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ATI Endocrine Practice Questions and correct answers A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? A. Calcium B. Potassium C. Iodine D. Hydrocortisone - Correct Answer: D. Hydrocortisone Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium levels fall, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency. Incorrect Answers: A. IV calcium corrects hypoparathyroidism, not acute adrenal insufficiency. B. Acute adrenal insufficiency causes hyperkalemia, which requires a potassium binding and excreting resin to treat, not additional potassium. C. Iodine-containing agents treat thyrotoxicosis, not acute adrenal insufficiency. A nurse in the emergency department is assessing a client who has pancreatitis. In which of the following laboratory results should the nurse expect to see an elevation? A. Amylase
B.
Potassium C. Calcium D. Hematocrit - Correct Answer: A. Amylase With pancreatitis, laboratory results typically show elevated amylase within 12 to 24 hours. This level remains elevated for 2 to 3 days. Incorrect Answers:B. With pancreatitis, potassium is not expected to increase. Alterations in electrolytes include a decrease in magnesium. C. With pancreatitis, hypocalcemia is an expected finding. D. With pancreatitis, hemoglobin and hematocrit are not expected to increase. An increase in WBC count is common, indicating inflammation. A nurse is planning to administer fluids to a client who has 25% total body surface area burns. The client has no prior medical history. Which of the following intravenous fluids is contraindicated for this client? A. Whole blood B. Lactated Ringer's C. Dextran 40 in 0.9% sodium chloride D. 0.45% sodium chloride - Correct Answer: D. 0.45% sodium chloride
D. While reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta. Additionally, it does not relate to glycemic control, which is a critical issue for this client. A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce total hours of sleep B. Keep the immediate environment warm C. Increase caloric intake with meals D. Gradually increase activity - Correct Answer: C. Increase caloric intake with meals Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance. Even with an increased appetite, meeting energy demands is often difficult, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake. Incorrect Answers:A. Clients who have hyperthyroidism often report an inability to sleep. A decreased attention span and mild to severe hyperactivity are common. The nurse should suggest frequent rest periods in a quiet environment. B. Clients who have hyperthyroidism often have a low-grade fever and diaphoresis due to their hypermetabolic state. A cool environment can decrease the discomfort of heat intolerance. D. Clients who have hyperthyroidism are often restless and have an increased systolic blood pressure, tachycardia, and other dysrhythmias. During the acute phase, increased activity is not an appropriate recommendation. A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan?
A.
Encourage the client to control weight B. Inspect the client's feet once each week C. Restrict the client's activity D. Apply moisturizer between the client's toes - Correct Answer: A. Encourage the client to control weight The nurse should encourage weight control to stabilize the client's blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes. Incorrect Answers:B. The nurse should inspect the client's feet daily. The client is at risk for foot injury due to impaired circulation and reduced sensation in the lower extremities. C. The nurse should seek to increase physical activity to reduce the client's weight and improve blood glucose control. D. The nurse should not apply moisturizer between the client's toes due to the risk of skin breakdown from excess moisture. A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D.
Sugar craving D. Pale skin tone - Correct Answer: A. Hypotension The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone. Incorrect Answers:B. The nurse should expect weight loss in a client who has Addison's disease. C. The nurse should expect salt craving in a client who has Addison's disease. D. The nurse should expect increased skin pigmentation in a client who has Addison's disease. A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates that the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL - Correct Answer: D. Fasting blood glucose 95 mg/dL A fasting blood glucose of 95 mg/dL is within the expected reference range of 70 to 110 mg/dL, which indicates that this client's diabetes is under control. Incorrect Answers:A. An HbA1c of 8.5% is above the expected reference of <7% and does not indicate that the client's diabetes is under control.
B. A postprandial blood glucose of 190 mg/dL is above the expected reference range of < mg/dL and does not indicate that the client's diabetes is under control. C. A casual blood glucose of 205 mg/dL is above the expected reference of <200 mg/dL and does not indicate that the client's diabetes is under control. A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors - Correct Answer: B. Increased urination Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis. Incorrect Answers:A. Increased hunger is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. C. Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. D. Tremulousness is a manifestation of hypoglycemia due to an adrenergic response to central glucose deprivation. A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? A. Polyuria
A client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. The adrenal glands produce several hormones including cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors; if untreated, this can be fatal. Incorrect Answers:B. A client who has an adrenalectomy has increased blood glucose levels due to the increase in the production of glucocorticoids. Glucocorticoids stimulate gluconeogenesis and are not given to inhibit glucose metabolism. C. A client who has an adrenalectomy has fluid retention from the increased production of glucocorticoids. Glucocorticoids have fluid retention properties and do not act as a diuretic to increase urine output. D. A client who has an adrenalectomy has a higher risk of infection due to the increased production of glucocorticoids. Glucocorticoids have potent anti-inflammatory and immunosuppressive properties and raise the client's susceptibility to infection. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure - Correct Answer: C. Kussmaul respirations The nurse should expect this client with DKA to experience Kussmaul respirations. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA. Incorrect Answers:A. The nurse should expect ketones to be present in the urine and blood of a client who has DKA due to excessive glucose production.
B. Distended neck veins are not an expected finding of DKA. Signs of dehydration (e.g. flattened neck veins, hypotension, dry skin, and sunken eyeballs) are common. D. A client with DKA is more likely to have orthostatic hypotension due to the dehydration caused by the excessive blood glucose and osmotic diuresis. A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid- stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis - Correct Answer: A. Bradycardia An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations. Incorrect Answers:B. Tremors are a manifestation of Graves' disease, the most common type of hyperthyroidism. TSH levels are decreased in Graves' disease. C. A low-grade fever is a manifestation of Graves' disease. D. Diaphoresis and heat intolerance are manifestations of Graves' disease. A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the evening intermediate-acting insulin dose to 90 min before dinner B.
The nurse should notify the provider immediately and prepare for a tracheostomy. Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms. Incorrect Answers:A. The nurse should not hyperextend the client's neck because this can place tension on the incision and cause bleeding. C. The nurse should elevate the head of the client's bed to promote ventilation. D. The nurse should not administer an analgesic because this can cause respiratory depression. A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis? A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7. D. Bicarbonate level 12 mEq/L - Correct Answer: D. Bicarbonate level 12 mEq/L A client who has diabetic ketoacidosis should have a bicarbonate level that is <15 mEq/L due to the increased production of counter-regulatory hormones that lead to metabolic acidosis. Incorrect Answers:A. A client who has diabetic ketoacidosis should have a blood glucose level that is >250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis. B. A client who has diabetic ketoacidosis should have positive urine ketones because of the increased production of counter-regulatory hormones that lead to the production of ketoacids. C. A client who has diabetic ketoacidosis should have a pH level that is <7.3 because of the increased production of counter-regulatory hormones that lead to metabolic acidosis.
A nurse is preparing a 24-hr urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hr urine specimen should the nurse use to determine the client's condition? A. Creatinine clearance B. Vanillylmandelic acid (VMA) C. 17-hydroxycorticosteroids (17-OHCS) D. Protein - Correct Answer: B. Vanillylmandelic acid (VMA) The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate. Incorrect Answers:A. A 24-hour urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating the glomerular filtration rate of the kidneys. C. A 24-hour urine specimen for 17-OHCS is used to determine if the client is producing an adequate amount of cortisol. An increase of cortisol in the specimen can indicate Cushing's disease. D. A 24-hr urine specimen for protein is used to evaluate the client's renal function. A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone
Thoracotomy tray D. Tracheostomy tray - Correct Answer: D. Tracheostomy tray Because of the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client. Incorrect Answers:A. Unless the client has a pre-existing cardiac dysrhythmia or is at risk for dysrhythmias, cardiac monitoring is not essential after a thyroidectomy. B. A defibrillator should be available on every nursing unit. However, unless the client has a history of cardiopulmonary arrest or is a particular risk for this condition, having a defibrillator nearby is not essential following a thyroidectomy. C. Unless the client has a history of pneumothorax or is at risk for pneumothorax, a thoracotomy is not essential following a thyroidectomy. A nurse is updating the plan of care for a client who is to receive total parenteral nutrition (TPN). Which of the following actions should the nurse include in the plan? (Select all that apply.) A. Weigh the client daily B. Obtain a serum blood glucose every 4 hr C. Apply a new dressing to the client's IV site every 5 days D. Change the IV tubing every 24 hr E. Infuse the TPN through a peripheral IV site - Correct Answers: A.
Weigh the client daily B. Obtain a serum blood glucose every 4 hr D. Change the IV tubing every 24 hr The nurse should weigh the client daily while receiving TPN. Clients who are receiving TPN are typically malnourished; therefore, the client's weight needs to be monitored closely. Fluid retention can also be an indication that the client is not digesting the TPN, and the rate of the transfusion might need to be decreased. The nurse should also obtain the client's serum blood glucose; insulin can be given if needed. Finally, the nurse should change the client's IV tubing every 24 hours to prevent bacteria from developing in the client's tubing. Incorrect Answers: C. The nurse should apply a new dressing to the client's IV site every 48 to 72 hours as per facility protocol to maintain the IV site and inspect the client's skin for irritation and infection. E. The nurse should infuse the TPN through the client's central line. Partial parenteral nutrition can be given through a peripheral line. A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia - Correct Answer: C. Difficulty sleeping
D. Desmopressin is a synthetic form of antidiuretic hormone that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus, not SIADH. A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? A. Warm the dialysate solution prior to administration B. Cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward C. Place the drainage bag at the level of the client's chest D. Apply clean gloves and cleanse the client's catheter site with cold water - Correct Answer: A. Warm the dialysate solution prior to administration The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping. Incorrect Answers:B. The nurse should cleanse the catheter site using a circular motion while moving outward. This prevents the nurse from contaminating the area already cleansed. C. The nurse should place the drainage bag below the level of the client's abdomen to enhance gravity of the fluid. D. The nurse should apply sterile gloves and use 3 cotton swabs soaked in povidone-iodine to cleanse the catheter site. This destroys the bacteria around the site and prevents infection. A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A. Check the client's blood glucose for hypoglycemia
B.
Check the client's urine specific gravity C. Weigh the client weekly D. Insert an indwelling urinary catheter for the client - Correct Answer: B. Check the client's urine specific gravity The nurse should check the client's urine specific gravity to assess for fluid volume overload. Incorrect Answers:A. The nurse should check the client for hyperglycemia because hypercortisolism elevates blood glucose levels. C. The nurse should weigh the client at the same time each day because treatment decisions are based on these findings. D. The nurse should have the client save all urine output to record the results every 24 hours. An indwelling urinary catheter needlessly exposes the client to a potential urinary tract infection. A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose Check Answer - Correct Answer: A. Glycosylated hemoglobin levels
