Endocrine

A nurse is caring for a client recently diagnosed with type 1 diabetes. For what signs and symptoms of an insulin reaction should the nurse assess this client? (Select all that apply.)

1. Headache 2. Diaphoresis 3. Nervousness

A nurse is caring for a client after a thyroidectomy. For which signs of thyroid storm should the client be monitored? (Select all that apply.)

1. Increased heart rate 2. Increased temperature

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? (Select all that apply.)

1. Irritability 4. Heart palpitations

The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:

1. Lability of mood

Which health problem should the nurse consider is most likely to precipitate acute hypoglycemia in a client?

1. Liver disease

The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include? (Select all that apply.)

3. It can improve A1c levels 5. Clients can exercise without eating more carbohydrates

A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. The primary cause of the client's ascites is a decrease in:

4. Plasma protein to maintain adequate capillary-tissue circulation.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

4. Regular insulin (Novolin R)

A nurse in the post-anesthesia care unit is caring for a client who just had a thyroidectomy. For which client response is it most important for

4. Signs of respiratory obstruction

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? (Select all that apply.)

1. Dry skin 2. Abdominal pain 3. Kussmaul respirations

A nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. Which action should be included in this client's plan of care?

1. Ensuring a large fluid intake

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include that will decrease the risk of complications? (Select all that apply.)

1. Examining the feet daily 2. Wearing well-fitting shoes 3. Performing regular exercise

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1. Fats 2. Protein 4. Carbohydrates

1. Fats *Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia? (Select all that apply)

1. Pallor 2. Tremors 5. Diaphoresis

A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" What is the nurse's best reply?

2. "I don't know if you do; let's talk about it."

When assessing a client with Graves disease, the nurse expects to identify:

3. Weight loss, exophthalmos, and restlessness *Weight loss and restlessness occur because of an increased basal metabolic rate; exophthalmos occurs because of peribulbar edema

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.)

1. Tremors 4. Heat intolerance

A nurse is monitoring a client's laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic?

4. 126 and 140 mg/dL

A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The health care provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should:

4. Ask the client to ingest one tube of glucose gel *One tube of glucose gel contains 15 g of carbohydrate and is the most appropriate intervention in this situation

A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will:

4. Break in my new shoes over the course of several weeks."

A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? (Select all that apply.)

4. Cardiac dysrhythmias 5. Hypoactive bowel sounds

A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake?

4. Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium.

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse monitor

4. Hypernatremia

A nurse is caring for a client who was admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

4. Hypoglycemia and hypotension

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin reaction should the nurse particularly be observant? (Select all that apply.)

2 Headache 3 Diaphoresis

Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?

2 Hypocalcemia

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

2. Tachycardia 5. Exophthalmos

A nurse plans to set up emergency equipment at the bedside of a client in the immediate postoperative period after a thyroidectomy. What should the nurse include in the bedside setup?

2. Tracheostomy set and oxygen

After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which manifestations of excessive levels of ADH should the nurse assess the client? (Select all that apply.)

2. Weight gain 4. Hyponatremia

For which client response should the nurse monitor when assessing for complications of

3. Bone pain

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes:

3. Complications are not present at the time of diagnosis.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

3. Urine negative for ketones and hyperglycemia.

A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:

4. An increased temperature and pulse rate

A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What signs of common complications of diabetes might the nurse expect to identify when assessing this client? (Select all that apply.)

1 . Leg ulcers 2 . Loss of visual acuity 3 . Thick, yellow toenails 5 . Decreased sensation in the feet

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions?(Select all that apply.)

1 Wear shoes when out of bed. 3 Dry between the toes after bathing.

A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question?

1. "There is no difference between readings."

A client in thyroid storm tells the nurse, "I know I'm going to die. I'm very sick." What is the nurse's best response?

1. "You must feel very sick and frightened."

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?

1. Administer intravenous (IV) steroids.

The nurse is assessing a client with hyperthyroidism. For which signs and symptoms should the nurse assess the client? (Select all that apply.)

1. Amenorrhea 4. Flushed appearance 5. Short attention span

A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiological changes that are associated with a long history of diabetes?

1. Blurry, spotty, or hazy vision

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?

1. Breakdown of fat stores for energy

A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.)

1. Cool skin 3. Constipation 4. Periorbital edema 5. Decreased appetite

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)

1. Emotional lability 2. Dyspnea on exertion 5. Hyperactive deep tendon reflexes

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

1. Diarrhea 3. Weight loss

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, "I should call my health care provider if I develop:

1. Dry hair and an intolerance to cold."

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? (Select all that apply.)

1. Dry skin 2. Lethargy 5. Sensitivity to cold

A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? (Select all that apply.)

1. Excessive thirst 3. Dry mucous membranes 6. Decreased urine specific gravity

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis?

1. Monitoring for signs of hypoglycemia as a result of treatment

A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse's most appropriate response is:

4. "Choose the foods you normally do and follow your food plan wherever you are."

A client who is 60 pounds more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight?

1. Obesity leads to insulin resistance

The nurse is counseling a client with type 1 diabetes about the client's favorite foods that are lowest in carbohydrates (CHO). The nurse determines that this concept is understood when the client chooses eight ounces of:

1. Skim milk *Skim milk contains about 12 grams of CHO per cup. There are about 30 grams CHO in 1 cup of apple juice. There are about 16 grams CHO in 1 cup of nonfat yogurt. There are about 25 grams CHO in 1 cup of orange juice

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing?

1. Somogyi effect

A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?

1. Stress response

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

1. Supports a better response to stress

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

1. Tetany

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? (Select all that apply.)

1. Use tinted glasses. 3. Elevate the head of the bed 45 degrees. 4. Tape eyelids shut at night if they do not close.

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning a teaching plan based on the results of this laboratory test?

3. Has followed the treatment plan as prescribed **The expected range of glycosylated hemoglobin (HbA1c ) is 4.4% to 6.4%. A value of 6% is within the expected range.

A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?

2. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected."

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations?

2. Calcium gluconate **The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Potassium iodide is prescribed for hyperthyroidism because it inhibits the release of thyroid hormones. Magnesium sulfate is prescribed for hypomagnesemia or to treat pregnant women who have preeclampsia. Potassium chloride is prescribed for hypokalemia, not hypocalcemia.

The nurse identifies that the dietary teaching provided for a client with diabetes is understood when the client states, "My diet:

2. Can be planned around a wide variety of commonly used foods."

conclusion? (Select all that apply.)

2. Headache 3. Tachycardia 4. Cool clammy skin

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?

2. T3, T4, and thyroid-stimulating hormone (TSH)

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?

2. Hyperplasia of the adrenal cortex

A client is receiving dexamethasone (Decadron) for adrenocortical insufficiency. To monitor for a negative side effect of the medication, the nurse should:

2. Measure blood glucose levels *Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely.

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?

2. Measure the blood glucose level between 2 AM and 4 AM.

A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? (Select all that apply.)

2. Obese trunk 4. Sleep disturbance 5. Thin arms and legs

A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time?

2. Observe for signs of tetany.

A nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? (Select all that apply.)

2. Palpitations 3. Diaphoresis 4. Slurred speech

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client?

2. Presence of infection

A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will:

2. Require larger doses of insulin than I did preoperatively."

A nurse evaluates that a client with diabetes understands the teaching about the treatment of hypoglycemia when the client says, "If I become hypoglycemic I initially should eat:

2. Sugar and a slice of bread.

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to:

3. Give supplemental doses of regular insulin

On the first day after a thyroidectomy, a client tolerates a full-liquid/fluid diet. When the diet is progressed to a soft diet the next day, the client complains of a sore throat when swallowing. How should the nurse respond?

3. Administer prescribed analgesics before meals

During the early postoperative period after a subtotal thyroidectomy, the nursing priority is to assess for:

3. Airway obstruction

Which factor identified by the nurse while obtaining the client's health history predisposes a client to type 2 diabetes?

3. Being twenty pounds overweight

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the:

3. Dosage can be adjusted to changing needs during recovery from surgery

A nurse is collecting information about a client who has type 1 diabetes and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? (Select all that apply.)

3. Excessive emotional stress 4. Running a fever with the flu

A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:

3. Improve the cellular uptake of glucose

A nurse is caring for a client with type 1 diabetes, and the health care provider prescribes one tube of glucose gel. What is the primary reason for the administration of glucose gel to this client?

3. Insulin-induced hypoglycemia

A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client's condition after this therapy should the nurse consider when providing care?

3. Mildly radioactive but should be treated with routine safety precautions

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action?

3. Perform a finger stick to test the client's blood glucose level.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:

3. There may not be enough thyroid tissue to supply adequate thyroid hormone

A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? (Select all that apply.)

4 . Nervousness 5 . Increased appetite

A client tells the nurse during the admission history that an oral hypoglycemic agent is taken daily. For which condition does the nurse conclude that an oral hypoglycemic agent may be prescribed by the health care provider?

4. Reduced insulin production

A client who has type 1 diabetes is admitted to the hospital for major surgery. Before surgery the client's insulin requirements are elevated but well controlled. Postoperatively, the nurse anticipates that the client's insulin requirements

4. Remain elevated *Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period. Insulin requirements will remain elevated rather than decrease.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." On the basis of this statement, the nurse's best action is to:

4. Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints

Which is the best advice the nurse can give regarding foot care to a client diagnosed with diabetes?

4. Wear synthetic fiber socks when exercising

-A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs?

4.Collaborate with the health care provider to alter the insulin prescription.

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?

2. Glucose level

A client who was diagnosed recently with type 1 diabetes states, "I feel bad. I don't think I even want to go home. My spouse doesn't care about my diabetes." What is the most appropriate nursing response?

4. "You are unhappy. Have you tried to talk with your spouse?"

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?

4. Mineralocorticoids

A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do?

4. Monitor blood glucose levels more frequently.

A client with type 2 diabetes has been receiving insulin in the hospital while being treated for sepsis. The client's infection is resolving, and the health care provider writes a prescription to discontinue the 7 AM dose of insulin and administer glyburide (Micronase) 5 mg twice daily (8 AM and 8 PM). The nurse on the day shift (8 AM to 4 PM) administers the Micronase at 8:30 AM. When recording its administration in the client's record, the nurse sees that the insulin had already been administered at 7 AM. What initial action should the nurse take?

4. Monitor for signs of hypoglycemia.

Before a client's discharge after a thyroidectomy, the nurse teaches the client to observe for signs of surgically induced hypothyroidism. What clinical indicators identified by the client provide evidence that the nurse's instructions are understood? (Select all that apply.)

1. Fatigue 2. Dry skin

A nurse is caring for a client after a thyroidectomy. Because of concerns about potential nerve injury associated with this type of surgery, the nurse should assess for which functional ability?

1. Speaking

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiological finding should be the nurse's focus when collecting additional data about this client?

1. Starvation

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. The nurse should base a response on the understanding that:

1. As long as medication is continued, ovulation will occur

A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is:

2. Neovascularization of the retina

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematological studies?

3. Phosphorus *Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorous levels decrease (greater than 3 mg/dL; greater than 0.1 mmol/L).

A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client?

3. Thyroxine replacement therapy will be required indefinitely.

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, the nurse should teach the client to:

4. Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone **Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:

3. Weight loss

A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? (Select all that apply.)

4. Nervousness 5. Increased appetite

What should the nurse do when collecting a 24-hour urine specimen?

1. Check to verify if a preservative is needed.

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? (Select all that apply.)

1. Hirsutism 3. Buffalo hump

A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being

1. Hypotension

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? (Select all that apply.)

1. Lability of mood 2. Slow wound healing

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response?

1. The tumor must be removed to prevent heart and kidney damage.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? (Select all that apply).

1. Thirst 4. Fruity breath odor 5. Excessive urination

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)

2. Weight loss 3. Tachycardia 4. Restlessness 6. Exophthalmos