NURS 2207 Endocrine EAQ Quiz (Graded)

Which classic sign will a nurse find in a client with Addison disease? 1. Ecchymosis 2. Hyperreflexia 3. Exopthalmos 4. Hyperpigmentation

ANS: 4 Hyperpigmentation Rationale: Hyperpigmentation, or "bronzing," is a classic sign of Addison disease. Ecchymosis (bruise) is the discoloration of the skin as a result of rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.

A client receiving corticosteroid therapy states, "I have difficulty controlling my temper, which is so unlike me, and I don't know why this is happening." How will the nurse respond? 1. Tell the client it is nothing to worry about. 2. Reassure that everyone does this at times. 3. Instruct the client to attempt to avoid situations that cause irritation. 4. Inquire about mood swings.

ANS: 4 Inquire about mood swings. Rationale: Corticosteroids increase the excitability of the central nervous system, which can cause labile emotions manifested as euphoria and excitability or depression. Telling the client it is nothing to worry about or that it is normal denies the value of the client's statement and offers false reassurance. The client has already stated the problem and does not know why this is happening. Instructing the client to attempt to avoid situations that cause irritation is impractical because the mood swings may occur without an overt cause.

An adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). A continuous insulin infusion is started. Which adverse reaction to the infusion is most important for the nurse to monitor? 1. Hypokalemia 2. Hypovolemia 3. Hypernatremia 4. Hypercalcemia

ANS: 1 Hypokalemia Rationale: Insulin moves potassium into the cells along with glucose, thus lowering the serum potassium level. Insulin does not lead to a reduced blood volume. Insulin does not directly alter the sodium levels. Insulin does not affect the calcium levels.

Which symptom would the nurse expect a client diagnosed with Cushing syndrome to exhibit? 1. Lability of mood 2. Postural hypotension 3. Increased skin thickness 4. Ectomorphism with a moon face

ANS: 1 Liability of mood Rationale: Excess adrenocorticoids can cause emotional lability, euphoria, and psychosis. Increased secretion of androgens results in hirsutism, hypertension, and hyperglycemia. Capillary fragility results in multiple ecchymotic areas, not skin thickness. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is not related to adaptations to Cushing syndrome.

Which body mechanism related to infectious processes is impaired as a result of Addison disease? 1. Stress response 2. Electrolyte balance 3. Metabolic processes 4. Respiratory function

ANS: 1 Stress response Rationale: Because of diminished glucocorticoid production, there is a decreased response to stress, reducing the ability to fight an infectious process. Hyponatremia and hyperkalemia occur in this disorder; however, these do not alter the defense against infection. Glucocorticoids are involved with metabolism; however, this does not directly affect susceptibility to infection. The respiratory system is not affected.

Hydrocortisone is prescribed for a client with Addison's disease. Which response is a therapeutic effect of this medication? 1. Supports a better response to stress 2. Promotes a decrease in blood pressure 3. Decreases episodes of shortness of breath 4. Controls an excessive loss of potassium

ANS: 1 Supports a better response to stress Rationale: Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus it enables the body to adapt to stress. It may promote fluid retention that results in hypertension and edema. Shortness of breath (dyspnea) is caused by hypovolemia and decreased oxygen supply; neither is affected by hydrocortisone. It may cause potassium depletion.

Which clinical sign would the nurse expect when assessing a school-age child with type 1 diabetes who is admitted with ketoacidosis? 1. Sweating 2. Hyperpnea 3. Bradycardia 4. Hypertension

ANS: 2 Hyperpnea Rationale: Deep, rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a compensatory mechanism associated with metabolic acidosis. Sweating is a physiological response to hypoglycemia. Tachycardia, not bradycardia, results from the hypovolemia caused by the polyuria associated with ketoacidosis. Hypotension, not hypertension, may result from the decreased vascular volume caused by the polyuria associated with ketoacidosis.

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

ANS: 3 Confusion Rationale: The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Tachycardia, not bradycardia, is associated with hypoglycemia. Anorexia is associated with hyperglycemia.

A client with Addison's disease is receiving cortisone therapy. Which complications would the nurse expect if the client abruptly stops the medication? Select all that apply. 1. Hypokalemia 2. Generalized edema 3. Shock 4. Alkalosis 5. Circulatory collapse

ANS: 3, 5 Rationale: An Addisonian (adrenal) crisis is triggered by an abrupt withdrawal from chronic corticosteroid therapy and can result in shock and circulatory collapse. Inadequate circulating corticosteroids result in excessive renal excretion of sodium and water, leading to hyponatremia, hyperkalemia, acidosis, cellular dehydration, and reduction of extracellular fluid volume.

Which symptom would the nurse assess in a client with a diagnosis of Addison disease? 1. Pyrexia 2. Hypertension 3. Hirsutism 4. Hypoglycemia

ANS: 4 Hypoglycemia Rationale: Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia. Pyrexia will occur only if there is a concomitant infection. Hypertension is related to Cushing disease because of excessive cortisol and aldosterone, resulting in fluid and sodium retention, not Addison disease. Hirsutism (excessive hair growth on the body) is related to Cushing disease, not Addison disease, and is caused by excessive androgen secretion.

The nurse is assessing a client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? 1. "I will stop taking my insulin when I am ill because I am not eating." 2. "I will check my urine for ketones when my blood sugar is over 250." 3. "I will alternate drinking Gatorade and water throughout the day while ill." 4. "I will continue all my insulin including my glargine when I am sick."

ANS: 1 "I will stop taking my insulin when I am ill because I am not eating." Rationale: The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. The client checking the urine for ketones when blood sugar is more than 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules. Alternating the intake of water and Gatorade throughout the day provides noncarbohydrate water and fluids containing glucose and electrolytes while reducing the risk of consuming too much sugar.

The nurse is caring for a client with Addison disease. Which dietary instruction would the nurse provide? 1. Add extra salt to food. 2. Consume high-potassium foods. 3. Omit protein foods at each meal. 4. Restrict the daily intake of fluids to 1 L.

ANS: 1 Add extra salt to food. Rationale: Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to developing hyponatremia. The addition of salt to the diet is advised. Clients with Addison disease are prone to hyperkalemia. High-potassium foods can be restricted. Protein is not omitted from the diet; ingestion of essential amino acids is necessary for optimum metabolism and healing. Fluids are not restricted for clients with Addison disease.

A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. Which electrolyte imbalance is causing these clinical findings? 1. Hypokalemia 2. Hyponatremia 3. Hyperglycemia 4. Hypercalcemia

ANS: 1 Hypokalemia Rationale: These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.

Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? 1. Hypokalemia 2. Hypoglycemia 3. Hypernatremia 4. Hypercalcemia

ANS: 1 Hypokalemia Rationale: These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.

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

ANS: 1 Hypokalemia Rationale: 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.

An adolescent with a history of type 1 diabetes is admitted in ketoacidosis. Which cause would the nurse suspect as a precipitating this episode of ketoacidosis? 1. Infection 2. Increased exercise 3. Recent weight loss 4. Overdose of insulin

ANS: 1 Infection Rationale: The stress of an infection increases the body's metabolism; the presence of glucocorticoids results in hyperglycemia. Exercise causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Rapid weight loss causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Excessive insulin results in hypoglycemia, not hyperglycemia and ketoacidosis.

Which initial intervention would the nurse expect the primary health care provider to order for a client admitted to the hospital with a diagnosis of diabetic ketoacidosis? 1. intravenous (IV) fluids 2. Potassium 3. NPH insulin (Novolin N) 4. Sodium polystyrene sulfonate (Kayexalate)

ANS: 1 Intravenous (IV) fluids Rationale: IV fluids are given to combat dehydration in ketoacidosis and to keep an IV line open for administration of medications. After electrolyte levels are evaluated, potassium may be added along with insulin. In acidosis, potassium ions initially shift from the intracellular to extracellular compartment, resulting in hyperkalemia; as acidosis is corrected, hypokalemia may occur, and then potassium may be administered. NPH insulin is an intermediate-acting insulin; rapid-acting insulin is indicated in an emergency. Sodium polystyrene sulfonate is not indicated; abnormally high serum potassium levels will revert once dehydration is corrected.

Which nursing intervention is appropriate to include in the plan of care for a client with diabetic ketoacidosis (DKA)? 1. Intravenous administration of regular insulin 2. Administer insulin glargine subcutaneously at hour of sleep 3. Maintain nothing prescribed orally (NPO) status 4. Intravenous administration of 10% dextrose

ANS: 1 Intravenous administration of regular insulin Rationale: A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.

Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? 1. Monitoring for signs of hypoglycemia resulting from treatment 2. Withholding glucose in any form until the situation is corrected 3. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally 4. Regulating insulin dosage according to the client's urinary ketone levels

ANS: 1 Monitoring for signs of hypoglycemia resulting from treatment Rationale: During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

Which blood gas result would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1. pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) 2. pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 3. pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 4. pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L (22 mmol/L)

ANS: 1 pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) Rationale: A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO3- will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO2 ranges from 35 to 45 mm Hg, and HCO3- ranges from 22 to 26 (22-26 mmol/L). A pH of 7.35 and a CO2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.

Which arterial blood gas results are associated with diabetic ketoacidosis? 1. pH: 7.28; Pco2: 28; HCO3: 18 2. pH: 7.30; Pco2: 54; HCO3: 28 3. pH: 7.50; Pco2: 49; HCO3: 32 4. pH: 7.52; Pco2: 26; HCO3: 20

ANS: 1 pH: 7.28; Pco2: 28; HCO3: 18 Rationale: Diabetic ketoacidosis would be associated with metabolic acidosis, which is reflected by a low pH and bicarbonate; a low Pco2 indicates compensatory hyperventilation. A low pH and elevated Pco2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated Pco2 indicates compensatory hypoventilation. An elevated pH and low Pco2 reflect hyperventilation and respiratory alkalosis.

A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. 1. Truncal obesity 2. Thin extremities 3. Increased linear growth 4. Loss of hair on the body 5. Decreased blood pressure

ANS: 1, 2 Rationale: An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

Cushing disease affects the glucose metabolism and results in reduced glucose uptake by tissues and increased blood glucose levels; interventions to regulate blood glucose levels should be undertaken. Hypersecretion of cortisol causes Cushing disease; interventions should be aimed at decreasing the cortisol levels. Sodium levels are elevated in hypercortisolism; interventions to decrease these levels should be initiated. Measures to increase the low serum calcium levels in Cushing disease will be beneficial to the client. 1. Avoid foods high in salt. 2. Restrict your fluid intake. 3. Eat foods high in potassium. 4. Limit your carbohydrate intake. 5. Continue your regular diet as before.

ANS: 1, 3 Rationale: Based on the laboratory results and not directly related to the client's chronic medical condition, dietary recommendations are as follows: A sodium level of more than 145 mEq (145 mmol/L) is considered hypernatremia; the client should be taught to avoid foods high in sodium (e.g., processed foods, specific condiments). A potassium level less than 3.5 mEq/L (3.5 mmol/L) is considered hypokalemia. The client should be encouraged to eat foods high in potassium. Restricting fluid intake will increase the serum sodium level and is contraindicated. A glucose level of 90 mg/dL (5 mmol/L) is within the expected range of less than 110 mg/dL (6 mmol/L) and is not a concern. The laboratory results for serum sodium and serum potassium are not within the expected values, and the client should be taught how to alter the diet.

Which signs and symptoms would the nurse include when teaching a client about ketoacidosis? Select all that apply. 1. Confusion 2. Hyperactivity 3. Excessive thirst 4. Fruity-scented breath 5. Decreased urinary output

ANS: 1, 3, 4 Rationale: Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased urination, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.

Which physical assessment findings would the nurse document on a client who is experiencing Cushing triad? Select all that apply. 1. Bradycardia 2. Tachycardia 3. Irregular respirations 4. Systolic hypertension 5. Diastolic hypertension 6. Widening pulse pressure

ANS: 1, 3, 4, 6 Rationale: A client experiencing Cushing triad presents with bradycardia (with a full and bounding pulse), irregular respirations, systolic hypertension, and a widening pulse pressure. These clients do not experience tachycardia or diastolic hypertension.

The nurse is providing instructions about foot care for a client with diabetes mellitus. Which would the nurse include in the instructions? Select all that apply. 1. Wear shoes when out of bed. 2. Soak the feet in warm water daily. 3. Dry between the toes after bathing. 4. Remove corns as soon as they appear. 5. Use a heating pad when the feet feel cold.

ANS: 1. 3 Rationale: Wearing shoes protects the feet from trauma; they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature.

Immediately after a bilateral adrenalectomy, a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed? 1. "I need to have periodic tests of my blood for glucose." 2. "I am glad that I only have to take the medication once a day." 3. "I must take the medicine with meals." 4. "I should tell my health care provider if I am overly restless or have trouble sleeping."

ANS: 2 "I am glad that I only have to take the medication once a day." Rationale: Usually a larger dose is given at 8:00 AM and the second dose is given before 4:00 PM to mimic expected hormonal secretion and prevent insomnia. Having periodic blood tests for glucose is necessary because long-term administration of steroids leads to elevated blood glucose levels and possible steroid-induced diabetes. Oral corticosteroids should be taken with food or antacids to prevent gastric irritation and gastric hemorrhage. Neurological and emotional side effects, such as euphoria, mood swings, and sleeplessness, are expected.

A client who is on long-term corticosteroid therapy after an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. Which statement is an important concern for client safety? 1. The dosage of steroids will have to be tapered down slowly to prevent acute adrenal crisis. 2. Steroid therapy will need to be increased to avert a life-threatening crisis. 3. Osteoporosis secondary to long-term corticosteroids increases fracture risk. 4. The client is at risk for Cushing syndrome if taking long-term corticosteroid therapy.

ANS: 2 Steroid therapy will need to be increased to avert a life-threatening crisis. Rationale: Clients with adrenocorticoid insufficiency who are receiving steroid therapy require increased amounts of medication during periods of stress because they are unable to produce the excess needed by the body. With severe stress, a failure to ensure adequate corticosteroid levels can be life-threatening. Increased stress requires an increase, not a decrease, in glucocorticoids. Although osteoporosis may have contributed to fractures secondary to trauma, this does not present a current risk. Cushing syndrome is a problem with excess corticosteroid therapy, but after an adrenalectomy, the corticosteroid is given in amounts sufficient to replace what the body cannot produce.

The nurse is caring for a client with hypoglycemia. The nurse anticipates a prescription for which medications? Select all that apply. 1. Insulin 2. Glucagon 3. Intravenous (IV) glucose 4. Oral hydrocortisone 5. Somatostatin

ANS: 2, 3, 4 Rationale: A client with hypoglycemia suffers with weakness and vision disturbances due to low glucose levels. Glucagon is the hormone secreted by the pancreas that helps with increasing the blood glucose levels. Administering IV glucose would immediately improve the blood glucose levels. Hydrocortisone is a glucocorticoid that prevents hypoglycemia by increasing liver gluconeogenesis and inhibiting peripheral glucose use. Insulin is administered when glucose levels are high as it increases the glucose reuptake, thereby reducing blood glucose levels. Somatostatin is a hormone released by delta cells of the pancreas that inhibits insulin and glucagon.

Which clinical manifestations would the nurse expect a client to exhibit with a diagnosis of Cushing syndrome? Select all that apply. 1. Emaciation 2. Weakness 3. Hypertension 4. Truncal obesity 5. Intermittent tonic spasms

ANS: 2, 3, 4 Rationale: Weakness occurs in response to the excessive catabolism of proteins and resulting loss of muscle mass. Hypertension occurs in response to excessive cortisol that causes an increase in circulating volume or an arteriole response to circulating catecholamines. Truncal obesity is caused by abnormal fat metabolism and deposition of fat in the mesenteric bed. Emaciation is associated with Addison disease. Intermittent tonic spasms of the extremities are associated with tetany, a neuromuscular manifestation, because of a decrease in ionized calcium occurring in hypoparathyroidism, not Cushing syndrome.

Which discharge instruction would the nurse emphasize when preparing a client with Addison disease for discharge? 1. "Limit physical activity." 2. "Restrict sodium in your diet." 3. "Continue steroid replacement therapy." 4. "Schedule frequent health care appointments."

ANS: 3 "Continue steroid replacement therapy." Rationale: Clients with Addison disease must take glucocorticoids regularly to enable them to adapt physiologically to stress and to prevent an Addisonian crisis, a medical emergency similar to shock. The client may be active, as tolerated. Sodium should be taken as desired because hyponatremia frequently occurs from diminished mineralocorticoid secretion. Frequent visits to a health care provider are not necessary after establishing control of the client's steroid replacement therapy.

Which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Providing oxygen 2. Encouraging carbohydrates 3. Administering fluid replacement 4. Teaching facts about dietary principles

ANS: 3 Administering fluid replacement Rationale: As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

A client is being treated for pituitary Cushing syndrome. The nurse anticipates that which medication will be prescribed? 1. Mitotane 2. Cabergoline 3. Cyproheptadine 4. Bromocriptine mesylate

ANS: 3 Cyproheptadine Rationale: Cyproheptadine is effective for the treatment of pituitary Cushing syndrome. Mitotane is prescribed for the treatment of adrenal Cushing syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.

Which outcome would be expected after a client received treatment for Cushing disease? 1. Increased cortisol levels 2. Increased sodium levels 3. Decreased blood glucose levels 4. Decreased serum calcium levels

ANS: 3 Decreased blood glucose levels Rationale: Cushing disease affects the glucose metabolism and results in reduced glucose uptake by tissues and increased blood glucose levels; interventions to regulate blood glucose levels should be undertaken. Hypersecretion of cortisol causes Cushing disease; interventions should be aimed at decreasing the cortisol levels. Sodium levels are elevated in hypercortisolism; interventions to decrease these levels should be initiated. Measures to increase the low serum calcium levels in Cushing disease will be beneficial to the client.

The registered nurse (RN) delegates the task of foot care for a client to unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task but was recently hired and is unfamiliar with the client's condition. Which process would the nurse follow in this situation? 1. Provide guidance to the UNP. 2. Observe and motivate the UNP. 3. Establish mutual expectations and conditions. 4. Explain what to do and how to perform the task.

ANS: 3 Establish mutual expectations and conditions. Rationale: If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the RN would establish mutual expectations and conditions of performance to establish a good relationship. If the delegatee has limited knowledge and ability to perform a task, the delegator is expected to guide the UNP. The RN is expected to observe and monitor the task performed by the delegatee to ensure the delegatee has the ability and willingness to establish a relationship and accomplish the work. The RN can also explain the task and how to perform it if the situation involves a new task and the relationship is ongoing.

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

ANS: 3 Hypertension Rationale: 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 insulin will the nurse prepare for the emergency treatment of ketoacidosis? 1. Glargine 2. NPH insulin 3. Insulin aspart 4. Insulin detemir

ANS: 3 Insulin aspart Rationale: Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

Which unique response is associated with diabetic ketoacidosis (DKA) that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Fluid loss 2. Glycosuria 3. Kussmaul respirations 4. Increased blood glucose level

ANS: 3 Kussmaul respirations Rationale: Kussmaul respirations occur in diabetic ketoacidosis (DKA) as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). HHNS affects people with type 2 diabetes who still have some insulin production; the insulin prevents the breakdown of fats into ketones. Fluid loss is common to both because an increased blood glucose level ultimately leads to polyuria. Glycosuria is common to both conditions. Hyperglycemia is common to both conditions.

A client, admitted with a diagnosis of Addison disease, is emaciated and reports muscular weakness and fatigue. Which disturbed body process would the nurse determine is the root cause of the client's clinical manifestations? 1. Fluid balance 2. Electrolyte levels 3. Protein catabolism 4. Masculinizing hormones

ANS: 3 Protein catabolism Rationale: Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein, decreased fat stores, and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.

The nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. Which purpose would this medication serve? 1. Treats hyperpnea 2. Prevents flaccid paralysis 3. Prevents hypokalemia 4. Treats cardiac dysrhythmias

ANS: 3 Rationale: Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with replacement fluids, is needed to prevent hypokalemia. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. There is no mention of dysrhythmias in the scenario; they are not a universal finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia does not always cause these to occur.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event would the nurse document in the client's clinical record? Select all that apply. 1. Diaphoresis 2. Retinopathy 3. Acetone breath 4. Increased arterial bicarbonate level 5. Decreased arterial carbon dioxide level

ANS: 3, 5 Rationale: A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis, the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance.

A client with diabetes is given instructions about foot care. Which statement made by the client shows effective learning? 1. "I will trim my toenails before bathing." 2. "I will soak my feet daily for 1 hour." 3. "I will examine my feet using a mirror at least once a week." 4. "I will break in my new shoes over the course of several weeks."

ANS: 4 "I will break in my new shoes over the course of several weeks." Rationale: A slower, longer period to break in new, stiff shoes will help prevent blisters and skin breakdown. The toenails should be trimmed by a podiatrist; they are usually trimmed after a foot bath when the nails are softer. Soaking the feet daily for 1 hour will cause maceration of the skin and should be avoided. Examining the feet using a mirror at least once a week is too infrequent; the client should examine the feet daily for signs of trauma.

Which statement is accurate when teaching the client with diabetes about foot care? 1. "Remove any corns on your feet." 2. "Wear shoes that are a size larger than your feet." 3. "Examine your feet weekly for potential sores." 4. "Wear synthetic fiber socks when exercising."

ANS: 4 "Wear synthetic fiber socks when exercising." Rationale: Research demonstrates that socks with synthetic fibers wick away moisture better than other fabrics when participating in vigorous activities. Self-removal of corns can result in injury to the feet. Shoes that do not fit appropriately will create friction causing sores, blisters, and calluses. The feet should be examined daily, not weekly.

The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? 1. 1 to 2 hours 2. 2 to 4 hours 3. 5 to 10 hours 4. 4 to 12 hours

ANS: 4 4 to 12 hours Rationale: NPH insulin onset is 1.5 to 4 hours, peaks in 4 to 12 hours, and has a duration of 12 to 18 hours.

The nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone can be impaired in its production because of this disease? 1. Estrogen 2. Androgens 3. Cortisol 4. Aldosterone

ANS: 4 Aldosterone Rationale: Aldosterone can be impaired in its production because of Addison disease, although Addison disease itself is caused by a cortisol deficiency. Aldosterone causes the kidneys to retain sodium ions. Increased sodium promotes water retention, which elevates blood pressure. The absence of aldosterone causes hypotension. The major effect of cortisol is on glucose metabolism and not on sodium and water concentrations, so the absence of this hormone will not cause significant hypotension. Estrogen and androgens are sex hormones and do not affect blood pressure.

The nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan? 1. Increase potassium intake to replace renal losses. 2. Increase protein intake to heal the adrenal tissue and thus cure the disease. 3. Take supplemental vitamins to supply energy and assist in regaining the weight that was lost. 4. Consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium.

ANS: 4 Consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium. Rationale: Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing; nor will they help the client gain weight.

Which clinical findings support the diagnosis of diabetic ketoacidosis (DKA)? 1. Nervousness and tachycardia 2. Erythema toxicum rash and pruritus 3. Diaphoresis and altered mental state 4. Deep respirations and fruity odor to the breath

ANS: 4 Deep respirations and fruity odor to the breath Rationale: Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.

The nurse is applying capsaicin to a client with diabetic neuropathy. Which action should the nurse perform immediately after applying the medication? 1. Monitor for skin irritation. 2. Perform a painful procedure. 3. Notify the health care provider. 4. Remove gloves and wash hands.

ANS: 4 Remove gloves and wash hands. Rationale: Topical applications of local anesthetics such as capsaicin are used to interrupt transmission of pain signals to the brain in a client with diabetic neuropathy. The nurse has to use gloves or wash the hands with soap and water after application of capsaicin to prevent nerve blockage in the nurse. The client should be monitored for skin irritation at the site of application. Painful procedures are performed only when the client loses pain perception at the site. The health care provider is notified if the client has severe side effects.

Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? 1. Potassium loss occurs rapidly from diaphoresis present during coma. 2. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. 3. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. 4. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.

ANS: 4 Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Rationale: Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.

Client A: Salivary Cortisol Level: 1 ng/mL Client B: Salivary Cortisol Level: 1.2 ng/mL Client C: Salivary Cortisol Level: 1.9 ng/mL Client D: Salivary Cortisol Level: 2.3 ng/mL Which client's laboratory result is consistent with a diagnosis of Cushing syndrome? 1. Client A 2. Client B 3. Client C 4. Client D

ANS: D Client D Rationale: Normal salivary cortisol level is lower than 2.0 ng/mL. A client with Cushing syndrome has high levels of salivary cortisol levels; therefore, client D has Cushing syndrome. Thus client A, client B, and client C do not have Cushing syndrome because they have normal levels of cortisol in the saliva.