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practice Questions endocrine
Terms in this set (109)
A nurse cares for a client who is prescribed a drug that blocks a hormone's receptor site. Which therapeutic effect should the nurse expect?
a. Greater hormone metabolism
b. Decreased hormone activity
c. Increased hormone activity
d. Unchanged hormone response
Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased.
A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency?
a. Increased urine output
c. Blood glucose of 98 mg/dL
d. Serum sodium of 144 mEq/L
Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.
A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess?
Parafollicular cells produce thyrocalcitonin (calcitonin), which regulates serum calcium levels. Calcitonin has no impact on potassium, sodium, or magnesium balances.
A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding should alert the nurse to urgently contact the health care provider?
a. Heart rate of 50 beats/min
b. Respiratory rate of 18 breaths/min
c. Oxygenation saturation of 92%
d. Blood pressure of 144/69 mm Hg
Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other vital signs are within normal limits and do not indicate a negative response to the medication.
A nurse prepares to palpate a client's thyroid gland. Which action should the nurse take when performing this assessment?
a. Stand in front of the client instead of behind the client.
b. Ask the client to swallow after palpating the thyroid.
c. Palpate the right lobe with the nurse's left hand.
d. Place the client in a sitting position with the chin tucked down.
The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.
A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is prescribed a 24-hour urine specimen collection. Which statement should the nurse include when delegating this activity to the UAP?
a. "Note the time of the client's first void and collect urine for 24 hours."
b. "Add the preservative to the container at the end of the test."
c. "Start the collection by saving the first urine of the morning."
d. "It is okay if one urine sample during the 24 hours is not collected."
The collection of a 24-hour urine specimen is often delegated to a UAP. The nurse must ensure that the UAP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the client's first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client's first void is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.
A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when assessing this client?
a. "How do you plan to pay for your treatments?"
b. "How do you feel about yourself?"
c. "What medications are you prescribed?"
d. "What are you doing to prevent this from happening?"
Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.
A nurse teaches a client who has been prescribed a 24-hour urine collection to measure excreted hormones. The client asks, "Why do I need to collect urine for 24 hours instead of providing a random specimen?" How should the nurse respond?
a. "This test will assess for a hormone secreted on a circadian rhythm."
b. "The hormone is diluted in urine; therefore, we need a large volume."
c. "We are assessing when the hormone is secreted in large amounts."
d. "To collect the correct hormone, you need to urinate multiple times."
Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. Dilution of hormones in urine, secretion of hormone amounts, and ability to collect the correct hormone are not reasons to complete a 24-hour urine test.
A nurse plans care for an older adult who is admitted to the hospital for pneumonia. The client has no known drug allergies and no significant health history. Which action should the nurse include in this client's plan of care?
a. Initiate Airborne Precautions.
b. Offer fluids every hour or two.
c. Place an indwelling urinary catheter.
d. Palpate the client's thyroid gland.
A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more diluted urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with simple pneumonia would not require Airborne Precautions. Indwelling urinary catheterization is not necessary for this client and would increase the client's risk for infection. The nurse should plan a toileting schedule and assist the client to the bathroom if needed. Palpating the client's thyroid gland is a part of a comprehensive examination but is not specifically related to this client.
A nurse cares for a client who is prescribed a 24-hour urine collection. The unlicensed assistive personnel (UAP) reports that, while pouring urine into the collection container, some urine splashed his hand. Which action should the nurse take next?
a. Ask the UAP if he washed his hands afterward.
b. Have the UAP fill out an incident report.
c. Ask the laboratory if the container has preservative in it.
d. Send the UAP to Employee Health right away.
For safety, the nurse should find out if the UAP washed his or her hands. The UAP should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the UAP is washing hands, if needed. The UAP would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The UAP also needs further education on Standard Precautions, which include wearing gloves.
A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which hormone value should the nurse assess first?
a. Posterior pituitary hormones
b. Adrenal medulla hormones
c. Anterior pituitary hormones
d. Parathyroid hormone
Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones would not cause fluid secretion from the client's breast.
A nurse cares for a client who has excessive catecholamine release. Which assessment finding should the nurse correlate with this condition?
a. Decreased blood pressure
b. Increased pulse
c. Decreased respiratory rate
d. Increased urine output
Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.
A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis?
a. "I have a terrible craving for potato chips."
b. "I cannot seem to drink enough water."
c. "I no longer have an appetite for anything."
d. "I get hungry even after eating a meal."
The nurse correlates a client's salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus.
A nurse teaches an older adult with a decreased production of estrogen. Which statement should the nurse include in this client's teaching to decrease injury?
a. "Drink at least 2 liters of fluids each day."
b. "Walk around the neighborhood for daily exercise."
c. "Bathe your perineal area twice a day."
d. "You should check your blood glucose before meals."
An older adult client with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse should encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not decrease injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.
A nurse cares for a client who is prescribed a serum catecholamine test. Which action should the nurse take when obtaining the sample?
a. Discard the first sample and then begin the collection.
b. Draw the blood sample after the client eats breakfast.
c. Place the sample on ice and send to the laboratory immediately.
d. Add preservatives before sending the sample to the laboratory.
A blood sample for catecholamine must be placed on ice and taken to the laboratory immediately. This sample is not urine, and therefore the first sample should not be discarded nor should preservatives be added to the sample. The nurse should use the appropriate tube and obtain the sample based on which drugs are administered, not dietary schedules.
A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.)
a. Hormones may travel long distances to get to their target tissues.
b. Continued hormone activity requires continued production and secretion.
c. Control of hormone activity is caused by negative feedback mechanisms.
d. Most hormones are stored in the target tissues for use later.
e. Most hormones cause target tissues to change activities by changing gene activity.
ANS: A, B, C
Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity
A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse expect to be affected by this condition? (Select all that apply.)
a. Thyroid-stimulating hormone
c. Follicle-stimulating hormone
e. Growth hormone
ANS: A, C, E
Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.
A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.)
a. Excessive thyroid-stimulating hormone - Increased bone formation
b. Excessive melanocyte-stimulating hormone - Darkening of the skin
c. Excessive parathyroid hormone - Synthesis and release of corticosteroids
d. Excessive antidiuretic hormone - Increased urinary output
e. Excessive adrenocorticotropic hormone - Increased bone resorption
ANS: A, B
Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.
A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone?
a. A 36-year-old female who has used oral contraceptives for 5 years
b. A 42-year-old male who experienced head trauma 3 years ago
c. A 55-year-old female with a severe allergy to shellfish and iodine
d. A 64-year-old male with adult-onset diabetes mellitus
B (Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.)
A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this clients plan of care?
a. Avoid intramuscular medications.
b. Place the client in protective isolation.
c. Use a lift sheet to re-position the client.
d. Assist the client to dangle before rising.
C (In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.)
A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement therapy. The client asks, How long will I need to take this medication? How should the nurse respond?
a. When your blood levels of testosterone are normal, the therapy is no longer needed.
b. When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever.
c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy.
d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old
B (Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm counts are high.)
A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). How should the nurse interpret these results?
a. Pituitary hypofunction
b. Pituitary hyperfunction
c. Pituitary-induced diabetes mellitus
d. Normal pituitary response to insulin
D (Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.)
After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?
a. I will no longer need to limit my fluid intake after surgery.
b. I am glad no visible incision will result from this surgery.
c. I hope I can go back to wearing size 8 shoes instead of size 12.
d. I will wear slip-on shoes after surgery to limit bending over.
C (Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.)
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first?
a. Encourage range-of-motion exercises.
b. Document the finding and monitor the client.
c. Take vital signs, including temperature.
d. Assess pain and administer pain medication.
C (Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all assessments are completed and should not be the only action. Although pain medication may be a palliative measure, it is not the most appropriate initial action.)
After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?
a. I will wear dark glasses to prevent sun exposure.
b. Ill keep food on upper shelves so I do not have to bend over.
c. I must wash the incision with peroxide and redress it daily.
d. I shall cough and deep breathe every 2 hours while I am awake.
B (After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.)
A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first?
a. Consult with the dietitian about increased dietary sodium.
b. Restrict the clients fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for re-positioning.
d. Instruct unlicensed assistive personnel to measure intake and output.
B (With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.)
