Adult Health Exam 4 Practice

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?

"I will take this medication in the morning, with my first bite of breakfast."

A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching?

"My cells are resistant to the effects of insulin."

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? 1. excessive thirst 2. weight gain 3. constipation 4. excessive hunger 5. urine retention 6. frequent, high-volume urination

1. excessive thirst 4. excessive thirst 6. frequent, high volume urination

Laboratory studies indicate that a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose utilization? 1. a fasting blood glucose test 2. 6-hour glucose tolerance test 3. a test of serum glycosylated hemoglobin (HbA1C) 4. a test for urine ketones

3. A test of serum glycosylated hemoglobin: HbA1C

A nurse understands that for the parathyroid hormone to exert its effect, what must be present?

Adequate vitamin D level

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress?

Administer hydrocortisone I.M.

A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first?

Ask the client to identify the types of foods she prefers.

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? A. Weigh the client. B. Administer oral hydrocortisone. C. Test urine for ketones. D. Assess vital signs.

Assess Vital Signs

A nurse in the emergency department is caring for a client who has a fruity breath odor, a dry mouth, and extreme thirst. Which of the following assessments should the nurse make?

Blood glucose level. Explanation: These findings are indications of hyperglycemia and diabetic ketoacidosis.

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?

Blood pH of 6.9

What is the most common cause of hyperaldosteronism? A. A pituitary adenoma B. Deficient potassium intake C. An adrenal adenoma D. Excessive sodium intake

C. An adrenal adenoma

The preferred preparation for treating hypothyroidism includes which of the following? A. Methimazole (Tapazole) B. Propylthiouracil (PTU) C. Levothyroxine (Synthroid) D. Radioactive iodine

C. Levothyroxine

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.

Calcium

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?

Change the needle every 3 days.

A nurse should expect a client with hypothyroidism to report: A. thyroid gland swelling. B. nervousness and tremors. C. increased appetite and weight loss. D puffiness of the face and hands.

D. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain.

A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms?

Dehydration Explanation: If the client with diabetes insipidus fails to drink a compensatory volume of fluid, dehydration with concentrated levels of electrolytes occurs.

A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination?

Glycosylated hemoglobin levels

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene?

Obtain a repeat fingerstick glucose level.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

Tetany

A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect?

a. Bradycardia b. Tremors c. Low-grade fever d. Diaphoresis A: An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations.

A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.

a. Decrease in serum thyroid-stimulating hormone (TSH) b. Increased T3 c. Increased T4 d. Increase in radioactive iodine uptake e. Increases in serum TSH a, b, c, d

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications?

a. Low blood pressure b. Urinary tract infections c. Lifelong obesity d. Elevated triglycerides B Explanation: Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections.

A nurse is planning a community health screening for a group of clients who are at risk for type 2 DM. Which of the following clients should the nurse include in the screening?

a. Men who smoke. b. Men and women who are obese. c. Women who have hepatitis. d. Men and women who consume high-protein and low-carbohydrate foods. B: There is a high correlation between obesity and type 2 diabetes mellitus.

Which clinical manifestations should the nurse anticipate when providing care to a client experiencing Addison's disease? Select all that apply. a. Hyperglycemia b. Hyponatremia c. Hyperkalemia d. Hypertension e. Hypocalcemia

b. Hyponatremia c. Hyperkalemia

Mrs. DeToro is at risk for pheochromocytoma as a result of the current diagnosis. Which assessment is the priority to monitor for while providing care? a. Eupnea b. Bradycardia c. Hypertension d. Hypoglycemia

c. Hypertension

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide?

"You don't have to give up pasta; just adjust the amount you eat."

The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? 1. Risk for Infection 2. Decreased cardiac output 3. Impaired physical mobility 4. Imbalanced nutrition: less than body requirement

2. Decreased cardiac output

When teaching a client about insulin administration, the nurse should include which instruction? 1. admin insulin after the first meal of the day 2. inject insulin at a 45-degree angle into the deltoid muscle 3. shake the insulin vial vigorously before withdrawing the medication 4. draw up clear insulin first when mixing two types of insulin in one syringe

4. Draw up clear insulin first when mixing two types of insulin.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?

High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia.

A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer?

Hydrocortisone

A client with type 1 diabetes has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

Hypoglycemia

The nurse is teaching a client that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?

Iodized table salt

Which instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client? 1. take the drug on an empty stomach 2. take the drug with meals 3. take the drug in the evening 4. take the drug whenever it's convenient

1. Take the drug on an empty stomach.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

"You'll need less insulin when you exercise or reduce your food intake."

The nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse a hypoglycemic reaction, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment ON HAND? 1. Epinephrine 2. Glucagon 3. 50% dextrose 4. Hydrocortisone

2. Glucagon.

Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism? 1. hypocalcemia 2. hypercalcemia 3. hyperphosphatemia 4. hypophosphaturia

2. Hypercalcemia

The nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: 1. I.M. or subcutaneous glucagon 2. I.V. bolus of dextrose 50% 3. 15 to 20 g of fast-acting carbohydrate such as OJ 4. 10 units of fact-acting insulin

3. 15-20 g of fast-acting carb such as OJ

A client is prescribed prednisone (Deltasone) daily. Which statement best explains why the nurse should instruct the client to take this drug in the morning? 1. Taking the drug at the same time every day establishes a regular routine, reducing the risk of forgetting a dose. 2. Prednisone has a longer half-life with morning administration, which makes it more effective. 3. Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern. 4. Prednisone is best absorbed when taken on an empty stomach first thing in the morning.

3. Morning administration of prednisone mimics the body's natural corticosteroid secretion pattern.

A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan? 1. maintenance of blood glucose levels between 180 and 200 mg/dl 2. smoking reduction but not complete cessation 3. an eye examination every 2 years until age 50 4. exercise and a weight loss reduction diet

4. Exercise and a weight loss reduction diet.

A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station?

A 24-year-old client with unstable hyperthyroidism with sinus tachycardia. Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station.

Which of the following is a clinical manifestation of hypothyroidism? A A pulse rate below 60 beats/minute. B Systolic murmurs C Exophthalmos D An elevated systolic blood pressure.

A. A pulse rate below 60 beats/minute.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? A. Cerebral edema B. Hypovolemic shock C. Severe hyperkalemia D. Tetany

A. Cerebral edema

The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? A Renal calculi and urinary obstruction B Metabolic acidosis and cardiac ischemia C Fluid volume overload and pruritus D Deep vein thrombosis and pulmonary embolism

A. Renal calculi and urinary obstruction.

A nurse is caring for a client who has type 1 DM and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? a. Kussmaul respirations b. Diaphoresis c. Decreased skin turgor d. Ketonuria

B. A client who has a blood glucose level below 70 mg/dL will exhibit manifestations of hypoglycemia.

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? A A decrease in blood pressure B A decrease in urine output C A decrease in appetite D A decrease in blood glucose levels

B. A decrease in urine output.

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? A. Fludrocortisone B. Calcium gluconate C Methylprednisolone D Sodium bicarbonate

B. Calcium gluconate

For a client with Graves' disease, which nursing intervention promotes comfort? A. Limiting intake of high-carbohydrate foods B.Maintaining room temperature in the low-normal range C. Restricting intake of oral fluids D. Placing extra blankets on the client's bed

B. Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss.

Patients with hyperthyroidism are characteristically: A Calm B Sensitive to heat C Apathetic and anorexic D Emotionally stable

B. Sensitive to heat

A nurse is caring for a client who has DI. For which of the following findings should the nurse monitor? a. proteinuria b. oliguria c. polyuria d. glycosuria

C. Polyuria

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? A. Inability to tolerate cold B Thick hard nails C Reports of increased appetite D Complaints of sleepiness

C. Reports of increased appetite.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? A. Restricting sodium intake to 1 gm/day B. Elevating the head of the client's bed to 90 degrees C. Restricting fluids to 800 ml/day D. Administering vasopressin as ordered

C. Restricting fluids to 800 mL/day Explanation: Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia.

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? A Diabetes insipidus B Syndrome of inappropriate antidiuretic hormone secretion C Thyrotoxic crisis DMyxedema coma

C. Thyrotoxic crisis

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? A. Administer a sedative as ordered. B. Administer an oral calcium supplement as ordered. C Administer IV calcium gluconate as ordered. D Start administering oxygen at 2 L/min via a cannula.

C. When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate.

The nurse is instructing a young adult with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which of the following situations? a. Completing the spring semester of school. b. Gaining 4 lb. c. Becoming engaged. d. Undergoing a root canal.

D. Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes?

Weight loss

A nurse is accepting a transfer from the PACU of a client who has had a subtotal thyroidectomy. Which of the following equipment should the nurse have available at the bedside for this client?

D. Tracheostomy tray

Which diet would likely be ordered for the client with hypothyroidism:

High roughage, low calorie.

The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?

Levothyroxine

A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include?

"Wear a medical alert identification tag when you exercise." Explanation: The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice?

"You should take your insulin after breakfast and after dinner." Explanation: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 4 to 12 hours, and a duration of 16 to 20 hours.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1. BUN level of 12 mg/dl 2. Blood glucose level of 90 mg/dl 3. Serum sodium level of 134 mEq/L 4. Serum potassium level of 5.8 mEq/L

(4) Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.

- Elevated blood urea nitrogen (BUN) and creatinine - Rapid onset - More common in type 1 diabetes

A 48-year-old female client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.

- High-fiber, low-calorie diet - Use of stool softeners - Thyroid hormone replacements

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.

- Hydrocortisone - Acetaminophen - Methimazole - Iodine

The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply.

- I will increase my intake of fluids. - I will test my blood sugar level every 3 to 4 hours. - I will call the doctor if I have vomiting or diarrhea. - I will eat soft foods if I cannot tolerate regular food.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.

- Numbness - Tingling - Muscle twitching and spasms

A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.)

- Tachycardia and hypertension: can indicate the occurrence of thyroid storm following removal of the thyroid gland. - Laryngeal stridor and hoarseness: can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. - Positive Trousseau's sign: indication of hypocalcemia, which is a complication of thyroid removal.

Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia

1. Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection.

Which of the following is a priority outcome for the client with Addison's disease? 1.Maintenance of medication compliance. 2.Avoidance of normal activities with stress. 3.Adherence to a 2-g sodium diet. 4.Prevention of hypertensive episodes.

1. Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis.

For a client in addisonian crisis, it would be very risky for a nurse to administer: 1. potassium chloride 2. normal saline solution 3. hydrocortisone 4. fludrocortisone

1. Potassium chloride

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?

10-15 minutes Explanation: rapid-acting insulin

The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1.Addison's disease will resolve over a few weeks, requiring no further treatment. 2.Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3.Fatigue, weakness, dizziness, and mood changes need to be reported to the physician. 4.A medical identification bracelet should be worn. 5.Family members need to be informed about the warning signals of adrenal crisis. 6.Dental work or surgery will require adjustment of daily medication.

2, 3, 4, 5, 6: Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

Which of the following is the priority for a client in addisonian crisis? 1.Controlling hypertension. 2.Preventing irreversible shock. 3.Preventing infection. 4.Relieving anxiety.

2. Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function.

When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from: 1.Insufficient secretion of growth hormone (GH). 2.Dysfunction of the hypothalamic pituitary 3.Idiopathic atrophy of the adrenal gland. 4.Oversecretion of the adrenal medulla.

3. Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands

Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? 1.Anorexia. 2.Dizziness. 3.Rapid weight gain. 4.Poor skin turgor.

3. Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement.

Which of the following is the best indicator for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1.Skin turgor. 2.Temperature. 3.Thirst. 4.Daily weight.

4. Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: 1. calcium and phosphorus abnormalities 2. chloride and magnesium abnormalities 3. sodium and chloride abnormalities 4. sodium and potassium abnormalities

4. Sodium and potassium abnormalities

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

70% NPH insulin and 30% regular insulin

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to DECREASE as a therapeutic effect of the procedure? a. Calcium b. Sodium c. Potassium d. Phosphorus

A. Calcium

A client comes to the clinic verbalizing a weight loss of 20 pound (9.1 kilogram) over the last month, even with a "ravenous" appetite and no change in activity level. The client is diagnosed with Graves' disease. Which other signs and symptoms of Graves' disease would the nurse assess? Select all that apply. a. Rapid, bounding pulse b. Bradycardia c. Heat intolerance d. Constipation e. Mild tremors f. Nervousness

A. Rapid, bounding pulse C. Heat intolerance E. Mild tremors F. Nervousness

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? a. Weight gain, decreased appetite, and constipation b. Weight loss, increased urination, and increased thirst c. Weight loss, increased appetite, and hyperdefecation d. Weight gain, increased urination, and purplish-red stria

A. Weight gain, decreased appetite, and constipation.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis?

Assess the client's breath odor Explanation: The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis.

A nurse is conducting a home visit for an older client who has DM and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? a. Dementia b. Hypoglycemia c. Infection d. Transient ischemic attack

B. A client who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near meal time each day because regular insulin peaks in 2-4 hours, causing a drop in the client's blood glucose.

The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? A Fatigue B Weight loss C Hair loss D Dyspnea

B. Weight loss

A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find?

Bronze pigmentation of the skin.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: A. systolic murmur at the left sternal border. B. exophthalmos and conjunctival redness. C. decreased body temperature and cold intolerance. D. flushed, warm, moist skin.

C. Decreased body temperature and cold intolerance.

A nurse is reviewing the laboratory results of a client who has DM. Which of the following results indicates that the client's diabetes is controlled? a. HbA1c 8.5% b. Postprandial blood glucose 190 mg/dL c. Casual blood glucose 205 mg/dL d. Fasting blood glucose 95 mg/dL

D. A fasting blood glucose of 95 mg/dL is within the expected reference range of 70-110 mg/dL.

A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?

High blood sugar decreases blood circulation to nerves.

A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis (thyroid storm)?

Hyperthermia Explanation: Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106 F).

A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?

Hypokalemia Explanation: Because a patient's serum potassium level may drop quickly as a result of rehydration and insulin treatment, potassium replacement must begin once potassium levels drop to normal in the patient with DKA.

A nurse is assessing a client who has Addison's disease. Which of the following findings should the nurse expect?

Hypotension

Which of the following clinical signs are associated with diabetes insipidus?

Hypotension

A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include?

Increase caloric intake with meals.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger. Explanation: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger).

A patient is prescribed Glucophage (Metformin), an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to:

Inhibit the production of glucose by the liver.

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take FIRST?

Initiate fluid replacement therapy. Explanation: The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively.

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition?

Ketoacidosis

The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of:

Kidney stones Explanation: The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism.

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client?

Low blood glucose concentration

A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively?

Monitor blood pressure (BP) frequently.

A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?

Myxedema coma

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?

Patient's eating and sleeping habits

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

Related to bone demineralization resulting in pathologic fractures.

A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension

Skeletal muscle weakness, mood changes, hypocalcemia, increased susceptibility to infection.

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?

Tachycardia Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia.

The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids?

Take your medication with meals or with an antacid. Explanation: Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise, with an antacid.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids?

The importance of watching for signs of hyperglycemia. Explanation: A serious adverse effect of corticosteroids is hyperglycemia.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?

This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: Long acting insulin

A client on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks' duration can suppress the adrenal cortex for how long?

Up to 1 year

The client with Addison's disease is taking glucocorticoids at home. Which of the following statements indicate that the client understands how to take the medication?

Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease?

a. "I always carry hard candy to eat in case my blood sugar level drops. b. "I avoid exposure to the sun as much as possible." c. "I always wear my medical identification bracelet." d. "I skip lunch when I don't feel hungry." D: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia.

