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N326 Quiz #2

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A client feeling increasingly tired seeks medical care. Type 1 diabetes is diagnosed. What causes increased fatigue with type 1 diabetes?

Increased metabolism at the cellular level

Increased glucose absorption from the intestine

Decreased production of insulin by the pancreas

Decreased glucose secretion into the renal tubules

Decreased production of insulin by the pancreas *Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.

A nurse is collecting information about a client with type 1 diabetes who is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition?

Taking too much insulin

Getting too much exercise

Excessive emotional stress

Running a fever with the flu

Eating fewer calories than prescribed

Excessive emotional stress Running a fever with the flu * Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia).

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. What is the best response by the nurse?

"The client will gain excessive weight if sodium is not limited."

"An inadequate intake of potassium contributed to the disease."

"This type of diet increases emotional stability."

"Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium."

"Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium." *Clients with Cushing syndrome or those receiving cortical hormones must limit their intake of sodium and increase their intake of potassium, because the kidneys are retaining sodium and excreting potassium. Although sodium retention causes fluid retention and weight gain, the need for increased potassium must be considered as well. An excessive secretion of adrenocortical hormones in Cushing syndrome, not inadequate potassium intake, is the problem. This type of diet has no direct effect on the client’s emotional status.

The nurse is caring for a 70-year-old client who presents with dilute urine even when fluid intake is low. What could be the possible cause of the client’s condition?

Decreased glucose tolerance

Decreased general metabolism

Decreased ovarian production of estrogen

Decreased antidiuretic hormone production

Decreased antidiuretic hormone production *Dilute urine with decreased fluid intake indicates a decrease in antidiuretic hormone production. Decreased glucose tolerance causes elevated fasting and random blood glucose levels. The clinical manifestations of decreased general metabolism are decreased heart rate and blood pressure, decreased appetite, and decreased tolerance to cold. Decreased ovarian production of estrogen may result in decreased bone density and thin and dry skin.

Which type of drug-induced hormonal imbalance is likely to be observed in the client undergoing treatment with demeclocycline?

Acromegaly

Diabetes mellitus

Diabetes insipidus

Cushing’s syndrome

Diabetes insipidus * Drug-induced diabetic insipidus is usually caused by demeclocycline, which can interfere with the response of the kidneys to antidiuretic hormone. Demeclocycline does not cause endocrine disorders, such as acromegaly, diabetes mellitus, and Cushing’s syndrome.

What is a major nursing concern when caring for a client diagnosed with hyperthyroidism?

Monitoring for hypoglycemia

Protecting visitors and staff from radiation exposure

Providing foods to increase appetite

Arranging for sufficient rest periods

Arranging for sufficient rest periods *Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.

A nurse provides care to a client following a subtotal thyroidectomy. Which interventions should the nurse implement?

Assessing for frequent swallowing

Ambulating the client the evening of surgery

Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes

Instructing the client to support the head and maintain the neck in a flexed position

Ensuring that oxygen, suction equipment, and a tracheostomy tray are at the bedside

Assessing for frequent swallowing; ambulating the client the evening of surgery; assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes; ensuring that oxygen, suction equipment, and a tracheostomy tray are at the bedside *Frequent swallowing in the postoperative period following a subtotal thyroidectomy may indicate hemorrhage. In the absence of complications, the client should be ambulated within a few hours following surgery. Facial spasms, apprehension, and tingling of the lips, fingers, or toes are indicative of tetany. Tetany is caused by hypocalcemia, resulting from damage to, or removal of, the parathyroid glands during a thyroidectomy. Tetany is a medical emergency. Oxygen, suction equipment, and a tracheostomy tray must be kept at the bedside in case of airway edema. The bed should be placed in semi-Fowler position, and the client should avoid neck flexion to prevent tension on the suture line.

What are the most common hormones produced in excess with hyperpituitarism?

Prolactin

Growth hormone

Luteinizing hormone

Antidiuretic hormone

Melanocyte-stimulating hormone

Prolactin, growth hormone *The most common hormones produced in excess with hyperpituitarism are prolactin and growth hormone. Excessive stimulation of luteinizing hormone and antidiuretic hormone is also associated with hyperpituitarism, but less commonly than prolactin and growth hormone. Secretion of melanocyte-stimulating hormone stimulates adrenocorticotropic hormone, which indirectly stimulates the pituitary gland, thus leading to hyperpituitarism.

Which clinical manifestation occurs in a client with vasopressin deficiency?

Impotence

Hypotension

Amenorrhea

Decreased libido

Hypotension *Vasopressin regulates fluid level and blood pressure. A vasopressin deficiency causes hypotension. Impotence, amenorrhea, and decreased libido in both men and women are clinical manifestations of luteinizing and follicle-stimulating hormone deficiencies.

Which cells does the nurse identify as producing thyrocalcitonin hormone?

Islet cells

Adrenal cells

Pituitary cells

Parafollicular cells

Parafollicular cells *Parafollicular cells produce thyrocalcitonin hormone. This hormone helps in the regulation of serum calcium levels. Islet cells are responsible for the production of hormones such as insulin and glucagon. Adrenal cells are responsible for the production of hormones such as cortisol and aldosterone. Pituitary cells are responsible for the production of growth hormone, prolactin, and adrenocorticotropic hormone.

Which hormones are secreted by the posterior pituitary gland?

Oxytocin

Prolactin

Corticotropin

Antidiuretic hormone

Melanocyte-stimulating hormone

Oxytocin, ADH *Oxytocin and antidiuretic hormone (vasopressin) [1] [2] are secreted by the posterior pituitary gland. Prolactin, corticotropin, and melanocyte-stimulating hormones are secreted by the anterior pituitary gland.

Which medical condition could most probably result in clients developing primary diabetes insipidus (DI)?

Meningitis

Brain tumor

Lithium therapy

Defect in hypothalamus

Defect in hypothalamus *A defect in the hypothalamus (thirst center) could be the most probable cause of primary DI. Meningitis or a brain tumor could interfere with the synthesis, transport, or release of antidiuretic hormone (ADH) and cause central DI. Lithium therapy affects the renal response to ADH and results in nephrogenic DI, or drug-related DI.

A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not get along. It seems as though my spouse doesn’t care about my diabetes." What is the nurse’s best response?

"You don’t get along with your spouse."

"I’m sorry. What can I do to make you feel better?"

"It may be temporary because your spouse also needs time to adjust."

"You are unhappy. I wonder, have you tried to talk to your spouse?"

You’re unhappy. I wonder, have you tried to talk to your spouse *The response "You are unhappy. I wonder, have you tried to talk to your spouse?" identifies the client’s feelings and accepts them but also points out the responsibility of the client to take action. Although the response "You don’t get along with your spouse" identifies one of the client’s concerns, the identification of the underlying feeling is more therapeutic. The response "I’m sorry. What can I do to make you feel better?" makes the nurse responsible for changing the situation, which is not appropriate or therapeutic. The response "It may be temporary because your spouse also needs time to adjust" denies the client’s feelings and provides false reassurance.

A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland, and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after surgery?

Place two pillows behind the client’s head.

Monitor for the complication of tetany resulting from hypocalcemia.

Assess the sides and back of the client’s neck for evidence of bleeding.

Encourage the client to perform deep-breathing and coughing exercises.

Assess the sides and back of the client’s neck for evidence of bleeding *In a back-lying (supine) position, blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client’s head flexes the neck excessively; this increases tension on the suture line and may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Although tetany resulting from hypocalcemia may be a complication of this surgery, tetany will not occur during the first 8 hours after surgery. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours, to limit stress on the suture line.

Which disease is caused by the deficiency of antidiuretic hormone?

Acromegaly

Diabetes insipidus

Cushing’s syndrome

Syndrome of inappropriate antidiuretic hormone

Diabetes insipidus *Diabetes insipidus is caused by the deficiency of antidiuretic hormone. Acromegaly and Cushing’s syndrome are not associated with antidiuretic hormone; excessive production of growth hormone results in acromegaly and excessive production of adrenocorticotropic hormone causes Cushing’s syndrome. Syndrome of inappropriate antidiuretic hormone occurs due to increased production of antidiuretic hormone.

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia?

Use tinted glasses.

Use warm, moist compresses.

Elevate the head of the bed 45 degrees.

Tape eyelids shut at night if they do not close.

Apply a petroleum-based jelly along the lower eyelid.

