Endocrine study set

180 or less

Normal blood sugars after eating

Metformin

Biguanide is

Airway then insulin

1st priority with DKA

GH and PRL

2 assessments of hyperpituitarism

Diuretic and hydration therapies. Parathyroidectomy

3 treatments of hyperparathyroidism

Correct Hypocalcemia, vitamin d deficiency, hypomagnesmia

3 treatments of hypoparathyroidism

Latrogenic, idiopathic, hypagnesmia

3 types of hypoparathyroidism

polyuria, polydipsia, polyphagia

3 P's of fluid and electrolyte imbalance

Thyroid scan, ultrasonography, ECG

3 diagnostic tests of hyperthyroidism

B,C,D

A client newly diagnosed with type 1 diabetes says she is not ready to learn everything about diabetes control right now. Which information has the greatest priority for the nurse to teach this client and her family for now to prevent harm? (Select all that apply.) Select all that apply. A. Causes of type 1 diabetes B. What to do when ill? C. Symptoms and treatment of hypoglycemia D. Insulin administration E. Dietary control of blood glucose F. Importance of regular exercise

Primary neutrogenic, secondary neutrogenic, nephrogenic, drug related

4 classifications of diabetes insipidus

T3, T4, TSH, TRAbs

4 lab assessments of hyperthyroidism

Papillary, follicular, medullary, anaplastic

4 types of thyroid cancer

type 2 diabetes

Hyperglycemic hyperosmolar state is seen more in

DKA

>300 blood sugar

ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones would the nurse expect to be decreased as a result? (Select all that apply.) a. Thyroid-stimulating hormone b. Vasopressin c. Follicle-stimulating hormone d. Calcitonin e. Growth hormone

A

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

ANS: A, B, E The client who has DI has excessive urination and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a low specific gravity.

A client is admitted with a possible diagnosis of diabetes insipidus (DI). What assessment findings would the nurse expect? (Select all that apply.) a. Hypotension b. Increased urinary output c. Concentrated urine d. Decreased thirst e. Poor skin turgor f. Bradycardia

ANS: D The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water toxicity. Water toxicity causes headache, vomiting, and acute confusion.

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy? a. The need to check the client's urinary specific gravity. b. The need to take blood pressure at least twice a day. c. The need to monitor blood glucose every day. d. The need to weigh every day and report weight gain.

ANS: A A1C measures the average blood glucose level to determine if the client is a diabetic or how controlled a diabetic client is.

A client is scheduled to have a glycosylated hemoglobin (A1C) drawn and asks the nurse why she has to have it. How would the nurse respond? a. "It measures your average blood glucose level for the past 3 months." b. "It determines what type of anemia you may have." c. "It measures the amount of liver glycogen you have." d. "It determines you have some type of leukemia or other blood cancer."

ANS: D Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Most thyroid problems are not inherited, although they may occur in families. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism. The nurse would assess the client further for hypothyroidism.

A nurse assesses a client on the medical-surgical unit. Which statement made by the client alerts the nurse to assess the patient for hypothyroidism? a. "My sister has thyroid problems." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even with 12 hours of sleep."

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse would inspect them for any signs of injury. After assessment, the nurse would document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and documentation have been completed.

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first? a. Document the finding in the client's chart. b. Assess tactile sensation in the client's hands. c. Examine the client's feet for signs of injury. d. Notify the primary health care provider.

ANS: A This patient is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse would administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment would be repeated. The patient does not need intravenous dextrose, insulin, or glucagon.

A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the client's signs and symptoms have not changed. What action would the nurse take next? a. Administer another half-cup (120 mL) of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

ANS: B Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.

A nurse is caring for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. Increased urine output

ANS: B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values would the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3− 22 mEq/L (22 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3− 18 mEq/L (18 mmol/L), PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3− 28 mEq/L (28 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3− 22 mEq/L (22 mmol/L), PCO2 58 mm Hg, PO2 88 mm Hg

ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The other vital signs are within normal limits and do not indicate any response to the medication.

A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding would indicate that the medication is effective? a. Heart rate of 92 beats/min b. Respiratory rate of 18 breaths/min c. Oxygenation saturation of 92% d. Blood pressure of 144/69 mm Hg

ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

A nurse assesses a client who is prescribed levothyroxine for hypothyroidism. Which assessment finding alerts the nurse that drug therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3 (6 × 109/L). d. Heart rate is 76 beats/min and regular.

ANS: D Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.

A nurse assesses a client who is recovering from a subtotal thyroidectomy and observes the development of stridor. What is the priority action for the nurse to take? a. Apply oxygen via nasal cannula at 2 L/min. b. Document the finding and assess the client hourly. c. Place the client in high-Fowler position in the bed. d. Contact the Rapid Response Team and prepare for intubation.

ANS: C Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse would assess for muscle twitching and, if present, notify the surgeon or Rapid Response Team to give calcium gluconate or other IV calcium replacement. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the first postoperative day before discharge, the client states, "I feel numbness and tingling around my mouth." What action does the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for muscle twitching. d. Ask the client orientation questions.

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values would the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L (150 mmol/L) b. Sodium: 130 mEq/L (130 mmol/L) c. Potassium: 2.5 mEq/L (2.5 mmol/L) d. Potassium: 5.0 mEq/L (5.0 mmol/L) e. pH 7.28 f. pH 7.50

ANS: D The client's tissue has been damaged from continuous use of the same site. The client would be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type of infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. What action would the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine

ANS: B Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse would inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening

A nurse assesses a female client who presents with hirsutism. Which question would the nurse ask when assessing this client? a. "How do you plan to pay for your treatments?" b. "How do you feel about yourself?" c. "What medications are you prescribed?" d. "What are you doing to prevent this from happening?"

ANS: A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually, patients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which assessment findings would the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension

ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, and Hispanics), obesity and physical inactivity, and giving birth to large babies. Liver trauma and a 30-lb (13.6 kg) gestational weight gain are not risk factors.

A nurse assesses adults at a health fair. Which adults would the nurse counsel to be tested for diabetes? (Select all that apply.) a. A 56-year-old African-American male b. A 22-year-old female with a 30-lb (13.6 kg) weight gain during pregnancy c. A 60-year-old male with a history of liver trauma d. A 48-year-old female with a sedentary lifestyle e. A 50-year-old male with a body mass index greater than 25 kg/m2 f. A 28-year-old female who gave birth to a baby weighing 9.2 lb (4.2 kg)

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus

ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest risk.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 19-year-old Caucasian b. A 22-year-old African American c. A 44-year-old Asian American d. A 58-year-old American Indian

ANS: A,B Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.

A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.) a. Excessive thyroid-stimulating hormone—increased bone formation b. Excessive melanocyte-stimulating hormone—darkening of the skin c. Excessive parathyroid hormone—synthesis and release of corticosteroids d. Excessive antidiuretic hormone—increased urinary output e. Excessive adrenocorticotropic hormone—increased bone resorption

ANS: A, C, E The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's health teaching? (Select all that apply.) a. Increased carbohydrates b. Decreased fats c. Increased calorie intake d. Supplemental vitamins e. Increased proteins

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The patient who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the patient glucose would be contraindicated. The patient does not require seizure precautions.

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take? a. Administration of oxygen via facemask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How would the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." b. "No genetic risk is associated with the development of type 1 diabetes mellitus." c. "The risk for becoming a diabetic is 50% because of how it is inherited." d. "Female children do not inherit diabetes mellitus, but male children will."

ANS: C Hashimoto thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy and will not be able to stop taking the medication.

A nurse cares for a client who has hypothyroidism as a result of Hashimotothyroiditis. The client asks, "How long will I need to take this thyroid medication?" How would the nurse respond? a. "You will need to take the thyroid medication until the goiter is completely gone." b. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication." c. "You'll need thyroid pills for life because your thyroid won't start working again." d. "When blood tests indicate normal thyroid function, you can stop the medication."

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client would be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing fluid intake will help increase the client's sodium.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for repositioning. d. Instruct assistive personnel to measure intake and output.

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer? a. Atropine sulfate b. Levothyroxine c. Propranolol d. Epinephrine

ANS: B Hypercortisolism can cause the client to have neurotic or psychotic behaviors. The client needs to know that these behavior changes do not reflect a true mental or behavioral health disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." How would the nurse respond? a. "I will ask your doctor to order a mental health consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the patient decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock.

A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How would the nurse respond? a. "You need to start with multiple injections until you become more proficient at self-injection." b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."

ANS: A Thiazolidinediones (including pioglitazone) can cause cardiovascular adverse effects including health failure which is manifested by peripheral edema and unintentional weight gain. The client should have been taught to weigh every week and report sudden increases in weight.

A nurse cares for a patient who is prescribed pioglitazone. After 6 months of therapy, the client reports that he has a new onset of ankle edema. What assessment question would the nurse take? a. "Have you gained unexpected weight this week?" b. "Has your urinary output declined recently?" c. "Have you had fever and achiness this week?" d. "Have you had abdominal pain recently?"

ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.

A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.) a. Hormones may travel long distances to get to their target tissues. b. Continued hormone activity requires continued production and secretion. c. Control of hormone activity is caused by negative feedback mechanisms. d. Most hormones are stored in the target tissues for use later. e. Most hormones cause target tissues to change activities by changing gene activity.

ANS: A The collection of a 24-hour urine specimen is often delegated to AP. The nurse must ensure that the AP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the client's first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client's first void is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.

A nurse collaborates with assistive personnel (AP) to provide care for a client who is prescribed a 24-hour urine specimen collection. Which statement would the nurse include when teaching the AP about this activity? a. "Note the time of the client's first void and collect urine for 24 hours." b. "Add the preservative to the container at the end of the test." c. "Start the collection by saving the first urine of the morning." d. "It is okay if one urine sample during the 24 hours is not collected."

ANS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse would collaborate with a registered dietitian nutritionist, clinical pharmacist, and primary health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

A nurse collaborates with the interprofessional team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members would the nurse include in this interprofessional team meeting? (Select all that apply.) a. Registered dietitian nutritionist b. Clinical pharmacist c. Occupational therapist d. Primary health care provider e. Speech-language pathologist

ANS: B Restriction of dietary protein is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories.

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet would the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

ANS: C,E The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau sign is a test for hypocalcemia

A nurse is caring for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. What actions does the nurse take? (Select all that apply.) a. Administer levothyroxine. b. Administer propranolol. c. Monitor the apical pulse. d. Assess for Trousseau sign. e. Initiate telemetry monitoring.

ANS: A The client with SIADH usually has a fluid restriction, not an increase in fluids. It is the role of the RN rather than AP to perform assessments and provide health teaching. The AP needs to weigh the client daily and report a significant weight changes.

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel. What statement by the AP indicates understanding of this client's care? a. "I will weigh the client carefully before breakfast and compare with yesterday's weight." b. "I will encourage plenty of fluids to promote urination and prevent dehydration." c. "I will teach the client not to select high-sodium or salty foods on the menu." d. "I will assess the client's mucous membranes and skin for signs of dehydration."

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?" How would the nurse respond? a. "Glucose is the only fuel used by the body to produce the energy that it needs." b. "Your brain needs a constant supply of glucose because it cannot store it." c. "Without a minimum level of glucose, your body does not make red blood cells." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client's plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the patient. d. Assist the client to dangle before rising.

ANS: A Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this patient.

A nurse plans care for a client with hyperparathyroidism. Which intervention does the nurse include in this client's plan of care? a. Use a lift sheet to assist the client with position changes in bed. b. Ask the client to ambulate in the hallway twice a day. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the assistive personnel to strain the patient's urine for stones.

ANS: C Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client's family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the patient's environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

A nurse plans care for a client with hypothyroidism. Which priority problem does the nurse address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL (4.2 mmol/L) • Postprandial blood glucose: 200 mg/dL (11.1 mmol/L) • Hemoglobin A1C level: 5.5% How would the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance

ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately? a. Serum chloride level of 98 mEq/L (98 mmol/L) b. Serum calcium level of 8.8 mg/dL (2.2 mmol/L) c. Serum sodium level of 132 mEq (132 mmol/L) d. Serum potassium level of 2.5 mEq/L (2.5 mmol/L)

ANS: D A client is diagnosed with diabetes if the client's A1C is 6.5% or greater. All listed values are below that level except for 7.4%.

A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1C value would the nurse expect? a. 5.0% b. 5.7% c. 6.2% d. 7.4%

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes. Preventing hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." b. "Restrict your fluid intake to no more than 2 L a day." c. "Prevent hypoglycemia by eating a bedtime snack." d. "Limit your intake of protein to prevent ketoacidosis."

