ATI MedSurg Endocrine Practice Test
Hypotension Note: Hypotension is an expected finding of hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance and cool dry skin.
A home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hypothyroidism. The client has not been taking the medication regularly. Which of the following findings should the nurse expect?
Reduction of the effects of thyroid hormone on the heart Note: Propranolol is beta 2 adrenergic blocking agent that decreases the rapid heart rate caused by excessive Thryoid stimulation Does not affect thyroid hormone release Does not increase the heart sensitive to thyroid hormone, it helps prevent dysrhythmias Does not affect uptake of thyroid hormone by that euthyroid gland, it does help lower the clients BP
A nurse has administered propranolol by IV bolus to a client who is having a thyroid storm. Which of the following findings indicates that the client is having a therapeutic response?
"I will apply lotion to the dry areas of my feet but not between my toes." Note: lotion can be used for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth. Topical over the counter medications can impair skin integrity and lead to further injury Clients should wear closed toe she's to prevent injury to their feet. Client should dry their feet thoroughly after washing to prevent bacterial growth between the toes
A nurse in an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching?
Tremors Note: Heat intolerance, restless, irritable, tremors, diaphoresis, insomnia, Exophthalmos are symptoms are hyperthyroidism
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings?
Monitor the temperature of bath water with a thermometer Note: Prevent injury the client should use bath thermometer to ensure a water temp below 43.3 C or 110 F Client should examine the skin of the feet daily Should shop for shoes later in the day when the feet are likely to have slight swelling Trim toenails straight across and smooth the edges with an emery board
A nurse is caring for a client who has DM and has developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to the client's feet?
Elevate the head of the client's bed. Note: Nurse should elevate the head of the clients bed to reduce blood pressure and abdominal pressure Nurse should monitor client for hypertension. Nurse should not palpate the abdomen of a client who has pheochromocytoma, because this can cause release of catecholamines and increase BP
A nurse is caring for a client who has a pheochromocytoma. Which of the following actions should the nurse take?
Laryngeal stridor Note: Laryngeal stridor is a harsh high pitched sound with inspiration that indicates respiratory obstruction. the nurse should take immediate action to preserver the clients airway. A productive cough can occur after general anesthesia due to buildup of secretions caused by endotracheal intubation Pain with hyperextension of the neck is an expected finding after a thyroidectomy- pillow to support head and neck Hoarse and weak voice is common after
A nurse is monitoring a client who is 24 hr postoperative after a total thyroidectomy. Which of the following findings should the nurse report to the provider?
Fasting blood glucose 96 mg/dL Note expected reference range is 70 to 110 mg/dL for a fasting blood glucose level and indicates that insulin therapy is effective.
A nurse is monitoring the laboratory values of a client who has DM and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy?
Ingest food with alcohol to reduce alcohol-induced hypoglycemia Note: alcohol inhibits the liver production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia Male clients should drink no more than one serving of alcohol per day Should reduce insulin dosage before planned exercise to prevent hypoglycemia Should instruct the client to exercise at least 3 times per week and have not more than 2 consecutive days without exercise
A nurse is planning teaching for a client who has type 1 DM. Which of the following instructions should the nurse plan to include?
Addison's disease Note: ACTH stimulation test is the standard test for Addison disease. It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency.
A nurse is teaching a client about the ACTH stimulation test. The nurse should explain that the purpose of the test is to assess for which of the following disorders?
Draw up the insulins into separate syringes Note: Instruct the client to draw up the insulin's into separate syringes because insulin glargine is not compatible with other insulins. Should expect both insulin to appear clear and to discard any that appear cloudy. Gently mix the insulin vials prior to administration to prevent altering the chemistry of the medication should instruct the client to inject the insulins into the sub q tissue to promote proper absorption.
A nurse is teaching a client who has DM about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include?
Cool, clammy skin, anxiety, nervousness, tachycardia and confusion
A nurse is assessing a client who has DM and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic?
Hirsutism Note: Elevated BP, Weight gain, thinking of the skin, hirtusim are expected finding of Cushing disease. Hirsutism = increased androgen production
A nurse is assessing a client who has a new diagnosis of Cushing's disease. Which of the following findings should the nurse expect?
Calcium 12.8 mg/dL Note: weight loss, calcium level above the expected range of 9-10.5 mg/dL, sodium level below the expected reference range of 136 to 145 mEq/L.
A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect?
Increased hematocrit Note: Tachycardia, increased hematocrit, increased urine output leads to diluted urine and low urine specific gravity, increased Bun level is an expected finding of diabetes insipius due to dehydration.
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings?
Sodium 110 mEq/L Note: A client who has SIADH retains fluids, which causes dilution hyponatremia. Clients who have SIADH experience hyperactive deep tendon reflexes of 3+ or 4+.
A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider?
