Endocrine NCLEX

The nurse is collecting data on a client with hyperparathyroidism. Which question would elicit accurate information about this condition from the client?

"Do you have tremors in your hands?" -> "Are you experiencing pain in your joints?" "Have you had problems with diarrhea lately?" "Do you notice swelling in your legs at night?"

The nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy. During the preoperative period, the priority nursing action should be to monitor which criterion?

-> Vital signs (hypertension) Intake and output Urine for glucose and acetone Blood urea nitrogen (BUN) level

The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder?

"Cushing's disease is characterized by an oversecretion of insulin." -> "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones." "Cushing's disease is characterized by an undersecretion of corticotropic hormones." "Cushing's disease is characterized by an undersecretion of glucocorticoid hormones."

Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. Which is the initial nursing action?

Document the complaints. Check for urinary glucose. Increase the client's fluid intake. -> Check the urine specific gravity.

A comatose client with an admitting diagnosis of diabetic ketoacidosis (DKA) has a blood glucose value of 368 mg/dL, arterial pH of 7.2, arterial bicarbonate of 14 mEq/L, and is positive for serum ketones. The diagnosis is supported by which noted data?

Hypertension -> Fruity breath odor Slow regular breathing Moist mucous membranes

A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's documentation and would expect to note which diagnosis?

Hypoglycemia Pheochromocytoma Diabetic ketoacidosis (DKA) -> Hyperglycemic hyperosmolar state (HHS)

The nurse is caring for a postoperative parathyroidectomy client. Which would require the nurse's immediate attention?

Incisional pain -> Laryngeal stridor Difficulty voiding Abdominal cramps

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs and symptoms noted in the client should alert the nurse to the presence of this crisis? Select all that apply.

Pallor -> Fever -> Sweating -> Agitation Bradycardia

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is reinforcing instructions to the client regarding the program. Which should the nurse include in the instructions?

Try to exercise before mealtime. Administer insulin after exercising. -> Take a blood glucose test before exercising. Exercise should be performed during peak times of insulin.

The nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the client's laboratory results and notes that the calcium level is extremely low. The nurse should expect to note which sign/symptom on data collection?

Unresponsive pupils -> Positive Trousseau's sign Negative Chvostek's sign Hyperactive bowel sounds

Which client complaint should alert the nurse to a possible hypoglycemic reaction?

-> Tremors and double vision Anorexia and blurred vision Hot, dry skin and weakness Muscle cramps and elevated temperature

The wife of a client with diabetes mellitus who takes insulin calls the nurse in a health care provider's office about her husband. She states that her husband is sleepy and that his skin is warm and flushed. She adds that his breathing is faster than normal and his pulse rate seems fast. Which action should the nurse tell the wife to do first?

Call an ambulance. Take his temperature. -> Check his blood glucose level. Drive him to the health care provider's office.

The nurse is caring for a client with a diagnosis of myasthenia gravis. The health care provider plans to perform an edrophonium (Enlon) test on the client to determine the presence of cholinergic crisis. In addition to planning care for the client during this testing, which equipment will the nurse ensure is at the bedside?

Cardiac monitor -> Oxygen equipment Vial of protamine sulfate and a syringe Potassium injection and a liter of normal saline solution

Which signs/symptoms should the nurse expect to note when collecting data on a client with Addison's disease?

Edema and weight gain -> Hypotension and vomiting Obesity and muscle hypertrophy Hirsutism and excessive hunger

A nursing student notes in the medical record that a client with Cushing's syndrome is experiencing body image disturbances. The need for additional education regarding this problem is identified when the nursing student suggests which nursing intervention?

Encouraging the client's expression of feelings Evaluating the client's understanding of the disease process Encouraging family members to share their feelings about the disease process -> Evaluating the client's understanding that the body changes need to be dealt with

The nurse is caring for a child with a diagnosis of diabetes insipidus. The nurse anticipates that the health care provider will prescribe which medications?

Furosemide (Lasix) Propylthiouracil (PTU) Methimazole (Tapazole) -> Desmopressin acetate (DDAVP)

The nurse is caring for a client with type 1 diabetes mellitus who is hyperglycemic. Which problem should the nurse consider first, when planning care for this client?

