Med-Surg HESI EAQ - Endocrine

The nurse provides dietary education for a client with newly diagnosed diabetes. The instructions include a food exchange list. The nurse determines that the teaching was effective when the client states that, instead of asparagus, broccoli, and mushrooms, the client plans to eat which food items? 1. String beans, beets, and carrots 2. Corn, lima beans, and dried peas 3. Baked beans, potatoes, and parsnips 4. Corn muffins, corn chips, and pretzels

1. String beans, beets, and carrots String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, and parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, and pretzels are from the bread exchange list.

**A client experiences ineffective control of type 1 diabetes. The client's study results indicate that a sudden decrease in blood glucose level is followed by rebound hyperglycemia. When this event occurs, which action would the nurse take? 1. Give the client 8 oz of orange juice 2. Seek a prescription to increase the insulin dose at bedtime 3. Encourage the client to eat smaller, more frequent meals 4. Collaborate with the primary healthcare provider to alter the insulin prescription

4. Collaborate with the primary healthcare primary to alter the insulin prescription The client is experiencing the Somogyi effect. It is a paradoxical situation in which sudden decreases in blood glucose are followed by rebound hyperglycemia. The body responds to the hypoglycemia by secreting glucagon, epinephrine, growth hormone, and cortisol to counteract the low blood sugar; this results in an excessive increase in the blood glucose level. It most often occurs in response to hypoglycemia when asleep. The primary health care provider may choose to decrease the insulin dose and then reassess the client. Giving the client 8 oz (240 mL) of orange juice will further increase the serum glucose level and is contraindicated. Increasing the insulin dose at bedtime will further worsen the problem. Encouraging the client to eat smaller, more frequent meals will not address the hypoglycemia and rebound hyperglycemia that occurs when sleeping. However, a bedtime snack may help minimize this event.

Which interventions would the nurse implement in caring for a client with diabetes insipidus (DI) after a head injury? Select all that apply. 1. Provide adequate fluids within easy reach 2. Report an increasing urine specific gravity 3. Administer prescribed erythromycin 4. Assess for and report changes in neuro status 5. Monitor for constipation, weight loss, hypotension, and tachycardia

1, 4, 5 Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore, erythromycin would not be prescribed. The primary pharmacological treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).

A client with type 1 diabetes has dry, hot, flushed skin; a fruity odor to the breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? 1. Ketoacidosis 2. Somogyi phenomenon 3. Hypoglycemic reaction 4. Hyperosmolar nonketotic coma

1. Ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

**The nurse is giving discharge teaching instructions to a client with diabetes who had a total hypophysectomy. Which statement made by the client indicates that further teaching is necessary? 1. "There is a risk that I could become permanently sterile" 2. "My insulin dose will need to be increased from now on" 3. "I must have cortisone therapy for the rest of my life" 4. "Lifelong thyroxine replacement therapy will be requires"

2. "My insulin dose will need to be increased from now on" Surgical removal of the hypophysis (pituitary gland) will reduce follicle-stimulating (FSH), luteinizing (LH), adrenocorticotropic (ACTH), and thyroid-stimulating (TSH) hormone levels. Infertility would be expected because FSH and LH will no longer stimulate spermatogenesis or oogenesis. Without ACTH, cortisone administration will be required to avoid addisonian crisis. Without TSH, thyroxine replacement therapy will be necessary to avoid myxedema coma. In general, insulin release is regulated by blood glucose and not directly by the pituitary gland. Also, because somatotropin release by the pituitary stops after the hypophysectomy, it cannot cause a blood glucose level elevation, so there will be no need to increase the insulin dosage because of the surgery alone.

**The nurse teaches a client with type 1 diabetes how to best treat hypoglycemia. If the teaching is effective, which foods would the client identify to manage hypoglycemia? 1. Hard candy and fruit juice 2. Cheese sandwich and sugar 3. Chocolate candy and an orange 4. Peanut butter crackers and a glass of milk

2. Cheese sandwich and sugar The suggested treatment for hypoglycemia is to give a conscious client a simple sugar (e.g., two packets of sugar) followed by a complex carbohydrate (e.g., bread) and protein (e.g., cheese); the simple sugar elevates blood glucose rapidly; the complex carbohydrate and protein produce a more sustained response. Hard candy and fruit juice are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Chocolate candy and an orange are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Neither peanut butter crackers nor a glass of milk provide fast-acting sugars; peanut butter crackers and milk can maintain the glucose level after it has been raised.

Which finding in a client who has syndrome of inappropriate antidiuretic hormone (SIADH) is an expected finding? 1. Preservation of salt 2. Retention of water 3. Decrease of vasopressin 4. Presence of pedal edema

2. Retention of water SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules. There is hyponatremia and dilution of serum sodium in SIADH. Decreased vasopressin is seen in diabetes insipidus. Generally, pedal (dependent) edema is not seen in SIADH despite the water retention.

**A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication? 1. Chest pain 2. Tachycardia 3. Hypertension 4. Atrial fibrillation

3. Hypertension Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.

Which manifestations are exhibited with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? 1. Increased blood urea nitrogen (BUN) and hypotension 2. Hyperkalemia and poor skin turgor 3. Hyponatremia and decreased urine output 4. Polyuria and increased specific gravity of urine

3. Hyponatremia and decreased urine output Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

**The nurse reviews a client's medical record, specifically the client's skull radiograph results. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is noted on the report. The nurse recalls that which hormone release is most probably affected? 1. Glucagon 2. Cortisol 3. Aldosterone 4. Corticotropin

4. Corticotropin The pituitary gland is the endocrine gland that is situated in a bony depression of the sphenoid bone. Corticotropin or adrenocorticotropic hormones are secreted by the anterior pituitary and could be affected by an abnormality in the pituitary. Glucagon is a hormone that is secreted by the pancreas. Cortisol and aldosterone are hormones secreted by the adrenal cortex. There is less likelihood that the release of glucagon, cortisol, or aldosterone might be affected by a suspected abnormality in the pituitary gland.

**The provider has ordered endocrine testing for a client. Arrange the steps to be followed for the urine specimen collection in the correct sequence. 1. Note the time 2. Empty bladder and discard the urine 3. The timing for the urine collection begins after this specimen 4. Empty bladder at the end of the timed period and add urine to the collection

The procedure to collect urine specimen for endocrine testing involves serial specimens collected over a timed period and begins with emptying the bladder. The initial voiding specimen should be discarded. The client should then note the time at which the specimen is discarded and then begin to collect the urine specimens. At the end of the procedure the client should empty the bladder and add that specimen to the collection.

**After a craniotomy to remove a brain tumor, the client develops the syndrome of inappropriate antidiuretic hormone (SIADH). For which clinical indicators would the nurse monitor the client? Select all that apply. 1. Polyuria 2. Insomnia 3. Bradycardia 4. Increased weight 5. Decreased serum sodium 6. Decreased level of consciousness

4, 5, 6 As fluid is retained, the body weight will increase. One liter of fluid weighs 2.2 pounds (1 kilogram). Excess antidiuretic hormone (ADH) causes water retention, which leads to dilutional hyponatremia. Dilution of blood and hyponatremia cause a decreased level of consciousness. Water retention and decreased urinary output occur because of ADH excess. Urine output decreases to less than 20 mL/hour. This client will be lethargic, confused, or comatose, depending on the degree of hyponatremia. Tachycardia, not bradycardia, occurs in response to fluid volume excess associated with increased ADH.

Which eye problem is the leading cause of blindness in clients with diabetes? 1. Cataracts 2. Glaucoma 3. Retinopathy 4. Astigmatism

3. Retinopathy Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.

The nurse is caring for a client with type 2 diabetes mellitus and renal insufficiency. The client is scheduled for a computerized tomography (CT) scan with contrast. Which medication would the nurse withhold to prevent lactic acidosis? 1. Pioglitazone 2. Insulin 3. Glyburide 4. Metformin

4. Metformin The metformin would be held in clients with renal impairment, as this medication along with contrast dye can cause lactic acidosis. Pioglitazone, insulin, and glyburide do not cause lactic acidosis.

**Which condition would the nurse expect to see in the laboratory reports of a client who has Cushing syndrome? 1. Hypokalemia 2. Hypovolemia 3. Hypocalcemia 4. Hyponatremia

1. Hypokalemia With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

**The nurse suspects that a client has diabetes mellitus. Which statements made by the client helped the nurse reach this conclusion? Select all that apply. 1. "I am 65 years old" 2. "I quite often feel thirsty" 3. "I eat food every 2 hours" 4. "I have excessive sweating" 5. "I sometimes experience shortness of breath"

1, 2, 3 Diabetes mellitus is more common in older clients. Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism.

**The nurse is reviewing the electronic health record of a client admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication order would the nurse question? 1. Furosemide (Lasix) 2. Tolvaptan (Aquaretic) 3. IV 0.9% sodium chloride 4. Demeclocycline (Declomycin)

3. IV 0.9% sodium chloride IV 0.9% sodium chloride should be administered cautiously in clients with SIADH, as it can further potentiate fluid volume overload. Instead, a 3% sodium chloride is hypertonic and can be used to treat severe hyponatremia related to SIADH. Diuretics such as furosemide (Lasix) can be used to treat heart failure if the sodium level is normal. Tolvaptan (Aquaretic) and demeclocycline (Declomycin) are both medications used to treat SIADH.

