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1215- Unit 3 Exam
Cardiac, Endocrine, Diabetes
Terms in this set (61)
Which initial physical assessment finding would the nurse expect to be present in a patient with acute left-sided heart failure?
Bubbling crackles and tachycardia
Clinical manifestations of left sided HF:
frothy, bloody sputum
cool, clammy skin
A pt. with chronic heart failure is treated with HCTZ, digoxin, and Lisinopril. To prevent the risk of digitalis toxicity what is most important for the nurse to monitor?
The nurse determines the treatment for left-sided HF has been successful when the pt. experiences?
Clear lung sounds and decreased HR
Which diagnostic test is more useful in differentiating dyspnea related to pulmonary effects of HF, from dyspnea related to pulmonary disease?
B-type natriuretic peptide (BNP) levels
A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions should the nurse perform first?
Check blood pressure
Risk factors to be considered for the development of venous thrombosis are:
Stasis of blood,
Vessel wall injury
The nurse teaches the pt. with any venous disorder that the best way to prevent venous stasis and increase venous return is to?
When obtaining a health history from a 72 yo man with PAD of the lower extremities the nurse asks about a history related to what condition(s)?
Coronary artery disease
What are characteristics of arterial disease?
Ulcers over bony prominences on the toes and feet, thick brittle nails, decreased peripheral pulses, & pallor when legs are elevated
A patient screened for diabetes at a clinic has a fasting blood glucose of 120 mg/dL. The nurse explains to the patient that this value:
Reflects impaired glucose tolerance which is known as pre-diabetes
When caring for a patient with metabolic syndrome, the nurse gives the highest priority to teaching the patient about?
Maintaining a normal weight
During a routine health screening, a patient is found to have a fasting plasma glucose (FPG) of 132 mg/dL. At a follow-up visit, a diagnosis of diabetes would be made based on?
A1C of 7.0%
How is diabetes diagnosed?
By two different tests done on serperate days. Three tests include:
-FPG of > 126 mg/dL
-A1C > 6.5%
-2 hr OGTT level of > 200 mg/dL
Which of the following is at greatest risk for developing Diabetes Mellitus?
A 34 yo woman whose parents both have type 2 Diabetes.
Which of the following would the nurse NOT expect in the patient with hyperglycemia?
Slurred Speech and combative behavior
S/S associated with hyperglycemia?
Nausea and vomiting, Increased dietary intake, increased stress level
Mild hypoglycemia S&S:
BG = 55 - <70 mg/dL
Moderate hypoglycemia S&S:
Inability to concentrate
BG = >40 - 55 mg/dL
Severe hypoglycemia S&S:
Loss of consciousness, Disoriented behavior
BG= < 40 mg/dL
No warning S&S until glucose level critically low; R/t autonomic neuropathy and lack of counterregulatory hormones
A patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last five mornings. The nurse advices the patient to?
Monitor glucose at bedtime, between 2 and 4 AM and when awakening.
A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm.
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes (rebound effect)
Ideally the patient goal of diabetes education is to:
Enable the patient to become the most active participant in the management of their diabetes
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting and diarrhea. It is important that the nurse advise the patient to:
Check the blood glucose levels every 2-4 hrs
Sick day rules for Diabetics:
Keep taking insulin or oral antidiabetics,
Test blood / urine every 3-4 hrs,
Supplemental insulin on a sliding scale,
Substitute soft foods PRN 6-8 times a day,
Liquids every 1/2 hr to 1 hr
In nutritional management of all types of diabetes, it is important for the patient to?
Eat regular meals at regular times
Goal for nutritional therapy for the patient with type 2 diabetes includes maintenance of?
Normal serum glucose and lipid levels
T/F: Type 1 diabetes is treated initially with diet and exercise?
T/F: The renal threshold for glucose is 180 to 200 mg/dL?
Which of the following insulin is in the category of rapid acting?
Aspart & Lispro
Which medication blocks synthesis of the thyroid hormone?
Which medication(s) suppress the release of the thyroid hormone?
Dexamethasone, Potassium Iodide, and Sodium Iodide.
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos (bulging eyes)
caused by prolonged exposure to high levels of glucocorticoid (cortisol and ACTH hormome)
Diabetes Type 1:
juvenile diabetes, insulin dependent diabetes where the body produces little or no insulin. patient must have insulin to survive.
Diabetes Type 2:
adult onset diabetes, non-insulin dependent, body produces insulin but no enough, is more common, can be controlled by diet and exercise.
Diabetic foot care:
-wash feet everyday (warm not hot water)
-inspect feet everyday
-keep skin soft and smooth, lotion feet but NOT between toes
-gently smooth corns and calluses
-trim toenails weekly and carefully
-wear cotton socks and shoes at all times
-protect feet from hot/cold
-keep feet warm to enhance blood flow.
Diabetes mellitus (DM)
metabolic disorder caused by the absence or insufficient production of insulin secreted by the pancreas, resulting in hyperglycemia and glucosuria
What is the leading cause of blindness in adults?
What are the major complications / risks associated with diabetes?
Peripheral Vascular Disease
Hypertrophy of the heart
Increase in the SIZE of cells resulting in enlarged tissue mass. this increase may be caused by additional work by the tissue, as demonstrated by an enlarged heart muscle. "cardiomyopathy"
What assessment finding would be found in a patient whose apical pulse is displaced to the left?
Hypertrophied heart ( enlarged heart)
The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______
Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to?
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism
A nurse should perform which intervention for a client with Cushing's syndrome?
Explain that the client's physical changes are a result of excessive corticosteroids.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
describes the most severe stage of hypothroidism when a patient may become hypothermic or unconcious; medical emergency and may lead to death
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
Which is a complication of hyperthyroidism?
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4?
Increasing the Heart Rate
Stimulating the Sympathetic Nervous System
Regulating TSH produced by the anterior pituitary gland
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms?
A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on?
Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st trimester of pregnancy.
Which of the following are treatment options for hyperthyroidism?
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
sodium and potassium abnormalities.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply:
*Patients who have hypothyroidism are very sensitive to narcotics and should take NON-NARCOTICS for pain relief.
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