AN - Endocrine and Reproductive Practice Exam ATI

A nurse is caring for a client who is postoperative following a thyroidectomy. Which of the following is a priority for the nurse to monitor during the first 24 hr of care for this client?

Airway patency - When using the airway, breathing, circulation approach to client care, the nurse determines that the priority to monitor is airway patency. A thyroidectomy can result in edema or bleeding that can obstruct the airway. Provide humidification and elevate the client's head of bed to reduce swelling.

A nurse is reinforcing teaching with a newly licensed nurse about the administration of depot medroxyprogesterone. What instruction should the nurse include in the teaching?

"Give the medication intramuscularly." - The nurse can administer depot medroxyprogesterone subcutaneously or intramuscularly.

A nurse manager in a health clinic is discussing complications associated with sexually transmitted infections (STIs) with a newly licensed nurse. What statement should be included in the discussion?

"Human papillomavirus can lead to cancer of the cervix." - HPV can cause cancer of the cervix, and less commonly the vulva, vagina, anus, and penis.

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

Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

A nurse is assisting with the plan of care for a client who had a subtotal thyroidectomy. In what position should the nurse plan to place the client?

Fowler's position - The nurse should position the client in the Fowler's position, to reduce the swelling of the operative area as well as facilitate breathing. The nurse may use sandbags to support the head to relieve tension on the sutures.

A 28-year-old woman seeks advice about oral contraceptives from the nurse in her company health office. What should the nurse tell her if she is a smoker?

Oral contraceptives can cause thrombophlebitis. - Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis.

A client at 16 weeks' gestation is being treated for Trichomonas vaginalis. What statement best indicates to the nurse that the client has learned measures to prevent a recurrence?

"My partner has to get treated before we have sex again." - The male partner should be treated to prevent the infection from passing back and forth between him and his sexual partner

A nurse is assisting with the care of a client who is returning to the medical unit from the PACU following an abdominal hysterectomy. What data should the nurse collect first?

Airway patency - ​When using the airway, breathing, circulation approach to client care, the nurse should first check the patency of the client's airway.

A nurse is collecting data on a client who has hyperthyroidism. What manifestation should the nurse expect the client to report?

Frequent mood changes - Hyperthyroidism develops when the thyroid gland produces an excess of the thyroid hormones that regulate the metabolic rate. Nervousness and frequent mood changes; hand tremors; a rapid, pounding, irregular heartbeat are common manifestations of hyperthyroidism.

A nurse is caring for a client who is postoperative and has a history Addison's disease. What manifestation should the nurse monitor?

Hypotension - The client who has Addison's disease is at risk for developing Addisonian crisis following a major physiological stressor such as surgery. Manifestations such as hypotension and tachycardia, extreme weakness and a decrease in mental status are noted. Untreated, Addisonian crisis may result in death.

A nurse is assisting with the care of a client who has diabetes insipidus. The nurse should monitor the client for what manifestation?

Hypotension - The client who has diabetes insipidus produces excessive urine resulting in hypovolemia and hypotension. The nurse should monitor the client for hypotension and dehydration.

A nurse in a clinic is caring for a female client who has gonorrhea. What action should the nurse take?

Obtain information about the client's recent sexual partners - Sexual partners should be examined, cultured, and treated due to the risk of reinfection.

A nurse is caring for a female client who is scheduled to have a pelvic examination. The client tells the nurse, "I'm really nervous because I've never had a pelvic exam before." What is an appropriate therapeutic response by the nurse?

"Tell me more about your concerns." - This therapeutic response is an open-ended statement and encourages the client to tell the nurse more about her concerns.

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

A pounding headache is secondary to the severe hypertension associated with excessive amounts of catecholamines. Palpitations are associated with stimulation of the sympathetic nervous system caused by catecholamines (epinephrine and norepinephrine). Diaphoresis is associated with stimulation of the sympathetic nervous system because of excessive catecholamines. Tachycardia, not bradycardia, is associated with stimulation of the sympathetic nervous system caused by catecholamines. Hypertension, not hypotension, is the principle clinical manifestation associated with pheochromocytoma because of stimulation of the sympathetic nervous system.

