endocrine review

A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. An increase in which component in the blood is a direct cause of this type of acidosis?

ketones

poor management of type 1 diabetes can result in :

loss of sensation of feet, thick yellow toe nails, leg ulcers, loss of visual acuity.

A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine?

myxedema

A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is:

Neovascularization of the retina

A client who is 60 pounds more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight?

Obesity leads to insulin resistance

calcium gluconate is administered to treat

hypocalcemia

Acromegaly is caused by

increased secretion of growth hormone in adults after full growth and epiphyseal closure

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?

Hypernatremia

A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" What is the nurse's best reply?

"I don't know if you do; let's talk about it."

A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client makes which statement?

"I will break in my new shoes over the course of several weeks."

A client newly diagnosed with type 1 diabetes receives information about insulin. The client states, "I hate shots. Why can't I take the insulin in pill form?" What is the nurse's best response?

"Insulin is poorly absorbed and its action is erratic when taken by mouth."

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?

Administer intravenous (IV) steroids.

On the first day after a thyroidectomy, a client tolerates a full-liquid/fluid diet. When the diet is progressed to a soft diet the next day, the client complains of a sore throat when swallowing. How should the nurse respond?

Administer prescribed analgesics before meals

The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is:

Arranging for sufficient rest periods

What should the nurse do when collecting a 24-hour urine specimen?

Check to verify if a preservative is needed.

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider?

Despite steroid therapy, the ability to cope with stress will be decreased

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, "I should call my health care provider if I develop:

Dry hair and an intolerance to cold."

A nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. Which action should be included in this client's plan of care?

Ensuring a large fluid intake

A nurse is collecting information about a client who has type 1 diabetes and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? (Select all that apply.)

Excessive emotional stress and Running a fever with the flu

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). The nurse includes measures to increase arterial blood flow to the extremities, including:

Exercises that promote muscular activity

A nurse is caring for a newly admitted client with a diagnosis of Graves disease. In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client?

High-calorie diet

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiologic responses?

Hyperplasia of the adrenal cortex

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

Hyperplasia of the adrenal cortex

A nurse is caring for a client who was admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

Hypoglycemia and hypotension

A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations?

Increased intracranial pressure

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis?

Insulin aspart (NovoLog)

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?

Rapid heartbeat and tremors

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis?

Receives long-term steroid therapy

Which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client?

Serum potassium of 7.2 mEq/L (7.2 mmol/L)

An obese client must self-administer insulin at home. The nurse should teach the client to use what technique?

Spread the tissue and inject at a 90-degree angle

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiological finding should be the nurse's focus when collecting additional data about this client?

Starvation

A nurse evaluates that a client with diabetes understands the teaching about the treatment of hypoglycemia when the client says, "If I become hypoglycemic I initially should eat:

Sugar and a slice of bread.

A client is scheduled to have a thyroidectomy for cancer of the thyroid. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching?

Support the head with the hands when changing position.

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

Supports a better response to stress

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." On the basis of this statement, the nurse's best action is to:

Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response?

The tumor must be removed to prevent heart and kidney damage.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:

There may not be enough thyroid tissue to supply adequate thyroid hormone

A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client?

Thyroxine replacement therapy will be required indefinitely.

After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client?

Tubular reabsorption of water increases

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

Urine negative for ketones and hyperglycemia.

A client with diabetes is self-administering insulin. Which action performed by the client indicates a need for correction?

Washing the hands with hot water

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions?

Wear shoes when out of bed and Dry between the toes after bathing.

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse's most appropriate response is:

"Choose the foods you normally do and follow your food plan wherever you are."

When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:

weight loss.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes:

Complications are not present at the time of diagnosis.

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. What does the nurse determine as the main difference between newly diagnosed type 1 and type 2 diabetes?

In type 1 diabetes long-term complications are not present at the time of diagnosis.

The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?

Observe for signs of infection

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. The primary cause of the client's ascites is a decrease in:

Plasma protein to maintain adequate capillary-tissue circulation

Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get the atomic cocktail?" The nurse explains that the medication is being prescribed because it decreases the:

Production of thyroid hormones.

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

Tetany

A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client's condition after this therapy should the nurse consider when providing care?

Mildly radioactive but should be treated with routine safety precautions

A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do?

Monitor blood glucose levels more frequently.

pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?

don't ingest anything before the test.

A client has a thyroidectomy for cancer of the thyroid. To evaluate for nerve injury that may be the result of surgery-related trauma, the nurse assesses the client's ability to:

speak

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake?

Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?

Increased serum lipids

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis?

Monitoring for signs of hypoglycemia as a result of treatment

A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider?

Reduced insulin production

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide:

Stimulates the pancreas to produce insulin

When assessing a client with Graves disease, the nurse expects to identify:

Weight loss, exophthalmos, and restlessness

Adrenocortical insufficiency causes

decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone, resulting in fluid excretion that leads to hypotension.

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?

mineralcorticoids

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations?

Calcium gluconate

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse expects that manifestations of excessive levels of antidiuretic hormone are:

Hyponatremia and decreased urine output

The nurse is counseling a client with type 1 diabetes about the client's favorite foods that are lowest in carbohydrates (CHO). The nurse determines that this concept is understood when the client chooses eight ounces of:

skim milk

Thyrotoxic crisis (thyroid storm) refers to

a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

diarrhea and weight loss.

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? (Select all that apply.)

dry skin, kussmaul respiration and abdominal pain.

Excess adrenocorticoids cause

emotional lability, euphoria, and psychosis

Hyperactive reflexes are a neurological manifestation related to

excessive production of thyroid hormones

The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include?

it improves hem A1c and pt can exercise without uping carbohydrate intake.

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. For what response should the nurse instruct the client to monitor in addition to nervousness and hunger?

sweating

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? (Select all that apply.)

tachycardia and palpitations

A client with type 1 diabetes self-administers Novolin N insulin every morning at 8 AM. The nurse evaluates that the client understands the action of the insulin when the client says, "I should be alert for signs of hypoglycemia between:

2 pm and 8 pm."

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia?

use tinted glasses, Elevate the head of the bed 45 degrees and tape eyelids shut at night if they do not close

A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective?

weakness, nervousness, and excessive perspiration (sweating)

The nurse identifies that the dietary teaching provided for a client with diabetes is understood when the client states, "My diet:

Can be planned around a wide variety of commonly used foods."

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?

Breakdown of fat stores for energy

A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs?

Collaborate with the health care provider to alter the insulin prescription.

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia?

palor, tremors, diaphoresis

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?

Hydrocortisone succinate (Solu-Cortef)

A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action?

Insulin lispro (Humalog)

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:

Lability of mood

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?

Measure the blood glucose level between 2 AM and 4 AM.

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include:

Parenteral steroids

Glycosylated hemoglobin measures

the average blood glucose level for the 90- to 120-day period before the blood sample is collected; thus, it is a reliable way to measure adherence to a therapy plan of insulin, diet, and exercise.

Hypoglycemia triggers

the sympathetic nervous system, which releases epinephrine, in turn causing vasoconstriction and pallor. Tremors are a sympathetic nervous system response to hypoglycemia. Diaphoresis results from the release of epinephrine by the sympathetic nervous system.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective?

thirst, fruity breath, and excessive urination

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations?

tremors and heat intolerance

Potassium chloride is prescribed for

hypokalemia

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?

Glucose level

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies?

Phosphorus

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient?

fats

A nurse is caring for a client newly admitted with a diagnosis of pheochromocytoma. Which clinical findings does the nurse expect when assessing this client? (Select all that apply.)

headache, palpitation, diaphoresis.

Magnesium sulfate is prescribed for

hypomagnesemia or to treat pregnant women who have preeclampsia

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for:

hypotension

A nurse is providing postoperative care for a client one hour after the client had an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication?

hypotension

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply.

irritability and heart palpitation.

Lack of mineralocorticoids (aldosterone) leads to

loss of sodium ions in the urine and subsequent hyponatremia.

A client is receiving dexamethasone (Decadron) for adrenocortical insufficiency. To monitor for a negative side effect of the medication, the nurse should:

measure blood glucose levels

Tachycardia occurs with hypoglycemia because of

neurogenic adrenergic response; it is a sympathetic nervous system response precipitated by a low blood glucose level.

Parathyroid removal eliminates the body's source of

parathyroid hormone (parathormone), which increases the blood calcium level

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

weight loss, tachycardia, restlessness, and exothalamus

For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?

bone pain

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify?

buffalo hump and hirsutism.

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? (Select all that apply.)

dry skin, lethargy, and sensitivity to cold

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis?

emotional lability , dyspnea on exertion and hyperactive deep tendon reflexes.

The nurse concludes that a client with type 1 diabetes is experiencing hypoglycemia. Which responses support this conclusion? (Select all that apply.)

headache, cool and clammy skin and tachycardia.

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. The nurse should base a response on the understanding that:

As long as medication is continued, ovulation will occur

A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:

Improve the cellular uptake of glucose

A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?

Kussmaul respirations

A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time?

Observe for signs of tetany.

A nurse is caring for an adult client with acromegaly. What clinical manifestation does the nurse expect the client to exhibit?

Prominent jaw

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant?

diaphoretic and headache