RN Targeted Medical Surgical Endocrine Online Practice 2019
A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching? "I will let my feet air dry after washing." "I will wear sandals to allow air to circulate around my feet." "I will buy over-the-counter medicine to treat the calluses on my feet." "I will apply lotion to the dry areas of my feet but not between my toes."
"I will apply lotion to the dry areas of my feet but not between my toes." Lotion can be used for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth.
A nurse is providing discharge teaching to a client who has diabetes insipidus and a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching? "Depress the pump once before using the nasal spray for the first time." "Blow your nose gently prior to using the nasal spray." "Administer the nasal spray while in a side-lying position." "Notify the provider if you develop numbness or tingling around the mouth."
"blow your nose gently prior to using the nasal spray." The nurse should instruct the client to blow his nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions.
A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include? "Drink at least 3 liters of fluid per day." "Weigh yourself weekly while wearing similar clothing at the same time of day." "Notify the provider of a weight loss of 1 pound or more per week." "Report nocturia because it requires a dosage adjustment."
"report nocturia because it requires a dosage adjustment." The client should take the initial dose of desmopressin in the evening. The provider will increase the dosage until the client no longer has nocturia.
A nurse is teaching a client about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders? Diabetes insipidus Hyperthyroidism Pheochromocytoma Addison's disease
Addison's disease The nurse should instruct the client that the ACTH stimulation test is the standard test for Addison's disease. It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency.
A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy? Fasting blood glucose 96 mg/dL Postprandial blood glucose 195 mg/dL Random blood glucose 210 mg/dL Preprandial blood glucose 60 mg/dL
fasting blood glucose 96 mg/dL This is within the expected reference range of 70 to 110 mg/dL for a fasting blood glucose level and indicates that insulin therapy is effective.
a nurse is reviewing the laboratory results of a client undergoing screening for primary cushing's disease. The nurse should expect an elevation in which of the following laboratory findings? Lymphocyte count Potassium Calcium Glucose
glucose Blood glucose is elevated in a client who has Cushing's disease.
A nurse is assessing a client who is taking propylthiouracil. the nurse should identify which of the following findings as an indication that the medication has been effective? Increased ability to sweat Increased bowel movements Increased body weight Increased libido
increased body weight Propylthiouracil suppresses the production of thyroid hormones and allows for weight gain. However, excessive weight gain could indicate that the dose of propylthiouracil is too high. (*propyl=proper) (*thio=thyroid) (*suppresses production of thyroid hormones....lo thyroid...cuz propyl=more simple...so less) (*hi thyroid=inc metabolism=lo fat)
Why do we do vanillylmandelic acid test for pehochromocytoma?
vanillylmandelic=sees # catecholamines pheochromocytoma=inc catecholamines hi catecholamines=sns prob (*pheochromocytoma) (*vanillylmadnelic acid=sees # catecholamines....chem that is released to breakdown sugars 4 energy)(liek vanilla) (*pheochromocytoma=inc cells of SNS (stress sys)+ adrenal gland (stress) = inc catecholamines (*cuz more cells=do more funct)(this is what these cells do...they rleease chem to breakdown food...to prepare for fight/flight)
A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of diabetic ketoacidosis (DKA)? a) Decreased urine output b) Weight gain of 0.45 kg (1 lb) in 24 hr c) Rapid, shallow respirations d) Blood glucose levels above 300 mg/dL
blood glucose levels above 300 mg/dL Blood glucose levels above 300 mg/dL are an expected finding of DKA. Levels above 600 mg/dL are an expected finding in a client who is in a hyperglycemic-hyperosmolar state. (*diabeitc=hi sugar)(cuz lo insulin) (*ketoacidosis=lots ketones (acid taht breaks down fat 4 energy) in blood) (*bad cuz too acidic blood=destroy cells) (*inc urine=to remove excess acid) (*weight gain=not applicable..this is fluid overload s/s not ketoacidosis) (*shallow resp=lo O2...so body trying to breath more to get more O2 + rid of CO2)....respiratory acidosis.....ketoacidosis is a metabolic situation) (*glucose levels >300=hi sugar=diabetes...whcih shows the need to use ketones...cuz body not taking in sugar..so hi sguar...so will release ketones to use fat as sugar(energy) instead)
A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching? "I should stop taking my insulin if I feel nauseous." "I will test my urine for protein when I start to feel ill." "I will call my doctor if my blood sugar is more than 250." "I should check my blood sugar level every 8 hours."
"I will call my doctor if my blood sugar is more than 250." The client should call the provider if their blood glucose levels exceed 250 mg/dL during illness.
a nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement. which of the following instructions should the nurse plan to include? "Take this medication on an empty stomach." "Take this medication with an antacid." "Change position slowly while taking this medication." "Limit your fluid intake while taking this medication."
"Take this medication on an empty stomach." To promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 min after.
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? a) pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L b) pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L c) pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L d) pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L
a) pH 7.32, PaCO2 36 mmHg, HCO3 14 mEq/L Metabolic acidosis is a common manifestation of DKA, with a low pH, carbon dioxide within the expected reference range, and low bicarbonate. (*lo pH=acidic)(less than 7.35) (*lo bicarbonate) (*CO2=normal...not affect CO2..cuz its ketones making it acidic, not CO2)
A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider? a) Sodium 110 mEq/L b) 2+ deep-tendon reflexes c) Potassium 3.7 mEq/L d) Urine specific gravity 1.025
a) sodium 110 mEq/L A client who has SIADH retains fluids, which causes dilutional hyponatremia. (*medical emergency.....cuz lo salt=hi water....may cause fluid edema in brain....brain damage) (*inapp=not working) (*antidiruetic=no peepee)(keep fluids in) (*hormone=send message) (*rest is normal) (****2+ =normal)(pulse, reflex) (*inapp=cuz excess) (*antidiuretic=no peepee)(*so fluids stay in)(inc fluids) (*hi fluids=lots water=dilutes content in body.....lowers it) (*sodium lo cuz too much water dilutes (breaks it down) (*lowes salt...cuz water breaks down bonds....so that it breaks down salt into its chem parts.....not salt anymore...so that is how salt content is decreased) (*Na=135-145)
A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take? Administer IV hydrocortisone sodium. Give oral spironolactone. Infuse 1 unit of platelets. Restrict daily fluid intake.
administer IV hydrocortisone sodium Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency. (*adrenal=addison's disease)(addison=annorexic...cuz hi stress....eats up food in body) (*coritosne=replenishes coritosl....which is secreted by adrenal glands=stress hormones)
A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia? a) Strong, bounding pulse b) Decreased bowel sounds c) Tingling and numbness of the hands and feet d) Diminished deep-tendon reflexes
c) tingling and numbness of the hands and feet Hypocalcemia causes paresthesia, which usually starts in the hands and feet. (*thryoidectomy=cut out thyroid) (*thyroid=release T3 hormone--> inc/dec metabolism) (*removal of thyroid=lo T3=lo metabolism...body slowed) (*hypocalcemia=lo calcium)(cuz less T3 to break calcium down into absorbable size for blood) (*parathyroid glands=inc calcium) (*calcium=like bridge allow nerve signals to pass=movement) (*lo calcium=lo movment/sensation cuz signla not pass from nerve to nerve smoothly w/o a calcium bridge)
a nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? Moon-shaped face Weight gain Calcium 12.8 mg/dL Sodium 150 mEq/L
calcium 12.8 mg/dL A client who has adrenal insufficiency will have a calcium level above the expected reference range of 4.5 to 5.6 mg/dL.
A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic? Rapid, deep respirations Cool, clammy skin Abdominal cramping Orthostatic hypotension
cool, clammy skin Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion.
A home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hypothyroidism. The client has not been taking the medication regularly. Which of the following findings should the nurse expect? a) Increased urine output b) Persistent diarrhea c) Tachycardia d) Hypotension
d) hypotension Hypotension is an expected finding of hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin. (*lifelong hormone replacement therapy=replenish hormones that body lacks) (*hormones=thyroid hormones) (*hypothyroidism=lo T3--> lo metabolism) (*not taking med regularly.....so still lo T3--> lo metabolisms--> less nutr + energy + breakdown of fat=less cell funct) (*hypo=lo)(sloww cell funct) (*hypotension=lo BP) (*cuz hypothyroid=lo breakdown food=lo nutr = lo energy=cells don't funct as much.........hypotension=heart cells dont get enough nutr to wrok harder to push blood thruout body)
A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include? Inject the insulins intramuscularly. Shake the insulins vigorously prior to administration. Draw up the insulins into separate syringes. Expect the insulins to appear cloudy.
draw the insulins into separate syringes The nurse should instruct the client to draw up the insulins into separate syringes because insulin glargine is not compatible with other insulins.
a nurse is caring for a client who has a pheochromocytoma. Which of the following actions should the nurse take? Elevate the head of the client's bed. Palpate the client's abdomen. Monitor the client for hypotension. Check the client's urine specific gravity.
elevate the head of the client's bed The nurse should elevate the head of the client's bed to reduce blood pressure and abdominal pressure. (*cuz hormones=gray) (*pheo=gray) (*cytochroma=gray cells overgrowth) (*gray like top of adrenal glands) (*lots adrenal glands=hi BP...cuz stress hormone inc...) (*so elevate head bed=lower BP...cuz drain blood down)so less pressure
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? Decreased heart rate Increased hematocrit High urine specific gravity Low BUN level
increased hematocrit Increased hematocrit is an expected finding of diabetes insipidus due to dehydration.
a nurse is teaching a client who is scheduled for a vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching? a) "Start fasting at midnight prior to the day of the test." b) "Begin the 24-hour urine collection with the first morning urination." c) "Take low-dose aspirin for pain during the testing period." d) "Restrict coffee intake 2 to 3 days prior to the test."
"Restrict coffee intake 2 to 3 days prior to the test." The client should avoid coffee and tea, even if they are decaffeinated, bananas, chocolate, and vanilla for 2 to 3 days prior to the test. (*restrict coffee=cuz coffee=inc catecholamines...cuz coffee stimulates body (wake up) by inc catecholamines to breakdown sugars...use it as energy) ...so false result...cuz may not be due to pheochromo...but to coffee) (*vanillylmendelic acid test=sees # catecholamines) (*catechol=catabolism) (*amine= protein) (*catehcolamine=.....a chem that breaks down food).....like vanilla in this case) (*vanillyl acid=chem that breaks down vanilla) (vanilla=dopamine, epinephrine, and norepinephrine)....cuz trying to balance out body's response to stress)(*pleasure + excitement ...cuz that's what vanilla gives) (*why imp? shows hwo stressed body is)
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching? "I need to fast after midnight the night before the test." "This test's result is a good indicator of my average blood glucose levels." "A level of 8 to 10 percent suggests adequate blood glucose control." "I will use my hemoglobin A1c level to adjust my daily insulin doses."
"This test's result is a good indicator of my average blood glucose levels." HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs.
A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect? Decreased blood pressure Weight loss Hirsutism Increased skin thickness
Hirsutism Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production.
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following adverse effects should the nurse include? (SATA) a) Osteoporosis b) Moon-shaped face c) Increased risk of infection d) Hearing loss e) Weight loss
a) osteoporosis b) moon-shaped face c) increased risk of infection -Osteoporosis is correct. Osteoporosis is an adverse effect of long-term corticosteroid therapy due to the suppression of bone formation and the acceleration of bone resorption that corticosteroid therapy can cause. -Moon-shaped face is correct. Long-term corticosteroid therapy causes characteristics of iatrogenic Cushing's syndrome, including a moon-shaped face, a potbelly, and a buffalo hump. (*cushing=crushed moon...face looks crushed)(steroid=lo immune sys)(*suppress adrenal sys too...cuz lower blood flow to area....when adrenal is suppressed= inc coritsol=crushings syndrome)(overactive face) -Increased risk of infection is correct. Increased risk of infection is an adverse effect of long-term corticosteroid therapy. Corticosteroid therapy reduces the phagocytic actions of macrophages and neutrophils, suppressing the immune system.
A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include? Consume no more than three servings of alcohol per day. Ingest food with alcohol to reduce alcohol-induced hypoglycemia. Increase insulin dosage before planned exercise. Rest for 3 days between periods of vigorous exercise
ingest food with alcohol to reduce alcohol-induced hypoglycemia Alcohol inhibits the liver's production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.
a nurse is monitoring a client who is 24 hr postoperative after a total thyroidectomy. Which of the following findings should the nurse report to the provider? Laryngeal stridor Productive cough Pain with hyperextension of the neck Hoarse, weak voice
laryngeal stridor Laryngeal stridor is a harsh, high-pitched sound with inspiration that indicates respiratory obstruction. The nurse should take immediate action to preserve the client's airway.
A nurse is caring for a client who has diabetes mellitus and has developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to the clients feet? Examine the skin of the feet feet weekly for alterations in skin integrity. Monitor the temperature of bath water with a thermometer. Shop for shoes early in the day. Round the edges of toenails when trimming them.
monitor the temperature of bath water with a thermometer Peripheral neuropathy makes it difficult to determine if bath water is too hot. Therefore, to prevent injury, the client should use a bath thermometer to ensure a water temperature below 43.3° C (110° F).
a tumor of the sympathetic nervous system or adrenal glands that produces excess norepinephrine and epinephrine---> causes hypertension, headaches, nausea, etc
pheochromocytoma (*pheo=dusky)(like phantom) (*chromo=color) (*cyto=cell) (*oma=tumor) (*called this because the inc growth of cells look gray)(like a ghost) (*also bc brain cells + cerebrospinal fluid (sns) are gray) (*SNS=fight or flight......norepinephrine + epiniephrine=inc cell funct....cuz released in respeonse to stressed...overworks body so ready (have enrgy) to fight or run)
A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Which of the following findings indicates that the client is having a therapeutic response? Reduction of the effects of thyroid hormone on the heart Blockage of the release of thyroid hormone from the thyroid gland Increase in the heart's sensitivity to thyroid hormone Increase in the uptake of thyroid hormone by the thyroid gland
reduction of the effects of thyroid hormone on the heart Propranolol is a beta2-adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation.
a nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? Serum pH 7.32 Blood glucose 250 mg/dL Blood glucose 425 mg/dL Serum pH 7.45
serum pH 7.45 A client who is experiencing HHS produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range. Glucose levels will be above 600 mg/dL.
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? Cold intolerance Lethargy Tremors Sunken eyes
tremors Findings of hyperthyroidism include tremors, diaphoresis, and insomnia.