A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:

An increased temperature and pulse rate - Thyrotoxic crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature.

A nurse is assisting with the care of a client who 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. What action should the nurse take?

Determine the client's calcium level - The nurse should determine the client's calcium level. A client who has had a thyroidectomy is at risk of hypocalcemia due to possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland. They are responsible for calcium regulation and, if they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these symptoms following a thyroidectomy, it would be important to see what the latest calcium level is.

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

Mineralocorticoids - Mineralocorticoids, such as aldosterone, cause the kidneys to retain sodium ions. With sodium, water is also retained, elevating blood pressure. Absence of this hormone thus causes hypotension.

​A nurse is reinforcing teaching with a client who asks which diagnostic test is the preferred method for detecting cervical cancer. What is an appropriate response by the nurse?

Papanicolaou test - The Papanicolaou (Pap) test is used to detect cervical cancer.

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

Weight loss, exophthalmos, and restlessness - Weight loss and restlessness occur because of an increased basal metabolic rate; exophthalmos occurs because of peribulbar edema.

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

Measure blood glucose levels - Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely.

A nurse is collecting data from a client who has Cushing's syndrome. What finding should the nurse expect?

Moon face - Moon face is a manifestation of Cushing's syndrome (hypercortisolism).

A nurse reviewing the laboratory of a client who had a total thyroidectomy discovers that his calcium level is 7mg/dL. What client finding should the nurse expect?

Muscle tetany - This calcium level is below the expected reference range. Therefore, the nurse should check the client for tetany as a finding of hypocalcemia.

Based on a client's recent history, a nurse suspects that a client is beginning menopause. What question should the nurse ask the client to help confirm the client is experiencing manifestations of menopause?

"Do you sleep well at night?" - Menopause causes vasomotor instability, which can cause night sweats and sleep disturbances. Therefore, this is an appropriate question for the nurse to ask.

A nurse is reinforcing teaching about the frequency of breast self-examination (BSE) with a young adult client. What statement by the client indicates an understanding of the teaching?

"The best day to perform BSE is 7 days after the menstrual cycle begins." - At this time in the menstrual cycle, the influence of hormones on breast tissue is decreased. There is minimal engorgement and breast tenderness, allowing for more accurate palpation of the breasts.

A nurse is providing discharge teaching to a client following a right mastectomy. What statement should indicate to the nurse that the client has a healthy body image?

"The incision looks like it is healing." - The client who has had a mastectomy is at risk for a body image disturbance because the resulting change in appearance may pose a threat to her self- concept. The client's statement indicates that she is concerned about her health and appearance and is making a positive statement about her recovery.

A nurse is reinforcing teaching with a client who has hypothyroidism and a prescription for levothyroxine. What statement should the nurse make to the client?

"Tremors, nervousness, and insomnia can indicate that your dose is too high." - Tremors, nervousness, and insomnia can indicate an overdose of the medication and the provider should be contacted.

A nurse is reinforcing teaching to a client who is preparing for a pelvic examination with Papanicolaou (Pap) test. What statement should the nurse include in the teaching?

"You will need to empty your bladder just before the exam." - The client should void prior to the gynecological exam as a full bladder makes the procedure more uncomfortable and prevents complete palpation of the pelvis.

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

Calcium gluconate - The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia.

A nurse is assisting with the plan of care for a client who is 4 hr postoperative from a subtotal thyroidectomy. What implementations should the nurse recommend?

Check for bleeding on the dressing at the back of the client's neck - The client is at risk for hemorrhage due to the vascularity of the surrounding tissue. The nurse should check the dressing on the back of the client's neck for evidence of hemorrhage

A nursing is reviewing nutrition therapy with a client who has Cushing's disease. Which of the following dietary modifications should the nurse include in this discussion?

