Assessment: NCLEX review Endocrine 2013

A nurse is caring for a client who is newly diagnosed with diabetes mellitus and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements?

"Glucotrol stimulates your pancreas to release adequate insulin." Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the beta cells of the pancreas. Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents Sulfonylurea agents reduce the glucose output of the liver.

A nurse is teaching a client who is morbidly obese and has been prescribed orlistat (Xenical). The nurse should recognize that the client has a good understanding of the medication if the client states which of the following?

"I will take Xenical three times a day, just before each meal." Orlistat, a lipase inhibitor, is used as an aid to help clients who are morbidly obese to lose weight. Orlistat prevents the absorption of some of the fat in the client's dietary intake at each meal. Therefore, the client should take the medication during the meal or within 1 hr of eating.

A nurse is caring for a client who is being evaluated for acromegaly. Which of the following manifestations should the nurse expect to find during assessment? (Select all that apply.)

*Diaphoresis is correct. Acromegaly is a chronic metabolic disorder caused by an excess of growth hormone after normal growth of the skeleton and other organs is complete. The physical manifestations associated with acromegaly include enlarged sebaceous glands with excessive sweating. *Coarse facial features is correct. The physical manifestations associated with acromegaly include enlarged facial bones with thickening of the skin, leading to coarse facial features. *Enlarged distal extremities is correct. The physical manifestations associated with acromegaly include enlarged hands and feet with thickening of the skin. *Muscle weakness is correct. The physical manifestations associated with acromegaly include fatigue and muscle weakness.

A nurse is assessing a client admitted with Cushing's syndrome. Which of the following manifestations should the nurse expect the client to report?

Increased bruising A client who has Cushing's syndrome will have thin skin that is fragile and easily bruised or traumatized. Ecchymoses, petechiae (small intradermal or submucosal bleeds), and striae (purple lines on the skin of the abdomen, thighs, and breasts) will often develop as well. The eye complications associated with Cushing's syndrome are glaucoma and corneal lesions. A client who has Cushing's syndrome will have a weight gain due to overproduction of adrenal cortical hormone.

A nurse is caring for a client who has meningitis, a temperature of 39.7° C (103.5° F), and is prescribed a hypothermia blanket. While using this therapy, the nurse should know that the client must carefully be observed for which of the following complications?

Shivering The hypothermia (cooling) blanket, if used improperly (at inappropriately low temperatures, or without skin protection), can cause the client to cool too fast, leading to shivering. To prevent heat loss from the skin, the body becomes peripherally vasoconstricted in an attempt to reduce heat loss. The body will also try to increase heat production by shivering, which can increase the metabolic rate by two to five times and in doing so greatly raise oxygen consumption.

A nurse is caring for a client admitted with end-stage cirrhosis of the liver. Which of the following interventions should the nurse anticipate taking to decrease the client's serum ammonia level?

Start the client on a low-protein, high-calorie diet. A low-protein, high-calorie diet will reduce the source of ammonia and provide adequate carbohydrates for energy requirements while sparing protein from breakdown for energy.

A nurse is caring for a client whose blood work indicates that the client has hyperthyroidism. The nurse should expect the client to report

frequent mood changes. Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulates metabolic rate. Nervousness; frequent mood changes; hand tremors; a rapid, pounding, irregular heartbeat; heat intolerance; diarrhea; and weight loss are common manifestations of hyperthyroidism. The client will have increased peristalsis and may experience diarrhea Hyperthyroidism causes an increased rate of body metabolism, so the client may experience heat intolerance Hyperthyroidism causes an increased rate of body metabolism, so the client may experience weight loss

A nurse is caring for a client admitted with a severe burn injury who is receiving intravenous fluid replacement therapy. The nurse evaluates the therapy to be inadequate if the client developed an increase in

heart rate. The client's increased heart rate is likely to be caused by hypovolemia, which indicates inadequate fluid replacement.

A nurse is caring for a client who is suspected of having diabetes insipidus and is scheduled for a water deprivation test. During the test, the nurse should know to frequently assess the client for the development of

hypotension. A client who has diabetes insipidus will continue to excrete urine even though there is no intake. Hypovolemia, with resulting hypotension, is possible.

A nurse is caring for a client whose total parenteral nutrition (TPN) was stopped for an hour by mistake. After restarting the infusion pump, the nurse should watch the client carefully for the development of

shakiness and diaphoresis. When a sudden interruption in the infusion of TPN occurs, the client is at risk for hypoglycemia. Shakiness and diaphoresis are manifestations of hypoglycemia.

A nurse is caring for a client who has been on levothyroxine (Synthroid) for several months. If the dose of this medication has been adequate, the nurse should expect to see a decrease in the

thyroid stimulating hormone (TSH). In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

A nurse in a clinic is reviewing the laboratory values obtained from a client being seen for suspected hypothyroidism. If this diagnosis is accurate, the nurse should expect to see an elevated

thyroid stimulating hormone (TSH). In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones, such as T3, T4, and free thyroxine, are released. Low levels of T3 and T4 are the underlying stimuli for the release of TSH from the anterior pituitary. This results in an elevation of the TSH level as the anterior pituitary continues to release TSH to stimulate the thyroid gland to release the thyroid hormones T3 and T4.

