Endocrine Passpoint

A client with hyperthyroidism develops high fever, extreme tachycardia, and altered mental status. Which condition does the nurse suspect is developing?

thyroid storm Thyroid storm is a form of severe hyperthyroidism that can be precipitated by stress, injury, or infection. Hepatic coma occurs in clients with profound liver failure. Myxedema coma is a rare disorder characterized by hypoventilation, hypotension, hypoglycemia, and hypothyroidism. HHNS occurs in clients with type 2 diabetes who are dehydrated and have severe hyperglycemia.

The LVN/LPN is visiting an adult client with diabetes mellitus who lives at home. Which of the following situations should the nurse be most concerned about?

An insulin bottle is left on the center table in the living room. A sharps container on a kitchen table possesses no risk for the client. An insulin bottle left on a center table can affect the potency of the drug because insulin needs to be refrigerated. This is not safe. The client is allowed to keep hard candy in case of a hypoglycemic episode. Bruises around the belly button results from injections. It can be minimized by rotating sites and not massaging the area vigorously after injection.

The nursing staff has just been trained how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

Calibrate the machine after installing a new battery. To obtain accurate readings, the nurse should calibrate the machine when a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse should wear gloves throughout blood glucose testing. The nurse should drop the blood — not smear it — on the reagent pad; smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer until the blood sample is collected.

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

Coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

The nursing care for the client in Addisonian crisis should perform which intervention?

Place the client in a private room. The client in Addisonian crisis has a reduced ability to cope with stress because of his inability to produce corticosteroids. Compared with a multibed room, a private room is easier to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs because ambulation isn't allowed. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.

A client with type 2 diabetes was diagnosed with retinopathy. While a nurse reviews the client's medication dosage, the client states, "I can't read the names on the medicine bottles, so I hope I'm taking the right pills at the right time." What should the nurse do with this information?

Teach the client how to tell the difference between the medicine bottles. The nurse should teach the client how to mark the medicine bottles so that she can identify the medications. The nurse shouldn't ask the physician to reduce the number of medications the client takes. Telling the client's son makes him aware of the problem but doesn't help to solve it. The nurse should document this information in the client's medical record, but documentation alone will not help solve the problem.

A client with a history of type 1 diabetes mellitus recently had an amputation and is in the rehabilitation unit. When the nurse enters the room to administer the client's daily insulin, the client is diaphoretic, reports having a headache, and has slurred speech. What should the nurse do next?

Withhold the client's insulin, check the blood glucose level, bring a glass of orange juice, and report the findings to the charge nurse. The client with a history of type 1 diabetes mellitus who is diaphoretic, reports having a headache, and has slurred speech is showing classic signs of hypoglycemia. Obtaining a blood glucose level determines if hypoglycemia is present. Orange juice helps reverse hypoglycemia. The charge nurse needs to be informed for continuity of evaluation and intervention. Insulin should be withheld until further evaluation and treatment of the hypoglycemia. Milk and crackers do not work as fast as orange juice to increase glucose levels.

The nurse is participating in a discharge planning conference for a school-age child with newly diagnosed diabetes mellitus. The parents express concern about the accommodations needed when the child returns to school. Which recommendations does the nurse expect the team to make? Select all that apply?

a schedule for blood glucose testing with target ranges and interventions a written plan for the school to follow regarding insulin administration education for appropriate school staff about care that will be rendered

A nurse collects data on a client who is postoperative thyroid surgery. The client has a positive Chvostek's sign. Which laboratory finding supports the presence of this finding?

calcium 7.1 mg/dL (1.77 mmol/L) The presence of Chvostek's sign indicates hypocalcemia (serum calcium levels below 8.2 mg/dL or 2.05 mmol/L). Chvostek's sign is elicited by lightly tapping the client's face over the facial nerve, just below the temple causing the client's facial muscles to twitch. Because the parathyroid glands (regulates calcium balance) are in close proximity to the thyroid gland, they are sometimes removed accidentally, resulting in hypocalcemia. Signs and symptoms of hyponatremia (serum sodium level below 135 mg/dl or 135 mmol/L) include weight loss, abdominal cramping, muscle weakness, headache, and orthostatic hypotension. Hypokalemia (serum potassium level below 3.5 mEq/L or 4.5 mmol/L) causes paralytic ileus, muscle weakness, fatigue, and cardiac conduction disturbances. Clients with hypermagnesemia (above normal serum magnesium levels 2.1 mg/dL or 1.05 mmol/L) may exhibit loss of deep tendon reflexes, coma, and cardiac arrest.

A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

calibrating the machine after installing a new battery To obtain accurate readings, the nurse should calibrate the machine whenever a new battery is installed. To adhere to standard precautions and prevent contact with blood, the nurse's hands should remain gloved throughout blood glucose testing. The nurse should drop the blood — not smear it — onto the reagent pad because smearing can cause an inaccurate reading. To help ensure accurate results, the nurse shouldn't start the timer before the blood sample is collected.

A client has flushed skin, bulging eyes, and perspiration, and states he or she has been "irritable" and having palpitations. Which interpretation of these findings might the nurse suspect?

hyperthyroidism Signs and symptoms of hyperthyroidism include nervousness, palpitations, irritability, bulging eyes, heat intolerance, weight loss, and weakness. MI usually involves chest pain, which may radiate to the arms, back, or neck, and shortness of breath. Pancreatitis involves severe abdominal pain and back tenderness. Type 1 diabetes involves polyuria, polydipsia, and weight loss.

A client with diabetes mellitus has just been prescribed insulin. When teaching the client about hypoglycemia, the nurse should mention that this reaction may cause?

nervousness, diaphoresis, and confusion. Signs and symptoms of hypoglycemia include nervousness, diaphoresis, and confusion. Headache, dizziness, irritability, weakness, pallor, seizures, and coma also may occur. Polyuria, polyphagia, polydipsia, and weight loss are classic manifestations of hyperglycemia, not hypoglycemia. Other signs and symptoms of hyperglycemia include fatigue, flushed and dry skin, blurred vision, and mental status changes.

When a nurse attempts to make sure the health care provider obtained informed consent for a thyroidectomy, the nurse realizes the client doesn't fully understand the surgery. The nurse approaches the physician, who curtly says, "I've told this client all about it. Just get the consent." The nurse should

tell the health care provider the client isn't comfortable consenting to surgery at this point. The nurse has evaluated the client's knowledge concerning the surgery and determined that the client doesn't have enough information to give informed consent. Even though the health care provider might want to move ahead, the nurse should advocate for the client by telling the health care provider the client isn't ready for the surgery. Telling the health care provider that the client hasn't been given enough information would be rude. The nurse shouldn't ask the charge nurse to talk with the health care provider unless the health care provider refuses to accept the nurse's professional opinion. Explaining surgery for the purpose of obtaining consent is beyond the nurse's scope of practice.

A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan?

Exercise and a weight reduction diet Type 2 diabetes is often obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.

A child is diagnosed with diabetes insipidus has developed a viral illness including congestion, nausea, and vomiting. What instructions should the nurse reinforce?

Obtain an alternate route for desmopressin acetate administration. For a child with diabetes insipidus who has a viral illness, an alternate route for administration of desmopressin acetate would be needed for absorption due to nasal congestion. The other actions need to be ordered by a health care provider.

The nurse is assigned to care for the following clients. Which client should the nurse see first?

a client diagnosed with hypothyroidism and a heart rate of 48 beats per minute. A heart rate of 48 beats per minute may have significant implications for cardiac output and hemodynamic stability. Clients with Graves disease usually have a rapid heart rate, but 94 beats per minute is a normal finding. The diabetic client may need sliding-scale coverage, which is not urgent. Clients with Cushing disease frequently have dependent edema.

When collecting data on a child for possible diabetes insipidus, a nurse should recognize which condition as a sign of this disorder?

dehydration polyuria excessive thirst relieved by water The cardinal signs of diabetes insipidus are polyuria and polydipsia. Dehydration occurs as a result of the excessive urine output. Hypernatremia, not hyponatremia, occurs with diabetes insipidus. Jaundice occurs because of abnormal bilirubin metabolism, not diabetes insipidus. Hyperchloremia, not hypochloremia, occurs with diabetes insipidus.

The nurse is caring for a client with type I diabetes who does not adhere to an insulin regimen regularly. The nurse identifies that the client is at risk for which complication?

diabetic ketoacidosis. A client with type I diabetes who fails to regularly take his insulin is at risk for hyperglycemia, which could lead to diabetic ketoacidosis. Hypoglycemia wouldn't occur because the lack of insulin would lead to increased levels of sugar in the blood. A client with chronic pancreatitis may develop diabetes (secondary to the pancreatitis), but insulin-dependent diabetes doesn't lead to pancreatitis. Respiratory failure isn't related to insulin levels.

The nurse is caring for a client with suspected parathyroid dysfunction. Which laboratory results support a diagnosis of primary hyperparathyroidism?

high parathyroid hormone and high calcium levels. A diagnosis of primary hyperparathyroidism is established based on increased serum calcium levels and elevated parathyroid hormone levels. Potassium, magnesium, TSH, and thyroid hormone levels aren't used to diagnose hyperparathyroidism.

A nurse reviews the laboratory data of a client. The data reveals increased blood and urine levels of triiodothyronine (T3) and thyroxine (T4). The nurse determines these values are associated with which condition?

hyperthyroidism Hyperthyroidism causes high levels of T3 and T4. A definitive diagnosis of Addison's disease must reflect low levels of adrenocortical hormones. Cushing syndrome manifests as excessive amounts of adrenocortical hormones. Lower pituitary hormone secretion levels are consistent with hypopituitarism.

A client has flushed skin, bulging eyes, and perspiration, and states he or she has been "irritable" and having palpitations. Which interpretation of these findings might the nurse suspect?

hyperthyroidism. Signs and symptoms of hyperthyroidism include nervousness, palpitations, irritability, bulging eyes, heat intolerance, weight loss, and weakness. MI usually involves chest pain, which may radiate to the arms, back, or neck, and shortness of breath. Pancreatitis involves severe abdominal pain and back tenderness. Type 1 diabetes involves polyuria, polydipsia, and weight loss.

A client's blood sugar level is 185 mg/dL. Two hours have passed since the client ate breakfast. Which test should the nurse review that would yield the most conclusive diagnostic information about the client's glucose utilization?

serum glycosylated hemoglobin (HbA1c) HbA1c is the most reliable indicator of glucose utilization because it reflects blood sugar levels for the prior 3 months. Although a fasting blood sugar and 6-hour glucose tolerance test yield information about a client's utilization of glucose, the results are influenced by other factors, such as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose utilization but is limited in its diagnostic significance.

A client with alcoholism is hospitalized with cirrhosis of the liver. The nurse notes hand tremors, irritability, and anxiety developing 24 hours after admission. What complication does the nurse suspect the client is developing?

acute alcohol withdrawal. Early signs of alcohol withdrawal include hand tremors, irritability, anxiety, nausea, and slight sweating. Later signs include hypertension, hallucinations, seizures, vomiting, tachycardia, and marked confusion. Portal hypertension and esophageal varices are complications of cirrhosis but do not present with these symptoms. Panic disorder is less likely than acute alcohol withdrawal considering the client's medical history.

A nurse is caring for a postoperative thyroidectomy client at risk for hypocalcemia. What intervention should the nurse implement in this client's care?

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system caused by hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess

Trousseau's sign. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

The nurse is caring for a client diagnosed with hyperthyroidism. Which nursing intervention should be the priority to decrease the client's anxiety?

providing a calm, restful environment. Clients with hyperthyroidism are typically anxious, diaphoretic, nervous, and fatigued; they need a calm, restful environment in which to relax and get adequate rest. Clients with hyperthyroidism are usually warm and need a cool environment. Activity shouldn't be increased. If a client is exhibiting dyspnea, he would benefit from high Fowler's position.

A client with diabetes insipidus has had limited fluid intake over the past 12 hours. For which complications should the nurse monitor the client?

severe dehydration and hypernatremia. A client with diabetes insipidus has high volumes of urine, even without fluid replacement. Therefore, limiting fluid intake will cause severe dehydration and hypernatremia. A client undergoing a fluid deprivation test may experience tachycardia and hypotension. A client with diabetes insipidus will usually experience weight loss, and the urine won't contain glucose. Diabetes insipidus has no effect on blood glucose; therefore, the client wouldn't suffer from hyperglycemia. Peripheral edema isn't a symptom of diabetes insipidus.

A client is admitted with Graves' disease. Which laboratory test should the nurse expect to be ordered?

thyroid panel Graves' disease is also known as hyperthyroidism. The nurse should expect a thyroid panel to be ordered.

A client has received dietary instructions as part of the treatment plan for diabetes type 1. Which statement by the client should alert the nurse that the client needs additional instructions?

"I can eat whatever I want as long as I cover the calories with sufficient insulin." Diabetes mellitus is a chronic condition associated with abnormally high glucose in the blood. The goal of dietary therapy in diabetes mellitus is to attain and maintain ideal body weight. Each client is prescribed a specific caloric intake and insulin regimen to help accomplish this goal. The other statements are correct.

The nurse is caring for a client who developed ketoacidosis. Which prescribed treatment does the nurse anticipate administering?

insulin and IV fluids. An IV bolus of insulin is given initially to control the hyperglycemia, followed by a continuous infusion, titrated to control blood glucose. After the client is stabilized, subcutaneous insulin is given. Insulin is never given IM.

The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Antidiuretic hormone (ADH) Clients with diabetes insipidus lack the hormone ADH. The client's TSH, FSH, and LH levels aren't affected.

The nurse educator is preparing a lecture on hypoparathyroidism. He includes the pathophysiology of the parathyroid. The nurse explains to the audience that for the parathyroid hormone to exert its effect, what must be present?

Adequate vitamin D level Adequate vitamin D must be present for parathyroid hormone to exert its effect — that is to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

The nurse is collecting data from an older adult client being screened for hypothyroidism. Which statement by the nurse demonstrates understanding the effects of aging?

"Hypothyroidism can be difficult to diagnose in older adults because symptoms may resemble normal aging." Hypothyroidism is more difficult to diagnose in the aging population because many of the symptoms closely resemble normal aging and other chronic diseases. Dosages of thyroid replacement drugs are lower in older adults. Therapy is initiated more slowly, and doses are increased with caution. Older adults have an increased risk of adverse reactions associated with cardiac function.

The nurse and a client have just discussed the client's recent diagnosis of hypothyroidism and its causes and effects. Which statement indicates that the client needs further instruction?

"I just eat too much. That's why I'm depressed and overweight." Hypothyroidism causes inadequate secretion of thyroid hormones, which slows all metabolic processes and can cause depression and weight gain. Hypothyroidism can also cause clumsiness, constipation, and a feeling of coldness. A client with hypothyroidism requires further instruction about the effects of the disease if the client insists that overeating has caused obesity and depression or claims that being hot or predisposed to diarrhea is caused by the disease.

Which statement made by a parent of a child with short stature would indicate to the nurse the need for further education?

"Obtaining blood studies won't aid in proper diagnosis." A complete diagnostic evaluation should include a family history, a history of the child's growth patterns and previous health status, physical examination, physical evaluation, radiographic survey, and endocrine studies that may involve blood samples.

The nurse is collecting data on a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine. During the physical assessment, the nurse is most likely to detect which vital sign or symptom?

Blood pressure of 176/88 mm Hg. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other findings.

During a physical assessment, the nurses notices the client has a Chvostek's sign when she tapped over the client's facial nerve. The nurse reviews the client's laboratory vales and expects to find which electrolyte imbalance?

Hypocalcemia. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, the client has hypocalcemia. Signs of hyponatremia are weight loss, abdominal cramping, muscle weakness, headache, and orthostatic hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.

The nurse is explaining the action of insulin to a client newly diagnosed with diabetes mellitus. During the teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the

beta cells of the pancreas. The beta cells of the pancreas secrete insulin. The adenohypophysis or anterior pituitary gland secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.

The nurse is reinforcing education with parents of a child with growth hormone deficiency. What sport should the nurse encourage?

gymnastics Children with growth hormone deficiency can be just as active as other children if directed to size-appropriate sports, such as gymnastics, swimming, wrestling, or soccer.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dL (44.40 mmol/L). Which solution is most appropriate when initiating therapy?

100 units of regular insulin in normal saline solution Only short-acting regular insulin is used in continuous insulin infusions for a child with diabetic ketoacidosis. Insulin is added to normal saline solution and administered until blood glucose levels fall. Further along in therapy, a dextrose solution is administered to prevent hypoglycemia.

An older adult client who has recently been diagnosed with hypothyroidism lives independently in an apartment in a community development designed for older adults. The client asks the nurse assigned to the complex for advice about managing this condition. What is the best response by the nurse?

"Increase fiber and fluids in your diet." Clients with hypothyroidism typically experience constipation. A diet high in fiber and fluids can help prevent this condition. Taking aspirin is not related to hypothyroidism management. There is no need to discontinue all group activities, although the client may need to limit them until the condition improves. Clients with hypothyroidism have an intolerance to cold and need an environment that is warmer than average.

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse would be most accurate in stating?

"It tells us about your sugar control for the last 3 months." The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse doesn't have enough information to conclude that the finding is the result of poor dietary management or inadequate insulin coverage.

A client's glucose level is 365 mg/dL. The health care provider orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/mL. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place?

0.1 Taking the initiative to gain new information relevant to client care as well as expressing a desire to support the unit's needs is an appropriate and professional nursing response. Refusing the assignment is inappropriate because the nurse isn't taking any initiative to learn about the pump. Refusing to care for the client until the nurse receives training is inappropriate; the nurse should gather information and evaluate the client before refusing to provide care. Accepting the assignment doesn't address the issue of lack of knowledge and may put the nurse or the client in jeopardy.

A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and her eyes feeling "gritty." Thyroid function tests reveal the following: a thyroid-stimulating hormone (TSH) level of 0.02 units/ml, a thyroxine level of 20 g/dl, and a triiodothyronine level of 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these findings, the nurse would suspect:

Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-age females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (‰¤ 2%). A multinodular goiter will show an uptake in the high-normal range (3% to 10%).

The nurse is caring for a postpartum client with Hashimoto's thyroiditis. While reinforcing education with the client, the nurse identifies which of the following as the cause of the condition?

a malfunction of the immune system in which antibodies attack the thyroid gland Hashimoto's thyroiditis is the most common form of thyroiditis. It is believed to be an autoimmune disorder that develops in response to some stressor. Lack of iodine in the diet and overproduction of FSH are not causes. Hashimoto's thyroiditis is a noninfective form of thyroiditis.