Endocrine system HESI EXIT
A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated?
Hypotension
A nurse is providing postoperative care for a client one hour after the client had an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication?
Hypotension
An obese client must self-administer insulin at home. The nurse should teach the client to use what technique?
Spread the tissue and inject at a 90-degree angle
A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply.
Polyuria Polydipsia
A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery?
Potassium iodide (SSKI
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?
Presence of infection
A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response?
Less thyroid tissue is available to supply thyroid hormone after surgery.
In addition to clients who are receiving insulin for type 1 diabetes, the nurse should assess for signs and symptoms of hypoglycemia in clients who are diagnosed with:
Liver disease
During the progressive stage of shock, anaerobic metabolism occurs. For which complication should the nurse assess the client?
Metabolic acidosis
A client with hyperthyroidism is being treated with propylthiouracil (PTU). What instruction should the nurse plan to include in the teaching plan regarding this drug? Select all that apply.
"Avoid abrupt discontinuation of the medication." Monitor your weight, pulse, and mood routinely." "Report side effects, such as sore throat, fever, joint pain, or oral lesions."
A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply.
1. Obese trunk 2. Sleep disturbance 3. Thin arms and legs
The nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these, if found, are signs of Cushing disease? Select all that apply
1. Round face 2. Dependent edema in the feet and ankles 3. Thin, translucent skin with bruising 4. Increased fatty deposition in the neck and back
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. 2. Elevate the head of the bed 45 degrees. 3. Tape eyelids shut at night if they do not close.
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.
1. Weight gain 2. Hyponatremia
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?
Collaborate with the health care provider to alter the insulin prescription.
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:
Complications are not present at the time of diagnosis.
A client with a head injury has been receiving dexamethasone (Decadron). The health care provider plans to reduce the dosage gradually and to continue a lower maintenance dosage. Which effect associated with the gradual dosage reduction of the drug should the nurse explain to the client?
Promotes return of cortisone production by the adrenal glands
Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis?
Receives long-term steroid therapy
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?
Reduced insulin production
A health care provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client?
Restoration of electrolyte balance
A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide:
Stimulates the pancreas to produce insulin
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?
Stress response
A client is scheduled for a computed tomography (CT) of the brain with contrast. Upon review of the client's medical record, what significant finding should the nurse report to the health care provider before the diagnostic procedure? The client:
Takes metformin (Glucophage) daily.
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?
"You must feel very sick and frightened."
The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is:
Arranging for sufficient rest periods
A client with human immunodeficiency virus (HIV)-associated Pneumocystis jiroveci pneumonia is to receive pentamidine isethionate (Pentam 300) intravenously (IV) once daily. The nurse should monitor the client for the side effect of:
Hypoglycemia
At 4:30 PM, a client who is receiving human insulin (Humulin N) every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing?
Hypoglycemia
A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will:
Break in my new shoes over the course of several weeks."
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?
Ensuring a large fluid intake
A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus?
Glucocorticoids accelerate the process of gluco-neogenesis.
A client is admitted to the hospital with a potential diagnosis of excess antidiuretic hormone. For which clinical indicator should the nurse monitor this client?
Hyponatremia
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client?
Intravenous (IV) fluids
The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?
Observe for signs of infection
A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include:
Parenteral steroids
What should a nurse do immediately when a client returns from the postanesthesia care unit following a subtotal thyroidectomy?
Place a tracheostomy set at the bedside
Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply.
Tachycardia Exophthalmos
While hospitalized, a client with diabetes is observed picking at calluses on the feet. The nurse should immediately:
Teach the client the importance of effective foot care
A client with type 2 diabetes is admitted to the ambulatory surgery unit for elective cataract surgery. Before surgery the client asks the nurse, "How will my diabetes be managed while I am here?" The best response by the nurse is:
I'm not quite certain I understand what you are asking."
The nurse is providing care to a client who is being treated for bacterial cystitis. Before discharge, it is most important for the client to:
Achieve relief of symptoms and to maintain kidney function
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?
C
A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?
Administer intravenous (IV) steroids.
A client with diabetes experiences tremors, pallor, and diaphoresis. What should the nurse consider is a possible cause of these clinical manifestations?
Aerobic exercise
During the early postoperative period after a subtotal thyroidectomy, the nursing priority is to assess for:
Airway obstruction
A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure?
Avoid holding an infant.
The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. The nurse concludes that the teaching is understood when the client states, "I should:
Avoid using a sleeping mask at night."
A urine specimen is needed to test for the presence of ketones in a client who is diabetic. What should the nurse do when collecting this specimen from a urinary retention catheter?
Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine
The nurse is caring for a client newly diagnosed with diabetes. The nurse should teach the newly diabetic client that which hypoglycemic symptom is one of the most common?
Confusion
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:
Dosage can be adjusted to changing needs during recovery from surgery.
A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?
Drugs to increase the blood pressure
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.
Tremors Heat intolerance
A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3) and thyroxine (T4)? Select all that apply.
Weight gain Cold intolerance
When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:
Weight loss
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?
speaking
A client is taking an antithyroid medication for hyperthyroidism. The nurse provides education about serious health problems that may develop if the medication is not effective and tachycardia continues. The nurse instructs the client to seek medical attention immediately if any of the problems occur. Which should be included in the teaching? Select all that apply.
1. Weight gain 2. Pedal edema
A client on prolonged cortisone therapy for adrenal insufficiency is being discharged. Which side effects should the nurse teach the client and family to expect? Select all that apply.
1. weakness 2. moon face 3. weight gain
A client with Addisonian crisis exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies. Which responses should the nurse expect the client to exhibit? Select all that apply.
1. Hyperkalemia 2. Hyponatremia 3. Postural hypotension
A client with a diagnosis of acquired immunodeficiency syndrome (AIDS) has a protozoal infection and is receiving pentamidine (NebuPent). The nurse should monitor the client for which common side effects? Select all that apply
1. Hypoglycemia 2. Decreased blood pressure
A nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply.
1. Leg ulcers 2. Loss of visual acuity 3. Prolonged capillary refill in the toes 4. Decreased sensation in the lower extremities
A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. The nurse concludes that this medication is given to:
Decrease the size and vascularity of the thyroid gland
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 2. Constipation 3. Periorbital edema 4. Decreased appetite
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 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 2. Dry mucous membranes 3. Decreased urine specific gravity
A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective? Select all that apply.
1. Fatigue 2. Weakness 3. Nervousness 4. Increased perspiration
A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply.
1. Hirsutism 2. Round face 3. Buffalo hump
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 nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? Select all that apply.
1. Palpitations Diaphoresis Slurred speech
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:
As long as medication is continued, ovulation will occur
What expected effect of increased serum cortisone levels does a nurse consider when caring for clients with multiple physical and emotional problems?
Decreased pituitary secretion of adrenocorticotropin hormone (ACTH)
A client who is feeling increasingly tired seeks medical care. Type 1 diabetes is diagnosed. The nurse explains that the increased fatigue is the result of:
Decreased production of insulin by the pancreas
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:
Dry hair and an intolerance to cold."
A nurse is assessing a client with a diagnosis of hypothyroidism. Which clinical manifestations should the nurse expect when assessing this client? Select all that apply.
Dry skin Brittle hair
The nurse is providing care for a client with small-cell carcinoma of the lung that develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply.
Edema Hyponatremia
A client with a brain tumor develops a urine output of 300 mL/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform for this client?
Evaluate urine specific gravity.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply.
Excessive thirst Fruity-scented breath Confusion
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?
Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium.
After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse expects that manifestations of excessive levels of antidiuretic hormone are:
Hyponatremia and decreased urine output
Immediately after a bilateral adrenalectomy a client is receiving corticosteroids that are to be continued after discharge from the hospital. The nurse evaluates a need for further teaching when the client states:
I am glad that I only have to take the medication once a day."
Which statement by a client with type 2 diabetes indicates to the nurse that additional teaching about the diet is needed?
I can eat as much dietetic fruit as I want."
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?
I don't know if you do; let's talk about it."
A client newly diagnosed as having type 1 diabetes is taught to exercise on a regular basis primarily because exercise has been shown to:
Improve the cellular uptake of glucose
A client with type 2 diabetes tells the nurse, "I take guaifenesin (Robitussin) cough syrup when I have a cold." The nurse teaches the client to:
Include the glucose in the cough syrup when calculating daily carbohydrate allowance
When a nurse plans to teach a client with type 1 diabetes about the use of an insulin pump, it is of major importance that the client understand that the:
Pump is an attempt to mimic the way a healthy pancreas works
A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement?
Regulated food intake is basic to control.
The nurse is caring for an older client who is admitted to the hospital with a diagnosis of type 2 diabetes. The nurse recalls that older adults with type 2 diabetes:
Seldom develop ketoacidosis
What is the most important test the nurse should check to determine whether a transplanted kidney is functioning?
Serum creatinine level
A client understands that an increase in vitamin E and beta-carotene is important for healthier skin. The nurse teaches the client that excellent food sources of both of these substances are:
Spinach and mangoes
A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiologic finding should be the nurse's focus when collecting additional data about this client?
Starvation
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?
Supports a better response to stress
A client with hyperthyroidism is treated initially with propylthiouracil (PTU). What should the nurse include when teaching the client about this medication?
Symptoms may not subside until the client has taken the medication for several weeks.
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?
Tetany
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?
Tetany
A client is worried about what to expect after having a pancreatoduodenectomy (Whipple procedure) for cancer of the pancreas. What is most important for the nurse to know when helping this client plan for the future?
The stage and grade of the client's cancer
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.
Thirst Fruity breath odor Excessive urination
nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply.
1. Leg ulcers 2. Loss of visual acuity 3. Prolonged capillary refill in the toes 4. Decreased sensation in the lower extremities
A client with small cell carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH). What signs should the nurse expect to observe? Select all that apply.
1. Oliguria 2. Seizures 3. Vomiting
When assessing a client with Graves disease, the nurse expects to identify:
Weight loss, exophthalmos, and restlessness
A client experiencing thyrotoxic crisis tells the nurse, "I know I'm going to die. I'm very sick." Which is the best response by the nurse?
You must feel very sick and frightened."
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.
1. Headache 2. Diaphoresis
When assessing a client with Grave's disease (hyperthyroidism) the nurse expects to identify a history of:
Diaphoresis
What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? Select all that apply.
Weight loss Tachycardia Restlessness Exophthalmos
Which common initial clinical effects should the nurse expect a client with multiple sclerosis to exhibit? Select all that apply.
1. Nystagmus 2. scanning speech 3. intention tremors
Immediately after a subtotal thyroidectomy the nurse plans to assess a client for unilateral injury of the laryngeal nerve every 30 to 60 minutes by:
Asking the client to say what the current time is
The nurse provides postoperative care to the client following subtotal thyroidectomy by: Select all that apply.
1. Assessing for frequent swallowing 2. Ambulating the client the evening of surgery 3. Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes 4. Ensuring that oxygen, suction equipment, and a tracheosomy tray are at the bedside
A client with the diagnosis of Cushing syndrome has the following laboratory results: Na (sodium) 149 mEq/L; K (potassium) 3.2 mEq/L; Hb (hemoglobin) 17 g/dL; and glucose 90 mg/dL. What should the nurse teach the client? Select all that apply.
1. Avoid foods high in salt. 2. Eat foods high in potassium.
A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion? Select all that apply.
1. Headache 2. Confusion 3. Profuse sweating
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 2. Flushed appearance 3. Short attention span
A client with type 1 diabetes self-administers Novolin N insulin every morning at 8 AM. The nurse evaluates that the client understands the action of the insulin when the client says, "I should be alert for signs of hypoglycemia between:
2 PM and 8 PM."
The parents of a young man suspected of having Cushing syndrome expresses anxiety about their son's condition. What should the nurse tell the parents to help them better understand the illness?
He may have mood swings or depression as a result of his illness.
A client with a small nodule of the thyroid gland is to have a subtotal thyroidectomy. The client asks the nurse for clarification about what this surgery involves. What information should the nurse include in a response to the question?
A small part of the gland is left intact.
Because of multiple physical injuries and emotional concerns, a hospitalized client is at high risk to develop a stress ulcer (Curling's). The nurse recalls that stress ulcers usually are evidenced by:
A sudden massive hemorrhage
A client with an aldosterone-secreting adenoma is scheduled for surgery to remove the tumor. The client asks what will happen if surgery is canceled. The nurse bases a response on the fact that:
Heart and kidney damage may occur if the tumor is not removed
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.
can improve A1c levels Clients can exercise without eating more carbohydrates
A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. Which should the nurse expect the health care provider to prescribe?
Acetylcysteine (Acetadote) before the test
A client with type 1 diabetes of long duration takes Novolin 70/30 (combination of Novolin N 70% and Novolin R 30%) every morning. At 11:30 AM, before eating lunch, the client is admitted to the emergency department with an acute myocardial infarction. At 1:30 PM, the client's serum glucose level drops to 30 mg/dL, and insulin coma is diagnosed. The nurse concludes that the reason for the development of acute hypoglycemia is that:
Because the client is taking insulin shots rather then an oral antidiabetic, the client's glucose level dropped more quickly
A nurse is reviewing the diagnostic blood tests of a client with a diagnosis of type 1 diabetes. Which laboratory results support the nurse's suspicion that the client is experiencing ketoacidosis?
Blood glucose of 300 mg/100 mL, blood pH of 7.20
The nurse expects the diagnostic studies of a client with Cushing syndrome to indicate:
High levels of 17-ketosteroids in a 24-hour urine test
An 11 year-old girl is admitted with enlarged supraclavicular lymph nodes, fatigue, and low-grade fever. She also has a persistent nonproductive cough. In light of these findings, the nurse knows to gear education toward preparation for:
Computed tomography and lymph node biopsy
A client who is to begin continuous ambulatory peritoneal dialysis asks the nurse what this entails. What information should the nurse include when answering the client's question?
Constant contact is maintained between the dialysate and the peritoneal membrane.
A nurse is caring for a client with a history of hyperthyroidism who now is experiencing thyroid crisis (thyroid storm). What does the nurse consider to be the most likely precipitating factor in the client's current health problem?
High levels of the hormone triiodothyronine
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?
Increased blood urea nitrogen levels
A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client?
Kussmaul respirations
The nurse is caring for a client with diabetes mellitus that is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. The only type of insulin that is compatible with intravenous solutions is:
Novolin R insulin
A 40-year-old male is prescribed Metformin XL (Glucophage) to control his type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? will stop taking Metformin for 24 hours before and after having a test involving dye." 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.
Examining the feet daily Wearing well-fitting shoes Performing regular exercise
After treatment with propylthiouracil for hyperthyroidism, a client has the thyroid ablated with 131I. On a visit to the endocrine clinic, the client exhibits signs and symptoms of thyrotoxic crisis (thyroid storm). The nurse recalls that what is often associated with thyrotoxic crisis?
Excessive hormone replacement
A client is diagnosed with hyperthyroidism and is treated with 131I. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms should be included in the teaching? Select all that apply.
Fatigue Dry skin Progressive weight gain
What change in blood pressure (BP) should the nurse anticipate after a client has an aldosteronoma surgically removed?
Gradually return to expected levels for an adult.
Late in the postoperative period after resection of an aldosterone-secreting adenoma, the nurse expects the client's blood pressure to:
Gradually return to near normal levels
A client suspected of having a hyperactive thyroid is scheduled for protein-bound iodine, T3, and T4 laboratory tests. To ensure accuracy of the test, the nurse asks if the client has:
Had recent x-rays using radiopaque dye
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?
Observe for signs of tetany.
A client with history of multiple chronic illnesses comes to the emergency department (ED) complaining of a small progressive weight loss over the last month and feeling lethargic and thirsty all the time. The client's vital signs are blood pressure (BP) 118/78 mm Hg, oral temperature 99.6º F, pulse 72 beats per minute and regular, and respirations 22 breaths per minute and irregular. The nurse reviews the assessment findings and the client's medical record. What condition does the nurse conclude the client is experiencing?
Hyperglycemia
A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?
Hypernatremia
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?
Hyperplasia of the adrenal cortex
The nurse is performing an assessment and notes that the client has exophthalmos and complains of double vision. These assessment findings are found with which condition?
Hyperthyroidism
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?
Hypoglycemia and hypotension
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.
Increased heart rate Increased temperature
A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia, and 15 g of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia?
Increases blood glucose levels
A client with diabetes asks how exercise will affect insulin and dietary needs. The nurse should respond, "Exercise:
Increases the need for carbohydrates and decreases the need for insulin."
Six hours after initiation of total parenteral nutrition, the client's serum glucose level increases to 240 mg/dL. What does the nurse conclude is the most likely cause of the increase?
Infusion is flowing too rapidly.
A client is diagnosed as having type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. The nurse should include in the teaching plan that people taking oral hypoglycemics:
May subconsciously relax dietary rules to gain a sense of control
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?
Measure the blood glucose level between 2 AM and 4 AM.
The nurse is caring for a client with diabetes. Which task can be delegated to the unlicensed assistant personnel (UAP)?
Obtain a blood glucose by finger stick
A nurse administers the prescribed regular insulin (Novolin R) to a client in diabetic ketoacidosis. In addition, the nurse anticipates that the intravenous (IV) solution prescribed will contain potassium to replenish potassium ions in the extracellular fluid that are being:
Moved into the intracellular fluid compartment because of the generalized anabolism induced by insulin and glucose.
A client is admitted to the hospital with a diagnosis of Cushing syndrome. When performing an assessment, the nurse should take into consideration that the client will most likely exhibit signs of:
Muscle weakness and frequent urination
A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is:
Neovascularization of the retina
A nurse is caring for a client with myxedema who has undergone abdominal surgery. What should the nurse consider when administering opioids to this client?
One-third to one-half the usual dose should be prescribed.
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L. When monitoring the ECG tracing, the nurse expects to observe:
Peaked T waves and widened QRS complexes
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 hematologic studies?
Phosphorus
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 will:
Remain elevated
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:
Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone
A client has a thyroidectomy for cancer of the thyroid. To evaluate for nerve injury that may be the result of surgery-related trauma, the nurse assesses the client's ability to:
Speak
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?
T3, T4, and thyroid-stimulating hormone (TSH)
A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client?
Thyroxine replacement therapy will be required indefinitely.
The nurse provides care to the client with syndrome of inappropriate antidiuretic hormone (SIADH) by: Select all that apply.
1. Providing frequent oral care 2. Instituting fall risk precautions 3. Monitoring for and reporting neurologic changes
A client with type 1 diabetes self-administers NPH insulin (Novolin N) every morning at 8:00 AM. The nurse concludes that the client understands the action of this insulin when the client says, "I should be alert for signs of hypoglycemia between:
12 PM and 8 PM."
A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for:
fatigue
Preparation of a client for a subtotal thyroidectomy may include the administration of potassium iodide solution. The client refuses to take the medication. What explanation should the nurse give as to why this medication should be taken?
it will reduce the risk of hemorrhage during surgery.
A nurse teaches a client with type 1 diabetes about the treatment of hypoglycemia. If the teaching is effective, which foods does the client identify to manage hypoglycemia?
Cheese sandwich and sugar
A client with type 2 diabetes travels frequently and asks how to plan meals during trips. The nurse's most appropriate response is:
"Choose the foods you normally do and follow your food plan wherever you are."
A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?
"Do not ingest anything before the test."
A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. What should the nurse determine is the most probable cause of these symptoms?
A hypoglycemic reaction
An obese client with type 2 diabetes asks about the intake of alcohol or special "dietetic" food in the diet. The nurse teaches the client that:
Alcohol can be consumed, with its calories counted in the diet
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 30 mg/dL. The healthcare provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should:
Ask the client to ingest one tube of glucose gel
A nurse is assessing a client for possible laryngeal nerve injury following a thyroidectomy. Which action should the nurse implement on an hourly basis?
Ask the client to speak.
A nurse is caring for a client who just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm?
Checking vital signs every two hours after they stabilize
A client is diagnosed with hyperthyroidism and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, the nurse plans to instruct the client to:
Eliminate coffee, tea, and cola from the diet
The nurse is planning discharge instructions for a client who had a thyroidectomy. For which signs of surgically induced hypothyroidism should the nurse alert the client? Select all that apply
Fatigue Correct Incorrect 2 Dry skin
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.
Fatigue Dry skin
A client is admitted to the hospital with diabetic ketoacidosis. The nurse identifies that the elevated ketone level present with this disorder is caused by the incomplete oxidation of:
Fats
A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?
Glucose level
A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?
Hydrocortisone succinate
A client is admitted with a head injury. The nurse identifies that the client's urinary retention catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?
Inadequate antidiuretic hormone (ADH) secretion
A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations?
Increased intracranial pressure
A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure?
Instruct the client to void.
During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" What is the nurse's best response?
Insulin is destroyed by gastric juices, rendering it ineffective."
A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action?
Insulin lispro (Humalog)
An obese client is diagnosed with diabetes. What increased physiological response to excessive weight should the nurse include when explaining the need for weight loss?
Insulin requirements
A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition?
Ketones as a result of rapid fat breakdown, causing acidosis
A nurse is caring for a client after radioactive iodine is administered for Grave's disease. What information about the client's condition after this therapy should the nurse consider when providing care?
Mildly radioactive but should be treated with routine safety precautions
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?
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 antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do?
Monitor blood glucose levels more frequently.
A client's parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery?
Muscle spasms
A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? Select all that apply.
Nervousness Increased appetite
A client with malignant hot nodules of the thyroid gland has a thyroidectomy. Immediately after the thyroidectomy, the nurse's priority action for this client is to:
Place in low-Fowler position to limit edema of the neck
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:
Require larger doses of insulin than I did preoperatively."
A nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify?
Retention of sodium and water
A client is admitted to the hospital for an adrenalectomy. When the nurse teaches the client about the prescribed medications, the nurse emphasizes that:
Salt intake may have to be restricted while taking the medications
A nurse notes that a client's urine has a sweet fruity odor. Which information is most important to evaluate when performing a further client assessment?
Serum glucose level
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:
Skim milk
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:
Sugar and a slice of bread."
A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?
The fingertip is preferred for glucose monitoring if hyperglycemia is suspected."
A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis?
Upper respiratory infection
When assessing the laboratory values of a client with type 2 diabetes, the nurse expects the results to reveal:
Urine negative for ketones and glucose in the blood
Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?
Urine negative for ketones and hyperglycemia
What should the nurse do when collecting a 24-hour urine specimen?
Check to verify if a preservative is needed.
A nurse is monitoring a client's fasting plasma glucose (FPG) level. At which FPG level should the nurse identify that the client has prediabetes?
100 mg/dL
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?
Calcium gluconate
A nurse is collecting information about a client who has type 1 diabetes and who is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? Select all that apply.
1. Excessive emotional stress 2. Running a fever with the flu
A nurse is caring for a client with a tentative diagnosis of pheochromocytoma who is receiving chlorpromazine (Thorazine). A 24-hour urine specimen to assess the presence of vanillylmandelic acid (VMA) is prescribed to assist in the confirmation of the diagnosis. What information should the nurse include in the client teaching regarding this test? Select all that apply.
1. All urine excreted over the 24-hour period must be saved and refrigerated. 2. Avoid coffee, chocolate, and citrus fruit for three days before and during the test.
Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? Select all that apply.
1. Blood in the stool 2. Ringing in the ears
Which physiological responses should a nurse expect when assessing a client with hyperthyroidism? Select all that apply.
1. Blurred vision 2. Increased appetite 3. Widened pulse pressure
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.
1. Cardiac dysrhythmias 2. Hypoactive bowel sounds
Fludrocortisone (Florinef) is prescribed for a client with adrenal insufficiency. Which responses to the medication should the nurse teach the client to report? Select all that apply.
1. Edema 2. Rapid weight gain
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 3. Hyperactive deep tendon reflexes
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 4. Decreased sensation in the feet
The client is admitted to the hospital with a large goiter, and a thyroidectomy is performed. What should the nurse do during the first four hours after the surgery? Select all that apply
1. Monitor for stridor or dyspnea . 2. Assess the sides and back of the client's neck for evidence of bleeding.
A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? Select all that apply.
1. Nausea and vomiting 2. Increased weight 3. Decreased serum sodium 4. Decreased level of consciousness
During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? Select all that apply.
1. Palpitations 2. Tachycardia 3. Menstrual disturbances
The nurse provides care to the client with diabetes insipidus (DI) following head injury by: Select all that apply.
1. Providing adequate fluids within easy reach 2. Assessing for and reporting changes in neurological status 3. Monitoring for constipation, weight loss, hypotension, and tachycardia
A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them.
1. Put air into the intermediate-acting insulin vial. 2. Put air into the short-acting insulin vial. 3. Withdraw the prescribed amount of short-acting insulin. 4. Withdraw the prescribed amount of intermediate-acting insulin. 5. Don a pair of clean gloves.
The nurse is caring for the client post transsphenoidal hypophysectomy. In assessing the client it is noted that the client is exhibiting clear drainage from the nares. The nurse recalls this could indicate:
A cerebral spinal fluid leak from an opening to the brain.
A client states, "I keep my insulin in the refrigerator because that is where my parents kept it." What reason should the nurse include when explaining that insulin should be stored at room temperature?
Absorption is enhanced and local irritation is decreased.
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply.
Acetone breath Decreased arterial carbon dioxide level
The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug:
Interferes with the synthesis of thyroid hormone
After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client?
Tubular reabsorption of water increases
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 2. Buffalo hump 3. 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 with a diagnosis of acquired immunodeficiency syndrome (AIDS) has a protozoal infection and is receiving pentamidine (NebuPent). The nurse should monitor the client for which common side effects? Select all that apply.
1. Hypoglycemia 2. Decreased blood pressure
Increased fatty deposition in the neck and backThe nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these, if found, are signs of Cushing disease? Select all that apply.
1. Round face 2. Dependent edema in the feet and ankles 3. Thin, translucent skin with bruising 4. Increased fatty deposition in the neck and back
A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for:
Hypotension
A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider?
Despite steroid therapy, the ability to cope with stress will be decreased
While assessing a client during a routine examination, a nurse in the clinic identifies signs and symptoms of hyperthyroidism. Which signs are characteristic of hyperthyroidism? Select all that apply.
Diaphoresis Weight loss Protruding eyes
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?
Has followed the treatment plan as prescribed
After a surgical procedure for cancer of the pancreas that included the removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, the postoperative manifestation by the client that requires immediate attention by the nurse is:
Hyperglycemia
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. What should the nurse conclude is causing these clinical findings?
Hypokalemia
A client is diagnosed as having type 2 diabetes. A priority teaching goal is, "The client will be able to:
Identify pending hypoglycemia or hyperglycemia
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?
Insulin-induced hypoglycemia
The nurse is caring for a client with diabetes mellitus. The nurse recalls that the primary fluid shift that occurs with this condition is:
Intracellular to intravascular because of hyperosmolarity
A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply.
Irritability Heart palpitations
A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because it:
Is released slowly
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?
Obesity leads to insulin resistance
After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? Select all that apply.
Polyuria is excessive urination. Polydipsia is excessive thirst Polyphagia is associated with the catabolic state induced by insulin deficiency.
A client with a diagnosis of Graves disease refuses to have radioactive iodine (RAI) therapy, and a subtotal thyroidectomy is performed. What should the nurse do postoperatively to reduce the risk of thyroid storm?
Prevent infection at the surgical site.
Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get the atomic cocktail?" The nurse explains that the medication is being prescribed because it decreases the:
Production of thyroid hormones.
A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations?
Protein anabolism
A client is scheduled to have a thyroidectomy for cancer of the thyroid. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching?
Support the head with the hands when changing position.
A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the health problem, the nurse should:
Tell the client that returning to work is okay because the body has two adrenal glands; the tumor was on just one of the glands.
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:
Test for Chvostek's and Trousseau's signs and notify the health care provider of the complaints
A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. What concern about the client requires the nurse to notify the health care provider?
There is a decreased ability to handle stress despite steroid therapy.
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?
There is no difference between readings."
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:
There may not be enough thyroid tissue to supply adequate thyroid hormone
