N406 Exam 3 Unit 11 PREPU (Endocrine)
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? a. Decreased phosphate level b. Adequate vitamin D level c. Functioning thyroid gland d. Increased calcium level
b. Adequate vitamin D level Rationale: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? a. Hypocalcemia b. Hypercalcemia c. Hyperphosphatemia d. Hypophosphaturia
b. Hypercalcemia Rationale: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? a. Numbness b. Increased hunger c. Fatigue d. Dizziness
b. Increased hunger Rationale: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? a. Thyroid storm b. Myxedemic coma c. Addison's disease d. Acromegaly
b. Myxedemic coma Rationale: Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
Which type of insulin acts most quickly? a. Regular b. NPH c. Lispro d. Glargine
c. Lispro Rationale: The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? a. A rise in serum calcium stimulates the release of T lymphocytes. b. A rise in serum calcium stimulates the release of erythropoietin. c. A rise in serum calcium inhibits the release of calcitonin. d. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.
d. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Rationale: Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.
A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? a. Glucocorticoids b. Mineralocorticoids c. Glucagon d. Epinephrine
d. Epinephrine Rationale: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? a. Respirations of 12 breaths/minute b. Cloudy urine c. Blood sugar 170 mg/dL d. Fruity breath
d. Fruity breath Rationale: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? a. Complaints of sleepiness b. Thick hard nails c. Inability to tolerate cold d. Reports of increased appetite
d. Reports of increased appetite Rationale: Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply: a. Elevated blood urea nitrogen (BUN) and creatinine b. Rapid onset c. More common in type 1 diabetes d. Absent ketones e. Normal arterial pH level
a, b, c Rationale: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.
A patient has been placed on corticosteroid therapy for Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply: a. Hypertension b. Alterations in glucose metabolism c. Poor wound healing d. Hypotension e. Weight loss
a, b, c Rationale: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
Vision and visual fields are altered in disorders of which of the following endocrine glands? a. Pituitary b. Thyroid c. Parathyroid d. Pancreas
a. Pituitary Rationale: The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? a. adrenal function b. thyroid function c. thymus function d. parathyroid function
a. adrenal function Rationale: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: a. an ectopic corticotropin-secreting tumor. b. adrenal carcinoma. c. a corticotropin-secreting pituitary adenoma. d. an inborn error of metabolism.
c. a corticotropin-secreting pituitary adenoma. Rationale: A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating
Which of the following hormones controls secretion of adrenal androgens? a. Adrenocorticotropic hormone (ACTH) b. Thyroid-stimulating hormone (TSH) c. Parathormone d. Calcitonin
a. Adrenocorticotropic hormone (ACTH) Rationale: ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH b. Iletin II c. Lispro (Humalog) d. Glargine (Lantus)
a. NPH Rationale: Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? a. Observe stool color. b. Monitor bowel patterns. c. Monitor vital signs every 4 hours. d. Observe urine output.
a. Observe stool color. Rationale: The nurse should observe the color of each stool and test the stool for occult blood
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? a. Administer a sedative as ordered. b. Administer IV calcium gluconate as ordered. c. Start administering oxygen at 2 L/min via a cannula. d. Administer an oral calcium supplement as ordered.
b. Administer IV calcium gluconate as ordered. Rationale: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? a. Polyuria b. Hypoglycemia c. Blurred vision d. Polydipsia
b. Hypoglycemia Rationale: The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? a. "I will avoid friends and family members who are sick." b. "I will eat lots of chicken and dairy products." c. "I may stop taking this medication when I feel better." d. "I will see my ophthalmologist regularly for a check-up."
c. "I may stop taking this medication when I feel better." Rationale: The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a. They have no effect. b. They decrease the need for insulin. c. They increase the need for insulin. d. They cause wide fluctuations in the need for insulin.
c. They increase the need for insulin. Rationale: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
What is the duration of regular insulin? a. 4 to 6 hours b. 3 to 5 hours c. 12 to 16 hours d. 24 hours
a. 4 to 6 hours Rationale: The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.
