Saunders NCLEX- Endocrine

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 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.

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a continuous mist of room air or oxygen. 3. Place the client in a flat position with the head and neck immobilized. 4. Use only a rectal thermometer for temperature measurement.

2. Administer a continuous mist of room air or oxygen. Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2.Administer a continuous mist of room air or oxygen. 3.Place the client in a flat position with the head and neck immobilized. 4.Use only a rectal thermometer for temperature measurement.

2.Administer a continuous mist of room air or oxygen. Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.

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 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.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum pH of 9.0 2. Absent ketones in the urine 3. Serum bicarbonate of 22 mEq/L (22 mmol/L) 4. Blood glucose level of 500 mg/dL (28.5 mmol/L)

4. Blood glucose level of 500 mg/dL (28.5 mmol/L) In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).

A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria, weight loss, and weakness. Laboratory results indicate a blood glucose level of 800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the primary health care provider's documentation and expects to note which diagnosis? 1. Hypoglycemia 2. Pheochromocytoma 3. Diabetic ketoacidosis (DKA) 4. Hyperosmolar hyperglycemic syndrome (HHS)

4. Hyperosmolar hyperglycemic syndrome (HHS) HHS is seen primarily in clients with type 2 diabetes mellitus, who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. In HHS, the client is nonketotic. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations. DKA typically occurs in type 1 diabetes mellitus.

The nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which behavior indicates to the nurse that the client is not ready to learn? 1. The client asks if the spouse may attend the teaching session. 2.The client asks appropriate questions about what will be taught. 3.The client asks for written materials about diabetes mellitus before class. 4.The client complains of fatigue whenever the nurse plans a teaching session.

4.The client complains of fatigue whenever the nurse plans a teaching session. Physical symptoms can interfere with an individual's ability to learn and can indicate to the teacher that the student lacks motivation to learn if the symptoms repeatedly recur when teaching is initiated. The remaining options identify active client participation in learning.

A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse should ask the client if which measure is taken? 1. Rotating sites for injection 2. Administering the insulin at a 45-degree angle 3. Cleaning the skin with alcohol before each injection 4. Aspirating for blood before injection into the subcutaneous tissue

1. Rotating sites for injection Lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) occurs in some clients with diabetes mellitus when injection sites are used for a prolonged period. Therefore, clients are instructed to adhere to a plan of rotating injection sites to avoid tissue changes. Angle of insulin administration, cleansing with alcohol, and aspiration do not produce this complication.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2.Flaccid paralysis 3. Tingling around the mouth 4.Absence of Chvostek's sign

3. Tingling around the mouth After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum pH of 9.0 2.Absent ketones in the urine 3.Serum bicarbonate of 22 mEq/L (22 mmol/L) 4.Blood glucose level of 500 mg/dL (28.5 mmol/L)

4.Blood glucose level of 500 mg/dL (28.5 mmol/L) In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1. Polyuria Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.

A nurse is reviewing the primary health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 1. Acetaminophen 2.Docusate sodium 3.Morphine sulfate 4.Levothyroxine sodium

3.Morphine sulfate Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which concept? 1. Always keep insulin vials refrigerated. 2. Ketones in the urine signify a need for less insulin. 3. Increase the amount of insulin before excessive exercise. 4. Systematically rotate insulin injections within 1 anatomical site.

4. Systematically rotate insulin injections within 1 anatomical site. Injection sites should be rotated systematically within 1 anatomical site. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. If ketones are found in the urine, it may indicate the need for additional insulin. Insulin doses should not be adjusted or increased before excessive exercise.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply. 1. Polyuria 2.Polydipsia 3.Polyphagia 4.Dry mouth 5.Flushed, dry skin 6.Moist mucous membranes

1, 2, 3, 4, & 5 Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia (excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration. Therefore, option 6 would not be noted.

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, 2, 4, & 5 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 family of a bedridden client with type 2 diabetes mellitus and chronic kidney disease calls the nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 1. "What is the client's urine output?" 2."What is the client's capillary blood glucose level?" 3."Has there been any change in the dietary intake?" 4."Have you increased the amount of fluids provided?"

2."What is the client's capillary blood glucose level?" Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is an acute complication of type 2 diabetes mellitus leading to hyperglycemia and dehydration. Headache, polydipsia, and increasing lethargy can be caused by the dehydration. The remaining options will not assist in determining a possible problem.

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 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 nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit a sign of thyroid storm. Which is an earlyindicator of this complication? 1. Bradycardia 2.Constipation 3.Hyperreflexia 4.Low-grade temperature

3.Hyperreflexia Clinical manifestations of thyroid storm include a fever as high as 106º F, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation, hypotension, atrial fibrillation, and cardiovascular collapse.

A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 1. Diarrhea 2.Infection 3.Polydipsia 4.Weight gain

3.Polydipsia Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Diarrhea is not indicative of the complication. Infection is not associated with diabetes insipidus. Anorexia and weight loss also may occur.

A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 1. "Are you rotating the injection site?" 2. "Are you aspirating before you inject the insulin?" 3. "Are you using a 1-inch needle to give the injection?" 4. "Are you placing an air bubble in the syringe before injection?"

1. "Are you rotating the injection site?" The client should be instructed that insulin injection sites should be rotated within 1 anatomical area before moving on to another area. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. The remaining options are not associated with the condition (skin leakage of insulin) presented in the question.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 1. Glycosylated hemoglobin of <6% 2. Presence of ketones in the urine 3. Presence of albumin in the urine 4. Fasting blood glucose level of 150 mg/dL (8.57 mmol/L)

1. Glycosylated hemoglobin of <6% This measurement of glycosylated hemoglobin (HgbA1C) detects glucose binding on the red blood cell (RBC) membrane and is expressed as a percentage. It measures glucose for the life of the RBC, which is 120 days. A HgbA1C of <6% is acceptable. The fasting blood glucose level should be 110 mg/dL (6 mmol/L). The urine should be free of both ketones and albumin.

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1. Hypotension and fever 2.Mental status changes and hypertension 3.Subnormal temperature and hypotension 4.Complaints of weakness and hypertension

1. Hypotension and fever The nurse should be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

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 3. Bone pain 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 is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 110 mg/dL (6.28 mmol/L) 3. A potassium (K+) level of 5.5 mEq/L (5.5 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. A potassium (K+) level of 5.5 mEq/L (5.5 mmol/L) The client with Cushing's syndrome experiences hyperkalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 1. It indicates nerve damage. 2. The hoarseness is permanent. 3. It is normal during this time and will subside. 4. It will worsen before it subsides, which may take 6 months.

3. It is normal during this time and will subside. Hoarseness in the postoperative period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. The other options are incorrect.

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? 1. Increase fluid intake. 2.Document the complaints. 3.Assess for urinary glucose. 4.Assess urine specific gravity.

4.Assess urine specific gravity. After hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess the specific gravity of the urine and notify the primary health care provider (PHCP) if the result is lower than 1.005. Although increasing fluid intake and documenting the complaints may be components of the plan of care, they are not initial actions. Additionally, the PHCP will prescribe increased fluids. Assessing for urinary glucose is unrelated to the client's condition.

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1. Irritability 2.Complaints of nausea 3.Sodium level of 128 mEq/L (128 mmol/L) 4.Potassium level of 3.2 mEq/L (3.2 mmol/L) 5.Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1, 2, 3, & 5 Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomiting, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthostatic hypotension. Irritability and depression may also occur in primary adrenal hypofunction.

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1. "Cortisol will be secreted." 2. "Aldosterone will be secreted." 3. "Additional glucagon will be produced." 4. "Adrenocorticotropic hormone production will increase."

2. "Aldosterone will be secreted." Aldosterone is the primary mineralocorticoid that is produced and secreted in response to lowered blood volume. Cortisol is a glucocorticoid. Glucagon is produced by the pancreas and functions to oppose the action of insulin in regulating blood glucose levels. Adrenocorticotropic hormone is produced by the pituitary gland and stimulates the adrenal cortex to produce glucocorticoids and mineralocorticoids.

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features

2. Bulging eyeballs Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse should expect an excess of which substance? 1. Calcium 2.Cortisol 3.Epinephrine 4.Norepinephrine

2. Cortisol Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

A client has been diagnosed with Cushing's syndrome. The nurse should assess the client for which expected manifestations of this disorder? 1. Dizziness 2.Weight loss 3.Hypoglycemia 4.Truncal obesity

4. Truncal obesity The client with Cushing's syndrome may exhibit a number of different manifestations. These may include moon face, truncal obesity, and a "buffalo hump" fat pad. Other signs include hyperglycemia, hypernatremia, hypocalcemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. Which is the appropriate nursing intervention? 1. Offer water only until the client is able to tolerate solid foods. 2.Withhold all fluids until vomiting has ceased for at least 4 hours. 3.Encourage the client to take 8 to 12 oz of fluid every hour while awake. 4.Maintain a clear liquid diet for at least 5 days before advancing to solids.

3.Encourage the client to take 8 to 12 oz of fluid every hour while awake. Small amounts of fluid may be tolerated, even when vomiting is present. The nurse should encourage liquids containing glucose and electrolytes every hour. The remaining options will not provide the adequate intake needed by the client with diabetes mellitus.

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations? 1. Cortisol 2.Androgens 3.Aldosterone 4.Epinephrine

4.Epinephrine Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse should provide the client with which best instruction? 1. Eat meals at approximately the same time each day. 2.Adjust mealtimes depending on blood glucose levels. 3.Vary mealtimes if insulin is not administered at the same time every day. 4.Avoid being concerned about the time of meals as long as snacks are taken on time.

1. Eat meals at approximately the same time each day. Mealtimes must be approximately the same each day to maintain a stable blood glucose level. The client should not be instructed that mealtimes can be varied depending on blood glucose levels, insulin administration, or consumption of snacks.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply. 1. Polyuria 2.Headache 3. Bone pain 4.Nervousness 5.Weight gain

1. Polyuria 3. Bone pain 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.

A primary health care provider has prescribed propylthiouracil for a client with hyperthyroidism. The nurse recalls that first-line treatment calls for methimazole for medication therapy. The nurse should question the client about her past medical history, specifically regarding which condition? 1. Pregnancy 2. Renal failure 3. Prolonged QT interval 4. Adverse reaction to levothyroxine

1. Pregnancy Methimazole and propylthiouracil are both used to treat hyperthyroidism. Methimazole is considered first-line treatment; however, this medication cannot be used for clients who are in their first trimester of pregnancy, have had a previous adverse reaction to methimazole, or need rapid reduction of symptoms. Renal failure, prolonged QT interval, and adverse reaction to levothyroxine are not related to contraindications for methimazole.

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 1. "Do you have tremors in your hands?" 2. "Are you experiencing pain in your joints?" 3. "Do you notice swelling in your legs at night?" 4. "Have you had problems with diarrhea lately?"

2. "Are you experiencing pain in your joints?" Hyperparathyroidism is associated with oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures. Tremors and diarrhea relate to assessment findings of hypoparathyroidism. Swelling in the legs at night is unrelated to hyperparathyroidism.

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 1. Maintain a supine position. 2.Monitor neck circumference every 4 hours. 3.Maintain a pressure dressing on the operative site. 4.Encourage deep-breathing exercises and vigorous coughing exercises.

2.Monitor neck circumference every 4 hours. After thyroidectomy, neck circumference is monitored every 2 hours to assess for the occurrence of postoperative edema. The client should be placed in an upright position to facilitate air exchange. A pressure dressing is not placed on the operative site because it may restrict breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. The nurse should assist the client with deep-breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision.

A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1. Amenorrhea 2.Menorrhagia 3.Metrorrhagia 4.Dysmenorrhea

1. Amenorrhea Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproductive system; however, they are not typical manifestations of Graves' disease.

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, 2, & 3 In the event of a suspected hypoglycemic reaction, the nurse should first check the client's blood glucose level. If a blood glucose monitor is not available and the client is experiencing the signs and symptoms of hypoglycemia, hypoglycemic reaction should be suspected. If the blood glucose level is below 70 mg/dL (3.9 mmol/L), the nurse should treat accordingly with 15 g of carbohydrate and recheck the level in 15 minutes. If the level is still below 70 mg/dL (3.9 mmol/L), the nurse should treat with an additional 15 g of carbohydrate. One more 15 g of carbohydrate is given if the level remains below 70 mg/dL (3.9 mmol/L). The nurse then rechecks the blood glucose level in another 15 minutes; if still below 70 mg/dL (3.9 mmol/L), the nurse should treat with an injectable form of glucose. The nurse should then have the client consume a snack, and then document the occurrence and explore the reasons the reaction occurred. If at any point the client becomes unconscious, the nurse should administer an injectable form of glucose to raise the blood glucose level.

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, 2, 3, & 4 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 nurse caring for a male client newly admitted to the hospital with a diagnosis of pneumonia suspects that the client is also at risk for metabolic syndrome if which characteristics have been identified in this client? Select all that apply. 1. Hemoglobin A1C of 6.5% 2.Waist circumference of 36 inches 3.Triglycerides 160 mg/dL (1.81 mmol/L) 4.Consistent systolic blood pressures <130 mm Hg 5.Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L)

1, 3, & 5 eatures of metabolic syndrome include abdominal obesity: waist circumference of 40 inches (100 cm) or more for men; hyperglycemia: fasting blood glucose level of 110 mg/dL (6 mmol/L) or more or on medication treatment for elevated glucose; abnormal hemoglobin A1C: >6.0%; hypertension: systolic blood pressure of 130 mm Hg or more or diastolic blood pressure of 85 mm Hg or more or on medication treatment for hypertension; hyperlipidemia: triglyceride level of 160 mg/dL or more or on medication treatment for elevated triglycerides, normal triglycerides is 40 to 160 mg/dL (0.45 to 1.81 mmol/L); high-density lipoprotein cholesterol less than 40 mg/dL for men: normal is >40 mg/dL (>1.55 mmol/L). The client's risk factors include elevated triglyceride level, elevated hemoglobin A1C, and elevated fasting blood glucose levels.

The nurse teaches a class on foot care for clients diagnosed with diabetes mellitus. Which instructions should the nurse include in the class? Select all that apply. 1. Wear closed-toe shoes. 2.Soak feet in hot water twice a day. 3.Massage lanolin lotion between the toes. 4.Cut toenails straight across and file the edges. 5.Pat feet dry gently, especially between the toes.

1, 4, & 5 People with diabetes mellitus are at high risk for foot ulcerations and resultant lower extremity amputations. The development of diabetic foot complications can be the result of a combination of microvascular and macrovascular diseases that place the client at risk for injury and serious infection. Options 1, 4, and 5 are correct, as measures should be taken to teach clients how to prevent foot ulcers and injury. These measures include wearing closed-toe shoes to protect the feet and toes (especially for those with peripheral neuropathy), cutting toenails straight across and filing the edges to avoid sharp toenail edges and cutting the skin of the toe, and drying the feet gently and thoroughly (including between the toes) to prevent maceration of the skin and infections. Option 2 is incorrect, as clients with diabetes should avoid hot water due to neuropathy and possible burns. Option 3 is incorrect, as lotion between the toes is not advised; it is necessary to keep the area between the toes dry to avoid maceration and infections.

The primary health care provider prescribes a 24-hour urine collection for vanillylmandelic acid (VMA). The community health nurse visits the client at home and instructs the client in the procedure for the collection of the urine. Which statement, if made by the client, would indicate a need for further instruction? 1. "I can take medication if I need to during the collection." 2."When I start the collection, I will urinate and discard that specimen." 3."I will pour the urine in the collection bottle each time I urinate and refrigerate the urine." 4."I will start the collection in 2 days. Starting now, I cannot eat or drink any tea, chocolate, vanilla, or fruit until the test is completed."

1. "I can take medication if I need to during the collection." Clients are reminded not to take medications for 2 to 3 days before a 24-hour urine collection for VMA. Because a 24-hour urine collection is a timed quantitative determination, it is essential that the client start the test with an empty bladder. Therefore, the client is instructed to void, discard the first urine, note the time, and start the test. The 24-hour urine specimen collection bottle must be kept on ice or refrigerated. For a VMA determination, the client is instructed to avoid tea, chocolate, vanilla, and all fruits for 2 days before urine collection begins.

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? 1. "I need to stop my insulin." 2."I need to increase my fluid intake." 3."I need to monitor my blood glucose every 3 to 4 hours." 4."I need to call the primary health care provider (PHCP) because of these symptoms."

1. "I need to stop my insulin." When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the PHCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness.

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply. 1. "Include adequate fiber and fluids in your diet." 2."Wear slip-on shoes rather than those that need to be tied." 3."A postnasal drip may be expected for several weeks after surgery." 4."Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5."Contact your primary health care provider immediately if you develop any headache, fever, or neck stiffness."

1. "Include adequate fiber and fluids in your diet." 2."Wear slip-on shoes rather than those that need to be tied." 4."Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5."Contact your primary health care provider immediately if you develop any headache, fever, or neck stiffness." Clients who have undergone a transsphenoidal hypophysectomy will have an incision just above the upper lip so that the pituitary gland can be accessed and removed through the sphenoid sinus. After the gland is removed, a muscle graft is taken, often from the thigh, to support the area and prevent leakage of cerebrospinal fluid (CSF). Clients should be taught to include adequate fluids and fiber in the diet to prevent straining during a bowel movement. Clients must also avoid bending from the waist to pick up objects or tie shoes because these activities will increase intracranial pressure. The client should also be taught to avoid brushing the teeth for 2 weeks to allow time for the incision to heal. Infection can occur after surgery, so clients should be taught to immediately report headache, fever, and nuchal (neck) rigidity because these may be indicative of meningitis. Postnasal drip can be an indication of CSF leak and should be reported immediately.

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1. Calcium level of 8 mg/dL (2.0 mmol/L) 2.Calcium level of 11.2 mg/dL (2.8 mmol/L) 3.Potassium level of 2.9 mEq/L (2.9 mmol/L) 4.Potassium level of 5.6 mEq/L (5.6 mmol/L)

1. Calcium level of 8 mg/dL (2.0 mmol/L) Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]), this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse should expect the calcium level to be low. Therefore, option 1 is the correct answer.

