Endocrine

A nurse is providing teaching to 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."

A. "My cells are resistant to the effects of insulin." Explanation: A 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.

A nurse is providing dietary teaching for a client with AIDS who has stomatitis of the mouth. Which of the following instructions should the nurse include in the teaching? A. "You can suck on popsicles to numb your mouth." B. "Season food with spices instead of salt." C. "Avoid the use of a straw to drink liquids." D. "Eat foods at hot temperatures."

A. "You can suck on popsicles to numb your mouth." Explanation: The nurse should instruct the client to suck on popsicles or ice chips, which can numb the mouth.

A nurse in the emergency department is assessing a client who has pancreatitis. In which of the following laboratory results should the nurse expect to see an elevation? A. Amylase B. Potassium C. Calcium D. Hematocrit

A. Amylase Explanation: With pancreatitis, laboratory results typically show elevated amylase within 12 to 24 hours. This level remains elevated for 2 to 3 days.

A nurse is teaching a client who has type 2 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I will apply moisturizer between my toes." B. "I will soak my feet daily." C. "I'll be sure to wear cotton socks every day." D. "I'll use a heating pad to warm my feet."

C. "I'll be sure to wear cotton socks every day." Explanation: The nurse should instruct the client to wear clean cotton socks every day to absorb moisture and reduce the risk of infection.

A nurse is assisting a client who has dysphagia with eating meals. Which of the following actions should the nurse take? A. Add water to soups for a thinner consistency B. Encourage using water to clear the client's mouth C. Ask the client to think of a food that produces salivation D. Remind the client to rest after meals

C. Ask the client to think of a food that produces salivation Explanation: prevent dryness in the mouth during meals, which can be a risk factor for choking, the nurse should ask the client to think of a food that promotes salivation (e.g. lemon slices or dill pickles).

A nurse is assessing a client who has Addison's disease. 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 the skin D. Jaundice of the face and sclera

C. Bronze pigmentation of the skin Explanation: A client who has Addison's disease will have a darkening of the skin on 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).

A nurse is assessing 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

C. Difficulty sleeping Explanation: A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone.

A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone

C. Hydrocortisone Explanation: The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels.

A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce total hours of sleep B. Keep the immediate environment warm C. Increase caloric intake with meals D. Gradually increase activity

C. Increase caloric intake with meals Explanation: Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance. Even with an increased appetite, meeting energy demands is often difficult, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake

A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure

C. Kussmaul respirations Explanation: The nurse should expect this client with DKA to experience Kussmaul respirations. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA.

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

C. Polyuria Explanation: Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity. Protein in the urine is a manifestation of kidney disease. Oliguria is a manifestation of kidney failure. Glucose in the urine is a manifestation of type 1 diabetes mellitus.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. Which of the following actions should the nurse perform? A. Change the tubing every 12 hr B. Check the client's blood glucose every 8 hr C. Apply a new dressing to the IV site every 76 hr D. Weigh the client daily

D. Weigh the client daily Explanation: The nurse should weigh the client who is receiving TPN daily due to the risk of fluid and electrolyte imbalances.

A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis

A. Bradycardia Explanation: An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations

A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis

A. Bradycardia Explanation: An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations.

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. Calcium B. Sodium C. Potassium D. Phosphorous

A. Calcium Explanation: Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bones by maintaining mineral levels. Hyperparathyroidism is associated with hypercalcemia; therefore, a decreased calcium level indicates an improvement in the client's condition.

A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? A. Encourage the client to control weight B. Inspect the client's feet once each week C. Restrict the client's activity D. Apply moisturizer between the client's toes

A. Encourage the client to control weight Explanation: The nurse should encourage weight control to stabilize the client's blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes.

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

A. Glycosylated hemoglobin levels Explanation: Checking glycosylated hemoglobin levels (HbA1c) is an accurate method of determining if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication.

A nurse is teaching a group of parents of toddlers about measures to reduce the risk of choking. Which of the following foods increase the risk of choking in toddlers? (Select all that apply.) A. Hot dogs B. Grapes C. Bagels D. Marshmallows E. Graham crackers

A. Hot dogs B. Grapes C. Bagels D. Marshmallows Explanation: Foods that are shaped like a tube, such as hot dogs and grapes, place toddlers at risk for choking because they can completely block the throat when swallowed whole due to their shape and solidity. Foods that are hard to chew, such as bagels and marshmallows, place toddlers at risk for choking; if swallowed before they are adequately chewed, they can block the airway.

A nurse is assessing a client who has Addison's disease. Which of the following findings should the nurse expect? A. Hypotension B. Weight gain C. Sugar craving D. Pale skin tone

A. Hypotension Explanation: The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone.

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

A. Shakiness Explanation: A client who has hypoglycemia can experience early manifestations of shakiness, as well as fatigue, a headache, difficulty thinking, sweating, and nausea.

A nurse is planning 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 the client's urine specific gravity C. Weigh the client weekly D. Insert an indwelling urinary catheter for the client

B. Check the client's urine specific gravity Explanation: The nurse should check the client's urine specific gravity to assess for fluid volume overload.

A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide

B. Hydrocortisone Explanation: The nurse should identify that a client who has Addison's disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is due to the pituitary's inability to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction of the adrenal gland or pituitary and become life-threatening.

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

B. Increased urination Explanation: Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

A nurse is monitoring a client following a thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? A. Elevated blood pressure B. Involuntary muscle spasms C. Cold intolerance D. Weight loss

B. Involuntary muscle spasms Explanation: The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesia can result due to decreased parathyroid hormone levels and calcium deficiency.

A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? A. Chlorpropamide B. Tolvaptan C. Vasopressin D. Desmopressin

B. Tolvaptan Explanation: SIADH is a disorder of water intoxication due to the inappropriate continuous secretion of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH.

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

B. Vanillylmandelic acid (VMA) Explanation: The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hour 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.

A nurse is caring for an infant who has gastroenteritis and is dehydrated. Which of the following characteristics places the infant at a higher risk of electrolyte imbalances compared to an adult client? A. Less extracellular fluid B. Reduced body surface area C. Longer intestinal tract D. Decreased rate of metabolism

C. Longer intestinal tract Explanation: Compared to adults or older children, infants have a longer intestinal tract. This results in greater fluid losses, especially through diarrhea.

A nurse is providing teaching to 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

C. Turkey and cheese sandwich Explanation: A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A 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 cortisol and, in some cases, aldosterone.

A nurse is teaching a client about the prostate-specific antigen (PSA) test. Which of the following directions should the nurse provide? A. "You should fast for 8 hours after the PSA test." B. "Annual PSA screening should begin at age 40." C. "Expected PSA values will decrease as you get older." D. "You should not ejaculate for 24 hours prior to the PSA test."

D. "You should not ejaculate for 24 hours prior to the PSA test." Explanation: PSA is a glycoprotein manufactured in the prostate that is used to screen for prostate cancer. Ejaculation within 24 hours prior to the test can falsely elevate levels of PSA.

A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis? A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7.38 D. Bicarbonate level 12 mEq/L

D. Bicarbonate level 12 mEq/L Explanation: A client who has diabetic ketoacidosis should have a bicarbonate level that is <15 mEq/L due to the increased production of counter-regulatory hormones that lead to metabolic acidosis

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw

D. Coleslaw Explanation: Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables.

A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL

D. Fasting blood glucose 95 mg/dL Explanation: A fasting blood glucose of 95 mg/dL is within the expected reference range of 70 to 110 mg/dL, which indicates that this client's diabetes is under control. An HbA1c of 8.5% is above the expected reference of <7% and does not indicate that the client's diabetes is under control. A postprandial blood glucose of 190 mg/dL is above the expected reference range of <160 mg/dL and does not indicate that the client's diabetes is under control. A casual blood glucose of 205 mg/dL is above the expected reference of <200 mg/dL and does not indicate that the client's diabetes is under control.

A nurse is assessing 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

D. Increased head size Explanation: A client who has acromegaly will present with an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull. A client who has acromegaly will have skeletal thickening due to the increased growth hormones secreted by the pituitary gland. A client who has acromegaly will have a barrel-shaped chest due to the increased growth hormones that enlarge the skeletal system. A client who has acromegaly will have vocal deepening due to hypertrophy of the vocal cords from the increased growth hormones secreted by the pituitary gland.

A nurse in the emergency department is caring for a client who has a fruity breath odor, a dry mouth, and extreme thirst. Which of the following assessments should the nurse make? A. Blood glucose level B. Pupillary reaction to light C. Deep tendon reflexes D. Liver function tests

A. Blood glucose level Explanation: These findings are indications of hyperglycemia and diabetic ketoacidosis. The nurse should check the client's blood glucose level as well as assess the client's respiratory status, vital signs, level of consciousness, and hydration status, including a laboratory assessment of his electrolyte levels.

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.) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign

A. Tachycardia and hypertension D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign Explanation: Tachycardia and hypertension are unexpected findings that 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. 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. 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 caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? A. Warm the dialysate solution prior to administration B. Cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward C. Place the drainage bag at the level of the client's chest D. Apply clean gloves and cleanse the client's catheter site with cold water

A. Warm the dialysate solution prior to administration Explanation: The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping.

A nurse is updating the plan of care for a client who is to receive total parenteral nutrition (TPN). Which of the following actions should the nurse include in the plan? (Select all that apply.) A. Weigh the client daily B. Obtain a serum blood glucose every 4 hr C. Apply a new dressing to the client's IV site every 5 days D. Change the IV tubing every 24 hr E. Infuse the TPN through a peripheral IV site

A. Weigh the client daily B. Obtain a serum blood glucose every 4 hr D. Change the IV tubing every 24 hr Explanation: The nurse should weigh the client daily while receiving TPN. Clients who are receiving TPN are typically malnourished; therefore, the client's weight needs to be monitored closely. Fluid retention can also be an indication that the client is not digesting the TPN, and the rate of the transfusion might need to be decreased. The nurse should also obtain the client's serum blood glucose; insulin can be given if needed. Finally, the nurse should change the client's IV tubing every 24 hours to prevent bacteria from developing in the client's tubing

A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? 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 your blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."

B. "Wear a medical alert identification tag when you exercise." Explanation: 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.

A nurse is teaching a client who is beginning a vegan diet and is concerned about maintaining an adequate protein intake. Which of the following food servings should the nurse recommend due to the high amount of protein? A. 1/2 cup tomato soup B. 1/2 cup of hummus C. 2 tablespoons of peanut butter D. 1 cup penne pasta

B. 1/2 cup of hummus Explanation: Hummus is the best food source to recommend of those provided because it contains 9.7 g of protein per 1/2 cup serving.

A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan

B. Ask the client to identify the types of foods she prefers Explanation: The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will promote her adherence to the dietary plan.

A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria

B. Diaphoresis Explanation: A client who has a blood glucose level below 70 mg/dL will exhibit manifestations of hypoglycemia. Expected findings associated with hypoglycemia include weakness, hunger, diaphoresis, nausea, shakiness, and confusion

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."

C. "You don't have to give up pasta; just adjust the amount you eat." Explanation: The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder.

A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread."

D. "I should replace white bread with whole-grain bread." Explanation: Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber.

A nurse is planning to administer fluids to a client who has 25% total body surface area burns. The client has no prior medical history. Which of the following intravenous fluids is contraindicated for this client? A. Whole blood B. Lactated Ringer's C. Dextran 40 in 0.9% sodium chloride D. 0.45% sodium chloride .

D. 0.45% sodium chloride Explanation: The nurse should identify that 0.45% sodium chloride is a hypotonic solution and is contraindicated for clients who have burns. Hypotonic fluid has an osmolarity value of <270 mOsm/L, which is less than the expected reference range of the osmolarity value for plasma and body fluid of 285 to 295 mOsm/L. Administering a hypotonic solution to this client can cause third-spacing of fluid.

A nurse is monitoring 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. Hypertension

D. Hypertension Explanation: A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone.

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? A. Avoid foods containing protein B. Drink liquids during each meal C. Eat foods that contain simple sugars D. Maintain a supine position after meals

D. Maintain a supine position after meals Explanation: The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at once, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine and decreasing blood volume, which causes the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension.