Endocrine
A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? (Select all that apply.) 1 Use tinted glasses. 2 Use warm, moist compresses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. 5 Apply a petroleum-based jelly along the lower eyelid.
1 Use tinted glasses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive . Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears, not a petroleum-based jelly, are used to moisten the eyes.
Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes? 1 Ketones in the blood but not in the urine. 2 Glucose in the urine but not hyperglycemia. 3 Urine negative for ketones and hyperglycemia. 4 Blood and urine positive for both glucose and ketones
3 Urine negative for ketones and hyperglycemia. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL. Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.
A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription? 1 High protein, high carbohydrate diet 2 Iodine preparations 3 Antithyroid drugs 4 Drugs to increase the blood pressure
4 Drugs to increase the blood pressure Having a normally functioning thyroid (euthyroid) decreases the risk of thyrotoxic crisis after surgery. Ideally the client should be normotensive; some clients are slightly hypertensive because of the increased metabolic rate associated with hyperthyroidism. Weighing in the expected range may be impossible; the client may be underweight because of the increased metabolic rate associated with hyperthyroidism. The client should be in a positive nitrogen balance to promote wound healing .
Confidence: Nailed it Stats Issue with this question? 2. A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? 1 Insulin lispro (Humalog) 2 Insulin glargine (Lantus) 3 NPH insulin (Novolin N) 4 Regular insulin (Novolin R)
4 Regular insulin (Novolin R) Regular insulin is rapid-acting and should be used for diabetic coma . Insulin lispro is too short-acting and must be administered concurrently with longer-acting insulin. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency.
After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client? 1 Serum osmolarity increases 2 Urine concentration decreases 3 Glomerular filtration decreases 4 Tubular reabsorption of water increases
4 Tubular reabsorption of water increases Reabsorption of sodium and water in the kidney tubules decreases urinary output and retains body fluids. There is no effect on filtration with ADH; ADH increases reabsorption in the tubules. The opposite is true of serum osmolarity increase, urine concentration decrease, and tubular reabsorption of water increase.
A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them. Correct 1. Put air into the intermediate-acting insulin vial. Correct 2. Put air into the short-acting insulin vial. Correct 3. Withdraw the prescribed amount of short-acting insulin. Correct 4. Withdraw the prescribed amount of intermediate-acting insulin.
Air should be injected into the air space of the intermediate-acting insulin vial before short-acting insulin is drawn into the syringe; the needle should not touch the insulin. The nurse should inject the amount of air into the short-acting insulin vial equivalent to the volume to be withdrawn to prevent negative pressure that can make withdrawal difficult. The short-acting insulin should be withdrawn first to prevent possible contamination of the vial with the intermediate-acting insulin, which would cause a delay in onset time of the short-acting insulin. The intermediate-acting insulin should be drawn up after the short-acting insulin to prevent contamination of the short-acting insulin.
Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.) 1 Lethargy 2 Tachycardia 3 Weight gain 4 Constipation 5 Exophthalmos
Correct2 Tachycardia Correct5 Exophthalmos Tachycardia is associated with hyperthyroidism and is caused by the increase in the basal metabolic rate. Exophthalmos is associated with hyperthyroidism and results from accumulation of fluid behind the eyeball. Lethargy is associated with hypothyroidism; hyperactivity occurs with hyperthyroidism. Weight gain occurs with hypothyroidism; weight loss occurs with hyperthyroidism because of the high metabolic rate. Constipation is associated with hypothyroidism; frequent loose stools occur with hyperthyroidism.
A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider? 1 With this type of emotion, the dosage of steroids may have to be reduced 2 Despite steroid therapy, the ability to cope with stress will be decreased 3 Mild sedation is needed to assist the client with coping with the loss 4 Feelings of exhaustion with lethargy will occur as a result of stress
Correct2 Despite steroid therapy, the ability to cope with stress will be decreased Clients with adrenocorticoid insufficiency who are receiving steroid therapy usually require increased amounts of medication during periods of stress because they are unable to produce the excess needed by the body. Increased stress requires an increase, not decrease, in glucocorticoids. Although sedation may be prescribed, the major concern is the regulation of glucocorticoids in the presence of emotional or physiological stress. Although feelings of exhaustion with lethargy may occur, they are not the primary reason the health care provider needs to be notified of the emotional stress that the client is experiencing; the major concern is the regulation of glucocorticoids in the presence of emotional or physiological stress. The dosage of glucocorticoids may have to be increased.
A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.) 1 1. Tremors 2 Bradycardia 3 Somnolence 4 Heat intolerance 5 Decreased blood pressure
Correct1 1. Tremors Correct4 Heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.
The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms identified by the client indicate that the teaching was effective? (Select all that apply.) 1 Thirst 2 Headache 3 Nervousness 4 Fruity breath odor 5 Excessive urination
Correct1 Thirst Correct4 Fruity breath odor Correct5 Excessive urination Thirst (polydypsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia . A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia and hyperglycemia because of central nervous system irritation.
A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will: 1 Be sterile for the rest of my life." 2 Require larger doses of insulin than I did preoperatively." 3 Have to take cortisone or a similar drug for the rest of my life." 4 Have to take thyroxine or a similar medication for the rest of my life."
Correct2 Require larger doses of insulin than I did preoperatively." The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy , any elevation of blood glucose level caused by somatotropin also will stop. Infertility may be expected after a hypophysectomy because the follicle-stimulating hormone and its releasing factor will no longer be present to stimulate spermatogenesis. When adrenocorticotropic hormone (ACTH) is absent, cortisone will have to be administered. Thyroid-stimulating hormone will not be present; extrinsic thyroxine will have to be taken.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? (Select all that apply.) 1 Decreased urinary output 2 Excessive thirst 3 Hyperactivity 4 Fruity-scented breath 5 Confusion
Correct2 Excessive thirst Correct4 Fruity-scented breath Correct5 Confusion Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternate fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.