Increased body weight Note: Proplythiouracil is an antithyroid agent that is expected to decrease bowel movement, decrease diaphoresis, decrease libido. Propylthiouracil suppresses the production of thyroid hormones and allows weight gain. If excessive weight gain dose is too high.
A nurse is assessing a client who is taking propylthiouracil. The nurse should identify which of the following findings as an indication that the medication has been effective?
Tingling and numbness of the hands and feet Note: Hypocalcemia: causes paresthesia usually starting in hands and feet. Increases gastrointestinal motility. Causes a weak, threads pulse and hyperactive deep tendon reflexes.
A nurse is caring for a client following thyroidectomy. The nurse should assess for which of the following findings as indication of hypocalcemia?
Serum pH 7.45 Note: a client who is experiencing hhs produces enough insulin to prevent ketosis but not enough or prevent hyperglycemia. Glucose levels will be above 600mg/dL
A nurse is caring for a client who has type 2 DM and is experiencing a hyperglycemic-hyperosmolar state (HHS). Which of the following lab findings should the nurse expect?
"Take this medication on an empty stomach." Note: To promote proper absorption, the client should take the medication on an empty stomach and not eat or drink anything for 30 to 60 min after. Aluminum containing antacids and calcium supplements can reduce the effectiveness of thyroid replacement therapy Medication can increased blood glucose levels in clients who have Dm. It does not cause orthostatic hypotension Full glass of H20 no fluid restrictions with medication therapy, 2-3L daily
A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement. Which of the following instructions should the nurse plan to include?
Administer IV hydrocortisone sodium Note: Hydrocortisone sodium is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency Don't want spironolactone because potassium sparing will worsen Hyperkalemia Acute adrenal insufficiency causes hypovolemia = indication for rapid fluid replacement Although client needs increased circulatory volume infusing platelets is not appropriate for a client who has acute adrenal insufficiency
A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take?
"Report nocturia because it requires a dosage adjustment." Note: The client should take the initial dose of desmopressin in the evening. The provider will increase the dosage until the client no longer has nocturia Client should weigh self daily to detect dehydration in its early stage Should drink an amt of fluid equal to his urine output each day
A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include?
"Blow your nose gently prior to using the nasal spray." Note: the nurse should instruct the client to blow his nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions. Client should sit upright with their head titled forward slightly when administering the spray prevents it from going down throat Client to prime the nasal spray pump by pressing down fourt times before the initial use.
A nurse is providing discharge teaching to a client who has diabetes insipidus and a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?
pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L Note: metabolic acidosis is a common manifestation of DKA with a low ph, carbon dioxide within the expected reference range and low bicarbonate
A nurse is reviewing lab values for a client who has DKA. Which of the following results should the nurse expect?
Glucose Note: Blood glucose is elevated in a client who has Cushing's disease Calcium, Potassium, and lymphocyte are below the expected reference range in a client who has Cushing's disease
A nurse is reviewing the lab results of a client undergoing screening for primary Cushing's disease. The nurse should expect an elevation in which of the following lab findings?
"This test's result is a good indicator of my average blood glucose levels." Note HbA1c reflects glucose over 120 day period Expected range is 4-6% No fasting before this test is necessary
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching?
Blood glucose levels above 300 mg/dL Note: Blood glucose levels are 300 mg/dL are an expected finding of DKA. Levels above 600 mg/dL are an expected finding in a client who is in a hyperglycemia-hyperosmolar state Deep labored breathing -Kussmaul respirations- is an expected of DKA Weight loss is an expected for DKA Increased urine output is expected finding of DKA
A nurse is teaching a client who has DM. Which of the following should the nurse include as an expected finding of DKA?
Osteoporosis Moon-shaped face Increased risk of infection Note: -Osteoporosis: adverse effect of long term corticosteroid therapy due to the suppression of bone formation and the acceleration of bone resorption caused by corticosteroid therapy -Moon-shaped face: long term therapy causes characteristics of iatrogenic Cushing's syndrome, including a moon shaped face, a potbelly and buffalo hump Increased risk of infection: corticosteroid therapy, reduces the phagocytic actions of macrophages
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long-term corticosteroid therapy. Which of the following adverse effects should the nurse include?
"I will call my doctor if my blood sugar is more than 250." Note: Should call if blood glucose levels exceed 250 mg/dL during illness. Should check their urine for ketones when blood glucose levels are greater than 240 mg/dL. Should check their blood glucose level every 4 hr during illness should continue taking the usual dose of insulin even when not feeling well.
A nurse is teaching a client who has type 1 DM about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching?
"Restrict coffee intake 2 to 3 days prior to the test." Note: Clients should avoid coffee and tea, even if they are decaffeinated, bananas, chocolate and vanilla from 2 to 3 days prior to the test. Client should avoid using aspirin because it will affect the test results.
A nurse is teaching a client who is scheduled for a vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching?