Practice Questions r/t Endocrine Concerns

Question 1

An emaciated client is to receive NPH insulin 20 units 1 hour before breakfast daily. The insulin should be administered:

1. intramuscularly at 90 degrees
2. subcutaneously at 90 degrees
3. intramuscularly at 45 degrees
4. subcutaneously at 45 degrees

Answer 1

Emaciated clients should have insulin administered at a 45-degree angle into subcutaneous tissue. The first factor to consider is the emaciated state of the client - this question assumes that this means there is a need to choose a 45 over 90 degree angle as using a 90-degree angle could cause the needle to go through the subcutaneous tissue into an emaciated client

you don’t give insulin IM

Question 2

an adolescent 15 years of age is hospitalized with type 1 insulin-dependent diabetes. Which of the following is essential to teach the client?

1. insulin dosage will be determined by food intake
2. insulin will have to be administered for the rest of the client’s life
3. insulin dosage will be adjusted by the way the client eats
4. insulin will be adjusted as the client grows older

Answer 2

exogenous insulin will be needed to be administered for the rest of the client’s life as persons with T1 have no endogenous insulin

Food intake, eating habits, and growth patterns are important factors in appropriate insulin dosing. However, the most essential to know is insulin will be required from now on

Question 3

The only insulin that can be administered IV is: _________________

Answer 3

Regular Insulin (aka rapid-acting aka Humulin R)

It is clear and does not contain modifying agents (also it makes sense in that Regular insulins effect happens at pace that can be adjusted using IV admin - something like a long-acting/prandial would be given and effects not seen until way later - totally risky)

Question 4

you client is receiving 30 units of NPH insulin daily at 07:00. What would the client need to do each day?

1. exercise for 30 minutes prior to lunch
2. consume a snack each day at 16:00
3. exercise for 30 minutes prior to bedtime
4. consume a bedtime snack at 21:00

Answer 4

NPH insulin peaks between 6 and 8 hours after administration. A snack should be consumed at 1600 to prevent hypoglycemia.

(onset - 2 hours, peak - 6-8, duration 12-16)

daily exercise should be accounted for and adjustments in daily insulin dosages may be needed. Additional glucose needs to be consume when client exercise more than usual as exercise has a hypoglycemic effect

long-acting insulin given at bedtime requires a bedtime snack the next day (onset 2 hours, peak 16-20, duration 24+ hours)

Question 5

A 26-year-old gravida 1 has type 1 insulin-dependent diabetes. Due to a change in insulin requirements during the first trimester, the nurse will carefully observe the client for signs of:

1. hypoglycemia
2. ketoacidosis
3. hyperglycemia
4. pregnancy-induced hypertension

Answer 5

The nurse will observe client for signs of hypoglycemia. There is a decreased need for insulin in the first trimester. the level of human placental lactogen (HPL) (an insulin antagonist) is low. Also, the client and developing fetus use more glucose and glycogen

ketoacidosis accompanies hyperglycemia, not hypoglycemia

pregnancy-induced hypertension is not a factor in first trimester (personal aside, based on my course notes, hypertension noted in first trimester is typically considered to have been pre-existing or related to other causes)

Question 6

a client is to receive 12 units of Regular insulin and 26 units of NPH insulin subcutaneously daily. Which procedure is correct.

1. Store all insulin in the refrigerator
2. massage the injection site after the injection
3. draw up the NPH insulin first, then the Regular
4. Roll the NPH insulin bottle between the pals of the hands prior to drawing it up

Answer 6

NPH insulin is an intermediate-acting insulin and should be rolled between the palms of the hands to thoroughly mix the dose prior to withdrawal from vial

insulin may be left at room temperature for up to 4 weeks unless the room temperature is higher than 85 F or below freezing. Extra insulin may/should be stored in fridge

after injecting insulin, some pressure should be applied as needle is being withdrawn. The swab should be held in place a few second, but not massaged.

when mixing intermediate-acting with Regular, Regular should always be drawn up first (RN - R before N)

Question 7

your client was started on 0.1 mg of Synthroid daily. What teaching will the client need in relation to this medication?

1. take the medication with meals
2. do not substitute generic brands
3. dosage can be self-adjusted based on energy needs
4. expect to loose 10 to 15 pounds within the first 6 months of therapy

Answer 7

Clients receiving Synthroid (levothyroxine) should not substitute generic brands as different brands have different preparations and may no be the same. To maintain appropriate thyroid levels, substitutions should not be made.

does not need to be taken with meals. Should be taken at same time each day to establish consistency

dose should not be self-adjusted as it should be done based on serum laboratory values and only done under direction of a qualified health care provider

weight loss may occur as result of increased basal metabolic rate, but not for all clients!

