ATI Endocrine Practice

A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? SATA A. Low sodium B. High Potassium C. Increased urine osmolality D. High Urine Sodium E> Increased Urine Specific Gravity

A, C, D, E

A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol. B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output

A. No change in plasma cortisol.

A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected. A. Elevated T4 B. Decreased T3 C. Elevated thyroid stimulating hormone D. Decreased cholesterol

B. Decreased levels of T3 in the blood is an expected finding for a client who has hypothyroidism.

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply.) A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia

B. Hyperthyroidism increases the client's metabolism, causing heat intolerance. D. Hyperthyroidism increases the client's metabolism, causing palpitations. E. Hyperthyroidism increases the client's metabolism, causing tachycardia.

A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs

B. Orthostatic hypotension

A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? Select All that Apply. A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly E. Eat a low-sodium diet.

B. Physical and emotional stress increase the need for hydrocortisone. The provider can increase the dosage when stress occurs. C. Weakness and dizziness are indications of adrenal insufficiency. The client should report these indications to the provider. D. Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. if hydrocortisone is to be discontinued, the dose should be tapered.

A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings is indicative of a thyroid crisis? (Select all that apply.) A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion.

C. Excessive levels of thyroid hormone can cause the client to experience dyspnea. D. When thyroid crisis occurs, the client can experience gastrointestinal conditions. (vomiting, diarrhea, and abdominal pain). E. Excessive thyroid hormone levels can cause the client to experience mental confusion.

A nurse is planning to teach a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base the instructions on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.

C. Secretion of corticotropin-releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH.

A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply). A. Observe cardiac monitor for dysrhythmias. B. Observe for evidence of urinary tract infection. C. Initiate IV fluids using 0.9% sodium chloride. D. Administer a levothyroxine IV bolus. E. Provide warmth using a heating pad.

A. A client who has myxedema can have a flat or inverted T wave as well as ST deviations. B. An infection (in the urinary tract) can precipitate myxedema coma. Observe the client for manifestations of infection so that the underlying illness can be treated. C. Hyponatremia is an expected finding in the presence of myxedema coma. IV therapy is administered using 0.9 sodium chloride. D. Myxedema coma is a severe complication of hypothyroidism that if left untreated can lead to coma or death. Levothyroxine is administered IV bolus to treat the condition.

A nurse in a provider's office is assessing a client who recently began taking levothyroxine to treat hypothyroidism. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech

A. Correct: Identify hand tremors as a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. Report this finding to the provider due to the possible need for a decrease in the dosage of medication.

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH_. Which of the following findings should the nurse expect? A. Decreased blood sodium B. urine specific gravity, 1.001 C. Blood osmolarity D. Polyuria E. Increased thirst.

A. Decreased blood sodium (An increase in the secretion of ADH leads to dilution hyponatremia.) C. Blood osmolarity (A decrease in blood osmolarity is caused by an increase in the secretion of ADH leading to water retention and dilution of blood components.)

A nurse is providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? Select All That Apply. A. Drink 2 L fluids daily. B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribed when ill. D. Notify the provider when blood glucose is 200 mg/dl E. Report ketones in the urine after 24 hr of illness.

A. Drinking 2 L fluids daily can prevent dehydration if the client develops diabetic ketoacidosis. B. Blood glucose tends to increase during illness. C. Illness often causes blood glucose to increase. Regular doses of insulin should be administered. E. The provider should be notified if there are ketones in the urine after 24 hr of illness.

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? Select All That Apply. A. Eat at regular intervals. B. Decrease intake of saturated fats. C. Increase daily fiber intake. D. Limit saturated fat intake to 15% of daily caloric intake. E. Include omega-3 fatty acids in the diet.

A. Eat at regular intervals. (The client should eat at regular intervals throughout the day to maintain blood glucose levels. B. Decrease intake of saturated fats (Healthy nutrition should include lowering LDL, by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia.) C. Increase daily fiber intake. Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. E. Include omega-3 fatty acids in the diet. Healthy nutrition should include omega-3 fatty acids for secondary prevention of diabetes and heart disease.

A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plane of care? A. Monitor CBC. B. Monitor triiodothyronine (T3) C. Instruct the client to increase consumption of shellfish. D. Advise the client to take the medication at the same time every day. E. Inform the client that an adverse effect of this medication is iodine toxicity.

A. Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Monitor CBC. B. Methimazole reduces thyroid hormone production. Monitor T3. D. Methimazole should be taken at the same time every day to maintain blood levels.

A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply). A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray

A. The client can require oral or tracheal suctioning. Ensure that suctioning equipment is available. B. the client can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available. D. The client can experience respiratory obstruction. A tracheostomy tray should be available at the bedside.

A nurse is planning care for a client who has Cushing's disease. The nurse should identify that clients who have Cushing's disease are at increased risk for which of the following (Select all that apply)? A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia

A. Suppression of the immune system places the client at risk for infection. B. The overproduction of cortisol inhibits the production of a protective mucus lining in the stomach and causes an increase in the amount of gastric acid. These factors place clients who have Cushing's disease at increased risk for gastric ulcers. D. Clients who have Cushing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis.

A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings should the nurse expect from this client? (Select All that Apply) A. Sodium 150 mEq/L Potassium 3.3 mEq/L Calcium 8.0 mg/dl D. Lymphocyte count 35% E. fasting glucose 145 mg/dl

A. This finding is above the expected reference range. Hypernatremia is an expected finding for clients who have Cushing's disease. B. This finding is below the expected reference range. Hypokalemia is an expected finding for clients who have Cushing's disease. C. This finding is below the expected reference range. Hypocalcemia is an expected finding for clients who have Cushing's disease. E. This finding is above the expected reference range. Clients who have Cushing's disease have an elevated fasting blood glucose because the disorder affects glucose metabolism.

A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (Select All that Apply). A. Sodium 130 mEq/L B. Potassium 6.1 mE1/L C. Calcium 11.6 mg/dl D. Blood urea nitrogen (BUN_ 28 mg/dl E. fasting blood glucose 148 mg/dl

A. This finding is below the expected reference range. In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Hyponatremia is an expected finding. B. This finding is above the expected reference range. hyperkalemia is an expected finding for a client who has Addison's disease. C. This finding is above the expected reference range. Hypercalcemia is an expected finding for a client who has Addison's disease. D. This BUN level is above the expected reference range, which is an expected finding for a client who has Addison's disease due to dehydration.

A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation of which of the following substances as an indication that the client has this disorder? A. Triiodothyronine B. Plasma-free metanephrine C. Urine cortisol D. Urine osmolality

A. Triiodothyronine

At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following findings is the priority? A. Weight gain B. Fatigue C. Fragile skin D. Joint Pain

A. Weight Gain. (The greatest risk to a client who has Cushing's disease is fluid retention, which can lead to pulmonary edema, hypertension, and heart failure therefore, this is the priority finding.

A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? (Select all that apply). A. Diarrhea B. Menorrhagia C. Dry Skin D. Increased libido E. Hoarseness

B. Abnormal menstrual periods. Including menorrhagia and amenorrhea, are manifestations of hypothyroidism. C. Dry skin is a manifestation of hypothyroidism. E. Hoarseness is a manifestation of hypothyroidism.

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Check blood glucose immediately after breakfast. B. Administer insulin when breakfast arrives. C. Hold breakfast for 1 hour after insulin administration. D. Clarify the prescription because insulin should not be administered at this time.

B. Administer insulin when breakfast arrives.

A nurse is reviewing laboratory reports of a client who has HHS. Which of the following finding should the nurse expect? A. Blood pH 7.2 B. Blood osmolarity 359 mOsm/L C. Blood potassium 3.8 mg/dL D. Blood creatinine 0.8 mg/dL

B. A client who has HHS would have a blood HHS, would havea blood osmolarity greater than 320 mOsm/L.

A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect. Select All That Apply. A. IV therapy with a 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide.

B. Clients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. C. Hydrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. D. Clients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. E. Loop and thiazide diuretics promote potassium excretion and are administered to treat hyperkalemia.

A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse expect? A. Presence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells.

B. Decreased specific gravity. The urine of a client who has diabetes insipidus will be dilute wit ha urine specific gravity of less than 1.005.

A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify which of the following laboratory results is an expected finding? A. Decreased thyrotropin receptor antibodies. B. Decreased thyroid-stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine.

B. Decreased thyroid-stimulating hormone (TSH) (In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone level are elevated)

A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "An adverse effect of this medication is jaundice." B. "Take your pulse before each dose." C. "The purpose of this medication is to decrease the production of thyroid hormone." D. "You should stop taking this medication if you have a sore throat."

B. Propranolol can cause bradycardia. The client should take their pulse before each dose. If there is a significant change, they should withhold the dose and consult the provider.

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (Select All That Apply) A. Weight gain B. Fruity odor of breath C. Abdominal Pain D. Kussmaul Respirations E. Metabolic acidosis

B. Fruity odor of breath is a manifestation of elevated ketone levels that lead to metabolic acidosis. C. Abdominal pain is a GI manifestation of increased ketones and acidosis. D. Kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. E. Metabolic acidosis is caused by glucose, protein, and fat breakdown, which produces ketones.

A nurse is caring for a client who asks why the provider bases the medication regimen on HbA1c results instead of the log of morning fasting blood glucose results. Which of the following responses should the nurse make? A. "HbA1c measures how well insulin is regulating your blood glucose between means." B. "HbA1c indicates how well you have regulated your blood glucose over the past 120 days." C. "HbA1c is the first test your doctor prescribed to determine that you have diabetes." D. "HbA1c determines if your doctor should adjust your insulin dosage."

B. HbA1c indicates how well you have regulated your blood glucose over the past 120 days.

A nurse is reviewing the health history of a client who has diabetes mellitus type 2. Which of the following are risk factors for hyperglycemic hyperosmolar state (HHS)? (Select All the Apply). A. Evidence of recent myocardial infraction B. BUN 35 mg/dL C. takes a calcium channel blocker D. Age 77 years E. Daily insulin injections

B. The client who has type 2 diabetes mellitus can be at risk for developing HHS when the BUN is 35 mg/dl because it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine. C. A calcium channel blocker is one of the several medications that increase the risk for HHS in a client who has type 2 diabetes mellitus. D. The older adult client is at risk for developing type 2 diabetes mellitus and can be unaware of associated manifestations, increasing the risk for HHS.

A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? (Select All That Apply) A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow-up blood TSH levels should be obtained. D. Take the medication on an empty stomach. E. use fiber laxatives for constipation.

B. The provider carefully titrates the dosage of this medication. It should be increased slowly until the client reaches a euthyroid state. The client should not discontinue the medication unless directed to do so by the provider. C. Blood TSH levels are used to monitor the effectiveness of the medication. D. The medication should be taken on an empty stomach to promote absorption.

A nurse is caring for a client who is 6 hours postoperative following a transsphenoidal hypophysectomy. The nurse should test the client's nasal drainage for the presence of which of the following? A. RBCs B. Ketones C. Glucose D. Streptococci

C. Cerebral spinal fluid contains glucose. Test nasal drainage for glucose.

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe. B. Draw up the glargine insulin then the regular insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait for 1 hr, and then administer the glargine insulin.

C. Draw up and administer regular and glargine insulin in separate syringes.

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect? A. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr B. Administer a slow IV infusion of 3% sodium chloride. C. Rapidly administer an IV infusion of 0.9% sodium chloride. D. Add glucose to the IV infusion when blood glucose is 350 mg/dL.

C. Expect to rapidly administer an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs. The initial infusion for a client who has an elevated sodium would be 0.45% sodium chloride.

A nurse is caring for a client who has blood glucose 52 mg/dl. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 min. B. Provide a carbohydrate and protein food. C. Provide 15 g of simple carbohydrates. D. Report findings to the provider.

C. Provide 15 g of simple carbohydrates.

A nurse is providing discharge teaching for a client who had transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? A. Brush teeth after every meal or snack. B. Avoid bending at the knees. C. Eat a high-fiber diet. D. Notify the provider of increased swallowing. E. Notify the provider of a diminished sense of smell.

C. To avoid constipation, which contributes to increased intracranial pressure, the client should eat a high-fiber diet and take docusate. D. Increased swallowing is an indication of leakage of cerebrospinal fluid. The client should notify their provider.

A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C. "I should expect to gain weight during this illness." D. "I might experience confusion or balance problems."

D. "I might experience confusion or balance problems." (Confusion and ataxia are findings associated with DI.)

A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low-Fowler's position. B. Encourage deep breathing and coughing. C. Encourage the client to brush their teeth when awake and alter. D. Observe dressing drainage for teh presence of glucose.

D. Observe dressing drainage for the presence for glucose. (The nurse should monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate the presence of CSF. Notify the provider if this occurs).

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select All That Apply.) A. Remove calluses using over-the-counter remedies. B. Apply lotion between toes. C. Test water temperature with the fingers before bathing. D. Trim toenails straight across. E. Wear closed-toe shoes.

D. Trim toenails straight across to prevent injury to the soft tissue of the toes. E. Wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.