disorders of the thyroid and parathyroid
A patient with diabetes mellitus wishes to know why diabetes increases the risk of developing dementia. How should the nurse explain this connection to the patient?
High glucose levels cause microangiopathy, which damages blood vessels of the brain.
A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply.
Hirsutism Round face Buffalo hump
A patient asks the nurse whether it is alright to take regularly scheduled insulin on the morning of surgery. What is the most appropriate nursing action?
Inform the surgeon of the patient's insulin use and ask whether the dose needs to be adjusted.
A patient with cystic fibrosis (CF) is hospitalized with exacerbation of symptoms, wheezing, purulent sputum, and a fasting blood glucose level of 194 mmol/L. The nurse anticipates that what medication will be prescribed?
Insulin
A patient reports "eye problems". On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient?
Systolic hypertension and increased heart rate
The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse:
"To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."
A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse?
"It may take several weeks to see the full benefits of the treatment."
What is the drug of choice for a 45-year-old patient who has a body mass index (BMI) of 30 kg/m2, random blood glucose of 200 mg/dL, and a history of hypertension?
Metformin
The nurse expects that which medication will be included in the drug therapy for a patient that has a thyroxine level of 14 µg/dL?
Methimazole
A nurse teaches a student nurse about pancreas transplantation. While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse strongly suggests ineffective learning?
"Regular monitoring of glucose level is required."
A patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient?
Cardiac monitoring to detect potassium changes
A client with type 1 diabetes asks what causes the several brown spots on the skin. What would be the best response by the nurse?
"Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."
Despite repeated instructions from a nutritionist, a diabetic patient failed to adhere to the recommended dietary allowance (RDA) for carbohydrates. This resulted in low levels of glucose in the blood. Which advice given by the nutritionist would be most appropriate for the patient?
"Evaluate blood glucose levels using carbohydrate counting."
The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective?
"I should take my levothyroxine every morning before eating my breakfast."
The nurse is educating the patient regarding administration of meal-time insulin, aspart. Which statement by the patient indicates correct knowledge of the onset of action of this medication?
"I will administer my aspart within 15 minutes of eating my meal."
Which statement from the patient with diabetes mellitus indicates effective learning?
"I will carry extra insulin during travel."
The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan?
"I will take a brisk 30-minute walk five days per week and do resistance training three times a week."
A patient has just begun long-term corticosteroid therapy. The nurse determines that the patient requires further education when making which statement?
"If I begin to gain weight I should stop taking my medication."
A 10-year-old girl with diabetes joins the school's soccer team. Her mother is unsure whether to tell the coach of her child's condition. The mother asks the school nurse for guidance. On what information should the nurse base the response?
Children with diabetes who participate in active sports can have episodes of hypoglycemia.
Which clinical manifestations does the nurse expect during the assessment of a hospitalized patient experiencing exophthalmos? Select all that apply.
Dyspnea Cardiac hypertrophy Bounding, rapid pulse
A nurse is educating a Native American patient on treatment options for new-onset diabetes. The nurse is aware that which value will impact the patient's treatment decision?
Spiritual guidance
The nurse is teaching a client newly diagnosed with diabetes about the importance of glucose monitoring. Which blood glucose levels should the nurse identify as hypoglycemia?
68 mg/dL (3.8 mmol/L)
A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal?
7.20 and 460 mg/dL (25.5 mmol/L)
A patient is admitted to the intensive care unit (ICU) with multiple organ abnormalities and a decreased level of consciousness. The nurse notes that the patient has a history of hypothyroidism. What interventions are appropriate to be included on the patient's plan of care? Select all that apply.
Administering thyroid hormone intravenously Monitoring cardiovascular status continuously
The nurse is caring for a patient undergoing radioactive iodine therapy in the outpatient setting. What instructions should the nurse provide to this patient? Select all that apply.
Avoid preparing food for others. Launder personal towels, bed linens, and clothes separately at home. Avoid being close to pregnant women or children for seven days after therapy.
The nurse advises a diabetic patient on insulin therapy who reports headaches on waking and night sweats to reduce the dose of insulin and have a bedtime snack. Which finding supports the nurse's instructions?