Question 8

your client had a bilateral adrenalectomy and Solu-Cortef has been prescribed. You know the purpose of this medication is to:

1. lower serum glucose
2. relieve postoperative pain
3. prevent adrenal insufficiency
4. decrease risk of postoperative stress ulcers

Answer 8

Hydrocortisone (Solu-Cortef) will replace the corticosteroid normally produced in the adrenal gland’s cortex and prevent adrenal insufficiency.

tends to raid, not lower serum glucose levels

not an analgesic and will not relieve postop pain

causes gastric irritation and should be given with meals (does not decrease risk of postop stress ulcers)

Question 9

a 22-year-old female is admitted to the unit with a BGM of 822 mg/dl and an arterial blood pH of 7.02. The client is unresponsive. The insulin type and rout you anticipate administering is:

1. humulin N given IV
2. humulin R given IV
3. humulin 70/30 given IV
4. Humulin N given subcutaneously only

Answer 9

Humulin R is rapid-acting insulin and can be administered IV to treat high blood glucose levels.

Humulin N is a suspension and cannot be given IV

Humulin 70/30 is a mix of intermediate and regular, it cannot be given IV

Rapid-acting is needed as pt is unresponsive. Humulin N is too slow via subcutaneous route and cannot be given via IV route

Question 10

A client is admitted to the nursing unit with a medical diagnosis of chronic hypothyroidism. The nursing assessment reveals a body temperature of 90 F, and apical heart rate of 58, and a respiratory rate of 10 breaths per minute. The nurse immediately recognizes these findings as indicative of:

1. hypercalcemia
2. hypermagnesemia
3. metabolic acidosis
4. myxedema coma

Answer 10

The nurse will associate the client’s symptoms with myxedema coma. A body temperature of 90 F, an apical of 50 BPM, and respirations of 10 per minute are classic symptoms of myxedema coma seen in clients with hypothyroidism

hypercalcemia (calcium serum levels above 10.1 mg/dl) may be seen in hyperthyroidism, not hypothyroidism

hypermagnesemia (magnesium serum levels above 2.1 mg/dl) is associated with acute adrenocortical insufficiency and untreated diabetic ketoacidosis

symptoms of metabolic acidosis include increased respiration rate and depth, not bradypnea

Question 11

A client with diabetes has been taking tolazamide 100 mg po daily. The client has just had a hip replacement and is to be on Coumadin 5 mg PO daily. You anticipate the following potential changes:

1. an increase in serum glucose levels
2. a decrease in prothrombin times
3. a decrease in serum glucose and an increase in prothrombin times
4. an increase in serum glucose and an increase in prothrombin times

Answer 11

You anticipate a decrease in serum glucose and an increase in prothrombin times. Tolazamide (Tolinase) and Warfarin (Coumadin) tend to augment each other’s actions. therefore, the prothrombin time will increase and the serum glucose levels will be lowered even more, since the two drugs are being used in combonation

Question 12

A client arrives in the ED restless, hypotensive, confused, and vomiting. The client’s friend states the client stopped taking betamethasone 4 days ago because it tended to cause heartburn. You anticipate administration of:

1. large doses of loop diuretic
2. narcotic
3. sodium bicarbonate and Humulin N intravenously
4. glucocorticoids

Answer 12

you will anticipate administration of glucocorticoid. This person is exhibiting classic signs of adrenal insufficiency, probably due to the abrupt cessation of glucocorticoid therapy

diuretics are usually not given to hypotensive clients because they lower BP by decreasing circulation volume

an analgesic is not anticipated since there is no indication client is experiencing pain

there is no indication that patient is experiencing something like metabolic acidosis that would require sodium bicarbonate

Question 13

your client is being treated with glucocorticoids for adrenal insufficiency secondary to abrupt withdrawal of cortisone. Your client’s family member inquires about what happened to the client’s adrenal glands. You explain:

1. the adrenal glands were destroyed by the cortisone therapy
2. the adrenal glands were not really affected and “adrenal insufficiency” is just a loosely applied term
3. the adrenal glands have probably developed tumors
4. the adrenal function was suppressed during cortisone therapy

Answer 13

You will explain that the function of the adrenal glands is suppressed during glucocorticoid therapy and abrupt cessation of glucocorticoids does not allow time for the adrenal glands to resume normal functioning

there is no evidence of permanent adrenal damage

the adrenal function was affected by glucocorticoid use

there is no evidence of a tumor

Question 14

Your client has been placed on a regime of methylprednisolone because of severe allergies. Your client teaching will include instruction to:

1. taper the medication dose according to the regime
2. take the medication only on days when allergies flare up
3. discontinue taking the medication when symptoms of allergies are no longer noticeable
4. contact the physician because this is not a recommended therapy for allergic reactions

Answer 14

The client will be taught to taper the methylprednisolone (Medrol) according to the regime. Tapering the dosage will avoid adrenal insufficiency

corticosteroids like methyprednisolon are to be taken on a regular basis - not just when an allergy is bothersome

sudden withdrawal can precipitate adrenal insufficiency

this is an appropriate med for treatment of allergic reactions

Question 15

During a thyroidectomy, a client’s parathyroid glands were inadvertently removed. Which of the following laboratory tests must be monitored very closely?

1. urine specific gravity
2. creatine kinase-MB isoenzyme
3. serum calcium
4. amylase

Answer 15

Serum calcium should be monitored carefully. The parathyroid gland’s function is to increase calcium absorption and increase blood calcium levels. Serum calcium levels must be scrupulously monitored. Extreme disturbances in calcium levels may lead to tetany or lethal arrhythmias

PTH (parathyroidhormone) does not directly affect urine specific gravity.

CK and CK-MB are used to confirm acute MI in hours following event - not related to PTH

Question 16

The nurse recognizes that clients receiving large dosages of vasopressin (ADH) may experience:

1. facial pallor
2. headache
3. flushing
4. dyspnea

Answer 16

Vasopressin (Pitressin) causes vasoconstriction, this can result in facial pallor

clients may experience dizziness and a pounding sensation in the head, but not a headache

clients may experience perspiration, paleness, and perioral blanching, but not flushing (opposite)

dyspnea is not associated with admin of Pitressin

Question 17

An adolescent with diabetes asks about the use of alcohol. The most appropriate counsel would be:

1. diabetics require more insulin when they consume alcohol
2. alcohol consumption increases blood glucose
3. hypoglycemia occurs with alcohol consumption
4. diabetics who consume alcohol become intoxicated easily

Answer 17

Diabetics should be taught that alcohol consumption inhibits release of glycogen from the liver, which results in hypoglycemia

alcohol doesn’t increase blood glucose or need for insulin

diabetes does not change when an individual becomes intoxicated - however, diabetics may develop hypoglycemia that goes unrecognized because of the similarity between symptoms and those symptoms associated with alcohol intoxication

Question 18

The physician prescribed 20 units of isophane (NPH) insulin 30 minutes before breakfast daily for a client with diabetes mellitus. The client is to have a midafternoon snack of milk and crackers. The client asks the nurse why the snack is necessary. Which response by the nurse would be bes?

1. it will improve your nutritional status
2. it will improve carbohydrate metabolism
3. it prevents an insulin reaction
4. it prevents diabetic ketoacidosis

Answer 18

it prevents hypoglycemia at peak action of isophaone insulin, which occurs 6 to 12 hours after administration.

Question 19

A client with hypoparathyroidism complains of tingling of the lips, hands, and face. You notify the physician because you suspect the development of which complication?

1. syndrome of inappropriate antidiuretic hormone
2. tetany
3. myxedema
4. Cushing’s syndrome

Answer 19

The nurse will suspect the development of tetany. Hypoparathyroidism causes a decrease in serum calcium levels due to lack of PTH. A decrease in calcium ion concentration causes tetany. Signs of tetany syndrome include tingling lips, hands, and feet; muscle tension, stiffness, and paresthesia (sensation of numbness)

SIADH is a complication of conditions such as increased intracranial pressure or endocrine and pulmonary disorders. It is associated with an increase in secretion of ADH which causes extracellular volume overload and a decrease in urine output

Myxedema is a type of hypothyroidism associated with extreme symptoms of hypothyroidism

Cushing’s syndrome results from excessive adrenocortical activity, not hypoparathyroidism

Question 20

hyperthyroidism is suspected in a 28-year-old client. Prescriptions include a radioactive iodine uptake test. The nurse will explain to the client that the chief purpose of a radioactive iodine uptake test is to:

1. ascertain the ability of the thyroid gland to produce thyroxine
2. measure the activity of the thyroid gland
3. estimate the concentration of thyrotropic hormone in the thyroid gland
4. determine the best method of treating the thyroid condition

Answer 20

The purpose of radioactive iodine uptake test is to measure the activity of the thyroid gland. The thyroid gland cannot distinguish between regular iodine and radioactive iodine. By administering tracer doses, the percentage of radioactive iodine used by the gland to produce thyroxine provides and indicator of gland activity. In clients with hyperthyroidism, the gland may use up to twice as much iodine as a euthyroid (normal) state

the test does not: determine the ability of the thyroid to produce thyroxine, estimate the concentration of thyrotropic hormone (thyroid-stimulating hormone)

treatment will not be addressed until assessment has been completed. This test is only one consideration!

