NCLEX Style Endocrine
A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia
1.Fever 2.Nausea 4.Tremors 5.Confusion Rationale:Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.
The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply 1.Polyuria 2.Headache 3.Bone pain 4.Nervousness 5.Weight gain
1.Polyuria 2.Headache 3.Bone pain 4.Nervousness Rationale:The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.
The nurse has provided instructions to the client with hyperparathyroidism regarding home care measures to manage the symptoms of the disease. Which statement by the client indicates a need for further instruction? 1."I should avoid bed rest." 2."I need to avoid doing any exercise at all." 3."I need to space activity throughout the day." 4."I should gauge my activity level by my energy level."
2."I need to avoid doing any exercise at all." Rationale:The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to avoid bed rest and use energy levels as a guide to activity. The client also should be instructed to avoid high-impact activity or contact sports
A client has been hospitalized for an endocrine system dysfunction of the pancreas. The registered nurse asks the new orientee nurse what kind of problem a client hospitalized for endocrine dysfunction of the pancreas would expect. The new orientee nurse demonstrates understanding if which statement is made? 1."Lipase levels will decrease." 2."Insulin production will be decreased." 3."There will be overproduction of trypsin." 4."Amylase will be secreted in excess amounts."
2."Insulin production will be decreased." Rationale:The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. When there is endocrine dysfunction, insulin production is affected due to damage to beta cells. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin.
The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1.To treat thyroid storm 2.To prevent cardiac irritability 3.To treat hypocalcemic tetany 4.To stimulate release of parathyroid hormone
3.To treat hypocalcemic tetany Rationale:Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.
A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority intervention in the plan of care? 1.Describe the use of loperamide. 2.Restrict fluids to 1000 mL per day. 3.Walk down the hall for 15 minutes 3 times a day. 4.Describe the administration of aluminum hydroxide gel.
3.Walk down the hall for 15 minutes 3 times a day. Rationale:Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids should not be restricted. Discussing the use of medications is not the priority with this client
The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels 1."I will check my blood glucose level every day at 5:00 p.m." 2."I will check my blood glucose level 1 hour after each meal." 3."I will check my blood glucose level 2 hours after each meal." 4."I will check my blood glucose level before each meal and at bedtime."
4."I will check my blood glucose level before each meal and at bedtime." Rationale:The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing should be done during the nighttime hours. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data to control the diabetes mellitus.
The nurse is providing education to a client with type 2 diabetes mellitus. The nurse explains in layperson's language the physiological mechanism behind hypoglycemia. Which response by the client determines that teaching has been successful? 1."My body cannot make insulin." 2."My body has decreased epinephrine levels." 3."My body decreases release of cortisol, which is a stress hormone." 4."My body increases glucagon production to fight low blood sugars."
4."My body increases glucagon production to fight low blood sugars." Rationale:Glucagon is secreted from the alpha cells in the pancreas in response to declining blood glucose levels. At the same time, hypoglycemia triggers increased cortisol release, increased epinephrine release, and decreased secretion of insulin. Options 1, 2, and 3 are not physiological mechanisms that take place to combat the decrease in the blood glucose level
A client has a tumor that is interfering with the function of the hypothalamus. The nurse should monitor for signs and symptoms related to which imbalance? 1.Melatonin excess or deficit 2.Glucocorticoid excess or deficit 3.Mineralocorticoid excess or deficit 4.Antidiuretic hormone (ADH) excess or deficit
4.Antidiuretic hormone (ADH) excess or deficit Rationale:The hypothalamus exerts an influence on both the anterior and the posterior pituitary gland. Abnormalities can result in excess or deficit of substances normally mediated by the pituitary. ADH could be affected by disease of the hypothalamus because the hypothalamus produces ADH and stores it in the posterior pituitary gland. The pineal gland is responsible for melatonin production. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.
A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA 1.Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, Paco2 50, HCO3- 26. 2.Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, Paco2 40, HCO3- 22. 3.Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, Paco2 39, HCO3- 29. 4.Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, Paco2 30, HCO3- 14
4.Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28, Paco2 30, HCO3- 14 Rationale:DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration. The correct option is 4, as it represents an elevated blood glucose and the arterial blood gases (ABGs) indicate metabolic acidosis. Option 1 is incorrect, as the ABGs indicate respiratory acidosis; option 2 is incorrect, as the ABG values are within normal; and option 3 is incorrect, as the ABGs indicate metabolic alkalosis.
During health history taking, the client complains of weight loss and diarrhea and says that he can "feel my heart beating in my chest." The nurse anticipates that which diagnostic test will most likely be prescribed by the primary health care provider (PHCP) in order to determine the underlying condition leading to the client's signs and symptoms? 1.Endoscopy 2.Electrocardiogram 3.Stool for occult blood 4.Serum thyroid-stimulating hormone (TSH)
4.Serum thyroid-stimulating hormone (TSH) Rationale:A client with increased activity of the thyroid gland exhibits weight loss as a result of the higher metabolic rate, increased frequency of bowel movements or diarrhea, and an increased pulse rate, which account for the client's complaint of feeling his heart beating in his chest. Therefore, a TSH level should be drawn to validate hyperthyroidism. The TSH level will be decreased in hyperthyroid states.
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? 1.Lack of knowledge 2.Inadequate fluid volume 3.Compromised family coping 4.Inadequate consumption of nutrients
2.Inadequate fluid volume Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the information in the question
A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse should anticipate that which substance will be elevated? 1.Glucose 2.Ketones 3.Glucagon 4.Lactate dehydrogenase
2.Ketones Rationale:Ketones are a byproduct of fat metabolism. When this process occurs to an extreme, the resulting condition is called ketoacidosis. The remaining options are not associated with the breakdown of fats.
The clinic nurse is providing instructions to a client with diabetes mellitus about the signs and symptoms of hypoglycemia. The nurse should tell the client that which would be noted in a hypoglycemic reaction? 1.Thirst 2.Hunger 3.Polydipsia 4.Increased urine output
2.Hunger Rationale:Signs and symptoms of hypoglycemia include hunger, nervousness, anxiety, dizziness, blurred vision, sweaty palms, confusion, and tingling and numbness around the mouth. Polydipsia (thirst) and increased urine output are noted in the client with hyperglycemia
A nurse is assigned to care for a client with type 1 diabetes mellitus. During the shift, the nurse should monitor for which manifestation as a sign of hypoglycemia? 1.Tremors 2.Anorexia 3.Hot, dry skin 4.Muscle cramps
1.Tremors Rationale:Decreased blood glucose levels trigger autonomic nervous system signs and symptoms, such as nervousness, irritability, and tremors. Hot, dry skin accompanies hyperglycemia. Anorexia and muscle cramps are unrelated to hypoglycemia
The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 1.Dry skin 2.Thin, silky hair 3.Bulging eyeballs 4.Fine muscle tremors
1.Dry skin Rationale:Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism
A client received 5 units of insulin aspart subcutaneously just before eating lunch at 12:00 p.m. The nurse should assess the client for a hypoglycemic reaction at which times? 1.Between 1:00 and 3:00 p.m. 2.10 minutes after administration 3.Between 4:00 p.m. and 12:00 a.m. 4.Between 8:00 and 10:00 p.m.
1.Between 1:00 and 3:00 p.m. Rationale:Insulin aspart is a rapid-acting insulin. Its onset of action is 15 minutes; it peaks in 1 to 3 hours, and its duration of action is 3 to 5 hours. Hypoglycemic reactions are most likely to occur during peak time
The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1.Fever and tachycardia 2.Pallor and tachycardia 3.Agitation and bradycardia 4.Restlessness and bradycardia
1.Fever and tachycardia Rationale:Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100º F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur
A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1.Obtain dark glasses for the client. 2.Lubricate the eyes with tap water every 2 to 4 hours. 3.Administer methimazole every 8 hours around the clock. 4.Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.
1.Obtain dark glasses for the client. Rationale:Because photophobia (light intolerance) accompanies this disorder, wearing dark glasses is helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client would be at risk for developing an eye infection because the solution is not sterile. Methimazole is a thyroid inhibitor, but medication therapy for Graves' disease does not help to alleviate the clinical manifestation of exophthalmos. There is no need to avoid straining or heavy lifting with exophthalmos.
What information stated by a nursing student about the 15/15 rule for treating a hypoglycemic reaction indicates a need for further teaching? Select all that apply. 1.Since my client is diabetic, I will check the blood glucose every 15 minutes during the shift. 2.If my client's blood glucose is over 70 mg/dL (3.9 mmol/L), I will give 15 g of juice every 15 minutes. 3.Since my client is diabetic, I will order 15 g of sugar and 15 g of simple carbohydrates to arrive on the lunch tray. 4.If my client's blood glucose is below 70 mg/dL (3.9 mmol/L), I will give 15 g of juice and recheck blood glucose in 15 minutes
1.Since my client is diabetic, I will check the blood glucose every 15 minutes during the shift. 2.If my client's blood glucose is over 70 mg/dL (3.9 mmol/L), I will give 15 g of juice every 15 minutes. 3.Since my client is diabetic, I will order 15 g of sugar and 15 g of simple carbohydrates to arrive on the lunch tray.
