RN Targeted Medical Surgical ENDOCRINE (ATI)
A nurse is providing discharge teaching to a client who has diabetes insipidus and a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching? - "Depress the pump once before using the nasal spray for the first time." - "Blow your nose gently prior to using the nasal spray." - "Administer the nasal spray while in a side-lying position." - "Notify the provider if you develop numbness or tingling around the mouth."
"Blow your nose gently prior to using the nasal spray." Rationale: The nurse should instruct the client to blow his nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions. RATIONALES: "Depress the pump once before using the nasal spray for the first time." - The nurse should instruct the client to prime the nasal spray pump by pressing down four times before the initial use. "Administer the nasal spray while in a side-lying position." - The nurse should instruct the client to sit upright with their head tilted forward slightly when administering the spray. The upright position prevents the spray from going down the client's throat. "Notify the provider if you develop numbness or tingling around the mouth." - Numbness or tingling around the mouth is a manifestation of hypocalcemia. Desmopressin can result in the adverse effect of hyponatremia.
A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching? - "I will let my feet air dry after washing." - "I will wear sandals to allow air to circulate around my feet." - "I will buy over-the-counter medicine to treat the calluses on my feet." - "I will apply lotion to the dry areas of my feet but not between my toes."
"I will apply lotion to the dry areas of my feet but not between my toes." Rationale: Lotion can be used for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth. RATIONALES: "I will let my feet air dry after washing." - The client should dry their feet thoroughly after washing to prevent bacterial growth between the toes. "I will wear sandals to allow air to circulate around my feet." - The client should wear closed-toe shoes to prevent injury to their feet. "I will buy over-the-counter medicine to treat the calluses on my feet." - Topical over-the-counter medications can impair skin integrity and lead to further injury.
A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching? - "I should stop taking my insulin if I feel nauseous." - "I will test my urine for protein when I start to feel ill." - "I will call my doctor if my blood sugar is more than 250." - "I should check my blood sugar level every 8 hours."
"I will call my doctor if my blood sugar is more than 250." Rationale: The client should call the provider if their blood glucose levels exceed 250 mg/dL during illness. RATIONALES: "I should stop taking my insulin if I feel nauseous." - The client should continue taking the usual dose of insulin even when not feeling well. "I will test my urine for protein when I start to feel ill." - The client should check their urine for ketones when blood glucose levels are greater than 240 mg/dL. "I should check my blood sugar level every 8 hours." - The client should check their blood glucose every 4 hr during illness.
A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include? - "Drink at least 3 L of fluid per day." - "Weigh yourself weekly while wearing similar clothing at the same time of day." - "Notify the provider of a weight loss of 1 pound or more per week." - "Report nocturia because it requires a dosage adjustment."
"Report nocturia because it requires a dosage adjustment." Rationale: The client should take the initial dose of desmopressin in the evening. The provider will increase the dosage until the client no longer has nocturia. RATIONALES: "Drink at least 3 L of fluid per day." - The client should drink an amount of fluid equal to his urine output each day. "Weigh yourself weekly while wearing similar clothing at the same time of day." - The client should weigh himself daily to detect dehydration in its early stage. "Notify the provider of a weight loss of 1 pound or more per week." - A weight gain or loss of 0.45 kg (1 lb) per week is not enough to suggest overhydration or dehydration.
A nurse is teaching a client who is scheduled for a vanillylmadelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching? - "Start fasting at midnight prior to the day of the test." - "Begin the 24-hour urine collection with the first morning urination." - "Take low-dose aspirin for pain during the testing period." - "Restrict coffee intake 2 to 3 days prior to the test."
"Restrict coffee intake 2 to 3 days prior to the test." Rationale: The client should avoid coffee and tea, even if they are decaffeinated, bananas, chocolate, and vanilla for 2 to 3 days prior to the test. RATIONALES: "Start fasting at midnight prior to the day of the test." - The client does not have to fast prior to the test, but there are foods the client should avoid, such as bananas and citrus foods. "Begin the 24-hour urine collection with the first morning urination." - The client should discard the first morning urine, and then collect all urine after that for 24 hr - "Take low-dose aspirin for pain during the testing period." - The client should avoid aspirin because it can affect the results.
A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement. Which of the following instructions should the nurse plan to include? - "Take this medication on an empty stomach." - "Take this medication with an antacid." - "Change position slowly while taking this medication." - "Limit your fluid intake while taking this medication."
"Take this medication on an empty stomach." Rationale: To promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 minutes after. RATIONALES: "Take this medication with an antacid." - Aluminum-containing antacids and calcium supplements can reduce the effectiveness of thyroid replacement therapy. "Change position slowly while taking this medication." - This medication can increase blood glucose levels in clients who have diabetes mellitus. However, it does not cause orthostatic hypotension. "Limit your fluid intake while taking this medication." - The client should take the medication with a full glass of water. Since there are no fluid restrictions with this medication therapy, the client should drink 2 to 3 L of fluid daily.
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching? - "I need to fast after midnight the night before the test." - "The test's result is a good indicator of my average blood glucose levels." - "A level of 8 to 10 percent suggests adequate blood glucose control." - "I will use my hemoglobin A1c level to adjust my daily insulin doses."
"The test's result is a good indicator of my average blood glucose levels." Rationale: HbA1c reflects the client's glucose levels over a 120-day period, which is the lifespan of RBCs RATIONALES: "I need to fast after midnight the night before the test." - The client does not need to fast before blood sampling for HbA1c. What the client eats the day before has no effect on the results of this test. "A level of 8 to 10 percent suggests adequate blood glucose control." - The expected reference range for HbA1c is 4-6% for adults. A result greater than 6.5% can indicate diabetes. "I will use my hemoglobin A1c level to adjust my daily insulin doses." - The client should use capillary blood glucose levels to adjust daily insulin doses with the provider's approval.
A nurse is teaching a client about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders? - Diabetes insipidus - Hyperthyroidism - Pheochromocytoma - Addison's disease
Addison's disease Rationale: The nurse should instruct the client that the ACTH stimulation test is the standard test for Addison's disease. It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency. RATIONALES: Diabetes insipidus - A 24-hr measurement of I&O, a urine specific gravity, and a test of urine osmolarity are used to diagnose diabetes insipidus. Hyperthyroidism - A thyroid scan and a thyroid-stimulating hormone test are used to diagnose hyperthyroidism. Pheochromocytoma - A 24-hr urine collection can detect catecholamines and other substances that can indicate pheochromocytoma.
A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take? - Administer IV hydrocortisone sodium - Give oral spironolactone - Infuse 1 unit of platelets - Restrict daily fluid intake
Administer IV hydrocortisone sodium Rationale: Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency RATIONALES: Give oral spironolactone - Administering a potassium-sparing diuretic, such as spironolactone, will further increase the client's potassium level, worsening the hyperkalemia Infuse 1 unit of platelets - Although this client needs increased circulatory volume, infusing platelets is not appropriate for a client who has acute adrenal insufficiency Restrict daily fluid intake - Acute adrenal insufficiency causes hypovolemia, which is an indication for rapid fluid replacement
A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of diabetic ketoacidosis (DKA)? - Decreased urine output - Weight gain of 0.45 kg (1 lb) in 24 hr. - Rapid, shallow respirations - Blood glucose levels above 300 mg/dL
Blood glucose levels above 300 mg/dL Rationale: Blood glucose levels above 300 mg/dL are an expected finding of DKA. Levels above 600 mg/dL are an expected finding in a client who is in a hyperglycemic-hyperosmolar state. RATIONALES: Decreased urine output - Increased urine output is an expected finding of DKA. Weight gain of 0.45 kg (1 lb) in 24 hr. - Weight loss is an expected finding of DKA. Rapid, shallow respirations - Deep, labored breathing, known as Kussmaul respirations, is an expected finding of DKA.
A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? - Moon-shaped face - Weight gain - Calcium 12.8 mg/dL - Sodium 150 mEq/L
Calcium 12.8 mg/dL Rationale: A client who has adrenal insufficiency will have a calcium level above the expected reference range of 9.0 to 10.5 mg/dL RATIONALES: Moon-shaped face - A rounded face or a moon-shaped face is a finding of Cushing's disease. Weight gain - Weight loss is a finding of adrenal insufficiency. Sodium 150 mEq/L - A client who has adrenal insufficiency will have a sodium level below the expected reference range of 136 to 145 mEq/L.
A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic? - Rapid, deep respirations - Cool, clammy skin - Abdominal cramping - Orthostatic hypotension
Cool, clammy skin Rationale: Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion RATIONALES: Rapid, deep respirations - Rapid, deep respirations are an expected finding of hyperglycemia. Abdominal cramping - Abdominal cramping is an expected finding of hyperglycemia. Orthostatic hypotension - Hyperglycemia can cause dehydration, resulting in orthostatic hypotension.
A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include? - Inject the insulins intramuscularly - Shake the insulins vigorously prior to administration - Draw up the insulins into separate syringes - Expect the insulins to appear cloudy
Draw up the insulins into separate syringes Rationale: The nurse should instruct the client to draw up the insulins into separate syringes because insulin glargine is not compatible with other insulins. RATIONALES: Inject the insulins intramuscularly - The nurse should instruct the client to inject the insulins into the subcutaneous tissue to promote proper absorption. Shake the insulins vigorously prior to administration - The nurse should instruct the client to gently mix the insulin vials prior to administration to prevent altering the chemistry of the medication. Expect the insulins to appear cloudy - The nurse should instruct the client to expect both insulins to appear clear and to discard any that appear cloudy.
A nurse is caring for a client who has pheochromocytoma. Which of the following actions should the nurse take? - Elevate the head of the client's bed - Palpate the client's abdomen - Monitor the client for hypotension - Check the client's urine specific gravity
Elevate the head of the client's bed Rationale: The nurse should elevate the head of the client's bed to reduce blood pressure and abdominal pressure. RATIONALES: Palpate the client's abdomen - The nurse should not palpate the abdomen of a client who has a pheochromocytoma, because this can cause release of catecholamines and increase blood pressure. Monitor the client for hypotension - The nurse should monitor a client who has pheochromocytoma for hypertension Check the client's urine specific gravity - The nurse should monitor the urine specific gravity of a client who has diabetes insipidus.
A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy? - Fasting blood glucose 96 mg/dL - Postprandial blood glucose 195 mg/dL - Random blood glucose 210 mg/dL - Preprandial blood glucose 60 mg/dL
Fasting blood glucose 96 mg/dL Rationale: This is within the expected reference range of 70 to 110 mg/dL for a fasting blood glucose level and indicates that insulin therapy is effective. RATIONALES: Postprandial blood glucose 195 mg/dL - A postprandial blood glucose level of 195 mg/dL is above the expected reference range of less than 180 mg/dL Random blood glucose 210 mg/dL - A random blood glucose level of 210 mg/dL is above the expected reference range of less than 200 mg/dL Preprandial blood glucose 60 mg/dL - A preprandial blood glucose level of 60 mg/dL is below the expected reference range of 70 to 130 mg/dL
A nurse is reviewing the laboratory results of a client undergoing screening for primary Cushing's disease. The nurse should expect an elevation in which of the following laboratory findings? - Lymphocyte count - Potassium - Calcium - Glucose
Glucose Rationale: Blood glucose is elevated in a client who has Cushing's disease RATIONALES: Lymphocyte count - The lymphocyte count is below the expected reference range in a client who has Cushing's disease. Potassium - Potassium is below the expected reference range in a client who has Cushing's disease. Calcium - Calcium is below the expected reference range in a client who has Cushing's disease.
A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect? - Decreased blood pressure - Weight loss - Hirsutism - Increased skin thickness
Hirsutism Rationale: Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production RATIONALES: Decreased blood pressure - Elevated blood pressure is an expected finding of Cushing's disease. Weight loss - Weight gain is an expected finding of Cushing's disease. Increased skin thickness - Thinning of the skin is an expected finding of Cushing's disease.
A home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hypothyroidism. The client has not been taking the medication regularly. Which of the following findings should the nurse expect? - Increased urine output - Persistent diarrhea - Tachycardia - Hypotension
Hypotension Rationale: Hypotension is an expected finding of hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin. RATIONALES: Increased urine output - Hypothyroidism is more likely to cause a decrease in urine output. Persistent diarrhea - Hypothyroidism is more likely to cause constipation. Tachycardia - Hypothyroidism commonly causes bradycardia.
A nurse is assessing a client who is taking propylthiouracil. The nurse should identify which of the following findings as an indication that the medication has been effective? - Increased ability to sweat - Increased bowel movements - Increased body weight - Increased libido
Increased body weight Rationale: Propylthiouracil suppresses the production of thyroid hormones and allows for weight gain. However, excessive weight gain could indicate that the dose of propylthiouracil is too high. RATIONALES: Increased ability to sweat - Diaphoresis is a manifestation of hyperthyroidism. Propylthiouracil is an antithyroid agent that is expected to decrease diaphoresis. Increased bowel movements - Increased bowel movements is a manifestation of hyperthyroidism. Propylthiouracil is an antithyroid agent that is expected to decrease bowel movements. Increased libido - Increased libido is a manifestation of hyperthyroidism. Propylthiouracil is an antithyroid agent that is expected to decrease libido.
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? - Decreased heart rate - Increased hematocrit - High urine specific gravity - Low BUN level
Increased hematocrit Rationale: Increased hematocrit is an expected finding of diabetes insipidus due to dehydration. RATIONALES: Decreased heart rate - Tachycardia is an expected finding of diabetes insipidus. High urine specific gravity - Increased urine output leads to diluted urine and a low urine specific gravity. Low BUN level - An increased BUN level is an expected finding of diabetes insipidus due to dehydration.
A nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hyperglycemic-hypersmolar state (HHS). Which of the following laboratory findings should the nurse expect? - Serum pH 7.32 - Blood glucose 250 mg/dL - Blood glucose 425 mg/dL - Serum pH 7.45
Serum pH 7.45 Rationale: A client who is experiencing HHS produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range. Glucose levels will be above 600 mg/dL RATIONALES: Serum pH 7.32 - The laboratory value indicates the client has diabetic ketoacidosis. Clients who are experiencing HHS will have a pH greater than 7.40 Blood glucose 250 mg/dL - The laboratory value indicates the client has hyperglycemia. Clients who are experiencing HHS will have a blood glucose level greater than 600 mg/dL Blood glucose 425 mg/dL - The laboratory value indicates the client has hyperglycemia. Clients who are experiencing HHS will have a blood glucose greater than 600 mg/dL
A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include? - Consume no more than three servings of alcohol per day - Ingest food with alcohol to reduce alcohol induced hypoglycemia - Increase insulin dosage before planned exercise - Rest for 3 days between periods of vigorous exercise
Ingest food with alcohol to reduce alcohol induced hypoglycemia Rationale: Alcohol inhibits the liver's production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia. RATIONALES: Consume no more than three servings of alcohol per day - The nurse should recommend that male clients drink no more than two servings of alcohol per day, and female clients drink no more than one serving of alcohol per day. Increase insulin dosage before planned exercise - The nurse should instruct the client to reduce insulin dosage before planned exercise to prevent hypoglycemia. Rest for 3 days between periods of vigorous exercise - The nurse should instruct the client to exercise at least three times per week and have no more than 2 consecutive days without exercise.
A nurse is monitoring a client who is 24 hr postoperative after a total thyroidectomy. Which of the following findings should the nurse report to the provider? - Laryngeal stridor - Productive cough - Pain with hyperextension of the neck - Hoarse, weak voice
Laryngeal stridor Rationale: Laryngeal stridor is a harsh, high-pitched sound with inspiration that indicates respiratory obstruction. The nurse should take immediate action to preserve the client's airway. RATIONALES: Productive cough - A productive cough can occur after general anesthesia due to a buildup of secretions caused by endotracheal intubation. Pain with hyperextension of the neck - Pain with hyperextension of the neck is an expected finding after a thyroidectomy. The nurse should use pillows to support the client's head and neck. Hoarse, weak voice - A hoarse and weak voice is common after general anesthesia as a result of endotracheal intubation. If hoarseness continues, it could indicate laryngeal nerve damage, which is usually transient.
A nurse caring for a client who has diabetes mellitus and has developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to the client's feet? - Examine the skin of the feet weekly for alterations in skin integrity - Monitor the temperature of bath water with a thermostat - Shop for shoes early in the day - Round the edges of toenails when trimming them
Monitor the temperature of bath water with a thermostat Rationale: Peripheral neuropathy makes it difficult to determine if bath water is too hot. Therefore, to prevent injury, the client should use a bath thermometer to ensure a water temperature below 43.3 C (110 F) RATIONALES: Examine the skin of the feet weekly for alterations in skin integrity - The client should examine the skin of the feet daily. Shop for shoes early in the day - To make sure they fit, the client should shop for shoes later in the day when the feet are likely to have slight swelling. Round the edges of toenails when trimming them - The client should trim toenails straight across and smooth the edges with an emery board.
