ATI_Med-Surg_Endocrine System
A nurse is reinforcing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C. "I should expect to gain weight during this illness." D. "I might be thirsty and weak."
"I might be thirsty and weak." *Extreme thirst and weakness are findings associated with DI. Excessive thirst is a manifestation of DM. Consumption of 4 to 30 L/day can be expected and fluid intake should not be limited. Elevated blood glucose levels are a manifestation of DM. Weight loss is a manifestation of DI.
A nurse is reinforcing discharge teaching with a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? (select all that apply) A. Drink 2 L fluids daily B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 mg/dL E. Report ketones in the urine after 24 hr of illness
1. Drink 2 L fluids daily 2. Monitor blood glucose every 4 hr when ill. 3. Administer insulin as prescribed when ill 4. Report ketones in the urine after 24 hr of illness *Drinking 2 L of fluids daily can prevent dehydration if the client develops diabetic ketoacidosis. Blood glucose tends to increase during illness. Blood glucose should be monitored every 4 hr. Illness often causes blood glucose to increase. Regular doses of insulin should be administered. Notify the provider when blood glucose remains greater than 250 mg/dL despite treatment. The provider should be notified if there are ketones in the urine after 24 hr of illness.
A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (select all that apply) A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Blood urea nitrogen (BUN) 28 mg/dL E. Fasting blood glucose 148 mg/dL
1. Sodium 130 mEq/L 2. Potassium 6.1 mEq/L 3. Calcium 11.6 mg/dL 4. Blood urea nitrogen (BUN) 28 mg/dL *Sodium is below the expected reference range. In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Hyponatremia is an expected finding. Potassium is above the expected reference range. Hyperkalemia is an expected finding for a client who has Addison's disease. Calcium is above the expected reference range. Hypercalcemia is an expected finding for a client who has Addison's disease. BUN level is above the expected reference range, which is an expected finding for a client who has Addison's disease due to dehydration. Fasting Blood Glucose is above the expected reference range. Hypoglycemia or blood glucose in the normal range is an expected finding for a client who has Addison's disease
A nurse is reinforcing teaching about foot care with a client who has diabetes mellitus. Which of the following information should the nurse include? (select all that apply) A. Remove calluses using over-the-counter remedies B. Apply lotion between toes C. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear closed-toe shoes
1. Trim toenails straight across 2. Wear closed-toe shoes *A podiatrist should remove calluses or corns. Over-the-counter remedies can increase the risk for tissue injury and an infection B. Applying lotion between the toes increases moisture for growth of micro-organisms, which can lead to infection. The client should check bathwater with the wrist or a thermometer to ensure it is a safe temperature. The fingers might not be as sensitive. Trim toenails straight across to prevent injury to soft tissue of the toes. Wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.
A nurse is assisting with the admission of a client for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? A. Administering a supplemental dose of hydrocortisone B. Instructing the client about coughing and deep breathing C. Collecting additional information about the client's history of Addison's disease D. Inserting an indwelling urinary catheter
Administering a supplemental dose of hydrocortisone *Acute adrenal insufficiency (adrenal crisis) is the greatest risk to the client who has Addison's disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal insufficiency, supplemental doses are administered during times of increased stress
A nurse is reinforcing dietary teaching with a client who has diabetes mellitus. Which of the following actions should the nurse take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from nonadherence to the dietary plan
Ask the client to identify the types of foods she prefers *The nurse must first collect adequate data from the client. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will help promote adherence to the dietary plan
A nurse is assisting with the plan of care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A. Check the client's blood glucose for hypoglycemia B. Check for hypertension C. Weigh the client weekly D. Insert an indwelling urinary catheter
Check for hypertension *The nurse should check the client for hypertension, which can indicate fluid volume overload
A nurse is caring for a client who has type 1 diabetes mellitus 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
Diaphoresis *A nurse should expect a client who has a blood glucose level below 70 mg/dL to exhibit indications of hypoglycemia. Expected findings associated with hypoglycemia include weakness, huger, diaphoresis, nausea, shakiness, and confusion
A nurse is assisting with the plan of care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? A. Encourage the client to control weight B. Inspect the client's feet once each week C. Restrict the client's activity D. Apply moisturizer between the client's toes
Encourage the client to control weight *The nurse should encourage weight control to stabilize blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes
A nurse is reviewing laboratory results for a client who has diabetes mellitus. Which of the following results indicates that the client is controlling the diabetes? 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
Fasting blood glucose 95 mg/dL *The nurse should identify that a fasting blood glucose of 95 mg/dL is within the expected reference range of 70 to 110 mg/dL, which indicates that the client has the diabetes under control
A nurse is checking a client with 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. Fever
Fever *A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the sudden development of an extreme elevation in body temperature, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone
A nurse is assisting with the care of a client who has Addison's disease and comes to the emergency department reporting nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should expect the provider to prescribe which of the following medications? A. Calcium B. Potassium C. Iodine D. Hydrocortisone
Hydrocortisone *Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening due to severe fluid and electrolyte imbalances. Without treatment sodium levels fall, and potassium levels in crease. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high-dose corticosteroids such as hydrocortisone are essential to correct the glucocorticoid deficiency
A nurse is caring for a client who is taking somatropin to stimulate growth. The nurse should plan to monitor the client for which of the following as an adverse effect of this medication? A. Increased heart rate B. Hyperthyroidism C. Sweating D. Hyperglycemia
Hyperglycemia *Increased heart rate is an adverse effect of vasopressin. Hypothyroidism is an adverse effect of somatropin. Sweating is an adverse effect of vasopressin. Identify that hyperglycemia is an adverse effect manifestation of somatropin
A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? A. Proteinuria B. Oliguria C. Polyuria D. Glycosuria
Polyuria *Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity
A nurse is collecting data from a client who is recovering from a thyroidectomy and has harsh, high-pitched respiratory sounds. 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
Prepare for a tracheostomy *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 collecting data from a client who has Cushing's syndrome. Which of the following skin manifestations should the nurse expect to find? A. Purple striae on the chest and abdomen B. Butterfly rash across the bridge of the nose C. Bronze skin pigmentation D. Jaundice of the face and sclera
Purple striae on the chest and abdomen *A client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen because cortisol destroys collagen under the skin
A nurse is preparing for the transfer of a client from the postanesthesia care unit (PACU) following a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the client's bedside? A. Cardiac monitor B. Defibrillator C. Thoracotomy tray D. Tracheostomy tray
Tracheostomy tray *Due to the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by raising tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client
A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation of which of the following substances as an indication that the client has this disorder? A. Triiodothyronine B. Plasma-free metanephrine C. Urine control D. Urine osmolality
Triiodothyronine *Increased Triiodothyronine (T3) indicates hyperthyroidism. An increase in plasma-free metanephrine indicates the presence of a pheochromocytoma (tumor of the cells of the adrenal medulla). A high cortisol level indicates hyperfunction of the adrenal cortex and can indicate that the client has Cushing's disease. Increased urine osmolality indicates SIADH
A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? A. Warm the dialysate solution to room temperature prior to administration B. Cleans the catheter site using a back-and-forth motion beginning at the end of the catheter and moving inward C. Place the drainage bag at the level of the client's chest D. Apply clean gloves and cleanse the client's catheter site with cold water
Warm the dialysate solution to room temperature prior to administration *The nurse should warm the dialysate solution to room temperature prior to administration. This prevents the client from experiencing pain and abdominal cramping due to a cold solution during dialysis
A nurse is caring for a client who asks why the provider bases the medication regimen on HbA1c results instead of the log of morning fasting blood glucose results. Which of the following responses should the nurse make? A. "HbA1c measures how well insulin is regulating your blood glucose between meals." B. "HbA1c indicates how well you have regulated your blood glucose over the past 120 days." C. "HbA1c is the first test your doctor prescribed to determine that you have diabetes." D. "HbA1c determines if your doctor should adjust your insulin dosage."
"HbA1c indicates how well you have regulated your blood glucose over the past 120 days." *HbA1c measures blood glucose over the past 120 days. Capillary glucose monitoring evaluates how well insulin is regulating blood glucose between meals. A fasting blood glucose is the first test providers prescribe to diagnose diabetes mellitus. HbA1c is not a screening test.
A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I will apply moisturizer 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."
"I'll be sure to wear cotton socks every day." *The nurse should instruct the client to wear clean cotton socks every day to absorb moisture and reduce the risk of infection
A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of this medication? A. "I'll take this medication after I eat." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medication at least 1 hour before I eat."
"I'll take this medicine 30 minutes before I eat." *Repaglinide peaks with 1 hr after administration; taking it after meals would not be effective in helping the client process the carbohydrates consumed during the meal. Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested. Repaglinide is only effective for about 4 hr, so taking the medication before bedtime would not help with management of mealtime carbohydrate intake. Repaglinide has a rapid onset and the risk of hypoglycemia would be high if the client takes the medication an hr before eating
A nurse is reinforcing teaching with 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? A. "My cells are resistant to the effects of insulin." B. "My body breaks down sugars too efficiently." C. "My pancreas does not produce insulin." D. "My body produces antibodies against pancreatic beta cells."
"My cells are resistant to the effects of insulin." *This client who has type 2 diabetes mellitus will have resistance to insulin ad a decrease in the secretion of insulin by the pancreatic beta cells
A nurse is reinforcing teaching with a client who has Graves' disease and a new prescription for propranolol. Which of the following client statements indicates effective reinforcement? A. "Propranolol helps blood flow to my thyroid gland." B. "Propranolol is used to prevent excess glucose in my blood." C. "Propranolol will decrease my tremors and fast heart beat." D. "Propranolol promotes a decrease of thyroid hormone in my body."
"Propranolol will decrease my tremors and fast heart beat." *Propranolol lowers blood pressure, but does not increase blood flow to the thyroid gland. Propranolol does not help prevent hyperglycemia. Propranolol is a beta adrenergic antagonist that increases heart rate and controls tremors. Propranolol does not promote decrease of thyroid hormone
A nurse is reinforcing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "An adverse effect of this medication is jaundice." B. "Take your pulse before each dose." C. "The purpose of this medication is to decrease production of thyroid hormone." D. "You should stop taking this medication if you have a sore throat."
"Take your pulse before each dose." *Propranolol can cause bradycardia. The client should take their pulse before each dose. If there is a significant change, they should withhold the dose and consult the provider. The purpose of propranolol is to suppress tachycardia, diaphoresis, and other effects of Graves' disease. Sore throat is not an adverse effect of this medication. The client should not discontinue this medication because this action can result in tachycardia and dysrhythmias
A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (select all that apply) A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
1. Heat intolerance 2. Palpitations 3. Weight loss *Hyperthyroidism increases the client's metabolism, causing increased hunger, heat intolerance, diarrhea, palpitations, weight loss, and tachycardia
A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? (select all that apply) A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness
1. Menorrhagia 2. Dry skin 3. Hoarseness *Constipation, Abnormal menstrual periods, including menorrhagia and amenorrhea, dry skin, decreased libido, and hoarseness are manifestations of hypothyroidism.
A nurse is reviewing the laboratory values for a client who has hyperglycemic hyperosmolar nonketotic syndrome. Which of the following laboratory values is consistent with hyperglycemic hyperosmolar nonketotic syndrome? A. Blood glucose 320 mg/dL B. Positive urine ketones C. Blood pH 7.34 D. Blood osmolality >350 mOsm/kg
Blood glucose 320 mg/dL *A client who has hyperglycemic hyperosmolar nonketonic syndrome should have a blood glucose level >250 mg/dL, which will cause cause spilling of ketones in the urine and development of metabolic acidosis
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. Phosphorus B. Sodium C. Potassium D. Calcium
Calcium *The parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bone by maintaining a balance between mineral levels in blood and bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client's condition
A nurse is preparing a 24-hour urine specimen for a client with suspected pheochromocytoma. Which of the following laboratory tests from the 24-hour urine specimen should the nurse use to determine the client's condition? A. Creatinine clearance B. Catecholamine metabolites C. 17-hydroxycorticosteroids (17-OHCS) D. Protein
Catecholamine metabolites *The nurse should expect the 24-hour urine specimen to test for catecholamine metabolites, which is used to determine of the client has pheochromocytoma. This test measures the level of catecholamines (epinephrine and norepinephrine) secretion in a 24-hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines, which are hormones that regulate blood pressure and heart rate
A nurse is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected? A. Elevated T4 B. Decreased T3 C. Elevated thyroid-stimulating hormone D. Decreased cholesterol
Decreased T3 *Decreased levels of T3 is an expected finding for a client who has hypothyroidism. Decreased T4 is an expected finding for a client who has hypothyroidism. Decreased thyroid stimulating hormone is an expected finding in a client who has secondary hypothyroidism. Elevated cholesterol is an expected finding for a client who has hypothyroidism
A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse expect? A. Presence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells
Decreased specific gravity *The urine of a client who has diabetes insipidus will be dilute with a urine specific gravity of less than 1.005. Glucose in the urine is indicative of DM. Ketones in the urine is indicative of DM. RBCs in the urine is indicative of DM.
A nurse is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following laboratory results is an expected finding? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid-stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine
Decreased thyroid-stimulating hormone (TSH) *In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated. In the presence of Graves' disease, elevated thyrotropin receptor, elevated free thyroxine index, and elevated triiodothyronin is an expected finding
A nurse is collecting data from a client who recently began taking levothyroxine to treat hypothyroidism. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech
Hand tremors *Identify hand tremors as a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. Report this finding to the provider due to the possible need for a decrease in the dosage of medication. Bradycardia is an expected finding for hypothyroidism. This finding indicates the need for continued thyroid hormone replacement therapy with a possible increase in dosage. Slow though processes and speech are expected findings for hypothyroidism. This finding indicates the need for continued thyroid hormone replacement therapy with a possible increase in dosage.