The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 1.The signs and symptoms of hypoadrenalism 2.The signs and symptoms of hyperadrenalism 3.Instructions to take the medications exactly as prescribed 4.The importance of maintaining regular outpatient follow-up care 5.A reminder to read the labels on over-the-counter medications before purchase
1.The signs and symptoms of hypoadrenalism 2.The signs and symptoms of hyperadrenalism 3.Instructions to take the medications exactly as prescribed 4.The importance of maintaining regular outpatient follow-up care Rationale:The client with Cushing's syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the primary health care provider (PHCP) before purchasing any over-the-counter medications, and maintaining regular outpatient follow-up care. The nurse also should instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism
The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1.A client with hypothyroidism 2.A client with Graves' disease who is having surgery 3.A client with diabetes mellitus scheduled for a diagnostic test 4.A client with diabetes mellitus scheduled for debridement of a foot ulcer
2. A client with Graves' disease who is having surgery Rationale:Thyrotoxicosis usually is seen in clients with Graves' disease in whom the symptoms are precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, delivery, or major surgery. It also must be recognized as a potential complication after thyroidectomy. The client conditions in the remaining options are not associated with thyrotoxicosis.
A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality? 1.Sodium 2.Calcium 3.Potassium 4.Magnesium
2.Calcium Rationale:The C cells of the thyroid gland are helpful in maintaining normal plasma calcium levels. They do not affect the levels of sodium, potassium, or magnesium.
A client has overactivity of the thyroid gland. The nurse should expect which finding? 1.Weight gain 2.Nutritional deficiencies 3.Low blood glucose levels 4.Increased body fat stores
2.Nutritional deficiencies Rationale:Although the client may experience an increased appetite with overactivity of the thyroid gland, food intake does not meet energy demands, and nutritional deficiencies can develop. Weight loss occurs as a result of the increased metabolic activity. Glucose tolerance is decreased, and the client experiences hyperglycemia. Overactivity of the thyroid gland also causes increased metabolism, including fat metabolism. This leads to decreased levels of fat in the bloodstream, including cholesterol, and decreased body fat stores.
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? Select all that apply 1.Polyuria 2.Shakiness 3.Palpitations 4.Blurred vision 5.Lightheadedness 6.Fruity breath odor
2.Shakiness 3.Palpitations 4.Blurred vision 5.Lightheadedness Rationale:Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia
The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1."I should avoid contact sports." 2."I should check my ankles for swelling." 3."I need to avoid foods high in potassium." 4."I need to check my blood glucose regularly."
3."I need to avoid foods high in potassium." Rationale:Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.
1."It will boost the cells in your pancreas if you have insufficient insulin." 2."It will help promote insulin absorption when your glucose levels are high." 3."It is for the times when your blood glucose is too low from too much insulin." 4."It will help prevent lipoatrophy from the multiple insulin injections over the years."A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question?
3."It is for the times when your blood glucose is too low from too much insulin." Rationale:Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. When consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated prescription? 1.Endotracheal intubation 2.100 units of NPH insulin 3.Intravenous infusion of normal saline 4.Intravenous infusion of sodium bicarbonate
3.Intravenous infusion of normal saline Rationale:The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS
The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse should instruct the client that it is acceptable to include which item in the diet? 1.Fish 2.Cereals 3.Vegetables 4.Meat and poultry
3.Vegetables Rationale:The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. Vegetables are allowed in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals.
The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 1."I need to eat foods high in potassium." 2."I need to drink at least 2 to 3 L of fluid daily." 3."I need to eat small, frequent meals and snacks if nauseated." 4."I need to increase my intake of dietary items that are high in calcium."
4."I need to increase my intake of dietary items that are high in calcium." Rationale: The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption of calcium. Dietary restriction of calcium may be used as a component of therapy. The client should eat foods high in potassium, especially if the client is taking furosemide. Drinking 2 to 3 L of fluid daily and eating small, frequent meals and snacks if nauseated are appropriate instructions for the client.
A client has begun medication therapy with propylthiouracil. The nurse should assess the client for which condition as an adverse effect of this medication? 1.Joint pain 2.Renal toxicity 3.Hyperglycemia 4.Hypothyroidism
4.Hypothyroidism Rationale:Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.
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? 1.It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2.It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3.It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4.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.
4.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. Rationale: An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas
The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms should the nurse monitor for? Select all that apply. 1.Anorexia 2.Dizziness 3.Weight loss 4.Moon face 5.Hypertension 6.Truncal obesity
4.Moon face 5.Hypertension 6.Truncal obesity Rationale:A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon face, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.