Endocrine
The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin reaction should the nurse particularly be observant? Select all that apply.
Headache, diaphoresis Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Lethargy is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.
A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply.
Tremors, heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.
The nurse is providing care to a client who is being treated for bacterial cystitis. Before discharge, it is most important for the client to:
Achieve relief of symptoms and to maintain kidney function To have relief of symptoms and continued urine output are measurable responses to therapy and are the desired outcomes. Understanding the need for 4 L of water per day is too much fluid; 2 to 3 L a day is recommended to flush the bladder and urethra. Dietary restrictions are not necessary with cystitis. Bleeding is not a complication associated with this procedure.
The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug:
Interferes with synthesis of thyroid hormone PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.
A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?
Measure the blood glucose level between 2 AM and 4 AM. During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counterregulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. Both the Somogyi effect and the dawn phenomenon are characterized by hyperglycemia, not hypoglycemia.
A nurse is caring for a client after radioactive iodine is administered for Grave's disease. What information about the client's condition after this therapy should the nurse consider when providing care?
Mildly radioactive but should be treated with routine safety precautions An individual treated for a thyroid problem by intake of radioactive iodine (131I) becomes mildly radioactive, particularly in the region of the thyroid gland, which preferentially absorbs the iodine. Such clients should be treated with routine safety precautions for 48 hours (e.g., avoid prolonged contact or near-contact with others, flush toilet twice after using because radioactive iodine is excreted via the urine, and thoroughly wash hands after toileting). Because radioactive iodine is internalized, the client becomes the source of radioactivity. The amount of radioactive iodine used is not enough to cause high radioactivity.
During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? Select all that apply.
Palpitations, tachycardia, menstrual disturbances Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema.
A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective? Select all that apply.
Weakness, nervousness, increased perspiration, fatigue Weakness is related to a decrease in glucose within the central nervous system. Nervousness is caused by increased adrenergic activity and increased secretion of catecholamines. Increased perspiration is related to increased adrenergic activity and increased secretion of catecholamines. Fatigue is related to hypoglycemia. Nausea is related to hyperglycemia, not hypoglycemia. Increased thirst with an excessive oral fluid intake (polydipsia) is associated with hyperglycemia and is one of the cardinal signs of diabetes mellitus.
A nurse is monitoring a client's fasting plasma glucose (FPG) level. At which FPG level should the nurse identify that the client has prediabetes?
100mg/dL The guidelines from the American Diabetes Association have lowered the level of an FPG that indicates whether a client has prediabetes from 110 mg/dL to 100 mg/dL; an FPG of 100 to 125 mg/dL is considered prediabetes. A 70 mg/dL FPG indicates that the client is hypoglycemic. An FPG of 126 mg/dL or higher indicates that the client has diabetes.
The nurse provides postoperative care to the client following subtotal thyroidectomy by: Select all that apply.
Assessing for frequent swallowing Ambulating the client the evening of surgery Assessing for facial spasms, apprehension, or tingling of the lips, fingers, or toes Ensuring that oxygen, suction equipment, and a tracheosomy tray are at the bedside Frequent swallowing in the postoperative period following subtotal thyroidectomy may indicate hemorrhage. In the absence of complications, the client should be ambulated within a few hours following surgery. Facial spasms, apprehension, and tingling of the lips, fingers, or toes are indicative of tetany. Tetany is caused by hypocalcemia, resulting from damage to or removal of the parathyroid glands during throidectomy. Tetany is a medical emergency. Oxygen, suction equipment, and a tracheostomy tray must be kept at the bedside in case of airway edema. The bed should be placed in semi-Fowler position and the client should avoid neck flexion to prevent tension on the suture line.
An 11 year-old girl is admitted with enlarged supraclavicular lymph nodes, fatigue, and low-grade fever. She also has a persistent nonproductive cough. In light of these findings, the nurse knows to gear education toward preparation for:
Computed tomography and lymph node biopsy The symptoms indicate possible Hodgkin's lymphoma, so diagnostic testing will likely include computed tomography (CT scan) and a lymph node biopsy. IV fluids, antibiotic therapy, oxygenation therapy, and nutritional therapy are not requirements at this point in treatment.
A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply.
Cool skin, periorbital edema, decreased appetite, constipation Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edema are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.
A client with Addisonian crisis exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies. Which responses should the nurse expect the client to exhibit? Select all that apply.
Hyponatremia, hyperkalemia, postural hypotension In the presence of hyponatremia, hyperkalemia results. Hyponatremia occurs because of glucocorticoid and mineralocorticoid insufficiency. Hypotension accompanies glucocorticoid and mineralocorticoid insufficiency. Tachycardia, not bradycardia, occurs as result of severe hypovolemia. Hypotension, not hypertension, occurs because of sodium and water losses that accompany glucocorticoid and mineralocorticoid insufficiency.
A client is admitted to the hospital with a diagnosis of Cushing syndrome. When performing an assessment, the nurse should take into consideration that the client will most likely exhibit signs of:
Muscle weakness and frequent urination Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness. As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.
A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply.
Obese trunk, thin arms and legs, sleep disturbance Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of sodium and water retention.
A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations?
Protein Anabolism Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.
A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will:
Require larger doses of insulin than I did preoperatively. The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy, any elevation of blood glucose level caused by somatotropin also will stop. Infertility may be expected after a hypophysectomy because the follicle-stimulating hormone and its releasing factor will no longer be present to stimulate spermatogenesis. When adrenocorticotropic hormone (ACTH) is absent, cortisone will have to be administered. Thyroid-stimulating hormone will not be present; extrinsic thyroxine will have to be taken.
After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which manifestations of excessive levels of ADH should the nurse assess the client? Select all that apply.
Hyponatremia, Weight gain Excessive levels of ADH cause inappropriate free water retention; for every liter of fluid retained, the client will gain approximately 2.2 lb. Free water retention results in a hypoosmolar state with dilutional hyponatremia. Oliguria, not polyuria, occurs as ADH acts on nephrons to cause water to be reabsorbed from the glomerular filtrate. Because of water reabsorption, blood volume may increase, causing hypertension, not hypotension. This increases, not decreases, as a result of increased urine concentration.
Fludrocortisone (Florinef) is prescribed for a client with adrenal insufficiency. Which responses to the medication should the nurse teach the client to report? Select all that apply
Edema, rapid weight gain Fludrocortisone has a strong effect on sodium retention by the kidneys, which leads to fluid retention, causing edema and weight gain. Fatigue may occur with adrenal insufficiency and is not related to cortisone therapy. Unpredictable changes in mood commonly occur but are not as serious a threat as fluid retention. Fluid retention, and thus decreased urination, may occur.
A client with diabetes states, "I cannot eat big meals; I prefer to snack throughout the day." What information should the nurse include in a response to this client's statement?
Regulate food intake is basic to control. An understanding of the diet is imperative for adherence. A balance of carbohydrates, proteins, and fats, usually apportioned over three main meals and two between-meal snacks, needs to be tailored to the client's specific needs, with consideration of exercise and pharmacologic therapy. A total dietary regimen proportioning carbohydrates, proteins, and fats must be followed, not just sugar restriction; salt is not restricted. That small, frequent meals are better for digestion is true; however, digestion is not the basis for the client's problems. Total caloric intake, rather than the size of meals, is the major factor in weight gain.
What expected effect of increased serum cortisone levels does a nurse consider when caring for clients with multiple physical and emotional problems?
Cortisone and ACTH work together via a feedback loop. ACTH is released in response to decreased blood levels of cortisone. ACTH then stimulates release of additional adrenocortical hormone. Cortisone has antiinflammatory properties, which delay wound healing. As a glucocorticoid, cortisone increases gluconeogenesis in the liver. Cortisone assists the body in responding to stress.
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply.
Acetone breath, decreased arterial carbon dioxide levels A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance.
A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them.
Air should be injected into the air space of the intermediate-acting insulin vial before short-acting insulin is drawn into the syringe; the needle should not touch the insulin. The nurse should inject the amount of air into the short-acting insulin vial equivalent to the volume to be withdrawn to prevent negative pressure that can make withdrawal difficult. The short-acting insulin should be withdrawn first to prevent possible contamination of the vial with the intermediate-acting insulin, which would cause a delay in onset time of the short-acting insulin. The intermediate-acting insulin should be drawn up after the short-acting insulin to prevent contamination of the short-acting insulin. Gloves are not needed to draw up insulin, but should be worn for its administration to the client.
A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? Select all that apply.
Bradycardia Decreased serum sodium Decreased level of consciousness Water retention and decreased urinary output occur because of excess secretion of antidiuretic hormone (ADH). Early manifestations are related to water retention and may include gastrointestinal (GI) disturbances, such as loss of appetite, nausea, and vomiting. Weight gain occurs because of the water retention. Serum sodium levels are decreased because of fluid retention and sodium loss. Central nervous system changes include headaches, lethargy, and decreased level of consciousness, progressing to coma and seizures. Hypothermia also occurs because of central nervous system disturbance. The pulse is full and bounding because of the increased fluid volume.
The nurse is caring for an older client who is admitted to the hospital with a diagnosis of type 2 diabetes. The nurse recalls that older adults with type 2 diabetes:
Seldom develop ketoacidosis Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes; therefore, ketones are not present in large enough amounts to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts. The incidence of chronic complications depends on the level of glucose control, not developmental level. The onset of type 2 diabetes usually is gradual, whereas in type 1 diabetes, it is sudden and dramatic.
