Endocrine and Metabolic Disorders Exam 3 Arnold
Which statement indicates that a client with the medical diagnosis of hypoparathyroidism understands diet instructions? "A spinach salad with cucumbers and tomatoes is a good meal." "I can have yogurt with fruit as a snack." "For breakfast, I can have scrambled eggs." "I will eat green beans, fish, and white bread for a meal."
"I will eat green beans, fish, and white bread for a meal." Explanation: Green beans, fish, and white bread are good choices because of the high calcium and low phosphorus content. Yogurt contains high levels of phosphorus. Egg yolks are restricted, and spinach contains oxalates that form insoluble calcium substances.
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? -hypernatremia and hypercalcemia -hypokalemia and hypoglycemia -hyperkalemia and hyperglycemia -hypocalcemia and hyperkalemia
hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.
The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? aspirin angiotensin-converting enzyme (ACE) inhibitors sulfonylureas steroids
steroids Explanation: Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.
A client with type 1 diabetes mellitus must learn how to self-administer insulin. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Rotate injection sites among different regions." "Administer insulin into sites near muscles that you plan to exercise." "Rotate injection sites within the same anatomic region." "Inject insulin into subcutaneous tissue with large blood vessels nearby."
"Rotate injection sites within the same anatomic region." Explanation: The nurse should instruct the client to rotate injection sites within the same anatomical regions. The other answers are incorrect and would lead to changes in absorption.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and phosphorus. sodium. magnesium. potassium.
phosphorus. Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, what should the nurse recommend to the client? Perform isometric exercises. Limit dietary vitamin D intake. Maintain a regular program of weight-bearing exercise. Increase the amount of potassium in the diet.
Maintain a regular program of weight-bearing exercise. Explanation: Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I will eat lots of chicken and dairy products." "I may stop taking this medication when I feel better." "I will avoid friends and family members who are sick." "I will see my ophthalmologist regularly for a check-up."
"I may stop taking this medication when I feel better." Explanation: The client requires additional teaching because they state that they may stop taking corticosteroids when they feel better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase their protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit their ophthalmologist regularly.
The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? "My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day." "Glucocorticoids are cumulative, so I will take a dose every third day." "I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids." "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage."
"Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." Explanation: The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, Addisonian crisis could result. Two-thirds of the daily dose should be taken at about 0800 and the remainder at about 1600. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 0400 and 0600 and lowest levels in the evening.
A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." "You won't need to monitor your fluid intake and output after you start taking desmopressin." "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." "Administer desmopressin while the suspension is cold."
"You may not be able to use desmopressin nasally if you have nasal discharge or blockage." Explanation: The nurse should advise the client that desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement.
A client with hypothyroidism reports feeling sad and depressed about the bodily changes experienced and states "I wonder if there is any reason to go on." What is the most appropriate response by the nurse? Ask if the client has thoughts about self-harm. Inform the client this is a common side effect of therapy. Ask the client if there is a family history of depression. Reassure the client mood will improve with treatment.
Ask if the client has thoughts about self-harm. Explanation: Hypothyroidism affects many body systems, including the client's mental and emotional processes. Even though the cause of the client's depression is most likely physiological, the client is experiencing a level of hopelessness. The nurse would evaluate these feelings to determine if any suicidal risk is present. Informing the client that these feelings are temporary, expected, and due to hypothyroidism are acceptable interventions, but they are less important than determining whether there are thoughts of self-harm. Assessing for a family history of depression is appropriate, but it is not the priority at this time. Hypothyroidism is treated with levothyroxine, which does not have depression as a common side effect.
The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for: Hypoglycemia. Hyperglycemia. Ketoacidosis. Metabolic acidosis.
Hypoglycemia. Explanation: The peak action of regular insulin is approximately 2 to 3 hours after administration. The client is having typical hypoglycemic symptoms. Acidosis results from uncontrolled diabetes mellitus, with hyperpnea (Kussmaul respirations) as the outstanding symptom. The hallmark symptoms of hyperglycemia are increased thirst, fruity breath, and glycosuria. The signs and symptoms of diabetic ketoacidosis include Kussmaul respirations, fruity breath, tachycardia, abdominal pain, nausea, vomiting, headache, thirst, dry skin, and dehydration.
The nurse is caring for a client who has returned from having a subtotal thyroidectomy. What finding would require a nurse to take immediate action? facial muscle twitching shortened QT interval incisional pain 6/10 diminished deep tendon reflexes
facial muscle twitching Explanation: Facial muscle twitching is a manifestation of hypocalcemia, and the healthcare provider should be immediately notified. A shortened QT interval can be a manifestation of hypercalcemia, and diminished deep tendon reflexes can be a manifestation of hypermagnesia; both these findings should be evaluated, but they are not the priority. Incisional pain 6/10 should be addressed, but is not the priority.
The client with type 1 diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." What is the best response by the nurse? "Eliminating carbohydrates from your diet is a good first step toward getting off of insulin." "It is correct that you do not need to count carbohydrates from fruits and vegetables." "All we ask you to do is have your blood sugar in range." "A person with diabetes should monitor their eating of proteins, fats, and carbohydrates."
"A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." Explanation: Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins. Limiting carbohydrate intake is just part of a comprehensive diabetic diet plan. A client with type 1 diabetes will need lifelong insulin therapy. Carbohydrates from fruit and vegetable sources will still need to be factored into carbohydrate intake. Telling a client "all we ask you to do" is a value-judgement and is not therapeutic communication.
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? "I'll call my physician if I notice tingling around my lips." "I will increase my fluid and calcium intake." "I'll schedule a follow-up visit with my physician as soon as I get home." "I will take my pain medications according to the schedule we developed."
"I will increase my fluid and calcium intake." Explanation: The client requires additional teaching if they state that they will increase their calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase their fluid intake, but should limit their calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with their physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? "Maintain weight within normal limits for your body size and muscle mass." "You should stop cigarette smoking." "Follow a high-protein diet including meat, dairy, and eggs." "Prevent developing hypertension by reducing stress and limiting salt intake."
"Maintain weight within normal limits for your body size and muscle mass." Explanation: The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-protein diet does not prevent diabetes mellitus, but it may contribute to hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Don't take your insulin or oral antidiabetic agent if you don't eat." "Follow your regular meal plan, even if you're nauseous." "Test your blood glucose every 4 hours." "It's okay for your blood glucose to go above 300 mg/dl while you're sick."
"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check their blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when the client is sick. If the client's blood glucose level rises above 300 mg/dl, the client should call their physician immediately. If the client is unable to follow the regular meal plan because of nausea, the client should substitute soft foods, such as gelatin, soup, and custard.
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 units of fast-acting insulin. I.V. bolus of dextrose 50%. I.M. or subcutaneous glucagon.
15 to 20 g of a fast-acting carbohydrate such as orange juice. Explanation: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
The nurse is caring for a client in the medical unit. The nurse receives a health care provider's order for hydrocortisone 100 mg intravenously at a rate of 10 mL/hour for a client in acute adrenal crisis. The nurse understands that this treatment is common in clients with which disease process? hypoparathyroidism Cushing's syndrome hyperthyroidism Addison's disease
Addison's disease Explanation: Intravenous hydrocortisone for clients in acute adrenal crisis is the proper treatment for individuals with Addison's disease. Cushing's syndrome is associated with excessive amounts of glucocorticoids. Hyperthyroidism and hypoparathyroidism are not treated with hydrocortisone.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What should the nurse anticipate in this client's plan of care? Bilateral nasal and tympanic membrane cultures Alternation of hot and cold compresses An increased need for insulin and blood glucose monitoring Prepare the client for transillumination of the sinuses
An increased need for insulin and blood glucose monitoring Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications. Culture and sensitivity testing of purulent nasal drainage to show the causative bacterial organisms is rarely done with sinus infection, and tympanic membranes are never cultured by the nurse. Although a practitioner can illuminate the sinuses, it is not routine and is not necessary for diagnosis. Warm compresses can be applied for clients with sinusitis for comfort, however, hot compresses are not applied. Cold compresses are applied after sinus surgery, not in the case of acute infection.
Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. What should the nurse do next? Have the client drink a glass of milk or orange juice. Administer the next dose of insulin. Contact the client's health care provider (HCP) to decrease the insulin dose. Tell the client to lie down for 30 minutes.
Have the client drink a glass of milk or orange juice. Explanation: Hypoglycemia is a blood glucose level below 70 mg/dl (3.9 mmol/L). The signs and symptoms of hypoglycemia include confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances. Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death. With effective treatment, hypoglycemia can usually be quickly reversed. If the client has manifestations of hypoglycemia and monitoring equipment is not available, hypoglycemia is assumed, and treatment is initiated. Hypoglycemia is treated by ingesting 10 to 15 g of simple (fast-acting) carbohydrate, such as 4 to 8 ounces of fruit juice or regular (non-diet) soft drink or 8 ounces of low-fat milk. The nurse can tell the client to eat the regularly scheduled meal or a snack that has protein, such as cheese or peanut butter, to prevent hypoglycemia from recurring. Without treating the possible hypoglycemia, the blood glucose level will go down even lower and the client may lose consciousness, develop seizures, or go into a coma. Contacting the HCP would delay treating the possible hypoglycemia. Decreasing the insulin dose or increasing the meal plan may prevent episodes of hypoglycemia in the future. Administering insulin would cause the blood sugar to go even lower.
Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, what should the nurse recommend to the client? Increase the amount of potassium in the diet. Perform isometric exercises. Maintain a regular program of weight-bearing exercise. Limit dietary vitamin D intake.
Maintain a regular program of weight-bearing exercise. Explanation: Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.
A client is diagnosed with diabetes mellitus. The physician orders 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes their hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use? -Inject 15 units air into regular insulin vial; inject 35 units air into NPH vial, withdraw 35 units NPH; withdraw 15 units regular insulin. -Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. -Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial; withdraw 35 units NPH; withdraw 15 units regular insulin. -Inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; inject 35 units air into NPH vial and withdraw 35 units NPH.
Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. Explanation: To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. The nurse should follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 units of regular insulin in the syringe, carefully withdraw 35 units of NPH, for a total of 50 units in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.
The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose? Prevention of hemorrhage. Stimulation of peristalsis of the bowel. Reduced peripheral edema and ascites. Reduced serum ammonia levels.
Reduced serum ammonia levels. Explanation: Lactulose is used to treat hepatic encephalopathy by reducing serum ammonia levels. It is not used to stimulate bowel peristalsis, even though diarrhea can be a side effect of the drug. Lactulose does not have any effect on edema, ascites, or hemorrhage.
A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect? hyperkalemia dysuria irregular pulse constipation
hyperkalemia Explanation: Spironolactone is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common adverse effects of spironolactone. An irregular pulse is not an adverse effect of spironolactone but could develop if serum potassium levels are not closely monitored.
The client, a 56-year-old woman, has just undergone a left adrenalectomy for pheochromocytoma. Which postoperative complication should be the nurse's priority concern? hypertension hyperkalemia hypernatremia hypercalcemia
hypertension Explanation: Following adrenalectomy for pheochromocytoma, the client must be closely monitored for hypertension. Clients with aldosterone producing tumors may have problems with hyperkalemia. Hypercalcemia and hypernatremia are not usually concerns following adrenalectomy.
Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? decreased edema, stable temperature, and decreased respiratory rate improved appetite, weight gain, and sleeping fewer hours increased energy, weight loss, and a higher temperature and pulse rate elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels
increased energy, weight loss, and a higher temperature and pulse rate Explanation: The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.
Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will: select a diabetic diet correctly. maintain normal fluid and electrolyte balance. state dietary restrictions. exhibit serum glucose level within normal range.
maintain normal fluid and electrolyte balance. Explanation: Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of myxedema coma. Hashimoto's thyroiditis. thyroid storm. cretinism.
myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m. (1400), the client has a capillary glucose level of 250 mg/dl for which the client receives 8 units of regular insulin. The nurse should expect the dose's onset to be at 2 p.m. (1400) and its peak to be at 3 p.m.(1500). onset to be at 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600). onset to be at 2:15 p.m. (1415) and its peak to be at 3 p.m.(1500). onset to be at 4 p.m. (1600) and its peak to be at 6 p.m.(1800).
onset to be at 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600). Explanation: Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m. (1400), the expected onset would be from 2:15 (1425) to 2:30 p.m. (1430) and the peak from 4 (1600) to 6 p.m. (1800).
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? serum sodium level of 124 mEq/L serum blood urea nitrogen (BUN) level of 8.6 mg/dl hematocrit of 52% serum creatinine level of 0.4 mg/dl
serum sodium level of 124 mEq/L Explanation: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? "Jog at least 2 miles (3.2 kilometers) per day." "Lose weight." "Rest as much as possible." "Maintain a moderate exercise program."
"Maintain a moderate exercise program." Explanation: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat? at any time because timing of meals with lispro injections is unnecessary. 1 hour after the injection. within 10 to 15 minutes after the injection. 2 hours before the injection.
within 10 to 15 minutes after the injection. Explanation: Insulin lispro begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of lispro is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.
A client tells the nurse that they have been working hard for the past 3 months to control the client's type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check urine glucose level. serum fructosamine level. fasting blood glucose level. glycosylated hemoglobin level.
glycosylated hemoglobin level. Explanation: Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.
A 60-year-old female is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment? nausea. weight gain. tachycardia. diarrhea.
weight gain. Explanation: Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and nausea are not symptoms of hypothyroidism.
For a client with hyperthyroidism, treatment is most likely to include a thyroid hormone antagonist. a synthetic thyroid hormone. thyroid extract. emollient lotions.
a thyroid hormone antagonist. Explanation: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces T3, thyroxine (T4), and calcitonin. iodine and thyroid-stimulating hormone (TSH). TSH, triiodothyronine (T3), and calcitonin. thyrotropin-releasing hormone (TRH) and TSH.
T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
The nurse is receiving results of a blood glucose level from the laboratory over the telephone. What should the nurse do? Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. Repeat the results to the caller from the laboratory, write the results on scrap paper, and then transfer the results to the medical record. Request that the laboratory send the results by e-mail to transfer to the client's medical record. Indicate to the caller that the nurse cannot receive results from lab tests over the telephone and ask the lab to bring the written results to the nurses' station.
Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. Explanation: To assure client safety, the nurse first writes the results on the chart, then reads them back to the caller and waits for the caller to confirm that the nurse has understood the results. The nurse may receive results by telephone; and although electronic transfer to the client's medical record is appropriate, the nurse can also accept the telephone results if the laboratory has called the results to the nurses station.
A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus? assessing the client experiencing a hypoglycemic reaction obtaining, reporting, and documenting fingerstick glucose levels treating hypoglycemia teaching the client dietary changes necessary with diabetes mellitus
obtaining, reporting, and documenting fingerstick glucose levels Explanation: The educator should teach the nursing assistants how to obtain and document a fingerstick glucose level. The educator should also teach them normal and abnormal results and the importance of reporting them to the registered nurse caring for the client. Treating hypoglycemia, teaching clients about dietary changes, and assessing clients experiencing hypoglycemic reactions are outside the scope of practice for a nursing assistant. They are the responsibility of the registered nurse.
The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test? cortisol levels after the system is challenged cortisol levels before and after the system is challenged with a synthetic steroid the amount of dexamethasone in the system changes in certain body chemicals, which are altered in depression
cortisol levels before and after the system is challenged with a synthetic steroid Explanation: The dexamethasone suppression test measures cortisol levels before and after the system is challenged with a synthetic steroid. The dexamethasone suppression test does not measure dexamethasone or body chemicals altered in depression. Dexamethasone is used to challenge the cortisol level.
Which intervention is the most critical for a client with myxedema coma? maintaining a patent airway measuring and recording accurate intake and output warming the client with a warming blanket administering an oral dose of levothyroxine
maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the health care provider will order diuretic therapy, restrict fluid intake, and provide sodium replacement to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise? hypovolemic shock tetany cerebral edema severe hyperkalemia
cerebral edema Explanation: Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema. Hypovolemic shock results from severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH.
A client's fasting blood sugar (FBS) is 63 mg/dL (3.5 mmol/L) at 0700. The client is alert and oriented. What should the nurse do first? Give one ampule of 50% dextrose via rapid I.V. infusion. Give the prescribed dose of insulin. Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes. Give the client a large glass of orange juice with two packages of sugar.
Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes. Explanation: According to American Diabetes Association (Canadian Diabetes Association) guidelines for treating hypoglycemia, the conscious adult client should be given 15 g of carbohydrate with a follow-up blood glucose level in 15 minutes. The other options do not follow these guidelines.
A nurse is assigned to a client who is using an insulin pump. The nurse has never cared for a client with an insulin pump and isn't sure what to do. What should the nurse do first? Refuse to accept the assignment until the nurse has received training about pump management. Inform the charge nurse that the nurse doesn't feel comfortable with this assignment. Request information about nursing responsibilities in caring for a client with a pump. Accept the client and do the best possible until the shift ends.
Request information about nursing responsibilities in caring for a client with a pump. Explanation: Taking the initiative to gain new information relevant to client care as well as expressing a desire to support the unit's needs is an appropriate and professional nursing response. Refusing the assignment is inappropriate because the nurse isn't taking any initiative to learn about the pump. Refusing to care for the client until the nurse receives training is inappropriate; the nurse should gather information and evaluate the client before refusing to provide care. Accepting the assignment doesn't address the issue of lack of knowledge and may put the nurse or the client in jeopardy.
A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? to increase exercise and monitor weight to stay within a recommended healthy weight range to meet energy needs by eating only foods that keep blood glucose within a relatively normal range to maintain blood glucose levels close to the normal range to reduce risk for long-term complications to maintain cholesterol levels to prevent the long-term complications of vascular disease
to maintain blood glucose levels close to the normal range to reduce risk for long-term complications Explanation: Maintaining normal blood glucose is the most important factor in preventing long-term complications associated with diabetes. Therefore, the most important purpose of nutritional management is maintaining blood glucose as close to normal as possible to prevent long-term complications. Following nutritional recommendations will meet energy needs, may contribute to weight control, and keep cholesterol levels within acceptable ranges, but the most important reason for nutritional management is to maintain blood sugars in the normal range.
The nurse is educating a client on diabetes management. The client is asking questions that cause the nurse to be concerned about the client's ability to retain the information. Which would be the best technique for the nurse to use to enhance the retention of information by the client? Repeat important information during the presentation. Conduct the education using a lecture format. Speak slowly to allow information to be absorbed. Provide the client with a thorough reference list.
Repeat important information during the presentation. Explanation: Repetition is an effective means of reinforcing critical information and enhancing content retention. The other options will not increase the client's ability to retain information and may decrease the client's concentration and ability to retain critical information.
A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect? normal insulin levels improved glucose metabolism concentration of urine lower blood pressure
concentration of urine Explanation: The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.
Which action is most effective when a nurse is assessing the client suspected of developing diabetes insipidus? measuring urine output hourly assessing arterial blood gas values every other day taking vital signs every 2 hours checking blood glucose levels
measuring urine output hourly Explanation: Diabetes insipidus results from deficiency of antidiuretic hormone (ADH). The condition may occur in conjunction with head injuries as well as with other disorders. In ADH deficiency, the client is extremely thirsty and excretes large amounts of highly diluted urine. Measuring the urine output to detect excess amount and checking the specific gravity of urine samples to determine urine concentration are appropriate measures to determine the onset of diabetes insipidus.The client may be tachycardic and hypotensive from fluid deficit; however, altered vital signs in a client with a head injury may occur for other reasons as well.Blood gas analysis will not reveal diabetes insipidus.Blood glucose levels are indicators of diabetes mellitus.