Insomnia Lack of appetite -> Signs of dehydration The need for knowledge about the diagnosis

A client has an endocrine system dysfunction of the pancreas. The nurse anticipates that the client will exhibit impaired secretion of which substance?

Lipase -> Insulin Trypsin Amylase

The nurse is caring for a client following a thyroidectomy. The client tells the nurse that she is concerned because of voice hoarseness. The client asks the nurse whether the hoarseness will subside. Which statement by the nurse regarding the hoarseness is accurate?

The hoarseness indicates nerve damage. The hoarseness is harmless but permanent. The hoarseness will worsen before it subsides. -> The hoarseness is normal and will gradually subside.

The nurse is collecting data from a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the medication regimen?

"By taking these medications, I am able to eat more." "When I become ill, I need to increase the number of pills I take." -> "The medication that I am taking helps release the insulin I already make." "I should take my metformin (Glucophage) only if my blood glucose is elevated."

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which response by the nurse is appropriate?

"Don't be concerned, this problem can be covered with clothing." "This is permanent, but looks are deceiving and not that important." -> "Usually, these physical changes slowly improve following treatment." "Try not to worry about it. There are other things to be concerned about."

A client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which response by the nurse is appropriate?

"I think you are making the right decision to have the surgery." -> "You have concerns about the surgical treatment for your condition?" "You are very ill. Your health care provider has made the correct decision." "There is no reason to worry. Your health care provider is a wonderful surgeon."

A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse reinforces which information in the preoperative teaching plan for the client?

-> Blowing the nose following surgery is prohibited. A small area will be shaved at the base of the neck. It will be necessary to cough and deep breathe following the surgery. Brushing the teeth vigorously and frequently is important to minimize bacteria in the mouth.

A client with diabetes mellitus visits the health care clinic. The client previously had been well controlled with glyburide (DiaBeta), but recently, the fasting blood glucose has been running 180 to 200 mg/dL. Which medication, if added to the client's regimen, may be contributing to the hyperglycemia?

-> Prednisone Phenelzine (Nardil) Atenolol (Tenormin) Allopurinol (Zyloprim)

The anticipated intended effect of fludrocortisone acetate (Florinef) for the treatment of Addison's disease is which?

-> Promote electrolyte balance. Stimulate thyroid production. Stimulate the immune response. Stimulate thyrotropin production.

The nurse is preparing to discharge a client who has had a parathyroidectomy. When reinforcing instructions to the client about the prescribed oral calcium supplement, which information should the nurse include?

-> Take the calcium 30 to 60 minutes following a meal. Avoid sunlight because it can cause skin color change. Store the calcium in the refrigerator to maintain potency. Check the pulse daily and hold the dosage if it is below 60 beats per minute.

The nurse has collected data on a client with diabetes mellitus. Findings include a fasting blood glucose of 130 mg/dL, temperature 101° F, pulse of 88 beats per minute, respirations of 22 breaths per minute, and a blood pressure of 118/78 mm Hg. Which finding would be of concern to the nurse?

-> Temperature Blood glucose Blood pressure Pulse and respirations

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care, understanding that which statement accurately reflects this client's level of knowledge?

-> The client needs immediate education before discharge. The client requires follow-up teaching regarding the administration of insulin. The client's statement is accurate, but knowledge should be evaluated further. The client's statement is inaccurate, and the client should be scheduled for outpatient diabetic counseling.

The nurse is discussing foot care with a diabetic client and the spouse. The nurse includes which instruction during this informational session?

-> The toenails should be cut straight across. Strong soap should be used to decrease skin bacteria. There is decreased risk of infection when feet are soaked in hot water. Lanolin should be applied to dry feet, especially the heels and between the toes.

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse should most closely monitor which assessment in the preoperative period?

-> Vital signs Intake and output Blood urea nitrogen (BUN) Urine glucose and ketones

A client with diabetes mellitus is scheduled to have a fasting blood glucose level determined in the morning. The nurse tells the client not to eat or drink after midnight. When the client asks for further information, the nurse clarifies by stating that which should be acceptable to take before the test?

-> Water Tea without any sugar Coffee without any milk Clear liquids such as apple juice

The nurse has just supervised a newly diagnosed diabetes mellitus client self-inject NPH insulin at 7:30 ᴀᴍ. The nurse reviews the time frames for peak insulin action with the client, telling the client to be especially watchful for a hypoglycemic reaction between which time frame?

7:30 ᴀᴍ and 9:30 ᴀᴍ -> 1:30 ᴘᴍ and 7:30 ᴘᴍ 8:30 ᴘᴍ and 12:00 ᴀᴍ 2:30 ᴀᴍ and 4:30 ᴀᴍ

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which intervention would be appropriate to decrease the client's anxiety?

Administer a sedative. -> Convey empathy, trust, and respect toward the client. Ignore the signs and symptoms of anxiety so that they will soon disappear. Make sure the client knows all the correct medical terms so that he or she can understand what is happening.

The nurse is collecting data on a client with a diagnosis of hypothyroidism. Which of these behaviors, if present in the client's history, should the nurse determine as being likely related to the symptoms of this disorder?

Anxiety Irritability -> Depression Nervousness

The nurse working on an endocrine nursing unit understands that which correct concept is used in planning care?

Clients with hyperthyroidism must be monitored for weight gain. Clients who have diabetes insipidus should be assessed for fluid excess. -> Clients who have hyperparathyroidism should be protected against falls. Clients with Cushing's syndrome are likely to experience episodic hypotension.

The nurse has provided diabetic teaching with the family of a client newly diagnosed with diabetes. The nurse determines that the family understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which condition?

Diabetic ketoacidosis -> Hypoglycemia from insulin overdose Hyperglycemia from insufficient insulin Hyperglycemia occurring on "sick days"

The nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that which client complaint would be characteristic of this disorder?

Diarrhea -> Polyuria Polyphagia Weight gain

Take the calcium 30 to 60 minutes following a meal. Avoid sunlight because it can cause skin color change. Store the calcium in the refrigerator to maintain potency. Check the pulse daily and hold the dosage if it is below 60 beats per minute.

High serum glucose level and an increase in pH Decreased urine output and Kussmaul's respirations Low serum potassium and high serum bicarbonate level High serum glucose level and low serum bicarbonate level

After receiving furosemide (Lasix) 40 mg slow intravenous push for chest pain related to shortness of breath and generalized edema, the client responds poorly. The client has no relief of the chest pain, shortness of breath, or edema and only minimal urine output (less than 40 mL of urine). The health care provider is notified, and after reviewing the chart, suspects the client has syndrome of inappropriate antidiuretic hormone (SIADH). Which findings would lead to this specific diagnosis? Refer to chart.

Hypertension and weight gain Generalize edema and pulse of 110 beats per minute Seizure disorder and serum sodium level of 118 mEq/L -> Minimal responsiveness to furosemide (Lasix) and small cell lung cancer

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?

Keep insulin vials refrigerated at all times. -> Rotate the insulin injection sites systematically. Increase the amount of insulin before unusual exercise. Monitor the urine acetone level to determine the insulin dosage.

The nurse is caring for a client experiencing thyroid storm. Which should be a priority concern for this client?

Lack of sexual drive -> Potential for cardiac disturbances Inability to cope with the treatment plan Self-consciousness about body appearance

In planning nutrition for the client with hypoparathyroidism, which diet would be appropriate?

Low in vitamins A, D, E, and K Low in water and insoluble fiber -> High in calcium and low phosphorous High in sodium with no fluid restriction

A client has a blood glucose level drawn for suspected hyperglycemia. After interviewing the client, the nurse determines that the client ate lunch approximately 2 hours before the blood specimen was drawn. The laboratory reports the blood glucose to be 180 mg/dL, and the nurse analyzes this result as indicative of which interpretation?

Normal Lower than the normal value -> Elevated from the normal value A dangerously high value requiring immediate health care provider notification

The nurse is caring for a client with hypothyroidism who is overweight. Which food items should the nurse suggest to include in the plan?

Peanut butter, avocado, and red meat Organ meat, carrots, and skim milk Seafood, spinach, and cream cheese -> Skim milk, apples, whole-grain bread, and cereal

When caring for a client diagnosed with pheochromocytoma, which information should the nurse know when assisting with planning care?

Profound hypotension may occur. -> Excessive catecholamines are released. Hypoglycemia is the primary presenting symptom. The condition is not curable and is treated symptomatically.

A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse should take which action?

Put the head of the bed flat. -> Test the drainage for glucose. Test the drainage for occult blood. Continue to observe for further drainage.