A nurse is reviewing the medical record of a client who takes desmopressin for diabetes insipidus. The nurse should identify that which of the following findings can be an adverse effect of desmopressin? A. Hypovolemia B. Hypercalcemia C. Agitation D. Headache
Headache *Edema and hypervolemia, rather than hypovolemia, are adverse effects of desmopressin. Calcium imbalance is not an adverse effect of desmopressin. Sleepiness, rather than agitation, is an adverse effect of desmopressin, which can indicate water intoxication. Headache during desmopressin therapy is an indication of water intoxication
A nurse is assisting with the care of a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following medication prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide
Hydrocortisone *This client with Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids such as hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction to the adrenal gland or pituitary and be life-threatening
A nurse is assisting with the plan of care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the client's evening intermediate-acting insulin dose to 90 minutes before dinner B. Increase the client's morning caloric intake C. Omit the client's evening snack D. Monitor the client's nighttime blood glucose levels
Monitor the client's nighttime blood glucose levels *The Somogyi effect is a swing of a high blood glucose level in the morning after an extremely low blood glucose level during the night. This swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels can provide an accurate diagnosis of the Somogyi effect
A nurse in an urgent care center is collecting data from an infant who has laryngotracheobronchitis. Which of the following findings should the nurse report to the provider as an indication of impending airway obstruction? A. Bradycardia B. Respiratory depression C. Nasal flaring D. Barking cough
Nasal flaring *Acute laryngotracheobronchitis (croup) causes dyspnea and swelling of the upper airway. Indications of impending airway instruction include tachycardia, increasing restlessness, flaring nares, and intercostal retraction
A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output
No change in plasma cortisol *No change in plasma cortisol indicates primary adrenal insufficiency (Addison's disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol. An elevated fasting blood glucose helps identify DM. An increase in sodium indicates primary adrenal insufficiency (Addison's disease or hypocortisolism). A decrease in urinary output indicates primary insufficiency (Addison's disease or hypocortisolism)
A nurse is assisting with collecting data from a client during a water deprivation test. For which of the following complication should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs
Orthostatic hypotension *Monitor for orthostatic hypotension resulting from dehydration during a water deprivation test. Tachycardia is a complication to monitor for during water deprivation test due to dehydration. Flat neck veins are likely during a water deprivation test. Monitor the client for dizziness rather than lung crackles during a water derivation test.
A nurse is caring for a client who has a blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 min B. Provide a carbohydrate and protein food C. Provide 15 g of simple carbohydrates D. Report findings to the provider
Provide 15 g of simple carbohydrates *Recheck the blood glucose in 15 min after a rapidly absorbed carbohydrate is ingested; however, another action is the priority. *Give the client a carbohydrate and protein food if the next meal is more than 1 hr away after the blood glucose returns to a normal range; however, take another action first. *The greatest risk to the client is injury from hypoglycemia; therefore, the priority action to take is to administer 15 to 20 g of rapidly-absorbed carbohydrates (juice). *Report the findings to the provider; however, take another action first.
A nurse is reinforcing teaching with client about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? A. Insulin glargine B. NPH insulin C. Regular insulin D. Insulin lispro
Regular insulin *Insulin glargine, a long-acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized. NPH insulin has a peak effect around 6 to 14 hr following administration. Regular insulin has a peak effect around 1 to 5 hr following administration. Insulin lispro has a peak effect around 30 min to 2.5 hr following administration
A nurse is reinforcing teaching with a client who has a new prescription for metformin. Which of the following findings should then nurse instruct the client to report as an adverse effect of metformin? A. Somnolence B. Constipation C. Fluid retention D. Weight gain
Somnolence *Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider. Diarrhea is an adverse effect of metformin. Fluid retention is an adverse effect of pioglitazone. Anorexia and weight loss are adverse effects of metformin.
A nurse is reinforcing teaching with a client who has diabetes mellitus about food choices. Which of the following client statements indicates the teaching has been understood? 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."
"I should replace white bread with whole-grain bread." *Clients who have diabetes mellitus have the same fiber requirements as the general population. 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 reinforcing teaching with a client who has a vaginal hysterectomy with a bilateral oophorectomy. Which of the following pieces of information should the nurse include in the teaching? A. "Plan to use some type of birth control for up to 6 weeks after surgery." B. "Use a water-based lubricant when having sexual intercourse." C. "Expect to have an increase in bloody vaginal drainage during the first 10 days after surgery." D. "Plan to start some type of aerobic exercise within a week after surgery."
