Endocrine

11. A client with a history of chronic hyperpara-thyroidism admits to being noncompliant. Based on initial assessment findings, the nurse diagnosis of Risk for Injury related to.

Elevated serum calcium level that may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury.

14. The nurse should expect a client with hypothyroidism to report which of the following health concerns?

(myxedema) causes facial puffiness, extremity edema, and weight gain.

6. To correct a client's long-term hypothyroid condition, Synthroid or Cytomel may be ordered. When administering the drug, the nurse should be aware that:

A hypothyroid state must be corrected slowly because a correction made too rapidly may result in angina, arrhythmias, or myocardial infarction. Improvement in symptoms may take 2 to 3 weeks.

33. A nurse understands a client with diabetes insipiidus would most likely be prescribed which diuretic?

A thiazide diuretic such as hydrochlorothiazide impairs sodium chloride reabsorption in the distal tubules, reducing the loss of free water and increasing urine concentration.

15. When assessing a client with pheochromocytoma, the nurse is most likely to detect:

A tumor of the adrenal medulla that secretes excessive catecholamine, which causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss.

16. A 50-year old client diagnosed with Addison's disease. What tests would confirm or refute this diagnosis?

Adrenal function is evaluated by examining cortisol levels in plasma and urine.

22. A nurse who is monitoring a client who is diabetic should be aware that glipizide, given orally, begins to act in:

Answer: A Rationale: after oral administration, glipizide begins to act in 30 minutes

34. A nurse is planning care for a 52-year-old client experiencing an acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a. Impaired physical mobility b. Imbalanced nutrition: Less than body requirements c. Risk for infection d. Decreased cardiac output

Answer: D- An acute addisonian crisis is a life-threatening even, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decreased cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse.

32. A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes mellitus with diet and exercise. To determine the effectiveness the nurse should check:

Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months.

A client who has a pheochromocytoma and is scheduled to have surgery in several days. Why might this client be tachycardic and diaphoretic?

Catecholamines stimulate beta receptors in the heart, and they cause an increase in sweat gland secretion.

9. A client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If not treated could lead to.

Cerebral edema a water intoxication from fluid retention caused by excessive antidiuretic hormone. The major electrolyte disturbance as hyponatremia.

18. A client who's had gastric bypass surgery shows edema to the right leg with skin color changes to the right lower extremity. The client reports pain at the incision site as a 3 point scale and pain to the right calf as 7. The nurse reports the finding and suspects that the client has:

DVT - Unilateral edema, skin color changes, and calf pain are all signs and symptoms of deep vein thrombosis, which can be a complication of postoperative immobility.

55. Antoinette has gone to her primary care provider for a routine physical. Some of her lab results indicated an endocrine disorder. In hyperparathyroidism which test results are typical?

Decreased WBC and increased alkaline phosphatas

1. The nurse expects a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) to have an elevated serum glucose level. Which of the following laboratory findings should the nurse also anticipate?

Decreased serum potassium level: a client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to hyperglycemia, hyperosmolar state caused by the relative insulin deficiency.

44. A nurse is assessing a postcrainotomy client and finds that the urine output from the catheter is 1,500 ml for the first hour and the same for the second hour. The nurse should suspect:

Diabetes insipiidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery.

40. The primary care provider evaluates a client for hyperthyroidism. Characteristic signs and symptoms of thyroid toxicity include:

Diarrhea and weight loss.

68. A nurse is assessing a client who has SIADH. Which of the following assessment findings indicate a dangerous complication of SIADH?

Distended neck veins, shortness of breath, and crackles heard with breath sounds are signs of fluid overload that may lead to pulmonary edema or heart failure.

41. A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

Excessive secretions of aldosterone in the adrenal cortex are responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes resorption of sodium and excretion of potassium and hydrogen ions.

51. Annabelle has been referred to an endocrinologist for evaluation of the following symptoms: infertility, hypogonadism, and delayed puberty. Which hormone from the pituitary is lacking in Annabelle?

FSH and LH

48. A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse should expect to find:

Fat distribution associated with Cushing's syndrome, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical area (buffalo hump), Hypertension because of fluid retention. Skin becomes thick and bruises easily due to loss of collagen, and muscle wasting causes muscle atrophy and thin extremities.

21. Prednisone is prescribed for a diabetic client with severe joint inflammation. If taken with isophane insulin suspension (NPH), prednisone may:

Glucocorticoids such as prednisone may cause hyperglycemia, it may increase insulin requirements.

12. For a client with Graves' disease, what are the signs & symptoms?

Heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

5. A client with insulin-dependent diabetes mellitus 14 years ago is admitted to the ER with abdominal pain. The client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

High blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia and leads to fluid loss, the nurse should expect to assess signs of a fluid volume deficit, as decreased BP, rapid respirations, a rapid, thread pulse.

42. Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

Humulin 70/30 is a combination of 70% NPH insulin and 30% regular insulin

60. Alexa, a 32-year-old female, has been diagnosed with metabolic syndrome. Teaching her about the typical accompanying signs and symptoms, such as:

Hypertension, low HDL, and elevated triglycerides

50. After a transsphenodal hypophysectomy, the nurse should assess the client carefully for which condition?

Hypocortisolism. Abrupt withdrawal of endogenous coritsol may lead to severe adrenal insufficiency. Steroids should be given during surgery to prevent hypocortisolism from occurring. Signs of hypocortisolism include vomiting, increased weakness, dehydration, and hypotension.

59. Adam has just been diagnosed with diabetes insipidus. The most common presenting sign is:

Increase in urination

37. Which intervention is most critical for a client with Myxedema coma?

Maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Thyroid replacement will be administered I.V. Intake and output are very important but aren't critical interventions at this time.