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is NOT a goal in the initial medical treatment of diabetic ketoacidosis?

a. Administer glucose. b. Monitor serum electrolytes and blood glucose levels. c. Administer isotonic fluid at a high volume. d. Administer potassium replacements. A

A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply.

a. Assess for neurologic changes. b. Closely monitor nasal packing and postnasal drainage. c. Encourage deep breathing and coughing. d. Offer the client a straw when drinking liquids. a, b: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.

A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. Which of the following laboratory values is consistent with DKA?

a. Blood glucose 30 mg/dL b. negative urine ketones c. Blood pH 7.38 d. Bicarbonate level 12 mEq/L Explanation: A client who has DKA should have a bicarbonate level that is LESS than 15 mEq/L

Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply. a. Cold intolerance b. Heat intolerance c. Fatigue d. Dry skin e. Hair loss f. Increased energy

a. Cold intolerance c. Fatigue d. Dry skin e. Hair loss

A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display?

a. Constipation b. Cold intolerancce c. Difficulty sleeping d. Anorexia c

A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

a. Constipation b. Headache c. Bradycardia d. Hypertension D. Hypertension

A nurse is assessing a client who is recovering from a thyroidectomy and has a harsh, high-pitched respiratory sound. Which of the following actions should the nurse take?

a. Hyperextend the client's neck. b. Prepare for a tracheostomy. c. Lower the head of the bed. d. Administer morphine. B: The nurse should notify the provider immediately and prepare for a tracheostomy. Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms.

A nurse is teaching a client who has type 2 DM about foot care. Which of the following statements by the client indicates an understanding of the teaching?

a. I will apply moisture between my toes. b. I will soak my feet daily. c. I'll be sure to wear cotton socks every day. d. I'll use a heating pad to warm my feet. C: to absorb moisture and reduce the risk of infection.

A nurse is providing teaching about food choices to a client who has DM. Which of the following statements by the client indicates an understanding of the teaching?

a. I will need to eliminate sweet desserts from my diet. b. I should avoid using sucralose in my coffee. c. I should consume alcohol between meals in moderation. d. I should replace white bread with whole-grain bread. Explanation: Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber.

A nurse is providing teaching to a client who has type 1 DM about hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

a. Shakiness b. Urinary frequency c. Dry mucous membranes d. Excess thirst A. Shakiness: A client who has hypoglycemia can experience early manifestations of shakiness, as well as fatigue, a headache, difficulty thinking, sweating, and nausea.

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

a. Sliced banana b. Baked potato c. Turkey and cheese sandwich d. Plain yogurt with peaches c: A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Bananas, baked potatoes, and plain yogurt with peaches are high in potassium.

A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply.

a. Strict intake and output b. Neurologic function c. Urine and blood chemistry d. Liver function tests e. Signs of dehydration a, b, c: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.

The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply.

a. Wear binding compression socks daily. b. Shave any calluses with a disposable razor. c. Apply lotion between the toes after bathing. d. Check the inside of shoes before putting them on. e. Check the bottom of the feet with a mirror every day. d, e

A client has experienced several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. What assessments would the nurse expect to find with a client with suspected Addison disease? Select all that apply.

a. Weight gain b. Increased appetite c. Hypoglycemia d. Depression e. Hypotension c, d, e: Addison disease is characterized by muscle weakness, anorexia, GI symptoms, fatigue, emaciation, hypotension, low blood glucose levels, low serum sodium levels, high serum potassium levels, and dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows. Depression, emotional lability, apathy, and confusion may also be present.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. muscle weakness b. tremors c. diaphoresis d. constipation

a. muscle weakness

Which statement made by a client diagnosed with adrenal insufficiency requires further education by the nurse? a. "I need to take my oral hormone replacement every day." b. "I no longer need to worry about symptoms of my disorder because it cannot recur." c. "I will purchase and wear a medical alert bracelet." d. "I will notify my doctor if I begin to gain weight."

b. "I no longer need to worry about symptoms of my disorder because it cannot recur."