Endocrine

The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). What laboratory result indicates a problem that should be managed?

blood glucose

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

blood glucose level 1,100 mg/dl (61.05 mmol/L)

A client with diabetes mellitus is admitted with hypoglycemia. Which information should the nurse include in the client teaching? Select all that apply.

"Hypoglycemia can result from excessive alcohol consumption." "Skipping meals can cause hypoglycemia." "Strenuous activity may result in hypoglycemia." "Symptoms of hypoglycemia include shakiness, confusion, and headache."

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands the condition and how to control it?

"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual."

A client has a tumor of the posterior pituitary gland. The nurse planning the client's care would include which interventions? Select all that apply.

Weigh the client daily. Measure urine specific gravity. Monitor intake and outpu

The nurse is teaching the family and a client newly diagnosed with type 1 diabetes how diet and exercise affect insulin requirements. Which statement made by the client indicates understanding of the teaching?

"I can remove my insulin pump when exercising."

The nurse is teaching a client with type I diabetes self-administration of insulin. Which statement by the client would be an expected outcome of the teaching session? Select all that apply.

"I need to make sure that I eat my meals and snacks on time after I take my insulin." "If I monitor and control my blood glucose levels carefully, there is less likelihood of suffering long-term complications." "If I exercise more than is normal, there is a risk that I might become hypoglycemic."

The client has various sensory impairments associated with type 1 diabetes. The nurse determines that the client needs further instruction when the client makes which statement?

"I will avoid kitchen activities."

When educating the client with type 1 diabetes, the nurse knows that more education is needed when the client says:

"I will be able to switch to insulin pills when my sugar is under control."

A client is going to receive an insulin pump prior to discharge and the nurse has done extensive teaching. Which statement indicates that the client has a good understanding about the pump?

"I will need to monitor blood glucose levels multiple times a day while on the insulin pump."

An obese client, age 65, is diagnosed with type 2 diabetes. When educating this client about the diagnosis, the nurse knows that more education is needed when the client says which statement? Select all that apply.

"If I follow my diet and exercise, I won't have diabetes any more." "I can never eat a hot fudge sundae again." "I guess I will need to stop meeting my friends at the coffee shop."

A physician orders acarbose, an alpha-glucosidase inhibitor, for a client with type 2 diabetes. Which statement by the client indicates a need for additional teaching?

"If I have hypoglycemia, I should eat some sugar, not dextrose."

An adult with type 2 diabetes is taking metformin 1,000 mg two times every day. The client asks the nurse about having an alcoholic drink. Which statement indicates the client understands the interaction of alcohol and metformin?

"If I know I'll be having alcohol, I shouldn't take metformin."

A client newly diagnosed with diabetes mellitus asks why they need ketone testing when the disease affects their blood glucose levels. How should the nurse respond?

"Ketones will tell us if your body is using other tissues for energy."

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."

When obtaining a health history from a client newly admitted to the hospital, which statement indicates the client's needs for further follow-up?

"No matter how much I drink, I'm still thirsty all the time."

The nurse teaches a client with type 2 diabetes mellitus about diabetic retinopathy. Which statement if made by the client would indicate to the nurse that teaching was effective?

"Tight control of blood sugar and blood pressure can prevent damage to my eye."

A 24-year old client who has diabetes mellitus accidentally cut themself while preparing dinner and has sustained a large laceration on the left wrist. After the laceration is sutured, the client asks the nurse, "How long will it take for my scars to disappear?" Which statement is the nurse's best response?

"With your history and the type and location of your injury, it's hard to say."

A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

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 maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications"

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?

steroids

A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus at 7 a.m. (0700). At what time should the nurse expect the client to be most at risk for hypoglycemia?

4 p.m. (1600)

A nurse in a diabetes clinic receives phone calls from four clients with type 1 diabetes. Which client's call would be the highest priority for the nurse to return?

A client reporting "I noticed that my urine has a foul odor."

The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia?

59 mg/dL (3.3 mmol/L)

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

70% NPH insulin and 30% regular insulin

On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first?

A 55-year-old complaining of chest pressure

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which action should the nurse take?

Administer a saline bolus as needed.

A nurse is caring for a client with type 1 diabetes who is light headed, begins sweating profusely, and loses consciousness. Which action should the nurse take?

Administer an IV bolus of 50% dextrose.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?

Administering 1 ampule of 50% dextrose solution, per physician's order

A client's 1200 blood glucose was inaccurately documented as 310 mg/dL (17.2 mmol/L) instead of 130 mg/dL (7.2 mmol/L). This error was not noticed until 1300. The nurse administered the sliding scale insulin for a blood glucose of 310 mg/dL (17.2 mmol/L). What should the nurse do first?

Assess the client for hypoglycemia.

The nurse reviewed laboratory values for a client with type 1 diabetes mellitus. The client's hemoglobin A1c (HbA1c) is 9 percent. What is the priority action for the nurse?

Assess the client's baseline knowledge about their treatment regimen

A client presents to the clinic for a follow-up visit for hospitalization due to uncontrolled diabetes. Which of the following assessment findings indicates a complication of diabetes mellitus?

Blood pressure of 160/100 mm Hg

Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome?

The client is severely dehydrated and needs 2 to 3 L of I.V. fluid rapidly.

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L (2.5 mmol/L), serum sodium level 140 mEq/L 140 mmol/L), and urine specific gravity 1.025. The client has two I.V. lines in place with normal saline solution infusing through both. Over the past 4 hours, the client's total urine output has been 50 ml. Which physician order should the nurse question?

Change the second I.V. solution to dextrose 5% in water.

A client with a serum glucose level of 618 mg/dl (34.33 mmol/L) is admitted to the facility. The client is awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?

Deficient fluid volume related to osmotic diuresis

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 15 g of carbohydrate and recheck the blood glucose in 15 minutes.

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.

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

Initiate fluid replacement therapy.

A client with syndrome of inappropriate antidiuretic hormone (SIADH) is experiencing lethargy, weakness, headache, and muscle aches. Which intervention is the nurse's priority?

Initiate seizure precautions.

A nurse is planning care for a client with hyperthyroidism. Which nursing interventions are appropriate? Select all that apply.

Instill isotonic eyedrops as necessary. Provide several small, well-balanced meals. Provide regular rest periods. Weigh the client daily.

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

Jugular vein distention

The nurse understands that the difference between diabetic coma and hyperosmolar hyperglycemic coma is that clients in diabetic coma can experience which finding?

Kussmaul respirations

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

Nervousness, diaphoresis, and confusion

A hospitalized adolescent with type 1 diabetes mellitus is weak and nauseated with poor skin turgor. The nurse notes a fruity odor to the client's breath. The client uses lispro insulin. The last meal was lunch, 2 hours ago. Place the nursing actions in the order in which the nurse should perform them. All options must be used.

Obtain a fingerstick test for blood glucose. Notify the health care provider (HCP). Start an IV infusion with normal saline solution. Administer insulin lispro.

A patient is coming to the clinic for a follow-up appointment after taking metformin for 9 months. After reviewing the patient's HbA1C level of 8.5%, the nurse anticipates what response from the primary care provider?

Order an additional oral antidiabetic agent.

Which information should the nurse include about hypoglycemia when teaching a client newly diagnosed with type 2 diabetes mellitus? Select all that apply.

Regular meals and a bedtime snack will decrease the incidence of hypoglycemia. Symptoms of hypoglycemia can include irritability, hunger, shaking, and sweating. A carbohydrate food source should be available during strenuous exercise. Alcohol consumption can increase the incidence of hypoglycemia.

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias?

Serum potassium level

A nurse is teaching a client with diabetes mellitus about self-management. Which statement would be correct about the administration of lispro insulin?

Take the insulin at around the same time each day at a meal.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

The isophane (NPH) insulin is peaking.

A nurse is providing home care to a client with a foot ulcer related to diabetes. The client needs daily insulin injections. Family caregivers do not possess the technical skills to inject insulin. Which should the nurse keep in mind?

The nurse needs to be creative in integrating the technical and relational aspects of care.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?

To restore liver glycogen and prevent secondary hypoglycemia

An adult with diabetes insipidus is hospitalized for care. Which finding should the nurse report to the physician?

Urine specific gravity of 1.001.

A client receives 12 units of intermediate- or long-acting insulin and 6 units of fast-acting insulin each morning. Place the following actions in chronological order of how the nurse would demonstrate how to mix insulins. Use all options.

Wipe off the vials with an alcohol swab. Inject 12 units of air into the intermediate- or long-acting insulin vial. Inject 6 units of air into the fast-acting insulin vial. Withdraw 6 units of fast-acting insulin. Withdraw 12 units of intermediate- or long-acting insulin .

A nurse is participating in a diabetes screening program. Which clients are at risk for developing type 2 diabetes? Select all that apply.

a 32-year-old female who delivered a 9.5-lb (4,309-g) infant a 44-year-old Native American (First Nations) person who has a body mass index (BMI) of 32 a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes a 12-year-old who is overweight

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect

a blood pressure of 176/88 mm Hg.

The nurse should review the glucose level of which clients who are going to surgery today? Select all that apply.

a client with diabetes mellitus controlled by diet a client with a high stress response to surgery a client receiving corticosteroids for the past 3 months

A client with diabetic ketoacidosis (DKA) has asked the unlicensed nursing assistant for another pitcher of water. It is the third such request over the past 4 hours. The nurse would recognize this request as which manifestation?

an occurrence of the excess loss of fluid associated with osmotic diuresis

A client is diagnosed with diabetic ketoacidosis. Which finding would the nurse anticipate?

arterial pH 7.33

When assessing a client with diabetes for diabetic nephropathy, the nurse should determine if the client has:

asymptomatic proteinuria.

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus?

below-normal urine osmolality level, above-normal serum osmolality level

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician 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?

cerebral edema

An elderly client with type 2 diabetes had hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent:

cerebral edema.

Following a transsphenoidal hypophysectomy, the nurse should assess the client for which sign of a potential complication?

cerebrospinal fluid (CSF) leak

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms?

coma, anxiety, confusion, headache, and cool, moist skin

A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect?

concentration of urine

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

confusion and seizures

An elderly client who is receiving steroids has secondary diabetes and chronic kidney disease (CKD) and takes insulin. The client has had episodes of hypoglycemia. The nurse should:

continue to monitor the client's blood glucose values.

A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment being received for SIADH is effective? Select all that apply.

decrease in body weight increase in urine output decrease in urine osmolarity

A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action?

deep, rapid respirations with long expirations

Following cardiac bypass surgery, the client has been referred to a cardiac rehabilitation exercise program. The client has type 1 diabetes and has bilateral leg discomfort with walking. The client is exercising using a stationary bicycle. The nurse should evaluate the client's response to exercise by assessing the presence of which condition?

diabetic neuropathy

The nurse caring for a client with diabetes realizes that the client has a higher risk of developing cataracts and should also assess the client for indications of:

diabetic retinopathy.

The nurse is caring for a client with diabetes insipidus. Which laboratory findings are indicative of this disorder? Select all that apply.

elevated serum creatinine elevated serum hematocr

A client with thyrotoxicosis says to the nurse, "I'm so irritable. I'm having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior? "You are experiencing:

excess thyroid hormone in your system."

A nurse is performing an admission assessment on a client diagnosed with diabetes insipidus. Which findings does the nurse anticipate during the assessment? Select all that apply.

extreme polyuria excessive thirst low urine specific gravity

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

glycosylated hemoglobin level.

A client is taking metformin. To prevent lactic acidosis resulting from use of this drug, the nurse should instruct the client to report which symptoms? Select all that apply.

hyperventilation muscle discomfort dizziness

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

hypokalemia and hypoglycemia

A hospitalized client is experiencing "fight versus flight," a stress-mediated physiologic response. As a result, the nurse should assess the client for which symptom?

increased blood glucose

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?

jugular vein distention

The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood?

ketones from rapid fat breakdown, causing acidosis

Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will:

maintain normal fluid and electrolyte balance.

A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client?

nitroprusside

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 2:30 p.m. (1430) and its peak to be at 4 p.m.(1600).

A nurse is caring for an older adult client who is admitted with an electrolyte imbalance. Which laboratory values should be a priority concern for the nurse? Select all that apply.

pH 7.32 potassium 5.8 mEq/L

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss?

rapid, deep respirations

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl (26.1 mmol/L). Which finding is most likely to accompany this blood glucose level?

rapid, thready pulse

Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of:

renal failure.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

restricting fluids

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

restricting fluids to 800 ml/day

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

serum glycosylated hemoglobin (Hb A1c)

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

A homeless client is brought to the emergency department by the police after being found unconscious on the street. Following examination and evaluation of laboratory test results, a diagnosis of diabetic ketoacidosis is confirmed. Which information is most crucial to document on the client's medical record? Select all that apply.

size of pupils and reaction of pupils to light response to verbal and painful stimuli skin condition and presence of any rashes, lesions, or ulcers blood pressure hourly urine output

Which finding should the nurse report to the client's health care provider for a client with unstable type 1 diabetes mellitus? Select all that apply.

systolic blood pressure, 145 mm Hg diastolic blood pressure, 87 mm Hg high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) glycosylated hemoglobin (HbA1c), 10.2% (0.1) triglycerides, 425 mg/dL (23.6 mmol/L)

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' disease. When conducting a focused assessment, what should the nurse should assess the client for?

tachycardia

After pituitary surgery, which laboratory finding should the nurse report to the health care provider?

urine specific gravity less than 1.010

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering

vasopressin.

When caring for a client with diabetes insipidus, the nurse expects to administer

vasopressin.

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into their teaching plan?

weight reduction through diet and exercise

A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat?

within 10 to 15 minutes after the injection.