M/S Exam 2: Endo

A client with a tentative diagnosis of HHNS has a history of type 2 diabetes. Which is the most important laboratory test for confirmation? A. Serum potassium level B. Serum sodium level C. Serum osmolarity D. Arterial blood gas levels

C

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A. Infusing I.V. fluids rapidly as ordered B. Encouraging increased oral intake C. Restricting fluids D. Administering glucose-containing IV fluids

C

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of deficient fluid volume? A. Distended neck veins B. Decreased serum sodium level C. Increased urine osmolarity D. Cool, clammy skin

C

Jan has type 1 DM and receives insulin for glycemic control. What should the nurse educate her about wine with dinner? A. The alcohol could cause pancreatic disease B. The alcohol could cause serious liver disease C. The alcohol could predispose you to hypoglycemia D. The alcohol could predispose you to hyperglycemia

C

This disorder is characterized by the increase in secretion of cortisol A. SIADH B. Diabetes insipidus C. Cushing's syndrome D. Addison's disease

C

What does the nurse expect to find in the patient w/ SIADH? Select all that apply: A. Low blood osmolality B. Increased serum osmolality C. Low urine specific gravity D. Hyponatremia E. Decreased urine output

ADE

A Desmorpressin therapy trial will be done to help diagnose which disease? A. Diabetes insipidus B. SIADH C. Cushings D. Addisons

A

A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? A. Hypokalemia B. Hyperglycemia C. Hyperkalemia D. Hyponatremia

A

The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: A. Deposits of adipose tissue in the trunk and dorsocervical area B. Thick, coarse skin C. Hypotension D. Weight gain in arms and legs

A

Which of the following is NOT a typical finding in HHNS? A. Blood pH <7.35 B. Dehydration C. Mental status changes D. Osmotic diuresis

A

Which of these signs suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? A. Neck vein distention B. Tetanic contractions C. Weight loss D. Polyuria

A

A client is suspected of developing diabetes insipidus. Which of the following is the most effective assessment? A. Measure urine output hourly B. Check the anion gap daily C. Monitor blood glucose D. Check vitals signs every 4 hours

A (B and C are correct for DKA)

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? A. short-acting B. rapid acting C. intermediate-acting D. long-acting

A (regular insulin only)

A nurse is caring for a client in Addisonian crisis. Which medication order should the nurse question? A. Potassium chloride B. Normal saline solution C. Hydrocortisone (Cortef) D. Fludrocortisone (Florinef)

A (the nurse should question this because Addisonian crisis results in hyperkalemia)

A pt is newly prescribed desmopressin nasal spray. Which statement by the pt indicates further teaching is needed? Select all that apply: A. Frequent headaches are normal B. This drug is used to decrease my frequent urination C. I am glad this drug is able to treat my SIADH D. I will record my output closely when taking this medication E. I will make sure and weigh myself daily

AC

The nurse's education regarding hemoglobin A1C has been effective if the patient makes which the following statements? Select all that apply: A. "hemoglobin A1C is altered in the presence of anemia" B. "hemoglobin A1C monitors effectiveness of diabetic therapy" C "hemoglobin A1C reviews blood glucose control over a period of time" D. "hemoglobin A1C must be a fasting result"

ABC (glucose bonds to hemoglobin and in the presence of anemia, a false decreased hA1C can exist)

Which of the following are risk factors for the development of renal insufficiency? Select all that apply: A. Obesity B. Hyperglycemia C. Middle aged Hispanic female D. High LDL cholesterol

ABCD

Which of the following are S/S of Addisonian crisis? A. Hypotension B. Vomiting, diarrhea C. Hyperglycemia D. Polyuria E. Shock

ABE (5 S's: shock, sudden pain, syncope, super low BP, severe vomiting & diarrhea & HA)

The drug of choice for central diabetes insipidus is desmopressin (DDAVP). What is this drug's mechanism of action? A. Blocks vasopressin and increases kidney water reabsorption B. Mimics vasopressin and increases kidney water reabsorption C. Blocks vasopressin and increases kidney salt excretion D. Mimics vasopressin and increases kidney salt excretion

B

This disorder is characterized in decreased ADH A. SIADH B. Diabetes insipidus C. Cushing's syndrome D. Addison's disease

B

What is the purpose of Mucomyst? A. Vasoconstriction of renal arteries B. Vasodilation of renal arteries C. Reduction of blood glucose levels D. Vasodilation of coronary arteries E. Vasoconstriction of coronary arteries

B

You are assessing a pt with Cushing syndrome. Which observation should you report to the Dr immediately? A. Pitting edema of the legs B. Irregular apical pulse C. Dry mucous membranes D. Frequent urination

B (bc Cushing's can lead to hypokalemia)

Hypertonic fluids, such as 3% saline, are the first line of treatment to correct dehydration in HHNS. A. True B. False

B (isotonic solutions like 0.9% NS are usually the first-line treatment)

Which of the following is not a sign or symptom of Diabetic Ketoacidosis? A. Positive Ketones in the urine B. Oliguria C. Polydipsia D. Abdominal Pain

B (they would have polyuria)

A client states she ran out of insulin last week and has been having nausea and vomiting. Which symptom would not be associated with DKA? A. Fruity breath B. Respiratory rate of 10 bpm C. Fatigue D. Blurred vision

B (we would expect faster, Kussmaul respirations)

A patient with type 2 DM has been admitted for HHS. Which lab test is the most important in confirming this diagnosis? A. ABG values B. Serum osmolarity C. Serum potassium D. Serum sodium

B (will typically be >350 in HHS)

Key features of DKA include.... (select all that apply) A. Uresis B. Acidosis C. Dehydration D. Hyperglycemia E. Hypoglycemia

BCD

Which of the following is a complication of SIADH? Select all that apply: A. Hypernatremia B. Hyponatremia C. Fluid overload D. Fluid deprivation E. HTN F. Hypotension

BCE

Your pt w/ a brain tumor develops diabetes insipidus. Which data do you expect to find? Select all that apply: A. Dark urine w/ increased specific gravity B. High blood serum osmolality C. Weight gain w/ edema D. Increased thirst E. Sodium below 135 F. Urine output 30 mL/hr or less

BD

Which of the following S/S are unique to HHS (vs DKA)? A. Dry MM B. Blood glucose level of 600+ C. Abdominal pain D. Neurologic changes

BD (abd pain is unique to DKA)

When caring for a pt w/ SIADH, what does the nurse expect to implement? Select all that apply: A. IV maintenance w/ 0.9% NS B. Fluid restriction C. Sodium restriction D. Seizure precautions E. Monitor I&Os F. Measure weekly weights

BDE

As a nurse you would expect which of the following lab findings for a patient experiencing HHNS? Select all that apply: A. Acidosis B. Increased blood osmolality C. Decreased blood osmolality D. Increased BUN E. Decreased creatinine F. Decreased potassium

BDF (may also see increased creatinine and decreased sodium)

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: A. an ectopic corticotropin-secreting tumor. B. adrenal carcinoma. C. a corticotropin-secreting pituitary adenoma. D. an inborn error of metabolism.

C (most common cause of Cushing's syndrome in women ages 20-40)

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? A. 10% to 20% B. 25% to 40% C. 50% to 60% D. 85% to 90%

C (the remainder is then administered after surgery)

Which of the following are common causes of SIADH? A. certain drugs such as Declomycin B. pregnancy C. lung cancer D. infection

CD

A nurse expects to note an elevated serum glucose level in a client with HHNS. Which other laboratory finding should the nurse anticipate? A. Serum ketone bodies B. Elevated serum acetone level C. Serum alkalosis D. Below-normal serum potassium level

D

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A. Decreased serum sodium level B. Cool, clammy skin C. Decreased urine osmolarity D. Increased urine osmolarity

D

The nurse administers glucagon to her diabetic client. Which type of drug interacts adversely with glucagon? A. Anabolic steroids B. Beta-adrenergic blockers C. Thiazide diuretics D. Oral anticoagulants

D

Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A. HR of 126 beats/ min B. BP of 90/56 C. Urine output measures more than 200ml/ hr D. Fluid intake is less than 2,500 ml/ day

D

True or false: when mixing short-acting insulin and longer-acting insulin, the ADA recommends regular insulin be drawn up first

True