Endocrine Function NCLEX CH 52
The nurse is assisting a diabetic patient to learn dietary planning as part of initial management of diabetes. The nurse would encourage the patient to limit intake of which of the following foods to help reduce the percent of fat in the diet? A) Cheese B) Broccoli C) Chicken D) Oranges
A) Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry.
For a client with hyperthyroidism, treatment is most likely to include: a) a thyroid hormone antagonist. b) thyroid extract. c) emollient lotions. d) a synthetic thyroid hormone.
A) A thyroid hormone antagonist Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, which of the following should be the nurse's initial intervention? A) Assess patient's perception of what it means to have diabetes. B) Ask the patient to write down current knowledge about diabetes. C) Set goals for the patient to actively participate in managing his diabetes. D) Assume responsibility for all of the patient's care to decrease stress level.
A) Assess patient's perception of what it means to have diabetes In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient.
The surgeon was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which of the following components of the patient's laboratory values? A) Calcium levels B) Potassium levels C) Blood glucose levels D) Sodium and chloride levels
A) Calcium levels The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not directly influenced by the loss of the parathyroid gland.
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does which of the following? A) Chooses a puncture site in the center of the finger pad B) Washes hands with soap and water to cleanse the site to be used C) Warms the finger before puncturing the finger to obtain a drop of blood D) Tells the nurse that the result of 120 mg/dl indicates good control of diabetes
A) Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad. This area contains many nerve endings and would be unnecessarily painful.
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which of the following symptoms reported by the patient is considered one of the classic clinical manifestations of diabetes? A) Excessive thirst B) Gradual weight gain C) Overwhelming fatigue D) Recurrent blurred vision
A) Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger).
Wallace Guterman, a 36-year-old construction manager, is being seen by a physician in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet and frequent headaches. What could be causing his symptoms? a) Hyperpituitarism b) Panhyperpituitarism c) Hypopituitarism d) Panhypopituitarism
A) Hyperpituitarism Acromegaly is a condition in which GH is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
Lab results are back for a 54-year-old patient with a 15-year history of diabetes. Which of the following lab results follows the expected pattern accompanying macrovascular disease as a complication of diabetes? A) Increased triglyceride levels B) Decreased low-density lipoproteins C) Increased high-density lipoproteins D) Decreased very-low-density lipoproteins
A) Increased trigylceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. For this reason, the patient should limit the amount of fat in the diet.
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? a) Insulin production insufficient b) Less common than type 1 diabetes c) Onset most common during adolescence d) Little to relation to pre-diabetes
A) Insulin production insufficient Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.
A nurse is attending a client in labor and is monitoring the duration and frequency of her uterine contractions. The client asks the nurse how the body knows how to give birth. Which hormone intensifies the contractions of the uterus and enables the uterus to push out the fetus? a) Oxytocin b) Insulin c) Prolactin d) Melanocyte
A) Oxytocin During labor, the positive feedback system is exemplified by the hormone oxytocin. Oxytocin intensifies the contractions of the uterus and enables the uterus to expel the fetus. Prolactin, melanocyte, and insulin are not responsible for the contractions of the uterus. Prolactin is a hormone secreted by the anterior lobe of the pituitary that stimulates milk production in women following pregnancy. Melanocyte-stimulating hormone influences skin pigmentation. Insulin is the key regulator of carbohydrate, protein, and fat metabolism and storage.
Lydia Kranston, a three-year-old female, is being seen by a physician in the endocrinology group where you practice nursing. She has a significant height deficit and is being seen for diagnostic purposes. What could be the cause of her disorder? a) Pituitary disorder b) Adrenal disorder c) Thyroid disorder d) Parathyroid disorder
A) Pituitary disorder Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of GH is insufficient during childhood.
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. The nurse should assess the patient for potential A) Thyroid disorders. B) Diabetes insipidus. C) Pituitary dysfunction. D) Parathyroid dysfunction.
A) Thyroid disorders Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? a) Thyroxine b) Parathormone c) Somatotropin d) Thymosin
A) Thyroxine The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.
Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus? a) The patient has not consumed food and continues to take insulin or oral antidiabetic medications. b) The patient has consumed food and has not taken or received insulin. c) The patient has not been exercising. d) The patient has not been compliant with the prescribed treatment regimen.
A) the patient has not consumed food and continues to take insulin or oral antidiabetic medications. Hypoglycemia occurs when a patient with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the patient has not been compliant with the prescribed treatment regimen. If the patient has eaten and has not taken or received insulin, DKA is more likely to develop.
The nurse is teaching a 54-year-old patient with diabetes about proper composition of the daily diet. The nurse explains that the guideline for carbohydrate intake is which of the following? A) 80% of daily intake B) Minimum of 80 g/day C) Minimum of 130 g/day D) Maximum of 130 g/day
C) Minimum of 130 g/day The recommendation for carbohydrate intake is a minimum of 130 g/day. Low-carbohydrate diets are not recommended for diabetes management.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse considers that which of the following could be a contributing factor for this lab result (select all that apply)? A) The level may be increased as a result of dehydration that accompanies hyperglycemia. B) The patient may be excreting extra sodium and retaining potassium because of malnutrition. C) The level is consistent with renal insufficiency that can develop with renal nephropathy. D) The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.
A,C,Malnutrition does not cause sodium excretion accompanied by potassium retention; thus it is not a contributing factor to this patient's potassium level. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH.
The patient received regular insulin 10 units subcutaneously at 8:30 pm for a blood glucose level of 253 mg/dl. The nurse plans to monitor this patient for signs of hypoglycemia at which of the following peak action times? A) 9:00 pm to 10:30 pm B) 10:30 pm to 11:30 pm C) 12:30 am to 1:30 am D) 2:30 am to 4:30 am
B) 10:30pm- 11:30pm Regular insulin exerts peak action in 2 to 3 hours, making the patient most at risk for hypoglycemia between 10:30 pm and 11:30 pm.
Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high? a) Hyperactivity b) Blurred vision c) Oliguria d) Increased energy
B) Blurred vision Blurred vision occurs when the blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.
A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? a) Home health nurse b) Dietitian c) Psychiatrist d) Social worker
B) Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.
A patient is noted to be anemic. Which hormone will affect the development of red blood cells in this patient? a) Epinephrine b) Erythropoietin c) Secretin d) Insulin
B) Erythropoietin The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells. Insulin is a pancreatic hormone that decreases blood sugar. The gastrointestinal mucosa produces the hormone of secretin. Epinephrine is a hormone that causes vasoconstriction to elevate blood sugar.
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes which of the following statements? A) "I should only walk barefoot in nice dry weather." B) "I should look at the condition of my feet every day." C) "I am lucky my shoes fit so nice and tight because they give me firm support." D) "When I am allowed up out of bed, I should check the shower water with my toes."
B) I should look at the condition of my feet every day Patients with diabetes mellitus need to inspect the feet daily for broken areas that are at risk for delayed wound healing. Water temperature should be tested with the hands first. Properly fitted (not tight) shoes should be worn at all times.
NPH is an example of which type of insulin? a) Short-acting b) Intermediate-acting c) Rapid-acting d) Long-acting
B) Intermediate-acting NPH is intermediate-acting insulin.
After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland? a) Pancreas b) Kidneys c) Testes d) Adrenal gland
B) Kidneys Although the kidneys secrete renin and erythropoietin, they are typically not considered endocrine glands. The pancreas, adrenal glands, and testes are considered endocrine glands.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include? A) Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B) Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C) Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D) Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.
B) Microangiography is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Sexual impotency and slowed gastric emptying result from microangiopathy. Macroangiopathy can occur in either type 1 or type 2 diabetes.
Which of the following assessment parameters is of highest priority when caring for a patient undergoing a water deprivation test? A) Serum glucose B) Patient weight C) Arterial blood gases D) Patient temperature
B) Patient weight A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient's weight drops more than 2 kg at any time. The other assessment parameters do not assess fluid balance.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a) magnesium. b) phosphorus. c) sodium. d) potassium.
B) Phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
A 54-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 am. The nurse instructs the patient to only drink water after what time? A) 6:00 pm on the evening before the test B) 4:00 am on the day of the test C) Midnight before the test D) 7:00 am on the day of the test
C) Midnight before the test Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 am should not have any food or beverages containing any calories after midnight.
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? a) Positive Trousseau's sign b) Positive Chvostek's sign c) Tetany d) Hyperactive deep tendon reflex
B) Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which of the following instructions regarding desmopressin acetate (DDAVP) would be most appropriate? A) The patient can expect to experience weight loss resulting from increased diuresis. B) The patient should alternate nostrils during administration to prevent nasal irritation. C) The patient should monitor for symptoms of hypernatremia as a side effect of this drug. D) The patient should report any decrease in urinary elimination to the health care provider.