**Which assessment finding differentiates central and nephrogenic diabetes insipidus? 1. Urine output 2. Specific gravity 3. Urine osmolarity 4. Serum osmolarity

3. Urine osmolarity Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus.

While assessing the health of a female client, the nurse suspects endocrine dysfunction. Which findings support the nurse's suspicion? Select all that apply. 1. Diminished pubic hair 2. Yellow-colored urine 3. Pulse of 74 bpm 4. Protrusion of eyeballs 5. Blood pressure of 172/80 mmHg

1, 4, 5 Diminished axillary and pubic hair, protruding eyeballs, and elevated blood pressure are signs of endocrine dysfunction. Yellow urine is a normal finding. The normal pulse rate ranges from 60 to 100 beats per minute.

**Which interventions would the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. 1. Provide frequent oral care 2. Institute fall risk precautions 3. Restrict fluids to 2 L per day 4. Place the client in high-Fowler position 5. Monitor for and report neurological changes

1, 2, 5 The excess production of antidiuretic hormone associated with SIADH leads to increased water reabsorption by the kidneys. Increased water reabsorption results in decreased urinary output, increased intravascular fluid volume, serum hypoosmolality, and dilutional hyponatremia. Because treatment includes restricting fluids, frequent oral care is provided to increase client comfort. Fall risk precautions are instituted to protect the client from injury that might occur as a result of neurological changes associated with declining serum sodium. The nurse monitors for and reports changes in neurological status resulting from cerebral edema and hyponatremia. Immediate treatment goals are to restore normal fluid balance and normal serum osmolality. Fluids are restricted to no more than 1000 mL and to no more than 500 mL for the client with severe hyponatremia. Treatment of SIADH includes placing the bed flat or elevating the head of the bed no more than 10 degrees. This position promotes venous return to the heart, which increases left ventricular filling pressure. Increasing left ventricular filling pressure stimulates osmoreceptors to send a message to the pituitary (via the hypothalamus) that antidiuretic hormone release should be decreased.

**The nurse is counseling a client with type 1 diabetes about choosing food items that are low in carbohydrate (CHO) content. Which food selection made by the client indicates effective teaching? 1. Skim milk 2. Apple juice 3. Nonfat yogurt 4. Fresh orange juice

1. Skim milk Skim milk contains about 12 g of CHO per cup. There are about 30 g CHO in 1 cup of apple juice. There are about 16 g CHO in 1 cup of nonfat yogurt. There are about 25 g CHO in 1 cup of orange juice.

**Which symptoms would be seen in a client with type 1 diabetes who is experiencing hypoglycemia? Select all that apply. 1. Vomiting 2. Headache 3. Tachycardia 4. Cool, clammy skin 5. Increased respirations

2, 3, 4 Headache is a neuroglycopenic response directly related to brain glucose deprivation. Tachycardia occurs with hypoglycemia because of a neurogenic adrenergic response; it is a sympathetic nervous system response precipitated by a low blood glucose level. Cool, clammy skin is a neurogenic cholinergic response; it is a sympathetic nervous system response precipitated by a low serum glucose level. Vomiting occurs with hyperglycemia because of the effects of metabolic acidosis. Increased respirations are a sign of hyperglycemia and are related to metabolic acidosis; this is a compensatory response in an attempt to blow off carbon dioxide and increase the pH level.

**An older adult who has an endocrine disorder is scheduled for a diagnostic study with contrast medium. The nurse identifies that it is essential for which laboratory test to be performed before the procedure? 1. Urine pH 2. Serum creatinine 3. Serum albumin 4. Creatinine clearance

2. Serum creatinine If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus the nurse would assess the client's renal function before the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help the nurse assess the client's risk of renal failure. A serum albumin test is performed if symptoms of liver disease or other liver problems are present; it is not routinely done before contrast medium tests. Creatinine clearance helps assess the glomerular filtration rate.

**A client is newly diagnosed with diabetes. The nurse would instruct the client to monitor for which indication of hypoglycemia? 1. Kussmaul respirations 2. Tachycardia 3. Confusion 4. Anorexia

3. Confusion The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Bradycardia is associated with hypoglycemia; tachycardia is not. Anorexia is associated with hyperglycemia.

While the nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." Which food would the nurse suggest to substitute for broccoli? 1. Peas 2. Corn 3. Green beans 4. Mashed potatoes

3. Green beans According to exchange lists for meal planning, green beans and broccoli are equivalent vegetable substitutes. Peas, corn, and mashed potatoes are all starches and are not equivalent vegetable substitutes for broccoli.

**Which lab finding will alert the nurse that aldosterone will be released in a client who has a history with an endocrine disorder? 1. Hypokalemia 2. Hypoglycemia 3. Hyponatremia 4. Hypochloremia

3. Hyponatremia Hyponatremia stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone.