RN Targeted Medical Surgical Endocrine Online Practice 2023

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?

Hypotension Rationale: Hypotension is an expected finding of hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin.

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 client's feet?

Monitor the temperature of bath water with a thermometer. Rationale: 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 nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching?

This test's result is a good indicator of my average blood glucose levels. Rationale: HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs.

**NEXT GEN QUESTION** A nurse is caring for a client on the medical surgical floor. The nurse evaluating discharge teaching with the client. Which of the following statements indicate an understanding of the teaching? (Select all that apply.) -I will eat low fiber foods. -I will sleep with my head flat. -I will not brush my teeth for 2 weeks. -I will drink lots of fluids. -I will use a room humidifier. -I will not blow my nose for one month. -I will bend at my knees to tie my shoes.

-I will not blow my nose for one month. -I will bend at my knees to tie my shoe. -I will drink lots of fluids. -I will use a room humidifier. -I will not brush my teeth for 2 weeks. Rationale: When evaluating outcomes, the nurse should identify the client understands to take measures to avoid increasing intracranial pressure, such as bend at the knees, avoid blowing the nose, and to take measures to prevent constipation, such as increasing fluid intake. The client also understands to avoid brushing teeth until incision is healed, and to use a room humidifier to promote comfort and moisten mucous membranes.

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? (Select all that apply.)

-Osteoporosis -Moon-shaped face -Increased risk of infection Rationale: 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.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. Hearing loss is incorrect. Long-term corticosteroid therapy can cause cataracts and glaucoma, but it does not cause hearing loss.Weight loss is incorrect. Long-term corticosteroid therapy is more likely to cause weight gain due to fluid and sodium retention.

**NEXT GEN QUESTION** A nurse is caring for a client on a medical-surgical unit. The nurse is reviewing the client's electronic medical record. Select the "5" findings that are possible manifestations of adrenal insufficiency. -Temperature -Skin findings -Glucose level -Energy level -Sodium level -Potassium level -Blood pressure

-Skin Findings -Energy level -Sodium level -Potassium level -Blood pressure Rationale: When recognizing cues, the nurse should identify that hypotension, hyperkalemia, fatigue, hyponatremia, and hyperpigmentation are findings consistent with adrenal insufficiency. For clients who have adrenal insufficiency, the hypothalamus-pituitary gland-adrenal gland feedback loop is not properly functioning. This leads to a decreased aldosterone production, impairing fluid and electrolyte balance. Additionally, this leads to increased production of melanocyte-stimulating hormone (MCH) causing skin hyperpigmentation.

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?

Addison's disease Rationale: 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 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 Rationale: Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency.

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)?

Blood glucose levels above 300 mg/dL (74 to 106 mg/dL) Rationale: Sudden onset of hyperglycemia with blood glucose levels above 300 mg/dL and ketonuria are expected findings of DKA

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?

Blow your nose gently prior to using the nasal spray. Rationale: The nurse should instruct the client to blow their nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions.

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?

Cool, clammy skin Rationale: Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion.

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?

Draw up the insulins into separate syringes. Rationale: The nurse should instruct the client to draw up the insulins into separate syringes because insulin glargine is not compatible with other insulins.

**NEXT GEN QUESTION** A nurse is caring for a client on a medical-surgical unit. For each body system below, click to specify the priority nursing intervention. Endocrine: -Administer eye drops -Apply hypothermia blanket -Obtain thyroid function levels Respiratory: -Obtain an arterial blood gas -Apply oxygen -Instruct client on strategies to stop smoking Cardiovascular: -Administer propranolol -Place client on continuous cardiac monitor -Start IV infusion **Note: Each category must have at least 1 response option selected.

Endocrine: -Apply hypothermia blanket Respiratory: -Apply oxygen Cardiovascular: -Place client on continuous cardiac monitor Rationale: When taking action using the urgent vs nonurgent priority framework, the nurse should immediately apply supplemental oxygen, a hypothermia (cooling) blanket, and place the client on a continuous cardiac monitor. Humidified oxygen is administered to improve oxygenation and promote gas exchange. Applying a hypothermia blanket is urgent to treat the client's hyperthermia. The nurse should immediately place the client on a continuous cardiac monitor to monitor the client's tachycardia and monitor the client prior to administering propranolol.

A nurse is reviewing the laboratory results of a client undergoing screening for primary Cushing's disease. The nurse should expect an evaluation in which of the following laboratory findings?

Glucose Rationale: Blood glucose is elevated in a client who has Cushing's disease.

A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect?

Hirsutism Rationale: Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production.

** NEXT GEN QUESTION** A nurse is caring for a client in the emergency department. The nurse is reviewing the client's electronic medical record. Click to specify if the findings are consistent with hypothyroidism or myxedema coma. Each finding may support more than 1 disease process. Assessment Findings: heart rate, peripheral assessment, glucose level, skin condition, sodium level, energy level, respiratory rate.

Hypothyroidism: Respiratory rate, heart rate, skin condition, peripheral assessment, energy level. Myxedema Coma: Respiratory rate, heart rate, skin condition, peripheral assessment, energy level, sodium level, glucose level. Rationale: When analyzing cues, the nurse should recognize that a slow respiratory rate, bradycardia, dry skin, peripheral edema, and lethargy are assessment findings associated with hypothyroidism and myxedema coma due to a decreased metabolism. The nurse should also identify findings associated with myxedema coma include hyponatremia and hypoglycemia.

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 apply lotion to the dry areas of my feet but not between my toes. Rationale: 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 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 will call my doctor if my temperature is greater than 38.6 C (101.5 F). Rationale: The client should call the provider if they have a temperature that is greater than 38.6˚C (101.5˚F), their fever is increasing over time, or for a fever for more than 24 hr.

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 body weight Rationale: 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.

A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings?

Increased hematocrit Rationale: Increased hematocrit is an expected finding of diabetes insipidus due to dehydration.

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 Rationale: 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 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. Rationale: Propranolol is a beta-adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation.

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?

Report nocturia because it requires a dosage adjustment. Rationale: 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 who is scheduled for a vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching?

Restrict coffee intake 2 to 3 days prior to the test. Rationale: 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.

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 7.41 Rationale: A client who is experiencing HHS produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Therefore, the nurse should expect the client's serum pH to be within the expected reference range.

A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings is the priority for the nurse report to the provider?

Sodium 110 mEq/L Rationale: A client who has SIADH retains fluids, which causes dilutional hyponatremia. A sodium level that is less than 120 mEq/L places the client at high risk for seizures or coma.

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. Rationale: 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 caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia?

Tingling and numbness of the hands and feet. Rationale: Hypocalcemia causes paresthesia, which usually starts in the hands and feet.

A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings?

Tremors Rationale: Findings of hyperthyroidism include tremors, diaphoresis, and insomnia.

A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect?

pH 7.32, PaCO2 36 mm HG, HCO3- 14 mEq/L Rationale: Metabolic acidosis is a common manifestation of DKA, with a low pH, carbon dioxide within the expected reference range, and low bicarbonate.