Endocrine: Saunders

Question 1

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated primary health care provider’s prescription?

Answer 1

Intravenous infusion of normal saline

Rationale:
The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered.

Question 2

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump?

Answer 2

It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

Rationale:
An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

Question 3

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.

Answer 3

Comatose state

Deep, rapid breathing

Elevated blood glucose level

Rationale:
Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid by-products of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul’s respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia.

Question 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.

Answer 4

Shakiness

Palpitations

Lightheadedness

Rationale:
Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

Question 5

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client’s anxiety?

Answer 5

Convey empathy, trust, and respect toward the client.

Rationale:
Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client’s anxiety. The nurse should not ignore the client’s anxious feelings. Anxiety needs to be managed before meaningful client education can occur.

Question 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?

Answer 6

“I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mmol/L.”

Rationale:
During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PHCP if the level is higher than 250 mg/dL (13.9 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the PHCP’s advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

Question 7

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer which medication?

Answer 7

IV fluids containing dextrose

Rationale:
Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (13.9 to 16.7 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (13.9 mmol/L), or until the client recovers from ketosis.

Question 8

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed?

Answer 8

Polyuria

Rationale:
Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia.

Question 9

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions should the nurse anticipate receiving? Select all that apply.

Answer 9

Initiate an infusion of 3% NaCl.

Restrict fluids to 800 mL over 24 hours.

Administer a vasopressin antagonist as prescribed.

Rationale:
Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1252.

Question 10

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?

Answer 10

Administer short-duration insulin intravenously.

Rationale:
Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.

Question 11

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply.

Answer 11

Polyuria
Bone pain

Rationale:
The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria.

Question 12

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem?

Answer 12

Inadequate fluid volume

Rationale:
An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe.

Question 13

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply.

Answer 13

Tremors
Irritability
Nervousness

Rationale:
Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1309.

Question 14

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder?

Answer 14

A heart rate that is 90 beats per minute and irregular

Rationale:
Pheochromocytoma is a catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include the chest, bladder, abdomen, and brain; it is typically a benign tumor but can be malignant. Excessive amounts of epinephrine and norepinephrine are secreted. The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 721, 1261-1262.

Question 15

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70 mg/dL (3.9 mmol/L). Which finding would be the priority concern to the nurse?

Answer 15

Temperature

Rationale:
In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus.

Reference(s):
Lewis et al. (2017), p. 1145.

Question 16

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 signs and symptoms are associated with this diagnosis? Select all that apply.

Answer 16

Feeling cold
Loss of body hair
Persistent lethargy
Puffiness of the face

Rationale:
Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

Reference(s):
Lewis et al. (2017), pp. 1168-1169.

Question 17

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply.

Answer 17

Fever
Nausea
Tremors
Confusion

Rationale:
Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1270.

Question 18

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse’s best response to the client’s question?

Answer 18

“It is for the times when your blood glucose is too low from too much insulin.”

Rationale:
Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. When consciousness has been regained, oral carbohydrates should be given.

Question 19

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

Answer 19

Instruct the client about thyroid replacement therapy.

Encourage the client to consume fluids and high-fiber foods in the diet.

Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

Rationale:
The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation.

Reference(s):
Lewis et al. (2017), pp. 1168-1169.

Question 20

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?

Answer 20

To treat hypocalcemic tetany

Rationale:
Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1269-1270.

Question 21

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 (2.28 mmol/L). Which medication should the nurse anticipate will be prescribed for the client?

Answer 21

Glucagon

Rationale:
A blood glucose level lower than 50 mg/dL (2.85 mmol/L) is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Insulin would lower the client’s blood glucose and would not be an appropriate treatment for hypoglycemia.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1310.

Question 22

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 (39.1 mmol/L). Which intervention should the nurse anticipate to be prescribed initially for the client?

Answer 22

Regular insulin via the intravenous (IV) route

Rationale:
The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client’s high blood glucose levels.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1313.

Question 23

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 finding on assessment of the client?

Answer 23

Positive Trousseau’s sign

Rationale:
Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek’s and Trousseau’s signs, which indicate potential tetany.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1277.

