ATI Learning System Med-Surg Endocrine Practice Quiz

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A) "My cells are resistant to the effects of insulin." B) "My body breaks down sugars too efficiently." C) "My pancreas does not produce insulin." D) "My body produces antibodies against pancreatic beta cells."

CORRECT -> A) "My cells are resistant to the effects of insulin." The client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. INCORRECT -> B) "My body breaks down sugars too efficiently." The client who has type 2 diabetes mellitus does not secrete enough insulin by the pancreatic beta cells to break down enough glucose. INCORRECT -> C) "My pancreas does not produce insulin." The client who has type 1 diabetes mellitus does not secrete insulin because of the destruction of the beta cells by the body. Although insulin is still produced by the client who has type 2 diabetes mellitus, it is of insufficient quantity to maintain homeostasis. INCORRECT -> D) "My body produces antibodies against pancreatic beta cells." The client who has type 1 diabetes mellitus has the destruction of the beta cells because of the body producing blood antibodies. This is not a manifestation of type 2 diabetes mellitus.

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

CORRECT -> A) Blood glucose 320mg/dL The client who has hyperglycemic hyperosmolar nonketotic syndrome should have a blood glucose level greater than 250mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis. INCORRECT -> B) Positive urine ketones The client who has hyperglycemic hyperosmolar nonketotic syndrome should have negative urine ketones because the body is able to produce enough insulin to prevent ketosis. INCORRECT -> C) Blood pH 7.34 The client who has hyperglycemic hyperosmolar nonketotic syndrome should have a pH level greater than 7.34 because the client has enough circulating insulin to prevent the development of acidosis. INCORRECT -> D) Blood osmolality greater than 350mOsm/kg INCORRECT The client who has hyperglycemic hyperosmolar nonketotic syndrome due to an illness or stress can have a blood osmolality greater than 350mOsm/kg. This manifestation is often seen in the client who has type 2 diabetes mellitus because of the small amount of circulating insulin produced which results in an absence of ketosis and acidosis.

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

CORRECT -> A) Compensate for the decrease in cortisol levels The client who has adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which, if untreated, is fatal. INCORRECT -> B) Inhibit glucose metabolism The client who has adrenalectomy has increased blood glucose levels due to the increase in the production of glucocorticoids. Glucocorticoids stimulate gluconeogenesis and are not given to inhibit glucose metabolism. INCORRECT -> C) Act as a diuretic to maintain urine output The client who has adrenalectomy has fluid retention from the increase in production of glucocorticoids. Glucocorticoids have fluid retention properties and do not act as a diuretic to increase urine output. INCORRECT -> D) Decrease susceptibility to infection The client who has adrenalectomy has an increased risk for infection due to the increase in the production of glucocorticoids. Glucocorticoids have potent anti-inflammatory and immunosuppressive properties and increase the client's susceptibility to infection.

A nurse is collecting data from a client who has Cushing's syndrome. Which of the following skin manifestations should the nurse expect to find? A) Purple striae on the chest and abdomen B) Butterfly rash across the bridge of the nose C) Bronze pigmentation of skin D) Jaundice of the face and sclera

CORRECT -> A) Purple striae on the chest and abdomen The client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen because cortisol destroys collagen under the skin. INCORRECT -> B) Butterfly rash across the bridge of the nose The client who has systemic lupus erythematosus should have a butterfly rash across the bridge of the nose. INCORRECT -> C) Bronze pigmentation of skin The client who has Addison's disease will have a darkening of the skin in both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). INCORRECT -> D) Jaundice of the face and sclera The client who has hepatic, biliary, or gallbladder disease should have jaundice of the face and sclera.

A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.) Tachycardia and hypertension Respiratory rate 16/min Negative Chvostek's sign Laryngeal stridor and hoarseness Positive Trousseau's sign

CORRECT -> Tachycardia and hypertension are correct. Tachycardia and hypertension are unexpected findings, which can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxic, or thyroid storm, is a life-threatening condition with a sudden onset that includes tachycardia, fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. INCORRECT -> A respiratory rate of 16/min is incorrect. This is within the expected reference range. INCORRECT -> A negative Chvostek's sign is incorrect. An expected finding is a positive Chvostek's sign (facial muscle spasm after tapping the facial nerve in front of the ear), which indicates hypocalcemia, a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired. CORRECT -> Laryngeal stridor and hoarseness are correct. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. CORRECT -> A positive Trousseau's sign is correct. A Positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include in the teaching? A) "You should exercise during a peak insulin time." B) "Wear a medical alert identification tag when you exercise." C) "Exercise can decrease the effects of insulin and cause the blood glucose levels to increase." D) "You will get the most benefit from exercise when your glucose levels are higher than normal."

INCORRECT -> A) "You should exercise during a peak insulin time." The nurse should teach the client to avoid exercising within 1hr of receiving the insulin, or at the peak time of insulin, because exercise can increase the absorption of the insulin at the injection site and cause the client to have a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1hr before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. CORRECT -> B) "Wear a medical alert identification tag when you exercise." The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease. INCORRECT -> C) "Exercise can decrease the effects of insulin and cause the blood glucose levels to increase." The client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease. INCORRECT -> D) "You will get the most benefit from exercise when your glucose levels are higher than normal." The client who has poorly controlled insulin-dependent diabetes mellitus is taught not to exercise when blood glucose levels are greater than 250mg/dL, or if ketones are noted in the urine, because there is not an adequate amount of insulin for transporting glucose.

A nurse is assisting with the plan of care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A) Check the client's blood glucose for hypoglycemia B) Check for hypertension C) Weigh the client weekly D) Insert an indwelling urinary catheter for the client

INCORRECT -> A) Check the client's blood glucose for hypoglycemia The nurse should check the client for hyperglycemia because hypercortisolism elevates blood glucose levels. CORRECT -> B) Check for hypertension The nurse should check the client for hypertension, which can indicate fluid volume overload. INCORRECT -> C) Weigh the client weekly The nurse should weigh the client at the same time each day because treatment decisions are based on the findings. INCORRECT -> D) Insert an indwelling urinary catheter for the client The nurse should have the client save all urine output to accurately record it every 24hr. An indwelling urinary catheter needlessly exposes the client to a potential urinary tract infection.

A nurse is collecting data from a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A) Constipation B) Cold intolerance C) Difficulty sleeping D) Anorexia

INCORRECT -> A) Constipation The client who has Graves' disease should report experiencing diarrhea due to the overproduction of thyroid hormone. INCORRECT -> B) Cold intolerance The client who has Graves' disease can experience heat intolerance due to the overproduction of thyroid hormone. CORRECT -> C) Difficulty sleeping The client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone. INCORRECT -> D) Anorexia The client who has Graves' disease should have an increase in appetite and still experience weight loss because of the overproduction of thyroid hormone.

A nurse is checking a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? A) Constipation B) Headache C) Bradycardia D) Fever

INCORRECT -> A) Constipation The client who is experiencing a thyroid storm will have diarrhea, abdominal pain, nausea, and vomiting in response to the overproduction of the thyroid hormone. INCORRECT -> B) Headache The client who is experiencing a thyroid storm will have restlessness, confusion, and possible seizures in response to the overproduction of the thyroid hormone. INCORRECT -> C) Bradycardia The client who is experiencing a thyroid storm will have tachycardia in response to the overproduction of the thyroid hormone. CORRECT -> D) Fever The client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a sudden extreme elevation in body temperature, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of the thyroid hormone.

A nurse is preparing a 24-hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hour urine specimen should the nurse use to determine the client's condition? A) Creatinine clearance B) Catecholamine metabolites C) 17-hydroxycorticosteroids (17-OHCS) D) Protein

INCORRECT -> A) Creatinine clearance A 24hr urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating the glomerular filtration rate of the kidneys. CORRECT -> B) Catecholamine metabolites The nurse should expect the 24hr urine specimen to test for catecholamine metabolites. The test is used to determine if the client has pheochromocytoma, which measures the level of catecholamines (epinephrine and norepinephrine) secretion in a 24hr urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines (epinephrine and norepinephrine), which are hormones that regulate blood pressure and heart rate. INCORRECT -> C) 17-hydroxycorticosteroids (17-OHCS) A 24hr urine specimen for 17-OHCS is used to determine if the client is producing an adequate amount of cortisol. An increase of cortisol in the 24hr urine specimen can indicate the client has Cushing's disease. INCORRECT -> D) Protein A 24hr urine specimen for protein is used to evaluate the client's renal function.

A nurse is checking laboratory values to determine if a client who has diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A) Glucose tolerance test B) Urine sugar and acetone C) Glycosylated hemoglobin levels D) Fasting serum glucose

INCORRECT -> A) Glucose tolerance test A glucose tolerance test is used to diagnose diabetes mellitus and most commonly identifies type 2 and gestational diabetes. INCORRECT -> B) Urine sugar and acetone Urine sugar and acetone reflect how well-controlled the client has been for the last few hours. CORRECT -> C) Glycosylated hemoglobin levels Checking glycosylated hemoglobin levels, or HbA1c, is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the life span of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication. INCORRECT -> D) Fasting serum glucose A fasting serum glucose provides the nurse with information about the previous 24hr.

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

INCORRECT -> A) Hunger Increased hunger is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. CORRECT -> B) Increased urination Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. INCORRECT -> C) Cold, clammy skin Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response from central glucose deprivation. INCORRECT -> D) Tremors Tremulousness is a manifestation of hypoglycemia due to an adrenergic response from central glucose deprivation.

A nurse is assisting with the plan of care for a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening? A) Men who smoke B) Men and women who are obese C) Women who have hepatitis D) Men and women who consume high-protein and low-carbohydrate foods

INCORRECT -> A) Men who smoke Smoking can produce cardiovascular and pulmonary complications, but no studies have found that smoking leads to type 2 diabetes mellitus. CORRECT -> B) Men and women who are obese There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells. This is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance. INCORRECT -> C) Women who have hepatitis Women who have hepatitis are at risk for developing cirrhosis but not type 2 diabetes mellitus. INCORRECT -> D) Men and women who consume high-protein and low-carbohydrate foods There is no correlation between a high-protein and a low-carbohydrate diet and a risk for developing type 2 diabetes mellitus.

A nurse is assisting with the plan of care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A) Move the evening intermediate-acting insulin dose to 90 min before dinner B) Increase the client's morning caloric intake C) Omit the client's evening snack D) Monitor the client's nighttime blood glucose levels

INCORRECT -> A) Move the evening intermediate-acting insulin dose to 90 min before dinner The nurse should plan to administer a smaller dose of intermediate-acting insulin at bedtime, or increase the client's bedtime snacks, to avoid conditions that can lead to the Somogyi effect. INCORRECT -> B) Increase the client's morning caloric intake The nurse should evaluate the client's evening caloric intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to the Somogyi effect. INCORRECT -> C) Omit the client's evening snack The nurse should ensure the client receives a bedtime snack to decrease the chance of hypoglycemia during the night. CORRECT -> D) Monitor the client's nighttime blood glucose levels The Somogyi effect is a swing of a high blood glucose level in the morning after an extremely low blood glucose level during the night. The swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect.

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? A) Phosphorous B) Sodium C) Potassium D) Calcium

INCORRECT -> A) Phosphorous Hyperparathyroidism is associated with hypophosphatemia; therefore, an increase in the phosphorous level indicates an improvement in the client's condition. INCORRECT -> B) Sodium Sodium levels are not regulated by the parathyroid gland but rather through the filtration system of the kidneys. INCORRECT -> C) Potassium Potassium levels are not regulated by the parathyroid gland but rather through the filtration system of the kidneys. CORRECT -> D) Calcium The parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bone by maintaining a balance between the mineral levels in the blood and the bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client's condition.

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

INCORRECT -> A) Proteinuria Protein in the urine is called proteinuria and is a manifestation of kidney disease. INCORRECT -> B) Oliguria Oliguria is a manifestation of kidney failure. CORRECT -> C) Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity. INCORRECT -> D) Glycosuria Glucose in the urine is a manifestation of type 1 diabetes mellitus.

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

INCORRECT -> A) Sliced bananas Bananas are high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia. INCORRECT -> B) Baked potato Baked potatoes are high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia. CORRECT -> C) Turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. INCORRECT -> D) Plain yogurt with peaches Plain yogurt with peaches is high in potassium and the client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia.

A nurse is collecting data from a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? A) Thinning of skeletal bone structure B) Concave chest wall C) High-pitched voice D) Increased head size

INCORRECT -> A) Thinning of skeletal bone structure The client who has acromegaly will have skeletal thickening due to the increase of growth hormones secreted by the pituitary gland. INCORRECT -> B) Concave chest wall The client who has acromegaly will manifest a barrel-shaped chest due to the increase of growth hormones that enlarge the skeletal system. INCORRECT -> C) High-pitched voice The client who has acromegaly will have a deepening of the voice due to hypertrophy of the vocal cords from an increase in growth hormones secreted by the pituitary gland. CORRECT -> D) Increased head size The client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after the closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. It results in the gradual enlargement of the client's body tissues, such as the bones of the face jaw, hands, feet, and skull.

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A) Irritability B) Urinary frequency C) Dry mucous membranes D) Excess thirst

CORRECT -> A) Irritability The client who has irritability is displaying an early manifestation of hypoglycemia for type 1 diabetes mellitus. Other early manifestations include fatigue, headache, difficulty thinking, sweating, and nausea. INCORRECT -> B) Urinary frequency The client who has hyperglycemia will have manifestations of increased urination called polyuria. INCORRECT -> C) Dry mucous membranes The client who has hyperglycemia will have manifestations of dehydration, such as dry mucous membranes and sunken eyeballs. INCORRECT -> D) Excess thirst The client who has hyperglycemia will have manifestations of excess thirst called polydipsia.

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

INCORRECT -> A) Polyuria The client who has SIADH will retain free water and have a decrease in urine output with increased urine osmolarity. INCORRECT -> B) Dehydration The client who has SIADH will retain free water in the circulatory system, which is due to excess antidiuretic hormone. The client will not have manifest dehydration. CORRECT -> C) Hyponatremia The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia. INCORRECT -> D) Hyperthermia The client who has SIADH will have hypothermia resulting from a disturbance in the central nervous system.