ATI Endocrine practice 15 PDF

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Detailed Answer Key ATI Complex Endocrine Practice

1. A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client? A. Chvostek's sign Rationale: The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia. B. Babinski's sign Rationale: Babinski's sign is a diagnostic test for brain damage or upper motor neuron damage. It is positive if the toes flare up when the nurse strokes the plantar aspect of the foot. C. Brudzinski's sign Rationale: Brudzinski's sign is an indication of meningeal irritation, such as in clients who have meningitis. With the client supine, the nurse should place one hand behind his head and places her other hand on his chest. The nurse then raises the client's head with her hand behind his head, while the hand on his chest restrains him and prevents him from rising. Flexion of the client's lower extremities constitutes a positive sign. D. Kernig's sign Rationale: Kernig's sign is an indication of meningeal irritation, such as in clients who have meningitis. The nurse performs the maneuver with the client supine with his hips and knees in flexion. The inability to extend the client's knees fully without causing pain constitutes a positive test.

2. A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? A. NPH insulin Rationale: Isophane NPH insulin is intermediate-acting. It has an onset of action of 1 to 3 hr and is not appropriate for emergency treatment of ketoacidosis. B. Insulin glargine Rationale: Insulin glargine is a long-acting insulin, with an onset of 2 to 4 hr. It is not appropriate for emergency treatment of ketoacidosis. C. Insulin detemir Rationale: Insulin detemir is an intermediate-acting insulin. It has an onset of action of 1 hr and is not appropriate for emergency treatment of ketoacidosis. D. Regular insulin Rationale:

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Detailed Answer Key ATI Complex Endocrine Practice Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

3. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? A. Dehydration Rationale: Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration. B. Polyphagia Rationale: Polyphagia is a finding of diabetes mellitus, not insipidus. C. Hyperglycemia Rationale: Hyperglycemia is a finding of diabetes mellitus, not diabetes insipidus. D. Bradycardia Rationale: Tachycardia, not bradycardia, is a manifestation of diabetes insipidus.

4. A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? A. A decrease in blood sugar Rationale: Blood sugar level is not affected in diabetes insipidus. B. A decrease in blood pressure Rationale: Diabetes insipidus causes the loss of large amounts of urine, which can lead to hypotension. An increase (or at least no further decrease) in blood pressure would be the desired response to vasopressin. C. A decrease in urine output Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response. D. A decrease in specific gravity Rationale: An increase in specific gravity (indicating a more concentrated urine) would be the desired response of vasopressin.

5. A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see?

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Detailed Answer Key ATI Complex Endocrine Practice A. pH below 7.35 Rationale: With acidosis, the pH is below 7.35. However, the pH alone does not indicate whether the problem is metabolic or respiratory. A pH above 7.45 indicates alkalosis. B. HCO3 above 26 mEq/L Rationale: With metabolic acidosis, the HCO3 is below 21 mEq/L. C. PaO2 below 70 mm Hg Rationale: With metabolic acidosis, the PaO2 is likely to be within the expected reference range of 80 to 100 mm Hg, unless the client has other complications that are causing hypoxia. D. PaCO2 above 45 mm Hg Rationale: With metabolic acidosis, the PaCO2 is within the expected reference range of 35 to 45 mm Hg or below 35 mm Hg with respiratory compensation. An elevated PaCO2 indicates respiratory acidosis.

6. A nurse is caring for a client who is 8 hr postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client? A. High Fowler's with neck extended Rationale: Neck extension could place excessive tension on the operative area and the sutures. B. High Fowler's with neck in a neutral position. Rationale: High Fowler's does not support the head and neck area well enough and could place excess pressure on the operative area. C. Semi-Fowler's with neck extended Rationale: Neck extension could place excessive tension on the operative area and the sutures. D. Semi-Fowler's with neck in a neutral position Rationale: Semi-Fowler's is the most comfortable position for a client who has had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the sutures. A neutral position is essential.

7. A nurse is reviewing a client’s laboratory report of blood gas findings: HCO3- 18 mEq/L and PaCO2 28 mm Hg. Which of the following pH values and conditions should the nurse expect when interpreting these findings? A. Decreased pH and metabolic acidosis Rationale: This client would have a decreased pH and be in metabolic acidosis. Other findings would include diarrhea, circulatory shock, decreased level of consciousness, abdominal pain, cardiac dysrhythmia, and increased depth and rate of respirations.

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Detailed Answer Key ATI Complex Endocrine Practice B. Decreased pH and respiratory acidosis Rationale: The client would have a decreased pH, but would not be in respiratory acidosis. C. Elevated pH and metabolic alkalosis Rationale: The client would not have an increased pH, but would be in metabolic alkalosis. D. Elevated pH and respiratory alkalosis Rationale: The client would not have an increased pH, and would not be in respiratory alkalosis.

8. A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor? A. Airway patency Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine it is the priority to monitor the client's airway. Nerve damage, hypocalcemia induced tetany, and edema can all impair the airway following thyroidectomy. B. Temperature Rationale: The nurse should monitor the client's temperature to detect infection of the incision site. However, there is another factor that is the priority for the nurse to monitor. C. Urination Rationale: The nurse should monitor the client's urinary output to determine hydration status. However, there is another factor that is the priority for the nurse to monitor. D. Pain control Rationale: The nurse should monitor the client's pain to promote comfort and compliance with breathing and mobility prescriptions. However, there is another factor that is the priority for the nurse to monitor.

9. A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor? (Select all that apply.) A. Bicarbonate excess B. Kussmaul's respirations C. Flushing D. Circumoral paresthesia E. Lethargy Rationale: Bicarbonate excess is correct. Bicarbonate excess is a clinical manifestation for a client

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Detailed Answer Key ATI Complex Endocrine Practice experiencing metabolic alkalosis.Kussmaul's respirations is incorrect. Kussmaul's respirations are a clinical manifestation for a client experiencing metabolic acidosis.Flushing is incorrect. Flushing is a clinical manifestation for a client experiencing respiratory acidosis.Circumoral paresthesia is correct. Circumoral paresthesia is a clinical manifestation for a client experiencing metabolic alkalosis.Lethargy is incorrect. Lethargy is a clinical manifestation for a client experiencing metabolic acidosis.

10.A nurse is admitting a client who has influenza and is reporting numbness and tingling of the toes and fingers. The nurse should recognize the client is experiencing which of the following acid-base imbalances? A. Metabolic acidosis Rationale: A client who has metabolic acidosis has a low pH level and a low bicarbonate level with manifestations such as Kussmaul’s respirations, lethargy and confusion. B. Metabolic alkalosis Rationale: A client who has influenza has experienced excessive vomiting leading to metabolic alkalosis. Manifestations include dizziness, Circumoral paresthesias, and numbness and tingling of the extremities. C. Respiratory acidosis Rationale: A client who has respiratory acidosis has a low pH and a high bicarbonate level with manifestations such as warm, flushed skin, headache and tachycardia. D. Respiratory alkalosis Rationale: A client who has respiratory alkalosis has high pH and a low bicarbonate level with manifestations such as tremulousness, blurred vision and difficulty concentrating.

11.A nurse is caring for a client who has the following arterial blood gas results: HCO3 18 mEq, PaCO2 28 mm Hg and pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances? A. Metabolic acidosis Rationale: A client experiencing metabolic acidosis would have a decreased pH, a decreased HCO3 and a decreased PaCO2. B. Respiratory acidosis Rationale: A client experiencing respiratory acidosis would have a decreased pH, a normal (or slightly elevated if acute) HCO3 and an increased PaCO2. C. Metabolic alkalosis Rationale: A client experiencing metabolic alkalosis would an increased pH, and increased HCO3 and an increased PaCO2. D. Respiratory alkalosis Rationale:

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Detailed Answer Key ATI Complex Endocrine Practice A client experiencing respiratory alkalosis would an increased pH, a normal (or slightly decreased if compensated) HCO3 and a decreased PaCO2.

12.A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect? A. Malignant hypertension Rationale: Diabetic ketoacidosis is a complication caused by the absence, or significant deficiency, of insulin. The clinical features include hyperglycemia, acidosis, and dehydration which manifests as hypotension. B. Acetone odor to breath Rationale: Because of the lack of insulin, the body is unable to use glucose and instead breaks down fats resulting in excessive ketones. The large amount of ketones causes the body to become acidotic and causes a fruity, or acetone odor to the breath C. Cheyne-Stokes breathing Rationale: In an attempt to regain homeostasis, the body increases the rate and depth of respirations (Kussmaul respirations). D. Blood glucose level below 40 mg/dL Rationale: Significant hyperglycemia is seen in the client who has diabetic ketoacidosis, with blood glucose levels between 300 and 800 mg/dL.

13.A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect? A. Hypoglycemia Rationale: Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety. B. Nephropathy Rationale: Manifestations of nephropathy include hypertension, microalbuminuria, and elevated uric acid levels. C. Hyperglycemia Rationale: Manifestations of hyperglycemia include warm skin, rapid respirations, and changes in mental status. D. Ketoacidosis Rationale: Manifestations of ketoacidosis include tachycardia, Kussmaul respirations, nausea, and lethargy.

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Detailed Answer Key ATI Complex Endocrine Practice

14.A nurse is assessing a client who has Graves' disease. The nurse should expect which of the following laboratory results? A. Decreased thyroid-stimulating hormone (TSH) level Rationale: The nurse should expect a TSH level below the expected reference range in a client who has Graves' disease. B. Decreased triiodothyronine (T3) level Rationale: The nurse should expect a T3 level above the expected reference range in a client who has Graves' disease. C. Decreased thyroxine (T4) level Rationale: The nurse should expect a T4 level above the expected reference range in a client who has Graves' disease. D. Decreased thyroid-stimulating immunoglobulins (TSI) percentage Rationale: The nurse should expect TSI above the expected reference range in a client who has Graves' disease.

15.A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider? A. Glucocorticoid medications Rationale: Glucocorticoid medications are prescribed for their anti-inflammatory effects. B. Dextrose 5% in 0.45% sodium chloride Rationale: Administration of dextrose 5% in 0.45% sodium chloride is prescribed when the blood glucose level reaches 250 mg/dL to prevent hypoglycemia and cerebral edema. C. Oral hypoglycemic medications Rationale: Oral hypoglycemic medications are prescribed for clients who have type 2 diabetes mellitus. D. 0.9% sodium chloride IV bolus Rationale: The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

16.A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH?

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Detailed Answer Key ATI Complex Endocrine Practice A. Osteoarthritis Rationale: Systemic lupus erythematosus can cause SIADH, but not osteoarthritis. B. Lung cancer Rationale: The nurse should ask the client if he has a history of lung cancer because some of the treatment options for small cell lung cancer can cause secretion of antidiuretic hormone. This results in the body retaining water and can cause the syndrome of inappropriate antidiuretic hormone (SIADH). C. Liver cirrhosis Rationale: Certain medications, such as fluoroquinolone antibiotics, can cause SIADH. However, liver cirrhosis does not cause SIADH. D. Dyspepsia Rationale: Bacterial pneumonia can cause SIADH. However, dyspepsia does not cause SIADH.

17.A nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take? A. Check the pedal pulses. Rationale: There is no indication of a problem with this client's circulation, so it is not necessary to check the pedal pulses at this time. B. Verify the most recent calcium level. Rationale: A client who has had a thyroidectomy is at risk of hypocalcemia due to the possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland that are responsible for calcium regulation. If they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these manifestations following a thyroidectomy, the nurse should check the client's latest calcium level. The expected reference range for calcium is 8.5 to 10.5 mg/dL. If the calcium level is low, the provider should be notified, and oral or intravenous calcium replacement should be administered. C. Request prescription for a relaxant. Rationale: A client who has had a thyroidectomy is at risk of hypocalcemia due to possible disruption of the parathyroid gland during surgery which causes muscle spasms, and numbness and tingling. If the client has a low calcium level, replacement with oral or intravenous calcium is required. Treating the manifestation without correcting the underlying cause places the client at risk for further complications of hypocalcemia, such as laryngospasm and airway obstruction. D. Administer an oral potassium supplement. Rationale: Clients who have low potassium levels often have leg cramps, rather than spasms. There is not a risk of low potassium associated with a thyroidectomy, and therefore this should not be a suspected cause of muscle cramps in this client. Additionally, the nurse should only administer

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Detailed Answer Key ATI Complex Endocrine Practice a potassium supplement to a client who has confirmed hypokalemia.

18.A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care? A. Measure blood glucose levels every 4 hr. Rationale: The nurse should measure the blood glucose of a client who has diabetes mellitus. B. Administer a diuretic. Rationale: The nurse should plan to administer a diuretic for a client who has a syndrome of inappropriate antidiuretic hormone to promote diuresis. C. Initiate fluid restrictions. Rationale: The nurse should increase fluids to prevent dehydration in a client who has diabetes insipidus. D. Check urine specific gravity. Rationale: The nurse should check the client’s urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

19.A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take? A. Turn the client ever 4 hr. Rationale: The nurse should turn the client every 2 hr to reduce the risk for impaired skin integrity and atelectasis. B. Check the client’s blood pressure every 2 hr. Rationale: The nurse should check the client’s blood pressure every hour to assess for hypotension. C. Initiate measures to cool the client. Rationale: The nurse should initiate warming measures for the client, such as warm blankets, to reduce the risk for hypothermia. D. Place the client on aspiration precautions. Rationale: The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryng...