Exam5 Practice Questions=====Endocrine

A nurse is teaching a client who has diabetes about which dietary source should provide the greatest percentage of calories. Which of the following statements indicates the client understands the teaching? "Most of my calories each day should be from fats." "I should eat more calories from complex carbohydrates than anything else." "Simple sugars are needed more than other calorie sources." "Protein should be my main source of calories."

"I should eat more calories from complex carbohydrates than anything else." Rationale: The client who has diabetes should consume the majority of calories from complex carbohydrates, such as whole grains, fruits, and vegetables.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? "Have an eye examination once per year." "Examine your feet carefully every day." "Wear compression stockings daily." "Maintain stable blood glucose levels."

"Maintain stable blood glucose levels." Rationale: Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.

A nurse is contributing to the plan of care for a client who is scheduled to receieve TPN. Which of the following actions should the nurse recommend including in the plan?

-Weigh the client daily -Obtain a serum blood glucose q4h -Change IV tubing q24h

A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider? Glucocorticoid medications Dextrose 5% in 0.45% sodium chloride Oral hypoglycemic medications 0.9% sodium chloride IV bolus

0.9% sodium chloride IV bolus Rationale: The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100

0820

A nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the laboratory results drawn on the client and notes that the calcium level is extremely low. The nurse would expect to note which of the following on data collection of the client? 1. Positive Trousseau's sign 2. Negative Chvostek's sign 3. Unresponsive pupils 4. Hyperactive bowel sounds

1. Positive Trousseau's sign rationale Hypoparathyroidism is related to a lack of parathyroid hormone secretion or to a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit positive Chvostek's and Trousseau's signs, which indicate potential tetany. Options 2, 3, and 4 are not related to the presence of hypocalcemia.

A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. A priority nursing measure to be included in the plan regarding this medication is to monitor the client for: Signs and symptoms of hypothyroidism Signs and symptoms of hyperglycemia Relief of pain Signs of renal toxicity

1. Signs and symptoms of hypothyroidism rationale Excessive dosing with propylthiouracil may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which of the following items in the diet? 1. Vegetables 2. Meat 3. Fish 4. Cereals

1. Vegetables rationale The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals. Vegetables are allowed in the diet.

A nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide (Lasix). The nurse reinforces dietary instructions to the client. Which of the following is an appropriate instruction? Increase dietary intake of calcium. Drink at least 2 to 3 L of fluid daily. Eat sparely when experiencing nausea. Decrease dietary intake of potassium.

2. Drink at least 2 to 3 L of fluid daily. rationale The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term, "hyperparathyroidism" can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable.

A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse plans care and places highest priority on which potential problem? 1. Nervousness 2. Infection 3. Concern about appearance 4. Inability to care for self

2. Infection rationale The client with a stab wound has a break in the body's first line of defense against infection. The client with Cushing's disease is at great risk for infection because of excess cortisol secretion and subsequent impaired antibody function and decreased proliferation of lymphocytes. The client may also have a potential for the problems listed in the other options but these are not the highest priority at this time.

What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease? Provide a high-fiber diet. Provide a restful environment. Provide three small meals per day. Provide the client with extra blankets.

2. Provide a restful environment. rationale Because of the hypermetabolic state, the client with Graves' disease needs to be provided with an environment that is restful both physically and mentally. Six full meals a day that are well balanced and high in calories are required, because of the accelerated metabolic rate. Foods that increase peristalsis (e.g., high-fiber foods) need to be avoided. These clients suffer from heat intolerance and require a cool environment.

The nurse caring for a client who has had a subtotal thyroidectomy reviews the plan of care and determines which problem is the priority for this client in the immediate postoperative period? 1. Dehydration 2. Infection 3. Urinary retention 4. Bleeding

4. Bleeding rationale Hemorrhage is one of the most severe complications that can occur following thyroidectomy. The nurse must frequently check the neck dressing for bleeding and monitor vital signs to detect early signs of hemorrhage, which could lead to shock. T3 and T4 do not regulate fluid volumes in the body. Infection is a concern for any postoperative client but is not the priority in the immediate postoperative period. Urinary retention can occur in postoperative clients as a result of medication and anesthesia but is not the priority from the options provided.

