Endocrine

The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison disease). The nurse recognizes which finding associated with the disease? 1.Bronze pigmentation of skin 2.Increased body or facial hair 3.Purple or red striae on the abdomen 4.Supraclavicular fat pad

1 Addison disease is caused by hypofunction of the adrenal cortex, decreasing production of glucocorticoids, mineralcorticoids, and androgens. Signs of Addison disease include vitiligo (blotchy skin), weakness and fatigue, anorexia, weight loss, hypotension, hyponatremia, salt cravings, N/V. Option 1: Hyperpigmentation is caused by the pituitary overproducing adrenocorticotropic hormone (ACTH) in an attempt to increase corticoid levels. Options 2, 3, 4: Striae, hirsutism (increased body hair) and supraclavicular fat pad (buffalo hump) are all signs of excess corticosteroid production (Cushing Syndrome).

The nurse cares for a client with Addison's disease who was involved in a motor vehicle accident and hospitalized for a fracture of the right femur. Which client information is most important to report to the primary health care provider (PHCP)? 1.Blood pressure change from 128/80 mm Hg to 90/50 mmHg 2.Development of a 1st-degree atrioventricular (AV) block on ECG 3.Reports of right femur pain of 7 on a scale of 1-10 4.Vesicular breath sounds auscultated over the lung tissue

1 Addison's disease is adrenocortical insufficiency/ hypofunction of the adrenal cortex. Addisonian crisis occurs when there is acute adrenocortical insufficiency and is a life-threatening complication of Addison's disease. It can lead to shock and should be reported immediately to the HCP. It can be triggered by stress and s/s include hypotension, tachycardia, dehydration, hypoglycemia, fever, hyperkalemia, and hyponatremia. Option 1: Hypotension is a sign of Addisonian crisis in a patient with Addison's disease. Option 2: An AV block should be investigated, but it's not the priority. Option 3: Pain is to be expected with a fracture. Option 4: Vesicular breath sounds are soft and low pitched, and are completely normal and common breath sounds.

A client is diagnosed with diabetic ketoacidosis (DKA). The client reports frequent urination, thirst, and weakness. The nurse assesses a temperature of 102.4 F (39.1 C), fruity breath, deep labored respirations with a rate of 30/min, and dry mucous membranes. What is the priority nursing diagnosis at this time? 1.Deficient fluid volume related to osmotic diuresis 2.Imbalanced nutrition, less than body requirements related to inability to metabolize glucose 3.Ineffective breathing pattern related to the presence of metabolic acidosis 4.Ineffective health maintenance related to the inability to manage DM during illness

1 DKA is a life-threatening complication that can occur with type 1 diabetes, as a lack of insulin causes hyperglycemia, ketosis (ketones burns for energy), metabolic acidosis, and dehydration. Hyperglycemia causes osmotic diuresis (flushing of glucose out of the body, along with ions), which causes hydration, thirst, electrolyte imbalances, hypovolemic shock, and renal failure. The condition requires rapid correction of fluids (volume and shifts) via intravenous fluids. Option 1: Circulation and correction of electrolyte imbalances is the priority with a patient with DKA. Option 2: Imbalanced nutrition is not life threatening at this time. Option 3: The patient's deep, labored breathing (Kussmaul's respirations) are an attempt to "blow off" CO2 to neutralize pH. This is a very effective breathing pattern for metabolic acidosis. Option 4: The patient's health maintenance may be the cause of his DKA, but it's not a priority at this time.

In the intensive care unit, the nurse cares for a client who develops diabetes insipidus (DI) 2 days after pituitary adenoma removal via hypophysectomy. Which intervention should the nurse implement?1.Administer desmopressin 2.Assess fasting blood glucose 3.Institute fluid restriction 4.Place the client in the Trendelenburg position

1 Diabetes insipidus (DI) is a neurological condition that occurs due to insufficient production/suppression of antidiuretic hormone (ADH). ADH causes fluid retention to maintain electrolyte balance, so low production of ADH would cause fluid excretion, leading to polyuria (increased urine output) and polydipsia (increased thirst). Option 1: Desmopressin and Vasopressin are antidiuretic drugs used to replace ADH. Vasopressin is the synthetic form of ADH, and also constricts blood vessels. Desmopressin retains fluid, but does not cause vasoconstriction. Option 2: Diabetes insipidus is unrelated to diabetes mellitus and does not affect blood glucose. Option 3: This client is most likely dehydrated from the polydipsia and fluids need to be increased, not restricted. Option 4: Trendelenburg position is contraindicated in most neurological conditions.

A client's diabetes is controlled with a morning dose of glargine and a scheduled, fixed dose of lispro with meals. Before breakfast, the client's fingerstick glucose is 105 mg/dL. The tray is in the room, and the client is eager to eat. What action should the nurse take?1.Administer both insulins as prescribed 2.Hold both glargine and lispro insulin 3.Hold the glargine insulin 4.Hold the lispro insulin

1 Glargine is a long-acting insulin that stabilizes blood glucose throughout the day, and Lispro is a rapid-acting insulin used to control glucose from a meal. Lispro would be held if the patient was not going to eat right away, or if their glucose <70 mg/dL.

The nurse is caring for a client with suspected Graves disease. Which assessment finding requires priority intervention? 1.Agitation and confusion 2.Heat intolerance 3.Pulse of 110/min, irregular rhythm 4.Red and bulging eyes

1 Graves disease is hypersecretion of thyroid hormone. A thyroid storm is an acute increase in thyroid hormone that occurs during times of stress (trauma, surgery, infection) characterized by tachycardia, hypertension, arrhythmias, high fever, and altered mental status. Option 1: Agitation and confusion are not normal symptoms of hyperthyroidism and may indicate a thyroid storm, which can be life-threatening. Option 2, 3: Heat intolerance and cardiac changes (palpitations, tachycardia) are normal symptoms of hyperthyroidism. Option 4: Bulging eyes are a possible complication of hyperthyroidism and don't specifically indicate a thyroid storm.