ANS: A,C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client would be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client would be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the primary health care provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." b. "Soak your feet in a tub each evening." c. "Trim toenails straight across with a nail clipper." d. "Treat any blisters or sores with Epsom salts." e. "Wash your feet every other day."

ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.

A nurse teaches a client with diabetes mellitus about sick-day management. Which statement would the nurse include in this client's teaching? a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." b. "Monitor your blood glucose levels at least every 4 hours while sick." c. "If vomiting, do not use insulin or take your oral antidiabetic agent." d. "Try to continue your prescribed exercise regimen even if you are sick."

ANS: D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client's teaching to prevent injury? a. "Examine your feet using a mirror every day." b. "Rotate your insulin injection sites every week." c. "Check your blood glucose level before each meal." d. "Use a bath thermometer to test the water temperature."

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for patients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 g of carbohydrates each day.

A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client's teaching to decrease the client's insulin needs? a. "Limit your fluid intake to 2 L a day." b. "Animal organ meat is high in insulin." c. "Limit your carbohydrate intake to 80 g a day." d. "Walk at a moderate pace for 1 mile daily."

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client's teaching? a. "Change positions slowly when you get out of bed." b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." c. "If you miss a dose of this drug, you can double the next dose." d. "Discontinue the medication if you develop a urinary infection."

ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including the lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess blood away from the strip or wear gloves.

A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this client's teaching to prevent bloodborne infections? a. "Wash your hands after completing each test." b. "Do not share your monitoring equipment." c. "Blot excess blood from the strip with a cotton ball." d. "Use gloves when monitoring your blood glucose."

ANS: B An older female with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse would encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

A nurse teaches an older woman who has a decreased production of estrogen. Which statement would the nurse include in this client's teaching to decrease injury? a. "Drink at least 2 quarts (2 L) of fluids each day." b. "Walk around the neighborhood for daily exercise." c. "Bathe your perineal area twice a day." d. "You should check your blood glucose before meals."

Hyperthyroidism

A person is at risk for Graves' disease with what

anaerobic respiration

Not enough oxygen =

Kidney disease

At risk for what with diabetes

Diabetic Ketoacidosis (DKA)

Absence of insulin

Life threatening

Acute adrenocortical insufficiency is

Adrenal gland hypofunction

Adrenal cortex production of steroid hormone may decrease as a result of inadequate secretion of ACTH, dysfunction of the hypothalamic-pituitary control mechanism, or direct problems of adrenal gland tissue

Hyperthyroidism

Affects protein, fat and glucose metabolism

A. "I will not eat any fatty foods 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 fatty foods while collecting urine for a 24-hour urine test to evaluate a hormone level. Eating fatty foods does not interfere with collection or testing of the urine sample. The other statements indicate correct understanding of the client's actions for collection of an accurate 24-hour urine specimen.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? A. "I will not eat any fatty foods when I am collecting urine for this test." B. "To end the collection, I must empty my bladder and add this urine to the collection." C. "I need to keep the urine container cool in a separate refrigerator or cooler." D. "I won't save the first urine sample of the day."

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

After teaching a client who has diabetes mellitus with retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise."

C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen."

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.

After teaching a client who is recovering from an endoscopic transsphenoidal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will wear dark glasses to prevent sun exposure." b. "I'll keep food on upper shelves so I do not have to bend over." c. "I must wash the incision with saline and redress it daily." d. "I should cough and deep breathe every 2 hours while I am awake."

ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Antirejection drugs cause immunosuppression, and the patient should avoid crowds and people who are ill. Changing the routine of antirejection medications may cause them to not work optimally.

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "If I develop an infection, I should stop taking my corticosteroid." b. "If I have pain over the transplant site, I will call the surgeon immediately." c. "I should avoid people who are ill or who have an infection." d. "I should take my cyclosporine exactly the way I was taught."

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.

After teaching a client with acromegaly who is scheduled for an open transsphenoidal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I will no longer need to limit my fluid intake after surgery." b. "I am glad no visible incision will result from this surgery." c. "I hope I can go back to wearing size 8 shoes instead of size 12." d. "I will wear slip-on shoes after surgery to limit bending over."

ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "The lower abdomen is the best location because it is closest to the pancreas." b. "I can reach my thigh the best, so I will use the different areas of my thighs." c. "By rotating the sites in one area, my chance of having a reaction is decreased." d. "Changing injection sites from the thigh to the arm will change absorption rates."

ANS: D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client's blood glucose levels causing hypoglycemia. The medication should be taken before meals instead of during meals.

After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client's understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy? a. "I'll take this medicine during each of my meals." b. "I must take this medicine in the morning when I wake." c. "I will take this medicine before I go to bed." d. "I will take this medicine immediately before I eat."

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "I will see the eye doctor when I have a vision problem and yearly after age 40." c. "My vision will change quickly. I should see the ophthalmologist twice a year." d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

Graves' disease

Autoimmune disorder resulting from Hashimoto's thyroiditis

Tumor

Primary neutrogenic is a

Hypoglycemia

Cool, clammy, diaphoretic are signs of

Growth hormone

Back and joint pain, change in size, headache and vision change, glucose testing are side effects of

Glucagon

Breaks down glycogen into glucose and puts it back into the blood stream

Insulin

Brings glucose into the cell for energy

Exopthalmos

Bulging eyes

Hypoparathyroidism

Decreased function of parathyroid gland; serum calcium levels cannot be maintained

hyperpituitarism

Hormone oversecretion that occurs with anterior pituitary tumors or tissue hyperplasia

Hyperthyroidism

Causes hypermetabolism and increased sympathetic nervous system activity

DKA

Check urine output with

B

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? A. Prolactin and prolactin inhibiting hormone (PIH) B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) C. Growth hormone (GH) and melanocyte-stimulating hormone (MSH) D. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

diabetes mellitus

Common, chronic complex disorder of impaired nutrient metabolism (especially glucose)

Hypothyroidism

Constipation, cold intolerance are a sign of

Secondary

Decreased or near normal levels in _ hypothyroidism

Hypopituitarism

Deficiencies of ACTH and TSH are most life threatening with

type 1 diabetes mellitus

Destruction of beta cells that make insulin

Hashimoto's thyroiditis, thyroid surgery, RAI treatment of hyperthyroidism

Etiology of hypothyroidism (3)

Polydipsia

Excess drinking

Polyphasia

Excess eating

diabetes insipidus

Excretion of large amount of dilute urine

Hyperthyroidism

Exopthalmos, eyelid retraction, globe lag are signs of

Kussmaul respirations

Fast and shallow sounds, fruity smelling breath

D

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? A. Dry lips and oral mucosa on examination B. Nasal drainage that tests negative for glucose C. Urine specific gravity of 1.016 D. Client report of a headache and stiff neck

A

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? A. Chest pain B. Constipation C. Headache D. Increased sleepiness

B

For which client will the nurse question the prescription for long-term androgen therapy? A. A 40 year old who also has syndrome of inappropriate antidiuretic hormone (SIADH). B. A 52 year old with a history of prostate cancer treatment. C. A 30 year old who is taking antiviral therapy for HIV disease. D. A 66 year old with impotence that is resistant to standard erectile dysfunction therapy.

