MS2 - ENDOCRINE SYSTEM

A. IV fluids containing dextrose

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? A. IV fluids containing dextrose B. NPH insulin subcutaneously C. An ampule of 50% dextrose D. Phenytoin for the preventions of seizures

D. Increase in pH

A client with a diagnosis of DKA is being treated in the emergency department. Which findings support this diagnosis? Except A. Deep, rapid breathing B. Decreased urine output C. Comatose D. Increase in pH

B. In the morning to prevent insomnia

A physician prescribes levothyroxine sodium (Synthroid), 0.15mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: A. three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels B. In the morning to prevent insomnia C. At various times during the day to prevent tolerance from occurring D. Only when the client complains of fatigue and cold intolerance

A. difficulty in swallowing

After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? A. Difficulty in swallowing B. Tetany C. Hoarseness of voice D. Fever

c. Myxedema coma

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidoses, bradycardia, hypotension, and non-pitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Hashimoto's thyroiditis b. Thyroid storm c. Myxedema coma d. Cretinism

B. Autoimmune-induced atrophy of the gland

Causes of primary hypothyroidism in adults include A. Surgical removal of thyroid gland B. Autoimmune-induced atrophy of the gland C. Malignant or benign thyroid nodules D. Surgical removal or failure of the pituitary gland

A. "What is it about giving yourself the insulin shots that bothers you?"

During a home visit, a diabetic client begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day.". Which of the following would be the best response by the nurse? A. "What is it about giving yourself the insulin shots that bothers you?" B. "We can teach your daughter to give the shots, so you will not have to do it." C. "If you do not give yourself your insulin shots, you will die." D. "I can arrange to have a home care nurse give you the shots every day."

d. Thyroid crisis

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Tetany b. Diabetic ketoacidosis c. Hypoglycemia d. Thyroid crisis

C. To report weight loss, anxiety, insomnia, and palpitations

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A. That the drug may be taken every other day if diarrhea occurs B. That the therapy typically lasts about 6 months C. To report weight loss, anxiety, insomnia, and palpitations D. That weekly laboratory tests for T4 levels will be required

A. gastrointestinal disturbances

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan? A. gastrointestinal disturbances b. hypoglycemia c. weight gain d. flushing and palpitations

d. Avoid close contact with children or pregnant women for one week after administration of drug.

Of what precautions should a client receiving radioactive iodine-131 be made aware? a. Drink plenty of fluids, especially those high in calcium. b. Wear a mask if around children or pregnant women c. Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety. d. Avoid close contact with children or pregnant women for one week after administration of drug.

D. Decreased cardiac contractility and coronary atherosclerosis

Physical changes of hypothyroidism that must be monitored when replacement therapy is started include: A. Anemia and increased capillary fragility B. Slowed mental process C. Achlorhydria and constipation D. Decreased cardiac contractility and coronary atherosclerosis

c. how to support the head with the hands when moving.

Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient a. that any tingling around the lips or in the fingers after surgery is expected and temporary b. that the head and neck will need to remain immobile until the incision heals c. how to support the head with the hands when moving. d. that coughing should due avoided to prevent pressure on the incision

d. signs and symptoms of hypothyroidism

The physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a. signs of renal toxicity b. relief of pain signs and symptoms of hyperglycemia d. signs and symptoms of hypothyroidism

C. 1am, while sleeping

The client with Type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5pm each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time: A. 11am, shortly before lunch B. 1pm, shortly after lunch C. 1am, while sleeping D. 6pm, shortly after dinner

C. Proteins, fats, and carbohydrates

The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay.". The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? A. Carbohydrates only B. Proteins and carbohydrates only C. Proteins, fats, and carbohydrates D. Fats and carbohydrates only

D. Refrigerate the insulin

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? A. Store the insulin in a dark, dry place B. Freeze the insulin C. Keep the insulin at room temperature D. Refrigerate the insulin

C. Steroids

The nurse is assessing the client's use of medications. Which of the following medications may cause a complication with the treatment plan of a client with diabetes? A. Aspirin B. Angiotensin-conerting enzyme (ACE) inhibitors C. Steroids D. Sulfonylureas

c. Polyuria

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? a. Pedal edema b. Diaphoresis c. Polyuria d. Decreased respiratory rate

c. Inadequate fluid volume

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? a. Inadequate consumption of nutrients b. Lack of knowledge c. Inadequate fluid volume d. Compromised family coping

A.Withdraws the NPH insulin first

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? A.Withdraws the NPH insulin first B. Injects an amount of or equal to the desired dose of insulin into each vial C. Injects into NPH insulin vial first D. Withdraws the regular insulin first

C. Temperature

The nurse performs a physical assessment on a client with Type 2 diabetes mellitus. Findings include a fasting blood clucose level of 120mg/dL (6.8 mmol/L), temperature of 101 F, pulse of 102 bpm, respirations of 22 pbm, and BP of 142/72 mmHg. Which finding would be the priority concern to the nurse? A. Pulse B. Blood pressure C. Temperature D. Respiration

d. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? a. "will decrease my insulin dose during times of illness." b. "I will adjust my insulin dose according to the level of glucose in my urine." c. "I will stop taking my insulin if I'm too sick to eat." d. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

a. Nervousness.

The nurse should teach the diabetic client that which of the following is the most common symptom of hypoglycemia? a. Nervousness. b. Anorexia. c. Bradycardia. d. Kussmaul's respirations.

c. avoid eating foods such as soybeans, turnips, and rutabagas

When providing discharge instructions to a patient following a subtotal thyroidectomy, the nurse advises the patient to a. never miss a daily dose of thyroid replacement therapy b. avoid regular exercise until thyroid function is normalized c. avoid eating foods such as soybeans, turnips, and rutabagas d. use warm saltwater gargles several times a day to relieve throat pain

A. Avoid going barefoot

When teaching the diabetic client about foot care, the nurse should instruct the client to do which of the following? A. Avoid going barefoot B. Use heating pads for sore feet C. Cut toenails at angles D. Buy shoes a half size larger

c. increased body temperature, increased pulse, and increased blood pressure

Which of the following assessment findings characterize thyroid storm? a. increased body temperature, increased pulse, and decreased blood pressure b. increased body temperature, decreased pulse, and decreased blood pressure c. increased body temperature, increased pulse, and increased blood pressure d. increased body temperature, decreased pulse, and increased blood pressure

D. Blood pressure of 160/100 mmHg

Which of the following indicates a potential complication of diabetes mellitus? A. Stooped appearance B. Inflamed, pallor, jaundice C. Hemoglobin of 9g/dL D. Blood pressure of 160/100mm/Hg

C. Imbalanced nutrition: less than body requirements

Which of the following is a priority nursing diagnosis for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? A. ineffective health maintenance related to ineffective coping skills B. Activity intolerance C. Imbalanced nutrition: less than body requirements D. acute pain

B. An expected coping mechanism

a client with diabetes mellitus is told that amputation of the leg is necessary to sustain life. The client is very upset and tells the nurse, "This is all my health care provider's fault. I have done everything I've been asked to do!". Which nursing interpretation is best for this situation? A. An ineffective defense mechanism B. An expected coping mechanism C. An expression of guilt on the part of the client D. A need to notify the hospital lawyer

b. Prednisone

client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? a. Atenolol b. Prednisone c. Phenelzine d. Allopurinol

b. Puffiness of the face and hands

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? a. Thyroid gland swelling b. Puffiness of the face and hands c. Nervousness and tremors d. Increased appetite and weight loss

b. "Keep all cuts clean and covered."

A client with diabetes mellitus comes to the clinic for a regular 3-month follow -up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I'm so clumsy. I'm always cutting my finger cooking or burning myself on the iron." Which of the following responses by the nurse would be most appropriate? a. "Why don't you have your children do the cooking and ironing?" b. "Keep all cuts clean and covered." c. "You really should be fine as long as you take your daily medication." d. "Wash all wounds in isopropyl alcohol."

D. Convey empathy, trust, and respect toward the client

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? A. Administer a sedative B. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening C. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear D. Convey empathy, trust, and respect toward the client

C. Increase the frequency of self-monitoring (Blood glucose testing)

A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to A. discontinue that dose of insulin if unable to eat B. Reduce food intake diminish nausea C. Increase the frequency of self-monitoring (Blood glucose testing) D. Take half of the normal dose of insulin

A. Tachycardia

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid). Which finding should nurse Hans recognize as an adverse drug effect? A. Tachycardia B. Blurred vision C. Dysuria D. Leg cramps

A. Decreased renal blood flow and glomerular filtration rate reduce kidneys ability to excrete water, which may cause hyponatremia

A nursing student is studying for a test on the care of a client with endocrine disorders. Which of the following statements demonstrates an understanding of the difference between hyperthyroidism and hypothyroidism? A. Decreased renal blood flow and glomerular filtration rate reduce kidneys ability to excrete water, which may cause hyponatremia B. Grave's disease is the most common cause of hypothyroidism C. Increased amounts of TH cause a decrease in cardiac output and peripheral blood flow D. Deficient amounts of TH cause abnormalities in lipid metabolism, with decreased serum cholesterol and triglyceride levels

d. elevated temperature and signs of heart failure

A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find a. hoarseness and laryngeal stridor b. bulging eyeballs and arrhythmias c. lethargy progressing suddenly to impairment of consciousness. d. elevated temperature and signs of heart failure

B. In a genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones

A patient with Grave's disease asks the nurse what caused the disorder. The best response by the nurse is: A. Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones B. In a genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones C. It is usually associated with goiter from an iodine deficiency over a long period of time D. The cause of Grave's disease is not known, although it is thought to be genetic.

D. Fever and sore throat

A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for: A. Blurred vision B. Gingival hyperplasia and lycopenemia C. Dyspnea and a dry cough D. Fever and sore throat

b. provides written instruction for all information related to the medication therapy

A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse a. informs the patient that medications must be taken until hormone balance is reestablished. b. provides written instruction for all information related to the medication therapy c. explains that caloric intake must be reduced when drug therapy is started d. assures the patient that a return to normal function will occur with replacement therapy

B. provides written instruction for all information related to the medication therapy

A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse: a. explains that caloric intake must be reduced when drug therapy is started b. provides written instruction for all information related to the medication therapy c. assures the patient that a return to normal function will occur with replacement therapy d. informs the patient that medications must be taken until hormone balance is reestablished

d. It administers a small continuous dose of short duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? a. It continuously infuses small amounts of PH insulin into the bloodstream while regularly monitoring blood glucose levels. b. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. c. It is timed to release programmed doses of either short -duration or NPH insulin into the bloodstream at specific intervals. d. It administers a small continuous dose of short duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

D. Renal failure

Anhiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of: A. Chronic obstructive pulmonary disease B. Cerebrovascular accident C. Pancreatic cancer D. Renal failure

D. Hypocalcemia

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? A. Hypercalcemia B. Hyperkalemia C. Hypokalemia D. Hypocalcemia

c. Alcohols

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Except a. Red meats b. Carbonated beverages c. Alcohols d. Whole-grain cereals

b. "need to stop my insulin."

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? a. "I need to increase my fluid intake." b. "need to stop my insulin." C. "I need to monitor my blood glucose every 3 to 4 hours." d. "Ineed to call the health care provider (HCP) because of these symptoms."

D. Disulfiram (Antabuse)-like symptoms

The nurse should caution the client with diabetes mellitus who is taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause which of the following: A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Disulfiram (Antabuse)-like symptoms

c. "I should keep the insulin in the cabinet during the day only."

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humülin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? a. "I can store the open insulin bottle in the kitchen cabinet for 1 month." b. "The best place for my insulin is on the windowsill, but in the cupboard is just as good." c. "I should keep the insulin in the cabinet during the day only." d. "I know I have to keep my insulin in the refrigerator at all times."

b. Polyuria

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Except a. Lightheadedness b. Polyuria c. Shakiness d. Palpitations