay teaching until patient discharge date is confirmed.

ANS: A Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.

A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Is there a family history of acromegaly?" d. "Are you experiencing tremors or anxiety?"

ANS: B Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours.

ANS: B After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include a. high blood pressure. b. decreased facial hair. c. elevated blood glucose. d. tachycardia and cardiac palpitations.

ANS: B Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.

The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's a. weight has increased. b. urinary output is increased. c. peripheral edema is decreased. d. urine specific gravity is increased.

ANS: B Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimoto's thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addison's disease who takes hydrocortisone twice daily

ANS: B Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness

ANS: B In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-year-old male who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

ANS: B Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? a. "How much milk do you drink?" b. "What medications are you taking?" c. "Are your immunizations up to date?" d. "Have you had any recent neck injuries?"

ANS: B Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter.

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels. c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation.

ANS: B Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)? a. The medication will be needed for 3 to 6 months. b. Inject the medication subcutaneously every day. c. Blood glucose levels may decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.

ANS: B Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.

Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Monitor for peripheral edema. b. Offer patient hard candies to suck on. c. Encourage fluids to 2 to 3 liters per day. d. Keep head of bed elevated to 30 degrees.

ANS: B Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for a. flushing. b. headache. c. bradycardia. d. hypoglycemia.

ANS: B The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information is most important to communicate to the surgeon? a. The patient reports 7/10 incisional pain. b. The patient has increasing neck swelling. c. The patient is sleepy and difficult to arouse. d. The patient's cardiac rate is 112 beats/minute.

ANS: B The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.

A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease? a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I had the stomach flu earlier this week, so I couldn't take the hydrocortisone." c. "I always double my dose of hydrocortisone on the days that I go for a long run." d. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."

ANS: B The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.

Which nursing action will be included in the plan of care for a 55-year-old patient with Graves' disease who has exophthalmos? a. Place cold packs on the eyes to relieve pain and swelling. b. Elevate the head of the patient's bed to reduce periorbital fluid. c. Apply alternating eye patches to protect the corneas from irritation. d. Teach the patient to blink every few seconds to lubricate the corneas.

ANS: B The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.

A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvostek's sign.

ANS: B The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.

ANS: B The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.

A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n) a. elevated hematocrit. b. decreased serum sodium. c. low urine specific gravity. d. increased serum chloride.

ANS: B When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.

A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Titrate the infusion of 5% dextrose in water. b. Teach the patient how to use desmopressin (DDAVP) nasal spray. c. Assess the patient's hydration status every 8 hours. d. Administer subcutaneous DDAVP.

ANS: D Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain caused by increased appetite." b. "A weight-bearing exercise program will help minimize the risk for osteoporosis." c. "The prednisone dose should be decreased gradually rather than stopped suddenly." d. "Call the health care provider if you experience mood alterations with the prednisone."

ANS: C Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.

The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to a. protect the patient's skin. b. monitor for signs of infection. c. balance fluids and electrolytes. d. prevent emotional disturbances.

ANS: C After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows.

ANS: C Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.

After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for a. sodium restriction to prevent fluid retention. b. insulin to maintain normal blood glucose levels. c. oral corticosteroids to replace endogenous cortisol. d. chemotherapy to prevent malignant tumor recurrence.

ANS: C Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.

Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.

ANS: C Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease although surgery may be used.

An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is a. excess fluid volume related to intake greater than output. b. impaired gas exchange related to fluid retention in lungs. c. sleep pattern disturbance related to frequent waking to void. d. risk for impaired skin integrity related to generalized edema.

ANS: C Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

ANS: C Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider? a. Patient's blood pressure is 148/94 mm Hg. b. Patient has bilateral 2+ pitting ankle edema. c. Patient stopped taking the medication 2 days ago. d. Patient has not been taking the prescribed vitamin D.

ANS: C Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment.

Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a. The blood glucose is 176 mg/dL. b. The lungs have bibasilar crackles. c. The blood pressure (BP) is 88/50 mm Hg. d. The patient reports 5/10 incisional pain.

ANS: C The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.

After obtaining the information shown in the accompanying figure regarding a patient with Addison's disease, which prescribed action will the nurse take first? a. Give 4 oz of fruit juice orally. b. Recheck the blood glucose level. c. Infuse 5% dextrose and 0.9% saline. d. Administer oxygen therapy as needed.

ANS: C The patient's poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may also be needed but are not the initial action for the patient.

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first? a. Administer the ordered muscle relaxant. b. Give the ordered oral calcium supplement. c. Have the patient rebreathe from a paper bag. d. Start the PRN oxygen at 2 L/min per cannula.

ANS: C The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.

Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg

ANS: C The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.

ANS: C There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.

A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. avoid brushing teeth for at least 10 days after the surgery. d. be positioned flat with sandbags at the head postoperatively.

ANS: C To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.

An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).

ANS: C Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting

ANS: D Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications.

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

ANS: D The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.

An abnormal finding by the nurse during an endocrine assessment would be: (select all that apply) a. blood pressure of 100/70 mm Hg b. excessive facial hair on a woman c. soft, formed stool every other day d. 3-lb weight gain over last 6 months e. hyperpigmented coloration in the lower legs

B. excessive facial hair on a woman E. hyperpigmented coloration in the lower legs

A child is about to be admitted to the pediatric intensive care unit (PICU) after surgery for removal of a tumor in the hypothalamic region of the brain. The nurse manager should intervene immediately when the child's nurse A. Places a hypothermia blanket at the bedside. B. Adjusts the bed to the Trendelenburg position. C. Obtains electronic equipment for monitoring the vital signs. D. Secures a pump to administer the ordered intravenous fluids.

B. Adjusts the bed to the Trendelenburg position. It is not safe to put the bed in the Trendelenburg position, because raising the foot increases blood flow to the brain, thereby increasing intracranial pressure. Temperature elevations may occur after a craniotomy because of stimulation of the hypothalamus. A hypothermic blanket should be ready if the temperature becomes precipitously elevated. Monitoring vital signs is a critical component of postoperative care. Intravenous infusions must be regulated precisely to minimize the possibility of cerebral edema.

What clinical indicator will the nurse most likely identify when assessing a patient with pyrexia? A. Dyspnea. B. Precordial pain. C. Increased pulse rate. D. Elevated blood pressure.

C. Increased pulse rate. The pulse rate increases to meet increased tissue demands for oxygen in the febrile state. Fever may increase but does not cause difficulty in breathing. Pain is not related to fever. Blood pressure is not necessarily elevated in fever.

An appropriate technique to use during physical assessment of the thyroid gland is: A. asking the patient to hyperextend the neck during palpation B. percussing the neck for dullness to define the size of the thyroid C. having the patient swallow water during inspection and palpation of the gland D. using deep palpation to determine the extent of a visibly enlarged thyroid gland

C. having the patient swallow water during inspection and palpation of the gland

Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria

b. neck vein distention

A priority nursing intervention for a patient with hyperthermia would be A. Initiating seizure precautions. B. Limiting oral intake. C. Providing a blanket. D. Removing excess clothing.

D. Removing excess clothing. Rationale The priority nursing intervention would be removal of excess clothing. Seizures may occur because of a high body temperature, but seizure precautions should not be the first intervention. Oral intake, especially of fluids, should not be limited for a patient with hyperthermia, because of the dangers of dehydration. Blanketing, like clothing, should be removed.

The nurse admitting a patient to the emergency room on a cold winter night would suspect hypothermia when the patient demonstrates A. Increased respirations. B. Rapid pulse rate. C. Red, sweaty skin. D. Slow capillary refill.

D. Slow capillary refill. With hypothermia, there is slow capillary refill. There is an increased respiration rate with hyperthermia. The heart rate increases with hyperthermia. The skin is usually pale or cyanotic with hypothermia.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? 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

All cells in the body are believed to have intracellular receptors for: A. insulin B. glucagon C. growth hormone D. thyroid hormone

D. thyroid hormone

Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states: a. "If I have hypoglycemia, I should eat some sugar, not dextrose." b. "The drug makes my pancreas release more insulin." c. "I should never take insulin while I'm taking this drug." d. "It's best if I take the drug with the first bite of a meal."

a. "If I have hypoglycemia, I should eat some sugar, not dextrose."

