Med-surg Endocrine ATI
A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My cells are resistant to the effects of insulin." B. "My body breaks down sugars too efficiently." C. "My pancreas does not produce insulin." D. "My body produces antibodies against pancreatic beta cells."
Correct Answer: A. "My cells are resistant to the effects of insulin." A client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. -Incorrect Answers: B. A client who has type 2 diabetes mellitus does not secrete enough insulin by the pancreatic beta cells to break down sufficient glucose. C. A client who has type 1 diabetes mellitus does not secrete insulin because of the destruction of the beta cells by the body. Although insulin is still produced in this condition, it is not sufficient to maintain homeostasis. D. A client who has type 1 diabetes mellitus has destruction of the beta cells because of the production of blood antibodies. This is not a manifestation of type 2 diabetes mellitus.
A nurse in the emergency department is assessing a client who has pancreatitis. In which of the following laboratory results should the nurse expect to see an elevation? A. Amylase B. Potassium C. Calcium D. Hematocrit
Correct Answer: A. Amylase With pancreatitis, laboratory results typically show elevated amylase within 12 to 24 hours. This level remains elevated for 2 to 3 days. -Incorrect Answers: B. With pancreatitis, potassium is not expected to increase. Alterations in electrolytes include a decrease in magnesium. C. With pancreatitis, hypocalcemia is an expected finding. D. With pancreatitis, hemoglobin and hematocrit are not expected to increase. An increase in WBC count is common, indicating inflammation.
A nurse in the emergency department is caring for a client who has a fruity breath odor, a dry mouth, and extreme thirst. Which of the following assessments should the nurse make? A. Blood glucose level B. Pupillary reaction to light C. Deep tendon reflexes D. Liver function tests
Correct Answer: A. Blood glucose level These findings are indications of hyperglycemia and diabetic ketoacidosis. The nurse should check the client's blood glucose level as well as assess the client's respiratory status, vital signs, level of consciousness, and hydration status, including a laboratory assessment of his electrolyte levels. -Incorrect Answers: B. The nurse should identify the probable cause of the client's manifestations and perform a focused assessment of the affected system; therefore, it is not necessary for the nurse to assess the client's pupillary reaction to light. C. It is not necessary for the nurse to assess the client's deep tendon reflexes. D. It is not necessary for the nurse to assess the client's liver function.
A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis
Correct Answer: A. Bradycardia An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations. -Incorrect Answers: B. Tremors are a manifestation of Graves' disease, the most common type of hyperthyroidism. TSH levels are decreased in Graves' disease. C. A low-grade fever is a manifestation of Graves' disease. D. Diaphoresis and heat intolerance are manifestations of Graves' disease.
A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? A. Calcium B. Sodium C. Potassium D. Phosphorous
Correct Answer: A. Calcium Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bones by maintaining mineral levels. Hyperparathyroidism is associated with hypercalcemia; therefore, a decreased calcium level indicates an improvement in the client's condition. -Incorrect Answers: B. Sodium levels are not regulated by the parathyroid gland but rather through the filtration system of the kidneys. C. Potassium levels are not regulated by the parathyroid gland but rather through the filtration system of the kidneys. D. Hyperparathyroidism is associated with hypophosphatemia; therefore, an increased phosphorous level indicates an improvement in the client's condition.
A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? A. Compensation for decreased cortisol levels B. Inhibition of glucose metabolism C. Diuretic action to maintain urine output D. Decreased susceptibility to infection
Correct Answer: A. Compensation for decreased cortisol levels A client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. The adrenal glands produce several hormones including cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors; if untreated, this can be fatal. -Incorrect Answers: B. A client who has an adrenalectomy has increased blood glucose levels due to the increase in the production of glucocorticoids. Glucocorticoids stimulate gluconeogenesis and are not given to inhibit glucose metabolism. C. A client who has an adrenalectomy has fluid retention from the increased production of glucocorticoids. Glucocorticoids have fluid retention properties and do not act as a diuretic to increase urine output. D. A client who has an adrenalectomy has a higher risk of infection due to the increased production of glucocorticoids. Glucocorticoids have potent anti-inflammatory and immunosuppressive properties and raise the client's susceptibility to infection.
A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? A. Encourage the client to control weight B. Inspect the client's feet once each week C. Restrict the client's activity D. Apply moisturizer between the client's toes
Correct Answer: A. Encourage the client to control weight The nurse should encourage weight control to stabilize the client's blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes. -Incorrect Answers: B. The nurse should inspect the client's feet daily. The client is at risk for foot injury due to impaired circulation and reduced sensation in the lower extremities. C. The nurse should seek to increase physical activity to reduce the client's weight and improve blood glucose control. D. The nurse should not apply moisturizer between the client's toes due to the risk of skin breakdown from excess moisture.
A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose
Correct Answer: A. Glycosylated hemoglobin levels Checking glycosylated hemoglobin levels (HbA1c) is an accurate method of determining if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication. -Incorrect Answers: B. Urine sugar and acetone levels reflect how well-controlled the client has been for the last few hours. C. A glucose tolerance test is used to diagnose diabetes mellitus and commonly identifies type 2 and gestational diabetes. D. A fasting serum glucose provides information about the previous 24 hours.
A nurse is assessing a client who has Addison's disease. Which of the following findings should the nurse expect? A. Hypotension B. Weight gain C. Sugar craving D. Pale skin tone
Correct Answer: A. Hypotension The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone. -Incorrect Answers: B. The nurse should expect weight loss in a client who has Addison's disease. C. The nurse should expect salt craving in a client who has Addison's disease. D. The nurse should expect increased skin pigmentation in a client who has Addison's disease.
A nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Shakiness B. Urinary frequency C. Dry mucous membranes D. Excess thirst
Correct Answer: A. Shakiness A client who has hypoglycemia can experience early manifestations of shakiness, as well as fatigue, a headache, difficulty thinking, sweating, and nausea. -Incorrect Answers: B. A client who has hyperglycemia will have manifestations of increased urination (polyuria). C. A client who has hyperglycemia will have manifestations of dehydration such as dry mucous membranes and sunken eyeballs. D. A client who has hyperglycemia will have manifestations of excessive thirst called polydipsia.
A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? A. Warm the dialysate solution prior to administration B. Cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward C. Place the drainage bag at the level of the client's chest D. Apply clean gloves and cleanse the client's catheter site with cold water
Correct Answer: A. Warm the dialysate solution prior to administration The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping. -Incorrect Answers: B. The nurse should cleanse the catheter site using a circular motion while moving outward. This prevents the nurse from contaminating the area already cleansed. C. The nurse should place the drainage bag below the level of the client's abdomen to enhance gravity of the fluid. D. The nurse should apply sterile gloves and use 3 cotton swabs soaked in povidone-iodine to cleanse the catheter site. This destroys the bacteria around the site and prevents infection.
A nurse is teaching a client who had a vaginal hysterectomy with a bilateral oophorectomy. Which of the following pieces of information should the nurse include in the teaching? A. "Plan to use some type of birth control for up to 6 weeks after surgery." B. "Use a water-based lubricant when having sexual intercourse." C. "Expect to have an increase in bloody vaginal drainage during the first 10 days after surgery." D. "Plan to start some type of aerobic exercise such as swimming within a week after surgery."
Correct Answer: B. "Use a water-based lubricant when having sexual intercourse." Vaginal dryness is a manifestation of menopause after the ovaries are removed. The client may require a water-based lubricant when having sexual intercourse. -Incorrect Answers: A. In some cases, hormone replacement therapy is prescribed by the provider, but birth control is not needed because the reproductive system is removed during the procedure. C. The client should expect a decrease in bloody vaginal drainage and report to the provider if vaginal drainage becomes bloodier, thicker, or foul-smelling. D. The client should begin to ambulate slowly in the immediate postoperative period but avoid any type of strenuous physical activity for 2 to 6 weeks after surgery (e.g. swimming, biking, gardening, dancing, or jogging).
A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? A. "You should exercise during a peak insulin time." B. "Wear a medical alert identification tag when you exercise." C. "Exercise can decrease the effects of insulin and cause your blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."
Correct Answer: B. "Wear a medical alert identification tag when you exercise." The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease. -Incorrect Answers: A. The client should avoid exercising within 1 hour of receiving insulin or at the peak time of insulin. This is because exercise can increase the absorption of insulin at the injection site and cause a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1 hour before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. C. A client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease. D. A client who has poorly controlled insulin-dependent diabetes mellitus should not exercise when blood glucose levels are >250 mg/dL or if ketones are noted in the urine; this is because there is an inadequate amount of insulin for transporting glucose.
A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan
Correct Answer: B. Ask the client to identify the types of foods she prefers The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will promote her adherence to the dietary plan. -Incorrect Answers: A. The nurse should work with a registered dietitian to provide the client with appropriate materials to use during the dietary teaching. Sample menus can give the client ideas of new foods or exchanges; however, there is another action that the nurse should take first. C. The nurse should identify the recommended blood glucose range that the client should maintain through diet, medication, and lifestyle changes; however, there is another action that the nurse should take first. D. The nurse should identify long-term complications so the client understands the importance of adherence to the dietary plan
A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A. Check the client's blood glucose for hypoglycemia B. Check the client's urine specific gravity C. Weigh the client weekly D. Insert an indwelling urinary catheter for the client
Correct Answer: B. Check the client's urine specific gravity The nurse should check the client's urine specific gravity to assess for fluid volume overload. -Incorrect Answers: A. The nurse should check the client for hyperglycemia because hypercortisolism elevates blood glucose levels. C. The nurse should weigh the client at the same time each day because treatment decisions are based on these findings. D. The nurse should have the client save all urine output to record the results every 24 hours. An indwelling urinary catheter needlessly exposes the client to a potential urinary tract infection.
A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria
Correct Answer: B. Diaphoresis A client who has a blood glucose level below 70 mg/dL will exhibit manifestations of hypoglycemia. Expected findings associated with hypoglycemia include weakness, hunger, diaphoresis, nausea, shakiness, and confusion. -Incorrect Answers: A. The nurse should expect Kussmaul respirations in a client who has hyperglycemia. C. The nurse should expect dehydration and decreased skin turgor in a client who has hyperglycemia. D. The nurse should expect ketonuria in a client who has hyperglycemia.
A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide
Correct Answer: B. Hydrocortisone The nurse should identify that a client who has Addison's disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is due to the pituitary's inability to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction of the adrenal gland or pituitary and become life-threatening. Incorrect Answers: A. A client who has Addison's disease and is experiencing an Addisonian crisis does not require an antidiuretic hormone such as desmopressin. Desmopressin acetate (DDAVP) is an analog of antidiuretic hormone (ADH) and the hormone replacement of choice for diabetes insipidus. It acts by reabsorbing water in the kidneys. C. A client who has Addison's disease and is experiencing an Addisonian crisis does not require a vasopressor such as dopamine. Dopamine is an intravenous vasopressor indicated for the treatment of shock that does not respond to IV fluid replacement. It should be given through a central venous catheter to minimize complications related to extravasation, as it can cause tissue necrosis with IV infiltration. D. A client who has Addison's disease and is experiencing an Addisonian crisis does not require a high-ceiling loop diuretic such as furosemide. Clients who have Addison's disease need fluid replacement due to volume loss.
A nurse is conducting a home visit for an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? A. Dementia B. Hypoglycemia C. Infection D. Transient ischemic attack
Correct Answer: B. Hypoglycemia Evidence-based practice indicates the nurse should first check the client for hypoglycemia by drawing a blood glucose level. A client who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near meal time each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations. -Incorrect Answers: A. A client who has manifestations of dementia becomes cognitively impaired and can exhibit varying manifestations throughout each day (e.g. confusion, disorientation, and difficulty with self-expression). However, because the client has diabetes mellitus and takes insulin, evidence-based practice indicates the nurse should consider another condition first. C. An older adult client who has an infection can have manifestations of disorientation, confusion, and a low-grade fever. However, because the client has diabetes mellitus and takes insulin, evidence-based practice indicates the nurse should consider another condition first. Other manifestations of infection include fatigue, malaise, and tachypnea. D. A client who is having transient ischemic attack may present with neurological deficits such as dizziness, loss of vision in an eye, double vision, weakness, and aphasia. However, because the client has diabetes mellitus and takes insulin, evidence-ba
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors
Correct Answer: B. Increased urination Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. -Incorrect Answers: A. Increased hunger is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. C. Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. D. Tremulousness is a manifestation of hypoglycemia due to an adrenergic response to central glucose deprivation.
A nurse is monitoring a client following a thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? A. Elevated blood pressure B. Involuntary muscle spasms C. Cold intolerance D. Weight loss
Correct Answer: B. Involuntary muscle spasms The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency. -Incorrect Answers: A. Hypertension is an indication of thyroid storm, which is a potential complication following a thyroidectomy. C. Cold intolerance is an indication of hypothyroidism. D. Weight loss is an indication of hyperthyroidism.
A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following clients should the nurse include in the screening? A. Men who smoke B. Men and women who are obese C. Women who have hepatitis D. Men and women who consume high-protein and low-carbohydrate foods
Correct Answer: B. Men and women who are obese There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells, which is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance. -Incorrect Answers: A. Smoking can produce cardiovascular and pulmonary complications, but no studies have found that smoking leads to type 2 diabetes mellitus. C. Women who have hepatitis are at risk of developing cirrhosis but not type 2 diabetes mellitus. D. There is no correlation between a high-protein and low-carbohydrate diet and a risk of developing type 2 diabetes mellitus.
A nurse is assessing a client who is recovering from a thyroidectomy and has a harsh, high-pitched respiratory sound. Which of the following actions should the nurse take? A. Hyperextend the client's neck B. Prepare for a tracheostomy C. Lower the head of the bed D. Administer morphine
Correct Answer: B. Prepare for a tracheostomy The nurse should notify the provider immediately and prepare for a tracheostomy. Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms. Incorrect Answers: A. The nurse should not hyperextend the client's neck because this can place tension on the incision and cause bleeding. C. The nurse should elevate the head of the client's bed to promote ventilation. D. The nurse should not administer an analgesic because this can cause respiratory depression.
A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? A. Chlorpropamide B. Tolvaptan C. Vasopressin D. Desmopressin
Correct Answer: B. Tolvaptan SIADH is a disorder of water intoxication due to the inappropriate continuous secretion of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH. -Incorrect Answers: A. Chlorpropamide is an antidiabetic agent with antidiuretic effects that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus, not SIADH. C. Vasopressin is an exogenous form of antidiuretic hormone that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus, not SIADH. D. Desmopressin is a synthetic form of antidiuretic hormone that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus, not SIADH.
A nurse is preparing a 24-hr urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hr urine specimen should the nurse use to determine the client's condition? A. Creatinine clearance B. Vanillylmandelic acid (VMA) C. 17-hydroxycorticosteroids (17-OHCS) D. Protein
Correct Answer: B. Vanillylmandelic acid (VMA) The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate. -Incorrect Answers: A. A 24-hour urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating the glomerular filtration rate of the kidneys. C. A 24-hour urine specimen for 17-OHCS is used to determine if the client is producing an adequate amount of cortisol. An increase of cortisol in the specimen can indicate Cushing's disease. D. A 24-hr urine specimen for protein is used to evaluate the client's renal function.
A nurse is teaching a client who has type 2 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I will apply moisturizer between my toes." B. "I will soak my feet daily." C. "I'll be sure to wear cotton socks every day." D. "I'll use a heating pad to warm my feet."
Correct Answer: C. "I'll be sure to wear cotton socks every day." The nurse should instruct the client to wear clean cotton socks every day to absorb moisture and reduce the risk of infection. -Incorrect Answers: A. The nurse should instruct the client to avoid applying moisturizer between the toes to reduce the risk of skin breakdown due to excess moisture. B. The nurse should instruct the client to avoid soaking the feet because this can cause skin breakdown due to excess moisture. D. The nurse should instruct the client to avoid using a heating pad or hot water bottle on the feet because reduced sensation can lead to burns
A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."
Correct Answer: C. "You don't have to give up pasta; just adjust the amount you eat." The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder. -Incorrect Answers: A. The nurse is capable of counseling clients and providing resources about appropriate dietary choices without consulting the provider. B. Although this idea has some merit, the client is expressing dismay about giving up pasta. Often, there is no substitute for what the client really enjoys. D. While reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta. Additionally, it does not relate to glycemic control, which is a critical issue for this client.
A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? A. Purple striae on the chest and abdomen B. Butterfly rash across the bridge of the nose C. Bronze pigmentation of the skin D. Jaundice of the face and sclera
Correct Answer: C. Bronze pigmentation of the skin A client who has Addison's disease will have a darkening of the skin on both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). -Incorrect Answers: A. A client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen. B. A client who has systemic lupus erythematosus should have a butterfly rash across the bridge of the nose. D. A client who has hepatic, biliary, or gallbladder disease should have jaundice of the face and sclera.
A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia
Correct Answer: C. Difficulty sleeping A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone. -Incorrect Answers: A. A client who has Graves' disease may report diarrhea due to the overproduction of thyroid hormone. B. A client who has Graves' disease can experience heat intolerance due to the overproduction of thyroid hormone. D. A client who has Graves' disease should have an increased appetite and still experience weight loss because of the overproduction of thyroid hormone.
A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone
Correct Answer: C. Hydrocortisone The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. -Incorrect Answers: A. Rifampin is an antiviral medication used to treat tuberculosis. B. Loperamide is an antidiarrheal, but this client is experiencing nausea and vomiting. D. Spironolactone is a potassium-sparing diuretic. A client who has Addison's disease has increased potassium levels, along with low sodium levels as a result of fluid depletion. The nurse should anticipate administering fluids and electrolytes to the client to restore the volume lost.
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? A. Polyuria B. Dehydration C. Hyponatremia D. Hyperthermia
Correct Answer: C. Hyponatremia A client who has SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia. Incorrect Answers: A. A client who has SIADH will retain free water and have decreased urine output with increased urine osmolarity. B. A client who has SIADH will retain free water in the circulatory system, which is due to excess antidiuretic hormone. The client will not have dehydration. D. A client who has SIADH will have hypothermia resulting from a disturbance in the central nervous system.
A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce total hours of sleep B. Keep the immediate environment warm C. Increase caloric intake with meals D. Gradually increase activity
Correct Answer: C. Increase caloric intake with meals Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance. Even with an increased appetite, meeting energy demands is often difficult, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake. -Incorrect Answers: A. Clients who have hyperthyroidism often report an inability to sleep. A decreased attention span and mild to severe hyperactivity are common. The nurse should suggest frequent rest periods in a quiet environment. B. Clients who have hyperthyroidism often have a low-grade fever and diaphoresis due to their hypermetabolic state. A cool environment can decrease the discomfort of heat intolerance. D. Clients who have hyperthyroidism are often restless and have an increased systolic blood pressure, tachycardia, and other dysrhythmias. During the acute phase, increased activity is not an appropriate recommendation.
A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure
Correct Answer: C. Kussmaul respirations The nurse should expect this client with DKA to experience Kussmaul respirations. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA. -Incorrect Answers: A. The nurse should expect ketones to be present in the urine and blood of a client who has DKA due to excessive glucose production. B. Distended neck veins are not an expected finding of DKA. Signs of dehydration (e.g. flattened neck veins, hypotension, dry skin, and sunken eyeballs) are common. D. A client with DKA is more likely to have orthostatic hypotension due to the dehydration caused by the excessive blood glucose and osmotic diuresis.
A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? A. Proteinuria B. Oliguria C. Polyuria D. Glycosuria
Correct Answer: C. Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity. -Incorrect Answers: A. Protein in the urine is a manifestation of kidney disease. B. Oliguria is a manifestation of kidney failure. D. Glucose in the urine is a manifestation of type 1 diabetes mellitus.
A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? A. Sliced bananas B. Baked potato C. Turkey and cheese sandwich D. Plain yogurt with peaches
Correct Answer: C. Turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone. -Incorrect Answers: A. B. D. Bananas, baked potatoes, and plain yogurt with peaches are high in potassium. A client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia.
A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread.
Correct Answer: D. "I should replace white bread with whole-grain bread." Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber. -Incorrect Answers: A. Sweet desserts are not prohibited for clients who have diabetes mellitus. Instead, they should be consumed in moderation and substituted for other carbohydrates in the client's meal plan. B. Sucralose is a non-nutritive sweetener that has been approved by the Food and Drug Administration for this use. It is considered safe for clients who have diabetes mellitus. C. Although clients who have diabetes mellitus can consume alcohol in moderation, the nurse should instruct the client to consume alcohol with food to avoid hypoglycemia.
A nurse is teaching a client about the prostate-specific antigen (PSA) test. Which of the following directions should the nurse provide? A. "You should fast for 8 hours after the PSA test." B. "Annual PSA screening should begin at age 40." C. "Expected PSA values will decrease as you get older." D. "You should not ejaculate for 24 hours prior to the PSA test."
Correct Answer: D. "You should not ejaculate for 24 hours prior to the PSA test." PSA is a glycoprotein manufactured in the prostate that is used to screen for prostate cancer. Ejaculation within 24 hours prior to the test can falsely elevate levels of PSA. -Incorrect Answers: A. Fasting is not required after this procedure. B. The American Cancer Society recommends that all men begin annual PSA testing at the age of 50. Men who have a family history of prostate cancer or men of African descent should discuss with their provider the possible benefits of initiating testing at age 45. C. Expected PSA values increase with age.
A nurse is planning to administer fluids to a client who has 25% total body surface area burns. The client has no prior medical history. Which of the following intravenous fluids is contraindicated for this client? A. Whole blood B. Lactated Ringer's C. Dextran 40 in 0.9% sodium chloride D. 0.45% sodium chloride
Correct Answer: D. 0.45% sodium chloride The nurse should identify that 0.45% sodium chloride is a hypotonic solution and is contraindicated for clients who have burns. Hypotonic fluid has an osmolarity value of <270 mOsm/L, which is less than the expected reference range of the osmolarity value for plasma and body fluid of 285 to 295 mOsm/L. Administering a hypotonic solution to this client can cause third-spacing of fluid. Incorrect Answers: A. The nurse should plan to administer whole blood to the client if the client's hematocrit is <20% to 25%, which can result from hemodilution caused by fluid replacement therapy. B. The nurse should plan to administer lactated Ringer's, which is an isotonic solution used to expand vascular volume. C. The nurse should plan to administer dextran 40 in 0.9% sodium chloride, which is an isotonic colloid solution, to increase the intravascular fluid volume.
A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis? A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7.38 D. Bicarbonate level 12 mEq/L
Correct Answer: D. Bicarbonate level 12 mEq/L A client who has diabetic ketoacidosis should have a bicarbonate level that is <15 mEq/L due to the increased production of counter-regulatory hormones that lead to metabolic acidosis. -Incorrect Answers: A. A client who has diabetic ketoacidosis should have a blood glucose level that is >250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis. B. A client who has diabetic ketoacidosis should have positive urine ketones because of the increased production of counter-regulatory hormones that lead to the production of ketoacids. C. A client who has diabetic ketoacidosis should have a pH level that is <7.3 because of the increased production of counter-regulatory hormones that lead to metabolic acidosis.
A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL
Correct Answer: D. Fasting blood glucose 95 mg/dL A fasting blood glucose of 95 mg/dL is within the expected reference range of 70 to 110 mg/dL, which indicates that this client's diabetes is under control. -Incorrect Answers: A. An HbA1c of 8.5% is above the expected reference of <7% and does not indicate that the client's diabetes is under control. B. A postprandial blood glucose of 190 mg/dL is above the expected reference range of <160 mg/dL and does not indicate that the client's diabetes is under control. C. A casual blood glucose of 205 mg/dL is above the expected reference of <200 mg/dL and does not indicate that the client's diabetes is under control.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. Which of the following actions should the nurse perform? A. Change the tubing every 12 hr B. Check the client's blood glucose every 8 hr C. Apply a new dressing to the IV site every 76 hr D. Weigh the client daily
Correct Answer: D. Weigh the client daily The nurse should weigh the client who is receiving TPN daily due to the risk of fluid and electrolyte imbalances. -Incorrect Answers: A. The nurse should change the TPN tubing every 24 hours to prevent bacteria from developing in the tubing. B. The nurse should check the client's blood glucose every 4 hours while the client is receiving TPN. Hyperglycemia is an adverse effect of TPN. C. The nurse should apply a new dressing to the client's IV site every 24 to 72 hours. The nurse should observe the site at this time for redness, irritation, or indications of infection.
A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? A. Calcium B. Potassium C. Iodine D. Hydrocortisone
Correct Answer: D. Hydrocortisone Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium levels fall, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high-dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency. Incorrect Answers: A. IV calcium corrects hypoparathyroidism, not acute adrenal insufficiency. B. Acute adrenal insufficiency causes hyperkalemia, which requires a potassium binding and excreting resin to treat, not additional potassium. C. Iodine-containing agents treat thyrotoxicosis, not acute adrenal insufficiency.
A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? A. Constipation B. Headache C. Bradycardia D. Hypertension
Correct Answer: D. Hypertension A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone. -Incorrect Answers: A. A client who is experiencing a thyroid storm will have diarrhea, abdominal pain, nausea, and vomiting in response to the overproduction of thyroid hormone. B. A client who is experiencing a thyroid storm will have restlessness, confusion, and possible seizures in response to the overproduction of thyroid hormone. C. A client who is experiencing a thyroid storm will have tachycardia in response to the overproduction of thyroid hormone.
A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? A. Thinning of skeletal bone structure B. Concave chest wall C. High-pitched voice D. Increased head size
Correct Answer: D. Increased head size A client who has acromegaly will present with an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull. -Incorrect Answers: A. A client who has acromegaly will have skeletal thickening due to the increased growth hormones secreted by the pituitary gland. B. A client who has acromegaly will have a barrel-shaped chest due to the increased growth hormones that enlarge the skeletal system. C. A client who has acromegaly will have vocal deepening due to hypertrophy of the vocal cords from the increased growth hormones secreted by the pituitary gland.
A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the evening intermediate-acting insulin dose to 90 min before dinner B. Increase the client's morning caloric intake C. Omit the client's evening snack D. Monitor the client's nighttime blood glucose levels
Correct Answer: D. Monitor the client's nighttime blood glucose levels The Somogyi effect describes a high blood glucose level in the morning after an extremely low blood glucose level during the night. This swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect. -Incorrect Answers: A. The nurse should plan to administer a smaller dose of intermediate-acting insulin at bedtime or increase the client's bedtime snacks to avoid conditions that can lead to the Somogyi effect. B. The nurse should evaluate the client's evening caloric intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to the Somogyi effect. C. The nurse should ensure the client receives a bedtime snack to decrease the chance of hypoglycemia during the night.
A nurse is caring for a client who has urolithiasis and requires further diagnostic testing after an initial test indicated hypercalcemia. Which of the following structures controls calcium concentration? A. Pancreas B. Thyroid gland C. Anterior pituitary gland D. Parathyroid gland
Correct Answer: D. Parathyroid gland The parathyroid gland secretes parathyroid hormones, which are substances that help the kidneys reabsorb calcium and increase calcium absorption from the gastrointestinal tract. -Incorrect Answers: A. The pancreas is the organ that controls the release of insulin. B. The thyroid gland controls the concentration of thyroid hormones, which are substances that regulate the body's metabolism. C. The anterior pituitary gland is responsible for the secretion of growth hormone.
A nurse is accepting a transfer from the postanesthesia care unit (PACU) of a client who has had a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the bedside for this client? A. Cardiac monitor B. Defibrillator C. Thoracotomy tray D. Tracheostomy tray
Correct Answer: D. Tracheostomy tray Because of the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client. -Incorrect Answers: A. Unless the client has a pre-existing cardiac dysrhythmia or is at risk for dysrhythmias, cardiac monitoring is not essential after a thyroidectomy. B. A defibrillator should be available on every nursing unit. However, unless the client has a history of cardiopulmonary arrest or is a particular risk for this condition, having a defibrillator nearby is not essential following a thyroidectomy. C. Unless the client has a history of pneumothorax or is at risk for pneumothorax, a thoracotomy is not essential following a thyroidectomy.
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign
Correct Answers: A. Tachycardia and hypertension D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxicity (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired. -Incorrect Answers: B. A respiratory rate of 16/min is within the expected reference range. C. A positive Chvostek's sign (facial muscle spasm after tapping the facial nerve in front of the ear) indicates hypocalcemia, a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.
A nurse is updating the plan of care for a client who is to receive total parenteral nutrition (TPN). Which of the following actions should the nurse include in the plan? (Select all that apply.) A. Weigh the client daily B. Obtain a serum blood glucose every 4 hr C. Apply a new dressing to the client's IV site every 5 days D. Change the IV tubing every 24 hr E. Infuse the TPN through a peripheral IV site
Correct Answers: A. Weigh the client daily B. Obtain a serum blood glucose every 4 hr D. Change the IV tubing every 24 hr The nurse should weigh the client daily while receiving TPN. Clients who are receiving TPN are typically malnourished; therefore, the client's weight needs to be monitored closely. Fluid retention can also be an indication that the client is not digesting the TPN, and the rate of the transfusion might need to be decreased. The nurse should also obtain the client's serum blood glucose; insulin can be given if needed. Finally, the nurse should change the client's IV tubing every 24 hours to prevent bacteria from developing in the client's tubing. -Incorrect Answers: C. The nurse should apply a new dressing to the client's IV site every 48 to 72 hours as per facility protocol to maintain the IV site and inspect the client's skin for irritation and infection. E. The nurse should infuse the TPN through the client's central line. Partial parenteral nutrition can be given through a peripheral line.
