FUCKING final regular fucking exam aka exam 5 Flashcards
Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes?
a. Renal ultrasound
b. Computed tomography
c. Intravenous pyelography
d. Voiding cystourethrography
ANS: A
The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for x-ray films. Contrast medium is injected into the bladder through the urethral opening for voiding cystourethrography. External radiation for x-ray films is used before, during, and after voiding.
Which diagnostic finding is present when a child has primary nephrotic syndrome?
a. Hyperalbuminemia
b. Positive ASO titer
c. Leukocytosis
d. Proteinuria
ANS: D
Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver’s inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.
Which factor predisposes a child to urinary tract infections?
a. Increased fluid intake
b. Short urethra in young girls
c. Prostatic secretions in males
d. Frequent emptying of the bladder
ANS: B
The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.
What should the nurse recommend to prevent urinary tract infections in young girls?
a. Wearing cotton underpants
b. Limiting bathing as much as possible
c. Increasing fluids; decreasing salt intake
d. Cleansing the perineum with water after voiding
ANS: A
Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.
The nurse understands that hypospadias refers to what urinary anomaly?
a. Absence of a urethral opening.
b. Penis shorter than usual for age.
c. Urethral opening along dorsal surface of penis.
d. Urethral opening along ventral surface of penis.
ANS: D
Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.
What is the term used to identify when the meatal opening is located on the dorsal surface of the penis?
a. Chordee
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: C
Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
An objective of care for the child with nephrosis is what desired outcome?
a. Reduced blood pressure
b. Reduced excretion of urinary protein
c. Increased excretion of urinary protein
d. Increased ability of tissues to retain fluid
ANS: B
The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.
What intervention is a component of the therapeutic management of nephrosis?
a. Corticosteroids
b. Antihypertensive agents
c. Long-term diuretics
d. Increased fluids to promote diuresis
ANS: A
Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.
What is a common side effect of corticosteroid therapy?
a. Fever
b. Hypertension
c. Weight loss
d. Increased appetite
ANS: D
Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.
The nurse closely monitors the temperature of a child diagnosed with nephrosis. The purpose of this is to detect an early sign of what undesirable outcome?
a. Infection
b. Hypertension
c. Encephalopathy
d. Edema
ANS: A
Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
The diet of a child with nephrosis usually includes requirement?
a. High protein
b. Salt restriction
c. Low fat
d. High carbohydrate
ANS: B
Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.
A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show:
a. bacteriuria and hematuria.
b. hematuria and proteinuria.
c. bacteriuria and increased specific gravity.
d. proteinuria and decreased specific gravity.
ANS: B
Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.
What is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
a. Risk for Injury related to malignant process and treatment.
b. Deficient Fluid Volume related to excessive losses.
c. Excess Fluid Volume related to decreased plasma filtration.
d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.
ANS: C
Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation.
What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?
a. The importance of taking prophylactic antibiotics
b. Suggestions for how to maintain fluid restrictions
c. The use of bubble baths as an incentive to increase bath time
d. The need for the child to hold urine for 6 to 8 hours
ANS: A
Prophylactic antibiotics are used to prevent urinary tract infections (UTIs) in a child with vesicoureteral reflux, although this treatment plan has become controversial. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.
What is the most common cause of acute renal failure in children?
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. Severe dehydration
ANS: D
The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.
The nurse, caring for a child with acute renal failure, should recognize event as a sign of hyperkalemia?
a. Dyspnea
b. Seizure
c. Oliguria
d. Cardiac arrhythmia
ANS: D
Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.
When a child diagnosed with chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as what?
a. Uremia
b. Oliguria
c. Proteinuria
d. Pyelonephritis
ANS: A
Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.
What major complication is noted in a child with chronic renal failure?
a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen
ANS: C
Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.
Which clinical manifestation would be seen in a child with chronic renal failure?
a. Hypotension
b. Massive hematuria
c. Hypokalemia
d. Unpleasant “uremic” breath odor
ANS: D
Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urine output occurs. Hyperkalemia is a concern in chronic renal failure.
One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term?
a. Deposits of urea crystals in urine
b. Deposits of urea crystals on skin
c. Overexcretion of blood urea nitrogen
d. Inability of body to tolerate cold temperatures
ANS: B
Uremic frost is the deposition of urea crystals on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.
Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to achieve which desired result?
a. Prevent vomiting
b. Bind phosphorus
c. Stimulate appetite
d. Increase absorption of fat-soluble vitamins
ANS: B
Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate; serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.
The diet of a child with chronic renal failure is usually characterized as:
a. high in protein.
b. low in vitamin D.
c. low in phosphorus.
d. supplemented with vitamins A, E, and K.
ANS: C
Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation with vitamins A, E, and K is not part of dietary management in chronic renal disease.
The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. What should the nurse contribute this behavior to?
a. Neurologic manifestations that occur with dialysis
b. Physiologic manifestations of renal disease
c. Adolescents having few coping mechanisms
d. Adolescents often resenting the control and enforced dependence imposed by dialysis
ANS: D
Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Neurologic manifestations that occur with dialysis and physiologic manifestations of renal disease are a function of the age of the child, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.
What is an advantage of peritoneal dialysis?
a. Treatments are done in hospitals.
b. Protein loss is less extensive.
c. Dietary limitations are not necessary.
d. Parents and older children can perform treatments.
ANS: D
Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis
Which statement is descriptive of renal transplantation in children?
a. It is an acceptable means of treatment after age 10 years.
b. It is preferred means of renal replacement therapy in children.
c. Children can receive kidneys only from other children.
d. The decision for transplantation is difficult since a relatively normal lifestyle is not possible.
ANS: B
Renal transplantation offers the opportunity for a relatively normal lifestyle versus dependence on dialysis and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes.
Which intervention is appropriate when examining a male infant for cryptorchidism?
a. Cooling the examiner’s hands
b. Taking a rectal temperature
c. Eliciting the cremasteric reflex
d. Warming the room
ANS: D
Cryptorchidism is the failure of one or both testes to descend normally through inguinal canal. For the infant’s comfort, the infant should be examined in a warm room with the examiner’s hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant’s testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.
The narrowing of preputial opening of foreskin is referred to as what?
a. Chordee
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: B
Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?
a. pH
b. Osmolality
c. Creatinine clearance
d. Protein level
ANS: C
The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.
The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?
a. Fever with a positive blood culture
b. Proteinuria and edema
c. Oliguria and hypertension
d. Anemia and thrombocytopenia
ANS: A
Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.
A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse’s best response should be to identify which occurrence?
a. Blood pressure will stabilize.
b. Child will have more energy.
c. Urine will be free of protein.
d. Urinary output will increase.
ANS: D
An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.
The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching?
a. “You will need to decrease the number of calories in your child’s diet.”
b. “Your child’s diet will need an increased amount of protein.”
c. “You will need to avoid adding salt to your child’s food.”
d. “Your child’s diet will consist of low-fat, low-carbohydrate foods.”
ANS: C
For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.
A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions?
a. WBC <1; specific gravity 1.008
b. WBC <2; specific gravity 1.025
c. WBC >2; specific gravity 1.016
d. WBC >2; specific gravity 1.030
ANS: D
The white blood cell (WBC) count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.
The nurse is conducting teaching for an adolescent being discharged to home after a renal transplantation. The adolescent needs further teaching if which statement is made?
a. “I will report any fever to my primary health care provider.”
b. “I am glad I only have to take the immunosuppressant medication for 2 weeks.”
c. “I will observe my incision for any redness or swelling.”
d. “I won’t miss doing kidney dialysis every week.”
ANS: B
The immunosuppressant medications are taken indefinitely after a renal transplantation, so they should not be discontinued after 2 weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplantation.
The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching?
a. “These injections will help with the hypertension.”
b. “We’re glad the injections only need to be given once a month.”
c. “The red blood cell count should begin to improve with these injections.”
d. “Urine output should begin to improve with these injections.”
ANS: C
Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections.
A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?
a. Spironolactone
b. Sodium polystyrene sulfonate
c. Lactulose
d. Calcium carbonate
ANS: B
Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.
What are the primary clinical manifestations of acute glomerulonephritis? (Select all that apply.)
a. Oliguria
b. Hematuria
c. Proteinuria
d. Hypertension
e. Bacteriuria
ANS: A, B, C, D
The principal feature of acute glomerulonephritis include oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria. Bacteriuria is not a principal feature of acute glomerulonephritis
The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed? (Select all that apply.)
a. Vomiting
b. Jaundice
c. Failure to gain weight
d. Swelling of the face
e. Back pain
f. Persistent diaper rash
ANS: A, C, F
Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.
A child with secondary enuresis who reports of dysuria or urgency should be evaluated for what condition? (Select all that apply.)
a. Hypocalciuria
b. Nephrotic syndrome
c. Glomerulonephritis
d. Urinary tract infection (UTI)
e. Diabetes mellitus
ANS: D, E
Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.
A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.)
a. Apples
b. Bananas
c. Cheese
d. Carrot sticks
e. Strawberries
ANS: A, D, E
Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.
A school-age child has been admitted to the hospital diagnosed with minimal-change nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.)
a. Weight loss
b. Generalized edema
c. Proteinuria > 2+
d. Fatigue
e. Irritability
ANS: B, C, D, E
The disease is suspected on the basis of clinical manifestations that include generalized edema, steadily gaining weight; appearing edematous; and then becoming anorexic, irritable, and less active. The hallmark of this syndrome is proteinuria (higher than 2+ on urine dipstick).
Which statement best describes idiopathic hypopituitarism?
a. Growth is normal during the first 3 years of life.
b. Weight is usually more retarded than height.
c. Skeletal proportions are normal for age.
d. Most of these children have subnormal intelligence.
ANS: C
In children with idiopathic hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.
A child with growth hormone (GH) deficiency is receiving GH therapy. What is the best time for the GH to be administered?
a. At bedtime
b. After meals
c. Before meals
d. On arising in the morning
ANS: A
Injections are best given at bedtime to more closely approximate the physiologic release of GH. Before or after meals and on arising in the morning are times that do not mimic the physiologic release of the hormone.
What is the priority nursing goal for a 14 year old diagnosed with Graves’ disease?
a. Relieving constipation
b. Allowing the adolescent to make decisions about whether or not to take medication
c. Verbalizing the importance of monitoring for medication side effects
d. Developing alternative educational goals
ANS: C
Children being treated with propylthiouracil or methimazole must be carefully monitored for side effects of the drug. Because sore throat and fever accompany the grave complication of leukopenia, these children should be seen by a health care practitioner if such symptoms occur. Parents and children should be taught to recognize and report symptoms immediately. The adolescent with Graves’ disease is not likely to be constipated. Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child’s medical provider. The management of Graves’ disease does not interfere with school attendance and does not require alternative educational plans.
At what age is sexual development in boys and girls considered to be precocious?
a. Boys, 11 years; girls, 9 years
b. Boys, 12 years; girls, 10 years
c. Boys, 9 years; girls, 8 years
d. Boys, 10 years; girls, 9.5 years
ANS: C
Manifestations of sexual development before age 9 in boys and age 8 in girls are considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.
A child will start treatment for precocious puberty. This involves injections of which synthetic medication?
a. Thyrotropin
b. Gonadotropins
c. Somatotropic hormone
d. Luteinizing hormone–releasing hormone
ANS: D
Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone–releasing hormone. Thyrotropin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.
Diabetes insipidus is a disorder of which organ?
a. Anterior pituitary
b. Posterior pituitary
c. Adrenal cortex
d. Adrenal medulla
ANS: B
The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.
The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would be observable?
a. Oliguria
b. Glycosuria
c. Nausea and vomiting
d. Polydipsia
ANS: D
Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.
What is a common clinical manifestation of juvenile hypothyroidism?
a. Insomnia
b. Diarrhea
c. Dry skin
d. Accelerated growth
ANS: C
Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.
A goiter is an enlargement or hypertrophy of which gland?
a. Thyroid
b. Adrenal
c. Anterior pituitary
d. Posterior pituitary
ANS: A
A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenals or the anterior and posterior pituitaries.
Exophthalmos may occur in children with what diagnosis?
a. Hypothyroidism
b. Hyperthyroidism
c. Hypoparathyroidism
d. Hyperparathyroidism
ANS: B
Exophthalmos (protruding eyeballs) is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.
The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves’ disease). Which statement made by the parent indicates a correct understanding of the teaching?
a. “I would expect my child to gain weight while taking this medication.”
b. “I would expect my child to experience episodes of ear pain while taking this medication.”
c. “If my child develops a sore throat and fever, I should contact the physician immediately.”
d. “If my child develops the stomach flu, my child will need to be hospitalized.”
ANS: C
Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and stomach flu are not usually associated with leukopenia.
A child diagnosed with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity?
a. Headache and seizures
b. Physical restlessness and voracious appetite without weight gain
c. Weakness and lassitude
d. Anorexia and insomnia
ANS: C
Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.
Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which organ?
a. Thyroid gland
b. Parathyroid glands
c. Adrenal cortex
d. Anterior pituitary
ANS: C
These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid glands produce parathyroid hormone. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.
Chronic adrenocortical insufficiency is also referred to as what?
a. Graves’ disease
b. Addison’s disease
c. Cushing’s syndrome
d. Hashimoto’s disease
ANS: B
Addison’s disease is chronic adrenocortical insufficiency. Graves’ and Hashimoto’s diseases involve the thyroid gland. Cushing’s syndrome is a result of excessive circulation of free cortisol.
A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of which medication?
a. Vitamin D
b. Cortisone
c. Stool softeners
d. Calcium carbonate
ANS: B
The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.
What is the characteristic of the immune-mediated type 1 diabetes mellitus?
a. Ketoacidosis is infrequent
b. Onset is gradual
c. Age at onset is usually younger than 18 years
d. Oral agents are often effective for treatment
ANS: C
The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes
Which symptom is considered a cardinal sign of diabetes mellitus?
a. Nausea
b. Seizures
c. Impaired vision
d. Frequent urination
ANS: D
Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.
What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty?
a. Advise the parents to consider birth control for their daughter.
b. Explain the importance of having the child foster relationships with same-age peers.
c. Assure the child’s parents that there is no increased risk for sexual abuse because of her appearance.
d. Counsel parents that there is no treatment currently available for this disorder.
ANS: B
Despite the child’s appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6 year old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
a. Moist skin
b. Weight gain
c. Fluid overload
d. Poor wound healing
ANS: D
Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on what information?
a. It is a less expensive method of testing.
b. It is not as accurate as laboratory testing.
c. Children need to learn to manage their diabetes.
d. The parents are better able to manage the disease.
ANS: C
Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should provide the parents with what information to address the child’s safety needs?
a. Exercise will increase blood glucose.
b. Exercise should be restricted.
c. Extra snacks are needed before exercise.
d. Extra insulin is required during exercise.
ANS: C
Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by:
a. saturated and unsaturated fat.
b. fruit juice.
c. several glasses of water.
d. complex carbohydrate and protein.
ANS: D
Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.
What are the manifestations of hypoglycemia?
a. Lethargy
b. Thirst
c. Nausea and vomiting
d. Shaky feeling and dizziness
ANS: D
Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections?
a. The parents do not need to learn the procedure.
b. He is old enough to give most of his own injections.
c. Self-injections will be possible when he is closer to adolescence.
d. He can learn about self-injections when he is able to reach all injection sites.
ANS: B
School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.
The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption?
a. Arm
b. Leg
c. Buttock
d. Abdomen
ANS: D
The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness?
a. Give the child half his regular morning dose of insulin.
b. Substitute simple carbohydrates or calorie-containing liquids for solid foods.
c. Give the child plenty of unsweetened, clear liquids to prevent dehydration.
d. Take the child directly to the emergency department.
ANS: B
A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis?
a. No urinary ketones
b. Low arterial pH
c. Elevated serum carbon dioxide
d. Elevated serum phosphorus
ANS: B
Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.
A child diagnosed with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which information?
a. Treatment is most successful if it is started during adolescence.
b. Treatment is considered successful if children attain full stature by adulthood.
c. Replacement therapy requires daily subcutaneous injections.
d. Replacement therapy will be required throughout the child’s lifetime.
ANS: C
Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.
An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which event occurs with acromegaly?
a. There is a lack of growth hormone (GH) being produced.
b. There is excess GH after closure of the epiphyseal plates.
c. There is an excess of GH before the closure of the epiphyseal plates.
d. There is a lack of thyroid hormone being produced.
ANS: B
Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.
The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder?
a. Insomnia
b. Diarrhea
c. Dry skin
d. Accelerated growth
ANS: C
Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.
Which clinical manifestation may occur in the child who is prescribed methimazole for the treatment of hyperthyroidism (Graves’ disease)?
a. Seizures
b. Enlargement of all lymph glands
c. Pancreatitis or cholecystitis
d. Sore throat or fever
ANS: D
Children being treated with propylthiouracil or methimazole must be carefully monitored for side effects of the drug. Because sore throat and fever accompany the grave complication of leukopenia, these children should be seen by a health care practitioner if such symptoms occur. Neither seizures, cholecystitis nor pancreatitis are associated with the administration of methimazole. Enlargement of the salivary and cervical lymph glands may occur.
The parent of a child diagnosed with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which reason?
a. Glucose is needed before administration of insulin.
b. Glucose is needed 4 times a day.
c. Glycosylated hemoglobin is required.
d. Ketonuria is suspected.
ANS: D
Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated for medication administration because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.
To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence?
a. Desire to be unique
b. Preoccupation with the future
c. Need to be perfect and similar to peers
d. Need to make peers aware of the seriousness of hypoglycemic reactions
ANS: C
Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes since the peer group would likely focus on the differences
The nurse is implementing care for a school-age child admitted to the pediatric intensive care experiencing symptomology associated with diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first?
a. Begin 0.9% saline solution intravenously as prescribed.
b. Administer regular insulin intravenously as prescribed.
c. Place child on a cardiac monitor.
d. Place child on a pulse oximetry monitor.
ANS: A
All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.
A nurse is reviewing the laboratory results on a school-age child diagnosed with hypoparathyroidism. Which results are consistent with this condition?
a. Decreased serum phosphorus
b. Decreased serum calcium
c. Increased serum glucose
d. Decreased serum cortisol
ANS: B
The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. Decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and decreased serum cortisol in adrenocortical insufficiency (Addison’s disease).
Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include which interventions? (Select all that apply.)
a. Weigh daily
b. Encourage fluids
c. Turn frequently
d. Maintain nothing by mouth
e. Restrict fluids
ANS: A, E
Increased secretion of ADH causes the kidney to resorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH since they are not associated with managing/monitoring for fluid retention.
Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.)
a. A newly diagnosed preschooler with type 1 diabetes.
b. A school-age child returning from surgery for removal of a brain tumor.
c. An infant with suspected meningitis.
d. An adolescent with blunt abdominal trauma following a car accident.
e. A school-age child with head trauma.
ANS: B, C, E
The disorder that results from hypersecretion of ADH from the posterior pituitary hormone. Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Type 1 diabetes and blunt abdominal trauma are not likely to cause SIADH since do not affect secretion of this hormone.
A child is diagnosed with juvenile hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? (Select all that apply.)
a. Weight loss
b. Sleepiness
c. Diarrhea
d. Puffiness around the eyes
e. Spare hair
ANS: B, D, E
A child diagnosed with juvenile hypothyroidism will display sleepiness; dry, periorbital puffiness; and spare hair growth. Weight loss and diarrhea are signs of hyperthyroidism.
The nurse should expect to assess which clinical manifestations in an adolescent with Cushing’s syndrome? (Select all that apply.)
a. Hyperglycemia
b. Hyperkalemia
c. Hypotension
d. Cushingoid features
e. Susceptibility to infections
ANS: A, D, E
In Cushing’s syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.
A nurse is planning care for a school-age child diagnosed with type 1 diabetes. Which insulin preparations are either rapid or short acting? (Select all that apply.)
a. Novolin N
b. Lantus
c. NovoLog
d. Novolin R
ANS: C, D
Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.
The nurse is caring for a school-age child with hyperthyroidism (Graves’ disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.)
a. Constipation
b. Hypotension
c. Hyperthermia
d. Tachycardia
e. Vomiting
ANS: C, D, E
A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration
. A nurse cares for a client who is prescribed a drug that blocks a hormones receptor site. Which therapeutic effect should the nurse expect? a. Greater hormone metabolism b. Decreased hormone activity c. Increased hormone activity d. Unchanged hormone response
ANS: B
Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby
changing the activity of the cell. When receptor sites are occupied by other substances that block hormone
binding, the cells response is the same as when the level of the hormone is decreased.
A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/
ANS: A
Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water
reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have
increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in
aldosterone deficiency, the client would have hyponatremia and hyperkalemia.
A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? a. Potassium b. Sodium c. Calcium d. Magnesium
ANS: C
Parafollicular cells produce thyrocalcitonin (calcitonin), which regulates serum calcium levels. Calcitonin has
no impact on potassium, sodium, or magnesium balances.
A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment
finding should alert the nurse to urgently contact the health care provider?
a. Heart rate of 50 beats/min
b. Respiratory rate of 18 breaths/min
c. Oxygenation saturation of 92%
d. Blood pressure of 144/69 mm Hg
ANS: A
Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse
expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min
would be cause for concern because this would indicate that the client was not responding to the medication. The other vital signs are within normal limits and do not indicate a negative response to the medication
A nurse prepares to palpate a clients thyroid gland. Which action should the nurse take when performing this
assessment?
a. Stand in front of the client instead of behind the client. b. Ask the client to swallow after palpating the thyroid. c. Palpate the right lobe with the nurses left hand. d. Place the client in a sitting position with the chin tucked down.
ANS: D
The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse
palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.
A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is
prescribed a 24-hour urine specimen collection. Which statement should the nurse include when delegating this
activity to the UAP?
a. Note the time of the clients first void and collect urine for 24 hours. b. Add the preservative to the container at the end of the test. c. Start the collection by saving the first urine of the morning. d. It is okay if one urine sample during the 24 hours is not collected
ANS: A
The collection of a 24-hour urine specimen is often delegated to a UAP. The nurse must ensure that the UAP
understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after
the clients first urination. The first urine specimen is discarded because there is no way to know how long it
has been in the bladder, but the time of the clients first void is noted. The client adds all urine voided after that
first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last
time and adds this specimen to the collection. The preservative, if used, must be added to the container at the
beginning of the collection. All urine samples need to be collected for the test results to be accurate.
A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when
assessing this client?
a. How do you plan to pay for your treatments?
b. How do you feel about yourself?
c. What medications are you prescribed?
d. What are you doing to prevent this from happening?
ANS: B
Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause
a disruption in body image, especially for female clients. The nurse should inquire into the clients body image
and self-perception. Asking about the clients financial status or current medications does not address the
clients immediate problem. The client is not doing anything to herself to cause the problem, nor can the client
prevent it from happening.
A nurse teaches a client who has been prescribed a 24-hour urine collection to measure excreted hormones. The client asks, Why do I need to collect urine for 24 hours instead of providing a random specimen? How
should the nurse respond?
a. This test will assess for a hormone secreted on a circadian rhythm. b. The hormone is diluted in urine; therefore, we need a large volume. c. We are assessing when the hormone is secreted in large amounts. d. To collect the correct hormone, you need to urinate multiple times.
ANS: A
Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection
that occurs over 24 hours will most accurately reflect hormone secretion. Dilution of hormones in urine, secretion of hormone amounts, and ability to collect the correct hormone are not reasons to complete a 24-hour
urine test
A nurse plans care for an older adult who is admitted to the hospital for pneumonia. The client has no known
drug allergies and no significant health history. Which action should the nurse include in this clients plan of
care?
a. Initiate Airborne Precautions. b. Offer fluids every hour or two. c. Place an indwelling urinary catheter. d. Palpate the clients thyroid gland.
ANS: B
A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a
more diluted urine output, which can lead to dehydration. If no contraindications are known, the nurse should
offer (or delegate) the client something to drink at least every 2 hours. A client with simple pneumonia would
not require Airborne Precautions. Indwelling urinary catheterization is not necessary for this client and would
increase the clients risk for infection. The nurse should plan a toileting schedule and assist the client to the
bathroom if needed. Palpating the clients thyroid gland is a part of a comprehensive examination but is not
specifically related to this client.
A nurse cares for a client who is prescribed a 24-hour urine collection. The unlicensed assistive personnel
(UAP) reports that, while pouring urine into the collection container, some urine splashed his hand. Which
action should the nurse take next?
a. Ask the UAP if he washed his hands afterward. b. Have the UAP fill out an incident report.
c. Ask the laboratory if the container has preservative in it. d. Send the UAP to Employee Health right away.
ANS: A
For safety, the nurse should find out if the UAP washed his or her hands. The UAP should do this for two
reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did
have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can
call the laboratory while the UAP is washing hands, if needed. The UAP would then need to fill out an incident
or exposure report and may or may not need to go to Employee Health. The UAP also needs further education
on Standard Precautions, which include wearing gloves.
A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which
hormone value should the nurse assess first?
a. Posterior pituitary hormones
b. Adrenal medulla hormones
c. Anterior pituitary hormones
d. Parathyroid hormone
ANS: C
Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary
gland. The other hormones would not cause fluid secretion from the clients breast.
A nurse cares for a client who has excessive catecholamine release. Which assessment finding should the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. Increased urine output
ANS: B
Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous
system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.
A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse
correlate with this diagnosis?
a. I have a terrible craving for potato chips. b. I cannot seem to drink enough water. c. I no longer have an appetite for anything. d. I get hungry even after eating a meal
ANS: A
The nurse correlates a clients salt craving with adrenal hypofunction. Excessive thirst is related to diabetes
insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus
A nurse teaches an older adult with a decreased production of estrogen. Which statement should the nurse
include in this clients teaching to decrease injury?
a. Drink at least 2 liters of fluids each day. b. Walk around the neighborhood for daily exercise. c. Bathe your perineal area twice a day. d. You should check your blood glucose before meals.
ANS: B
An older adult client with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse should encourage the client to participate in weight-bearing exercises such as walking. Drinking
fluids and performing perineal care will decrease vaginal drying but not decrease injury. Older adults often
have a decreased glucose tolerance, but this is not related to a decrease in estrogen.
A nurse cares for a client who is prescribed a serum catecholamine test. Which action should the nurse take
when obtaining the sample?
a. Discard the first sample and then begin the collection. b. Draw the blood sample after the client eats breakfast. c. Place the sample on ice and send to the laboratory immediately. d. Add preservatives before sending the sample to the laboratory.
ANS: C
A blood sample for catecholamine must be placed on ice and taken to the laboratory immediately. This sample
is not urine, and therefore the first sample should not be discarded nor should preservatives be added to the
sample. The nurse should use the appropriate tube and obtain the sample based on which drugs are
administered, not dietary schedules.
A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all
that apply.)
a. Hormones may travel long distances to get to their target tissues. b. Continued hormone activity requires continued production and secretion. c. Control of hormone activity is caused by negative feedback mechanisms. d. Most hormones are stored in the target tissues for use later. e. Most hormones cause target tissues to change activities by changing gene activity.
ANS: A, B, C
Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone
activity can increase or decrease according to the bodys needs, and continued hormone activity requires
continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for
later use, and they do not alter genetic activity.
A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse
expect to be affected by this condition? (Select all that apply.)
a. Thyroid-stimulating hormone
b. Vasopressin
c. Follicle-stimulating hormone
d. Calcitonin
e. Growth hormone
ANS: A, C, E
Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the
anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from
the thyroid gland.
A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with
the endocrine disorder? (Select all that apply.)
a. Excessive thyroid-stimulating hormone Increased bone formation
b. Excessive melanocyte-stimulating hormone Darkening of the skin
c. Excessive parathyroid hormone Synthesis and release of corticosteroids
d. Excessive antidiuretic hormone Increased urinary output
e. Excessive adrenocorticotropic hormone Increased bone resorption
ANS: A, B
Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte- stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water
reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and
stimulates the synthesis and release of corticosteroids.
A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency
of gonadotropin and growth hormone?
a. A 36-year-old female who has used oral contraceptives for 5 years
b. A 42-year-old male who experienced head trauma 3 years ago
c. A 55-year-old female with a severe allergy to shellfish and iodine
d. A 64-year-old male with adult-onset diabetes mellitus
ANS: B
Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of
anterior pituitary hypofunction. The other factors do not increase the risk of this condition.
A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in
this clients plan of care?
a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to re-position the client. d. Assist the client to dangle before rising.
ANS: C
In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone
deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the
client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient
in growth hormone.
A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement
therapy. The client asks, How long will I need to take this medication? How should the nurse respond?
a. When your blood levels of testosterone are normal, the therapy is no longer needed. b. When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue
forever. c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy. d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years
old.
ANS: B
Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is
achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout
life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm
counts are high.
A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post-stimulation
laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). How should the nurse interpret these results?
a. Pituitary hypofunction
b. Pituitary hyperfunction
c. Pituitary-induced diabetes mellitus
d. Normal pituitary response to insulin
ANS: D
Some tests for pituitary function involve administering agents that are known to stimulate the secretion of
specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The
stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1
unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients
with normal pituitary function causes increased release of GH and ACTH.
After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the
clients understanding. Which statement made by the client indicates a need for additional teaching?
a. I will no longer need to limit my fluid intake after surgery. b. I am glad no visible incision will result from this surgery. c. I hope I can go back to wearing size 8 shoes instead of size 12. d. I will wear slip-on shoes after surgery to limit bending over
ANS: C
Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as
needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal
rigidity. Which action should the nurse take first?
a. Encourage range-of-motion exercises. b. Document the finding and monitor the client. c. Take vital signs, including temperature. d. Assess pain and administer pain medication.
ANS: C
Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with
this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of- motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all
assessments are completed and should not be the only action. Although pain medication may be a palliative
measure, it is not the most appropriate initial action
After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse
assesses the clients understanding. Which statement made by the client indicates a correct understanding of the
teaching?
a. I will wear dark glasses to prevent sun exposure. b. Ill keep food on upper shelves so I do not have to bend over.
c. I must wash the incision with peroxide and redress it daily. d. I shall cough and deep breathe every 2 hours while I am awake.
ANS: B
After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client
should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is
no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.
A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The
clients serum sodium level is 114 mEq/L. Which action should the nurse take first?
a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.
ANS: B
With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as
little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and
diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client
should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.
A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients
plan of care to prevent injury?
a. Pad the siderails of the clients bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the clients position. d. Keep suctioning equipment at the clients bedside.
ANS: C
Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive
bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting
the client to change position may be effective, but these measures will not protect him or her as much as using
a lift sheet. The client should not require suctioning.
A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a
severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop
taking these medications? How should the nurse respond?
a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.
ANS: B
One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of
long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis
and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal
production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone
effectiveness. Building the clients immune system and rebound inflammation are not concerns related to
stopping high-dose corticosteroids.
A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should
the nurse respond?
a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups?
d. I will close the door to your room and restrict visitors.
ANS: B
Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that
these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower
and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.
A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which
precautions does the nurse teach this client?
a. Read the label before using salt substitutes. b. Do not add salt to your food when you eat. c. Avoid exposure to sunlight. d. Take Tylenol instead of aspirin for pain.
ANS: A
Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to
hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause
complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on
spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.
A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take?
a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the clients daily chest x-ray.
ANS: A
Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces
antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is
present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in
isolation. The client does not need a daily chest x-ray.
A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take
first?
a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe. c. Report clear or light yellow drainage from the nose. d. Apply petroleum jelly to lips to avoid dryness.
ANS: C
A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client
should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to
the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.
A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which
statement should the nurse include in this clients instructions?
a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.
ANS: B
Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot
weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no
need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.
An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the
nurse take first?
a. Obtain intravenous access. b. Administer hydrocortisone succinate (Solu-Cortef). c. Assess blood glucose. d. Administer insulin and dextrose.
ANS: A
All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the
priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and
treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia
A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating
ANS: A, C, D, E, F
Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.
A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for
hypopituitarism? (Select all that apply.)
a. A 20-year-old female with benign pituitary tumors
b. A 32-year-old male with diplopia
c. A 41-year-old female with anorexia nervosa
d. A 55-year-old male with hypertension
e. A 60-year-old female who is experiencing shock
f. A 68-year-old male who has gained weight recently
ANS: A, C, D, E
Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and
syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.
A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50
ANS: A, C, E
Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes
hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are
manifestations of adrenal insufficiency.
A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this
clients teaching? (Select all that apply.)
a. Low calcium
b. Low carbohydrate
c. Low protein
d. Low calories
e. Low sodium
ANS: B, D, E
The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary
modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of
hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict
their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein
intake will help decrease muscle loss.
A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment
findings indicate a therapeutic response to this therapy? (Select all that apply.)
a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased.
f. Urine osmolality is decreased
ANS: A, D, F
Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a
low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as
evidenced by an increased specific gravity.
A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal
insufficiency? (Select all that apply.)
a. A 22-year-old female with metastatic cancer
b. A 43-year-old male with tuberculosis
c. A 51-year-old female with asthma
d. A 65-year-old male with gram-negative sepsis
e. A 70-year-old female with hypertension
ANS: A, B, D
Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active
tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key
manifestation of Cushings disease. These are not risk factors for adrenal insufficiency.
A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy
ANS: A, D, E
Clinical manifestations of Cushings disease include moon face, weight gain, hypertension, petechiae, and
muscle atrophy
A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment
finding should alert the nurse to a side effect of this therapy?
a. Blurred and double vision
b. Increased thirst and urination
c. Profuse nausea and diarrhea
d. Decreased attention and insomnia
ANS: B
Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with
increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.
A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
a. Reassure the client that the voice change is temporary. b. Document the finding and assess the client hourly. c. Place the client in high-Fowlers position and apply oxygen. d. Contact the provider and prepare for intubation
ANS: D
Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician
function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the
provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be
applied, but this action will not keep the airway open.
A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day
the client states, I feel numbness and tingling around my mouth. What action should the nurse take?
a. Offer mouth care. b. Loosen the dressing. c. Assess for Chvosteks sign. d. Ask the client orientation questions.
ANS: C
Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which
could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for
Chvosteks sign and Trousseaus sign. Then the nurse should notify the provider. Mouth care, loosening the
dressing, and orientation questions do not provide important information to prevent complications of low
calcium levels.
A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the
nurse to the possibility of hypothyroidism?
a. My sister has thyroid problems. b. I seem to feel the heat more than other people. c. Food just doesnt taste good without a lot of salt. d. I am always tired, even with 12 hours of sleep.
ANS: D
Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems
are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of
hypothyroidism.
A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication
should the nurse anticipate being prescribed to the client?
a. Atropine sulfate
b. Levothyroxine sodium (Synthroid)
c. Propranolol (Inderal)
d. Epinephrine (Adrenalin)
ANS: B
The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium.
If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for
short-term management. Propranolol is a beta blocker and would be contraindicated for a client with
bradycardia.
A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention
ANS: C
Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason
for seeking medical attention. Memory and attention span may be impaired. The clients family may have great
difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the clients environment is safe. Heat
intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over
mental status and safety.
A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which
assessment finding should alert the nurse that the medication therapy is effective?
a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3. d. Heart rate is 70 beats/min and regular.
ANS: D
Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and
constipation. If a clients heart rate is bradycardic while on thyroid hormone replacement, this is an indicator
that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the
client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do
not represent a therapeutic response to this medication.
A nurse cares for a client who has hypothyroidism as a result of Hashimotos thyroiditis. The client asks, How long will I need to take this thyroid medication? How should the nurse respond?
a. You will need to take the thyroid medication until the goiter is completely gone. b. Thyroiditis is cured with antibiotics. Then you wont need thyroid medication. c. Youll need thyroid pills for life because your thyroid wont start working again. d. When blood tests indicate normal thyroid function, you can stop the medication.
ANS: C
Hashimotos thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid
replacement therapy. The client will not be able to stop taking the medication.
A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for
hyperparathyroidism?
a. A 29-year-old female with pregnancy-induced hypertension
b. A 41-year-old male receiving dialysis for end-stage kidney disease
c. A 66-year-old female with moderate heart failure
d. A 72-year-old male who is prescribed home oxygen therapy
ANS: B
Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from
the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at
higher risk for hyperparathyroidism
A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in
this clients plan of care?
a. Ask the client to ambulate in the hallway twice a day. b. Use a lift sheet to assist the client with position changes. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the unlicensed assistive personnel to strain the clients urine for stones.
ANS: B
Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic
fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the
risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine
strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific
interventions for this client.
A nurse cares for a client who is recovering from a parathyroidectomy. When taking the clients blood
pressure, the nurse notes that the clients hand has gone into flexion contractions. Which laboratory result does
the nurse correlate with this condition?
a. Serum potassium: 2.9 mEq/L
b. Serum magnesium: 1.7 mEq/L
c. Serum sodium: 122 mEq/L
d. Serum calcium: 6.9 mg/dL
ANS: D
Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This
effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseaus
sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte
imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.
A nurse cares for a client newly diagnosed with Graves disease. The clients mother asks, I have diabetes
mellitus. Am I responsible for my daughters disease? How should the nurse respond?
a. The fact that you have diabetes did not cause your daughter to have Graves disease. No connection is known
between Graves disease and diabetes. b. An association has been noted between Graves disease and diabetes, but the fact that you have diabetes did
not cause your daughter to have Graves disease. c. Graves disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease
such as diabetes mellitus. d. Unfortunately, Graves disease is associated with diabetes, and your diabetes could have led to your daughter
having Graves disease
ANS: B
An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been
noted. The predisposition is probably polygenic, and the mothers diabetes did not cause her daughters Graves
disease. The other statements are inaccurate.
While assessing a client with Graves disease, the nurse notes that the clients temperature has risen 1 F. Which action should the nurse take first?
a. Turn the lights down and shut the clients door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the clients apical-radial pulse deficit. d. Administer a dose of acetaminophen (Tylenol).
ANS: A
A temperature increase of 1 F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that
increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit
would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.
After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the clients
understanding. Which statement made by the client indicates a need for additional instruction?
a. I may need calcium replacement after surgery. b. After surgery, I wont need to take thyroid medication. c. Ill need to take thyroid hormones for the rest of my life. d. I can receive pain medication if I feel that I need it.
ANS: B
After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain
medication postoperatively.
A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority
intervention should the nurse include in this clients plan of care?
a. Monitor the clients intravenous site every shift. b. Administer acetaminophen (Tylenol) for fever. c. Ensure that working suction equipment is in the room. d. Assess the clients vital signs every 4 hours.
ANS: C
A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency
situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the
clients room because it may be needed if myxedema coma develops. The other interventions are necessary for
any client with pneumonia, but having suction available is a safety feature for this client.
A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol)
ANS: B, D
The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium
sulfate). The potassium level is high, so replacement is not needed. The clients sodium level is normal, so
hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is
not needed.
A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating
hormone levels. Which actions should the nurse take? (Select all that apply.)
a. Administer levothyroxine (Synthroid). b. Administer propranolol (Inderal). c. Monitor the apical pulse. d. Assess for Trousseaus sign. e. Initiate telemetry monitoring.
ANS: C, E
The clients laboratory findings suggest that the client is experiencing hyperthyroidism. The increased
metabolic rate can cause an increase in the clients heart rate, and the client should be monitored for the
development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic
nervous system activity in hyperthyroidism. Trousseaus sign is a test for hypocalcemia.
A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this
clients teaching? (Select all that apply.)
a. Increased carbohydrates
b. Decreased fats
c. Increased calorie intake
d. Supplemental vitamins
e. Increased proteins
ANS: A, C, E
The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are
especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease
fat intake or take supplemental vitamins.
A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that
the clients level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.)
a. Infuse intravenous fluids. b. Cover the client with warm blankets. c. Monitor blood pressure every 4 hours. d. Maintain a patent airway. e. Administer oral glucose as prescribed.
ANS: A, B, D
A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of
consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.
A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the
nurse include in this clients education? (Select all that apply.)
a. Do not share utensils, plates, and cups with anyone else. b. You can play with your grandchildren for 1 hour each day. c. Eat foods high in vitamins such as apples, pears, and oranges. d. Wash your clothing separate from others in the household. e. Take a laxative 2 days after therapy to excrete the radiation
ANS: A, D, E
A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and
cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or
bones, which will leave contaminated remnants; to wash clothing separate from others in the household and
run an empty cycle before washing other peoples clothing; and to take a laxative on days 2 and 3 after
receiving treatment to help excrete the contaminated stool faster.