Lispro (Humalog) is an example of which type of insulin? a. Rapid-acting b. Intermediate-acting c. Short-acting d. Long-acting
a. Rapid-acting Rationale: Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus).
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? a. Give prescribed antiemetics. b. Begin fluid replacements. c. Administer prescribed dose of insulin. d. Administer bicarbonate to correct acidosis.
b. Begin fluid replacements. Rationale: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin.
The primary function of the thyroid gland includes which of the following? a. Control of cellular metabolic activity b. Facilitation of milk ejection c. Reabsorption of water d. Reduction of plasma level of calcium
a. Control of cellular metabolic activity Rationale: The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? a. Detecting evidence of hormone hypersecretion b. Detecting information about possible tumor growth c. Determining the presence or absence of testosterone levels d. Determining the size of the organs and location
a. Detecting evidence of hormone hypersecretion Rationale: The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? a. Presence of islet cell antibodies b. Obesity c. Rare ketosis d. Requirement for oral hypoglycemic agents
a. Presence of islet cell antibodies Rationale: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.
A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? a. Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. b. Encourage the client to participate in outside activities to boost coping strategies. c. Suggest that the client wear cosmetics to cover any changes in appearance. c. Refer the client to professional counseling.
a. Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. Rationale: The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.
What is the only insulin that can be given intravenously? a. Regular b. NPH c. Lantus d. Ultralente
a. Regular Rationale: Insulins other than regular are in suspensions that could be harmful if administered IV.
Which nursing diagnosis is most appropriate for a client with Addison's disease? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia
a. Risk for infection Rationale: Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? a. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) b. Diabetes insipidus (DI) c. Hypothyroidism d. Hyperthyroidism
a. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Rationale: Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a. Risk for infection b. Decreased cardiac output c. Impaired physical mobility d. Imbalanced nutrition: Less than body requirements
b. Decreased cardiac output Rationale: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a. thyroiditis. b. Graves' disease. c. Hashimoto's thyroiditis. d. multinodular goiter.
b. Graves' disease. Rationale: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? a. Insulin b. Hydrocortisone c. Potassium d. Hypotonic saline
b. Hydrocortisone Rationale: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
A 40-year-old male client with a history of childhood non-Hodgkin lymphoma and radiation treatment is being admitted for thyroid cancer. The client is a commercial airline pilot, does not smoke, exercises regularly, and eats mostly take-out food. What risk factors are primarily associated with his diagnosis? a. Childhood cancer and physical activity b. Employment and smoking history c. Age and radiation history d. Dietary choices and gender
c. Age and radiation history Rationale: Cancer of the thyroid is less prevalent than other forms of cancer, but the incidence of the condition is increasing. Thyroid cancer is more likely to develop in clients younger than 50 years old. Exposure to radiation or external radiation of the head, neck or chest in infancy and childhood increases the risk of this condition. Women, not men, are at a greater risk for this condition. Additional risk factors include smoking, low physical activity, unhealthy eating habits, and high stress levels.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? a. Arterial pH 7.25 b. Plasma bicarbonate 12 mEq/L c. Blood glucose level 1,100 mg/dl d. Blood urea nitrogen (BUN) 15 mg/dl
c. Blood glucose level 1,100 mg/dl Rationale: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? a. Fasting blood glucose level b. Glucose via a urine dipstick test c. Glycosylated hemoglobin level d. Glucose via an oral glucose tolerance test
c. Glycosylated hemoglobin level Rationale: Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.
For a client with Graves' disease, which nursing intervention promotes comfort? a. Restricting intake of oral fluids b. Placing extra blankets on the client's bed c. Limiting intake of high-carbohydrate foods d. Maintaining room temperature in the low-normal range
d. Maintaining room temperature in the low-normal range Rationale: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a. Monitor laboratory values daily for elevated thyroid-stimulating hormone. b. Observe for swelling of the neck, tracheal deviation, and severe pain. c. Evaluate the quality of the client's voice postoperatively, noting any drastic changes. d. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
d. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Rationale: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a. sodium. b. potassium. c. magnesium. d. phosphorus.
d. phosphorus. Rationale: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply: a. "At times my vision is blurry." b. "I have to void nearly every hour." c. "I cannot seem to quench my thirst." d. "I sleep at least 8 hours each night." e. "I have lost 10 pounds without even trying."
a, b, c, e Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus a random or casual plasma glucose concentration equal to or greater than 200 mg/dL. Symptoms of diabetes include vision changes, polyuria (or the increased need to urinate), polydipsia (or increased thirst), and sudden weight loss.
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply: a. Ketosis-prone b. Little or no endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age
a, b, d Rationale: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? a. "Maintain a moderate exercise program." b. "Rest as much as possible." c. "Lose weight." d. "Jog at least 2 miles per day."
a. "Maintain a moderate exercise program." Rationale: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? a. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone
a. Acromegaly Rationale: Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a. Albumin b. Bacteria c. Red blood cells d. White blood cells
a. Albumin Rationale: Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of proteins, which would include microalbumin.
Insulin is secreted by which of the following types of cells? a. Beta cells b. Melanocytes c. Neural cells d. Basal cells
a. Beta cells Rationale: Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? a. Blood glucose can be controlled through diet and exercise b. Client is usually thin at diagnosis c. Client is prone to ketosis d. Clients demonstrate islet cell antibodies
a. Blood glucose can be controlled through diet and exercise Rationale: Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? a. Calcium gluconate b. Synthroid c. Propylthiouracil (PTU) d. Tapazole
a. Calcium gluconate Rationale: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
Trousseau's sign is elicited by which of the following? a. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. b. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. c. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. d. The patient complains of pain in the calf when his foot is dorsiflexed.
a. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Rationale: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
Which of the following insulins are used for basal dosage? a. Glargine (Lantus) b. NPH (Humulin N) c. Lispro (Humalog) d. Aspart (Novolog)
a. Glargine (Lantus) Rationale: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.
The adrenal cortex is responsible for producing which substances? a. Glucocorticoids and androgens b. Catecholamines and epinephrine c. Mineralocorticoids and catecholamines d. Norepinephrine and epinephrine
a. Glucocorticoids and androgens Rationale: The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? a. Hand flexing inward b. Cardiac dysrhythmia c. Moon face and buffalo hump d. Bulging forehead
a. Hand flexing inward Rationale: Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.
A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? a. Helps the body adjust to stress b. Maintains blood pressure c. Slows the body's response to inflammation d. Regulates metabolism
a. Helps the body adjust to stress Rationale: Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.
A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia b. Hyperkalemia c. Hyperglycemia d. Hyponatremia
a. Hypokalemia Rationale: Because a patient's serum potassium level may drop quickly as a result of rehydration and insulin treatment, potassium replacement must begin once potassium levels drop to normal in the patient with DKA.
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? a. Hypokalemia and hypoglycemia b. Hypocalcemia and hyperkalemia c. Hyperkalemia and hyperglycemia d. Hypernatremia and hypercalcemia
a. Hypokalemia and hypoglycemia Rationale: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage
a. Tetany Rationale: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: a. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. b. Insulin will be released to facilitate the transport of sugar. c. Glycogenesis will be decreased by the liver. d. The process of gluconeogenesis will be inhibited.
a. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Rationale: When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? a. The secretions are released directly into the blood stream. b. The glands contain ducts that produce the hormones. c. The secreted hormones act like target cells. d. The glands play a minor role in maintaining homeostasis.
a. The secretions are released directly into the blood stream. Rationale: The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? a. The short-acting insulin is withdrawn before the intermediate-acting insulin. b. The intermediate-acting insulin is withdrawn before the short-acting insulin. c. Different types of insulin are not to be mixed in the same syringe. d. If administered immediately, there is no requirement for withdrawing one type of insulin before another.
a. The short-acting insulin is withdrawn before the intermediate-acting insulin. Rationale: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? a. glycosylated hemoglobin b. hematocrit B1C c. postprandial glucose d. CAT scan
a. glycosylated hemoglobin Rationale: Once a client with diabetes receives a treatment regimen to follow, the physician can assess the effectiveness of treatment and the client's compliance by obtaining a hemoglobin A1c test. The results of this test reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. Normally, the level of glycosylated hemoglobin is less than 7%. Amounts of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.
