RN Learning Med-Surg 3.0: Endocrine Quiz
A nurse is providing teaching to a client who has type two diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? "My cells are resistant to the effects of insulin." "My body breaks down sugars too efficiently." "My pancreas does not produce insulin." "My body produces antibodies against pancreatic beta cells."
"My cells are resistant to the effects of insulin." Rationale: The client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. The client who has type 1 diabetes mellitus does not secrete insulin because of the destruction of the beta cells by the body. Although insulin is still produced by the client who has type 2 diabetes mellitus, it is of insufficient quantity to maintain homeostasis. The client who has type 2 diabetes mellitus does not secrete enough insulin by the pancreatic beta cells to break down enough glucose.
A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. Which of the following statements to the nurse include in the teaching? "You should exercise during a peak insulin time." "Wear a medical alert identification tag when you exercise." "Exercise can decrease the effects of insulin and cause the blood glucose levels to increase." "You will get the most benefit from exercise when your glucose levels are higher than normal."
"Wear a medical alert identification tag when you exercise." Rationale: 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 the blood glucose levels to decrease. The nurse should teach the client to avoid exercising within 1 hr of receiving the insulin, or at the peak time of insulin, because exercise can increase the absorption of the insulin at the injection site and cause the client to have a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1 hr before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. The client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease.
Which lab values are consistent with Diabetic Ketoacidosis (DKA) lab values? Blood glucose 30 mg/dL Negative urine ketones Blood pH 7.38 Bicarbonate level 12 mEq/L
Bicarbonate level 12 mEq/L Rationale: The client who has diabetic ketoacidosis should have a bicarbonate level less than 15 mEq/L because the client has an increased production of counter-regulatory hormones that lead to metabolic acidosis. DKA VALUES: Low pH < 7.3 Bicarbonate < 15 Positive urine ketones Blood glucose > 250
A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find for Addison's disease? -Purple striae on the chest and abdomen -Butterfly rash across the bridge of the nose -Bronze pigmentation of skin -Jaundice of the face and sclera
Bronze skin pigmentation, darkening of the skin in 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). The client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen. The client who has systemic lupus erythematosus should have a butterfly rash across the bridge of the nose. The client who has hepatic, biliary, or gallbladder disease should have jaundice of the face and sclera.
A nurse is caring for a client who is postoperative following parathyroidectomy to treat hyperparathyroidism. What lab values should decrease as an effect of the procedure? Calcium Sodium Potassium Phosphorous
Calcium Rationale: The parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bone by maintaining a balance between the mineral levels in the blood and the bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client's condition.
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? Check the client's blood glucose for hypoglycemia. Check the client's urine specific gravity. Weigh the client weekly. Insert an indwelling urinary catheter for the client.
Check the client's urine specific gravity. Rationale: The nurse should check the client's urine specific gravity to assess for fluid volume overload. The nurse should check the client for hyperglycemia because hypercortisolism elevates blood glucose levels.
A nurse is caring for a client 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? -Compensate for decrease in cortisol levels -Inhibit glucose metabolism -Act as a diuretic to maintain urine output -Decrease susceptibility to infection
Compensate for decrease in cortisol levels Rationale: The 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. One of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which, if untreated, is fatal.
A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? Constipation Cold intolerance Difficulty sleeping Anorexia
Difficulty sleeping Rationale: The client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone. The client who has Graves' disease can experience heat intolerance and report experiencing diarrhea due to the overproduction of thyroid hormone. The client who has Graves' disease should have an increase in appetite and still experience weight loss because of the overproduction of thyroid hormone.
A nurse is assessing a client who has Grave's disease. What findings should the nurse expect the client to display due to the overproduction of thyroid hormone?
Difficulty sleeping and anxiety Heat intolerance Weight loss and increased appetite Diarrhea
Exercise and Type 1 Diabetes
Exercise potentiates the effects of insulin and cause blood glucose levels to decrease
A nurse is checking labs to determine is a diabetic patient is adhering to the treatment plan. Which test should the nurse use to make this determination? Glycosylated hemoglobin levels Urine sugar and acetone Glucose tolerance test Fasting serum glucose
Glycosylated hemoglobin levels Rationale: Checking glycosylated hemoglobin levels, or HbA1c, is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the life span of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication.
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? -Constipation -Headache -Bradycardia -Hypertension
Hypertension Rationale: The 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. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of the thyroid hormone. The client who is experiencing a thyroid storm will have diarrhea, abdominal pain, nausea, and vomiting in response to the overproduction of the thyroid hormone. The client who is experiencing a thyroid storm will have restlessness, confusion, and possible seizures in response to the overproduction of the thyroid hormone.
A nurse is monitoring client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? Polyuria Dehydration Hyponatremia Hyperthermia
Hyponatremia Rationale: The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia. NOT polyuria: The client who has SIADH will retain free water and have a decrease in urine output with increased urine osmolarity. NOT dehydration: The client who has SIADH will retain free water in the circulatory system, which is due to excess antidiuretic hormone. The client will not have manifest dehydration. NOT hyperthermia: The client who has SIADH will have hypothermia resulting from a disturbance in the central nervous system.
A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? Thinning of skeletal bone structure Concave chest wall High-pitched voice Increased head size
Increased head size Rationale: The client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. It results in the gradual enlargement of the client's body tissues, such as the bones of the face, jaw, hands, feet, and skull. The client who has acromegaly will have a deepening of the voice due to hypertrophy of the vocal cords from an increase in growth hormones secreted by the pituitary gland. The client who has acromegaly will manifest a barrel-shaped chest due to the increase of growth hormones that enlarge the skeletal system. The client who has acromegaly will have skeletal thickening due to the increase of growth hormones secreted by the pituitary gland.
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings should indicate to the nurse that the client has hyper glycemia? Hunger Increased urination Cold, clammy skin Tremors
Increased urination Rationale: Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. Dehydration: dry mucosa, sunken eyes Excess thirst (polydipsia) *Every other option was a manifestation of HYPOglycemia not HYPERglycemia
A nurse is planning care for a client who is experiencing Somogyi effect and takes intermittent acting insulin. What should the nurse include in the plan? -Move the evening intermediate-acting insulin dose to 90 min before dinner. -Increase the client's morning caloric intake. -Omit the client's evening snack. -Monitor the client's nighttime blood glucose levels.
Monitor nighttime blood glucose levels Rationale: The Somogyi effect is a swing of a high blood glucose level in the morning after an extremely low blood glucose level during the night. The 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. Ensure the client receives a bedtime snack to decrease the chance for hypoglycemia during the night Evaluate the client's evening caloric intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to the Somogyi effect Administer a smaller dose of intermediate-acting insulin at bedtime, or increase the client's bedtime snacks, to avoid conditions that can lead to the Somogyi effect.
A nurse is caring for a client who has diabetes insipidus. What should the nurse monitor for? Proteinuria Oliguria Polyuria Glycosuria
Polyuria Rationale: Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.
A nurse is providing teaching to a client who has type one diabetes Mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? Shakiness Urinary frequency Dry mucous membranes Excess thirst
Shakiness Rationale: The client who has hypoglycemia can experience early manifestations of shakiness. Other early manifestations include fatigue, headache, difficulty thinking, sweating, and nausea. Hunger, tremors, pallor, fatigue, headache, difficulty thinking, sweating, nausea, cold clammy skin from cholinergic response to central glucose deprivation. The client who has hyperglycemia will have manifestations of dehydration, such as dry mucous membranes and sunken eyeballs. The client who has hyperglycemia will have manifestations of excess thirst called polydipsia.
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? (select all that apply) Tachycardia and hypertension Respiratory rate 16/min Negative Chvostek's sign Laryngeal stridor and hoarseness Positive Trousseau's sign
Tachycardia and hypertension: unexpected findings, which can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxic, or thyroid storm, is a life-threatening condition with a sudden onset that includes tachycardia, fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Laryngeal stridor and hoarseness: unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. Positive Trousseau's sign: 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 providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates understanding of the teaching? -Sliced bananas -Baked potato -Turkey and cheese sandwich -Plain yogurt with peaches
Turkey and cheese sandwich Rationale: A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. 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 of the hormone cortisol and, in some cases, the hormone aldosterone.
A nurse is planning care for a client who has Cushing's from chronic corticosteroid use. What should the nurse include in the plan of care?
Urine specific gravity to assess for fluid volume overload Hyperglycemia because hypercortisolism elevates blood glucose Weight daily because treatment is dependent on findings
A nurse is preparing a 24 hr urine speciment for a pt who is suspected to have pheochromocytoma. Which lab tests from the 24 hr specimen should the nurse determine the clients condition? Creatinine clearance Vanillylmandelic acid (VMA) 17-hydroxycorticosteroids (17-OHCS) Protein
Vanillylmandelic acid (VMA) Rationale: The nurse should expect the 24-hr urine specimen to test for VMA. This test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hr urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate. A 24-hr urine specimen for 17-OHCS is used to determine if the client is producing an adequate amount of cortisol. An increase of cortisol in the 24-hr urine specimen can indicate the client has Cushing's disease. A 24-hr urine specimen for protein is used to evaluate the client's renal function. A 24-hr urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating the glomerular filtration rate of the kidneys.
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? -men who smoke -men and women who are obese -women who have hepatitis -men and women who consume high-protein and low-carbohydrate foods
men and women who are obese Rationale: 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. This is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance. There is no correlation between a high-protein and a low-carbohydrate diet and a risk for developing type 2 diabetes mellitus. Women who have hepatitis are at risk for developing cirrhosis but not type 2 diabetes mellitus. Smoking can produce cardiovascular and pulmonary complications, but no studies have found that smoking leads to type 2 diabetes mellitus.
