Adult Health - Endocrine

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nursedaisy98
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256678
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Adult Health - Endocrine
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2014-04-20 10:58:06
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NCLEX RN
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Adult Health
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Endocrine
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  1. A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 
    1. Endotracheal intubation 
    2. 100 units of NPH insulin 
    3. Intravenous infusion of normal saline 
    4. Intravenous infusion of sodium bicarbonate
    3. Intravenous infusion of normal saline
  2. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? 
    1. Is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals 
    2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 
    3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream 
    4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
    4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
  3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 
    1. Increase in pH 
    2. Comatose state 
    3. Deep, rapid breathing 
    4. Decreased urine output 
    5. Elevated blood glucose level 
    6. Low plasma bicarbonate level
    • 3. Deep, rapid breathing 
    • 5. Elevated blood glucose level 
    • 6. Low plasma bicarbonate level
  4. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply.
    1. Polyuria 
    2. Shakiness 
    3. Palpitations 
    4. Blurred vision 
    5. Lightheadedness 
    6. Fruity breath odor
    • 2. Shakiness 
    • 3. Palpitations 
    • 5. Lightheadedness
  5. A client with diabetes mellitus demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the most appropriate intervention to decrease the client's anxiety? 
    1. Administer a sedative. 
    2. Convey empathy, trust, and respect toward the client. 
    3. Ignore the signs and symptoms of anxiety so that they will soon disappear. 
    4. Make sure that the client knows all the correct medical terms to understand what is happening.
    2. Convey empathy, trust, and respect toward the client.
  6. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 
    1. "I will stop taking my insulin if I'm too sick to eat." 
    2. "I will decrease my insulin dose during times of illness." 
    3. "I will adjust my insulin dose according to the level of glucose in my urine." 
    4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."
    4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."
  7. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 
    1. Ampule of 50% dextrose 
    2. NPH insulin subcutaneously 
    3. Intravenous fluids containing dextrose 
    4. Phenytoin (Dilantin) for the prevention of seizures
    3. Intravenous fluids containing dextrose
  8. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? 
    1. Polyuria 
    2. Diaphoresis 
    3. Hypertension 
    4. Increased pulse rate
    1. Polyuria
  9. The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places highest priority on which client problem? 
    1. Lack of knowledge 
    2. Inadequate fluid volume 
    3. Compromised family coping 
    4. Inadequate consumption of nutrients
    2. Inadequate fluid volume
  10. The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 
    1. "I need to stop my insulin." 
    2. "I need to increase my fluid intake." 
    3. "I need to monitor my blood glucose every 3 to 4 hours." 
    4. "I need to call the health care provider (HCP) because of these symptoms."
    1. "I need to stop my insulin."
  11. The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 
    1. Lower the head of the bed. 
    2. Test the drainage for glucose. 
    3. Obtain a culture of the drainage. 
    4. Continue to observe the drainage.
    2. Test the drainage for glucose.
  12. After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? 
    1. Fatigue 
    2. Diarrhea 
    3. Polydipsia 
    4. Weight gain
    3. Polydipsia
  13. A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 
    1. Warm the client. 
    2. Maintain a patent airway. 
    3. Administer thyroid hormone. 
    4. Administer fluid replacement.
    2. Maintain a patent airway.
  14. The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 
    1. Correct the acidosis. 
    2. Administer 5% dextrose intravenously. 
    3. Apply a monitor for an electrocardiogram. 
    4. Administer short-duration insulin intravenously.
    4. Administer short-duration insulin intravenously.
  15. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 
    1. "The best time for me to exercise is after I eat." 
    2. "The best time for me to exercise is after breakfast." 
    3. "The best time for me to exercise is mid- to late afternoon." 
    4. "The best time for me to exercise is after my morning snack."
    3. "The best time for me to exercise is mid- to late afternoon."
  16. The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder?
    1. Diarrhea 
    2. Polyuria 
    3. Polyphagia 
    4. Weight gain
    2. Polyuria
  17. The nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the health care provider immediately? 
    1. Laryngeal stridor 
    2. Abdominal cramps 
    3. Difficulty in voiding 
    4. Mild to moderate incisional pain
    1. Laryngeal stridor
  18. A client is diagnosed with pheochromocytoma. The nurse understands that pheochromocytoma is a condition that has which characteristic? 
    1. Causes profound hypotension 
    2. Is manifested by severe hypoglycemia 
    3. Is not curable and is treated symptomatically 
    4. Causes the release of excessive amounts of catecholamines
    4.Causes the release of excessive amounts of catecholamines
  19. The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaints would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 
    1. Tremors 
    2. Anorexia 
    3. Irritability 
    4. Nervousness 
    5. Hot, dry skin 
    6. Muscle cramps
    • 1. Tremors 
    • 3. Irritability 
    • 4. Nervousness
  20. The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder?
    1. A coagulation time of 5 minutes 
    2. A urinary output of 50 mL/hour 
    3. A blood urea nitrogen level of 20 mg/dL 
    4. A heart rate that is 90 beats/minute and irregular
    4. A heart rate that is 90 beats/minute and irregular
  21. The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 
    1. "Cushing's disease results from an oversecretion of insulin." 
    2. "Cushing's disease results from an undersecretion of corticotropic hormones." 
    3. "Cushing's disease results from an undersecretion of mineralocorticoid hormones." 
    4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."
    4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."
  22. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101° F, pulse of 88 beats/minute, respirations of 22 breaths/minute, and blood pressure of 100/72 mm Hg. Which assessment would be of most concern to the nurse? 
    1. Pulse 
    2. Respiration 
    3. Temperature 
    4. Blood pressure
    3. Temperature
  23. The nurse is interviewing a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder? 
    1. "I take oral insulin instead of shots." 
    2. "By taking these medications, I am able to eat more." 
    3. "When I become ill, I need to increase the number of pills I take." 
    4. "The medications I'm taking help release the insulin I already make."
    4. "The medications I'm taking help release the insulin I already make."
  24. The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? 
    1. "I will need to limit the amount of protein in my diet." 
    2. "I should eat foods that have a lot of potassium in them." 
    3. "I am fortunate that I can eat all the salty foods I enjoy." 
    4. "I am fortunate that I do not need to follow any special diet."
    2. "I should eat foods that have a lot of potassium in them."
  25. The nurse is caring for a client who is 2 days postoperative following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carbohydrate-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is most appropriate at this time? 
    1. Call a code to obtain needed assistance immediately. 
    2. Obtain a capillary blood glucose level and perform a focused assessment. 
    3. Ask the unlicensed assistive personnel (UAP) to stay with the client while obtaining 15 to 30 g of a carbohydrate snack for the client to eat. 
    4. Stay with the client and ask the UAP to call the health care provider (HCP) for a prescription for intravenous 50% dextrose.
    2. Obtain a capillary blood glucose level and perform a focused assessment.
  26. The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority? 
    1. Vital signs 
    2. Intake and output 
    3. Blood urea nitrogen results 
    4. Urine for glucose and ketones
    1. Vital signs
  27. The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this diagnosis? Select all that apply. 
    1. Tremors 
    2. Weight loss 
    3. Feeling cold 
    4. Loss of body hair 
    5. Persistent lethargy 
    6. Puffiness of the face
    • 3. Feeling cold 
    • 4. Loss of body hair 
    • 5. Persistent lethargy 
    • 6. Puffiness of the face
  28. A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 
    1. Hypoglycemia 
    2. Level of hoarseness 
    3. Respiratory distress 
    4. Edema at the surgical site
    3. Respiratory distress
  29. A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? Select all that apply. 
    1. Fever 
    2. Nausea 
    3. Lethargy 
    4. Tremors 
    5. Confusion 
    6. Bradycardia
    • 1. Fever 
    • 2. Nausea 
    • 4. Tremors 
    • 5. Confusion
  30. The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which most important statement? 
    1. "Your hair will need to be shaved." 
    2. "You will receive spinal anesthesia." 
    3. "You will need to ambulate after surgery." 
    4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery."
    4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery."
  31. The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 
    1. Provide a cool environment for the client.
    2. Instruct the client to consume a high-fat diet.
    3. Instruct the client about thyroid replacement therapy. 
    4. Encourage the client to consume fluids and high-fiber foods in the diet. 
    5. Inform the client that iodine preparations will be prescribed to treat the disorder. 
    6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.
    • 2. Instruct the client to consume a high-fat diet. 
    • 3. Instruct the client about thyroid replacement therapy. 
    • 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.
  32. A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement should the nurse make to the client? 
    1. "Don't be concerned; this problem can be covered with clothing." 
    2. "Usually these physical changes slowly improve following treatment." 
    3. "This is permanent, but looks are deceiving and are not that important." 
    4. "Try not to worry about it; there are other things to be concerned about."
    2. "Usually these physical changes slowly improve following treatment."
  33. The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 
    1. To treat thyroid storm 
    2. To prevent cardiac irritability 
    3. To treat hypocalcemic tetany 
    4. To stimulate release of parathyroid hormone
    3. To treat hypocalcemic tetany
  34. A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 
    1. Try to exercise before mealtimes. 
    2. Administer insulin after exercising. 
    3. Take a blood glucose test before exercising.
    4. Exercise is best performed during peak times of insulin.
    3. Take a blood glucose test before exercising.
  35. The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 
    1. Provide a warm environment for the client. 
    2. Instruct the client to consume a low-fat diet. 
    3. A thyroid-releasing inhibitor will be prescribed. 
    4. Encourage the client to consume a well-balanced diet. 
    5. Instruct the client that thyroid replacement therapy will be needed. 
    6. Instruct the client that episodes of chest pain are expected to occur.
    • 1. Provide a warm environment for the client. 
    • 2. Instruct the client to consume a low-fat diet. 
    • 4. Encourage the client to consume a well-balanced diet. 
    • 5. Instruct the client that thyroid replacement therapy will be needed.
  36. A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client tells the nurse, "will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 
    1. The client needs immediate education before discharge. 
    2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 
    3. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. 
    4. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.
    1. The client needs immediate education before discharge.
  37. A client with type 1 diabetes mellitus is having trouble remembering the types, duration, and onset of the action of insulin. The client tells the nurse that the family members have not been supportive. Which response by the nurse is best? 
    1. "What is it that you don't understand?" 
    2. "You can't always depend on your family to help." 
    3. "It's not really necessary for you to remember this." 
    4. "Let me go over the types of insulin with you again."
    4. "Let me go over the types of insulin with you again."
  38. A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL. Which medication should the nurse anticipate to be prescribed for the client? 
    1. Glucagon 
    2. Humulin N insulin 
    3. Humulin R insulin 
    4. Glyburide (DiaBeta)
    1. Glucagon
  39. A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL. Which intervention should the nurse anticipate to be initially prescribed for the client? 
    1. Glucagon via the subcutaneous route
    2. Glyburide (DiaBeta) via the oral route 
    3. Humulin N insulin via the subcutaneous route 
    4. Humulin R insulin via the intravenous (IV) route
    4. Humulin R insulin via the intravenous (IV) route
  40. The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 
    1. A platelet count of 200,000 cells/mm3 
    2. A blood glucose level of 110 mg/dL 
    3. A potassium (K+) level of 5.5 mEq/L 
    4. A white blood cell (WBC) count of 6000 cells/mm3
    3. A potassium (K+) level of 5.5 mEq/L
  41. The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which on assessment of the client? 
    1. Unresponsive pupils
    2. Positive Trousseau's sign 
    3. Negative Chvostek's sign 
    4. Hyperactive bowel sounds
    2. Positive Trousseau's sign
  42. The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication should be included on the list? 
    1. Shakiness 
    2. Increased thirst 
    3. Profuse sweating 
    4. Decreased urine output
    2. Increased thirst
  43. The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperglycemic hyperosmolar state (HHS). The nurse understands that the hyperglycemia associated with this disorder results from which occurrence? 
    1. Increased use of glucose 
    2. Overproduction of insulin 
    3. Increased production of glucose 
    4. Increased osmotic movement of water
    3. Increased production of glucose
  44. The nurse is caring for a client with a diagnosis of Addison's disease. The nurse is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 
    1. Agitation 
    2. Diaphoresis 
    3. Restlessness 
    4. Severe abdominal pain
    4. Severe abdominal pain
  45. The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 
    1. Infertility 
    2. Gynecomastia 
    3. Sexual dysfunction 
    4. Body image changes
    4. Body image changes
  46. The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of pheochromocytoma. The nurse reads the assessment findings and expects to note documentation of which major symptom associated with this condition? 
    1. Glycosuria 
    2. Diaphoresis 
    3. Weight loss 
    4. Hypertension
    4. Hypertension
  47. The nurse is performing an assessment on a client with a diagnosis of Cushing's syndrome. Which should the nurse expect to note on assessment of the client? 
    1. Skin atrophy 
    2. The presence of sunken eyes 
    3. Drooping on one side of the face 
    4. A rounded "moon-like" appearance to the face
    4. A rounded "moon-like" appearance to the face
  48. The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding should the nurse expect to note in this client? 
    1. Dry skin 
    2. Thin, silky hair 
    3. Bulging eyeballs 
    4. Fine muscle tremors
    1. Dry skin
  49. The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding should the nurse expect to note in this client? 
    1. Dry skin 
    2. Bulging eyeballs 
    3. Periorbital edema 
    4. Coarse facial features
    2. Bulging eyeballs
  50. The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 
    1. "I will check my blood glucose level every day at 5:00 pm." 
    2. "I will check my blood glucose level 1 hour after each meal." 
    3. "I will check my blood glucose level 2 hours after each meal." 
    4. "I will check my blood glucose level before each meal and at bedtime."
    4. "I will check my blood glucose level before each meal and at bedtime."
  51. The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse should provide the client with which best instruction? 
    1. Eat meals at approximately the same time each day. 
    2. Adjust meal times depending on blood glucose levels. 
    3. Vary meal times if insulin is not administered at the same time every day. 
    4. Avoid being concerned about the time of meals so long as snacks are taken on time.
    1. Eat meals at approximately the same time each day.
  52. A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? 
    1. "Are you rotating the injection site?" 
    2. "Are you aspirating before you inject the insulin?" 
    3. "Are you using a 1-inch needle to give the injection?" 
    4. "Are you placing an air bubble in the syringe before injection?"
    1. "Are you rotating the injection site?"
  53. The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of Humulin N and Humulin R insulin. The nurse should instruct the client that which is thefirst step in this procedure? 
    1. Draw up the correct dosage of Humulin N insulin into the syringe. 
    2. Draw up the correct dosage of Humulin R insulin into the syringe.
    3. Inject air equal to the amount of Humulin N prescribed into the vial of Humulin N insulin. 
    4. Inject air equal to the amount of Humulin R prescribed into the vial of Humulin R insulin.
    3. Inject air equal to the amount of Humulin N prescribed into the vial of Humulin N insulin.
  54. The nurse is reviewing the health care provider (HCP) prescriptions for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the HCP prescriptions? 
    1. A decreased-calorie diet 
    2. An increased-calorie diet 
    3. A decreased amount of NPH daily insulin
    4. An increased amount of NPH daily insulin
    4. An increased amount of NPH daily insulin
  55. The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication? 
    1. Slow pulse; lethargy; warm, dry skin 
    2. Elevated pulse; lethargy; warm, dry skin 
    3. Elevated pulse; shakiness; cool, clammy skin 
    4. Slow pulse, confusion, increased urine output
    3. Elevated pulse; shakiness; cool, clammy skin
  56. The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse that he is planning to eat a dinner meal at a local restaurant this week. He asks the nurse if eating at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most appropriate? 
    1. "You are not allowed to eat in restaurants." 
    2. "You should order a half-portion meal and have fresh fruit for dessert." 
    3. "If you plan to eat in a restaurant, you need to skip the lunchtime meal." 
    4. "You should increase your daily dose of insulin by half on the day that you plan to eat in the restaurant."
    2. "You should order a half-portion meal and have fresh fruit for dessert."
  57. The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. 
    1. Monitor daily weight. 
    2. Monitor intake and output. 
    3. Assess extremities for edema. 
    4. Maintain a high-sodium diet. 
    5. Maintain a low-potassium diet.
    • 1. Monitor daily weight. 
    • 2. Monitor intake and output. 
    • 3. Assess extremities for edema.
  58. The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 
    1. Encourage client's expression of feelings. 
    2. Assess the client's understanding of the disease process. 
    3. Encourage family members to share their feelings about the disease process. 
    4. Encourage the client to recognize that the body changes need to be dealt with.
    4. Encourage the client to recognize that the body changes need to be dealt with.
  59. The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 
    1. Hypotension and fever 
    2. Mental status changes and hypertension 
    3. Subnormal temperature and hypotension 
    4. Complaints of weakness and hypertension
    1. Hypotension and fever
  60. The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 
    1. The signs and symptoms of hypoadrenalism 
    2. The signs and symptoms of hyperadrenalism 
    3. Instructions to take the medications exactly as prescribed 
    4. The importance of maintaining regular outpatient follow-up care 
    5. A reminder to read the labels on over-the-counter medications before purchase
    • 1. The signs and symptoms of hypoadrenalism 
    • 2. The signs and symptoms of hyperadrenalism 
    • 3. Instructions to take the medications exactly as prescribed 
    • 4. The importance of maintaining regular outpatient follow-up care
  61. The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply. 
    1. Monitor for changes in mentation. 
    2. Encourage an intake of low-protein foods. 
    3. Encourage an intake of low-sodium foods. 
    4. Encourage fluid intake of at least 3000 mL per day. 
    5. Monitor vital signs, skin turgor, and intake and output.
    • 1. Monitor for changes in mentation. 
    • 4. Encourage fluid intake of at least 3000 mL per day. 
    • 5. Monitor vital signs, skin turgor, and intake and output.
  62. The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider's (HCP) prescriptions, if noted on the record, would indicate the need for clarification? 
    1. Assess vital signs and neurological status. 
    2. Instruct the client to avoid blowing his nose. 
    3. Apply a loose dressing if any clear drainage is noted. 
    4. Instruct the client about the need for a Medic-Alert bracelet.
    3. Apply a loose dressing if any clear drainage is noted.
  63. The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 
    1. Maintain a supine position. 
    2. Monitor neck circumference every 4 hours. 
    3. Maintain a pressure dressing on the operative site. 
    4. Encourage deep breathing exercises and vigorous coughing exercises.
    2. Monitor neck circumference every 4 hours.
  64. The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign/symptom, if noted in the client, wouldmost likely indicate the presence of hypocalcemia? 
    1. Bradycardia 
    2. Flaccid paralysis 
    3. Tingling around the mouth 
    4. Absence of Chvostek's sign
    3. Tingling around the mouth
  65. The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 
    1. The hoarseness is permanent. 
    2. It indicates nerve damage. 
    3. It is normal during this time and will subside. 
    4. It will worsen before it subsides, which may take 6 months.
    3. It is normal during this time and will subside.
  66. The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 
    1. Fever and tachycardia 
    2. Pallor and tachycardia 
    3. Agitation and bradycardia
    4. Restlessness and bradycardia
    1. Fever and tachycardia
  67. The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 
    1. A client with hypothyroidism 
    2. A client with Graves' disease who is having surgery 
    3. A client with diabetes mellitus scheduled for a diagnostic test 
    4. A client with diabetes mellitus scheduled for débridement of a foot ulcer
    2. A client with Graves' disease who is having surgery
  68. The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide (Lasix) and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 
    1. "I need to eat foods high in potassium." 
    2. "I need to drink at least 2 to 3 L of fluid daily." 
    3. "I need to eat small, frequent meals and snacks if nauseated." 
    4. "I need to increase my intake of dietary items that are high in calcium."
    4. "I need to increase my intake of dietary items that are high in calcium."
  69. The nurse has provided instructions to the client with hyperparathyroidism regarding home care measures to manage the symptoms of the disease. Which statement by the client indicates a need for further instruction? 
    1. "I should avoid bed rest." 
    2. "I need to avoid doing any exercise at all." 
    3. "I need to space activity throughout the day." 
    4. "I should gauge my activity level by my energy level."
    2. "I need to avoid doing any exercise at all."
  70. The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse should instruct the client that it is acceptable to include which item in the diet? 
    1. Fish 
    2. Cereals 
    3. Vegetables 
    4. Meat and poultry
    3. Vegetables
  71. The nurse has provided home care measures to the client with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further instruction? 
    1. "I should always wear a Medic-Alert bracelet." 
    2. "I should perform my exercise at peak insulin time." 
    3. "I should always carry a quick-acting carbohydrate when I exercise." 
    4. "I should avoid exercising at times when a hypoglycemic reaction is likely to occur."
    2. "I should perform my exercise at peak insulin time."
  72. The nurse is caring for a client admitted to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the nurse anticipates that which medication would most likely be prescribed? 
    1. Glucagon 
    2. Regular insulin 
    3. Glyburide (DiaBeta) 
    4. Neutral protamine Hagedorn (NPH) insulin
    2. Regular insulin
  73. A registered nurse (RN) is caring for a client with a diagnosis of Cushing's syndrome. A nursing student is working with the RN for the day. Which statement by the student indicates understanding of Cushing's syndrome? 
    1. "Cushing's syndrome is caused by excessive amounts of cortisol." 
    2. "Cushing's syndrome is caused by decreased amounts of aldosterone." 
    3. "Cushing's syndrome is caused by excessive amounts of antidiuretic hormone." 
    4. "Cushing's syndrome is caused by decreased amounts of parathyroid hormone."
    1. "Cushing's syndrome is caused by excessive amounts of cortisol."
  74. A nurse is providing home care instructions to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruction? 
    1. "I need to wear a Medic-Alert bracelet." 
    2. "I need to purchase a travel kit that contains cortisone." 
    3. "I will need to take daily medications until my symptoms decrease." 
    4. "I need an increased dose of glucocorticoid medication during stressful minor illnesses."
    3. "I will need to take daily medications until my symptoms decrease."
  75. A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 
    1. Hypernatremia 
    2. Signs of water deficit 
    3. High urine osmolality 
    4. Low serum osmolality 
    5. Hypotonicity of body fluids 
    6. Continued release of antidiuretic hormone
    • 3. High urine osmolality 
    • 4. Low serum osmolality 
    • 5. Hypotonicity of body fluids 
    • 6. Continued release of antidiuretic hormone
  76. A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 
    1. Polyuria 
    2. Polydipsia 
    3. Concentrated urine 
    4. Complaints of excessive thirst 
    5. Specific gravity lower than 1.005
    • 1. Polyuria 
    • 2. Polydipsia 
    • 4. Complaints of excessive thirst 
    • 5. Specific gravity lower than 1.005
  77. A client with suspected Cushing's syndrome is scheduled for adrenal venography. A nurse has provided instructions to the client regarding the test. Which statement by the client indicates a need for further instruction? 
    1. "I need to sign an informed consent." 
    2. "The insertion site will be locally anesthetized." 
    3. "I will be placed in a high-sitting position for the test." 
    4. "I may feel a burning sensation after the dye is injected."
    3. "I will be placed in a high-sitting position for the test."
  78. A client has been hospitalized for an endocrine system dysfunction of the pancreas. The nurse providing care for the client anticipates that he or she will exhibit impaired secretion of which substances? 
    1. Insulin 
    2. Lipase 
    3. Trypsin 
    4. Amylase
    1. Insulin
  79. A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse providing care for the client anticipates that he or she may exhibit altered secretion of which hormones? 
    1. Growth hormone (GH) 
    2. Luteinizing hormone (LH) 
    3. Antidiuretic hormone (ADH) 
    4. Follicle-stimulating hormone (FSH)
    3. Antidiuretic hormone (ADH)
  80. A hospitalized client is diagnosed with dysfunction of the adrenal medulla. The nurse monitors for changes in client status related to altered production and secretion of which substance? 
    1. Cortisol 
    2. Androgens 
    3. Aldosterone 
    4. Epinephrine
    4. Epinephrine
  81. A client has a tumor that is interfering with the function of the hypothalamus. The nurse expects that which clinical problem will be exhibited by the client? 
    1. Melatonin excess or deficit 
    2. Glucocorticoid excess or deficit 
    3. Mineralocorticoid excess or deficit 
    4. Antidiuretic hormone (ADH) excess or deficit
    4. Antidiuretic hormone (ADH) excess or deficit
  82. A client's serum calcium level is high. The nurse plans care knowing that which hormones are directly responsible for maintaining the free or unbound portion of the serum calcium within normal limits? 
    1. Thyroid hormone 
    2. Parathyroid hormone 
    3. Follicle-stimulating hormone 
    4. Adrenocorticotropic hormone
    2. Parathyroid hormone
  83. A nurse is assigned to the care of a client who has an altered production of cortisol. The nurse anticipates that the client is experiencing difficulty with synthesis of which type of substance? 
    1. Androgens 
    2. Catecholamines 
    3. Glucocorticoids 
    4. Mineralocorticoids
    3. Glucocorticoids
  84. A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. The nurse plans care, knowing that which gland is most likely to be responsible for these findings? 
    1. Thyroid 
    2. Pituitary 
    3. Parathyroid 
    4. Adrenal cortex
    1. Thyroid
  85. A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). The nurse plans care for the client, anticipating that he or she may have a deficiency of which dietary elements? 
    1. Iodine 
    2. Calcium 
    3. Phosphorus 
    4. Magnesium
    1. Iodine
  86. A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. The nurse plans care, knowing that this client is primarily at risk for abnormalities of which electrolytes? 
    1. Sodium 
    2. Calcium 
    3. Potassium 
    4. Magnesium
    2. Calcium
  87. A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The nurse plans care, understanding that, as part of this response, the endocrine system will increase production and secretion of which mineralocorticoid? 
    1. Cortisol 
    2. Glucagon 
    3. Aldosterone 
    4. Adrenocorticotropic hormone
    3. Aldosterone
  88. A client has overactivity of the thyroid gland. The nurse plans care, knowing that the client will experience which effects from this hormonal excess? 
    1. Weight gain 
    2. Nutritional deficiencies 
    3. Low blood glucose levels 
    4. Increased body fat stores
    2. Nutritional deficiencies
  89. A client has been diagnosed with pheochromocytoma. The nurse plans care, knowing that the client will exhibit which effect based on the pathophysiology of this disorder? 
    1. Water loss 
    2. Bradycardia 
    3. Hypertension 
    4. Decreased cardiac output
    3. Hypertension
  90. A client is diagnosed with Cushing's syndrome. The nurse plans care, knowing that this client has an excess of which substances? 
    1. Calcium 
    2. Cortisol 
    3. Epinephrine 
    4. Norepinephrine
    2. Cortisol
  91. A hospitalized client is experiencing an episode of hypoglycemia. The nurse plans care, knowing that which is the physiological mechanism that should take place to combat the decline in the blood glucose level? 
    1. Decreased cortisol release 
    2. Increased insulin secretion 
    3. Increased glucagon secretion 
    4. Decreased epinephrine release
    3. Increased glucagon secretion
  92. A client with diabetes mellitus who refuses to take insulin as prescribed exhibits markedly increased blood glucose levels after a meal. The nurse caring for the client anticipates that which initial body response to elevated glucose levels will worsen the situation for the client? 
    1. Glycogenolysis 
    2. Gluconeogenesis 
    3. Binding of glucose onto cell membranes 
    4. Transport of glucose across cell membranes
    1. Glycogenolysis
  93. A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse plans care for the client, knowing that pathological fat metabolism is occurring if the client has elevated levels of which substance? 
    1. Glucose 
    2. Ketones 
    3. Glucagon 
    4. Lactate dehydrogenase
    2. Ketones
  94. A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 
    1. Platelets 
    2. Muscle tissue 
    3. Adipose tissue 
    4. Red blood cells
    4. Red blood cells
  95. A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. 
    1. Viruses 
    2. Genetic factors 
    3. Autoimmune factors 
    4. Human leukocyte antigen (HLA) 
    5. Primary failure of glucagon secretion
    • 1. Viruses 
    • 2. Genetic factors 
    • 3. Autoimmune factors 
    • 4. Human leukocyte antigen (HLA)
  96. A nurse is reviewing the health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 
    1. Morphine sulfate 
    2. Docusate sodium (Colace) 
    3. Acetaminophen (Tylenol) 
    4. Levothyroxine sodium (Synthroid)
    1. Morphine sulfate
  97. The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 
    1. Serum pH of 9.0 
    2. Absent ketones in the urine 
    3. Serum bicarbonate of 22 mEq/L 
    4. Blood glucose level of 500 mg/dL
    4. Blood glucose level of 500 mg/dL
  98. The nurse is providing instructions regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that additional instruction is needed if the client identifies which as a cause of hypoglycemia? 
    1. Omitted meals 
    2. Increased intensity of activity 
    3. Decreased daily insulin dosage 
    4. Inadequate amount of fluid intake
    3. Decreased daily insulin dosage
  99. The clinic nurse is providing instructions to a client with diabetes mellitus about the signs and symptoms of hypoglycemia. The nurse should tell the client that which would be noted in a hypoglycemic reaction? 
    1. Thirst 
    2. Hunger 
    3. Polydipsia 
    4. Increased urine output
    2. Hunger
  100. A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's documentation and expects to note which diagnosis? 
    1. Hypoglycemia 
    2. Pheochromocytoma 
    3. Diabetic ketoacidosis (DKA) 
    4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
    4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
  101. A client tells the nurse that he enjoys outdoor gardening. The nurse understands that this client probably has active synthesis of which vitamin? 
    1. Vitamin B 
    2. Vitamin D 
    3. Vitamin E 
    4. Vitamin K
    2. Vitamin D
  102. A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period? 
    1. Vital signs 
    2. Fluid balance 
    3. Anxiety level 
    4. Creatinine levels
    1. Vital signs
  103. A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 
    1. Diarrhea 
    2. Infection 
    3. Polydipsia 
    4. Weight gain
    3. Polydipsia
  104. A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 
    1. Edema 
    2. Obesity 
    3. Hirsutism 
    4. Hypotension
    4. Hypotension
  105. A client has begun medication therapy with propylthiouracil (PTU). The nurse should assess the client for which condition as an adverse effect of this medication? 
    1. Joint pain 
    2. Renal toxicity 
    3. Hyperglycemia 
    4. Hypothyroidism
    4. Hypothyroidism
  106. A nurse is assessing the glycemic status of a client with diabetes mellitus. Which sign or symptom would indicate that the client is developing hyperglycemia? 
    1. Polyuria 
    2. Diaphoresis 
    3. Hypertension 
    4. Increased pulse rate
    1. Polyuria
  107. A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL. The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 
    1. Hyponatremia 
    2. Rise in serum pH 
    3. Presence of ketone bodies 
    4. Elevated serum bicarbonate level
    3. Presence of ketone bodies
  108. A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 
    1. Polyuria 
    2. Diarrhea 
    3. Polyphagia 
    4. Weight gain
    1. Polyuria
  109. A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 
    1. Laryngeal stridor 
    2. Difficulty voiding 
    3. Mild incisional pain 
    4. Absence of bowel sounds
    1. Laryngeal stridor
  110. A nurse is assigned to care for a client with type 1 diabetes mellitus. During the shift, the nurse should monitor for which manifestation as a sign of hypoglycemia? 
    1. Tremors 
    2. Anorexia 
    3. Hot, dry skin 
    4. Muscle cramps
    1. Tremors
  111. A client is admitted to the hospital with a diagnosis of pheochromocytoma. The nurse would check which item to detect the primary manifestation of this disorder? 
    1. Weight 
    2. Urine ketones 
    3. Blood pressure 
    4. Skin temperature
    3. Blood pressure
  112. A nurse is caring for a client with a thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse should assess for which sign or symptom? 
    1. Bradycardia 
    2. Constipation 
    3. Hypertension 
    4. Low-grade temperature
    3. Hypertension
  113. During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 
    1. Serum glucose 
    2. Blood pressure 
    3. Respiratory rate 
    4. Urine specific gravity
    4. Urine specific gravity
  114. A client has been diagnosed with Cushing's syndrome. The nurse should assess this client for which expected manifestations of this disorder? 
    1. Anorexia and weight loss 
    2. Hypotension and dizziness 
    3. Moon facies and truncal obesity 
    4. Hyperkalemia and peripheral edema
    3. Moon facies and truncal obesity
  115. A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse should next assess the results of which serum laboratory study? 
    1. Sodium 
    2. Calcium
    3. Potassium 
    4. Magnesium
    2. Calcium
  116. A client visits the health care provider's office for a routine physical examination and reports a new onset of intolerance to cold. Since hypothyroidism is suspected, which additional information would be noted during the client's assessment? 
    1. Weight loss and tachycardia 
    2. Complaints of weakness and lethargy 
    3. Diaphoresis and increased hair growth 
    4. Increased heart rate and respiratory rate
    2. Complaints of weakness and lethargy
  117. A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority intervention in the plan of care? 
    1. Restrict fluids to 1000 mL per day. 
    2. Describe the use of loperamide (Imodium). 
    3. Walk down the hall for 15 minutes three times a day. 
    4. Describe the administration of aluminum hydroxide gel.
    3. Walk down the hall for 15 minutes three times a day.
  118. The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is at the client's bedside? 
    1. Cardiac monitor 
    2. Tracheotomy set 
    3. Intermittent gastric suction device 
    4. Underwater seal chest drainage system
    2. Tracheotomy set
  119. A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 
    1. Amenorrhea 
    2. Menorrhagia 
    3. Metrorrhagia 
    4. Dysmenorrhea
    1. Amenorrhea
  120. The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 
    1. Maintain an endotracheal tube for 24 hours. 
    2. Administer a continuous mist of room air or oxygen. 
    3. Place in a flat position with the head and neck immobilized. 
    4. Use only a rectal thermometer for temperature measurement.
    3. Place in a flat position with the head and neck immobilized.
  121. The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 
    1. "Do you have tremors in your hands?" 
    2. "Are you experiencing pain in your joints?" 
    3. "Do you notice swelling in your legs at night?" 
    4. "Have you had problems with diarrhea lately?"
    2. "Are you experiencing pain in your joints?"
  122. The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 
    1. "I should avoid contact sports." 
    2. "I should check my ankles for swelling." 
    3. "I need to avoid foods high in potassium." 
    4. "I need to check my blood glucose regularly."
    3. "I need to avoid foods high in potassium."
  123. The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for in the client's focused assessment? 
    1. Peripheral edema 
    2. Bilateral exophthalmos 
    3. Signs and symptoms of hypovolemia 
    4. Signs and symptoms of hypocalcemia
    3. Signs and symptoms of hypovolemia
  124. A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 
    1. Obtain dark glasses for the client. 
    2. Lubricate the eyes with tap water every 2 to 4 hours. 
    3. Administer methimazole (Tapazole) every 8 hours around the clock. 
    4. Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.
    1. Obtain dark glasses for the client.
  125. The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 
    1. "I expect to experience some tingling of my toes, fingers, and lips after surgery." 
    2. "I will definitely have to continue taking antithyroid medications after this surgery." 
    3. "I need to place my hands behind my neck when I have to cough or change positions."
    4. "I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."
    3. "I need to place my hands behind my neck when I have to cough or change positions."
  126. The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diet. Which statement, if made by the client, indicates a need for further teaching? 
    1. "I'll eat a balanced meal plan." 
    2. "I need to drink diet soft drinks." 
    3. "I'll snack on fruit instead of cake." 
    4. "I need to purchase special dietetic foods."
    4. "I need to purchase special dietetic foods."
  127. A client received 5 units of aspart insulin (NovoLog) subcutaneously just before eating lunch at 12:00 pm. The nurse should assess the client for a hypoglycemic reaction at which times? 
    1. Between 1:00 and 3:00 pm 
    2. 10 minutes after administration 
    3. Between 4:00 pm and 12:00 am 
    4. Between 8:00 pm and 10:00 pm
    1. Between 1:00 and 3:00 pm
  128. The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply. 
    1. "Include adequate fiber and fluids in your diet." 
    2. "Wear slip on shoes rather than those that need to be tied." 
    3. "A post-nasal drip may be expected for several weeks after surgery." 
    4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 
    5. "Contact your health care provider (HCP) immediately if you develop any headache, fever, or neck stiffness."
    • 1. "Include adequate fiber and fluids in your diet." 
    • 2. "Wear slip on shoes rather than those that need to be tied." 
    • 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 
    • 5. "Contact your health care provider (HCP) immediately if you develop any headache, fever, or neck stiffness."
  129. Which condition on assessment of the client with Addison's disease should the nurse expect to note? 
    1. Edema 
    2. Obesity 
    3. Hirsutism 
    4. Hypotension
    4. Hypotension
  130. The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 
    1. An enlarged thyroid gland 
    2. The presence of heart damage 
    3. Client complaints of chronic fatigue 
    4. Client complaints of slow wound healing
    1. An enlarged thyroid gland
  131. The nurse is assessing the learning readiness of a client newly diagnosed with diabetes mellitus. Which behavior indicates to the nurse that the client is not ready to learn? 
    1. The client asks if the spouse may attend the teaching session. 
    2. The client asks appropriate questions about what will be taught. 
    3. The client asks for written materials about diabetes mellitus before class. 
    4. The client complains of fatigue whenever the nurse plans a teaching session.
    4. The client complains of fatigue whenever the nurse plans a teaching session.
  132. A young man with type 1 diabetes mellitus tells the nurse that he might lose his job because he has been having frequent hypoglycemic reactions. His boss thinks that he is drunk during these episodes and that he has been drinking on the job. Which action by the nurse would best assist this client to meet his needs? 
    1. Ask the client if he indeed has been drinking at work. 
    2. Ask the client what he does to treat his hypoglycemia. 
    3. Contact the local employment office to help him find another job. 
    4. Examine factors with the client that may be causing frequent hypoglycemic episodes.
    4. Examine factors with the client that may be causing frequent hypoglycemic episodes.
  133. The health care provider prescribes a 24-hour urine collection for vanillylmandelic acid (VMA). The community health nurse visits the client at home and instructs the client in the procedure for the collection of the urine. Which statement, if made by the client, would indicate a need for further instruction? 
    1. "I can take medication if I need to during the collection." 
    2. "When I start the collection, I will urinate and discard that specimen." 
    3. "I will pour the urine in the collection bottle each time I urinate and refrigerate the urine." 
    4. "I will start the collection in 2 days. Starting now, I cannot eat or drink any tea, chocolate, vanilla, or fruit until the test is completed."
    1. "I can take medication if I need to during the collection."
  134. The client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which statement is the appropriate response by the nurse? 
    1. "I think you are making the right decision to have the surgery." 
    2. "You have concerns about the surgical treatment for your condition?" 
    3. "You are very ill. Your health care provider has made the correct decision." 
    4. "There is no reason to worry. Your health care provider is a wonderful surgeon."
    2. "You have concerns about the surgical treatment for your condition?"
  135. A client with diabetes mellitus has been instructed in the dietary exchange system. The client asks the nurse if bacon is allowed in the diet. Which nursing response is most appropriate? 
    1. "Bacon is not allowed." 
    2. "Bacon is much too high in fat." 
    3. "Bacon may be eaten if you eliminate one meat item from your diet." 
    4. "One strip of bacon may be eaten if you eliminate 1 teaspoon of butter."
    4. "One strip of bacon may be eaten if you eliminate 1 teaspoon of butter."
  136. A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse should ask the client if which measure is taken? 
    1. Rotating sites for injection 
    2. Administering the insulin at a 45-degree angle 
    3. Cleaning the skin with alcohol before each injection 
    4. Aspirating for blood before injection into the subcutaneous tissue
    1. Rotating sites for injection
  137. A nurse is performing an admission assessment on a client with a diagnosis of pheochromocytoma. The nurse should assess for the major sign associated with pheochromocytoma by performing which action? 
    1. Obtaining the client's weight 
    2. Taking the client's blood pressure 
    3. Testing the client's urine for glucose 
    4. Palpating the skin for its temperature
    2. Taking the client's blood pressure
  138. A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis and a serum glucose level of 789 mg/dL. The health care provider (HCP) prescribes 10 units of regular insulin by intravenous (IV) bolus, followed by a continuous insulin infusion at a rate of 5 units/hr. The pharmacy sends 500 mL of normal saline solution containing 50 units of regular insulin. After administering the IV bolus of 10 units of regular insulin, the nurse sets the infusion pump flow rate of the normal saline solution containing 50 units of regular insulin to infuse at how many milliliters per hour to deliver 5 units/hr?
    50 mL per hour
  139. A nurse is preparing to provide instructions to a client with Addison's disease regarding diet therapy. The nurse knows that which diet would most likely be prescribed for this client? 
    1. High fat intake 
    2. Low protein intake 
    3. Normal sodium intake 
    4. Low carbohydrate intake
    3. Normal sodium intake
  140. A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which items would be the most appropriate choice for this client to meet nutritional needs? 
    1. Crackers with cheese and tea 
    2. Graham crackers and warm milk 
    3. Toast with peanut butter and cocoa 
    4. Vanilla wafers and coffee with cream and sugar
    2. Graham crackers and warm milk
  141. A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. Which is the appropriate nursing intervention? 
    1. Offer water only until the client is able to tolerate solid foods. 
    2. Withhold all fluids until vomiting has ceased for at least 4 hours. 
    3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. 
    4. Maintain a clear liquid diet for at least 5 days before advancing to solids.
    3. Encourage the client to take 8 to 12 oz of fluid every hour while awake.
  142. The family of a bedridden client with type 2 diabetes mellitus and a chronic kidney disease calls a nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 
    1. "What is the client's urine output?" 
    2. "What is the client's capillary blood glucose level?" 
    3. "Has there been any change in the dietary intake?" 
    4. "Have you increased the amount of fluids provided?"
    2. "What is the client's capillary blood glucose level?"
  143. A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the health care provider's documentation and should expect to note which diagnosis? 
    1. Hypoglycemia 
    2. Pheochromocytoma
    3. Diabetic ketoacidosis (DKA) 
    4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
    4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
  144. A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 
    1. Soak the feet in hot water. 
    2. Avoid using a mild soap on the feet. 
    3. Always have a podiatrist cut the toenails. 
    4. Apply a moisturizing lotion to dry feet but not between the toes.
    4. Apply a moisturizing lotion to dry feet but not between the toes.
  145. A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which concept? 
    1. Always keep insulin vials refrigerated. 
    2. Ketones in the urine signify a need for less insulin. 
    3. Increase the amount of insulin before excessive exercise. 
    4. Systematically rotate insulin injections within one anatomical site.
    4. Systematically rotate insulin injections within one anatomical site.
  146. A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse develops a plan of care for the client. The nurse should assess for which condition as a priority? 
    1. Relief of pain 
    2. Signs of renal toxicity 
    3. Signs of hyperglycemia 
    4. Signs of hypothyroidism
    4. Signs of hypothyroidism
  147. A nurse is assisting a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which is most important to include in the plan of care? 
    1. Test urine for ketone levels. 
    2. Eat six small meals per day. 
    3. Monitor blood glucose levels frequently. 
    4. Receive appropriate follow-up health care.
    3. Monitor blood glucose levels frequently.
  148. A nurse is performing an assessment on a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate? 
    1. Check for signs of bleeding. 
    2. Administer calcium gluconate. 
    3. Notify the health care provider (HCP) immediately. 
    4. Reassure the client that this is usually a temporary condition.
    4. Reassure the client that this is usually a temporary condition.
  149. After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? 
    1. Increase fluid intake. 
    2. Document the complaints. 
    3. Assess for urinary glucose. 
    4. Assess urine specific gravity.
    4. Assess urine specific gravity.
  150. A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 
    1. Urine is negative for ketones. 
    2. Serum potassium is 6.8 mEq/L. 
    3. Serum osmolality is 260 mOsm/L. 
    4. Arterial blood gas values are: pH 7.52, Pco2 44 mm Hg, HCO3 30 mEq/L.
    2. Serum potassium is 6.8 mEq/L.
  151. A client with diabetes mellitus has a blood glucose level of 50 mg/dL and reports feeling hungry and shaky. Which should the nurse provide the client? 
    1. 3 oz of 2% milk 
    2. 4 oz of apple juice 
    3. 2 oz of orange juice 
    4. A teaspoon of granulated sugar
    2. 4 oz of apple juice
  152. Which findings should raise suspicion to the nurse that a head-injured client may be experiencing diabetes insipidus? Select all that apply. 
    1. Ketones are present in the urine. 
    2. Urine specific gravity is 1.001. 
    3. Jugular venous distention is observed. 
    4. Serum osmolality is 320 mOsm/kg of water. 
    5. Blood glucose levels are greater than 200 mg/dL. 
    6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.
    • 2. Urine specific gravity is 1.001. 
    • 4. Serum osmolality is 320 mOsm/kg of water.
    • 6. Urine output has increased from 1000 mL in 24 hours to 4000 mL in 24 hours.
  153. During physical examination of a client, which finding is characteristic of hypothyroidism? 
    1. Periorbital edema 
    2. Flushed warm skin 
    3. Hyperactive bowel sounds 
    4. Heart rate of 120 beats/min
    1. Periorbital edema
  154. A client's serum blood glucose level is 48 mg/dL. The nurse would expect to note which as an additional finding when assessing this client?
    1. Slurred speech 
    2. Increased thirst 
    3. Increased appetite 
    4. Increased urination
    1. Slurred speech
  155. A client's serum blood glucose level is 389 mg/dL. The nurse would expect to note which as an additional finding when assessing this client? 
    1. Unsteady gait 
    2. Slurred speech 
    3. Increased thirst 
    4. Cold, clammy skin
    3. Increased thirst
  156. The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply. 
    1. Polyuria 
    2. Polydipsia 
    3. Polyphagia 
    4. Dry mouth 
    5. Flushed, dry skin 
    6. Moist mucous membranes
    • 1. Polyuria 
    • 2. Polydipsia 
    • 3. Polyphagia 
    • 4. Dry mouth 
    • 5. Flushed, dry skin
  157. A newly diagnosed client with diabetes mellitus is started on a two-dose insulin protocol combination of short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast and what portion before the evening meal? 
    1. Half before breakfast and half before the evening meal 
    2. Two thirds before breakfast and one third before the evening meal 
    3. One third before breakfast and two thirds before the evening meal 
    4. Three fourths before breakfast and one fourth before the evening meal
    2. Two thirds before breakfast and one third before the evening meal
  158. A nurse understands that which hormone is directly responsible for maintaining the free or unbound portion of serum calcium within normal limits? 
    1. Thyroid hormone 
    2. Parathyroid hormone 
    3. Follicle-stimulating hormone 
    4. Adrenocorticotropic hormone
    2. Parathyroid hormone
  159. A client with an endocrine disorder complains of weight loss and diarrhea, and says that he can "feel his heart beating in his chest." The nurse interprets that which gland is most likely responsible for these symptoms? 
    1. Thyroid 
    2. Pituitary 
    3. Parathyroid 
    4. Adrenal cortex
    1. Thyroid
  160. A client is experiencing an episode of hypoglycemia. The nurse understands that the physiological mechanism that should take place to combat this decrease in the blood glucose level is which mechanism? 
    1. Decreased cortisol release 
    2. Increased insulin secretion 
    3. Decreased epinephrine release 
    4. Increased glucagon secretion
    4. Increased glucagon secretion
  161. A client with diabetes mellitus experiences breakdown of fats for conversion to glucose. The nurse determines that this response is occurring if the client has elevated levels of which substance? 
    1. Glucose 
    2. Ketones 
    3. Glucagon 
    4. Lactic dehydrogenase
    2. Ketones
  162. A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 
    1. Glycosylated hemoglobin of 6% 
    2. Presence of ketones in the urine 
    3. Presence of albumin in the urine 
    4. Fasting blood glucose level of 150 mg/dL
    1. Glycosylated hemoglobin of 6%
  163. A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit signs of thyroid storm. Which is an early indicator of this complication? 
    1. Constipation 
    2. Bradycardia 
    3. Hyperreflexia 
    4. Low-grade temperature
    3. Hyperreflexia
  164. A client is undergoing an oral glucose tolerance test. The nurse interprets that the client's results are compatible with diabetes mellitus if the glucose level is at which value after 120 minutes (2 hours)? 
    1. 80 mg/dL 
    2. 110 mg/dL 
    3. 130 mg/dL 
    4. 160 mg/dL
    4. 160 mg/dL
  165. A client who visits the health care provider's office for a routine physical reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse should check for which manifestations? 
    1. Weight loss and thinning skin 
    2. Complaints of weakness and lethargy 
    3. Diaphoresis and increased hair growth 
    4. Increased heart rate and respiratory rate
    2. Complaints of weakness and lethargy
  166. A client who has had intracranial surgery is experiencing diabetes insipidus. The nurse understands that the diabetes insipidus resulted from which problem? 
    1. Water intoxication 
    2. Excess production of dopamine 
    3. Excess production of angiotensin II 
    4. Insufficient production of antidiuretic hormone (ADH)
    4. Insufficient production of antidiuretic hormone (ADH)
  167. A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would monitor for which problems associated with this disease? Select all that apply. 
    1. Obesity 
    2. Syncope 
    3. Hirsutism 
    4. Hypotension 
    5. Muscle weakness
    • 2. Syncope 
    • 4. Hypotension 
    • 5. Muscle weakness
  168. The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs should the nurse monitor for? Select all that apply.
    1. Anorexia 
    2. Dizziness 
    3. Hypertension 
    4. Weight loss 
    5. Moon facies 
    6. Truncal obesity
    • 3. Hypertension 
    • 5. Moon facies 
    • 6. Truncal obesity
  169. A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible thyroid surgery complication? 
    1. Increased serum sodium level 
    2. Increased serum glucose level 
    3. Decreased serum calcium level 
    4. Decreased serum albumin level
    3. Decreased serum calcium level
  170. A home health nurse is visiting a client with type 1 diabetes mellitus. The client tells the nurse that he is not feeling well and has had a "respiratory infection" for the past week, which seems to be getting worse. After interviewing the client, what should be the initial nursing action? 
    1. Notify the health care provider. 
    2. Document the assessment data. 
    3. Check the client's blood glucose. 
    4. Obtain the client's sputum for culture and sensitivity.
    3. Check the client's blood glucose.

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