Unit Q-Endocrine

Question 1

The nurse assesses an older client. What age-related physiologic changes would the nurse expect?

a. Heat intolerance
b. Rheumatoid arthritis
c. Dehydration
d. Increased appetite

Answer 1

ANS: C
As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production. This change, in addition to less body fluid being present as one ages, can cause dehydration. Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age-related change; osteoarthritis causes primarily by aging.

Question 2

The nurse assesses a client who is scheduled to have a laboratory test to determine if the client’s adrenal glands are hypoactive. What type of testing would the client likely have?

a. Catecholamine testing
b. Suppression testing
c. Bone marrow testing
d. Provocative testing

Answer 2

ANS: D
Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland

Question 3

A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding would indicate that the medication is effective?

a. Heart rate of 92 beats/min
b. Respiratory rate of 18 breaths/min
c. Oxygenation saturation of 92%
d. Blood pressure of 144/69 mm Hg

Answer 3

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 other vital signs are within normal limits and do not indicate any response to the medication

Question 4

A nurse collaborates with assistive personnel (AP) to provide care for a client who is prescribed a 24-hour urine specimen collection. Which statement would the nurse include when teaching the AP about this activity?

a. “Note the time of the client’s 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.

Answer 4

ANS: A
The collection of a 24-hour urine specimen is often delegated to AP. The nurse must ensure that the AP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the client’s 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 client’s 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.

Question 5

A nurse assesses a female client who presents with hirsutism. Which question would 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?

Answer 5

ANS:BHirsutism, 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 would inquire into the client’s body image and self-perception. Asking about the client’s financial status or current medications does not address the client’s immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.

Question 6

A nurse is caring for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition?

a. Decreased blood pressure
b. Increased pulse
c. Decreased respiratory rate
d. Increased urine output

Answer 6

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

Question 7

The nurse is teaching assistive personnel (AP) about hormones that are produced by the
adrenal glands. Which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition?
a. Sodium
b. Magnesium
c. Aldosterone
d. Renin

Answer 7

ANS: C
Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume. Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure. Magnesium and sodium are electrolytes and not hormones.

Question 8

The nurse reviews the function of thyroid gland hormones. What is the primary function of calcitonin?

a. Sodium and potassium balance
b. Magnesium balance
c. Norepinephrine balance
d. Calcium and phosphorus balance

Answer 8

ANS:D
Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.

Question 9

A nurse teaches an older woman who has a decreased production of estrogen. Which statement would the nurse include in this client’s teaching to decrease injury?

a. “Drink at least 2 quarts (2 L) 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.”

Answer 9

ANS: B
An older female with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse would encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

Question 10

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.

Answer 10

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 body’s 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.

Question 11

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones would the nurse expect to be decreased as a result? (Select all that apply.)

a. Thyroid-stimulating hormone
b. Vasopressin
c. Follicle-stimulating hormone
d. Calcitonin
e. Growth hormone

Answer 11

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.

Question 12

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

Answer 12

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

Question 13

When caring for an older client who has hypothyroidism, what assessment findings will the nurse expect? (Select all that apply.)

a. Lethargy
b. Diarrhea
c. Low body temperature
d. Tachycardia
e. Slowed speech
f. Weight gain

Answer 13

ANS: A,C,E,F
A client who has an underactive thyroid gland has a decreased metabolic rate, resulting in lethargy and lack of energy, weight gain, slowed speech, and decreased vital signs like a lowered body temperature. The client also typically has constipation (instead of diarrhea) due to slower peristalsis and bradycardia (instead of tachycardia).

Question 14

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

Answer 14

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.

Question 15

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client’s plan of care?

a. Avoid intramuscular medications.
b. Place the client in protective isolation.
c. Use a lift sheet to reposition the patient.
d. Assist the client to dangle before rising.

Answer 15

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.

Question 16

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe?

a. Large hands and face
b. Thin, dry skin
c. Short height
d. Truncal obesity

Answer 16

ANS: A
The client who has acromegaly has an excess of growth hormone as an adult and therefore has a large musculoskeletal structure that is readily observed.

Question 17

After teaching a client with acromegaly who is scheduled for an open transsphenoidal hypophysectomy, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further 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.