The nurse caring for a client who underwent intracranial surgery is suspected of having diabetes insipidus. Which finding noted by the nurse is consistent with this complication of surgery? 1. Complaints of excessive thirst 2. Urine specific gravity of 1.030 3. Urine output of 10 to 15 mL/hour 4. Systolic blood pressures running consistently over 150 mm Hg

1. Complaints of excessive thirst Diabetes insipidus results from insufficient antidiuretic hormone (ADH) production, which in this case was caused by the intracranial surgery. Findings associated with diabetes insipidus include greatly increased urine output, low urine specific gravity (<1.005), hypotension, signs of dehydration, increased plasma osmolarity, increased thirst, and output that does not decrease when fluid intake decreases. A complaint of thirst is the only option consistent with diabetes insipidus.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hr 5. Clear drainage on nasal dripper pad

2, 4, & 5 Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery, and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone, and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.

A client with type 1 diabetes mellitus who takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late-afternoon." 4. "NPH is a basal insulin, so I should exercise in the evening."

2. "The best time for me to exercise is after breakfast." Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10- to 15-g carbohydrate snack, and they should check their blood glucose level before exercising. Option 1 is incorrect because clients with diabetes should exercise, though they should check with their primary health care provider before starting a new exercise program. Option 3 in incorrect; clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Option 4 is incorrect; NPH insulin is an intermediate-acting insulin, not a basal insulin.

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? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

2. Convey empathy, trust, and respect toward the client. Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client's anxiety. The nurse should not ignore the client's anxious feelings. Anxiety needs to be managed before meaningful client education can occur.

The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if eating at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most appropriate? 1. "You are not allowed to eat in restaurants." 2."You should order a half-portion meal and have fresh fruit for dessert." 3."If you plan to eat in a restaurant, you need to skip the lunchtime meal." 4."You should increase your daily dose of insulin by half on the day that you plan to eat in the restaurant."

2."You should order a half-portion meal and have fresh fruit for dessert." Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or parties. Some useful strategies include ordering a half-portion, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrees. Clients are not instructed to skip meals or increase their prescribed insulin dosage.

A home health nurse is visiting a client with type 1 diabetes mellitus. The client tells the nurse that he is not feeling well and has had a "respiratory infection" for the past week, which seems to be getting worse. After interviewing the client, what should be the initial nursing action? 1. Document the assessment data. 2.Check the client's blood glucose. 3.Notify the primary health care provider (PHCP). 4.Obtain the client's sputum for culture and sensitivity.

2.Check the client's blood glucose. Uncontrolled hyperglycemia may lead to the production of ketones, thus leading to diabetic ketoacidosis (DKA), a life-threatening condition. The most common precipitating factor for development of DKA is infection. Assessment data should be documented but are not a priority. The PHCP may need to be notified if the client's blood glucose is elevated and the client has other symptoms of DKA or a respiratory infection. After determining the client's blood glucose, the nurse should obtain a sputum sample if the client is expectorating yellow, green, or bloody secretions.

A client's laboratory results indicate the serum calcium is 12 mg/dL (3 mmol/L) and the serum phosphorous is 2.1 mg/dL (0.697 mmol/L). Based on these findings, the nurse suspects imbalance of which hormone? 1. Thyroid hormone 2.Parathyroid hormone 3.Follicle-stimulating hormone 4.Adrenocorticotropic hormone

2.Parathyroid hormone Parathyroid hormone is responsible for maintaining serum calcium and phosphorous levels within normal range. Knowledge of normal ranges for serum calcium (9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and serum phosphorous (3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]) is needed to determine that the client's calcium is elevated and phosphorus is decreased, consistent with hyperparathyroidism. Thyroid hormone is responsible for maintaining a normal metabolic rate in the body. Follicle-stimulating hormone and adrenocorticotropic hormone are produced by the anterior pituitary gland. They are responsible for growth and maturation of the ovarian follicle and stimulation of the adrenal glands, respectively.

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2.Test the drainage for glucose. 3.Obtain a culture of the drainage. 4.Continue to observe the drainage.

2.Test the drainage for glucose. After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which prescription, if noted on the record, would indicate the need for clarification? 1. Assess vital signs and neurological status. 2. Instruct the client to avoid blowing his nose. 3. Apply a loose dressing if any clear drainage is noted. 4. Instruct the client about the need for a MedicAlert bracelet.

3. Apply a loose dressing if any clear drainage is noted. The nurse should observe for clear nasal drainage; constant swallowing; and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted after this procedure, the surgeon needs to be notified. Therefore, clarification is needed regarding application of a loose dressing. The remaining options indicate appropriate postoperative interventions.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

3. Take a blood glucose test before exercising. A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtimes places the client at risk for hypoglycemia. Insulin should be administered as prescribed.

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 bestresponse to the client's question? 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."

3."It is for the times when your blood glucose is too low from too much insulin." 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 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 bestresponse to the client's question? 1. "It will boost the cells in your pancreas if you have insufficient insulin." 2."It will help to 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 to prevent lipoatrophy from the multiple insulin injections over the years."