B) The patient should alternate nostrils during administration to prevent nasal irritation DDAVP is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. DDAVP can cause nasal irritation, headache, nausea, and other signs of hyponatremia.
When caring for a client with diabetes insipidus, the nurse expects to administer: a) furosemide (Lasix). b) vasopressin (Pitressin). c) 10% dextrose. d) regular insulin.
B) Vasopressin (Pitressin) Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse? A) "With type 2 diabetes, the body of the pancreas becomes inflamed." B) "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." C) "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D) "With type 2 diabetes, the body produces autoantibodies that destroy b-cells in the pancreas."
B) With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin.
The patient has an order to receive 45 mg of prednisone by mouth daily. Available are 10-mg tablets. How many tablets should the nurse prepare to give? A) 1.6 B) 2 C) 4.5 D) 6
C) 4.5 45 mg ÷ 10 mg = 4.5 tablets
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? a) Perform capillary blood glucose monitoring four times daily. b) Drink 8 oz of fluids. c) Administer hydrocortisone I.M. d) Continue to take his usual dose of hydrocortisone.
C) Administer hydrocortisone I.M Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
The sounds of sirens announce the arrival of the latest trauma to address the trauma center where you practice nursing. Your heart is pounding, your mouth is dry. What gland is responsible for your physiologic response? a) Pineal gland b) Thyroid gland c) Adrenal glands d) Parathyroid gland
C) Adrenal glands The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? a) Sodium phosphorus b) Sodium bicarbonate c) Calcium gluconate d) Potassium chloride
C) Calcium gluconate Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
What skin findings should a nurse pay particular attention to in a client with a history of endocrine problems? a) Rashes b) Skin breaks that heal quickly c) Excessive hair growth or loss d) Susceptibility to sunburn
C) Excessive hair growth or loss While assessing skin findings related to the endocrine system, the nurse inspects the skin for excessive oiliness or dryness, excessive or absent areas of pigmentation, excessive hair growth or loss, and skin breaks that heal poorly.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? a) Tetany b) Buffalo hump c) Exophthalmos d) Striae
C) Exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
The nurse is educating a couple who has had difficulty with conception. The client asks about the hormone, which is responsible for the production of eggs. The nurse answers that this hormone is called: a) melanocyte-stimulating hormone b) luteinizing hormone (LH) c) follicle-stimulating hormone (FSH) d) interstitial cell-stimulating hormone (ICSH)
C) Follicle-stimulating hormone (FSH) FSH stimulates the growth and secretion of ovarian follicles in women and the production of sperm in men. LH is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men. In women, LH stimulates ovulation and the formulation of the corpus luteum. In men, LH is called ICSH and it influences the secretion of testosterone and other sex hormones from specialized areas in the testes. Melanocyte-stimulating hormone influences skin pigmentation, and is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men.
Which statement indicates that a client with diabetes mellitus understands proper foot care? a) "I'll go barefoot around the house to avoid pressure areas on my feet." b) "I'll rotate insulin injection sites from my left foot to my right foot." c) "I'll wear cotton socks with well-fitting shoes." d) "I'll schedule an appointment with my physician if my feet start to ache."
C) I'll wear cotton socks with well-fitting shoes The client demonstrates understanding of proper foot care if he states that he'll wear cotton socks with well-fitting shoes because cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. Aching isn't a common sign of foot problems; however, a tingling sensation in the feet indicates neurovascular changes. Injecting insulin into the foot may lead to infection. The client shouldn't go barefoot. Doing so can cause injury.
A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? A) Central apnea B) Hypoventilation C) Kussmaul respirations D) Cheyne-Stokes respirations
C) Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations? A) Neurologic irritability B) Declining urine output C) Lethargy and weakness D) Hyperactive bowel sounds
C) Lethargy and weakness Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include polyuria, constipation, nausea and vomiting, lethargy, and muscle weakness.
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which of the following assessments should the nurse prioritize when providing postoperative care for this patient? A) Assessing the patient's white blood cell levels and assessing for infection B) Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels C) Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia D) Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
C) Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
Which of the following is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? A) Providing a dark, low-stimulation environment B) Closely monitoring the patient's intake and output C) Patient teaching related to levothyroxine (Synthroid) D) Patient teaching related to radioactive iodine therapy
C) Patient teaching related to levothyroxine (Synthroid) A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine (Synthroid). It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.
A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? A) Prevention of hypothyroidism B) Prevention of diabetes insipidus C) Prevention of adrenal insufficiency D) Prevention of cardiovascular complications
C) Prevention of adrenal insufficiency Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of stopping corticosteroid therapy suddenly.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a) Infusing I.V. fluids rapidly as ordered b) Administering glucose-containing I.V. fluids as ordered c) Restricting fluids d) Encouraging increased oral intake
C) Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
When instructing a patient regarding a urine study for free cortisol, it is most important for the nurse to tell the patient to A) Save the first voided urine in the am. B) Maintain a high-sodium diet 3 days before collection. C) Try to avoid stressful situations during the collection period. D) Complete at least 30 minutes of strenuous exercise before collecting the urine sample.
C) Try to avoid stressful situations during the collection period A urine study for free cortisol requires a 24-hour urine collection. The patient should be instructed to avoid stressful situations and excessive physical exercise that could unduly increase cortisol levels. The patient should also maintain a low-sodium diet before and during the urine collection period.
The nurse performs a fingerstick blood glucose level of a client with diabetes before lunch. The nurse would notify the physician for which blood glucose level? a) 115 mg/dL b) 90 mg/dL c) 130 mg/dL d) 145 mg/dL
D) 145 mg/dL Ideally, with fingerstick testing, the blood sugar should measure 90 to 130 mg/dL before meals and <180 mg/dL one to two hours after meals.
Which of the following diagnostic tests are done to determine suspected pituitary tumor? Choose the correct option. a) Radiographs of the abdomen b) A radioimmunoassay c) Measuring blood hormone levels d) A computed tomography scan
D) A computed tomography scan A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? a) Infuse 1000 mL D5W over a 12-hour period. b) Encourage the client to drink orange juice with added sugar. c) Check the client's urine for the presence of sugar and acetone. d) Administer 50% glucose intravenously.
D) Administer 50% glucose intravenously The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth
The nurse would monitor for which of the following adverse changes in the patient's laboratory values as a result of being treated with dexamethasone (Decadron)? A) Sodium 130 mEq/L B) Calcium 8.2 mg/dl C) Potassium 4.9 mEq/L D) Blood glucose 162 mg/dl
D) Blood glucose 162 mg/dl Hyperglycemia or increased blood glucose level is an adverse effect of corticosteroid therapy.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: a) weight gain in arms and legs. b) thick, coarse skin. c) hypotension. d) deposits of adipose tissue in the trunk and dorsocervical area.
D) Deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient's past glucose control? A) Prealbumin level B) Urine ketone level C) Fasting glucose level D) Glycosylated hemoglobin level
D) Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months.
Which statement best indicates that a client understands how to administer his own insulin injections? a) "I need to wash my hands before I give myself my injection." b) "If I'm not feeling well, I can get a friend or neighbor to help me." c) "I need to be sure no air bubbles remain." d) "I wrote down the steps in case I forget what to do."
D) I wrote down the steps in case I forgot. The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps. Awareness of air bubbles and hand washing indicate that the client understands certain aspects of giving an injection, but doesn't confirm he understands all of the steps. Saying that he can ask a friend or neighbor for help indicates a need for further instruction.
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? a) Weight loss b) Pale thick skin c) Hypotension d) Moon face
D) Moon face Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.
A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient education related to which of the following diagnostic tests? A) Thyroid scan B) Fasting glucose test C) Oral glucose tolerance D) Water deprivation test
D) Water deprivation test A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not directly related to the diagnosis of diabetes insipidus.
A client has a disorder of the pancreas. The nurse recognizes that which of the following hormones may be affected as a result? Select all that apply. a) Somatostatin b) Glucagon c) Aldosterone d) Insulin e) Epinephrine
Somatostatin, Glucagon, Insulin The pancreas lies below the stomach, with the head of the gland close to the duodenum. It is both an exocrine and an endocrine gland. The exocrine portion secretes digestive enzymes that the common bile duct carries to the small intestine. The hormone-secreting cells of the pancreas, called the islets of Langerhans, release insulin, glucagon, somatostatin, and pancreatic polypeptide. Insulin lowers the level of blood glucose when it rises beyond normal limits. Glucagon raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Somatostatin helps maintain a relatively constant level of blood sugar by inhibiting the release of insulin and glucagons.