Blood glucose levels; 60 mg/dL between 2 AM and 4 AM
A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing. Why is blood glucose monitoring preferred?
Blood glucose monitoring is more accurate.
A patient with diabetes mellitus has a neurogenic bladder leading to urinary retention. How is the Credé maneuver performed to help the patient completely empty the bladder?
By performing mild massage downward over the lower abdomen and bladder
The health care provider prescribes an oral hypoglycemic for the patient with type 2 diabetes. What will the nurse need to consider when developing the teaching plan?
Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control.
A patient with type 2 diabetes mellitus (DM) is prescribed an oral hyperglycemic agent. The nurse provides the patient with a list of food items with a high glycemic index (GI). What should the nurse include on the list?
Cornflake cereal with regular milk and white bread sandwich with potato stuffing
The nurse would encourage a patient with diabetes mellitus and coronary artery disease to limit intake of which of the following foods to help reduce the percentage of saturated fat in the diet?
Dairy products
The nurse reviews lab values for a patient who underwent thyroidectomy 48 hours ago. Which finding is of most concern?
Decreased serum calcium
A patient with a blood sugar level of 210 mg/dL has bone density of -1.5 standard deviation. The nurse expects what diagnostic findings? Select all that apply.
Destruction of islet cells in the pancreas Insufficient levels of testosterone hormone Chronically elevated inflammatory cytokines
A client with type 1 diabetes complains of hunger, thirst, tiredness, and frequent urination. Based on these findings, the nurse should take what action?
Determine the client's blood glucose level.
The nurse would monitor which comorbidity in the patient treated for an asthma exacerbation with methylprednisolone?
Diabetes mellitus
A patient diagnosed with hyperthyroidism presents with neck nodules that are less than 3 cm in size. Biopsy reveals the nodules are non-malignant. Which treatment does the nurse expect for this patient?
Endoscopic thyroidectomy
If a patient cannot afford medical supplies, what responsibility does the nurse have to advocate for this patient?
Ethical obligation
The nurse is caring for a patient diagnosed with a toxic nodular goiter with painless thyroiditis. The nurse suspects that the patient has an autoimmune disease based on what assessment finding?
Exophthalmos
An unconscious 16-year-old adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). What finding does the nurse expect during the initial assessment?
Hyperpnea
A patient's T3 and T4 levels are decreased, and the TSH (thyroid-stimulating hormone) level is increased. The nurse suspects what condition?
Hypothyroidism
A 9-year-old child with type 1 diabetes is hospitalized for insulin dosage regulation. A nurse observes the child sneaking food and trying to talk family members into bringing candy. What action should the nurse take when the child complains of feeling hypoglycemic?
Obtain a blood glucose level.
An 8-year-old child is being given insulin glargine before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack?
Offer a snack to prevent hypoglycemia during the night.
A nurse is performing a skin assessment for an obese patient. The nurse suspects the patient has diabetes mellitus. Which skin conditions indicate diabetes mellitus? Select all that apply.
Presence of skin tags Rashes under the breast and axillae
The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine?
Serum glucose level
A patient with type 2 diabetes takes oral hypoglycemics and is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide?
The infection increases the glucose level, resulting in a need for more insulin.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate?
The patient should alternate nostrils during administration to prevent nasal irritation.
The nurse creates a plan of care for a patient with Graves' disease. What is an appropriate expected outcome?
The patient will demonstrate maintenance of his weight.
Which patient is at high risk for developing irreversible renal failure after an aortic aneurysm surgery?
The patient with diabetes
The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. What is the most accurate answer to the patient's question?
To block the sympathetic nervous system response to excess thyroid hormone
After administering an intramuscular (IM) glucagon injection in an unconscious patient, why does the nurse turn the patient on the side?
To prevent aspiration
A nurse is caring for a patient admitted for hyperthyroidism. What laboratory results will the nurse expect to see in the electronic chart to confirm hyperthyroidism? Select all that apply.
Undetectable TSH level Elevated free thyroxine (free T4) level Low thyroid-stimulating hormone (TSH) level
A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication?
Vagus nerve stimulation
Which medication does the nurse expect to be prescribed for a patient diagnosed with metastatic thyroid cancer that has a calcitonin level of 25 pg/mL?
Vandetanib