Which nursing measure would be effective in preventing complications in a client with Addison's disease?

Restricting fluid intake -> Monitoring the blood glucose Offering foods high in potassium Checking family support systems

During data collection on a postoperative client who has undergone hypophysectomy, the client complains of thirst and frequent urination. Knowing the expected complication of this surgery, the nurse should check which parameter next?

Serum glucose Blood pressure Respiratory rate -> Urine specific gravity

A client with newly diagnosed Cushing's syndrome expresses concern about personal appearance, specifically about the "buffalo hump" that has developed at the base of the neck. When counseling the client about this symptom, the nurse should incorporate which knowledge?

This is a permanent feature. It can be minimized by wearing tight clothing. -> It may slowly improve with treatment of the disorder. It will quickly disappear once medication therapy is started.

Glucagon hydrochloride injection would most likely be prescribed for which disorder?

Thyroid crisis Hypoadrenalism -> Type 1 diabetes mellitus Excess growth hormone secretion

A client has just been admitted with a diagnosis of myxedema coma. If all of the following interventions were prescribed, the nurse should place highest priority on completing which action first?

Warming the client -> Administering oxygen Giving fluid replacement Administering thyroid hormone

A client is admitted with a diagnosis of pheochromocytoma. The nurse should monitor which parameter to detect the most common sign of pheochromocytoma?

Weight gain Positive urine ketones -> Blood pressure elevation Decreased skin temperature

The nurse caring for a client who has had a subtotal thyroidectomy reviews the plan of care and determines which problem is the priority for this client in the immediate postoperative period?

Infection -> Bleeding Dehydration Urinary retention

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching?

"I'll eat a balanced meal plan." "I need to drink diet soft drinks." -> "I need to buy special dietetic foods." "I will snack on fruit instead of cake."

A client with hypoparathyroidism has hypocalcemia. The nurse avoids giving the client the prescribed vitamin and calcium supplement with which liquid?

-> Milk Water Iced tea Fruit juice

When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?

"I will stop taking my insulin if I'm too sick to eat." "I will decrease my insulin dose during times of illness." "I will adjust my insulin dose according to the level of glucose in my urine." -> "I will notify my health care provider if my blood glucose level is consistently greater than 250 mg/dL."

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?

"I should not exercise after lunch." "I should not exercise after breakfast." "I should not exercise in the late evening." -> "I should not exercise in the late afternoon."

The nurse is preparing to reinforce instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which diet should be prescribed for this client?

Low-sodium, low-protein diet Low-protein, high-carbohydrate diet Low-carbohydrate, low-protein diet -> High-sodium, high-carbohydrate diet

The nurse is assisting in preparing a plan of care for the client with diabetes mellitus and plans to reinforce the client's understanding regarding the signs/symptoms of hypoglycemia. Which signs/symptoms should the nurse review?

Slow pulse; lethargy; and warm, dry skin Elevated pulse; lethargy; and warm, dry skin -> Elevated pulse; shakiness; and cool, clammy skin Slow pulse, confusion, and increased urine output

The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?

Soak the feet in hot water. Avoid using soap to wash the feet. -> Apply a moisturizing lotion to dry feet, but not between the toes. Always have a podiatrist cut your toenails; never cut them yourself.

The nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists in developing a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan?

Spinal anesthesia is used. Hair will need to be shaved. Deep breathing and coughing will be needed after surgery. -> Toothbrushing will not be permitted for at least 2 weeks following surgery.

The nurse is collecting data from a client newly diagnosed with diabetes mellitus regarding the client's learning readiness. Which client behavior indicates to the nurse that the client is not ready to learn?

The client asks if the spouse can attend the classes also. The client asks appropriate questions about what will be taught. The client asks for written materials about diabetes before class. -> The client complains of fatigue whenever the nurse plans a teaching session.

The nurse is reinforcing discharge instructions to a client who had a unilateral adrenalectomy. Which information should be a component of the instructions?

The reason for maintaining a diabetic diet -> Instructions about early signs of a wound infection Teaching regarding proper application of an ostomy pouch The need for lifelong replacement of all adrenal hormones

A client newly diagnosed with diabetes mellitus is having difficulty learning the technique of blood glucose measurement. The nurse should teach the client to do which action to perform the procedure properly?

Wash the hands first using cold water. Puncture the center of the finger pad. Puncture the finger as deeply as possible. -> Let the arm hang dependently and milk the digit.

Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?

Weigh the client. Test the client's urine for glucose. -> Monitor the client's blood pressure. Palpate the client's skin to determine warmth.

The nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which are signs and symptoms related to adrenal insufficiency? Select all that apply.

-> Fever -> Weakness -> Hypotension Double vision -> Mental status changes

The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse should focus on which potential problem for this client?

-> Dehydration Lack of knowledge about nutrition Inability of family to cope with the client's diagnosis The need for knowledge about the causes of hyperglycemia

The nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further teaching? Select all that apply.

"I enjoy exercising but I need to be careful." "I need to pace my activities throughout the day." -> "I need to limit playing football to only the weekends." "I should gauge my activity level by my energy level." -> "I should exercise in the evening to encourage a good sleep pattern."

The nurse is reinforcing dietary instructions to a client newly diagnosed with diabetes mellitus. The nurse accurately instructs the client with which statement?

-> It is best to eat meals at approximately the same time each day. It is best to adjust mealtimes depending on blood glucose levels. It is best to vary mealtimes if insulin is not administered at the same time every day. It is best to avoid being concerned about the time of meals as long as snacks are taken on time.

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?

-> Less than 50 mg/dL Less than 90 mg/dL Less than 100 mg/dL Less than 120 mg/dL

The nurse notes in the medical record that a client with Cushing's syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? Select all that apply.

-> Monitoring daily weight -> Monitoring intake and output -> Maintaining a low-sodium diet Maintaining a low-potassium diet -> Monitoring extremities for edema

The nurse is reviewing a plan of care for a client with Addison's disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing intervention is an appropriate component of the plan of care? Select all that apply.

-> Monitoring intake and output Maintaining a low-sodium diet -> Monitoring for changes in mental status Encouraging an intake of low-protein foods -> Encouraging fluid intake of at least 3000 mL/day

The nurse is reviewing a health care provider's prescriptions for a client with newly diagnosed, untreated hypothyroidism. Which medication prescribed for the client should the nurse question and verify?

-> Morphine sulfate Atenolol (Tenormin) Docusate sodium (Colace) Levothyroxine (Synthroid)

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which intervention would best assist the client with this problem?

-> Obtaining dark glasses for the client Administering methimazole (Tapazole) every 8 hours Lubricating the eyes with tap water every 2 to 4 hours Instructing the client to avoid straining or heavy lifting

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection?

-> Plan for injection rotation Consistency of aspiration Preparation of the injection site Angle at which the medication is administered

Which client is at risk for developing thyrotoxicosis?

A client with hypothyroidism -> A client with Graves' disease who is having surgery A client with diabetes mellitus scheduled for debridement of a foot ulcer A client with diabetes insipidus scheduled for an invasive diagnostic test

The nurse is reviewing the prescriptions of a client diagnosed with diabetes mellitus who was admitted because of an infected foot ulcer. Which health care provider's prescription supports the treatment of this condition?

A decreased-calorie diet An increased-calorie diet A decreased amount of NPH daily insulin -> An increased amount of NPH daily insulin

Which measure should the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease?

A high-fiber diet -> A restful environment Three small meals per day Providing the client with extra blankets

The nurse is caring for a client with pheochromocytoma. Which data are indicative of a potential complication associated with this disorder?

A urinary output of 50 mL/hr A coagulation time of 5 minutes -> Congestion heard on auscultation of the lungs A blood urea nitrogen (BUN) level of 20 mg/dL

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?

Blurred vision and hot, dry skin -> Excessive thirst and urine output Diarrhea and decreased urine output Weight gain and increased urine specific gravity

The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which sign/symptom noted in the client indicates the presence of hypocalcemia?

Bradycardia Flaccid paralysis Negative Chvostek's sign -> Tingling around the mouth

The nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate?

Check for signs of bleeding. Administer calcium gluconate. Notify the registered nurse immediately. -> Reassure the client that this is usually a temporary condition.

A client recently diagnosed with diabetes mellitus requiring insulin tells the clinic nurse that he is traveling by air throughout the next week. The client asks the nurse for any suggestions about managing the disorder while traveling. Which action should the nurse tell the client to do?