A nurse is caring for a client after a craniotomy for pituitary tumor who has developed diabetes insipidus. The client is receiving vasopressin (Pitressin). The desired response to the medication is evident when the nurse observes which of the following findings?

A decrease in urine output. The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Pitressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize which of the following as manifestations of Cushing's syndrome? (Select all that apply.)

Cushing's syndrome have hirsutism, excessive body hair, rather than alopecia, hair loss. Tremors are not a common finding in Cushing's syndrome. *Moon face is correct. Moon face, manifested by a round, red, full face, is common in Cushing's syndrome. *Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are a common manifestation in Cushing's syndrome. Obese extremities is incorrect. Clients who have Cushing's syndrome have truncal obesity (a protuberant abdomen) with thin extremities. *Buffalo hump is correct. Buffalo hump, a collection of fat between the shoulder blades, is a common manifestation in Cushing's syndrome.

A nurse is preparing teaching for a female client who smokes, is obese, and has hypertension. In establishing health promotion goals for the client, the nurse should recognize that which of the following is an inappropriate recommendation for the client?

Eliminate sodium from the diet.

A nurse is completing an assessment on a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

Hyperpigmentation Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

A nurse is performing teaching with a client who has newly diagnosed type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following manifestations of hypoglycemia? (Select all that apply.)

Manifestations of hyperglycemia include polyuria (excessive urination). *Vertigo is correct. Manifestations of hypoglycemia include vertigo (dizziness). Manifestations of hyperglycemia include polydipsia (excessive thirst). *Tachycardia is correct. Manifestations of hypoglycemia include tachycardia. Manifestations of hyperglycemia include acetone breath (due to ketosis). *Moist, clammy skin is correct. A client who is newly diagnosed with type 2 diabetes mellitus should be taught to recognize the manifestations of hypoglycemia (decreased blood sugar) that may occur as a result of an insulin reaction, inadequate intake of glucose, or increased exercise. Manifestations of hypoglycemia include moist, clammy skin.

A nurse is caring for a client who has nephrotic syndrome and is receiving high-dose corticosteroid therapy. To detect an electrolyte imbalance caused by corticosteroid use, the nurse should monitor the client for which of the following?

Muscle weakness Corticosteroid use can lead to hypokalemia, which features manifestations of muscle weakness and cardiac arrhythmia.

On the first postoperative day following a subtotal thyroidectomy, the client reports a tingling sensation in the hands, soles of the feet, and around the lips. For which of the following should the nurse assess the client?

Positive Chvostek's sign. The nurse suspects that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Symptoms of hypocalcemia include numbness and tingling in the hands, soles of the feet, and around the lips. These symptoms typically appear between 24 and 48 hours after surgery. To elicit Chvostek's sign, the nurse taps the client's face at a point just anterior to the ear and just below the zygomatic bone. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia. -Babinski sign is a diagnostic test for brain damage or upper motor neuron damage. It is considered positive if the toes flare up upon stroking the plantar aspect of the foot. -Brudzinski's sign is an indication of meningeal irritation, which may be positive in clients with meningitis. With the client supine, the nurse places one hand behind the client's head and places the other hand on the client's chest. The nurse then raises the client's head (with the hand behind the head) while the hand on the chest restrains the client and prevents the client from rising. Flexion of the client's lower extremities constitutes a positive sign. -Kernig's sign is an indication of meningeal irritation, which may be positive in clients with meningitis. The maneuver is usually performed with the client supine with hips and knees in flexion. Extension of the knees is attempted, and the inability to extend the client's knees beyond 135 degrees without causing pain constitutes a positive test.

A nurse is caring for a client admitted with a diagnosis of hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months despite increased appetite. Additional symptoms reported include increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following measures should the nurse include in the client's plan of care to prevent a thyroid crisis?

Provide a quiet, low-stimulus environment. Thyroid crisis can occur in response to a stressor, so the client should not be exposed to other clients who have active infections or an environment that is noisy and stimulating.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

Regular (Humulin R) Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of hyperglycemia.

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Nursing care of this client should include which of the following nursing actions?

Taking daily weights Addison's disease is an endocrine disorder that occurs in all age groups and affects men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and unexposed parts of the body. Daily weight will alert the nurse that dehydration is occurring, which could indicate an impending crisis.

A nurse is caring for a client who sustained a basal skull fracture. On assessment, the nurse notices a thin stream of clear drainage coming from the client's right nostril. Which of the following actions should the nurse take first?

Test the drainage for glucose. This is the priority nursing action. Because of the high risk of cerebral spinal fluid (CSF) leak in clients with basal skull fractures, the nurse should realize there is a possibility that the clear fluid coming from the client's nostril is CSF.

A nurse is discontinuing a course of prednisone (Deltasone) for a client with an exacerbation of asthma. The nurse should taper the dose so that the client does not experience

adrenocortical insufficiency. Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids may depress the body's normal adrenocortical activity, and abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.