ATI Endocrine 2013
A nurse is performing an assessment on a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessment data should the nurse report? A. Serum sodium 110 mEq/L B. 2+ deep-tendon reflexes C. Serum potassium 3.7 mEq/L D. Urine specific gravity 1.025
A - Correct - A client who has SIADH retains fluids, which causes dilutional hyponatremia. B - Incorrect - Deep-tendon reflexes of 2+ are within the expected reference range. C - Incorrect - This serum potassium level is within the expected reference range. D - Incorrect - This urine specific gravity is within the expected reference range.
A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect? A. Decreased blood pressure B. Weight loss C. Hirsutism D. Increased skin thickness
A - Incorrect - Elevated blood pressure is an expected finding of Cushing's disease. B - Incorrect - Weight gain is an expected finding of Cushing's disease. C - Correct - Increased hair growth, or hirsutism, is an expected finding of Cushing's disease due to increased androgen production. D - Incorrect - Thinning of the skin is an expected finding of Cushing's disease.
A nurse is preparing to give a client information about an adrenocorticotropic hormone (ACTH) stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders? A. Cushing's syndrome B. Hyperthyroidism C. Pheochromocytoma D. Addison's disease
A - Incorrect - Urine and serum cortisol levels are checked to test for Cushing's syndrome. B - Incorrect - In clients who have hyperthyroidism, T3 and T4 are high. Thyroid-stimulating hormone is low in clients who have Graves' disease and high in clients who have secondary or tertiary hyperthyroidism. C - Incorrect - A 24-hr urine collection is used to detect catecholamines and other substances that can indicate pheochromocytoma. D - Correct - 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. ...
A nurse is preparing insulin for a client who has diabetes mellitus. The client is to receive evening doses of insulin glargine and regular insulin. Which of the following actions should the nurse take to administer these two medications safely? A. Draw up the insulin glargine into the syringe first, and then draw up the regular insulin. B. Draw up the regular insulin into the syringe first, and then draw up the insulin glargine. C. Draw up the insulin glargine and the regular insulin into separate syringes. D. Draw up either insulin into the syringe first because both insulins are clear.
A - Incorrect - When mixing insulins, the nurse should draw up the short-acting insulin first. However, there is only one longer-acting insulin, NPH insulin, that is safe to mix with short-acting insulin. B - Incorrect - When mixing insulins, the nurse should draw up the short-acting insulin first. However, there is only one longer-acting insulin, NPH insulin, that is safe to mix with short-acting insulin. C - Correct - The nurse should not mix insulin glargine with any other insulin in the same syringe due to the low pH of its diluent. D - Incorrect - Whether a particular type of insulin is clear or cloudy does not determine its suitability for mixing. Acceptable mixtures include mixing clear, short-acting insulin with cloudy, longer-acting insulin, NPH insulin.
A nurse is managing the care of a client who is postoperative and experiencing acute adrenal insufficiency. Which of the following actions should the nurse take? A. Administer IV hydrocortisone sodium succinate. B. Give oral spironolactone. C. Infuse 1 unit of platelets. D. Restrict daily fluid intake.
A - Correct - Hydrocortisone sodium succinate is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency. B - Incorrect - Administering a potassium-sparing diuretic will further increase the client's potassium level, potentiating the state of hyperkalemia. C - Incorrect - Although this client needs to increase volume, infusing platelets is not indicated. D - Incorrect - Rapid fluid replacement is indicated for this client due to hypovolemia. ...
A nurse is monitoring a client's status 24 hr after a total thyroidectomy. Which of the following findings should the nurse report to the provider? A. Laryngeal stridor B. Productive cough C. Pain with hyperextension of the neck D. Hoarse, weak voice
A - Correct - Laryngeal stridor is a harsh, high-pitched sound upon inspiration that indicates respiratory obstruction. The nurse should take immediate action to preserve the client's airway. B - Incorrect - A productive cough can occur after endotracheal intubation and is caused by a buildup of secretions. C - Incorrect - Pain with hyperextension of the neck D - Incorrect - 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 is providing teaching for a client who has diabetes mellitus. Which of the following findings associated with diabetic ketoacidosis (DKA) should the nurse include? A. Decreased urine output B. Weight gain of 0.45 kg (1 lb) in 24 hr C. Rapid, shallow respirations D. Blood glucose levels greater than 300 mg/dL
A - Incorrect - Increased urine output is an expected finding of DKA. B - Incorrect - Weight loss is an expected finding of DKA C - Incorrect - Deep Kussmaul respirations are an expected finding of DKA. D - Correct - Blood glucose levels above 300 mg/dL are an expected finding of DKA.