D

For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider? A. Calf muscle cramping B. Runny nose C. Anorexia D. Hand tremors

A,C,D, F

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) Select all that apply. A. Decreased urine output B. Hypotension C. Weigh gain of more than 2.2 lb (1 kg) in 24 hours D. Persistent headache E. Hyperglycemia F. Acute confusion

Hypothyroidism

High TSH in primary _?

2

How many times is an A1C done for a diabetic yearly

B

How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%? A. The values indicate that the client has poorly managed his or her disease. B. The values indicate that the client has managed his or her disease well. C. The client's glucose control for the past 24 hours has been good but the overall control is poor. D. The client's glucose control for the past 24 hours has been poor but the overall control is good.

A

How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible? A. "You can have a beer with a meal if you test yourself for hypoglycemia an hour later." B. "You can have a beer with a meal if you test yourself for hyperglycemia an hour later." C. "There are nonalcoholic beers available that you can substitute for a regular beer." D. "If you gave up dessert, you can still have one beer."

Short acting

Humulin is

Kussmaul respirations

In DKA you will see which type of respirations

B

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? A. High carbohydrate, low potassium, and fluid restriction B. Low carbohydrate, high calorie, and low sodium C. Low protein, high carbohydrate, and low calcium D. High protein, high carbohydrate, and low potassium

hyperparathyroidism

Increase in parathyroid hormone, hypercalcemia, hypophosphatemia

Thyroiditis

Inflammation of thyroid gland. Dysphasia and painless thyroid enlargement

Hyperglycemic Hyperosmolar State (HHS)

Insulin deficiency and severe dehydration

Nephrogenic

Kidney problem, kidney doesn't respond to ADH

Hypopituitarism

Laboratory assessment measures effects of hormones rather than actual hormone levels wirh

Long acting

Lantus is

hyperpituitarism

May be caused any a benign tumor

silent myocardial infarction

May not feel what due to chronic hyperglycemia

Resistance

Metabolic syndrome leads to insulin _

<100 is normal with fasting

Normal FBG

Glucose

Necessary for the brain to function

Acromegaly

Overproduction of GH in adults

Thyroid storm

Patient may have to have a partial or total thyroidectomy with

Macro vascular complications

Poor perfusion, tissue ischemia is a complication pertaining to

Adrenal gland hypofunction

Prevent hypoglycemia with

Amylin

Secreted with insulin to slow the rate or glucose travel to small intestine for absorption into the bloodstream

Prolactin levels

Sexual function difficulty, menstrual changes, decreased libido or impotence are side effects of

Hypothyroidism

Sleeping 14-16 hours daily is a sign of

ANS: A The client who has acromegaly has an excess of growth hormone as an adult and therefore has a large musculoskeletal structure that is readily observed.

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe? a. Large hands and face b. Thin, dry skin c. Short height d. Truncal obesity

ANS: D Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland.

The nurse assesses a client who is scheduled to have a laboratory test to determine if the client's adrenal glands are hypoactive. What type of testing would the client likely have? a. Catecholamine testing b. Suppression testing c. Bone marrow testing d. Provocative testing

ANS: A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension

ANS: C As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production. This change, in addition to less body fluid being present as one ages, can cause dehydration. Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age-related change; osteoarthritis causes pr imarily by aging.

The nurse assesses an older client. What age-related physiologic changes would the nurse expect? a. Heat intolerance b. Rheumatoid arthritis c. Dehydration d. Increased appetite

A

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." B. A 30 year old with type 1 diabetes who is reporting thirst. C. A 40 year old with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L). D. A 50 year old with type 2 diabetes with a blood pressure of 150/90 mm Hg.

D

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 42 year old with diabetes insipidus who has a dose of desmopressin due. B. A 35 year old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). C. A 50 year old with pituitary adenoma who is reporting a severe headache. D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

C

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 50 year old taking repaglinide who has nausea and back pain. B. A 55 year old taking pioglitazone who has bilateral ankle swelling. C. A 45 year old taking metformin who has abdominal cramps. D. A 40 year old taking glyburide who is dizzy and sweaty.

ANS: C The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.

The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition? a. Hypotension b. Hyperthyroidism c. Abdominal obesity d. Hypoglycemia

ANS: B,F The client who has hypoglycemia is often anxious, nervous, and possibly confused. Due to lack of glucose, vision may be blurred or the client may report diplopia (double vision). Clients who have hyperglycemia from diabetes mellitus type 1 have warm skin, Kussmaul respirations that are rapid and deep, dehydration due to elevated blood glucose, and ketoacidosis.

The nurse is caring for a client who has diabetes mellitus type 1 and is experiencing hypoglycemia. Which assessment findings will the nurse expect? (Select all that apply.) a. Warm, dry skin b. Nervousness c. Rapid deep respirations d. Dehydration e. Ketoacidosis f. Blurred vision

ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the patient at 2000 and 2300 would be too late. The nurse would check the patient at 1600 (4:00 p.m.).

The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin? a. 8:00 a.m. (0800) b. 4:00 p.m. (1600) c. 8:00 p.m. (2000) d. 11:00 p.m. (2300)

ANS: A, B, C, D, F All of these factors place a client at risk for hypothyroidism except for laryngitis which is an inflammation of the larynx.

The nurse is caring for a client who has possible hypothyroidism. What possible risk factors can cause this health problem? (Select all that apply.) a. Lithium drug therapy b. Thyroid cancer c. Autoimmune thyroid disease d. Iodine deficiency e. Laryngitis f. Pituitary tumors

ANS: A, B, C, D The client who has severe hypoglycemia often has a blood sugar of less than 20 mg/dL (1.0 mmol/L) and may be unconscious or seizing. Therefore, the client cannot swallow and needs glucagon. To keep the client safe during the seizure, the nurse ensures that the side rails are up to prevent the client from falling out of bed. The nurse would also monitor the client's blood sugar to evaluate the effectiveness of the interventions.

The nurse is caring for a client who has severe hypoglycemia and is experiencing a seizure. What actions will the nurse take at this time? (Select all that apply.) a. Administer glucagon 1 mg subcutaneously. b. Be sure the bed side rails are in the up position. c. Notify the primary health care provider immediately. d. Monitor the client's blood glucose level. e. Increase the intravenous infusion rate immediately.

ANS: C The client who has DI has fluid loss through excessive urination. Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature. Pulmonary embolism (PE) could possible as a clot in the lower extremity (caused by dehydration) could fragment and travel to the lungs.

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor? a. Hypertension b. Bradycardia c. Dehydration d. Pulmonary embolus

ANS: B If the client's urine turns dark and/or the skin has a yellow appearance, the client may have possible liver toxicity from the drug. This is a serious adverse effect and needs to be reported to the primary health care provider after stopping the drug. If weight gain and cold intolerance occurs, then the client may need a lower dose of the drug. The drug should not cause GI distress or a metallic taste in his or her mouth.

The nurse is caring for a client who is starting on propylthiouracil for hyperthyroidism. What statement by the client indicates a need for further teaching? a. "I will let my provider know if I have weight gain and cold intolerance." b. "I will let my provider know if I have a metallic taste or stomach upset." c. "I will avoid crowds and other people who have infection." d. "I am aware that if the drug changes the color of my urine, I should stop it."

ANS: D Bromocriptine should be started on a low dose and taken with food. The drug can cause decreased blood pressure, including orthostatic hypotension. Serious effects such as cardiac dysrhythmias, coronary artery spasms, and cerebrospinal leak can occur Therefore, the nurse teaches the client should seek medical attention if he or she experiences chest pain, dizziness, and watery nasal discharge.

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include? a. "Take this drug on an empty stomach first thing in the morning." b. "You will be starting on a high dose of the drug to ensure it will work." c. "You might experience an increase in blood pressure in about a week." d. "Seek medical attention immediately if you have chest pain and dizziness."

ANS: D The client who has adrenal insufficiency has hyperkalemia that can cause cardiac dysrhythmias. Therefore, the nurse would monitor the client's cardiovascular status through frequent assessments.

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform? a. Respiratory assessment b. Skin assessment c. Neurologic assessment d. Cardiac assessment

ANS: C The first priority in caring for a client with HHS is to increase blood volume to prevent shock or severe hypotension from dehydration. The nurse would monitor vital signs, urinary output, and blood glucose to determine if interventions were effective. Regular insulin is also indicated but not as the first priority action.

The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic-hyperosmolar state (HHS). What is the nurse's priority action at this time? a. Assess the client's blood glucose level. b. Monitor the client's urinary output every hour. c. Establish intravenous access to provide fluids. d. Give regular insulin per agency policy.

ANS: D The client most likely has diabetes mellitus type 2 and has a high blood glucose causing increased blood osmolarity and dehydration, as evidenced by an insufficient urinary output and increased BUN. Older adults are at the greatest risk for dehydration due to age-related physiologic changes.

The nurse is caring for a newly admitted older adult who has a blood glucose of 300 mg/dL (16.7 mmol/L), a urine output of 185 mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44 mg/dL (15.7 mmol/L). What diabetic complication does the nurse suspect? a. Diabetic ketoacidosis (DKA) b. Severe hypoglycemia c. Chronic kidney disease (CKD) d. Hyperglycemic-hyperosmolar state (HHS)

ANS: B Levothyroxine is a replacement hormone for clients who have hypothyroidism and is taken orally for life. Vital signs do not have to be checked every day, but the client should report any chest pain and dyspnea when first starting the drug.

The nurse is planning health teaching for a client starting on levothyroxine. What health teaching about this drug would the nurse include? a. The need to take the drug when the client feels fatigued and weak. b. The need to report chest pain and dyspnea when starting the drug. c. The need to check blood pressure and pulse every day. d. The need to rotate injection sites when giving self the drug.

ANS: A Acarbose is an alpha-glucosidase inhibitor that works in the intestinal tract to prevent enzymes from breaking down starches into glucose. However, it must be taken with food at each meal, usually 3 times a day, to allow the drug to work as intended.

The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching? a. "Be sure to take the drug with each meal." b. "Take the drug every evening before bedtime." c. "Take the drug on an empty stomach in the morning." d. "Decide on the best day of the week to take the drug."

ANS: C Exenatide ER is an incretin mimetic (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion, reducing liver glucose production, and delaying gastric emptying. As an extended-release drug, it is given only once a week by injection.

The nurse is planning teaching for a client who is starting exenatide extended release (ER) for diabetes mellitus type 2. Which statement will the nurse include in the teaching? a. "Be sure to take the drug once a day before breakfast." b. "Take the drug every evening before bedtime." c. "Give your drug injection the same day every week." d. "Take the drug with dinner at the same time each day."

ANS: C Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and death.

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor? a. Increased intracranial pressure b. Myocardial infarction c. Rapid-onset hypernatremia d. Bowel perforation

ANS: C Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume. Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure. Magnesium and sodium are electrolytes and not hormones

The nurse is teaching assistive personnel (AP) about hormones that are produced by the adrenal glands. Which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition? a. Sodium b. Magnesium c. Aldosterone d. Renin

ANS: D Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.

The nurse reviews the function of thyroid gland hormones. What is the primary function of calcitonin? a. Sodium and potassium balance b. Magnesium balance c. Norepinephrine balance d. Calcium and phosphorus balance

D

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 is the nurse's best next action? A. Administering acetaminophen B. Observing for the presence of chills C. Initiating the Rapid Response Team D. Assessing cardiac status

Replacement of deficient hormones

Treatment for hypopituitarism

Hyperthyroidism

Thyrotoxicosis is

Hypoglycemia

Too much insulin, not enough sugar, or too little glucose

autoimmune disease

Type I diabetes is a

Cardiovadcular disease

Type II diabetics are at increased risk for this

<1.005

Urine specific gravity with diabetes insipidus

Diabetes insipidus

Water metabolism problem caused by an ADH deficiency or inability of kidneys to respond to ADH

Hyperthyroidism

Weight loss, increased appetite, heat intolerance, vision changes are signs of

A

What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot? A. "Make an appointment with your podiatrist as soon as possible." B. "Make an appointment with a pedicurist and have them cut or file off the callus." C. "Soak your feet nightly in warm water and peel of a little of the callus every day." D. "Apply an over-the-counter callus-dissolving pad and follow the package directions."

Abdominal obesity, hyperglycemia, hypertension, hyperlipidemia

What are the four metabolic factors that increase risk for type 2 diabetes

fluid and electrolyte balance, perfusion, acid base imbalance

What are the three complications of lack of insulin

Type one and two

What are the two types of diabetes

Hypoglycemia

What can mimic a stroke

B. Increased sodium; increased glucose Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? A. Decreased sodium; decreased glucose B. Increased sodium; increased glucose C. Increased sodium; decreased glucose D. Decreased sodium; increased glucose

Glucose

What is the main source of energy

B

What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet? A. Testing the sensory perception of the client's hands B. Examining both feet for indications of injury C. Explaining to the client that peripheral neuropathy is now present D. Documenting the finding as the only action

A

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? A. Ensuring the phlebotomist wears a facemask while in the client's room B. Asking the phlebotomist to delay the blood draw C. Monitoring the client closely for cold-like symptoms D. Placing a facemask on the client

C. "Can you please tell me more?" An open-ended question such as, "Can you please tell me more?," is a best first response because it allows the nurse to explore the client's feelings more thoroughly. Clients with endocrine disorders may report issues with infertility, impotence, and changes in sexual function.Telling a client not to worry or that something happens to many others is dismissive and therefore incorrect. Referring the client to a counselor is not an appropriate first step. This action does not allow for assessment of the issue nor allow him to express his concerns. Asking about drug use is not a good first question until the nurse or other health care provider knows more about how long the problem has been present and about the client's general health. Sexual difficulties may also be psychological, as well as be caused by a variety of physical changes.

What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."? A. Don't worry. It happens to everyone occasionally." B. "Do you use any over the counter or recreational drugs?" C. "Can you please tell me more?" D. "Would you like to speak with a counselor?"

D

What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty? A. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." B. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." C. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost." D. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.

C

What is the nurse's best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug? A. "Injected insulin works faster than oral drugs to lower blood glucose levels." B. "Oral insulin is so weak that it would require very high dosages to be effective." C. "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

C

What is the nurse's best response to a client with type 2 diabetes controlled with metformin who asks why now that he is recovering from surgery, is he prescribed to receive insulin therapy for a few days? A. "Your insurance doesn't permit metformin to be used during hospitalization." B. "Your presurgical testing indicates that you now have type 1 diabetes and require daily insulin." C. "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." D. "You must take insulin from now on because the surgery has aggravated the intensity of your diabetes."

B

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? A. "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." C. "I will tell your primary health care provider order a psychiatric consult for you." D. "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"

B

What is the nurse's best response when a client with diabetes who is being treated for hypoglycemic asks why people without diabetes don't become severely hypoglycemic even after fasting for 8 hours? A. In a person without diabetes, fasting for 8 hours converts proteins into glycose (gluconeogenesis) so that hypergycemia develops rather than hypoglycemia. B. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). C. Normal metabolism is so slow when a person without diabetes fasts that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur. D. Lipolysis (fat breakdown) in fat stores occurs faster in the nondiabetic person, which converts fatty acids into glucose to maintain blood glucose levels.

B

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? A. "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." C. "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." D. "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."

D

What is the nurse's best response when family members of a client with hyperthyroidism express concern about the client's frequent mood swings? A. "Do the client's mood swings make you feel angry?" B. "The medications will make the mood swings disappear completely." C. "Your family member is sick. You must be patient." D. "Mood swings are common should diminish with treatment."

ANS: A, C, E, F A client who has an underactive thyroid gland has a decreased metabolic rate, resulting in lethargy and lack of energy, weight gain, slowed speech, and decreased vital signs like a lowered body temperature. The client also typically has constipation (instead of diarrhea) due to slower peristalsis and bradycardia (instead of tachycardia).

When caring for an older client who has hypothyroidism, what assessment findings will the nurse expect? (Select all that apply.) a. Lethargy b. Diarrhea c. Low body temperature d. Tachycardia e. Slowed speech f. Weight gain

Low carb low calorie

What type of diet with disbetes

C

When (at which time) will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes received regular insulin at 7:00 a.m.? A. 7:30 a.m. B. 7:30 p.m. C. 11:00 a.m. D. 2:00 p.m.

ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don't know another way to manage the disease is dismissive of the client's concerns.

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How would the nurse respond? a. "I can give your injections to you while you are here in the hospital." b. "Everyone gets used to giving themselves injections. It really does not hurt." c. "Your disease will not be managed properly if you refuse to administer the shots." d. "Tell me what it is about the injections that are concerning you."

Hypothyroidism

When thyroid cells fail to produce sufficient levels of thyroid hormones

D

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. Administering morphine for pain B. Assessing the wound dressing for bleeding C. Hyperextending the neck D. Monitoring oxygen saturation

D

Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: 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? A. Administering oxygen B. Connecting a cardiac monitor C. Assessing arterial blood gas (ABG) values D. Assessing blood glucose level

A,D

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) A. Select all that apply. B. Bending at the waist C. Talking D. Deep breathing E. Coughing F. Wearing makeup G. Using dental floss

B

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? A. Urine output for the past 24 hours has increased. B. Client reports numbness and tingling around the mouth. C. Temperature is now elevated. D. pH is now 7.43.

A. Checking the client's blood glucose levels every 4 hours. Monitoring blood glucose is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.Assessing and teaching are actions that are within only the nurse's scope of practice. When IV insulin is given for a stimulation test, adverse reactions, especially hypoglycemia, are common and the client needs monitoring by a health care worker who knows exactly what the signs and symptoms are. Such a person must be either a registered nurse or an LPN/LVN.

Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)? A. Checking the client's blood glucose levels every 4 hours B. Monitoring the client's response to the IV insulin given during a stimulation test C. Teaching the client about a hormone suppression test D. Assessing the client for symptoms of hypopituitarism

C

Which action is appropriate for the nurse to delegate to the assistive personnel (AP) when caring for clients with diabetes? A. Monitoring a client who reports palpitations and anxiety B. Verifying the infusion rate on a continuous infusion insulin pump C. Performing a blood glucose check on a client who requires insulin D. Assessing a client who reports tremors and irritability

D. Encouraging fluids every 2 hours A decrease in ADH production in the older adult causes urine to be more dilute. In this instance, urine might not concentrate when fluid intake is low, allowing for excess water loss. Encouraging fluid intake every 2 hours, even during the night, is important to prevent dehydration.Weight-bearing activities are appropriate for older adults to prevent bone loss, not fluid loss. Development of foot or leg ulcers is not associated with changes in ADH production. Although a client with dehydration may be constipated, the problem is not the priority when ADH production is low.

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? A. Inspecting feet and legs for ulcers B. Planning for weight-bearing activities C. Stressing the important of fiber in the diet D. Encouraging fluids every 2 hours

D

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? A. Increasing the IV infusion rate B. Initiating the Rapid Response Team C. Assessing temperature D. Applying oxygen by mask

C

Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "dawn phenomenon" to achieve better control? A. Eat a bedtime snack containing equal amounts of protein and carbohydrates." B. Avoid eating any carbohydrate with your evening meal." C. Take your evening insulin dose right before going to bed instead of at supper time." D. Inject the insulin into your arm rather than into the abdomen around the navel."

C

Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed? A. Hypoactive bowel sounds B. Apical pulse of 92 beats/min C. Bilateral leg muscle twitching D. Dry mouth

D

Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys? A. White blood cells (WBCs) in the urine during a random urinalysis B. Ketone bodies in the urine during acidosis C. Glucose in the urine during hyperglycemia D. Protein in the urine during a random urinalysis

A

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? A. Urine output of 30 to 50 mL/hr B. Blood glucose level of 110 mg/dL (6.1 mmol/L) C. Respiratory rate of 20 breaths/min D. Potassium level of 3.9 mEq/L (mmol/L)

C

Which assessment is a priority for the nurse to make when a client with diabetic ketoacidosis (DKA) who is being monitored while receiving an insulin infusion begins to show an irregular heart beat with inverted T-waves? A. Rate of IV infusion B. Urine output C. Potassium level D. Breath sounds

A

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? A. Serum sodium increases from 122 mEq/L to 140 mEq/L. B. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. C. Serum chloride decreases from 109 mEq/L to 99 mEq/L. D. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.

C, D

Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone? (Select all that apply.) Select all that apply. A. Hypoglycemia B. Hyponatremia C. Hypokalemia D. Hypernatremia E. Hyperglycemia F. Hyperkalemia

D

Which changing trends in a client's serum laboratory values indicate to the nurse that thyroid hormone replacement therapy for hypothyroidism is effective? A. Declining thyroglobulin (Tg) levels; rising thyrotropin receptor antibody (TRAb) levels B. Declining thyroid hormone (TH) levels; rising thyroid-stimulating hormone (TSH) levels C. Rising thyroglobulin (Tg) levels; declining thyrotropin receptor antibody (TRAb) levels D. Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels

Secondary neurogenic

Which classification of diabetes insipidus has a physical effect on hypothalamus

A. Increased facial hair and absent menses in a 28-year-old nonpregnant woman Absence of menses when pregnancy is not present is considered abnormal, especially when accompanied by hirsutism. Possible endocrine problems associated with these changes include ovarian, adrenal gland, hypothalamic, or anterior pituitary dysfunction.Male-pattern baldness in a man is usually associated with a genetic predisposition. Dry skin is a normal finding in older women. An increased appetite when physical activity increases is also considered normal.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? A. Increased facial hair and absent menses in a 28-year-old nonpregnant woman B. Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago C. Male-pattern baldness in a 32-year-old man D. Dry skin on the shins of a 70-year-old woman

C

Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy? A. Loss of sensation in both feet B. Hyperglycemia C. Intermittent constipation D. Increased thirst

A

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

D

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? A. 5-lb weight loss B. Dry, cracked lips C. Thinning pubic hair D. Skin darkening

C

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? A. New-onset hypertension. B. The client reports extreme salt craving. C. No change in urine output with minimal fluid intake. D. The client's headache is gradually increasing in intensity.

D

Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management? A. Current energy level and rest patterns B. Sexual orientation C. Current lifestyle for diet and exercise D. Education and literacy levels

D. Cold environmental temperatures Cold and stress are two factors that cause the hypothalamus to secrete thyrotropin-releasing hormone (TRH), which then stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH) to increase production of the two major thyroid hormones.Constipation does not affect thyroid hormone production. Stress from inadequate sleep could increase TH production but adequate sleep does not. Protein-calorie malnutrition would decrease production of many hormones, including TH.

Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)? A. Getting 8 hours of sleep nightly B. Chronic constipation C. Protein-calorie malnutrition D. Cold environmental temperatures

C,D,E,F

Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) Select all that apply. A. Hypertonic saline B. Furosemide C. Calcium gluconate D. Oxygen E. Suction F. Emergency tracheotomy kit

C. 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, requiring immediate action to prevent increased intracranial pressure, seizures, and death as the intravascular fluid shifts into brain tissue. The most likely cause of the problem is an increased vasopressin level that is increasing water reabsorption and diluting the serum sodium level.Although all the other laboratory values are also out of the normal range, none are close to reaching a critically low or high value.

Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately? A. Blood glucose 148 mg/dL (7.4 mmol/L) B. Blood urea nitrogen (BUN) 40 mg/dL (14.3 mmol/L) C. Serum sodium 110 mEq/L (110 mmol/L) D. Serum potassium 3.2 mEq/L (3.2 mmol/L)

B. Glycosylated hemoglobin (HbA1c) The glycosylated hemoglobin (HbA1c) evaluates the average blood glucose level for 2 to 3 months; this is the best indicator of overall blood glucose control.Although fasting blood glucose can be used to monitor daily glucose control, it is not the best method to evaluate blood glucose over a period of time. A random blood glucose level reflects what the client has eaten within the last few hours and provides no real indication of long-term control. Fasting insulin levels are not used to evaluate anything.

Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months? A. Random blood glucose level B. Glycosylated hemoglobin (HbA1c) C. Fasting blood insulin level D. Fasting blood glucose level

A,D,E,F

Which new-onset symptoms will the nurse instruct a client with diabetes who is prescribed to take the sodium-glucose cotransport inhibitor, empagliflozin, to report to the diabetes health care provider to prevent harm? (Select all that apply.) Select all that apply. A. Muscle weakness and dizziness on standing B. Redness and tenderness at the injection site C. Rapid weight gain and shortness of breath D. Redness and tenderness of the perineum E. Sensations of hunger, tremors, sweating, and confusion F. Pain and burning on urination

B

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm? A. "Check your hands and feet weekly for chronic excessive sweating." B. "Change positions slowly when moving from sitting to standing." C. "Avoid drinking caffeine or caffeinated beverages." D. "Be sure to take your blood pressure drug daily."