Check the blood glucose every 2 hours during the flight. Obtain referrals to health care providers in the destination cities. -> Keep snacks in carry-on luggage to prevent hypoglycemia during the flight. Pad the insulin and syringes against breakage and place in a suitcase to be stowed.

The nurse is reinforcing instructions to a client newly diagnosed with diabetes mellitus regarding insulin administration. The health care provider has prescribed a mixture of NPH and regular insulin. The nurse should stress that which is the first step?

Draw up the correct dosage of NPH insulin into the syringe. Draw up the correct dosage of regular insulin into the syringe. -> Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

The nurse is reinforcing instructions with a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?

Eat six small meals daily. Test the urine ketone levels. -> Monitor blood glucose levels frequently. Receive appropriate follow-up health care.

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?

Give the client a glass of orange juice. -> Check the client's capillary blood glucose. Prepare for the administration of an insulin drip. Prepare for the administration of a bolus dose of 50% dextrose.

A client has been diagnosed with hypoparathyroidism. Which food groups should be included in the diet?

High in phosphorus and low in calcium Low in phosphorus and low in calcium -> Low in phosphorus and high in calcium High in phosphorus and high in calcium

A client who is managing diabetes mellitus with insulin injections asks the nurse for information about any necessary changes in her diet to avoid hyperinsulinism. Which diet would be appropriate for the client?

Low-fiber, high-fat diet Limit carbohydrate intake to three meals per day Large amounts of carbohydrates between low-protein meals -> Small frequent meals with protein, fat, and carbohydrates at each meal

When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is essential?

Lower the head of the bed. -> Test the drainage for glucose. Obtain a culture of the drainage. Continue to observe the drainage.

The nurse reviews a plan of care for a postoperative client following a thyroidectomy and notes that the client is at risk for breathing difficulty. Which nursing intervention should the nurse include in the plan of care?

Maintain a supine position. -> Monitor neck circumference frequently. Maintain a pressure dressing on the operative site. Encourage coughing and deep breathing exercises.

The nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which item in the diet?

Meat Fish Cereals -> Vegetables

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?

NPH insulin A nasal cannula IV infusion of sodium bicarbonate -> Intravenous (IV) infusion of normal saline

A client newly diagnosed with diabetes mellitus takes NPH insulin every day at 7:00 am. The nurse has taught the client how to recognize the signs of hypoglycemia. The nurse determines that the client understands the information presented if the client watches for which signs and symptoms in the late afternoon?

Nausea and vomiting, and abdominal pain -> Hunger; shakiness; and cool, clammy skin Drowsiness; red, dry skin; and fruity breath odor Increased urination; thirst; and rapid, deep breathing

The nurse is caring for a postoperative adrenalectomy client. Which finding does the nurse specifically monitor for in this client?

Peripheral edema Bilateral exophthalmos Signs and symptoms of hypocalcemia -> Signs and symptoms of hypovolemia

A client is in metabolic acidosis caused by diabetic ketoacidosis (DKA). The nurse prepares for the administration of which medication as a primary treatment for this problem?

Potassium -> Regular insulin Sodium bicarbonate Calcium gluconate

The nurse should expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

Provide a cool environment for the client. Instruct the client to consume a high-fat diet. -> Instruct the client about thyroid replacement therapy. -> Encourage the client to consume fluids and high-fiber foods in the diet. Inform the client that iodine preparations will be prescribed to treat the disorder. -> Instruct the client to contact the health care provider if episodes of chest pain occur.

A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. Which nursing measure would be included in the plan regarding this medication?

Relief of pain Signs of renal toxicity -> Signs and symptoms of hypothyroidism Signs and symptoms of hyperglycemia

The nurse participating in a free health screening at the local mall obtains a random blood glucose level of 200 mg/dL on an otherwise healthy client. The nurse tells the client to do which as a next step?

Seek treatment for diabetes mellitus. Ask the pharmacist about starting insulin therapy. Begin blood glucose monitoring three times a day. -> Call the health care provider to have the value rechecked as soon as possible.

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list?

Shakiness -> Increased thirst Profuse sweating Decreased urine output

While collecting data on a client being prepared for an adrenalectomy, the nurse obtains a temperature reading of 100.8° F. The nurse analyzes this temperature reading as which?