Question 21

A client develops carpopedal spasms subsequent to a subtotal thyroidectomy. Which of the following medications will the nurse have available for administration?

1. calcium gluconate
2. potassium chloride
3. diazepam
4. phenytoin sodium

Answer 21

The nurse will have calcium gluconate available. When a client develops carpopedal spasms (spasms of the hands and feet) subsequent to a thyroidectomy, calcium gluconate should be administered. Muscular twitching and hyperirritability of the nervous system indicates tetany due to hypocalcemia. This condition develops if the parathyroid glands are accidently removed during thyroid surgery. Calcium replacement therapy is indicated for treatment of this problem

potassium chloride (slow-k) is administered for the treatment of potassium deficiencies and digitalis intoxication. it is not affected by thyroidectormy

diazepam (valium) is a sedative/hypnotic, anticonvulsant, and skeletal muscle relaxant. it doesn’t replace calcium

phenytoin sodium (Dilantin) is an anticonvulsant and does not replace calcium

Question 22

A client undergoes a subtotal thyroidectomy. During the immediate postop period, the nurse should assess for laryngeal nerve damage. Which of the following findings would indicate the presence of this problem?

1. facial twitching
2. wheezing
3. hoarseness
4. hemorrhage

Answer 22

Hoarseness and weakness of the voice following a subtotal thyroidectomy is an indication of laryngeal nerve damage. The damage occurs if there is unilateral injury of the pharyngeal nerve during surgery

facial twitching may occur if the parathyroid glands are damaged or removed during the thyroidectomy

wheezing could occur as a result of edema, not laryngeal nerve damage

hemorrhage could occur following a thyroidectomy due to vascularity of the operative site. However, hemorrhage is not associated with laryngeal nerve damage

Question 23

Your client is experiencing acromelagy (hyperpetuitarism). You will expect your assessment to reveal: (select all that apply)

a. enlarged hands and broad feet
b. alopecia
c. prominent frontal and orbital ridges
d. hypertension
e. pallor

Answer 23

a, c, d
The growth hormone effects associated with acromegaly (hyperpituitarism) include enlarged hands and broad feet, prominent frontal and orbital ridges, and hypertension

increased body hair, not alopecia, is experienced by acromegaly

clients experiencing acromegaly have increased skin pigmentation, not pallor

Question 24

an insulin-dependent diabetic is scheduled for surgery. Administration of Regular insulin is prescribed in lieu of isophane insulin. The client is asking why the insulin prescription had to be changed. Which explanation by the nurse would be best?

1. stress-induced fluctuations in blood glucose can be more adequately managed with Regular insulin
2. during the first week following recovery from diabetic acidosis the likelihood of a recurrence is greatest
3. diminished activity intensifies the body response to long-acting insulin
4. diabetic acidosis causes a temporary increase in the rate of food absorption

Answer 24

stress-induced fluctuations in blood glucose can be more adequately managed with Regular insulin. Regular insulin is rapid acting, beginning within 15 minutes after administration. It peaks within 2 to 4 hours and duration is 5 to 8 hours. Regular insulin is the only insulin that may be used intravenously when the client’s blood glucose is out of control. Regular insulin may also be used with intermediate- or long-acting insulin to maintain better control. Regular insulin is the only insulin that can be used in the insulin pump. The used of Regular insulin with this client will minimize the occurrence of intraoperative and postoperative complications associated with blood glucose levels

there is no indication that the client is experiencing or will experience diabetic acidosis

the long-acting insulin will not be used because it cannot be administered intravenously and is not fast acting. Regular insulin is needed to adequately manage blood glucose levels

there is no indication that the client is experiencing diabetic acidosis

Question 25

A mother makes all of the following comments about her 3-month-old daughter. Which comment indicates to the nurse the infant may have thyroid hormone deficiency

1. my baby smiles a lot
2. my baby’s good and never cries
3. my baby notices toys and knows my voice
4. my baby spends a great deal of time watching her hands

Answer 25

an early indication that an infant may have thyroid hormone deficiency is the statement by the mother, “my baby is good and never cries”. Early manifestations of hypothyroidism are inactivity, excessive sleeping, and minimal crying, which leads parents to the erroneous conclusion the baby is quiet and good

a normal 3-month-old should be smiling, vocalizing, and noticing surroundings

Question 26

the physician has prescribed warm saline dressings be applied to a heel ulcer of a diabetic client. You observe another nurse preparing a clean basin and washcloth to implement the procedure. Which of the following actions should you take?

1. Interrupt the nurse assembling supplies to discuss the procedure
2. present the situation for discussion at a staff meeting
3. do nothing, the nurse is following the correct procedure
4. do nothing, because nurses are accountable for their own actions

Answer 26

you should interrupt the nurse assembling the supplies and informed of the need for sterile technique. Sterile technique is required when applying soaks to a foot ulcer. The client is a diabetic with a foot ulcer and is susceptible to infection and gangrene. Sterile technique is an essential factor in the client’s recovery.

something should be said and immediately as it could prevent contamination of the client’s foot ulcer.

safe practice should be monitored by ANY nurse directly or indirectly involved in a client’s care

Question 27

A client with Addison’s disease is admitted to your unit. What do you expect your assessment to reveal?

1. osteoporosis
2. hirsutism
3. sodium and water retention
4. dark pigmentation of the skin

Answer 27

an assessment of a client with Addison’s disease would reveal dark pigmentation of the skin, especially the sun-exposed areas over joints and in creases such as on the palms of hands. Other assessment findings in the early period of the disease include muscular weakness, hypotension, fatigue, emacination, anorexia, and low blood glucose. Addison’s disease (adrenal insufficiency) results from a deficiency in the secretion of the adrenocortical hormones due to autoimmune influiences (75% of cases) and other conditions such as surgical removal, infection, or tuberculosis of the adrenal glands

adrenocortical insufficiency does not affect reduction in bone mass (osteoporosis)

hirsutism (excessive growth of hair of presence of hair in unusual places) is not associated with adrenocortical insufficiency

sodium and water retention are not associated with adrenocortical insufficiency

Question 28

A client with type 2 non-insulin-dependent diabetes takes 5 mg of po daily of glyburide for glucose control. Which statement by the client indicates a need for further teaching?

1. I will not take an extra pill if I eat too much
2. I will eat 3 meals a day
3. I will call a physician if I get sick
4. I will take my pill every night before I go to bed

Answer 28

Clients with T2 non-insulin dependent DM who take glyburide (Micronase) for glucose control should take the medication at the same time daily at breakfast or at the first main meal. Following administration, the medication is absorbed within 1 hour, peaks between 2 and 4 hours, and lasts 24 hours.

Glyburide should be taken po, qid and clients should consume 3, regular schedule meals. they should also contact physician if they are ill as blood glucose levels may require insulin to control (like Regular via IV route)

Question 29

The physician has written the following prescriptions for a client with myxedema. Which prescription will you question?

1. levothyroxine sodium 0.2 mg IV every day
2. nitroglycerin gr 1/150 sublingually prn for chest pain
3. morphine sulfate 4 mg IV q4h prn for severe pain
4. monitor capillary blood glucose at 0700, 1100, 1600, and 2100

Answer 29

The nurse wil question a prescription for morphine sulfat. Clients who have myxedema (a type of hypothyroidism) are sensitive to sedatives, opiates, and anesthetic agents. Nurse should question any prescription for these medications.

Levothyroxine is a thyroid hormone replacement and is appropriate.

clients with myxedema are likely to have elevated serum cholesterol levels and coronary artery disease so nitroglycerin is appropriate

monitoring capilary blood glucose is necessary since synthroid increases the metabolic rate of body tissue

Question 30

A client had a subtotal thyroidectomy. While assessing, the nurse observes that the client swallows frequently and speaks with a twang. The blood pressure is 20 points lower, the pulse is 30 points higher, and respirations twice as fast as baseline admission assessment. Which of the following is an appropriate nursing action?

1. continue to monitor vital signs q30minutes as prescribed
2. record finding; considering the client’s postoperative state, vital signs are within normal ranges
3. notify the surgeon; the client may be bleeding internally
4. report findings to the nursing supervisor

Answer 30

the clients behavior and vital signs indicatei internal bleeding and the surgeon should be notified. As a result of bleeding, tracheal narrowing has occured, causing the client to speak with a twang

just monitoring vitals q30min is inadequate and are outside the normal postoperative expectations

the surgeion should benoified since internal bleeding is probable

Question 31

A client with myxedema was admitted to your unit. What do you expect your assessment to reveal?

1. weight loss
2. subnormal temperature
3. tachycardia
4. hirsutism

Answer 31

the nurse would expect an assessment of a client with severe hypothyroidism to (myxedema) to reveal a subnormal body temperature, bradycardia, and weight gain. The client’s skin becomes thickened, the face expressionless, and mental processes are dulled. Early symptoms of myxedema include fatigue, hair loss, brittle nails, dry skin, numbness and tingling of fingers, and hoarseness.

hirsutism is an increased growth of hair or hair occurring on unusual places. This is not associated with myxedema - which recall had thinning and dryness of hair

Question 32

you are planning a teaching program for a 16-year-old who has recently been diagnosed with type 1 diabetes. when planning the program, you understand the greatest influence on its success is:

1. the client’s acceptance of the diagnosis
2. the parents’ acceptance of the diagnosis
3. whether or not the entire teaching plan is implemented by one nurse
4. whether or not teaching is limited to 1-hour periods

Answer 32

the nurse will recognize that clients’ acceptance of their condition will have the greatest influence on the success of teaching programs. When initiating a teaching plan, the nurse will be aware that this client is an adolescent in the process of forming a unique identity as a significant, capable person who is able to assume responsibility.

the ultimate success depends on the client’s acceptance, not the parents. Adolescents are usually more concerned with their peers’ attitudes, not what their parents think

the number of professionals involved should not affect the success

teaching should be limited to an hour to support learning by allowing time to absorb information - this however, requires client to accept condition to matter

Question 33

A mother with DM has delivered her baby. Two hours after delivery, the nurse observes that the infant is lethargic and has developed mild generalized cyanosis and twitching. The nurse should recognize these may be symptoms of:

1. hypoglycemia
2. hypercapnia
3. hypothermia
4. hypercalcemia

Answer 33

The nurse will recognize that the neonate of the diabetic mother is experiencing hypoglycemia. Prior to delivery, the fetus was exposed to high levels of maternal glucose. The fetus responded to the high glucose levels by increasing insulin production and hyperplasia of the pancreatic beta cells. following the birth of the infant, the maternal glucose supply is gone and the infant becomes hypoglycemic as a result of high circulating levels of insulin

there is no reason to suspect hypercapnia (increased amounts of carbon dioxide in serum). Hypercapnia is associated with conditions like COPD

The cyanosis is due to hypoglycemia, not hypothermia

hypercalcemia (serum calcium levels above 10.0 mg/dl) is not associated with infants born to diabetic mothers

Question 34

Which of the following measures is the most effective in achieving normal blood sugar levels in the client with type 2 diabetes?

1. increasing sodium intake
2. decreasing water intake
3. achieving ideal body weight
4. decreasing daily exercise

Answer 34

achieving an ideal body weight is effective in maintaining normal blood sugar levels. The number of insulin receptros is decreased in the very obese. Many obese persons who experience marked fluctuations in their blood sugar find their blood sugars can be regulated with weight loss. Obese people tend to be insulin resistant

increasing sodium in the diet may lead to hypertension and electrolyte imbalance

decreasing water intake may lead to dehydration

regular daily exercise is encouraged for clients who experience hyperglycemia. Exercise stimulates insulin production

Question 35

your client has a closed head injury and is experiencing increased intracranial pressure. You will monitor the client for potential damage to the:

1. adrenal gland
2. parathyroid gland
3. thyroid gland
4. pituitary gland

Answer 35

The pituitary gland. It is located in the inferior portion (base) of the brain. Swelling of the brain may put pressure on the pituitary gland. Fluctuation in blood pressure or diuresis may be evident if client experiencing an increase in intracranial pressure is lacking vasopressin (antidiuretic hormone) secreted by the pituitary

the adrenal glands are located near the kidneys while the thyroid and parathyroid glands are both in the neck

Question 36

your client has acromegaly. you know this condition is caused by over secretion of: ________________

Answer 36

Growth Hormone.

Acromegaly, or enlargement of the viscera, develops as a result of oversecretion of growth hormone which is secreted by the pituitary gland.

Oversecretion of growth hormone developing in early childhood may result in giantism (major difference is epiphyseal closure has not yet occurred so bones grow longer)

Question 37

Increased levels of serum calcium may result in which of the following?

1. increased secretion of growth hormone
2. increased secretion of parathyroid hormone (parathormone)
3. decreased secretion of follicle-stimulated hormone
4. decreased secretion of parathormone

Answer 37

elevated serum levels will result in decreased secretion of parathormone. PTH is secreted by the parathyroid glands. Parathormone regulates calcium metabolism and is affected by serum calcium levels. A feedback loop causes decreases in PTH to result in elevated serum calcium levels and vice versa.

Neither growth hormone nor follicle-stimulating hormone is directly affected by serum calcium levels

an increase in serum calcium levels will result in a decrease in PTH secretion

Question 38

Clients experiencing hypothyroidism are generally treated with thyroid replacement therapy. which of the following is a potentially serious side effect of initiation of thyroid replacement?

1. angina
2. increased urination
3. increased energy levels
4. myxedema

Answer 38

At the time thyroid replacement therapy is initiated, the client could experience the side effect of angina. Clients who experience hypothyroidism for extended periods often develop elevated cholesterol levels and atherosclerotic changes in their vessels. They also tend to have a slow heart rate and relatively low metabolic demands. With the institution of thyroid replacement therapy, the metabolic rate increases, as does the heart rate. This may precipitate angina or an ischemic cardiac event

a marked increase in urination is no associated with this

increased energy level is a desirable effect of thyroid replacement therapy

myxedema occurs as a result of hypothyroidism

Question 39

A client is to receive Lugol’s solution 0.2 ml tid 12 days prior to a thyroidectomy. The nurse knows to administer the medication:

1. on an empty stomach
2. immediately before meals
3. dilute in juice and taken through a straw
4. with an iodine-rich food

Answer 39

Lugol’s solution (a strong iodine solution) should be diluted in fruit juice, water, or milk, and taken through a straw. Iodine may cause nausea and vomiting and it will also stain the teeth

it should be taken with meals to prevent gastric irritation

iodine-rich foods are not permitted because they interfere with the dosage of the prescribed iodine. High iodine foods include iodized salts, oysters, spinach, lima beans, beef liver, and navy beans

Question 40

An infant is receiving levothyroxine for treatment of congenital hypothyroidism. The infant’s parents should be taught to notify their child’s healthcare provider if they observe:

1. mottled and cool skin
2. a pulse rate above 150 bpm
3. feeding difficulty
4. edema and weight gain

Answer 40

A pulse rate above 150 bpm indicates possible tachycardia and can be a sign of too much levothyroxine

mottled and cool skin, feeding difficulty, edema, and weight gain are all signs of hypothyroidism and suggest that the medication has not yet eliminated these symptoms

Question 41

The following diagnostic studies have been prescribed: protein bound iodine, radioactive iodine uptake, and triiodothyronine. Which of the following instructions will the nurse give to prepare the client for these procedures?

1. food and fluids are restricted prior to these procedures
2. proper imaging of the thyroid during these tests requires restricting movement
3. tests may take some time because injected dyes travel slowly to thyroid
4. ingestion of iodine is restricted prior to these tests

Answer 41

ingestion of iodine is restricted prior to tests that utilize iodine. The protein-bound iodine (PBI) and the triiodothyronine (T3) uptake tests are blood studies. The radioactive iodine uptake shows the percentage of radioactive ingested orally which has been stored in the thyroid gland. No special preparation needed for any of these tests. However, ingesting iodine in the form of iodized salt, foods, or drugs may alter the results of these tests.

There is no need to restrict food or fluids for any of these studies

there is no imaging required with any of these tests

no dyes are injected. The client is given a po tracer dose of 131 iodine when being prepared for the radioactive iodine uptake test

Question 42

A client has pheochromocytoma. The nurse will monitor the client’s:

1. blood pressure
2. respiratory rate
3. hemoglobin level
4. white blood cell count

Answer 42

clients with pheochromocytoma should have their blood pressure monitored closely. Pheochromocytoma is a tumor of the adrenal medulla. Functioning tumors of the adrenal medulla cause hypertension and other cardiovascular disturbances. Life-threatening blood pressures as high as 350/200 mmHg have been recorded

respiratory rate, hemoglobin level, and white blood cell count are not directly affected by pheochromocytoma.

Question 43

A client who is experiencing manifestations of a pituitary tumor will probably complain of:

1. decrease in peripheral vision
2. tearing and eye pain with exposure to sunlight
3. dependent edema
4. dyspnea

Answer 43

clients who are experiencing manifestations of a pituitary tumor will probably complain of a decrease in peripheral vision. Complains of visual field disturbance are not uncommon in clients with a pituitary tumor. Growing pituitary tumors may exert pressure on surrounding structures. Visual fields may be affected by the tumor’s growth as pressure is exerted on the optic chiasm.

tearing and eye pain with exposure to sunlight is often due to a disorder in the eye itself, such as increased pressure due to glaucoma

dyspnea and dependent edema are more likely due to disorders of cardiovascular or renal systems, such as congestive heart failure or fluid overload, or to respiratory disorders

Question 44

Which of the following medications would most likely be administered to treat the signs and symptoms associated with Graves’ disease?

1. epinephrine
2. codeine
3. beta-blockers
4. laxatives

Answer 44

beta-blockers may be prescribed for clients with Graves’ disease (a form of hyperthyroidism). It is associated with the signs and symptoms of accelerated metabolism Tachycardia, nervousness, and tremors are typical signs of this condition. Beta-blockers tend to slow the heart rate and are thus very useful in the adjunct therapy for Graves’ disease

Epinephrine tends to increase, not decrease sympathetic nervousness and system response

Codeine’s analgesic effects are not indicated for this typically painless disease

laxatives are rarely indicated because persons with Graves’ disease tend to have hyperactive bowel function

Question 45

Your client is experiencing hypothyroidism. which of the following comments made by this client do you associate with this condition? (select all that apply)

a. I don’t seem to have an appetite
b. I have difficulty sleeping
c. I have gained a lot of weight recently
d. I take laxatives 2-3 times a week for constipation
e. my heart feels like it is going to come out of my chest

Answer 45

a, c, d

insomnia and a bounding, rapid pulse with palpitations are associated with hyperthyroidism, not hypo

Question 46

Your client had a subtotal thyroidectomy. You are teaching the client to prevent postoperative complications by avoiding goitrogenic foods. Which of the following do you recognize as potent goitrogens? (select all that apply)

a. grapes
b. turnips
c. rutabagas
d. pinto beans
e. peanut skins

Answer 46

2, 3, 5

substances that produce enlargement of the thyroid gland are known as goitrogens. Goitrogens are found naturally in foods. Potent goitrogens, include turnips, rutabagas, and peanut skins

Question 47

Your client is experiencing Cushing’s syndrome. You expect your assessment of the client to reveal: (select all that apply)

a. weight loss
b. moon face
c. hirsutism
d. ecchymosis
e. facial pallor

Answer 47

b, c, d

Cushing’s syndrome causes symptoms including moon face, hirsutism (growth of hair in unusual places), and ecchymosis (superficial bleeding under the skin or mucous membranes aka bruising). These symptoms are associated with excessive corticosteroids, especially glucocorticoids

Clients with Cushing’s syndrome experience weight gain and have red cheeks (not pallor)

Question 48

Your client is experiencing hypothyroidism and is constipated due to gastrointestinal hypomotility. You are teaching the client how to avoid constipation. Which comments by the client suggest additional teaching may be need?
(select all that apply)
a. I will drink 2-3 litres of fluid a day
b. I will consume foods low in bulk and roughage
c. I will take a stool softener if needed
d. I will cut back on my physical activity
e. I will schedule small, frequent meals

Answer 48

b, d, e

consuming food high in bulk and residue will help clients experiencing hypomotility have daily, soft stool

physical activity stimulates peristalsis and is recommended to treat constipation

small, frequent meals will not increase gastrointestinal mobility. The type of food and amount of fluid are more significant factors than the amount of food and timing of meals

consuming enough fluid is recommended as is use of stool softeners as needed

Question 49

a client with hyperthyroidism is experiencing exophthalmos. To minimize the risk factors associated with exophthalmos, you will teach the client to: (select all that apply)

a. increase dietary salt intake
b. sleep with the head of the bed raised
c. exercise extraocular muscles daily
d. apply methylcellulose eyedrops
e. cover the eyes with a mask at night

Answer 49

.b, c, d

sleeping with the head of the bed raised will help to promote fluid drainage.

exercising extraocular muscles daily can maintain flexibility. Severe exophthalmos can cause paralysis of these muscles

methylcellulose eyedrops (artificial tears) can help prevent eye discomfort. Dryness can occur when patients with exophthalmos are unable to fully close eyes. It can lead to corneal ulceration

dietary salt intake should be restricted since it contributes to periorbital edema

covering the eyes with a mask or taping the lids closed may be necessary when exophthalmos prevents clients from closing eyes

Question 50

your client has Addison’s disease. You anticipate an assessment of the client’s skin to reveal: (select all that apply)

a. cyanosis
b. hyperpigmentation
c. bluish-black gums and oral mucosa
d. pallor
e. ecchymosis

Answer 50

b,c
Addison’s is primary adrenal cortical insufficiency. Clients with Addison’s disease experience hyperpigmentation of the skin. Skin exposed and unexposed to the sun has a tanned appearance. This is due to elevated adrenocorticotropic hormone (ACTH)

gums and oral mucosa of a client with Addison’s disease will be bluish-black colour. This is due to elevated adrenocorticotropic hormone (ACTH).

cyanosis (blue, gray, slate, or dark purple discoloration of the skin) is not associated with Addison’s. Typically associated with deoxygenated or reduced hemoglobin in the blood

pallor (lack or color or paleness of the skin) is not associated with Addison’s. Associated with conditions like anemia

ecchymosis is not associated with Addison’s. Seen in clients with who have disseminated intravascular coagulation (DIC) or hepatitis

Question 51

The exogenous administration of glucocorticoids is usually given to:

1. promote diuresis
2. for their anti-inflammatory effects
3. for their analgesic properties
4. for their antiarrhythmic properties

Answer 51

2 - for the anti-inflammatory effects. Systemic administration of glucocorticoids may be used in allergic reaction or inflammatory disorders. Glucocorticoids such as cortisol are produced by the adrenal cortex and affect metabolism and inflammation