Endocrine

81. The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids? 1. "Take your medication with a full glass of water." 2. "Take your medication on an empty stomach." 3. "Take your medication at bedtime to increase absorption." 4. "Take your medication with meals or with an antacid.

take your medication with meals or with an antacid

67. Which of the following indicates that the client with diabetes insipidus understands how to manage care? 1. The client will maintain normal fluid and electrolyte balance. 2. The client will select a diabetic diet correctly. 3. The client will state dietary restrictions. 4. The client will exhibit serum glucose level within normal range.

the client will maintain normal fluid and electrolyte balance

86. The nurse should teach the client with Addison's disease that the bronzecolored skin is thought to be caused by which of the following? 1. Hypersensitivity to sun exposure. 2. Increased serum bilirubin level. 3. Adverse effects of the glucocorticoid therapy. 4. Increased secretion of adrenocorticotropic hormone (ACTH).

increased secretion of adrenocorticotropic (ACTH)

65. After pituitary surgery, the nurse should assess the client for which of the following? 1. Urine specific gravity less than 1.010. 2. Urine output between 1 and 2 L/day. 3. Blood glucose level higher than 300 mg/dL (16.7 mmol/L). 4. Urine negative for glucose and ketones

urine specific gravity less than 1.010

76. The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1. Addison's disease will resolve over a few weeks, requiring no further treatment. 2. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3. Fatigue, weakness, dizziness, and mood changes need to be reported to the physician. 4. A medical identification bracelet should be worn. 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Dental work or surgery will require adjustment of daily medication

2,3,4,5,6

The nurse has just completed an assessment of a Pt with a head injury. What lab value is concerning ?

Increased urinary output with specific gravity of <1.005

77. The nurse should assess a client with Addison's disease for which of the following? 1. Weight gain. 2. Hunger. 3. Lethargy. 4. Muscle spasms.

Lethargy

70. Which of the following would be an expected finding in a client with adrenal crisis (addisonian crisis)? 1. Fluid retention. 2. Pain. 3. Peripheral edema. 4. Hunger

Pain

The nurse is caring for a postoperative client who has undergone surgical removal of of pituitary gland (hypophysectomy), and now has developed DI. The nurse should assess for :

Severe dehydration and HYPeRnatremia

80. Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy? 1. Take both drugs three times a day. 2. Take the entire dose of both drugs first thing in the morning. 3. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. 4. Take half of each drug in the morning and the remaining half of each drug at bedtime.

Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon.

The nurse is caring for a postoperative client who has undergone a transsphenoidal hypophysectomy. Which assessments would be most important for this client ? SATA

Urinary output Fluid and electrolyte balance Visual assessment

88. A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: 1. Collect a 24-hour urine specimen to measure serum cortisol levels. 2. Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. 3. Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. 4. Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.

administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning

87. A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for: 1. Orthostatic hypotension. 2. Muscle hypertrophy in the extremities. 3. Bruised areas on the skin. 4. Decreased body hair.

bruised areas on the skin

111. The elderly client with type 2 diabetes has hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent: 1. Ketone body formation. 2. A major vascular accident. 3. Fluid volume depletion. 4. Cerebral edema.

cerebral edema

89. The nurse should monitor the client with Cushing's disease for which of the following? 1. Postprandial hypoglycemia. 2. Hypokalemia. 3. Hyponatremia. 4. Decreased urine calcium level.

hypokalemia

75. When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from: 1. Insufficient secretion of growth hormone (GH). 2. Dysfunction of the hypothalamic pituitary. 3. Idiopathic atrophy of the adrenal gland. 4. Oversecretion of the adrenal medulla.

idiopathic atrophy of the adrenal gland

A client with Cushing's disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which of the following concepts? 1. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels. 2. A single random blood test cannot provide reliable information about endocrine levels. 3. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. 4. Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.

the excessive cortisol levels seen in Cushing's disease results from loss of normal diurnal secretion pattern

85. The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations? 1. Returning to work after a weekend. 2. Going on vacation. 3. Having oral surgery. 4. Having a routine medical checkup

having oral surgery

105. Which of the following should the nurse include in the teaching plan of a female client with bilateral adrenalectomy?

requires lifelong adrenal hormone replacement

To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, the nurse should instruct the client to: 1. Rinse the mouth with saline solution. 2. Perform frequent toothbrushing. 3. Clean the teeth with an electric toothbrush. 4. Floss the teeth thoroughly

rinse the mouth with saline

58. To help minimize the risk of postoperative respiratory complications after a hypophysectomy, during preoperative teaching, the nurse should instruct the client how to: 1. Use incentive spirometry. 2. Turn in bed. 3. Take deep breaths. 4. Cough.

take deep breaths

82. Which of the following is the best indicator for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1. Skin turgor. 2. Temperature. 3. Thirst. 4. Daily weight

daily weight

69. Which of the following is the priority for a client in addisonian crisis? 1. Controlling hypertension. 2. Preventing irreversible shock. 3. Preventing infection. 4. Relieving anxiety.

Preventing irreversible shock

91. The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? 1. Increase calories. 2. Restrict sodium. 3. Restrict potassium. 4. Reduce fat to 10%.

Restrict sodium

64. The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? 1. Acromegaly. 2. Cushing's disease. 3. Diabetes mellitus. 4. Hypopituitarism.

Hypopituitarism

66. Vasopressin is administered to the client with diabetes insipidus because it: 1. Decreases blood pressure. 2. Increases tubular reabsorption of water. 3. Increases release of insulin from the pancreas. 4. Decreases glucose production within the liver

increases tubular reabsorption of water

84. Which of the following is a priority outcome for the client with Addison's disease? 1. Maintenance of medication compliance. 2. Avoidance of normal activities with stress. 3. Adherence to a 2-g sodium diet. 4. Prevention of hypertensive episodes

maintenance of medication compliance

83. Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? 1. Anorexia. 2. Dizziness. 3. Rapid weight gain. 4. Poor skin turgor.

rapid weight gain

hypophysectomy

surgical removal of the pituitary gland and/or tumor Post op care- pt must be on lifelong hormone replacement Monitor for nose bleed and csf Avoid blowing the nose, coughing,sneezing,and straining. Elevate the head Monitor for SIADH and Diabetes insipidus

59. Following a transsphenoidal hypophysectomy, the nurse should assess the client for: 1. Cerebrospinal fluid (CSF) leak. 2. Fluctuating blood glucose levels. 3. Cushing's syndrome. 4. Cardiac arrhythmias

cerebrospinal fluid leak

Initial treatment for a cerebrospinal fluid (CSF) leak after transsphenoidal hypophysectomy would most likely involve: 1. Repacking the nose. 2. Returning the client to surgery. 3. Enforcing bed rest with the head of the bed elevated. 4. Administering high-dose corticosteroid therapy.

enforcing bed rest with the head of bed elevated

78. Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? 1. The importance of watching for signs of hyperglycemia. 2. The need to adjust the steroid dose based on dietary intake and exercise. 3. To notify the health care provider when the blood pressure is suddenly high. 4. How to decrease the dose of the corticosteroids when the client experiences stress.

the importance of watching for signs of hyperglycemia

The nurse is caring for a client after hypophysec- tomy and notes clear nasal drainage from the cli- ent's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2 Rationale: After hypophysectomy, the client should be moni- tored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospi- nal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the: 1. Back of the mouth. 2. Nose. 3. Sinus channel below the right eye. 4. Upper gingival mucosa in the space between the upper gums and lip

4. upper gingival mucosa in the space between the upper gums and lip