Endocrine

4- Signs and symptoms of hypothyroidism

10) A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: 1- Relief of pain 2- Signs of renal toxicity 3- Signs and symptoms of hyperglycemia 4- Signs and symptoms of hypothyroidism

1- Polyuria

11) A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification? 1- Polyuria 2- Diaphoresis 3- Hypertension 4- Increased pulse rate

1- Fluid volume, deficient

12) A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: 1- Fluid volume, deficient 2- Family processes, dysfunctional 3- Nutrition: less than body requirements, imbalanced 4- Knowledge, deficient: disease process and treatment

1- "I need to stop my insulin"

13) A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching? 1- "I need to stop my insulin" 2- "I need to increase my fluid intake" 3- "I need to monitor my blood glucose every 3 to 4 hours" 4- "I need to call the physician because of these symptoms"

2- Test the drainage for glucose

15) A nurse is caring for a client after hypophysectomy. The nurse notices a clear nasal drainage from the client's nostril. The initial nursing action would be to: 1- Lower the head of the bed 2- Test the drainage for glucose 3- Obtain a culture of the drainage 4- Continue to observe the drainage

3- Monitor blood glucose levels frequently

19) A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which of the following is most important to include in the plan of care? 1- Test urine for ketone levels 2- Eat six small meals per day 3- Monitor blood glucose levels frequently 4- Receive appropriate follow-up health care

2- Takes the client's blood pressure

30) A nurse is performing an admission assessment on a client admitted with a diagnosis of pheochromocytoma. The nurse assesses for the major symptom associated with pheochromocytoma when the nurse: 1- Obtains the client's weight 2- Takes the client's blood pressure 3- Tests the client's urine for glucose 4- Palpates the skin for its temperature

3- Temperature

37) A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose of 120 mg/dL, temperature of 101F, pulse of 88 beats/min, respirations of 22 breaths/min, and blood pressure of 100/72 mm Hg. Which finding would be of most concern to the nurse? 1- Pulse 2- Respiration 3- Temperature 4- Blood pressure

2- Convey empathy, trust, and respect toward the client

7) A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to: 1- Administer a sedative 2- Convey empathy, trust, and respect toward the client 3- Ignore the signs and symptoms of anxiety so that they will soon disappear 4- Make sure that the client knows all the correct medical terms to understand what is happening

4- "The medications I'm taking help release the insulin I already make"

38) A nurse is interviewing a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder? 1- "I take oral insulin instead of shots" 2- "By taking these medications, I am able to eat more" 3- "When I become ill, I need to increase the number of pills I take" 4- "The medications I'm taking help release the insulin I already make"

3- Polydipsia

16) After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? 1- Fatigue 2- Diarrhea 3- Polydipsia 4- Weight gain

4- A heart rate that is 90 beats/min and irregular

34) A nurse is performing an assessment on the client with pheochromocytoma. Which of the following assessment data would indicate a potential complication associated with this disorder? 1- A coagulation time of 5 minutes 2- A blood urea nitrogen level of 20 mg/dL 3- A urinary output of 50 mL per hour 4- A heart rate that is 90 beats/min and irregular

4- "I will notify my physician if my blood glucose level is higher than 250 mg/dL

8) A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client states: 1- "I will stop taking my insulin if I'm too sick to eat" 2- "I will decrease my insulin dose during times of illness" 3- "I will adjust my insulin dose according to the level of glucose in my urine" 4- "I will notify my physician if my blood glucose level is higher than 250 mg/dL

3- Apply a moisturizing lotion to dry feet but not between toes

1) A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan? 1- Soak feet in hot water 2- Avoid using a mild soap on the feet 3- Apply a moisturizing lotion to dry feet but not between toes 4- Always have a podiatrist cut your toenails; never cut them yourself

1- Tremors

27) A nurse is caring for a client with type 1 diabetes mellitus. Which client complaint would alert the nurse to the presence of a possible hypoglycemic reaction? 1- Tremors 2- Anorexia 3- Hot, dry skin 4- Muscle cramps

4- Assess urine specific gravity

14) After hypophysectomy, a client complains of being thirsty and having to urinate frequently. The initial nursing action is to: 1- Increase fluid intake 2- Document the complaints 3- Assess for urinary glucose 4- Assess urine specific gravity

4- Reassure the client that this is usually a temporary condition

17) A nurse performing an assessment on a client following a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate? 1- Check for signs of bleeding 2- Administer calcium gluconate 3- Notify the physician immediately 4- Reassure the client that this is usually a temporary condition

2- Maintain a patent airway

18) A client is admitted to an emergency room, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1- Warm the client 2- Maintain a patent airway 3- Administer thyroid hormone 4- Administer fluid replacement

4- Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

3) An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurses bases the response on the information that the pump: 1- Is timed to release programmed doses of regular or NPH insulin into the bloodstream at the specific intervals 2- Continuously infuses small amounts of NPH insulin into bloodstream while regularly monitoring blood glucose levels 3- Is surgically attached to the pancreas and infuses regular insulin into pancreas, which in turn releases the insulin into the blood stream 4- Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

4- Higher than normal, indicating pheochromocytoma

31) A nurse collects urine specimens for catecholamine testing from a client with suspected pheochromocytoma. The results of the catecholamine test are reported at 20 mcg/100 mL urine. The nurse analyzes these results as: 1- Normal 2- Insignificant and unrelated to pheochromocytoma 3- Lower than normal, ruling out pheochromocytoma 4- Higher than normal, indicating pheochromocytoma

1- Vital signs

32) A nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, the priority nursing action would be to monitor: 1- Vital signs 2- Intake and output 3- Blood urea nitrogen results 4- Urine for glucose and ketones

2- Obtain a capillary blood glucose level and perform a focused assessment

40) The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but that client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is appropriate at this time? 1- Call a code to obtain needed assistance immediately 2- Obtain a capillary blood glucose level and perform a focused assessment 3- Stay with the client and ask the nursing assistant to call the physician for an order for intravenous 50 % dextrose 4- Ask the nursing assistant to stay with the client while obtaining 15 to 30 g of a carbohydrate snack for the client to eat

4- Elevated blood glucose level and low plasma bicarbonate level

5) A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis? 1- Comatose state 2- Decreased urine output 3- Increased respirations and an increase in pH 4- Elevated blood glucose level and low plasma bicarbonate level

2- Shakiness

6) A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms develop? 1- Polyuria 2- Shakiness 3- Blurred vision 4- Fruity breath odor

3- Intravenous infusion of normal saline

2) A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglyemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's orders? 1- Endotracheal intubation 2- 100 units of NPH insulin 3- Intravenous infusion of normal saline 4- Intravenous infusion of sodium bicarbonate

1- Laryngeal stridor

25) A nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a serious, life-threatening complication may be developing, requiring immediate notification of the physician? 1- Laryngeal stridor 2- Abdominal cramps 3- Difficulty in voiding 4- Mild to moderate incision pain

4- Administer regular insulin intravenously

20) A nurse is caring for a client admitted to the emergency room with diabetic ketoacidosis (DKA). In the acute phase, the priority nursing action is to prepare to: 1- Correct the acidosis 2- Apply a monitor for an electrocardiogram 3- Administer 5% dextrose intravenously 4- Administer regular insulin intravenously

4- Hyperglycemia hyperosmolar nonketotic syndrome (HHNS)

21) A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physician's documentation and would expect to note which of the following diagnoses? 1- Hypoglycemia 2- Pheochromocytoma 3- Diabetic ketoacidosis (DKA) 4- Hyperglycemia hyperosmolar nonketotic syndrome (HHNS)

2- "What is the client's capillary blood glucose level?"

22) The family of a bedridden client with type 2 diabetes mellitus and chronic renal failure calls a nurse to report the following symptoms: headache, polydipsia, and increased lethargy. To determine a possible diagnosis, the nurse asks the family which most important question? 1- "What is the client's urine output?" 2- "What is the client's capillary blood glucose level?" 3- "Has there been any change in the dietary intake?" 4- "Have you increased the amount of fluids provided?"

3- "The best time for me to exercise is mid- to late afternoon"

23) A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 1- "The best time for me to exercise is after I eat" 2- "The best time for me to exercise is after breakfast" 3- "The best time for me to exercise is mid- to late afternoon" 4- "The best time for me to exercise is after my morning snack"

2- Polyuria

24) A nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? 1- Diarrhea 2- Polyuria 3- Polyphagia 4- Weight gain

1- Rotates sites for injection

26) A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse would appropriately inquire whether the client: 1- Rotates sites for injection 2- Administers the insulin at a 45-degree angle 3- Cleanses the skin with alcohol before each injection 4- Aspirates for blood before injection into the subcutaneous tissue

3- Encourage the client to take 8 to 12 oz of fluid every hour while awake

28) A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. The appropriate nursing intervention is to: 1- Offer water only until the client is able to tolerate solid foods 2- Withhold all fluids until vomiting has ceased for at least 4 hours 3- Encourage the client to take 8 to 12 oz of fluid every hour while awake 4- Maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the stomach and bowel to dissipate

4- Causes the release of excessive amounts of catecholamines

29) A client is diagnosed with pheochromocytoma. A nurse prepares a plan of care for the client; while planning, the nurse understands that pheochromocytoma is a condition that: 1- Causes profound hypotension 2- Is manifested by severe hypoglycemia 3- Is not curable and is treated symptomatically 4- Causes the release of excessive amounts of catecholamines

2- Graham crackers and warm milk

33) A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. The most appropriate choice for this client to meet nutritional needs would be which of the following? 1- Crackers with cheese and tea 2- Graham crackers and warm milk 3- Toast with peanut butter and cocoa 4- Vanilla wafers ad coffee with cream and sugar

3- Normal sodium intake

35) A nurse is preparing to provide instructions to a client with Addison's disease regarding diet therapy. The nurse knows that which of the following diets most likely would be prescribed for the client? 1- High-fat intake 2- Low-protein intake 3- Normal sodium intake 4- Low-carbohydrate intake

4- "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone"

36) A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1- "Cushing's disease results from an oversecretion of insulin" 2- "Cushing's disease results from an undersecretion of corticotropic hormones" 3- "Cushing's disease results from an undersecretion of mineralocorticoid hormones" 4- "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone"

1- "I can eat foods that have a lot of potassium in them"

39) A nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary managment are understood? 1- "I can eat foods that have a lot of potassium in them" 2- "I will need to limit the amount of protein in my diet" 3- "I am fortunate that I can eat all the salty foods I enjoy" 4- "I am fortunate that I do not need to follow any special diet"

4- Systematically rotate insulin injections within one anatomic site

4) A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts? 1- Always keep insulin vials refridgerated 2- Ketones in urine signify a need for less insulin 3- Increase the amount of insulin before unusual exercise 4- Systematically rotate insulin injections within one anatomic site

3- Intravenous fluids containing 5% Dextrose

9) A client is admitted to a hospital with diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following? 1- Ampule of 50% dextrose 2- NPH insulin subcutaneously 3- Intravenous fluids containing 5% Dextrose 4) Phenytoin (Dilantin) for the prevention of seizures