Test 3 Endocrine System (pt.2)

An external insulin pump is prescribed for a client with DM and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? a) is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d) 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

D. 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

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this med? SATA: a) administer methimazole with food b) place the client on a low-cal, low-protein diet c) assess the client for unexplained bruising or bleeding d) instruct the client to report side/adverse effects such as sore throat, fever, or headaches e) use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration

a) administer methimazole with food c) assess the client for unexplained bruising or bleeding d) instruct the client to report side/adverse effects such as sore throat, fever, or headaches

Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication? a) alcohol b) organ meats c) whole-grain cereals d) carbonated beverages

a) alcohol

You are caring for a patient who is developing DKA. Which task delegation is most appropriate? a) ask the UC to page the physician to come to the unit b) ask the LPN to administer IV push insulin according to sliding scale c) ask the UAP to hang a new bag of normal saline d) ask the UAp to get the patient a cup of orange juice

a) ask the UC to page the physician to come to the unit The nurse should not leave the patient. The scope of the unit clerk's job includes calling and paging physicians. LPNs generally do not administer IV push medications & IV fluid administration is not within the scope of practice of a UAP.

The nurse cares for a client immediately after thyroidectomy. It is most important for the nurse to contact the HCP if which is observed? a) change in quality of respirations b) nausea and vomiting c) poor intake of solid foods d) dysphagia

a) change in quality of respirations patient may have respiratory distress due to swelling or tetany; assess for laryngeal stridor; keep tracheostomy kit at bedside; place in semi-Fowler's position with ice bag to decrease swelling Instruct client to support neck when changing positions (ABCs!)

The plan of care for a diabetic pt includes all of these interventions. Which intervention should you delegate to the UAP? a) checking to make sure that the pt's bath water is not too hot b) discussing community resources for diabetic outpatient care c) teaching the pt to perform daily foot inspections d) assessing the pt's technique for drawing insulin into a syringe

a) checking to make sure that the pt's bath water is not too hot

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this med? SATA: a) insomnia b) weight loss c) bradycardia d) constipation e) mild heat intolerance

a) insomnia b) weight loss e) mild heat intolerance

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 health care provider immediately? a) laryngeal stridor b) abdominal cramps c) difficulty in voiding d) mild to moderate incisional pain

a) laryngeal stridor

The nurse is monitoring a client newly dX with DM for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? a) polyuria b) diaphoresis c) hypertension d) increased pulse rate

a) polyuria

A client with DM visits a health care clinic. The client's DM previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? a) prednisone b) phenelzine (Nardil) c) Atenolol (Tenormin) d) Allopurinol (Zyloprim)

a) prednisone

In the care of a pt with type 2 diabetes, which actions can you delegate to a UAP? SATA: a) providing the pt with extra packets of artificial sweetner for coffee b) assessing how well the pt's shoes fit c) recording the liquid intake from the pt's breakfast tray d) teaching the pt what to do if diziness or lightheadedness occurs e) checking and recording the pt's BP

a) providing the pt with extra packets of artificial sweetner for coffee c) recording the liquid intake from the pt's breakfast tray e) checking and recording the pt's BP

Which change in vital signs would you instruct the UAP to report immediately for a pt with hyperthyroidism? a) rapid heart rate b) dereased systolic BP c) increased respiratory rate d) decreased oral temp

a) rapid heart rate The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Pts with hyperthyroidism also may have increased body temp related to increased metabolic rate. Respiratory changes are usually not symptomatic of this condition.

The nurse assesses a client receiving levothyroxine sodium. Which indicates a favorable outcome to the nurse? a) decreased BP b) increased urine output c) decreased pulse rate d) increased respiratory rate

b) increased urine output synthroid increases metabolic processes in the body, including GFR, thereby increasing urine output Edema will decrease as the water is excreted via the kidneys Side effects include nervousness, tremors, insomnia, tachycardia, and palpitations Nurse should instruct client to report chest pain, palpitations, sweating, nervousness, and shortness of breath to HCP Take medication at same time every day in the AM

