Targeted 2019: Endocrine
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 With DKA, the pH is low, carbon dioxide is within the expected reference range, bicarbonate is low. Clients who have DKA have an acidic pH not Alkaline or pH within normal ranges.
A nurse is planning preoperative care for a client who has pheochromocytoma. Which of the following interventions should the nurse anticipate as being the priority?
Avoiding palpating the abdomen. The greatest risk to this client is injury from hypertensive crisis. Therefore, the priority intervention is to avoid palpating the abdomen, which can cause a sudden release of catecholamines, causing a hypertensive crisis.
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 Hypoglycemia causes cool clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion. Rapid, deep respirations are an expected finding of hyperglycemia - Abdominal cramping is an expected finding of hyperglycemia - hyperglycemia can cause dehydration, resulting in orthostatic hypotension
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, avoiding application between my toes." Lotion is appropriate for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth The client should dry their feet thoroughly after washing to prevent bacterial growth between the toes - the client should wear closed-toe shoes to prevent injury to their feet - topical over-the-counter medications can impair skin integrity and lead to further injury and should not be used to treat calluses on the feet.
A nurse is providing teaching for a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements indicates that the client understands the teaching?
"I will call my doctor if my blood sugar is more than 250 mg/dL The client should call the provider if blood glucose levels exceed 250 mg/dL during illness. The client should continue taking the usual dose of insulin even when not feeling well, like feeling nauseous - the client should check their urine for ketones not protein when blood glucose levels are greater than 240 - the client should check their blood glucose level every 4 hours during illness
A nurse is preparing a teaching plan for a client who has diabetes insipidus and is receiving receiving intranasal desmopressin. Which of the following information should the nurse include in the teaching plan?
"Report nocturia because it requires a dosage adjustment." Occurrence of nocturia indicates the need for a dosage-adjustment. The initial dose of desmopressin is administered in the evening; the provide will increase the dosage until the client no longer experiences nocturia. 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. -The client should drink an amount of fluid to his urine output each day -The client should weigh himself daily to detect dehydration in its early stage -A weight gain or loss of 0.45 kg (1 lb) per week is not enough to suggest overhydration or dehydration
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following statements by the client indicates an understanding of the information about this test?
"This test 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. -The client does not need to fast before blood sampling for HbA1c. What the client eats the day before has no effect on the results of this test. -The expected reference range for HbA1c is 4-6% for adults. A result greater than 6.5% can indicate diabetes.
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following effects should the nurse include? (Select all that apply.)
1. Osteoporosis is an adverser effect of long-term corticosteroid therapy due to the suppression of bone formation and the acceleration of bone resorption that corticosteroid therapy can cause 2. Moon-shaped face Long-term corticosteroid therapy causes characteristics of the iatrogenic syndrome characterized by a moon-shaped face, a potbelly, and buffalo hump. 3. Increased risk of infection is an adverse effect of long-term corticosteroid therapy due to the decrease it causes in the number of circulating lymphocytes. Long term corticosteroid therapy can also cause cataracts and glaucoma [but not cause hearing loss] Long Term corticosteroid therapy also is likely to cause weight gain due to fluid and sodium retention.
A nurse is preparing to give a client information about an adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorder?
Addison's disease 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 24 hour measurement of I&O a urine specific gravity test, and a test of urine osmalarity are used to diagnose diabetes insipidus -A thyroid scan and a thyroid-stimulatinging hormone test are used to diagnose hyperthyroidism - a 24 hour urine collection can detect catecholamines and other substances that can indicate pheochromocytoma
A nurse is managing the care of a client who is postoperative and experiencing acute adrenal insufficiency. Which of the following actions should the nurse take?
Administer IV hydrocortisone sodium succinate Hydrocortisone sodium succinate necessary to replace the cortisol deficiency that occurs with adrenal insufficiency. -Administering a potassium-sparing diuretic, such as spironolactone, will further increase the client's potassium level, worsening the hyperkalemia -Although this client needs increase circulatory volume, infusing platelets is not appropriate for a client who has acute adrenal insufficiency -Acute adrenal insufficiency causes hypovolemia, which is an indication for rapid fluid replacement.
A nurse caring for a client undergoing screening for primary Cushing's disease. The nurse should expect that which of the following laboratory findings to be elevated?
Blood Glucose Blood glucose is elevated with Cushing's disease. -The lymphocyte count is below the expected reference range in a client who has Cushing's disease -Potassium is below the expected reference range in a client who has Cushing's disease -Calcium is below the expected reference range in a client who has Cushing's diesase.
A nurse is providing teaching for a client who has diabetes mellitus. Which of the following findings associated with diabetic ketoacidosis (DKA) should the nurse include?
Blood glucose levels greater than 300 mg/dL Blood glucose levels above 300 mg/dL are an expected finding of DKA. Increased urine output is an expected finding of DKA - Weight loss is an expected finding of DKA - Deep, labored breathing, known as Kussmaul respirations, is an expected finding of DKA
A nurse is caring for a client who has type 2 DM and is admitted with hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect?
Blood glucose of 846 mg/dL and serum pH 7.40 With HHS, the client produces enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range, but the blood glucose is greater than 600 mg/dL 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 -Serum pH 7.32 laboratory value indicates the client has DKA. Clients who are experiencing HHS will have a pH greater than 7.4 -blood glucose of 250 indicates the client has hyperglycemia. Clients who are experiencing HHS will have a blood glucose level greater than 600
A nurse is providing discharge teaching for a client who has diabetes insipidus and has new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?
Blow nose gently prior to using nasal spray By blowing the nose gently prior to use of the spray, the client avoids dilution of the medication by nasal secretions or improper absorption of the medication due to nasal blockage. This action prevents the dilution of the medication with nasal secretions. The nurse should instruct the client to prime the nasal spray pump by pressing down four times before the initial use - the nurse should instruct the client to sit upright with their head tilted forward slightly when administering the spray. this upright position prevents the spray from going down the client's throat. - numbness or tingling around the mouth is a manifestation of hypocalcemia. desmopressin can resulting in the adverse effect of hyponatremia.
A nurse is preparing insulin for a client who has DM. The client is to receive evening doses of insulin glargine and regular insulin. Which of the following actions should the nurse take to administer these two medications safely?
Draw up the insulin glargine and the regular insulin into separate syringes. The nurse should not mix insulin glargine with any other insulin in the same syringe due to the low pH of its diluent. Insulin glargine is not compatible with other insulins. The nurse should instruct the client to inject he insulins into the subcutaneous tissue to promote proper absorption not intramuscularly - the nurse should instruct the client to gently mix the insulin vials prior to administration to prevent altering the chemistry of the medication - the nurse should instruct the client to expect both insulins to appear clear and to discard any that appear cloudy.
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. The nurse should elevate the head of the client's bed to reduce blood pressure and abdominal pressure - The nurse should not palpate the abdomen of a client who has a pheochromocytoma, because this can cause release of catecholamines and increase blood pressure - the nurse should monitor a client who has a pheochromocytoma for hypertension. - the nurse should monitor the urine specific gravity of a client who has diabetes insipidus not pheochromocytoma.
A nurse is monitoring the laboratory values of a client who has DM and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy?
Fasting blood glucose 96 mg/dL This is within the expected reference range for a fasting blood glucose level and indicates insulin therapy is effective expected reference range of 70-110 for a fasting blood glucose level indicates that insulin therapy is effective -a postprandial blood glucose level of 195 is above the expected reference range of less than 180 -a random blood glucose level of 210 is above the expected reference range of less than 200 a preprandial blood glucose level of 60 is below the expected reference range of 70 to 130
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 Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production.
A home health nurse is assessing a client who is on lifelong hormone replacement therapy for treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect?
Hypotension Hypotension is an expected finding of hypothyroidism. Along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin. -Hypothyroidism is more likely to cause a decrease in urine output, not an increase in urine output -Hypothyroidism is more likely to cause constipation not persistent diarrhea -Hypothyroidism commonly causes bradycardia not tachycardia
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings?
