Capstone Midterm (Endocrine & Endocrine Meds)

The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder?

"Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."

The community health nurse visits a client at home. Prednisone, 10mg PO daily, has been prescribed and the nurse teaches about the medication. Which statement by the client indicates a need for FURTHER teaching?

"I can take my aspirin or antihistamine if I need it." (No OTC meds without physician approval)

The home health nurse visits a client with a diagnosis of type 1 DM. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed in 24 hours. Which additional statement by the client indicates a need for FURTHER teaching?

"I need to stop my insulin."

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood?

"I should eat foods that have a lot of potassium in them." (encourage protein and potassium!)

The nurse provides instructions to a client newly diagnosed with type 1 DM. The nurse recognizes accurate understanding of measures to prevent DKA when the client makes what statement?

"I will notify my HCP is my blood glucose level is higher than 250 mg/dL"

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an INADEQUATE understanding of the peak action of NPH insulin and exercise?

"The best time for me to exercise is mid-to late afternoon."

The nurse is interveiwing a client with type 2 DM. Which statement by the client indicates an understanding of the treatment for this disorder?

"The medications I'm taking help release the insulin I already make."

The nurse is caring for a client admitted to the ED with DKA. In the acute phase, the nurse plans for which PRIORITY intervention?

Administer short-duration insulin IV.

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication?

Administer with food. Assess the client for unexplained bruising or bleeding. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches.

Glimepride (Amaryl) is prescribed for a client with DM. The nurse instructs the client to avoid consuming which food while taking this medication?

Alcohol

A client is diagnosed with pheochromocytoma. The nurse understands that pheochromocytoma is a condition that has which characteristic?

Causes the release of excessive amounts of catecholamines

A client with DM demonstrated acute anxiety when first admitted to the hospital for treatment of hyperglycemia. What is the MOST APPROPRIATE intervention to decrease the client's anxiety?

Convey empathy, trust, and respect towards the client.

A client with a diagnosis of DKA is being treated in the ED. Which findings would the nurse expect to not as confirming this diagnosis?

Deep, rapid breathing Elevated blood glucose level Low plasma bicarbonate level

The home health care nurse is visiting a client who was recently diagnosed with type 2 DM. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should provide which instructions to the client?

Diarrhea may occur secondary to the metformin. The repaglinide is not taken if a meal is skipped. The repaglinide is taken 30 min before eating. A simple sugar food item is carried and used to treat mild hypoglycemia episodes.

A daily dose of prednison is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is BEST to take the medication?

Early morning (Before 9am to minimized adrenal insufficiency and mimic natural steroid release)

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with the diagnosis?

Feeling cold Loss of body hair Persistent lethargy Puffiness of the face

A client has been diagnosied with hyperthyroidism. Which s/s may indicate thyroid storm, a complication of this disorder?

Fever Nausea Tremors Confusion

An external insulin pump is prescribed for a client with DM and the client asks the nurse about the functions of the pump. The nurse bases the response on which information about the pump?

Gives a small continuous dose of short-duration insulin SubQ and the client can self administer a bolus with an additional dose from the pump before each meal.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouriacil (PTU) is taken daily. The nurse continues collecting data from the client, suspecting that the client has a history of which condition?

Grave's disease (PTU inhibits thyroid synthesis and is used to treat hyperthyroidism aka Grave's disease)

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client?

Hypoglycemia may be experienced before dinnertime. The insulin should be administered at room temp.

A client is admitted to a hospital with a diagnosis of DKA. The initial blood glucose was 950. A continous IV of short-acting insulin is initiated, along with IV rehydration with NS. The serum glucose level is now 240. The nurse would NEXT prepare to administer which item?

IV fluids containing dextrose. (During DKA, blood sugar needs to stay 250-300 until pt is recovered from ketosis)

A client is brought to the ED in an unresponsive state and a diagnosis of hyperglycemia hyperosmolar nonketotic syndrome is made. The nurse would IMMEDIATELY prepare to initiate which anticipated health care provider's prescription?

IV of normal saline

The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places the HIGHEST PRIORITY on which client problem?

Inadequate fluid volume

Prednisone is prescribed for a client with DM who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with prednisone?

Increase in the amount of daily NPH insulin

The nurse is monitoring a client receiving levothyroxine sodium (synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication?

Insomnia Weight loss Mild heat intolerance (Too much med = hyperthyroid symptoms)

The nurse is caring for a post-op parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the HCP IMMEDIATELY?

Laryngeal stridor

A client is admitted to the ED and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out INITIALLY?

Maintain a patent airway

The nurse is caring for a client who is 2 days post-op following an abdominal hysterectomy. The client has a history of DM and has been receiving regular glucose insulin according to capillary blood glucose testing 4 times a day. A carb-controlled diet is prescribed, but the client is complaining of nausea and not eating. On entering the client's room, the nurse finds the client confused and diaphoretic. Which action is MOST APPROPRIATE at this time?

Obtain a capillary blood glucose level and perform a focused assessment.

The nurse provides instructions to a client who is taking levothyroxine (synthroid).The nurse should tell the client to take the medication at which time?

On an empty stomach

After several diagnostic tests, a client is diagnosed with DI. The nurse performs an assessment on the client, knowing that which symptom is MOST indicative of this disorder?

Polydipsia

The nurse is monitoring a client newly diagnosed with DM for signs of complications. Which sign would indicate hyperglycemia?

Polyuria

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathryoidism. Which client complaint would be characteristic of this disorder?

Polyuria (hypercalcemia causes diuresis)

A client with DM visits a health care clinic. The client's DM previously had been well controlled with glyburide (DiaBeta) daily, but recently fasting blood glucose level has been 180-200 mg/dL. Which medication, if added to the client's regmind, may have contributed to the hyperglycemia?

Prednisone (steroid = hyperglycemia)

The home care nurse visits a client recently diagnosed with DM who is taking Humulin NPH insulin daily. The client asks the nurse how to store unopened vials of insulin. The nurse should tell the client to take which action?

Refrigerate the insulin

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is PRIORITY for this client?

Respiratory distress

The nurse is instructing a client regarding intranasal decompressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication?

Runny nose

The nurse teaches the client with DM about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of teaching by stating that a form of glucose should be taken if which symptoms develop?

Shakiness Palpitations Lightheadedness

The nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101F, pulse of 88, respirations of 22, and BP of 100/72. Which finding would be of most concern to the nurse?

Temperature

The nurse is caring for a client after hypophysectomy and notes clear nasal draining from the client's nostril. What INITIAL action should the nurse take?

Test the drainage for glucose

The nurse provides medication instructions to a client who is taking levothyroxine (synthroid) and should tell the client to notify the healthcare provider is which problems occurs?

Tremors (Hyperthyroid symptoms- tachycardiac, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, sweating)

The nurse is monitoring a client who was diagnosed with type 1 DM and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemia reaction?

Tremors irritability Nervousness

Sildenafil (Viagra) is prescribed to treat a client with ED. The nurse reviews the client's medical records and should question the prescription if which data is noted in the client's chart?

Use of nitroglycerin

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the pre-op period, what should the nurse monitor as the PRIORITY?

Vital signs (Hypertension is the hallmark)

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action by the client indicates the need for FURTHER teaching?

Withdraws NPH first. (air into NPH, air into regular, draw regular, draw NPH)

The HCP prescribes exenatide (Byetta) for a client with type 1 DM who takes insulin. The nurse should plan to take which MOST APPROPRIATE intervention?

Withhold the medication and call the HCP, questioning the prescription for the client. (This medication is used for type 2 DM and not recommended for clients taking insulin)

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder?

A heart rate that is 90 BPM and irregular