The nurse cares for a client with type 1 diabetes mellitus who is obtunded and responding to only painful stimuli. A STAT blood sample reveals a blood glucose level of 38 mg/dL. Which initial action by the nurse is best? 1.Administer 50% dextrose in water IV push 2.Assist the client to drink 4 oz (120 mL) of orange juice 3.Measure the client's heart rate and blood pressure 4.Observe for sweating, shakiness, and pallor

1 Obtundation refers to the client no longer being fully conscious and aware of environment. It is a sign of severe hypoglycemia (<70 mg/dL). Option 1: IV glucose replacement will quickly restore blood glucose and prevent more lethal neurological changes (seizures, coma, death). Option 2: The patient is obtunded and attempting to get them to drink fluids PO would be very difficult and an aspiration risk. Option 3: HR and BP should be assessed, but they are not the priority and doing this will not help the problem. Option 4: Sweating, shakiness, and pallor are all early signs of hypoglycemia; obtundation is a late sign.

The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse question? 1. 0.45% sodium chloride (NaCl) solution prescribed for a client with syndrome of inappropriate antidiuretic hormone secretion who has a sodium level of 120 mEq/L 2. 0.9% NaCl solution prescribed for a client with gastrointestinal bleeding who has a hemoglobin level of 8.9 g/dL 3. 1,000 mL bolus of 0.9% NaCl solution prescribed for a client with septic shock who has a white blood cell count of 18,000/mm3 4.Lactated Ringer's solution prescribed for a male client with hypovolemic shock and a thermal burn who has a hematocrit level of 56%

1 Option 1: Although a serum sodium of 120 is low (normal is 135-145 mEq/L), a client with SIADH is already retaining water will be at risk of further ion dilution and fluid overload, as 0.45% NS is hypotonic. Option 2: The patient has a low Hgb count (normal is 14-18 g/dL for men) due to GI bleeding; he is hypovolemic; an isotonic solution will expand intravascular volume and his hypovolemia. Option 3: Septic shock involves an inflammatory response to pathogens that leads to massive vasodilation and increased capillary permeability, resulting in intravascular hypovolemia and severe hypotension. An isotonic solution will expand intravascular volume. 4. Burn injuries cause increased capillary permeability (↑ intravascular hypovolemia), as well as evaporation and fluid shift into interstitial tissue (edema). An isotonic solution such as LR will correct the hypovolemia, hypotension, and hemoconcentration due to fluid loss.

The nurse in the intensive care unit cares for a client with primary adrenocortical insufficiency (Addison's disease). The client reports nausea and abdominal pain. The blood pressure suddenly drops from 120/74 mm Hg to 88/48 mm Hg, heart rate increases from 80 to 100/min, and the client appears confused. Which action should the nurse take first? 1.Administer as-needed dose of hydrocortisone intravenous (IV) push 2.Complete a head-to-toe assessment to identify any sources of infection 3.Document the findings in the client's electronic medical record 4.Take blood pressure sitting and standing to assess for orthostatic hypotension1

1 The sudden drop in BP, abdominal pain, and altered mental status are indicative of an Addisonian crisis, in which there is an acute adrenocortical insufficiency. Priority emergency management of addisonian crisis includes shock management, with fluid resuscitation using 0.9% normal saline and 5% dextrose; and administration of high-dose hydrocortisone replacement IV push.

In the intensive care unit, the nurse cares for a client admitted with a head injury who develops syndrome of inappropriate antidiuretic hormone. Which data should the nurse expect with the onset of this condition? Select all that apply. 1. Decreased serum osmolality 2. High serum osmolality 3. High urine specific gravity 4. Increased urine output 5. Low serum sodium

1, 3, 5 SIADH causes an overproduction in antidiuretic hormone (ADH). ADH signals the kidneys to retain water. Option 1: Serum osmolality will be low, as the extra retention of water will "dilute" ions. Option 2: See option 1. Option 3: Urine specific gravity will be high (↑ concentration of solutes) because the amount of fluid being urinated out of the body is low. Option 4: The body will retain more water, so urine output will be decreased. Option 5: ADH causes water to be retained, not sodium. Like other ions, sodium will also be diluted due to increase in water.

The nurse educates a 30-year-old female client who is being evaluated for hyperthyroidism with a radioactive iodine uptake (RAIU) test. Which instruction(s) should the nurse include in the teaching plan? Select all that apply. 1."A pregnancy test must be obtained prior to RAIU test administration." 2."All jewelry or metal around the neck area should be removed before the RAIU test." 3."Antithyroid medications should be held for 5-7 days before the RAIU test." 4."Conscious sedation will be used to help with relaxation during the RAIU test." 5."It is important to refrain from eating or drinking for at least 12 hours before the RAIU test."

1, 2, 3 A RAIU test involves administering a radioactive iodine (thyroid gland is the only tissue that uses iodine) to assess for areas of the thyroid actively absorbing iodine and determine if the client's thyroid is hyperactive and what type of hyperthyroidism they have (ex. Graves disease). Option 1: Radioactive iodine can cause fetal harm. Option 2: Jewelry needs to be removed to clear visualization during the scan. Option 3: Antithyroid meds can affect the test results. Option 4: No conscious sedation is used with this test. Option 5: Patient must be NPO for 2-4 hours prior to the procedure.

The nurse cares for a client who is experiencing exophthalmos as a complication of Graves' disease. Which nursing action(s) should be included in the client's plan of care? Select all that apply. 1.Administer artificial tears to moisten the conjunctiva 2.If eyelids don't close during sleep, lightly tape them shut 3.Recommend the use of dark glasses to prevent irritation 4.Teach about the importance of smoking cessation 5.Teach avoidance of eye movement to prevent further damage

1, 2, 3, 4 Exophthalmos is a complication of hyperthyroidism from Graves' Disease that causes the eyeballs to protrude by increased orbital tissue expansion and can be irreversible. Option 1: The exposed cornea is at risk for dryness due to inability to blink properly. Artificial tears can prevent abrasions of the eye. Option 2: Sleep with eyelids taped shut to protect the cornea; also sleep with HOB elevated to promote periorbital drainage. Option 3: More of the eye is exposed to sunlight, so glasses can prevent irritation and damage from light. Option 4: Smoking increases the risk of Graves' disease and causes other eye problems. Salt should also be avoided, as it increase periorbital edema. Option 5: The eyes should be exercises (turning eyes side to side, up and down) to remain flexibility.

Thyroid-stimulating hormone (TSH): 8.6 µU/L Reference: 04.-4.2 Total triiodothyronine (T3): 30 ng/dL Reference: 70-204 Free thyroxine (T4): 0.2 ng/dL Reference: 0.8-2.7 The clinic nurse is reviewing the laboratory results of a 35-year-old client who reports fatigue for the last month. Based on the laboratory results, which additional clinical manifestations would the nurse expect? Select all that apply. 1.Bradycardia 2.Cold intolerance 3.Constipation 4.Hair loss 5.Warm, moist skin 6.Weight loss

1, 2, 3, 4 Primary hypothyroidism is an endocrine disorder of low circulating thyroid hormone (T3 and T4) and high TSH. The TSH is high in an attempt to stimulate the thyroid to produce more thyroid hormones, but it cannot. Thyroid hormone increases metabolic functions in multiple body systems (body temp, cell energy, O2 consumption, neuronal conduction, etc.). Option 1: Cardiac changes: low thyroid causes bradycardia and hypotension Option 2: Temp changes: low thyroid causes cold intolerance and hypothermia Option 3: GI changes: low thyroid causes decreased metabolism and GI motility Option 4: Integumentary changes: low thyroid causes skin and hair to become brittle, weak, and dry Option 5: Warm, moist skin is a skin is a sign of hyperthyroidism. Option 6: Weight loss is a sign of an overactive metabolism, which would be hyperthyroidism. Hypothyroidism causes weight gain.

The nurse assesses a client with Cushing syndrome. Which clinical manifestations should the nurse expect? Select all that apply. 1.Hyperglycemia 2.Hypertension 3.Hyponatremia 4.Truncal obesity 5.Weight loss

1, 2, 4 Cushing syndrome is caused by excess production, or prolonged exposure to, corticosteroids (prednisone, hydrocortisone). The excess steroids cause the adrenal glands too overproduce cortisol (and androgen). Signs of Cushing syndrome include moon face, buffalo hump, bruising, purple striae, bone loss, hirsutism Options 1, 2, 4: Excess cortisol causes a "fight or flight" response, which stimulates gluconeogenesis for energy causing hyperglycemia (and then insulin resistance), hypertension (vessels constrict), and truncal obesity (GI dysfunction occurs, decreased metabolism). Options 3, 5: Hyponatremia and weight loss are associated with adrenocortical insufficiency (Addison's disease).

The clinic nurse is taking vital signs on a client who reports being fatigued every day and gaining weight lately despite not eating much. The nurse should also ask about which symptoms? Select all that apply. 1.Cold intolerance 2.Constipation 3.Fever 4.Menstrual irregularity 5.Night sweats 6.Tachycardia

1, 2, 4 The nurse should look for signs of hypothyroidism, which would be a decrease in metabolic function in body systems. Fever, night sweats (↑ temp), and tachycardia are all signs of hyperthyroidism, not hypothyroidism.

The nurse is planning care for a client immediately following a thyroidectomy. Which of the following nursing actions are appropriate to include in the plan of care? Select all that apply. 1. Assessing frequently for facial or extremity numbness or tingling 2.Encouraging the client to perform neck flexion and extension frequently 3.Ensuring that a tracheostomy insertion kit is at the bedside 4.Maintaining the head of the bed at 30-45 degrees 5.Monitoring the client's voice strength and quality

1, 3, 4, 5 Option 1: Numbness, tingling, muscle spasms, or tetany are all signs of hypocalcemia, a potential complication of a thyroidectomy, as the parathyroid hormone is removed as well. Option 2: Neck exercises should be avoided post-op, as this can damage the incision. Option 3: Laryngeal spasm is a potential complication after an thyroidectomy and can cause respiratory distress. Option 4: Maintaining HOB 30-45 degrees can promote drainage of surgical site edema and reduce the risk of respiratory distress. Option 5: The larynx (which holds the vocal cords) is incised during a thyroidectomy; a weak voice can indicate laryngeal nerve damage.

The nurse teaches disease management to a group of clients with type I diabetes mellitus. Which of the following should the nurse teach as signs or symptoms associated with hypoglycemia? Select all that apply. 1.Diaphoresis 2.Flushing 3.Pallor 4.Polyuria 5.Trembling

1, 3, 5 Hypoglycemia (<70 mg/dL) occurs when there is not enough glucose to feed cells. When hypoglycemia occurs, epinephrine is released, which can lead to trembling, palpitations, anxiety, restlessness, diaphoresis, and vasoconstriction (which will cause pallor).. After a long duration of no glucose, neuroglycopenic symptoms can develop (confusion, seizures, coma). Option 1, 3, 5: Diaphoresis trembling, and pallor are caused by epinephrine release. Option 2: Flushing is seen with fever and polycythemia vera; it does not occur with hypoglycemia or hyperglycemia. Option 4: Polyuria occurs with hyperglycemia as the body tries to flush out all the excess glucose.

A client is suspected of having Graves' disease (hyperthyroidism). Which signs and/or symptoms are expected to be present in this client? Select all that apply. 1.Anxiety 2.Bradycardia 3.Dry skin 4.Heart palpitations 5.Protrusion of the eyeballs 6.Weight gain

1, 4, 5 Hyperthyroidism causes a hypermetabolic state in multiple body systems, causing weight loss (increased metabolism), diarrhea (increased GI motility), tachycardia and palpitations, increased temp, warm sweaty skin, anxiety, tremors, insomnia, and increased orbital tissue expansion (exophthalmos).

During a screening clinic, the nurse performs a health assessment on several adult clients. Which finding by the nurse is most important to report to the primary health care provider? 1.Body mass index (BMI) of 23 2.Brownish skin thickening on the neck 3.Fasting total cholesterol of 180 mg/dL 4.Round 3x3 mm pale pink mole

2 Acanthosis nigricans is a skin disorder that may indicate insulin resistance.. It's characterized by symmetric, hyperpigmented velvety plaques at skin folds. Option 1: BMI of 23 is a normal (Normal range 18-25) Option 2: This may be acanthosis nigricans. Option 3: A cholesterol <200 is normal Option 4: Round, pale or brown moles are normal, and it's not a concern if it's <5 mm. Any changes or growth should be reported to the HCP.

The nurse cares for a client with type 1 diabetes mellitus. Which laboratory result is most important to report to the primary health care provider? 1.Fasting blood glucose 99 mg/dL 2.Serum creatinine 2.0 mg/dL 3.Serum potassium 3.9 mEq/L 4.Serum sodium 140 mEq/L

2 Creatinine is a waste product produced by muscle metabolism. The kidneys filter creatinine from blood and excrete it through urine. If the kidneys are functioning properly, increase creatinine levels my accumulate in blood. Creatinine can indicate how well the kidneys are filtering blood (glomerular filtration rate). In patients with diabetes, microvascular blood vessels damage to the kidneys can occur (diabetic nephropathy), affecting their function. Options 1, 3, 4: Glucose (70-100 mg/dL), potassium (3.5-5 mEq/L), and sodium (135-145 mEq/L) are all within normal limits. Option 2: Normal serum creatinine is 0.6-1.3 mg/dL, so his serum creatinine is elevated.

The nurse is caring for an adolescent client diagnosed with type 1 diabetes. The client exhibits hot, dry skin and a glucose level of 350 mg/dL. Arterial blood gases show a pH of 7.27. STAT serum chemistry labs have been drawn. Cardiac monitoring shows a sinus rhythm with peaked T waves, and the client has minimal urine output. What is the nurse's next priority action? 1.Administer IV regular insulin 2.Administer normal saline infusion 3.Obtain urine for urinalysis 4.Request prescription for potassium infusion

2 Elevated glucose, acidic pH, and polyuria are all signs of diabetic ketoacidosis. This patient is no longer experiencing polyuria (now he's experiencing oliguria) because he is dehydrated. Remember ABC (airway, breathing, circulation) to determine the priority action. Option 1: IV insulin would be the second action; circulation should always come first. Option 2: The patient is dehydrated, and circulation will always be the priority action (except for airway). Option 3: A UA is not the priority. Option 4: Peaked T waves indicate hyperkalemia, so potassium would be contraindicated. Metabolic acidosis causes a cell shift between H+ ions (into cells) and K+ ions (into blood), causing hyperkalemia.

The nurse cares for a client with type 2 diabetes mellitus and hemoglobin A1C results of 8% at an outpatient health clinic. Which statement by the nurse will best address these results? 1."It is important for us to review the signs and symptoms of a hypoglycemic reaction." 2."Let's review your diet, exercise, and medication regimen over the past 2-3 months." 3."Please describe what you have eaten in the last 24-48 hours." 4."You should fast for at least 8 hours prior to your morning blood work."

2 Hemoglobin A1C is a diagnostic test used to measure the percentage of glycosylated hemoglobin in the blood. A normal hemoglobin A1C is 4%-6% in clients without diabetes; the goal is to keep the level <7% in clients with diabetes. Higher levels indicate poor adherence to a diet/exercise regimen over a 2-3 month period.

The nurse teaches proper foot care to a client with diabetes mellitus. Which statement by the client indicates that further teaching is needed? 1."I will apply lanolin to my feet to prevent dry skin." 2."I will make sure my flip flops are made of leather." 3."I will not apply a heating pad directly to my feet." 4."I will test the water with a thermometer before bathing."

2 Individuals with diabetes (type 1 or 2) are at increased risk for developing an infection or ulcer on their feet due to the chronic complications of peripheral neuropathy. Peripheral neuropathy results from damage to the nerves in the extremities. Clients may be unable to feel injuries if they occur and must take extra measures in caring for their feet. Option 1: Feet should be dried thoroughly and lotion should be applied everywhere but between toes. Inspect for skin integrity daily. Toenails should be cut straight across. Option 2: The client with DM should wear close toed, breathable shoes and should never walk barefoot or in flip flops, to prevent the risk of injury to the feet. Options 3, 4: The client may not be able to feel hot temperatures and is at risk for burns.

A client with type 1 diabetes is prescribed NPH insulin before breakfast and dinner. Although the client reports feeling well, the 6 AM blood glucose level has averaged 60 mg/dL (3.3 mmol/L) over the past week. Which action is appropriate for the nurse to recommend to the client? 1.Collect urine sample to check for urine ketones 2.Consume a snack of milk and cereal at bedtime 3.Increase carbohydrate intake at each meal 4.Take only the pre-breakfast dose of NPH

2 NPH insulin is intermediate-acting with an onset of 1-2 hours, peak of 4-12 hours, and duration of 12-18 hours. Hypoglycemia can occur due to its long peak, especially overnight when no carbohydrates are consumed. Option 1: There are no signs ketoacidosis present, nor is the client sick, so there is no reason to check ketones. Option 2: Consuming carbs at bedtime will keep glucose levels higher overnight. Option 3: Increasing carbs at each meal will not affect the AM blood glucose level. Option 4: Drastically altering insulin dosages can be dangerous. It is also outside of the nurse's scope of practice to change a prescribed dose.

When no changes are made to the diet or prescribed insulin, which client with type 1 diabetes mellitus does the nurse anticipate having the highest risk of developing hypoglycemia? 1.29-year-old with new onset of influenza 2.40-year-old experienced cyclist who rides an extra 10 miles 3.65-year-old with cellulitis of the right leg 4.72-year-old with emphysema who is taking prednisone

2 Options 1, 3: Clients with acute illness are more likely to experience hyperglycemia while ill, not hypoglycemia. Illness causes a physiological response that increases glucose levels. Clients also do not eat a proper diet or stay hydrated while sick. Option 2: Aerobic exercises lower blood glucose levels, as the muscles use it up for energy. People with diabetes tend to not produce enough glucose from the liver to keep up with the energy demand and may become hypoglycemia. Extra exercise may require extra carbohydrates to be eaten. Option 4: Prednisone can cause hyperglycemia, not hypoglycemia.

A nurse is teaching a nutrition class for clients with newly diagnosed type 2 diabetes. Which meal represents the best adherence to the principles of and recommendations for diabetic meal planning?1.Baked tilapia with tomato salsa, steamed white rice 2.Black bean chili with brown rice, mixed green salad 3.Grilled chicken breast with baked French fries 4.Hamburger on a whole wheat bun with lettuce and tomato

2 People with diabetes should eat food with a low glycemic index, low fat, and high fiber. Option 1: White rice is a high glycemic index food. Option 2: Beans and brown rice are low glycemic. Option 3: French fries are high glycemic. Option 4: Whole wheat is low glycemic, but hamburger is high fat and not the best option.

The nurse cares for a client with type 2 diabetes mellitus. The client is alert and oriented but also shaky, pale, and diaphoretic. The client's fingerstick blood glucose is 50 mg/dL. Which of the following is the best next step the nurse can take? 1.Administer dextrose 50 mg IV push 2.Give client 6 oz of orange juice or low-fat milk 3.Inject the client with glucagon 2 mg intramuscularly 4.Verify fingerstick blood glucose with serum blood draw

2 Since this client is alert and oriented, blood glucose should be increased via 15g of simple carbohydrates like juice. Blood sugar should be checked 15 minutes later, and more carbohydrate should be given if still low. Options 1, 3: These will quickly increase blood glucose levels, but are saved for clients who are unstable or unable to be given carbs PO because they can cause rebound hypoglycemia (↑ insulin stimulation after the high dose of sugars are given). Option 2: Carbs should be simple for easy digestion and low fat, as fat decreases the rate of absorption. Option 4: A fingerstick glucose check is just as accurate as a serum draw; a second draw is unnecessary.

A client is admitted to the intensive care unit with diagnoses of a brain tumor complicated by transient diabetes insipidus. Which client data related to this complication should the nurse expect? Select all that apply. 1.Dark amber urine with sediment 2.High serum osmolality 3.Low urine specific gravity 4.Recent weight gain 5.Reports of excessive thirst

2, 3, 5 Diabetes insipidus is caused by a dysfunction of the pituitary gland, in which insufficient antidiuretics hormone (ADH) is produced. ADH release signals the kidneys to retain fluid. Without sufficient ADH, large quantities of water are excreted from the body, leading to polydipsia (increased thirst), polyuria (increased urine output, relative hypernatremia, and high serum osmolality. Option 1: Urine would be very light, as a lot of fluid is leaving and would dilute any waste. Option 2: Ion concentration would be high relative to fluid volume Option 3: Excess fluid in urine with decrease the concentration of solutes in urine Option 4: Weight loss from fluid loss would occur, not weight gain Option 5: As the body excretes a lot of fluid, you will become dehydrated and thirsty

The emergency department nurse cares for a client admitted with a diagnosis of hyperosmolar hyperglycemic state. The nurse understands which characteristics are commonly associated with this complication? Select all that apply. 1.Abdominal pain 2.Blood glucose level >600 mg/dL 3.History of type 2 diabetes 4.Kussmaul respirations 5.Neurological manifestations

2, 3, 5 HHS is an extreme complication of type 2 diabetes in which the patient is producing enough insulin to prevent diabetic ketoacidosis, but not enough to prevent extreme hyperglycemia. The hyperglycemia, osmotic diuresis (body is trying to excrete the glucose), and extracellular fluid deficit. Because the body is still producing insulin, blood glucose rises slowly and and the client may not be aware of symptoms until it is severe. Option 1: HHS does not cause any form of acidosis, so no (DKA is a form of metabolic acidosis), so no GI symptoms will be present. Option 2: Complications related HHS arise due to severely high (>600 mg/dL) serum glucose levels. Option 3: The patient cannot get HHS without having type 2 diabetes. The patient needs to be producing insulin, but not enough to control effectively blood glucose. Option 4: Kussmaul's respirations (rapid and deep breathing) occurs due to acidosis; the body is trying to decrease CO2 (acidic) to neutralize pH. Option 5: Neurological complications will occur such as blurry vision, lethargy, obtundation (altered consciousness), and eventually coma.

The nurse cares for a client admitted to the hospital due to confusion. The client has a nonmetastatic lung mass and a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Which action(s) should the nurse expect to implement? Select all that apply. 1.Fluid bolus (normal saline) 2.Fluid restriction 3.Salt restriction in the diet 4.Seizure precautions 5.Strict record of fluid intake and output

2, 4, 5 SIADH causes an overproduction of antidiuretic hormone, which causes increased fluid retention. This causes hypervolemia, and relative low osmolality of electrolytes due to dilution. Option 1: The client is already experiencing hypervolemia; extra fluid will exacerbate the condition. Option 2: Fluid should be restricted to <1000 ml a day. Option 3: Due to the hypervolemia, electrolytes are diluted in vessels; hyponatremia needs to be treated, not restricted. PO salt tablets or a hypertonic saline solution can be given. Option 4: Hyponatremia can cause neurological complications such as confusion and seizures. Option 5: Strict I&Os need to be taken, along with daily weights, to monitor improvement or decompensation.

A nurse is reviewing the most recent laboratory results of a client on the telemetry floor. The client is currently asymptomatic, and the telemetry monitor indicates sinus rhythm. Which of the following critical values is most likely due to laboratory error? 1.Blood urea nitrogen (BUN) of 60 mg/dL 2.Creatinine of 4.0 mg/dL 3.Potassium of 7.0 mEq/L 4.Sodium of 155 mEq/L

3 A potassium level >6.5 (normal 3.5-5.0) is considered dangerously high and would cause severe weakness, paralysis, arrhythmias, and cardiac arrest. If the patient's sinus rhythm is normal. Option 1:

The nurse is conducting a health-screening clinic at an industrial work site. The nurse should be most concerned about which client's risk for metabolic syndrome? 1. 27-year-old woman with triglycerides of 210 mg/dL, blood pressure of 128/82 mm Hg, and fasting blood glucose of 98 mg/dL 2. 45-year-old man with waist circumference of 38 inches, high-density lipoprotein of 49 mg/dL, and fasting blood glucose of 118 mg/dL 3. 55-year-old woman with waist circumference of 37 inches, triglycerides of 190 mg/dL, and fasting blood glucose of 120 mg/dL 4. 82-year-old man with high-density lipoprotein of 45 mg/dL, blood pressure of 148/88 mm Hg, and fasting blood glucose of 104 mg/dL

3 Metabolic syndrome is the presence of at least 3 metabolic health factors that increase the risk of stroke, diabetes, and cardiovascular disease: waist circumference >40" men (<35" women), triglycerides >150 mg/dL, HDL <40 mg/dL, HTN >130/85, fasting glucose >100 mg/dL Option 1: Although her triglycerides are elevated, her BP is nearly within normal limits and her glucose is good. Option 2: His waste is WNL, HDL is good, and glucose is his only risk factor. Option 3: Her waist circumference, triglycerides, and glucose are all above normal limits. Option 4: His LDL is good, BP is elevated, and glucose is slightly elevated.

A client diagnosed with septic shock has an upward-trending glucose level (180-225 mg/dL) requiring control with insulin. The client's spouse asks why insulin is needed as the client is not a diabetic. What is the most appropriate response by the nurse? 1."It is common for critically ill clients to develop type II diabetes. We give insulin to keep the glucose level under control." 2."The client was diabetic before, but you just didn't know it. We give insulin to keep the glucose level in the normal range." 3."The increase in glucose is a normal response to stress by the body. We give insulin to keep the level at 140-180 mg/dL." 4."This increase is common in critically ill clients and affects their ability to fight off infection. We give insulin to keep the glucose level in the normal range."

3 Stress-induced hyperglycemia can occur due to surgery, trauma, acute illness, or infection. To minimize complications and avoid hypoglycemia, the goal while in the hospital is to maintain a glucose level of 140-180 mg/dL if critically ill. Options 1, 2: Hyperglycemia does not necessarily mean that a patient has type II diabetes. Option 3: Stress increases the rate of gluconeogenesis to supply energy to cells during times of increase energy needs. Option 4: Insulin is given to decrease glucose levels, and this will help fight infections, but it is not given to lower it to normal range (70-100 mg/dL). The goal is 140-180 mg/dL if critically ill, or <140 mg/dL fasting for non-critically ill clients.

The nurse practicing in an out-patient clinic cares for a client recently diagnosed with hyperthyroidism. Which diet-related teaching should the nurse add to the client's plan of care? Select all that apply. 1.Emphasize the importance of a low-carbohydrate diet 2.Encourage the client to increase high-fiber foods in the diet 3.Include meals and snacks high in protein content 4.Teach avoidance of caffeine-containing liquids 5.Teach the client about consumption of a high-calorie diet of 4000-5000 calories/day

3, 4, 5 Option 1: Increased secretion of thyroid hormones leads to increased metabolic rate. The client needs to learn methods to prevent weight loss. Option 1: Low carb diet would be beneficial to a diabetic, but someone with high thyroid needs carbs for quick energy. Option 2: High fiber foods can hyper-stimulate the GI tract and cause diarrhea; they are not recommended unless constipation is a concern. Option 3: High density, high protein meals are crucial to maintain adequate nutrition intake. Option 4: Avoid substances that further cause GI stimulation such as spicy foods, coffee, tea, soft drinks Option 5: The client should eat 6 small meals a day

A client with type I diabetes mellitus is brought to the emergency department by his wife. The client has fruity breath with rapid, deep respirations at 36 breaths per minute, reports abdominal pain, and appears weak. The nurse should anticipate implementation of which prescription(s)? Select all that apply. 1.Administer dextrose 50 mg intravenous (IV) push 2.Instruct client to breathe into a paper bag to treat hyperventilation 3.Perform a fingerstick and serum blood glucose test 4.Prepare to administer an IV infusion of regular insulin 5.Start an IV line and administer a bolus of normal saline

3, 4, 5 The client is in diabetic ketoacidosis. Signs/symptoms include fruity breath, rapid/deep respirations (Kussmaul's respirations), abdominal pain (caused by metabolic acidosis), and weakness (caused by hyperglycemia). This occurs when there is no insulin production at all, so glucose cannot get into cells (hyperglycemia occurs), and the body breaks down fat stores at too fast a rate which produces acidic ketones (byproduct of fat metabolism). Option 1: The client is already hyperglycemic; dextrose will only increase is blood glucose further. Option 2: Kussmaul's respirations occur when the body is trying to compensate for the acidotic state, by increasing O2 and decreasing/"blowing off" CO2 to decrease acidity. Blowing into a bag would increase CO2 and increase the acidotic state. Option 3: Signs of hypoglycemia and DKA can overlap, so a glucose check should be done to ensure the right treatments are performed. Option 4: Regular insulin is given to decrease blood glucose levels. Option 5: DKA causes osmotic diuresis, as the body tries to flush out the excess glucose; electrolytes are lost in the process and the client will likely become dehydrated. Normal saline will expand intravascular volume and supplement some electrolytes.

The nurse is performing an initial assessment on a client diagnosed with Addison's disease. Which assessment findings should the nurse anticipate? Select all that apply. 1.Acanthosis nigricans 2.Hirsutism 3.Hyperpigmented skin 4.Truncal obesity 5.Weight loss

3, 5 Addison's disease is chronic adrenal insufficiency, which causes a low production of corticosteroids and androgens. Symptoms include weight loss, muscle weakness, hypotension, hypoglycemia, and hyperpigmented skin. Option 1: Acanthosis nigricans is a skin condition caused by obesity or diabetes and indicates insulin resistance. It's unrelated to the adrenal glands. Option 2: Hirsutism is unwanted facial hair growth in women and occurs from an overproduction of steroids. Option 3: Hyperpigmented skin is caused by increased adrenocorticotropic hormone, which is produced in excess in a a futile attempt to get the dysfunctional adrenal glands to product more steroids. Option 4: Truncal obesity is increased abdominal fat and occurs from an overproduction of steroid hormone (Cushing's Syndrome). Option 5: Weight loss is a common symptom of decrease steroid production.

The nurse assesses a 40-year-old client with acromegaly in an outpatient health clinic. Which new finding is most important to report to the health care provider? 1. Complaints of knee pain when walking 2. Dark leathery skin 3. Fasting blood glucose 126 mg/dL (7.0 mmol/L) 4. Presence of S3 and S4 heart sound

4 Acromegaly is caused by an overproduction of growth hormone (GH). It is usually due to pituitary adenoma, and onset in adult clients generally occurs at age 40-45. In an adult, increased GH results in overgrowth of soft tissues of the face, hands, feet, and organs. All options are associated with acromegaly, but option 4 can be life-threatening if not treated.

In the intensive care unit, the nurse cares for a client who has been admitted with diabetic ketoacidosis. The client is on a continuous infusion of regular insulin at 5 units/hr via IV pump. Which action should the nurse expect to implement? 1.Check serum BUN and creatinine levels every hour 2.Discontinue insulin infusion when blood glucose is <350 mg/dL 3.Increase insulin infusion rate when blood glucose level decreases 4.Initiate potassium IV when serum potassium is 3.5-5.0 mEq/L

4 DKA causes metabolic acidosis, which causes a cellular shift (H+ ions move into cells, K+ moves into vascular compartment) and hyperkalemia occur. As the DKA is resolved through insulin (↓ hyperglycemia) and fluid replacement (↓ dehydration/osmotic diuresis), the potassium will shift back into cells and hypokalemia can occur. Option 1: BUN and creatinine indicate kidney function and may be elevated due to dehydration, but they are unrelated to DKA (kidney function is related to diabetic nephropathy, however). Labs typically monitored with DKA are potassium, glucose, and anion gap. Option 2: The insulin infusion is typically discontinued <250 mg/dL. If insulin is given until glucose is at a more acceptable level (<170 for critically ill patients), then hypoglycemia can occur due to its residual effects. Option 3: Insulin should be decreased as glucose goes down, not increased, as hypoglycemia can occur. Option 4: Although most patients with DKA also have hyperkalemia, it can quickly turn into hypokalemia has the DKA resolves and potassium shifts back into cells.

The nurse assesses a client with hyperparathyroidism who had a parathyroidectomy 4 hours ago. Which assessment technique should the nurse use to check for complications in this client? 1.Ask client to place backs of the hands against each other to provide hyperflexion of the wrist while the elbows remain flexed 2.Instruct client to lie down and run the heel of one foot down the shin of the other leg 3.Perform Romberg test by asking the client to stand with eyes closed and feet together 4.Place blood pressure (BP) cuff on arm, inflate to pressure > than systolic BP, and hold in place for 3 minutes

4 Hyperparathyroidism is a condition in which the parathyroid overproduces parathyroid hormone (PTH). Parathyroid hormone regulates blood calcium concentration. If serum calcium is too high, more PTH is produced and calcium is pulled from bone. Option 1: Phalen's maneuver assesses for carpal tunnel Option 2: Heel-to-shin tests cerebellar function Option 3: Romberg test is used to test vestibular function (perception of head position in space), proprioception (perception of the body in space), and vision. Option 4: Hypocalcemia is a potential complication after a parathyroidectomy, as less PTH will be produced and it becomes more difficult to pull calcium from bones when blood calcium levels (8.5-10 mg/dL) are low. A positive Trousseau's sign (muscle spasms in arm after brachial artery is occluded) indicates hypocalcemia.

The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with tingling around the mouth and muscle twitching in the right arm. Which action is most important for the nurse to implement first? 1. Change the surgical dressing to assess for bleeding 2. Document the findings in the electronic medical record 3. Draw arterial blood gases 4. Obtain a serum calcium level

4 Option 1: Bleeding is a potential complication of a thyroidectomy, but these aren't the symptoms of blood loss. Option 2: Documenting the findings should be the last thing the RN does Option 3: The client is not exhibiting any signs of hypoxemia (stridor, respiratory distress, cyanosis, low pulse ox), so drawing ABGs is not necessary. Although laryngeal spasms are a potential complication of a thyroidectomy and can cause respiratory distress. Option 4: The muscle twitching and tingling are signs of hypocalcemia, can can occur after a thyroidectomy, as the parathyroid glands are removed along with it.

Vitals: BP 156/84, HR 60/min, RR 16/min Labs: Glucose 270 mg/dL, Potassium 3.6 mEq/L, Sodium 137 mEq/L Meds: Determir 7 units subQ BID @ 0900 & 2100 Hydrochlorothiazide 25 mg PO daily @ 0900 Spironolactone 50 mg PO daily @ 0900 Allergies: none The nurse cares for a newly admitted client with type 1 diabetes mellitus. The nurse reviews the electronic health record before the breakfast trays arrive on the unit and contacts the HCP for which reason? 1.To increase the detemir prescription 2.To question the spironolactone prescription 3.To report the serum potassium level 4.To request a prescription for insulin lispro

4 Option 1: Determine is a long-acting insulin that brings overall blood glucose levels down through a 24 hour period. They are meant to prevent, and not treat, hyperglycemia. It would not help decrease the current blood glucose level (ideally, we want it <140 mg/dL while the patient is in the hospital). Option 2: Spironolactone is a potassium-sparing diuretic; their BP is not dangerously high to warrant the use of a diuretic at all, and their potassium is within normal range (3.5-5.0) Option 3: Serum potassium is within normal limits, as well as their sodium level (135-145) Option 4: A rapid-acting insulin (lispro, aspart, or glargine) have a very short onset and can quickly decrease blood glucose levels.

The nurse is giving report to a licensed practical nurse (LPN) who will be helping to monitor a client who just had a total thyroidectomy. What will the nurse emphasize as most important to report immediately? 1.Elevated blood pressure 2.Heart rate irregularity 3.Low oxygen saturation 4.Noisy breathing

4 Option 1: Elevated BP can occur due to stress, pain, or an underlying symptom. This client just had their thyroid removed, so it is not a potential thyroid storm (excess thyroid in the body). It is not as important as airway. Option 2: This is less important than airway. Option 3: Low O2 sat can be a sign of impending airway compromise, but it is also common post-op coming off of anesthesia. This is not as specific of a sign of airway compromise as noisy breathing. Option 4: Swelling at the base of the neck after a thyroidectomy can cause difficulty breathing and stridor. Rapid response should be activated.

The nurse in the endocrinology clinic is reviewing phone messages from clients. Which client would be the priority to call first? 1. Client with a history of thyroidectomy who needs a refill for levothyroxine 2. Client with Addison disease who is taking corticosteroids and reports new mood swings 3. Client with diabetes who reports blood sugars of 250-300 mg/dL in the past week 4. Client with hyperthyroidism who has a new temperature reading of 101.5 F (38.6 C)

4 Option 1: Thyroid medication is necessary for this patient to prevent hypothyroidism, which can cause bradycardia and extreme fatigue. This patient should be called third. Option 2: Mood swings are a possible side effect of corticosteroids. This patient should be called last. Option 3: Sustained elevated blood glucose with no other symptoms of hyperglycemia is not the priority. They should be called second, as sustained hyperglycemia can cause dehydration and acidosis. Option 4: A patient with hyperthyroidism and an elevated temperature may be developing thyroid storm, a life-threatening condition caused by too much thyroid hormone in the body. Other s/s include tachycardia, dysrhythmias, N/V, AMS, diarrhea. It can cause cardiac compromise.

A client is admitted to the intensive care unit with suspected pheochromocytoma. The client's vital signs are temperature of 99.6 F (37.5 C), blood pressure (BP) of 200/110 mm Hg, heart rate of 110/min, and respirations of 20/min. The client is sweating profusely and reports a severe headache. Which prescription should the nurse implement first? 1.Draw labs to assess electrolyte panel 2.Give acetaminophen 650 mg by mouth as needed for headache 3.Place a fan in the client's room 4.Start nitroprusside infusion at 0.5 mcg/kg/min

4 Pheochromocytoma is a condition caused by a tumor in the adrenal medulla. This results in excess release of catecholamines (epinephrine and norepinephrine), leading to paroxysmal hypertensive crisis. A hypertensive crisis puts the client at risk for a stroke, so his blood pressure needs to get under control. Nitroprusside is a powerful antihypertensive that relax smooth muscles of blood vessels and cause vasodilation.

The nurse is caring for a 72-year-old client with hypothyroidism admitted to the emergency department for altered mental status. His vitals were a temp of 95 F, BP 90/50, HR 50/min, O2 83%. The client lives alone and has not taken medications for several months. Which action is the priority? 1.Administer IV levothyroxine 2.Check serum TSH, triiodothyronine, and thyroxine 3.Place a warming blanket on the client 4.Prepare for endotracheal intubation

4 Severe hypothyroidism can cause a condition called myxedema, which causes decreased LOC and eventually a coma. Myxedema coma is characterized by hypothermia, bradycardia, hypotension, and hypoventilation. Option 1: This client will definitely need thyroid replacement therapy, but airway needs to come first since his O2 sat was 83%. Option 2: Thyroid levels needs to be checked to confirm hypothyroidism, but it can wait until the patient is more stable. Option 3: Preventing hypothyroidism is a priority, but not as much a priority as airway. Option 4: Airway is the biggest priority. The low respiratory rate and O2 sat may soon progress to respiratory failure.

The nurse cares for a group of clients on a medical surgical floor. The client with which condition is at highest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)? 1.Carpal tunnel syndrome 2.Diabetes mellitus 3.Sciatica 4.Small cell lung cancer

4 Some cancer cells have the ability to produce and secrete ADH, leading to SIADH. Options 1, 3: These are nerve disorders and are unrelated to the endocrine system. Option 2: Although DM is an endocrine disorder, it is not a central nervous system disorder.