A client is admitted to an ED and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? a) warm the client b) maintain a patent airway c) administer thyroid hormone d) administer fluid replacement

b) maintain a patent airway

For a pt with hyperthyroidism, which task will you delegate to an experienced UAP? a) instructing the pt to report any occurence of palpitations, dyspnea, vertigo, or chest pain b) monitoring the apical pulse, BP, and temp. every 4 hours c) drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine, and thyroxine d) teaching the pt about side effects of the drug propylthiouracil

b) monitoring the apical pulse, BP, and temp. every 4 hours

The nurse cares for a client after a subtotal thyroidectomy. The nurse identifies that damage to the parathyroid gland is indicated by which symptom? a) muscle flaccidity b) numbness in the fingers c) pain in the lower extremeties d) mental lethargy

b) numbness in the fingers damage to the PARAthyroids may cause a decrease in CALCIUM, which would be manifested by numbness; also causes TETANY, SEIZURES, CONFUSION, TROUSSEAU'S SIGN, & CHVOSTEK'S SIGN

As the shift begins, you are assigned to care for the following pts. Which one should you assess first? a) 38 yo with Graves disease and a heart rate of 94 bpm b) 63 yo with type 2 diabetes and fingerstick glucose level of 137 mg/dL c) 58 yo with hypothyroidism and a heart rate of 48 bpm d) 49 yo with Cushing disease and dependent edema rated as 1+

c) 58 yo with hypothyroidism and a heart rate of 48 bpm

A client is admitted to a hospital with a dX of DKA. The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? a) ampule of 50% dextrose b) NPH insulin subcutaneously c) IV fluids containing dextrose d) Phenytoin (Dilantin) for the prevention of seizures

c) IV fluids containing dextrose

A pt has newly-dX type 2 diabetes. Which action should you assign to an LPN instead of a UAP? a) measuring the pt's vitals every shift b) checking the pt's glucose level before each meal c) administering subQ insulin on a sliding scale as needed d) assisting the pt with morning care

c) administering subQ insulin on a sliding scale as needed

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 the prednisone? a) an additional dose of prednisone daily b) a decreased amount of humulin NPH insulin daily c) an increased amount of daily Humulin NPH insulin d) the addition of an oral hypoglycemic medication daily

c) an increased amount of daily Humulin NPH insulin

On the day of discharge, the client newly dX with type 1 diabetes says to the nurse, "tell me again, what should I do if I develop a fever?" Which response is best? a) increase your caloric intake and decrease your insulin dosage. b) discontinue taking insulin until after your febrile state has passed c) continue taking insulin as prescribed d) contact your physician to have the insulin dose adjusted

c) continue taking insulin as prescribed

The nurse understands that which statement BEST describes the action of glucocorticoids? a) prepare for "fight or flight" mechanism b) regulate calcium metabolism c) convert protein and fat into glucose d) enhance musculoskeletal capacity

c) convert protein and fat into glucose glucocorticoids are secreted by the adrenal CORTEX primary glucocorticoid is cortisol; cortisol, or steroids, provides rapid evergy from the conversion of proteins and fats into glucose These are also potent anti-inflammatory agents

A client with a diagnosis of DKA is being treated in the ED. Which findings would the nurse expect to note as confirming this diagnosis? SATA: a) increase in pH b) comatose state c) deep, rapid breathing d) decreased urine output e) elevated blood glucose level f) low plasma bicarbonate level

c) deep, rapid breathing e) elevated blood glucose level f) low plasma bicarbonate level

A daily dose of Prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the med and should instruct the client that which time is BEST to take this med? a) at noon b) at bedtime c) early morning d) any time, at the same time, each day

c) early morning

A pt is admitted to the med unit with possible Graves disease. Which assessment finding supports this diagnosis? a) periorbital edema b) bradycardia c) exophthalmos d) hoarse voice

c) exophthalmos

The nurse is preparing a client with a new dX of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this dX? SATA: a) tremors b) weight loss c) feeling cold d) loss of body hair e) persistent lethargy f) puffiness of the face

c) feeling cold d) loss of body hair e) persistent lethargy f) puffiness of the face

You are preparing to review a teaching plan for a pt with type 2 diabetes. To determine the pt's level of compliance with prescribed diabetic regimen, which value would you be sure to review? a) fasting glucose level b) oral glucose tolerance test results c) glycosylated hemoglobin (HgbA-1c) level d) fingerstick glucose findings for 24 horus

c) glycosylated hemoglobin (HgbA-1c) level

The pt with type 2 diabetes is NPO for a cardiac catheterization. An LPN who is administering meds to this patient asks you (the supervising RN) whether the pt should receive his ordered repaglinide (Prandin). What is your best response? a) yes, because the drug will increase the pt's insulin secretion and prevent hyperglycemia b) no, b/c this drug may cause the pt to experience GI symptoms such as nausea c) no, b/c this drug should be given 1 to 30 minutes before meals and the patient is NPO d) yes, b/c this drug should be taken 3 times a day whether the pt eats or not

c) no, b/c this drug should be given 1 to 30 minutes before meals and the patient is NPO

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? a) a coagulation time of 5 mins b) a urinary output of 50 mL/hour c) a blood urea nitrogen level of 20 mg/dL d) a heart rate that is 90 beats per minute and irregular

d) a heart rate that is 90 beats per minute and irregular

The nurse is caring for a client admitted to the ED with DKA. In the acute phase, the nurse plans for which priority intervention? a) correct the acidosis b) admin 5% dextrose IV c) apply a monitor for an EKG d) administer short-duration insulin IV

d) administer short-duration insulin IV

A client is dX with pheochromocytoma. The nurse understands that this is a condition that has which characteristic? a) causes profound hypotension b) is manifested by severe hypoglycemia c) is not curable and is treated symptomatically d) causes the release of excessive amounts of catecholamines

d) causes the release of excessive amounts of catecholamines

The nurse provides instructions to a client newly dX with type I DM. The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement? a) I will stop taking my insulin if I'm too sick to eat b) i will decrease my insulin dose during times of illness c) i will adjust my insulin dose according to the level of glucose in my urine d) i will notify my HCP if my blood glucose level is higher than 250 mg/dL

d) i will notify my HCP if my blood glucose level is higher than 250 mg/dL

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? a) it results from an oversecretion of insulin b) it results from an undersecretion of corticotropic hormones c) it results from an undersecretion of mineralocorticoid hormones d) it results from an increased pituitary secretion of adrenocorticotropic hormone

d) it results from an increased pituitary secretion of adrenocorticotropic hormone

While working in the diabetes clinic, you obtain this info about an 8 yo with type 1 diabetes. Which finding is most important to address when planning child and parent education? a) most recent hemoglobin A-1C level of 7.8% b) many question about diet choices from the parents c) child's participation in soccer practice after school 2 days a week d) morning preprandial glucose range of 55 to 70 mg/dL

d) morning preprandial glucose range of 55 to 70 mg/dL The low morning fasting glucose level indicates possible nocturnal hypoglycemia. Research indicates that it is important to avoid hypoglycemic episodes in pediatric patients because of the risk for permanent neurologic damage and adverse developmental outcomes.

A pt has newly diagnosed type 2 diabetes. which tasks should you delegate to a UAP? a) arranging a consult with a physician b) assessing the pt's insulin injection technique c) teaching the pt to use a glucometer to monitor glucose at home d) reminding the pt to check the glucose level before each meal

d) reminding the pt to check the glucose level before each meal

A UAP tells you that while assisting with the morning care of a post-op pt with type 2 diabetes who has been given insulin, the pt asked if she will always need to take insulin now. What is your priority for teaching the patient? a) explain to the pt that she is now considered to have type 1 diabetes b) tell the pt to monitor fingerstick glucose level every 4 hours after discharge c) teach the pt that a person with type 2 diabetes does not always need insulin d) talk with the pt about the relationship between illness and increased glucose levels

d) talk with the pt about the relationship between illness and increased glucose levels

The nurse teaches a client dX with Graves' disease about diet. The nurse determines that further teaching is required when the client selects which food? a) brook trout b) apples c) milk d) tea

d) tea tea is a stimulant; do not give the client a food or fluid that would further increase metabolic rate

The nurse is interviewing a client with type 2 DM. Which statement by the client indicates an understanding of the treatment for this disorder? a) i take oral insulin instead of shots b) by taking these meds, i am able to eat more c) when i become ill, i need to increase the number of pills i take d) the meds im taking help release the insulin i already make

d) the meds im taking help release the insulin i already make

A pt with type 1 diabetes reports feeling dizzy. What should the nurse do first? a) check the pt's BP b) give the pt some orange juice c) give the pt's morning dose of insulin d) use a glucometer to check the pt's glucose level

d) use a glucometer to check the pt's glucose level

The nurse instruct the client recently dX with type 1 diabetes about proper meal planning. Which action should the nurse take first? a) instruct the client about the importance of eating regular meals b) inform the client that 50 to 60% of calories should come from carbohydrates c) obtain a diet hX that includes the client's fav foods and usual meal patterns d) teach the client how to use the Exchange List for Meal Planning

c) obtain a diet hX that includes the client's fav foods and usual meal patterns assessment: prior to beginning teaching, the nurse should obtain a thorough diet hX as well as obtain the client's weight and determine whether there is a need for weight loss, weight gain, or weight maintenance Goal of diet is for clietn to maintain a reasonable body and control blood glucose Client more likely to make the lifestyle changes required if they enjoy the diet.

The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the med at which time? a) with food b) at lunchtime c) on an empty stomach d) at bedtime with a snack

c) on an empty stomach

After several diagnostic tests, a client is dX with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? a) fatigue b) diarrhea c) polydipsia d) weight gain

c) polydipsia

An LPN's assessment of two diabetic pts reveals all of these findings. Which would you instruct the LPN to report immediately? a) fingerstick glucose reading of 185 mg/dL b) numbness and tingling in both feet c) profuse perspiration d) bunion on the left great toe

c) profuse perspiration

A client has just been admitted to the nursing unit following throidectomy. Which assessment is the priority for this client? a) hypoglycemia b) level of hoarseness c) respiratory distress d) edema at the surgical site

c) respiratory distress

The nurse is instructing a client regarding intradermal desmopressin (DDAVP). The nurse should tell the client that which occurence is a side effect of the medication? a) headache b) vulval pain c) runny nose d) flushed skin

c) runny nose

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 101 F, pulse of 88 bpm, respirations of 22 breaths/min, and BP of 100/72. Which finding would be of MOST concern for the nurse? a) pulse b) respiration c) temperature d) BP

c) temperature

A client with type 1 DM calls the nurse to report current episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? a) the best time for me to exercise is after i eat b) the best time for me to exercise is after breakfast c) the beset time for me to exercise is mid to late afternoon d) the best time for me to exercise is after my morning snack

c) the beset time for me to exercise is mid to late afternoon

The home care nurse monitors a client 7 days after a transsphenoidal hypophysectomy. The nurse should intervene if which is observed? a) the client bends at the knees to pick up shoes b) the client eats a diet high in fiber and fluids c) the client brushes teeth morning and night d) the client uses a mirror to check the gums for bleeding

c) the client brushes teeth morning and night not allowed to brush teeth for 1 to 2 weeks to allow incision to heal instruct client to floss and use mouthwash

The nurse counsels a client about prep for a subtotal thyroidectomy. The client asks the nurse why the HCP has prescribed strong iodine solution. Which response by the nurse is best? a) the med will increase the release of thyroid hormone b) this med will increase your basal metabolic rate c) this med will prevent postoperative hemorrhage d) this med will prevent nervousness and anxiety

c) this med will prevent postoperative hemorrhage reduces VASCULARITY and SIZE of the thyroid Will reduce postoperative hemorrhage

Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. The nurse reviews the client's medical record and should question the prescription if which data is noted in the client's history? a) insomnia b) neuralgia c) use of nitroglycerin d) use of multivitamins

c) use of nitroglycerin

A client is brought to the ED in an unresponsive state, and a dX of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would IMMEDIATELY prepare to initiate which anticipated health care provider's prescription? a) endotracheal intubation b) 100 units of NPH insulin c) IV infusion of normal saline d) IV infusion of sodium bicarbonate

C IV infusion of normal saline

A nursing dX for a pt with newly-dX diabetes is "risk for injury related to sensory alterations". which key points should you include in the teaching plan for this patient? SATA: a) clean and inspect your feet everyday b) be sure that your shoes fit properly c) nylon socks are best to prevent friction on your toes from shoes d) only a podiatrist should trim your toenails e) report any nonhealing skin breaks to your HCP

a) clean and inspect your feet everyday b) be sure that your shoes fit properly e) report any nonhealing skin breaks to your HCP Sensory alterations are the major cause of foot complications in diabetic patients, and patients should be taught to examine their feet on a daily basis. Properly fitting shoes protect the pt from foot complications. Broken skin increases the risk of infection. COTTON socks are recommended to absorb moisture. Pts, family, or health care providers may trim toenails.

The home health care nurse is visiting a client who was recently dX with type 2 DM. the client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these meds. The nurse should provide which instructions to the client? SATA: a) diarrhea may occur secondary to the metformin b) the repaglinide is not taken if a meal is skipped c) the repaglinide is taken 30 mins before eating d) a simple sugar food item is carried and used to treat mild hypoglycemia episodes e)metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. f) muscle pain is an expected effect of metformin and may be treated with acetaminophen (tylenol)

a) diarrhea may occur secondary to the metformin b) the repaglinide is not taken if a meal is skipped c) the repaglinide is taken 30 mins before eating d) a simple sugar food item is carried and used to treat mild hypoglycemia episodes

The UAP reports to you that a pt with type 1 diabetes has a question about exercise. What important points would you be sure to teach this pt? SATA: a) exercise guidelines are based on BG and urine ketone levels b) be sure to test your blood glucose only after exercising c) you can exercise vigorously if your BG is between 100 and 250 mg/dL d) exercise will help resolve the presence of ketones in your urine e) a 5 to 10 min. warm-up and cool-down period should be included in your exercise

a) exercise guidelines are based on BG and urine ketone levels c) you can exercise vigorously if your BG is between 100 and 250 mg/dL c) you can exercise vigorously if your BG is between 100 and 250 mg/dL Guidelines for exercise are based on BG and urine ketone levels. Pts should test BG before, during, and after exercise to be sure that it is safe. When ketones are present in urine, the pt should not exercise because they indicate that current insulin levels are not adequate. Vigorous exercise is permitted in pts with type 1 diabetes if glucose levels are between 100 and 250 mg/dL. Warm-up and cool-down should be included in exercise to gradually increase and decrease the heart rate.

A client has been dX with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? SATA: a) fever b) nausea c) lethargy d) tremors e) confusion f) bradycardia

a) fever b) nausea d) tremors e) confusion

A 58 yo with type 2 diabetes was admitted to your unit with a dX of COPD exacerbation. When you prepare a plan of care for this pt, what would you be sure to include? SATA: a) fingerstick blood glucose checks before meals and at bedtime b) sliding-scale insulin dosing as ordered c) bed rest until the COPD exacerbation is resolved d) teaching about the Atkins diet for weight loss e) demonstration of the components of foot care

a) fingerstick blood glucose checks before meals and at bedtime b) sliding-scale insulin dosing as ordered e) demonstration of the components of foot care When a diabetic pt is ill, glucose levels become elevated, and administration of insulin may be necessary. Teaching or reviewing the components of proper foot care is always a good idea with a diabetic pt. Bed rest is not necessary, and glucose level may be better controlled when a pt is more active. The Atkins diet recommends decreasing the consumption of carbohydrates and is not a good diet for diabetic pts.