"Use a water-based lubricant when having sexual intercourse." *Vaginal dryness is a manifestation of menopause after the ovaries are removed, and the client might require a water-based lubricant when having sexual intecourse
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include in the teaching? A. "You should exercise during a peak insulin time." B. "Wear a medical alert identification tag when you exercise." C. "Exercise can decrease the effects of insulin and cause the blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."
"Wear a medical alert identification tag when you exercise." *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 the blood glucose levels to decrease
A nurse is reinforcing teaching with 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 make? A. "Let's discuss this with your doctor; giving up pasta might not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added salt tomato products on your pasta."
"You don't have to give up pasta; just adjust the amount you eat." *The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful evaluation of usual dietary practices and modifications is an important part of helping clients manage this disorder
A nurse is planning to administer fluids to a client who has 25% total body surface area burns. The client has no prior medical history. Which of the following intravenous fluids should the nurse identify as contraindicated for this client? A. Whole blood B. Lactated Ringer's C. Dextran 40 in 0.9% sodium chloride D. 0.45% sodium chloride
0.45% sodium chloride *The nurse should identify that 0.45% sodium chloride is a hypotonic solution and is contraindicated for clients who have burns. Hypotonic fluid has an osmolarity value of <270 mOsm/L, which is less than the expected reference range of the osmolarity value for plasma and body fluid of 285 to 295 m)sm/L. Administering a hypotonic solution to this client can cause third-spacing of fluid
A nurse is reinforcing teaching with a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following information should the nurse include? (select all that apply) A. "Take oral medications 30 minutes before injection." B. "Use upper arms as preferred injection sites" C. "Mix pramlintide with the breakfast dose of insulin." D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days."
1. "Inject pramlintide just before a meal." 2. "Discard open vials after 28 days." *Pramlintide delays oral medication absorption, so oral medications should be taken 1 hr before or 2 hr after pramlintide injection. The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection. Pramlintide should not be mixed in a syringe with any type of insulin. Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. Unused medication in the open pramlintide vial should be discarded after 28 days.
A nurse is reinforcing teaching with a client who had a transsphenoidal hypophysectomy. Which of the following instruction should the nurse reinforce? (select all that apply) A. Avoid brushing teeth for two weeks post operatively B. Avoid bending at the knees C. Eat a low-fiber diet D. Take deep breaths and cough hourly E. Expect to experience a diminished sense of smell
1. Avoid brushing teeth for two weeks post operatively 2. Expect to experience a diminished sense of smell *The client should avoid brushing their teeth for 2 weeks to allow time for the incision to heal. The client should avoid bending at the waist. If bending is necessary, they should bend at the knees. To avoid constipation, which contributes to increased intracranial pressure, the client should eat a high-fiber diet. The client should avoid coughing, this activity can lead to leaking of cerebrospinal fluid. A diminished sense of smell is an expected finding after surgery
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply) A. Decreased blood sodium B. Urine specific gravity 1.001 C. Blood osmolarity 230 mOsm/L D. Polyuria E. Increased thirst
1. Decreased blood sodium 2. Blood osmolarity 230 mOsm/L *An increase in the secretion of ADH leads to dilutional hyponatremia. A decrease in blood osmolarity is caused by an increase in the secretion of ADH leading to water retention and dilution of blood components. A urine specific gravity greater than 1.030 (concentrated urine) is caused by an increase in the secretion of ADH. Reduced urine output is caused by the increase in the secretion of ADH. Increased thirst is an expected finding in a client who has diabetes insipidus
A nurse is collecting data from a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (select all that apply) A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis
1. Fruity odor of breath 2. Abdominal pain 3. Kussmaul respirations 4. Metabolic acidosis *Weight loss occurs when the cells are unable to use glucose because of insulin deficiency and places the body in a catabolic state, and fluid loss from dehydration decreases body weight. Fruity odor of breath is a manifestation of elevated ketones and acidosis. Abdominal pain is a GI manifestation of increased ketones and acidosis. Kussmaul respirations are an attempt tp excrete carbon dioxide and acid when in metabolic acidosis. Metabolic acidosis is caused by glucose, protein, and fat breakdown, which produces ketones
A nurse is caring for a client who has Cushing's disease. The nurse should identify that this client is at an increased risk for which of the following? (Select all that apply) A. Infection B. Electrolyte imbalances C. Renal calculi D. Bone fractures E. Dysphagia
1. Infection 2. Electrolyte imbalances 3. Bone fractures *Suppression of the immune system places the client at risk for infection. Clients who have Cushing's disease are at risk for electrolyte imbalances including hypernatremia, hypokalemia, and hyperglycemia. Client's who have Cushing's disease are not at risk for renal calculi, but they are at risk for neurologic and cardiovascular problems. Clients who have Cushing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis. Clients who have Cushing's disease are not at risk for dysphagia, but they are at risk for other gastrointestinal problems, including anorexia, nausea, vomiting, and abdominal pain
A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? (select all that apply) A. Low sodium B. High potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity
1. Low sodium 2. Increased urine osmolality 3. High urine sodium 4. Increased urine specific gravity *SIADH results in water retention, causing a low sodium level. SIADH results in an increase in urine osmolality due to the decreased urine volume. SIADH results in water retention, causing a high urine sodium level. SIADH results in water retention causing an increase in urine specific gravity. SIADH does not affect potassium levels
A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse reinforce? (select all that apply) A. Weight gain is expected while taking this medication B. Medication should not be discontinued without the advice of the provider C. Follow-up blood TSH levels should be obtained D. Take the medication on an empty stomach E. Use fiber laxatives for constipation
1. Medication should not be discontinued without the advice of the provider 2. Follow-up blood TSH levels should be obtained 3. Take the medication on an empty stomach *The provider carefully titrates the dosage of this medication. It should be increased slowly until the client reaches a euthyroid state. The client should not discontinue the medication unless directed to do so by the provider. Blood TSH levels are used to monitor the effectiveness of the medication. The medication should be takin on an empty stomach to promote absorption. Levothyroxine speeds up metabolism. Weight loss is an expected effect. Fiber laxatives reduce absorption of the medication and should be avoided.
A nurse is contributing to the plan of care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (select all that apply) A. Monitor CBC B. Monitor triiodothyronine (T3) C. Instruct the client to increase consumption of shellfish D. Advise the client to take the medication at the same time every day E. Inform the client that an adverse effect of this medication is iodine toxicity
1. Monitor CBC 2. Monitor triiodothyronine (T3) 3. Advise the client to take the medication at the same time every day *Methimazole can cause a umber of hematologic effects, including leukopenia and thrombocytopenia. Monitor CBC. Methimazole reduces thyroid production monitor T3. Methimazole reduces thyroid hormone production by blocking iodine. Instruct the client to limit iodine containing foods (shellfish). Methimazole should be taken at the same time every day to maintain blood levels. Iodine toxicity is an adverse effect of potassium iodide solution
A nurse is contributing to the plan of care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply) A. Monitor daily weights B. Observe for evidence of urinary tract infection C. Record aspiration precautions D. Initiate aspiration precautions E. Provide warmth using a heating pad
1. Monitor daily weights 2. Observe for evidence of urinary tract infection 3. Record aspiration precautions 4. Initiate aspiration precautions *The nurse should monitor the client's daily weight because decreasing weight is an indication of effective therapy. An infection such as in the urinary tract, can precipitate myxedema coma. The nurse should observe the client for manifestations of infection and treat any underlying illness. The nurse should record daily I&O because increased urine output is an indication of effective therapy. The nurse should initiate aspiration precautions because myxedema coma is a severe complication of hypothyroidism that can lead to compromised airway. The nurse should provide warmth with extra clothing and blankets. Avoid electric heating devices because the combination of vasodilation, decreased sensation, and decreased alertness places the client at risk for burns.