Answer 17

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

Question 18

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include?

a. “Take this drug on an empty stomach first thing in the morning.”
b. “You will be starting on a high dose of the drug to ensure it will work.”
c. “You might experience an increase in blood pressure in about a week.”
d. “Seek medical attention immediately if you have chest pain and dizziness.”

Answer 18

ANS: D
Bromocriptine should be started on a low dose and taken with food. The drug can cause decreased blood pressure, including orthostatic hypotension. Serious effects such as cardiac dysrhythmias, coronary artery spasms, and cerebrospinal leak can occur Therefore, the nurse teaches the client should seek medical attention if he or she experiences chest pain, dizziness, and watery nasal discharge.

Question 19

After teaching a client who is recovering from an endoscopic transsphenoidal hypophysectomy, the nurse assesses the client’s 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. “I’ll keep food on upper shelves so I do not have to bend over.”
c. “I must wash the incision with saline and redress it daily.”
d. “I should cough and deep breathe every 2 hours while I am awake.

Answer 19

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.

Question 20

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client’s serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate?

a. Consult with the dietitian about increased dietary sodium.
b. Restrict the client’s fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for repositioning.
d. Instruct assistive personnel to measure intake and output.

Answer 20

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 client’s 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 would be on intake and output; however, this will monitor only the client’s intake, so it is not the best answer. Reducing fluid intake will help increase the client’s sodium.

Question 21

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor?

a. Hypertension
b. Bradycardia
c. Dehydration
d. Pulmonary embolus

Answer 21

ANS: C
The client who has DI has fluid loss through excessive urination. Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature. Pulmonary embolism (PE) could possible as a clot in the lower extremity (caused by dehydration) could fragment and travel to the lungs

Question 22

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy?

a. The need to check the client’s urinary specific gravity.
b. The need to take blood pressure at least twice a day.
c. The need to monitor blood glucose every day.
d. The need to weigh every day and report weight gain.

Answer 22

ANS: D
The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water toxicity. Water toxicity causes headache, vomiting, and acute confusion.

Question 23

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 would the nurse respond?

a. “I will ask your doctor to order a mental health 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.”

Answer 23

ANS: B
Hypercortisolism can cause the client to have neurotic or psychotic behaviors. The client needs to know that these behavior changes do not reflect a true mental or behavioral health 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.

Question 24

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone
(SIADH) with assistive personnel. What statement by the AP indicates understanding of this
client’s care?
a. “I will weigh the client carefully before breakfast and compare with yesterday’s
weight.”
b. “I will encourage plenty of fluids to promote urination and prevent dehydration.”
c. “I will teach the client not to select high-sodium or salty foods on the menu.”
d. “I will assess the client’s mucous membranes and skin for signs of dehydration.”

Answer 24

ANS: A
The client with SIADH usually has a fluid restriction, not an increase in fluids. It is the role of the RN rather than AP to perform assessments and provide health teaching. The AP needs to weigh the client daily and report a significant weight changes.

Question 25

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor? a. Increased intracranial pressure b. Myocardial infarction c. Rapid-onset hypernatremia d. Bowel perforation

Answer 25

ANS:C Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and death.

Question 26

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform? a. Respiratory assessment b. Skin assessment c. Neurologic assessment d. Cardiac assessment

Answer 26

ANS: D The client who has adrenal insufficiency has hyperkalemia that can cause cardiac dysrhythmias. Therefore, the nurse would monitor the client’s cardiovascular status through frequent assessments.

Question 27

A client is admitted with possible diagnosis of diabetes insipidus (DI). What assessment findings would the nurse expect? SATA a. hypotension b. increased urinary output c. Concentrated urine d. Decreased thirst e. poor skin turgor f. bradycardia

Answer 27

ANS: A,B,E The client who has DI has excessive urinations and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a low specific gravity

Question 28

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values would the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L (150 mmol/L) b. Sodium: 130 mEq/L (130 mmol/L) c. Potassium: 2.5 mEq/L (2.5 mmol/L) d. Potassium: 5.0 mEq/L (5.0 mmol/L) e. pH 7.28 f. pH 7.50

Answer 28

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.

Question 29

A nurse teaches a client with Cushing disease. Which dietary requirements would the nurse include in this client’s health teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

Answer 29

ANS: B,D,E The client with Cushing 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.

Question 30

A nurse assesses a client with Cushing disease. Which assessment findings would the nurse expect? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

Answer 30

ANS: A,D,E | Clinical manifestations of Cushing disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

Question 31

The nurse is planning health teaching for a client starting on levothyroxine. What health teaching about this drug would the nurse include? a. The need to take the drug when the client feels fatigued and weak. b. The need to report chest pain and dyspnea when starting the drug. c. The need to check blood pressure and pulse every day. d. The need to rotate injection sites when giving self the drug.

Answer 31

ANS: B Levothyroxine is a replacement hormone for clients who have hypothyroidism and is taken orally for life. Vital signs do not have to be checked every day, but the client should report any chest pain and dyspnea when first starting the drug.

Question 32

A nurse assesses a client who is recovering from a subtotal thyroidectomy and observes the development of stridor. What is the priority action for the nurse to take? a. Apply oxygen via nasal cannula at 2 L/min. b. Document the finding and assess the client hourly. GRADESLAB.COM c. Place the client in high-Fowler position in the bed. d. Contact the Rapid Response Team and prepare for intubation.

Answer 32

ANS: D Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying 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.

Question 33

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the first postoperative day before discharge, the client states, “I feel numbness and tingling around my mouth.” What action does the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for muscle twitching. d. Ask the client orientation questions.

Answer 33

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 would assess for muscle twitching and, if present, notify the surgeon or Rapid Response Team to give calcium gluconate or other IV calcium replacement. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

Question 34

A nurse assesses a client on the medical-surgical unit. Which statement made by the client alerts the nurse to assess the patient for hypothyroidism? a. “My sister has thyroid problems.” b. “I seem to feel the heat more than other people.” c. “Food just doesn’t taste good without a lot of salt.” d. “I am always tired, even with 12 hours of sleep.”

Answer 34

ANS: D Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Most thyroid problems are not inherited, although they may occur in families. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism. The nurse would assess the client further for hypothyroidism.

Question 35

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer? a. Atropine sulfate b. Levothyroxine c. Propranolol d. Epinephrine

Answer 35

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine. 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.

Question 36

A nurse plans care for a client with hypothyroidism. Which priority problem does the nurse address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

Answer 36

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 client’s 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 patient’s environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

Question 37

A nurse assesses a client who is prescribed levothyroxine for hypothyroidism. Which assessment finding alerts the nurse that drug therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. Total white blood cell count is 6000 cells/mm3 (6  109/L). c. d. Heart rate is 76 beats/min and regular.

Answer 37

ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client’s 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

Question 38

A nurse cares for a client who has hypothyroidism as a result of Hashimotothyroiditis. The client asks, “How long will I need to take this thyroid medication?” How would 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 won’t need thyroid medication.” c. “You’ll need thyroid pills for life because your thyroid won’t start working again.” d. “When blood tests indicate normal thyroid function, you can stop the medication.”

Answer 38

ANS: C Hashimoto thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy and will not be able to stop taking the medication

Question 39

The nurse is caring for a client who is starting on propylthiouracil for hyperthyroidism. What statement by the client indicates a need for further teaching? a. “I will let my provider know if I have weight gain and cold intolerance.” b. “I will let my provider know if I have a metallic taste or stomach upset.” c. “I will avoid crowds and other people who have infection.” d. “I am aware that if the drug changes the color of my urine, I should stop it.”

Answer 39

ANS: B If the client’s urine turns dark and/or the skin has a yellow appearance, the client may have possible liver toxicity from the drug. This is a serious adverse effect and needs to be reported to the primary health care provider after stopping the drug. If weight gain and cold intolerance occurs, then the client may need a lower dose of the drug. The drug should not cause GI distress or a metallic taste in his or her mouth.

Question 40

A nurse plans care for a client with hyperparathyroidism. Which intervention does the nurse include in this client’s plan of care? a. Use a lift sheet to assist the client with position changes in bed. b. Ask the client to ambulate in the hallway twice a day. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the assistive personnel to strain the patient’s urine for stones.

Answer 40

ANS: A 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 patient.

Question 41

While assessing a client with Graves disease, the nurse notes that the client’s temperature has risen 1° F (1° C). What does the nurse do first? a. Turn the lights down and shut the patient’s door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client’s apical-radial pulse deficit. d. Administer a dose of acetaminophen.

Answer 41

ANS: A A temperature increase of 1° F (5/9° C) may indicate the development of thyroid storm, and the primary health care provider or RRT needs to be notified. But before notifying the provider, the nurse should first 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 acetaminophen is not needed because the temperature increase is due to thyroid activity.

Question 42

The nurse is caring for a client who has possible hypothyroidism. What possible risk factors can cause this health problem? (Select all that apply.) a. Lithium drug therapy b. Thyroid cancer c. Autoimmune thyroid disease d. Iodine deficiency e. Laryngitis f. Pituitary tumors

Answer 42

ANS: A,B,C,D,F All of these factors place a client at risk for hypothyroidism except for laryngitis which is an inflammation of the larynx.

Question 43

A nurse is caring for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. What actions does the nurse take? (Select all that apply.) a. Administer levothyroxine. b. Administer propranolol. c. Monitor the apical pulse. d. Assess for Trousseau sign. e. Initiate telemetry monitoring.

Answer 43

ANS: C,E The client’s laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client’s 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. Trousseau sign is a test for hypocalcemia.

Question 44

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client’s health teaching? (Select all that apply.) a. Increased carbohydrates b. Decreased fats c. Increased calorie intake d. Supplemental vitamins e. Increased proteins

Answer 44

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.

Question 45

1. A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?” How would the nurse respond? a. “Glucose is the only fuel used by the body to produce the energy that it needs.” b. “Your brain needs a constant supply of glucose because it cannot store it.” c. “Without a minimum level of glucose, your body does not make red blood cells.” d. “Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”

Answer 45

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

Question 46

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. “At my age, I should continue seeing the ophthalmologist as I usually do.” b. “I will see the eye doctor when I have a vision problem and yearly after age 40.” c. “My vision will change quickly. I should see the ophthalmologist twice a year.” d. “Diabetes can cause blindness, so I should see the ophthalmologist yearly.”

Answer 46

ANS:D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

Question 47

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first? a. Document the finding in the client’s chart. b. Assess tactile sensation in the client’s hands. c. Examine the client’s feet for signs of injury. d. Notify the primary health care provider.

Answer 47

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse would inspect them for any signs of injury. After assessment, the nurse would document findings in the client’s chart. Testing sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and documentation have been completed.

Question 48

A nurse cares for a client who has a family history of diabetes mellitus. The client states, “My father has type 1 diabetes mellitus. Will I develop this disease as well?” How would the nurse respond? a. “Your risk of diabetes is higher than the general population, but it may not occur.” b. “No genetic risk is associated with the development of type 1 diabetes mellitus.” c. “The risk for becoming a diabetic is 50% because of how it is inherited.” d. “Female children do not inherit diabetes mellitus, but male children will.”

Answer 48

ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

Question 49

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client’s plan of care to delay the onset of microvascular and macrovascular complications? a. “Maintain tight glycemic control and prevent hyperglycemia.” b. “Restrict your fluid intake to no more than 2 L a day.” c. “Prevent hypoglycemia by eating a bedtime snack.” d. “Limit your intake of protein to prevent ketoacidosis.”

Answer 49

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes. Preventing hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.

Question 50

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 19-year-old Caucasian b. A 22-year-old African American c. A 44-year-old Asian American d. A 58-year-old American Indian

Answer 50

ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest risk.

Question 51

A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this client’s teaching to prevent bloodborne infections? a. “Wash your hands after completing each test.” b. “Do not share your monitoring equipment.” c. “Blot excess blood from the strip with a cotton ball.” d. “Use gloves when monitoring your blood glucose.”

Answer 51

ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including the lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess blood away from the strip or wear gloves.

Question 52

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client’s teaching? a. “Change positions slowly when you get out of bed.” b. “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).” c. “If you miss a dose of this drug, you can double the next dose.” d. “Discontinue the medication if you develop a urinary infection.”

