Thyroid, SAIDH, Diabetes, Graves', Cushing's, Addison's (2 of 2) NCLEX

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? (SATA) 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Dry mouth 5. Flushed, dry skin 6. Moist mucous membranes

1, 2, 3, 4, 5 ~ Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia (excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration. Therefore, option 6 would not be noted.

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? (SATA) 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care 5. A reminder to read the labels on over-the-counter medications before purchase

1, 2, 3, 4 ~ The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the health care provider (HCP) before purchasing any over-the-counter medications, and maintaining regular outpatient follow-up care. The nurse also should instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? (SATA) 1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA) 5. Primary failure of glucagon secretion

1, 2, 3, 4 ~ Viruses and autoimmune factors are thought to play a role in the development of type 1 diabetes mellitus. Other causes of type 1 diabetes mellitus include genetic factors, specifically the presence of HLA. This factor is found in many clients with type 1 diabetes mellitus. The problem with type 1 diabetes mellitus is destruction of the beta cells. It is not caused by a primary failure of glucagon secretion.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? (SATA) 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1, 2, 4, 5 ~ A triad of clinical symptoms-polyuria, polydipsia, and excessive thirst-often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? (SATA) 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1, 3, 4 ~ Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger.

A nursing instructor is teaching the class about Addison's disease. The instructor determines that the class understands the disease process if they indicate which are affected in this disease? (SATA) 1. Androgens 2. Bicarbonate 3. Electrolytes 4. Glucocorticoids 5. Mineralocorticoids

1, 4, 5 ~ In Addison's disease, all three classes of corticosteroids are affected: glucocorticoids, mineralocorticoids, and androgens. Electrolytes and bicarbonate are not directly affected by Addison's disease.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? (SATA) 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3, 4, 5, 6 ~ Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 1. An enlarged thyroid gland 2. The presence of heart damage 3. Client complaints of chronic fatigue 4. Client complaints of slow wound healing

1. ~ An enlarged thyroid gland develops in the client with goiter because of an excessive amount of thyroxine in the thyroid gland. Heart damage occurs with selenium deficiency. In addition, heart damage would not likely be noted during the nursing assessment. Further diagnostic tests in addition to the assessment would be necessary to determine heart damage. Chronic fatigue occurs with iron deficiency. Slow wound healing occurs with zinc deficiency.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1. Polyuria 2. Diarrhea 3. Polyphagia 4. Weight gain

1. ~ Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period? 1. Vital signs 2. Fluid balance 3. Anxiety level 4. Creatinine levels

1. ~ Hypertension is the hallmark symptom of pheochromocytoma. Severe hypertension can precipitate a stroke (brain attack) or sudden blindness. Although all of the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate education before discharge. 2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 3. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. 4. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.

1. ~ If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the HCP should be notified. The client's statement indicates a need for immediate education to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other options may be true, the most appropriate analysis is that the client requires immediate education.

A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse should assess the client for a hypoglycemic reaction at which times? 1. Between 1:00 and 3:00 p.m. 2. 10 minutes after administration 3. Between 4:00 p.m. and 12:00 a.m. 4. Between 8:00 and 10:00 p.m.

1. ~ Insulin aspart is a rapid-acting insulin. Its onset of action is 15 minutes; it peaks in 1 to 3 hours, and its duration of action is 3 to 5 hours. Hypoglycemic reactions are most likely to occur during peak time.

A client is admitted with a serum glucose level of 650 mg/dL (37.14 mmol/L) and diabetic ketoacidosis (DKA) is suspected. Which additional laboratory result does the nurse identify as being supportive of DKA? 1. Ketones in urine 2. Lactic dehydrogenase (LDH) of 200 U/L 3. pH of 7.52 on arterial blood gas (ABG) analysis 4. Blood urea nitrogen (BUN) of 10 mg/dL (3.6 mmol/L)

1. ~ Ketones are a byproduct of fat metabolism. When this process occurs to the extreme, it is termed ketoacidosis. Ketone bodies are a product of fat metabolism, and the presence of moderate to high urine ketones (hyperketonuria) indicates a severe lack of insulin, such as in DKA. Options 2, 3, and 4 are incorrect. BUN of 10 mg/dL (3.6 mmol/L) is a normal value, as normal is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Elevations in LDH (normal is 100 to 190 U/L) can be indicative of heart failure, hemolytic disorders, hepatitis dysfunction, myocardial infarction, pulmonary embolus, or skeletal muscle damage. In acidotic conditions the pH will be decreased (normal is 7.35 to 7.45).

A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse should ask the client if which measure is taken? 1. Rotating sites for injection 2. Administering the insulin at a 45-degree angle 3. Cleaning the skin with alcohol before each injection 4. Aspirating for blood before injection into the subcutaneous tissue

1. ~ Lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) occurs in some clients with diabetes mellitus when injection sites are used for a prolonged period. Therefore, clients are instructed to adhere to a plan of rotating injection sites to avoid tissue changes. Angle of insulin administration, cleansing with alcohol, and aspiration do not produce this complication.

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 1. "Are you rotating the injection site?" 2. "Are you aspirating before you inject the insulin?" 3. "Are you using a 1-inch needle to give the injection?" 4. "Are you placing an air bubble in the syringe before injection?"

1. ~ The client should be instructed that insulin injection sites should be rotated within 1 anatomical area before moving on to another area. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. The remaining options are not associated with the condition (skin leakage of insulin) presented in the question.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

1. ~ The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 1. Glycosylated hemoglobin of <6% 2. Presence of ketones in the urine 3. Presence of albumin in the urine 4. Fasting blood glucose level of 150 mg/dL (8.57 mmol/L)

1. ~ This measurement of glycosylated hemoglobin (HgbA1C) detects glucose binding on the red blood cell (RBC) membrane and is expressed as a percentage. It measures glucose for the life of the RBC, which is 120 days. A HgbA1C of <6% is acceptable. The fasting blood glucose level should be 110 mg/dL (6 mmol/L). The urine should be free of both ketones and albumin.

The nurse is caring for a client diagnosed with type 1 diabetes mellitus experiencing the Somogyi effect. Which blood glucose results and treatment would the nurse expect? 1. 0300 blood glucose 68 mg/dL (3.8 mmol/L) and 0700 blood glucose 200 mg/dL (11.1 mmol/L). Instruct to decrease amount of evening insulin. 2. 0300 blood glucose 68 mg/dL (3.8 mmol/L) and 0700 blood glucose 200 mg/dL (11.1 mmol/L). Instruct to increase amount of evening insulin. 3. 0300 blood glucose 190 mg/dL (10.6 mmol/L) and 0700 blood glucose 240 mg/dL (13.3 mmol/L). Instruct to decrease amount of evening insulin. 4. 0300 blood glucose 190 mg/dL (10.6 mmol/L) and 0700 blood glucose 240 mg/dL (13.3 mmol/L). Instruct to increase amount of evening insulin.

1. ~ With the Somogyi effect, hyperglycemia occurs in the morning as a result of hypoglycemia during the night from too much evening insulin. Treatment includes having a bedtime snack, decreasing the amount of evening insulin, or both. Thus, option 1 is the correct answer (hypoglycemia during the night and hyperglycemia in the morning, which is treated by decreasing the evening dose of insulin). Option 2 is incorrect because it instructs the client to increase the evening dose of insulin. Options 3 and 4 are incorrect because the nighttime blood glucose levels indicate hyperglycemia, which would indicate dawn phenomenon.

The nurse is caring for a client with a new diagnosis of hypothyroidism. Which clinical manifestations might the nurse expect to note on examination of this client? (SATA) 1. Irritability 2. Periorbital edema 3. Coarse, brittle hair 4. Slow or slurred speech 5. Abdominal distention 6. Soft, silky, thinning hair

2, 3, 4, 5 ~ The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. The client may exhibit skin manifestations, such as coarse, brittle hair; thick, brittle nails; coarse, scaly skin; delayed wound healing; periorbital edema; and face puffiness. Neuromuscular manifestations include lethargy, slow or slurred speech, and impaired memory. Gastrointestinal manifestations include complaints of constipation, weight gain, and abdominal distention. Irritability and soft, silky, thinning hair on the scalp are manifestations of hyperthyroidism.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? (SATA) 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

2, 3, 5 ~ Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism, build up and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? (SATA) 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2, 3, 5 ~ Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? (SATA) 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hour 5. Clear drainage on nasal dripper pad

2, 4, 5 ~ Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a continuous mist of room air or oxygen. 3. Place the client in a flat position with the head and neck immobilized. 4. Use only a rectal thermometer for temperature measurement.

2. Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.

A nurse is caring for a client after a thyroidectomy. Which specific emergency equipment should the nurse have available as it relates to this procedure? 1. Defibrillator 2. Tracheostomy tray 3. Dextrose 50% in water 4. Normal saline for intravenous bolus

2. ~ After thyroidectomy, airway obstruction, although not common, can occur. This is considered an emergency situation. If this develops, emergency management needs to occur and oxygen, suction equipment, and a tracheostomy tray should be immediately available at the bedside. The other supplies are not necessary specifically for thyroidectomy.

The family of a bedridden client with type 2 diabetes mellitus and chronic kidney disease calls the nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 1. "What is the client's urine output?" 2. "What is the client's capillary blood glucose level?" 3. "Has there been any change in the dietary intake?" 4. "Have you increased the amount of fluids provided?"

2. ~ Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is an acute complication of type 2 diabetes mellitus leading to hyperglycemia and dehydration. Headache, polydipsia, and increasing lethargy can be caused by the dehydration. The remaining options will not assist in determining a possible problem.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1. "Cortisol will be secreted." 2. "Aldosterone will be secreted." 3. "Additional glucagon will be produced." 4. "Adrenocorticotropic hormone production will increase."

2. ~ Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hypoactive bowel sounds

2. ~ Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

A client newly diagnosed with diabetes mellitus is started on a 2-dose insulin protocol combination of short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast, and what portion is given before the evening meal? 1. Half before breakfast and half before the evening meal 2. Two thirds before breakfast and one third before the evening meal 3. One third before breakfast and two thirds before the evening meal 4. Three fourths before breakfast and one fourth before the evening meal

2. ~ Initially the 2-dose insulin protocol is two thirds of the dose before breakfast and one third before the evening meal. Any future changes in these ratios are based on results of blood glucose monitoring. Therefore, the remaining options are incorrect amounts.

A nurse is reviewing the health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 1. Acetaminophen 2. Docusate sodium 3. Morphine sulfate 4. Levothyroxine sodium

2. ~ Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

The client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which statement is the appropriate response by the nurse? 1. "I think you are making the right decision to have the surgery." 2. "You have concerns about the surgical treatment for your condition?" 3. "You are very ill. Your health care provider has made the correct decision." 4. "There is no reason to worry. Your health care provider is a wonderful surgeon."

2. ~ Paraphrasing is restating the client's messages in the nurse's own words. The correct option addresses the therapeutic communication technique of paraphrasing. Telling the client that there is no reason to worry is offering a false reassurance, and this type of response will block communication. Telling the client that the health care provider has made the correct decision also represents a communication block in that it reflects a lack of the client's right to an opinion. In the remaining option, the nurse is expressing approval, which can be harmful to the nurse-client relationship.

A client has been hospitalized for an endocrine system dysfunction of the pancreas. The registered nurse asks the new orientee nurse what kind of problem a client hospitalized for endocrine dysfunction of the pancreas would expect. The new orientee nurse demonstrates understanding if which statement is made? 1. "Lipase levels will decrease." 2. "Insulin production will be decreased." 3. "There will be overproduction of trypsin." 4. "Amylase will be secreted in excess amounts."

2. ~ The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. When there is endocrine dysfunction, insulin production is affected due to damage to beta cells. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? (SATA) 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

3, 4, 5, 6 ~ SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? (SATA) 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

3, 4, 6 ~ The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

3. ~ A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtime places the client at risk for hypoglycemia. Insulin should be administered as prescribed.

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance? 1. Growth hormone (GH) 2. Luteinizing hormone (LH) 3. Antidiuretic hormone (ADH) 4. Follicle-stimulating hormone (FSH)

3. ~ ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH.

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for during the client's focused assessment? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypovolemia 4. Signs and symptoms of hypocalcemia

3. ~ Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. Thus, a deficiency can cause hypovolemia. A deficiency of adrenocortical hormones (such as after adrenalectomy) does not cause the clinical manifestations noted in the remaining options.

A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which is most important to include in the plan of care? 1. Test urine for ketone levels. 2. Eat 6 small meals per day. 3. Monitor blood glucose levels frequently. 4. Receive appropriate follow-up health care.

3. ~ Client education after DKA should emphasize the need for home glucose monitoring 2 to 4 times per day. Instructing the client to notify the health care provider when illness occurs is also important. The presence of urine ketones indicates that DKA has occurred already. The client should eat well-balanced meals with snacks as prescribed.

A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. Which is the appropriate nursing intervention? 1. Offer water only until the client is able to tolerate solid foods. 2. Withhold all fluids until vomiting has ceased for at least 4 hours. 3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. 4. Maintain a clear liquid diet for at least 5 days before advancing to solids.

3. ~ Small amounts of fluid may be tolerated, even when vomiting is present. The nurse should encourage liquids containing glucose and electrolytes every hour. The remaining options will not provide the adequate intake needed by the client with diabetes mellitus.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 110 mg/dL (6.28 mmol/L) 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. ~ The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse should instruct the client that which is the first step in this procedure? 1. Draw up the correct dosage of NPH insulin into the syringe. 2. Draw up the correct dosage of regular insulin into the syringe. 3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin. 4. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.

3. ~ The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer acting form.

During health history taking, the client complains of weight loss and diarrhea and says that he can "feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the health care provider (HCP) in order to determine the underlying condition leading to the client's signs and symptoms? 1. Endoscopy 2. Electrocardiogram 3. Stool for occult blood 4. Serum thyroid-stimulating hormone (TSH)

4. ~ A client with increased activity of the thyroid gland exhibits weight loss as a result of the higher metabolic rate, increased frequency of bowel movements or diarrhea, and an increased pulse rate, which account for the client's complaint of feeling his heart beating in his chest. Therefore, a TSH level should be drawn to validate hyperthyroidism. The TSH level will be decreased in hyperthyroid states.

The nurse is monitoring a diabetic client with a blood glucose level of 400 mg/dL (22.2 mmol/L). Which clinical manifestation would indicate diabetic ketoacidosis (DKA)? 1. Bradycardia 2. Cool, clammy skin 3. Lower extremity edema 4. Rapid, deep respirations

4. ~ DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration. The correct option is 4. This is because the body's compensatory response to the metabolic acidosis is to increase carbon dioxide (CO2) excretion by the lungs through deep, rapid breathing (Kussmaul respirations). Options 1, 2, and 3 are incorrect, as clients with DKA are dehydrated and thus have an increased heart rate and dry, scaly skin and do not have lower extremity edema.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 1. Encourage the client's expression of feelings. 2. Assess the client's understanding of the disease process. 3. Encourage family members to share their feelings about the disease process. 4. Encourage the client to recognize that the body changes need to be dealt with.

4. ~ Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum pH of 9.0 2. Absent ketones in the urine 3. Serum bicarbonate of 22 mEq/L (22 mmol/L) 4. Blood glucose level of 500 mg/dL (28.5 mmol/L)

4. ~ In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).

A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which concept? 1. Always keep insulin vials refrigerated. 2. Ketones in the urine signify a need for less insulin. 3. Increase the amount of insulin before excessive exercise. 4. Systematically rotate insulin injections within 1 anatomical site.

4. ~ Injection sites should be rotated systematically within 1 anatomical site. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. If ketones are found in the urine, it may indicate the need for additional insulin. Insulin doses should not be adjusted or increased before excessive exercise.

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations? 1. Cortisol 2. Androgens 3. Aldosterone 4. Epinephrine

4. ~ Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

The nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which behavior indicates to the nurse that the client is not ready to learn? 1. The client asks if the spouse may attend the teaching session. 2. The client asks appropriate questions about what will be taught. 3. The client asks for written materials about diabetes mellitus before class. 4. The client complains of fatigue whenever the nurse plans a teaching session.

4. ~ Physical symptoms can interfere with an individual's ability to learn and can indicate to the teacher that the student lacks motivation to learn if the symptoms repeatedly recur when teaching is initiated. The remaining options identify active client participation in learning.

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

4. ~ The client is instructed to use a moisturizing lotion on the feet and avoid applying lotion between the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns. The client should be instructed to wash the feet daily with a mild soap. The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails are thick or hard to cut or if vision is poor.

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 p.m." 2. "I will check my blood glucose level 1 hour after each meal." 3. "I will check my blood glucose level 2 hours after each meal." 4. "I will check my blood glucose level before each meal and at bedtime."

4. ~ The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing should be done during the nighttime hours. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data to control the diabetes mellitus.