C

Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)? A. "Increase the amount of fiber in your diet to prevent the side effect of constipation." B "Stop this drug immediately if you discover you are pregnant." C. "Avoid over-the-counter medications unless prescribed by your primary health care provider." D. "If you miss a dose, double your next day's dose."

D

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? A. Administering an infusion of 150 mL hypertonic saline over the next 3 hours B. Drawing blood for hemoglobin and hematocrit levels C. Measuring serial weights at the same daily with the client wearing the same amount of clothing D. Inserting an indwelling catheter and monitoring urine output

D

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? A. "Do you think if I lost weight my sleep apnea would improve?" B. "Why do I feel thirsty all the time?" C. "How can I make my skin less itchy?" D. "Does everyone's feet get bigger during menopause?"

D

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? A. "Are you experiencing any pain during sexual intercourse?" B. "Do you work with or have hobbies that involve exposure to chemicals?" C. "Have you gained or lost any weight recently?" D. "How often do you need to shave your face?"

A,B,D,E

Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) Select all that apply. A. Elevated temperature B. Tachycardia C. Somnolence D. Elevated systolic blood pressure E. Abdominal pain and nausea F. Slow respiratory rate

B,D,F

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) Select all that apply. A. Goiter B. Nonpitting edema of hands and feet C. Warm, moist skin D. Decreased deep tendon reflexes E. Agitation and inability to sleep F. Pulse rate below 60 beats/min

B

Which specific action is a priority for the nurse to teach a client with diabetes who has peripheral neuropathy to prevent harm? A. "Wear a medical alert bracelet." B. "Never go barefoot." C. "Never reuse insulin syringes." D. "Drink at least 3 L of fluids daily."

A

Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur? A. "I will eat three graham crackers." B. "I will drink a glass of water." C. "I will sit down and rest." D. "I will give myself a dose of glucagon."

A

Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed? A. "If I continue to lose weight, I may need an increased dose." B. "I will have more energy with this medication." C. "If I often am constipated and feel tired, I may need an increased dose." D. "I will take the medication every morning."

A

Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation? A. "The abdominal site is best because it is closest to the pancreas." B. "I can reach my thigh best, so I will use different areas of the same thigh." C. "If I change my injection site from the thigh to an arm, the inulin absorption may be different." D. "By rotating sites within one area, my chance of having skin changes is less."

C

Which statement made by a client who is undergoing therapy with radioactive iodine (RAI) for Graves disease indicates a lack of understanding about the disorder and its treatment? A. "Luckily, I have my own bathroom, so I won't be exposing the rest of my family to radiation. B. "If this treatment works, maybe I will stop sweating all the time. C. "It will be great to lose my "bug-eyed" appearance. D. "I hope I don't gain too much weight when my thyroid function is normal.

B

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? A. "I seem to feel the heat more than other people." B. "I am always tired, even when I get 10 or 12 hours of sleep." C. "Food just doesn't taste good without a lot of salt." D. "My grandmother had thyroid problems."

B

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? A. "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." B. "I will keep the cat food bowl on my counter so that I do not have to bend over." C. "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." D. "If the dressing gets wet, I will wash the incision line and redress it immediately."

B,C,D

Which statements regarding hyperthyroidism are accurate? (Select all that apply.) Select all that apply. A. Has a sudden onset of symptoms. B. Is much more common among women than among men. C. Produces symptoms of a hypermetabolic state. D. Most common form is Graves disease. E. Can be diagnosed by the presence of a goiter. F. Often occurs weeks after exposure to ionizing radiation.

A

Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism? A. Below normal calcium levels; above normal phosphorus levels B. Below normal calcium levels; below normal phosphorus levels C. Above normal calcium levels; above normal phosphorus levels D. Above normal calcium levels; below normal phosphorus levels

Type one

Which type loses a lot of weight initially

Type 1

Which type of diabetes has a Childhood onset, insulin dependent. Makes 0 insulin

Type 2

Which type of diabetes is obesity and depends on lifestyle

C

Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism? A. Antipyretics B. Opioid analgesics C. Furosemide diuretics D. Calcium supplements

Type 2

Which type would have sores on feet

Type 1

Which type would have unexplained weight loss

ANS: A A temperature increase of 1° F (5/9° C) may indicate the development of thyroid storm, and the primary health care provider or RRT needs to be notified. But before notifying the provider, the nurse should first take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and acetaminophen is not needed because the temperature increase is due to thyroid activity.

While assessing a client with Graves disease, the nurse notes that the client's temperature has risen 1° F (1° C). What does the nurse do first? a. Turn the lights down and shut the patient's door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client's apical-radial pulse deficit. d. Administer a dose of acetaminophen.

Native American Indians, African Americans, Hispanic/Latino, obese, hypertensive, hyperlipidemic, Pacific Islander, older adult, hx of gestational diabetes

Who is at risk to develop type 2 diabetes

Women 30-60

Who is most at risk for hypothyroidism

B

Why is a goiter often present in clients who have Graves disease? A. The low circulating levels of thyroid hormones stimulates the feedback system and triggers the anterior pituitary gland to secrete more thyroid-stimulating hormone, which increases the numbers and size of glandular cells in the thyroid gland. B. The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. C. The autoantibodies stimulate blood vessel growth and blood storage within the thyroid gland, increasing its overall size. D. The autoantibodies stimulate the inflammatory and immune responses to increase the number of white blood cells circulating in the thyroid gland, which increases tissue size without increasing the number of glandular cells.

B

With which client will the nurse be aware of an increased risk for hypoparathyroidism? A. A 28-year-old woman with pregnancy-induced hypertension B. A 35-year-old woman who had radiation therapy for Graves disease C. A 50-year-old man starting on insulin therapy for type 2 diabetes mellitus D. A 55-year-old man with moderate heart failure after myocardial infarction

Hypothyroidism

Women are 7 times more affected than men with

Hyperpituitarism

acromegaly is caused by

Polyuria

excessive urination

Hypopituitarism

deficiency of one or more pituitary hormones

GH

high blood glucose can suppress

Hypothyroid crisis

myxedema coma is

Below 5.7

normal A1C

30mL/hr

normal urine output