Endocrine

A patient has an elevated thyroid-stimulating hormone (TSH) level and low T4 values. The nurse suspects the patient is experiencing which disorder? a. Hypothyroidism b. Hyperthyroidism c. Thyrotoxicosis d. Thyroid storm

a. Hypothyroidism The laboratory results are consistent with hypothyroidism. Hyperthyroidism would be indicated by low thyroid-stimulating hormone (TSH) with high T4 levels. Thyrotoxicosis is associated with hyperthyroidism. Thyroid storm is a common name for thyrotoxicosis.

The nurse is teaching a client about the manifestations and emergency management of hypoglycemia. Which response by the client indicates a correct understanding of what to do if the client feels hungry and shaky? a. "I will drink a glass of water." b. "I will eat three graham crackers." c. "I will give myself 1 mg of glucagon." d. "I will sit down and rest."

b. "I will eat three graham crackers." Correct understanding of what the client needs to do if the client feels hungry and shaky is to eat three graham crackers. This is the correct management strategy for mild hypoglycemia.Drinking a glass of water or sitting down and resting does not remedy hypoglycemia. Glucagon is generally administered for episodes of severe not mild hypoglycemia.

The postoperative craniotomy patient has a serum osmolality of 320 mOsm/L and urine output of 400 mL/h for the past 3 hours with a urine specific gravity of 1.003. Which treatment would the nurse anticipate the practitioner ordering for this patient? a. 0.9 NaCl at 150 mL/h intravenously b. 1.5 mcg desmopressin acetate (DDAVP) subcutaneously every 12 hours c. Insulin drip at 7 units/h d. Oral vasopressin 5 units every 12 hours

b. 1.5 mcg desmopressin acetate (DDAVP) subcutaneously every 12 hours The patient has diabetes insipidus (DI), and desmopressin acetate (DDVAP) is the appropriate treatment. Hypotonic saline (not isotonic) is normally used for DI. Insulin is not indicated for DI, and vasopressin is not an oral medication.

The nurse in the endocrine clinic is providing education for a client who has just been diagnosed with diabetes. Which factor is most important for the nurse to assess before providing instruction to the client about the disease and its management? a. Current lifestyle b. Educational and literacy level c. Sexual orientation d. Current energy level

b. Educational and literacy level The most important factor for the nurse to determine before providing instruction to the newly diagnosed client with diabetes is the client's educational level and literacy level. A large amount of information must be synthesized. Written instructions are typically given. The client's ability to learn and read is essential to provide the client with instructions and information about diabetes.Although lifestyle would be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the client to provide self-care. Although energy level will influence the ability to exercise, it is not essential.

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? a. Anxiety b. Headache c. Nausea d. Weight loss

b. Headache A side effect of fludrocortisone is hypertension, likely related to hyponatremia and fluid retention. New onset of headache must be reported, and the client's blood pressure would be monitored.Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction, but not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

A postoperative craniotomy patient has a serum osmolality of 260 mOsm/kg/H2O and a urine osmolality of 1500 mOsm/kg. The nurse suspects that the patient is experiencing which problem? a. Diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone (ADH) secretion c. Diabetes mellitus d. Diabetic ketoacidosis (DKA)

b. Syndrome of inappropriate antidiuretic hormone (ADH) secretion The patient has a low serum osmolality with a high urine osmolality which is evidence of syndrome of inappropraite antidiuretic hormone secretion. In diabetes insipidus, the patient has a high serum osmolality with a low urine osmolality. Diabetes mellitus is an insulin problem, and diabetic ketoacidosis (DKA) involves hyperglycemia.

The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH) admitted with change in mental status. To determine whether fluid restrictions have been effective, for which of these outcomes will the nurse monitor? a. Decreased hematocrit b. Decreased serum osmolality c. Increased serum sodium d. Increased urine specific gravity

c. Increased serum sodium Increased serum sodium due to fluid restriction indicates effective therapy.Restricting fluid would result in increasing hematocrit levels as the fluid volume excess resolves. Plasma osmolality is decreased as a result of SIADH, so treatment would result in this level rising to near normal. Urine specific gravity is increased with SIADH and would decrease to near normal with treatment.

An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)? a. Ask the client about any numbness or tingling. b. Check for bone deformities in the client's back. c. Measure the client's intake and output hourly. d. Monitor the client for shortness of breath.

c. Measure the client's intake and output hourly. Measuring hourly intake and output is a commonly delegated nursing action that is within the UAP scope of practice. Numbness and tingling is part of the client assessment that needs to be completed by a licensed nurse. Bony deformities can be due to pathologic fractures. Physical assessment is a complex task that cannot be delegated to a UAP. An older client receiving an IV at 150 mL/hr is at risk for congestive heart failure. Careful monitoring for shortness of breath is the responsibility of the RN.

An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. When the cardiac monitor shows ventricular ectopy, which assessment will the nurse make? a. Urine output b. 12-lead electrocardiogram (ECG) c. Potassium level d. Rate of IV fluids

c. Potassium level After DKA therapy starts, serum potassium levels drop quickly. An ECG shows conduction changes and ectopy related to alterations in potassium. Hypokalemia is a common cause of death in the treatment of DKA. Detecting and treating the underlying cause of the ectopy is essential.Ectopy is not associated with changes in urine output even though hyperglycemia will cause osmotic diuresis. A 12-lead ECG can verify the ectopy, but the priority is to detect and fix the underlying cause, which is most likely hypokalemia. Increased fluids treat the symptoms of dehydration secondary to DKA, but do not treat the hypokalemia.

A client with newly diagnosed hypothyroidism tells the nurse, "I just want to feel better now. Why can't I just get a standard dose of medication instead of all this dosage adjustment?" The nurse explains that starting levothyroxine sodium (Synthroid) at a high dose may cause which of these problems? a. Bradycardia and decreased level of consciousness b. Decreased respiratory rate and hypoxemia c. Hypotension and shock d. Hypertension and heart failure

d. Hypertension and heart failure Hypertension and heart failure are possible if the levothyroxine sodium dose is started too high or raised too rapidly, because levothyroxine would essentially put the client into a hyperthyroid state.The client would experience tachycardia, not bradycardia. The client may have an increased respiratory rate when taking high doses of thyroid replacement therapy. Shock may develop, but only as a late effect and as the result of "pump failure."

The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and a hemoglobin A1c (A1C) of 5.9%. What is the nurse's interpretation of these findings? a. The client's glucose control for the past 24 hours has been good but the overall control is poor. b. The client's glucose control for the past 24 hours has been poor but the overall control is good. c. The values indicate that the client has poorly managed his or her disease. d. The values indicate that the client has managed his or her disease well.

d. The values indicate that the client has managed his or her disease well. Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client's FBG is well within the normal range. A1C provides an indication of general blood glucose control for the past several months because when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client's A1C level is within the desirable range, indicating good long-term glucose control as well as short-term control.

A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? a. Encourage the client to cough and deep-breathe. b. Instruct the client not to strain during a bowel movement. c. Instruct the client to blow the nose if there is any postnasal drip. d. Place the client in the Trendelenburg position.

b. Instruct the client not to strain during a bowel movement. Straining during a bowel movement increases ICP and must be avoided. Laxatives or stool softeners may be given and fluid intake be encouraged to prevent straining.Although deep breathing is encouraged, the client must avoid coughing early after surgery because this increases pressure in the incision area and may lead to a cerebrospinal fluid (CSF) leak. If the client has postnasal drip, he or she must inform the nurse and not blow the nose. Postnasal drip may indicate leakage of CSF. The head of the bed must be elevated after surgery.

An RN and LPN/LVN are caring for a group of clients on the medical-surgical unit. Which client will be the best to assign to the LPN/LVN? a. Client with Graves' disease who needs discharge teaching after a total thyroidectomy b. Client with hyperparathyroidism who is just being admitted for a parathyroidectomy c. Client with type 2 diabetes who requires insulin while receiving prednisone (Deltasone) d. Newly diagnosed client with hypothyroidism who needs education about the use of thyroid supplements

c. Client with type 2 diabetes who requires insulin while receiving prednisone (Deltasone) The best client to assign to the LPN/LVN is the client with infiltrative ophthalmopathy who needs high-dose prednisone administered. Medication administration is within the scope of practice of the LPN/LVN.Discharge teaching is a complex task that cannot be delegated to the LPN/LVN. A client being admitted for a parathyroidectomy needs preoperative teaching, which must be provided by the RN. A client who has a new diagnosis will have questions about the disease and prescribed medications. Teaching is a complex task that is appropriate for the RN.

The patient has a glycosylated hemoglobin of 8. The nurse understands that this represents an average blood sugar of over what time frame? a. 7 days b. 30 days c. 60 days d. 120 days

d. 120 days HgbA1C represents the average blood sugar level for the life of the red blood cells, which is 120 days. The other answers are not the correct correlation or time frame (120 days) to represent HgbA1C.

Which statements describe how the production and regulation of the thyroid is regulated by feedback mechanisms? (Select all that apply.) a. Serum blood levels of T3 and T4 are elevated, so the pituitary increases production of thyroid-stimulating hormone (TSH). b. Serum blood levels of T3 and T4 are elevated, so the pituitary decreases production of TSH. c. The release of T4 increases metabolic rate by increasing heart rate, respirations, and blood pressure through sympathetic nervous system (SNS) stimulation. d. The release of T3 will increase metabolic rate by increasing heart rate, respirations, and blood pressure through SNS stimulation. e. T4 activates β cell receptors in the body.

B, C, E Increased T3 and T4 levels stimulate the production of thyroid-stimulating hormone (TSH), not decrease it. T4, not T3, is released and then is converted to T3 to increase heart rate, respirations, and blood pressure through sympathetic nervous system (SNS) stimulation. T4 activates β cell receptors in the body.

A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? a. "Can you please tell me more?" b. "Don't worry. That is normal." c. "How does she feel?" d. "Can I make an appointment for you with a counselor?"

a. "Can you please tell me more?" The nurse's best response to the client is, "Can you please tell me more?" Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly. Infertility, impotence, and other changes in sexual function may result from endocrine problems.Telling a client that something is "normal" is dismissive and incorrect. This issue to satisfy his wife is new to the client and is a concern for him. The focus of the nurse's response needs to be on the client, not on the wife initially. Referring the client to a counselor is not an appropriate first step. This action does not allow him to express his frustrations at the moment.

The nurse is instructing a client who will undergo an adrenal suppression test. Which statement by the client indicates that teaching was effective? a. "I am being tested to see whether my hormone glands are hyperactive." b. "I am being tested to see whether my hormone glands are hypoactive." c. "I am being tested to see whether my kidneys work at all." d. "I will be given more hormones as a trigger."

a. "I am being tested to see whether my hormone glands are hyperactive." Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyper function and hyperactivity.A provocative (stimulation) test assesses whether hormone glands are hypoactive. The adrenal glands are endocrine glands that are located on the kidneys. A suppression test does not measure kidney function. Hormones are given as a trigger in a provocative (stimulation) test.

The nurse is teaching a client with newly diagnosed type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? a. "I will begin exercising for at least an hour a day." b. "I will monitor my diet and avoid empty calories." c. "If I lose weight, I may not need to use the insulin anymore." d. "Weight loss can be a sign of diabetic ketoacidosis."

a. "I will begin exercising for at least an hour a day." Further teaching is needed when the client says that "I will begin exercising for at least an hour a day." The goal of weight control for Type 2 diabetes is to change sedentary behavior to active behavior. This is begun by starting low-intensity activities in short sessions (less than 10 minutes). The client may increase sessions to moderate or vigorous aerobic physical activity to lose and or sustain weight loss.Monitoring the diet and avoiding empty calories is essential to managing type 2 diabetes. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis due to osmotic diuresis.

The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation? a. Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily b. Client with follicular thyroid cancer who has vocal hoarseness and difficulty swallowing c. Client with Graves' disease who is experiencing increasing anxiety and diaphoresis d. Client with hyperparathyroidism who has just arrived on the unit after a parathyroidectomy

a. Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily The client with chronic hypothyroidism and dementia is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN.A client with vocal hoarseness and difficulty swallowing is at risk for airway complications and requires close observation by a more experienced nurse. Increasing anxiety and diaphoresis in a client with Graves' disease can be an indication of impending thyroid storm, which is an emergency. This is not a situation to be managed by a newly graduated RN. A client who has just arrived on the unit after a parathyroidectomy requires close observation for hypocalcemia, bleeding, and airway compromise and requires assessment by an experienced nurse.

The nurse working on a medical surgical endocrine unit has just received change-of-shift report. Which client will the nurse see first? a. Client with type 1 diabetes whose insulin pump is beeping "occlusion" b. Newly diagnosed client with type 1 diabetes who is reporting thirst c. Client with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L) d. Client with type 2 diabetes with a blood pressure of 150/90 mm Hg

a. Client with type 1 diabetes whose insulin pump is beeping "occlusion" The client the nurse sees first is the client with type 1 diabetes whose insulin pump is beeping "occlusion." Because glucose levels will increase quickly in clients whose continuous insulin pumps malfunction, the nurse must assess this client and the insulin pump first to avoid hyperglycemia or diabetic ketoacidosis.Thirst is an expected symptom of hyperglycemia and, although important, is not a priority. The nurse could delegate fingerstick blood glucose to unlicensed assistive personnel while assessing the client whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL (8.3 mmol/L) is mildly elevated, this does not require immediate action. Mild hypertension does not require immediate action. The nurse can later assess if this is within the client's usual range or represents a change before taking action.

The nurse is teaching a client about the expected outcome for treatment of syndrome of inappropriate antidiuretic hormone (SIADH). What does the nurse tell the client to look for? a. Decrease in difficulty in breathing b. Dry mucous membranes c. Increasing heart rate d. Muscle spasms

a. Decrease in difficulty in breathing The nurse tells the client to look for a decrease in difficulty in breathing. The syndrome of inappropriate antidiuretic hormone (SIADH) is a disease where vasopressin (antidiuretic hormone [ADH]) is secreted even when plasma osmolarity is low or normal. Symptoms of fluid overload including dyspnea will resolve with treatment as the fluid retention decreases.Dry mucous membranes are a sign of fluid volume deficit or; fluid excess should resolve during treatment of SIADH, but not to the point of dehydration, an increased heart rate indicates increased fluid retention or dehydration and hypovolemia, and either condition is an indication that therapy is not effective. Muscle spasms are associated with hyponatremia, typically found in SIADH, and are an indication that hyponatremia is still present. Untreated hyponatremia can lead to seizures and coma.

When caring for the older adult with decreased antidiuretic hormone (ADH) production, the nurse would include which of these in the plan of care? a. Encourage fluids every 2 hours. b. Plan for weight-bearing activities. c. Inspect the feet and legs for ulcers. d. Increase fiber in the diet.

a. Encourage fluids every 2 hours. The nurse needs to encourage the client to drink fluids every 2 hours. A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss. If fluids are not restricted because of another health problem, unlicensed assistive personnel (UAP) can offer fluids at least every 2 hours while the client is awake.Weight-bearing activities are appropriate for older adults to prevent bone loss, not fluid loss. Foot or leg ulcers that do not heal in 2 weeks would prompt an investigation into hyperglycemia and diabetes. Increasing fiber can be helpful for decreased metabolism such as occurs with hypothyroidism.

The nurse is teaching a client about proper nutrition to prevent an endocrine disorder. Which food does the nurse suggest adding to the diet when the client indicates a dislike of fish? a. Iodized salt b. Red meat c. Soy products d. Salt substitute

a. Iodized salt Dietary deficiencies in iodide-containing foods may be a cause of certain endocrine disorders. For clients who do not eat saltwater fish on a regular basis, the nurse teaches them to use iodized salt in food preparation.The client would eat a well-balanced diet that includes less animal fat. Eating soy products contributes to a healthier diet, but does not prevent an endocrine disorder. Using a salt substitute does not prevent an endocrine disorder. In fact, salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.

The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (Select all that apply.) a. Calcium gluconate b. Emergency tracheotomy kit c. Furosemide (Lasix) d. Hypertonic saline e. Oxygen f. Suction

A, B, E, F Calcium gluconate needs to be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema occludes the airway. Oxygen always needs to be at the bedside and especially for the thyroidectomy client who may experience respiratory distress from swelling or damage to the laryngeal nerve leading to spasm. It is also important to have suction available at the client's bedside because of the risk for increased secretions.Furosemide is a diuretic used to treat hypercalcemia associated with hyperparathyroidism. However, hypocalcemia from inadvertent parathyroid removal during thyroidectomy is the greater concern. Hypertonic saline is not necessary for this client. This client is not expected to have hyponatremia after surgery.

Which statements made by a client who has diabetes insipidus indicate to the nurse that more teaching is needed? (Select all that apply.) a. If I gain more than 2 lbs (1 kg) in a day, I will limit my fluid intake. b. If I become more thirsty, I will take another dose of the drug. c. I will avoid aspirin and aspirin-containing substances. d. I will stop taking the drug for 24 hours before I have any dental work performed. e. I will limit my intake of salt and sodium to no more than 2 g daily. f. I will wear my medical alert bracelet at all times.

A, C, D, E With diabetes insipidus (DI), output is excessive and does not vary to match intake. Thus the client is at risk for dehydration and should not limit his or her fluid intake. Although weight gain could indicate water toxicity, other symptoms would also be present. Aspirin is not a contraindication for the drugs used to treat DI and these drugs do not increase the risk for bleeding. Thus, there is no need to stop the drug before dental work. Limiting salt or sodium intake does not manage the problem of DI and is not a recommended action.

Which physiologic actions result from normal insulin secretion? (Select all that apply.) a. Increased liver storage of glucose of glycogen b. Increased gluconeogenesis c. Increased cellular uptake of blood glucose d. Increased breakdown of lipids (fats) for fuel e. Increased production and release of epinephrine f. Decreased storage of free fatty acids in fat cells g. Decreased blood glucose levels h. Decreased blood cholesterol levels

A, C, G, H The main metabolic effects of insulin are to stimulate glucose uptake in skeletal muscle and heart muscle and to suppress liver production of glucose and very-low-density lipoprotein (VLDL). In the liver, insulin promotes the production and storage of glycogen (glycogenesis) at the same time that it inhibits glycogen breakdown into glucose (glycogenolysis). It increases protein and lipid (fat) synthesis and inhibits ketogenesis (conversion of fats to acids) and gluconeogenesis (conversion of proteins to glucose). In muscle, insulin promotes protein and glycogen synthesis. In fat cells, it promotes triglyceride storage. Overall, insulin keeps blood glucose levels from becoming too high and helps keep blood lipid levels in the normal range.

A client newly diagnosed with diabetes is not ready to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? (Select all that apply.) a. Pathophysiology of diabetes b. Causes and treatment of hypoglycemia c. Dietary control of blood glucose d. Insulin administration e. Physical activity and exercise

B, D The priority information the nurse needs to teach the client and family about diabetes are the causes and treatment of hypoglycemia and proper insulin administration. This information is essential for the client's survival and must be understood by both the client and family to ensure client safety.The pathophysiology of diabetes and hyperglycemia is a topic for secondary teaching and is not a survival need or the priority during hospitalization. Dietary control and exercise regimen are important, but are not the priority during the acute care stay.

A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain to the client the proper use of the glucose monitor? a. Day of discharge b. On admission c. When the client states readiness d. While performing the test in the hospital

d. While performing the test in the hospital Teaching the client about the operation of the machine while performing the test in the hospital is the best time for the nurse to introduce the client to SMBG. The teaching can be reinforced each time testing is performed on the client and again before discharge.Instructing the client on the day of admission or the day of discharge would not allow time for redemonstration and correction of the skill if needed. Other time-consuming activities are done on those days and could distract the client and make the client feel overwhelmed. Also, waiting for the client to state readiness may postpone the instructions too long.

A client at the medical clinic is being evaluated for hypothyroidism. For which of these symptoms consistent with hypothyroidism does the nurse assess? (Select all that apply.) a. Pulse rate below 60 beats per minute b. Agitation and inability to sleep c. Increasing thermostat settings in the home d. Increase in appetite over the last year e. Bizarre or manic behavior

A, C The nurse assesses the client with hypothyroidism for bradycardia (heart rate below 60). Blood pressure and heart rate and rhythm must be monitored as well as any indications of shock (e.g., hypotension, decreased urine output, changes in mental status). Intolerance to cold is also noted and increasing thermostat settings in the home or additional clothing may be necessary for comfort.Hypothyroidism does not cause agitation and inability to sleep; those symptoms are consistent with hyperthyroidism. Hypothyroidism can cause lethargy, apathy, drowsiness, decreased attention span, and memory. The client often reports an increase in time spent sleeping, sometimes up to 14 to 16 hours daily. The appetite decreases rather than increases and constipation frequently ensues. Bizarre or manic behaviors do not occur with hypothyroidism. Mood swings may occur with hyperthyroidism along with laughing and crying without cause.

Which symptoms are most often seen in hypothyroidism? (Select all that apply.) a. Increased appetite b. Cold intolerance c. Constipation d. Hypotension e. Exophthalmia f. Palpitations g. Tremors h. Weight gain

B, C, D, H Hypothyroidism slows metabolism way below normal. Appetite is decreased, not increased. The client may not generate sufficient heat to maintain core body temperature. The GI system is slowed, resulting in constipation. Cardiac output decreases leading to hypotension. Exophthalmia is a complication of the Grave's form of hyperthyroidism. Palpitations and tremors occur when the central nervous system and the cardiovascular system are overstimulated by hypermetabolism. They are not associated with hypometabolism. Because metabolism is slowed, caloric use for energy decreases and weight is gained even when intake is not excessive.

Which problems does the nurse expect in an older adult as a result of age-related changes in endocrine function? (Select all that apply.) a. Increased basal metabolic rate (BMR) b. Decreased core body temperature c. Dehydration d. Diarrhea e. Hyperglycemia f. Polyuria

B, C, E, F The aging process generally causes a decline in the secretion of hormones from endocrine glands, especially those of the thyroid, pancreas, and adrenal glands. Decreased thyroid hormone secretion causes a decrease in overall metabolism and basal metabolic rate. The slower metabolism results in lower core body temperatures and constipation. Decreased adrenal gland secretion limits the ability of the older adult to reabsorb water and sodium or to concentrate urine. This condition increases the risk for dehydration. The decreased secretion of insulin from the pancreas and the decline in metabolism both result in hyperglycemia. When hyperglycemia is present, the osmolarity (osmolality) of the blood increases, causing the adult to have increased thirst and to move interstitial and intracellular fluids into the plasma volume, leading to polyuria. If insufficient fluid intake occurs, this situation also increases the risk for dehydration.

The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral neuropathy. Which statement by the client indicates a need for further teaching about injury prevention? a. "I can break in my shoes by wearing them all day." b. "I need to monitor my feet daily for blisters or skin breaks." c. "I will never go barefoot." d. "I need to quit smoking."

a. "I can break in my shoes by wearing them all day." Further teaching about injury prevention is needed when the client with diabetic peripheral neuropathy says that "I can break in my shoes by wearing them all day." Shoes need to be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering.People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated because if the client has diabetic neuropathy, stepping on something sharp or harmful would not be felt. Tobacco use further decreases peripheral circulation increasing the risk for vascular complications.

A client is being discharged with a prescription for propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? a. "I can return to my job at the day care center." b. "I must call the primary health care provider if my urine is dark." c. "I must faithfully take the drug every 8 hours." d. "I need to report weight gain."

a. "I can return to my job at the day care center." The client would not return to the job at the day care center because PTU reduces blood cell counts and the immune response, which increases the risk for infection. The client does not, however, need to remain completely at home.Dark urine may indicate liver toxicity or failure, and the client must notify the primary health care provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures consistent medication action. The client must notify the primary health care provider of weight gain because this may indicate hypothyroidism requiring titration of the medication to a lower dose.

The nurse and nursing student are caring for a client with pheochromocytoma who is admitted for surgery. Which of these statements by the student requires immediate intervention by the nurse? a. "When performing the gastrointestinal assessment, I need to palpate the client's abdomen." b. "I will review the chest x-ray results for pulmonary edema." c. "I will initiate a 24-hour urine collection now." d. "I have requested the client be placed with a roommate for distraction."

a. "When performing the gastrointestinal assessment, I need to palpate the client's abdomen." The abdomen must not be palpated in a client with pheochromocytoma because this action could cause a sudden release of catecholamines and trigger severe hypertension.Reviewing the chest x-ray for pulmonary edema is not necessary. The tumor on the adrenal gland causes sympathetic hyperactivity, increasing blood pressure and heart rate, not pulmonary edema. A 24-hour urine collection will already have been completed to determine the diagnosis of pheochromocytoma. A client diagnosed with a pheochromocytoma may feel anxious as part of the disease process, but providing a roommate for distraction will not reduce the client's anxiety.

The nurse is reviewing the function of antidiuretic hormone (ADH) with a nursing student. Which statement is accurate? a. ADH controls the amount of fluid lost and retained within the body. b. V1 receptors are located in pituitary tissue and control smooth muscle contractions. c. V2 receptors can alter permeability of the kidney tubule to electrolytes. d. Insufficient ADH production results in fluid volume excess.

a. ADH controls the amount of fluid lost and retained within the body. Antidiuretic hormone (ADH) controls the amount of fluid lost and retained within the body. V1 receptors are located in the arterial walls and contract the smooth muscles located in the arterial walls. V2 receptors can alter the permeability of kidney tubules to water (not electrolytes). Insufficient ADH production results in fluid volume deficit, and excessive ADH production results in fluid volume excess.

A client with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L (105 mmol/L). Which request by the health care provider does the nurse carry out first? a. Administer infusion of 150 mL of 3% NaCl over 3 hours. b. Draw blood for hemoglobin and hematocrit (H&H). c. Insert an indwelling catheter and monitor urine output. d. Weigh the client on admission and daily thereafter.

a. Administer infusion of 150 mL of 3% NaCl over 3 hours. The first intervention the nurse performs is to administer an infusion of 150 mL of 3% NaCl over 3 hours. When the serum sodium level is below 115 mEq/L (115 mmol/L), the client is at increased risk for seizures and coma.Drawing blood for an H&H, inserting an indwelling catheter for urine monitoring, and weighing the newly admitted client are not top priority interventions.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L (130 mmol/L), K+ 6.6 mEq/L (6.6 mmol/L), and glucose 72 mg/dL (4 mmol/L). Which prescription will the nurse implement first? a. Administer insulin with dextrose in normal saline. b. Give spironolactone (Aldactone) orally. c. Initiate ulcer prophylaxis protocol with a histamine2 (H2) blocker d. Obtain arterial blood gases.

a. Administer insulin with dextrose in normal saline. The nurse would first administer insulin (20 to 50 units) with dextrose (20 to 50 mg) in normal saline to correct hyperkalemia. Insulin shifts potassium into cells to prevent or treat dysrhythmias.Spironolactone is a potassium-sparing diuretic that helps the body retain potassium and not eliminate it. Although H2blocker therapy with ranitidine would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess cardiac dysrhythmias and peaked T waves associated with hyperkalemia. An electrocardiogram needs to be obtained instead.

Which patient with a fasting blood sugar of 110 mg/dL has the highest risk for development of metabolic syndrome? a. African American woman with a 40-inch waist, blood pressure of 140/90 mm Hg, triglycerides of 180, and high-density lipoprotein (HDL) of 25 b. Asian American man with a 30-inch waist, blood pressure of 130/60 mm Hg, triglycerides of 140, HDL of 45 c. Native American man with a 28-inch waist, blood pressure of 120/50 mm Hg, triglycerides of 130, HDL of 50 d. Hispanic American woman with a 34-inch waist, blood pressure of 130/50 mm Hg, triglycerides of 145, HDL of 40

a. African American woman with a 40-inch waist, blood pressure of 140/90 mm Hg, triglycerides of 180, and high-density lipoprotein (HDL) of 25 Although all of the patients have some risk factors for metabolic syndrome, the African American woman has the highest number of risk factors (waist greater than 40 inches in men and greater than 35 inches in women, triglycerides greater than 150, high-density lipoprotein [HDL] less than 40 for men and less than 35 for women). All of the patients have a genetic risk factor and high fasting blood sugar.

Which is the best referral that the community health nurse can suggest to a client who has been newly diagnosed with diabetes? a. American Diabetes Association (ADA) b. Centers for Disease Control and Prevention c. Primary health care provider office d. Pharmaceutical representative

a. American Diabetes Association (ADA) The American Diabetes Association is the best agency to refer the diabetic client to. The ADA provides national and regional support and resources to clients with diabetes and their families.The Centers for Disease Control and Prevention does not specifically focus on diabetes. The client's primary health care provider's office is limited in the resources available to the client with diabetes. A pharmaceutical representative is not an appropriate resource for diabetes information and support.

A client with iatrogenic Cushing's disease is a resident in a long-term care facility. Which nursing action included in the plan of care is most appropriate to delegate to unlicensed assistive personnel (UAP)? a. Assist with personal hygiene and skin care. b. Develop a plan of care to minimize risk for infection. c. Instruct the client on the reasons to avoid overeating. d. Monitor for signs and symptoms of fluid retention.

a. Assist with personal hygiene and skin care. Assisting a client with bathing and skin care is included in UAP scope of practice.It is not within the UAP's scope of practice to develop a plan of care, although they will play a very important role in following the plan of care as delegated by a professional nurse. Client teaching requires professional knowledge and education and would not be delegated to UAP. Monitoring for signs and symptoms of fluid retention is part of client assessment, and is not within the UAP's skill set. This monitoring requires a higher level of education and clinical judgment possessed by a professional nurse.

A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4°F (36.9°C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action will the nurse take first? a. Check the blood glucose. b. Administer oxygen. c. Offer reassurance. d. Attach a cardiac monitor.

a. Check the blood glucose. The nurse would first obtain the client's glucose level. Breathing deeply and stating, "I can't catch my breath" is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis.Based on the oxygen saturation, oxygen administration is not indicated. The nurse provides support, but it is early in the course of assessment and intervention to offer reassurance without more information. Cardiac monitoring may be implemented, but the first action would be to obtain the glucose level.

The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? a. Client with Cushing's syndrome who requires orthostatic vital signs assessments b. Client with diabetes mellitus who was admitted with a blood glucose of 35 mg/dL (1.9 mmol/L) c. Client with exophthalmos who has many questions about endocrine function d. Client with possible pituitary adenoma who has just arrived on the nursing unit

a. Client with Cushing's syndrome who requires orthostatic vital signs assessments The most appropriate client to assign to an LPN/LVN is the client with Cushing's syndrome. An LPN/LVN would be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs.The client with a blood glucose of 35 mg/dL (1.9 mmol/L) is unstable and requires interventions and subsequent monitoring by the professional nurse. The client with questions about endocrine function and the client with a possible pituitary adenoma have complex needs, including the need for education. These clients require the experience and scope of practice of the RN.

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? a. Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L) b. Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due c. Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L (3.4 mmol/L) d. Client with pituitary adenoma who is reporting a severe headache

a. Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L) The nurse first attends to the client with adrenal insufficiency who has a blood glucose level of 36 mg/dL (2.0 mmol/L). The client's condition is considered a medical emergency and must be assessed and treated immediately.Although it is important to maintain medications on schedule, the client requiring a dose of desmopressin cannot take priority over treatment of severe hypoglycemia. A serum potassium of 3.4 mEq/L (3.4 mmol/L) in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic) based on specific hospital levels. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency.

The nurse is planning to administer medications to a client with diabetes insipidus (DI) who has dry lips and mucous membranes and poor skin turgor. Which intervention will the nurse provide first? a. Encourage oral fluid intake b. Offer lip balm c. Perform a 24-hour urine test d. Withhold desmopressin acetate (DDAVP)

a. Encourage oral fluid intake The nurse first needs to encourage fluid intake. Dry lips and mucous membranes and poor skin turgor are indications of dehydration, which can occur with DI due to diuresis. This is a serious condition that requires ongoing fluid replacement to maintain perfusion until treatment is effective.Lip balm may make the client more comfortable, but does not address the problem of dehydration. A 24-hour urine test will identify loss of electrolytes and adrenal androgen metabolites, but will not correct dehydration. Desmopressin acetate is a synthetic form of antidiuretic hormone that is given to reduce urine production. It is the anticipated treatment for DI and would not be withheld.

The nervous system and endocrine system work together to maintain dynamic equilibrium. How is this accomplished? a. Hormones can travel through the bloodstream because they affect only target organs. b. The nervous system releases hormones that control cardiac muscle. c. Hormones do not require stimulation to be released; it is an automatic process. d. Target cells and receptors are required for the function of the skeletal muscle system.

a. Hormones can travel through the bloodstream because they affect only target organs. When stimulated, the endocrine glands secrete hormones into surrounding body fluids. When in circulation, these hormones travel to specific target tissues, where they exert a pronounced effect. The nervous system communicates by nerve impulses (not hormones) that control skeletal muscle, smooth muscle tissue, and cardiac muscle tissue. The endocrine system controls and communicates by distributing potent hormones throughout the body. Receptors found on or within these specialized target tissue cells are equipped with molecules that recognize the hormone and bind it to the cell, producing a specific response.

Which hormone changes does the nurse expect when a client receives a continuous cortisol infusion for 24 hours when his or her endocrine feedback mechanisms are functioning normally? a. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels b. Lower than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels c. Higher than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels d. Higher than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin releasing hormone (CRH) levels

a. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin releasing hormone (CRH) levels The release of CRH and ACTH is affected by the serum level of free cortisol acting through a negative feedback loop. The stimulus for release of CRH from the hypothalamus, which is responsible for stimulating the release of ACTH from the anterior pituitary gland, is a low blood level of cortisol. A continuous infusion of cortisol for 24 hours would be sensed by the hypothalamus as either adequate or elevated levels of cortisol, not low blood levels of cortisol. As a result, little if any CRH would be released from the hypothalamus and circulating levels would be lower than normal. With low levels of CRH, the anterior pituitary cells are not stimulated to release ACTH; thus circulating levels of this hormone would also be lower than normal. Adequate or elevated blood levels of cortisol inhibit the release of CRH and ACTH.

The nurse caring for four clients with diabetes has these activities to perform. Which activity is appropriate to delegate to unlicensed assistive personnel (UAP)? a. Perform a blood glucose check on a client who requires insulin. b. Verify the infusion rate on a continuous infusion insulin pump. c. Assess a client who reports tremors and irritability. d. Monitor a client who is reporting palpitations and anxiety.

a. Perform a blood glucose check on a client who requires insulin. Performing bedside glucose monitoring is a task that may be delegated to UAPs because it does not require extensive clinical judgment to perform. There is no evidence the client is unstable at this time. The nurse will follow up with the results and insulin administration after assessing the less stable clients.Intravenous therapy and medication administration are not within the scope of practice for UAPs. The client with tremors and irritability is displaying symptoms of hypoglycemia requiring further assessment and intervention that are not within the scope of practice for UAPs. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention. This client must be assessed by licensed nursing staff.

Which assessment finding of a client 10 hours after a subtotal thyroidectomy indicates to the nurse possible airway obstruction? a. The client is drooling. b. The oxygen saturation is 97%. c. The dressing has a moderate amount of serosanguinous drainage. d. The client responds to questions correctly but does not open the eyes while talking.

a. The client is drooling. Drooling may be a normal response for some patients while sleeping; however, it is also a major indication of swelling in the neck that could result in airway obstruction. More assessment is needed to determine whether the client is in danger of losing his or her airway. The oxygen saturation is within normal limits for a healthy adult. A moderate amount of drainage may be more than expected but is not an indication of obstruction. After general anesthesia, most clients are sleepy. Not opening his or her eyes during a response to a question is not an indication of airway obstruction.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. The client has a prescription for Desmopressin (DDAVP). Which outcome indicates a positive response to treatment? a. Urine output of 60-80 mL/hour b. Blood glucose level of 110 mg/dL (6.1 mmol/L) c. Ability to sit quietly and read a magazine d. Potassium level within expected range

a. Urine output of 60-80 mL/hour Lithium may cause drug-related diabetes insipidus causing the kidneys to be unable to respond to ADHl, causing profound diuresis. Desmopressin acetate (DDAVP), a synthetic form of vasopressin (ADH), is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels. The ability to sit quietly and read a magazine is not an expected outcome after the administration of desmopressin; this is potentially and outcome for clients receiving lithium therapy for bipolar disorder. Hypokalemia may result from the ongoing diuresis of DI, but this does not evaluate the outcome of treatment.

The islets of Langerhans excrete four different cell types with different functions. Which statement is accurate? a. α cells secrete glucagon in response to decreased blood glucose levels. b. β cells release insulin in response to decreased blood glucose levels. c. δ cells release somatostatin in response to decreased blood glucose levels. d. PP cells release pancreatic polypeptide to decrease gallbladder contractions.

a. α cells secrete glucagon in response to decreased blood glucose levels. α cells secrete glucagon in response to decreased blood glucose levels. β cells secrete insulin in response to increased blood glucose levels. δ cells release somatostatin in response to hyperglycemia. PP cells release pancreatic polypeptide to increase gallbladder secretions.

The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? a. "I will go barefoot in my house so that my feet are exposed to air." b. "I must inspect my shoes for foreign objects before putting them on." c. "I will soak my feet in warm water to soften calluses before trying to remove them." d. "I must wear canvas shoes as much as possible to decrease pressure on my feet."

b. "I must inspect my shoes for foreign objects before putting them on." The statement by the diabetic client that indicates that teaching was effective is, "I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes need to be checked for foreign objects before the feet are inserted in them.Clients with diabetes would not go barefoot because foot injuries can occur in those clients who lack sensation. To avoid injury or trauma, a callus needs to be removed by a podiatrist, not by the client. To prevent injury, the client with diabetes must wear protective shoes for support and not canvas shoes.

Which statement by a client undergoing radioactive iodine (RAI) therapy demonstrates to the nurse that the client has correct understanding of post-procedure precautions? a. "I will wear a wig until my hair grows back in." b. "I will be sure to use only one toilet and not let others use it for 2 weeks." c. "I will avoid crowds and people who are ill to reduce the risk for an infection." d. "I will avoid having a manicure or pedicure during the first month after treatment"

b. "I will be sure to use only one toilet and not let others use it for 2 weeks." The client's urine will contain small amounts of radioactive iodine that can pose a hazard to others, particularly if it is absorbed through mucous membranes. Until the client has completely cleared this material, he or she should use a separate toilet. Radioactive iodine therapy does not result in significant hair loss, nor does it reduce immunity. There is no risk for exposure of the radioactive material during either a pedicure or a manicure.

The nurse is teaching a client about the correct procedure for a 24-hour urine test for a hormone level. Which statement by the client indicates a need for further teaching? a. "I need to keep the urine container cool in a separate refrigerator or cooler." b. "I will not eat any protein when I am collecting urine for this test." c. "I won't save the first urine sample of the day." d. "To end the collection, I must empty my bladder and add this urine to the collection."

b. "I will not eat any protein when I am collecting urine for this test." A need for further teaching is needed when the client says that he/she will not eat any protein while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating protein does not interfere with collection or testing of the urine sample.Because the specimen must be kept cool, it can be placed in an inexpensive cooler with ice. The client would not keep the specimen container with food or beverages. The timing of the 24-hour collection begins after the initial void of the day. To end a 24-hour urine specimen, emptying the bladder and adding it to the collection is the proper procedure.

The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? a. "If I become hyperglycemic, it is a medical emergency." b. "If I become hypoglycemic, I could become unconscious." c. "Medical personnel may need confirmation of my insurance." d. "I may need to be admitted to the hospital suddenly."

b. "If I become hypoglycemic, I could become unconscious." The statement by the client that indicates a correct understanding about the need to wear a MedicAlert bracelet is, "If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency in clients with diabetes. A MedicAlert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care.Hyperglycemia does not pose the same type of acute medical emergency as hypoglycemia unless it is severe and acidosis develops. Insurance information does not appear on a MedicAlert bracelet. Information on the MedicAlert bracelet may be helpful if a sudden hospitalization occurs when the client cannot communicate. However, it is standard procedure to assess blood glucose in that instance.

The nurse is caring for a client with a parathyroid dysfunction. Which comment by the client indicates a need for further assessment? a. "I am worried about my bones breaking down." b. "Lately, I lose my temper more quickly." c. "The doctor will need to check my vitamin D levels." d. "My weight has been stable these past few years."

b. "Lately, I lose my temper more quickly." Further assessment is needed when the client says, "Lately, I lose my temper more quickly." Many endocrine problems can change a client's behavior, personality, and psychological responses. The client stating that he or she has become more quick-tempered warrants further assessment.PTH increases bone resorption (bone release of calcium into the blood from bone storage sites), thus weakening bones and increasing serum calcium. In the kidneys, PTH activates vitamin D, which then increases the absorption of calcium and phosphorus from the intestines. Vitamin D levels are affected by parathyroid dysfunction. Rapid changes in weight without diet changes are often associated with many endocrine disorders, so a stable weight is beneficial for the client.

Family members of a client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's best response? a. "Do the client's mood swings make you feel angry?" b. "The mood swings would diminish with treatment." c. "The medications will make the mood swings disappear completely." d. "Your family member is sick. You must be client."

b. "The mood swings would diminish with treatment." Telling the family that the client's mood swings would diminish over time with treatment will provide information to the family, as well as reassurance that this behavior is expected. Asking the family if the client's mood swings make them angry is a closed-ended question and could make the family members feel guilty. The response needs to be client centered. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware that the client is sick. Telling them to be client can also encourage feelings of guilt and does not address the family's concerns.

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time? a. 7:30 a.m. b. 11:00 a.m. c. 2:00 p.m. d. 7:30 p.m.

b. 11:00 a.m. Regular insulin is a short-acting type of insulin. Onset of action to regular insulin is ½ to 1 hour. The peak effect time is when hypoglycemia may start to occur. Peak time for regular insulin is 2-4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m.The other options for peak times for regular insulin are incorrect.

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? a. 75-year-old client whose blood glucose levels show little variation b. 55-year-old client who has hypoglycemic unawareness c. 80-year-old client with type 2 diabetes mellitus d. 45-year-old client with type 1 diabetes mellitus

b. 55-year-old client who has hypoglycemic unawareness Comparison studies have shown wide variation between fingertip and alternate sites, and variation is most evident during times when blood glucose levels are rapidly changing. Teach patients that there is a lag time for blood glucose levels between the fingertip and other sites when blood glucose levels are changing rapidly and that the fingertip reading is the only safe choice at those times. Because of this lag time, clients who have hypoglycemic unawareness should never use alternate sites for SMBG.

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? a. Assess the client for clinical manifestations of hypopituitarism. b. Administer regular insulin for the growth hormone stimulation test. c. Palpate the thyroid gland for size and firmness. d. Teach the client about the adrenocorticotropic hormone stimulation test.

b. Administer regular insulin for the growth hormone stimulation test. The most appropriate nursing action for the RN to delegate to the LPN/LVN the administration of insulin. Medication administration is within the LPN/LVN scope of practice.Client assessment for clinical manifestations of hypopituitarism, palpating the thyroid gland, and client teaching are complex skills requiring education and expertise, and are best performed by an RN.

A client receiving methimazole (Tapazole) calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? a. Advise the client to go to a calming environment. b. Ask whether the client has increased cold sensitivity or weight gain. c. Instruct the client to see his primary health care provider immediately. d. Tell the client to check his pulse again and call back later.

b. Ask whether the client has increased cold sensitivity or weight gain. The nurse's best response is to ask the client if he is experiencing increased sensitivity to cold and/or weight gain. These could be symptoms of hypothyroidism, indicating an overcorrection by the medication. The client must be assessed further because he may require a lower dose of medication.A calming environment will not increase the client's heart rate. The client will want to notify the primary health care provider about the change in heart rate. If other symptoms such as chest pain, shortness of breath, or confusion accompany the slower heart rate, then the client would notify the primary health care provider or go to the ED immediately. If the client was concerned enough to call because his heart rate was slower than usual, the nurse needs to stay on the phone with the client while he rechecks his pulse. This time could also be spent providing education about normal ranges for that client.

A patient is complaining of blurred vision, fatigue, and nausea. The nurse notes that the patient's face is flushed, and he has a heart rate of 125 beats/min and blood pressure of 90/40 mm Hg. Which action should the nurse take next? a. Offer the patient some orange juice. b. Check a capillary blood glucose level. c. Administer glucagon intramuscularly. d. Start the patient on oxygen at 2 L/min.

b. Check a capillary blood glucose level. The patient is exhibiting signs of hyperglycemia, so the first action is to check the blood sugar to determine treatment. Orange juice would increase the blood sugar. Glucagon would increase the blood sugar, and oxygen would not address the hypoglycemia.

The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first? a. Client taking repaglinide (Prandin) who has nausea and back pain b. Client taking glyburide (Diabeta) who is dizzy and sweaty c. Client taking metformin (Glucophage) who has abdominal cramps d. Client taking pioglitazone (Actos) who has bilateral ankle swelling

b. Client taking glyburide (Diabeta) who is dizzy and sweaty The nurse needs to first assess the client taking glyburide (Diabeta) who is dizzy and sweaty and has symptoms consistent with hypoglycemia. Because hypoglycemia is the most serious adverse effect of antidiabetic medications, this client must be assessed as soon as possible.Nausea is a documented side effect of repaglinide. Checking the client's back pain requires assessment, which can be performed after the nurse assesses the client displaying signs and symptoms of hypoglycemia. Metformin may cause abdominal cramping and diarrhea, but the client taking it does not require immediate assessment. Ankle swelling is an expected side effect of pioglitazone.

The client tells the visiting nurse his blood glucose values over the last week have been excellent. Which of these resources does the nurse evaluate to verify the client's statement? a. Fasting blood glucose b. Glycosylated hemoglobin (HbA1c) c. Client's blood glucose log d. Postprandial glucose

b. Glycosylated hemoglobin (HbA1c) The nurse would evaluate the client's glycosylated hemoglobin (HbA1c). The laboratory result indicates the average blood glucose over several months and is the best indicator of overall blood glucose control.Fasting blood glucose can be used to monitor glucose control, but it is not the best method to evaluate blood glucose over a period of time. Oral glucose testing and urine glucose levels look at one period of time and are not the best methods to look at overall effectiveness of treatment.

A client had a parathyroidectomy 8 hours ago. Which finding requires immediate attention? a. Edema at the surgical site b. Hoarseness c. Pain on moving the head d. Sore throat

b. Hoarseness Hoarseness, stridor, or drooling is an indication of respiratory distress and requires immediate attention.Edema at the surgical site of any surgery is an expected finding. Pain when the client moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a client has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for clients who have had surgery involving the neck.

The nurse notes that the client on a medical surgical unit who is being treated for hyperparathyroidism has a very high urine output. Of these actions, what will the nurse do next? a. Call the primary health care provider. b. Monitor intake and output. c. Perform a cardiac assessment. d. Slow the rate of IV fluids.

b. Monitor intake and output. The nurse needs to next monitor the client's intake and output. Increased urine output is expected with hyperparathyroidism. Diuretic and hydration therapies are used to promote renal calcium excretion and reduce serum calcium levels.The primary health care provider does not need to be notified. Cardiac assessment is part of the nurse's routine evaluation of the client. Slowing the rate of IV fluids is contraindicated because the client will become dehydrated due to the use of diuretics to increase kidney excretion of calcium.

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8°F oral. Which nursing intervention is the highest priority for this client? a. Administering furosemide (Lasix) b. Providing isotonic fluids c. Replacing potassium losses d. Restricting sodium

b. Providing isotonic fluids Acute adrenal insufficiency (Addisonian crisis) is a life-threatening condition in which the need for cortisol and aldosterone is greater than the body's supply. Providing isotonic fluid is the highest priority nursing intervention because hypotension and tachycardia indicate volume loss that is caused by acute adrenal insufficiency. Isotonic fluids will help to correct hyponatremia which typically accompanies adrenal insufficiency. IV access is also needed to administer IV medications such as hydrocortisone.Furosemide is a loop diuretic to increase fluid loss. This client is already experiencing fluid volume depletion related to insufficient cortisol and aldosterone. Potassium is normally increased in acute adrenal insufficiency, so replacing potassium is not needed. Sodium levels are already low, so restricting sodium is inappropriate. GI problems, such as nausea, vomiting, and diarrhea, often occur, increasing the effect of fluid loss.

A client who is admitted to the intensive care unit with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What will the nurse do next? a. Call the primary health care provider. b. Reduce any stimulation to the client. c. Keep the client's door open to visualize the client's actions. d. Tell the client to slow down.

b. Reduce any stimulation to the client. The nurse needs to reduce stimulation to the client to prevent complications of hyperthyroidism including cardiac dysrhythmias. The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse also encourages the client to rest, keeps the environment as quiet as possible by closing the door to the room, limits visitors, and eliminates or postpones any nonessential care or treatments.Because the client's behavior is anticipated along with the increased metabolic rate, there is no need to call the primary health care provider. Keeping the client's door open can increase stimulation in the client's environment. Telling the client to slow down is unsupportive and unrealistic.

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? a. "I will have more energy with this medication." b. "I will take the medication every morning." c. "If I continue to lose weight, I may need an increased dose." d. "If I gain weight and feel tired, I may need an increased dose."

c. "If I continue to lose weight, I may need an increased dose." The statement, "If I continue to lose weight, I may need an increased dose," indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose.One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Gaining weight and continuing to feel tired is an indication that the dose may need to be increased.

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes? a. "Avoid drinking ice-cold beverages." b. "Be sure to check your blood pressure twice daily." c. "Change positions slowly when moving from sitting to standing." d. "Check your hands and feet weekly for areas of numbness or sensation change."

c. "Change positions slowly when moving from sitting to standing." Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults. Although checking blood pressure twice daily is helpful, it does not prevent orthostatic hypotension, nor is there any guarantee that such hypotension will occur during blood pressure measurement. Sensation changes are associated with peripheral neuropathy, not cardiovascular autonomic neuropathy. Avoiding cold beverages is no longer a recommended action.

A client with typically well controlled diabetes has a glycosylated hemoglobin (HbA1C) level of 9.4%. Which response by the nurse is most appropriate? a. "Keep up the good work." b. "This is not good at all." c. "Have you been doing something differently? d. "You need an increase in your insulin dose."

c. "Have you been doing something differently? The most appropriate response by the nurse is telling the client that the level is high and then assessing the client's regimen or changes he or she may have made. This is the best format to formulate interventions to gain control of blood glucose. HbA1C levels for diabetic clients need to be less than 7%. A value of 9.4% shows poor control over the past 3 months.Telling the client to "keep up the good work" is incorrect. A(HbA1C) level of 9.4% is too high. Scolding the client by saying "this is not good," although true, does not take into account problems the client may be having with the regimen or an undiagnosed illness. Although it may be true that the client needs more insulin, an assessment of the client's regimen is needed before decisions are made about medications.

The nurse is providing discharge instructions to a client receiving spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? a. "I must call the primary health care provider if I am more tired than usual." b. "I need to increase my salt intake." c. "I will eat a banana every day." d. "This drug will not control my heart rate."

c. "I will eat a banana every day." Spironolactone increases potassium levels, so potassium supplements and foods rich in potassium, such as bananas, need to be avoided to prevent hyperkalemia.While taking spironolactone, symptoms of hyponatremia such as drowsiness and lethargy must be reported. Sodium intake is not typically increased while taking a diuretic; this would exacerbate underlying problems for which the diuretic was prescribed. The client may need increased dietary sodium. Spironolactone will not have an effect on the client's heart rate.

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? a. "It is overwhelming, isn't it?" b. "Let's see how much you can learn today, so you are less nervous." c. "Let's tackle it piece by piece. What is most scary to you?" d. "Many people live with diabetes and do it just fine."

c. "Let's tackle it piece by piece. What is most scary to you?" The nurse's best response is to suggest that the client tackle it piece by piece and ask what is most scary to him or her. This is the best client centered response, and acknowledges the client's concern, letting the client master survival skills first.Referring to the illness as overwhelming may reflect the client's feelings, but is a closed-ended question and does not encourage the client to express his feelings about the underlying fear. Trying to see how much the client can learn in one day may add to his anxiety by overwhelming him with information and the need to "do it all" in one day. Suggesting that other people handle the illness just fine criticizes the client and does not recognize his concerns.

A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin? a. "Your diabetes is getting worse, so you will need to take insulin." b. "You can't take your metformin while in the hospital." c. "Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily." d. "You must take insulin from now on because the surgery will affect your diabetes."

c. "Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily." The nurse's best response is that due to the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for clients with diabetes who use oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides.No evidence suggests that the client's diabetes has worsened. However, surgery is stressful and may increase insulin requirements. Metformin may be taken in the hospital, but not on days when the client is NPO for surgery. When the client returns to his or her previous health state, oral agents will be resumed.

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? a. "Don't mind this. The disease is causing this." b. "I need to check the client's cortisol level." c. "The disease can sometimes affect emotional responses." d. "Medication is available to help with this."

c. "The disease can sometimes affect emotional responses." The nurse's best response is that the disease can affect emotional responses. The client may have inappropriate or psychotic behavior or difficulty concentrating as a result of high blood cortisol levels. Being honest with the family helps them to understand what is happening.Telling the family not to mind the laughter and that the disease is causing it is vague and minimizes the family's concern. Because the diagnosis of Cushing's disease and hypercortisolism has already been made, blood levels do not need to be redrawn. Telling the family that medication is available to help with inappropriate laughing does not assist them in understanding the cause of or the reason for the client's current behavior. This is the perfect opportunity for the nurse to educate the family about the disease.

Which of these clients with diabetes will the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? a. A client with sensory neuropathy who needs teaching about foot care b. A client with diabetic ketoacidosis who has an IV running at 250 mL/hr c. A client who needs blood glucose monitoring and insulin before each meal d. A client who was admitted with fatigue and shortness of breath

c. A client who needs blood glucose monitoring and insulin before each meal A nurse from the labor/delivery unit would be familiar with blood glucose monitoring and insulin administration because clients with type 1 and gestational diabetes are frequently cared for in the labor/delivery unit.The clients with sensory neuropathy, diabetic ketoacidosis, and the client with fatigue and shortness of breath all have specific teaching or assessment needs that are better handled by nurses more familiar with caring for adults with diabetes-related complications.

A patient's serum cortisol level is 7 mcg/dL. After administration of 250 mcg of cosyntropin, the cortisol level is 9 mcg/dL. The nurse suspects the patient is experiencing which disorder? a. Aldosteronism b. Hyperthyroidism c. Adrenal insufficiency d. Pheochromocytoma

c. Adrenal insufficiency Adrenal insufficiency is tested for by measuring cortisol levels. Aldosteronism and pheochromocytoma are diagnosed in the presence of uncontrolled hypertension, and hyperthyroidism is tested for by serum testing.

The nurse is trying to decrease the temperature of the patient in thyroid storm. Which treatment should the nurse question? a. Tepid water sponge bath b. Cold packs to the groin and axilla c. Aspirin suppository d. Circulating fan at the bedside

c. Aspirin suppository Pyrexia is treated with hypothermia measures such as a cooling blanket, tepid sponge baths, cold packs, fans, and acetaminophen. Salicylates (aspirin) are contraindicated because they prevent protein binding of T3 to T4, increasing the free, metabolically active thyroid hormone.

A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? a. Ask about risk factors for adrenocortical problems. b. Assess the client's response to physiologic stressors. c. Check the client's blood glucose levels every 4 hours. d. Teach the client how to do a 24-hour urine collection.

c. Check the client's blood glucose levels every 4 hours. The nursing activity that is the best one for the charge nurse to delegate to an experienced nursing assistant is checking the client's blood glucose every 4 hours. Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.Asking the client about risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multistep process, and would not be delegated to a nursing assistant.

The nurse is assessing a client who had a transsphenoidal hypophysectomy yesterday. Which finding requires immediate notification to the primary health care provider? a. Dry lips and oral mucosa on examination b. Nasal drainage that tests negative for glucose c. Client report of a headache and stiff neck d. Urine specific gravity of 1.016

c. Client report of a headache and stiff neck Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provider.Dry lips and mouth are not unusual after surgery. The client was NPO and received anesthesia. Frequent oral rinses and the use of dental floss would be encouraged because the client cannot brush the teeth until the surgeon gives permission. Any nasal drainage is expected to test negative for glucose. Nasal drainage that tests positive for glucose indicates the presence of a cerebrospinal fluid leak. A urine specific gravity of 1.016 is within normal limits.

The nurse is caring for a client who has frequent episodes of hypoglycemia with loss of consciousness. During interdisciplinary rounds, which of these does the nurse suggest the client's family learn to use? a. Norepinephrine b. Calcitonin c. Glucagon d. Insulin

c. Glucagon The nurse suggests that the client's family learn to inject Glucagon when the client has episodes of hypoglycemia and loss of consciousness. Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, increasing blood glucose levels.Norepinephrine is a catecholamine released from the adrenal medulla. It activates the sympathetic nervous system and creates a "fight or flight" response. Calcitonin regulates serum calcium, not glucose. Beta cells in the pancreas are responsible for synthesizing and secreting the hormone insulin which is responsible for lowering blood glucose by increasing its uptake by the cell.

A patient has had several days of nausea, vomiting, and diarrhea. The heart rate is 125 beats/min, blood pressure is 80/40 mm Hg, and urine output is less than 30 mL/h. Which statement is the best explanation for the low urine output? a. Fluid dehydration in the body inhibits release of antidiuretic hormone (ADH). b. Urine output decreases with the inhibition of the release of ADH. c. Increased serum osmolality stimulates the release of ADH. d. Decreased serum osmolality results in decreased urine output.

c. Increased serum osmolality stimulates the release of ADH. Increased serum osmolality (fluid dehydration) stimulates the release of antidiuretic hormone (ADH), which in turn reduces the amount of water lost through the kidney (urine output decreases). Decreased serum osmolality inhibits the release of ADH, the kidney tubules increase their permeability, and fluid is eliminated (increased urine output) from the body in an attempt to regain normal concentration of particles in the bloodstream.

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? a. Assess the wound dressing for bleeding. b. Administer morphine sulfate for pain. c. Monitor oxygen saturation using pulse oximetry. d. Support the head and neck with pillows.

c. Monitor oxygen saturation using pulse oximetry. Airway assessment and management is always the first priority with every client. This is especially important for a client t who has had surgery that involves potential bleeding and edema near the trachea. Remember the ABCs (airway, breathing, and circulation) of physical assessment.Assessing the wound dressing for bleeding is a high priority, which is performed after assessing airway and breathing. Pain control and supporting the head and neck with pillows are important priorities, but can be addressed after airway assessment.

When reviewing the laboratory values of a client who has chronic obstructive pulmonary disease and pneumonia, the nurse observes these findings. Which one does the nurse report to the provider immediately? a. International normalized ratio (INR) 2.1 b. Serum chloride 96 nEq/L (mmol/L) c. Serum sodium 117 mEq/L (mmol/L) d. pH 7.28

c. Serum sodium 117 mEq/L (mmol/L) All of the values are out of the normal range. The only one that is at a critical level, given the client's diagnoses of COPD and pneumonia, is the serum sodium level. This client is in danger of seizures and action must be taken immediately to prevent complications.

The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of nursing students. Which explanation by the students indicates their understanding of the types of diabetes? a. Most clients with type 1 diabetes are born with it. b. People with type 1 diabetes are often obese. c. Those with type 2 diabetes make insulin, but in inadequate amounts. d. People with type 2 diabetes do not develop typical diabetic complications.

c. Those with type 2 diabetes make insulin, but in inadequate amounts. The explanation by the students that indicate understanding of the type of diabetes is "Those with type 2 diabetes make insulin, but in inadequate amounts." People with type 2 diabetes may also have resistance to existing insulin.Most clients with type 1 diabetes are not born with it. Although type 1 diabetes may occur early in life, it is considered an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person. Risk for type 1 DM is determined by inheritance of genes coding for the HLA-DR and HLA-DQA and DQB tissue types (McCance et al., 2014). However, inheritance of these genes only increases the risk, and most people with these genes do not develop type 1 DM. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for typical diabetic complications, especially cardiovascular diseases.

A client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? a. The client eating a morning meal of cereal and fruit b. The physical therapist walking with the client in the hallway c. Unlicensed assistive personnel (UAP) pulling the client up in bed by the shoulders d. Visitors talking with the client about going home

c. Unlicensed assistive personnel (UAP) pulling the client up in bed by the shoulders The UAP pulling the client up in bed by the shoulders requires the nurse to intervene. The client with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the client carefully. A lift sheet would be used to reposition the client.The client with hyperparathyroidism is not restricted from eating and needs to maintain a balanced diet. The client can benefit from moderate exercise and physical therapy, and is not restricted from having visitors.

A nurse is teaching the diabetic patient about insulin therapy. Which statement by the patient indicates the teaching was effective? a. "I will take my long-acting insulin before a meal." b. "I will monitor my blood sugar weekly." c. "If I am not going to eat right away, it is okay to take my short-acting insulin anyway." d. "I need to rotate the site I use to obtain blood for glucose monitoring."

d. "I need to rotate the site I use to obtain blood for glucose monitoring." Sites should be rotated to avoid trauma and bruising. Long-acting insulin is administered once or twice daily. Blood sugar should be monitored at least daily in the diabetic patient and probably more often depending on therapy. Short-acting insulin should be taken before a meal.

A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching? a. "I cannot share my toothpaste with anyone." b. "I must flush the toilet three times after I use it." c. "I need to wash my clothes separately from everyone else's clothes." d. "I'm ready to hold my newborn grandson now."

d. "I'm ready to hold my newborn grandson now." The client's statement that indicates further teaching is needed is, "I'm ready to hold my newborn grandson now." Clients undergoing oral 131I therapy need to avoid close contact with pregnant women, infants, and young children for 1 week after treatment. Clients would remain at least 1 meter (39 inches, or roughly 3 feet) away, and limit exposure to less than 1 hour per day.Toothpaste cannot be shared for at least one week. Some radioactivity will remain in the client's salivary glands for up to 1 week after treatment. Care needs to be taken to avoid exposing others to the saliva. Flushing the toilet three times after use will ensure that all urine has been diluted and removed. It is best to use a toilet that is not used by others for at least 2 weeks after receiving the radioactive iodine. Clothing needs to be washed separately and the washing machine then needs to be run empty for a full cycle before it is used to wash the clothing of others.

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? a. "You will see effects of this medication immediately." b. "You will see effects of this medication within 1 week." c. "You will see full effects from this medication within 1 to 2 days." d. "You will see some effects of this medication within 2 weeks."

d. "You will see some effects of this medication within 2 weeks." The nurse's best response is that the client will see some effects of this medication within 2 weeks. Methimazole (Tapazole) blocks thyroid hormone production by preventing iodide binding in the thyroid gland. The response to these drugs is delayed because the client may have large amounts of stored thyroid hormones that continue to be released. It may take several more weeks before metabolism returns to normal.Although onset of action is 30 to 40 minutes after an oral dose, the client will not see therapeutic effects immediately. Effects will take 2 weeks to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of triiodothyronine (T3) and thyroxine (T4) will be monitored and dosages adjusted as levels fall.

The intensive care nurse is caring for a client admitted in a hyperglycemic-hyperosmolar state. Which of these prescriptions made by the primary health care provider will the nurse question? a. Add 20 mEq of KCl to each liter of IV fluid b. IV regular insulin at 2 units/hr c. IV normal saline at 100 mL/hr d. 1 ampule Sodium Bicarbonate IV now

d. 1 ampule Sodium Bicarbonate IV now Sodium Bicarbonate is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state that presents with hyperglycemia and absence of ketosis/acidosis.Insulin puts potassium into the cell. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from osmotic diuresis and electrolyte shifts. IV regular insulin at 2 units/hr will help correct hyperglycemia. IV normal saline at 100 mL/hr will help correct dehydration.

In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion. What is the nurse's best action? a. Request a "time-out" to determine whether this is a valid prescription. b. Ask the client whether he or she usually takes prednisone. c. Hold the dose because the client has a high cortisol level. d. Administer the drug as prescribed.

d. Administer the drug as prescribed. Although the client has hypercortisolism, removal of the adrenal gland will stop the secretion of this important hormone that is essential for life. Further, the stress of surgery also increases the client's need for this hormone. Supplying the hormone throughout surgery prevents the complication (or at least reduces the risk for) acute adrenal crisis.

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next? a. Instruct the client to continue with the current diet and metformin use. b. Discuss the need to check blood glucose several times every day. c. Talk about the possibility of adding rapid-acting insulin to the regimen. d. Ask the client about current dietary intake and medication use.

d. Ask the client about current dietary intake and medication use. The nurse's next action would be to assess the client's adherence to the currently prescribed diet and medications. The nurse would also check for any stressors or undocumented illnesses. Glycosylated hemoglobin (HbA1C) levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy.Instructing the client to continue with current diet and metformin use is inappropriate without further assessment. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The HbA1C indicates that the client's average glucose level is higher than the target range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse would not assume that adding insulin, which must be prescribed by the primary health care provider, is the answer without assessing the underlying reason for the treatment failure.

The nurse reviews the vital signs of a client diagnosed with Graves' disease and notes that the client's temperature is 99.6°F (37.6°C). After notifying the primary health care provider, what does the nurse do next? a. Administers acetaminophen b. Alerts the Rapid Response Team c. Asks any visitors to leave d. Assesses the client's cardiac status

d. Assesses the client's cardiac status Graves' disease is manifested by symptoms of hyperthyroidism and increased metabolic rate, including fever. The nurse must next assess the client's cardiac status as atrial fibrillation or other dysrhythmia may have developed. If the client has a cardiac monitor, the nurse needs to check for any dysrhythmias.Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time as no instability has been noted. Asking visitors to leave is not necessary if the visitors are providing comfort to the client.

Which nursing action will the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? a. Assist the client's spouse in choosing appropriate dietary items. b. Evaluate the client's use of a home blood glucose monitor. c. Inspect the extremities for evidence of poor circulation. d. Assist the client with washing the feet and applying moisturizing lotion.

d. Assist the client with washing the feet and applying moisturizing lotion. The nursing action that the home health nurse can delegate to a home health aide who is making daily visits to a newly diagnosed type 2 diabetic client is assisting with personal hygiene. This action is included in the role of home health aides.Assisting with appropriate dietary selections, evaluating the effectiveness of teaching, and performing assessments are complex actions that would be performed by licensed nurses.

The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? a. Client with Hashimoto's thyroiditis and a large goiter b. Client with hypothyroidism and an apical pulse of 51 beats/min c. Client with parathyroid adenoma and flank pain due to a kidney stone d. Client who had a parathyroidectomy yesterday and has muscle twitching

d. Client who had a parathyroidectomy yesterday and has muscle twitching The client who needs to be assessed first is the one-day postoperative client who had a parathyroidectomy and has muscle twitching. This client is showing signs of hypocalcemia and is at risk for seizures. Rapid assessment and intervention are needed.Clients with Hashimoto's thyroiditis are usually stable. This client does not need to be assessed first. Although an apical pulse of 51 is considered bradycardia, a low heart rate is a symptom of hypothyroidism. A client with a kidney stone will be uncomfortable and would be asked about pain medication as soon as possible, but this client does not need to be assessed first.

The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? a. Client who is receiving IV hydrocortisone for an Addisonian crisis b. Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer c. Client being discharged after a unilateral adrenalectomy to remove a pheochromocytoma d. Client with Cushing's syndrome who requires frequent glucose monitoring and administration of insulin

d. Client with Cushing's syndrome who requires frequent glucose monitoring and administration of insulin The best client to assign to the RN who was floated to the medical-surgical unit from the pediatric unit is the client with Cushing's syndrome. An RN who works with pediatric clients would be familiar with glucose monitoring and insulin administration related to this client.A client in Addisonian crisis would best be monitored by an RN from the medical-surgical floor. Although the float RN could complete the admission history, the client with SIADH secondary to lung cancer might require hypertonic saline and correction of hyponatremia. Teaching and orientation to the unit that is best provided by a nurse more familiar with that area. Discharge teaching specific to adrenalectomy would be provided by the RN who is regularly assigned to the medical-surgical floor and is more familiar with care of postoperative adult clients with endocrine disorders.

The nurse is performing an admission assessment on a 52-year-old client admitted with type 2 diabetes: Lungs clear, Glucose 179 mg/dL (9.9 mmol/L), Regular insulin 8 units if blood glucose 250 to 275 mg/dL (13.9 to 15.3 mmol/L), Right great toe mottled and cold to touch, Hemoglobin A1c 6.9%, Regular insulin 10 units if glucose 275 to 300 mg/dL (15.3 to 16.7 mmol/L), client states wears eyeglasses to read. After completing the above assessment, which complication of diabetes does the nurse report to the primary health care provider? a. Poor glucose control b. Visual changes c. Respiratory distress d. Decreased peripheral perfusion

d. Decreased peripheral perfusion A cold, mottled right great toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization. This must be reported to the primary health care provider to avoid potential gangrene and amputation.Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted.

When caring for a client with hypercortisolism the nurse notices that the phlebotomist, who plans to draw blood from the client, displays symptoms of a cold. What would the nurse do? a. Request another phlebotomist be sent from the laboratory. b. Monitor the client for cold-like symptoms. c. Refuse to allow the phlebotomist to enter the client's room. d. Ensure the phlebotomist wears a facemask.

d. Ensure the phlebotomist wears a facemask. The nurse needs to make sure the phlebotomist wears a facemask. A client with hypercortisolism will be immunosuppressed. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.Asking for another phlebotomist might be an option in some facilities, but it is not necessary. The phlebotomist, not the client, is exhibiting cold-like symptoms, so monitoring the client for these symptoms is not appropriate. Refusing to allow the phlebotomist to enter the room will delay treatment.

An older female patient admitted with weight gain, depression, and cold intolerance has respiratory acidosis and hypoventilation. She is unarousable. Which treatment would the nurse anticipate the practitioner ordering for this patient? a. Propranolol 1 mg IV every 4 hours b. Sodium iodine 1 g IV every 12 hours c. Reserpine 1 mg every 24 hours d. Levothyroxine 100 mcg IV followed by 75 mg/day

d. Levothyroxine 100 mcg IV followed by 75 mg/day The patient is experiencing myxedema coma, and the treatment is levothyroxine 100 mcg IV followed by 75 mg/day. Sodium iodine, reserpine, and propranolol are treatments for thyroid storm or thyrotoxicosis.

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? a. Assess skin turgor and mucous membranes for hydration status. b. Discuss the dietary restrictions for 24-hour urine testing. c. Plan ways to control the environment that will avoid stimulating the client. d. Remind the client to not order coffee with meals

d. Remind the client to not order coffee with meals The most appropriate nursing action for the charge nurse to delegate to the nursing assistant is to remind the client to not order coffee with meals. Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because the effects of catecholamines that stimulate blood pressure changes. The nursing assistant's scope of practice includes assisting clients with ordering meals, and reminding clients about previous nursing instructions.Client assessment, client teaching, and environment planning are higher level skills that require the experience and responsibility of the RN, and are not within the scope of practice of the nursing assistant.

The nurse is reviewing the laboratory test results for a client with a possible pituitary disorder. Which information requires immediate intervention by the nurse? a. Blood glucose 125 mg/dL (6.9mmol/L) b. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) c. Serum potassium 5.0 mEq/L (5.0 mmol/L d. Serum sodium 110 mEq/L (110 mmol/L)

d. Serum sodium 110 mEq/L (110 mmol/L) The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia leading to dangerous complications. The client is at risk for increased intracranial pressure, seizures, and death as the intravascular fluid shifts toward the brain. The RN must act quickly because this situation requires immediate intervention.The normal range for fasting blood glucose is 60 to 110 mg/dL <3.3 to 6.1 mmol/L); 125 mg/dL (6.9 mmol/L) is high, but is not considered dangerous. The normal range for BUN is 7 to 20 mg/dL (2.5 to 7.1 mmol/L); 40 mg/dL (14.3 mmol/L) is high, but does not require immediate intervention. The normal range for serum potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L); 5.0 mEq/L (5.0 mmol/L) is high normal.

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? a. Document symptoms of incisional infection or meningitis. b. Give over-the-counter laxatives if the client is constipated. c. Set up medications as prescribed for the day. d. Test any nasal drainage for the presence of glucose.

d. Test any nasal drainage for the presence of glucose. Home health aides can perform testing for nasal drainage for the presence of glucose after education and validation of the skill. After delegating this task, the nurse would follow up on the result to determine if the primary health care provider needs to be contacted. Cerebrospinal fluid (CSF) will test positive using a glucose "dipstick." Nasal drainage that is positive for glucose after a transsphenoidal hypophysectomy would indicate a CSF leak that would require immediate notification of the primary health care provider.Assessing for symptoms of infection and documenting them in the record, medication administration, and setting up medication are not within the scope of practice of the home health aide.

A client with Cushing's disease says that she has lost 1 pound (0.5 kg) What does the nurse do next? a. Auscultate the lungs for crackles. b. Check urine for specific gravity. c. Check the blood pressure. d. Weigh the client.

d. Weigh the client. The nurse would next weigh the client. Fluid retention with weight gain is more of a problem than weight loss in clients with Cushing's disease.Crackles in the lungs indicate possible fluid retention, which would cause weight gain, not weight loss. Urine specific gravity will help assess hydration status, but this would not be the next step in the client's assessment. Increases in blood pressure will correlate with excess water and sodium reabsorption causing fluid retention and weight gain in the client with Cushing's disease.

The nurse reviewing the laboratory work of a client with hypoparathyroidism finds all the following blood values. For which value does the nurse immediately assess the client's reflexes? a. Sodium 131 mEq/L (mmol/L) b. Potassium 5.1 mEq/L (mmol/L) c. Calcium 7.8 mg/dL (1.76 mmol/L) d. pH 7.33

d. pH 7.33 All of the laboratory values are somewhat out of the normal range but do not reach critical values. Sodium is slightly decreased, potassium is slightly elevated, and pH is a little low. Even though severe hyponatremia can result in seizures, it must be much lower for this complication to occur. Only the serum calcium level is low enough to indicate severe problems and a greatly increased risk for seizure activity. Assessing the client's reflexes can provide a reasonable determination of risk severity.