PVN 142

An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she has taken for 15 years, has been reduced. The nurse's best response would be that the decreased dose is related to: Drug-related hypertrophy of the thyroid Changes in your diet and activity level Age-related reduction in metabolic rate Improved efficacy of the thyroid preparation

3

Calcitonin: decreases calcium storage in bones. reveals thyroid functioning in the protein-bound iodine (PBI) test. has the opposite effect of parathyroid hormone. raises blood calcium levels.

3

Hypopituitarism can produce: loss of secondary sex characteristics, decreased metabolism, goiter, diabetes insipidus, hyperthyroidism increased metabolism, gigantism, diabetes insipidus, hyperthyroidism loss of secondary sex characteristics, decreased metabolism, dwarfism, diabetes insipidus, hypothyroidism, enlarged hands and feet, goiter, hypothyroidism, increased libido

3

If hypersecretion of growth hormone occurs after epiphyseal closure, which of the following conditions might be observed by the nurse? Dwarfism Cretinism Acromegaly Gigantism

3

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment.Which of the following statements demonstrates Mr. M. Blahnik's need for more teaching? " I can have occasional wine if it is calculated into my diet.": "If I want to lose weight, I have to exercise and continue to monitor my weight and blood sugar." "I will maintain better control of my blood sugar if I skip a meal a day." " It is important that I eat properly, exercise regularly, and take my insulin injection."

3

Propranolol (Inderal) is used in the treatment of hyperthyroidism to: reduce the uptake of iodide by the thyroid glands prevent the chemical conversion of thyroglobulin treat the cardiovascular effects of hyperthyroidism prolong the action of anti thyroid drugs.

3

The condition that results from the administration of more insulin than is required to deal with a glucose load is called: DKA. Hyperglycemia and hyperosmolar. Hypoglycemia / insulin reaction. Diabetic coma

3

The family of a client with SIADH asks the nurse if the water restriction is a punishment for the client's uncooperative behavior. What is the nurse's best response? "No, limiting water intake prevents the client from losing too much fluid by vomiting." "No, limiting fluid decreases the client's sense of thirst and prevents him from drinking liquids that contain an excess of sodium." "No, limiting fluid intake keeps the client's blood from becoming more dilute and causing other complications." "No, limiting fluid intake decreases the risk of kidney failure."

3

The nurse caring for a patient with diabetes insipidus (DI) should be alert for the following and report which sign that indicates a change in condition? Increase thirst Moist mucous membranes Increase heart rate Light clear urine

3

The nurse is doing discharge teaching with a client who has had a bilateral adrenalectomy. What should be included in the teaching plan? Teaching her urine and blood testing to help in the regulation of steroid dosages. Reinforcing that steroids should be slowly tapered if she decides to stop taking them. Explaining that she will need to take corticosteroids for the rest of her life. Telling her that after 1-2 years she will likely not need to take medication.

3

The underlying pathogenic mechanism for both type 1 and type 2 diabetes is lack of exercise and chronic overeating. lack of insulin receptors. impaired glucose transport into cells. pancreatic b-cell destruction.

3

Use the following coverage to determine the amount of insulin to give Mr. C. Louboutin andMs. K. Spade.Humalog (Lispro) 5 units subcutaneously before lunch and dinnerGlargine 10 units at bedtimeAdminister Humalog (Lispro) insulin subcutaneously AC & HS for:Glucose less than 170 = No coverage ; Glucose 171-200 = 1 unit Glucose 201 - 250 = 2 units; Glucose 251 -300 = 3 unitGlucose 301 -350 = 4 units ; Glucose 351-400 = 6 unitsGlucose over 400 call physicianMr.C.Louboutin was admitted with left foot ulcer r/t tight fitting shoes. He has a pre- meal blood glucose (BG) of 247 mg/dL ac lunch. He eats his meals very well each day and is almost finish with his meal 15 minutes after you served his tray. Which is the correct amount / dose of insulin to give him? 5 units after he finishes his meal 2 units now 7 units now 5 units now and 2 units when he finishes his meal

3

What instruction should the nurse emphasize when teaching the diabetic client about how to alter diabetes management during a period of illness that includes nausea and vomiting. "Continue your prescribed exercise regimen." "Avoid eating or drinking to reduce vomiting." "Monitor your blood glucose levels at least every 4 hours." "Do not use insulin or take your oral antidiabetic agent."

3

What is the classic clinical manifestation of Addison's disease? hoarseness and vocal stridor tetany skin hyperpigmentation in sun exposed areas of the body moon-shaped face and buffalo hump

3

When a client asked the nurse how "diabetic pills" differ from insulin, nurse Tiffany Bleu would response knowing that some oral hypoglycemic agents work by increasing hepatic glucose production. stimulating the islet cells to secrete more glucagon. causing the cells in the pancreas to release more insulin. decreasing hepatic insulin sensitivity.

3

When a patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill in addition to insulin, the nurse replies that in type 2 diabetes mellitus, the body makes insulin but: Overweight and underactive people cannot simply use the insulin produced. Sometimes the autoimmune system works against the action of the insulin. The cells become resistant to the action of insulin. Pills are given to increase the sensitivity. Metabolism is slowed in some people so they have to take a pill to speed up their metabolism.

3

When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP), the nurse notes that a drug interaction will occur if which drug is taken with desmopressin? Aspirin Digoxin Lithium Penicillin

3

Which assessment finding in the client with diabetes mellitus indicates that the disease is damaging the kidneys? The presence of white blood cells in the urine during UTI The presence of glucose in the urine during hyperglycemia The presence of protein in the urine during a random urinalysis The presence of ketone bodies in the urine during acidosis

3

Which clinical manifestation alerts the nurse to the possibility of an endocrine disorder? Chronic constipation Muscle cramps after heavy exercise and during hot weather Increased sense of thirst and increased urine output Weight gain of 5 pounds in the past 12 months

3

Which of the following is the correct procedure for mixing two types of insulin in the same syringe? Draw each insulin in a separate syringe then combine the two. Two types of insulin should not be mixed in the same syringe. Withdraw the short acting insulin prior to the intermediate insulin. Withdraw any insulin that is clear prior to any other types of insulin.

3

Which of the following medications can be associated with the onset of SIADH? NSAIDS oral contraceptives opiates antibiotics

3

A patient has returned to his room after a thyroidectomy. He is presenting with signs and symptoms of thyroid crisis. During thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the potentially lethal complication of bradycardia delirium with restlessness. severe nausea and vomiting. congestive heart failure.

4

All statements about the pituitary glands are true but: It works closely with the hypothalamus. It is called the "master gland." It is divided into two segments, each with specialized hormones. One of its hormone is responsible for the "fight or flight" response

4

An abnormality with which of the following posterior pituitary hormones could lead to water imbalance in a client? Luteinizing hormone Adrenocorticotropic hormone Thyroid stimulating hormone Antidiuretic hormone

4

Calcitonin and parathyroid hormone secretions are regulated by negative feedback. Increased blood calcium levels result in increased calcitonin and increased parathyroid hormone decreased calcitonin and decreased parathyroid hormone decreased calcitonin and increased parathyroid hormone increased calcitonin and decreased parathyroid hormone

4

Following thyroidectomy, a client would be at risk for which of these effects on the metabolic rate and subsequent symptoms? rate increased with weight gain and decreased appetite rate decrease with weight loss and increased appetite rate increase with weight gain and decreased appetite rate decreased with weight gain

4

In clients with hyperparathyroidism, which of the following calcium levels would be considered an acute hypercalcemic crisis? 7.5 mg/dl 2 mg/dl 10.5 mg/dl 15 mg/dl

4

Insulin forces which of the following electrolytes out of the plasma and into the cells? Calcium Sodium Magnesium Potassium

4

Parathyroid hormone increases calcium absorption in the intestines by activating: Calcitonin Vitamin A. Iron Vitamin D

4

Recently, attention has turned to a new line of therapy using substances called incretins for patients with type 2 diabetes. Which of the following statements is true about this hormone? It has more side effects. Speeds up the emptying of the stomach's contents into the intestines, which lowers blood sugar levels after a meal. It promotes a feeling of hunger , minimizing the risk of hypoglycemia. GLP-1 is an important incretin hormone that helps normalize blood sugar levels.