Use tinted glasses, elevate the head of the bed 45 degrees, tape eyelids shut at night if they do not close. * Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly.

A client with diabetes mellitus complains of difficulty seeing. What would the nurse suspect as the causative factor?

Lack of glucose in the retina

Neovascularization of the retina

Inadequate glucose supply to rods and cones

Destructive effect of ketones on retinal metabolism

Neovascularization of the retina * With diabetes mellitus, proliferation of fragile vessels and progressive thickening of the capillary basement membranes lead to decreased retinal perfusion and to hemorrhages in the eye. Hemorrhages in the eyes precipitate retinal detachment, resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; thickening of the capillary basement membranes can occur, even if the glucose level is maintained within normal limits. Ketones do not affect retinal metabolism; retinopathy is a result of vascular changes, retinal detachment, and hemorrhage within the eye.

A nurse is caring for a client with endocrine problems. Which lab finding will alert the nurse that aldosterone will be released?

Hypokalemia

Hypoglycemia

Hyponatremia

Hypochloremia

Hyponatremia * Hyponatremia stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone.

A nurse is caring for a client with hypoglycemia. Which nursing intervention would be appropriate in managing the client’s condition?

Administering insulin

Administering glucagon

Administering IV glucose

Administering oral hydrocortisone

Administering somatostatin

Administering glucagon, IV glucose and oral hydrocortisone * A client with hypoglycemia suffers with weakness and vision disturbances due to low glucose levels. Glucagon is the hormone secreted by the pancreas that helps with increasing the blood glucose levels. Administering IV glucose would immediately improve the blood glucose levels. Hydrocortisone is a glucocorticoid that prevents hypoglycemia by increasing liver gluconeogenesis and inhibiting peripheral glucose use. Insulin is administered when glucose levels are high as it increases the glucose reuptake, thereby reducing blood glucose levels. Somatostatin is a hormone released by delta cells of the pancreas that inhibits insulin and glucagon.

A client reports backache and abnormal increase in shoe size. The primary healthcare provider prescribes 100 g of oral glucose and blood and urine samples are collected for testing. Which finding in the client indicates an abnormality?

Growth hormone level is 7 ng/mL

Growth hormone level is 3 ng/mL

Urine produced in 24 hours is 3 L

Urine produced has a specific gravity of 1.006

Growth hormone level is 7ng/ml *Growth hormone level of 7 ng/ml indicates an abnormality. An abnormal increase in shoe size and backache are indicative of hypersecretion of growth hormone. Therefore suppression testing should be performed because high glucose levels are known to suppress the release of growth hormone. After administering 100 g of oral glucose, if the client’s levels of growth hormone fail to fall below 5 ng/mL, then an abnormality in the secretion of growth hormone is considered. Growth hormone level of 3 ng/mL post-oral glucose intake is a normal result. Urine output of 3 L and specific gravity of 1.006 are normal results. The client is said to have diabetes insipidus if the urine output in 24 hours is greater than 4 L and has low specific gravity of less than 1.005.

After a surgical procedure for cancer of the pancreas with removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, what symptom exhibited by the client requires immediate attention by the nurse?

Jaundice

Indigestion

Weight loss

Hyperglycemia

Hyperglycemia *When the head of the pancreas is removed, the client has a greatly reduced number of insulin-producing cells, and hyperglycemia will occur; immediate treatment is necessary. Jaundice, indigestion, and weight loss are not immediately life threatening and will take time to develop.

The nurse is planning discharge instructions for a client who had a thyroidectomy. What signs/symptoms will the client exhibit with surgically induced hypothyroidism?

Fatigue

Dry skin

Insomnia

Excitability

Weight loss

Intolerance to heat

Fatigue, dry skin *Fatigue results from the decreased metabolic rate associated with hypothyroidism. Dry skin is caused by decreased glandular function. Insomnia is associated with hyperthyroidism because of the increased metabolic rate. Lethargy, not excitability, is associated with hypothyroidism because of the decreased metabolic rate. Weight gain, not loss, is associated with hypothyroidism because of the decreased metabolic rate. Intolerance to heat is associated with hyperthyroidism.

A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?

"I need to rub my forearm vigorously until warm before testing at this site."

"The fingertip is preferred for glucose monitoring if hyperglycemia is suspected."

"Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."

"I have to make sure that my current glucose monitor can be used at an alternative site."

The fingertip is preferred for glucose monitoring if hyperglycemia is suspected *The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected. The response "I need to rub my forearm vigorously until warm before testing at this site" will increase blood flow, which helps to minimize the difference between forearm and fingertip results, although it does not eliminate them. In a study in which rapidly fluctuating glucose levels were initiated, glucose levels at the forearm were significantly lower than samples from the fingertips. The fingertip should be used when testing before, during, and after exercising, and before driving, after eating, and during illness; the fingertip most closely reflects a current glucose level. Not all glucose monitors on the market can be used for AST.

Which adverse effect can be seen in a female client with gonadotropin deficiency and undergoing hormone replacement therapy?

Thrombosis

Hypotension

Dehydration

Increased thirst

Thrombosis *A female client with gonadotropin deficiency is treated by replacement therapy of combined hormones, namely estrogen and progesterone. The side effect of this therapy is the increased risk of thrombosis or formation of blood clots in deep veins. Hypertension is a side effect of estrogen-progesterone therapy. Dehydration and increased thirst could indicate vasopressin deficiency.

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). What measures should the nurse include to increase arterial blood flow to the extremities?

Exercises that promote muscular activity

Meticulous care of minor skin breakdown

Elevation of the legs above the level of the heart

Soaking the feet in hot water each day

Exercises that promote muscular activity *Arterial blood flow is improved with exercise by fostering the development of collateral circulation. Meticulous care of minor skin breakdown is important for the person with diabetes, but it does not improve arterial blood flow. Elevating the legs above the heart reduces arterial blood flow; the legs should be kept dependent to facilitate tissue perfusion. Soaking the feet in hot water is contraindicated because it can burn the skin or cause drying; also, individuals with diabetes may have neuropathies, which alter the perception of temperature.

After assessing a client’s condition, the nurse suspects that the client has diabetes mellitus. Which statement made by the client would be most appropriate in helping the nurse reach this conclusion?

"I am 55 years old."

"I quite often feel thirsty."

"I eat food every 2 hours."

"I have excessive sweating."

"I sometimes experience shortness of breath."

I am 55 yo, I quite often feel thirsty, and I eat food every 2 hours. *Diabetes mellitus is more common in older clients. Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism.

A nurse working in the diabetes clinic is evaluating a client’s success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease?

Reduction in excess body weight

Stabilization of the serum glucose

Demonstrated knowledge of the disease

Adherence to the prescription for insulin

Stabilization of the serum glucose *A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease.

Which nursing care should be provided to a client who has undergone unilateral adrenalectomy?

Offer a high-sodium diet.

Encourage the client to use saliva-inducing agents

Instruct the client to wear a medical alert bracelet.

Administer temporary glucocorticoid replacement therapy.

Administer temporary glucocorticoid replacement therapy *Temporary glucocorticoid replacement therapy is needed for a client who has undergone a unilateral adrenalectomy. Spironolactone therapy is used when surgery cannot be performed. A client on spironolactone therapy is advised to increase sodium intake to reduce the risk of hyponatremia. Spironolactone therapy can cause a side effect of dry mouth that can be managed by saliva-inducing agents. A client who has undergone bilateral adrenal gland removal will require lifelong replacement of glucocorticoids and should wear a medical alert bracelet as an indication.

Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis?

Urine output

Specific gravity

Urine osmolarity

Serum osmolarity

Urine osmolarity *Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus.

A nurse is monitoring a client’s laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic?

40 to 60 mg/dL (2.2 to 3.3 mmol/L)

80 to 99 mg/dL (4.5 to 5.5 mmol/L)

100 to 125 mg/dL (5.6 to 6.9 mmol/L)

126 to 140 mg/dL (7.0 to 7.8 mmol/L)

126-140mg/dL *Results in the range 126 to 140 mg/dL (7.0 to 7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2 to 3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5 to 5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. (Results in the range of 6.1 to 6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.)

The laboratory reports of a client who underwent a hypophysectomy show an intracranial pressure (ICP) of 20 mmHg. Which action made by the client is responsible for this condition?

Drinking lots of water

Eating high-fiber foods

Bending over at the waist

Bending knees when lowering body

Bending over at the waist *Bending over at the waist should be avoided as this position increases intracranial pressure in clients who underwent hypophysectomy. Drinking lots of water and eating high-fiber foods reduce the risk of constipation, so this should not cause increased intracranial pressure. The client should bend the knees then lowering their body to reduce the risk of intracranial pressure.

A registered nurse is providing information to a group of student nurses regarding the actions of parathyroid hormone (PTH). Which statement made by the student nurse indicates a need for further teaching?

"It activates vitamin D in the kidneys."

"Its secretion increases serum calcium levels."

"It allows reabsorption of phosphorus in the kidney tubules."

"It decreases serum calcium levels by increasing bone resorption."

"It regulates calcium and phosphorous metabolism by acting on the gastrointestinal tract."

"It allows reabsorption of phosphorus in the kidney tubules." "It decreases serum calcium levels by increasing bone resorption." *Parathyroid hormone (PTH) allows calcium to be reabsorbed in the kidney tubules. PTH increases bone resorption, thus increasing serum calcium levels. PTH activates vitamin D in the kidneys, which increases the absorption of calcium and phosphorous from the intestines. Secretion of PTH increases serum calcium levels. PTH regulates calcium and phosphorous metabolism by acting on the GI tract, bones, and kidneys.

Which hormone regulates blood levels of calcium?

Parathormone

Luteinizing hormone

Thyroid stimulating hormone

Adrenocorticotropic hormone

Parathyroid hormone *Parathyroid hormone (PTH), or parathormone, regulates the blood levels of calcium and phosphorus. Luteinizing hormone (LH) stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. Thyroid stimulating hormone (TSH) stimulates the release of thyroid hormones and the growth and functioning of the thyroid gland. Adrenocorticotropic hormone (ACTH) promotes the growth of the adrenal cortex and stimulates the release of corticosteroids.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering?

Estrogen

Progesterone

Human growth hormone

Human chorionic gonadotropin

Human chorionic gonadotropin *Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

The nurse is assessing a client suspected of having hypercortisolism. Which questions should the nurse ask to help confirm the diagnosis?

"Did you lose any weight unintentionally?"

"Did you notice your extremities to be thin?"

"Did you notice any roughness of your skin?"

"Did you notice any skin darkening recently?"

"Did the hair on your body become thicker?"

Did you notice your extremities to be thin? Did the hair on your body become thicker? *Clients with hypercortisolism may have thin extremities. Increased body hair also indicate hypercortisolism. Increased skin pigmentation (particularly in sun-exposed areas) indicates hypocortisolism. Unintentional weight loss is an indication for hyperthyroidism or diabetes mellitus. Skin may be rough (coarse) or leathery in clients with hypothyroidism or excess growth hormone levels.

Which term should the nurse use in a report to describe the absence of menstrual periods in a 35-year-old non-pregnant client?

Rhinorrhea

Menopause

Amenorrhea

Dyspareunia

Amenorrhea *The absence of menstrual periods in a non-pregnant client less than 55 years old is called amenorrhea. Rhinorrhea is an allergic state that is manifested by a runny nose. Menopause is cessation of menstruation after 55 years of age. Dyspareunia is pain during sexual intercourse.

A nurse is assessing the skin of a client with a cortisol deficiency. Which integumentary assessment finding will most likely be observed in this client?

Dry skin

Ulcerated skin

Generalized edema

Diminished axillary hair

Diminished axillary hair *Clients with cortisol deficiencies will have diminished axillary and pubic hair. Dry skin is associated with hypothyroidism. Ulcerated skin is a sign of peripheral neuropathy and peripheral vascular disease. Generalized edema is seen in clients with hypothyroidism due to mucopolysaccharide accumulation in the tissues.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

Ketones in the blood but not in the urine

Glucose in the urine but not hyperglycemia

Urine negative for ketones and hyperglycemia

Blood and urine positive for both glucose and ketones

Urine negative for ketones and hyperglycemia *In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.

A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client?

Chest pain

Tachycardia

Hypertension

Atrial fibrillation

Hypertension *Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.

A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. What symptom might the nurse identify when assessing this client?

Fatigue

Dry skin

Anorexia

Bradycardia

Fatigue *Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective?

Thirst

Headache

Nervousness

Fruity breath odor

Excessive urination

Thirst, fruity breath odor, excessive urination *Thirst (polydipsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a by-product of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia because of central nervous system irritation.

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which statement by the client indicates that teaching was effective?

"I should eliminate excessive blinking."

"I should not move my extraocular muscles."

"I should elevate the head of my bed at night."

"I should avoid using a sleeping mask at night.

"I should avoid using a sleeping mask at night. * The mask may irritate or scratch the eyes if the mask moves during sleep. Blinking of the eyes will bathe the eyes and prevent corneal ulceration. Not moving extraocular muscles will not relieve edema or prevent ulceration of the eyes. Although elevating the head of the bed at night will help reduce periorbital edema, it will not prevent ulceration of the cornea.

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone?

Increased blood urea nitrogen (BUN) and hypotension

Hyperkalemia and poor skin turgor

Hyponatremia and decreased urine output

Polyuria and increased specific gravity of urine

Hyponatremia and decreased urine output *Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

The registered nurse instructs the new nurse in orientation regarding the physiologic processes of the endocrine system prior to client assessment. Which statement made by the new nurse indicates effective learning?

"The endocrine system comprises glands with narrow ducts."

"The endocrine system comprises salivary and lacrimal glands."

"The hormones of the endocrine system exert their action by ‘lock and key’ mechanism."

"The hormones secreted by endocrine system exert their action on all tissues they contact."

The hormones of the endocrine system exert their action by ‘lock and key’ mechanism *The endocrine glands secrete hormones that exert their action on the target tissues by the "lock and key" mechanism. The hormones recognize and adhere only to specific receptor sites on the target tissue, like a correct key alone can open its specific lock. The glands of the endocrine system are ductless and secrete hormones that are carried via the blood circulation. Salivary and lacrimal glands are not endocrine but secretory glands. The hormones are carried via blood to various tissues, but they exert their action only on specific target tissues.

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client?

Palpitations

Tachycardia

Thickened skin

Apathetic attitude

Menstrual disturbances

Palpitations, tachycardia, menstrual disturbances *Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema.

Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching is needed?

"I can eat as much dietetic fruit as I want."

"I can have a lettuce salad whenever I want it."

"I know that half of my diet should be carbohydrates."

"I need to reduce the amounts of saturated fats in my diet."

I can eat as much dietetic fruit as I want. *The client needs further teaching; dietetic fruit is not sugar-free and must be calculated in a diabetic individual’s diet. Lettuce is considered a free food in the diet of a diabetic person. It is suggested that the caloric intake of a diabetic person’s diet should be 50% carbohydrate, 20% protein, and 30% fat. Saturated fats should be limited to 10% of the fat intake; 90% of fat should be unsaturated fats.

A nurse is caring for a client with hypothyroidism. Which clinical manifestations should the nurse anticipate when assessing this client? .

Dry skin

Brittle hair

Weight loss

Resting tremors

Heat intolerance

dry skin, brittle hair *Dry skin results from a decrease in the metabolic rate, which is associated with hypothyroidism. Dry, brittle hair results from a decrease in the metabolic rate, which is associated with hypothyroidism. Weight loss is associated with hyperthyroidism because of an increase in body metabolism. Resting tremors are not associated with hypothyroidism; they are associated with Parkinson’s disease. Heat intolerance is associated with hyperthyroidism, not hypothyroidism, because of the increase in body metabolism.

Which physiologic responses should a nurse expect when assessing a client with hyperthyroidism?

Bradycardia

Blurred vision

Cold intolerance

Increased appetite

Widened pulse pressure

Blurred vision, increased appetite, widened pulse pressure *Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate.

While caring for a client receiving fludrocortisone, the nurse suspects that the drug has caused a negative side effect. Which finding supports the nurse’s conclusion?

Body temperature of 37˚C (98.6˚F)

Blood glucose of 100 mg/dL (5.5 mmol/L)

Serum sodium of 137 mEq/L (137 mmol/L)

Blood pressure of 150/90 mm Hg

Blood pressure of 150/90 mm Hg *The use of fludrocortisone is associated with hypertension as a side effect. The normal blood pressure of a healthy individual is 120/90 mm Hg. Therefore a blood pressure of 150/90 mm Hg supports the nurse’s suspicion. The normal body temperature is 37°C (98.6°F). A blood glucose level of 100 mg/dL (5.5 mmol/L) is a normal finding; blood glucose levels should be less than 110 mg/dL (6.1 mmol/L). The normal serum sodium concentration ranges from 135 to 145 mEq/L (135 mmol/L).

A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the problem, what is the nurse’s response?

Caution the client about high expectations because the prognosis is variable; the outcome depends on many factors.

Tell the client that returning to work is okay because the body has two adrenal glands; the tumor was on just one of the glands.

Advise the client to investigate other occupational alternatives if the client wishes to stay in the workforce.

Tell the client that returning to work is possible if the client takes prescribed hormone supplements.

Tell the client that returning to work is okay because the body has two adrenal glands; the tumor was on just one of the glands. *The body has two adrenal glands; an aldosteronoma is a unilateral tumor. The prognosis usually is excellent; cautioning the client about high expectations because the outcome is variable is unnecessarily alarming. Advising the client to investigate other occupational alternatives if planning to return to work is unnecessary; the prognosis usually is excellent. Hormones are not necessary; there is another adrenal gland that will secrete an adequate amount of hormones.

Which organ has only beta 1-receptors?

Liver

Heart

Bladder

Pancreas

The heart has only beta 1 receptors, which increase heart rate and contractility. The liver has only alpha receptors. The bladder and pancreas have both alpha and beta receptors.

A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client’s clinical manifestations?

Fluid balance

Electrolyte levels

Protein anabolism

Masculinizing hormones

Protein anabolism *Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.

The nurse is caring for a client immediately after a subtotal thyroidectomy. How will the nurse assess for unilateral injury of the laryngeal nerve?

Checking the throat for edema

Asking the client to say what the current time is

Eliciting spasms of the facial muscles

Palpating the neck for seepage of blood

Asking the client to say what the current time is *If the laryngeal nerve is damaged during surgery, the client will be hoarse and have difficulty speaking. Checking the throat for edema does not indicate injury to the laryngeal nerve; this is part of the assessment for a compromised airway. Eliciting the Chvostek sign assesses for hypocalcemia resulting from inadvertent removal of the parathyroid glands. Palpating the neck for seepage of blood assesses for bleeding and possible hemorrhage, not laryngeal nerve injury.

The nurse is caring for a client who is prescribed desmopressin acetate. What is the expected outcome in the client?

Sodium: 136mEq/L

Specific gravity: 1.005

Urine output: 3 L/day

Osmolarity: 100 mOsm/kg

Urine output: 3L/day *Desmopressin acetate is used for the treatment of diabetes insipidus, a disease associated with urine output of more than 4 L/day. The amount of urine output should decrease when the client is treated with desmopressin acetate. Sodium levels may not be altered in a client taking medication for diabetes insipidus. The specific gravity in a client under medication for diabetes insipidus should be more than 1.005. Osmolarity between 50 to 200 mOsm/kg indicates that the client has diabetes insipidus and is not an outcome of desmopressin acetate treatment

Late in the postoperative period after resection of an aldosterone-secreting adenoma, what would the nurse expect the client’s blood pressure to do?

Gradually return to near normal levels

Rise quickly above the preoperative level

Fluctuate greatly during this entire period

Drop very low, then increase rapidly to normal levels

Gradually return to near normal levels *Once the excessive secretion of aldosterone is stopped, the blood pressure gradually drops to a near normal level. The blood pressure drops gradually; it does not rise. Blood pressure will fluctuate if the hypervolemia is overcorrected; this is not expected. The blood pressure drops gradually in response to decreasing serum corticosteroid levels; a rapid drop immediately after surgery may indicate hemorrhage.

An 11-year-old client is admitted with enlarged supraclavicular lymph nodes, fatigue, and low-grade fever. She also has a persistent nonproductive cough. In light of these findings, the nurse knows to gear education toward preparation for which therapies?

Intravenous (IV) fluids and nutritional therapy

Bloodwork and oxygenation therapy

IV fluids and antibiotic therapy

Computed tomography (CT) and lymph node biopsy

CT and lymph node biopsy *The symptoms indicate possible Hodgkin lymphoma, so diagnostic testing will likely include CT and a lymph node biopsy. IV fluids, antibiotic therapy, oxygenation therapy, and nutritional therapy are not requirements at this point in treatment.

The laboratory report of a pregnant client shows increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels. What should the primary healthcare provider instruct the nurse to include in the plan of care for the client to help to reduce the risk of death in the client?

Monitoring weight

Administering mifepristone

Monitoring fluid overload at every 6 hours

Including 5 g of sodium in the diet everyday

Monitoring weight *The increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels indicate pituitary Cushing’s syndrome. In pituitary Cushing’s syndrome, prevention of fluid overload is very important as it can cause pulmonary edema, which may result in death. The easiest way to monitor fluid overload is monitoring the weight of the client. Each 1 lb (about 500 g) of weight gained is equal to 500 mL of retained water. The weight should be taken at the same time daily before breakfast using the same scale. Mifepristone is effective for the treatment of pituitary Cushing’s syndrome, but should not be prescribed to a pregnant client because it can cause miscarriage. Signs of fluid overload should be monitored every 2 hours. In pituitary Cushing’s syndrome, the client has elevated levels of sodium. Therefore, the client should be restricted to a 2- to 4-g/day sodium diet.

The nurse is caring for a client who is diagnosed with diabetes insipidus and is on intranasal desmopressin acetate (DDAVP). The client develops an upper respiratory tract infection during a hospital stay. Which alteration does the nurse anticipate in the client’s prescription?

Cessation of DDAVP administration

Reduced DDAVP dose via oral route

Reduced DDAVP dose via subcutaneous route

Continuation of DDAVP administration via nasal route

Reduced DDAVP SQ route *The client develops an upper respiratory tract infection while on desmopressin acetate (DDAVP) therapy for diabetes insipidus. Therefore the best alternative is to administer the DDAVP via oral or subcutaneous routes. The subcutaneous (parenteral) form of DDAVP is almost 10 times more potent than intranasal and oral forms. Therefore, if opting for subcutaneous route, the dose of DDAVP should be reduced. The DDAVP cannot be stopped as it can lead to uncontrolled fluid loss. The DDAVP can be continued in the prescribed dose if opting for oral route, but it does not need to be reduced. The DDAVP cannot be administered via nasal route because the client has developed an upper respiratory tract infection.

During the progressive stage of shock, anaerobic metabolism occurs. Which complication should the nurse anticipate in this client?

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis *Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid associated with the progressive stage of shock. Respiratory acidosis can result from decreased respiratory function in late shock, further compounding metabolic acidosis. Respiratory alkalosis occurs as a result of hyperventilation during early shock.

Which statement regarding calcitonin is correct?

It is secreted by follicular cells.

Its actions are opposite to that of parathyroid hormone.

It decreases phosphorous levels by increasing bone resorption.

It works along with thyroid hormone to maintain normal calcium levels in blood.

Its actions are opposite to that of parathyroid hormone *Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels. Therefore, the actions of calcitonin are opposite to that of parathyroid hormone. Calcitonin is secreted by parafollicular cells of the thyroid gland. Calcitonin decreases calcium and phosphorus levels by decreasing bone resorption. Calcitonin works along with parathyroid hormone to maintain calcium levels in blood.

Which hormone secretion does the nurse state is an example of a positive feedback mechanism?

Insulin

Estradiol

Parathormone

Catecholamines

Estradiol *Estradiol secretion pattern is an example of a positive feedback mechanism. Insulin secretion pattern is an example of a negative feedback mechanism. The relationship between calcium and parathormone is also an example of a negative feedback mechanism. Catecholamines secretion is controlled by the nervous system. It is secreted by the sympathetic nervous system.

The primary healthcare provider instructs the client to increase their intake of seafood and protein in the diet. What could be the reason for this instruction?

The client has vitiligo.

The client has hypothyroidism.

The client has diabetes mellitus.

The client has a urinary infection.

Hypothyroidism *Nutritional deficiencies due to inadequate diet, especially decreases in protein and iodine intake, may be a cause for certain endocrine disorders, such as hypothyroidism. Therefore, to meet nutritional requirements clients with hypothyroidism are instructed to increase the intake of seafood and proteins to 60 mg/day. Because of hypofunction of the adrenal gland, clients with skin pigmentation conditions, such as vitiligo, are mainly instructed to consume more water. To improve metabolism, clients with diabetes mellitus are advised to add high-fiber food to their diet. A client with a urinary infection may not be advised to add seafood and proteins to their diet.

A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T 3) and thyroxine (T 4)?

Irritability

Tachycardia

Weight gain

Cold intolerance

Profuse diaphoresis

Weight gain, cold intolerance *A decrease in metabolism will result in a gain in weight. Decreased production of thyroid hormones lowers metabolism, which leads to decreased heat production and cold intolerance. Lethargy, rather than irritability, is expected. Decreased metabolism requires less oxygen, so the pulse rate is generally slower. The skin is dry and coarse, not moist.

The nurse is caring for a client with hyperplasia of pituitary tissue. What would be the most appropriate goals of management?

To alleviate headache

To replace lost sodium

To eliminate visual disturbances

To check the urine specific gravity

To return hormone levels to normal

To alleviate headache, eliminate visual disturbances, return to hormone levels to normal *A client with hyperplasia of pituitary tissue (tissue overgrowth) will have oversecretion of pituitary hormones resulting in hyperpituitarism. The client with hyperpituitarism will experience headaches and changes in vision, thus the goal of management should be to have normal pituitary hormone levels. Replacement of lost sodium is important if the client has syndrome of inappropriate antidiuretic hormone secretion. The specific gravity of urine may be low in certain conditions such as hyperaldosteronism.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome?

Lability of mood

Slow wound healing

A decrease in the growth of hair

Ectomorphism with a moon face

An increased resistance to bruising

Lability of mood, slow wound healing *Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas.

Which drug acts as an abortifacient in female clients?

Mifepristone

Metyrapone

Cyproheptadine

Aminoglutethimide

Mifepristone *Mifepristone is an antiprogesterone that blocks the progesterone receptors and acts as an abortifacient. Metyrapone, cyproheptadine, and aminoglutethimide are used to treat hyperfunctioning of the adrenal glands (Cushing’s disease/syndrome).

A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion?

Nervousness and tachycardia

Erythema toxicum rash and pruritus

Diaphoresis and altered mental state

Deep respirations and fruity odor to the breath

Deep respirations and fruity odor to the breath *Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system’s attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.

A client who is 60 pounds (27.2 kilograms) more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight?

Obesity leads to insulin resistance.

Surplus fat causes excretion of insulin.

Fat cells absorb insulin and prevent its circulation to other cells.

Lipids accumulate in the pancreas and interfere with insulin production.

Obesity leads to insulin resistance *Excess fat alters glucose metabolism, causing cells to become insulin resistant. Fat cells have no relationship to the function of the kidneys. Fat cells do not absorb insulin and therefore do not prevent the circulation of insulin to other cells. Clients with type 1 diabetes do not produce insulin. If lipids should accumulate in the pancreas of a healthy adult, they do not interfere with insulin production.

What should the nurse do when collecting a 24-hour urine specimen?

Check to verify whether a preservative is needed

Weigh the client before starting the collection

Discard the last voided specimen of the 24-hour period

Assess the client’s intake and output (I & O) for the previous 24-hour period

Check to verify whether a preservative is needed *Depending on the purpose of the collection, a preservative to prevent breakdown of the specimen may be necessary. Weighing the client is not necessary. The last specimen should be collected as close as possible to the end of the 24-hour period and added to the urine collected. Collecting urine for the next 24 hours, and not checking the intake and output for the previous 24 hours, is important.

A registered nurse is teaching the student nurse about drugs used to treat hyponatremia in hospitalized clients. Which statement made by the student nurse indicates an effective learning?

"Tolvaptan is given intravenously."

"Tolvaptan used for more than 30 days causes liver failure."

"These drugs promote water retention with no sodium loss."

"Conivaptan use should be stopped when the serum sodium levels increase more than 12 mEq/L in 24 hours."

Tolvaptan used for more than 30 days causes liver failure *Tolvaptan is a vasopressin antagonist which is given orally. When used at higher doses or for longer than 30 days, tolvaptan may cause liver failure and death. Tolvaptan and conivaptan are drugs that promote water excretion without causing sodium loss. Tolvaptan has a black box warning that rapid increases in serum sodium levels of greater than 12 mEq/L in 24 hours may be associated with central nervous system demyelination and can lead to serious complications and death.

When obtaining the history of a client recently diagnosed with type 1 diabetes, what will the nurse expect to discover?

Edema

Anorexia

Weight loss

Hypoglycemic episodes

weight loss *Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.

A client who has hypofunction of the adrenal gland is prescribed oral hydrocortisone. Which clinical finding indicates the need for dosage adjustment in the client?

Fever

Fluid retention

Severe diarrhea

Rapid weight gain

Increase in blood pressure

Fluid retention, rapid weight gain *Clients taking hydrocortisone medication may experience fluid retention, rapid weight gain, and "round face," which are the characteristic features of Cushing’s syndrome and indicates a need for dosage adjustment. This is mainly due to hyperfunction of the adrenal gland caused by the medication. Fever and severe diarrhea are seen in clients prescribed with prednisone. Increased blood pressure is the side effect of fludrocortisone.

The nurse is assessing a client who reports frequent urination. Which inquiry made by the nurse will help determine diabetes insipidus?

"Do you have history of cancer?"

"Are you on fluoroquinolone therapy?"

"Are you on lithium carbonate therapy?"

"Do you have a history of lymphoma?

Are you on lithium carbonate therapy *Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Therefore enquiring about lithium carbonate therapy can help assess for diabetes insipidus, which has a clinical manifestation of frequent urination. Inquiry about history of cancer helps in assessing syndrome of inappropriate antidiuretic hormone (SIADH) because some cancer therapy drugs result in SIADH. Treatment with fluoroquinolone antibiotics also can result in SIADH. Hodgkin’s and Non-Hodgkin’s lymphoma are causes of SIADH.

The nurse is caring for a client with type 1 diabetes who is developing ketoacidosis. Which arterial blood gas report is indicative of diabetic ketoacidosis?

PCO 2: 49, HCO 3: 32, pH: 7.50

PCO 2: 26, HCO 3: 20, pH: 7.52

PCO 2: 54, HCO 3: 28, pH: 7.30

PCO 2: 28, HCO 3: 18, pH: 7.28

PCO 2: 28, HCO 3: 18, pH: 7.28 * Decreased pH and bicarbonate values reflect metabolic acidosis; a decreased PCO 2 value indicates compensatory hyperventilation. Increased pH and bicarbonate values reflect metabolic alkalosis; an increased PCO 2 value indicates compensatory hypoventilation. Increased pH and decreased PCO 2 values reflect hyperventilation and respiratory alkalosis. Decreased pH and increased PCO 2 values reflect hypoventilation and respiratory acidosis.

What clinical indicators should a nurse assess when caring for a client with hyperthyroidism?

Dry skin

Weight loss

Tachycardia

Restlessness

Constipation

Exophthalmos

Weight loss, tachycardia, restlessness, exophthalmos *Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.

What should a nurse do immediately when a client returns from the postanesthesia care unit following a subtotal thyroidectomy?

Inspect the incision.

Instruct the client not to speak.

Place a tracheostomy set at the bedside.

Place in the supine position for 24 hours.

Place a tracheostomy set at the bedside *Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause an airway obstruction. A patent airway takes priority over incision inspection. Speaking is important to determine the status of the laryngeal nerve. The semi-Fowler position is indicated to maximize respiratory excursion.

Which carcinoma is the most common type of thyroid cancer and is most often found in younger women?

Papillary carcinoma

Follicular carcinoma

Medullary carcinoma

Anaplastic carcinoma

Papillary carcinoma *Papillary carcinoma is the most common type of thyroid cancer; it is most often seen in younger women. Follicular carcinoma occurs most often in older adults. Medullary carcinoma is seen mostly in clients older than 50 years. Anaplastic carcinoma is a rapid-growing, aggressive tumor.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

Diabetes insipidus

Adrenal Cushing’s syndrome

Pituitary Cushing’s syndrome

Syndrome of inappropriate antidiuretic hormone

Pituitary Cushing’s syndrome *In pituitary Cushing’s syndrome, urine cortisol and serum adrenocorticotropic hormone levels are raised. Diabetes insipidus is the result of decreased levels of antidiuretic hormone and is not associated with cortisol and ACTH levels. Adrenal Cushing’s syndrome is caused by chronic steroid use, so the client will have increased urine cortisol and decreased ACTH levels. Syndrome of inappropriate antidiuretic hormone is the result of elevated levels of antidiuretic hormone and is not related with the ACTH and cortisol levels.

A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion?

Headache

Confusion

Extreme thirst

Profuse sweating

Increased urination

Headache, confusion, profuse sweating *Neurologic responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. Thirst (polydipsia) is a classic symptom of hyperglycemia. Increased urination (polyuria) is a classic sign of hyperglycemia.

The laboratory report of a client reveals increased serum cholesterol levels. Which other finding indicates growth hormone deficiency in the client?

Scalp alopecia

Intolerance to cold

Pathological fractures

Increased urine output

Pathological fractures Growth hormone deficiency results in thinning of bones and increases the risk for pathological fractures. Thyrotropin deficiency results in scalp alopecia and intolerance to cold. Marked increase in the volume of urine output is a sign of diabetes insipidus caused by vasopressin deficiency.

The nurse is caring for a client in labor whose medical report states posterior pituitary hormone deficiency. Which medication administration is required for the client considering the medical condition?

Oxytocin to promote uterine contractions

Prolactin to promote breast milk ejection

Luteinizing hormone to promote painless labor

Follicle-stimulating hormone to promote estrogen secretion

Oxytocin to promote uterine contractions Oxytocin is a posterior pituitary hormone that acts on the uterus to stimulate uterine contractions. Therefore the nurse should administer oxytocin to the client. Prolactin is an anterior pituitary hormone that promotes breast milk production, not milk ejection. Luteinizing hormone is an anterior pituitary hormone that stimulates progesterone secretion and ovulation and does not promote painless labor. Follicle-stimulating hormone is secreted by the anterior pituitary and is involved in estrogen secretion and follicle maturation

A nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

Free thyroxine (FT 4)

Thyroxine (T 4), total

Free triiodothyronine (FT 3)

Triiodothyronine (T 3), total

T4, total The thyroxine (T 4) total study is the best method of monitoring thyroid therapy. A free thyroxine (FT 4) study measures the active component of total T 4; this test is an indicator of thyroid function. Free triiodothyronine (FT 3) measures the active component of triiodothyronine (T 3) total. Total T 3 helps to diagnose hyperthyroidism when T 4 levels are normal.

The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention?

Intravenous administration of regular insulin

Administer insulin glargine subcutaneously at hour of sleep

Maintain nothing prescribed orally (NPO) status

Intravenous administration of 10% dextrose

IV administration of regular insulin A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client’s blood glucose.

Which action by the nurse while administering human growth hormone ensures effective therapy?

Administration at nighttime

Administration via oral route

Administration along with meals

Administration by metered spray

Administration at nighttime Human growth hormone therapy shows best results when the hormone is administered at nighttime because the body naturally produces growth hormone at night. Therefore the normal body rhythm is being mimicked to ensure effective therapy. Subcutaneous injections of growth hormone yield effective results. Hyperpituitarism is treated by the administration of bromocriptine, which should be taken along with food to reduce side effects. Desmopressin acetate is administered either orally or intranasally with a metered spray to treat diabetes insipidus.

The nurse is assisting the primary healthcare provider, who is examining the client’s skull radiograph. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is suspected. Which hormone release is most probably affected?

Glucagon

Cortisol

Aldosterone

Corticotropin

Corticotropin The pituitary gland is the endocrine gland that is situated in a bony depression of the sphenoid bone. Corticotropin or adrenocorticotropic hormones are secreted by the anterior pituitary and could be affected by an abnormality in the pituitary. Glucagon is a hormone that is secreted by the pancreas. Cortisol and aldosterone are hormones secreted by the adrenal cortex. There is less likelihood that the release of glucagon, cortisol, or aldosterone might be affected by a suspected abnormality in the pituitary gland.

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?

"Eat your usual breakfast."

"Have clear liquids for breakfast."

"Take your medication before the test."

"Do not ingest anything before the test."

"Do not ingest anything before the test." Fasting before the test is indicated for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients. Food should not be ingested before the test; food will increase the serum glucose level, negating accuracy of the test. Instructing the client to have clear liquids for breakfast is inappropriate; some clear fluids contain simple carbohydrates, which will increase the serum glucose level. Medications are withheld before the test because of their influence on the serum glucose level.

The nurse is caring for the client posttranssphenoidal hypophysectomy. When assessing the client, the nurse observes clear drainage from the nares. What could be the cause of this drainage?

A cerebral spinal fluid leak from an opening to the brain.

A normal occurrence for this client’s procedure.

The client is developing an infection.

The client may have had a cold preoperatively, and the nurse will continue to monitor.

A cerebral spinal fluid leak from an opening to the brain. Transsphenoidal hypophysectomy is removal of the pituitary gland. This procedure is close to the brain. Clear drainage from the nares could indicate a cerebral spinal fluid (CSF) leak. The nurse should contact the primary healthcare provider and send the drainage to the laboratory for glucose evaluation. If the glucose level is greater than 30 mg/dL, this would indicate a CSF leak. This is not a normal occurrence postoperatively for this procedure. Clear drainage would not indicate an infection.

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. What is the nurse’s most appropriate action?

Administer insulin to the client

Give the client lunch immediately

Encourage the client to drink fluids

Assess the client’s blood glucose level

Assess the client’s blood glucose level The client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within four hours or just before lunchtime. After hypoglycemia is verified, the client should be given an immediate source of glucose. Administering insulin is contraindicated; the client is experiencing adaptations of hypoglycemia, and administering insulin will decrease further an already low blood glucose level. Giving the client lunch may be done after hypoglycemia is determined.

A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse’s primary responsibility two days after surgery when preparing the client to eat dinner?

Checking the client’s serum glucose level

Assisting the client out of bed into a chair

Placing the client in the high-Fowler position

Ensuring the client’s residual limb is elevated

Checking the client’s serum glucose level Because the client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. To prevent flexion contractures of the hip, the client should not sit for a prolonged time; this is not the priority. Raising the head of the bed flexes the hips, which may result in hip flexion contractures; this is not the priority. Ensuring the client’s residual limb is elevated may result in a hip flexion contracture and should be avoided.

The nurse is caring for a client who is diagnosed with hyperpituitarism due to a prolactin-secreting tumor. Which clinical manifestation can help confirm the diagnosis?

Hypertrophy of skin

Enlargement of liver

Hypertrophy of the heart

Absence of menstruation

Absence of menstruation A prolactin-secreting tumor is a common type of pituitary adenoma that results from excessive secretion of prolactin. Therefore, ultimately, there are associated clinical symptoms, such as absence of galactorrhea and menstruation and infertility. Excessive production of growth hormone is manifested by clinical symptoms, such as skin hypertrophy and enlargement of organs (e.g., liver and heart).

The primary healthcare provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. What is the goal of treatment with glucose levels for this client?

40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood

70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood

110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood

150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood

70-105 The range of 70 to 105 mg/dL (4 to 6 mmol/L) of blood is the expected range for . The range of 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood is indicative of hypoglycemia. The ranges 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood and 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood are indicative of hypoglycemia.

Which statement made by a diabetic client shows that dietary teaching by the nurse was effective?

"My diet should be rigidly controlled to avoid emergencies."

"My diet can be planned around a wide variety of commonly used foods."

"My diet is based on nutritional requirements that are the same for all people."

"My diet must not include eating any combination dishes and processed foods."

My diet can be planned around a wide variety of commonly used foods Each client should be given an individually devised diet consisting of commonly used foods from the American Diabetic Association (Canadian Diabetes Association) diet; family members should be included in the diet teaching. Rigid diets are difficult to follow; appropriate substitutions are permitted. Nutritional requirements are different for each individual and depend on many factors, such as activity level, degree of compliance, and physical status. Combination dishes and processed foods can be eaten when accounted for in the dietary regimen.

An older adult with a history of small cell lung carcinoma reports muscle cramping, thirst, and fatigue. The primary healthcare provider diagnoses the client with a pituitary disorder and is treating the client accordingly. Which is an effective outcome of the treatment?

Urine output of 10 L/day

Urine specific gravity less than 1.025

Urine osmolarity of 80 mOsm/kg (80 mmol/kg)

Serum osmolarity of 600 mOsm/kg (600 mmol/kg)

Urine specific gravity less than 1.025 Because the specific gravity is less than 1.025 after treatment, the outcome is considered positive. In syndrome of inappropriate antidiuretic hormone (SIADH), the specific gravity is greater than 1.025. Small cell lung cancer is a risk factor of SIADH. Muscle cramping, thirst, and fatigue are clinical manifestations of SIADH. A serum osmolarity of 600 mOsm/kg indicates central diabetes insipidus. A urine output 10 L/day and a urine osmolarity of 80 mOsm/kg indicate diabetes insipidus.

A nurse is reviewing a client’s history and finds images showing progressive development of facial changes due to acromegaly. Which diagnostic study would have confirmed this diagnosis?

Somatotropin

Radioactive iodine uptake

Insulin-like growth factor 1 (IGF-1)

Adrenocorticotropic hormone (ACTH)

Insulin-like growth factor 1 (IGF-1) T Acromegaly, a condition which causes progressive facial changes, is associated with increased levels of growth hormone (GH). This is diagnosed by evaluating plasma insulin-like growth factor 1 (IGF-1) levels. Somatotropin also evaluates the GH levels, but the significance of isolated GH levels is difficult to interpret and is not as reliable as IGF-1. Radioactive iodine uptake is for thyroid conditions. ACTH is associated with Cushing syndrome or Addison’s disease.

A nurse is caring for a client admitted to the hospital with a diagnosis of Addison disease. The nurse should assess the client for what signs related to this disorder?

Diarrhea and pyrexia

Edema and hypertension

Moon face and hirsutism

Hypoglycemia and hypotension

Hypoglycemia and hypotension Adrenocortical insufficiency causes decreased glucocorticoids, resulting in hypoglycemia; also, it causes decreased aldosterone, resulting in fluid excretion that leads to hypotension. Although diarrhea can occur initially with steroid replacement, it should subside; pyrexia will occur only if there is a concomitant infection. Edema and hypertension are not related to Addison disease; they are associated with Cushing disease, because of excessive cortisol and aldosterone, resulting in fluid and sodium retention. Moon face and hirsutism are related to Cushing disease, not Addison disease; moon facies is caused by adipose tissue deposition, and hirsutism is caused by excessive androgen secretion.

A nurse is teaching a client with diabetes about the treatment of hypoglycemia. The nurse knows that teaching was effective if the client picks which foods to treat a hypoglycemic attack?

Fruit juice and a lollipop.

Sugar and a slice of bread.

Chocolate candy and a banana.

Peanut butter crackers and a glass of milk.

Sugar and a slice of bread The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response. Fruit juice and a lollipop are fast-acting sugars, and neither of them will provide a sustained response. The fat content of chocolate candy decreases the rate of absorption of glucose. Neither peanut butter crackers nor a glass of milk is a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised.

What other name can the nurse use for vasopressin?

Growth hormone

Luteinizing hormone

Antidiuretic hormone

Thyroid-stimulating hormone

ADH Antidiuretic hormone is also called vasopressin. Growth hormone can be called somatotropin. Luteinizing hormone is a gonadotropin. Thyroid-stimulating hormone can be called thyrotropin.

A nurse is caring for a client with type 1 diabetes who is experiencing a fluid imbalance. Which fluid shift associated with diabetes should the nurse take into consideration when assessing this client?

Intravascular to interstitial as a result of glycosuria

Extracellular to interstitial as a result of hypoproteinemia

Intracellular to intravascular as a result of hyperosmolarity

Intercellular to intravascular as a result of increased hydrostatic pressure

Intracellular to intravascular as a result of hyperosmolarity The osmotic effect of hyperglycemia pulls fluid from the cells, resulting in cellular dehydration. Hyperglycemia pulls fluid from the interstitial compartment to the intravascular compartment. Interstitial fluid is part of the extracellular compartment; the osmotic pull of glucose exceeds that of other osmotic forces. An increase in hydrostatic pressure results in an intravascular-to-interstitial shift.

After a head injury, a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider before assessing the patient about the response to secretion of ADH?

Serum osmolarity increases

Urine concentration decreases

Glomerular filtration decreases

Tubular reabsorption of water increases

Tubular reabsorption of water increases Reabsorption of sodium and water in the kidney tubules decreases urinary output and retains body fluids. There is no effect on filtration with ADH; ADH increases reabsorption in the tubules. The opposite is true of serum osmolarity increase, urine concentration decrease, and tubular reabsorption of water increase.

A nurse is caring for a client with endocrine problems. Which lab finding will alert the nurse that aldosterone will be released?

Hypokalemia

Hypoglycemia

Hyponatremia

Hypochloremia

Hyponatremia Hyponatremia stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone.

Which statement does the nurse know is true regarding the effects of parathyroid hormone on bones for the maintenance of calcium balance?

Increases bicarbonate and sodium excretion

Enhances absorption of calcium and phosphorous

Increases reabsorption of calcium and magnesium

Increases net release of calcium into extracellular fluid

Increases net release of Ca into extracellular fluid Parathyroid hormone affects target tissues such as bone, kidney, and the gastrointestinal tract. The effects of parathyroid hormone on bones will be associated with the increase in the net release of calcium into extracellular fluid. Kidneys are responsible for increasing the bicarbonate and sodium excretion from the body. Action of parathyroid hormone on the gastrointestinal tract would show effects such as enhanced absorption of calcium and phosphorous. Kidneys are responsible for increased reabsorption of calcium and magnesium.

One week after beginning antithyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis. What is the most important intervention to implement for this client?

Limiting fluid intake

Reducing body temperature and heart rate

Observing for an exaggerated response to sedatives

Treating the associated hyperglycemia and ketoacidosis

Reducing body temperature and heart rate Immediate treatment in this emergency focuses on reduction of oxygen demands and thus cardiac workload to prevent cardiac decompensation. The need is for an increase, not decrease, in fluid intake to compensate for that loss because of the high metabolic rate. A response to sedatives is not likely because drugs are metabolized more rapidly with thyrotoxic crisis; there is a danger of exaggerated effects of the drug with hypothyroidism. Clients with thyrotoxic crisis are more apt to develop hypoglycemia from the high metabolic rate.

The nurse is assessing a client admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these are signs of Cushing disease?

Round face

Dependent edema in the feet and ankles

Increased fatty deposition in the extremities

Thin, translucent skin with bruising

Increased fatty deposition in the neck and back

round face, dependent edema in feet & ankles, thin translucent skin with bruising, increased fatty deposition in the neck and back

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations?

Irritability, polydipsia, and polyuria

Polyuria, polydipsia, and polyphagia

Nocturia, weight loss, and polydipsia

Polyphagia, polyuria, and diaphoresis

Polyuria, polydipsia, and polyphagia

Which hormone levels peak during the client’s sleep?

Cortisol, thyrotropin, and growth hormone levels peak during sleep.

A nurse is caring for a client with myxedema who has undergone abdominal surgery. What should the nurse consider when administering opioids to this client?

Tolerance to the drug develops readily.

One-third to one-half the usual dose should be prescribed.

Opioids may interfere with the secretion of thyroid hormones.

Sedation will have a paradoxical effect, causing hyperactivity.

One-third to one-half the usual dose should be prescribed. Because of a decreased metabolism, the usual adult dose of an opioid may result in an overdose. A decreased basal metabolic rate prolongs the time for drug detoxification and elimination. Hypothyroidism does not alter tolerance. Opioids do not alter the thyroid hormone; opioids will cause excessive sedation, not hyperactivity.

Which glands secrete hormones that regulate metabolism of carbohydrates, proteins, and fats?

Pancreas

Thyroid gland

Adrenal cortex

Adrenal medulla

Parathyroid gland

pancreas, thyroid gland, adrenal cortex The pancreas secretes insulin and glucagon, which affects the body’s metabolism of carbohydrates, proteins, and fats. The thyroid gland secretes thyroid hormones T 3 and T 4 that regulate carbohydrates, proteins, and fat metabolism. Cortisol is a glucocorticoid secreted by the adrenal cortex that affects carbohydrates, proteins, and fat metabolism. Adrenal medulla secretes catecholamines, which do not affect metabolism of carbohydrates, proteins, and fats. Hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism.

Which physiologic responses should a nurse expect when assessing a client with hyperthyroidism?

Bradycardia

Blurred vision

Cold intolerance

Increased appetite

Widened pulse pressure

blurred vision, increased appetite, widen pulse pressure Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate.

A nurse is developing a discharge plan for a client hospitalized with severe cirrhosis of the liver. What should be included in this plan?

The need for a high-protein diet

The use of a sedative for relaxation

The need to increase fluids

The importance of reporting personality changes to the primary healthcare provider

The importance of reporting personality changes to the primary healthcare provider The damaged liver may cause increased ammonia levels, resulting in central nervous system (CNS) irritation, which produces behavioral changes. A damaged liver does not metabolize protein adequately; a low-protein diet is indicated. Sedatives are detoxified by the liver and are contraindicated in severe hepatic disease. Kidney function usually is not affected.

A client is admitted to the hospital with a diagnosis of Cushing syndrome. What signs and symptoms will the client most likely exhibit?

Hyperkalemia and edema

Hypotension and sodium loss

Muscle wasting and hypoglycemia

Muscle weakness and frequent urination

Muscle weakness and frequent urination Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness. As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.

What is the effect of parathyroid hormone on bones?

Increased bone breakdown

Increased serum calcium levels

Increased sodium and phosphorus excretion

Increased absorption of calcium and phosphorus

Increased net release of calcium and phosphorus

Increased bone breakdown, Increased serum calcium levels, Increased net release of calcium and phosphorus Parathyroid hormone increases bone breakdown, which increases serum calcium levels. Parathyroid hormone increases net release of calcium and phosphorus from bone into the extracellular fluid. It increases sodium and phosphorus excretion by the kidneys, not in the bone and increases absorption of calcium and phosphorus in the gastrointestinal tract by using activated vitamin D. However, this increased absorption of calcium and phosphorus is not related to the bone.

Which hormonal deficiency causes breast atrophy in female clients?

Growth hormone

Luteinizing hormone

Thyroid-stimulating hormone

Adrenocorticotropic hormone

Luteinizing hormone A luteinizing hormone deficiency causes atrophy of the breasts. A growth hormone deficiency causes decreased bone density and pathologic fractures. A thyroid-stimulating hormone deficiency results in hirsutism, weight gain, and menstrual abnormalities. An adrenocorticotropic hormone deficiency causes postural hypotension, hypoglycemia, and anorexia.

A nurse is caring for a client with a suspected endocrine tumor that presents with hypertension. Which study will the nurse prepare to monitor that best screens for this condition?

Thyroglobulin

Metanephrine

Catecholamine

Vanillylmandelic acid

Metanephrine An endocrine tumor that presents with hypertension is pheochromocytoma. Metanephrine is the best study to screen for pheochromocytoma. Thyroglobulin is used to identify thyroid tumor cells. Although catecholamine and vanillylmandelic acid studies are used to screen for pheochromocytoma, metanephrine studies are more accurate.

A client complains of fatigue, hair loss, and weight gain. On assessment, the client is found to have anemia. Which therapy does the nurse anticipate in the client’s prescription?

Iodine

Methimazole

Levothyroxine

Propylthiouracil

Levothyroxine Fatigue, hair loss, weight gain, and anemia are the clinical manifestations of hypothyroidism, which occurs due to deficiency of thyroid hormones. Treatment includes restoration of euthyroid state by hormone therapy, such as levothyroxine. Iodine is used to prepare the client for thyroidectomy to treat thyrotoxicosis. Methimazole and propylthiouracil inhibit the synthesis of thyroid hormones and are used to treat hyperthyroidism.

A nurse is assessing a client with diabetes insipidus. Which signs indicative of diabetes insipidus should the nurse identify when assessing the client? .

Excessive thirst

Increased blood glucose

Dry mucous membranes

Increased blood pressure

Decreased serum osmolarity

Decreased urine specific gravity

excessive thirst, dry mucous membranes, decreased urine specific gravity As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases.

A client with acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. Which statement made by the client indicates a need for further teaching?

"I will be sterile for the rest of my life."

"I will require larger doses of insulin than I did preoperatively."

"I will have to take cortisone or a similar drug for the rest of my life."

"I will have to take thyroxine or a similar medication for the rest of my life."

"I will require larger doses of insulin than I did preoperatively." The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy, any elevation of blood glucose level caused by somatotropin also will stop. Infertility may be expected after a hypophysectomy because the follicle-stimulating hormone and its releasing factor will no longer be present to stimulate spermatogenesis. When adrenocorticotropic hormone (ACTH) is absent, cortisone will have to be administered. Thyroid-stimulating hormone will not be present; extrinsic thyroxine will have to be taken.

A nurse is providing postoperative care for a client who had a thyroidectomy. What response should the nurse assess in the client when concerned about the potential risk of thyrotoxic crisis?

Elevated serum calcium

Sudden drop in pulse rate

Hypothermia and dry skin

Rapid heartbeat and tremors

rapid heartbeat and tremors Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition. Hypercalcemia is not related to thyrotoxic crisis; hypocalcemia results from accidental removal of the parathyroid glands. Tachycardia is an increased, not decreased, heart rate, which occurs with thyrotoxic crisis because of the sudden release of thyroid hormones; thyroid hormones increase the basal metabolic rate. Fever, not hypothermia, and diaphoresis, not dry skin, occur with thyrotoxic crisis because of the sudden release of thyroid hormones, which increase the basal metabolic rate.

What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury?

Providing adequate fluids within easy reach

Reporting an increasing urine specific gravity

Administering prescribed erythromycin

Assessing for and reporting changes in neurological status

Monitoring for constipation, weight loss, hypotension, and tachycardia

Providing adequate fluids within easy reach, Assessing for and reporting changes in neurological status, Monitoring for constipation, weight loss, hypotension, and tachycardia Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore erythromycin would not be prescribed. The primary pharmacologic treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).

Which carcinoma is the most common type of thyroid cancer and is most often found in younger women?

Papillary carcinoma

Follicular carcinoma

Medullary carcinoma

Anaplastic carcinoma

Follicular

Which statement is true regarding cortisol?

Cortisol metabolizes free fatty acids.

Cortisol stimulates gluconeogenesis.

Cortisol stimulates protein synthesis.

Cortisol levels decline in stressful conditions.

cortisol stimulates gluconeogenesis Cortisol maintains the blood glucose concentration by stimulating the liver for gluconeogenesis. Gluconeogenesis involves formation of glucose from amino acids and fatty acids. Cortisol mobilizes free fatty acids and inhibits protein synthesis. The blood levels of cortisol increase in stressful conditions.

While reviewing the laboratory reports of a client, the nurse finds that the client has low sodium levels. Which hormonal imbalance should the nurse suspect in the client?

Epinephrine

Glucagon

Calcitonin

Cortisol

Cortisol Cortisol is the glucocorticoid secreted by the adrenal cortex that maintains sodium and water balance. Therefore, reduced sodium levels in the client indicate a cortisol imbalance. Additionally, depleted sodium levels in a client indicate hyponatremia. Epinephrine is a catecholamine, which helps in maintaining homeostasis. Glucagon increases blood glucose levels and does not play a role in maintaining electrolyte balance. Calcitonin helps in regulating serum calcium levels.

After assessing a client, the nurse anticipates that the client has hyperpituitarism. Which questions asked by the nurse helps confirm the diagnosis?

"Is there any change in your vision?"

"Do you experience severe headaches?"

"Are you suffering with frequent urination?"

"Do you eat more than five times a day?"

"Is there any change in your menstrual cycle?"

"Is there any change in your vision?" "Do you experience severe headaches?" "Is there any change in your menstrual cycle?" Hyperpituitarism manifests with vision disturbances and severe headaches. Due to hypersecretion of prolactin in females, a change in menstrual cycle may also be observed. Frequent urination is observed in a client with diabetes insipidus. Clients with diabetes mellitus experience intense hunger.

A nurse working in the diabetes clinic is evaluating a client’s success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease?

Reduction in excess body weight

Stabilization of the serum glucose

Demonstrated knowledge of the disease

Adherence to the prescription for insulin

Stabilization of the serum glucose A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism?

Diarrhea

Listlessness

Weight loss

Bradycardia

Decreased appetite

diarrhea, weight loss Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

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