A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients plan of care to prevent injury?
a. Pad the siderails of the clients bed.
b. Assist the client to change positions slowly.
c. Use a lift sheet to change the clients position.
d. Keep suctioning equipment at the clients bedside.
C (Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning.)
A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications? How should the nurse respond?
a. It is possible for the inflammation to recur if you stop the medication.
b. Once you start corticosteroids, you have to be weaned off them.
c. You must decrease the dose slowly so your hormones will work again.
d. The drug suppresses your immune system, which must be built back up.
B (One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the clients immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.)
A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond?
a. I will ask your doctor to order a psychiatric consult for you.
b. You feel this way because of your hormone levels.
c. Can I bring you information about support groups?
d. I will close the door to your room and restrict visitors.
B (Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.)
A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client?
a. Read the label before using salt substitutes.
b. Do not add salt to your food when you eat.
c. Avoid exposure to sunlight.
d. Take Tylenol instead of aspirin for pain.
A (Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.)
A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take?
a. Wash hands when entering the room.
b. Keep the client in airborne isolation.
c. Observe the client for signs of infection.
d. Assess the clients daily chest x-ray.
A (Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.)
A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first?
a. Keep the head of the bed flat and the client supine.
b. Instruct the client to cough, turn, and deep breathe.
c. Report clear or light yellow drainage from the nose.
d. Apply petroleum jelly to lips to avoid dryness.
C (A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.)
A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions?
a. You will need to learn how to rotate the injection sites.
b. If you work outside in the heat, you may need another drug.
c. You need to follow a diet with strict sodium restrictions.
d. Take one tablet in the morning and two tablets at night.
B (Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.)
An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first?
a. Obtain intravenous access.
b. Administer hydrocortisone succinate (Solu-Cortef).
c. Assess blood glucose.
d. Administer insulin and dextrose.
A (All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.)
A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.)
a. Protrusion of the lower jaw
b. High-pitched voice
c. Enlarged hands and feet
e. Barrel-shaped chest
f. Excessive sweating
A, C, D, E, F (Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.)
A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.)
a. A 20-year-old female with benign pituitary tumors
b. A 32-year-old male with diplopia
c. A 41-year-old female with anorexia nervosa
d. A 55-year-old male with hypertension
e. A 60-year-old female who is experiencing shock
f. A 68-year-old male who has gained weight recently
A, C, D, E (Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.)
A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.)
a. Sodium: 150 mEq/L
b. Sodium: 130 mEq/L
c. Potassium: 2.5 mEq/L
d. Potassium: 5.0 mEq/L
e. pH: 7.28
f. pH: 7.50
A, C, F (Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.)
A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.)
a. Low calcium
b. Low carbohydrate
c. Low protein
d. Low calories
e. Low sodium
B, D, E (The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.)
A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.)
a. Urine output is increased.
b. Urine output is decreased.
c. Specific gravity is increased.
d. Specific gravity is decreased.
e. Urine osmolality is increased.
f. Urine osmolality is decreased.
B, D, E (Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.)
A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy?
a. Blurred and double vision
b. Increased thirst and urination
c. Profuse nausea and diarrhea
d. Decreased attention and insomnia
Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.
A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
a. Reassure the client that the voice change is temporary.
b. Document the finding and assess the client hourly.
c. Place the client in high-Fowler's position and apply oxygen.
d. Contact the provider and prepare for intubation.
Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.
A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take?
a. Offer mouth care.
b. Loosen the dressing.
c. Assess for Chvostek's sign.
d. Ask the client orientation questions
Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.
A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism?
a. "My sister has thyroid problems."
b. "I seem to feel the heat more than other people."
c. "Food just doesn't taste good without a lot of salt."
d. "I am always tired, even with 12 hours of sleep."
Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.
A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client?
a. Atropine sulfate
b. Levothyroxine sodium (Synthroid)
c. Propranolol (Inderal)
d. Epinephrine (Adrenalin)
The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.
A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client?
a. Heat intolerance
b. Body image problems
c. Depression and withdrawal
d. Obesity and water retention
Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client's family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the client's environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.
A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective?
a. Thirst is recognized and fluid intake is appropriate.
b. Weight has been the same for 3 weeks.
c. Total white blood cell count is 6000 cells/mm3.
d. Heart rate is 70 beats/min and regular.
Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.
A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How should the nurse respond?
a. "You will need to take the thyroid medication until the goiter is completely gone."
b. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication."
c. "You'll need thyroid pills for life because your thyroid won't start working again."
d. "When blood tests indicate normal thyroid function, you can stop the medication."
Hashimoto's thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication.
A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism?
a. A 29-year-old female with pregnancy-induced hypertension
b. A 41-year-old male receiving dialysis for end-stage kidney disease
c. A 66-year-old female with moderate heart failure
d. A 72-year-old male who is prescribed home oxygen therapy
Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.
A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care?
a. Ask the client to ambulate in the hallway twice a day.
b. Use a lift sheet to assist the client with position changes.
c. Provide the client with a soft-bristled toothbrush for oral care.
d. Instruct the unlicensed assistive personnel to strain the client's urine for stones.
Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client.
A nurse cares for a client who is recovering from a parathyroidectomy. When taking the client's blood pressure, the nurse notes that the client's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition?
a. Serum potassium: 2.9 mEq/L
b. Serum magnesium: 1.7 mEq/L
c. Serum sodium: 122 mEq/L
d. Serum calcium: 6.9 mg/dL
Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.
A nurse cares for a client newly diagnosed with Graves' disease. The client's mother asks, "I have diabetes mellitus. Am I responsible for my daughter's disease?" How should the nurse respond?
a. "The fact that you have diabetes did not cause your daughter to have Graves' disease. No connection is known between Graves' disease and diabetes."
b. "An association has been noted between Graves' disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves' disease."
c. "Graves' disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus."
d. "Unfortunately, Graves' disease is associated with diabetes, and your diabetes could have led to your daughter having Graves' disease."
An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mother's diabetes did not cause her daughter's Graves' disease. The other statements are inaccurate.
While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1° F. Which action should the nurse take first?
a. Turn the lights down and shut the client's door.
b. Call for an immediate electrocardiogram (ECG).
c. Calculate the client's apical-radial pulse deficit.
d. Administer a dose of acetaminophen (Tylenol).
A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.
After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction?
a. "I may need calcium replacement after surgery."
b. "After surgery, I won't need to take thyroid medication."
c. "I'll need to take thyroid hormones for the rest of my life."
d. "I can receive pain medication if I feel that I need it."
After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively.
A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client's plan of care?
a. Monitor the client's intravenous site every shift.
b. Administer acetaminophen (Tylenol) for fever.
c. Ensure that working suction equipment is in the room.
d. Assess the client's vital signs every 4 hours.
A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the client's room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.
A nurse evaluates the following laboratory results for a client who has hypoparathyroidism:
Calcium 7.2 mg/dL
Sodium 144 mEq/L
Magnesium 1.2 mEq/L
Potassium 5.7 mEq/L
Based on these results, which medications should the nurse anticipate administering? (Select all that apply.)
a. Oral potassium chloride
b. Intravenous calcium chloride
c. 3% normal saline IV solution
d. 50% magnesium sulfate
e. Oral calcitriol (Rocaltrol)
ANS: B, D
The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.
A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.)
a. Administer levothyroxine (Synthroid).
b. Administer propranolol (Inderal).
c. Monitor the apical pulse.
d. Assess for Trousseau's sign.
e. Initiate telemetry monitoring.
ANS: C, E
The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia.
A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's teaching? (Select all that apply.)
a. Increased carbohydrates
b. Decreased fats
c. Increased calorie intake
d. Supplemental vitamins
e. Increased proteins
ANS: A, C, E
The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.
A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the client's level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.)
a. Infuse intravenous fluids.
b. Cover the client with warm blankets.
c. Monitor blood pressure every 4 hours.
d. Maintain a patent airway.
e. Administer oral glucose as prescribed.
ANS: A, B, D
A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.
A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this client's education? (Select all that apply.)
a. "Do not share utensils, plates, and cups with anyone else."
b. "You can play with your grandchildren for 1 hour each day."
c. "Eat foods high in vitamins such as apples, pears, and oranges."
d. "Wash your clothing separate from others in the household."
e. "Take a laxative 2 days after therapy to excrete the radiation."
ANS: A, D, E
A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other people's clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.
Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.
A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond?
a. "Glucose is the only fuel used by the body to produce the energy that it needs."
b. "Your brain needs a constant supply of glucose because it cannot store it."
c. "Without a minimum level of glucose, your body does not make red blood cells."
d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."
Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.
A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria?
a. Serum sodium: 163 mEq/L
b. Serum creatinine: 1.6 mg/dL
c. Presence of urine ketone bodies
d. Serum osmolarity: 375 mOsm/kg
Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?
a. "At my age, I should continue seeing the ophthalmologist as I usually do."
b. "I will see the eye doctor when I have a vision problem and yearly after age 40."
c. "My vision will change quickly. I should see the ophthalmologist twice a year."
d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."
Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?
a. Document the finding in the client's chart.
b. Assess tactile sensation in the client's hands.
c. Examine the client's feet for signs of injury.
d. Notify the health care provider.
Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.
A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond?
a. "Your risk of diabetes is higher than the general population, but it may not occur."
b. "No genetic risk is associated with the development of type 1 diabetes mellitus."
c. "The risk for becoming a diabetic is 50% because of how it is inherited."
d. "Female children do not inherit diabetes mellitus, but male children will."
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control.
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications?
a. "Maintain tight glycemic control and prevent hyperglycemia."
b. "Restrict your fluid intake to no more than 2 liters a day."
c. "Prevent hypoglycemia by eating a bedtime snack."
d. "Limit your intake of protein to prevent ketoacidosis."
Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk.
A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
a. A 29-year-old Caucasian
b. A 32-year-old African-American
c. A 44-year-old Asian
d. A 48-year-old American Indian
Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves.
A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections?
a. "Wash your hands after completing each test."
b. "Do not share your monitoring equipment."
c. "Blot excess blood from the strip with a cotton ball."
d. "Use gloves when monitoring your blood glucose."
NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching?
a. "Change positions slowly when you get out of bed."
b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)."
c. "If you miss a dose of this drug, you can double the next dose."
d. "Discontinue the medication if you develop a urinary infection."
Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client's blood glucose levels. The medication should be taken before meals instead of during meals.
After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy?
a. "I'll take this medicine during each of my meals."
b. "I must take this medicine in the morning when I wake."
c. "I will take this medicine before I go to bed."
d. "I will take this medicine immediately before I eat."
Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the client's most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake.
A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take?
a. Assess for pain or burning with urination.
b. Review the client's liver function study results.
c. Instruct the client to increase water intake.
d. Test a sample of urine for occult blood.
Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock.
A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond?
a. "You need to start with multiple injections until you become more proficient at self-injection."
b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns."
c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates."
d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."
The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
a. "The lower abdomen is the best location because it is closest to the pancreas."
b. "I can reach my thigh the best, so I will use the different areas of my thighs."
c. "By rotating the sites in one area, my chance of having a reaction is decreased."
d. "Changing injection sites from the thigh to the arm will change absorption rates."
The client's blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client's blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client's blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
a. Administer 1 mg of intramuscular glucagon.
b. Encourage the client to drink orange juice.
c. Insert a new intravenous access line.
d. Administer 25 mL dextrose 50% (D50) IV push.
Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle.
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How should the nurse respond?
a. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up."
b. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light."
c. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes."
d. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container."
Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered.
A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education?
a. "Test your urine daily for ketones."
b. "Use only buffered insulin in your pump."
c. "Store the insulin in the freezer until you need it."
d. "Change the needle every 3 days."
Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.
After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
a. "I have so many complications; exercising is not recommended."
b. "I will exercise more frequently because I have so many complications."
c. "I used to run for exercise; I will start training for a marathon."
d. "I should look into swimming or water aerobics to get my exercise."
Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.
An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition?
a. Increased rate and depth of respiration
b. Extremity tremors followed by seizure activity
c. Oral temperature of 102° F (38.9° C)
d. Severe orthostatic hypotension
When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.
A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client?
a.pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg
b.pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg
c.pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg
d.pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg
The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions.
