Medsurge2 week 1
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output
The most common type of goiter is caused by lack of which of the following?
Iodine
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis?
Glucagon
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?
Hypokalemia and hypoglycemia
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
A nurse caring for a hospitalized patient with hypoparathyroidism reviews his electrocardiogram (ECG) strip and completes a cardiac assessment. The nurse recognizes the diagnostic sign of:
Prolonged QT interval.
The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse?
"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?
"I may stop taking this medication when I feel better."
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?
"Maintain a moderate exercise program."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
"Test your blood glucose every 4 hours."
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice?
"You should take your insulin after you eat breakfast and dinner."
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
The nurse is aware that the best time of day for the total large corticosteroid dose is between:
7:00 AM and 8:00 AM
Which of the following diagnostic tests are done to determine suspected pituitary tumor? Choose the correct option.
A computed tomography scan
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient?
Calcium
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering?
Calcium gluconate
Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?
Can control blood glucose through diet and exercise
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following?
Cretinism
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP)
Which of the following would be considered a "free" item from the exchange list?
Diet soda
When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following?
Inadequate secretion of parathormone
A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition?
Ketoacidosis
A patient who is diagnosed with type 1 diabetes would be expected to:
Need exogenous insulin.
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?
Rapid, thready pulse
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?
Serum potassium level of 5.8 mEq/L
A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient?
Signs of hypoglycemia
Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus?
The patient has not consumed food and continues to take insulin or oral antidiabetic medications.
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands?
The secretions are released directly into the blood stream.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland?
Thyroxine
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
hyperglycemic female weighs 210 lb 95kg, husband sleeps in another room, snores keep him a wake large hands horse voice
acromegaly *
elevated glycosylated hemoglobin
checks sugar control for last 3 months *
while assessing a client with hypoparathyroidism, the nurse taps the client facial nerve and observes
chvosteks sign*
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
deposits of adipose tissue in the trunk and dorsocervical area.
which of the following would a nurse expect to find in a client with severe hyperthyroidism?
exothalmos *
The nurse is educating a couple who has had difficulty with conception. The client asks about the hormone, which is responsible for the production of eggs. The nurse answers that this hormone is called:
follicle-stimulating hormone (FSH)
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands.
lispro
rapid-acting insulin *
A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
suggest referral to a sex counselor or other appropriate professional.
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? (Select all that apply.)
-Administration of calcitonin -Intravenous isotonic saline solution in large quantities -Monitoring the patient for fluid overload
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?
100 units of regular insulin in normal saline solution
A 6 months' pregnant patient was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of:
138 mg/dL, 2 hours postprandial.
The nurse performs a fingerstick blood glucose level of a client with diabetes before lunch. The nurse would notify the physician for which blood glucose level?
145 mg/dL
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder?
Blood pressure varying between 120/86 and 240/130 mm Hg
What skin findings should a nurse pay particular attention to in a client with a history of endocrine problems?
Excessive hair growth or loss
The pharmacology instructor is discussing the endocrine system with a class of pre-nursing students. What would the instructor tell the students is considered to be a hormone?
Norepinephrine
over secretion of growth hormone before puberty
gigantism *
A nurse understands that for the parathyroid hormone to exert its effect, what must be present?
Adequate vitamin D level
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first?
Administer 50% glucose intravenously.
The sounds of sirens announce the arrival of the latest trauma to address the trauma center where you practice nursing. Your heart is pounding, your mouth is dry. What gland is responsible for your physiologic response?
Adrenal glands
megalyEvaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
Bulging forehead
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
CALCIUM GLUCONATE
Which of the following would be inconsistent as a cause of DKA?
Competency in injecting insulin
Which of the following is true regarding gestational diabetes?
A glucose challenge test should be performed between 24 to 28 weeks.
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion
Which of the following medications is considered a glitazone?
Actos
Which of the following hormones controls secretion of adrenal androgens?
Adrenocorticotropic hormone (ACTH)
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?
Albumin
A nurse is caring for an elderly patient who has type 2 diabetes mellitus. She suspects that the patient is exhibiting symptoms of diabetic ketoacidosis (DKA) instead of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which of the following are indicators of a diagnosis of DKA? Select all that apply.
Blood glucose level of 280 mg/dL Arterial pH of 7 Plasma bicarbonate level of 13 mEq/L
Ross Babcock, a 42-year-old firefighter, is being seen by an endocrinologist at the endocrinology group where you practice nursing. At this visit, he will receive results of previously-ordered diagnostics. During your client education session, you describe the mechanism of hormone level maintenance. What causes most hormones to be secreted?