4

Synthesis of thyroid hormones is stimulated by ACTH. is increased by thyrotropin-inhibiting factor. occurs in perifollicular C cells. is inhibited by iodine deficiency.

4

The client with diabetes mellitus who is just starting on insulin therapy wants to know why more than one injection of insulin each day will be required. What is the nurse's best response? "You need to start with multiple injections until you become more proficient at self-injection." "A regimen of a single dose of insulin injected each day would require that you could eat no more than one meal each day." "A single dose of insulin would be too large to be absorbed predictably, so you would be in danger of unexpected insulin shock." "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns closely enough."

4

After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? "I will wear dark glasses to prevent sun exposure." "I'll keep food on upper shelves so I do not have to bend over." "I must wash the incision with peroxide and redress it daily." "I shall cough and deep breathe every 2 minutes while I am awake."

2

Which client would be a candidate for radioactive iodine therapy? 46-year-old man with prior hx of thyroidectomy and recurring hyperthyroidism 64-year-old woman with hypothyroidism 21-year-old newly married woman with Graves' disease 82-year-old man status post TURP with myxedema crisis

1

Which clinical manifestation indicates to the nurse that the therapy for the client with hyperglycemic, hyperosmolar, nonketotic syndrome (HHNS) is not effective and needs to be adjusted? The client's score on the Glasgow Coma Scale of 8 is unchanged from 12 hours ago. The client's blood glucose level changed from 950 to 750 mg/dL. The client's serum potassium level increased from 2.8 mEq/L to 3.4 mEq/L. The client's urine has remained negative for ketone bodies for the past 12 hours.

1

Which of the following medications would be used to treat diabetes insipidus? Desmopressin (DDAVP) Glucocorticoids Tolvaptan (Samsca) Vaprisol (Conivaptan)

1

With the understanding of blood osmolarity, the student nurse knows that the activity of the thirst center will be increased if blood volume is increased calcium ions are less concentrated in the blood urine output is abnormally low blood osmolarity is increased

1

An increase in ADH secretion occurs in response to hyponatremia. dehydration. hypervolemia. a decrease in serum osmolality.

2

Dipeptidyl peptidase-4 inhibitors (DPP-4i) such as Sitagliptin (Januvia) can be used either alone or in combination with other oral antihyperglycemic agents to: Prevent production of glucagon and insulin. Prevent degradation of incretin. Prevent degradation of glucagon. Prevent degradation of insulin

2

Exenatide (Byetta) works by: facilitating glucose production in type 2 diabetics. causing insulin release from the pancreas only when serum glucose levels are high. oral administration in conjunction with other hypoglycemic agents. replacing regular insulin therapy for newly diagnosed type 2 diabetics.

2

High blood levels of ADH would be found in someone who has: just eaten a meal high in sugar or other carbohydrates. been working in high temperatures and is dehydrated. a high level of calcium in the blood. a low level of calcium in the blood.

2

If fluid intake is limited in a client with diabetes insipidus, which of the following complications will he be at high risk for developing? Hypertension and bradycardia Severe dehydration and hypernatremia Peripheral edema and hyperglycemia Glucosuria and weight gain

2

In comparison with the nervous system, the regulatory effects of the endocrine system are: rapid and long lasting slow to appear, but long-lasting. the same, because the systems work together. rapid to appear; but short-lived.

2

Most signs and symptoms of SIADH appear when serum sodium level falls below 130 mEq/L 125 mEq/L. 135 mEq/L 145 mEq/L

2

A physician has prescribed propylthiouracil (PTU) for a client with thyroid disorder. The nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: signs and symptoms of hyperthyroidism. signs and symptoms of hypothyroidism relief of pain signs of renal toxicity

2

Ms. QRS, is a 29 year old secretary who received 131 Iodine yesterday in an attempt to slow the progression of her thyroid condition. For which of the following personnel would participating in her direct bedside can be dangerous? A 34- year- old nurse who is new to the unit. A 22- year-old LVN who is 6 weeks pregnant. A 49 -year-old staff nurse just returning from being ill. A 19- year - old first semester nursing student.

2

The client getting ready to engage in a 30-minute, moderate-intensity exercise program performs a self-assessment. Which data indicate that exercise should be avoided at this time? Pulse rate of 66 beats/min Ketone bodies in the urine Blood sugar level of 155 mg/dL Weight 1 pound higher than the week before

2

All are clinical symptoms the nurse can observe in a patient with thyrotoxicosis except: Sweating Anxiety Decreased heart rate Restlessness Muscle tremors

3

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse expect to be affected by this condition? (Select all that apply.) Thyroid-stimulating hormone Vasopressin Follicle-stimulating hormone Calcitonin Growth hormone

1,3,5

Which of these nursing diagnoses is most appropriate for a client who has hyperthyroidism? "Risk for injury related to potential for hypertensive crisis." "Imbalanced nutrition, less than body requirements." "Anxiety related to complications of hyperthyroidism." "Impaired swallowing related to exophthalmos."

"Imbalanced nutrition, less than body requirements."

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment.The nurse notes that Manolo's breath has a fruity odor, and he is exhibiting Kussmaul respirations. What is the mechanism that results in Kussmaul respirations? To compensate for metabolic acidosis, the respirations are deep and rapid. Hypoxemia causes labored, gasping, and irregular respirations. Injury to the brain's respiratory center results in periods of apnea. To overcome respiratory acidosis, the respirations are fast and shallow.

1

A client is taking levothyroxine (Synthroid) as treatment for hypothyroidism. The nurse determines that which of the following client manifestations is consistent with an underdose? Lethargy Diarrhea Heat intolerance Weight loss

1

A client who is insulin-dependant fails to take insulin regularly. He is at risk for which of the following conditions? Diabetic ketoacidosis Gestational Diabetes Metabolic alkalosis Hypoglycemia

1

A client who is taking levothyroxine (Synthroid) begins to develop weight loss, diarrhea, and insomnia. The nurse should be aware that this might be indications of what hormonal condition? Hyperthyroidism Myxedema Cretinism Hashimoto's tyroiditis

1

A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered correction insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating "I don't want to start taking that drug! I'll need it the rest of my life." What is the nurse's best response? Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you're feeling better, your provider will determine if your oral medication is all you will need." "This is the same drug as the oral medication you were taking. It's a stronger dose while you are in the hospital." "Don't worry. You shouldn't need this too often. As you feel better, your blood glucose level will drop." "Your disease is progressing and your pancreas is not producing insulin. I know this is a hard time for you."

1

A rapid-acting insulin use to help control the spike in blood sugar levels that occurs after meals. Glulisine (Apidra) Lantus Toujeo Glargine

1

All statements about the pituitary glands are true but: One of its hormone is responsible for the "fight or flight" response. It is divided into two segments, each with specialized hormones. It works closely with the hypothalamus. It is called the "master gland."

1

An 8-year-old child has been diagnosed with true pituitary disorder and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome from this therapy?? Increased growth Decreased urinary output Increased muscle strength Increased height when the child reaches puberty

1

Another name for the pituitary gland hypophysis posterior pituitary anterior pituitary epiphysis

1

Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. Which is the immediate nursing action? Check the urine specific gravity. Document the complaints. Increase the client's fluid intake. Check for blood glucose.

1

If a patient is suspected to have an acute onset of SIADH which would be the most important assessment finding for the nurse to report to the doctor immediately? A weight gain of 3lbs overnight A weight loss of 3lbs overnight A normal set of vital signs A urine specific gravity of 1.010

1

In drawing up a teaching plan for a patient with Addison disease, the nurse will include: Wearing a medical alert tag and carrying emergency dexamethasone. Decreasing medication if the patient is under stress or is being treated for an infection. Discontinuing hormonal replacement therapy if the patient becomes nauseated or has diarrhea. Beginning a vigorous exercise program to overcome weakness and muscle wasting.

1

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment.Once the acute ketoacidosis is controlled, Manolo is told that he has Type 1 diabetes mellitus. The nurse obtains Manolo's history. Manolo states that prior to the flu, he had been healthy. However, he had noticed that he had been eating more than normal, but had not been gaining any weight. Manolo also states that he had been drinking a lot of diet colas and that he got up at night frequently to go to the bathroom. The nurse identifies that Manolo has experienced classic symptoms of diabetes, which are: Polyuria, polyphagia, and polydypsia. Dysuria, dyspepsia, and dysphagia. Abnormal diet, drink, and distention. Increased metabolism, increased fluid volume, and increased urgency.

1

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment.The nurse assigned to care for Manolo is aware that diabetes ketoacidosis is a life-threatening condition that results in: Inability of carbohydrates, fats, and proteins to be metabolized Dangerously elevated pH and bicarbonate levels in the blood Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream Severe hypoglycemia, which can result in coma and convulsions

1

One medical management of SIADH includes administration of a hypertonic solution. The nurse is aware that this is necessary to pull water out of the vascular system to correct hypernatremia to correct hyperkalemia to stimulate production of ADH

1

A laboratory finding that would help confirm the diagnosis of aldosterone deficiency is hypokalemia hypernatremia hyperkalemia hypoglycemia.

3

The client has been diagnosed with Addison's disease. His wife asks the nurse if he could be developing Alzheimer's disease because he has been exhibiting memory loss and some confusion. Which is the most accurate response from the nurse? "Forgetfulness and some confusion are symptoms of Addison's disease. I'll tell your doctor that you are concerned." "I'll arrange with his physician for testing." "I'll perform an assessment and try to determine if there is evidence present of the disease." "Have you told your doctor you are concerned about Alzheimer's disease in your family?"

1

The client is being admitted with acute adrenal insufficiency (Addisonian crisis). What medication should the nurse be prepared to administer? Hydrocortisone in saline and glucose solution Regular Insulin IV Sodium bicarbonate Insulin 20 units and dextrose 20%

1

The client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking the corticosteroids. Which is the nurse's best response? "The drug suppresses your adrenal gland secretion of corticosteroids and you need to decrease your dose slowly so your glands will begin to work again." "It is possible for the inflammation to recur." "The drug suppresses your immune system and you need to build this back up by slowly decreasing the medication." "Once you have been started on a replacement hormone, you must continue the hormone replacement therapy for a certain amount of time."

1

The client who has type 2 diabetes mellitus is prescribed to take the insulin glargine once daily and regular insulin four times daily. The first dose of regular insulin occurs at the same time of day as the insulin glargine dose. How should the nurse teach the client to take these two medications? "Draw up and inject the insulin glargine first and then using another syringe, draw up and inject the dose of regular insulin." "First draw up the dose of regular insulin, and then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together." "Draw up and inject the insulin glargine first, wait 1 hour, and then using another syringe draw up and inject the dose of regular insulin." "First draw up the dose of insulin glargine, and then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together."

1

The growth hormone is known to be associated with this condition seen in both type 1 and type 2 diabetes mellitus when an increase in blood sugar level occurs between 4AM and 8AM. Dawn Phenomenon Diabetic ketoacidosis Insulin reaction Hyperosmolar state

1

The hormones responsible for blood calcium levels are: Melatonin and follicle-stimulating hormone Calcitonin and parathormone Estrogen and progesterone Thyroid- stimulating hormone and epinephrine

1

The neurohypophysis serves as a storage and release site for: antidiuretic hormone and oxytocin Oxytocin and prolactin antidiuretic hormone and prolactin both A and B

1

The nurse explains that type 1 diabetes mellitus is a disease in which the body initially does not produce enough insulin; consequently, the blood glucose is elevated because of the: Destruction of the beta cells in the pancreas. Malfunction of the glycogen-storing capabilities of the liver. Insulin resistance of the receptor cells in the muscle tissue. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth hormone) levels.

1

The nurse should instruct diabetic clients about "sick day management" of their disease by emphasizing which of these actions? Monitor blood glucose closely and continue taking the scheduled insulin or oral hypoglycemic agent. Use sliding scale insulin to manage hypoglycemia. Report blood glucose lower than 100 mg/dL to the health care provider. Increase intake of carbohydrates for the duration of the illness.

1

The patient with hypopituitarism must take medications for the rest of his or her life. The patient teaching plan would include: "You must become familiar with the signs and symptoms of inadequate or excessive hormone replacement." "It is not necessary to wear a medical alert bracelet or necklace." "Your self-image is important. Take positive steps to improve your appearance." "Constipation must be prevented because straining increases intracranial pressure."

1

This oral hypoglycemic agent lowers blood glucose by reducing hepatic glucose production , enhancing tissue repose to insulin and improving glucose transport into cells. Metformin (Glucophage) Humulin R Tolbutamide ( Orinase) Glyburide (Micronase)

1

Use the following coverage to determine the amount of insulin to give Mr. C. Louboutin andMs. K. Spade.Humalog (Lispro) 5 units subcutaneously before lunch and dinner Glargine 10 units at bedtimeAdminister Humalog (Lispro) insulin subcutaneously AC & HS for:Glucose less than 170 = No coverage ; Glucose 171-200 = 1 unit Glucose 201 - 250 = 2 units; Glucose 251 -300 = 3 unitGlucose 301 -350 = 4 units ; Glucose 351-400 = 6 unitsGlucose over 400 call physicianIt is now 0630 in the morning and Ms. K. Spade is getting ready for breakfast. Her fingerstick blood sugar is 168 mg/dL. How much insulin should the nurse prepare to administer Ms. K. Spade? None 5 units Humalog 5 units of Humalog and 10 units of Glargine 6 units of Humalog

1

Use the following coverage to determine the amount of insulin to give Mr. C. Louboutin andMs. K. Spade.Humalog (Lispro) 5 units subcutaneously before lunch and dinnerGlargine 10 units at bedtimeAdminister Humalog (Lispro) insulin subcutaneously AC & HS for:Glucose less than 170 = No coverage ; Glucose 171-200 = 1 unit Glucose 201 - 250 = 2 units; Glucose 251 -300 = 3 unitGlucose 301 -350 = 4 units ; Glucose 351-400 = 6 unitsGlucose over 400 call physicianMs. K Spade is a 45 year old woman with type 2 diabetes mellitus. She was referred to your clinic for diabetes education program because she has not achieve adequate glycemic control with dietary measures and exercise. Kate is very eager to learn about insulin to control her blood glucose. The physician and the dietician worked with her using nutritional , basal and correction insulin dosing. Kate checked her bedtime blood sugar which was 275 mg/dL. Using the information provided , how much insulin and what type of insulin would Kate receive? 3 units of Humalog and 10 units of Glargine 10 units of Glargine only 8 units of Humalog and 10 units of Glargine 10 units of Humalog and 3 units of Glargine

1

What is the major hormone secreted by the adrenal medulla? Epinephrine Dopamine Aldosterone Vasopressin

1

Identify the clinical manifestations of SIADH. (Select all that apply.) irritability & disorientation peripheral edema & weight gain weakness & muscle cramps hyponatremia & weight gain

1,3,4

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment. To restore Manolo's blood glucose to a normal level, what would the LVN expect the RN to prepare to administer? An IV infusion containing short acting (insulin drip). Humulin-N insulin SC before meals. 50% dextrose IV push. Glucagon subcutaneously PRN per sliding scale.

1 Continuous IV infusions containing regular insulin are used to reduce the client's blood glucose level. Lara's IV solution will be changed to one that contains glucose when her blood glucose level reaches 250 mg/dl.

Your client who is being treated for hyperparathyroidism is receiving calcitonin. The action of this hormone is to inhibit release of calcium from the bones promote excretion of calcium in the urine promote calcium absorption from the gastrointestinal (GI) tract help in the excretion of kidney stones

1 Calcitonin cause calcium to be stored in the bonesPTH increased calcium ; calcitonin will make calcium stay in the bones

The nurse explains to the patient that antithyroid drugs is given pre surgical to:(Select all that apply). Decrease the threat of a thyroid storm. Increase weight Help reduce the risk of hemorrhage during surgery. Decrease the level of hormone in the blood before surgery.

1,3,4

A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) Hepatomegaly High-pitched voice Enlarged hands and feet Appear younger than age Bulging forehead

1,3,5

A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? Magnesium Potassium Calcium Sodium

3

A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.) Continued hormone activity requires continued production and secretion. Control of hormone activity is caused by negative feedback mechanisms. Most hormones are stored in the target tissues for use later. Hormones may travel long distances to get to their target tissues. Most hormones cause target tissues to change activities by changing gene activity.

1,2,3

Clinical manifestations of diabetes insipidus are: (Select all that apply.) hypernatremia polydypsia polyuria oliguria

1,2,3

Which of the following statements is true about the endocrine system? (Select all that apply.) it produces effects that can last for hours, days, or even longer. it releases hormones that can alter the metabolic activities of many different tissues and organs. it communicates through the use of neurotransmitters. it releases chemicals into the bloodstream for distribution throughout the body.

1,2,4

A cause for acromegaly can be which of the following? Increased ADH Idiopathic hyperplasia Decreased ADH Congenital

2

A client receiving NPH insulin everyday at 8 in the morning will be instructed to watch for signs of hypoglycemia reaction to occur at what time? around 4 am the next morning from around 2pm to about after midnight around10 am never

2

A client with diabetes mellitus receives a breakfast tray from the dietary unit at 07:30. If the client has an order for a morning dose of insulin lispro (Humalog), the nurse should plan to administer the dose at which of the following optimal times? 07:25 PM 07:15 AM 08:15 AM 06:30AM

2

A client with lung cancer has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following interventions should the client's care plan include? Increased oral fluid intake. Restriction of fluid intake. Rapid correction of hyponatremia. Massive intravenous fluid administration.

2

A life-threatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease. Hypocalcemia Myxedema coma Hypertension Hypercalcemia

2

A nurse cares for a client after a pituitary gland stimulation test using insulin-like growth hormone (IGF 1). The client's post-stimulation laboratory results indicate elevated levels of growth hormone (GH) regardless of high levels of IGF-1. How should the nurse interpret these results? Pituitary hypofunction Pituitary hyperfunction Pituitary-induced diabetes mellitus Normal pituitary response to insulin

2

A nurse caring for a patient who is receiving vasopressin understands that this medication will: block the release of thyroid hormone. decrease urine output. decrease smooth muscle contraction. cause vasodilation of vascular vessels.

2

A patient enters the emergency department in an addisonian crisis. Vital signs are blood pressure 85/52 mm Hg and pulse 88 beats/min. The patient is lethargic. Which event in the patient's week most likely precipitated this crisis? Maintaining usual exercise of walking each night Being laid off from a job Taking Tylenol for a headache Eating a high-fat diet

2

A patient has recently been diagnosed with acromegaly. Using Maslow's hierarchy, which of the nursing diagnoses listed below should be of the highest priority in caring for him? Risk for chronic low self-esteem Risk for trauma Risk for activity intolerance Risk for ineffective coping

2

A patient has type 1 diabetes mellitus (IDDM). The nurse is teaching her early signs and symptoms of insulin reaction, which include dyspnea and pallor. perspiration and a trembling sensation. abdominal pain and nausea. flushing of the skin and headache.

2

A patient with myxedema complains to the nurse that he has a "hangover" the next morning after taking a pain medication at night. Which explanation by the nurse is the most accurate? "The pain medication is incompatible with your thyroid medication and you should find another analgesic to take." "You have increased sensitivity to the medicine because of your thyroid condition." You are not taking enough thyroid medication and you should increase the dosage." "Because you haven't been sleeping, you have increased fatigue and should increase the analgesic."

2

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes the insulin precursor that is secreted by the pancreas is not activated by the liver. there is decreased insulin secretion and cellular resistance to insulin that is produced. the patient is totally dependent on an outside source of insulin. the immune system destroys the pancreatic insulin-producing cells.

2

The client newly diagnosed with type 1 diabetes mellitus has just learned to measure urine ketone bodies. She asks the nurse when this should be done. What is the nurse's best response? "Whenever you participate in vigorous exercise or experience a change in your daily activity level." "Whenever you are ill or your blood sugar is consistently higher than 300 mg/dL." "Whenever you test your blood for glucose." "Daily, just before you take your insulin."

2

The diabetic client asks the nurse why it is necessary to maintain blood glucose levels no lower than about 70 mg/dL. What is the nurse's best response? "The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis." "The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel." "Glucose is the only fuel form used by body cells to produce energy needed for physiologic activity." "Without a minimum level of glucose circulating in the blood, increase coagulation will resilt".

2

The mechanism of action of the glitazones, such as Rosiglitazone (Avandia) , a new class of oral antidiabetic agents, is to: stimulate insulin release in the pancreas. increase the body's sensitivity to the insulin that is currently present. block the breakdown of starches. assist the pancreas in the production of insulin.

2

The mother of a 6-foot, 2-inch, 16-year-old girl who is being treated for hypopituitarism says, "I can't stand it that my beautiful daughter is a freak." The nurse's best response is: "Her height could help her be a basketball star or a model." "What is it about her height that makes her a freak?" "All parents feel responsible when their children have problems." "Gigantism is treatable and reversible."

2

The nurse evaluates no need for further instruction for self-care for the patient with Cushing syndrome who states: "I am careful to wear well-fitting shoes." "I avoid being exposed to anyone with an infection." "I make a point to avoid exposure to sun." "I know I should add salt to everything I eat."

2

The nurse explains to the client beginning drug therapy with desmopressin (DDAVP) that which of the following signs of water intoxication as most crucial to report as an adverse effect? Insomnia Confusion Dark urine Weight loss

2

The nurse is aware that the large flattened features of the patient with acromegaly are caused by an excess of: Prolactin Growth- hormone Adrenocorticotropic hormone Thyroid-stimulating hormone

2

The patient believed to have acromegaly asks the purpose of the diagnostic glucose-tolerance test (GTT). The nurse responds by saying that: "The growth hormone will cause the glucose to be used up very quickly during the test." "It measures the growth hormone in the presence of oral glucose levels at specified times." "It tells whether your thyroid reacts to the high levels of sugar taken during this test." "The doctor wants to know if you have either diabetes insipidus or cretinism."

2

The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Her blood glucose level is very high (880 mg/dl) on admission. The physician believes that her condition is the result of large amounts of glucose solutions administered intravenously (IV) during kidney dialysis. The nurse anticipates that the patient would exhibit: Fruity breath and a high level of ketones in her urine Severe dehydration and glycosuria caused by the hyperglycemia Exactly the same symptoms and signs as DKA Kussmaul respirations, nausea, and vomiting

2

The significant findings that you would expect to see when you take care of a client with Cushing's syndrome would be High levels of potassium and low levels of sodium, weakness, and wasting. Excess adipose tissue in the trunk, slender extremities, and "moon" face. Wasting of the abdomen with thick calloused skin. Edema of the trunk, extremities, and face.

2

Two days after a hypophysectomy the patient complains of a headache and nucchal rigidity. Based on these assessments the nurse should: Closely monitor the patient's blood pressure. Report suspected meningitis to the physician. Medicate with the prescribed analgesic. Elevate the head of the bed to 45 degrees.

2

What is the primary function of insulin? to increase breakdown of protein into amino acids to stimulate active transport of glucose into muscle and adipose tissue cells to stimulate breakdown of adipose tissue to convert glycogen to glucose

2

What is the priority nursing diagnosis in a 45-year-old man with Cushing's syndrome? Decreased Cardiac Output related to electrolyte imbalances Disturbed Body Image related to change in appearance Risk for dehydration related to hyperkalemia. Risk for Injury related to decreased bone density

2

When a client's glucose level drops below 70 mg/dL, often before meals or when insulin action is peaking, the client is experiencing ketosis hypoglycemia proteinuria diabetic neuropathy

2

When the patient with type 2 diabetes says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." The nurse responds that the level of hemoglobin A1c: Reflects the effect of a high level of glucose on the ability to produce red blood cells (RBCs). Shows what the glucose level has done during the last 3 months. Shows how a high level of glucose can cause a significant drop in the hemoglobin level. Indicates a true picture of the patient's nutritional state.

2

Which client statement alerts the nurse to the possibility of hypothyroidism? "I seem to feel the heat more than other people." "I am always tired, even with 10 or 12 hours of sleep." "Food just doesn't taste good without a lot of salt." "My sister has thyroid problems."

2

Your client has recently been diagnosed with Graves' disease. She has asked you for additional information regarding this disease. You tell her "Your thyroid gland is not sending out enough hormones, and so you will need replacement hormones." "Your thyroid gland is overactive. There are ways to treat it - through medicine or surgery." "Your doctor will be able to answer all your questions. It's best to ask him." It's an autoimmune disorder --- just the same as diabetes and multiple sclerosis

2

The nurse caring for a patient with Addison disease suspects adrenal crisis when the patient exhibits: Bradycardia and nausea Confusion and tachycardia Hypertension and abdominal pain Widening pulse pressure and shortness of breath

2 Confusion and tachycardia are signs that the patient may be in adrenal crisis, which is a medical emergency and should be brought to the attention of the charge nurse.

The nurse recommends the use of salt that is iodized because iodized salt: Is instrumental in preventing tumors of the parathyroid gland. Can prevent the development of goiter in adults and cretinism in infants. Can help prevent hypothyroidism Works as an important component of thyroid replacement therapy

2 Iodine is needed to convert thyroid hormones. Without it, the TSH continues to send the message to the thyroid gland to increase production of thyroid hormones.

A client with SIADH has a nursing diagnosis of " Excess fluid volume, related to decreased urine output." Which nursing intervention is the most appropriate? Encourage liberal fluid intake. Monitor laboratory results such as electrolytes. Assess temperature every 2 hours. Provide frequent oral care.

2 Monitor laboratory values for hyponatremia; SIADH leading to increased water retention and decreased urine output; need to restrict fluid

Twelve hours after a total thyroidectomy, the client develops stridor on exhalation. Which is the nurse's priority intervention? Hyperextending the client's neck Calling for emergency assistance Reassuring the client that the voice change is temporary Documenting the finding and assess the client hourly

2 Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. Emergency intubation also may be necessary. The other choices would not address the emergency situation.

What is the most likely cause of tetany after thyroidectomy? Swelling of the incisional area Removal of the parathyroids during surgery Excess circulating thyroid hormone released during manipulation of the gland during surgery Overdose of preoperative antithyroid medication

2 Tetany can occur if the parathyroid glands are accidentally removed during thyroid surgery. Because of the proximity of the parathyroid glands to the thyroid, it is sometimes difficult for the surgeon to avoid them. In the absence of parathyroid hormone, serum calcium levels drop, and tetany results. Excess thyroid hormone causes a thyrotoxic crisis. Swelling and antithyroid medication do not cause tetany.

The client on an intensified insulin regimen consistently has a fasting blood glucose between 70 and 80 mg/dL, a postprandial blood glucose level below 200 mg/dL, and a hemoglobin A1c level of 5.1%. What is the nurse's interpretation of these findings? The client is demonstrating signs of insulin resistance. The client is demonstrating good control of blood glucose. The client is at increased risk for developing hypoglycemia. The client is at increased risk for developing hyperglycemia.

2 The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen (fasting blood glucose 60 to 120 mg/dL; postprandial blood glucose less than 200 mg/dL; hemoglobin A1c 4% to 6%).

A client presents with elevations in triiodothyronine (T3) and thyroxine (T4), and a decrease in thyroid stimulating hormone levels (TSH). Which is the nurse's priority intervention? Assess for Trousseaus' sign. Monitor the apical pulse. Administer levothyroxine (Synthroid). Administer liothyronine (Cytomel).

2 The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The reduction in TSH comes as a negative feedback from the elevated thyroid hormone levels and elevated metabolic rate. The increased metabolic rate can cause an increase in the client's heart rate and the client should be monitored for the development of dysrhythmias. Placing the client on telemetry monitory might also be a precaution.

A woman was admitted with complaints of dysphagia, dyspnea, and enlarged thyroid glands and was diagnosed with colloid goiter. Simple or colloid goiter is the result of: An overgrowth of the parathyroid gland The thyroid gland increasing the formation of thyroglobulin. Insufficient dietary intake of calcium The increase level of iodine

2 pg 516

Upon change of shift report, you are told a patient diagnosed with SIADH began to have seizures and lab results showed serum sodium levels of 100mEq/L. You just received a new order from the physician to start a hypertonic solution of 3% NaCl IV stat at 75 mL/hr. How will this affect the patient's serum sodium level? The solution will add more volume to the blood thus increasing the serum sodium level. The solution will draw water from the intracellular fluid and into the blood thus increasing the serum sodium level. The solution will add more volume to the blood, thus decreasing the serum sodium level. The solution will draw water from blood volume, thus decreases the serum sodium level.

2 sodium follow water

A nurse is caring for a client with pheochromocytoma. Which data would indicate a potential complications associated with this disorder? A urinary output of 50mL / hour. A blood urea nitrogen (BUN) of 20 mg/dL. Crackles heard on auscultation of the lungs. BP of 180/85

3

A patient has recently been diagnosed with diabetes mellitus. Using Maslow's hierarchy, which of the nursing diagnoses listed below should be of the highest priority in caring for him? Chronic low self-esteem r/t diagnosis. Ineffective coping r/t/ use of insulin. Injury r/t neuropathy Activity intolerance r/t fatigue.

3

After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? "I will no longer need to limit my fluid intake after surgery." "I am glad no visible incision will result from this surgery." "I hope I can go back to wearing size 8 shoes instead of size 12." "I will wear slip-on shoes after surgery to limit bending over."

3

In type 2 diabetes mellitus, hyperglycemia is caused by: (Select all that apply). absolute lack of insulin abnormal hepatic glucose regulation beta- cell dysfunction advancing destruction of the beta-cell

2,3

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) Urine output is increased. Urine output is decreased. Specific gravity is increased. Specific gravity is decreased. Sodium level from 160 mEq/L to148 mEq/L

2,3,5

A client with Cushing's syndrome is on a low sodium, high potassium diet for which of the following reasons? Shock can occur in clients who have decreased amounts of adrenocortical steroids. Excessive cortisone production causes hypertension. Increased aldosterone levels cause sodium retention and potassium excretion in the kidneys. Decreased amounts of corticosteroids cause electrolyte imbalances.

3

A client with diabetes newly admitted to the hospital needs to receive an insulin injection at 08:00. The client states that the previous morning's dose was given in the abdomen. The nurse is aware that best practiuce is to give this morning's dose in which of the following locations Right arm Left arm Abdomen Either thigh

3

Which of the following statements is true concerning adrenal crisis? Administering adrenal steroids is not necessary after a stressful surgical procedure to prevent adrenal crisis. Problems generally occur with either low or very high doses, not in the mid range The adrenal crisis occurs because of a relative lack of corticosteroids during stress. Once adrenal suppression occurs, the adrenal gland will never respond normally again.

3

Which of these nursing diagnoses would be most appropriate for the client with diabetes insipidus? "Body image disturbance related to physical changes" "Risk for infection related to chronic steroid therapy" "Fluid volume deficit related to polyuria" "Altered nutrition, less than body requirements, related to imbalance between insulin, diet, and activity"

3

Which symptoms should the nurse expect a client to exhibit who is known to have a pheochromocytoma? Numbness, tingling, and cramps in the extremities. Nausea, vomiting, and muscular weakness. Headache, diaphoresis, and palpitations. Cyanosis, fever, and classic signs of shock.

3 (tumor in adrenal glands = hyposecretion)

Which condition can occur if congenital hypothyroidism is not treated? Grave's disease Hashimoto's thyroiditis Cretinism Thyroid crisis

3 CONGENITAL not ANTIBODY

The client who is taking corticosteroids daily for severe asthma now has an elevated blood glucose level. He asks the nurse if he is now considered diabetic. What is the nurse's best response? "Yes, whenever blood glucose levels are abnormally high, the condition is called diabetes." "Yes, the corticosteroids have destroyed the ability of the pancreas to make insulin." "No, the blood glucose level is elevated because corticosteroids increase the production of glucose." "No, the lack of insulin is temporary and will return to a normal level when the asthma is better."

3 Corticosteroids cause a "pseudodiabetes" with increased blood glucose levels by stimulating liver synthesis of glucose and suppressing glucose use by cells. The ability of the pancreas to synthesize insulin is unaffected.

Exenatide (Byetta) is a drug that belongs to what class of drugs ? Euglycemic agents Alpha-glucosidase inhibitors Incretin -based therapy New rapid- acting insulin

3 Exenatide, an incretin mimetic, has an amino acid sequence similar to human glucagon-like peptide-1 (GLP-1) and in the presence of glucose acts to stimulate insulin secretion. Exenatide is indicated as an alternative to starting insulin in patients with type II diabetes who have not achieved adequate control with metformin, a sulfonylurea, or both.

M. Blahnik, a 20-year-old fashion design student comes to the student health center with a four-day history of flu-like symptoms. He reports feeling increasing fatigue, thirst, and nausea over the last twenty-four hours. Further assessment and lab work indicate that Manolo is experiencing diabetic ketoacidosis (DKA). He is transferred to N Marcus Medical Center for further treatment. The nurse is infusing Regular insulin to Manolo. Which laboratory value indicates that the infusion is too rapid? Serum sodium level of 135 mmol/L Serum potassium level of 5 mEql/L Serum potassium level of 2.5 mEql/L Serum blood sugar level of 310 mg/dL

3 Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid and resulting in hypokalemia. Insulin will open cell and move Potassium inside resultung in hypokalemia

What is the physiologic basis for the polyuria manifested by individuals with untreated diabetes mellitus? Early-stage renal failure causing a loss of urine concentrating capacity Chronic stimulation of the detrusor muscle by the ketone bodies in the urine Osmotic diuresis caused by excess excretion of glucose in the urine. Inadequate secretion of antidiuretic hormone (ADH)

3 Polyuria results from an osmotic diuresis caused by excess excretion of glucose in the urine. Hyperosmolarity of the extracellular fluids secondary to hyperglycemia

A 30 y/old client was newly diagnosed with hypopituitarism. The nurse understands his disorder to be: cretinism acromegaly diabetes insipidus. gigantism

3 Primary hypopituitarism can produce a loss of secondary sex characteristics, decreased metabolism, dwarfism, diabetes insipidus, hypothyroidism, Addison disease, loss of pigmentation, thinning and softening of the skin, decreased libido, and retarded dental development. Incorrect choices: Hypersecretion of pituitary hormones can produce sexual precocity, goiter, Cushing disease, acromegaly, and giantism.

The patient with exophthalmos is distressed about her appearance and asks when it will go away. The nurse's best and most informative response would be based on the knowledge that exophthalmos: Can be disguised with sunglasses and makeup. Is not reversible. Usually subsides after medication for hyperthyroidism is started. Can be minimized with plastic surgery to the eyelids.

3 The "startled" appearance of the patient with exophthalmos usually subsides several weeks after therapy for hyperthyroidism becomes effective.

The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi phenomenon when the patient exhibits: Abdominal pain and elevated blood pressure Drowsiness and disorientation after eating Headache on awakening and nausea and vomiting. You Answered 6 AM blood sugar of 60 and nausea

3 The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of hypoglycemia during the early morning. The patient wakes with a headache, enuresis, nausea and vomiting, nightmares, and a high level of blood sugar.

A 63-year-old patient on the medical floor has a diagnosis of adrenal hyperfunction (Cushing's syndrome). She will probably have to adhere to a diet that contains more carbohydrates. less potassium. less sodium. more calories.

3 The diet should be lower in sodium to help decrease edema.

The nurse stresses that the patient with type 1 diabetes mellitus is at risk for cardiovascular disorders because the lack of insulin causes: Increased metabolism of ketones, which causes hypertension Sufficient metabolism of proteins, which prevents ketosis Increased fatty acid levels High glucose levels that irritate and shrink the vessels

3 The increase in fatty acid levels causes an increase in the level of triglycerides and an attendant rise in low-density lipoprotein (LDL) levels.

A nurse is providing teaching to a client with SIADH. The client shows understanding of the syndrome when stating: "I need to start increasing my daily fluid intake." "Once being on medication for a few months, I can stop taking it because my SIADH will resolve." "If I experience any side effects from the medications, I shouldn't report them as they will resolve on their own." "Since I'm on fluid restriction, I will need to monitor my weight daily."

4

The patient asks about his lab test, which showed a high level of TSH and a low level of T4. You explain: "That means that you will have to go on hormone therapy for the rest of your life." "I am sorry. You will have to ask your doctor about your lab results. We are not allowed to discuss them." "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that." "It means that you have an inconsistency in your thyroid tests, and you will need more testing."

3 The test determines if the problem is in the pituitary or in the thyroid. In this case the high TSH is coming from the pituitary as it should but the thyroid is not responding.

Which of the following items would be least important to the nurse who is assessing the therapeutic effectiveness of vasopressin (Pitressin)? Specific gravity Intake and output Blood albumin Blood pressure

3 The therapeutic effectiveness of vasopressin is evaluated by monitoring specific gravity of the urine, intake and output, daily weights, and blood pressure; blood albumin level is not a factor.

A patient has asked why she needs insulin post surgery when she never used insulin at home and just take "the pills". The nurse tells her that if the diabetic patient has surgery, then the insulin requirement decreases. remains unchanged. is changed to regular insulin. increases.

4

Which of the following anterior pituitary hormones are involved in the female menstrual cycle: (1) thyroid-stimulating hormone (TSH), (2) adrenocorticotropic hormone (ACTH), (3) follicle stimulating hormone (FSH), (4) luteinizing hormone (LH)? 1, 2, 3, 4 1, 2 1, 3 2, 3 3, 4

3, 4

A client tells the nurse about experiencing symptoms of a hypoglycemic insulin reaction. Which of these actions should the nurse take first? Give the client juice or hard candy immediately, then call physician. Have the client lie down, and see if symptoms subside. Call the nurse supervisor. Assess the blood glucose level, and administer glucose in the most appropriate form.

4

A nurse cares for a client who is prescribed a drug that blocks a hormone's receptor site. Which therapeutic effect should the nurse expect? Increased hormone activity Unchanged hormone response Greater hormone metabolism Decreased hormone activity

4

The client with hypothyroidism as a result of Hashimoto's thyroiditis asks the nurse how long she will have to take thyroid medication. Which is the nurse's best response? "When thyroid function studies indicate a normal blood level, you can stop the medication." "You will need to take the thyroid medication until the goiter is completely gone." "The thyroiditis will be cured with antibiotics. Then you won't need the thyroid medication." "You'll need thyroid replacement therapy for life because the gland function will not return."

4

The nurse caring for a patient with Addison disease suspects adrenal crisis when the patient exhibits: Hypertension and abdominal pain Widening pulse pressure and shortness of breath Bradycardia and confusion Confusion and tachycardia

4

The nurse clarifies that the drug, octreotide (Sandostatin), is a treatment for acromegaly and will: Reverse the effects of acromegaly. Be given on a daily basis by injection. Increase insulin secretion causing hypoglycemia Suppress the growth hormone.

4

The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the client with diabetes mellitus? pH 7.28, HCO3- 22 mEq/L, PCO2 58 mm Hg pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg

4

The nurse making a care plan for a 10-year-old boy with hyperpituitarism identifies a disturbed self-image. The nursing diagnosis she would add to the nursing care plan would best be stated as "Disturbed self-image, related to": "Lack of facial hair" "Skin eruptions on face" "Short stature" "Excessive height"

4

The nurse prepares to administer a prescribed dose of desmopressin (DDAVP) intranasal to a client who has which of the following conditions? Acromegaly Diabetes mellitus Syndrome of inappropriate antidiuretic hormone Diabetes Insipidus

4

The nurse understands that thyroid hormone concentration in the body is regulated by which of the following? The posterior pituitary and the anterior pituitary modulation effect The adrenal cortical and the posterior pituitary regulation system The medullary pituitary and the cortical pituitary feedback system The hypothalamus, anterior pituitary and the thyroid feedback mechanism

4

The physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain, muscle aches and pains, and constipation. These laboratory tests will help confirm the diagnosis of hypothyroidism when: The level of thyroxin rises then falls back to subnormal levels. The T3 test elevates, and the T4 test decreases. Both tests show increases. Both tests show decreases.

4

The preoperative teaching for a patient scheduled for a transsphenoidal hypophysectomy should include the instruction that postoperatively, the patient should: Drink through a straw. Wash mouth out with peroxide. Cough forcefully. Avoid sneezing.

4

These group of oral hypoglycemic agents work by increasing insulin sensitivity and are most appropriate for adults with type 2 diabetes mellitus with inadequate or ineffective insulin receptor sites. Biguanides Alpha glucosidase inhibitors Sulfonylureas Thiazolidinediones

4

What disorder places the patient at risk for compression fractures? Hyperthyroidism Hypoparathyroidism Hypothyroidism Hyperparathyroidism

4

What effect would adrenocortical insufficiency have on an individual's response to surgical stress? More prone to hyperglycemia More susceptible to hypertensive crisis Decreased sensitivity to anesthesia More prone to hypotension

4

When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? Improved appetite Increased serum albumin levels Increased serum potassium levels Decreased urinary output

4

Which action should the nurse teach the diabetic client as being most beneficial in delaying the onset of microvascular and macrovascular complications? Restricting fluid intake Preventing hypoglycemia Preventing ketosis Controlling hyperglycemia

4

Which dietary modification will the nurse provide for the client with hyperthyroidism? Supplemental vitamins and reduction of calories Elimination of carbohydrates and increased proteins and fats Decreased calories and proteins and increased carbohydrates Increased calories, proteins, and carbohydrates

4

Which of the following combinations of adverse effects must be carefully monitored when a patient received intravenous insulin to a client diagnosed with DKA? Hyperkalemia and Hyperglycemia Hypokalemia and Hyperglycemia Hyperkalemia and Hypoglycemia Hypokalemia and Hypoglycemia

4

Which of the following conditions is caused by excessive secretion of vasopressin? Acromegaly Diabetes insipidus Gigantism SIADH

4

Which of the following disorders is characterized by a sudden drop in blood glucose, followed by rebound hyperglycemia ? Diabetic ketoacidosis Dawn syndrome Hyperosmolar hyperglycemic non ketotic syndrome Somogyi phenomenon

4

Which of the following is an example of an oral combination hypoglycemic agent? Avandia Prandin Januvia Janumet

4

Which of these responses to inflating a blood-pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes would confirm a diagnosis of hypoparathyroidism? tetany Homans' sign Chevostek's sign Trousseau's sign

4

Why would a patient with hyperthyroidism be prescribed the drug propylthiouracil ? To destroy part of the hyperactive thyroid tissue. To limit the effect of the pituitary on the thyroid. To block the production of iodine. To block the production of thyroid hormones.

4

What is the priority intervention for the client having Kussmaul respirations as a result of diabetic ketoacidosis? Administration of oral hypoglycemic agents. Implementation of seizure precautions Intravenous administration of 10% glucose Administration of intravenous insulin

4 (insulin always corrects)

The client has a deficiency of all the following pituitary hormones. Which one should be addressed first? Follicle-stimulating hormone Growth hormone Luteinizing hormone Thyroid-stimulating hormone

4 A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

The client is receiving methimazole (Tapazole). Which should be included in client education regarding the initiation of this therapy? "This medication may cause dyspnea or vertigo. Call your doctor if this occurs." "Nausea and vomiting are serious complication of the medication you are taking." "Take your pulse every day, as you were taught. If it is too fast, call your doctor." "An increased need for sleep can occur with this drug. If it does, call your doctor."

4 Antithyroid medication may result in hypothyroidism, which is manifested by sleepiness and intolerance to cold. The client must be closely monitored to determine the need for drug regimen changes.

Humalog (Lispro) is human insulin whose onset of action occurs within how many minutes? 35 60 45 15

4 Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The new formula can be injected 15 minutes before a meal.

Which assessment maneuver will the nurse avoid performing with a client suspected of having a pheochromocytoma? Attempting to dorsiflex the feet Inflating the blood pressure cuff above 200 mm Hg Having the client attempt to touch the chin to the chest Palpating the abdomen

4 Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and precipitate a hypertensive crisis. There is no reason why the nurse could not dorsiflex the feet, touch the client's chin to the chest, or inflate the blood pressure cuff above 200 mm Hg.

On an intake physical examination, the nurse questions the patient with diabetes insipidus (DI) about the classic symptoms of that disease, which are Bradycardia, insomnia, and muscle cramps Stress incontinence, vomiting, and edema Dizziness, hypertension, and excitability Diuresis, tachycardia, and hypotension

4 The hypovolemia from massive diuresis leads to decreased blood pressure, tachycardia, and weakness.

The hallmark findings expected when assessing a patient with Cushing syndrome are: High levels of potassium and low levels of sodium, weakness, and wasting Edema of the trunk, extremities, and moon face. Wasting of the abdomen with thick, calloused skin Excess adipose tissue in the trunk and slender extremities.

4 Truncal obesity, thin extremities, and moon face are the classical signs of Cushing syndrome caused by long-term corticosteroid therapy.

To prevent the development of a serious adverse drug effect, the nurse would ask the physician about withholding metformin (Glucophage) for a client who has which of the following circumstances? Scheduled for morning blood work Going for radiograph examination Awaiting cataract surgery Having an angiogram

4 Use of contrast dyes in diagnostic imaging may increase the potential for lactic acidosis. Holding metformin doses before use of contrast dyes through 48 hours after completion of procedure is recommended.

The care of a patient who underwent a hypophysectomy, during which the entire pituitary was removed, would include: Withholding analgesics to assess the level of consciousness. Keeping the patient flat in bed for 3 days. Providing mouth care with thorough cleansing of the oral cavity. Maintaining strict intake and output fluids.

4 With the removal of the entire pituitary gland, the patient will have no effective ADH and will excrete large amounts of urine. The patient is usually kept in a semi-Fowler position and is medicated as needed for pain. Because of the graft, mouth care is minimal, if provided at all.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? A 36-year-old female who has used oral contraceptives for 5 years A 42-year-old male who experienced head trauma 3 years ago A 55-year-old female with a severe allergy to shellfish and iodine A 64-year-old male with adult-onset diabetes mellitus

A 42-year-old male who experienced head trauma 3 years ago

This hormone controls the release of cortisol from the adrenal cortex. Vasopressin Somatotropin ADH ACTH

ACTH

The autoimmune disease characterized by the production of antibodies that destroy essential enzymes needed for the production of T3 and T4 resulting in hypothyroidism. Goiter Hashimoto's disease Graves disease Hyperthyroidism

Hashimoto's disease

You are assigned to a client who has had a subtotal thyroidectomy the previous day. When you walked into her room you see that her color is poor, her pulse and respirations are rapid, and she feels very warm. She tells you that she is really frightened. Your first action is to Run out to get a tracheostomy set Call for emergency help since she may be going into thyroid crisis Tell her that there is nothing to be frightened about and stay with her to calm her. Ask her is she would like something for pain or a soothing back rub

Call for emergency help since she may be going into thyroid crisis

A nurse cares for a client who is prescribed a drug that blocks a hormone's receptor site. Which therapeutic effect should the nurse expect? Increased hormone activity Unchanged hormone response Greater hormone metabolism Decreased hormone activity

Decreased hormone activity

Which of these nursing interventions would be included in the care of a client who has hyperparathyroidism? Encourage the client to alternate rest and activity periods. Encourage the client to decrease ambulation each day. Place the client in a room with reverse ventilation. Encourage the family to seek hospice care for the client.

Encourage the client to alternate rest and activity periods.

The client with hyperparathyroidism will be started on drug therapy to increase excretion of calcium. The nurse anticipates an order for which of the following drugs? Desmopressin (DDAVP) Calcitonin (Miacalcin) Liothyronine (Cytomnel) Furosemide (Lasix)

Furosemide (Lasix)

Which hormone prevents hypoglycemia by promoting the conversion of glycogen to glucose (glycogenolysis) and the conversion of protein to glucose (gluconeogenesis)? Glucagon Insulin Testosterone Somatostatin

Glucagon

A patient with a history of heart failure was recently diagnosed with hypothyroidism. With your understanding of the function of the thyroid gland, what change will most likely be required because of drug interaction with glycosides and thyroid replacement therapy ? Gradual increase in the daily glycoside dosage Decreased thyroid replacement dosage Not able to begin thyroid replacement therapy because of the underlying heart condition Decrease in the daily digoxin dosage

Gradual increase in the daily glycoside dosage

Hyperthyroidism caused by autoimmune is also known as: thyroid storm myxedema Hashimoto's thyroiditis Grave's disease

Grave's disease

Which hormone increases the rate of cell division? Growth hormone Thymosin Thyroid hormone Cortisol

Growth hormone

Osmoreceptors are cells which are sensitized to osmotic pressure. Osmotic pressure changes with the concentration of solutes in the body. The most important osmo receptors are located in the: spinal cord stomach liver hypothalamus

Hypothalamus

An adult is admitted to the hospital with a diagnosis of hypothyroidism.Which findings would the nurse most likely elicit during the nursing assessment? Decreased blood pressure and elevated temperature. Hypothermia and constipation Moist skin and coarse hair. Weight loss and tachycardia

Hypothermia and constipation

The PN should identify which problem as a possible long-term side effect of radioactive iodine (RAI)? Thyroiditis. Thyroid nodules. Thyroid storm. Hypothyroidism.

Hypothyroidism.

Mrs. Pool is discharged 2 days post thyroidectomy with instructions to return for a follow-up appointment in six weeks. At her six week postoperative appointment, Mrs. Pool complains of fatigue, some increasing constipation, and weight gain. Her serum TSH level is elevated. Based on the clinical manifestations and lab results, what change in medication should the nurse anticipate? Increase her dose of Levothyroxine. Discontinue the levothyroxine. Change to a new hormone replacement medication. Decrease her dose of Levothyroxine.

Increase her dose of Levothyroxine.

Which of the following is a function of TSH? Inhibits inflammatory responses. Decreased release calcium in the blood. Increased release of calcium Increased release of T3.

Increased release of T3.

Parathyroid hormone increases the serum calcium level in what way? It pulls calcium out of the vascular system. It promotes calcium storage in the bone. It increases the reabsorption of calcium from the kidneys It increases the absorption of calcium from the intestines.

It increases the reabsorption of calcium from the kidneys

The ovary secretes: estrogen FSH LH all of the above

LH

A patient has undergone tests that indicate a deficiency of the parathormone secretion (= decreased calcium levels). She should be informed of which of the following potential complications? Laryngeal spasms Gall bladder stones Lethargy Kidney stones

Laryngeal spasms

One of the hormones produced by the posterior pituitary gland is prolactin. thyroxine. somatotropin. oxytocin.

Oxytocin

All statements about the pituitary glands are true but: It works closely with the hypothalamus. It is called the "master gland." It is divided into two segments, each with specialized hormones. One of its hormone is responsible for the "fight or flight" response.

One of its hormone is responsible for the "fight or flight" response.

These two hormones produced in the hypothalamus and stored in the posterior pituitary are released in response to a nerve stimulation received from the hypothalamus. insulin and glucagon growth hormone and thyroxin epinephrine and nor epinephrine Oxytocin and ADH

Oxytocin and ADH

What is the nursing priority when administering care to a client with severe hyperthyroidism? Provide a calm, nonstimulating environment Assess for recent emotional trauma Provide diversionary activity Encourage range-of-motion exercises

Provide a calm, nonstimulating environment

The nurse clarifies that the drug, octreotide (Sandostatin), is a treatment for acromegaly and will: Be given on a daily basis by injection. Increase insulin secretion causing hypoglycemia. Suppress the growth hormone. Reverse the effects of acromegaly.

Suppress the growth hormone.

The anterior pituitary secretes: TSH oxytocin ADH all of the above

TSH

A client experiences a thyroid storm after thyroidectomy. The nurse understands that the cause of the complication is: Thyroid hormones moving into the blood stream during surgery. Release of excessive iodine from the glands. Edema of the glands. Increased TSH.

Thyroid hormones moving into the blood stream during surgery.

The client who has hypothyroidism can live a full and normal life if he is Able to exercise in order to burn extra calories and maintain a normal weight Taught to take care of his energy needs through adequate nutrition Taught the importance of taking his anti thyroid medication until it is no longer needed Treated with thyroid replacement therapy

Treated with thyroid replacement therapy

How does a tropic hormone differ from other hormones? Tropic hormones are exclusively involved in the production of sex hormones. Tropic hormones are not under negative feedback control. Tropic hormones stimulate other endocrine glands to secrete hormones. Tropic hormones are synthetic and are given to clients who have a hormone deficiency.

Tropic hormones stimulate other endocrine glands to secrete hormones.

Which of these responses to inflating a blood-pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes would confirm a diagnosis of hypoparathyroidism? tetany Chvostek's sign Homans' sign Trousseau's sign

Trousseau's sign

A 35-year-old man is diagnosed with diabetes mellitus. Which clinical manifestations would indicate type 1 diabetes mellitus? (Select all that apply). Sudden increased in appetite. A 10-pound weight loss within the past month Diabetic Ketoacidosis Increased thirst over the past week

all 4 are correct

Identify all the insulin that can be used for basal coverage. (Select all that apply). Lantus Tresiba Glargine Toujeo

all are correct

Match the following disorders with the clinical findings below hypotension Addison disease fatty deposits Cushing's disease hypertension Pheochromocytoma slow mentation Myxedema

all correctly paired

The placenta releases: estrogen progesterone chorionic gonadotropins all of the above

all of the above

With the understanding of blood osmolarity, the studnet nurse knows that the activity of the thirst center will be increased if blood volume is increased calcium ions are less concentrated in the blood urine output is abnormally low blood osmolarity is increased

blood osmolarity is increased

Hormones produced by the pancreatic islets affect the body's use of: potassium glucose sodium calcium

glucose

The nurse is explaining to the client the Chvostek's and Trousseau's signs. These are tests to determine the presence of hypokalemia hypocalcemia hypercalcemia hyperglycemia

hypocalcemia

All are true about the endocrine system except it produces effects that can last for hours, days, or even longer. it releases chemicals into the bloodstream for distribution throughout the body. it releases hormones that can alter the metabolic activities of many different tissues and organs. it communicates through the use of neurotransmitters.

it communicates through the use of neurotransmitters.

Deficiency of thyroxin in an adult can result in cretinism myxedema tetany acromegaly

myxedema

The hormone that causes ejection of milk into the mammary ducts is: progesterone estrogen aldosterone oxytocin

oxytocin

The thymus gland: is located in the neck produces thymosin is important in the development of red blood cells both A and B above

produces thymosin

Which of the following is not a tropic hormone? prolactin luteinizing hormone thyroid stimulating hormone adrenocorticotropic hormone

prolactin

The endocrine system consists of glands that: release chemicals into ducts release chemicals into the blood release chemicals into body cavities all of the above

release chemicals into the blood

The target tissues for oxytocin are the: pituitary & hypothalamus breasts & pineal glands thyroid & parathyroid uterus & breasts

uterus & breasts