A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? A. Moon face B. Weight gain C. Serum calcium 12.8 mg/dL D. Serum sodium 150 mEq/L
A - Incorrect - A rounded face is a finding of Cushing's disease. B - Incorrect - Weight loss is a finding of adrenal insufficiency. C - Correct - A client who has adrenal insufficiency has a serum calcium level above the expected reference range. D - Incorrect - A client who has adrenal insufficiency has a serum sodium level below the expected reference range. ...
A nurse is caring for a client undergoing screening for primary Cushing's disease. The nurse should expect that which of the following laboratory findings to be elevated? A. Lymphocyte count B. Serum potassium C. Serum calcium D. Blood glucose
A - Incorrect - Lymphocyte count is below the expected reference range with Cushing's disease. B - Incorrect - Serum potassium is below the expected reference range with Cushing's disease. C - Incorrect - Serum calcium is below the expected reference range with Cushing's disease. D - Correct - Blood glucose is elevated with Cushing's disease. ...
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.) A. Osteoporosis B. Moon-shaped face C. Increased risk of infection D. Hearing loss E. Weight loss
A - Correct - 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. B - Correct - Long-term corticosteroid therapy causes characteristics of the iatrogenic syndrome characterized by a moon-shaped face, a potbelly, and a buffalo hump. C - Correct - Increased risk of infection is an adverse effect of long-term corticosteroid therapy due to the decrease it causes in the number of circulating lymphocytes. D - Incorrect - Long-term corticosteroid therapy is more likely to cause cloudy or blurred vision than hearing loss. E - Incorrect - Long-term corticosteroid therapy is more likely to cause weight gain due to the fluid retention corticosteroids cause. ...
A nurse is preparing to administer propranolol by IV bolus to a client experiencing a thyroid storm. Which of the following findings indicates the client is having a therapeutic response? A. Reduction of the effects of thyroid hormone on the heart B. Blockage of the release of thyroid hormone from the thyroid gland C. Increase of the heart's sensitivity to thyroid hormone D. Increase of the uptake of thyroid hormone by the thyroid gland
A - Correct - Propranolol is a beta2-adrenergic blocking agent that decreases the rapid heart rate caused by excessive thyroid stimulation. B - Incorrect - Propranolol does not affect thyroid hormone release. C - Incorrect - Propranolol does not increase the heart's sensitivity to thyroid hormone. D - Incorrect - Propranolol does not affect the uptake of thyroid hormone by the thyroid gland.
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? A. Fasting blood glucose 96 mg/dL B. Postprandial blood glucose 195 mg/dL C. Casual blood glucose 210 mg/dL D. Preprandial blood glucose 60 mg/dL
A - Correct - This is within the expected reference range for a fasting blood glucose level and indicates that insulin therapy is effective. B - Incorrect - A postprandial blood glucose level of 195 mg/dL is above the expected reference range. C - Incorrect - A casual blood glucose level of 210 mg/dL is above the expected reference range. D - Incorrect - A preprandial blood glucose level of 60 mg/dL is below the expected reference range.
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? A. "Take this medication on an empty stomach." B. "Take this medication with an antacid." C. "Change position slowly while taking this medication." D. "Limit your fluid intake while taking this medication."
A - Correct - To promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 min after taking it. B - Incorrect - Aluminum-containing antacids and calcium supplements can reduce the effectiveness of thyroid replacement therapy. C - Incorrect - This medication does not cause orthostatic hypotension. D - Incorrect - The client should drink 2 to 3 L of fluid daily.
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? A. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L B. pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L C. pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L D. pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L
A - Correct - With DKA, the pH is low, carbon dioxide is within the expected reference range, and bicarbonate is low. B - Incorrect - Clients who have DKA have an acidic pH, not a pH within the expected reference range. C - Incorrect - Clients who have DKA have an acidic pH, not a pH within the expected reference range. D - Incorrect - Clients who have DKA have an acidic pH, not an alkaline pH. ...
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? A. Cold intolerance B. Lethargy C. Tremors D. Sunken eyes
A - Incorrect - A client who has hyperthyroidism has heat intolerance. B - Incorrect - A client who has hyperthyroidism is restless and irritable. C - Correct - Findings of hyperthyroidism include tremors, diaphoresis, and insomnia. D - Incorrect - A client who has hyperthyroidism can have exophthalmos, which causes a wide-eyed or startled appearance...
A nurse is preparing a teaching plan for a client who has diabetes insipidus and is receiving intranasal desmopressin. Which of the following information should the nurse include in the teaching plan? A. Daily fluid intake should be at least 3 L. B. Obtain weight weekly while wearing similar clothing at the same time of day. C. Notify the provider if a weight loss of 0.45 kg (1 lb) or more per week is noted. D. Occurrence of nocturia indicates the need for a dosage adjustment.
A - Incorrect - Fluid intake should be limited to no more than 3 L per day. B - Incorrect - The client should obtain his weight daily to detect dehydration in the early stage. C - Incorrect - A weight gain or loss of 0.45 kg (1 lb) per week is not suggestive of overhydration or dehydration. D - Correct - The initial dose of desmopressin is administered in the evening; the provider will increase the dosage until the client no longer experiences nocturia.
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? A. Strong, bounding pulse B. Decreased bowel sounds C. Tingling and numbness of the hands and feet D. Diminished deep-tendon reflexes
A - Incorrect - Hypocalcemia causes a weak, thready pulse. B - Incorrect - Hypocalcemia increases gastrointestinal motility. C - Correct - Hypocalcemia causes paresthesias, usually starting in the hands and feet. D - Incorrect - Hypocalcemia causes hyperactive deep-tendon reflexes. ...
A home health nurse is assessing a client who is on lifelong hormone replacement therapy for treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect? A. Significant weight loss B. Persistent diarrhea C. Tachycardia D. Hypotension
A - Incorrect - Hypothyroidism is more likely to cause weight gain. B - Incorrect - Hypothyroidism is more likely to cause constipation. C - Incorrect - Hypothyroidism commonly causes bradycardia. D - Correct - Hypotension is an expected finding of hypothyroidism. ...
A nurse is caring for a client who is taking propylthiouracil (PTU). The nurse should recognize that the client has met the treatment goals when she reports an increase in which of the following effects? A. Sweating B. Stools C. Weight D. Appetite
A - Incorrect - PTU should cause a decrease in diaphoresis. B - Incorrect - PTU should cause a decrease in bowel movements. C - Correct - PTU suppresses the production of thyroid hormones and, therefore, allows for weight gain. D - Incorrect - PTU should cause a reduction in appetite.
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? A. Rapid, deep respirations B. Cool, clammy skin C. Abdominal cramping D. Orthostatic hypotension
A - Incorrect - Rapid, deep respirations are an expected finding of hyperglycemia. B - Correct - Hypoglycemia causes cool, clammy skin, in addition to anxiety, nervousness, tachycardia, and confusion. C - Incorrect - Abdominal cramping is an expected finding of hyperglycemia. D - Incorrect - Hyperglycemia can cause dehydration, resulting in hypotension.
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? A. Decreased heart rate B. Increased hematocrit C. High urine specific gravity D. Decreased BUN
A - Incorrect - Tachycardia is an expected finding of diabetes insipidus. B - Correct - An increased hematocrit level is an expected finding related to dehydration. C - Incorrect - Increased urine output leads to dilute urine and a low urine specific gravity. D - Incorrect - An increase in BUN levels is an expected finding related to dehydration.
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? A. Start fasting at midnight prior to the day of the test. B. Begin the 24-hr urine collection with the first morning urination. C. Take low-dose aspirin for pain during the testing period. D. Restrict coffee intake 2 to 3 days prior to the test.
A - Incorrect - The client does not have to fast prior to the test. B - Incorrect - The client should discard the first morning urine, and then collect all urine after that for 24 hr. C - Incorrect - The client should avoid aspirin because it can affect test results. D - Correct - 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. ...
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following statements by the client indicates an understanding of the information about this test? A. "I need to fast after midnight the night before the test." B. "This test is a good indicator of my average blood glucose levels." C. "A level of 8% to 10% suggests adequate blood glucose control." D. "I will use my hemoglobin A1c level to adjust my daily insulin doses."
A - Incorrect - The client does not need to fast before blood sampling for HbA1c. In fact, what the client eats the day before has no effect on the results of this test. B - Correct - HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs. C - Incorrect - Clients who have diabetes mellitus should keep their HbA1c below 7%. D - Incorrect - The client should use capillary blood glucose levels to adjust daily insulin doses with the provider's approval.
A nurse is providing teaching for a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements indicates that the client understands the teaching? A. "I should stop taking my insulin if I feel nauseous." B. "I will test my urine for protein when I start to feel ill." C. "I will call my doctor if my blood sugar is more than 250 mg/dL." D. "I should check my blood glucose level every 8 hours."