An LPN is to administer rapid-acting insulin (Lispro) to a pt with type 1 diabetes. What essential information would you be sure to tell the LPN? a) give this insulin after the pt's food tray has been delivered and the pt is ready to eat b) only give this insulin if the pt's fingerstick glucose reading is above 200 mg/dL c) this insulin mimics the basal glucose control of the pancreas d) rapid-acting insulin is the only insulin that can be given subQ or IV

a) give this insulin after the pt's food tray has been delivered and the pt is ready to eat

You are caring for an 81 yo adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the pt's risk for development of hyperglycemic-hyperosmolar syndrome (HHS)? SATA: a) hydrochlorothiazide (HCTZ) prescribed to control her diabetes b) weight gain of 6 pounds over the past month c) avoids consuming liquids in the evening d) BP of 168/94 mm Hg e) urine output of 50 to 75 mL/hr

a) hydrochlorothiazide (HCTZ) prescribed to control her diabetes c) avoids consuming liquids in the evening HHS often occurs in older adults with type 2 diabetes. Risk factors include taking diuretics and inadequate fluid intake. Weight loss (not weight GAIN) would be a symptom. While the pt's blood pressure is high, this is not a risk factor. A urine output of 50 to 75 mL/hour is adequate.

A client taking Humulin NPH insulin and rugular insulin every morning. The nurse should provide which instructions to the client? SATA: a) hypoglycemia may be experienced before dinnertime b) the insulin dose should be decreased if illness occurs c) the insulin should be administered at room temp d) the insulin vial needs to be shaken vigorously to break up the precipitates e) the NPH insulin should be drawn into the syringe first, then the regular insulin

a) hypoglycemia may be experienced before dinnertime c) the insulin should be administered at room temp

The community health nurse visits a client at home. Prednisone, 10 mg orally daily, has been prescribed for the client and the nurse teaches the client about the med. Which statement, if made by the client, indicates that further teaching is necessary? a) i can take aspirin or my antihistamine if i need it b) i need to take the med every day at the same time c) i need to avoid coffee, tea, cola in my diet d) if i gain more than 5 lbs in a week, i will call my HCP

a) i can take aspirin or my antihistamine if i need it

The home health nurse visits a client with a dX of type 1 DM. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a NEED FOR FURTHER TEACHING? a) i need to stop my insulin b) i need to increase my fluid intake c) i need to monitor my blood glucose every 3 to 4 hours d) i need to call the HCP because of these symptoms

a) i need to stop my insulin

You are caring for a diabetic pt admitted with hypoglycemia that occured at home. Which teaching points for treatment of hypoglycemia at home would you include in a teaching plan for the patient and family before discharge? SATA: a) signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL b) treat hypoglycemia with 4 to 8 g or carbs such as glucose tabs or 1/4 cup of fruit juice c) retest blood glucose in 30 mins d) repeat the carbohydrate treatment if the symptoms do not resolve e) eat a small snack of carbohydrate and protein if the next meal is more than an hour away

a) signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL d) repeat the carbohydrate treatment if the symptoms do not resolve e) eat a small snack of carbohydrate and protein if the next meal is more than an hour away The manifestations listed in option A are correct. The symptoms should be treated with carbohydrate, but 10 to 15 grams -- not 4 to 8. Glucose should be retested in FIFTEEN minutes. 30 is too long to wait. Options D and E are correct.

You are orienting a new grad nurse who is providing diabetes education for a pt about insulin injection. For which teaching statement by the new nurse must you intervene? a) to prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs b) to correctly inject the insulin, lightly grasp a fold of skin and inject at a 90 degree angle c) always draw your regular insulin into the syringe first before your NPH insulin d) avoid injecting the insulin into scarred sites because those areas slow the absorption of insulin

a) to prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs While it is important to rotate injection sites for insulin, it is preferred that the injection sites be rotated within ONE anatomic site to prevent day to day changes in the absorption rate of the insulin. All of the other teaching points are appropriate.

The nurse is monitoring a client who was dX 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 hypoglycemic reaction? SATA: a) tremors b) anorexia c) irritability d) nervousness e) hot, dry skin f) muscle cramps

a) tremors c) irritability d) nervousness

The nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, what should the nurse monitor as the priority? a) vital signs b) intake and output c) blood urea nitrogen results d) urine for glucose and ketones

a) vital signs

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? a) withdraws the NPH insulin first b) withdraws the regular insulin first c) injects air into NPH insulin vial first d) injects an amount of air equal to the desired dose of insulin into each vial

a) withdraws the NPH insulin first

The health care provider prescribes exenatide (Byetta) for a client with type 1 DM who takes insulin. The nurse should plan to take which most appropriate intervention? a) withhold the medication and call the HCP, questioning the prescription for the client b) administer the medication within 60 mins b4 the morning and evening meal c) monitor the client for the GI side effects after administering the med d) withdraw the insulin from the prefilled pen into an insulin syringe to prep for administration

a) withhold the medication and call the HCP, questioning the prescription for the client

You are serving as preceptor to a nurse who has recently graduated and passed the RN licensure examination. The new nurse has only been on the unit for 2 days. Which pt should you assign to the new nurse? a) 68 yo with diabetes who is showing signs of hyperglycemia b) 58 yo with diabetes who has cellulitis of the left ankle c) 49 yo with diabetes who has just returned from the postanesthesia care unit after a below-knee amputation d) 72 yo with diabetes with DKA who is receiving IV insulin

b) 58 yo with diabetes who has cellulitis of the left ankle

The nurse understands that which type of insulin has the longest duration of action? a) Regular b) Glargine c) NPH d) Humulin R

b) Glargine onset of Glargine insulin: 3 to 4 hours Small amount has NO peak; duration = 24 hours *NPH also has a duration of 24 hours but unlike Glargine, it DOES have a peak (4-12 hours)

The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the HCP if which problem occurs? a) Fatigue b) Tremors c) Cold intolerance d) Excessively dry skin

b) Tremors

Which actions can the school nurse delegate to UAPs who are working with a 7 yo child with type 1 diabetes in an elementary school? SATA: a) obtaining info about the child's usual insulin use from the parents b) administering oral glucose tabs when BG level falls below 60 mg/dL c) teaching the child about what foods have high carbohydrate levels d) obtaining blood glucose readings using the child's BG monitor e) reminding the child to have a snack after the P.E. class

b) administering oral glucose tabs when BG level falls below 60 mg/dL d) obtaining blood glucose readings using the child's BG monitor e) reminding the child to have a snack after the P.E. class National guidelines published by the ADA indicate that administration of emergency treatment for hypoglycemia, obtaining blood glucose readings, and reminding children are appropriate tasks for non-health care professional personnel such as teachers, paraprofessionals, and UAPs. Assessments and education require more specialized education and scope of practice and should be done by the school nurse.

A client with DM demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the MOST APPROPRIATE intervention to decrease the client's anxiety? a) administer a sedative b) convey empathy, trust, and respect toward the client c) ignore the signs and symptoms of anxiety so that they will soon disappear d) make sure that the client knows all the correct medical terms to understand what is happening

b) convey empathy, trust, and respect toward the client

It is important for the nurse to monitor a client with Addison's disease for the development of which condition? a) urinary retention b) dysrhythmias c) glycosuria d) water intoxication

b) dysrhythmias Addison's disease causes increased retention of potassium, which may result in cardiac dysrhythmias

A pt with diabetes has hot, dry skin, rapid and deep respirations, and a fruity odor to his breath. As charge nurse, you observe a newly-graduated RN performing all the following pt tasks. Which one requires that you intervene immediately? a) checking the pt's fingerstick glucose level b) encouraging the pt to drink orange juice c) checking the pt's order for sliding-scale insulin dosage d) assessing the pt's vital signs every 15 minutes

b) encouraging the pt to drink orange juice

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 propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? a) myxedema b) graves disease c) addison's disease d) cushing's syndrome

b) graves disease

The nurse recognizes which symptoms are characteristic of impending diabetic ketoacidosis? a) hyperreflexia, babinski reflex, excessive thirst, rapid pulse b) hot, dry, flushed skin, excessive thirst, rapid pulse c) hot flashes, severe hunger, bradycardia d) profuse diaphoresis, headache, bradycardia

b) hot, dry, flushed skin, excessive thirst, rapid pulse signs of impending DKA are the SAME as the signs of HYPERglycemia: confusion, hot, flushed, dry skin, increased temperature, thirst, anorexia, increased pulse, and possibly vomiting Clients then become lethargic, develop acetone breath and Kussmaul's respirations (fast & deep)

