N326 Quiz 2 | Questions, Answers and Rationales

N326 Quiz 2 | Questions, Answers and Rationales A client feeling increasingly tired seeks medical care. Type 1 diabetes is diagnosed. What causes increased fatigue with type 1 diabetes? Increased metabolism at the cellular level Increased glucose absorption from the intestine Decreased production of insulin by the pancreas Decreased glucose secretion into the renal tubules *Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine. A nurse is collecting information about a client with type 1 diabetes who is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? Taking too much insulin Getting too much exercise Excessive emotional stress Running a fever with the flu Eating fewer calories than prescribed * Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia). A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. What is the best response by the nurse? "The client will gain excessive weight if sodium is not limited." "An inadequate intake of potassium contributed to the disease." "This type of diet increases emotional stability." "Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium." *Clients with Cushing syndrome or those receiving cortical hormones must limit their intake of sodium and increase their intake of potassium, because the kidneys are retaining sodium and excreting potassium. Although sodium retention causes fluid retention and weight gain, the need for increased potassium must be considered as well. An excessive secretion of adrenocortical hormones in Cushing syndrome, not inadequate potassium intake, is the problem. This type of diet has no direct effect on the client's emotional status. The nurse is caring for a 70-year-old client who presents with dilute urine even when fluid intake is low. What could be the possible cause of the client's condition? Decreased glucose tolerance Decreased general metabolism Decreased ovarian production of estrogen Decreased antidiuretic hormone production *Dilute urine with decreased fluid intake indicates a decrease in antidiuretic hormone production. Decreased glucose tolerance causes elevated fasting and random blood glucose levels. The clinical manifestations of decreased general metabolism are decreased heart rate and blood pressure, decreased appetite, and decreased tolerance to cold. Decreased ovarian production of estrogen may result in decreased bone density and thin and dry skin. Which type of drug-induced hormonal imbalance is likely to be observed in the client undergoing treatment with demeclocycline? Acromegaly Diabetes mellitus Diabetes insipidus Cushing's syndrome * Drug-induced diabetic insipidus is usually caused by demeclocycline, which can interfere with the response of the kidneys to antidiuretic hormone. Demeclocycline does not cause endocrine disorders, such as acromegaly, diabetes mellitus, and Cushing's syndrome. What is a major nursing concern when caring for a client diagnosed with hyperthyroidism? Monitoring for hypoglycemia Protecting visitors and staff from radiation exposure Providing foods to increase appetite Arranging for sufficient rest periods *Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite. A nurse provides care to a client following a subtotal thyroidectomy. Which interventions should the nurse implement? Assessing for frequent swallowing Ambulating the client the evening of surgery Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes Instructing the client to support the head and maintain the neck in a flexed position Ensuring that oxygen, suction equipment, and a tracheostomy tray are at the bedside *Frequent swallowing in the postoperative period following a subtotal thyroidectomy may indicate hemorrhage. In the absence of complications, the client should be ambulated within a few hours following surgery. Facial spasms, apprehension, and tingling of the lips, fingers, or toes are indicative of tetany. Tetany is caused by hypocalcemia, resulting from damage to, or removal of, the parathyroid glands during a thyroidectomy. Tetany is a medical emergency. Oxygen, suction equipment, and a tracheostomy tray must be kept at the bedside in case of airway edema. The bed should be placed in semi-Fowler position, and the client should avoid neck flexion to prevent tension on the suture line. What are the most common hormones produced in excess with hyperpituitarism? Prolactin Growth hormone Luteinizing hormone Antidiuretic hormone Melanocyte-stimulating hormone *The most common hormones produced in excess with hyperpituitarism are prolactin and growth hormone. Excessive stimulation of luteinizing hormone and antidiuretic hormone is also associated with hyperpituitarism, but less commonly than prolactin and growth hormone. Secretion of melanocyte-stimulating hormone stimulates adrenocorticotropic hormone, which indirectly stimulates the pituitary gland, thus leading to hyperpituitarism. Which clinical manifestation occurs in a client with vasopressin deficiency? Impotence Hypotension Amenorrhea Decreased libido *Vasopressin regulates fluid level and blood