A nurse is reviewing the medication administration record of a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (Select all that apply) A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide
1. Regular insulin 2. Hydrocortisone sodium succinate 3. Sodium polystyrene sulfonate 4. Furosemide *0.45% sodium chloride is hypotonic. Clients who have acute adrenal insufficiency are hyponatremic. Clients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. Hydrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. Clients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. Loop and thiazide diuretics promote potassium excretion and are administered to treat hyperkalemia
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by adenoma. Which of the following findings should the nurse reports to the provider? (Select all that apply) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign
1. Tachycardia and hypertension 2. Laryngeal stridor and hoarseness 3. Positive Trousseau's sign *A thyrotoxic crisis (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Laryngeal stridor and hoarseness are unexpected findings and 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. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal that occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired
A nurse is contributing to the plan of care for a client who is scheduled to receive total parenteral nutrition (TPN). Which of the following actions should the nurse recommend including in the plan of care? (Select all that apply) A. Weight the client daily B. Obtain a serum blood glucose every 4 hours C. Apply a new dressing to the client's IV site every 5 days D. Change the IV tubing every 24 hours E. Monitor the TPN through a peripheral IV site
1. Weight the client daily 2. Obtain a serum blood glucose every 4 hours 3. Change the IV tubing every 24 hours *The nurse should recommend weighing the client daily while receiving TPN. Clients who are receiving TPN are typically malnourished; therefore, the client's weight needs to be monitored closely. Fluid retention can also be an indication that the client is not digesting the TPN, at which point the rate of transfusion might need to be decreased. Also, the nurse should recommend obtaining the client's serum blood hyperglycemia; insulin can be given if needed. Finally, the nurse should recommend changing the client's IV tubing every 24 hours to prevent bacteria from developing
A nurse is preparing to assist with the care of a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply) A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray
1. suction equipment 2. humidified oxygen 3. tracheostomy tray *The client can require oral or tracheal suctioning. Ensure that suctioning equipment is available. The client can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available. The client can experience respiratory obstruction. A tracheostomy tray should be available at the bedside. A flashlight is used to measure the reaction of the pupils to light for a client who has intracranial disorder. Checking pupil reaction with a flashlight is not indicated for this client. A chest tube tray would be used for a client who develops a hemothorax or pneumothorax. This is not an expected complication of a thyroidectomy. This equipment is not indicated for this client
A nurse is reviewing information with a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base the review on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland D. The client is instructed to take a dose of ACTH by mouth the evening before the test
ACTH is a hormone produced by the pituitary gland *The ACTH stimulation test measures the response by the adrenal glands to ACTH. In the presence of primary adrenal insufficiency, plasma cortisol levels do not rise in response to administration of ACTH. Secretion of corticotropin-releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH. ACTH is administered IV during the testing process, and plasma cortisol levels are measure 30 min and 1 hr after the injection
A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Check blood glucose immediately after breakfast B. Administer insulin when breakfast arrives C. Hold breakfast for 1 hr after insulin administration D. Clarify the prescription because insulin should not be administered at this time.
Administer insulin when breakfast arrive *Blood glucose should be checked prior to insulin administration to prevent an episode of hypoglycemia. Administer insulin aspart when breakfast arrives to avoid a hypoglycemic episode. Insulin aspart is rapid-acting and should be administered 5 to 10 min before breakfast. The client should eat within 5 to 15 min of taking insulin aspart to prevent hypoglycemia. Insulin aspart is administered at meal times.
A nurse is collecting data from a client who develops fruity breath odor, dry mouth, and extreme thirst. Which of the following additional data should the nurse collect? A. Blood glucose using a glucometer B. Pupillary reaction to light C. Deep tendon reflexes D. Liver function laboratory values
Blood glucose using a glucometer *The client's manifestations are indications of hyperglycemia and diabetic ketoacidosis. The nurse should check the client's blood glucose level, as well as respiratory status, vital signs, level of consciousness, and hydration status (including electrolyte levels)
A nurse is reviewing the laboratory reports for a client and notes an elevated thyroid-stimulating hormone (TSH) level. When collecting data from the client, which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis
Bradycardia *An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations
A nurse is caring for a client who is taking propylthiouracil. Which of the following findings should the nurse monitor for as an adverse effect of this medication? A. Bradycardia B. Insomnia C. Heat intolerance D. Weight loss
Bradycardia *Bradycardia is an adverse effect of propylthiouracil. Monitor for bradycardia. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil
A nurse is caring for a client who is posteoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? A. Compensate for decreased cortisol levels B. Inhibit glucose metabolism C. Act as a diuretic to maintain urine output D. Decrease susceptibility to infection
Compensate for decreased cortisol levels *With an adrenalectomy, the client requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors, which is fatal if untreated
A nurse is collecting data from a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia
Difficulty sleeping *A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone
A nurse is checking laboratory values to determine if a client who has diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glucose tolerance test B. Urine sugar and acetone C. Glycosylated hemoglobin levels D. Fasting serum glucose
Glycosylated hemoglobin levels *Checking glycosylated hemoglobin levels (HbA1c) is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by affected by recent changes in the client's diet or medication
A nurse is assisting with the care of a client who has Addison's disease and was admitted with muscle weakness and dehydration, as well as nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone
Hydrocortisone *This client with Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids such as hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction to the adrenal gland or pituitary and be life-threatening
A nurse is conducting a home visit with an older adult client who has diabetes mellitus 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
Hypoglycemia *Evidence-based practice indicates that the nurse should first check the client for hypoglycemia by drawing a blood glucose level. A client who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near mealtimes each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? A. Polyuria B. Dehydration C. Hyponatremia D. Hyperthermia
Hyponatremia *This client with SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia
A nurse is collecting data from a client who has Addison's disease. Which of the following findings should the nurse expect? A. Hypotension B. Weight gain C. Sugar craving D. Pale skin tone
Hypotension *The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone
A nurse is reviewing the dietary choices of a client who has chronic pancreatitis. Which of the following food items should the nurse suggest removing from the client's dietary choices for the following day? A. White rice B. Boiled cod C. Ice cream D. Canned peaches
Ice cream *Clients who have chronic pancreatitis should limit their fat intake to no more than 30% to 40% of their total calories. Ice cream is high in fat, with 48 g of fat in a 1-cup serviing of vanilla ice cream. The client should choose healthier options to support a balanced diet such as avocados and nuts
A nurse is reinforcing teaching with a client who has hyperthyroidism about managing this disorder. Which of the following recommendation should the nurse include? A. Reduce her total hours of sleep B. Keep her immediate environment warm C. Increase her caloric intake with meals D. Gradually increase her activity
Increase her caloric intake with meals *Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in loss of protein stores and a negative nitrogen balance. Even with an increased appetite, it is often difficult to meet energy demands, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake
A nurse is collecting data from a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? A. Thinning of skeletal bone structure B. Concave chest wall C. High-pitched voice D. Increase head size
Increased head size *A client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This condition results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicate that the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors
Increased urination *Increased urination (polyuria) is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis
A nurse is monitoring a client following a thyroidectomy. Which of the following findings should the nurse identify as an indication of hypoparathyroidism? A. Elevated blood pressure B. Involuntary muscle spasms C. Cold intolerance D. Weight loss
Involuntary muscle spasms *The nurse should identify involuntary muscle spams as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Irritability B. Urinary frequency C. Dry mucous membranes D. Excess thirst
Irritability
A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure
Kussmaul respirations *The nurse should expect the client to experience Kussmaul respirations with DKA. These deep and rapid respirations are the body's attempt to exhale carbon dioxide to reverse the metabolic acidosis that occurs with DKA
A nurse is caring for a client who has taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? A. WBC B. Amylase C. Platelet count D. Liver function tests
Liver function tests *Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication. Sitagliptin and exenatide can cause rare pancreatitis. Recommend checking the amylase and lipase for a client taking those medication if the client reports uncontrolled abdominal pain. Acarbose does not effect the platelet levels. Acarbose can lead to iron deficiency anemia, so ensure monitoring of the client's hemoglobin. Acarbose can cause liver toxicity when taken long-term. Ensure the client's liver function is monitored while taking this medication
A nurse is assisting with a plan for community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which of the following client groups 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-carbohydrates
Men and women who are obese *There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells, which is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance
A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low-Fowler's position B. Encourage deep breathing and coughing C. Encourage the client to brush their teeth when awake and alert D. Observe dressing drainage for the presence of glucose
Observe dressing drainage for the presence of glucose *Monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate the presence of CSF. Notify the provider if this occurs. The client should be placed into a high-Fowler's position. Coughing should be limited in the client who is postoperative, as this increases intracranial pressure and can cause a leak of CSF. Oral care for the client who is in post-operative following a transsphenoidal hypophysectomy includes oral rinses and flossing. Brushing teeth can cause a leak of CSF and is contraindicated.
A nurse is caring for a client who has urolithiasis and requires further diagnostic testing after an initial assessment indicated hypercalcemia. The nurse should explain that which of the following structures controls calcium concentration? A. Pancreas B. Thyroid gland C. Anterior pituitary gland D. Parathyroid gland
Parathyroid gland *The parathyroid gland secretes parathyroid hormones, which help the kidneys reabsorb calcium and increase calcium absorption from the gastrointestinal tract
A nurse is caring for an older adult client who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse nurse expect for this client? A. The client will start at a high dosage, and the amount will be tapered as needed. B. The client will remain on the initial dosage during the course of the treatment C. The client's dosage will be adjusted daily based on blood levels D. The client will start on a low dosage, which can be gradually increased
The client will start on a low dosage, which can be gradually increased *Starting a new medication at a high dosage can cause harm. The client's dosage will change periodically throughout treatment. The client's dosage will be based on blood levels, but daily monitoring is not required. Expect that levothyroxine will be started at a low dosage and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity.
A nurse is reinforcing teaching with a client who has Addison's disease about healthy snacks. Which of the following food choices by the client indicates an understanding of the teaching? A. Sliced bananas B. Baked potato C. Turkey and cheese sandwich D. Plain yogurt with peaches
Turkey and cheese sandwich *A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet that is low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (Adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone.