Increased hematocrit An increased hematocrit level is an expected finding related to dehydration.
A nurse is planning dietary teaching for a client who has type 1 DM. Which of the following information should the nurse include regarding alcohol consumption?
Ingest alcohol with meals to reduce alcohol-induced hyperglycemia Alcohol prevents liver production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.
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?
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 -The nurse should recommend that male clients drink no more than 2 servings of alcohol per day, and female clients drink no more than one serving of alcohol per day - The nurse should instruct the client to reduce insulin dosages before planned exercise to prevent hypoglycemia -the nurse should instruct the client to exercise at least three times per week and have no more than 2 consecutive days without exercise
A nurse is monitoring a client's status 24 hr after a total thyroidectomy. Which of the following findings should the nurse report to the provider?
Laryngeal stridor Laryngeal stridor is a harsh, high-pitched sound upon the inspiration that indicates respiratory obstruction. The nurse should take immediate action to preserve the client's airway -A productive cough can occur after general anesthesia due to a buildup of secretions caused by endotracheal intubation -Pain with hyperextension of the neck is an expected finding after a thyroidectomy. the nurse should use pillows to support the client's head and neck - a hoarse and weak voice is common after general anesthesia as a result of endotracheal intubation. if hoarseness continues, it could indicate laryngeal nerve damage, which is usually transient.
A nurse is caring for a client who has DM and developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to his feet?
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 the water temperature is less than 43.3 C (110 F)
A nurse is preparing to administer propranolol by by IV bolus to a client experiencing a thyroid storm. Which of the following findings indicates the client is having a therapeutic response?
Reduction of the effects of thyroid hormone of the heart Propranolol is a beta 2-adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation -Propranolol does not affect thyroid hormone release and it does not increase the heart's sensitivity to thyroid hormone. it helps prevent dysrhythmias - propranolol does not affect the uptake of thyroid hormone by the thyroid gland. it helps lower the client's blood pressure.
To screen a client for pheochromocytoma, a nurse schedules a vanillylmandelic acid test. When teaching the clients about this test, which of the following instructions should the nurse include
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. -The client does not have to fast prior to the test, but there are foods the client should avoid, such as bananas and citrus fruits -the client should discard the first-morning urine, and then collect all urine after that for 24 hours -the client should avoid aspirin because it can affect test results
A nurse is assessing a client who has adrenal insufficiency. Which of the findings should the nurse expect?
Serum calcium 12.8 mg/dL A client who has adrenal insufficiency has a serum calcium level above the expected reference range. a rounded face or moon-shaped face is a finding of Cushing's disease - Weight loss is a finding of adrenal insufficency- clients who have adrenal insufficiency will have a sodium level below the expected reference range of 136 to 145
A nurse is performing an assessment on a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessment data should the nurse report?
Serum sodium 110 mEq/L A client who has SIADH retains fluids, which causes dilutional hyponatremia Deep tendon reflexes of 2+ is an expected response. Clients who have SIADH experience hyperactive deep tendon reflexes of 3+ or 4+ Urine specific gravity of 1.025 is within the expected reference range of 1.005-1.030 The potassium of 3.7 is within the expected reference range of 3.5 to 5
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 To promote absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 min after taking it. Aluminum-containing antacids and calcium supplements can reduce the effectiveness of thyroid replacement therapy The medication can increase blood glucose levels in clients who have DM but it does not cause orthostatic hypotension The client should take the medication with a full glass of water. There are no fluid restrictions with this medication therapy, the client should drink 2 to 3 L of fluid daily.
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 Hypocalcemia causes paresthesias, usually starting in the hands and feet Hypocalcemia causes a weak, thready pulse Hypocalcemia increases gastrointestinal motility Hypocalcemia causes hyperactive deep-tendon reflexes
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings?
Tremors Findings of hyperthyroidism include tremors, diaphoresis, and insomnia
A nurse is caring for a client who is taking propylthiouracil (PTU). The nurse should recognize that the client has met the treatment goals when she reports an increase in which of the following effects?
Weight PTU suppresses the production of thyroid hormone and, therefore, allows for weight gain.