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following adverse effects should the nurse include? (Select all that apply.) - Osteoporosis - Moon-shaped face - Increased risk of infection - Hearing loss - Weight loss
Osteoporosis Moon-shaped face Increased risk of infection Rationale: Osteoporosis is an adverse effect of long-term corticosteroid therapy due to the suppression of bone formation and the acceleration of bone resorption that corticosteroid therapy can cause. Long-term corticosteroid therapy causes characteristics of iatrogenic Cushing's syndrome, including a moon-shaped face, a potbelly, and a buffalo hump. Increased risk of infection is an adverse effect of long-term corticosteroid therapy. Corticosteroid therapy reduces the phagocytic actions of macrophages and neutrophils, suppressing the immune system. RATIONALES: Hearing loss - Long-term corticosteroid therapy can cause cataracts and glaucoma, but does not cause hearing loss. Weight loss - Long-term corticosteroid therapy is more likely to cause weight gain due to fluid and sodium retention.
A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Which of the following findings indicates that the client is having a therapeutic response? - Reduction of the effects of thyroid hormone on the heart - Blockage of the release of thyroid hormone from the thyroid gland - Increase in the heart's sensitivity to thyroid hormone - Increase in the uptake of thyroid hormone by the thyroid gland
Reduction of the effects of thyroid hormone on the heart Rationale: Propranolol is a beta 2 adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation. RATIONALES: Blockage of the release of thyroid hormone from the thyroid gland - Propranolol does not affect thyroid hormone release. Increase in the heart's sensitivity to thyroid hormone - Propranolol does not increase the heart's sensitivity to thyroid hormone. It helps prevent dysrhythmias. Increase in the uptake of thyroid hormone by the thyroid gland - Propranolol does not affect the uptake of thyroid hormone by the thyroid gland. It helps lower the client's blood pressure.
A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider? - Sodium 110 mEq/L - 2+ deep tendon reflexes - Potassium 3.7 mEq/L - Urine specific gravity 1.025
Sodium 110 mEq/L Rationale: A client who has SIADH retains fluids, which causes dilutional hyponatremia. RATIONALES: 2+ deep tendon reflexes - Deep tendon reflexes of 2+ is an expected response. Clients who have SIADH experience hyperactive deep tendon reflexes of 3+ or 4+. Potassium 3.7 mEq/L - The potassium level is within the expected reference range of 3.5 to 5 mEq/L. Urine specific gravity 1.025 - The urine specific gravity is within the expected reference range of 1.005 to 1.030.
A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia? - Strong, bounding pulses - Decreased bowel sounds - Tingling and numbness of the hands and feet - Diminished deep-tendon reflexes
Tingling and numbness of the hands and feet Rationale: Hypocalcemia causes paresthesia, which usually starts in the hands and feet. RATIONALES: Strong, bounding pulses - Hypocalcemia causes a weak, thready pulse. Decreased bowel sounds - Hypocalcemia increases gastrointestinal motility. Diminished deep-tendon reflexes - Hypocalcemia causes hyperactive deep-tendon reflexes.
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? - Cold intolerance - Lethargy - Tremors - Sunken eyes
Tremors Rationale: Findings of hyperthyroidism include tremors, diaphoresis, and insomnia. RATIONALES: Cold intolerance - A client who has hyperthyroidism can experience heat intolerance. Lethargy - A client who has hyperthyroidism can be restless and irritable. Sunken eyes - A client who has hyperthyroidism can have exophthalmos, which causes a wide-eyed or startled appearance.
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? - pH 7.32, PaCO2 36 mmHg, HCO3- 14 mEq/L - pH 7.38, PaCO2 55 mmHg, HCO3- 22 mEq/L - pH 7.44, PaCO2 40 mmHg, HCO3- 24 mEq/L - pH 7.50, PaCO2 42 mmHg, HCO3- 30 mEq/L
pH 7.32, PaCO2 36 mmHg, HCO3- 14 mEq/L Rationale: Metabolic acidosis is a common manifestation of DKA, with a low pH, carbon dioxide within the expected reference range, and low bicarbonate. RATIONALES: pH 7.38, PaCO2 55 mmHg, HCO3- 22 mEq/L - Clients who have DKA have an acidic pH, not a pH within the expected reference range. pH 7.44, PaCO2 40 mmHg, HCO3- 24 mEq/L - Clients who have DKA have an acidic pH, not a pH within the expected reference range. pH 7.50, PaCO2 42 mmHg, HCO3- 30 mEq/L - Clients who have DKA have an acidic pH, not an alkaline pH.