Which instruction about insulin administration should nurse Kate give to a client? a. "Always follow the same order when drawing the different insulins into the syringe." b. "Shake the vials before withdrawing the insulin." c. "Store unopened vials of insulin in the freezer at temperatures well below freezing." d. "Discard the intermediate-acting insulin if it appears cloudy."

a. "always follow the same order when drawing the different insulins into the syringe"

Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. "Be sure to take glipizide 30 minutes before meals." b. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." c. "You won't need to check your blood glucose level after you start taking glipizide." d. "Take glipizide after a meal to prevent heartburn."

a. "be sure to take glipizide 30 minutes before meals."

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation

a. muscle weakness

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? a. Cool, clammy skin b. Distended neck veins c. Increased urine osmolarity d. Decreased serum sodium level

c. increased urine osmolarity

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include: a. hypernatremia and edema b. muscle spasticity and hypertension c. low urine output and hyponatremia d. weight gain and decreased glomerular filtration rate

c. low urine output and hyponatremia

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: a. Trousseau's sign. b. Homans' sign. c. Hegar's sign. d. Goodell's sign.

a. Trousseau's sign This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? a. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone

a. acromegaly

A male 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 of the following glands? a. Adrenal cortex b. Pancreas c. Adrenal medulla d. Parathyroid

a. adrenal cortex

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).

a. antidiuretic hormone (ADH)

A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression b. Neuropathy c. Hypoglycemia d. Hyperthyroidism

a. depression Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? a. Dry skin b. Lethargy c. Insomnia d. Tachycardia e. Sensitivity to cold

a. dry skin b. lethargy e. sensitivity to cold Dry skin is a response to hypothyroidism that is related to the associated decreased metabolic rate. Lethargy and sensitivity to cold are symptoms related to hypothyroidism that are associated with a decreased metabolic rate. Insomnia and tachycardia are related to hyperthyroidism, not hypothyroidism.

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.

a. fluid intake is less than 2,500 ml/day

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? a. Hirsutism b. Round face c. Pitting edema d. Buffalo hump e. Hypoglycemia

a. hirsutism b. round face d. buffalo hump

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? a. Hypocalcemia b. Hypercalcemia c. Hypokalemia d. Hyperkalemia

a. hypocalcemia

Nurse Wayne is aware that a positive Chvostek's sign indicate? a. Hypocalcemia b. Hyponatremia c. Hypokalemia d. Hypermagnesemia

a. hypocalcemia

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to: a. increase calcium intake to 1500 mg/day b. perform glucose monitoring for hypoglycemia c. obtain immunizations due to high risk of infections d. avoid abrupt position changes because of orthostatic hypotension

a. increase calcium intake to 1500 mg/day

Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? a. Oral anticoagulants b. Anabolic steroids c. Beta-adrenergic blockers d. Thiazide diuretics

a. oral anticoagulants As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn't interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.

A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer: a. phentolamine (Regitine). b. methyldopa (Aldomet). c. mannitol (Osmitrol). d. felodipine (Plendil).

a. phentolamine (Regitine) Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism b. Graves' disease c. Thyrotoxicosis d. Euthyroidism

a. primary hypothyroidism

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? a. Related to bone demineralization resulting in pathologic fractures b. Related to exhaustion secondary to an accelerated metabolic rate c. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces d. Related to tetany secondary to a decreased serum calcium level

a. related to bone demineralization resulting in pathologic fractures

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in: a. Serum glucose level. b. Hair loss. c. Bone mineralization. d. Menstrual flow.

a. serum glucose level

Which diagnostic test does the nurse consider to help in identifying the abnormalities of the sella turcica in hyperpituitarism? a. Skull x-ray b. Angiography c. Computer tomography d. Magnetic resonance image

a. skull x-ray

When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? a. sulfisoxazole (Gantrisin) b. mexiletine (Mexitil) c. prednisone (Orasone) d. lithium carbonate (Lithobid)

a. sulfisoxazole (Gantrisin) Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage

a. tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic). b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.

a. vasopressin (Pitressin Synthetic)

A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? a. "You'll need more insulin when you exercise or increase your food intake." b. "You'll need less insulin when you exercise or reduce your food intake." c. "You'll need less insulin when you increase your food intake." d. "You'll need more insulin when you exercise or decrease your food intake."

b. "You'll need less insulin when you exercise or reduce your food intake."

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? a. "You must lie flat for 24 hours after surgery." b. "You must avoid coughing, sneezing, and blowing your nose." c. "You must restrict your fluid intake." d. "You must report ringing in your ears immediately."

b. "you must avoid coughing, sneezing, and blowing your nose" After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: a. 2 to 5 g of a simple carbohydrate. b. 10 to 15 g of a simple carbohydrate. c. 18 to 20 g of a simple carbohydrate. d. 25 to 30 g of a simple carbohydrate.

b. 10 to 15g of a simple carbohydrate

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.

b. monitoring blood glucose levels e. protecting patient from exposure to infection

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? a. At least once a week b. At least three times a week c. At least five times a week d. Every day

b. at least three times a week

Nurse Troy is aware that the most appropriate nursing diagnosis for a client with Addison's disease is? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia

b. excessive fluid volume Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

Polydipsia and polyuria related to diabetes mellitus are primarily due to: a. The release of ketones from cells during fat metabolism b. Fluid shifts resulting from the osmotic effect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin

b. fluid shifts resulting from the osmotic effect of hyperglycemia

A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: a. prefers to take insulin orally. b. has type 2 diabetes. c. has type 1 diabetes. d. is pregnant and has type 2 diabetes.

b. has type 2 diabetes Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

A characteristic common to all hormones is that they: 1. circulate in the blood bound to plasma proteins 2. influence cellular activity of specific target tissues 3. accelerate the metabolic processes of all body cells 4. enter a cell to alter the cell's metabolism or gene expression

b. influence cellular activity of specific target tissues

After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? a. Initiate insulin therapy. b. Switch the client to a different oral antidiabetic agent. c. Prescribe an additional oral antidiabetic agent. d. Restrict carbohydrate intake to less than 30% of the total caloric intake.

b. switch the client to a different oral anti diabetic agent

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany

b. thyroid crisis

A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: a. "The test needs to be repeated following a 12-hour fast." b. "It looks like you aren't following the prescribed diabetic diet." c. "It tells us about your sugar control for the last 3 months." d. "Your insulin regimen needs to be altered significantly."

c. "It tells us about your sugar control for the last 3 months

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? a. "Administer desmopressin while the suspension is cold." b. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." c. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." d. "You won't need to monitor your fluid intake and output after you start taking desmopressin."

c. "you may not be able to use desmopressin nasally if you have nasal discharge or blockage"

Which drug can cause diabetes insipidus? a. Cabergoline b. Metyrapone c. Demeclocycline d. Aminoglutethimide

c. Demeclocycline

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? a. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs. b. It interacts with plasma membrane receptors to inhibit enzymatic actions. c. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. d. It regulates the threshold for water resorption in the kidneys.

c. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels? a. Diabetes insipidus b. Adrenal Cushing's syndrome c. Pituitary Cushing's syndrome d. Syndrome of inappropriate antidiuretic hormone

c. Pituitary Cushing's syndrome

For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? a. They contain exudate and provide a moist wound environment. b. They protect the wound from mechanical trauma and promote healing. c. They debride the wound and promote healing by secondary intention. d. They prevent the entrance of microorganisms and minimize wound discomfort.

c. They decried the wound and promote healing by secondary intention

A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise? <p>A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise? a. To decrease insulin sensitivity b. To stimulate glucagon production c. To improve the cellular uptake of glucose d. To reduce metabolic requirements for glucose

c. To improve the cellular uptake of glucose

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to: a. monitor blood glucose levels b. restrict fluid and sodium intake c. administer potassium-sparing diuretics d. advise the patient to make postural changes slowly

c. administer potassium-sparing diuretics

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: 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

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? a. Restricting fluids b. Restricting sodium c. Forcing fluids d. Restricting potassium

c. forcing fluids The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Thyroid storm. b. Cretinism. c. Myxedema coma. d. Hashimoto's thyroiditis.

c. myxedema coma Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is: a. once a day at bedtime b. every other day on awakening c. on arising and in the late afternoon d. at consistent intervals every 6 to 8 hours

c. on arising and in the late afternoon

Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose's: a. Onset to be at 2 p.m. and its peak to be at 3 p.m. b. Onset to be at 2:15 p.m. and its peak to be at 3 p.m. c. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. d. Onset to be at 4 p.m. and its peak to be at 6 p.m.

c. onset to be at 2:30 p.m. and its peak to be at 4 p.m. Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.

Which does the nurse state is a secondary cause of adrenal insufficiency? a. Hemorrhage b. Tuberculosis c. Pituitary tumors d. Metastatic cancer

c. pituitary tumors Adrenal insufficiency is also called Addison's disease. Secondary causes of adrenal insufficiency include pituitary tumors. Primary causes, which are responsible for adrenal insufficiency, include hemorrhage, tuberculosis, and metastatic cancer.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered

c. restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug a. Dysuria b. Leg cramps c. Tachycardia d. Blurred vision

c. tachycardia

During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? a. "The head of your bed must remain flat for 24 hours after surgery." b. "You should avoid deep breathing and coughing after surgery." c. "You won't be able to swallow for the first day or two." d. "You must avoid hyperextending your neck after surgery."

d. "you must avoid hyperextending your neck after surgery"

Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: a. I.M. or subcutaneous glucagon. b. I.V. bolus of dextrose 50%. c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. d. 10 U of fast-acting insulin.

d. 15 to 20 g of a fast-acting carbohydrate such as orange juice

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? 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. Body image disturbance 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

Which hormone is released from the pancreas? a. Oxytocin b. Prolactin c. Calcitonin d. Somatostatin

d. Somatostatin Somatostatin is a hormone produced by the pancreas that inhibits the release of insulin and glucagon. Oxytocin is a hormone produced by the posterior pituitary gland that acts on the uterus and mammary glands. Prolactin is a hormone produced by the anterior pituitary gland that targets the ovaries and mammary glands in women and testes in men. Calcitonin is a hormone produced by the thyroid gland that interacts with bone tissue.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: a. a blood pressure of 130/70 mm Hg. b. a blood glucose level of 130 mg/dl. c. bradycardia. d. a blood pressure of 176/88 mm Hg.

d. a blood pressure of 176/88 mm Hg

The nurse is aware that the following is the most common cause of hyperaldosteronism? a. Excessive sodium intake b. A pituitary adenoma c. Deficient potassium intake d. An adrenal adenoma

d. an adrenal adenoma

Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a. Increasing saturated fat intake and fasting in the afternoon. b. Increasing intake of vitamins B and D and taking iron supplements. c. Eating a candy bar if lightheadedness occurs. d. Consuming a low-carbohydrate, high protein diet and avoiding fasting.

d. consuming a low-carbohydrate, his protein diet and avoid fasting

A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? a. Diabetes mellitus b. Diabetes insipidus c. Hypoparathyroidism d. Hyperparathyroidism

d. hyperparathyroidism

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing. d. laryngospasms and tingling in the hands and feet.

d. laryngospasms and tingling in the hands and feet

A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? a. Serum potassium level b. Serum sodium level c. Arterial blood gas (ABG) values d. Serum osmolarity

d. serum osmolality

Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to: 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

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. the patient must receive insulin therapy to prevent ketoacidosis b. the patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin c. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome

d. the patient may have sufficient endogenous insulin to prevent ketosis but is at a risk for hyperosmolar hyperglycemic syndrome