Question 1

For which complication of thyroidectomy would the nurse monitor?
A)Hypercalcemia
B)Respiratory obstruction
C)Elevated serum T4
D)Paralytic ileus

Accepted Answer

Respiratory obstruction, hemorrhage, tetany, and laryngeal nerve injury are the major complications following thyroid surgery. Hypocalcemia, not hypercalcemia (Choice A), is a complication resulting from damage to the parathyroid glands during surgery. Serum T4 will be decreased or absent, not elevated (Choice C), and the client will need replacement therapy because no thyroid hormone is secreted once the total thyroid gland is removed. Choice D is not related to thyroidectomy.

Question 2

Maia Clarins, 24 years old, was diagnosed with hypopituitarism. When performing the history and physical exam, which of the following findings should the nurse anticipate?
A)Increased cardiac output
B)Truncal obesity
C)Increased blood pressure
D)Hyperactivity or increased energy levels

Accepted Answer

In hypopituitarism, there is decreased cardiac output, decreased blood pressure, and decreased energy level (fatigue). These symptoms occur due to an absence of hormones resulting from the decreased pituitary activity and truncal obesity is commonly associated with this disorder.

Question 3

Vasopressin (Pitressin) is ordered for a client with diabetes insipidus in order to do which of the following?
A)Stimulate the pancreas to secrete insulin
B)Slow the absorption of glucose in the intestine
C)Increase the reabsorption of water in the tubules
D)Increase blood pressure

Accepted Answer

Vasopressin (Pitressin) is an antidiuretic hormone and is given to a client with diabetes insipidus to increase urine concentration by increasing the tubular reabsorption of water. Vasopressin does not increase blood pressure or affect either insulin production or intestinal absorption of glucose.

Question 4

The client with Addison's disease is ordered glucocorticoid therapy. Which of the following statements indicates that the client has a correct understanding of the medication regimen?
A)"Dosage adjustments in my medication dosages may be needed."
B)"On days I feel good, I will not need to take the medication."
C)""I will adjust my dosages based on my home blood glucose test results."
D)"I am on an every-other-day dosing regimen."

Accepted Answer

"Dosage adjustments in my medication dosages may be needed." Glucocorticoid medication therapy is established with a basal dose. The typical regimen begins with two-thirds of the daily dose taken in the morning (8 AM) and the remaining one-third later (4 PM) in the day. This regimen closely resembles the diurnal pattern of secretion. Glucocorticoid medications do not have a cumulative effect and must be taken daily. Glucocorticoid needs fluctuate according to daily life events and/or stressors.

Question 5

The nurse administers a dose of six units of regular insulin (Humulin R) to a patient at 8:00 AM. Knowing the action of regular insulin, when would the nurse anticipate that a hypoglycemia reaction could occur?
A)Between 8:00 AM and 10:00 AM
B)Between 10:00 AM and 12:00 PM
C)Between 2:00 PM and 10:00 PM
D)Between 10:00 PM and 8:00 AM the next day

Accepted Answer

Between 10:00 AM and 12:00 PM. Regular insulin is a short-acting insulin with an onset of action in ½ - 1 hour, a peak that occurs in 2-3 hours, and a duration of action of 4-8 hours. Hypoglycemia is most likely to occur during peak insulin times.

Question 6

The nurse is working with a client who is just beginning to use a new external insulin pump. Which statement made by the client indicates a need for more teaching regarding the use of the pump?
A)"I will change my tubing and site every three days."
B)"I will use only regular insulin (buffered) in my pump."
C)"My pump delivers a continuous (basal) rate of insulin and I will use it to deliver additional (bolus) insulin with meals."
D)"When I disconnect the pump overnight, I will use the sterile cap to cover the end of the tubing."

Accepted Answer

"When I disconnect the pump overnight, I will use the sterile cap to cover the end of the tubing." The external insulin pump is a continuous subcutaneous insulin delivery system. It consists of a syringe in the pump attached to a long, thin, narrow-lumen plastic tubing with either a needle or Teflon catheter at the end. The needle/catheter is inserted into the subcutaneous tissue (usually in the abdomen). The syringe, tubing, and site are changed every three days. The pump uses regular buffered insulin. The pump delivers a continual (basal) infusion of insulin and additional low (bolus) doses of insulin are administered by the client at meal times. The pump provides flexibility for the client. The pump is worn continuously and is not disconnected for more than one hour at a time. Most pumps are now waterproof and can be worn during showers, swimming, etc.

Question 7

The client is admitted with metabolic acidosis secondary to diabetic ketoacidosis (DKA). Understanding metabolic acidosis, the nurse should choose which of the following as the priority nursing diagnosis?
A)Decreased urinary elimination related to reduced output and muscle function.
B)Decreased cardiac output related to fluid and electrolyte imbalance.
C)Ineffective breathing pattern related to hyperventilation.
D)Anxiety related to fears of long-term outcomes and discomfort.

Accepted Answer

DKA is associated with excessive urine output, dehydration, and hypokalemia, placing the client at risk for decreased cardiac output and cardiac dysrhythmias. Choice A is false regarding output and does not address the metabolic pattern. Choices C and D may apply to the client, but are not the priority needs; in addition, Choice C will resolve as the DKA is treated.

Question 8

Keller is an elderly client with dry flaky skin and activity intolerance secondary to myxedema. She was admitted to the progressive care unit to improve her activity intolerance and gain independence in self-care. For hygiene care the nursing order is two total baths per week on Saturday and Wednesday, with partial baths on the remaining days of the week. Which of the following would be the desired outcome of this intervention?
A)Client is able to sleep through the night and stay awake most of the day.
B)Gradual increase in ambulation ability over the first month.
C)Increased energy by the end of the first week of paced rest and activity.
D)Intact elastic moist warm skin by the end of first week.

Accepted Answer

Intact elastic moist warm skin by the end of first week. Daily total baths remove the protective sebum from the skin, placing the client at risk for altered skin integrity. Since the client's level of participation in the bath or other self-care activity is not presented, the other 3 choices are inappropriate. In addition, Choices B and C are not specific and measurable enough to meet criteria for an outcome statement.

Question 9

Davidson is 8 hours post partial thyroidectomy for Grave's disease. What is the best documentation by the nurse of evaluation outcome criteria for the nursing diagnosis risk for effective airway clearance?
A)Dressing is clean dry and intact, pain minimal and controlled, alert, and oriented
B)Vital signs stable; client supports neck with hand during change of position
C)No tracheal stridor, speaks clearly, and denies numbness or tingling
D)Balanced intake and output, vital signs stable, and alert and oriented

Accepted Answer

Early signs of edema of the larynx leading to airway obstruction are tight-fitting dressing, stridor, stertor, and/or weak or harsh voice. Numbness or tingling of the extremities, lips, or mouth are signs of hypocalcemia that can lead to respiratory distress due to tetany. The data in the other choices are important routine postoperative assessments, but they do not relate to the client's airway.

Question 10

Marcus Pinel, 43-years-old, is brought back to the nursing unit following a thyroidectomy. Which of the following methods should the nurse use to assess for bleeding?
A)Inspect the dressing for signs of hemorrhage
B)Change the dressing applied in the operating room
C)Check the latest hemoglobin to determine if there has been a drop in value
D)Palpate the back of the neck and shoulders for evidence of bleeding

Accepted Answer

Palpate the back of the neck and shoulders for evidence of bleeding. The danger of hemorrhage is greatest during the first 24 hours following thyroid surgery. The tendency is for blood to flow down at the sides and posteriorly if hemorrhage occurs in the area of the neck. Inspecting the dressings for signs of hemorrhage may not reveal bleeding (Choice A). Changing dressings immediately after surgery is not appropriate (Choice B). A drop in hemoglobin may be a clue to bleeding, but is not the best initial assessment action (Choice C).

Question 11

Diaz, a 56-year-old candle maker, developed diabetic ketoacidosis (DKA) and is given intravenous normal saline infusion and regular insulin. In addition to hourly blood glucose monitoring, what assessment data are early signs of clinical improvement?
A)Respiratory rate of 12 to 15 and normal BP in the standing position
B)Temperature and pulse in normal range
C)Improved level of consciousness and decreasing urine output
D)Client eats a full meal and respiratory rate is normal

Accepted Answer

Level of consciousness responds quickly to early changes in pH and restoration of fluid and electrolyte balance. Urine output decreases as hyperglycemia is resolved. The respiratory buffer system takes a few hours to respond to change in pH. Dehydration is usually so severe that several hours of rehydration are needed to reduce pulse (Choice B) and resolve orthostatic BP (Choice A). Choice D is inappropriate because eating a full meal is not an early sign of improvement.

Question 12

Joshua Caine, age 48 years old, had a bilateral adrenalectomy for Cushing's syndrome. He is being sent home with a new prescription for hydrocortisone. The best statement indicating understanding of the drug and associated risk is:
A)"I am taking this drug to replace the hormones usually secreted by the adrenal medulla."
B)"I should take this pill every morning before breakfast."
C)"This pill may cause weight gain so I should exercise and eat less."
D)"I should call the doctor if I think I am starting a cold and I should not take aspirin."

Accepted Answer

"I should call the doctor if I think I am starting a cold and I should not take aspirin." Usually the cortex of the adrenal gland (not the medulla) increases secretion of cortisol to stimulate the immune system in response to an infection. Thus the replacement dose during the illness may need to be adjusted once a client's adrenal glands are removed. Hydrocortisone can irritate the gastric mucosa and so clients should take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

Question 13

Following a hypophysectomy, the client complains of clear nasal drainage. What is the most appropriate initial action for the nurse?
A)Notify the surgeon immediately
B)Encourage the client to blow his nose to clear the sinuses
C)Check the nasal drainage for glucose
D)Place the client in Trendelenburg position

Accepted Answer

Check the nasal drainage for glucose. A cerebral spinal leak is suspected and testing the fluid for the presence of glucose would confirm this. Most leaks heal spontaneously, but occasionally, surgical repair is needed. Packing the nose will not heal the leak at this site. The head of the bed should not be elevated to decrease pressure on the graph site and blowing the nose is contraindicated.

Question 14

Thomas, newly admitted to your unit this morning, presents with lipodystrophy on both upper thighs. It would be most important to assess which of the following?
A)Whether Mrs. Thomas aspirates before administering the insulin
B)Whether Mrs. Thomas administers the insulin at a 45° angle
C)Whether Mrs. Thomas cleanses the site with alcohol before each injection
D)Whether Mrs. Thomas rotates injection sites using sites other than the thighs

Accepted Answer

Whether Mrs. Thomas rotates injection sites using sites other than the thighs. When the same site is used for insulin injections over an extended period of time, lipodystrophy (hypertrophy or atrophy of the tissue) can occur. The other options describe appropriate insulin injection administration techniques.

Question 15

Which of the following tests is used to diagnose Cushing's syndrome?
A)Fluid deprivation test
B)Glucose tolerance test
C)Low-dose dexamethasone suppression test
D)Thallium stress test

Accepted Answer

A low-dose dexamethasone suppression test is used to detect changes in plasma cortisol levels. A fluid deprivation test is used to diagnose diabetes insipidus. The glucose tolerance test is used to determine gestational diabetes in pregnant women. A Thallium stress test is used to monitor heart function under stress.

Question 16

Which of the following nursing considerations must be taken into account for a client with type 1 diabetes mellitus on the morning of surgery?
A)The client should take half of his usual daily insulin.
B)The client should receive an oral antidiabetic agent.
C)The client should receive an I.V. insulin infusion.
D)The client should take his full daily insulin dose with no dextrose infusion.

Accepted Answer

Half the insulin dose will provide all that is needed. If the client takes his full daily dose of insulin when he isn't allowed anything orally before surgery, he'll become hypoglycemic. Clients with type 1 diabetes don't take oral antidiabetic agents. I.V. insulin infusions aren't standard for routine surgery; they're used in the management of clients undergoing stressful procedures, such as transplants or coronary artery bypass surgery.

Question 17

A nurse is caring for a client with type 1 diabetes mellitus. Because the client is at risk for hypoglycemia, the nurse teaches the client which of the following?
A)Glucose tablets and subcutaneous glucagon should be made available.
B)If the client is exercising, the evening dose of NPH insulin can be discontinued.
C)Urine should be monitored for presence of acetone.
D)Assess for signs of coma and drowsiness.

Accepted Answer

Glucose tablets and subcutaneous glucagon should be made available. Glucose tablets are taken if a hypoglycemic reaction occurs while glucagon is administered subcutaneously or intramuscularly if the client loses consciousness and is unable to take glucose by mouth. Glucagon resolves hypoglycemia by releasing glycogen stores and raises blood glucose levels. Members of the family can be taught to administer this medication and possibly prevent an emergency room visit. The nurse would not instruct a client to omit insulin. Acetone in the urine may indicate hyperglycemia. Although signs of hypoglycemia need to be taught to the client, drowsiness and coma are not the initial and key signs of this complication.

Question 18

Donna has Addison's disease and is receiving fludrocortisone acetate. The nurse knows that the therapeutic effect of this is to:
A)Stimulate thyroid gland production
B)Activate parathyroid production
C)Maintain electrolyte imbalance
D)Activate the immune response

Accepted Answer

Fludrocortisone acetate is a medication used for long term treatment for Addison's disease and its therapeutic effect is to maintain electrolyte imbalance. The medication does not affect the immune response or thyroid or thyrotropin production.

Question 19

The nurse receives notification from the laboratory that the client, who is diabetic, has an HgbA1c of 6%. The best action by the nurse would be to:
A)Counsel the client on the need for better glycemic control
B)Document the results in the client record
C)Encourage a diet with more red meat and green leafy vegetables
D)Acknowledge the client's successful glycemic control

Accepted Answer

The client needs reinforcement and positive feedback that the current diabetic management is achieving the desired goal of HgbA1c below 7%.

Question 20

Which of the following chronic complications is associated with diabetes mellitus?
A)Dizziness, dyspnea on exertion, and angina
B)Retinopathy, neuropathy, and coronary artery disease
C)Leg ulcers, cerebral ischemic events, and pulmonary infarcts
D)Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

Accepted Answer

Retinopathy, neuropathy, and coronary artery disease are all chronic complications of diabetes mellitus. Dizziness, dyspnea on exertion, and angina are symptoms of aortic valve stenosis. Hyperparathyroidism causes fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.

Quiz 2: Endocrine

For which complication of thyroidectomy would the nurse monitor?

Maia Clarins, 24 years old, was diagnosed with hypopituitarism. When performing the history and physical exam, which of the following findings should the nurse anticipate?

Vasopressin (Pitressin) is ordered for a client with diabetes insipidus in order to do which of the following?

The client with Addison's disease is ordered glucocorticoid therapy. Which of the following statements indicates that the client has a correct understanding of the medication regimen?

The nurse administers a dose of six units of regular insulin (Humulin R) to a patient at 8:00 AM. Knowing the action of regular insulin, when would the nurse anticipate that a hypoglycemia reaction could occur?

The nurse is working with a client who is just beginning to use a new external insulin pump. Which statement made by the client indicates a need for more teaching regarding the use of the pump?

The client is admitted with metabolic acidosis secondary to diabetic ketoacidosis (DKA) . Understanding metabolic acidosis, the nurse should choose which of the following as the priority nursing diagnosis?

Davidson is 8 hours post partial thyroidectomy for Grave's disease. What is the best documentation by the nurse of evaluation outcome criteria for the nursing diagnosis risk for effective airway clearance?

Marcus Pinel, 43-years-old, is brought back to the nursing unit following a thyroidectomy. Which of the following methods should the nurse use to assess for bleeding?

Diaz, a 56-year-old candle maker, developed diabetic ketoacidosis (DKA) and is given intravenous normal saline infusion and regular insulin. In addition to hourly blood glucose monitoring, what assessment data are early signs of clinical improvement?

Joshua Caine, age 48 years old, had a bilateral adrenalectomy for Cushing's syndrome. He is being sent home with a new prescription for hydrocortisone. The best statement indicating understanding of the drug and associated risk is:

Following a hypophysectomy, the client complains of clear nasal drainage. What is the most appropriate initial action for the nurse?

Thomas, newly admitted to your unit this morning, presents with lipodystrophy on both upper thighs. It would be most important to assess which of the following?

Which of the following tests is used to diagnose Cushing's syndrome?

Which of the following nursing considerations must be taken into account for a client with type 1 diabetes mellitus on the morning of surgery?

A nurse is caring for a client with type 1 diabetes mellitus. Because the client is at risk for hypoglycemia, the nurse teaches the client which of the following?

Donna has Addison's disease and is receiving fludrocortisone acetate. The nurse knows that the therapeutic effect of this is to:

The nurse receives notification from the laboratory that the client, who is diabetic, has an HgbA1c of 6%. The best action by the nurse would be to:

Which of the following chronic complications is associated with diabetes mellitus?