Which clinical manifestation should the nurse expect to note when assessing a client with Addison's disease? Edema Obesity Hirsutism Hypotension

4. Hypotension rationale Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in options 1, 2, and 3 are not associated with Addison's disease.

A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? 6.3% 7.8% 8.5% 10%

6.3% Rationale: The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.

A nurse is reviewing the laboratory values for a client who has hyperglycemic hyperosmolar nonketotic syndrome. The nurse should expect that which of the following laboratory values is consistent with hyperglycemic hyperosmolar nonketotic syndrome? Blood glucose 320 mg/dL Positive urine ketones Blood pH 7.34 Blood osmolality greater than 350 mOsm/kg

A Blood glucose 320 mg/dL The client who has hyperglycemic hyperosmolar nonketotic syndrome should have a blood glucose level greater than 250 mg/dL which will cause spilling of ketones in the urine and development of metabolic acidosis

A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? Compensate for decrease in cortisol levels Inhibit glucose metabolism Act as a diuretic to maintain urine output Decrease susceptibility to infection

A Compensate for decrease in cortisol levels The client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. On of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loos of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which if untreated, is fatal.

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? A decrease in blood sugar A decrease in blood pressure A decrease in urine output A decrease in specific gravity

A decrease in urine output Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection? A needleless syringe and a doll A video game A story book about a child who has diabetes A period of play in the playroom

A needleless syringe and a doll Rationale: Playing with a needleless syringe and a doll is an appropriate therapeutic activity for the child, because they will allow the child to act out feelings of anger and helplessness.

A patent who is taking metformin (Glugophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast dye. The health care professional should recognize that an interaction between metformin and the IV contrast dye can increase the patients risk for which of the following: Hypokalemia Hyperglycemia Acute renal failure Acute pancreatitis

Acute renal failure

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? Hyperglycemia Adrenocortical insufficiency Severe dehydration Rebound pulmonary congestion

Adrenocortical insufficiency Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Urinate every 4 hr. Take the drug 2 hr after a meal.

Avoid drinking alcohol.

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings should indicate to the nurse that the client has hyperglycemia? Hunger Increased urination Cold, clammy skin Tremors

B. Increased urination Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements

Beta blockers

A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? Polyuria Dehydration Hyponatremia Hyperthermia

C Hyponatremia The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? Proteinuria Oliguria Polyuria Glycosuria

C Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity

A nurse is reinforcing teaching with a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? Sliced bananas Baked potatoes Turkey and cheese sandwich Plain yogurt and peaches

C Turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein

A nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect? Flaccid muscles Client report of numbness in his hands Negative Chvostek's sign Client report of anorexia

Client report of numbness in his hands Rationale: Numbness and tingling in the client's hands and feet are manifestations of hypoparathyroidism due to hypocalcemia.

A nurse is planning a community diabetes mellitus management program. Which of the following goals should the nurse include for the program? Proper foot care will be demonstrated to clients during the program. Clients will have a decreased incidence of foot amputations. A facility will be reserved for the program. Handouts and teaching materials will be distributed at the program.

Clients will have a decreased incidence of foot amputations. Rationale: A goal is the desired result toward which effort is directed. A reduced incidence of foot amputations is an appropriate, measurable, and realistic goal for a community diabetes management program.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? Dehydration Polyphagia Hyperglycemia Bradycardia

Dehydration Rationale: Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include? Draw up the NPH insulin into the syringe first. Inject air into the regular insulin first. Shake the NPH insulin until it is well mixed. Discard regular insulin that appears cloudy.

Discard regular insulin that appears cloudy .Rationale: The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should be clear. NPH insulin has a cloudy appearance.

A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? Perform vigorous exercise when blood glucose is less than 100 mg/dL. Do not exercise if ketones are present in your urine. Avoid eating for 2 hr before exercise. Examine your feet weekly.

Do not exercise if ketones are present in your urine. Rationale: The nurse should instruct the client not exercise if ketones are present in her urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia.

A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations? Sensitivity to cold Constipation Frequent mood changes Weight gain of 4.5 kg (10 lb) in 3 weeks

Frequent mood changes Rationale: Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulate the metabolic rate. Clients experience emotional lability that fluctuates between emotional hyperexcitability and irritability. They often cannot sit quietly.

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? Give the insulin at 0700. Give the insulin when the breakfast tray arrives. Give the insulin 30 min after breakfast with the client's other routine medicines. Give the insulin at 0730.

Give the insulin at 0730. Rationale: Regular insulin has an onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin.

A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide? "Glipizide absorbs the excess carbohydrates in your system." "Glipizide stimulates your pancreas to release insulin." "Glipizide replaces insulin that is not being produced by your pancreas." "Glipizide prevents your liver from destroying your insulin."

Glipizide stimulates your pancreas to release insulin." Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

A nurse is assisting with the care of a client who has Addison's disease and comes to the ED reporting nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should expect the provider to prescribe which of the following medications?

Hydrocortisone

A nurse is caring for a client who has type 2 DM and is displaying manifestations of hyperglycemia. Which of the following findings indicate that the client has hyperglycemia?

Increased urination

A nurse is caring for a client who is at 22 weeks of gestation and has been unable to control her gestational diabetes mellitus with diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client? Acarbose Repaglinide Insulin Glipizide

Insulin Rationale: Insulin is the first line of treatment for clients who are pregnant and are unable to maintain blood glucose levels within the recommended range. Unlike oral hyperglycemics, insulin does not cross the placenta and affect the fetus.

A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client? Radioactive iodine Levothyroxine Sumatriptan Levofloxacin

Levothyroxine Rationale: Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication.

A nurse is assisting with the plan of care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan?

Monitor the client's nighttime blood glucose levels

A nurse in an urgent care center is collecting data from an infant who has laryngotracheobronchitis. Which of the following findings should the nurse report to the provider as an indication of impending airway obstruction?

Nasal flaring

A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? Administer glucagon for hyperglycemia. Obtain an influenza vaccine annually. Inject insulin in the deltoid muscle. Take glyburide with breakfast.

Obtain an influenza vaccine annually. Rationale: The client should obtain an influenza vaccine annually.

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate? Hypernatremia Oliguria Weight loss Increased thirst

Oliguria Rationale: The nurse should expect a client who has developed SIADH following a craniotomy to manifest oliguria. The decrease in urine output can be dramatic with output less than 20 mL/hr.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? Cimetidine Dextromethorphan Prednisone Atorvastatin

Prednisone Rationale: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis? Provide a quiet, low-stimulus environment. Administer aspirin as prescribed for any sign of hyperthermia. Keep the client NPO. Observe the client carefully for signs of hypocalcemia.

Provide a quiet, low-stimulus environment. Rationale: Thyroid crisis can occur in response to a stressor, so the nurse should minimize stressful stimuli in the client's environment.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? NPH insulin Insulin glargine Insulin detemir Regular insulin

Regular insulin Rationale: Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate? Maintain an IV of 0.45% sodium chloride. Restrict fluid intake to 1,000 mL per day. Provide a diet containing 2 g of sodium per day. Administer desmopressin acetate 0.2 mg orally.

Restrict fluid intake to 1,000 mL per day. Rationale: Clients who have SIADH have an increased amount of antidiuretic hormone, which results in excess fluid volume. This excess fluid dilutes the sodium level in the blood, causing dilutional hyponatremia. Oral fluids are restricted in an attempt to restore the fluid balance and the sodium level in the blood. The nurse should offer this client frequent oral care to prevent discomfort and breakdown of the oral mucosa.

A nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which of the following herbal supplements? Saw palmetto Cranberry Soy Garlic

Soy Rationale: The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? Peripheral pulses Urine output Skin integrity Blood glucose

Urine output

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? Joint pain Constipation Weight gain Dilated pupils

Weight gain

A nurse is assisting a client who has hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to her diet? Ripe bananas Poached eggs Whole grains Baked chicken

Whole grains Rationale: Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber.