Targeted Medical-Surgical: Endocrine

A nurse is providing discharge teaching for a client who has diabetes insipidus and has a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching? 1) depress the pump once before using the spray 2) blow your nose gently prior to using the nasal spray 3) administer the nasal spray while in the side-lying position 4) notify the provider if you develop numbness or tingling around the mouth

"2 This action prevents dilution of the medication with nasal secretions *should press down 4 times before initial use

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? 1) take the medication on an empty stomach 2) take the medication with an antacid 3) change positions slowly while taking this medication 4) limit your fluid intake

"Take this medication on an empty stomach." To promote proper absorption, the client should take the medication on an empty stomach (and get a full glass of water) and not eat or drink anything for 30 to 60 min after taking it. *antacids decrease effect & can raise blood sugar

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? 1) administer IV hydrocortisone sodium 2) give oral spironolactone 3) infuse 1 units of platelets 4) restrict fluid intake

1 *causes cortisol deficiency, hyperkalemia, & hypovolemia

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? 1) sodium 110 mEq/L 2) 2+ DTR 3) Potassium 3.7 mEq/L 4) urine specific gravity 1.025

1 A client who has SIADH retains fluids, which causes dilutional hyponatremia.

A nurse is monitoring a client's status 24 hours after a total thyroidectomy. Which of the following findings should the nurse report to the provider? 1) laryngeal stridor 2) productive cough 3) pain with hyperextension of the neck 4) hoarse, weak voice

1 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.

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? 1) inject insulins IM 2) shake insulins vigorously prior to administration 3) draw up in separate syringes 4) expect the insulins to appear cloudy

3 Insulin glargine is not compatible with other insulins *inject SQ, gently mix insulins & both should be clear

A nurse is caring for a client who is taking propylthiouracil. The nurse should identify that the client has met the treatment goals when she reports an increase in which of the following manifestations? 1) increased ability to sweat 2) increased BM 3) increased body weight 4) increased libido

3 Propylthiouracil suppresses the production of thyroid hormones and, therefore, allows for weight gain. However, excessive weight gain could indicate that the dose of propylthiouracil is too high

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? 1) Diabetes insipidus 2) hyperthyroidism 3) pheochromocytoma 4) addison's disease

4 *It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency.

A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? 1) moon-shaped face 2) weight gain 3) calcium 12.8 mg/dL 4) Sodium 150 mEq/L

Calcium 12.8 mg/dL A client who has adrenal insufficiency has a calcium level above the expected reference range. *sodium will be low & see weight loss

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? 1) rapid, deep respirations 2) cool, clammy skin 3) abdominal cramping 4) orthostatic hypotension

Cool, clammy skin Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion. *all others are signs of hypoerglycemia

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? 1) fasting blood gluose 96 mg/dL 2) Postprandial blood glucose 165 mg/dL 3) Random blood glucose 210 mg/dL 4) Praprandial blood glucose 60 mg/dL

Fasting blood glucose 96 mg/dL This is within the expected reference range of 70-110 mg/dL

A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following effects should the nurse include? (select all that apply) 1) osteoporosis 2) moon-shaped face 3) increased risk of infection 4) hearing loss 5) weight loss

Osteoporosis 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 due to suppression of the immune system. Long-term corticosteroid therapy can cause cataracts and glaucoma, but it does not cause hearing loss. More likely to cause weight gain due to the fluid and sodium retention these medications cause.

A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? 1) pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L 2) pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L 3)pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L 4) pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L

1 Metabolic acidosis is a common manifestation of DKA, with pH characteristically low, carbon dioxide within the expected reference range, and bicarbonate low.

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? 1) reduction of the effects of thyroid hormone on the heart 2) blockage of the release of thyroid hormone from the thyroid gland 3) increase the heart's sensitivity to thyroid hormone 4) increase in the uptake of thyroid hormones by the thyroid gland

1 Propranolol is a beta2-adrenergic blocking agent that decreases the rapid heart rate that excessive thyroid stimulation causes.

A nurse is caring for a client who has a pheochromocytoma. Which of the following actions should the nurse take? 1) Elevate the head of the client's bed 2) palpate abdomen 3) monitor for hypotension 4) check the client's urine specific gravity

1 The nurse should elevate the head of the client's bed to reduce blood pressure and abdominal pressure. *don't palpate abdomen b/c it can increase pressure (releases catecholamines) *monitor for hypertension

A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include? 1) consume no more than three servings of alcohol a day 2) Ingest alcohol with food to reduce alcohol-induced hypoglycemia 3) increase insulin dosage before planned exercise 4) rest for 3 days between vigorous exercise

2 Alcohol inhibits the liver from producing glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.

A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? 1) decreased heart rate 2) increased hematocrit 3) high specific gravity 4) low BUN level

2 An increased hematocrit is an expected finding resulting from dehydration.

A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following statements should the nurse identify as an indication that the client understands the information about this test? 1) I need to fast before the test 2) This test's result is a good indicator of my average blood glucose levels 3) A level of 8-10 percent suggests good control 4) I will use my A1c level to adjust my daily insulin doses

2 HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs *don't need to fast *expected range is 4-6%

A nurse is 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? 1) examine skin of the feet weekly for alterations in skin integrity 2) monitor temperature of bath water with a thermometer 3) shop for shoes early in the day 4) round the edges of toenails when trimming them

2 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).

A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements should the nurse identify as an indication that the client understands the teaching? 1) I should stop taking insulin 2) I will test my urine for proteins 3) I will call my doctor if my blood sugar is more than 250 4) I should check my blood sugar level every 8 hours

3 *check glucose every 4 hours

A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse should expect an elevation in which of the following laboratory findings? 1) potassium 2) calcium 3) glucose 4) lymphocyte count

3 Blood glucose is elevated in a client who has Cushing's disease *all others will be decreased

A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? 1) cold intolerance 2) lethargy 3) tremors 4) sunken eyes

3 Findings of hyperthyroidism include tremors, diaphoresis, and insomnia.

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? 1) strong, bounding pulses 2) decreased bowel sounds 3) tingling and numbness of the hands and feet 4) diminished DTR

3 Hypocalcemia causes paresthesias, which usually starts in the hands and feet.

A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect? 1) decreased BP 2) weight loss 3) hirsutism 4) increased skin thickness

3 Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production. *will see increased BP, weight gain, & thinning of skin

A nurse is caring for a client who has type 2 diabetes melliltus and has hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? 1) pH 7.32 2) blood glucose 250 3) blood glucose 425 4) pH 7.45

4 A client who has 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.

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)? 1) decreased urine output 2) weight gain of 0.45 kg (1lb) in 24 hr 3) rapid, shallow respirations 4) blood glucose levels above 300 mg/dL

4 Blood glucose levels above 300 mg/dL are an expected finding with DKA. Levels above 600 mg/dL are an expected finding with hyperglycemic-hyperosmolar state. *will see Kussmaul respirations, weight loss, and increased urine output

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 his medication regularly. Which of the following findings should the nurse expect? 1) increased urine output 2) persistent diarrhea 3) tachycardia 4) hypotension

4 Hypotension is an expected finding with hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin.

A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements should the nurse identify as an indication that the client understands the teaching? 1) I will let my feet air dry 2) I will wear sandals to allow air to circulate around my feet 3) I will buy OTC medicine to treat my calluses 4) I will apply lotion to the dry areas of my feet, but not between my toes

4 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. *they should dry their feet & wear closed-toed shoes

To screen a client for pheochromocytoma, a nurse schedules a vanillylmandelic acid test. When teaching the client about this test, which of the following instructions should the nurse include? 1) start fasting at midnight prior to the day of the test 2) begin a 24-hour urine collection with the first morning urination 3) take low-dose aspirin for pain 4) restrict coffee intake 2-3 days prior to the test

4 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 *discard the first morning urine *patients don't have to be NPO @ MN

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 in the teaching plan? 1) drink at least 3 liters of fluid per day 2) weight yourself weekly while wearing similar clothing at the same time of day 3) notify provider of weight loss 4) report nocturia because it requires a dosage adjustment

4 The client should receive the initial dose of desmopressin in the evening; the provider will increase the dosage until the client no longer has nocturia *weight yourself daily