Within normal limits -> A finding that needs to be reported immediately Slightly abnormal but an insignificant finding An expected finding caused by the operative stress response

The nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which is the appropriate choice for this client to meet nutritional needs?

Crackers with cheese and tea -> Graham crackers and warm milk Toast with peanut butter and cocoa Vanilla wafers and coffee with cream and sugar

A client with myxedema has changes in intellectual function such as impaired memory, decreased attention span, and lethargy. The client's husband is upset and shares his concerns with the nurse. Which statement by the nurse is helpful to the client's husband?

"Give it time. I've seen dozens of clients with this problem that fully recover." "I don't blame you for being frustrated, because the symptoms will only get worse." "Would you like me to ask the health care provider for a prescription for a stimulant?" -> "It's seems that you are concerned about your wife's condition, but the symptoms may improve with continued therapy."

The nurse has reinforced instructions about measuring blood glucose levels to a client newly diagnosed with diabetes mellitus. The nurse determines that the client understands the procedure when making which most accurate statement?

"I should check my blood glucose level once a day." "I should check my blood glucose level 2 hours after each meal." "I should check my blood glucose level before eating a big meal." -> "I should check my blood glucose level before eating each meal, regardless of how much I eat."

The nurse in an outpatient diabetes clinic is assisting in caring for a client on insulin pump therapy. Which statement by the client indicates that a need for teaching regarding insulin pump therapy?

"I'll need to check my blood sugars before meals in case I need a premeal insulin bolus." "If my blood sugars are elevated, I can bolus myself with additional insulin as prescribed." -> "Now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis occurring again." "I still need to follow an appropriate diet and exercise plan even though I don't have to inject myself daily anymore."

The nurse is reinforcing home care instructions to a client with a diagnosis of Cushing's syndrome. Which client statement reflects a need for further teaching?

"Taking my medications exactly as prescribed is essential." -> "I need to read the labels on any over-the-counter medications I purchase." "My family needs to be familiar with the signs and symptoms of hypoadrenalism." "I could experience the signs and symptoms of hyperadrenalism because of Cushing's."

The nurse is caring for a client newly diagnosed with diabetes mellitus. The client asks the nurse whether eating at a restaurant will affect the diabetic control and whether this is allowed. Which nursing response is appropriate?

"You really should not eat in restaurants." "If you plan to eat in a restaurant, you need to avoid carbohydrates." -> "You should order a half-portion meal and have fresh fruit for dessert." "You should increase your daily dose of insulin by half on the day you plan to eat out."

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the nurse that after giving the injection, the insulin seems to leak through the skin. The nurse can appropriately determine the problem by asking the client which?

-> "Are you rotating the injection site?" "Are you aspirating before you inject the insulin?" "Are you using a 1-inch needle to give the injection?" "Are you placing an air bubble in the syringe before injection?"

The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant health care provider notification?

-> "I am urinating a lot." "My pulse is really slow." "I am sweating for no reason." "My blood pressure is really high."

The nurse is reinforcing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood?

-> "I can eat foods that contain potassium." "I will need to limit the amount of protein in my diet." "I am fortunate that I can eat all the salty foods I enjoy." "I am fortunate that I do not need to follow any special diet."

A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she "felt funny." Which statement by the client indicates an understanding of this occurrence?

-> "I forgot to take my usual mid-afternoon snack yesterday." "I took less insulin this morning, so I won't feel funny today." "My blood glucose levels are running low because I'm tired." "I don't know why I have to check my blood glucose four times a day. That seems too much."

The nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching?

-> "I need to stop my insulin." "I need to increase my fluid intake." "I need to call my health care provider." "I need to monitor my blood glucose every 4 to 6 hours."

The nurse has reinforced home care measures to a client diagnosed with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further teaching?

-> "I should perform my exercise at peak insulin time." "I should always carry a quick-acting carbohydrate when I exercise." "I should always wear a Medic-Alert bracelet especially when I exercise." "I should avoid exercising at times when a hypoglycemic reaction is likely to occur."

The nurse is instructing a client with Addison's disease about a newly prescribed medication, fludrocortisone acetate (Florinef). Which statement by the client indicates a need for further teaching?

-> "I will be glad to gain weight." "I will take it with milk or food." "I will wear a Medic-Alert bracelet." "I will taper down the dosage of the medication."

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply.

-> Dry skin Irritability Palpitations Weight loss -> Constipation -> Cold intolerance

A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse plans care and places highest priority on which potential problem?

-> Infection Nervousness Inability to care for self Concern about appearance

The nurse is monitoring the results of periodic serum laboratory studies drawn on a client with diabetic ketoacidosis (DKA) receiving an insulin infusion. The nurse determines that which value needs to be reported?

-> Potassium 3.1 mEq/L Calcium 9.2 mg/dL Sodium 137 mEq/L Serum osmolality 288 mOsm/kg H2O

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial serum glucose level was 950 mg/dL. Intravenous (IV) insulin was started along with rehydration with IV normal saline. The serum glucose level is now 240 mg/dL. The nurse who is assisting in caring for the client obtains which item, anticipating a health care provider's prescription?

An ampule of 50% dextrose -> IV infusion containing 5% dextrose Phenytoin (Dilantin) for prevention of seizures NPH insulin and a syringe for subcutaneous injection

The nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique would provide data necessary to support the admitting diagnosis?

Auscultation of lung sounds -> Inspection of facial features Percussion of the thyroid gland Palpation of the adrenal glands

A hospitalized client is newly diagnosed with diabetes mellitus. The client must take both NPH and Regular insulin for glucose control. The nurse develops a teaching plan to help the client meet which outcome as a first step in managing the disease?

Avoid all strenuous exercise. Maintain health at an optimum level. Lose 40 pounds to achieve ideal body weight. -> Adjust insulin according to capillary blood glucose levels.

A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which food in the diet?

Bananas Oatmeal -> Ice cream Chicken breast

The nurse is planning to instruct a client with diabetes mellitus who has hypertension about "sick day management." Which beverage does the nurse avoid putting on a list of easily consumed carbohydrate-containing beverages for use when the client cannot tolerate food orally?

Cola Ginger ale Apple juice -> Mineral water

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding should the nurse expect to note as confirming this diagnosis?

Coma Decreased urine output Increased respirations and an increase in pH -> Elevated blood glucose and low plasma bicarbonate

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?

Constipation Temperature of 96.6° F -> Blood pressure of 80/60 mmHg Heart rate of 44 beats per minute

An older client with a history of hyperparathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans to address which problem first?

Constipation Urinary retention -> The possibility of injury Need for teaching about the disorder

The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase?

Correct the acidosis. Administer IV 5% dextrose. -> Administer intravenous (IV) regular insulin. Apply an electrocardiogram (ECG) monitor.

A client scheduled for a thyroidectomy says to the nurse, "I am so scared to get cut in my neck." Based on the client's statement, the nurse determines that the client is experiencing which problem?

Fear about impending surgery -> Lack of support related to the surgical procedure Inadequate knowledge about the surgical procedure Embarrassment about the changes in personal appearance

The nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide (Lasix). The nurse reinforces dietary instructions to the client. Which is an appropriate instruction?

Increase dietary intake of calcium. -> Drink at least 2 to 3 L of fluid daily. Eat sparely when experiencing nausea. Decrease dietary intake of potassium.

The nurse is caring for a client with Addison's disease. The nurse checks the client's vital signs and determines that the client has orthostatic hypotension. The nurse determines that this finding relates to which factor?

Increased levels of androgens A decrease in cortisol release -> A decreased secretion of aldosterone An increase in epinephrine secretion

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider's prescription noted on the record indicates the need for clarification?

Instruct the client to avoid blowing the nose. Monitor vital signs and neurological status. -> Apply a loose dressing if any clear drainage is noted. Instruct the client about the need for a Medic-Alert bracelet.

The nurse reviews the nursing care plan of an older client with diabetic neuropathy of the lower extremities as a result of type 2 diabetes mellitus. The nurse plans care, knowing that which problem has the highest priority for this client?

Pain as a result of intermittent claudication Lack of self-esteem as a result of perceived loss of abilities Lack of self-confidence as a result of impaired ability to walk -> The possibility of injury as a result of decreased sensation in the legs and feet

The nurse reinforces teaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?

Polyuria -> Shakiness Blurred vision Fruity breath odor