Which is a characteristic of type 2 diabetes? a. insulin resistance b. presence of islet antibodies c. little or no insulin d. ketosis-prone when insulin absent
a. insulin resistance Rationale: Type 2 diabetes is characterized by either a decrease in endogenous insulin or an increase accompanied by insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the client with type 1 diabetes is ketosis-prone when insulin is absent and often has islet cell antibodies.
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? a. ketoacidosis b. hyperosmolar hyperglycemic nonketotic syndrome c. hepatic disorder d. All options are correct.
a. ketoacidosis Rationale: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? a. kidneys b. cardiac atria c. brain d. liver
a. kidneys Rationale: The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? a. pituitary disorder b. thyroid disorder c. parathyroid disorder d. adrenal disorder
a. pituitary disorder Rationale: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? a. "The spleen releases ketones when your body can't use glucose." b. "Ketones will tell us if your body is using other tissues for energy." c. "Ketones can damage your kidneys and eyes." d. "Ketones help the physician determine how serious your diabetes is."
b. "Ketones will tell us if your body is using other tissues for energy." Rationale: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? a. Cheyne-Stokes respirations b. Increased urine output c. Decreased appetite d. Diaphoresis
b. Increased urine output Rationale: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? a. Onset most common during adolescence b. Insulin production insufficient c. Less common than type 1 diabetes d. Little to no relation to pre-diabetes
b. Insulin production insufficient Rationale: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which characteristic would the nurse inform the group is associated with type 2 diabetes? a. Onset most common during adolescence b. Insulin resistance or insufficient insulin production c. Less common than type 1 diabetes d. Little relation to prediabetes
b. Insulin resistance or insufficient insulin production Rationale: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and adults aged 45 to 64 years were highest among newly diagnosed age groups for type 2 diabetes in 2018, not adolescents. The absence of insulin production by beta cells in the islets of Langerhans of the pancreas is characteristic of type 1 diabetes mellitus, not type 2. Prediabetes can lead to type 2 diabetes.
Which statement is correct regarding glargine insulin? a. Its peak action occurs in 2 to 3 hours. b. It cannot be mixed with any other type of insulin. c. It is absorbed rapidly. d. It is given twice daily.
b. It cannot be mixed with any other type of insulin. Rationale: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? a. Indwelling urinary catheter kit b. Tracheostomy set c. Cardiac monitor d. Humidifier
b. Tracheostomy set Rationale: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
A nurse should expect a client with hypothyroidism to report: a. increased appetite and weight loss. b. puffiness of the face and hands. c. nervousness and tremors. d. thyroid gland swelling.
b. puffiness of the face and hands. Rationale: Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: a. folic acid. b. vitamin D. c. potassium. d. iron.
b. vitamin D. Rationale: Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? a. "Don't take your insulin or oral antidiabetic agent if you don't eat." b. "It's okay for your blood glucose to go above 300 mg/dl while you're sick." c. "Test your blood glucose every 4 hours." d. "Follow your regular meal plan, even if you're nauseous."
c. "Test your blood glucose every 4 hours." Rationale: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? a. "I will refer you to a dietician who can help you with your weight." b. "You may be having undiagnosed infections, causing you to lose extra weight." c. "Your body is using protein and fat for energy instead of glucose." d. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."
c. "Your body is using protein and fat for energy instead of glucose." Rationale: Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: a. I.M. or subcutaneous glucagon. b. I.V. bolus of dextrose 50%. c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. d. 10 units of fast-acting insulin.
c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. Rationale: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? a. Sodium bicarbonate b. Fludrocortisone c. Calcium gluconate d. Methylprednisolone
c. Calcium gluconate Rationale: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.
The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? a. Skeletal deformities b. Paresthesias c. Erectile dysfunction d. Soft tissue ulceration
c. Erectile dysfunction Rationale: Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy.
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? a. Somatostatin b. Insulin c. Glucagon d. Cholecystokinin
c. Glucagon Rationale: Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.
A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress? a. Testosterone b. Mineralocorticoids c. Glucocorticoids d. Estrogen
c. Glucocorticoids Rationale: Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? a. Keep an accurate record of intake and output. b. Use nasal desmopressin acetate (DDAVP). c. Have regular follow-up care. d. Exercise to improve cardiovascular fitness.
c. Have regular follow-up care. Rationale: The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? a. With diabetes, drinking more results in more urine production. b. Increased ketones in the urine promote the manufacturing of more urine. c. High sugar pulls fluid into the bloodstream, which results in more urine production. d. The body's requirement for fuel drives the production of urine.
c. High sugar pulls fluid into the bloodstream, which results in more urine production. Rationale: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? a. Exophthalmos b. Thyroid storm c. Myxedema coma d. Tibial myxedema
c. Myxedema coma Rationale: Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? a. Fasting blood glucose test b. 6-hour glucose tolerance test c. Serum glycosylated hemoglobin (Hb A1c) d. Urine ketones
c. Serum glycosylated hemoglobin (Hb A1c) Rationale: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.
Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: a. Transport of potassium. b. Release of glucose. c. Synthesis of glucose from noncarbohydrate sources. d. Storage of glucose as glycogen in the liver.
c. Synthesis of glucose from noncarbohydrate sources. Rationale: Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? a. The concentration of a substance in plasma b. Details about the size of the organ and its location c. The functioning of endocrine glands d. The client's blood sugar level
c. The functioning of endocrine glands Rationale: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland? a. Mid trachea b. Distal to the carotid arteries c. The lower neck anterior to the trachea d. The upper neck posterior to the trachea
c. The lower neck anterior to the trachea Rationale: The thyroid gland is located in the lower neck anterior to the trachea. It is divided into two lateral lobes joined by a band of tissue called the isthmus.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? a. Parathormone b. Thymosin c. Thyroxine d. Somatotropin
c. Thyroxine Rationale: The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland
The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? a. If two different types of insulin are ordered, they need to be given in separate injections. b. When mixing insulin, the NPH insulin is drawn up into the syringe first. c. When mixing insulin, the regular insulin is drawn up into the syringe first. d. There is no need to inject air into the bottle of insulin before withdrawing the insulin.
c. When mixing insulin, the regular insulin is drawn up into the syringe first. Rationale: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a. thyroid storm. b. cretinism. c. myxedema coma. d. Hashimoto's thyroiditis.
c. myxedema coma. Rationale: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: a. severe hypotension. b. excessive thirst. c. profound neuromuscular irritability. d. acute gastritis.
c. profound neuromuscular irritability. Rationale: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." b. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." c. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." d. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
d. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Rationale: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: a. 90 mg/dL before meals. b. 120 mg/dL, 1 hour postprandial. c. 80 mg/dL, 1 hour postprandial. d. 138 mg/dL, 2 hours postprandial.
d. 138 mg/dL, 2 hours postprandial. Rationale: The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Disturbed body image related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess Rationale: n the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
Which intervention is the most critical for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway
d. Maintaining a patent airway Rationale: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? a. The client continues medication therapy despite adequate food intake. b. The client has not consumed sufficient calories. c. The client has been exercising more than usual. d. The client has eaten and has not taken or received insulin.
d. The client has eaten and has not taken or received insulin. Rationale: If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.