100. What type of acid-base imbalance is likely in a client with diabetic ketoacidosis (DKA)? How should the nurse recognize compensation for this acid-base disorder?

Metabolic acidosis secondary to breakdown of fats for energy manifested by ketosis is most likely. Rapid, deep respirations (Kussmaul's respirations) will show compensation for the acidosis as the body blows off carbon dioxide, a respiratory acid.

45. A client with diabetes takes insulin and metoprolol. When teaching the client about drug interactions, the nurse should instruct the client to check his:

Metoprolol and insulin can cause hypoglycemia or hyperglycemia, a client taking both drugs should check his glucose level frequently.

81. A nurse is caring for a client who has Cushing's disease and has excessive cortisol levels. Which of the following is the priority assessment?

The greatest risk to a client who has Cushing's disease is fluid retention, which can lead to hypertension and heart failure. The nurse should weigh the client daily, check extremities for peripheral edema, assess neck veins for distention, and monitor cardiac rhythm and breath sounds.

36. A nurse is caring for a client who underwent a unilateral adrenalectomy. To assess for hyperkalemia, which sign or symptom should the nurse look for?

Muscle weakness, bradycardia, nausea, diarrhea and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adrenal glands are removed.

20. A nurse is teaching a client about risk factors for diabetes mellitus. Which risk factor for diabetes mellitus is nonmodifiable?

Nonmodifiable risk factors are factors that the client doesn't have an ability to change, such as genetics.

39. Parathyroid hormone (PTH) has which effect on the kidney?

PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form.

38. When monitoring a client receiving propylthiouracil (PTU), the nurse should be alert for which signs and symptoms of hyperthyroidism?

PTU can induce hypothyroidism, which may present as depression, cold intolerance, and hard, nonpitting edema.

A client who has a pheochromocytoma and is scheduled to have surgery in several days. Why is this client at risk for developing hypertension?

Pheochromocytomas secrete catecholamines. These catecholamines directly stimulate the alpha receptors, which causes vasoconstriction.

8. A client complaining of agitation, restlessness, and weight loss. Examination reveals exophthalmos, a classic sign of Graves' disease. Exophthalmos is characterized by:

Protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism.

7. A client with type 1 (insulin-dependent) diabetes mellitus has just learned she's pregnant. The nurse is teaching her about insulin requirements during pregnancy. Which of the following guidelines should the nurse provide?

Rationale: Maternal insulin requirements usually decrease during the first trimester, they rise again during the second and third trimesters when fetal growth slows. During labor, insulin requirements diminish because of the extreme maternal energy expenditure.

66. A nurse is caring for a client who has diabetes insipidus. Which of the following tests should the nurse use to assess the client's urine for diabetes insipidus?

Specific gravity-Urine will be dilute with a urine specific gravity of less than 1.005.

23. The onset of insulin action for a client who has received 8 units of regular insulin and 25 units of isophane insulin suspension (NPH) subcutaneously is: a. 15 minutes b. ½ hour to 1 hour c. 3 hours d. 2 hours

Subcutaneous regular insulin has an onset of action of ½ hour to 1 hour.

56. Addison's disease frequently causes skin pigment changes. When teaching the patient about medications used for Addison's disease, it is important that he or she understands:

That they continue for life

93. A nurse is caring for a client whose blood glucose is 49 mg/dL. The client is lethargic but arousable. Which of the following is the priority nursing action?

The greatest risk to the client is a lack of glucose for cell metabolism. Give 15 to 20 g of carbohydrates to raise the client's serum blood glucose level and should be checked in 15 min. If the blood glucose remains below 70 mg/dL, give 15 g more of carbohydrates should be given and repeated until the client's blood glucose is above 70 mg/dL

19. A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia.

31. In a geriatric client receiving thyroid therapy, a nurse should monitor for which adverse reaction?

The thyroid drug may produce angina pectoris or MI if coronary artery disease is present, more likely in a geriatric client. Neurologic adverse effect of thyroid therapy includes tremor and nervousness.

10. When assessing a client with syndrome of inappropriate diuretic hormone (SIADH), a nurse should be aware that which of the following signs ?

Vascular fluid overload, signaled by neck vein distention. This may cause weight gain and fluid retention (secondary to oliguria)

26. A nurse is caring for a client with diabetes insipiidus. The nurse should anticipate the administration of:

Vasopressin given subcutaneously in the acute management of diabetes insipiidus. Insulin is used to manage diabetes mellitus. Furosemide is used to promote diuresis. Potassium chloride is given for hypokalemia.

79. A nurse is caring for a client who has Cushing's disease. The nurse should know that this client is at risk for developing which of the following?

X--- Infection X--- Gastric ulcer X--- Bone fractures A client who has Cushing's disease has excessive cortisol levels, which may increase the risk of infection, gastric ulcers, and pathological bone fractures.

63. Which of the following laboratory values should the nurse expect for a client who is producing too much antidiuretic hormone?

X--- Low serum sodium X--- High urine sodium X--- Increased urine-specific gravity SIADH causes a client to retain water, creating dilutional hyponatremia with concurrent urinary excretion of sodium.

65. A nurse is caring for a client who has primary diabetes insipidus. Which of the following manifestations should the nurse expect to find?

X--- Serum sodium of 155 mEq/L X--- Fatigue X--- Polyuria X--- Increased thirst X--- Nocturia X__ Serum osmolarity>300 mOsm/L Primary diabetes insipidus is caused by a reduction in the secretion of ADH.