NR 325 Endocrinology and DM

A nurse is reviewing the laboratory values if a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis? a. Blood glucose 30mg/dL b. Negative urine ketones c. Blood pH 7.38 d. Bicarbonate level 12 mEq/L

A client who has diabetic ketoacidosis should have a bicarbonate level that is <15 mEq/L due to the increased production of counter-regulatory hormones that lead to metabolic acidosis.

A nurse is updating the plan of care for a client who is to receive total parenteral nutrition (TPN). Which of the following actions should the nurse include in the plan? (Select all that apply.) a. Weigh the client daily b. Obtain a serum blood glucose every 4 hours c. Apply a new dressing to the client's IV site every 5 days. d. Change the IV tubing every 24 hours. e. Infuse the TPN through a peripheral IV site

A, B, D. The nurse should weigh the client daily while receiving TPN. Clients who are receiving TPN are typically malnourished; therefore the client's weight needs to be monitored closely. Fluid retention can also be an indication that the client is not digesting the TPN, and the rate of transfusion might need to be decreased. The nurse should also obtain the client's serum blood glucose; insulin can be given if needed. Finally, the nurse should change the client's IV tubing every 24 hours to prevent bacteria from developing in the client's tubing.

1. Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)? a. You will need to avoid smoking before the test. b. Exercise should be avoided until the testing is complete. c. Several blood samples will be obtained during the testing. d. You should follow a low-calorie diet the day before the test. e. The test requires that you fast for at least 8 hours before testing.

A, C, E. Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.

A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? a. tachycardia and hypertension b. respiratory rate 16/min c. negative Chvostek's Sign d. laryngeal stridor and hoarseness e. positive Trousseau's sign

A, D, E. Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following the removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxicity (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.

A nurse is caring for a patient who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? a. compensation for decreased cortisol levels b. inhibition of glucose metabolism c. diuretic action to maintain urine output d. decrease susceptibility to infection

A. A client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. The adrenal glands produce several hormones including cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors; if untreated, this can be fatal.

A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? a. Shakiness b. Urinary frequency c. Dry mucous membranes d. Excess thirst

A. A client who has hypoglycemia can experience early manifestations of shakiness, as well as fatigue, a headache, difficulty thinking, sweating, and nausea.

A nurse is teaching a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? a. "My cells are resistant to the effects of insulin." b. "My body breaks down sugars too efficiently." c. "My pancreas does not produce insulin." d. "My body produces antibodies against pancreatic beta cells."

A. A client who has type 2 diabetes mellitus will have a resistance to insulin and a decrease in the secretions of insulin by the pancreatic beta cells.

A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? a. Bradycardia b. Tremors c. Low-grade fever d. Diaphoresis

A. An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, parasthesia, hearing loss, depression, and many other manifestations.

In order to assist an older diabetic patient to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what type of activities the patient enjoys. b. Remind the patient that exercise will improve self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.

A. Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions will also be implemented but are not the most important in improving compliance.

The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test? a. History of renal insufficiency b. Complains of chronic headache c. Recent bilateral visual field loss d. Blood glucose level of 134 mg/dL

A. Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patients diagnosis of a pituitary tumor.

A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? a. glycosylated hemoglobin levels b. urine sugar and acetone levels c. glucose tolerance test d. fasting serum glucose

A. Checking glycosylated hemoglobin levels (HbA1c) is an accurate method of determining if the client is routinely compliant. Glycosylated hemoglobin refers to the hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by recent changes to the client's diet or medication.

A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show a. increased urinary cortisol. b. decreased serum thyroxine. c. elevated serum aldosterone levels. d. low urinary catecholamines excretion.

A. Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

Which hormone is both released from, and stored within, the posterior pituitary gland? a. Oxytocin b. Vasopressin c. Growth hormone d. Antidiuretic hormone

A. Oxytocin is a hormone that is both secreted, and stored, in the posterior pituitary gland. Its primary function is to stimulate contractions to facilitate childbirth.

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? a. calcium b. sodium c. potassium d. phosphorus

A. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bones by maintaining mineral levels. Hyperparathyroidism is associated with hypercalcemia; therefore a decrease in calcium level indicates an improvement in the client's condition.

Which statement by the patient indicates a need for additional instruction in administering insulin? a. I need to rotate injection sites among my arms, legs, and abdomen each day. b. I can buy the 0.5 mL syringes because the line markings will be easier to see. c. I should draw up the regular insulin first after injecting air into the NPH bottle. d. I do not need to aspirate the plunger to check for blood before injecting insulin.

A. Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.

A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.

A. The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient? a. The patient will reach a glycosylated hemoglobin level of less than 7%. b. The patient will follow a diet and exercise plan that results in weight loss. c. The patient will choose a diet that distributes calories throughout the day. d. The patient will state the reasons for eliminating simple sugars in the diet.

A. The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.

A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? a. Encourage the client to control weight. b. Inspect the client's feet once each week. c. Restrict the client's activity. d. Apply moisturizer between the client's toes.

A. The nurse should encourage weight control to stabilize the client's blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes.

A nurse is assessing a client who has Addison's disease. Which of the following findings should the nurse expect? a. Hypotension b. Weight gain c. Sugar craving d. Pale skin tone

A. The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone.

Which endocrine gland is responsible for the body's circadian rhythm? a. Pineal b. Thyroid c. Parathyroid d. Hypothalamus

A. The pineal gland produces a hormone called melatonin which is responsible for the maintenance of the body's sleep-wake cycle, or circadian rhythm.

A nurse in the emergency department is caring for a client who has fruity breath odor, a dry mouth and an extreme thirst. Which of the following assessments should the nurse make? a. Blood glucose level b. Pupillary reaction to light c. Deep tendon reflexes d. Liver function tests

A. These findings are indications of hypercalcemia and diabetic ketoacidosis. The nurse should check the patient's blood glucose level as well as assess the patient's respiratory status, vital signs, LOC, and hydration status, including a lab assessment of electrolyte levels.

Which student statement regarding the function of the pituitary gland requires clarification from the instructor? a. "The pituitary glands plays a significant role in development." b. "The pituitary gland plays a significant role in maintaining blood pressure." c. "The pituitary gland plays a significant role in fluid balance within the body." d. "The pituitary gland plays a significant role in the process of labor during childbirth."

A. This student statement requires clarification from the instructure because while the pituitary gland plays a significant role in physical growth, it does not play a meaningful role in development. Development is defined as the progressive acquisition of various skills.

A nurse in the emergency department is assessing a client who has pancreatitis. In which of the following laboratory results should the nurse expect to see an elevation? a. Amylase b. Potassium c. Calcium d. Hematocrit

A. With pancreatitis, lab results typically show elevated Amylase within 12 to 14 hours. This level remains elevated for 2-3 days.

A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? a. Warm the dialysate solution prior to administration. b. Cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward. c. Place the drainage bag at the level of the client's chest. d. Apply clean gloves and cleanse the client's catheter site with cold water.

A. The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping.

Which hormone is secreted by the adrenal cortex? a. Adrenaline b. Aldosterone c. Noradrenaline d. Catecholamine

Aldosterone is produced in the adrenal cortex of the adrenal glands. These glands are located above the kidneys.

A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48mg/dL. Which of the following findings should the nurse expect? a. Kussmaul respirations b. Diaphoresis c. Decreased skin turgor d. Ketonuria

B. A client who has a blood glucose level below 70mg/dL will exhibit manifestations of hypoglycemia. Expected findings associated with hypoglycemia include weakness, hunger, diaphoresis, nausea, shakiness, and confusion.

The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider? a. The patient complains of intense thirst. b. The patient has a 5-lb (2.3 kg) weight loss. c. The patients urine osmolality does not increase. d. The patient feels dizzy when sitting on the edge of the bed.

B. A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test? a. Bilateral poor peripheral vision b. Allergies to iodine and shellfish c. Recent weight loss of 20 pounds d. Complaint of ongoing headaches

B. Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

Which information about a 30-year-old patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test? a. The patient reports having occasional orthostatic dizziness. b. The patient takes oral corticosteroids for rheumatoid arthritis. c. The patient has had a 10-pound weight gain in the last month. d. The patient drank several glasses of water an hour previously.

B. Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test? a. Urinary 17-ketosteroids b. Antidiuretic hormone level c. Growth hormone stimulation test d. Adrenocorticotropic hormone level

B. Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patients hyponatremia.

A nurse is conducting a home visit for an older adult client who has diabetes and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which one of the following conditions should the nurse consider first when responding to these manifestations? a. Dementia b. Hypoglycemia c. Infection d. Transient Ischemic Attack

B. Evidence-based practice indicates that nurse should first check the client for hypoglycemia by drawing a blood glucose level. A patient who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near meal time each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations.

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? a. Hunger b. Increased urination c. Cold, clammy skin d. Tremors

B. Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? a. The RN checks the blood pressure on both arms. b. The RN palpates the neck thoroughly to check thyroid size. c. The RN lowers the thermostat to decrease the temperature in the room. d. The RN orders nonmedicated eye drops to lubricate the patients bulging eyes.

B. Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? a. Chlorpropamide b. Tolvaptan c. Vasopressin d. Desmopressin

B. SIADH is a disorder of water intoxication due to inappropriate secretions of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and an vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH.

A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? a. "You should exercise during a peak insulin time." b. "Wear a medical alert identification tag when you exercise." c. Exercise can decrease the effects of insulin and cause your blood glucose levels to increase." d. "You will get the most benefit from exercise when your glucose levels are higher than normal."

B. The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease.

A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? a. Check the client's blood glucose for hypoglycemia b. Check the client's urine specific gravity c. Weigh the client weekly d. Insert an indwelling urinary catheter for the client

B. The nurse should check the client's urine specific gravity to assess for fluid volume overload.

A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? a. Obtain sample menus from the dietician to give to the client. b. Ask the client to identify the types of foods she prefers. c. Identify the recommended range of the client's blood glucose level d. Discuss long-term complications that can result from non-adherence to the dietary plan.

B. The nurse should first ask the client about food preferences to provide an opportunity for the nurse to include these foods in the client's diet. Involving the client in the planning will promote her adherence to the dietary plan.

A nurse is monitoring a client following an thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? a. elevated blood pressure b. involuntary muscle spasms c. cold intolerance d. weight loss

B. The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and parathesias can result due to decreased parathyroid hormone levels and calcium deficiency.

A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42mmHg. Which of the following prescriptions should the nurse anticipate? a. Desmopressin b. Hydrocortisone c. Dopamine d. Furosemide

B. The nurse should identify that a client who has Addison's disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels.

A nurse is assessing a client who is recovering from a thyroidectomy and has a harsh, high-pitched respiratory sound. Which of the following actions should the nurse take? a. Hyperextend the client's neck b. Prepare for a tracheostomy c. Lower the head of the bed d. Administer morphine

B. The nurse should notify the provider immediately and prepare for a tracheostomy.

Which nerve is essential for the accurate secretion of melatonin by the endocrine system? a. Ulnar nerve b. Optic nerve c. Radial nerve d. Sciatic nerve

B. The secretion of melatonin is stimulated and released with darkness. It is inhibited when light is sensed. The optic nerve is responsible for the body's ability to sense lightness and darkness.

A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to a. insert and maintain a retention catheter. b. keep the specimen refrigerated or on ice. c. drink at least 3 L of fluid during the 24 hours. d. void and save that specimen to start the collection.

B. The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

During the physical examination of a 36-year-old female, the nurse finds that the patients thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patients neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

B. The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid- stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening? a. Men who smoke b. Men and women who are obese c. Women who have hepatitis d. Men and women who consume high-protein and low-carbohydrate foods

B. There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells, which is referred to as peripheral insulin resistance.

A nurse is teaching a client who had a vaginal hysterectomy with a bilateral oophorectomy. Which of the following pieces of information should the nurse included in the teaching? a. "Plan to use some type of birth control for up to 6 weeks after surgery." b. "Use a water-based lubricant when having sexual intercourse." c. "Expect to have an increase in bloody vaginal drainage during the first 10 days after surgery." d. "Plan to start some type of aerobic exercise such as swimming within a week after surgery."

B. Vaginal dryness is a manifestation of menopause after the ovaries are removed.

A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease? a. Ideal weight b. Value system c. Activity level d. Visual changes

B. When dealing with a patient with a chronic condition such as diabetes, identification of the patients values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.

A nurse is preparing a 24-hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hour urine specimen should the nurse use to determine the client's condition? a. Creatinine clearance b. Vanillylmandelic acid (VMA) c. 17-hydrocorticosteroids (17-OHCS) d. Protein

B. The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinepherine and norepinepherine, which are hormones that regulate blood pressure and heart rate.

A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? a. Purple striae on the chest and abdomen. b. Butterfly rash across the bridge of the nose. c. Bronze pigmentation of the skin. d. Jaundice of the face and sclera.

C. A client who has Addison's disease will have darkening of the skin on both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex).

A nurse is monitoring a client who has SIADH. Which of the following findings should the nurse expect? a. Polyuria b. Dehydration c. Hyponatremia d. Hyperthermia

C. A client who has SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia.

Which laboratory value should the nurse review to determine whether a patients hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level

C. A low TSH level indicates that the patients hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

A nurse is providing teaching to a client who had Addison's disease about healthy snack food. Which of the following food choices by the client indicates an understanding of the teaching? a. sliced bananas b. baked potatoes c. turkey and cheese sandwich d. plain yogurt with peaches

C. A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in protein, carbohydrates, and sodium. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone.

A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for a. increased serum sodium. b. decreased urinary output. c. elevated serum potassium. d. evidence of fluid overload.

C. Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

4. Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder? a. What methods do you use to help cope with stress? b. Have you experienced any blurring or double vision? c. Have you had a recent unplanned weight gain or loss? d. Do you have to get up at night to empty your bladder?

C. Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

Which hormone does the thyroid gland secrete in response to changes in serum calcium levels? a. Oxytocin b. Thyroxine c. Calcitonin d. Triiodothyronine

C. Calcitonin is the hormone that is secreted by the thyroid gland to maintain serum calcium levels within the human body. Calcitonin helps to maintain the health of bones in the musculoskeletal system.

A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? a. Reduce total hours of sleep. b. Keep the immediate environment warm. c. Increase caloric intake with meals. d. Gradually increase with activity.

C. Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance.

5. A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide? a. Avoid adding any salt to your foods for 24 hours before the test. b. You will need to lie down for 30 minutes before the blood is drawn. c. Come to the laboratory to have the blood drawn early in the morning. d. Do not have anything to eat or drink before the blood test is obtained.

C. Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

A nurse is caring for a client who has diabetes insipidus. For which of the following finding should the nurse monitor? a. Proteinuria b. Oliguria c. Polyuria d. Glycosuria

C. Diabetes insipidus is characterized by extreme thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.

A nurse is assessing a client who has Grave's disease. Which of the following findings should the nurse expect the client to display? a. Constipation b. Cold intolerance c. Difficulty sleeping d. Anorexia

C. Due to the overproduction of thyroid hormone.

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

C. For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.

The nurse reviews a patients glycosylated hemoglobin (Hb A1C) results to evaluate a. fasting preprandial glucose levels. b. glucose levels 2 hours after a meal. c. glucose control over the past 90 days. d. hypoglycemic episodes in the past 3 months.

C. Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

Which is a hormone secreted by the uterus during pregnancy? a. Inhibin b. Estrogen c. Prolactin d. Progesterone

C. Human prolactin is a hormone that is secreted by the uterus during pregnancy.

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. I can have an occasional alcoholic drink if I include it in my meal plan. b. I will need a bedtime snack because I take an evening dose of NPH insulin. c. I can choose any foods, as long as I use enough insulin to cover the calories. d. I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.

C. Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

Which additional information will the nurse need to consider when reviewing the laboratory results for a patients total calcium level? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.

C. Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing a. a water deprivation test. b. testing for serum T3 and T4 levels. c. a 24-hour urine test for free cortisol. d. a radioactive iodine (I-131) uptake test.

C. Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate

C. Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? a. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." b. "Is there another favorite dish you can substitute?" c. "You don't have to give up pasta, just adjust the amount you eat." d. "You can use no-added-salt tomato products on your pasta."

C. The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder.

Which hormone is stored and released by the intermediate-pituitary gland? a. Thyroid-stimulating hormone b. Corticotropin-releasing hormone c. Melanocyte-stimulating hormone d. Growth hormone-releasing hormone

C. The melanocyte-releasing hormone is secreted by the intermediate-pituitary. The primary function of this hormone is controlling appetite, developing pigmentation, and protecting the skin from ultraviolet (UV) rays.

A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? a. urine negative for ketones b. distended neck veins c. Kussmaul respirations d. elevated blood pressure

C. The nurse should expect this client with DKA to experience Kussmaul respirations. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA.

A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? a. rifampin b. loperamide c. hydrocortisone d. spironolactone

C. The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels.

A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.

C. The patients impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

Which statement regarding the structures of the endocrine system requires clarification? a. "The thyroid is an endocrine gland." b. "The pancreas is an endocrine gland." c. The thymus is an endocrine gland." d. "The hypothalamus is an endocrine gland."

C. The thymus is no longer classified as an endocrine gland because it does not secrete hormones. It does, however, play a role in the immune system.

The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which question is most appropriate for the nurse to ask? a. Are you anorexic? b. Is your urine dark colored? c. Have you lost weight lately? d. Do you crave sugary drinks?

C. Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

A nurse is teaching a client who has type 2 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? a. "I will apply moisturizer between my toes." b. "I will soak my feet daily." c. "I'll be sure to wear cotton socks every day." d. "I'll use a heating pad to warm my feet."

C. The nurse should instruct the client to wear clean socks every day to absorb moisture and reduce the risk of infection.

A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? a. thinning of skeletal bone structure b. concave chest wall c. high-pitched voice d. increased head size

D. A client who has acromegaly will present with an enlarged head due to excessive production of growth hormones after closing of the ephiphyses (the growth plate at the end of long bones) by the pituitary gland. This results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull.

A nurse is monitoring a client who has Grave's disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? a. Constipation b. Headache c. Bradycardia d. Hypertension

D. A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of fever, hypertension, abdominal pain, and tachycardia. Grave's disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone.

A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? a. Calcium b. Potassium c. Iodine d. Hydrocortisone

D. Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium levels fall, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high-dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency.

A nurse is accepting a transfer from the postanesthesia care unit (PACU) of a client who has a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the bedside for this client? a. Cardiac monitor b. Defibrilator c. Thoracotomy tray d. Tracheostomy tray

D. Because of the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in an airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client.

Which stress hormone is released by the adrenal medulla? a. Cortisol b. Androgens c. Aldosterone d. Catecholamines

D. Catecholamines can serve as neurotransmitters, transferring signals from neuron to neuron in addition to serving as hormones. The adrenal glands, specifically the adrenal medulla, send catecholamines into the blood when the human body is emotionally or physically stressed.

A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching. a. "I will need to eliminate sweet desserts from my diet." b. "I should avoid using sucralose in my coffee." c. "I should consume alcohol between meals in moderation." d. "I should replace white bread with whole-grain bread."

D. Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is high in fiber.

Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? a. I notice my breasts are tender lately. b. I am so thirsty that I drink all day long. c. I get up several times at night to urinate. d. I feel a lump in my throat when I swallow.

D. Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

Which hormone is stored and secreted by the hypothalamus? a. Prolactin b. Melatonin c. Thyroxine d. Dopamine

D. Dopamine is a hormone that is secreted by the hypothalamus. It is specifically classified as a neurohormone. Its action is that of an inhibitor of prolactin from the anterior lobe of the pituitary gland.

Which hormone secreted by the hypothalamus impacts both ovarian and testicular function within the reproductive system? a. Antidiuretic hormone b. Vasopressin hormone c. Prolactin releasing hormone d. Gonadotropin releasing hormone

D. Gonadotropin releasing hormone stimulates the pituitary gland to produce and secrete both luteinizing hormone and follicle stimulating hormone which are essential to the function of the ovaries and testicles within the reproductive system.

An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a. ice in a basin. b. glargine insulin. c. a cardiac monitor. d. 50% dextrose solution.

D. Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

Which hormone is secreted by the pineal gland? a. Prolactin b. Oxytocin c. Thyroxine d. Melatonin

D. Melatonin is stored and secreted by the pineal gland. It plays a role in maintaining circadian rhythm.

A nurse is teaching a client about the prostate-specific antigen (PSA) test. Which of the following directions should the nurse provide? a. "You should fast for 8 hours after the PSA test." b. "Annual PSA screenings should begin at age 40." c. "Expected PSA values will decrease as you get older." d. "You should not ejaculate for 24 hours prior to the PSA test."