pressure. A vasopressin deficiency causes hypotension. Impotence, amenorrhea, and decreased libido in both men and women are clinical manifestations of luteinizing and follicle-stimulating hormone deficiencies. Which cells does the nurse identify as producing thyrocalcitonin hormone? Islet cells Adrenal cells Pituitary cells Parafollicular cells *Parafollicular cells produce thyrocalcitonin hormone. This hormone helps in the regulation of serum calcium levels. Islet cells are responsible for the production of hormones such as insulin and glucagon. Adrenal cells are responsible for the production of hormones such as cortisol and aldosterone. Pituitary cells are responsible for the production of growth hormone, prolactin, and adrenocorticotropic hormone. Which hormones are secreted by the posterior pituitary gland? Oxytocin Prolactin Corticotropin Antidiuretic hormone Melanocyte-stimulating hormone *Oxytocin and antidiuretic hormone (vasopressin) [1] [2] are secreted by the posterior pituitary gland. Prolactin, corticotropin, and melanocyte-stimulating hormones are secreted by the anterior pituitary gland. Which medical condition could most probably result in clients developing primary diabetes insipidus (DI)? Meningitis Brain tumor Lithium therapy Defect in hypothalamus *A defect in the hypothalamus (thirst center) could be the most probable cause of primary DI. Meningitis or a brain tumor could interfere with the synthesis, transport, or release of antidiuretic hormone (ADH) and cause central DI. Lithium therapy affects the renal response to ADH and results in nephrogenic DI, or drug-related DI. A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not get along. It seems as though my spouse doesn't care about my diabetes." What is the nurse's best response? "You don't get along with your spouse." "I'm sorry. What can I do to make you feel better?" "It may be temporary because your spouse also needs time to adjust." "You are unhappy. I wonder, have you tried to talk to your spouse?" *The response "You are unhappy. I wonder, have you tried to talk to your spouse?" identifies the client's feelings and accepts them but also points out the responsibility of the client to take action. Although the response "You don't get along with your spouse" identifies one of the client's concerns, the identification of the underlying feeling is more therapeutic. The response "I'm sorry. What can I do to make you feel better?" makes the nurse responsible for changing the situation, which is not appropriate or therapeutic. The response "It may be temporary because your spouse also needs time to adjust" denies the client's feelings and provides false reassurance. A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland, and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after surgery? Place two pillows behind the client's head. Monitor for the complication of tetany resulting from hypocalcemia. Assess the sides and back of the client's neck for evidence of bleeding. Encourage the client to perform deep-breathing and coughing exercises. *In a back-lying (supine) position, blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client's head flexes the neck excessively; this increases tension on the suture line and may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Although tetany resulting from hypocalcemia may be a complication of this surgery, tetany will not occur during the first 8 hours after surgery. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours, to limit stress on the suture line. Which disease is caused by the deficiency of antidiuretic hormone? Acromegaly Diabetes insipidus Cushing's syndrome Syndrome of inappropriate antidiuretic hormone *Diabetes insipidus is caused by the deficiency of antidiuretic hormone. Acromegaly and Cushing's syndrome are not associated with antidiuretic hormone; excessive production of growth hormone results in acromegaly and excessive production of adrenocorticotropic hormone causes Cushing's syndrome. Syndrome of inappropriate antidiuretic hormone occurs due to increased production of antidiuretic hormone. A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Use tinted glasses. Use warm, moist compresses. Elevate the head of the bed 45 degrees. Tape eyelids shut at night if they do not close. Apply a petroleum-based jelly along the lower eyelid. * Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly. A client with diabetes mellitus complains of difficulty seeing. What would the nurse suspect as the causative factor? Lack of glucose in the retina Neovascularization of the retina Inadequate glucose supply to rods and cones Destructive effect of ketones on retinal metabolism * With diabetes mellitus, proliferation of fragile vessels and progressive thickening of the capillary basement membranes lead to decreased retinal perfusion and to hemorrhages in the eye. Hemorrhages in the eyes precipitate retinal detachment, resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; thickening of the capillary basement membranes can occur, even if the glucose level is maintained within normal limits. Ketones do not affect retinal metabolism; retinopathy is a result of vascular changes, retinal detachment, and hemorrhage within the eye. A nurse is caring for a client with endocrine problems. Which lab finding will alert the nurse that aldosterone will be released? Hypokalemia Hypoglycemia Hyponatremia Hypochloremia * Hyponatremia stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone. A nurse is caring for a client with hypoglycemia. Which nursing intervention would be appropriate in managing the client's condition? Administering insulin Administering glucagon Administering IV glucose Administering oral hydrocortisone Administering somatostatin * A client with hypoglycemia suffers with weakness and vision disturbances due to low glucose levels. Glucagon is the hormone secreted by the pancreas that helps with increasing the blood glucose levels. Administering IV glucose would immediately improve the blood glucose levels. Hydrocortisone is a glucocorticoid that prevents hypoglycemia by increasing liver gluconeogenesis and inhibiting peripheral glucose use. Insulin is administered when glucose levels are high as it increases the glucose reuptake, thereby reducing blood glucose levels. Somatostatin is a hormone released by delta cells of the pancreas that inhibits insulin and glucagon. A client reports backache and abnormal increase in shoe size. The primary healthcare provider prescribes 100 g of oral glucose and blood and urine samples are collected for testing. Which finding in the client indicates an abnormality? Growth hormone level is 7 ng/mL Growth hormone level is 3 ng/mL Urine produced in 24 hours is 3 L Urine produced has a specific gravity of 1.006 *Growth hormone level of 7 ng/ml indicates an abnormality. An abnormal increase in shoe size and backache are indicative of hypersecretion of growth hormone. Therefore suppression testing should be performed because high glucose levels are known to suppress the release of growth hormone. After administering 100 g of oral glucose, if the client's levels of growth hormone fail to fall below 5 ng/mL, then an abnormality in the secretion of growth hormone is considered. Growth hormone level of 3 ng/mL post-oral glucose intake is a normal result. Urine output of 3 L and specific gravity of 1.006 are normal results. The client is said to have diabetes insipidus if the urine output in 24 hours is greater than 4 L and has low specific gravity of less than 1.005. After a surgical procedure for cancer of the pancreas with removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, what symptom exhibited by the client requires immediate attention by the nurse? Jaundice Indigestion Weight loss Hyperglycemia *When the head of the pancreas is removed, the client has a greatly reduced number of insulin-producing cells, and hyperglycemia will occur; immediate treatment is necessary. Jaundice, indigestion, and weight loss are not immediately life threatening and will take time to develop. The nurse is planning discharge instructions for a client who had a thyroidectomy. What signs/symptoms will the client exhibit with surgically induced hypothyroidism? Fatigue Dry skin Insomnia Excitability Weight loss Intolerance to heat *Fatigue results from the decreased metabolic rate associated with hypothyroidism. Dry skin is caused by decreased glandular function. Insomnia is associated with hyperthyroidism because of the increased metabolic rate. Lethargy, not excitability, is associated with hypothyroidism because of the decreased metabolic rate. Weight gain, not loss, is associated with hypothyroidism because of the decreased metabolic rate. Intolerance to heat is associated with hyperthyroidism. A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary? "I need to rub my forearm vigorously until warm before testing at this site." "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels." "I have to make sure that my current glucose monitor can be used at an alternative site." *The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected. The response "I need to rub my forearm vigorously until warm before testing at this site" will increase blood flow, which helps to minimize the difference between forearm and fingertip results, although it does not eliminate them. In a study in which rapidly fluctuating glucose levels were initiated, glucose levels at the forearm were significantly lower than samples from the fingertips. The fingertip should be used when testing before, during, and after exercising, and before driving, after eating, and during illness; the fingertip most closely reflects a current glucose level. Not all glucose monitors on the market can be used for AST. Which adverse effect can be seen in a female client with gonadotropin deficiency and undergoing hormone replacement therapy? Thrombosis Hypotension Dehydration Increased thirst *A female client with gonadotropin deficiency is treated by replacement therapy of combined hormones, namely estrogen and progesterone. The side effect of this therapy is the