A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take?
a. Administration of oxygen via face mask
b. Intravenous administration of 10% glucose
c. Implementation of seizure precautions
d. Administration of intravenous insulin
Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating.
A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond?
a. "Drinking any wine or alcohol will increase your insulin requirements."
b. "Because of poor kidney function, people with diabetes should avoid alcohol."
c. "You should not drink alcohol because it will make you hungry and overeat."
d. "One glass of wine is okay with a meal and is counted as two fat exchanges."
Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day.
A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs?
a. "Limit your fluid intake to 2 liters a day."
b. "Animal organ meat is high in insulin."
c. "Limit your carbohydrate intake to 80 grams a day."
d. "Walk at a moderate pace for 1 mile daily."
An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation.
A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond?
a. "Following the drug regimen more closely would have prevented this."
b. "One acute rejection episode does not mean that you will lose the new organs."
c. "Dialysis is a viable treatment option for you and may save your life."
d. "Since you are on the national registry, you can receive a second transplantation."
Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of anti-rejection medications may cause them to not work optimally.
After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional education?
a. "If I develop an infection, I should stop taking my corticosteroid."
b. "If I have pain over the transplant site, I will call the surgeon immediately."
c. "I should avoid people who are ill or who have an infection."
d. "I should take my cyclosporine exactly the way I was taught."
The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a "fruity" odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this client's problem.
A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take?
a. Encourage the client to use an incentive spirometer.
b. Increase the client's intravenous fluid flow rate.
c. Consult the provider to test for ketoacidosis.
d. Perform meticulous pulmonary hygiene care.
Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required.
A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take?
a. Document the finding in the client's chart.
b. Administer a bolus of regular insulin IV.
c. Call the surgeon to cancel the procedure.
d. Draw blood gases to assess the metabolic state.
Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury?
a. "Examine your feet using a mirror every day."
b. "Rotate your insulin injection sites every week."
c. "Check your blood glucose level before each meal."
d. "Use a bath thermometer to test the water temperature."
Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have anti-inflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful.
A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond?
a. "Many people with long-term diabetes become depressed after a while."
b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?"
c. "This antidepressant also has anti-inflammatory properties for diabetic pain."
d. "No. Many medications can be used for several different disorders."
Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.
A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client?
a. Urine specific gravity of 1.033
b. Presence of protein in the urine
c. Elevated capillary blood glucose level
d. Presence of ketone bodies in the urine
Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories.
A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease?
d. Total calories
This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.
A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next?
a. Administer another half-cup of orange juice.
b. Administer a half-ampule of dextrose 50% intravenously.
c. Administer 10 units of regular insulin subcutaneously.
d. Administer 1 mg of glucagon intramuscularly.
Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.
A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately?
a. Serum chloride level of 98 mmol/L
b. Serum calcium level of 8.8 mg/dL
c. Serum sodium level of 132 mmol/L
d. Serum potassium level of 2.5 mmol/L
When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.
A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching?
a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea."
b. "Monitor your blood glucose levels at least every 4 hours while sick."
c. "If vomiting, do not use insulin or take your oral antidiabetic agent."
d. "Try to continue your prescribed exercise regimen even if you are sick."
A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the client's state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.
A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?
a. Serum potassium level has increased.
b. Blood osmolarity has decreased.
c. Glasgow Coma Scale score is unchanged.
d. Urine remains negative for ketone bodies.
Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600.
A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin?
Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don't know another way to manage the disease is dismissive of the client's concerns.
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond?
a. "I can give your injections to you while you are here in the hospital."
b. "Everyone gets used to giving themselves injections. It really does not hurt."
c. "Your disease will not be managed properly if you refuse to administer the shots."
d. "Tell me what it is about the injections that are concerning you."
The client's tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take?
a. Apply ice to the site to reduce inflammation.
b. Consult the provider for a new administration route.
c. Assess the client for other signs of cellulitis.
d. Instruct the client to rotate sites for insulin injection.
Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future.
After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
a. "I need to have an annual appointment even if my glucose levels are in good control."
b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick."
c. "I can still develop complications even though I do not have to take insulin at this time."
d. "If I have surgery or get very ill, I may have to receive insulin injections for a short time."
Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.
39.A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose?
a. Pioglitazone (Actos)
b. Glimepiride (Amaryl)
c. Glipizide (Glucotrol)
d. Metformin (Glucophage)
The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
a. "I should increase my intake of vegetables with higher amounts of dietary fiber."
b. "My intake of saturated fats should be no more than 10% of my total calorie intake."
c. "I should decrease my intake of protein and eliminate carbohydrates from my diet."
d. "My intake of water is not restricted by my treatment plan or medication regimen."
The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.
A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen:
• Fasting blood glucose: 75 mg/dL
• Postprandial blood glucose: 200 mg/dL
• Hemoglobin A1c level: 5.5%
How should the nurse interpret these laboratory findings?
a. Increased risk for developing ketoacidosis
b. Good control of blood glucose
c. Increased risk for developing hyperglycemia
d. Signs of insulin resistance
Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward.
A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information:
• Insulin glargine: 12 units daily at 1800
• Regular insulin: 6 units QID at 0600, 1200, 1800, 2400
Based on the client's medication administration record, which action should the nurse take?
a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin.
c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together.
d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together.
After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.
43.A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications.
1. Inspect bottles for expiration dates.
2. Gently roll the bottle of NPH between the hands.
3. Wash your hands.
4. Inject air into the regular insulin.
5. Withdraw the NPH insulin.
6. Withdraw the regular insulin.
7. Inject air into the NPH bottle.
8. Clean rubber stoppers with an alcohol swab.
a. 1, 3, 8, 2, 4, 6, 7, 5
b. 3, 1, 2, 8, 7, 4, 6, 5
c. 8, 1, 3, 2, 4, 6, 7, 5
d. 2, 3, 1, 8, 7, 5, 4, 6
The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse should first increase the IV rate and then consult with the provider about the potassium.
A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis for .......
*Vital Signs and Assessment,
-Blood pressure: 90/62 mm Hg
-Pulse: 120 beats/min
-Respiratory rate: 28 breaths/min
-Urine output: 20 mL/hr via catheter
-Serum potassium: 2.6 mEq/L
-Potassium chloride 40 mEq IV bolus STAT
-Increase IV fluid to 100 mL/hr
Which action should the nurse take?
a. Administer the potassium and then consult with the provider about the fluid order.
b. Increase the intravenous rate and then consult with the provider about the potassium prescription.
c. Administer the potassium first before increasing the infusion flow rate.
d. Increase the intravenous flow rate before administering the potassium.
The client's symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The client's oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises.
At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below:
Capillary Blood Glucose Testing (AC/HS) / Dietary Intake
—At 0630:95 Breakfast: 10% eaten,client states she is not hungry
—At 1130: 70 Lunch: 5% eaten - client is nauseous; vomits once
—At 1630: 47
After reviewing the client's assessment data, which action is appropriate at this time?
a. Assess the client's oxygen saturation level and administer oxygen.
b. Reorient the client and apply a cool washcloth to the client's forehead.
c. Administer dextrose 50% intravenously and reassess the client.
d. Provide a glass of orange juice and encourage the client to eat dinner.
ANS: A, D, E, F
Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.
A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.)
a. 56-year-old African-American male
b. Female with a 30-pound weight gain during pregnancy
c. Male with a history of pancreatic trauma
d. 48-year-old woman with a sedentary lifestyle
e. Male with a body mass index greater than 25 kg/m2
f. 28-year-old female who gave birth to a baby weighing 9.2 pounds
ANS: A, C, E
DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.
A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.)
a. Deep and fast respirations
b. Decreased urine output
d. Dependent pulmonary crackles
e. Orthostatic hypotension
ANS: A, C
Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.
A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.)
a. "Do not walk around barefoot."
b. "Soak your feet in a tub each evening."
c. "Trim toenails straight across with a nail clipper."
d. "Treat any blisters or sores with Epsom salts."
e. "Wash your feet every other day."
ANS: A, B, C
Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.
A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.)
b. Kidney failure
d. Respiratory failure
ANS: A, B, D
When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.
A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.)
a. Registered dietitian
b. Clinical pharmacist
c. Occupational therapist
d. Health care provider
e. Speech-language pathologist
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