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? a) i will need to limit the amount of protein in my diet b) i should eat foods that have a lot of potassium in them c) i am fortunate that i can eat all the salty foods i enjoy d) i am fortunate that i donot need to follow any special diet

b) i should eat foods that have a lot of potassium in them

The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places highest priority on which client problem? a) lack of knowledge b) inadequate fluid volume c) compromised family coping d) inadequate consumption of nutrients

b) inadequate fluid volume

The nurse is caring for a client who is 2 days post-op following an abdominal hysterectomy. The client has a history of diabetes mellitus and has been receiving regular insulin according to capillary blood glucose testing four times a day. A carb-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the client's room, the nurse finds the client to be confused and diaphoretic. Which action is most appropriate at this time? a) call a code to obtain needed assistance immediately b) obtain a capillary blood glucose level and perform a focused assessment c) ask the unlicensed assistive personnel (UAP) to stay with the client while obtaining 15 to 30 g of carbohydrate snack for the client to eat d) stay with the client and ask the UAP to call the HCP for a prescription for IV 50% dextrose

b) obtain a capillary blood glucose level and perform a focused assessment

The nurse is completing an assessment on a client who is being admitted for a dX workup for primary hyperparathyroidsim. which client complaint would be characteristic of this disorder? a) diarrhea b) polyuria c) polyphagia d) weight gain

b) polyuria

In the ED during initial assessment of a newly admitted pt with diabetes, the nurse discovers all of these findings. Which finding should be reported to the HCP immediately? a) hammer toe of the left second metatarsophalangeal joint b) rapid respiratory rate with deep inspirations c) numbness and tingling bilaterally in the feet and hands d) decreased sensitivity and swelling of the abdomen

b) rapid respiratory rate with deep inspirations

The home care nurse visits a client recently dX with diabetes mellitus who is taking humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? a) freeze the insulin b) refrigerate the insulin c) store the insulin in a dark, dry place d) keep the insulin at room temperature

b) refrigerate the insulin

The nurse teaches a client with DM about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? SATA: a) polyuria b) shakiness c) palpitations d) blurred vision e) lightheadedness f) fruity breath odor

b) shakiness c) palpitations e) lightheadedness

The experienced UAP has been delegated to take vital signs and check fingerstick glucose on a diabetic pt who is postoperative. Which vital sign change would you instruct the UAP to report immediately? a) BP increase from 132/80 to 138/84 b) temp increase from 98.4 F to 99 F c) respiratory rate increase from 18 breaths to 22 breaths per minute d) glucose increase from 190 mg/dL to 236 mg/dL

b) temp increase from 98.4 F to 99 F

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? a) lower the head of the bed b) test the drainage for glucose c) obtain a culture of the drainage d) continue to observe the drainage

b) test the drainage for glucose

You are the preceptor for a senior nursing student who will teach a diabetic pt about self-care during sick days. For which statement by the student must you intervene? a) when you are sick, be sure to monitor your BG at least every 4 hours b) test your urine for ketones whenever your BG level is less than 240 mg/dL c) to prevent dehydration, drink 8 oz of sugar-free liquid every hour while you are awake d) continue to eat your meals and snacks at the usual times

b) test your urine for ketones whenever your BG level is less than 240 mg/dL (Correct -- urine ketones should be tested for when BG is GREATER than 240 mg/dL)

the nurse in the outpatient clinic cares for a client with the diagnosis of Cushing's disease. The nurse should expect to observe which symptom? a) weight loss b) thin legs and arms c) hypoglycemia d) hypotension

b) thin legs and arms even though there is truncal obesity, clients will have thin arms and legs due to MUSCLE WASTING Patients will also have edema, purple striations, and a decreased resistance to infection

While you are performing an admission assessment on a pt with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time? a) do you have any days when you do not drink? b) when during the day do you drink your beers? c) do you drink any other forms of alcohol? d) have you ever had a lipid profile completed?

b) when during the day do you drink your beers? (Correct -- Alcohol-induced hypoglycemia possible)