increased risk of thrombosis or formation of blood clots in deep veins. Hypertension is a side effect of estrogen-progesterone therapy. Dehydration and increased thirst could indicate vasopressin deficiency. The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). What measures should the nurse include to increase arterial blood flow to the extremities? Exercises that promote muscular activity Meticulous care of minor skin breakdown Elevation of the legs above the level of the heart Soaking the feet in hot water each day *Arterial blood flow is improved with exercise by fostering the development of collateral circulation. Meticulous care of minor skin breakdown is important for the person with diabetes, but it does not improve arterial blood flow. Elevating the legs above the heart reduces arterial blood flow; the legs should be kept dependent to facilitate tissue perfusion. Soaking the feet in hot water is contraindicated because it can burn the skin or cause drying; also, individuals with diabetes may have neuropathies, which alter the perception of temperature. After assessing a client's condition, the nurse suspects that the client has diabetes mellitus. Which statement made by the client would be most appropriate in helping the nurse reach this conclusion? "I am 55 years old." "I quite often feel thirsty." "I eat food every 2 hours." "I have excessive sweating." "I sometimes experience shortness of breath." *Diabetes mellitus is more common in older clients. Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism. A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease? Reduction in excess body weight Stabilization of the serum glucose Demonstrated knowledge of the disease Adherence to the prescription for insulin *A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease. Which nursing care should be provided to a client who has undergone unilateral adrenalectomy? Offer a high-sodium diet. Encourage the client to use saliva-inducing agents Instruct the client to wear a medical alert bracelet. Administer temporary glucocorticoid replacement therapy. *Temporary glucocorticoid replacement therapy is needed for a client who has undergone a unilateral adrenalectomy. Spironolactone therapy is used when surgery cannot be performed. A client on spironolactone therapy is advised to increase sodium intake to reduce the risk of hyponatremia. Spironolactone therapy can cause a side effect of dry mouth that can be managed by saliva-inducing agents. A client who has undergone bilateral adrenal gland removal will require lifelong replacement of glucocorticoids and should wear a medical alert bracelet as an indication. Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? Urine output Specific gravity Urine osmolarity Serum osmolarity *Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus. A nurse is monitoring a client's laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic? 40 to 60 mg/dL (2.2 to 3.3 mmol/L) 80 to 99 mg/dL (4.5 to 5.5 mmol/L) 100 to 125 mg/dL (5.6 to 6.9 mmol/L) 126 to 140 mg/dL (7.0 to 7.8 mmol/L) *Results in the range 126 to 140 mg/dL (7.0 to 7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2 to 3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5 to 5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. (Results in the range of 6.1 to 6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.) The laboratory reports of a client who underwent a hypophysectomy show an intracranial pressure (ICP) of 20 mmHg. Which action made by the client is responsible for this condition? Drinking lots of water Eating high-fiber foods Bending over at the waist Bending knees when lowering body *Bending over at the waist should be avoided as this position increases intracranial pressure in clients who underwent hypophysectomy. Drinking lots of water and eating high-fiber foods reduce the risk of constipation, so this should not cause increased intracranial pressure. The client should bend the knees then lowering their body to reduce the risk of intracranial pressure. A registered nurse is providing information to a group of student nurses regarding the actions of parathyroid hormone (PTH). Which statement made by the student nurse indicates a need for further teaching? "It activates vitamin D in the kidneys." "Its secretion increases serum calcium levels." "It allows reabsorption of phosphorus in the kidney tubules." "It decreases serum calcium levels by increasing bone resorption." "It regulates calcium and phosphorous metabolism by acting on the gastrointestinal tract." *Parathyroid hormone (PTH) allows calcium to be reabsorbed in the kidney tubules. PTH increases bone resorption, thus increasing serum calcium levels. PTH activates vitamin D in the kidneys, which increases the absorption of calcium and phosphorous from the intestines. Secretion of PTH increases serum calcium levels. PTH regulates calcium and phosphorous metabolism by acting on the GI tract, bones, and kidneys. Which hormone regulates blood levels of calcium? Parathormone Luteinizing hormone Thyroid stimulating hormone Adrenocorticotropic hormone *Parathyroid hormone (PTH), or parathormone, regulates the blood levels of calcium and phosphorus. Luteinizing hormone (LH) stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. Thyroid stimulating hormone (TSH) stimulates the release of thyroid hormones and the growth and functioning of the thyroid gland. Adrenocorticotropic hormone (ACTH) promotes the growth of the adrenal cortex and stimulates the release of corticosteroids. A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering? Estrogen Progesterone Human growth hormone Human chorionic gonadotropin *Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency. The nurse is assessing a client suspected of having hypercortisolism. Which questions should the nurse ask to help confirm the diagnosis? "Did you lose any weight unintentionally?" "Did you notice your extremities to be thin?" "Did you notice any roughness of your skin?" "Did you notice any skin darkening recently?" "Did the hair on your body become thicker?" *Clients with hypercortisolism may have thin extremities. Increased body hair also indicate hypercortisolism. Increased skin pigmentation (particularly in sun-exposed areas) indicates hypocortisolism. Unintentional weight loss is an indication for hyperthyroidism or diabetes mellitus. Skin may be rough (coarse) or leathery in clients with hypothyroidism or excess growth hormone levels. Which term should the nurse use in a report to describe the absence of menstrual periods in a 35-year-old non-pregnant client? Rhinorrhea Menopause Amenorrhea Dyspareunia *The absence of menstrual periods in a non-pregnant client less than 55 years old is called amenorrhea. Rhinorrhea is an allergic state that is manifested by a runny nose. Menopause is cessation of menstruation after 55 years of age. Dyspareunia is pain during sexual intercourse. A nurse is assessing the skin of a client with a cortisol deficiency. Which integumentary assessment finding will most likely be observed in this client? Dry skin Ulcerated skin Generalized edema Diminished axillary hair *Clients with cortisol deficiencies will have diminished axillary and pubic hair. Dry skin is associated with hypothyroidism. Ulcerated skin is a sign of peripheral neuropathy and peripheral vascular disease. Generalized edema is seen in clients with hypothyroidism due to mucopolysaccharide accumulation in the tissues. Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes? Ketones in the blood but not in the urine Glucose in the urine but not hyperglycemia Urine negative for ketones and hyperglycemia Blood and urine positive for both glucose and ketones *In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes. A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client? Chest pain Tachycardia Hypertension Atrial fibrillation *Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma. A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. What symptom might the nurse identify when assessing this client? Fatigue Dry skin Anorexia Bradycardia *Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? Thirst Headache Nervousness Fruity breath odor Excessive urination *Thirst (polydipsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a by-product of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia because of central nervous system irritation. The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which statement by the client indicates that teaching was effective? "I should eliminate excessive blinking." "I should not move my extraocular muscles." "I should elevate the head of my bed at night." "I should avoid using a sleeping mask at night. * The mask may irritate or scratch the eyes if the mask moves during sleep. Blinking of the eyes will bathe the eyes and prevent corneal ulceration. Not moving extraocular muscles will not relieve edema or prevent ulceration of the eyes. Although elevating the head of the bed at night will help reduce periorbital edema, it will not prevent ulceration of the cornea. After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone? Increased blood urea nitrogen (BUN) and hypotension Hyperkalemia and poor skin turgor Hyponatremia and decreased urine output Polyuria and increased specific gravity of urine *Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration. The registered nurse instructs the new nurse in orientation regarding the physiologic processes of the endocrine system prior to client assessment. Which statement made by the new nurse indicates effective learning? "The endocrine system comprises glands with narrow ducts." "The endocrine system comprises salivary and lacrimal glands." "The hormones of the endocrine system exert their action by 'lock and key' mechanism." "The hormones secreted by endocrine system exert their action on all tissues they contact." *The endocrine glands secrete hormones that exert their action on the target tissues by the "lock and key" mechanism. The hormones recognize and adhere only to specific receptor sites on the target tissue, like a correct key alone can open its specific lock. The glands of the endocrine system are ductless and secrete hormones that are carried via the blood circulation. Salivary and lacrimal glands are not endocrine but secretory glands. The hormones are carried via blood to various tissues, but they exert their action only on specific target tissues. During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? Palpitations Tachycardia Thickened skin Apathetic attitude Menstrual disturbances *Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema. Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching is needed? "I can eat as much dietetic fruit as I want." "I can have a lettuce salad whenever I want it." "I know that half of my diet should be carbohydrates." "I need to reduce the amounts of saturated fats in my diet." *The client needs further teaching; dietetic fruit is not sugar-free and must be calculated in a diabetic individual's diet. Lettuce is considered a free food in the diet of a diabetic person. It is suggested that the caloric intake of a diabetic person's diet should be 50% carbohydrate, 20% protein, and 30% fat. Saturated fats should be limited to 10% of the fat intake; 90% of fat should be unsaturated fats. A nurse is caring for a client with hypothyroidism. Which clinical manifestations should the nurse anticipate when assessing this client? . Dry skin Brittle hair Weight loss Resting tremors Heat intolerance *Dry skin results from a decrease in the metabolic rate, which is associated with hypothyroidism. Dry, brittle hair results from a decrease in the metabolic rate, which is associated with hypothyroidism. Weight loss is associated with hyperthyroidism because of an increase in body metabolism. Resting tremors are not associated with hypothyroidism; they are associated with Parkinson's disease. Heat intolerance is associated with hyperthyroidism, not hypothyroidism, because of the increase in body metabolism. Which physiologic responses should a nurse expect when assessing a client with hyperthyroidism? Bradycardia Blurred vision Cold intolerance Increased appetite Widened pulse pressure *Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate. While caring for a client receiving fludrocortisone, the nurse suspects that the drug has caused a negative side effect. Which finding supports the nurse's conclusion? Body temperature of 37˚C (98.6˚F) Blood glucose of 100 mg/dL (5.5 mmol/L) Serum sodium of 137 mEq/L (137 mmol/L) Blood pressure of 150/90 mm Hg *The use of fludrocortisone is associated with hypertension as a side effect. The normal blood pressure of a healthy individual is 120/90 mm Hg. Therefore a blood pressure of 150/90 mm Hg supports the nurse's suspicion. The normal body temperature is 37°C (98.6°F). A blood glucose level of 100 mg/dL (5.5 mmol/L) is a normal finding; blood glucose levels should be less than 110 mg/dL (6.1 mmol/L). The normal serum sodium concentration ranges from 135 to 145 mEq/L (135 mmol/L). A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the problem, what is the nurse's response? Caution the client about high expectations because the prognosis is variable; the outcome depends on many factors. Tell the client that returning to work is okay because the body has two adrenal glands; the tumor was on just one of the glands. Advise the client to investigate other occupational alternatives if the client wishes to stay in the workforce. Tell the client that returning to work is possible if the client takes prescribed hormone supplements. *The body has two adrenal glands; an aldosteronoma is a unilateral tumor. The prognosis usually is excellent; cautioning the client about high expectations because the outcome is variable is unnecessarily alarming. Advising the client to investigate other occupational alternatives if planning to return to work is unnecessary; the prognosis usually is excellent. Hormones are not necessary; there is another adrenal gland that will secrete an adequate amount of hormones. Which organ has only beta 1-receptors? Liver Heart Bladder Pancreas The heart has only beta 1 receptors, which increase heart rate and contractility. The liver has only alpha receptors. The bladder and pancreas have both alpha and beta receptors. A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations? Fluid balance Electrolyte levels Protein anabolism Masculinizing hormones *Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease. The nurse is caring for a client immediately after a subtotal thyroidectomy. How will the nurse assess for unilateral injury of the laryngeal nerve? Checking the throat for edema Asking the client to say what the current time is Eliciting spasms of the facial muscles Palpating the neck for seepage of blood *If the laryngeal nerve is damaged during surgery, the client will be hoarse and have difficulty speaking. Checking the throat for edema does not indicate injury to the laryngeal nerve; this is part of the assessment for a compromised airway. Eliciting the Chvostek sign assesses for hypocalcemia resulting from inadvertent removal of the parathyroid glands. Palpating the neck for seepage of blood assesses for bleeding and possible hemorrhage, not laryngeal nerve injury. The nurse is caring for a client who is prescribed desmopressin acetate. What is the expected outcome in the client? Sodium: 136mEq/L Specific gravity: 1.005 Urine output: 3 L/day Osmolarity: 100 mOsm/kg *Desmopressin acetate is used for the treatment of diabetes insipidus, a disease associated with urine output of more than 4 L/day. The amount of urine output should decrease when the client is treated with desmopressin acetate. Sodium levels may not be altered in a client taking medication for diabetes insipidus. The specific gravity in a client under medication for diabetes insipidus should be more than 1.005. Osmolarity between 50 to 200 mOsm/kg indicates that the client has diabetes insipidus and is not an outcome of desmopressin acetate treatment Late in the postoperative period after resection of an aldosterone-secreting adenoma, what would the nurse expect the client's blood pressure to do? Gradually return to near normal levels Rise quickly above the preoperative level Fluctuate greatly during this entire period Drop very low, then increase rapidly to normal levels *Once the excessive secretion of aldosterone is stopped, the blood pressure gradually drops to a near normal level. The blood pressure drops gradually; it does not rise. Blood pressure will fluctuate if the hypervolemia is overcorrected; this is not expected. The blood pressure drops gradually in response to decreasing serum corticosteroid levels; a rapid drop immediately after surgery may indicate hemorrhage. An 11-year-old client is admitted with enlarged supraclavicular lymph nodes, fatigue, and low-grade fever. She also has a persistent nonproductive cough. In light of these findings, the nurse knows to gear education toward preparation for which therapies? Intravenous (IV) fluids and nutritional therapy Bloodwork and oxygenation therapy IV fluids and antibiotic therapy Computed tomography (CT) and lymph node biopsy *The symptoms indicate possible Hodgkin lymphoma, so diagnostic testing will likely include CT and a lymph node biopsy. IV fluids, antibiotic therapy, oxygenation therapy, and nutritional therapy are not requirements at this point in treatment. The laboratory report of a pregnant client shows increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels. What should the primary healthcare provider instruct the nurse to include in the plan of care for the client to help to reduce the risk of death in the client? Monitoring weight Administering mifepristone Monitoring fluid overload at every 6 hours Including 5 g of sodium in the diet everyday *The increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels indicate pituitary Cushing's syndrome. In pituitary Cushing's syndrome, prevention of fluid overload is very important as it can cause pulmonary edema, which may result in death. The easiest way to monitor fluid overload is monitoring the weight of the client. Each 1 lb (about 500 g) of weight gained is equal to 500 mL of retained water. The weight should be taken at the same time daily before breakfast using the same scale. Mifepristone is effective for the treatment of pituitary Cushing's syndrome, but should not be prescribed to a pregnant client because it can cause miscarriage. Signs of fluid overload should be monitored every 2 hours. In pituitary Cushing's syndrome, the client has elevated levels of sodium. Therefore, the client should be restricted to a 2- to 4-g/day sodium diet. The nurse is caring for a client who is diagnosed with diabetes insipidus and is on intranasal desmopressin acetate (DDAVP). The client develops an upper respiratory tract infection during a hospital stay. Which alteration does the nurse anticipate in the client's prescription? Cessation of DDAVP administration Reduced DDAVP dose via oral route Reduced DDAVP dose via subcutaneous route Continuation of DDAVP administration via nasal route *The client develops an upper respiratory tract infection while on desmopressin acetate (DDAVP) therapy for diabetes insipidus. Therefore the best alternative is to administer the DDAVP via oral or subcutaneous routes. The subcutaneous (parenteral) form of DDAVP is almost 10 times more potent than intranasal and oral forms. Therefore, if opting for subcutaneous route, the dose of DDAVP should be reduced. The DDAVP cannot be stopped as it can lead to uncontrolled fluid loss. The DDAVP can be continued in the prescribed dose if opting for oral route, but it does not need to be reduced. The DDAVP cannot be administered via nasal route because the client has developed an upper respiratory tract infection. During the progressive stage of shock, anaerobic metabolism occurs. Which complication should the nurse anticipate in this client? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis *Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid associated with the progressive stage of shock. Respiratory acidosis can result from decreased respiratory function in late shock, further compounding metabolic acidosis. Respiratory alkalosis occurs as a result of hyperventilation during early shock. Which statement regarding calcitonin is correct? It is secreted by follicular cells. Its actions are opposite to that of parathyroid hormone. It decreases phosphorous levels by increasing bone resorption. It works along with thyroid hormone to maintain normal calcium levels in blood. *Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels. Therefore, the actions of calcitonin are opposite to that of parathyroid hormone. Calcitonin is secreted by parafollicular cells of the thyroid gland. Calcitonin decreases calcium and phosphorus levels by decreasing bone resorption. Calcitonin works along with parathyroid hormone to maintain calcium levels in blood. Which hormone secretion does the nurse state is an example of a positive feedback mechanism? Insulin Estradiol Parathormone Catecholamines *Estradiol secretion pattern is an example of a positive feedback mechanism. Insulin secretion pattern is an example of a negative feedback mechanism. The relationship between calcium and parathormone is also an example of a negative feedback mechanism. Catecholamines secretion is controlled by the nervous system. It is secreted by the sympathetic nervous system. The primary healthcare provider instructs the client to increase their intake of seafood and protein in the diet. What could be the reason for this instruction? The client has vitiligo. The client has hypothyroidism. The client has diabetes mellitus. The client has a urinary infection. *Nutritional deficiencies due to inadequate diet, especially decreases in protein and iodine intake, may be a cause for certain endocrine disorders, such as hypothyroidism. Therefore, to meet nutritional requirements clients with hypothyroidism are instructed to increase the intake of seafood and proteins to 60 mg/day. Because of hypofunction of the adrenal gland, clients with skin pigmentation conditions, such as vitiligo, are mainly instructed to consume more water. To improve metabolism, clients with diabetes mellitus are advised to add high-fiber food to their diet. A client with a urinary infection may not be advised to add seafood and proteins to their diet. A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T 3) and thyroxine (T 4)? Irritability Tachycardia Weight gain Cold intolerance Profuse diaphoresis *A decrease in metabolism will result in a gain in weight. Decreased production of thyroid hormones lowers metabolism, which leads to decreased heat production and cold intolerance. Lethargy, rather than irritability, is expected. Decreased metabolism requires less oxygen, so the pulse rate is generally slower. The skin is dry and coarse, not moist. The nurse is caring for a client with hyperplasia of pituitary tissue. What would be the most appropriate goals of management? To alleviate headache To replace lost sodium To eliminate visual disturbances To check the urine specific gravity To return hormone levels to normal *A client with hyperplasia of pituitary tissue (tissue overgrowth) will have oversecretion of pituitary hormones resulting in hyperpituitarism. The client with hyperpituitarism will experience headaches and changes in vision, thus the goal of management should be to have normal pituitary hormone levels. Replacement of lost sodium is important if the client has syndrome of inappropriate antidiuretic hormone secretion. The specific gravity of urine may be low in certain conditions such as hyperaldosteronism. Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Lability of mood Slow wound healing A decrease in the growth of hair Ectomorphism with a moon face An increased resistance to bruising *Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas. Which drug acts as an abortifacient in female clients? Mifepristone Metyrapone Cyproheptadine Aminoglutethimide *Mifepristone is an antiprogesterone that blocks the progesterone receptors and acts as an abortifacient. Metyrapone, cyproheptadine, and aminoglutethimide are used to treat hyperfunctioning of the adrenal glands (Cushing's disease/syndrome). A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? Nervousness and tachycardia Erythema toxicum rash and pruritus Diaphoresis and altered mental state Deep respirations and fruity odor to the breath *Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine. A client who is 60 pounds (27.2 kilograms) more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept should the nurse include in teaching about diabetes when discussing strategies to lose weight? Obesity leads to insulin resistance. Surplus fat causes excretion of insulin. Fat cells absorb insulin and prevent its circulation to other cells. Lipids accumulate in the pancreas and interfere with insulin production. *Excess fat alters glucose metabolism, causing cells to become insulin resistant. Fat cells have no relationship to the function of the kidneys. Fat cells do not absorb insulin and therefore do not prevent the circulation of insulin to other cells. Clients with type 1