ATI Medical-Surgical: Endocrine RSNG Spring 2018

3. difficulty sleeping The client with Grave's disease can have difficulty and anxiety due to an overproduction of thyroid hormone.

A nurse is assessing a client who has Grave's disease. Which of the following findings should the nurse expect the client to display? 1. constipation 2. cold intolerance 3. difficulty sleeping 4. anorexia

3. bronze pigmentation of the skin The client with Addison's Disease will have a 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).

A nurse is assessing a client with Addison's Disease. Which of the following skin manifestations should the nurse expect to find? 1. purple straie on the chest and abdomen 2. butterfly rash across the bridge of the nose 3. bronze pigmentation of the skin 4. jaundice of the face and sclera

4. increased head size The client who has acromegaly will manifest an enlarged head size due to excessive production of growth hormones after closing of the epiphyses (the growth plate at the end 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 jaw, hands, face, feet, and skull.

A nurse is assessing a client with manifestations of acromegaly. Which of the following findings should the nurse expect? 1. thinning of skeletal bone structure 2. concave chest wall 3. high pitched voice 4. increased head size

1. tachycardia and hypertension 4. laryngeal stridor and hoarseness 5. positive Trouseau's sign Tachycardia and hypertension are unexpected findings, which can indicate the occurrence of thyroid storm, following the removal of the thyroid gland, especially if the client was in a hyperthyroid state before the surgery. Thyroid storm is a life threatening condition with the sudden onset that includes tachycardia, fever, sweating, restlessness and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. A positive Trouseau's sign is an indication of hypocalecemia, which is a complication of thyroid removal. This occurs also when the parathyroid glands are removed and regulation of serum calcium is impaired.

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) 1. tachycardia and hypertension 2. respiratory rate of 16/min 3. negative Chvostek's sign 4. laryngeal stridor and hoarseness 5. positive Trouseau's sign

1. compensate for decrease in cortisol levels The client who had an adrenalectomy requires glucocorticoids before, during and after to prevent an adrenal crisis caused by a sudden drop in cortisol levels. If untreated, it can be fatal.

A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administered glucocorticoids following the procedure to enhance which of the following therapeutic effects? 1. compensate for decrease in cortisol levels 2. inhibit glucose levels 3. act as a diuretic to maintain output 4. decrease susceptibility to infection

1. calcium The parathyroid regulates calcium, phosphorus and magnesium balance with the client's blood and bone by maintaining a balance between the mineral levels of the blood and the bone. Hyperparathyroidism is associated with hypercalcemia; therefore a decrease in calcium indicates an improvement in the client's condition.

A nurse is caring for a client who is postoperative for a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as an effect of the therapeutic effect procedure? 1. calcium 2. sodium 3. potassium 4. phosphorus

3. polyuria This client will have increased urine (polyuria) and increased thirst (polydipsia)

A nurse is caring for a client with diabetes insipidus. For which of the following findings should the nurse monitor? 1. proteinuria 2. oliguria 3. polyuria 4. glycosuria

2. increased urination

A nurse is caring for a client with type 2 DM and is displaying manifestations of hyperglycemia. Which of the following findings should indicate to the nurse that the client has hyperglycemia? 1. hunger 2. increased urination 3. cold, clammy skin 4. tremors

1. glycosylated hemoglobin levels The glycosylated hemoglobin level test is also known as the HbA1c test.

A nurse is checking laboratory values to determine if a client with DM is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? 1. glycosylated hemoglobin levels 2. urine sugar and acetone 3. glucose tolerance test 4. fasting serum glucose

4. Hypertension The client with Thyroid Storm will have an exaggerated condition of hyperthyroidism associated with the development of fever, hypertension, fever and tachycardia. Grave's Disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by over production of the thyroid hormone.

A nurse is monitoring a client who has Grave's disease for development of Thyroid Storm. The nurse should report which of the following findings to the provider? 1. Constipation 2. Headache 3. Bradycardia 4. Hypertension

3. hyponatremia The client with SIADH will have hyponatremia caused by excessive release of ADH. As a result of the excess ADH, the client retains water that cause dilutional hyponatremia.

A nurse is monitoring a client who has a syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? 1. polyuria 2. dehydration 3. hyponatremia 4. hyperthermia

2. Men and women who are obese Obesity plays a major role in the development of type 2 DM 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.

A nurse is planning a community health screening for a group of clients that are at risk for type 2 DM. Which of the following clients should the nurse include? 1. Men who smoke 2. Men and women who are obese 3. Women who have hepatitis 4. Men and women who consume high protein and low carbohydrate foods

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

A nurse is planning care for a client who is experiencing Somogyi effect and is takes intermediate-acting insulin. Which of the following actions should the nurse include in the plan? 1. move the evening dose of intermediate-acting insulin to 90 minutes before dinner 2. increase the client's morning intake 3. omit the client's evening snack 4. monitor the client's nighttime glucose levels

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

A nurse is planning care for a client with Cushing's Syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? 1. check the client's blood glucose level 2. check the client's urine specific gravity 3. weigh the client weekly 4. insert an indwelling urinary catheter for the client

2. vanillylmandelic acid (VMA) The VMA test is used to detect pheochromocytoma which measures the level of catecholamine metabolites in the 24 hour urine specimen. Pheochromocytoma is a tumor of the adrenal gland that causes excessive release of the catecholamine epinephrine and norepinephrine, which are hormones that regulate heart rate and blood pressure.

A nurse is preparing for a 24 hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following test from the 24 hour urine specimen should the nurse use to determine the client's condition? 1. creatinine clearance 2. vanillylmandelic acid (VMA) 3. 17 hydroxycorticoid steroids (OHCS) 4. protein

2. Wear a medical alert identification tag when you exercise The patient should wear a medical alert bracelet in case of a hypoglycemic response, because exercise can potentiate the effects of insulin and cause the blood glucose levels to decrease.

A nurse is providing teaching for a patient with Type 2 DM about exercise. Which of the following statements should the nurse include in the teaching? 1. You should exercise during a peak insulin time 2. Wear a medical alert identification tag when you exercise 3. Exercise can decrease the effects of insulin and cause the blood glucose levels increase 4. You will get the most benefit from exercise when your glucose levels are higher than normal

1. My cells are resistant to the effects of insulin

A nurse is providing teaching to a client who has type 2 DM about the pathophysiology of the disease. Which of the following statements by the client indicates and understanding of the disease? 1. My cells are resistant to the effects of insulin 2. My body breaks down sugars too effectively 3. My pancreas does not produce insulin 4. My body produces antibodies against pancreatic beta cells

3. turkey and cheese sandwich 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, 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 providing teaching to a client with Addison's Disease about healthy snack foods. Which of the following food choices by the client indicates an understanding? 1. sliced bananas 2. baked potato 3.

1. shakiness The client with hypoglycemia can experience manifestations of shakiness. Other early manifestations include headache, difficulty thinking, sweating and nausea.

A nurse is providing teaching to a client with Type 1 DM about hypoglycemia. Which of the following manifestations should the nurse include in the teaching. 1. shakiness 2. urinary frequency 3. dry mucous membranes 4. excess thirst

4. bicarbonate level of 12 mEq The client with diabetic ketoacidosis should have a bicarbonate level of less than 15 mEq because the client has an increased production of counter-regulatory hormones that lead to metabolic acidosis.

The nurse is reviewing the lab values of a client with diabetic ketoacidosis. The nurse should understand that the following lab values are consistent with diabetic ketoacidosis. 1. blood glucose 30 mg 2. negative urine ketones 3. blood pH of 7.38 4. bicarbonate level of 12 mEq