Decrease sodium intake - Clients who have Cushing's disease experience the impaired breakdown of nutrients resulting in hypernatremia, hyperglycemia, and hypokalemia. Therefore, the nurse should instruct the client to decrease sodium intake.

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

Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

A nurse is collecting data for a female client who has genital herpes. What finding should the nurse expect?

Dysuria - Symptoms of genital herpes develop 3 to 7 days after skin-to-skin contact with an infected person. Genital herpes lesions appear as small blisters on the genitals. During urination, the client may experience pain. Other symptoms may include fever, muscle weakness, headaches, and burning genital pain.

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

Ensuring a large fluid intake - Fluids help prevent the formation of renal calculi associated with high levels of serum calcium.

A nurse is reinforcing teaching with a 55-year-old client who is experiencing menopause and is prescribed estrogen/progestin therapy (EPT). The nurse should tell the client that what is a benefit of estrogen/progestin therapy in women who are postmenopausal?

Estrogen prevents fractures from osteoporosis - EPT and estrogen therapy both delay the occurrence of osteoporosis and prevent fractures in women who are postmenopausal. Other benefits include prevention of hot flashes and urethral atrophy, which causes urinary incontinence.

A nurse is monitoring a client for findings related to diabetes insipidus following a craniotomy. What finding should indicate a manifestation of this condition to the nurse?

Increased urine output - Diabetes insipidus is a water metabolism disorder caused by a deficiency of antidiuretic hormone (ADH). This deficiency results in the excretion of large amounts of dilute urine. Dehydration and shock may ensue, resulting in a life-threatening situation for the client.

A nurse in a clinic is caring for a client who is postmenopausal and has risk factors for osteoporosis. The nurse anticipates the client will be prescribed what medication?

Raloxifene hydrochloride - Raloxifene hydrochloride is prescribed for prevention of osteoporosis in postmenopausal women.

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following actions should the nurse take?

Restrict oral fluids to 800 to 1,000 mL/day - Clients who have SIADH have an increased amount of antidiuretic hormone, which results in excess fluid volume. This excess fluid dilutes the sodium level in the blood, causing dilutional hyponatremia. Oral fluids are restricted in an attempt to restore the fluid balance and therefore the sodium level in the blood. This dilutional hyponatremia does not occur only in clients who have SIADH, but also can result in clients with excess fluid volume (e.g., heart failure, liver cirrhosis, nephrotic syndrome).

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

Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints - These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the health care provider are the priorities.

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

Tetany - Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death.

A nurse is reinforcing teaching to a client who is at high risk for breast cancer and is prescribed tamoxifen citrate for prophylaxis. What statement should the nurse make regarding adverse effects of the medication?

"Hot flashes are a common side effect of this drug." -The nurse should instruct the client that hot flashes are a common adverse effect of tamoxifen.

A nurse is reinforcing breast self- examination (BSE) teaching with a client who is menopausal. Which of the following statements by the client indicate an understanding of the teaching? (Select all that apply.)

"I can stand in the shower to perform the examination." - A client can perform a BSE while in a lying position, or when bathing or showering. "It is important to press my breasts firmly to detect any lumps." - Women should press firmly on the breasts to detect changes in underlying tissues. The nurse should demonstrate the proper amount of pressure and the correct positioning of the hands. "Since I no longer have periods, I can do the exam at any time of the month." - Women who no longer have the monthly hormonal influences of menstruation can perform an examination at any time. Inform the client that It is best to select a specific date each month for her BSE. "I will make sure to feel for changes in my underarm area." - It is important to check the area between the breast tissue and the underarm as well as the underarm itself for any changes. Lymph nodes located in this area are assessed for inflammation, tenderness, and firmness.

A nurse in a provider's officer is collecting date from a client who has ovarian cancer. What manifestation should the nurse expect?

Abdominal bloating - The nurse should expect the client who has ovarian cancer to manifest abdominal bloating.

