ATI: DM, ENDOCRINE & CONNECTIVE TISSUE DISORDER TEST

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching?

"Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." The client should check his urine for ketones when blood glucose levels are greater than 240 mg/dL in order to detect DKA. The client should contact the provider if he has moderate or large amounts of ketones in his urine.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching?

"I give the insulin injections in my abdominal area." The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

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?

"Maintain stable blood glucose levels." 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 teaching a client who has a new diagnosis of Type 1 diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include?

"Store the current bottle of insulin at room temperature." The nurse should instruct the client to keep the bottle of insulin she is currently using at room temperature to minimize painful injections. The client should refrigerate unused bottles of insulin to protect the quality of the medication.

A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. Which of the following instructions should the nurse include in the teaching?

"Take the medication with a meal." MY ANSWER The client should take metformin with a meal to avoid hypoglycemia and GI upset, and to provide the most absorption of the medication.

A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?

Acetone odor to breath Because of the lack of insulin, the body is unable to use glucose and instead breaks down fats resulting in excessive ketones. The large amount of ketones causes the body to become acidotic and causes a fruity, or acetone odor to the breath

A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?

Check the client's voice every 2 hr. The nurse should assess the client's voice every 2 hr to monitor for hoarseness, which is a manifestation of laryngeal nerve damage.

A nurse is caring for a client who is diabetic and reports a headache, restlessness, fatigue, and hunger. Then nurse should identify that the client is likely experiencing which of the following conditions?

Hypoglycemia Hypoglycemia is a complication of diabetes indicating a blood glucose level less than 70 mg/dL. It can occur when excessive insulin or oral hypoglycemic are administered, with excessive physical activity, or when too little food is consumed. The manifestations of hypoglycemia include sweating, tremor, tachycardia, palpitations, headache, fatigue, nervousness, and hunger.

A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect?

Hypoglycemia Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety

A nurse is assessing a client to identify risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome?

Large waist size Central obesity due to excessive abdominal fat is a risk factor for metabolic syndrome. Metabolic syndrome increases the risk for the development of diabetes and coronary artery disease.

A nurse is caring for a client who has chronic hypothyroidism. For which of the following conditions should the nurse monitor?

Lethargy Lethargy is an early indication of myxedema coma, which can progress to stupor and respiratory failure.

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism?

Moon face A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing's syndrome.

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take?

Place the client on aspiration precautions. The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryngeal edema and tongue thickening.

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

Tingling of the extremities A serum calcium level of 7.6 mg/dL is below the expected reference range, indicating hypocalcemia. A client who undergoes a total thyroidectomy is at risk for parathyroid injury which can lead to hypocalcemia. The nurse should monitor the client for reports of tingling and numbness of the extremities and around the mouth, muscle tremors, cramps and cardiac dysrhythmias.

A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication?

Urine specific gravity 1.015 A therapeutic effect of the medication would be urine specific gravity within the expected reference range, which is 1.010-1.025.

A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings?

Weight gain The nurse should expect to find weight gain in clients who have hypothyroidism, even with no change in dietary intake.

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?

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

A nurse is caring for a client who has acute pancreatitis. After treating the client's pain, which of the following should the nurse address as the priority intervention?

Withhold oral fluids and food. To rest the pancreas and reduce secretion of pancreatic enzymes, NPO status must be initiated and maintained during the acute phase of pancreatitis. This is the priority intervention to address after the client's pain has been treated.

A nurse is providing teaching about foot care for a client who has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

"I should buy new shoes late in the day." The client's feet are larger later in the day. Therefore, this is the best time to buy new shoes.

A nurse is teaching about self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

"I will check my blood glucose every 4 hours when I am sick." The client should follow specific guidelines when sick. The nurse should instruct the client to monitor blood glucose every 3 to 4 hr and continue to take insulin or oral antidiabetic agents. The client should consume 4 oz of sugar-free, noncaffeinated liquid every 30 min to prevent dehydration and eet carbohydrate needs through soft food if possible. If not, the client should consume liquids equal to usual carbohydrate content. The nurse should also instruct the client to test urine for ketones and report to provider if they are abnormal (the level should be negative to small).

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching?

"I will feel shaky." Manifestations of hypoglycemia include feeling shaky and nervous.

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?

0.9% sodium chloride IV bolus 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 is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times?

0745 Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus?

Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus.

A nurse is assessing a client who has myxedema. Which of the following findings should the nurse expect?

Facial edema Facial edema is an expected finding of myxedema, which is a severe form of hypothyroidism. A client who has myxedema typically experiences non-pitting edema everywhere, especially around the eyes and in the hands and feet.

A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?

Frequent mood changes 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 assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect?

Heat intolerance The client who has an acute overdose of levothyroxine will exhibit heat intolerance, sweating, and hyperthermia. These manifestations are indications of excessive levels of thyroid hormone that could lead to death.

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing's syndrome. Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing's syndrome. Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing's syndrome.

A nurse is performing a monofilament sensory assessment of a client who has diabetes mellitus. When performing this assessment, for which of the following complications is the nurse monitoring?

Neuropathy Neuropathy is a loss of sensation in the feet, which is a complication that occurs as a result of long term hyperglycemia which affects the microvasculature and causes demyelinization of the nerves. Peripheral neuropathy is assessed by lightly touching a monofilament to different areas of the client's feet to assess the client's ability to feel light touching. An inability to feel light touching is indicative of peripheral neuropathy, which places the client at risk for injury and infection.

A nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take?

Verify the most recent calcium level. A client who has had a thyroidectomy is at risk of hypocalcemia due to the possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland that are responsible for calcium regulation. If they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these manifestations following a thyroidectomy, the nurse should check the client's latest calcium level. The expected reference range for calcium is 8.5 to 10.5 mg/dL. If the calcium level is low, the provider should be notified, and oral or intravenous calcium replacement should be administered.

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take?

Weigh the client daily. Addison's disease is an endocrine disorder that causes weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin. Obtaining the client's daily weight will alert the nurse that dehydration is developing, which could indicate an impending crisis.

A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching?

"I'll check my feet every day for sores and bruises." The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see

A nurse is talking with a client whose thyroid-stimulating hormone (TSH) level will be measured. Which of the following statements by the nurse explains the purpose of this test?

"This test determines whether your thyroid gland is overactive, appropriately active, or underactive." This describes the TSH test, which helps determine thyroid status and helps monitor the effectiveness and dosage of thyroid hormone replacement therapy.

A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?

"Tremors, nervousness, and insomnia may indicate your dose is too high." The nurse should teach that tremors, nervousness, and insomnia may indicate an overdose of the medication and to notify the provider.

A client who has Type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make?

"Your body has insulin resistance and decreased insulin secretion." A client genetically susceptible can develop Type 2 diabetes mellitus when obesity and physical inactivity lead to insulin resistance at cells as well as decreased secretion of insulin by pancreatic beta-cells.

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% 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 results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism?

A client who has a phosphate of 5.7 mg/dL This level is above the expected reference range of 3.0 to 4.5 mg/dL. Phosphorus levels are increased in a client who has hypoparathyroidism.

A nurse is caring for a client who is being evaluated for acromegaly. Which of the following manifestations should the nurse expect to find during assessment? (Select all that apply.)

Acromegaly is a chronic metabolic disorder caused by an excess of growth hormone (hyperpituitarism) during adulthood, after normal growth of the skeleton and other organs is complete. Often rising from an adenoma, the tumor compresses the optic nerve and causes visual changes such as loss of color discrimination, narrowed perceptual field, or blindness.

A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL?

Administer 15 g of carbohydrates. The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.

A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor?

Airway patency When using the airway, breathing, circulation approach to client care, the nurse should determine it is the priority to monitor the client's airway. Nerve damage, hypocalcemia induced tetany, and edema can all impair the airway following thyroidectomy.

A nurse is assessing a female client who is at risk for developing type 2 diabetes mellitus. The nurse should identify that which of the following manifestations increases the client's risk for developing type 2 diabetes?

Blood pressure 138/98 mm Hg A female client who has a blood pressure greater than 130 mm Hg systolic and 85 mm Hg diastolic is at risk for type 2 diabetes.

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

Blurred vision is correct. Manifestations of hypoglycemia include blurred vision. Tachycardia is correct. Manifestations of hypoglycemia include tachycardia. Moist, clammy skin is correct. Manifestations of hypoglycemia include moist, clammy skin.

A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care?

Check urine specific gravity. The nurse should check the client's urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Chvostek's sign The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.

A nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect?

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

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia?

Cool, clammy skin Cool, clammy skin is a manifestation of hypoglycemia.

A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.)

Cushing's syndrome affects blood glucose levels by causing increased release of glucose from the liver and decreased sensitivity of insulin receptors. This can result in elevated blood glucose levels.

A nurse is assessing a client who has Graves' disease. The nurse should expect which of the following laboratory results?

Decreased thyroid-stimulating hormone (TSH) level The nurse should expect a TSH level below the expected reference range in a client who has Graves' disease.

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

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

A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include?

Do not exercise if ketones are present in your urine. 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 caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following?

Graham crackers After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

Hyperpigmentation Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect?

Hyperpigmentation Hyperpigmentation, bruising, and striae or stretch marks, are manifestations of Cushing's syndrome.

A nurse is caring for a client who has nephrotic syndrome and is receiving high-dose corticosteroid therapy. For which of the following electrolyte imbalances should the nurse monitor?

Hypokalemia If the nephrotic syndrome is immunologic in origin, it is often treated with the administration of corticosteroids such as methylprednisolone. Corticosteroid use can lead to hypokalemia, which features manifestations of muscle weakness and cardiac arrhythmia.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take?

Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH?

Lung cancer The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH).

A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority?

Monitor the client for hypoglycemia. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.

A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

Pantoprazole 80 mg IV bolus twice daily The nurse should anticipate a provider's prescription for a proton pump inhibitor to decrease gastric acid production, which ultimately decrease pancreatic secretions.

A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications?

Pathologic fractures A client who has hyperparathyroidism is at risk for pathological fractures due to the release of calcium and phosphate into the blood, which reduces bone density and places the client at risk for pathologic fractures.

A nurse is admitting an older adult client who has diabetic neuropathy with painful, burning feet. Which of the following interventions should the nurse anticipate the health care provider to prescribe?

Place a bed cradle on the client's bed. A bed cradle can reduce pain for a client who has diabetic neuropathy by preventing sheets from touching hypersensitive skin.

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. 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?

Regular insulin 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 nursing is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should nurse include in the teaching?

Restrict sodium intake. The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect?

Weight loss Weight loss is an expected finding for a client who has uncontrolled diabetes.

A nurse is caring for a client who is 8 hr postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client?

Semi-Fowler's with neck in a neutral position Semi-Fowler's is the most comfortable position for a client who has had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the sutures. A neutral position is essential.

A nurse is reviewing the laboratory results for four clients. The nurse should recognize that which of the following clients has a manifestation of primary hyperparathyroidism?

The client who has an increased magnesium level Magnesium level is increased in a client who has primary hyperparathyroidism.

A nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values?

Thyroid stimulating hormone (TSH) The nurse should anticipate that TSH will be elevated.

A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea. Which of the following findings should the nurse expect?

Weak, irregular pulse Common manifestations of potassium depletion include a weak and irregular pulse, muscle weakness, fatigue, and ventricular dysrhythmias.