Answer 52

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

Question 53

After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client’s understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy? a. “I’ll take this medicine during each of my meals.” b. “I must take this medicine in the morning when I wake.” c. “I will take this medicine before I go to bed.” d. “I will take this medicine immediately before I eat.”

Answer 53

ANS: D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client’s blood glucose levels causing hypoglycemia. The medication should be taken before meals instead of during meals.

Question 54

A nurse cares for a client with diabetes mellitus who asks, “Why do I need to administer more than one injection of insulin each day?” How would the nurse respond? a. “You need to start with multiple injections until you become more proficient at self-injection.” b. “A single dose of insulin each day would not match your blood insulin levels and your food intake patterns.” c. “A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates.” d. “A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock.”

Answer 54

ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the patient decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client’s risk of insulin shock.

Question 55

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching? a. “The lower abdomen is the best location because it is closest to the pancreas.” b. “I can reach my thigh the best, so I will use the different areas of my thighs.” c. “By rotating the sites in one area, my chance of having a reaction is decreased.” d. “Changing injection sites from the thigh to the arm will change absorption rates.”

Answer 55

ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration

Question 56

A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1C value would the nurse expect? a. 5.0% b. 5.7% c. 6.2% d. 7.4%

Answer 56

ANS: D A client is diagnosed with diabetes if the client’s A1C is 6.5% or greater. All listed values are below that level except for 7.4%.

Question 57

The nurse is planning teaching for a client who is starting exenatide extended release (ER) for diabetes mellitus type 2. Which statement will the nurse include in the teaching? a. “Be sure to take the drug once a day before breakfast.” b. “Take the drug every evening before bedtime.” c. “Give your drug injection the same day every week .” d. “Take the drug with dinner at the same time each day.”

Answer 57

ANS: C Exenatide ER is an incretin mimetic (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion, reducing liver glucose production, and delaying gastric emptying. As an extended-release drug, it is given only once a week by injection.

Question 58

The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching? a. “Be sure to take the drug with each meal.” b. “Take the drug every evening before bedtime.” c. “Take the drug on an empty stomach in the morning.” d. “Decide on the best day of the week to take the drug.”

Answer 58

ANS: A Acarbose is an alpha-glucosidase inhibitor that works in the intestinal tract to prevent enzymes from breaking down starches into glucose. However, it must be taken with food at each meal, usually 3 times a day, to allow the drug to work as intended.

Question 59

After teaching a client who has diabetes mellitus with retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching? a. “I have so many complications; exercising is not recommended.” b. “I will exercise more frequently because I have so many complications.” c. “I used to run for exercise; I will start training for a marathon.” d. “I should look into swimming or water aerobics to get my exercise.

Answer 59

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

Question 60

The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension

Answer 60

ANS: A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

Question 61

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take? a. Administration of oxygen via facemask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

Answer 61

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body’s attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The patient who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the patient glucose would be contraindicated. The patient does not require seizure precautions.

Question 62

A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client’s teaching to decrease the client’s insulin needs? a. “Limit your fluid intake to 2 L a day.” b. “Animal organ meat is high in insulin.” c. “Limit your carbohydrate intake to 80 g a day.” d. “Walk at a moderate pace for 1 mile daily

Answer 62

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for patients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 g of carbohydrates each day.

Question 63

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching? a. “If I develop an infection, I should stop taking my corticosteroid.” b. “If I have pain over the transplant site, I will call the surgeon immediately.” c. “I should avoid people who are ill or who have an infection.” d. “I should take my cyclosporine exactly the way I was taught.”

Answer 63

ANS: A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Antirejection drugs cause immunosuppression, and the patient should avoid crowds and peoplGeRwAhoDEarSeLillA.BC.haCnOgiMng the routine of antirejection medications may cause them to not work optimally.

Question 64

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client’s teaching to prevent injury? a. “Examine your feet using a mirror every day.” b. “Rotate your insulin injection sites every week.” c. “Check your blood glucose level before each meal.” d. “Use a bath thermometer to test the water temperature.

Answer 64

ANS: D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

Question 65

A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine

Answer 65

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

Question 66

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client’s diet would the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

Answer 66

ANS: B Restriction of dietary protein is recommended for clients with microalbuminuria to delay progression to renal failure. ThGeRclAieDntE’sSdLieAtBdo.eCsOnoMt need to be decreased in carbohydrates, fats, or total calories.

Question 67

A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the client’s signs and symptoms have not changed. What action would the nurse take next? a. Administer another half-cup (120 mL) of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

Answer 67

ANS: A This patient is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse would administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment would be repeated. The patient does not need intravenous dextrose, insulin, or glucagon.

Question 68

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately? a. Serum chloride level of 98 mEq/L (98 mmol/L) b. Serum calcium level of 8.8 mg/dL (2.2 mmol/L) c. Serum sodium level of 132 mEq (132 mmol/L) d. Serum potassium level of 2.5 mEq/L (2.5 mmol/L)

Answer 68

ANS: D Insulin activates the sodium–potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

Question 69

A nurse teaches a client with diabetes mellitus about sick-day management. Which statement would the nurse include in this client’s teaching? a. “When ill, avoid eating or drinking to reduce vomiting and diarrhea.” b. “Monitor your blood glucose levels at least every 4 hours while sick.” c. “If vomiting, do not use insulin or take your oral antidiabetic agent.” d. “Try to continue your prescribed exercise regimen even if you are sick.”

Answer 69

ANS: B When ill, the client should monGitRorAhDisEoSrLhAerBb.loCoOdMglucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.

Question 70

The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin? a. 8:00 a.m. (0800) b. 4:00 p.m. (1600) c. 8:00 p.m. (2000) d. 11:00 p.m. (2300)

Answer 70

ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the patient at 2000 and 2300 would be too late. The nurse would check the patient at 1600 (4:00 p.m.).

Question 71

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, “I will never be able to stick myself with a needle.” How would the nurse respond? a. “I can give your injections to you while you are here in the hospital.” b. “Everyone gets used to giving themselves injections. It really does not hurt.” c. “Your disease will not be managed properly if you refuse to administer the shots.” d. “Tell me what it is about the injections that are concerning you.

Answer 71

ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don’t know another way to manage the disease is dismissive of the client’s concerns.

Question 72

The nurse is caring for a newly admitted older adult who has a blood glucose of 300 mg/dL (16.7 mmol/L), a urine output of 185 mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44 mg/dL (15.7 mmol/L). What diabetic complication does the nurse suspect? a. Diabetic ketoacidosis (DKA) b. Severe hypoglycemia c. Chronic kidney disease (CKD) d. Hyperglycemic-hyperosmolar state (HHS)

Answer 72

ANS: D The client most likely has diabetes mellitus type 2 and has a high blood glucose causing increased blood osmolarity and dehydration, as evidenced by an insufficient urinary output and increased BUN. Older adults are at the greatest risk for dehydration due to age-related physiologic changes.

Question 73

The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic-hyperosmolar state (HHS). What is the nurse’s priority action at this time? a. Assess the client’s blood glucose level. b. Monitor the client’s urinary output every hour. c. Establish intravenous access to provide fluids. d. Give regular insulin per agency policy.

Answer 73

ANS: C The first priority in caring for a client with HHS is to increase blood volume to prevent shock or severe hypotension from dehydration. The nurse would monitor vital signs, urinary output, and blood glucose to determine if interventions were effective. Regular insulin is also indicated but not as the first priority action.

Question 74

A nurse assesses adults at a health fair. Which adults would the nurse counsel to be tested for diabetes? (Select all that apply.) a. A 56-year-old African-American male b. A 22-year-old female with a 30-lb (13.6 kg) weight gain during pregnancy c. A 60-year-old male with a history of liver trauma d. A 48-year-old female with a sedentary lifestyle e. A 50-year-old male with a body mass index greater than 25 kg/m2 f. A 28-year-old female who gave birth to a baby weighing 9.2 lb (4.2 kg)

Answer 74

ANS: A,D,E,F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, and Hispanics), obesity and physical inactivity, and giving birth to large babies. Liver trauma and a 30-lb (13.6 kg) gestational weight gain are not risk factors.

Question 75

A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which assessment findings would the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension

Answer 75

ANS: A,C,E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually, patients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

Question 76

A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client’s teaching? (Select all that apply.) a. “Do not walk around barefoot.” b. “Soak your feet in a tub each evening.” c. “Trim toenails straight across with a nail clipper.” d. “Treat any blisters or sores with Epsom salts.” e. “Wash your feet every other day.”

Answer 76

ANS: A,C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client would be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client would be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the primary health care provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

Question 77

A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

Answer 77

ANS: A,B,C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

Question 78

A nurse collaborates with the interprofessional team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members would the nurse include in this interprofessional team meeting? (Select all that apply.) a. Registered dietitian nutritionist b. Clinical pharmacist c. Occupational therapist d. Primary health care provider e. Speech–language pathologist

Answer 78

ANS: A,B,D When planning care for a client newly diagnosed with diabetes mellitus, the nurse would collaborate with a registered dietitian nutritionist, clinical pharmacist, and primary health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

Question 79

The nurse is caring for a client who has severe hypoglycemia and is experiencing a seizure. What actions will the nurse take at this time? (Select all that apply.) a. Administer glucagon 1 mg subcutaneously. b. Be sure the bed side rails are in the up position. c. Notify the primary health care provider immediately. d. Monitor the client’s blood glucose level. e. Increase the intravenous infusion rate immediately.

Answer 79

ANS: A,B,C,D The client who has severe hypoglycemia often has a blood sugar of less than 20 mg/dL (1.0 mmol/L) and may be unconscious or seizing. Therefore, the client cannot swallow and needs glucagon. To keep the client safe during the seizure, the nurse ensures that the side rails are up to prevent the client from falling out of bed. The nurse would also monitor the client’s blood sugar to evaluate the effectiveness of the interventions.

Question 80

The nurse is caring for a client who has diabetes mellitus type 1 and is experiencing hypoglycemia. Which assessment findings will the nurse expect? (Select all that apply.) a. Warm, dry skin b. Nervousness c. Rapid deep respirations d. Dehydration e. Ketoacidosis f. Blurred vision

Answer 80

ANS: B,F The client who has hypoglycemia is often anxious, nervous, and possibly confused. Due to lack of glucose, vision may be blurred or the client may report diplopia (double vision). Clients who have hyperglycemia from diabetes mellitus type 1 have warm skin, Kussmaul respirations that are rapid and deep, dehydration due to elevated blood glucose, and ketoacidosis.

Question 81

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.

Answer 81

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.

Question 82

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

Answer 82

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.

Question 83

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

Answer 83

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.

Question 84

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

Answer 84

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

Question 85

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

Answer 85

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone–releasing horNmUoRnSeIN. TGhTyBr.CotOroMpin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.

Question 86

Diabetes insipidus is a disorder of which organ? a. Anterior pituitary b. Posterior pituitary c. Adrenal cortex d. Adrenal medulla

Answer 86

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.

Question 87

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

Answer 87

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.

Question 88

What is a common clinical manifestation of juvenile hypothyroidism? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

Answer 88

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.

Question 89

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

Answer 89

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.

Question 90

Exophthalmos may occur in children with what diagnosis? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

Answer 90

ANS: B Exophthalmos (protruding eyeballs) is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

Question 91

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.”

Answer 91

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.

Question 92

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

Answer 92

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.

Question 93

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which organ? a. Thyroid gland b. Parathyroid glands c. Adrenal cortex d. Anterior pituitary

Answer 93

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.

Question 94

Chronic adrenocortical insufficiency is also referred to as what? a. Graves’ disease b. Addison’s disease c. Cushing’s syndrome d. Hashimoto’s disease

Answer 94

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.

Question 95

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

Answer 95

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 produNceUdR,SsIoNGciTrBcu.ClaOtMory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

Question 96

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.

Answer 96

ANS: C Additional support is required forNcUhiRldSIrNenGTwBh.oCOreMquire 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.

Question 97

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.

Answer 97

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.

Question 98

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

Answer 98

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.

Question 99

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

Answer 99

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.

Question 100

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

Answer 100

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).

Question 101

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

Answer 101

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.

Question 102

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

Answer 102

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.

Question 103

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

Answer 103

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

Question 104

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

Answer 104

ANS: A, D, E In Cushing’s syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia

Question 105

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

Answer 105

ANS: C, D, E A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.