Question 24

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?

Answer 24

Increased thirst

Rationale:
The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia.

Reference(s):
Urden et al. (2018), p. 716.

Question 25

The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence?

Answer 25

Increased production of glucose

Rationale:
Hyperglycemia results from decreased use and increased production of glucose. Increased use of glucose and overproduction of insulin would most likely cause hypoglycemia. Option 4 is incorrect.

Reference(s):
Lewis et al. (2017), p. 1144.

Question 26

A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 8%. On the basis of this test result, the nurse plans to teach the client about the need for which measure?

Answer 26

Preventing and recognizing hyperglycemia

Rationale:
The normal reference range for the glycosylated hemoglobin A1c is less than 6.0%. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose.

Reference(s):
Lewis et al. (2017), p. 1118.

Question 27

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply.

Answer 27

Red meats
Whole-grain cereals
Carbonated beverages

Reference(s):
Hodgson, Kizior (2018), p. 527.

Question 28

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply.

Answer 28

Diarrhea may occur secondary to the metformin.
The repaglinide is not taken if a meal is skipped.
The repaglinide is taken 30 minutes before eating.
A simple sugar food item is carried and used to treat mild hypoglycemia episodes.

Rationale:
Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea.

Reference(s):
Hodgson, Kizior (2018), pp. 732, 1017-1018.

Question 29

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply.

Answer 29

Administer methimazole with food.
Assess the client for unexplained bruising or bleeding.
Instruct the client to report side and adverse effects such as sore throat, fever, or headaches.

Rationale:
Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the primary health care provider should be notified immediately.

Reference(s):
Skidmore-Roth (2017), pp. 761-762.

Question 30

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.

Answer 30

Insomnia
Weight loss
Mild heat intolerance

Rationale:
Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium.

Reference(s):
Lewis et al. (2017), p. 1169.

Question 31

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply.

Answer 31

“I should sit up for at least 30 minutes after taking this medication.”

“I should take this medication first thing in the morning on an empty stomach.”

Rationale:
Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it.

Reference(s):
Lewis et al. (2017), p. 1513.

Question 32

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record?

Answer 32

Calcium level of 8 mg/dL (2.0 mmol/L)/ Low serum calcium

Rationale:
Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]), this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse should expect the calcium level to be low.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1012, 1239.

Question 33

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder?

Answer 33

Polyuria

Rationale:
Hypercalcemia classically occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis.

Reference(s):
Lewis et al. (2017), pp. 1122, 1171-1173.

Question 34

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?

Answer 34

Walk down the hall for 15 minutes 3 times a day.

Rationale:
Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi.

Reference(s):
Lewis et al. (2017), p. 1173.

Question 35

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client’s condition?

Answer 35

“Are you experiencing pain in your joints?”

Rationale:
Hyperparathyroidism is associated with oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and, sometimes, pathological fractures.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1276-1277.

Question 36

The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply.

1. “This medication will turn my urine orange.”
2. “I should decrease my oral fluids when I start this medication.”
3. “The amount of urine I make should increase if this medicine is working.”
4. “I need to follow a low-fat diet to avoid pancreatitis when taking this medicine.”
5. “I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin.”

Answer 36

2. “I should decrease my oral fluids when I start this medication.”
3. “I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin.”

Rationale:
In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an antidiuretic hormone that enhances reabsorption of water in the kidney. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and should be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine should decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

Reference(s):
Skidmore-Roth (2017), pp. 343-344.

Question 37

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client’s record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client’s primary health care provider?

Answer 37

A decreased dosage of warfarin sodium

Rationale:
Levothyroxine accelerates the degradation of vitamin K–dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

Reference(s):
Hodgson, Kizior (2018), pp. 674-675.

Question 38

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction?

Answer 38

Between 1400 and 2200

Rationale:
Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

Reference(s):
Lewis et al. (2017), p. 1126.

Question 39

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching?

1. “I should keep the insulin in the cabinet during the day only.”
2. “I know I have to keep my insulin in the refrigerator at all times.”
3. “I can store the open insulin bottle in the kitchen cabinet for 1 month.”
4. “The best place for my insulin is on the windowsill, but in the cupboard is just as good.”

Answer 39

3. “I can store the open insulin bottle in the kitchen cabinet for 1 month.”

Rationale:
An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1297.

Question 40

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client’s teaching plan?

Answer 40

Gastrointestinal disturbances

Rationale:
The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

Reference(s):
Hodgson, Kizior (2018), p. 734.

Question 41

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication?

Answer 41

Achieve normal thyroid hormone levels

Rationale:
Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy.

Reference(s):
Lewis et al. (2017), pp. 1168-1169.

Question 42

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?

Answer 42

Metformin

Rationale:
Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of a contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 657-658, 1291.

Question 43

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?

Answer 43

Hypertension

Rationale:
Hypertension is the major symptom associated with pheochromocytoma. Glycosuria, weight loss, and diaphoresis also are clinical manifestations of pheochromocytoma; however, they are not major symptoms.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1261-1262.

Question 44

The nurse is admitting a client diagnosed with pheochromocytoma. The client is complaining of a pounding headache and palpitations and the blood pressure is 170/90 mm Hg. The nurse is aware that which substance is responsible for these clinical manifestations?

Answer 44

Epinephrine

ationale:
Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine, which are produced by the adrenal medulla. Hypertension is the principal manifestation, and the client has episodes of high blood pressure accompanied by pounding headaches. The excessive release of catecholamines also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. In addition, the other substances listed (cortisol, androgens, and aldosterone) are produced by the adrenal cortex.

Reference(s):
Lewis et al. (2017), pp. 1181-1182.

Question 45

A client has been diagnosed with pheochromocytoma. Which clinical manifestation is most indicative of this condition?

Answer 45

Hypertension

Rationale:
The client with pheochromocytoma has a benign or malignant tumor in the adrenal medulla. Because the medulla secretes epinephrine and norepinephrine, the client will exhibit signs related to excesses of these catecholamines, including tachycardia, increased cardiac output, and increased blood pressure. Vasoconstriction of the renal arteries triggers the renin-angiotensin system, resulting in water reabsorption and retention.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1261-1262.

Question 46

A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which item in the preoperative period?

Answer 46

Vital signs

Rationale:
Hypertension is the hallmark symptom of pheochromocytoma. Severe hypertension can precipitate a stroke (brain attack) or sudden blindness. Although all of the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1261-1262.

Question 47

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

Answer 47

2. Graham crackers and warm milk

Rationale:
The client with pheochromocytoma needs to be provided with a diet high in vitamins, minerals, and calories. Foods or beverages that contain caffeine, such as cocoa, coffee, tea, or colas, are prohibited because they can precipitate a hypertensive crisis.

Reference(s):
Ignatavicius, Workman, Rebar (2018), p. 1262.

Question 48

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which statement?

Answer 48

“Brushing your teeth needs to be avoided for at least 2 weeks after surgery.”

Rationale:
A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1249-1250.

Question 49

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply.

Answer 49

High urine osmolality
Low serum osmolality
Hypotonicity of body fluids
Continued release of antidiuretic hormone (ADH)

Rationale:
SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

Reference(s):
Lewis et al. (2017), pp. 1159-1160.

Question 50

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

Answer 50

Polyuria
Polydipsia
Complaints of excessive thirst
Specific gravity lower than 1.005

Rationale:
A triad of clinical symptoms–polyuria, polydipsia, and excessive thirst–often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1250-1251, 1283.

Question 51

A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance?

Answer 51

Antidiuretic hormone (ADH)

Rationale:
ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland. These hormones are released as needed into the bloodstream. The anterior pituitary gland produces GH, LH, and FSH.

Reference(s):
Urden et al. (2018), pp. 710-711.

Question 52

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?

Answer 52

Urine specific gravity

Rationale:
After hypophysectomy, temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess urine specific gravity and notify the primary health care provider if the result is less than 1.005. Although the remaining options may be components of the assessment, the nurse would next assess urine specific gravity.

Reference(s):
Ignatavicius, Workman, Rebar (2018), pp. 1249-1250.