A nurse is contributing to the plan of care for a client who has diabetes insipidus. What intervention should the nurse include?

Administer desmopressin - Clients who have diabetes insipidus can manage the disease by taking desmopressin intranasally or orally as replacement therapy. Desmopressin acts on the renal tubular epithelium to promote reabsorption of water.

A nurse is reinforcing teaching with a middle adult female client who has fibrocystic breast disease. The nurse should emphasize to the client that manifestations of this disease are present at what time?

Before menstruation begins - Manifestations of benign fibrocystic breast changes include painful breasts, smooth moveable lumps, and possible nipple discharge and tend to worsen premenstrually. Reducing salt and caffeine intake sometimes helps.

A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical manifestations should the nurse expect to observe? (Select all that apply.)

Buffalo hump- Cushing's syndrome is a disease caused by an increased production of cortisol or by excessive use of corticosteroids. Buffalo hump, a collection of fat between the shoulders, is a common manifestation of Cushing's syndrome. Purple striations - Purple striations on the skin of the abdomen, thighs, and breasts are a common manifestation of Cushing's syndrome. This is due to the collection of body fat in these areas. Moon face - Moon face is a common manifestation of Cushing's syndrome. Clients who have this manifestation present with a round, red, full face.

A nurse is assisting with meal planning for a client who has hypothyroidism. The nurse should reinforce with the client that she should increase her daily intake of what nutrient?

Fiber - Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fiber and fluid intake to help prevent constipation.

Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. What complication does the nurse suspect the client is experiencing?

Hypocalcemia - The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood.

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

Hypoglycemia and hypotension - Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone, resulting in fluid excretion that leads to hypotension.

A nurse is caring for a client after a thyroidectomy. For which signs of thyroid storm should the client be monitored? (Select all that apply.)

Increased heart rate and increased temperature - Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby causing an increased heart rate (tachycardia). Because of the increased metabolic rate associated with thyroid storm, body temperature will increase. Because of the increased metabolic rate associated with thyroid storm, the respiratory rate increases (tachypnea) to meet the body's oxygen needs. Pulse deficit, the difference between apical and peripheral pulse rates, is not indicative of thyroid storm. The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

A nurse is reinforcing teaching about breast self-examination (BSE) with a client who has a regular menstrual cycle. The nurse should instruct the client to perform BSE at what time?

Three to seven days after menses stops - The client should plan to perform breast self-examination about 3 to 7 days after menstruation, when the breasts are least tender and not engorged.`

A nurse plans to set up emergency equipment at the bedside of a client in the immediate postoperative period after a thyroidectomy. What should the nurse include in the bedside setup?

Tracheostomy set and oxygen - A tracheostomy set and oxygen are necessary if the client experiences an acute respiratory obstruction as a result of postoperative edema, nerve damage, or tetany.

A young client tells the nurse that her mother complains about having dysmenorrhea and asks the nurse what this means. How should the nurse describe dysmenorrhea?

Uterine pain during the menstrual period - Uterine pain during the menstrual period is the definition of dysmenorrhea.

A nurse is collecting data from a male client who has been exposed to syphilis and has a genital chancre. What prescription should the nurse anticipate when notifying the provider of the findings?

Veneral disease research laboratory [VDRL] - The VDRL tests for the presence of the antibodies to the spirochete Triponema pallidum which causes syphilis. The test is positive several weeks after infection and will return to normal following treatment..

A nurse is caring for a client who is experiencing menopausal symptoms and requests information about hormone replacement therapy (HRT). What item in the client's health history is a contraindication for hormone replacement therapy?

​History of breast cancer - A history of breast cancer is a contraindication to the use of HRT.

A nurse in a clinic is caring for a client who has a new diagnosis of hypothyroidism. What finding should the nurse expect?

Weight gain - The nurse should expect the client to experience weight gain caused by a decreased metabolic rate. The client may report anorexia and decreased dietary intake.