ATI Endocrine Review

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? A. Hyperpigmentation B. Intention tremors C. Hirsutism D. Purple striations

A Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? A. Dehydration B. Polyphagia C. Hyperglycemia D. Bradycardia

A Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

A nurse is providing care for a client who has diabetes insipidus (DI). Which of the following is a cause of acquired central DI? A. Surgery B. Sickle cell disease C. Renal failure D. Hypokalemia

A Surgical procedures, as well as autoimmune and vascular diseases, sarcoidosis, surgery, trauma, structural malformations, metastasis, hypoxic brain injury, and ischemia can cause acquired central DI.

A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching? A. Keep the open vial of insulin at room temperature B. Inject the insulin into a large muscle C. Aspirate the medication prior to administration D. Administer the insulin in two separate injections

A The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.

A nurse is preparing to provide care for a client in the emergency department who has syndrome of inappropriate antidiuretic hormone (SIADH). The client has a serum sodium of 115 mEq/L (136 - 145 mEq/L). Which of the following IV solutions should the nurse anticipate will be prescribed? A. 3% sodium chloride B. Dextrose 5% in 0.9% sodium chloride C. Dextrose 5% in 0.45% sodium chloride D. 0.9% sodium chloride

A The nurse should anticipate provider prescriptions for hypertonic IV fluids and medications to facilitate removal of excess water from the body. When the serum sodium is less than 120 mEq/L, 3% sodium chloride is prescribed.

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? A. Teach the parents about cortisol replacement therapy B. Place the child on a low-sodium diet C. Monitor the child for fluid volume excess D. Discuss the manifestations of hyperglycemia with the parents

A The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.) A. Buffalo hump B. Hypertension C. Purple striations D. Tremors E. Moon face

A, B, C, E

Which of the following assessment findings would indicate to the nurse that the client is at risk for developing diabetic ketoacidosis (DKA)? A. Ketones present in urine B. Elevated C-Peptide blood level C. Serum blood glucose 300 mg/dL D. HbA1c 12.6% E. Hypertension F. ABG results of: pH 7.20 (7.35 to 7.45) PaCO2 35 mm Hg (35 to 45 mm Hg) PaO2 85 (70 to 100 mm Hg) HCO3- 12 mEq/L (22 to 26 mEq/L)

A, C, D, F

A nurse is assessing a client who has myxedema. Which of the following findings should the nurse expect? A. Diarrhea B. Facial edema C. Tachycardia D. Heat intolerance

B Facial edema is an expected finding of myxedema, which is a severe form of hypothyroidism. A client who has myxedema typically experiences non-pitting edema everywhere, especially around the eyes and in the hands and feet.

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? A. "Test your blood glucose level every 8 hours." B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL" C. "Withhold you usual daily dose of insulin" D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours"

B The client should check his urine for ketones when blood glucose levels are greater than 240 mg/dL in order to detect DKA. The client should contact the provider if he has moderate or large amounts of ketones in his urine.

A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? A. Give the client 15 to 20 g of carbohydrate B. Monitor the client for hypoglycemia C. Complete an incident report D. Notify the nurse manager

B The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate? A. Hypernatremia B. Oliguria C. Weight loss D. Increased thirst

B The nurse should expect a client who has developed SIADH following a craniotomy to manifest oliguria. The decrease in urine output can be dramatic with output less than 20 mL/hr. -also will see hyponatremia, weight gain, and decreased thirst

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching? A. Limit intake of potassium-rich foods B. Restrict sodium intake C. Increase carbohydrate intake D. Decrease protein intake

B The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.

A nurse is providing care for a client who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following is a clinical manifestation of HHS? A. Metabolic acidosis B. Hypervolemia C. Insulin resistance D. Ketosis

C -metabolic acidosis and ketosis are a manifestation of DKA -hypovolemia is a manifestation of both HHS and DKA

A nurse is providing teaching to a client who has hypothyroidism and has been prescribed levothyroxine. Which of the following medication instructions would the nurse include in the teaching? A. "Take this medication during your morning meal" B. "Take this medication with high-protein foods." C. "Take this medication before a meal or several hours after a meal" D. "Take this medication with a full glass of water or fruit juice"

C Levothyroxine should be taken on an empty stomach. It must be taken an hour before a meal or 3 hr post-meal. Many clients take it before breakfast or before sleep.

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? A. A decrease in blood sugar B. A decrease in blood pressure C. A decrease in urine output D. A decrease in specific gravity

C The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is assessing a client who is experiencing thyroid storm. Which of the following findings should the nurse anticipate? A. Coma B. Fruity smelling breath C. Hypothermia D. Tachycardia

D -coma = myxedema coma -fruity smelling breath = DKA -elevated temp = thyroid storm

A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescription from the provider? A. Glucocorticoid medications B. Dextrose % in 0.45% sodium chloride C. Oral hypoglycemic medications D. 0.9% sodium chloride IV bolus

D The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take? A. Turn the client every 4 hr B. Check the client's blood pressure every 2 hr C. Initiate measures to cool the client D. Place the client on aspiration precautions

D The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryngeal edema and tongue thickening.