3."It is for the times when your blood glucose is too low from too much insulin." 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 primary health care provider's 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 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 is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which statement? 1. "Your hair will need to be shaved." 2."You will receive spinal anesthesia." 3."You will need to ambulate after surgery." 4."Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4."Brushing your teeth needs to be avoided for at least 2 weeks after surgery." A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site.

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." 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.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 1. Encourage the client's expression of feelings. 2.Assess the client's understanding of the disease process. 3.Encourage family members to share their feelings about the disease process. 4.Encourage the client to recognize that the body changes need to be dealt with.

4.Encourage the client to recognize that the body changes need to be dealt with. Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

A young man with type 1 diabetes mellitus tells the nurse that he might lose his job because he has been having frequent hypoglycemic reactions. His boss thinks that he is drunk during these episodes and that he has been drinking on the job. Which action by the nurse would best assist this client to meet his needs? 1. Ask the client if he indeed has been drinking at work. 2.Ask the client what he does to treat his hypoglycemia. 3.Contact the local employment office to help him find another job. 4.Examine factors with the client that may be causing frequent hypoglycemic episodes.

4.Examine factors with the client that may be causing frequent hypoglycemic episodes. Hypoglycemic reactions present as adrenergic symptoms of tremor, shakiness, and nervousness that are comparable or alike to the signs of alcohol intoxication. The best strategy to assist the client to meet his needs is to decrease the episodes of hypoglycemia by first identifying and then eliminating those factors that precipitate this event. Asking the client if he has been drinking at work and contacting the local employment office are inappropriate. Asking the client what he does to treat his hypoglycemia is not directly related to the subject, factors that may cause frequent hypoglycemic episodes.

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 1. Edema 2.Obesity 3.Hirsutism 4.Hypotension

4.Hypotension Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea and vomiting, abdominal cramps, weight loss, depression, and irritability. The remaining options do not occur with this disease.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention should the nurse anticipate to be prescribed initially for the client? 1. Glyburide via the oral route 2.Glucagon via the subcutaneous route 3.Insulin aspart via the subcutaneous route 4.Regular insulin via the intravenous (IV) route

4.Regular insulin via the intravenous (IV) route The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus. Insulin aspart is a short-acting insulin and is not appropriate for the emergency treatment of DKA.

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) 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.

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2.Blood pressure 3.Respiratory rate 4.Urine specific gravity

4.Urine specific gravity After hypophysectomy, temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess urine specific gravity and notify the primary health care provider if the result is less than 1.005. Although the remaining options may be components of the assessment, the nurse would next assess urine specific gravity.

The nurse is caring for a client with a diagnosis of Addison's disease and is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2.Diaphoresis 3.Restlessness 4.Severe abdominal pain

4.Severe abdominal pain Addisonian crisis is a serious life-threatening response to acute adrenal insufficiency that most commonly is precipitated by a major stressor. The client in addisonian crisis may demonstrate any of the signs and symptoms of Addison's disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure. The remaining options do not identify clinical manifestations associated with addisonian crisis.

A nursing instructor is teaching the class about Addison's disease. The instructor determines that the class understands the disease process if they indicate which are affected in this disease? Select all that apply. 1. Androgens 2.Bicarbonate 3.Electrolytes 4.Glucocorticoids 5.Mineralocorticoids

1, 4, & 5 In Addison's disease, all three classes of corticosteroids are affected: glucocorticoids, mineralocorticoids, and androgens. Electrolytes and bicarbonate are not directly affected by Addison's disease.

Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply. 1. Urine specific gravity is 1.001. 2.Ketones are present in the urine. 3.Jugular venous distention is observed. 4.Serum osmolality is 320 mOsm/kg (320 mmol/kg) of water. 5.Blood glucose levels are greater than 200 mg/dL (11.4 mmol/L). 6.Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.

1, 4, & 6 Signs of diabetes insipidus include low urine specific gravity (<1.005), high serum osmolality (>300 mOsm/kg of water), and increased urine output from a deficiency of antidiuretic hormone (ADH). Options 2, 3, and 5 are not characteristic of diabetes insipidus.

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1. Thyroid 2.Pituitary 3.Parathyroid 4.Adrenal cortex

1. Thyroid The thyroid gland is responsible for a number of metabolic functions in the body. Among these are metabolism of nutrients such as fats and carbohydrates. Increased metabolic function places a demand on the cardiovascular system for a higher cardiac output. A client with increased activity of the thyroid gland will experience weight loss from the higher metabolic rate and will have an increased pulse rate. The anterior pituitary gland produces growth hormone, luteinizing hormone, and follicle-stimulating hormone. Antidiuretic hormone (ADH) and oxytocin are secreted by the posterior pituitary gland. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. The adrenal cortex is responsible for the production of glucocorticoids and mineralocorticoids.

During physical examination of a client, which finding is characteristic of hypothyroidism? 1. Periorbital edema 2.Flushed, warm skin 3.Hyperactive bowel sounds 4.Heart rate of 120 beats/min

1. Periorbital edema Because cellular edema occurs in hypothyroidism, the client's appearance is changed. Nonpitting edema occurs, especially around the eyes and in the feet and hands. Knowing this should direct you to option 1. Flushed, warm skin; hyperactive bowel sounds; and tachycardia (heart rate >100 beats/min) are clinical manifestations of hyperthyroidism, which occurs as a result of excess thyroid hormone secretion, resulting in a hypermetabolic state.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1. Polyuria 2.Diarrhea 3.Polyphagia 4.Weight gain

1. Polyuria Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis, making polyuria the correct option. The other manifestations listed are not associated with this disorder.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2.Anorexia 3.Irritability 4.Nervousness 5.Hot, dry skin 6.Muscle cramps

1. Tremors 3.Irritability 4.Nervousness Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger.

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 symptoms develop? Select all that apply. 1. Polyuria 2.Shakiness 3.Palpitations 4.Blurred vision 5.Lightheadedness 6.Fruity breath odor

2, 3, & 5 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.

A client has undergone a 2-hour oral glucose tolerance test (OGTT). Which of the listed glucose levels is compatible with diabetes mellitus at the conclusion of the test? 1. 80 mg/dL (4.57 mmol/L) 2.110 mg/dL (6.0 mmol/L) 3.130 mg/dL (7.42 mmol/L) 4.160 mg/dL (9.14 mmol/L)

4.160 mg/dL (9.14 mmol/L) The normal reference values for OGTTs are lower than 140 mg/dL (8 mmol/L) at 120 minutes; lower than 200 mg/dL (11.4 mmol/L) at 30, 60, and 90 minutes; and lower than 115 mg/dL (6.57 mmol/L) in the fasting state. A glucose level of 160 mg/dL (9.14 mmol/L) is higher than the normal reference range, so therefore it is the correct answer.

A client with diabetes mellitus has a blood glucose level of 50 mg/dL (2.85 mmol/L) and reports feeling hungry and shaky. Which should the nurse provide the client? 1. 3 oz of 2% milk 2. 4 oz of apple juice 3. 2 oz of orange juice 4.A teaspoon of granulated sugar

2. 4 oz of apple juice When a client is exhibiting symptoms of mild hypoglycemia, the nurse should provide the client with 15 g of a simple carbohydrate to quickly increase the blood glucose level. One half cup of apple juice is equivalent to 15 g of carbohydrates. The items in the remaining options do not provide a sufficient amount of carbohydrate.

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 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 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 nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 1. Skin atrophy 2.The presence of sunken eyes 3.Drooping on 1 side of the face 4.A rounded "moonlike" appearance to the face

4.A rounded "moonlike" appearance to the face With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic corticosteroid use, the person with Cushing's syndrome develops a rounded moonlike face; prominent jowls; red cheeks; and hirsutism on the upper lip, lower cheek, and chin. The remaining options are not associated with the assessment findings in Cushing's syndrome.

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement should the nurse make to the client? 1. "Don't be concerned; this problem can be covered with clothing." 2."Usually these physical changes slowly improve following treatment." 3."This is permanent, but looks are deceiving and are not that important." 4."Try not to worry about it; there are other things to be concerned about."

2."Usually these physical changes slowly improve following treatment." The client with Cushing's syndrome should be reassured that most physical changes resolve with treatment. All other options are not therapeutic responses.

A client who visits the primary health care provider's office for a routine physical examination reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations? 1. Weight loss and thinning skin 2.Complaints of weakness and lethargy 3.Diaphoresis and increased hair growth 4.Increased heart rate and respiratory rate

2.Complaints of weakness and lethargy Weakness and lethargy are common complaints associated with hypothyroidism. Other common symptoms include weight gain, bradycardia, decreased respiratory rate, dry skin, and hair loss.

After client education about the importance of sunscreen use and active vitamin production via the skin, the nurse determines that the client understands the teaching when which statement is made? 1. "Vitamin B is activated in the outer layer of the skin by the sun." 2."Vitamin E deficiency occurs from lack of exposure to sunlight." 3."Vitamin K can be depleted if exposed to excess ultraviolet light." 4."Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight."

4."Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight." Vitamin D is activated in the epidermis by ultraviolet (UV) light, such as sunlight. Once activated, it is distributed by the blood to the gastrointestinal tract to promote uptake of dietary calcium. The vitamins in the remaining options are neither activated nor depleted by UV light, such as sunlight.

The nurse in a health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the primary health care provider (PHCP). The nurse notes that the PHCP has prescribed acarbose. Which preexisting disorder, if noted in the client's record, would indicate a contraindication to the use of this medication? 1. Hypothyroidism 2.Renal insufficiency 3.Arterial insufficiency 4.Coronary artery disease

2.Renal insufficiency Acarbose is an antidiabetic medication that may be administered alone or in conjunction with another antidiabetic medication. It is contraindicated in clients with significant renal dysfunction. It also is contraindicated in clients with inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction.

A nurse is caring for a client after a thyroidectomy. Which specific emergency equipment should the nurse have available as it relates to this procedure? 1. Defibrillator 2.Tracheostomy tray 3.Dextrose 50% in water 4.Normal saline for intravenous bolus

2.Tracheostomy tray After thyroidectomy, airway obstruction, although not common, can occur. This is considered an emergency situation. If this develops, emergency management needs to occur, and oxygen, suction equipment, and a tracheostomy tray should be immediately available at the bedside. The other supplies are not necessary specifically for thyroidectomy.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2.Weight loss 3.Feeling cold 4.Loss of body hair 5.Persistent lethargy 6.Puffiness of the face

3, 4, 5, & 6 Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

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." 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.

The nurse is caring for a client admitted to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the nurse anticipates that which medication would most likely be prescribed? 1. Glucagon 2.Glyburide 3.Regular insulin 4.Neutral protamine Hagedorn (NPH) insulin

3.Regular insulin Giving regular insulin by the intravenous route is the treatment of choice for DKA. A short-acting insulin is the only insulin that can be given intravenously because it can be titrated to the client's blood glucose levels. Glucagon is used to treat hypoglycemia because it increases blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are inappropriate. NPH insulin is an intermediate-acting insulin and therefore is not appropriate for treatment of DKA.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2.Level of hoarseness 3.Respiratory distress 4.Edema at the surgical site

3.Respiratory distress Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

The client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which statement is the appropriate response by the nurse? 1. "There is no reason to worry. Your surgeon is wonderful." 2."I think you are making the right decision to have the surgery." 3."You are very ill. Your surgeon has made the correct decision." 4."You have concerns about the surgical treatment for your condition?"

4."You have concerns about the surgical treatment for your condition?" Paraphrasing is restating the client's messages in the nurse's own words. The correct option addresses the therapeutic communication technique of paraphrasing. Telling the client that there is no reason to worry is offering a false reassurance, and this type of response will block communication. Telling the client that the surgeon has made the correct decision also represents a communication block in that it reflects a lack of the client's right to an opinion. In the remaining option, the nurse is expressing approval, which can be harmful to the nurse-client relationship.

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, 5, & 6 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.

A client with type 1 diabetes mellitus is having trouble remembering the types, duration, and onset of the action of insulin. The client tells the nurse that family members have not been supportive. Which response by the nurse is best? 1. "What is it that you don't understand?" 2. "You can't always depend on your family to help." 3. "It's not really necessary for you to remember this." 4. "Let me go over the types of insulins with you again."

4. "Let me go over the types of insulins with you again." Reinforcement of knowledge and behaviors is vital to the success of the client's self-care. All of the other options do not address the need for client instructions and are not therapeutic responses.

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

4. Apply a moisturizing lotion to dry feet but not between the toes. The client is instructed to use a moisturizing lotion on the feet and avoid applying lotion between the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns. The client should be instructed to wash the feet daily with a mild soap. The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails are thick or hard to cut or if vision is poor.

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2.Administer 5% dextrose intravenously. 3.Apply a monitor for an electrocardiogram. 4.Administer short-duration insulin intravenously.

4.Administer short-duration insulin intravenously. Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.

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 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.

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. 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 monitoring a diabetic client with a blood glucose level of 400 mg/dL (22.2 mmol/L). Which clinical manifestation would indicate diabetic ketoacidosis (DKA)? 1. Bradycardia 2.Cool, clammy skin 3.Lower extremity edema 4.Rapid, deep respirations

4.Rapid, deep respirations 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. This is because the body's compensatory response to the metabolic acidosis is to increase carbon dioxide (CO2) excretion by the lungs through deep, rapid breathing (Kussmaul respirations). Options 1, 2, and 3 are incorrect, as clients with DKA are dehydrated and thus have an increased heart rate and dry, scaly skin and do not have lower extremity edema.

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 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.

A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which is most important to include in the plan of care? 1. Test urine for ketone levels. 2.Eat 6 small meals per day. 3.Monitor blood glucose levels frequently. 4.Receive appropriate follow-up health care.

3.Monitor blood glucose levels frequently. Client education after DKA should emphasize the need for home glucose monitoring 2 to 4 times per day. Instructing the client to notify the primary health care provider when illness occurs is also important. The presence of urine ketones indicates that DKA has occurred already. The client should eat well-balanced meals with snacks as prescribed.