A - Incorrect - The client should continue taking the usual dose of insulin, even when not feeling well. B - Incorrect - The client should check urine for ketones when blood glucose levels are greater than 240 mg/dL. C - Correct - The client should call the provider if blood glucose levels exceed 250 mg/dL during illness. D - Incorrect - The client should check her blood glucose level every 4 hr during illness. ...
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? A. "I will let my feet air dry after washing." B. "I will wear sandals to allow air to circulate around my feet." C. "I will buy over-the-counter medicine to treat the calluses on my feet." D. "I will apply lotion to the dry areas of my feet, avoiding application between my toes."
A - Incorrect - The client should dry her feet thoroughly after washing to prevent bacterial growth between the toes. B - Incorrect - The client should wear closed-toe shoes to prevent injury to her feet. C - Incorrect - Over-the-counter medications can impair skin integrity and lead to further injury. D - Correct - Lotion is appropriate for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth.
A nurse is caring for a client who has diabetes mellitus and developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to his feet? A. Examine the skin and feet weekly for alterations in skin integrity. B. Monitor the temperature of bath water with a thermometer. C. Shop for shoes early in the day. D. Round the edges of toenails when trimming.
A - Incorrect - The client should examine his skin and feet daily. B - Correct - 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 the water temperature is less than 43.3° C (110° F). C - Incorrect - The client should shop for shoes later in the day when his feet are slightly swollen to make sure the shoes fit. D - Incorrect - The client should trim his toenails straight across and smooth the edges with an emery board. ...
A nurse is planning dietary teaching for a client who has type 1 diabetes mellitus. Which of the following information should the nurse include regarding alcohol consumption? A. Substitute two carbohydrate exchanges for every one alcoholic beverage. B. Ingest alcohol with meals to reduce alcohol-induced hypoglycemia. C. Consuming alcohol decreases blood triglyceride levels. D. Expect to increase insulin dosage when consuming alcohol.
A - Incorrect - The client should substitute two fat exchanges for every beverage containing alcohol. B - Correct - Alcohol prevents liver production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia. C - Incorrect - Consuming alcohol increases triglyceride levels. D - Incorrect - The client might need to decrease insulin dosage due to the hypoglycemic effect of alcohol.
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? A. Breathe deeply while using the nasal spray. B. Blow nose gently prior to using the nasal spray. C. Administer the nasal spray while in a side-lying position. D. Instill the medication four times per day.
A - Incorrect - The medication is absorbed through the nasal mucosa. The client should hold his breath while spraying the medication. B - Correct - By blowing the nose gently prior to use of the spray, the client avoids dilution of the medication by nasal secretions or improper absorption of the medication due to nasal blockage. C - Incorrect - The client should sit upright when administering the spray. This helps to keep the spray from going down the throat. D - Incorrect - The client should instill the medication every 8 hr to 24 hr as prescribed by the provider. ...
A nurse is planning preoperative care for a client who has pheochromocytoma. Which of the following interventions should the nurse anticipate as being the priority? A. Use same arm for BP measurement. B. Avoid palpating the abdomen. C. Manage headaches with analgesics. D. Provide a private, darkened room.
A - Incorrect - The nurse should measure the client's BP in the same arm to obtain accurate readings. However, this is not the priority intervention. B - Correct - The greatest risk to this client is injury from hypertensive crisis. Therefore, the priority intervention is to avoid palpating the abdomen, which can cause a sudden release of catecholamines, causing a hypertensive crisis. C - Incorrect - The nurse should administer analgesics to treat the client's headaches. However, this is not the priority intervention. D - Incorrect - The nurse should provide a private, darkened room to promote rest and comfort. However, this is not the priority intervention. ...
A nurse is caring for a client who has type 2 diabetes mellitus and is admitted with hyperglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? A. Blood glucose of 496 mg/dL and serum pH of 7.32 B. Blood glucose of 550 mg/dL and serum pH of 7.02 C. Blood glucose of 702 mg/dL and serum pH of 6.11 D. Blood glucose of 846 mg/dL and serum pH of 7.40
A - Incorrect - These laboratory values indicate diabetic ketoacidosis. B - Incorrect - These laboratory values indicate diabetic ketoacidosis. C - Incorrect - These laboratory values indicate diabetic ketoacidosis. D - Correct - With HHS, the client produces enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. Therefore, the serum pH is within the expected reference range, but the blood glucose is greater than 600 mg/dL. ...