D. PSA is a glycoprotein manufactured in the prostate that is used to screen for prostate cancer. Ejaculation within 24 hours prior to the test can falsely elevate levels of PSA.

A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels. a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone

D. Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a counter-mechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

Which electrolyte is primarily maintained by the parathyroid glands? a. Sodium b. Potassium c. Magnesium d. Phosphorus

D. Phosphorus, in addition to calcium, are the electrolytes that are maintained by the parathyroid glands.

Which endocrine gland is responsible for growth hormone? a. Thyroid b. Hypothalamus c. Posterior pituitary d. Anterior pituitary

D. The anterior pituitary secretes six different hormones, including growth hormone.

A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? a. HbA1c 8.5% b. Postprandial blood glucose 190mg/dL c. Casual blood glucose 205mg/dL d. Fasting blood glucose 95mg/dL

D. The expected reference range for fasting blood glucose is 70-110mg/dL.

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level

D. The glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

Which structure is considered a "master gland" of the endocrine system? a. Pancreas b. Adrenals c. Parathyroid d. Hypothalamus

D. The hypothalamus is an endocrine gland that is housed near the base of the skull just above the pituitary gland. Because it performs several roles, this gland is one of the "master glands" of the endocrine system.

A nurse is planning to administer fluids to a client who have 25% total body surface area burns. The client has no prior medical history. Which of the following intravenous fluids is contraindicated for this client? a. Whole blood b. Lactated Ringers c. Dextran 40 in 0.9% sodium chloride d. 0.45% sodium chloride

D. The nurse should identify that 0.45% sodium chloride is a hypotonic solution and is contraindicated for clients who have burns.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. Which of the following actions should the nurse perform? a. Changing the tubing every 12 hours b. Check the client's blood glucose every 8 hours c. Apply a new dressing to the IV site every 76 hours d. Weigh the client daily

D. The nurse should weigh the client who is receiving TPN daily due to the risk of fluid and electolyte imbalances.

A nurse is caring for a client who has urolithiasis and requires further diagnostic testing after an initial test indicated hypercalcemia. Which of the following structures controls calcium concentration? a. Pancreas b. Thyroid gland c. Anterior pituitary gland d. Parathyroid gland

D. The parathyroid gland secretes parathyroid hormones, which are substances that help the kidneys reabsorb calcium and increase calcium absorption from the gastrointestinal tract.

Which hormone is stored and secreted by the thyroid gland? a. Oxytocin b. Melatonin c. Vasopressin d. Triiodothyronine

D. Triiodothyronine is a hormone that is stored and secreted by the thyroid. It plays a role in the body's metabolism.

A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

D. When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The other statements are correct.

Which student statement regarding the function of the hypothalamus requires clarification from the instructor? a. "The hypothalamus helps to maintain body temperature." b. "The hypothalamus helps to maintain fluid balance via the antidiuretic hormone." c. "The hypothalamus stimulates the pituitary to release all of its different hormones." d. "The hypothalamus stimulates production of human milk via the corticotropin hormone."

D. While the hypothalamus plays a role in the production of human milk it does so via oxytocin and prolactin releasing hormones and not via the corticotropin hormone; therefore, this student statement requires clarification from the instructor.

Which statement regarding the endocrine function of the islets of the pancreas requires clarification? a. "This structure secretes insulin." b. "This structure secretes glucagon." c. "This structure secretes somatostatin." d. "This structure secretes digestive enzymes."

D. While this is a function of the pancreas, this is a digestive function and not an endocrine function of the islets of the pancreas.

A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? a. Move the evening intermediate-acting insulin dose to 90 minutes before dinner. b. Increase the client's morning caloric intake. c. Omit the client's evening snack. d. Monitor the client's nighttime blood glucose levels.

D. The Somogyi effect describes a high blood glucose level in the morning after an extremely low blood glucose level during the night. This swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect.

Which disorder is caused by an overactive thyroid gland? a. Addison''s disease b. Hypothyroidism c. Hyperthyroidism d. Cushing syndrome

Hyperthyroidism (i.e., overactive thyroid) occurs when the thyroid gland produces excessive amounts of thyroxine, one of the primary thyroid hormones. Hyperthyroidism can accelerate the body's metabolism thereby leading to symptoms such as an irregular or abnormal heartbeat and unintentional weight loss.