Decrease in hormonal levels
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin
A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating:
Catecholamines.
Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing's syndrome *
Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?
Serum glycosylated hemoglobin (Hb A1c)
Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin?
Do not mix with other insulins
Which of the following nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms?
Elevating the head of the bed.
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate?
Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow.
A group of students are reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla?
Epinephrine
A nurse should perform which intervention for a client with Cushing's syndrome?
Explain that the client's physical changes are a result of excessive corticosteroids.
A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test?
Fine-needle biopsy of the thyroid gland
A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?
Fluid deprivation test
Margaret Lawson, a 52-year grocery clerk, has been experiencing a decrease in serum calcium. She has undergone diagnostics and her physician proposes her calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?
Four
Which of the following insulins are used for basal dosage?
Glarginet (Lantus)
A 53-year-old client is being seen by a physician in the primary care group where you practice nursing. It is time for her annual physical and her pre-examination blood work results have arrived for the physician's use. The client has a 30-year-history of type 2 diabetes. What blood test would you expect the physician to order to monitor her treatment compliance?
Glycosylated hemoglobin
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
Hypercalcemia
Which of the following is the most rapid acting insulin?
Humalog
Wallace Guterman, a 36-year-old construction manager, is being seen by a physician in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet and frequent headaches. What could be causing his symptoms?
Hyperpituitarism
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
Hypocalcemia *
The pharmacology instructor is diagramming the nervous and endocrine systems. What organ would the instructor diagram as the connector between the nervous and endocrine systems?
Hypothalamus
A 37-year-old client has been diagnosed with pre-diabetes. Following his physician visit, where he received the diagnosis, you begin your client education session to discuss treatment strategies. How can the client delay or avoid type 2 diabetes?
Increased physical activity Weight loss
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?
Increased urine output *
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?
Insulin production insufficient
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of:
Intolerance to heat
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.)
Ketosis-prone Little endogenous insulin Younger than 30 years of age
After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland?
Kidneys
While not being designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones which are involved in increasing blood pressure and volume and maturation of red blood cells?
Kidneys
The preferred preparation for treating hypothyroidism includes which of the following?
Levothyroxine (Synthroid)
Which of the following would the nurse expect the physician to order for a client with hypothyroidism?
Levothyroxine sodium
Wendy Corcoran, a 34-year-old teacher, is being seen at the primary care group where you practice nursing. She is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by her altered thyroid function?
Metabolic rate
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
Metformin
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones?
Methimazole
Lydia Kranston, a three-year-old female, is being seen by a physician in the endocrinology group where you practice nursing. She has a significant height deficit and is being seen for diagnostic purposes. What could be the cause of her disorder?
Pituitary disorder
Hypocalcemia is associated with which of the following manifestations?
Muscle twitching
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
Myxedema coma
A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate?
Myxedema coma
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland?
Oxytocin
Which glands regulate calcium and phosphorous metabolism?
Parathyroid
Which of the following glands is considered the master gland?
Pituitary
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?
Potassium of 6.0 mEq/L
Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])?
Presence of islet cell antibodies
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
Regular
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find?
Reports of increased appetite
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan?
Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns
A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
Serum glucose level of 52 mg/dl
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which laboratory test is the most important for confirming this disorder?
Serum osmolarity
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
Sweating, tremors, and tachycardia
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient?
Symptoms of acute coronary syndrome
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) *
A nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
Tachycardia
The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency?
Temperature of 102ºF *
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes
The client has eaten and has not taken or received insulin.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?
The client has eaten and has not taken or received insulin.
A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client?
The client's consumption of carbohydrates
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?
The functioning of endocrine glands
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that, if the body needs more sugar:
The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?
They increase the need for insulin.
Which of the following hormones is secreted by the posterior pituitary?
Vasopressin
Which hormones are secreted by the posterior lobe of the pituitary gland? Select all that apply.
Vasopressin Oxytocin
A client is having problems with parathyroid hormone. What vitamin would the nurse suspect as potentially contributing to the client's problem?
Vitamin D
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions?
Weight loss
For a client with hyperthyroidism, treatment is most likely to include:
a thyroid hormone antagonist.
A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
glycosylated hemoglobin level.
a nurse finds which signs and symptoms in a client experiencing hypoglycemia?
nervousness diaphoresis, and confusion. *
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus.
When caring for a client with diabetes insipidus, the nurse expects to administer:
vasopressin (Pitressin).
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and:
vitamin D.
